USMLE Step 2 CK Study Guide

USMLE Step 2 CK Study Guide

After several requests, I’ve decided to put together a brief Step 2 CK Study Guide.

One of biggest differences between Step 1 and Step 2CK is the drop in the quality of resources. Unlike UFAP etc. where there are 2-3 clear resources to use, Step 2 CK has many good resources but few “Gold Standard” resources. Let’s get started.

The Long Game

64657662_f382e794f5_oDay 1 of Step 2 studying, you look around and think can’t believe I’m done with all that hard work… Wait what? It’s day one of clinicals?

Welcome to Step2CK studying. If you truly want to crush this exam, you begin studying shortly after Step 1 ends and as soon as your clinical rotations start. Now for most of you at the end of each clinical rotation you will have either an NBME shelf examination, or an equivalent shelf from your medical school. Depending on your school, your score on these examinations make up a different part of your clinical rotation grade. It’s important to do well on these, beyond the preparation for Step 2, CK, clinical grades are almost always among the top 3 considerations for Residency Program Directors when selecting applicants to interview. Cue heart rates rising…

Calm down, you can, like the 1000s of students before you, can do this. I think there is no question that this stretch of third year is the most difficult time in medical school, but you just conquered Step 1 so you got this. I’ll let you into the secret of third year – Balance. You can’t cram at the last minute, and you also can’t skip classes anymore to self-study by yourself in a cubicle, so you need to find a balance.

I would normally spend the first week of a rotation getting my bearings. I use this  time to figure out where everything is within the hospital/facility (especially tough when you are at a new hospital, it once took me 3 weeks to learn there was a SECOND cafeteria!). Also, getting to know the attendings, residents, and fellow students is beneficial in the long run. You will need to learn exactly what your clinical roles/responsibilities are, and just how rounds are conducted on the service. I was reluctant to study a ton during the first week, finding my place was stressful enough. As a new student the expectations are also a bit lower in the first week, and looking like an idiot now has the added benefit of appearing like a genius weeks later once you do actually study. A reference letter where the attending can comment on how much your medical knowledge improved by leaps and bounds always helps, and it certainly doesn’t hurt when they’ll feel the contributed strongly to your learning.

After this first week, I’d begin by trying to study at the hospital as much as possible. You’ll quickly realize most rotations you spend an amazing amount of time sitting around and waiting. Whether it’s sitting around and waiting for an attending to appear, or sitting around and waiting to be dismissed, don’t waste this time. I normally kept either a reference book in my white coat, or would do USMLE World questions on my phone. In addition to this I’d attempt to study 1 hour once I got home, obviously exceptions are made on days I had call or a particular strenuous day, but I thought it was good to keep a goal of 1 hour per day. I’d ramp this up accordingly as my shelf exam neared, and would normally pick one day a weekend to get a good 4-6 hour study session in. If you can keep up with reviewing each day, learn from the topics on the floor, and learning from the didactic sessions you’ll be in good shape.

A side note – Look up every interesting condition that you round on. Even if it isn’t your patient or you think you’ll ever see it again, look it up. The best way to consolidate facts is when you have real world experiences. Plus where do you think your attending will find pimp questions to ask you? It won’t always be about your patient, but it’ll be about interesting cases on the floor. You’ll eventually learn how to predict a few questions ahead of time.

I outline many of the resources for shelf exams here. If you prepare for each rotation accordingly, and do anywhere from 200-400 UWorld Questions (likely more or with the addition of MKSAP for Internal Medicine) per rotation you’ll be in fantastic shape for Step 2 CK. Before you  jump on me and say but there aren’t 200 questions even for every topic – mix in some internal medicine questions. I think 50%+ of my surgery shelf examination was internal medicine and I’d wager ~%50 of Step 2 CK is Internal Medicine.

I’d also like to do a quick shout out again to FireCracker, as a great resource to use throughout 3rd year. It’s a great way to keep the facts you learned 4 rotations ago fresh. Memorang is also coming out with Step 2 cards shortly, so keep an eye out on them as well.  I’d like to highly recommend Toronto Notes. These are great pdfs with the salient points of each topic, they include the bare bones but are incredibly high yield.

Getting Down to Business 

At this point I’m going to assume you’ve made it through all your clinical rotations and shelf examinations. Congratulations! Hopefully you have a few weeks ahead of you with  a less intense rotation or totally dedicated study time to begin focusing on Step2CK.

I’ll begin by saying I believe this examination is slightly easier than Step 1, but requires more mental endurance. Student average scores are typically 5-10 points higher, so if you received a 235 on Step 1 a 240-245 would be a good goal for the Step 2 CK. Personally I’m not sure of reason behind these statistics but I’d wager the averages also rise because fewer students write Step 2CK vs Step 1 (likely international students who failed Step 1 or scored poorly and do not continue on with their Step examinations). Step 2CK is also less important for most residencies in selecting applicants to interview. Even though it is more clinically oriented. The reason being that this exam for many schools is not required before their students begin residency interviews, thus you can’t use it to evaluate all the candidates fairly. I’ve harped on this point in my NRMP Match Timeline post but if you are an international student I don’t care what your school/best friend’s cousin/Dr. Sanjay Gupta says – write this exam in time to have the results by early September. Summer is the busiest time for Step 2 CK so score reporting in July/August often runs several weeks late, so aim for the mid-end of July latest.

With that out of the way, let’s get down to evaluating the resources you have available to you:


First Aid Step 2 CK

The golden child from Step 1 studying suddenly finds itself with some competition. While I’d rank FA Step 1 a solid A+ as a resource, the Step 2CK version finds itself in B territory. It’s not as comprehensive, it lacks the detail needed and it isn’t always clear on the next best step, screening test, treatment etc. It’ll give you a great overview of the key features of many diseases, as well as key findings but unlike the Step 1 version you will find some topics missing. A huge plus for some students though is that it is the same familiar format as Step 1, and while it’s a larger book than the other Step 2 CK books, much of this is due to the space left to annotate and add notes. I’d say this book has the best illustrations and diagrams.

Step up to Step 2 & Step up to Medicine

I’d wager Step up to Step 2 is the most popular Step 2CK study book. DIT actually is based off Step up to Step 2 rather than First Aid, so they clearly believe it to be the superior book. I included both Step up to Medicine and Step up to Step 2 under one section, but as you can imagine Step up to Medicine only covers IM topics, while Step up to Step 2 covers all topics. Step up to Step 2 however is much shorter, and the shortest of all the major Step 2 review books. If your medicine base is good you can likely skim/ignore Step up to Medicine and focus only on Step up to Step 2. It’s a more concise book than First Aid, and the style is also quite different as a review book. Like FA you may find some topics are either covered far too briefly or not at all, and after you purchase any review book I strongly suggest you check the errata. I primarily used Step up to Step 2, and thought it was sufficient but did find myself leaning on other resources to fill in some holes.

Master the Boards Step 2CK

From the famous/infamous Conrad Fischer. If you are a fan of his Kaplan videos and his style of teaching I’d strongly recommend you choose this are your go to book. Out of all the books here I actually found the organization of this book the best, it very clearly outlines what’s the best test, best treatment, gold standard are etc. While it also doesn’t cover all the topics thoroughly enough, most of the remaining  information can be filled in from the question banks. Personally, I’ve heard of students having the greatest success making flashcards (ANKI or otherwise) off those quick hits, and bold terms.  It may not be the most comprehensive book, I thought for most students its high yield enough to do quite well on this exam.

Before making a choice I’d recommend you check out all 3 books from either an upper term student, library or even on (look inside feature). You’ll quickly realize some books style simply doesn’t jive with how you like to learn, but once you pick a book stick to it.

Question Banks

Now time to pick a Question Bank. USMLEWorld. Done. Easy wasn’t it?

The same bank I suggest you use during your clinical rotations is no surprise the best one for the actual exam as well. At this point and if you’ve kept up to date with doing questions and clinicals you should either be done or very nearly done the entire bank. If that’s the case I’d recommend resetting the bank (be careful I believe you can only do this once), and starting fresh. While there are some concerns that you are doing questions you’ve seen before, it’s likely been many months since you’ve seen some of them, and this time you’ll see them in a more random fashion.

If you want a source of extra questions I recommend the MKSAP (Get the computer based app vs book) questions or the Kaplan bank. Unfortunately both of them don’t compare well to USMLE world as both are far too detail oriented for the actual examination. NBME’s also exist for Step2CK, but are less useful than they were for Step 1.

The Final Push 

With question bank and book in hand, it’s time to do this. Your precise study plan will depend on exactly how much time you have. I recommend planning to get through at least each chapter once, and difficult chapters 2-3x while doing 2-3 full blocks of questions a day. At that pace you’ll quickly end up being able to re-do most of Uworld quite quickly. You can do one block or half block on the chapter you reviewed that day, and the rest on random. I’d likely default to what worked best for Step 1.

The one thing every student I’ve talked to complained about on Step 2CK? Stamina. This exam is a block longer than Step 1, and the research/drug ad questions are tedious. In fact I’d go as far to recommend you flag them and do them at the end of blocks if time has ever been an issue for you during exams. It’s not worth reading a whole abstract to solve 1 question and missing 4 at the end. Also I’d suggest practicing a few times doing questions in 5-6 hour blocks at a minimum just to get used to the idea of writing such a long exam again. Bring snacks, bring a source of caffeine if you’ll need it (you will), and bring tylenol/advil.

Get ready to knock this sucker out of the park, one more step down. Good Luck!

I talk about Step 1 here and Step 2 CS here for those interested.