Ultimate Study Guide for USMLE Step 2 CK

How I Scored 263 on the USMLE STEP 2

The end of third year is monumental. You finished your rotations. You took all the shelf exams. You learned a great deal about what it means to “be a physician.” Now, you have to put it all together and take your second USMLE exam. It’s a daunting task, and it is a difficult test— but it is absolutely doable. How do you start? Here. This is how I jumped almost 30 points from STEP 1 and scored 95th percentile on STEP 2.

Consider why you are taking STEP 2

For me, STEP 2 was a chance to redeem my STEP 1 score. I wanted to apply into a competitive specialty, and I wanted to prove to programs that I knew how to take a standardized test. I also did not want STEP 2 looming over me during applications or after match. For that reason, I chose to take STEP 2 early in my fourth year before I started with sub-internships and applications. Others may choose to delay STEP 2 until after applications are due or to the end of fourth year. Check with your school about timing requirements, and plan accordingly.

Set a timeline

Having STEP 1 in your rear-view is great for studying for STEP 2. How long did it take you to effectively study for STEP 1? How did it feel to study for it? Did you burn out quickly? Use the lessons you learned from studying for STEP 1 and apply them to studying for STEP 2. Typically, medical students take about three to four weeks to study for STEP 2; think about how you felt about the “typical” STEP 1 study period and adjust this one accordingly. (It may sound like too little time, but I promise your third-year work will help you!)

Break old habits

When thinking about how STEP 1 went for you, think about what did not work and things you would have done differently. Was Anki not effective for you? Did you start watching Sketchy too late? Were your days too long? Did you take enough time off? Studying for STEP 2 is a chance to break your old study habits and form new ones. Make a list of the things you want to do differently and apply them as you work through this checklist.

Organize your fourth-year schedule to match your timeline

Different medical schools allow different opportunities to schedule time to take STEP 2. Some students choose to study during fourth-year clerkships, and others choose to use vacation or research time to take the exam. Either way, be intentional about the time you give yourself and use your STEP 1 experience as a gauge. Can you balance studying and rotations? Do you need dedicated time with no distractions? Be honest with yourself to set yourself up for success. Consider speaking to graduating fourth years about options that may be unique to your school.

Schedule your exam and try your best not to move it

Schedule your exam to match your timeline, and try your best to stick to the date you pick. Fourth-year is full of other big commitments (away rotations, letters, sub-internships, etc.), and you need to have time for those things too.

Identify your resources

This is going to be the bulk of your studying. Most students choose to go through the UWorld question bank at least once; I went through it twice between third year and my “dedicated” time. I would go through multiple 40-question blocks (timed!) and review them that same day. I also extensively reviewed Sketchy Micro, Pharm, and Path (yes, Path!); I watched the videos and quizzed myself on the images using their website. Intermittently, I returned to Boards & Beyond and OnlineMedEd if I ran into topics I needed to re-learn or re-review. I used Amboss as a side question bank for difficult questions (to work on being better at making educated guesses) and to read up on topics that I was rusty on. At this stage of medical school, you know what works for you. Don’t shift gears now. Pick what you are going to use and stick to it.

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Create a schedule and schedule breaks

Work backward and use your resources to make your schedule. How many UWorld questions do you have to get done? How much time are you giving yourself? Do you have other commitments during this time period (rotations, etc.)? Be reasonable—schedule “off” days or afternoons. Give yourself days to catch up if you fall behind. Keep in mind how long it takes you to finish and effectively review a UWorld block—remember, reviewing is almost more important than doing the block itself. And (I can’t emphasize this enough), schedule your breaks. Take evenings off or afternoons off to do things that bring you joy and happiness. At the end of the day, STEP 2 is just an exam. It is an overwhelming exam, but it is just an exam. Don’t burn yourself out over it.

Find a memorization method and stick with it

Everyone remembers differently. For some people, Anki works wonders. For others, it doesn’t. I personally could not make Anki work for my brain throughout medical school. I was a big-picture person and spent a lot of my study time coming up with my own mnemonics and study guides that I then memorized. Don’t use a method just because it works for everyone else. Find one that works for you and stick with it. There are a lot of tiny things to remember and memorize, and doing it in a way you are comfortable with will be the way that brings you the most success.

Review your mistakes

Ask yourself why and how you made them. Then, study topics that are “trouble topics” for you. Unlike STEP 1, STEP 2 allows you more chances to eliminate answers; it gives you opportunities to make “educated” guesses based on what you have learned throughout medical school. This means you should review all your mistakes with a fine-toothed comb. Ask yourself why you missed each question. Did you read the question wrong? Work on being thorough with how you approach the questions. Did you misunderstand a concept? Go back to your resources (Sketchy, Boards and Beyond, Amboss) and learn it again. Did you get tired and not take the questions as seriously? Take a break and try again. Are there patterns in the mistakes you make? Identify them and break them. How you approach your mistakes is how you will do on the exam. This part really pays off. Use the “flag” feature during your blocks to point out questions you struggled with. Do you miss questions you flag? Work ongoing through the answer choices and see how you could have better eliminated the one you selected. Use the “notes” function to write out what you were thinking with each question to make it easier to review later. I would also recommend spending days at the end of your study period doing only questions you missed on UWorld. This will help you re-review “trouble topics” in a question format and will allow them to be fresher in your mind right before exam day.

Be consistent

Follow your schedule—and be forgiving when you don’t. The hardest part of a dedicated block of studying is following a schedule. It can be exhausting to wake up in the morning and know that there are 200 UWorld questions standing between you and your evening plans. But you’ve done this before, and you’ll have to do it again. Be consistent and get in the mindset of doing a lot of questions a day; you will need to build up the stamina for the nine-hour exam on test day. If you fall behind, take advantage of your “catch up” days. And, at the end of it all, be forgiving. Don’t beat yourself up. Don’t get too in your head about how you performed that day. You will have good blocks and bad blocks—good days and bad days. Be consistent. And be forgiving. You are your best supporter during your study time.

Take practice exams and practice being in the testing mindset.

Practice exams are very important—not because they tell you how well you are going to do but because they help you get into the testing mindset. Look into how the timing of STEP 2 works; you will have an allotted amount of break time that you will need to split for food, rest, and bathroom breaks between the various sections of the exam. (Keep in mind that most testing centers will take away from some of this time with scanning and security measures!) Time your practice exams exactly like the real test. Eat the kinds of snacks/lunches you would eat on an exam day. If you are going to wear earplugs on test day, wear them on practice test day. Don’t use your phone during the practice exam. The “testing mindset” is all of these things. The better you do in simulating the real thing, the better (and more comfortable) you will feel the day of the exam. When you see a number at the end of the exam, take it with a grain of salt. Test day will feel different and will be a different set of circumstances. Don’t set your expectations too high or too low—just do your best. Most people choose to take both the UWorld 1 and UWorld 2 practice exams. Amboss typically does a “free exam” for STEP 2 takers around March-June that is helpful for seeing a different style of questions. There is a “Free 120” released by the USMLE, which is very similar to the real exam; I would recommend taking this one closer to your test date. Schedule full-length exams throughout your study period; schedule a full day to go through and review each one.

Stay away from “the noise.”

One of the hardest parts of making it through medical school is staying away from what I call “the noise.” Ask for advice, but always take it with a grain of salt. Don’t latch onto what worked for someone else or how someone else is doing during their STEP 2 time. These study weeks are about you and about your progress. Surround yourself with people who support you and bring you positive energy. There is no perfect way to study for STEP 2; there are many ways that work for many people.

On test day, be confident and believe in the work you have done

It is easy to get bogged down on test day by difficult sections. I found that what helped me was to intentionally reset between blocks and to think of the test as eight different tests. Remember, many of the questions on the USMLE exams are “trial” questions that the test writers are trying out that do not count towards your score. Keep that in mind as you see questions that confuse you or bog you down.

Overall, there is no right way to study for STEP 2; the highest scorers each have their own methods for scoring well. In the end, be intentional. Consider why you are taking the test and when you need to take it depending on your school, grades, and specialty of choice. Set a timeline and break old habits that may have held you back during your STEP 1 dedicated time. Organize your fourth-year schedule to set aside time for the test and book your test date. Identify your resources, create a schedule, and find a memorization method that works for you. Review, review, review! Be consistent, take practice exams, and be confident in yourself.

A few questions with consolidated, quick answers:

When should you take STEP 2?

This depends on why you are taking STEP 2. If you already have a STEP 1 score that is competitive for your specialty, you may opt to take it after ERAS applications are due. If you need to outscore your STEP 1 score, you may want to take it immediately after STEP 1. If you are taking the test simply to take and pass it, study and take it during rotations. If you are taking the test to score well, take a vacation or research block and try to get dedicated time for the exam.

What are the best resources, and how do you get them?

UWorld, Sketchy, Anki, OnlineMedEd, Boards & Beyond, Amboss, and NBME are typical resources used by many medical students; most schools do not cover these resources, so cost may be an important factor for you.

A few details on these resources are listed below:

Resource	Cost	Use/Significance	Pros	Cons
UWorld	$299 for 30-days, $399 for 90-days + 1 assessment, $439 for 180-days + 2 assessments	4050+ questions that are USMLE-style with detailed answers and explanations and images for each question	UWorld is an absolute MUST. Most students try to go through the entire question bank over the course of their study period.	Expensive, very tedious to go through and review
Sketchy	$299 for 6 months, $399 for 12 months Get 10% off with code EVERYTHINGMEDSCHOOL	Sketches and mnemonics to learn pathology, microbiology, and pharmacology. Website includes details	Visual learners swear by Sketchy; it helps with long-term retention and with memorizing more niche topics. The website is also incredibly user-friendly!	Expensive and time-consuming to watch each and every sketch; SketchyPath can be a little complicated, and many students find it harder to remember
Online MedEd (Clincial)	$365 for 12 months; $0.99 for a 7-day trial	Detailed, easy-to-follow videos detailing important shelf topics; topics are broken down and outlined on the site. Some come with self-testing questions.	Very helpful to go through after a tough UWorld block or to re-review topics; videos are short and digestible. Some topics can be accessed for free with a login.	Expensive for a full subscription and can be time-consuming to watch each video; some topics are a little too detailed for STEP2 (more appropriate for shelf exams).
Boards & Beyond	$24 for 1 week, $249 for 12 months, $399 for 24 months	Detailed, traditional videos on pre-clinical curriculum with accompanying books and slides for notes/studying.	Very helpful to go through after a tough UWorld block or to re-review topics; most students are familiar with the platform and the teaching style already with STEP 1/preclinical studying.	Lectures can feel bland and overwhelming with the amount of material presented; some topics are a little too detailed for STEP2 (more appropriate for shelf or preclinical exams).
Amboss	$14.99 per month, or $8.25 per month billed yearly	3200+ STEP 2-style questions with a detailed library of information, medical imaging, and pictures; also includes an Anki add-on	Helpful as an adjunct to UWorld in that Amboss questions are different stylistically and cover different topics; may be useful to use at the end of the study period to practice looking at ?different questions? and to practice educated guessing techniques	Expensive and questions are sometimes thought to be ?harder? than the real thing
NBME Exams	$60 per assessment	4 sections with 50 questions each that can be taken to practice ?test-taking?	Helpful to see a different style of questions that still test on UWorld material	Not many test forms have answer explanations; the format of the tests also do not follow that of STEP 2 (50 questions per block instead of 40)

How much time should you study?

Most medical students spend about 3-4 weeks studying for STEP 2; they review UWorld at least once (maybe twice, depending on how much time they give themselves. A sample study schedule is included below.

What does the test look like?

STEP 2 is a one-day exam composed of eight one-hour sections within a nine-hour testing block. Each section has about 40 questions. The test covers various systems and processes that can be found on the USMLE website – generally including internal medicine, obstetrics and gynecology, pediatrics, preventative medicine, surgery, psychiatry, and statistics.

Which practice tests should you take?

Absolutely take UWorld 1 and UWorld 2. The Free 120 is a great resource provided by the USMLE. NBME exams should be used for questions instead of scores; good NBME forms include 9, 10, and 11, which were recently updated to include questions on ethical, legal, and patient-safety aspects of medicine; forms 25, 26, 27, 28, 29, and 30 have answers with explanations. Other forms may not. AMBOSS also offers free STEP 2CK practice tests during the springtime.

When will you know your score? What is considered a “good” score?

Scores are typically sent out 2-3 weeks after the test is taken. “Good” scores vary based on what specialty you are aiming to go into and whether or not you already have a competitive STEP 1 score. The AAMC has a table of average STEP 2CK scores by specialty that you can find here.

Sunidhi Ramesh

Sunidhi Ramesh, MD is a resident at Thomas Jefferson University and Wills Eye Hospital. She graduated Alpha Omega Alpha and top ten in her class from Thomas Jefferson University. In 2018, she graduated Phi Beta Kappa from Emory University with degrees in both sociology and neuroscience.