Persistence of memory: USMLE Step 2 CK preparation and thoughts

During the months of May and June, I had dedicated study time for my second board exam, USMLE Step 2 CK. Truthfully, preparation was ongoing throughout M3 year, and my dedicated prep started in March when I was studying for my Surgery shelf exam. I took the exam June 1, 2016.

I had one goal for USMLE Step 2; to beat my USMLE Step 1 score. If I could do that, I would be satisfied. Anything on top of that would be considered style points. I had a secondary goal of beating my score by 10.

In March, aside from general surgery review, I began redoing the IM portion of UWorld, and I completed the entire IM question bank during April, my FM rotation. After this, I began to redo the rest of the questions, subject by subject – Ob/Gyn, Peds, and Surgery. I also had my prior notes assembled for each subject’s shelf exam, which I reviewed in tandem with each subject. Whatever text I had used for the shelves were reviewed for contentious topics – Case files and Pestana for Surgery, Case files and APGO uWISE for Ob/Gyn, and MKSAP and Pretest for IM.

I did not review each text in its entirety – instead, whenever I missed a question and needed review, I looked it up (notably, the algorithms for workup of a thyroid nodule are different in Case files Surgery and UpToDate). Also, because I had not yet completed my Pediatric clerkship, I made particular effort to be thorough with that subject.

Aside from UWorld, which is the staple of preparation, I used the few other essential resources above and below for questions and reading. Similar to the prior board exam, here are my recommendations:

• My first wisdom is to have a solid foundation. I completed UWorld once and the bulk of my shelf exams before starting review. Only after this should you reset your question bank.
• My second wisdom is to re-build stamina. Just like Step 1, I timed my tests, simulated exams, and pushed myself to the limits of my concentration in order to ensure that I wouldn’t lose focus on the real deal.
  • This time, there was a week where I did 5 blocks a day (with review) in order to make sure I kept focus. It was rough, but necessary.
  • Because this exam was after Step 1 training, it wasn’t as hard to regain testing stamina because the muscle memory was there. Within 4 weeks of training I was at peak performance levels.
  • Overall I did about 5,500 q’s leading up to the exam.
  • Breakdown:
    • UWorld: 2,300
    • USMLE-Rx: 1,900
    • MKSAP for students: 500
    • Pre-test IM: 500
    • APGO uWISE: 50
    • NBME 4: 200
    • UWSA: 200
  • One note I’d like to make is that unlike for USMLE Step 1, I did not rely heavily on the NBME’s for predictive value or review. There are 4 available, and one of those doesn’t even have feedback.
    • The feedback is not particularly useful either.
    • When you have limited time, you want to be able to learn and digest rather than shock and awe.
    • I didn’t like NBME 4 and didn’t think it was a conducive use of my time, so I decided against buying more of them.
    • Also, the NBMEs for Step 2 are notoriously unpredictive and can easily give you false hope or burst your bubble of confidence.
• My third wisdom is to use UpToDate. It is the most comprehensive resource that gives definitive management in a digestible summary form. Review texts are great, but U2D is the bread and butter for learning and review. I unofficially attend U2D SOM.

I got my score, 262, while on the beach with my fiancée. I am happy to say I achieved my primary goal, though was a bit shy of my secondary goal. Regardless, I am happy with my outcome.

My workout routine

I haven’t posted about lifting in a while, but a conversation with my cousin Rishi prompted me to make this post. I stick to 2 different workouts, a push day and a pull day. I usually take about 2-3 min between sets for rest.

• Pull day (back + biceps)
  • Weighted chin-ups
    • 15 sets
    • Bodyweight + 45 + 45 + 25 x 3
    • BW + 45 + 45 x 3
    • BW + 45 + 25 x 5
    • BW + 45 x 10
    • BW + 25 x 11
    • BW x 20
    • BW x 10
  • Machine row, horizontal
    • 4-5 sets
  • Bicep curls
    • 4-5 sets
    • Superset with leg raises and crunches
  • Pull-downs
    • 3 sets
• Push day (chest + triceps)
  • Incline DB bench
    • 5 sets
    • Max: 105×3
  • BW dips
    • 4 sets
    • With assist in last sets
  • Triceps pushdown
    • 3-4 sets
    • Superset with leg raises
  • Lateral raises
    • 4 sets
    • Superset with shrugs
  • Occasionally, I do 3-5 sets of squats on this day also

I’ve been doing this split for the last 2 years.

The Engagement: Of families and friends

After wrapping up my cumulative year of M3 into the two neat little packages of USMLE Step 2 CK and CS in the first 2 weeks of June 2016, I was able to focus on the latter half that my parents had been planning for months: a formal engagement party for myself and Amanda held in Baton Rouge, Louisiana. The party served as a festive backdrop through which Amanda was introduced to my many relatives who live across the US who I do not see frequently. Amanda’s family also came in full force and they were able to get a sense of the larger picture of who my parents are.

 

In was a resplendent day, with introductions, family, friends, and feasting. I would be doing a disservice if I did not mention the efforts of my mother and her friends in preparation of the desserts and other appetizers: kulfi, penda, idli, sambhar, Mexican mules. Amanda and I also enjoyed a night out with the cousins in the rambunctious red stick.

The event was held at my house for much of the ceremonial portions and then the reception was at India’s Restaurant. It was an event that I will always remember, and it evoked feelings I will always hold close. The love I felt that day was immense, and, in retrospect, it has always been there. It may take such an event for those emotions to come to the surface, but once recognized they endure.

 

A guide to M3: The clerkships and SHELF exams

I made this post to help guide study efforts (for NBME Shelf exams) during M3 year. I found that there was a mix of information as to which sources were the best sources to use during core rotations, and given that you have limited time to dedicate to studying, it is imperative to use it well. That being said, everyone, including myself, has their own sets of resources they used that they will claim is the best. It should be stated that the best prep for any rotation is working up patients and looking up their best treatment and management regimen on UpToDate while on the wards. Here’s my additional study plan:

• Internal medicine
  • UWorld is the staple for prep – about 1400 q’s. This will take a considerable amount of time but is worth it in the end if you can finish it during your rotation.
  • MKSAP for students (aka IM essentials) – another key learning tool. The explanations are better than UW in my opinion. It takes a lot of effort and doesn’t simulate your exam, but it’s great for building a foundation of clinical IM knowledge.
  • Pre-test IM – a few wonky questions and many are too short or easy, but this book gives you some random factoids that might help in tricky stems (e.g. CHF is more likely to cause R-sided pleural effusion). I did about 10-20 q’s every morning to get through the book.
  • MKSAP audio – probably a bit overkill, but I like listening to audio lectures rather than reading, so I went through the sections on cardiology and GI. I love this series, and listened to the bulk of it throughout M3. Great for the gym and commuting. Not great when you’re driving with people though, haha.
• Obstetrics and Gynecology
  • APGO uWISE – plenty of short quizzes on high yield topics. The problem is that you’re going to miss a lot of questions if you don’t already have a solid foundation of knowledge. This is the best source hands down.
  • Case Files Ob/Gyn – I used this to sort of learn the basics of Ob/Gyn and get a foundation. It’s a good text without too much filler or fluff. Even some of the more esoteric topics in the book came up on the shelf. To note, I never used Blueprints.
  • UWorld – a staple, but not enough. I think it is better to save these q’s for 2-3 weeks before your shelf to use as a gauge.
  • Dr.Chapa’sObGynPearls: Texas A&M College of Medicine – this is the best audio source for this rotation. Go to you podcast app and subscribe. Usually about 7-12 minutes a piece on high yield topics (e.g. endometriosis), covering every salient point (e.g. MCC, presenting symptom). If you learn the material for each topic, you’ll be able to present with some competence and actually have a discussion about stuff.
• Surgery
  • Pestana – a great ‘cover your bases’ review of many topics. The staple for this rotation. Has some questions in the back.
  • Case Files Surgery – I used this extensively, but be warned that some things might be outdated if you don’t have the latest version (I was burned on thyroid nodules). Overall this was my second staple.
  • UWorld – not many q’s, but you should supplement by re-doing some of IM. Many IM topics are bound to show up. Spleen and GI questions come up a lot.
  • Pestana audio – this was my favorite resource. He reminded me of one of my pathology professors from Basic Science years.
• Psychiatry
  • UWorld – this covers most bases. There will be a few esoteric topics on the shelf exam that you won’t find anywhere.
  • First Aid Psychiatry – A good thing to review if you have nothing else to do and want to read something.
  • Lange Q and A – I wish I had known about this beforehand – i did some of these and they were good quality questions
• Pediatrics
  • Honestly, I had little time or patience at this point in my M4 year for this exam – I was more focused on interviews. There are likely better places for advice on this topic
  • UWorld – solid “cover your bases” approach with a decent amount of questions
  • Pretest – more filler questions if you have time
  • UT HSC video review – this was the majority of my studying