With all of the information on the internet about how difficult the USMLE Step 1 is, many individuals discount Step 2 CK as merely another, much easier, step up the US residency ladder. This assumption is completely wrong, and I’ve had the misfortune of directly experiencing the bad consequences of making it. This is my story about my USMLE Step 2 CK exam experience and how it influenced my journey to residency. I’ll try to cover all of the materials and details I used during my preparation. I hope you found this post to be useful.
Overview of the USMLE Step 2 CK
The USMLE Step 2 (commonly known as Step 2 Clinical Knowledge, or CK) is one of three standardized tests necessary in the United States to get a medical license.
Although study preparation is essential, comprehending the exam arrangement is equally vital to your success! Before taking the exam, you should concentrate on mastering key medical activities, physiological circumstances, and disorders. Once you feel you’ve mastered those topics, concentrate on achieving the highest potential score. Remember that in order to go to Step 3, you must have a passing score on Step 1 (which changed to pass/fail score reporting on January 26, 2022) and Step 2.
Previously, you would have had to complete an in-person clinical skills assessment, often known as Step 2 CS, before being able to take Step 3. Due to the COVID-19 pandemic, Step 2 CS was postponed in 2020, and the test was terminated in early 2021. Step 2 CK and CS may still be mentioned on the NBME® website and elsewhere, but it is no longer necessary for licensing.
When Should to Schedule For Step 2 CK?
Unlike Step 1, Step 2 is intended to put your clinical rotation knowledge to the test. Medicine, Surgery, Pediatrics, Obstetrics and Gynecology, and Psychiatry are the specific fields assessed on Step 2:
|Medicine||50%–60% of questions|
|Obstetrics & Gynecology||10%–20%|
As a result, we strongly advise completing these fundamental clinical rotations prior to taking the exam, and then taking the test immediately thereafter, while the content is fresh in your memory. For example, if you complete your clinical rotations in your third year of medical school, you can consider taking Step 2 the summer before submitting your ERAS application. If you didn’t perform well on your previous examinations, you might want to spend some extra time reviewing concepts you struggled with before taking the exam.
Step 2 is currently the first “numeric” score provided for licensing tests, after the recent modifications in Step 1 score reporting to pass/fail. Because this movie is so new, it’s unclear how Step 2 results will be utilized to extend interviews or rank applicants for residencies. You should speak with your medical school counselor or potential program directors to see how programs are dealing with this transition.
When you apply to take Step 2, you must select a 3-month qualifying period to take the test. Choose this time period carefully, as the exam is not available at every Prometric testing site. If your local Prometric testing location does not provide step 2, you will need to schedule travel and your residence application stages wisely.
What Can You Expect on the Step 2 CK?
Step 2 CK is a full-day test with eight 60-minute blocks and an hour of rest time. Each block has no more than 40 questions (but it may contain less), for a total of 318 questions. While Step 1 is a foundational and fundamental science-based test, Step 2 is a far more clinically-focused exam that focuses on the application of medical knowledge to particular settings. For instance, you could be requested to:
- Give a diagnosis and a prognosis.
- Apply your understanding of fundamental science to particular clinical problems.
- Determine the next step(s) in the patient’s care.
In Step 2, you will be asked three different sorts of questions:
Traditional questions are stories about patients with four or more multiple choice responses. The correct solution will not be as straightforward as you may believe. Why? Multiple response choices may be somewhat right, but only one choice is the optimal answer. You should double-check your responsibility to ensure that it is not only technically correct but also the best alternative.
Items in order
A single patient-centered narrative is followed by two to three consecutive questions in a sequential item.
Take care! You will not be able to modify your answer for the previous question in this brief series once you have marked your answer option and moved on to the next question.
If you are unclear about a question, make an educated guess using your best judgment. Unanswered questions are immediately counted as wrong, therefore any answer is preferable to no answer.
Abstracts of scientific papers
Abstract questions present a sample or extract from a medical journal or research publication and ask you to analyze the material to answer a question. This style is typically used to assess biostatistics and data interpretation, but it may also require you to apply the information in the abstract to the care of a specific patient or to identify potential sources of bias or data constraints. The easiest method to prepare for test day is to become familiar with the format of abstract questions on the NBME website.
USMLE Step 2 CK Content
- 15% of the questions were easy, brief, and straightforward. These were first-ordered queries on high-yield themes that we encounter frequently. There were also a few fundamental Step 1 information (for example, what is the virulence component for the insect that causes this disease?).
- 35% of the questions were really difficult. These were made up of extraordinarily lengthy, twisted stalks. Third or fourth-order questions I’d never heard of these terms or subjects before. I mostly made educated guesses on them, noted them, and went on.
- 50% of the queries were reasonable. They discussed subjects found in Uworld or NBMEs. I could generally limit it down to two response options and make an educated estimate.
USMLE Step 2 CK Time
Surprisingly, I completed each block with around 5 minutes to spare. This enabled me to review my marked questions (about 8-9 per block). The question stems were shorter than the majority of the Uworld questions and were NBME-style. I focused a lot on timing during devoted because I ran out of time on numerous blocks during Step 1.
Things I’ve never seen before on the exam
Abstracts from scientific studies Okay, I believe I saw an example of this in the Uworld Assessment. The ones on the real exam, on the other hand, were significantly more complicated and demanded great critical thinking abilities. These abstracts demand you to understand a study, apply it to a patient situation, and identify the research study’s merits and limitations. I had two abstracts, each of which included three questions.
There are 38 questions for each block. The two blocks containing the abstracts have 38 rather than 40 questions. These questions took longer to complete, but I’m happy the exam authors considered this.
Patient demonstrations Despite being new, these weren’t too difficult. They included an admittance note (i.e. patient age, chief complaint, past medical history, review of systems, physical exam). The inquiries that accompanied these were quite straightforward, such as “What is the diagnosis?” “What is the next managerial step?” I had around 4-5 of these in all.
What is the minimum score you need on the step 2 CK?
Step 2 is the first numerically scored test you’ll have to complete before applying for residence, as Step 1 is now pass/fail.
Step 2’s current minimum passing score is 209.
While in principle, all students might pass Step 2, the pass percentage has traditionally differed between US medical graduates and overseas medical graduates:
|U.S. or Canada||0.96|
|Outside the U.S. or Canada||0.71|
While 209 is the minimal passing score for Step 2, certain residency programs may utilize a higher cutoff to determine whether or not to interview or rank applicants. It is critical to understand what an expected score for your preferred specialty would be and to prepare thoroughly to achieve the highest possible result on exam day.
Keep in mind that you are not permitted to retry Step 2 in order to improve your score – make your first effort your best attempt!
Scores are normally provided three to four weeks following your exam, on Wednesdays. These outcomes will be available for 120 days. If you fail the Step 2 test, you will be eligible to repeat it as long as you fulfill the qualifying conditions. However, keep in mind that tries are restricted — beginning of July 1, 2021, the total number of permissible attempts is four. Any failed attempt will be recorded on your record, so make sure you are well-prepared before taking the test.
Points of interest
- The audio stems of heart sounds were difficult to work with. I couldn’t tell which murmur was being provided, and the question stem wasn’t very helpful in revealing the solution. On my exam, there were maybe three of them. I had a couple of derm photos that asked 2nd or 3rd ordered inquiries that Uworld didn’t cover. Otherwise, this was a rather low-yielding topic.
- Surprisingly, I had no queries about the kid’s immunization schedule or developmental milestones.
- Biostats. I had around 7-8 first-ordered questions covering a wide range of issues like power, bias, relative risk, testing, and mistake.
- It was a comprehensive exam, and I didn’t feel that any subject was given more attention than others.
- “What is your first move in management?” was the most often requested question. All of the answer options contained measures you would take to manage the patient, however, you were forced to choose the best initial step.
- There were basic Step 1 knowledge questions peppered throughout (about 1-2 each block). There just isn’t any way to prepare for these. I don’t think it’s worth it to spend hours going through all of Sketchy or First Aid.
- There were a couple of questions that were extremely similar to the NBMEs (almost verbatim). Despite the fact that the NBMEs are renowned for underestimating scores, they serve as an excellent guide to learning high-yield, testable topics.
My study plan
I intend to write a more in-depth piece on this later. But here’s a brief rundown:
- I had three weeks of focused study time. In a perfect world, I would have put my exam out a week (primarily since I didn’t finish Uworld), but I understood that with the COVID-19 scenario, this wasn’t an option.
- Throughout my third-year clerkships, I finished Uworld, resetting it a week before my devoted period. During pre-dedicated (while on my neurology clerkship), I performed 1-2 blocks of 40 questions each day, then 4 blocks per day during devoted. I did not complete Uworld (had about 300 questions left).
- As for supplements, I utilized Online Med Ed and Zanki.
- I researched management methods on UpToDate and definitely suggest it!
- I finished all of the NBMEs and the Uworld Self Assessments. My NBMEs were in the 230s to 240s, and my Uworlds were in the 250s.
Begin studying strategically
Most students in the United States take the USMLE® Step 2 following their third year of medical school, right after completing clinical rotations. This is due to the fact that most of what is assessed in Step 2 is directly related to what you learn during your clinical rotations. But how can you study well while you’re in the middle of rotations and Shelf exams? It’s actually simpler than you think — what you’re doing in rotations is already preparing you for success in Step 2!
How should I prepare for the Step 2 CK exam?
Step 2’s road to success will be similar to Step 1’s path to success. The study timetable and resource categories will be nearly the same, but your material and practice will be different. Your initial objective? Determine your daily agenda and allot enough time for studying. Your research should include high-yield resources as well as a strategy for taking NBME practice examinations.
It is commonly advised to take one NBME practice exam every week. Creating a timetable might be difficult, but Lecturio provides tools to assist you in developing a program for Step 2 as well as any clinical subjects you may still need to learn. Take the time to personalize or utilize these plans as-is, and then focus on making your study plan a part of your habit.
- Amboss biostats
- NBME CMS forms
- First aid step 1
- Uworld step 2 CK
- Online research
- Uworld step 3
I just utilized UWORLD as a resource. I was first dubious about utilizing simply Uworld. So I attempted Step Up to Medicine at first, but it was not worthwhile. I also utilized MTB3 for specific pediatrics and OB/GYN themes, but it was not essential in my opinion. Uworld covers practically everything, and if you have previously completed step 1 and want to review anything from the book, utilize first aid step 1 rather than step 2 CK books.
I supplemented anything I didn’t grasp with extensive web study. During the second portion of my preparation, I used UpToDate.
My preparation was divided into three stages:
- Phase 1 — UWorld initial round and review (8–10 weeks)
I began doing Uworld in an organized and timed manner. During this time, I created my own Uworld notes by snapping screenshots of flashcards. I didn’t appreciate having to read from someone else’s notes. I supplemented my notes with any fresh information I discovered through web research. I used to offer a brief overview of whatever system I was working on, starting with First Aid Step 1.
Memorize Uworld thoroughly. I cannot emphasize this more. If you’re taking notes, don’t forget to add the notes from the incorrect option explanations. To be honest, I got a handful of questions right on the exam because I recalled some of the incorrect selections that had enough information to identify the condition.
Taking Uworld notes throughout this period seems to take a long time, but it was well worth it in the end. These notes saved my life.
- Phase 2 — Second review and second round of Uworld (8 weeks)
After I had completed one entire Uworld. I began studying Uworld flashcards that I had saved from the first round. I have not yet begun the second set of Uworld questions. This was the most important stage of my preparation.
During this time, I supplemented using UpToDate. You must utilize UpToDate with caution since it contains far too much information. I mostly read summaries and used algorithms. If used correctly, UpToDate algorithms are gold.
I completed NBME CMS and Uworld phase 3 for each system. I did not utilize these two tools as a learning aid, but rather as a practice and assessment tool. I used to do four CMS forms in four hours, and then the next day I would do the Uworld step three all system questions in a row, for example 160 questions cardiology, and then I would read over the explanations after I finished all the questions. I updated my Uworld step 3 notes with fresh information.
I would recommend completing all CMS forms, especially the newest ones. They contain all of the unexpected questions that you may experience on the real test. I didn’t have the money to acquire the new forms, but someone was kind enough to publish the only questions from the updated CMS on the Facebook USMLE forum. I used to come across similar queries now and then.
Step 3 of Uwolrd enabled me to think beyond the box. It contained a lot of high-end biostats medication advertising and abstracts. These questions prepared my mind to be cool in the face of challenging inquiries.
Step 2 of Uworld Because all of the questions from the UW biostats review and step 1 Uworld are repeated, biostats is a terrible resource.
After reading all of the systems in my notes, I took NBME 6 and received a 271. It was both soothing and overly prescriptive.
So, after finishing Uworld notes, Uworld step 3, CMS, UpToDate, and NBME 6
I began doing Uwolrd step 2 CK questions in the second round of what I call the “UWORLD Marathon.”
I call it the UWORLD marathon since I completed it in a week, completing 10 blocks every day to simulate the real test.
Doing Uworld again in the same way you did it before, in my opinion, is a waste of effort. Use it just as an evaluation tool. Simulate it as though you were taking the real test. It will improve your attention stamina and help you identify several flaws such as when to take a break when you lose concentration, and so on.
After the second round of Uworld, I took UWSA 1 and received a score of 272. I felt UWSA1 and NBME 6 were the simpler ones, therefore they are both over-predictive.
- Phase 3 — Third review and NBMEs (4 weeks)
The most important advice
Prepare yourself mentally for this lengthy exam. Step 2 CK has one additional block than Step 1, but the same amount of break (1 hour total). The extra block may seem insignificant, but this 9-hour exam takes tremendous endurance and stamina. Remember to think positively. After each block, take a few minutes to reset. Don’t carry your stress from one block to the next.
I scheduled the exam for November 26th and began reviewing everything again. Now I had my notes from many sources, such as UW step 2, UW step 3, online research, and UpToDate algorithms. I didn’t have to bother about introducing a new resource at this point. During the designated period, the notes you make truly pay off.
During my second review, my main issue was how to retain all of this material. So I devised a new method of keeping everything fresh in my mind. I wrote sticky notes of anything that was easily forgotten and taped them on a wall in my room. I went through these sticky notes at least once a day, if not all of them. I made reviewing these sticky notes a morning habit, and the first thing I did was go through them.
During this period, I took NBME 8 and received a score of 252. I was exhausted and distracted. I was horrified when my grade dropped dramatically. But I didn’t give up. I used my bad grade as motivation to work harder.
I took NBME 7 a week before the test and received a 265; I then took UWSA 2 two days before the exam and received a 265. I was worried about being caught on one figure, but because my exam was only two days away, I didn’t dwell on it.
During the previous two days, I examined EKGs, cardiac sounds, imaging, and genetic illnesses.
At 8 p.m., I stopped studying and rested. I went to bed at 10 p.m. and awoke at 6 a.m. I was fortunate to receive a decent night’s sleep, as sleep is the most critical factor in exam success.
What is the primary distinction between Step 1 and Step 2 CK?
Step 2 CK, as the name suggests, is a clinical knowledge exam for medical students. While this statement is correct, it does not include any information on how different the two exams are. Step 1 was all on “How?” and “Why?” questions, whereas Step 2 CK is all about “What do you do?” questions. Simply said, Step 2 CK is an exam that assesses your knowledge of diagnosis and management, whereas Step 1 assesses your understanding of how the body functions and why diseases emerge.
Step 2 CK required a lot of endurance! It is only an hour longer than Step 1 at 9 hours, but the difference was significant enough for me to feel significantly wearier afterward. The question stems also felt lengthier to me, however, this might have been due to a peculiarity of my specific test.
Is Step 2 easier than Step 1?
Everyone appears to like comparing Step 2 CK against Step 1 in difficult competition. While I loathe comparing two very different examinations, I must state straight away that you should not trust anyone who tells you it’s simple; it is not! I made the mistake of thinking that because I had covered most of the critical topics in Step 1, I would undoubtedly obtain a higher grade in Step 2. While your core scientific studies might teach you a lot, if you don’t know the diagnostic and management recommendations, you simply don’t know them!
To my sorrow, I did not prepare as thoroughly for Step 2 CK as I did for Step 1. I wasted too much time, notably over 6 months, studying in a disorganized manner, and my score reflects this! My Step 2 CK score is significantly lower than my Step 1 score, indicating that I performed worse on this ostensibly “easier” exam.
Step 2 CK questions appeared to be more difficult knowledge-based questions than Step 1 ones. Using reasoning to determine the findings was more challenging since I could limit it down to two viable responses, but picking the proper one needed prior knowledge. My advice here is to thoroughly study diagnostic and management approaches.
Is Step 2 CK important for residency?
This question has a resounding yes! And, when the USMLE Step 1 score reporting changes to pass/fail, it will only become more significant over time. Many residency program directors like to see “score advancement,” which means that the applying student’s Step 2 score is higher than their Step 1 score. My score did progress, but alas, it was in the other way!
It was difficult to get past the 2020-2021 residency Match. Interviewers for competitive residency programs are not afraid to ask you questions you don’t know how to answer. I found myself rationalizing and justifying why I had a lower Step 2 CK score than my Step 1 score. I’m certain it had a significant influence on my Match outcomes. Fortunately, I was still able to Match and get into one of my top options!
Can a good Step 2 score compensate for a poor Step 1 score?
Sometimes the entire USMLE experience dehumanizes us. We begin to think of ourselves in terms of our grades when we should be focusing on our whole application. While many residency programs have so-called “filters” for Step 1 and 2 scores, most students do not need an impossible number to go beyond them. Aside from that, each application is unique and is evaluated based on its overall merits. So, the answer to this question is yes; if you have a poor Step 1 score, you may strive higher with Step 2 to compensate.
Personally, I felt the weight of the matching process firmly on my shoulders. I requested letters of recommendation from all of the clinicians I’ve worked with in the United States, and I had to select how I would write my personal statement. We forget that the other components of the application process are just as significant as our grades. After all, those grades have nothing to do with whether we’ll be excellent or lousy physicians!
Board test preparation might be intimidating, but it doesn’t have to be. Allow us to lead you to Step 2 success. Our post gives information about USMLE Step 2 CK exam experience are particularly intended to help you get the required score and prepare you for residency and beyond. Finally, the outcome is determined by your efforts, exam performance, and chance. But, as the great Rumi says, you have the capacity to achieve everything and go beyond your bounds. We wish you well with your exam preparation and medical career – now get to work!
Don’t forget to take our free USMLE practice test at Medtutor to get familiarized with the format as well as the questions of the actual exam to strengthen your knowledge and skills, as a result, enhancing your chance to pass the USMLE exam with a high score on your first attempt. Good luck to you![Sassy_Social_Share]