The ambiguity surrounding resource selection for Step 2 CK can be frustrating. With Step 1, the optimal resources were relatively standardized: complete UWorld, get through First Aid a few times, integrate Pathoma and you’ll be well on your way to a great score. However, with Step 2 CK, it seems that no such standardization exists— each resource comes with its own set of pros and cons that may make it ideal for certain students and frustrating for others. As a result, many students waste weeks experimenting with resources. Some never seem to find one to consistently utilize. In this post, I will examine some of the available resources for Step 2 CK and offer some insight that may help you select the appropriate one. While there is no consensus on a single “best resource,” there is most likely a best resource for you.
UWorld Step 2 CK
If I could only use one resource for Step 2 CK, this would be it. Regardless of the type of learner you are, the key to success on Step 2 CK is completing as many questions as possible. With Step 1, questions were often fact based (i.e. what is the mechanism of action of digoxin) and rarely made you work through more than one step to reach a clinical diagnosis. In contrast, Step 2 CK is about forcing you to think like a physician. With each question, you’ll be working through a differential diagnosis, ruling out answers, picking the best diagnosis, and finding a next best diagnostic maneuver or treatment. All the knowledge in the world cannot compensate for bad test-taking ability on Step 2 CK. You must learn the various strategies for approaching each type of question.
Here’s how you can make the most of UWorld for Step 2 CK:
- Aim for two complete passes through the question bank as well as one pass through your incorrect questions.
- Rarely utilize subject specific blocks. If you know that a block is about cardiology, it can easily allow you to eliminate answers that aren’t related. Earning a successful score on Step 2 CK requires you to develop the ability to decipher the appropriate diagnosis – the best way to do that is through randomized, mixed blocks.
- Look for patterns. When reviewing a question, don’t solely focus on the explanations and incorrect answers; in addition, make sure to review the question stem to search for patterns and common variables seen in all questions about a topic.
- Complete most of your blocks on timed mode. Even if you did not struggle with timing on Step 1, Step 2 CK is a different beast. Questions are longer and you’ll be spending much more time thinking through the answer choices; starting off on timed mode will allow you to ensure optimal pacing on the exam day.
Step Up to Medicine
Step Up to Medicine is perfect for 3rd and 4th year. It's a great, comprehensive resource that can help you master the content for internal medicine, family medicine, and surgery. For each organ system it will present the most commonly encountered diseases in a well-organized fashion that walks you through epidemiology, presentation, exam findings/diagnostic findings, and treatment options.
Pros: It serves as an in-depth, comprehensive resource for internal medicine disciplines, neurology, ambulatory medicine, and most of the test content from general surgery. The organization walks you through the necessary steps for Step 2 CK: recognizing a disease, understanding the differential diagnosis, and making appropriate diagnostic or treatment steps.
Cons: This is a long resource that is best utilized for Step 2 CK when a student has already read through it at least once before and/or has at least 4-6 weeks to study for their exam. Some of the chapters are long and I’ve seen slower readers require 2 days to complete them. Additionally, the information is presented in bullet point format, so if you don’t like that type of presentation, it may not be for you. There are lots of details presented in Step Up to Medicine and it requires skill to decipher what is important, and discipline to keep yourself from getting bogged down trying to memorize each one. Finally, this is not a comprehensive resource – you will still need a separate resource for ObGyn, Psychiatry, Pediatrics, and some of the surgical disciplines.
Step Up to Step 2
Personally, this is my favorite review book. The chapters are very short which makes for an efficient read that pairs well with UWorld.
Pros: The chapters are very efficient and can be quickly read, which makes it an ideal resource for students that are spending the majority of their day learning through completing practice questions. It also provides quick, relevant details for some of the subspecialties that aren’t heavily tested (i.e. urology, ENT, neurosurgery) and thus prevents learners from wasting time studying unnecessary, low-yield information.
Cons: Again, information is presented in bullet point format, so it's not optimal for learners who prefer to read traditional text books. Furthermore, each chapter is presented in a high-yield, efficient, fly by approach— students who are easily stressed out by a lack of fine details may feel nervous that something is missing. Finally, if you're especially weak in a given subject area, you may need to seek out additional resources that cover the material more in depth.
First Aid for Step 2 CK
While First Aid does serve as the gold standard for Step 1, it's not as strong for Step 2 CK. I always encourage students to investigate other resources as opposed to utilizing it out of habit.
Pros: This resource is presented in a traditional, paragraph format (unlike First Aid for Step 1), which makes it ideal for learners who struggle with bullet points. Each section is very detailed, which makes it unlikely that you would need an additional text-based resource.
Cons: Each section is very long and the paragraph format can make it time consuming to read. Furthermore, each section tends to include a significant amount of low yield, nit-picky detail that can both frighten an already anxious learner, and can lead to significant time wasted trying to memorize low-yield content. Finally, the text does not do a great job of highlighting high yield material or presenting information in a way that helps you learn “next best diagnostic steps” and first line treatment options.
Master the Boards for Step 2 CK
In my experience as a tutor, this seems to be the resource that is most frequently used by students. I think that it serves as a nice middle ground option between Step Up to Step 2 and First Aid.
Pros: It's easier to read and more detailed than Step Up to Step 2, and it does a better job of highlighting important material than First Aid. The information is presented in a way that gives you a logical approach to each disease process: recognizing symptoms, making a differential diagnosis, conducting a diagnostic workup, and selecting a treatment option.
Cons: There is a lot of clinical information that is irrelevant for Step 2 CK and would be more likely to appear on Step 3 or a subspecialty board exam. For example, I’ve seen paragraphs discussing PCI with bare metal stents versus drug eluting stents – this is not useful information for Step 2 CK. I’ve seen students waste a lot of time trying to learn content that will not be on the test.
Online Med Ed
This is my favorite video-based resource for Step 2 CK. Students with a lower foundation of knowledge and a lot of time to study can work through all of the video content, while others can focus solely on videos corresponding to areas where they struggle.
Pros: It’s free – which is always a good thing! The videos are high-yield, concise, and presented in a way that focuses on relevant information for Step 2 CK— especially helping you learn “next best steps” and appropriate first line treatment options for each condition. Additionally, I think the lecturers offer a lot of helpful hints not seen in other books, and give some general advice on recognizing common patterns for many diseases. Finally, most videos are less than 15 minutes and can be quickly integrated into a study schedule as needed.
Cons: As with any video based resource, students will get the most out of it if they are audio-visual learners. Additionally, students attempting to replace a traditional, written text with these videos should be aware that, like Step Up to Step 2, these videos are focused on the most high-yield details and will often leave some of the fine details out.
**Also note that Online Med Ed does have a Step 2 question bank available for purchase. While I don't think that it can be used to replace UWorld, it does serve as a good, second-line question bank for someone who has completed UWorld twice and still has some significant time left to prepare for Step 2 CK. The questions are less helpful for working on test-taking strategy. However, as they're significantly shorter than what you will encounter on UWorld and the actual USMLE and they're often much more straightforward with less tricky distractors.
Doctors in Training (DIT)
Admittedly, I’m not a huge fan of DIT as I find it to be very time-consuming and I’ve seen some students struggle to complete their daily UWorld questions while working through it. However, I do understand that it can be a valuable resource for audio-visual learners and those that are coming into Step 2 CK with significant deficiencies in their foundation of knowledge. If you are going to use it, make sure that you're giving yourself ample time to complete UWorld and even consider using it while on rotations prior to your dedicated study period.
Flashcards aren’t just for Step 1! With Step 2 CK, flashcards can be very useful for memorizing important diagnostic findings for each disease, next best steps, and first line treatments. I especially like Memorang because it allows you to rely on excellent pre-made content while also creating your own flashcards as you read and complete UWorld. Additionally, the software allows for multiple quizzing options, such as matching and multiple choice, which makes it beneficial for those that do not like the traditional format of flashcards. Finally, the spaced repetition software will ensure that you spend more time reviewing material that you struggle with.
First Aid for Step 1
And here you thought that it was safe to put this on the shelf and never look at it again. Relax, I’m not suggesting that you go back to the biochemistry chapter and memorize the Krebs cycle all over again. However, there's a lot of useful information in there. Over the past few years, it seems that Step 2 CK is including more content from genetics, immunodeficiency, and some of the biochemical diseases like lysosomal storage disorders and glycogen storage disorders. Additionally, some of the pharmacology and microbiology can be helpful to review.
Comprehensive enough? Is there anything else I can answer? Please let me know in the comments — and good luck!