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Guide to USMLE Step 2: Clinical Knowledge

The USMLE Step II CK exam is a test of the clinical knowledge gained during the third year medical College core clerkships. It is similar in format to Step I, but is more clinically oriented, i.e. you are given a patient scenario and asked about the diagnosis or next step. The exam consists of eight blocks, which is one section longer than the seven blocks of Step I. 

Subjects tested include Internal Medicine, Surgery, Pediatrics, Obstetrics and Gynecology, Psychiatry, Neurology, Emergency Medicine, Dermatology, selected surgical sub-specialties and Radiology. There are a few questions that feature audio and/or video clips. More detail on all aspects of the exam is available on the USMLE website. 

The Jefferson AOA Guide to the USMLE Step II CK will answer your Common Questions about the test, will assist you in Planning a Schedule, and will suggest the Right Resources to help you prepare appropriately. Also, please check out the official USMLE Step II website for more information:

Common Questions

How important is the USMLE Step II CK score anyway?

A passing score on the USMLE Step II CK is required for all medical students prior to beginning residency. Although less important than the Step I, a strong Step II CK score can only help your residency application, as programs will see your score regardless of when you take the exam.  Due to the more clinical nature of the exam, most students improve on their prior Step I score.

What is the best time of year for Jefferson students to take the USMLE Step II CK?

Some students prefer to take the test right after third year because they feel well prepared coming off of their final shelf exam.  Additionally, they feel that taking the exam early and scoring well is a great way to strengthen their residency application, especially if they may have been disappointed with their Step I score. There are usually 2 weeks between 3rd and 4th year that students can use to study. If you have internal medicine or family medicine as your last rotation of third year you’ll be in great shape to take Step II soon after the shelf exam but others have still taken it and done well coming off Psychiatry or even the more demanding OB-GYN.

Other students choose to take the exam during the first few months of 4th year or after they submit their residency application. If you decide to take it later, programs can invite you for an interview without a Step II score.  However, you will need to take the exam before they can rank you. Some people recommend taking it later if you are happy with your Step I score, but in the end the decision should come down to the amount of time you need to study.

For those of you who were happy with your Step 1 score and who want to take Step 2 later due to concern about “ruining” a Step 1 score with a potentially poor Step 2 score, keep the following in mind. First, most people do the same or better on Step 2 as they did on Step 1 – trust us, it’s true. Second, your shelf exam scores will give you a good idea of how you might expect to do on Step 2. Third, taking Step 2 in December is not always the best option. You don’t always know what interview season will hold and Step 2 can become a lot more stressful than it needs to be if it’s intertwined with trying to coordinate interviews and traveling.

Resources

One of the best sources for step 2 CK is to study from our medical notes, which are designed professionally to let you study the high yield information, therefore they save your time and let you memorize the important concepts easily. 

Practice Questions

We recommend starting questions about one month before the exam if you’re on an elective, maybe earlier if you plan to get through all of them. Some students only do UWorld questions and fit all of them into a two-week period. Not everyone completes the UWorld either before taking Step II CK. If you are strapped for time it’s not necessary to complete the bank as long as you feel you are improving, but the more practice the better. Check out some online resources below.

USMLEWorld: There are approximately 2000+ questions in the UWorld qbank. Some people will do blocks throughout 3rd year to study for shelf exams and then repeat the questions before taking Step II. Others wait to purchase the Q-bank when they begin studying for Step II. Either way, getting through all of the questions at least once is definitely enough. 

Kaplan Q-bankVery few students use this resource. It is another good yet more expensive option and consists of 2,200 on-line questions; similar to Q-Bank for Step I.

The Bottom Line: The majority of people use USMLE world Q-bank and a supplementary review book (e.g. First Aid or Step-Up to CK).  You shouldn’t need much more than this.

Planning a Schedule

The schedule for Step II CK preparation varies significantly depending on how much time has passed since completion of the clerkships, and whether you are studying during vacation or during a 4th year rotation.  Overall, study time usually ranges from 1-4 weeks with most students taking 2-3 weeks.  Students who take the exam during a vacation will often need less time since they have more time each day to study.  Students who take the exam while on rotation might need to start studying earlier given that they have less free time during the day.

The daily study schedule is constructed similarly to a Step I schedule.  Intersperse question blocks and sections from the review book, making sure you review most/all topics at least once.

Overall, studying for Step II is much less intense than Step I, but be sure to give yourself enough time to get through most/all of your resources.  If you do this, you should be in great shape. If you want more practice you can purchase a practice test along with the qbank. This isn’t entirely necessary since you now know what it’s like to take a day-long test, but if you want it it’s there. 

Good Luck!

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How to Survive Medical School

 

Surviving medical school can be tough, but there are a number of strategies you can use to help keep you on track. This article will describe some of these strategies which will lead you to success in medical school.

 

1

Learn how to be organized.
  • Study materials. You will find it impossible to survive medical school without at least finding a way to keep your notes and books in order. Binders, color coding, and organized folders on your computer are some examples of how to do this.
  • Schedule. Always know where you need to be and when. Keep a schedule with you at all times with your lecture schedule, exams, rotation schedule, meeting times, etc.
  • Study space. If you study at home, make sure you have an area dedicated to studying. Keep this area free from clutter and from distractions (i.e. television)
2

Figure out how you learn best.
  • Use study tools.The value of study tools really comes into play during medical school. Everyone has a different style or different things that work for them, and don't be fooled into thinking that you're doing something wrong if you do it a different way yourself. Have a study system, and stick to it.
  • Consider studying with other people around your study area. This works well for some people and poorly for many others. Having study partners, much like exercise partners, may help you stay on target and avoid quitting early. Also, the company may keep you from feeling isolated and overwhelmed. Others however find that they get overly distracted when they study with others. Experiment and find out for yourself if you find it helpful.
  • If what you're doing isn't working, don't be afraid to try a different method.
3

Create a study schedule.
  • It helps to plan out your work, even as far ahead as several weeks. This way you can avoid getting behind, which can be devastating in medical school.
  • Having a well-organized schedule will also allow you to plan out free time. Try to give yourself a half to a full day off each week. This will keep you focused during the rest of the week and keep you from getting burnt out.
  • Never cram. If you keep to your schedule, this won't be an issu4
    Prepare for the boards and for the application process.
    • Board exams. Sign up well in advance for the boards, as you will find that testing dates become very limited if you wait until a month or two prior to your preferred dates.
    • Residency application/interviews. This is something you need to stay vigilant about. Know the application schedule well, and be ready to submit your application as soon as possible. When you start getting invitations to interviews, respond immediately or you will find it very difficult to plan out your interview season.
    5

    Be professional.
    • Be on time. Part of surviving medical school is learning how to be professional, and being on time is a key aspect of this.
    • Dress professionally. No exceptions.
    • Treat everyone with respect. This not only goes for your professors and acquaintances , but your classmates as well. It's much more to your benefit to be a team player than it is to disregard others.
    6

    Ask for guidance.
    • Your professors and Deans of Student Affairs and Academic Support are immensely valuable resources that you should take advantage of if you feel you are struggling.
    • Look to your seniors. Talking to those a year or two ahead of you can be very helpful since they were recently experiencing the same thing.
    • Find a mentor. Many schools assign faculty mentors to you, but if not, consider contacting a faculty member that you know or someone in your field of interest to meet with you.
    • Find a tutor. Most schools offer tutoring of some sort, and tutors can meet you at any level. Tutoring also doesn't mean that you are a poor student, because even the best students can benefit from having someone go through material with them at their own pace
    7

    Keep your body healthy.
    • Medical school is in some ways as taxing on your body as it is on your mind. It may be difficult, but it's worth it to take the extra time to make a healthy meal or spend a few minutes in the gym or on walk.
    • Allow yourself time to relax. Know that it's OK to spend time with your friends and family, because medical school survival also involves taking the time to socialize when it's appropriate.
    • Get enough sleep. Whether for you that means 5 hours or 10, it's essential to get regular, restful sleep.
    8

    Recognize the difference between stress and depression. Stress is a common and often necessary part of not only medical school but of life in general. However when stress begins to affect your quality of sleep, your eating habits, or your ability to function in general, stress is no longer a motivating factor but rather it is holding you back. Seek out support in your family, friends at school, old friends, and upper-level students if you begin to feel down or depressed.
     
     
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15 Quick Tips to Prepare for the USMLE Step 1

The USMLE Step 1 tests knowledge that's gained over about 3 years of full-time medical study and some background material from undergraduate learning. That’s a LOT of information. 

For those preparing (or re-preparing) for this test, the amount of material to cover is daunting. What if you’ve been out of school for a few years and/or are preparing to take the exam again after a lengthy absence? 

Here are some quick guidelines for how to prepare:

1. Know Yourself

How much of the material have you retained since your last exposure? 50%? 20%? 

An easy way to find out where you stand today is to do two mixed blocks of questions in UWorld and average your score for the two blocks. Once you know how much you have to re-learn you will be able to plan a realistic schedule.

2. Know Your Lifestyle

How much time do you have each day to devote to study? If you're serious about your Step, in an ideal world you'd be able to solely focus on preparing for said exam. 

If you're working full time and will only be able to squeeze in an hour or two of study each day, it's going to take quite some time to be fully prepared, and the longer your studies drag out, the harder an uphill battle you'll fight with retention and burnout.

If your schedule doesn’t permit a review course then independent study is the best approach, but you must be consistent. Anything less than your best effort will not do.

3. Ready for a Review Course?

Take a look at a review course's schedule and material, specifically the lecture notes. Is everything familiar? How long would it take you to review the notes for one week of class? (Time yourself reviewing a typical set of notes for a day’s schedule within the course.) Are you able to keep up this kind of schedule and stay ahead of the course? If not, you may need to adjust the other demands in your life to be able to do so (see #7).

4. Preparation is Key

If you choose a review course, make sure you prepare at least the first two weeks of material before the course begins. You want to be in a position over the first two weeks of SOLIDIFYING knowledge rather than learning it from scratch in the course. And again, as I said above, you want to consistently stay ahead of the course.

5. Schedule Your Time 

If you are taking a course, one of the ways to stay ahead is to be sure to schedule time to prepare for upcoming lectures and to review the past ones. Another easy tool for success is to re-read your lecture notes right before and right after a lecture.

6. Keep Materials Simple and Few

First Aid, BRS Physiology, and the UWorld question bank are more than enough for your initial run-through. 

Just like getting into shape, you can't just join a gym and have the pounds melt away. You have to show up, put in the effort, build muscie and sweat it out. The same thing applies to the USMLEs.

7. Make Room in Your Schedule

Make a schedule that takes into account how much you have to learn and your expected rate of progress. For example, a very general rule of thumb is that a page of the First Aid could take an hour of study. 

And as I mentioned before, the more seriously you take this exam, and the more you're able to make it your sole focus, the better and swifter results you'll see.

8. Use First Aid as your Study Strategy

Use a systems-based approach to learning. Work through organ systems, i.e. cardiology, using First Aid as a checklist. And remember: First Aid is meant to be a high-yield skeleton upon which you build your studies. It is not the end-all be-all encyclopedia for every single detail you'll need to know for your exam. Knowing this, and following these tips can help you maximize the Step 1 "Bible."

9. Use Your Tutor Wisely

If you're working 1-on-1 with a tutor, save high yield questions that you do not understand for your sessions. Email your tutor the night before with some of your questions for the next day. 

We may know what you need to cover to be fully prepared for test day, but we cannot read your mind. Help us help you and always be honest with us. If anxiety's getting the better of you, or you really want to skip ahead to something, tell us, and we'll be able to either adjust accordingly or bring more perspective to the approach.

10. Celebrate Small Victories

If you finally understand the ventricular volume and pressure loops after two hours of study you have done well! Congratulate yourself! The same thing goes with harder-earned victories. If you've been beating your head against a wall trying to master a difficult concept, and things finally click, celebrate! 

You're essentially running a marathon, so it's important to celebrate the little victories to keep yourself energized and to keep going,

11. Be Realistic

Most students require several months to learn the material. If you’ve been away from the material or have limited time to study each day it will obviously take longer — possibly in the range of 6-12 months or more. 

Be patient with and kind to yourself throughout the process. Remember that you're not studying to take a driver's test; it's a beast of a medical licensing exam, and like any mountain worth climbing, persistence and determination are needed to persevere. After all, the harder the struggle, the more glorious the triumph.

12. Accept the Multiple Pass Approach

You will not learn everything the first pass through. Period. The sooner you accept this, the better off you'll be.

Instead of aiming for unachievable perfection on your first pass, try to focus on high yield material and make notes sparingly. You will have to review this material at least 4 times so don’t let your first pass through First Aid or UWorld take months.

13. One Foot in Front of the Other

Learn something every day. Even if it is something small. Don’t lose momentum. Keep at it. You can do it.

14. Adjust Your Schedule Every 6 Weeks to Address Areas of Weakness

As you make your way through your studies, you will uncover areas of weakness that you may or may not have expected to be there. Don't shy away from the tough spots.Lean into the challenge. The more you embrace the harder areas head on, the more empowered you'll feel as you chip away at them and slowly but surely gain mastery.

15. Stay Positive

This is a difficult process. Allow for failure. When you stumble, pick yourself up, dust yourself off, and try again! 
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