Are you a medical student looking for advice about USMLE Step 2? Look no further - this article is your ultimate guide to success! In this comprehensive guide, we will provide you with all the strategies, tips, and resources you need to master USMLE Step 2 and excel on test day.
USMLE Step 2 is a crucial examination that assesses a student's clinical knowledge and skills, and it plays a significant role in residency program admissions. With so much at stake, it is essential to approach your exam preparation with a well-defined plan and the right mindset.
In this article, we will walk you through every step of the process, from understanding the exam format to creating a study schedule and selecting the most effective study materials.
Understanding the Format and Structure of USMLE Step 2
USMLE Step 2 consists of 320 multiple-choice questions divided into 8 blocks of each. The total testing time is approximately 9 hours, including breaks. The questions are designed to assess your clinical decision-making abilities and cover a wide range of medical specialties.
Importance of USMLE Step 2 for Residency Applications
For years program directors listed Step 1 score as one of the most important criteria when determining who to offer interviews to. Step 2 was considered to be a factor, but less so compared to Step 1. With applicants coming from different schools with varying degrees of difficulty, GPA was difficult to interpret. USMLE exams provide some level of standardization. This makes these exams a logical way to stratify students. It also gives program directors an easy place to draw cutoffs for who should be interviewed.
Step 2 was typically seen as a chance to make a second impression if your Step 1 score was lower than desired. Students who scored low on Step 1 could redeem themselves with a strong Step 2 score and show residency programs that they had adapted and made changes. On the flip side, those who scored well on Step 1 could hurt themselves by scoring lower on Step 2. Either way you look at it, you had two chances to show your ability with one of those chances (Step 1) considered slightly more important than the other. Step 1 transitioning to Pass/Fail has completely reconfigured how the Step exams contribute to your residency application. Obviously, failing Step 1 will still be a red flag. However, for the majority who pass Step 1 on the first try they will look the same on paper. Step 2 is now even more important than Step 1 used to be because it is your only real chance to differentiate yourself from your peers in an objective and standardized way. For more on the transition to Pass/Fail and how it impacts your residency application check out this article.
Key differences between USMLE Step 1 and Step 2
While both the USMLE Step 1 and Step 2 are important examinations for medical students, there are key differences between the two. USMLE Step 1 primarily tests your knowledge of basic sciences, including anatomy, physiology, biochemistry, and pathology. It assesses your understanding of foundational concepts in medicine and is often taken after the second year of medical school. In contrast, the Step 2 exam focuses more on the application of medical knowledge in real-world clinical scenarios.
Step 2 requires the same combination of knowledge and strategy that was necessary on Step 1. Some may argue that Step 2 actually places more emphasis on strategy and skills. Regardless, you will still need both. Part of doing well on Step 2 is laying the groundwork during Step 1 studying. If you didn’t score as well as you’d hoped on Step 1, you need to be willing to adjust your strategy for Step 2. The methods are the same in terms of how to study. Try to understand not memorize. The key difference is that with Step 2 you have to go deeper. It’s not enough to look at a patient’s labs and realize they have a BUN/Cr ratio >20:1 which signifies prerenal injury. Now you need to know exactly what kind of fluid the patient needs to rehydrate them. Or if this prerenal injury is actually due to impaired forward flow in a patient who has systolic heart failure. You spend less time identifying the underlying disease/pathophysiology and focus on the next logical step in diagnosis and treatment. Yes, there are treatment questions on Step 1 too, but Step 2 is more like the real world where you have to take into account all of the patient’s history and comorbidities when trying to decide on which diagnostic test to order and what medication to prescribe. Step 2 will often include more extraneous information in the question vignettes. This is because most patients don’t walk in the door and only give you the relevant details. They give you all of the information and it is your job to distill it down to the pertinent positives and negatives to come up with an appropriate differential.
Another key difference between Step 1 and Step 2 is the timing of the exams. Step 1 is usually taken before starting clinical rotations, while Step 2 is typically taken during the clinical years of medical school. This transition from basic sciences to clinical practice is reflected in the content and format of the Step 2 exam.
Goal Score For USMLE Step 2
Everyone's goal for Step 1 is PASS. Step 2 becomes a very important opportunity to differentiate yourself from your peers. Goal Score is an important topic because the data shows that the higher you aim, the better you score on the real exam. The goal will be different for everyone but one benefit of having Step 1 converted to Pass/Fail is that you should have an idea of what specialty you want to go into by the time Step 2 rolls around. If you know your application is strong in other areas then a 245-250 on Step 2 might allow you to be competitive for orthopedic surgery.
When setting a goal score, the most important factor is usually desired specialty. Whatever the average for your desired specialty, aim for 10 points higher. Below are several charts showing average Step 2 score for specific specialties among matched and unmatched applicants in the 2022 Match. Certain specialties had very small sample sizes and may not be represented on the charts for DO's and IMG's.
Whatever goal you set, monitor progress over time to make sure you are progressing towards your goals. If you aren’t making strides toward your goal then you need to evaluate your strategy and also your goal. Altering your strategy may put you back on track to reach your goal score. However, if this doesn’t help then you may need to take a closer look at your goal score to decide if you should change your goal or change your test date to allow more time.
Study resources for USMLE Step 2
To effectively prepare for the USMLE Step 2, it is important to have access to high-quality study resources. There are various options available, including textbooks, online review courses and question banks.
One of the most popular and comprehensive resources for Step 2 CK is the UWorld Qbank. It contains thousands of practice questions that closely resemble the actual exam and covers a wide range of topics. Many students complete the UWorld Qbank during their clinical rotations while studying for Shelf Exams. If you follow this approach, I recommend you use a different question bank during your dedicated Step 2 studying. Using new questions from an alternative high quality question bank is much better than repeating questions from a previously used question bank, regardless of how long it has been since you previously completed the questions. If you used UWorld during your clinical rotations, consider trying Amboss during your dedicated studying.
The jury is still out on what resources are best for Step 2. There isn’t one resource that seems to cover all the different specialties well. For Internal Medicine, Step Up to Medicine provides a nice outline format, but, similar to First Aid for Step 1, this book doesn’t provide much depth. Master the Boards is another commonly used resource. You will likely need to reference other resources for topics you are completely unfamiliar with. OnlineMedEd can provide some nice videos to explain difficult concepts and emphasize distinctions. For Surgery, Di Virgilio's Surgery: A Case Based Clinical Review provides nice cases with thorough explanations. Dr. Pestana’s Surgery Notes is another book that many students like. Pediatrics and OBGYN don’t have many must use resources and students often end up relying on OnlineMedEd and question banks to learn this material. First Aid for Psychiatry is easy to read and concise. It will give you the criteria for various diagnoses, treatment options and the mechanisms of treatment. This should be sufficient to score well on your Psychiatry Shelf exam as well as Psychiatry questions on Step 2. One additional resource that students often find helpful is the review videos made by Emma Holliday. This can be found by typing “High Yield Emma Holliday” into YouTube. These videos typically cover the most important subjects on a given Shelf exam and are a great review the few days before the exam. Unfortunately, she does not have one for every Shelf subject.
When selecting study resources, it is important to consider your learning style, preferences, and budget. You can also seek recommendations from older medical students or online forums to gain insights into the most effective resources for Step 2 preparation.
Practice Exams for USMLE Step 2
Practice exams and mock tests are essential components of USMLE Step 2 preparation. They help familiarize you with the exam format, assess your knowledge and performance, and identify areas for improvement. Here are some practice resources to consider:
- SHELF or COMAT Exams- The single best way to prepare well for Step 2 is to take your Shelf or COMAT exams seriously during your clinical rotations. Study hard during your rotations and spend time preparing for Shelf or COMAT exams. Make sure you have a solid understanding of these topics the first time around so you can fill in the details during your dedicated Step 2 study (if your school allows it).
- NBME Practice Exams- For Step 2, the NBME creates Comprehensive Clinical Science Self-Assessments (CCSSA’s). There are only six CCSSA’s (Forms 9-14) available so make sure to take all of them if you are able.
- Practice Shelf Exams- The NBME also offers multiple practice Shelf exams for each given specialty. These cost money but many students find it helpful to take at least one of these 1-2 weeks before the Shelf exam. These tests have multiple benefits including showing the high yield material calibrating your sense of strengths and weaknesses.
- UWorld Self-Assessment Exams: UWorld offers self-assessment exams that closely resemble the actual USMLE Step 2 CK. UWorld offers three self-assessments which provide a simulated testing experience and help gauge your readiness for the real exam. They also provide a predicted score, which can be helpful for setting realistic goals.
Creating a Study Schedule for USMLE Step 2
Creating a study schedule and timeline is essential for effective USMLE Step 2 preparation. It helps you stay organized, ensures adequate coverage of all exam topics, and allows you to make the most of your study time.
Start by assessing the amount of time you have available for preparation. Take into account your other commitments, such as clinical rotations, research projects, vacations, weddings, etc. You should also consider if you want to build in one day off per week to take care of necessities like going to the grocery store or spending time with family.
Next, break down the different exam topics and allocate time accordingly. Consider the weightage of each topic and your personal strengths and weaknesses. Step 2 Content Outlines published by the NBME give the following relative importance:
Medicine: 50-60%
Surgery: 20-30%
Pediatrics: 20-25%
Obstetrics and Gynecology: 10-20%
Psychiatry: 10-15%
These percentages add up to more than 100% because certain questions will combine multiple subjects. It is also important to understand that the Medicine category encompasses multiple subjects like Family Medicine, Emergency Medicine and Neurology that students typically rotate through during clinical rotations. Be sure to allocate more time to challenging areas while still giving attention to all the subjects.
Use objective data from your question banks and practice exams to determine which subjects require more attention for you. Your strengths and weaknesses are likely different than your classmates so don’t get caught up in trying to follow someone else’s study plan.
When you are setting up your study schedule, I recommend starting with practice questions. There are many studies demonstrating the incredible benefit that practice questions can have on your USMLE performance. Make sure you have time for at least one block of practice questions per day. If possible, try starting with two question blocks per day and working up to three question blocks per day if you have time. In addition to practice questions, allocate time for practicing content review using some of the resources mentioned above.
Some students prefer a very specific hour by hour schedule while others prefer to have a list of tasks to get done each day. If you need assistance setting up your schedule, feel free to reach out to ahiett@step-101.com to help create a schedule customized to your needs.
Remember to be flexible with your study schedule and make adjustments as needed. It is normal to encounter unexpected challenges or need additional time for certain topics. Regularly evaluate your progress and make necessary changes to ensure efficient and effective preparation.
