How to Study for the USMLE Step 2 CK Exam

You’re deep into your medical school training – you’ve taken preclinical courses, started clinical rotations (or will soon), and have likely already completed Step 1. Your days are packed with clinical duties and now your program has reminded you about taking Step 2 CK (for most trainees, this is between March and November of the year they are applying to residency). It’s not uncommon to feel overwhelmed at this point in medical school.

So how should you address these challenges when formulating how to study for Step 2 CK? Here, we’ll go through key differences to keep in the back (or front) of your mind between Step 1 and Step 2 CK, some key resources for Step 2 CK preparation, and how to balance your clinical duties and protect your own study time in preparation for clinical exams and Step 2 CK.

Key Differences between Step 1 and Step 2 CK Preparation

Having taken Step 1, you are likely a veteran USMLE examinee at this point. However, there are a few crucial differences between Step 1 and Step 2 CK that are worth keeping in mind as you begin your Step 2 CK preparatory journey.

1. Step 2 CK is scored

At this point, you likely completed Step 1 after it transitioned to pass/fail (if not, feel free to skip this bullet). For better or worse, the reality is that Step 2 CK is still scored, which means that it is important to reflect on your career aspirations to identify what your goal score should be. Head on over to the AAMC Careers in Medicine or NRMP Match Data and Reports website and take a quick peek at what the average Step 2 CK scores are for your specialty of interest. It’s also worth meeting with an advisor to discuss your goals to make sure you are on track to apply for the match when the time comes.

2. Limited “dedicated” study time

During preclinical learning, you have 1 job – study, study, study. Many students receive some additional dedicated study time to prepare for Step 1. But in most cases, this is not the case for Step 2 CK. Most students will take Step 2 CK intermixed with their clinical activities at the end of their core clerkships or during advanced studies, which means your time will be split between your clinical duties and studying. This can be a challenging transition, so we’ve included a thorough discussion below of how to balance clinical work and exam preparation.

3. Exam content is different

As you advance in your training, the expectation of how you apply your knowledge also advances. Much of Step 1 content is focused on recognizing basics of disease pathophysiology and presentation, with other content relating to diagnosis, communication and interpersonal skills, and biostatistics and epidemiology. Step 2 CK represents a significant shift in focus, as the vast majority of questions are directed toward diagnosis and management, with others relating to professionalism, systems-based practice and patient safety, and biostatistics and epidemiology. It is important to be cognizant of this transition to ensure you are focusing your energy on higher level content and avoiding getting bogged down in much of the biochemical pathways, genetics, and basic physiology that were high yield on Step 1.

Key Resources for Step 2 CK Preparation

While preparing for Step 1, many students use a core group of resources to help them prepare (videos, Qbanks, flashcards, etc). When studying for Step 2 CK, some of these resources can (and should) still be used, while others will need to be replaced by some more focused on diagnosis and management.

The core of Step 2 CK preparation should revolve around the use of a Qbank for practice questions. This serves two purposes: 1) completing questions and reviewing explanations is a fantastic way to actively learn and review material in a way that helps you identify and strengthen your weaknesses, and 2) it helps you learn how to “communicate” with the test so all the knowledge in your brain is translated into the maximum possible score. Begin doing practice questions early and often in your Step 2 CK preparation, even as early as your first day of your clinical clerkships. The more questions you are able to complete and review, the better you will perform on Step 2 CK (as well as your clinical shelf exams). In most cases, a single USMLE Step 2 Qbank should be sufficient preparation as they are structured to cover over 95% of the testable content for both shelf exams and Step 2 CK. The addition of a second Qbank is only valuable once the first one has been fully completed.

In addition to using a Qbank, many students will choose to incorporate additional resources for Step 2 CK preparation. Keep in mind that because your time will likely be split between clinical duties and studying, you must be judicious with your resource selection. One or two additional review resources are usually more than enough to be successful, while 3 or more often will become overwhelming and detrimental to preparation. Because study time is interspersed throughout the day, many students find flashcards to be a highly efficient way to review material throughout the day during downtime. There are multiple highly curated Anki decks available online that cover all information tested on Step 2 CK (see AnkiPalace.com for some of the top rated Anki resources). Additionally, incorporating a video resource can help provide a high-level overview and strong scaffold for filing additional detailed information from other experiences (clinical learning and question review).

So you’ve selected your review resources. But how and when should you use them to maximize your success?

Structure and Timing of Step 2 CK Preparation

As mentioned above, you will most likely be studying for Step 2 CK and completing clinical duties concurrently. If you are one of the blessed few who has dedicated Step 2 CK study time, you can use a similar scheduling strategy as you used for Step 1 in the weeks leading up to Step 2 CK. For everyone else, there are 2 rules that will help you reach your maximum possible score: discipline and consistency. You must be both consistent and disciplined in your study routine (in an often inconsistent and unpredictable clinical world).

Initially, it is most important to take a broad view of your timeline: when are you planning to take your exam and how many months/weeks/days do you have until that time? What rotations are you on and how intense are they? Based on your overarching timeline, try to roughly gauge how much you anticipate being able to complete – how many Qbank questions, how many flashcards, how many videos, how many chapters, etc. Be as realistic as possible with your goals. If you need to make a rough estimate, consider these recommended times for completing various tasks:

• Qbank questions: 3–5 minutes per question (includes both answering the question and reviewing the content)
• Flashcards: 10–20 seconds per flashcard
• Videos: Best to check specific video times (most review videos are 20–30 minutes, but some can run much longer)
• Textbook chapters: 1–2 minutes per page (again, will depend on the source and content)

Once you have a rough idea, it is often most effective to divide up the resources by week based on the assumed intensity of your schedule. For example, a week on an outpatient rotation will afford more study time than a week of inpatient medicine, so you should anticipate the need to do more studying during those less intense weeks. Dividing content up on a weekly basis gives day-to-day flexibility, which is important when your schedule may be inconsistent. If clinical duties run later than anticipated one day, there are still six other days to catch up with tasks and stay on track for the week. Additionally, per ACGME regulations, many programs will parallel resident and student schedules, such that students have at least one day off for every seven days on service. Using those days off to aggressively study will help alleviate stress the rest of the week.

Example Step 2 Study Schedule 

Here is an example log from an actual student during a month of an internal medicine rotation while preparing for Step 2 CK. Note that H&P = history and physical examination, OSCE = objective structured clinical examination, and Q&R = questions and review:

Keep in mind that this schedule was built with the goal of doing ~ 200 questions, ~ 2 hours of video, and ~ 700 flashcards per week, but those numbers varied day-to-day and week-to-week over the course of the rotation. It was also completed during one of the final core clinical blocks, when the student was well acclimated to their clinical responsibilities and was very efficient in completing their tasks.

Studying for Step 2 CK and Shelf Exams Concurrently

For the majority of students, clinical shelf exams throughout the third year of medical school are excellent benchmarks for Step 2 CK preparation, as most standardized NBME shelf exams include similar questions, both in style and content, as Step 2 CK. While it is tempting to focus exclusively on preparing for individual shelf exams during the corresponding rotations, the long-term benefit of continuing broad Step 2 CK preparation in tandem with studying for a specific shelf exam will provide the most bang for your buck. This often means continuing to review material from past clinical blocks and shelf exams throughout the entirety of the third year (via flashcards, questions, and/or text/note review). Selecting resources that allow easy discrimination between content for specific shelf exams while covering all Step 2 CK material (such as TrueLearn’s new Step 2 CK and shelf exam SmartBank) can seamlessly integrate continued Step 2 CK preparation with current shelf studying.

Early on in the year, this likely seems like an impossible task. How will I have enough time to review old material and still learn new material for my upcoming shelf exam? While in theory this does create a challenge, the vast majority of students will find themselves becoming more acclimated and efficient in completing their clinical tasks over the course of clinical rotations. This ultimately leads to relatively more time to spend studying as the year progresses. It is important to set the expectation that this extra time will be devoted to your board preparation.

Conclusion

While studying for Step 2 CK can feel daunting, early preparation and planning will help you feel more than capable of tackling this next board exam. Take time to evaluate your career plans and aspirations so you know what you need to achieve. Determine your realistic study goals based on your testing timeline and divide up the work on a week-by-week basis to give yourself the necessary flexibility to be successful. Select your resources judiciously and balance your review of new material for shelf exams with continued studying of old Step 2 CK–relevant material from past rotations. Stay consistent and disciplined with your study routine, and maximize your Step 2 CK success.

Author Bio

Dr. Alec Gramann, MD, PhD, is currently an internal medicine resident at The University of Texas Southwestern Medical Center in Dallas, TX. He has many years of experience as a USMLE Qbank editor and medical school tutor, with a focus on standardized test preparation and question approach strategies.