How I scored a 260 on the USMLE Step 2 CK

We have with us today Dr. Priyanka Lakshmanan sharing her USMLE Step 2 CK experience. Dr. Priyanka has always been academically strong. After scoring 267 on her USMLE Step 1 (Find out how I scored 267 on the USMLE Step 1), she managed to get a whopping 260 on her Step 2 CK. Below is her step-by-step guide on how you can crack this exam, all relevant for The Indian Medical Student.

STEP 2 CK: The Journey and the Real Deal.

I am an IMG (International Medical Graduate) and very recently graduated. I took my USMLE Step 1 examination in my 3^rd year of medical school (2015) and my Step 2 CS in April 2017.

I planned to wrap up Step 2 CK during my internship. I returned to India after 2 months of USCE  (United States Clinical Experience) and taking my Sep 2 CS by the end of April’17. After taking almost a month to get over the jet lag and trying to figure internship out, I decided to start prepping for CK.

Now here is the tough part.

A lot of people have their own “recipe for success” if I may call it, for this exam. I felt that people had more unanimous opinions about resources to be used for Step 1. But for CK, one shoe does not fit all sizes and that is something I certainly want to get out of the way before I go into details of my prep.

SOURCES USED (In NO particular order)

[Number of stars is directly proportional to relevance)

• Kaplan Notes for Step 2 CK **
• Step Up to Medicine 4^th Edition ***
• MTB for Step 2 and Step 3 ***
• Online med-ed for videos **
• U World for Step 2 CK *****
• First Aid for STEP 1 ****
• Behavioural Sciences Kaplan Step 1 ****
• Up-to-date (summary and recommendations) *****
• U World self assessments 1,2 *****
• NBME 6,8 ****
• CMS family medicine forms 1,2 ***

The Journey

I am going to divide my prep into 4 phases for ease of understanding. You need not go through all these phases. This is solely my experience.

Phase 1 (June ‘17-July ‘17): The Slow Coach

This is the part where I had absolutely no direction. I was reading random resources to figure out the content and orient myself to it.

I did the whole of Ob/gyn, 70% of internal medicine, and parts of pediatrics from the Kaplan notes. This was also the time I started reading Step Up to Medicine and usually had a discussion with a friend at the end of every chapter. I was not very consistent during this part (because of my postings, birthday month, a vacation).

I was also watching the online med-ed videos (available free of cost at onlinemeded.com) for topics that I felt were foreign to me or things that weren’t my strong point. This stretched out till about mid-july when I realized that it was time to pull out the big guns.

Phase 2 (July ’17 – October’17) : Enter U World

Here is where I started with my U World. I purchased the 6 month subscription which for me was a huge mistake since I ended up pushing my exam. Nevertheless, I started solving the Q bank.

Internal Medicine was the subject I started with and I decided to solve system wise (CVS, GI, ID so on and so forth). After every test (Timed mode), I would review the test and write almost everything down from the explanation. This was where I did not understand the amount of time I was losing and how impractical it was.

It took me almost 3 months to wrap 2 subjects (Int Med and Ob/gyn) from U World and that is when I decided to shift gears.

Phase 3 (Nov ’17 – Feb’18): When the synthyroid kicks in

This is when I stopped writing stuff and started reviewing on screen. It made the whole process so much faster without really affecting my level of retention. I thought I was doing a decent job (given my medicine postings at the time).

Things seemed to be going fine until mid-February where I lost my momentum yet again (Thanks to pre-convocation, convocation, post-convocation, running around for signatures). I had finished about 90% of U world by this time, but I really wanted to get done with it so that I could reset the Q bank and re-do it.

By the end of Feb’18, I was done with 100% of the Q bank and I restarted the whole of U world in the first week of March. By the second week, I picked up speed yet again. This time around, I was solving random tests (not system wise) in the timed mode.

This is also the phase where I took some time off to read bio statistics from Kaplan for Step 1 and watch any videos for concepts that were unclear.

Phase 4 (March’18-April’18): The Last Lap

I wrapped up U World for the second time by the 2^nd week of April (bear in mind that I had to extend my subscription). When I was solving U World for the 2nd time, I had marked a fewer number of questions to review at a later date.

I also added all important tables and portions of the explanations that were super relevant to the “Flash-cards” feature for quick revision and this certainly made a lot of difference to my prep.

By the 3^rd week of April, I was done with my self -assessments and I spent my last 10 days before the exam revising the marked questions and the flashcards.

My Assessments (Listed in the order in which they were taken)

1. U World (Total Average)
   • 1^ST time: 78%
   • 2^nd time: 91%
2. NBME 6: 247
3. UWSA 1: 267
4. NBME 8: 268
5. UWSA 2: 263

Things to take away

• Allocate your time wisely.
• U World is the MOST important learning tool for the main exam.
• The complexity, length and pattern of the questions in U World is a decent estimate of the real exam. So try and do it as many times as possible (I feel that for most test-takers out there, solving the Q bank twice should be sufficient.)
• Try and understand concepts behind the explanations. Figure out what went wrong rather than being fixated on the right answer.
• Re-solving the Q bank is not to memorize the answers. It is to get more thorough with the content and the concepts.
• A major chunk of the exam focuses on diagnosis and management. So while doing tables or flow charts, pay special attention to those parts as they become extremely important and are the deciding factors.
• The exam does not really test you on your capabilities to identify the symptoms of a disease or what gene mutation causes a particular disorder (sparing a few questions).The exam is mainly directed to test your capabilities to manage a given condition.
• More often than not, you will find yourself confused between 2 options. At this point, try your level best to figure out why one of those choices cannot be the answer. It is not as easy as it sounds and it becomes imperative to leave a margin of error because clinical judgement varies among physicians (and hence among the people who frame these questions).
• This exam is all about protocols, so adhere to them. There is a reason they exist (most of them are supported by clinical trials).

Besides U world, there are a million other resources out there and I probably am not aware of a lot of them. But instead of reading a hundred different things,

Try and use a limited number of resources to the fullest.

The REAL deal: 260

(For those who are wondering about the discrepancy in my NBME 6 score and the rest of my assessments, I guess my score was on the lower side probably because I had just started my UW for the 2^nd time and had not revised a lot of topics. That combined with my exceptional ability to over think accounted for this difference)

Among my assessments, I felt that UWSA form 2 was the closest in terms of correlation to the main exam.

Before I end this post, I have to take a moment to mention the patient safety notes from Kaplan for Step 2 CK (Behavioral sciences). Definitely try and go through his section from the book once close to your exam as some of the concepts may be tested on the main step.

Happy CK diaries to all!

-Dr. Priyanka Lakshmanan

(Seth GS Medical College, Mumbai)

Dr. Priyanka is now doing clinical rotations in the US. She plans to apply this year for interviews. We wish her all the best! If you would like to ask her questions related to this article, proceed to the comments section below.

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