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Preclinical classes are to Step 1 as the core clinical rotations are to Step 2 CK. In the same way you can prepare for Step 1 by keeping up with the physiology and pathophysiology curriculum of medical school, so too can you do well on Step 2 CK by making the most of your clerkships. Here the most important strategies to do precisely that.

5 Ways to Leverage Rotations for Step 2 CK: Your Step 2 CK Study Plan

 

1. Maximizing experiences and efficiency during clerkship year

As you move through clerkship year, your primary goal far and above is to take optimal care of the patients whom you are following and learn as much as you can in the process. By developing a great fund of knowledge, you would be able to accomplish that while also setting yourself up for success on the shelf exams and ultimately Step 2 CK.

In terms of how and what to study in each rotation, this primarily takes the form of preparing for the shelf exam; in the process, you will learn the material you need to perform well in the clinic or on rounds.

Furthermore, Step 2 CK can in many ways be considered a comprehensive year-end final exam that incorporates content tested on each of the shelf exams. The most efficient way then to do well on each rotation, each shelf exam, and Step 2 CK, is to focus on maximizing your performance on the shelf exams specifically.

 

2. Questions above all else

Integral components of your study plan are question banks and specifically UWorld. As you progress through each rotation, it is recommended that you complete the associated Step 2 CK UWorld questions for that area of medicine.

As was the case with Step 1, this bank has well-researched questions and explanations that hit on the high-yield concepts you will encounter on the shelf exams and Step 2 CK.

One caveat with the UWorld is that the explanations for the Step 2 CK bank tend to be longer and it may take more time to work through all of the details; simultaneously, you should maintain efficiency and space your repetition. In other words, it is better to prioritize getting through more questions quickly than to attempt to master a limited number, only to forget much of it days or weeks later.

Another question bank to consider is AMBOSS, a relatively new platform originally from Europe. Here the questions tend to be longer and test more granular details about diagnosis and management. The interface is also slightly different from the UWorld and the explanations shorter. Ultimately, while a good resource, this question bank is probably best to utilize after finishing the UWorld for a given rotation.

Finally, the Pretest series also publishes questions; though unique because they are only released in print, it is also useful if you have finished UWorld and are looking for more questions.

You should tailor which resources you plan to use over the course of the year to the rotation. If it is a shorter clerkship or affords little time to study when not on service, it may not be possible to utilize all of these resources. Furthermore, some are more aligned to certain banks including ones not listed here.

For example, the American College of Obstetrics and Gynecology (ACOG) has a useful subscription for students on the OB/GYN rotation. Similarly, the Lange question book for the psychiatry clerkship is a great extension on the UWorld.

As you enter the dedicated study period, you will have answered the majority of the questions you needed, but as some of these may have been upwards of a year ago, it is worthwhile to redo them. Here again, you should have an honest conversation about how many you believe that you should and are able to get through. At a minimum, a second pass through the UWorld is warranted, but the approach beyond that is individualized based on your circumstances.

 

3. Textbooks as a supplement - 5 must-have resources

Questions are the primary resource, but oftentimes it is worthwhile to have a textbook or two on each rotation as an adjunct. Many series exist with specific editions for various clerkships; some of these are better summaries for certain rotations than others but not necessarily for all of them.

Furthermore, each textbook presents information in different ways that might be better tailored to a particular learning style. The optimal way to approach your reading during rotations is to balance the quality of the text for the specific area with which format works best how you like to learn.

As you move onto your dedicated study period, textbooks are again a great adjunct; however, they become even more so second-line to questions with your limited time constraints. If you have kept up with reading during the course of the clerkship year, you can view these books as as-needed review resources for specific resources.

Like the version for Step 1, the First Aid series comprehensively presents content in an organized bullet format. Unfortunately, First Aid for the USMLE Step 2 CK is not quite as practical as First Aid for the USMLE Step 1; where this collection shines is on the psychiatry clerkship, as it is thorough but still well-organized and manageable.

Blueprints is very similar to the First Aid collection with the exception that it is written in paragraph form. The best rotations for this textbook are neurology and OB/GYN.

Case Files is unique in the way that it presents information in the context of a clinical vignette, much like the question banks, and is therefore a solid choice for learners who like to learn in the context of a patient story. Great rotations for Case Files are pediatrics and family medicine.

Step Up to Medicine is arguably the best resource for internal medicine (IM); because IM comprises so much, it can be challenging to balance finishing all of the text while going through all of the questions. During the dedicated study period, Step Up to Medicine is another book to consider utilizing on a regular basis, since much of Step 2 CK draws from IM.

The Kaplan Pestana Notes book is specific to surgery alone and is the go-to resource for that rotation; here again, the text summarizes the salient points of medical management of surgical patients that are tested on the surgery shelf and then later on Step 2 CK.

It should be noted that this resource review is not comprehensive and many other well-organized textbooks are available for different rotations. Ultimately, it is not expected, recommended, or frankly possible to read all of them for each rotation or during the dedicated study period; rather, it is best to identify the ones that work best for how you learn and stick with those.

And you should remember that as you enter the dedicated study period, you can relegate textbooks to a backseat and use them mainly as targeted review for specific information (e.g., if you are struggling with congenital heart disease, you can focus on that section of the cardiology chapter rather than studying the entire chapter).

 

4. Other great review resources

OnlineMedEd is a platform featuring videos, handouts, and multiple choice questions that cover most aspects of clinical medicine. Of these, the videos are of the greatest value in your study plan and could be compared Boards and Beyond for Step 1.

As you move through different rotations, you can either watch all of the videos relevant to what you are doing or choose specific ones to watch. For example, if you are on your surgery clerkship and having difficulty with the trauma algorithms, it may be more efficient to review those lectures in isolation; alternatively, if you have the time and want a broader review of many different surgical concepts, watching all of the videos in the series is also reasonable.

In addition to its question bank, AMBOSS also has a great library of information for a wide breadth of content. The interface allows you to input a diagnosis and returns learning cards that present the epidemiology, pathophysiology, history and physical exam findings, diagnostic studies, and management for the relevant disease in outline format. What makes this library stand out from others is that it provides good depth but not overwhelmingly and highlights content most likely to appear on the exam; furthermore, abstracts are often included and there is an option to filter out lower yield information.

Medical school is very much so a process of learning information, forgetting parts of what you learned, relearning that content, and then repeating the cycle. To that end, spaced repetition is a very practical learning technique to solidify information over the long term which will translate into success on comprehensive standardized exams.

In particular, a flashcard platform like Anki or Memorang will help you accomplish this by helping you self-identify challenging material and then re-presenting that at timed intervals. One especially practical strategy is to make flashcards based off of the UWorld as you work through it; if you pick out one or two facts from each question of which you were not previously aware or had forgotten and add that to a flashcard, you will have amassed close to three thousand flashcards by the time you finish the question bank.

An important point here is that, if you decide to adopt these cards, you should commit to using them every day as that is the only way you can take advantage of this spaced repetition.

Finally, UpToDate is an exceedingly valuable resource for your rotations and can greatly assist in developing an assessment and plan for the patients under your care. Furthermore, you can use your reading here to incorporate evidence-based medicine into your presentations on rounds and in the clinic and show your curiosity and enthusiasm to the team.

Concurrently, however, each entry has considerable depth to account for all of ongoing research that may not represent content commonly tested on standardized exams including the shelf exams and Step 2 CK, and for this reason, UpToDate is not recommended as a primary study tool. For example, if you are following a patient hospitalized for cirrhosis and are interested in learning about the management of liver failure, UpToDate can certainly give you the depth you may be seeking, but it would be overwhelming to attempt to prepare that way for the cirrhosis questions on Step 2 CK.

 

5. The dedicated study period and scheduling the exam

The length of the dedicated study period has to be individualized to how much time your medical school allots, how proactive you were in preparing throughout your clerkship year, and how much studying would be required to reach your target score.

Though Step 2 CK does allot a more generous curve, many people underestimate how much time they would need to achieve their goals and do not afford themselves sufficient time to finish everything they should. At the same time, if you have been keeping up with the content throughout the span of clerkship year, you likely have already amassed a remarkable fund of knowledge and would be ready to take the exam sooner.

Furthermore, the actual timing of the exam can vary depending on your personal circumstances. Specifically, if you fell short of your goals on Step 1, Step 2 CK can be a great way to demonstrate improvement and strengthen your application; in this scenario, you would want to schedule your exam so that you receive your score before you submit your ERAS application. If you decide to defer your exam until after you apply, you have the ability to resend your scores, but there is a chance that it may not be factored into the consideration of residency admissions committees.

In short, there is no single plan that everyone should follow to prepare for Step 2 CK. By the end of clerkship year, every student is on a slightly different trajectory and has taken a unique path through medical school. For that reason, it is best to think about what has worked and has not worked in the past and use that experience to set yourself up for success later. That said, by being proactive at the start of clerkship year and using your rotations to take the best care of your patients and simultaneously learn as much as you can, you will develop the fund of knowledge to excel on your shelf exams, maximize your efficiency during your dedicated study period, and shine on Step 2 CK.

Want more Step 2 CK Resources? We have you covered: 

Download our Step 2 CK Sample Study Schedule

Learn How to Score 284 on Step 2 CK

Check out our Step 2 CK Resource Review


Photo by Hugh McCann on Unsplash

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Michael Stephens

Michael Stephens

Originally from the Kentucky suburbs of Cincinnati, OH, Mike finished his undergraduate degree at a small Kentucky liberal arts school called Thomas More University. From there, he attended medical school at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, PA, where he was involved in the Medical Student Government, Dermatology Interest Group, and University City community clinic. He is currently completing an preliminary internship in Internal Medicine at Brigham and Women's Hospital in Boston, MA and will be staying for dermatology residency at the Harvard combined program. Outside of medicine, Mike enjoys hiking, playing tennis, and just generally being outside; though the Patriots and Eagles might have super bowl wins behind them, he will always be a Bengals fan at heart.
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