I have recently passed the Step 2 USMLE and thought I should share my experience. I had earlier shared my Step 1 experience in the Step 1 Forum. My preparation for Step 2 and this review is along similar lines. My advice may apply more to the IMG, and the practicing clinician but others may find it useful too. The advice also assumes that you have at some stage in your life had a reasonable exposure to clinical medicine.
Just a few words on my background. I graduated from Medical school in Nigeria in 1990. Since 1992 I have engaged purely in surgical practice so my contact with the non-surgical specialties is very distant. I am a resident in cardiothoracic surgery in the United Kingdom and only want to go to the States for a year to do a fellowship. For this reason I just needed a pass mark for the USLME. My advice would therefore be less useful for those who require a high score but for those who are struggling to pass or just need a pass. My advice might be slightly tainted because I have been a clinician for over 10 years and have taken many exams in my time.
I took my Step 1 in September 2003. In October I had a break from USMLE to sit an (unrelated) surgical exam and then I sat Step 2 in November. Many enquire as to the best sequence to do Step 1 and Step 2...I certainly found that a reasonable amount of the stuff I read for Step 1 was useful in Step 2 and felt the short interval between the two exams was a bonus.
I used exclusively 2 sources for all my study for Step 2
1) Crush the boards Step 2 2003 edition
2) QBank 1 month $150 for online version
I did not own or use any other books. I think this is the most important aspect of preparation – RESTRICT YOUR READING MATERIAL. There are always books to read, Internal Medicine, Gynae, ENT, Dermatology, Pharm etc containing 100s of pages each. The list of books and sources is limitless and you could spend the rest of your life reading for this exam. I think the key to time management is not to waste time on things that yield low output. There is no need to read a big dermatology book when Crush the boards can provide you answers on 90% of the dermatology questions in exam. Unless you intend to get more than 90% correct why read bigger books? Reading big books is for those who need to score 99. If you want to pass there is more than enough in crush (or any good review book). Also bear in mind that the objective is to pass and NOT to acquire knowledge, so if Crush the boards lists 3 causes or associations just acccept them and understand that they will answer 95% of questions, no need to go to Harrison‘s and search for 10 more rare causes and associations that will answer only 5% of questions on the topic. Move to the next fact, don’t be greedy and try to get all the marks cos the time you spend, maybe 30 minutes consolidating on one fact that might yield you one correct answer (or none) in the whole Step 2, you could have used to cover a broad topic that would answer you five questions.
Duration of preparation
I sat my exam 19 November 2003. I started preparation October 20 2003. Prior to this I had done no preparation whatsoever towards step 2. In the week before the exam my attention was somewhat divided as I was sitting CSA the following week on 24 November and started also preparing for that exam. My last exposure to Obstetrics, Gynae, Paeds, Psych, and most of Internal medicine had been in 1991 when I did my internship. Also my exposure to these specialties had been in a developing country where the emphasis, exposure and practice differs from USMLE standard. I was working full time as a resident in cardiac surgery and worked all through my preparations up to the day before the exam. As you can imagine being a cardiothoracic resident is very busy, working over 80 hours a week. So depending on how busy my day has been I would study for 0 minutes to 2 or 3 hours maximum on weekdays and several hours on weekends. The only reason I include this is to illustrate to you that it is possible to PASS this exam with minimal effort and a short period of study provided you use the right approach (and assuming you have a good clinical foundation). I think rather than preparing for months and then putting in for the exam you should put in for the exam immediately leaving a SHORT period of preparation, maybe 2 months, 3 months max. You will then focus your preparations. You can then understand why I did not read big books…I simply could not afford to as I just had 4 weeks to prepare and was working full time. Big books is for people who have the time…but then even if you have time why waste it?. Use it for something better. Although I used only 4 weeks to prepare, I do recognise others may need longer, particularly those out of clinical practice or those practicing in relatively restricted specialties such as ophthalmology, psychiatry, gynecology etc. Those in acute medical specialties should not need more than a month or two.
Sequence of preparation.
I had 4 weeks to prepare. In the first week and a half or so I read Crush cover to cover once. I then registered for Q-bank which would become my sole method of study for the 3 weeks up to the exam.
When I wrote my review for Step 1 I was accused of being an agent of Kaplan masking as a USMLE taker. Well I again make no apologies for again promoting the ONLINE Qbank as a sure way to PASS Step 2 with minimal effort! QBank to me is the MOST IMPORTANT contribution to my passing the exam. My advice to you is to buy the online version. It is well worth the 150 dollars. If you pay for a month's access you will be forced to work hard and finish the 1000+ Qs in a month and take the whole thing seriously as you don’t want to waste your hard earned money. If on the other hand you had a free disc you probably would not finish or would pace yourself and spend the next 12 months studying. Also the online version gives you better feedback on your progress. If you are concerned that 150 dollars is a lot to pay, I would say it is much cheaper than the 800 dollars it would cost to retake the exam and the hundreds of dollars you will spend from interview to interview if you do not make a good score. Other question banks may serve the same role but I only have experience in QBank.
QBank has 3 main roles, it gives you concentrated knowledge in a manner that is easier to retain (compared with reading big books), it offers you self assessment, and it prepares you for the real thing. To dismiss the last point first, if you have done loads of QBank tests the real exam would not overwhelm you, your time management will be precise, your marking methods will be spot on, you will learn your own limits, how to guess, when to change and not to change etc. In other words you will know how to play the game…it is a game and while knowledge is important, probably more important is how you play. For every person the optimal approach to answering questions differs, for example the traditional teaching is not to change an answer unless you have a good reason to do so. My experience from Qbank was that when I did change answers, it was from incorrect to correct in 65%, correct to incorrect in 15 and incorrect to incorrect in 20 so this gave me the impunity to change responses in the real exam. So QBank will help define the best approach to answering questions for YOU.
I think Qbank is particularly important for Step 2 because of the long windy questions you encounter in real exam. It is an art being able to maintain concentration and read a whole parable prior to answering a question. Often half way reading the question you forget you are in exam and your mind fades and strays. You get to the question - which is the next most likely step in management of her abdominal pain? Then you suddenly say to yourself, abdominal pain? Never knew she had abdominal pain, then you have to start reading the preamble again. Before you know it you have 5 mins left and still at Q 38. A lot of people struggle with time management in Step 2 and one way to be sure you never get caught out is doing repeat practice exams on Qbank. The questions in Qbank are often longer than in the real exam so by time you are through with Q-Bank, the real exam should not surprise you.
NEVER do QBank in a tutor mode (or you lose on the latter 2 objectives). Always set yourself tests of 46 questions so you would have done so many simulated exams that the real one cannot faze you. Don’t despair when you fail questions. Indeed it is better to fail questions because it points you to your areas of deficiencies. No point wasting time on things you know already. After each QBank test review ALL the answers…study Kaplans explanations and read the relevant areas in Crush. As you go along you will get better and learn the art of question answering. You will never get all questions right…some of them are stupid…some require too much effort. If it requires too much effort to grasp leave it and accept you will fail it if it comes out in the real exam. Accept some areas are your impossible subjects and don’t put too much energy into changing that, you cannot be good at everything. Forget it and move to the next. Your performance should increase over the 4 weeks; I started at about 60% and ended averaging 80% or so. Overall average was I think 73%. Actually I never completed QBank, I stopped at about 1000 Qs because I felt my score had peaked and I had covered most areas enough to pass the exam. Like I said why put in any more effort than you need to? Also QBank will tell you your strong subjects (forget them) and weak subjects (read relevant Crush the boards chapter again). By the time you have finished QBank there will be few things they can ask in the exam that you have not dealt with in one way or the other. And you can get all this in 4 weeks…believe me.
I will not go into the exam in detail because previous discussion threads give a very good insight into the exam. Only comments I will make is that you do it as if you were doing QBank. If it worked for QBank it will work in main exam. Just imagine your USMLE was another test on the QBank…if you passed the last 10 you did with over 65% you will certainly pass the USMLE too (provided you answer in exactly the same manner). Remember USMLE is set by human beings too and they can’t be much different from the human beings setting Kaplan so not many new things they can think of. Don’t think too hard…there is no problem with failing one question…indeed there is no problem with failing 100…you will still pass. As you go on you may realise from present questions that you failed a previous question in an earlier block as subjects are often repeatedly tested…just smile or laugh and move on. Remember there is an element of competence based testing so performing ‘badly’ on a block doesn’t mean failing. Also be prepared for many strange questions, some I doubt anyone other than the person who wrote it knows the answer, smile again, mark B, C or D and move on. The question probably won’t even count to the final score. There is another type of question though which is very long and seems to ask something you know nothing about; don’t bother reading those, mark them and then come back to them if you have time. When you come back you may find the question has a workable answer.
After the exam
You will remember loads of questions you failed. You will hardly remember any you passed. That is human nature. Smile and get on with whatever else you have to do.
Hope you find this advice useful. I think the reason most people fail any exam has nothing to do with knowledge but all to with their approach to preparation. Follow the path of least resistance - get rid of those big books, read Crush the boards, do QBank! Months of preparation won’t make that much difference…it is how you prepare that matters. For most people, provided you have been through medical school okay (without struggling), it should be possible to PASS without excessive effort. I don’t think my approach is risky either; using the above approach my score was 94/232 so there is plenty of safety margin.
Best of luck