By Alyssa Ehrlich, MD
Once a minor hurdle on the road to Match Day, the USMLE Step 2 CK is now the "new Step 1", with many residency programs filtering applications based on Step 2 CK scores. Although I took Step 2 CK before Step 1 was Pass/Fail and was happy with my Step 1 score, I planned to take Step 2 CK well before applying for residency, and at the time, I thought I be pursuing a highly competitive sub-specialty, gastroenterology (spoiler alert, I ended up in Psychiatry!). Regardless, I'm happy I prepared for Step 2 the way I did.
Four weeks after my test day, I received my results, and I was shocked. I scored a 281. While many with high scores will say that the key to their success was sheer time and effort, I took a more strategic approach, which I believe allowed for my success on test day after only about three weeks of dedicated study time.
After looking back on my own preparation, I've come to view these five steps (in addition to test-taking skills) as critical for anyone hoping for an ultra-high Step 2 score.
1. Make Every Clinical Rotation Count
Proper preparation for shelf exams during rotations is key to establishing a solid foundation for Step 2 CK. This can be challenging because what you learn on the wards may not have any relevance to how you are assessed on the shelf. It may seem obvious, but it’s important to recognize that test-taking requires a fundamentally different skill set than actually practicing medicine. If you think about it, what you see and are taught on the wards is essentially random. When you get a tricky question right on a shelf exam, you often find yourself saying, “I’m lucky I saw that one time!” But you won’t excel if you leave content mastery, a key component of test prep, to luck. To do well on these exams, you need a comprehensive foundation, which in my case was built using UWorld and OnlineMedEd videos. I also did every exam in the NBME Clinical Mastery Series (the "CMS forms") prior to the relevant shelf, cross-referencing UWorld and OME as necessary, to fully understand each question that I had gotten wrong. If you do your best to prepare for every single shelf exam during your third year, by the time you get to Step 2 CK studying, you’ll be way ahead.
2. Master a Few Key Resources
The only resources I used for Step 2 CK were the UWorld Qbank and Self-Assessments, the NBME Comprehensive Clinical Science Self-Assessments, and OME. A significant number of students use too many resources without reviewing any of them in sufficient depth. It’s much better to thoroughly review the most well-done and high-yield resources like UWorld and the NBMEs. Another common mistake is to initially avoid question-based resources, claiming that you should “save” questions for when you’ve built a solid knowledge base through reading, yet reading alone results in much poorer information retention than doing practice questions. All the content you need to master for Step 2 CK can be found in the UWorld explanations, and OME is a great way to learn that content in a more efficient way. In addition to mastering content, test-taking technique is crucial for USMLE success, and unless you have the option of tutoring, the only way to hone these skills is through practice questions.
3. Think Like The Test-Maker
For UWorld, I did blocks of random topics in the “Timed” mode as this most closely simulates test-day conditions. I find that both “Tutor” mode and doing questions by subject can create bad habits, such as answering questions carelessly because you’re used to seeing the answer right away, or relying too heavily on the context of a question’s subject area. In my 8 years as a test-prep tutor, I’ve learned that the key to standardized tests is not only doing practice questions, but also thinking like the test maker, always asking “what are they testing here?” and approaching questions from that perspective. This doesn’t come naturally to everyone, but as a USMLE tutor, I’ve found that it’s definitely teachable.
4. Don’t Overwork Yourself
Some claim the only way to ace the USMLE is to study 14 hours a day; I disagree. Yes, you need to study a lot, but not so much that you’re sleeping less than 8 hours a night. Take frequent, short (15-minute) breaks. Take a day off from studying periodically, exercise and maybe even meditate. Stay attuned to when you feel overworked, and cut back accordingly; it’s okay to only do 50% of the UWorld Qbank during your Step 2 dedicated period if you already did all the questions during third year (that’s what I did!). If you’re a little bit of a workaholic, and grinding through UWorld two times makes you truly happy, that’s okay too. Don’t try to dramatically change your way of life during your dedicated study period. To get to this point in medical school, you’ve already come so far and had your fair share of successes: do what you can to stay true to that best version of yourself.
5. It’s Okay to Change Your Test Date, But for the Right Reasons
About five days before my exam, what had started out as a pesky dry cough turned into acute bronchitis. I was coughing so frequently at night that I essentially wasn’t sleeping at all, and chose to change my test date to give myself a few days to recover. For such an important exam, the change fees were money well spent, and ultimately everything worked out. While you should not hesitate to move your exam date if you’re not feeling 100%, try not to change your test date in response to self-doubt. The boards can cause extreme anxiety. But once you have a test date, try your best to stick to it, or you can find yourself constantly pushing back your test date and self-doubting, preventing the most efficient study plan, and risking burnout.
We all worry we might fail; I did, and I ended up getting a 281.
Alyssa Ehrlich, MD is a PGY4 Psychiatry Resident at Brigham and Women's Hospital, and the founder of USMLE Pro. She tutors for Step 2 CK and Step 3, and is a residency application advisor and interview coach.
Ready to take your studying to the next level? Schedule a free consultation to speak directly with Dr. Ehrlich for advice on a personalized study plan that addresses your unique challenges and learning style, guiding you towards your Step 2 CK success.