A Study of Step 2

USMLE Step 2

A Study of Step 2

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:

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.


Crush Step IIFirst Aid for the USMLE Step II CKand Step-up to USMLE Step 2 provide a broad overview of topics. Most would agree that First Aid for Step II CK is much less useful than its younger sibling was for Step I, particularly with regards to surgery topics. Most don’t go back to the First Aid series for Step II.

 Crush Step II, however, is a frequently used resource for Step II CK preparation, and is favored by those that prefer a text-based approach to test preparation. Step-up to USMLE Step 2 is organized well (ie.

H/P, labs, Radiology, Treatment, complications subtitles for each disease entity) and it has a section on ER, critical care and surgery which was weak in other texts. 

DO NOT read lengthy subject-specific books. Reading individual subject-specific Blueprints or Recall books is not needed.

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-bank: Very 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 to take a day-long test, but if you want it it’s there.


Good Luck!

Источник: https://www.jefferson.edu/academics/colleges-schools-institutes/skmc/student-resources/alpha-omega-alpha/guides/usmle-step-2.html

USMLE Step 2 Guide

A Study of Step 2

About the Test

Step 2 CK will test not only your general medical knowledge and ability to diagnose but also next steps in management of patients (next lab or imaging test, best therapy, etc.).

The test is 9 hours and comprised of 8 different 60 minute blocks, with up to 40 questions per block.

In general, studying for Step 2 CK takes less prep time than Step 1 with less focus on the nitty-gritty details that you had to know for Step 1.

Study Materials

  • UWorld (a must): Go through UWorld throughout third year as you are doing your clerkships and studying for your shelf exams. It is great already having completed the Qbank at least one time by the time you start studying for Step 2. I recommend going through the Qbank at least another complete pass during your dedicated Step 2 studying time. Just for Step 1, the Qbank is very comprehensive and you learn a lot by going through the answers to questions.
  • First Aid for the USMLE Step 2 CK (optional): I used this resource. Overall, it is easy to read just First Aid for Step 1; however, un First Aid for Step 1 it is very superficial and is not in any way comprehensive for what you need to know for the test. Don’t use this as your only resource, but it is a good supplement with overall highlights of things you need to know. The rapid review in the back I found very helpful just for Step 1.
  • USMLE Step 2 Secrets (optional): I had friends who d this book and thought it was a nice supplement to use in addition to or in place of First Aid for Step 2 CK.
  • Master the Boards Step 2 CK (optional): Another resource that students found helpful to use instead of First Aid or Step 2 Secrets.
  • NBME Practice tests (optional): I only took one NBME practice test at the beginning of my studying so that I could get a sense of what my baseline score was. Others found it very helpful to take additional practice tests to gauge their progress, but I focused instead on the Qbank, since the NBME tests don’t have answers included.

Prep Time

Deciding whether to take a dedicated month to study vs. taking a very light rotation during Step 2 studying is totally up to you and you knowing how you study best.

I took a month off to study and studied intensely for 3 weeks for CK and then took CS the following week.

Other classmates took easier rotations (tox, path) and studied during those electives and also felt they had plenty of time.

Scheduling Your Test

Schedule your test early! You will be happy to be done with it. Most students recommend taking the test in July or August.

Also, if you did not do as well on Step 1 as you had hoped, Step 2 is a great way to show you’re a good test taker (because in general most students do much better on Step 2) so make sure to study hard and take the test early enough so that your scores are released by the day residency applications are due.

Other Advice

Studying hard for shelf exams throughout third year definitely helps prepare you for CK, so you are more prepared at baseline than you think! The test is long and just a shelf exam time you often feel pressed for time to complete each section.

Do as many practice questions (I used Uworld) as you can and try to work on managing your time so that you don’t feel rushed on your test day. Just for Step 1, you will have breaks during your test so bring snacks and warm clothes (the test center is freezing!).

Most people do better than they think so study hard and good luck!

Neeta Malviya, Class of 2017

About the Test

Step 2 CK is a 9-hour exam taken at the beginning of the fourth year of medical school after completing the core clerkships. The test essentially feels a really long shelf exam, but the style of questions is very similar since the NBME writes all of these exams.

The majority of people do much better on Step 2 than on Step 1 even with less studying. This test focuses more on the next step in a patient presentation. Questions such as which lab or test to order next. There will also be plenty of diagnosis questions as well.

Overall the test seems to be less memorization heavy than Step 1 given that there is none of the nitty gritty biochemistry, pathway, or mechanism questions.

Study Materials

UWorld (a must): You will be using UWorld throughout the year to prepare for your individual clerkship shelf examinations. While studying for Step 2CK you can reset the QBank for free and redo all of the questions from the year. Again, you should focus on understanding the explanations and really reading through all of them well. The exam is very similar to UWorld.

First Aid for the USMLE Step 2 CK (optional): I did not personally use this resource but I know several people who did. The general consensus was that it was definitely not as good as First Aid for Step 1 and was lacking in organization. You can use this as a reference for individual topics that you feel that you are weak in your performance on UWorld.

Master the Boards Step 2 CK (optional): I d having a book to read through for the exam and this was the one that I ended up picking. I felt that it highlighted in bullet points some important concepts for the exam. Beware that certain aspects of this book are outdated in regards to guidelines and recommendations.

NBME Practice tests (optional): I found the practice tests helpful because it let me know where I was standing in regards to my score and if I was in the range I was aiming for on the real test. While these tests do not provide you with answers they do provide you with the questions that you missed and you can go back and read about it on your own to figure out the answer.

Individual Shelf Prep Books (optional): I had accumulated these books throughout MS3 from studying for shelves and only pulled them out if wanted to review a very specific topic that I felt that I maybe had forgotten.

Peds was my first clerkship so I felt very rusty on those questions, which is why I brushed up a little bit on some of the chapters from my peds shelf books.

Otherwise, you really do not to be reading entire shelf prep books.

Prep Time

Depending on your own pace and preferences, you can choose to take a dedicated month to study for CK or you can study while concurrently on a lighter elective month.

Plenty of people have chosen either route and have done well.

Step 2 does not require the same degree of intensive studying as Step 1 did as you will have already completed a year long of shelf exams and studying for those will have you pretty prepared for CK.

Scheduling Your Test

Schedule your test as early as you are able to so that you have the most dates to choose from and can take it in your desired testing center. The school now requires Step 2 CK to be taken by the last week of September due to certain residency programs wanting to see the score prior to granting interviews.

Plan accordingly because it is during this time frame that you will be completing your Sub-I, away rotations, and residency applications. Taking it sooner rather than later is definitely sound advice so that you still have MS3 fresh in your head and you can get CK the way before you have to worry about residency applications and away rotations.

I ended up having to take CK in the middle of an away rotation, which was not fun, so take it as early as possible!

Other Advice

Step 2CK really tests your endurance more than anything else. You know your stuff from studying throughout the year, so make sure you do your best to prepare to take an exhausting 9 hour exam. Bring plenty of food, snacks, and ibuprofen/acetaminophen just in case.

Be careful of your caffeine intake if it has you running to the restroom too often during the exam. I took a simulated full length test by doing 8 blocks together under the same timing and break conditions as the real test in order to plan out my breaks.

Resist the urge to rush through the last block because you are tired. I took a longer break before the last block and stretched to wake myself up. I ended up taking multiple small breaks between many of the sections because this is what worked best for me.

Figure out how you are best able to fight exam fatigue and use those strategies on test day.


Caroline Smith, Class of 2017

About the Test

You have 12 patient encounters with standardized patients and potentially a telephone encounter. You have 15 minutes to interview each patient and 10 minutes to write each patient note. The test is only held at a few places around the country (most UTSW students pick Houston but any site is fine). The test is graded as pass/fail.

Study Materials

  • First Aid for the USMLE Step 2 CS (recommended): I went through the entire book one time and the mini cases twice and found the book very helpful. I also recommend going through the cases with friends or family to simulate patient encounters. Pay attention to what details the book writes in their sample notes so that you can write quick/pertinent notes on exam day.
  • Website (recommended): http://www.usmle.org/step-2-cs/#overview Take a look at the CS website the day before the test. If you tend to write a lot, the only problem you may have on exam day is running words. Practicing the day before the test on the online template (link below) will allow you to gauge how much space you will have on exam day. http://www.usmle.org/practice-materials/step-2-cs/patient-note-practice2.html

Prep Time

Most people study anywhere from a day to a week for this exam.

While for most the exam doesn’t require much prep time, don’t blow off the test because you don’t want to fail! Your COSCE is a good metric for you to determine how much time you need to prepare.

If you were close to failing the COSCE, definitely take a more time to study. I would say you need less prep time if you take CS in close proximity to CK because you already have the knowledge base from studying for CK.

Scheduling Your Test

Schedule the test as early as you can. Most people recommend July, August or September. You’ll be happy if you get it done early. I recommend taking CS close to when you take CK so that you are fresh on possible diagnoses from CK studying. I took my CS the week after I took CK.

Other Advice

Be friendly/empathetic during every patient encounter. Always wash your hands (or foam in). Be thorough in your patient encounter because there are checklists the standardized patients evaluate you on.

In your note, always include all elements of the Subjective/History (HPI, review of systems, Past medical history, Surgical History, Social History, Medications, Allergies). Be careful with abbreviations as there are only certain sanctioned abbreviations.

If you have one bad encounter, don’t get bogged down just keep moving since you have plenty of others to make up for it!

Источник: https://www.utsouthwestern.edu/education/students/student-orgs/aoa/guides/usmle-step-2.html

Step 2 CK and CS Tips from Upperclassmen

A Study of Step 2

IU School of Medicine Sep 04, 2018

Check out these tips from IU School of Medicine upperclassmen and recent alumni.

June 2019 Tips

Step 2 CK tip

  • “I felt I’d been studying for step 2 my entire third year by taking every clerkship exam seriously and doing the USMLE Q bank questions during each respective clerkship. By the time I got to a month and a half before the exam I was just reviewing problem areas rather than relearning information. I also don’t think it’s necessary to waste a vacation on studying. I just took a lighter elective in July of my fourth year so I would have the weekends off. My number one piece of advice would be to take it early in your fourth year. You will never know more than you do right now.

Step 2 CS Tip

  • “Active listening: The standardized patients will only know that you listened to them if you paraphrase what you told them. I paraphrased each time before the end of the encounter. wise, it is important to ask if the patient has any more questions—I did this at the end of each encounter. 5 minutes at a minimum need to be budgeted for counseling/closure/questions.”

May 2019 Tips

Step 2 CK tips

  • “Studying hard during clerkships for the clerkship exam is actually pretty good prep for step 2. The more studying you do during the clerkships, the less dedicated studying for step 2 you will have to do. It’s always better for board studying to be review rather than learning new material.”
  • Want more advice on preparing for Step 2 CK? Check out the Step 2 Survey results on Canvas.

Step 2 CS tips

  • “Create a history-taking flow chart for each common presentation (dysuria, chest pain, etc.) with the most relevant questions; pertinent questions can be found in a number of history taking books such as Symptom to Diagnosis or First Aid for the CS.”
  • Want more advice on preparing for Step 2 CS? Check out the Step 2 CS Advice page on Canvas.

April 2019 Tips

Step 2 CK tips

  • “ how much time you have to study, design a study strategy early on and stick to it, including your time away from studying.  For example, if you have a month to study, plan on doing about 100 questions with thorough review daily with a few practice tests throughout. With the short amount of time most of us have to study compared to the breadth of knowledge we need to know, it’s easy to get overwhelmed, but making a study plan and sticking to it eases some of the worrying.”
  • “When completing Qbank questions, mix all of the questions on timed mode. Although it is daunting at first, it helps you transition between OBGYN and medicine quickly, just the real test. You will constantly be reviewing material throughout your study period, so you won’t feel you learned cardiology at the beginning, and now can’t remember which murmurs get louder with specific maneuvers.”

Step 2 CS tips

March 2019 Tips

Step 2 CK tip 

  • “Take snacks. Take two blocks, 12 minute break, two blocks, break, two blocks, break, two blocks, etc. do not ‘power through.’ Do the bank questions. Write notes on questions that are wrong then teach the concept to someone or your dog :)“

Step 2 CS tip

January 2019 Tips

Step 2 CK tip

  • “My biggest advice for preparing for the exam is to do USMLE qbank and carefully read over the answers. I also did three NBME practices tests and 1 USMLE, along with the practice test the school gave. I read Master the Boards but on a much more casual study basis.”

Step 2 CS tip

A student who failed CS the first time and passed the second time compared their approach to open-ended questions for both exams.

  • “I recommend using open-ended questions.”
  • Round 1 (failed the exam)
    • “I greeted the patient and ask how their headache was. They said it hurts all of the time, and I jump straight to OPQQRST having to pull every detail out individually. This happened every encounter, felt I was pulling teeth to get a complete history.”
  • Round 2 (passed the exam)
    • “I ask the headache was, got the same response about it hurting. However, this time I followed up with “can you tell me more about that.” This phrase began to seem a secret code word. Every patient would then open up and give a detailed description of their complaint. To maximize CIS scoring, maintain eye contact and don’t interrupt patients. Always use basic language, no medical jargon just because they’re a standardized patient.”

View Step 2 CS scheduling availability.

December 2018 Tips

Step 2 CK tip

  • “USMLE Qbank is clutch. Read every answer right or wrong. Study for each clerkship during third year and review everything from clerkships for step 2. Try to do some sort of systematic review before the test with some book to frame your memory.” -Upperclassman student

Step 2 CS tips

  • “Coming up with a good set of pertinent differentials; the key is to support each one with as many pertinent findings; pertinent negatives are overlooked and can play a big role–such as being afebrile and so can acuity and chronicity-these can be applied almost to any case.” -Upperclassman student

November 2018 Tips

Step 2 CK tip

  • “Complete as many practice questions on UWorld Qbank as possible. This is the single most helpful tool I found when studying. I completed the question bank once during third year by completing the questions relevant to that clerkship, and then reset the Qbank and went through it a second time prior to taking Step 2 CK.” -Upperclassman student

Step 2 CS tips

  • USMLE provides a practice note on their website. Check it out!

October 2018 Tips

Step 2 CK Tip

  • I think more so than Step 1, Step 2 CK is an exam where itsreallyadvantageoustolearnyourweakareasearlyandfocusonthese. I used a lot of review books but didn’t really read through them all–I would take useful tables/figures or questions about things I have never been great at ( pretty much all of OB/GYN, for example) and put them in my “topics I need to know better” notes.  Otherwise, Step 1, the questions from UWorld will probably be the most useful to you so rely on those and supplement your weaker topics with review books.

Step 2 CS Tips

  • Practiceactivelisteningskills the standardized patients will only know that you listened to them if you paraphrase what you told them-I paraphrased each time before the end of the encounter. You can practice these skills during third year.
  • Schedule your exam as soon as possible! Spots fill up fast! As of August 22, 2018, there was no availability until January 2019, and only 68 percent of spots were still available in January!

September 2018 Tips

Step 2 CK Tips

  1. I felt I’d been studying for Step 2 my entire third year by taking every clerkship exam seriously and doing the USMLE Q bank questions during each respective clerkship. By the time I got to a month and a half before the exam I was just reviewing problem areas rather than relearning information. I also don’t think it’s necessary to waste a vacation on studying. I just took a lighter elective in July of my fourth year so I would have the weekends off. My number one piece of advice would be to take it early in your fourth year. You will never know more than you do right now.
  2. Studying hard during clerkships for the clerkship exam is actually pretty good prep for Step 2. The more studying you do during the clerkships, the less dedicated studying for Step 2 you will have to do. It’s always better for board studying to be review rather than learning new material.
  3. Medicine clerkship is the most important clerkship in regards to doing well on Step 2 and studying and doing well on the shelf is what helped me the most with doing well on Step 2.

Step 2 CS Tips

Coming up with a good set of pertinent differentials; the key is to support each one with as many pertinent findings; pertinent negatives are overlooked and can play a big role–such as being afebrile and so can acuity and chronicity-these can be applied almost to any case.

The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.


With more than 60 academic departments and specialty divisions across nine campuses and strong clinical partnerships with Indiana’s most advanced hospitals and physician networks, Indiana University School of Medicine is continuously advancing its mission to prepare healers and transform health in Indiana and throughout the world.

Источник: https://medicine.iu.edu/blogs/md-student-news/step-2-ck-and-cs-tips-from-upperclassmen

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