USMLE Step 2 CK: How to Prepare and Set Yourself Up for Success the Day of the Exam.
Since I am 2 days away from taking the USMLE Step 2 Clinical Knowledge exam, I figured I would share a post about what I have been doing to prepare. I started preparing after I got my Step 1 score, and realized that I was really going to have to learn how to improve my score. Being a marathon, these exams really take calculated preparations way in advance. So, I started my third year clerkships with the goal of mastering as much material during each core so I would be best prepared for the USMLE CK exam. You can see previous posts for how I prepared for each core clerkship shelf exam. At this point, I am confident with my preparations, and there is little (if anything) that I would have changed.
For dedicated Step 2 CK preparation, here’s what I recommend:
uWorld – 2 passes over the course of third year, preferably. Read every explanation to every question, even if you get it right. I ran out of uWorld about 2 months ago, and bought a Kaplan subscription. Kaplan questions are good before starting uWorld, in my opinion, but not after. The Kaplan questions are vague, and focus on stuff that is either not high-yield, or it basic and you learned the material through your core already. So, the one thing I would redo is buy a Kaplan subscription for 2 months that I would start during my first core, and I would save the subscription provided by my school (we get one year), to be used during my second core and beyond.
Pick a review book (I have been using First Aid for Step 2 CK), and annotate the crap out of it throughout the year. I am reviewing through my book and I am so thankful for all the little tips I have written in the sidelines. It’s almost like being Harry Potter and having the best textbook for Potions class thanks to the H-B P. If you understood that reference, you’re my kind of friend.
Anyway, that’s about it for dedicated prep. You can review other sources if you have FOMO, but if you have prepared diligently for each shelf exam then it will be superfluous and a waste of your time that you could be dedicating to reviewing your heavily-annotated review book.
The Exam
According to usmle.org, “Step 2 assesses whether you can apply medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision and includes emphasis on health promotion and disease prevention.” This is a one-day examination (Step 3 is 2 days, yikes!), that is split up as 8 one-hour blocks. There will be no more than 318 questions, with each block not to exceed 40 questions.
There are 15 minutes allowed for the tutorial, and 45 minutes allowed for one break. If you are prepared, then you should be able to skip the tutorial and bank those 15 minutes for later when you start to become fatigued in the test and need an additional break.
Also, I think many students do not take advantage of the Personal Item Exceptions list provided by the USMLE that can provide you more comfort on test day. See this list for completeness -> Personal Item Exceptions List.
Personally, I am a fan of bringing eye drops because focused reading for that long really can dry out your eyes and you would be surprised how much better you will feel with some lubricated eyes with all that reading. Also, the pillow for lumbar support is magical. This is a long exam and taking steps to ensure you are comfortable can help make this less painful than it seems. Bring some ibuprofen or acetomenophen for the tension headache that is likely to develop, but I don’t think it’s necessary to have them with you in the secure testing area (plus who wants to take meds without water….?) but I do recommend them being in your packed lunch.
FOOD! How else can you perform at your peak in a marathon without food and water? I think it is essential to bring plenty of snacks and fluids to get you through the day. I recommend bringing quick to eat snacks that need no preparations. I would advise against added sugars to your foods as you do not want to get fatigued early in the game. I am personally bringing some jerky, trail mix without added chocolate or yogurt pieces, an apple with peanut butter, a kind bar that does have some chocolate that will be used toward the end of the exam for the sugar boost at the end, water. I used a google search and reading through some blogs for inspiration on foods to bring for test day which I recommend if you need ideas. I bought everything that I am bringing last night, and I will prepare my stuff tomorrow so that everything will be ready to go for Monday.
Day of the Exam
For optimal performance, I think everyone should have a basic plan of attach for how they will space out each block performance. Having 8 blocks, you have the potential to take 7 breaks but you will only have 60 minutes to divide over that time (unless you end blocks early and bank some extra time for breaks). Based on Step 1 and how I do on practice tests, I generally can do the first two blocks without needing a break. On Step 1, I did 2 blocks at a time before taking a break for a total of 3 breaks but I could feel the fatigue by the end so I am planning something a little different by increasing the number of breaks that I take. Here is a rough outline of what I will do on Monday:
Blocks 1&2 - save five minutes per block (total break time at 70 minutes).
10 minutes break for snack (some trail mix), restroom, quiet breathing (60 minutes remaining)
Block 3 – Don’t save time, enjoy the questions.
5 minute break for restroom (55 minutes remaining)
Block 4 – Save ten minutes because I’ll be ready for a long break after this one (105 minutes)
40 minute break – lunch, but not too heavy. This is where the protein will come into play (jerky and the apple/peanut butter). Plenty of water early in the break so that I will be able to empty the bladder right before heading into the afternoon session. I will also likely watch a motivational youtube video, and do a quiet breathing exercise to refocus my efforts. (25 minutes remaining).
Blocks 5&6 – After having such a restful lunch, it’s time to power through these two blocks.
10 minute break for restroom and giving my eyes a rest. This is where the Kind bar with chocolate will come into play too for a boost of energy for the end (15 minutes remaining).
Block 7 – I will use all the time here and start off the block by refocusing my efforts on the exam and reminding myself not to let my thoughts wander about what I am going to do with the rest of fourth year since I’m almost done with Step 2 CK!
Last break – 15 minutes – If I have extra break time, then I will consider taking it here but I will likely be ready to be done by this point and won’t want to take much longer than 15 minutes.
Block 8 – Gauge my pace based on how I am feeling. If I am really feeling fatigued, then I will use some of my positive self-talk to get me motivated since the finish line is so close.
Finish exam, receive print out of confirmation, email the confirmation to my school after snapping a photo, and GET OUT OF THERE!!! I will spend the rest of the evening with my wife and kids, enjoying the fact that I have finished my last exam of medical school!
Best of luck to anyone preparing for this exam, and I can’t wait to update you all after this is all said and done! The next thing over this last year of school will be the residency application process, interview trail, and matching. I will keep you all posted along the way, and continue providing my thoughts and opinions as I meander through this process. If you ever have questions or concerns, feel free to reach out to me anytime!
