The switch to Pass/Fail for Step 1 puts increased pressure on students to perform well on USMLE Step 2CK. Your Step score is a key element of your residency application and serves as a benchmark of your progress thus far in medical school. Although the test is far from the only application component residency programs look at, it is a key metric—one that competitive specialties, like dermatology and plastic surgery, expect to see top marks for.
Med School Insiders blog contributor Austin Johnson, an upper-year medical student at Stanford University, took the time to share his thoughts and experiences after completing the Step 2 CK exam. Here’s what Austin wishes he knew before taking Step 2. He hopes you can take what he’s learned into your own exam, as well as some tips and resources that will help you approach the test.
1 | No Matter How Much You Prepare, There Will Be Curveballs
Don’t expect you’ll walk out of your test floating on cloud nine, even if that’s how you felt after your MCAT or Step 1. The experience you gain from each of your core rotations won’t be enough to prepare you for everything Step 2 throws at you.
This isn’t said to scare you, but to help you understand that no matter how much you prepare, there still may be questions you might not know the answer to. Not knowing the answer to a question or being surprised by one can catch even the most well-trained student off guard.
No matter how prepared you are, there still may, and likely will, be a few questions you aren’t prepared for. You could do the entire UWorld or AMBOSS question bank and still come across questions you are surprised by. Knowing this before you enter your test can help you calm your nerves when you inevitably run into a question you don’t know how to answer.
Take a deep breath, and answer the question to the best of your ability. Trust that you did enough to prepare yourself. You’ll either work through the surprise question to come to the right answer, or it may be one you miss, and that’s okay. You can still receive a stellar Step 2 score having missed a couple of questions.
When you leave the test, even if you were stumped by a question here or there, you can leave it with confidence. Know that you are very far from the only person who was stumped by a question or two.
2 | Step 1 and Step 2 Are Different Beasts
Although Step 1 and Step 2 share some similarities, they are quite different tests.
Based on your studying for Step 1, it’s likely that you either knew or didn’t know the answer to the questions you faced. If you didn’t know the answer, you could then make an educated guess.
On Step 2, the correct answer is often much less clear. You’ll find yourself narrowing the answer down to the better of two options, with less certainty of the right answer. While it does make the test more stimulating and engaging, it also makes it that much harder, and the uncertainty can leave many students feeling uneasy or less confident after the test.
As you work through the test, have confidence in your previous preparation. Take time to read the questions before the vignette so you know what to look for and how to make the best educated guess if you need to.
Another key difference is there are lots of SOAP (Subjective, Objective, Assessment, Plan) notes, and they can slow you down.
For the SOAP notes, instead of being presented with a paragraph vignette that goes over the patient’s symptoms, vitals, physical exam, and test results, you are essentially given a one-page document that comprehensively documents the patient visit in a bulleted format:
- Chief Complaint – “I have abdominal pain”
- Past Medical History
- Family History
- Medications
- Review of Symptoms (extra symptoms beyond abdominal pain)
- Vitals
- Physical Exam
After presenting all of this information, they then ask you any number of questions, from diagnosis to medication management. Overall, this format of presenting information makes it more difficult to skim and complete the question in a reasonable amount of time.
The strategy for these questions is to identify what the question wants before going hunting for information, much like you would do with an MCAT Science/CARS passage.
3 | You’ll Face Plenty of Questions That Require Solid Ethical Judgment
Be prepared to face quite a number of ethical questions aimed at testing your judgment. As you prepare for the test, be sure to brush up on your ethical reasoning and problem-solving skills. This is best done by continually answering practice questions and completing practice tests, and by allowing yourself only so much time per question to come to an answer.
For ethical questions, you won’t necessarily know what the right answer is. Be ready for scenarios that ask you to make quick decisions based on your own judgment.
There will be a gray zone here to wade through, as many questions do not have clear, straightforward answers.
In many ways, some questions are much like the CARS section on the MCAT or Casper. They act like situational judgment tests, where you have to use your previous knowledge, ethical code, and reasoning to reach an answer.
4 | Each Question Is Worth the Same Value
Don’t get caught up on one question that stumps you. Remember that each question is worth the same value, and just because the problem solver in you wants to find the correct or most ideal solution, sometimes it’s in your best interest to move on to the next question.
This is especially important to remember for questions that test your judgment. There isn’t necessarily one right answer to these kinds of questions, so don’t get too hung up on them.
You should also keep this in mind when approaching the question sections that require you to dissect a complex research abstract. You can recognize these sections because they ask 38 questions instead of 40. While the associated questions may not inhabit the same gray zone as those interrogating your medical ethics, they still require a ton of your critical thinking energy and time to come to the correct conclusion.
Moreover, there will undoubtedly be extraneous information included in the abstract, so it is important to read the three associated questions before diving in to give you the right lens to tackle this part of Step 2. Think of it as a throwback to the CARS section of the MCAT; critical thinking must replace flashcard recall.
If you worked hard during your rotations and put in the hours studying, preparing, and taking practice tests, have faith in yourself. Answer the question based on your own ethical code and move onto the next one. You only have so much time to get through the entire test.
5 | You’ll Have to Figure Out How to Get to a Diagnosis
Step 2 CK becomes much more realistic. Just like in the real world, there are multiple ways to get to a diagnosis, but you must balance multiple factors when selecting the diagnostic method.
This includes level of invasiveness (less invasive is usually better for “initial” steps), sensitivity/specificity (a lab test that can be elevated secondary to a ton of conditions would not be helpful in narrowing things down), and, most importantly, where the patient is at in the workup.
With regards to the latter, there is a HUGE difference when being asked the “best initial” or “next best” step in diagnosis compared to “confirming the diagnosis;” confirming often requires skipping down the flowchart/diagnostic tree in your mind and going to the test (whether it be a biopsy, advanced lab test, or imaging) that clinches the diagnosis, often irrespective of cost.
6 | Finding Balance While Studying Is More Important Than Ever
The further you get into medical school, the more important it is to maintain balance and carve out time for wellness. This is because finding this time won’t come naturally. As any upper-year medical student knows, you’re going to be incredibly busy.
Between rotations, exams, extracurriculars, and regular school work, there won’t be much time left over, but it’s absolutely critical for your health, longevity, and future success that you make time to take care of yourself.
Will you be busier than usual as you ramp up your studying for Step 2—absolutely. But remember, you can’t study productively all day long. You need breaks to maintain your focus and efficiency, and it’s what you do with these breaks that counts.
In your downtime between studying or other commitments, don’t turn to negative habits like social media or television. Instead, focus on healthy activities that will leave you feeling rejuvenated, such as exercise, walking, meditation, stretching, and the hobbies you enjoy. You still have a long way to go in your doctor journey—don’t burn yourself out before the finish line.
It’s an Important Test, But Only One Test
You are progressing in medical school and, therefore, the tests and circumstances you have to face are getting more difficult.
Remember that although Step 2 is a very important test, it is only one test.
You’re aiming for perfect effort, not a perfect score. So long as you’ve put in the effort during your rotations and have taken the time to study effectively, have confidence in yourself. This confidence will help on test day, as many questions require you to lean on everything you’ve learned so far along with your own ethical judgment—just like a professional doctor does everyday.
If you miss a question or are surprised by something you didn’t expect, don’t allow that one question to push you off your game. It’s a big test, and getting an answer wrong here or there will not significantly impact your final score. What will negatively impact your results is allowing one question to take up notable time, throw you off your groove, and derail your confidence.
For better or worse, you will get through this test, and you will move onto the next phase of your medical school journey. Even though Step 2 scores have more weight since Step 1 made the change to pass/fail, the test is still just one piece of your larger residency application. The other aspects of your application can help you land an ideal residency placement, even if your Step 2 score isn’t what you hoped for.
Customized Step 2 Tutoring
If you are concerned about your Step 2 score or are having difficulty with practice tests, we can help. Med School Insiders offers premium tutoring for Step 2, in addition to other medical school courses and exams. Our tutors excelled on the test themselves by utilizing the tried-and-true Med School Insiders methodology. That means a customized approach and, ultimately, a significantly better score for you.
Reach out to our team any time to learn more about our services, and follow the Med School Insiders blog for the latest how-to advice, strategies, personal stories, and industry updates. As you progress in medical school, we have comprehensive guides dedicated to helping you conquer each of your clerkships, as well as your residency application.
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