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.


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