Tags: USMLE® Step 2 and COMLEX® Step 2
Sarosh Vaqar, MD; Hospitalist, Clinical Volunteer Teaching Faculty, and Medical Student Mentor
So you just finished the first two years of medical school and aced the USMLE® or COMLEX® Step 1. Life is good. You are seemingly on your way. The simple reality is you are really at the beginning of a long journey, and how you prepare for USMLE® Step 2 CK or COMLEX® Step 2 and USMLE® 3 or COMLEX® Step 3 may very well set the stage for selecting your residency training specialty of choice, getting into the best training program, and most importantly successfully becoming an outstanding clinician.
After mentoring a little over 500 medical students, plus making a lot of mistakes along the way myself, I think over time and experience, I have learned what it takes to achieve the top score on USMLE® or COMLEX® exams, and in particular, USMLE® Step 2 CK or COMLEX® Step 2. It is unnecessary how much time you devote, but how you devote the limited time you have to prepare.
I believe the best students start preparing on day 1 of their first clinical rotation. I mentor my students in a three-fold study approach.
First, during each of the big five (medicine, pediatrics, surgery, psychiatry, and obstetrics/gynecology), I recommend spending a minimum of one hour a day doing practice questions every single day of the rotation, always marking any question you missed. I also recommend completing the NBME®️ or NBOME®️ Self-Assessment towards the end of the rotation. While studying, take brief notes. By the end of your 3rd year of training, you should have several hundred pages of facts that need to be reviewed before the USMLE® Step 2 CK or COMLEX® Step 2.
Second, every night before you go to bed, or when you are waiting for the attending to round, spend a minimum of 30 minutes doing random practice questions on the prior rotations you have completed and missed. In other words, keep going over what you have learned previously, particularly the questions you missed. When you finally get a day off, devote a portion of your free time to review your notes.
Third, make the USMLE® Step 2 CK or COMLEX® Step 2 a priority. It is probably best to take the exam within 3-6 months of finishing your core clinical rotations. Make sure you schedule a month off before the exam. This should be treated as the most important month of your life. This is the time when you lock yourself in the library, and you don’t come out until the day before the exam.
At this point, you should have already identified your weaknesses; you should have hundreds of pages of short notes to review. In addition, you should have purchased a year-long subscription for at least one database of questions where you have identified every question you missed. Go over every one of them. Make extremely brief final high-yield notes. Devote a portion of each day to review concepts you are still missing.
In the case of the USMLE® Step 2 CK or COMLEX® Step 2, the early bird gets the worm. Be diligent, use the clerkship year and practice shelf exams to prepare yourself to achieve a high score. Most of these questions are clinical scenario-based, so at the same time you study for the USMLE® Step 2 CK or COMLEX® Step 2, you are also preparing yourself to become a great diagnostician.
If you want to achieve a competitive score for the best training program possible, make sure you commit to a long-term study plan. As time narrows down, you have dedicated at least a month with no distractions to your USMLE® Step 2 CK or COMLEX® Step 2 preparation.
The amount of time needed depends on how far you are away from your core rotations and if you have failed to plan ahead and do random questions daily. I tell students they should spend their entire 3rd year and any free time they have preparing for the USMLE® Step 2 CK or COMLEX® Step 2, and then take at least a dedicated month off before the exam.
James Hughes, MD; Associate Professor Family Medicine (retired), Volunteer Teaching Faculty
Doing well on USMLE® Step 2 CK or COMLEX® Step 2, in my opinion, involves organization and careful time management.
Students with a bad USMLE® Step 2 CK or COMLEX® Step 2 study plan and poor time management will waste time, and they are unlikely to do well. The students I have seen with challenging scores are those that wait until the last minute. Time after time, I have had students with a well-thought-out USMLE® Step 2 CK or COMLEX® Step 2 study plan, starting early, allowing time each day to study, lead to the best results.
Another reason for poor performance is those that attempt to memorize rather than master the concepts. There is far too much information in medical school to memorize it all. You have to develop an understanding so that you learn to apply the concepts to patient care.
The transition from classroom learning to clinical care and application is also a challenge for some students. Clinicians work in interdisciplinary teams with residents, medical students, nurses, and multiple allied health professionals working toward the same goal of improving patient care.
Medical students have to transition their thought process to thinking about acquiring lifetime learning skills rather than just getting through the next exam. This necessitates a far different approach to studying for USMLE® Step 2 CK or COMLEX® Step 2 that is very different from preparing for USMLE® Step 1 or COMLEX® Step 1. This approach is how most physicians build upon and improve their practice skills.
The student needs to start with their basic science foundational knowledge, then learn to apply it to patient care. In my opinion, this means doing as many clinically vignette questions as possible. In some respects, this is very similar to the practice of medicine. The more patients you have seen, the more you become skilled at recognizing patterns and deviations from the expected.
Time management and organization are, in my opinion, the key to a student achieving high USMLE® Step 2 CK or COMLEX® Step 2 scores while simultaneously shining in clinical rounds. The approach I recommend is as follows:
- Read StatPearls articles on all patients daily and do all the review questions associated with the topic. StatPearls is the only teaching system I am aware of that has articles on all topics with 5 to 10 practice questions.
- Spend at least one hour per day doing random questions that cover the current clerkship rotation, make sure you read the explanations, and for further understanding the entire article if a concept is unfamiliar; if you miss a question, mark it for your final review
- Spend at least 30 minutes per day repeating questions from clerkship rotations you have previously completed
- Take brief written notes on any point you missed and review on your days off
Prior to End of Rotation Exam
- Review questions you missed
- Review your notes
- Complete a practice NBME®️ self-assessment examination
Prior to USMLE® Step 2 CK or COMLEX® Step 2 Exam
- Take one month off for a detailed focused review
- Review all questions you missed over your year-long clerkship study on core topics
- Review all your notes
- Complete a practice NBME®️ USMLE® Step 2 or NBOME®️ COMLEX® Step 2 self-assessment exam and identify and correct knowledge deficits
Focus every day of your clinical training on increasing your foundation of knowledge and honing your evaluation and diagnostic skills by:
- Daily mastering new material by reading StatPearls articles and questions
- Daily review so that you don’t forget what you have already learned
Soon you will be saving time by building on a strong knowledge base based on an active ongoing learning mentality. This process will be carried on throughout your life as an attending physician. The best doctors stop to take the time to read about new patient problems and are constantly adding to their fund of knowledge by reading articles. Soon your patients will become the questions, and you will be responsible for making the correct answer or decision for the best patient care.