The Step 2 Survival Guide
HIGH-YIELD STUDY PLAN – Summary: 1 – View Step 2 High Yield as primer for each rotation. Follow along in Master the Boards Step 2 CK
taking notes. Do 15 Qbank questions a week. 2 – Start studying for Step 2 CK six weeks before test day. View High Yield again. again. Do 46 Qbank
questions a day. Plan on… o
Internal Medicine: 14 days
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Surgery: 4 days
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Pediatrics: 4 days
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Psychiatry: 4 days
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Ob/Gyn: 4 days
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Dermatology, Ophthalmology: 1 day
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Radiology, Preventive: 1 day
question blocks per per day. 3 – In the final week, review Master the Boards again. Do two 46 question
Phase 1: Pre-Preparation: Pre-Preparation: •
Obtain Master the Boards Step 2 CK. Many students find it useful to take the book to a print shop to have the binding removed and put it in a binder. Use this as the core of your High-Yield studies.
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Add notes to margins and watch out for high yield, helpful notes from class to insert. insert. The goal is to end up with one resource to study from.
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Proper planning minimizes stress and maximizes performance. performance. Create a daily study schedule. At a minimum include 3 quick, healthy meals, a 30-minute walk, 2 hours of non-study, and 8 hours of sleep. Take one day off studying each w eek.
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Ensure that your plan includes Qbank, High Yield lectures, and a reviewing Master the Boards Step 2 CK. Lectures are particularly helpful helpful because they they provide forward momentum when your energy is low after being on the wards.
Phase 2: Preparation For Rotations Step 2 High Yield •
Use the Step 2 High Yield lectures lectures as a primer for your rotations. rotations. Plan to cover the relevant section before each rotation starts to ensure that you make a good first impression and that you have the framework in place to get the most out of each rotation.
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As well as helping with your rotations, this will e nsure that that you have completed the c ourse once before your Step 2 CK preparation starts in in earnest. Repeating content with a delay between views – spaced repetition – is key to effective retention.
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Starting to study with your resources early ensures that you will be comfortable with them before you start your intense pre paration.
Qbank •
Begin doing ~15 USMLE questions per week that align with your rotations. Understanding the way the USMLE tests material early will help you identify test-relevant material from class that you should be adding to your High-Yield Folder.
Phase 3: 6 weeks until test High Yield •
Complete High Yield – 2 hrs 30 minutes of lecture per day ( x1 speed).
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Cover your weakest sections first. Use any remaining time to repeat these sections at the end.
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Plan on…
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o
Internal Medicine: 12 days
o
Surgery: 4 days
o
Pediatrics: 4 days
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Psychiatry: 4 days
o
Ob/Gyn: 4 days
o
Dermatology, Ophthalmology: 1 day
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Radiology, Preventive: 1 day
Follow along in your Master the Boards Step 2 CK Book taking notes – put a check next to each Master the Boards heading you feel confident in. Try not to let anything pass you by without
understanding it fully. Put an X next to headings you need to review again. •
At the end of each week, set aside time to review your notes from the previous week
Qbank •
Do a 46 question Qbank block each day covering the lectures you reviewed the day before. Again – this gives you the benefit of spaced repetition.
Exam Simulation •
At the start of this phase, establish a baseline with an NBME self assessment form. Most students find these fairly reflective of the test and a reasonable predictor of performance. However, use all score estimates to reduce stress and not as a reason to stop studying. Don’t worry if you do badly. Seeing that you need to raise your score lends urgency to your study.
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2 weeks before test day, take a full length simulated exam. You cannot expect to have the stamina for an 9-hour test unless you do a full length simulation.
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On test day, students sitting for other , shorter tests come and go throughout the day. Consider taking your practice tests in a public place like a library or coffee shop so you can practice shutting out distractions.
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Studying outside the home can also help to stop you feeling like you are “Missing Life”.
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Other notes •
Download the NBME test software, work through some questions and take the tutorial. This will give you the confidence to click through the tutorial on test day and add that time to your break. The only part of the tutorial that you should complete on test day is testing your headphones.
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Schedule an activity you enjoy immediately after the test to reward your hard work. Let your family and friends know that you will need to focus on Step 2 until test day.
Phase 4: Final Week •
Don’t study any new material in the last week.
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Go over your High-Yield Folder completing equal portions each day. You will now have repeated the content 3 times.
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Create a separate cheat sheet by writing out anything you haven’t mastered.
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Start doing two 46 question mixed topic blocks per day.
Other Notes •
Check the USMLE website for late-breaking announcements.
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Make sure you know your route to the testing center.
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Plan out how you want to distribute you break time on test day.
Phase 5: Final Day •
Your goal today is to ensure that you are well rested and relaxed for test day.
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Some students take the day off. Some students find a day off more stressful than studying. If you must study, limit yourself to 5 hours and focus on reviewing your cheat sheet. Absolutely no study of new material.
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Keep the same sleep schedule/meal schedule you have been using up until this point.
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Avoid talking to others who have taken the exam about the test. It will just stress you out.
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Make preparations for test day. Buy snacks, drinks, and make yourself lunch.
Phase 6: Test Day •
We don’t recommend any review on the morning of the test.
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Bring snacks, water, and simple lunch.
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Wear layers so you can adjust for temperature.
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You can’t bring anything into the exam room except your ID. No watches or hats. Headphones will be provided.
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High-Yield Syllabus The average lecture length in High Yield is 20 minutes. Here are the durations and numbers of lectures in each section of Step 2 High Yield. # of lectures
Duration of section (hr:min)
Duration at x1.5 speed (hr:min)
10
3:28
2:18
1
0:27
0:18
10
5:16
3:31
Endocrinology
5
2:17
1:31
Pulmonology
9
2:59
1:59
Rheumatology
8
1:36
1:04
Hematology
9
2:49
1:53
Gastroenterology
4
1:42
1:08
Neurology
8
2:42
1:48
Nephrology
8
3:48
2:32
Oncology
1
0:55
0:37
Preventive Medicine
4
2:13
1:29
Dermatology
2
0:59
0:39
Surgery
6
3:04
2:03
Pediatrics
9
3:48
2:32
15
3:12
2:08
Radiology
3
1:03
0:42
Ophthalmology
1
0:21
0:14
Psychiatry
7
2:31
1:41
Emergency Medicine
4
1:09
0:46
Ethics
3
0:46
0:30
Section
Infectious Diseases Allergy & Immunology Cardiology
Obstetrics & Gynecology
Question Practice: •
You are not going to know every question on test day. Practice picking the most plausible choice, marking the question, and returning if time allows.
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Questions that you perceive as unfair/obscure can t hrow your performance on subsequent questions. Practice calmly moving on.
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The test includes a few experimental questions that do not count towards your score, however assume that even the most bizarre question counts.
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Don’t expect any test-wise clues on the test (e.g. correct answers more precisely defined than distracters). Buzzwords still appear occasionally but don’t count on them. 4
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You should start using the timed test mode as soon as possible during your preparation – the length of vignettes on step 2 makes time keeping particularly important for Step 2.
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While preparing, experiment to see whether reading the answer choices first when you hit a long vignette allows you to answer more quickly.
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Most students take more care and go slower in the actual test. Aim to finish practice blocks with at least 2-3 minutes to spare in order to compensate for this.
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Bear in mind that you will answer re-used questions more quickly and score higher in them.
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Do not waste time checking the timer. Check your timer at the half way point and then with 10 questions to go to ensure you have a chance to answer all questions.
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You will be provided with a white board for note -taking – keep scrap paper handy when using Qbank to determine how you will want to use this resource on test day.
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Qbank and the test software both provide access to lab values. Many questions include panels of lab values. Being able to quickly recognize abnormal values will save you time. The lab values in the test will be clear – learning to recognize ke y values will save you time.
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Qbank provides information on whether changing your answer choice positively or negatively impacts your score. Use this information to decide whether to have the courage of your conviction or second guess yourself.
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STEP 2 FACTS •
355 Questions. 8 one-hour blocks over a 9 hour day. # of questions varies per block – limited to 45 questions per block. Average ~80 seconds per question.
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If you skip the tutorial on test day, you add 15 minutes to your 45-minute break time.
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You can take the optional break time at any time between blocks.
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Finishing a block early does not add time to subsequent blocks – it does add to break time.
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Passing score increased in 2012 from 189 to 196. This is part of a general move to make Step 2 more challenging. The 2-digit score is no longer reported to program directors.
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60%-70% correct = pass.
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Average scores (US seniors - 2011): For those who match: 235 | unmatched: 221.
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On average, programs do not grant interviews to students that score <206 in Step 2. They generally do interview students who score >225.
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Once you pass, you cannot retake the exam to improve your score.
What to expect on Step 2 •
All questions are single, best answer. There can be up to 26 answer options (options A to Z).
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Step 2 includes the following question types: o
A single vignette followed by a single question and answer set.
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Sequential items. A single vignette followed by a series o f question and answer sets.
Questions are answered in sequences and choices cannot be changed after clicking “Proceed to Next Item”. o
Matching Sets. A single set of answer options followed by a series of
vignettes/questions. Select the answer to each question from the option set. •
Most questions are clinical vignettes. A few questions are based on journal abstracts/drug ads.
RESIDENCY FACTS •
The average program receives 716 applications. Many internal medicine programs get >2000.
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Step 1 and 2 are used to decide which applications to review. Once a Program Director is looking at an application, they rate the importance of factors as follows:
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Grades in clerkship in desired specialty – 4 .2 out of 5
Honors in clerkship in desired specialty – 4.1 out of 5
Grades in required clerkships – 4.0 out of 5
USMLE/COMLEX Step 1 scores – 4.1 out of 5
USMLE/COMLEX Step 2 scores – 4.0 out of 5
As the number of US applicants is increasing rapidly and the number of positions is static, having a high Step 2 score has become essential to a complete application.
References: NRMP Program Director survey: http://www.nrmp.org/data/programresultsbyspecialty2010v3.pdf NRMP Charting Outcomes in the Match: http://www.nrmp.org/data/chartingoutcomes2011.pdf Step 2 CK Content outline: http://www.usmle.org/step-2-ck/
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