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Step 2 CK Study Plan: NBME 168 to Step 2CK 261

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by Alec Palmerton, MD in Plan, Yousmlers
Step 2 CK Study Plan Surgery

How much does a bad Step 2 CK study plan hold you back? Most of us never find out. We are too busy burying ourselves in textbooks and QBanks until exhaustion. In this article, Minills describes exactly how much her previously study plan had been holding her back.

The upshot? A better Step 2 CK study plan led to incredible results. She scored 95%ile on multiple shelf exams and a 261 on Step 2 CK.

Here is Minills:

Med School Highlights:

Before Yousmle, my approach was mediocre. I memorized for my exams, and never mastered the material. As a result, I was a mediocre student. I scored average or above average on my MS1/MS2 exams.

My first NBME was one week before my Step 1 dedicated study. I scored a 168 and went into panic mode. With less than 2 months to prepare, I needed help. I reached out to Alec and started tutoring and the Yousmle Online Course.

In 2 months, I increased my Step 1 score by 60 points. I scored 228 on Step 1. (Read more about my Step 1 experiences here). Although I improved my score significantly, I had a long way to go to achieve my Step 2 CK goals.

After Yousmle, I became, as one attending wrote, “an exceptional student.” Here’s the breakdown:

  • Honors in 5 clerkships
  • 95th percentile on IM, Peds and Neurology shelf exams
  • 261 on Step 2 CK

How did I transition from a mediocre to an exceptional student? Keep reading to find out.

My Step 2 CK Study Plan: Third-Year

The third-year of medical school is a difficult transition. We go from classroom learning to clinical application on the wards. Instead of working independently for the next exam, we work in interdisciplinary teams to provide patient care.

As a result, our Step 2 CK study plan is necessarily different from our Step 1 plan. We no longer have the luxury of waking up late. There are no more recorded lectures online. Instead, we pre-round (sometimes at 4:30 in the morning). We have to show up on time and know our patients well. We’re finally practicing to be a real doctor.

The week before I started third-year, I was filled with dread. The thought of clinical evaluations and shelf exams was overwhelming. Most of all, I was worried about my Step 2 CK study plan.

A Two-Fold Approach

I met with Alec a couple of weeks into clerkships and expressed my concerns about third-year:

“What is the best Step 2 CK study plan to succeed on the board exams and the wards?”

Alec shared a two-fold approach:

  1. Build foundational knowledge and
  2. Master question interpretation

This approach was deceptively simple. However, it provided me with the exact Step 2 CK study plan I followed to “exceptional.”

Strong Foundation = Master New Concepts + Spaced Repetition

Clerkships are hard and exhausting. Finding time to do anything outside of clinical duties is a challenge. Despite that, I developed the habits of:

  1. Deliberately mastering new material, and
  2. Never forgetting it by using spaced repetition/Anki

One key to my dramatic improvement: mastering new material. I continued with the Step 1 and Pharmacology Anki cards. During clerkships, I added the Step 2 cards.

In addition, to supplement my knowledge I made new cards from:

  • UWorld questions,
  • Discussions during rounds, and
  • Management plans my team came up with

My goal: master any unfamiliar concept that came up. By putting that information into Anki cards, I never forgot what I was learning.

This final point is crucial. There was so much new clinical information. I quickly realized the importance of doing my Anki cards daily. Daily Anki review allowed me to retain what I had already mastered.

As Alec reminded me: it is better to never forget something than to re-learn it.

Finish Your Cards Before Leaving the Hospital

To remember what I was mastering, Alec recommended finishing my cards before leaving the hospital. This was easier during inpatient rotations where the workload was geared towards the morning. The front-loading of work on inpatient rotations allowed me to focus my evenings on mastering new material and question interpretation. (More on question interpretation later).

Every day I built a stronger foundation by:

  • Mastering new material while
  • Never forgetting the old

Throughout the year, attendings and residents commented on my strong knowledge base and active learner mentality. In actuality, I wasn’t spending much time reading new material. Instead, I was recalling information I already learned.

Daily Anki review helped me ace my shelf exams. Not only could I handle random pimp questions with ease, but I also built professional confidence by recalling medical information necessary for patient care. This growing mastery built the foundation for my Step 2/shelf success: question interpretation.

Step 2 CK Study Plan Key: Question Interpretation

Mastering question interpretation was the most important factor to my clerkship and Step 2 success. With question interpretation, I moved beyond “buzz words” to understand the purpose of each sentence in a clinical vignette.

To do this, my third-year focus was interpreting questions and understanding pathophysiology. To practice vignettes, there are a ton of resources for questions. Each shelf exam has specific resources better suited for it than others.

(To read Honor Your Shelf Exams By Becoming A Wizard Test-Taker, click here).

UWorld is the standard QBank. I usually completed ~10 UWorld questions during the weekdays, and 50 on my days off. I learned to be flexible with the number of questions between UWorld and shelf-specific resources.

Quality of UWorld Reviews > Quantity of QBank Questions

The quantity of UWorld questions per day didn’t ultimately lead me to a 260+ Step 2 CK score. Rather, the quality of my interpretation took my examination skills to the next level.

I took NBME Clinical Mastery Series (CMS) exams regularly throughout clerkships. (There are about 4 NBME CMS exams for each shelf). After I completed an NBME, I would go over wrong answers line-by-line. I contextualized each sentence in the overall clinical picture, asking “what does this sentence mean in context?” “Why are they telling me this?” Then I wrote down a pathophysiologic mechanism that could explain the symptoms and presentation in the vignette.

(To read how “pathophysiologic chronologies” can help you improve your USMLE scores, click here).

The Importance of Understanding What Each Question is Asking You

In addition, I would create a “stand-alone question.” A “stand-alone question” is a question that can be answered by itself without knowing the full vignette or question stem. For example, a QBank question may describe an elderly man who suddenly stops urinating after a surgical procedure. The question is often something generic, like

  • “What is the next step in management?”

Notice that the typical “next-step management” question doesn’t stand alone. In other words, if I asked you “What is the next step in management?” without explaining the context, you couldn’t answer it.

Instead, the stand-alone question would be:

  • “How do you manage a man with symptomatic BPH presenting with a post-renal acute kidney injury?”
Good Stand-Alone Questions = Fewer Questions Wrong

Without knowing anything about the vignette or the answer choices, I should be able to answer from only the stand-alone question. (Hence why it can “stand alone”). Boiling everything down to a single question gauges whether you understand the vignette and what the question is asking.

I would then look at the answer choices and do a process of elimination. I also prioritized my weaker concepts by focusing my content review on questions I missed.

Step 2 CK Study Plan: Optimize Your Clerkship Sequence

At my school, I had the option to schedule shelf exams in the order that I wanted. This is rare. More commonly, students can make requests on the order of their clerkships.

If you can decide the order of your clerkships, I recommend:

  • Pairing the clerkships/shelf exams that have content overlap

For example, I ended up scheduling the internal medicine and surgery shelf exams one week apart. If you can’t do this, I’d recommend doing your internal medicine clerkships, followed by surgery.

I took the internal medicine exam first because it:

  • Covered the most material,
  • Had the most number of UWorld questions, and
  • Helped me establish a broad base of knowledge early on

I also sequenced neurology/psychiatry and pediatrics/OB back-to-back. Family medicine (FM) was my final clerkship. Because FM has content spread across all the shelf exams, it was an excellent way to tie everything together before Step 2 CK.

Step 2 CK Study Plan Surgery

It’s hard to find time to study on busy rotations like surgery. Sequencing your clerkships so shelf exam content overlaps will make your Step 2 CK study plan more efficient.

Question Interpretation is Critical Regardless of Clerkship Sequence

Regardless your shelf exam sequence, you can excel by improving question interpretation. This means:

  • Doing a few questions every day and
  • Writing out the interpretation for questions you missed

Over time, you will identify weaknesses and high-yield material to review.

Yousmle Online Course Helped Improve Question Interpretation

To accelerate my question interpretation practice, I attended the Yousmle question interpretation (QI) sessions each month. These are included in Yousmle Online Course. These sessions were invaluable in building my own interpretation skills, as I could reinforce strategies and provide/receive feedback from other students.

(To read The Secret to Scoring 250/260+ You Can Learn Right Now: Question Interpretation, click here).

From Shelf to Step 2 CK Prep

During my third-year, I aligned short-term goals (i.e. shelf scores) with long-term goals (performing well on Step 2 CK). As a result, I tracked my progress over time and prioritized review topics during my dedicated study period.

I ended up honoring my shelf exams for:

  • Internal Medicine (88%),
  • Pediatrics (89%),
  • Family Medicine (84%),
  • Neurology (90%), and
  • Psychiatry (85%)

Thus, during my dedicated study period, I needed to prioritize:

  • Surgery (76%) and
  • Ob/Gyn (74%)
Proper Third-Year Preparation → Dedicated Study Time ↓ 

As my shelf scores indicated, I had mastered most of the Step 2 CK material prior to my dedicated study. And because of my daily Anki reviews of old material, I had little remaining “gaps” in my knowledge. As a result, my 3 weeks of Step 2 CK studying was plenty.

I had completed UWorld before my dedicated study period. Recycling questions that I already knew felt unproductive. As a result, I didn’t reset/repeat UWorld.

Instead, I used the Kaplan QBank for interpretation practice. I completed 40-80 questions/day.

For content, I focused on understanding surgery and Ob/Gyn topics. (These were my weaknesses identified by my lower shelf scores). For surgery, I referred to Christian de Virgilio’s Surgery: A Case-Based Clinical Review. For Ob/Gyn, I used the UWise APGO Question Bank.

I also went through my NBME shelf exams for Ob/Gyn and Surgery. Like with my QBanks, I made sure I fully comprehended each sentence of every question I missed.

The results of my dedicated focus on Surgery and Ob/Gyn? On my Step 2 CK score report, these previous weaknesses were my two best areas.

Step 2 CK NBMEs Were Poor Predictors of my Final Score

There are 3 NBMEs for Step 2 CK. I would recommend spacing them out. I scheduled full-length NBME CK exams at 3 months, 1 month, and 2 weeks prior to my actual test date.

The scores you receive on the Step 2 CK NBMEs weren’t predictive of my final results. My NBME trajectory went from:

  • 3 months prior: 228
  • 1 month prior: 219
  • 2 weeks prior: 260
  • Final Step 2 CK score: 261

Despite the score variability, I made sure I understood every sentence of each vignette, just as I had for my practice shelf exams.

(To read NBME Self Assessments: Ultimate Guide for the USMLEs and Shelf Exams, click here).

How Yousmle Helped Me to Step 2CK 261

It’s been a year and a half since I first started working with Alec for Step 1 and Step 2 CK. I couldn’t have imagined scoring a 260+ on the USMLE in the beginning days of Step preparation. By sticking with the two-fold approach of building foundational knowledge and mastering interpretation, I not only

  • Performed well on the USMLEs, but also
  • Became a valuable team member actively involved in patient care

The skills I acquired through question interpretation directly applied to clinical situations.

My preparation for the USMLEs was challenging and demanding. Ultimately, however, it was rewarding and fulfilling! Most importantly, I ended up building confidence as a doctor-in-training and thoroughly enjoying third year.



Photo by Piron Guillaume.

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.