Preparing for Step Two
The USMLE Step 2 is broken into two distinct sections. The first section is designed to test your knowledge of the clinical fundamentals needed for the practice of medicine ("Clinical Knowledge", also known as USMLE Step 2 CK). Like any standardized test, it has its problems, but it tries to ensure that students are ready for the clinical part of their training.
The second part is USMLE Step 2 CS, or "Clinical Skills". This is a "live" exam in which you have 15 minutes to examine "Standardized Patients." The goal of this part of the exam is to determine if you have the basic skills in history taking and physical exam.
There are several clinical tasks that the USMLE step 2 tries to address, including topics like preventative medicine, disease mechanisms, differential diagnosis, and patient/case management principles. All questions are multiple choice, but requiring either 1) best answer, 2) matching one-to-one, or 3) matching with more than one answer.
Basic Techniques for Studying for USMLE Step 2 CK
Sample questions. Sample questions. Sample questions.
Having been through the process, it is clear that the most effective way to study for the USMLE step 1 is by using question banks. These question banks focus on the important, tested topics, and do a good job of identifying and explaining distractors.
Focus on your weaknesses.
Because USMLE Step 2 is broken down by topics, you have to perform in all the areas to do well on the test as a whole. You can get an objective assessment of your strengths and weaknesses using practice tests. Built into most USMLE test prep materials are diagnostic assessments that let you know how you're doing in a specific subtopic.
Study for the USMLE as you study your medical school course.
This seems like a trivial answer, but it's not always implemented. Some medical schools use board-exam like tests in their courses, but some are pass-fail. If you're in a pass-fail course its important to realize that you're preparing for the USMLE - and study that way.
One of the biggest pitfalls for students who don't see success on the 1st round with USMLE Step 2- can be their clinical experience. Students are used to their practical hands-on experience (which is great since this is what Step 2 is testing) BUT they are used to working in the 'real' world. Step 2 tests focus on hypothetical patient situations in 'USMLE-land' which is a strange world where everything works right the first time. Students often have a hard time separating what they would do in the real world from what USMLE wants them to do. USMLE typically is looking for answers that are more procedural than they might do when face-to-face with the patient situation. The great news from this is that a med student is in the BEST place to take this exam because their clinical experience helps prepare them for the Step 2 CK more than their first two years prepped them for the Step 1.
Another dilemma that students face with Step 2 CK is that the exam presents questions and case studies NOT grouped by subject within a block. For example, you won't find a section devoted to pediatrics. This random ordering of items presents students with a unique challenge. Students must switch from thinking about one subject, such as surgery, to another, such as obstetrics, without skipping a beat. This can be a hard switch if they've just finished rotations where everything is block oriented. It is important that students mentally prepare for this constant switching back and forth.
Students who take the exam more than once also deal with a great deal of stress that has nothing to do with the exam itself and everything to do with the fact that they are taking the exam again. This stress is increased immeasurably with the 3rd attempt- so students need to learn to work through anxiety issues and explore relaxation techniques that work for them. Students also need to focus on positive mental preparation, i.e. telling themselves that they will succeed on the exam vs. telling themselves that they will fail. Guided imagery is one tool students can utilize to help accomplish this.