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Studying Smarter, Not Harder: The Value of a Longitudinal Study Approach to the USMLE Step 2 CK

During medical school, many of us attempt to study by cramming at the last possible moment. We tell ourselves that we have adequate time during dedicated study periods to fill in our knowledge gaps. While this can work for some students, for some exams, it does not work for many, especially on massive exams like Step 2 CK. Even if cramming does work in the short-term, it is a much more stressful experience than studying needs to be. In light of this, I want to highlight some tricks and tips for applying a more longitudinal, year-long study strategy that will not only increase your Step 2 CK score but also protect your well-being in the process.

1. Understand the purpose of Step 2 CK

CK tests the knowledge that students should have gained during all of the following core rotations, listed here in order of content representation on the exam: Internal Medicine, Surgery, Pediatrics, OB/GYN, and Psychiatry. Studying for each core rotation is basically learning small chunks of Step 2 CK material in a nutshell. Given this, doesn’t it make more sense to build your foundation for CK as you go, rather than wait until your test is a few weeks out and cram?

2. Implement a study strategy on each clinical rotation

At the end of the day, studying over time helps in two ways: 1) you will look like a rockstar on your clinical rotations, and 2) you will have a solid foundation for dedicated study time from which to build. Here is the simple, streamlined approach for studying for shelf exams:

  • OnlineMedEd: This is your crash course on the essential vocabulary of a specialty and should be your emphasis the first week of a rotation. The videos are easy to digest and facilitate a simplistic but near-comprehensive understanding of each subject. I would recommend watching these first before starting questions.

  • UWorld: This is the “bible” of practice questions and contains almost all the information you need to know, for shelves and CK. There are a few options on how to use it on your rotations. One approach is to set a daily question goal (the number of questions for each subject divided by the number of days left in a clerkship). I highly recommend starting them after watching OnlineMedEd. You will still have plenty of time on the rotation to complete all the questions.

  • Anki: I will talk about this tool in a separate section because it is so important.

  • Clinical Mastery Series (CMS) practice NBMEs: Each rotation has four practice NBME exams similar to each shelf exam. Each one costs $20, but they are time and money well spent. Sometimes, if you are lucky, nearly identical questions will appear on the actual shelf exams.

  • Shelf-specific resources: For surgery, in particular, Pestana’s is a quick read on surgical management that is a great resource to use. Additionally, there are 2-hour review videos for most rotations done by a physician named Emma Holliday. You can find these on YouTube, and they are great reviews to watch a few days before your shelf exam.

I do not believe it is wise to spend time reading in-depth textbooks on rotations, as all of the information you need to know is in the following resources. Many of my fellow tutors at USMLE Pro agree. If you have the time and interest, you can consider pursuing them, but not at the expense of mastering the core resources.

3. Use Anki (yes, you really have to)

Anki is not a recommendation – it’s a MUST. You can use this program in two ways:

  • Making your own review cards: On each rotation, create a new deck for that rotation. As you review the UWorld questions you answered incorrectly, you should make cards to understand why the answer choice was right, why the other answer choices were wrong, and what the key take-away points are. The facts on the card should be the facts that, if you had known them when you answered the question, you would have gotten it right. The crucial bonus of making your own cards is that when it comes time to review for CK as a whole, you have an incredible resource library from which you can re-learn or review your core topics. You have all of the information in one place and don’t have to put as much time and effort into making cards during your dedicated period.

  • Using pre-made cards: while the pre-made decks aren’t as tried and true for CK as they are for Step 1, I still think it can be worthwhile to use a pre-made deck, especially on downtime on core rotations. Step 2 Zanki is probably the best one currently available and is a great way to stay fresh with your knowledge and do something active on clerkships. Making your own cards is still the ideal approach.

4. Don’t study every night of 3rd year: Take time for yourself!

For most students, studying for CK is not nearly as arduous a task as prepping for Step 1. While some rotations require more than others (specifically IM because there are so many questions to get through), you do not need to be doing practice questions every night. Often, just taking 30 minutes to read about your patients’ conditions is a great way to spend your time. Your clinical year is a marathon, and it is important to space out studying and take time for yourself, including getting adequate sleep and exercise.

5. Your dedicated time should look like this...

After you have all of your Anki cards made, you should use your dedicated time to go through all of the cards you made, re-watch some OnlineMedEd videos, and master the NBME practice tests. If you study diligently throughout the year, your dedicated time should be more of a review than learning information for the first time. I promise that it won’t be nearly as stressful if you space out your studying during the year.

While this post is nothing revolutionary, many students overlook the message that you should be preparing for Step 2 CK CK for an entire year rather than just during your dedicated time. Countless students who have skipped critical steps--like doing the NBME practice tests--will ask if it’s worthwhile to go back and do this during their dedicated study time. Often, there isn’t time to do this. Instead, use each rotation as a building block for CK, trusting that if you master the information on shelf exams, you’ll have sufficient knowledge to achieve excellent clinical evaluations while also laying the groundwork for a fantastic Step 2 CK score in the process.

Benjamin Bernard is a student in the University of Missouri-Kansas City’s 6-year BA/MD program and is currently applying for ENT residency. He tutors for the USMLE Step 1, Step 2 CK, and shelf exams with USMLE Pro.

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