NBME 168 to Step 2CK 261: My 3rd Year Game PlanCHECK IT OUT
NBME 168 to Step 2CK 261: My 3rd Year Game Plan


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

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by Alec in Plan

How much does your approach hold you back? Most of us never find out, since we are too busy burying ourselves in textbooks and recorded lectures until the point of exhaustion. In this article, Minills describes exactly how much her approach had been holding her back, and the remarkable results she achieved when she changed it – including 95%ile on multiple shelf exams and a 261 on Step 2 CK.

Med School Highlights:

Before Yousmle, I was a mediocre student. I scored average or above average on my MS1/MS2 exams. The first NBME I took a week before my Step 1 dedicated study, I scored a 168 and went into panic mode. I knew I needed more help. I reached out to Alec and started Yousmle. In 2 months, I increased my score by 60 points and ended with 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 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 exceptional student? Keep reading to find out.

My Third Year Game Plan

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. We no longer have the luxury of waking up late and watching recorded lectures online. We pre-round (sometimes at 4:30 in the morning) and are expected to show up to work on time and know our patients well. We’re finally practicing to be a doctor out in the real world.

The week before I started third year, I was filled with dread. I was overwhelmed by the thought of clinical evaluations, shelf exams and the USMLE Step 2 CK.

A Two-Fold Approach

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

“How can I succeed on the board exams and the wards?”

He shared a two-fold approach: build foundational knowledge and master question interpretation. This approach was deceptively simple, but provided me with the exact framework I followed to “exceptional.”

Building a Strong Foundation: Mastery of 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 deliberately mastering new material, and never forgetting it by using spaced repetition/Anki.

I was methodical in how I mastered new material. I continued with the Yousmle.com Step 1 and Pharmacology Anki cards, and added the Yousmle.com Step 2 cards.  I made new cards from practice questions, discussions during rounds, and management plans my team came up with; my goal was to master any unfamiliar concept that came up.  By putting that information into Anki cards, I set myself up to never forget it.

This final point is crucial: with so much new clinical information, I quickly realized the importance of doing my Anki cards daily, to retain what I had already mastered. As Alec reminded me, it is better to never forget something than to re-learn it.

To accomplish this, Alec recommended trying to finish my cards before I went home every day. This was easier during inpatient rotations, when the workload was heavily geared towards the morning, and allowed me to focus my evenings on mastering new material and question interpretation (more on this later). Every day I built a stronger foundation by mastering new material while never forgetting the old.

Throughout the year, several attendings and residents commented on my strong knowledge base and active learner mentality. In actuality, I wasn’t spending as much time reading new material, as I was recalling information I already learned. Going through Anki cards every day helped me answer random pimp questions, perform well on exams, and build professional confidence by being able to recall medical information necessary for patient care. In addition, it also provided the foundation for the key to my Step 2/shelf success: question interpretation.

Mastering Question Interpretation

Mastering question interpretation was the most important factor to my clerkship and Step 2 success – moving beyond “buzz words” to understand the purpose of each sentence in a clinical vignette. To do this, much of my time and energy third year was spent interpreting questions and understanding pathophysiology.

There are a ton of resources for questions, and each shelf exam has specific resources better suited for it than others. UWorld is the standard QBank, and I tried to complete about 10 UW 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.

It wasn’t the number of UW questions per day I was doing that ultimately led me to a 260+ Step 2 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 exams for each shelf). After I completed an NBME, I would go over wrong answers line-by-line, contextualizing each sentence in the overall clinical picture. I would then write down a pathophysiologic mechanism that could explain the symptoms and presentation in the vignette. In addition, I would create a “stand-alone question,” which is a question that can be answered by itself without knowing the full vignette or question stem. For example, the stand-alone question for “What is the next step in management?” could be “What is the next step in management for a man with symptomatic BPH who presents with acute urinary retention and renal failure?” 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.” 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.

At my school, I had the option to schedule shelf exams in the order that I wanted. This is rare, but if you have the opportunity, or if you can decide the order of your clerkships, here’s my recommendation: Pair the shelf exams that have content overlap.

For example, I ended up scheduling the internal medicine and surgery shelf exams one week apart. I did the same thing for neurology/psychiatry and pediatrics/OB. I left family medicine for the end, as it had content spread across all the shelf exams. I intentionally took the internal medicine exam first because it covered the most material, had the most number of UW questions, and helped me establish a broad base of knowledge early on.

Regardless of how your shelf exams are scheduled, you have the ability to perform well by diligently improving interpretation. This means doing a few questions every day and writing out the interpretation for questions you missed to identify weaknesses and high-yield material that needs more review. I would also try to go to at least one of the many Yousmle question interpretation (QI) sessions each month, included in Yousmle Group Tutoring. These sessions were invaluable in building my own interpretation skills, as I could reinforce strategies and provide/receive feedback from other students.

From Shelf to Step 2 CK Prep

By aligning short term goals (i.e. shelf scores) with long-term goals (performing well on Step 2 CK), I was able to track my progress over time and prioritize review topics during my dedicated study period. I ended up honoring my shelf exams for IM (88%), Peds (89%), Family Med (84%), Neurology (90%), and Psychiatry (85%). Thus, during my dedicated study period, I needed to prioritize Surgery (76%) and Ob/Gyn (74%).

I only spent 3 weeks studying for Step 2 CK, and felt that was plenty.

There are 3 NBMEs for Step 2 CK, and 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 NBMEs aren’t necessarily predictive of your final results; my trajectory went from 228 to 219 to 260. Despite the score variability, I made sure I understood every sentence of each vignette, just as I had for my practice shelf exams.

I had completed UW before my dedicated study period, and recycling questions that I already knew felt unproductive. I got the Kaplan QBank and completed 40-80 questions/day for interpretation practice. For content, I focused on understanding surgery and Ob/Gyn topics, my weaknesses identified by my lower shelf scores. I referred to Christian de Virgilio’s Surgery: A Case Based Clinical Reviewand the UWise APGO Question Bank provided by my school for Ob/Gyn. I also went through my NBME shelf exams for Ob/Gyn and Surgery and made sure I fully comprehended the questions I missed the first time I took them. When I received my score report back, Surgery and Ob/Gyn were my two best areas.

The Yousmle Edge  

It’s been a year and a half since I first started working with Alec for Step 1 and Step 2. 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, but ultimately rewarding and fulfilling! Most importantly, I ended up building confidence as a doctor-in-training and thoroughly enjoying third year.



Score higher on ANY med school exam

With the FREE 50+ page eBook, "The Busy Med Student's Guide to Score Higher on Any Exam," learn the secret to scoring so high that everyone will be begging you to be study partners — even if your version of photographic memory says, “Error: file not found”