USMLE Step 2

Step 2 CK

Caroline Smith, Class of 2017

  1. About the Test

Step 2 CK will test not only your general medical knowledge and ability to diagnose but also next steps in management of patients (next lab or imaging test, best therapy, etc.). The test is 9 hours and comprised of 8 different 60 minute blocks, with up to 40 questions per block. In general, studying for Step 2 CK takes less prep time than Step 1 with less focus on the nitty-gritty details that you had to know for Step 1.

  1. Study Materials
  • UWorld (a must): Go through UWorld throughout third year as you are doing your clerkships and studying for your shelf exams. It is great already having completed the Qbank at least one time by the time you start studying for Step 2. I recommend going through the Qbank at least another complete pass during your dedicated Step 2 studying time. Just like for Step 1, the Qbank is very comprehensive and you learn a lot by going through the answers to questions.
  • First Aid for the USMLE Step 2 CK (optional): I used this resource. Overall, it is easy to read just like First Aid for Step 1; however, unlike First Aid for Step 1 it is very superficial and is not in any way comprehensive for what you need to know for the test. Don’t use this as your only resource, but it is a good supplement with overall highlights of things you need to know. The rapid review in the back I found very helpful just like for Step 1.
  • USMLE Step 2 Secrets (optional): I had friends who liked this book and thought it was a nice supplement to use in addition to or in place of First Aid for Step 2 CK.
  • Master the Boards Step 2 CK (optional): Another resource that students found helpful to use instead of First Aid or Step 2 Secrets.
  • NBME Practice tests (optional): I only took one NBME practice test at the beginning of my studying so that I could get a sense of what my baseline score was. Others found it very helpful to take additional practice tests to gauge their progress, but I focused instead on the Qbank, since the NBME tests don’t have answers included.
  1. Prep Time

Deciding whether to take a dedicated month to study vs. taking a very light rotation during Step 2 studying is totally up to you and you knowing how you study best. I took a month off to study and studied intensely for 3 weeks for CK and then took CS the following week. Other classmates took easier rotations (tox, path) and studied during those electives and also felt like they had plenty of time.

  1. Scheduling Your Test

Schedule your test early! You will be happy to be done with it. Most students recommend taking the test in July or August. Also, if you did not do as well on Step 1 as you had hoped, Step 2 is a great way to show you’re a good test taker (because in general most students do much better on Step 2) so make sure to study hard and take the test early enough so that your scores are released by the day residency applications are due.

  1. Other Advice

Studying hard for shelf exams throughout third year definitely helps prepare you for CK, so you are more prepared at baseline than you think! The test is long and just like a shelf exam time you often feel pressed for time to complete each section. Do as many practice questions (I used Uworld) as you can and try to work on managing your time so that you don’t feel rushed on your test day. Just like for Step 1, you will have breaks during your test so bring snacks and warm clothes (the test center is freezing!). Most people do better than they think so study hard and good luck!

Neeta Malviya, Class of 2017

About the Test

Step 2 CK is a 9-hour exam taken at the beginning of the fourth year of medical school after completing the core clerkships. The test essentially feels like a really long shelf exam, but the style of questions is very similar since the NBME writes all of these exams. The majority of people do much better on Step 2 than on Step 1 even with less studying. This test focuses more on the next step in a patient presentation. Questions such as which lab or test to order next. There will also be plenty of diagnosis questions as well. Overall the test seems to be less memorization heavy than Step 1 given that there is none of the nitty gritty biochemistry, pathway, or mechanism questions.

Study Materials

UWorld (a must): You will be using UWorld throughout the year to prepare for your individual clerkship shelf examinations. While studying for Step 2CK you can reset the QBank for free and redo all of the questions from the year. Again, you should focus on understanding the explanations and really reading through all of them well. The exam is very similar to UWorld.

First Aid for the USMLE Step 2 CK (optional): I did not personally use this resource but I know several people who did. The general consensus was that it was definitely not as good as First Aid for Step 1 and was lacking in organization. You can use this as a reference for individual topics that you feel that you are weak in based on your performance on UWorld.

Master the Boards Step 2 CK (optional): I liked having a book to read through for the exam and this was the one that I ended up picking. I felt that it highlighted in bullet points some important concepts for the exam. Beware that certain aspects of this book are outdated in regards to guidelines and recommendations.

NBME Practice tests (optional): I found the practice tests helpful because it let me know where I was standing in regards to my score and if I was in the range I was aiming for on the real test. While these tests do not provide you with answers they do provide you with the questions that you missed and you can go back and read about it on your own to figure out the answer.

Individual Shelf Prep Books (optional): I had accumulated these books throughout MS3 from studying for shelves and only pulled them out if wanted to review a very specific topic that I felt that I maybe had forgotten. Peds was my first clerkship so I felt very rusty on those questions, which is why I brushed up a little bit on some of the chapters from my peds shelf books. Otherwise, you really do not to be reading entire shelf prep books.

Prep Time

Depending on your own pace and preferences, you can choose to take a dedicated month to study for CK or you can study while concurrently on a lighter elective month. Plenty of people have chosen either route and have done well. Step 2 does not require the same degree of intensive studying as Step 1 did as you will have already completed a year long of shelf exams and studying for those will have you pretty prepared for CK.

Scheduling Your Test

Schedule your test as early as you are able to so that you have the most dates to choose from and can take it in your desired testing center. The school now requires Step 2 CK to be taken by the last week of September due to certain residency programs wanting to see the score prior to granting interviews. Plan accordingly because it is during this time frame that you will be completing your Sub-I, away rotations, and residency applications. Taking it sooner rather than later is definitely sound advice so that you still have MS3 fresh in your head and you can get CK out of the way before you have to worry about residency applications and away rotations. I ended up having to take CK in the middle of an away rotation, which was not fun, so take it as early as possible!

Other Advice

Step 2CK really tests your endurance more than anything else. You know your stuff from studying throughout the year, so make sure you do your best to prepare to take an exhausting 9 hour exam. Bring plenty of food, snacks, and ibuprofen/acetaminophen just in case. Be careful of your caffeine intake if it has you running to the restroom too often during the exam. I took a simulated full length test by doing 8 blocks together under the same timing and break conditions as the real test in order to plan out my breaks. Resist the urge to rush through the last block because you are tired. I took a longer break before the last block and stretched to wake myself up. I ended up taking multiple small breaks between many of the sections because this is what worked best for me. Figure out how you are best able to fight exam fatigue and use those strategies on test day.


Caroline Smith, Class of 2017

  1. About the Test

You have 12 patient encounters with standardized patients and potentially a telephone encounter. You have 15 minutes to interview each patient and 10 minutes to write each patient note. The test is only held at a few places around the country (most UTSW students pick Houston but any site is fine). The test is graded as pass/fail.

  1. Study Materials
  • First Aid for the USMLE Step 2 CS (recommended): I went through the entire book one time and the mini cases twice and found the book very helpful. I also recommend going through the cases with friends or family to simulate patient encounters. Pay attention to what details the book writes in their sample notes so that you can write quick/pertinent notes on exam day.
  • Website (recommended): Take a look at the CS website the day before the test. If you tend to write a lot, the only problem you may have on exam day is running out of words. Practicing the day before the test on the online template (link below) will allow you to gauge how much space you will have on exam day.
  1. Prep Time

Most people study anywhere from a day to a week for this exam. While for most the exam doesn’t require much prep time, don’t blow off the test because you don’t want to fail! Your COSCE is a good metric for you to determine how much time you need to prepare. If you were close to failing the COSCE, definitely take a more time to study. I would say you need less prep time if you take CS in close proximity to CK because you already have the knowledge base from studying for CK.

  1. Scheduling Your Test

Schedule the test as early as you can. Most people recommend July, August or September. You’ll be happy if you get it done early. I recommend taking CS close to when you take CK so that you are fresh on possible diagnoses from CK studying. I took my CS the week after I took CK.

  1. Other Advice

Be friendly/empathetic during every patient encounter. Always wash your hands (or foam in). Be thorough in your patient encounter because there are checklists the standardized patients evaluate you on. In your note, always include all elements of the Subjective/History (HPI, review of systems, Past medical history, Surgical History, Social History, Medications, Allergies). Be careful with abbreviations as there are only certain sanctioned abbreviations. If you have one bad encounter, don’t get bogged down just keep moving since you have plenty of others to make up for it!


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