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How Step 1 and Step 2 CK Are Different From Any Test You’ve Taken

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by Alec Palmerton, MD in Plan

Step 2 CK is now the most important test you will take for getting into residency. To be at your best for Step 2 CK, you have to understand how the USMLE Step 1 and Step 2 CK are different from any test you’ve ever taken. Because Step 1 is pass-fail, it’s critical to prepare well from the beginning – you only have one shot. If you don’t do well on Step 2 CK, unlike previously with a scored Step 1, there isn’t another readily available USMLE to make up for a low score. Plus, Step 2 CK is usually taken much later in the process / closer to your residency applications.

A common cohort of students I work with is IMGs who were the top of their class in their home country. Some of them were even the top students in the country. But how many of those previously top students remain at the top for Step 2 CK? Very few.

Why do so many people – US or IMGs – struggle? The USMLEs are different from any exam you’ve taken before. In this article, you will learn the reasons why Step 2 CK and Step 1 are different from other tests you’ve taken. By understanding these differences, you can change your approach so you can be at your peak for Step 2 CK – and your clinical career.

The USMLEs Use Two-Step Reasoning

The USMLEs are famous for “two-step reasoning.” One-step reasoning is what most tests use. Here are some examples:

  • “How fast will a penny dropped from a height of 5 meters be moving just before it hits the ground?”
  • “What is the second step of the central dogma of molecular biology?”
  • “a + b + c = 15, and b + c = 10. What does a equal?”

Note that all of these things require only a single step in reasoning.

The USMLEs, in contrast, use two-step reasoning. Here is an example:

A 55-year-old man is brought into the emergency department with sudden-onset chest pain 4 hours ago. He has known coronary artery disease. Initial ECG demonstrates ST-elevations in II, III, and aVF, with initial serum troponin 2.4 ng/dL.

A one-step reasoning question would be, “what is the diagnosis?” A two-step reasoning question might ask, “what is the best next step in management?”

Understanding the format of the test is critical so you can set your expectations appropriately.

The USMLEs Test Your Ability to Apply Critical Concepts

The NBME, which writes Step 1 and Step 2 CK, is very clear on this. They want you to be able to apply important concepts. Here are some direct quotes from the manual used by Step 2 CK, Step 1, and shelf exam test-writers:

  • “Each item should assess application of knowledge, not recall of an isolated fact.”
  • “Avoid asking about the leading cause of death in some subpopulation; instead, focus on the application of this knowledge.”
  • “The NBME decided that it was not important to assess whether students know definitions; instead, the goal became assessment of whether or not test-takers could apply ethical principles on their decisions related to patient care.”

This emphasis on application is different from the way many of us have taken tests

Step 1 and Step 2 CK Aren’t About Memorizing List of Facts

We’ve all taken tests that required us to memorize minutiae, especially in med school. To get a particular question right, we needed to remember the 5th line of the 47th PowerPoint slide.

The USMLEs couldn’t be more different than our med school tests. Step 1 and Step 2 CK do NOT test our ability to regurgitate memorized lists. The USMLE test-writers are very clear:

“Questions should NOT focus on the direct assessment of isolated facts.”

Many of us may have done extremely well by working harder and memorizing more. However, a memorization-heavy approach will get you into trouble on the USMLEs.

Be sure to focus on mastery of concepts rather than memorization of details on your one shot at Step 2 CK.

The USMLEs Use Lots of Vignettes to Weed Out Memorizers

As discussed above, the USMLEs are about the mastery – not memorization – of concepts. In short, they are testing your ability to apply critical concepts.

To ensure you understand real medicine, the USMLEs rely heavily on clinical vignettes. Here is the NBME, writers of Step 1 and Step 2 CK:

“Questions with a clinical vignette as part of the item stem have several benefits. First, the authenticity of the examination is greatly enhanced by using questions that require test-takers to “solve” clinical problems. Second, the questions are more likely to focus on important information, rather than trivia. Third, these questions help to identify those test-takers who have memorized a substantial body of factual information but are unable to use that information effectively in clinical situations.”

  • Do vignettes force you to apply knowledge to solve a problem? Check.
  • Do they focus on critical concepts and not esoterica? Check.
  • Do vignettes weed out memorizers? Checkmate.

Concluding Thoughts

How often do top students struggle on Step 1 and Step 2 CK? All the time. The USMLEs are different from any other test you’ve ever taken. As such, the approaches we’ve taken to do well up to this point may not work – or even worse, may be the opposite of a good plan.

By knowing HOW the USMLEs are different, you can formulate a better plan to be at your best for Step 2 CK.

At Yousmle, our bread and butter is helping people be at their peak for Step 2 CK. Like they say, overnight success takes years. Your Step 2 CK score is the product of years of work – for better or worse.

We will help you at any point in your journey to master – not memorize – so you can get the impressive scores to stand out to residencies. Haven’t even started studying for Step 1? We will help you use concepts from Day 1 to learn more without working harder so you can love learning again.

Sign up for a free consultation to see how you can get a high Step 2 CK score…even if you haven’t taken Step 1.

What do you think? How are the USMLEs different from other tests you’ve taken? Is your usual approach working? Let us know in the comments!

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Want FREE Cardiology Flashcards?

Cardiology is key for impressive USMLE scores. Master cardiology from a Harvard-trained anesthesiologist who scored USMLE 270 with these 130+ high-yield flash cards. You’ll be begging for cardio questions - even if vitals make you queasy.