Advice For Creating Your Step 2 Study Plan

When Step 1 transitioned to pass/fail, shelf examinations and Step 2 became more important than ever, particularly for those attempting to match into the most competitive specialties. This has been reflected in my own experience as a USMLE/shelf tutor, with more students than ever reaching out to me for help in creating a study plan for Step 2 and shelf exams. So what do these students want to talk about? Let me use my experience to answer some of the most common questions about these exams.

Why is the USMLE Step 2 score important?

Step 2 has become even more important because it is now the only standardized quantitative assessment that residency programs can use to evaluate potential applicants. While we can certainly debate the merits of using this score as an evaluation, the fact remains that many program directors do believe that this score matters and factor it heavily into their decision-making process when offering interviews and ranking applicants. This is especially true for more competitive programs and specialties (e.g., neurosurgery, plastic surgery, dermatology). 

Those who are involved in the residency selection process believe your  Step 2 score matters, with common reasons including:

• “Earning a strong Step 2 score requires good critical thinking ability and some clinical reasoning. Those are useful qualities for a resident to have.”
  
• “Residents will not have as much time to study for Step 3 and in-service examinations as they did for Step 1 or 2. Earning a high score gives me some reassurance that you will do well with the examinations that you need to pass in residency.”
  
• “A high score shows me that you were able to focus on a goal and put in the work necessary to succeed. It also shows me that you are willing to work hard and learn things that you might not find interesting.”

At the end of the day, whether you like it or not, many programs do care about USMLE scores, and Step 2 is now the only one that is available. 

The field that I am applying to doesn’t care much about Step 2, so why should I?

As was stated above, it is definitely true that some specialties care about Step 2 scores more than others. That being said, even if you have done your research and feel confident that your Step 2 score will not be heavily considered for the field that you are applying to, there are still a lot of reasons to care:

• While the field as a whole might not care much about Step 2 scores, there will certainly be some outlier programs that do and use it as a filter for offering interviews and a data point for ranking applicants. With that in mind, a higher score is going to keep the door open to these programs.
  
• You may change your mind about what you want to do. Plenty of residents will change fields after 1-2 years of residency. With this in mind, having a strong Step 2 score will keep as many doors open as possible.
  
• A good score won’t hurt you and putting in the work to maximize your potential is a great philosophy for life and a career in medicine.

Finally, consider what is happening with Step 1, where the transition to pass/fail was met with a decrease in the pass rate. Those who “don’t care” about their score or “just want to pass” often cut corners and fail to put in enough work. In doing so, they significantly increase their chance of failing the examination. 

What is considered a good Step 2 score?

Currently, 209 is the passing score, while 245 is the average score. From there, what constitutes a “good” score will depend on your own subjective opinion and the field that you are applying to. In order to determine your target score, you should do some research (e.g., charting outcomes in the match) to determine the average score for matched applicants in the specialty that you are applying to. Any score above that average can be considered a good one.

How long should I study for Step 2?

Now that we have established why Step 2 matters, the question becomes, how long should you be studying for. Unfortunately, there is no uniform answer. Some students who work hard throughout the 3rd year are able to score upwards of 260 with only a 2-3 week dedicated studying period. For others, 6-8 weeks (or longer) may be required to earn their best score. 

With that in mind, rather than focusing on a goal for how long you should be studying, focus instead on goals that should be completed prior to taking the exam. These goals would include:

• Completing at least one Step 2 question bank fully and reviewing all of your incorrect answers
  
• Completing all of the sample NBME examinations and, ideally, achieving a score that is within 10 points of your goal
  
• Developing a strong foundation of test-taking and critical thinking skills that you will be able to apply to each question

In terms of additional resources, this becomes a subjective point relative to the learning style and preferences of individual students. Depending on how you learn and what you need to improve on, you could benefit from completing a second question bank and working through flashcards, text-based resources (e.g., First Aid), and video lectures.

Why are shelf examinations important?

Shelf examinations are not going to be evaluated the same way that Step 2 is for a residency application. However, they are still an important part of your journey. First and foremost, your shelf examination is often factored into your overall grade for a rotation and can have an impact on whether you honor the rotation or not (e.g., some schools require a minimum shelf examination score in order to earn honors). Beyond this, working hard to do well on shelf examinations will help you develop the study and critical thinking skills necessary to do well with Step 2. Doing well on these examinations will ultimately set you up for success on Step 2. Alternatively, coasting through these examinations can hurt you later when you are forced to learn concepts for the first time during Step 2 preparation.

What is considered a good shelf examination score?

There is no right answer to this question, as various schools will grade shelf examinations differently. Additionally, there is significant variance in terms of the shelf examination score that is required to honor a particular rotation. As such, check with your own institution to learn the expectations and scores needed to pass and honor.

How should I study for shelf examinations?

While there can be some benefit to other resources (e.g., reviewing basic science from First Aid, flashcards, videos), working through practice questions will give you the best chance for success as it can help you learn both the content and critical thinking skills. With this in mind, you should do the following:

• In most cases, a single question bank will be sufficient for shelf examination preparation. While some students will opt to work through multiple banks for each shelf, this often requires a focus on quantity over quality and, in turn, prevents the student from maximum learning. Focus on one bank now and consider getting a new bank when it comes time for dedicated Step 2 studying.
  
• Make it a goal to get through all of the available questions for each shelf (e.g., do all of the questions tagged under psychiatry to prepare for your psychiatry shelf). If possible, go back through your incorrect questions prior to test day.
  
• The NBME has several practice examinations for each shelf. While not necessary, these can be a great way to identify and correct weaknesses before test day.

How can I manage my time to effectively study while on rotations?

One of the biggest challenges for doing well on shelf examinations is that you will have to balance 40+ hour work weeks with finding time to study. To do this effectively, consider the following:

• Rather than focusing on daily goals (e.g., I have to do 30 questions every day), try setting weekly ones (e.g., I have to do 180 questions this week). Doing this will account for the fact that there will assuredly be days where you are too busy to study. In doing so, it will take some pressure off of you and will prevent a lot of the negative emotions that can come with not meeting daily goals.
  
• Start studying on day one of the rotation. My experience as a tutor has shown me that students often wait too long to begin studying for their shelf examinations. In doing so, they simply run out of time before they can review all of the necessary material and start having to cram at the end, which leads to exhaustion, suboptimal retention, and worse performance on the exam.
  
• Find ways to study at work. Many rotations will feature significant amounts of downtime where you are forced to be at the rotation but will not have any work to do. Don’t waste this time just sitting around; instead, use it to work on practice questions (doing blocks of 5 at a time works well when at work) or go through other study resources. 

About the Author

Christopher Carrubba, MD, is an experienced medical education executive with over 12 years of experience in USMLE and COMLEX tutoring, question writing, and content development. During residency in Internal Medicine at the University of Colorado, he was hired to the position of medical director at MedSchool Tutors where, in addition to completing over 5,000 hours of personalized tutoring, he was responsible for hiring and training new tutors and establishing consulting relationships with medical schools and content providers. In 2017, he began his own tutoring and consulting firm where he is still active as a personal tutor and consultant for medical schools. He is also a medical director at TrueLearn and is responsible for item development in the USMLE and shelf banks. His focus is on creating content that mimics the tutor experience and provides students with multiple learning methods and an opportunity to improve their test-taking skills. He has taken several courses in learning theory and applies this to his work. In his free time, he enjoys spending time with his wife Aakriti and two sons, Donovan and Kairav.