Writing this
experience as I didn’t come across good, detailed Step 2 CK experiences unlike
Step 1. All I heard was to do UWORLD and you’ll be good to go, whereas, I had
2-3 PDFs (of different Step 1 scores) when preparing for step 1 which helped me
choose a resource or change my course whenever I felt confused. While
describing my experience, I will be contrasting it with my prep for Step 1 too.
So here it is:
Final
exam score: 255.
Exam in June, 2019
Total
prep time: Almost 4
months. I bought my UWORLD subscription in the mid of February but my actual
preparation started at the end of Feb, around 25th.
Background: Graduated in 2018 and gave my Step
1 in October, 2018 and scored 258 in it. I did a part of my internship
(housejob) year for 3 months in internal medicine right after my step 1 as I
was too drained out after studying for 6 months constantly. I got the CK notes
printed in December, but couldn’t get to them during my rotation. But the
passive learning during the job did help at times later on for CK, but I think
doing CK directly after Step 1 would have
been a better idea as a lot of pathophysiology and pharma from FA is
tested, especially in the final exam if not the UWORLD practice exam.
Practice
Test Scores:
UWSA
1 ( 4 weeks before the
exam): 264. This result was after I had completed my 2nd block by
resuming it which had 3-4 questions omitted due to lack of time. Made me
realize how much I needed to work on time management skills.
NBME
8 (3 weeks before the
exam): Almost 16 questions wrong which is about 252-254. This is a very
straightforward exam with little help in adding to content for your
preparation, but for some reason most of the students I ask have their final
exam score very near to this. A certain correlation graph after widespread
research which is doing rounds on different Facebook forums says that NBME 7 is
most predictive but this is all based on the perspective.
UWSA
2 (5 days before the
exam): 264. I didn’t resume any block despite rushing through the last 5
questions of every block, but it helped me be ready for the lack of time during
the last part of each block in my actual exam.
Free120 (same day as UWSA 2): 88%. They are
easier than the real thing but definitely do them and look at the tutorial. I
made the mistake of not looking at the tutorial for this as I thought it was
the same as step 1. But it introduces you to abstract questions and other new
stuff which I came to know by wasting two minutes of break time in the real
thing.
Resources:
UWORLD
NOTES: I got the
original ones printed but found 2019 ones later so had them in front of me on
pdf almost all the time. But they are also very deficient to cover all of the
new questions. I hope we can find the editable word version of the pdf so that
it can be edited and updated with time like FA for Step 1 is. Went through them
thrice over the period of my preparation. I didn’t do so but I’d suggest going
through the notes before starting UW questions. The reasoning has been given in
detail later.
UWORLD
STEP2 CK: Did it only
once, and then quickly went through almost 40% of the questions that were
marked or wrong.
OnlineMedEd: I watched videos for topics that
were confusing like arrythmias, antibiotics choice etc etc. The best part of
OME videos is the final algorithm at the end of the video which is on the
whiteboard. I took screenshots of it, but that were not clear.
Uptodate: Used it a lot in the last month
before the exam. Especially to search stuff that people were posting on
facebook forums and new things from NBME 8 and little bit of CMS forms I did.
CMS: Only did 2 blocks of surgery as I
had a low percentage in UW surgery portion.
FA
for Step 1. Important
topics: Side effects and uses of drugs in Pharma, all of Biostatistics and
ethics including patient safety notes, diseases in Biochemistry like Glycogen
and Lipid storage diseases, and a lot of Psychiatry but it is covered in CK in
more detail too. One has to know pathophysiology of almost all diseases as the
final disease name won’t be there in the options, instead its pathology will be
written just to confuse you a bit. So a background knowledge of Step 1 does
helps a lot.
Study
partner: Someone who
shares a similar final exam date to you, and who you judge to have a similar
intellectual level. This was more beneficial in Step 1 as there was more
conceptual learning in subjects like physiology, compared to the hundreds of algorithms
in ck which just need to be remembered. But if you can stomach it, I preferred
someone bombarding me with random questions all the time. Sometimes it
embarrassed me when I couldn’t recall simple stuff, but then such times make
you remember that stuff more clearly when the real deal comes.
Anki
Cards: I initially
downloaded Tzanki and WiWa and did CVS from them, but I decided instead to make
my own cards. This allowed me to have no other notebook when doing notes for the
second time. I didn’t highlight anything in my notes, instead I made a
flashcard of anything that I couldn’t remember or I thought it was new to me.
So the last two days before my exam, I just went through these flash cards.
Excellent way to build memory. Also did the flash cards of a few difficult
topics before UWSAs.
Patient
Safety Notes: Go through
them once before the exam. Helps a lot in making sense to what you initially
think can be answered just by common sense. Last few pages of Public Health chapter
of FA covering swiss cheese model etc. helps with this too.
Step
Up to Medicine: I
studied this book for my medicine clerkship and final medicine professional
exam in final year of med school. I loved this book. Even though it had been
more than a year since I studied it, I still remembered some major algorithms
from it. It has a lot of extra knowledge that’s not needed but it had made a
base for me to build upon. If you have more time, I’d suggest starting with
this book.
MTB
2&3 and FA for CK:
Have no idea about them. Never saw the book or pdf of them.
UW
for Step 3: Didn’t use
it myself but can be helpful for those who didn’t do random, timed uworld for
ck. Will help dealing with unknown questions. Don’t go through the explanations
just use it as a question practice tool.
UWORLD FOR STEP 2CK
UW covers almost 80% of the actual test items. But then again
the questions are an amalgam of common sense, step 1 knowledge and clinical
knowledge. There are 3 types of questions: Diagnosis & risk factors, Best
investigation/treatment, Best next step. One can do diagnosis by Step 1
knowledge usually. It’s for the latter two that you have to prepare for. A
colleague said to me: if you think you are guessing the answer in CK, then
you are doing it wrong. There is always a right answer according to some latest
guideline.
HOW TO DO
UWORLD?
A question
that confused me a lot during both my Step 1 and CK was how to do my UWORLD?
I did UW for Step 1 random, and timed from the beginning and
completed it in 2 months and so was able to give my exam more quickly compared
to other exam takers. Now an advice I would like to give to everyone, preparing
for either Step 1 or CK is that even though UWORLD is a huge knowledge source,
it is also a very good testing source. Yes, the percentage of correct questions
doesn’t matter a lot, but it helps you measure every single day of your
preparation. Most importantly though, the questions are perfectly written. They
are exactly what you need for practicing the confusing scenarios of the final
exam. I did it slightly differently in Step 2 CK and not completely random as I
have described later.
The reason
why I advocate doing random, timed UW is because: Firstly, it teaches you time
management from the get go. Secondly, it recreates an exam-like environment
which trains you for the final exam which at the end will be random and will
have unknown questions that you’ll have to solve by ruling out the wrong
options. And the only way to practice for that is to start with random stuff.
So you save prep time and train your mind to think openly. And I will stress on
one final point, everyone looks at the answer once done with the question, but
remember to look at the QUESTION STEM again when reviewing the answers as now
you’ll be able to find the specific clue related to the answer. Also look at
the age, risk factor etc. within the stem as these are very important in CK.
Finally,
everyone has their own way to go about this question bank, some even do it
tutored which was also useful to me in my marked questions as I will describe later.
But again, once a question is used it almost becomes useless the second time.
Doing random, timed UWORLD the second time takes away the time management
required and also the surprise factor which is necessary to prepare you for the
out of the world questions of the final exam.
Preparation
timeline
First Month – until end of March – Did 60% of the UW in timed,
alternative blocks of each volume way
I always
studied in my bedroom throughout med school, but I decided to go to a library
nearby for both step 1 and ck as it is necessary to maintain sanity with people
around for such a long study schedule.
So now
coming to how I went about my prep. Sorry to disappoint you, my main resource
was also UWORLD. I had the notes printed and made them my main book as I have
this bad need to write stuff down and I write so much that it becomes confusing
even to my own self, hence I devised a method to avoid any confusion and also
used this with FA when doing step 1 that I’d write question IDs of most
of the difficult questions, almost one-third of all, on my notes write next to
the topic heading that the question pertains to. I did the same with FA
previously in step 1. Now it’s very arduous work to open the notes to the page
of the same topic of the notes when you are doing it randomly, so I’d have the
pdf open on my laptop. I’d just search the word in notes pertaining to my
question and it would appear, if not I’d know this question is not in the
notes. So I’ll have to write down its information myself. I did this with FA
too in step 1. I started UW without giving a read to the notes to ensure I
maintain the surprise factor of the UW and read the notes along with UW. There
is one thing I did differently in the UWORLD for CK to help me jotting down new
points more easily:
I did the UW
not completely random. A colleague who, herself, got a very good score in CK
advised me that doing UW completely randomly is not advantageous in CK as you
can easily know the system of the question by looking at the stem, and making
notes is so tough with it. So initially, I followed her way. My notes were
divided into 5 volumes:
1. CVS,
Resp, Endocrinology 2. Rheumatology,
Hemonc, ID&Immuno 3. Neuro and
GI 4. Gyne/Obs, Renal, Male RS 5. Derma, Eye, ENT, Multisystems, BS,
Biostats, Psychiatry and all other small topics
So I used to
take only one volume to my library each day and I would just make a block of
the specific 3 or so systems in that volume. So first day I’d do a block of
CVS, Resp and Edo of all Med, Surgery, Paeds etc. And then next day I’ll do 1
block of next volume until I came back to the first volume on the 6th
day. So this allowed me to maintain a certain amount of randomization, and I
would come back to each topic every week. This allows reinforcement of the
specific system every now and then which is very important in long term
studying. As the more you study something over time, the easier it becomes to
retain over a long period of time. This is a better way than doing one system
complete first, and then second and so on as then you forget the initial
systems by the time you reach the last one. After the initial start I’d try to
review more than 40 questions/day so I’d do two blocks of one volume in one go
to build some stamina and review at least 60 questions/day.
Remember, I
had timed blocks from the get go. Initially, I used to go over time by
10 minutes. The overtime was calculated based on the time it took to resume and
complete the omitted questions. But by the end I was able to devise ways to
read questions that allowed me to complete the block in time. But remember, the
time issue is a big one in CK vs Step 1 in which you are left with more than 5
minutes in every block no matter how difficult. But CK is different with longer
stems and confusing scenarios. While reviewing, I’d add anything missing from
the notes and carefully read the explanations. It took 6-8 hours to do one
block initially and only 4 hours later on when I had acquired some knowledge. I
was scoring barely 70% which had me worried throughout. By the end of the month
I was done with 60% of the UW which was adding questions at the speed of light.
2nd
month – Until end of April, 2019 – Revised notes
I had done
60% of UW with equal amount of blocks from each volume. And since I had only
improved to about 72% in my correct questions I decided to do the notes
completely once before I continued doing questions. So I spent almost all
of April except last 2-3 days doing the notes. I reviewed them extensively and
would open the Question IDs I wrote, wherever I felt that the information in
the notes was lacking despite my own annotations. Of course, I was yet to
annotate 40% of the notes as I hadn’t complete UW. I would make flash cards on ANKIDroid of
anything peculiar or new or something that needed to be remembered and took
pictures/screenshots of all the algorithms from the notes. After every system I
revised from notes, I’d do the important onlinemeded videos. So every
volume, as I have described above, took me almost 5-6 days to review. For
biostats here, I revised the FA and also revised Biostats review Qs which I had
already done for Step 1, so took me almost 2 hours to do again. I’d supplement
anything confusing with FA during this preparation and ensured I understood
everything before moving back to solving questions.
One thing
that I was worried about during this revision was that I’d be compromising on
the questions of the rest of 40% of UW that I was yet to do by already reading
the information pertaining to the question in the notes. But what I realized
later is, that unless you have read the question before, you are still tackling
it for the first time. If you read only the information in the form of notes,
you just gain the knowledge like you do with FA before random UW in step 1. So
going through notes is basically familiarizing yourself with the extra
knowledge that Step 2CK brings. Basically, these notes were exactly like FA to
me. So they don’t compromise on what the question tries to confuse you with.
You just have extra knowledge that the question bank tests.
3rd
month- Until May 25th, completed the remaining 40% UW and did some
practice tests
So starting from May 1st, I started doing UW
again from where I left it, this time completely random, timed and not
according to volumes like before. I did 60-80 questions per day and completed
my remaining 40% questions in almost 18-20 days. My overall percentage improved
from 72% to 76%. I could see the effect of reviewing notes once and going
through OME. I was scoring in 80s and sometimes even 90% in the blocks and
overall I was feeling more confident. But obviously these scores were still
less than my random, timed Step 1 average. Once I completed UW, I spent the
next day reviewing ANKICards I had made of important topics.
On 21st May, I
gave my UWSA1. As I have said before, I was short of time in one of the blocks.
I did resume the block and completed the test in more time to get 264 at the end.
But I was disappointed by the time management problems I had encountered. So I
decided to approach questions by looking at the last two lines of the stem and
options before looking at the labs and the rest of the stem. This helped me a
lot in reducing the time spent per question but then again the issue wasn’t
completely resolved even on my test day. There are some new concepts in UWSAs
that are very important so make sure you review them.
I did NBME 8 offline after
UWSA 1. Also did CMS forms 3 and 4 of Surgery. I think CMS forms are good
preparation for new and unknown concepts not discussed in UW but the questions
themselves are of poor quality. They are direct questions that don’t require
the multiple levels of thinking like in UW and most of the final exam
questions. But I have to admit, the final exam does have some direct scenarios
like in CMS or NBME which actually were a pleasant surprise. I didn’t have time
to do more CMS forms.
Last month – Until exam in mid of June – Revised
notes, simulated exam and flash cards
So beginning May, 25th I started my final revision
of notes. This time I completed each volume of book within 3-4 days which
amounted to almost 17 days in total. I used to add to my AnkiFlashCards any new
information. Before each system, I’d review the previously made flashcards so
that I could know what needs to be added while revising the chapter. I would
spend an hour every day to do my marked UW questions.
I was left with 5-6 days before my exam date when I gave my
UWSA 2, Free120 and a question block of UW of newly added questions on the
same day. This was a recreation of the exam environment as I used a timer
to ensure that I don’t take more than an hour break. I had similar eating items
that I would subsequently use in my exam and I changed the library so that no
one I know disturbed me during it. I scheduled my breaks like I would do on the
final exam. I did similarly in Step 1 many times, but here I could do it only
once as there is a small pool of practice exams. I reviewed all these questions
the following day. And then spent two days completing my marked questions. I
did 10 blocks a day, each of which only took 35 min to complete as you already
know the answers to most of the questions. I got more 90% in most of the
blocks, but there were some that surprised me with relatively low percentage.
In the last 15 blocks or so I used tutor mode to save time so that I didn’t
have to review the block again once I have solved it. Like this I was able to
do and also review a block in an hour. In the last two days, I mainly did
flashcards, looked at a few algorithms and also radiographs from UW flashcards
that I had made while reviewing UW.
TEST DAY
I am kind of a night owl, and get very insomniac during exam
nights. But a 9 hour exam like this requires utmost alertness. To tackle this,
I started changing my routine 15 days before the exam. I used melatonin
initially to correct my cycle. I took a sleeping pill (a benzo) before the exam
night and slept around 12 am to wake up at 5 30 which was good enough for me. I
did a trial of the sleeping pill before my UWSA2 and Free120 exam simulation
too.
Three days before the test, I developed the flu and had 102F
fever. I kept studying during it but I also got apprehensive and called
prometric to delay my exam, but they were asking for around $300. I waited till
the last day but I still had a lot of congestion but no fever. I used a nasal
spray that helped me clear my congestion by a huge margin. I took a jacket with
me to the center even in summers to tackle any extreme air conditioning in the
room. Btw, according to them even asking for a tissue paper will lead to a
report being sent to USMLE people. WTH. So I arrived at the prometric center,
there were a lot of CK test takers due to the upcoming change in pool and delay
of result reporting. We were placed before step 1 takers and the exam started. Thankfully
the nasal spray had done it’s magic and I didn’t even need a napkin during the
exam.
I did the first two block in the same sitting. From the
beginning, I had a problem with timing, I had 2 minutes for the last 2
questions but was able to do them. Took a break after 2nd block for
about 12 minutes in which I had some tea, a bite or two of the Subway sandwich
I had brought along, and a little bit of chocolate. Then I did 3rd
and 4th block together too. It was a mistake as I got really slow in
the 4th block and I actually missed out on two questions. But I
made sure to mark a random response on those two questions in the last 10
seconds despite not reading the complete stem. Make sure you do that. Subsequently,
I took a break after every block. After the fourth block, I was a bit down, and
also started feeling a bit bloated as I was constantly sipping tea, and so
really wasn’t hungry enough to eat the sandwich. I remember I felt 6 inch
sandwich wasn’t enough in Step 1, so I had brought a footlong this time. But my
appetite was completely opposite now. Anyways, I missed out on a question in
another block so make sure you practice time management skills. Oddly enough,
my best block was my last block.
Why did I miss questions in my final exam eventhough I was
able to complete my practice blocks in time? I believe for most of the exam I was overthinking a
lot. I just couldn’t stop myself from doing it. I never leave questions and
move on to the next item. So I would stay stuck between two options which were
close enough to confuse you. The stems in the actual exam are balanced. There
are some very long questions which I would start reading from the last line
before moving up, and a lot of short questions that aren’t so prevalent in UW.
So the only reason I couldn’t manage time was because of this added pressure
that I couldn’t make the wrong choice between the two options because now this
was the real exam and not a practice one. PLEASE AVOID THIS IF YOU CAN. Mark
your first choice. I also did some questions correct by overthinking and
catching a clue at the last second. So it’s a dilemma. I’d mark around 10-12
questions per block but that mark was for my own conditioning to leave the
question and move on, otherwise I didn’t get to review them in any block.
What I did that helped me get a good score?
- ·
Wrote
question IDs on my notes and went back to them when revising
- ·
Focused
on the question stems as much as the answer explanations
- ·
Used
uptodate a lot to clear my confusions
- ·
Timed
blocks from the start
- ·
Random
blocks from the start.. the method I described above for ck was really helpful
in making notes too
- ·
Kept
First Aid in the loop
- ·
Simulated
the 9 hour exam at least once before the real deal
What I did that prevented from getting a better score, closer
to my UWSA 2?
- ·
Get
the flu right before the exam. Ofcourse I couldn’t control this factor
- ·
Overthinking during the exam. And poor time management. I think this
could have given me an extra 5 score definitely. As CK is more about the exam
day than Step 1. You can acquire knowledge as much as you want, but that day is
very important. Critical thinking is essential.
- ·
Not
doing Step 3 questions, which help developing your mind for the multitude of
unknown questions coming up
- ·
Not
doing CMS for Obs/Gyne
- ·
Gave
15 minutes to 10 questions during each block. But one should aim for 13 minutes
to give yourself some leverage for the final 10 questions as they are more
stressful.
Lastly, after my mess ups on the last day, and some friends
getting bad score around the same time, I was very worried about my result.
Infact the wait for this result was more nerve-wrecking than any exam result
ever. I am glad I got a respectable score. So I guess I can say that if you
have a 260+ in your UWSA and you can calm your nerves during the exam day,
you’re good to go for a 250+ score on the final exam. Best of luck!
