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Dr. Raymond Beyda and Mike Stephens contributed to this post. 
 
Step 2 CK: Like the round 2 to Step 1, right? If you were hoping for a higher score on Step 1, you may be dreading going through the process all over again. How and what should you change? Should you study longer? Or study differently?
 
History is not doomed to repeat itself, and even if you may have been hoping for a better score on Step 1, that should not hold you back from confidently tackling this next exam.

First, completely eliminate from your memory the adage “2 months for Step 1, 2 weeks for Step 2, and number 2 pencil for Step 3”.
 
While considerable emphasis historically has been placed on Step 1, the dynamics are changing and increasingly underscoring Step 2 CK performance. It makes sense since understanding the next step in management, for example, is far more applicable to what you will do as a resident than the tricarboxylic acid cycle.
 
This is a good thing if you are not thrilled with your Step 1 score.
 
Use this opportunity to demonstrate to admissions committees your resilience and ability to self-improve, and let us show you how.
 

Can Step 2 CK make up for a bad Step 1 score?

 
It depends. There's actually no clear-cut answer, with specialties and specific residency programs placing emphasis on Step 1 over Step 2 CK and vice versa, and there's not a real consensus across the board either.
 

If you did poorly on Step 1, can you actually improve on that score? 

Yes! 

Also, even if you did really well on Step 1, are you just gonna “go sit” for Step 2 CK and put that awesome Step 1 score at risk of being next to a mediocre Step 2 CK score? Probably not. In fact, chances are that if you did well on Step 1, you are still going to want to do well on USMLE Step 2 CK.

How do I even think about Step 2 CK?

You can view Step 2 CK as the application of what you learned for Step 1 to patient care. While the two exams do overlap in many ways, you shift from thinking about molecular genetics and biochemical pathways to diagnostic and treatment modalities, and this is what makes them fundamentally different.

You will become familiar with algorithms for workup and management of conditions like thyroid nodules, myocardial infarctions, and acute peritonitis. With discipline and the right approach, you can leverage these nuances to leave Step 1 in the past and crush Step 2 CK.

But how do you tackle that vast amount of clinical knowledge and then apply it to answering Step 2 CK questions?

There are different schools of thought regarding how to study for Step 2 CK, but one approach involves reliving third year in a condensed two- to four-week study schedule utilizing UWorld and either Step Up to Medicine or First Aid as the primary review text.

If you take this approach, we normally recommend taking an NBME at the outset of your dedicated Step 2 CK study period to get a baseline reading on how far you are from your goal score. That will help you determine just how aggressive you need to be in your studies and will also help you decide if your timeline is realistic.

Other approaches include a slightly less condensed but still intensive review over four to six weeks of full-time study when students are lucky enough to have that much wiggle room at their disposal, study time-wise.

But how to organize all of the information, how to maximize UWorld, and should you make flashcards? Making a Step 2 CK study schedule is key, much like for Step 1 of the USMLE.

When it comes to flashcards, it depends on your unique areas of weakness. Flashcards can be time-consuming, but they are often extremely effective when done right, so they're often worth the time investment if they're right for the areas you're trying to strengthen.

What is the best resource for Step 2 CK practice questions?

Once again, UWorld delivers like no other resource with both high yield and high quality questions that come with full-length articles for your reading pleasure, should you have the time. When it comes to books, for Step 2 CK this is a bit more challenging. Indeed, the market is inundated with review book after review book, all with comparable quality and coverage. 

Which Step 2 CK study resources should I use?

Perhaps unsurprisingly, UWorld should again represent the centerfold of your study plan. Questions in general represent the optimal way to incorporate active learning and assimilate content, and UWorld has the highest quality questions and explanations available. At a minimum, you should attempt to make one pass through this resource, though ideally you would be able to make multiple.

If you have still more time in your dedicated study period, pat yourself on the back for your efficiency and then consider another great question bank like AMBOSS.

The bottom line is the more questions you are able to use, the more prepared you will be by the morning of your exam.

In terms of textbooks, Step 2 CK unfortunately does not come with quite a comprehensive review as First Aid for the USMLE Step 1. Options include First Aid for the USMLE Step 2 CK, Step Up to Medicine, and Step Up to the USMLE Step 2 CK. Reading these textbooks cover-to-cover is a feat both daunting and unnecessary. Said resources are supplemental and should be used to take a deeper dive into areas of weakness; if you are struggling with antiarrhythmic pharmacology, review this section in an aforementioned textbook, but do not feel compelled to read the entire cardiology chapter en bloc.

You will most likely not need to consult the majority of the shelf-specific resources you have during your Step 2 CK studies (e.g. Case Files, Blueprints, etc.), so you can set those aside and treat them as supplemental resources while focusing primarily on UWorld and First Aid (or Step Up to Medicine).

Whatever you do, resist the urge to cram at the last minute before your Shelf exams and Step 2 CK.

The consistent and regular approach to your studies over your clerkships will not only help preserve your sanity in the long run, but it will also give you the best chance of scoring high. If you're worried about being able to juggle all of this on your own, get with an expert tutor who can guide you through the process, help you stay on track, and ensure you're working as efficiently and effectively as possible in the limited time you have.

How long should I study for Step 2 CK?

Generally speaking, anywhere between one to two months of dedicated review for Step 2 CK is sufficient; however, if you are motivated to make a large improvement from Step 1 or have unsteady footing with the content, more time may be warranted.

The bottom line for determining how long to study for Step 2 CK depends on circumstances including: your Step 1 experience, the timing of your applications, and your other commitments including sub-internships and clerkships.

You should have a foundation after your shelf exams and clerkships, but this will need to be rehearsed and then expanded.  Regardless, you should not and frankly cannot cram for this exam, so do not expect to squeeze in thousands of UWorld questions in mere days or weeks.

The great part about studying for Step 2 CK is that if you take it before your fourth year, it can even boost your clinical knowledge and performance during your subsequent sub-internships but when to take it is a very personal decision to make.



So when it comes to Step 2 CK, make a schedule, define your goals, get UWorld and First Aid and make it happen.
All in all, if you feel like previous exams let you down, don’t let that weigh on you as you gear up for Step 2 CK. See this as an opportunity, organize a plan, and rock the exam like a pro. It’s taken quite a bit to get to this point; know that you’ve got it in you to succeed and that we’re here to help along the way.


Further reading:
 
 
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