How to Study for USMLE Step 2
There are definitely less resources and guidance when it comes to studying for Step 2. There is no good one encompassing book and most of your content material is in pieces which can be frustrating. With Step 2 being scored and carrying more weight in the future, doing well is imperative. The average for Step 2 is much higher than Step 1, at 240-245. People tend to do better because they understand how to study, strategize from previous board exams, and gain clinical experience on rotations.
I scored 250-255 based on my studying methods and I will share with everyone what worked for me. This is also based on retrospective evaluation which is extremely valuable since I’ve experienced the formatting and content of the exam.
Changes from Step 1 to 2
Most of the questions will be 4th, 5th order - meaning the diagnosis and first line management is already insinuated in the prompt and you have to determine the next line in management thereafter – whether it’s further testing/imaging, rule out of other emergent pathologies, etc.
There will be 8 blocks of questions, 60 mins each instead of 7 (it is longer so be prepared!!) It will be 9 hours and 30 mins total with 5 mins optional break between each section and 45 mins optional lunch break.
PREDEDICATED
This period will coincide with your clinical rotations. During these rotations, you will be studying for the specific specialty in medicine and taking an end of rotation exam (NBME/COMAT/shelf/subject exams). To do well on these exams, you will be relying on content resources and a question bank of your choice.
It is best to study for these subject exams to the best of your ability because all of your core rotations will prepare you for Step 2.
For content review, I used Amboss, Case files, Onlinemeded, UptoDate, and Anki. The most important book source I used was Step Up to USMLE Step 2 CK. It was a compact and comprehensive review of all the content I needed to remember for Step 2. From my experience, I didn’t realize how useful it was until I took the exam and saw many questions I was struggling to answer listed in the book. You can also refer to some of your Step 1 material like First Aid and Sketchy for key topics that will help you. If you like more in depth video resources, I also used Board and Beyond Step 2 at first but I felt the videos were too long and dense to keep up with. Dr. Ryan explains topics very well and if you have time, he will teach you everything but it just didn’t work for me for Step 2.
For question banks, I used Uworld and Truelearn (more useful for osteopathic students). You are welcome to ask upperclassmen and residents how to best study for the rotation. They might point you to additional resources that will be very helpful for you in understanding certain topics. You can also research on the internet which resources would be best for _______ clerkship. It is also important to learn from your clinical experiences how to diagnose and manage patients because Step 2 will test you on the most current practice of medicine.
Doing well on your shelves is a good indicator of succeeding on Step 2.
Before starting dedicated, I used the Amboss Step 2 Self Assessment which gave me a predictor score and how I am doing at this point in studying. Having any sort of benchmark practice exam is important so that you can adjust your studying accordingly.
As I got closer to dedicated and being done with all my rotations, I also started splitting my Uworld question sessions into doing randomized Uworld incorrect questions and rotation specific questions.
How I reviewed my questions
I used this method for all my UWorld questions during prededicated and dedicated. If I get a question wrong, I read the entire explanation of the correct and incorrect answers. I add the fact into my Incorrect spreadsheet and I find the associated Anki cards for it in the Step 2 Anking deck, release it, and move it to my personal UWorld Incorrects deck. I also modify or make my own Anki cards when necessary and have it in my UWorld Incorrects deck.
DEDICATED
This period should be a time allotted by your medical school to study for Step 2 where you have no extracurricular commitments, no rotations or classes. This period can range drastically and cut into your summer/winter break/4th year depending on how much time you feel you need. I personally took 5 weeks which was less than Step 1 (6 weeks) based on my prior experience and confidence.
Making a study schedule: this will depend on how many weeks of dedicated you have allotted and how many practice exams you are planning on taking. Currently, there are 4 NBME forms available (Form 9, 10, 11, 12), 2 UWorld assessments, and the Free 120. The self assessments are usually 4 blocks long and many people opt to add an additional 4 blocks of Uworld to simulate the real testing day. These are the standard minimum practice exams you should use but you are welcome to explore your options if you feel like it.
During this period, you can adjust your Uworld bank to fit your needs. You can reset your UWorld bank if you finish all of it and restart, do your incorrects, or focus on specific topics you’re struggling with.
Do content review from Step Up to Step 2 CK book
Go over flowcharts of how to manage disease processes. A great way I found to do this is by using Amboss. In their search box, type in “algorithm” and it will pop up a list of all their high yield tree diagrams. I reviewed these nightly or whenever I had free time.
Take practice exams and review them THOROUGHLY. It should take you a whole day to take it and 2 days to review it.
Amboss has flowcharts of high yield disease and their management.
TEST STRATEGIES
Understanding the pattern of how and what Step 2 asks about will help you ace this exam and I’m going to tell you how.
Example pattern: The stem will most likely always describe and give the diagnosis (they already tested you for how to diagnose in Step 1 so these are not the main questions you are getting). They will also likely give you the first line treatment or imaging so you can’t just memorize 1 thing from each diagnosis. They focus on testing you on the COURSE of treatment/management to see if you truly know how to clinically practice.
Example simplified question: A teenager came into the ER with aspirin toxicity and was given activated charcoal, what is the next step in management?
So for this question, if you only remembered at surface level that this is how you treat aspirin toxicity and you don’t remember anything else… well that’s how they get you. How to answer this is that you need to know the full course of treatment and go down the management “tree” for aspirin toxicity. So if this patient is not getting better, you can also give IV sodium bicarbonate or if their labs show severe acidosis, then do hemodialysis.
This is a general overview so you can know where to start! If you have any questions, please feel free to email me at shanonology.com or reach me on my other social platforms via @shanonology. Found this informative? Buy me a coffee as a token of thanks!
Good luck!
lub dub, Shanon
