My USMLE Step 2 CK Exam Experience: What You Should Know

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Hey all! I just finished taking USMLE Step 2 CK this past weekend and wanted to share my experience for those who may find it helpful! For those who don’t know, the USMLE is a three-part series of exams necessary to obtain a medical license in the U.S. Step 1 and 2 are taken during medical school whereas Step 3 is taken during first year of residency. Step scores are heavily evaluated by residency programs to determine a student’s competitiveness for residency. Step 2 is broken down into two parts: Clinical Knowledge (CK) and Clinical Skills (CS). CK is a 9-hour exam that includes 8 blocks of 40 multiple choice questions with 1 hour total break time. Meanwhile, CS is an oral exam that requires interaction with standardized patients.

While preparing for Step 2 CK, I found reading other students’ experiences extremely helpful. So, I’d like to pay it forward by offering my thoughts on this exam.

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Content

• 15% of the questions were simple, short, and straightforward. These were first ordered questions on high yield topics we see all the time. There were also a few on basic Step 1 knowledge (i.e. What is the virulence factor for the bug that causes this disease?).
• 35% of the questions were extremely tough. These consisted of very long, convoluted stems. 3rd or 4th order questions. Terms or topics I had never seen before. I mainly guessed on these, marked them, and moved on.
• 50% of the questions were fair. They covered topics seen in Uworld or NBMEs. I usually could narrow it down to two answer choices and made a well-educated guess.

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Timing

• Surprisingly, I finished each block with roughly 5 minutes to spare. This allowed me to go back through my marked questions (about 8-9 per block). The questions stems were shorter than most of the Uworld questions and represented NBME-style questions. Of note, timing was something I worked a lot on during dedicated since I ran out of time on many blocks during Step 1.

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Stuff I’ve Never Seen Before

• Abstracts from research studies. Ok, I think there’s an example of this in the Uworld Assessment. But, the ones on the real exam were much more complex and required strong critical thinking skills. These abstracts require one to interpret a study, apply it to a patient case, and identify the strengths and weaknesses of the research study. I had two abstracts and they both consisted of three questions each.
• 38 questions per block. The two blocks that contained the abstracts consisted of 38 instead of 40 questions. These questions took longer to get through so I’m glad the test writers accounted for this.
• Patient presentations. Although new, these weren’t terribly hard. They consisted of an admission note (i.e. patient age, chief complaint, past medical history, review of systems, physical exam). The questions corresponding to these were fairly straight forward, “What’s the diagnosis?” “What’s the next step in management?” I had maybe 4-5 of these total.

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Miscellaneous Points

• The audio stems of heart sounds were tough. I could not distinguish which murmur was being presented and the question stem wasn’t super helpful in giving away the answer. There were about three of these on my exam. I had a few derm images that asked 2nd or 3rd ordered questions that weren’t covered in Uworld. Otherwise, this topic was fairly low-yield.
• To my surprise, I didn’t have any questions regarding pediatric vaccine schedule or developmental milestones.
• Biostats. I had about 7-8 first ordered questions that covered a broad range of topics such as power, bias, relative risk, tests, and error.
• It was a comprehensive exam and I didn’t feel like there was one particular subject that was more heavily covered than others.
• Most of the questions asked, “What is your initial step in management?” All the answer choices included steps you would take to manage that patient but forced you to decide which is the best first step.
• There were questions on basic Step 1 knowledge sprinkled in throughout (about 1-2 each block). There’s really no way to prepare for these. I don’t think spending hours reviewing all of Sketchy or First Aid is worth it.
• There were a few questions very similar to those on the NBMEs (almost verbatim). Even though the NBMEs are notorious for underpredicting scores, these exams serve as a great guide to understanding high yield, testable topics.
• Public health and ethical questions. I struggled with these and felt like Uworld didn’t cover them well. I had about 1-2 each block with at least 3-4 questions on public health topics that I had never even heard of!
• Compared to Step 1 or Uworld, there weren’t many questions that required multiple answers within the answer (i.e. up/down arrows for different values). I only had one or two of these questions total.
• If I had to compare it to Step 1, this exam is slightly easier. Step 1 seemed like a complete blur whereas I was able to reason through many of the questions on Step 2 and make well-educated guesses.

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Study Plan

I plan to do a more comprehensive post on this later. But as a quick overview:

• I had three solid weeks of dedicated studying. In an ideal world, I would have pushed my exam back a week (mainly because I didn’t finish Uworld), but knew this wasn’t possible with the COVID-19 situation.
• I completed Uworld throughout my third-year clerkships, resetting it a week before my dedicated period. I did 1-2 blocks of 40 questions a day during pre-dedicated (while on my neurology clerkship) then 4 blocks a day during dedicated. I didn’t finish Uworld (had about 300 questions left).
• I used Online Med Ed and Zanki as supplemental material.
• I looked up management algorithms on UpToDate and highly recommend doing so!
• I completed all the NBMEs and Uworld Self Assessments. My NBMEs ranged from 230s-240s and my Uworlds were in the 250s.

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I made this for you so that you can stay organized and overcome the overwhelm during dedicated Step Studying!

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Biggest Advice

• Mentally prepare yourself for this long exam. Step 2 CK includes one block more than Step 1, but with the same amount of break (1 hour total). The extra block may sound like nothing, but this 9-hour exam requires so much endurance and stamina. Remember to think positive thoughts. Take a few minutes to reset after each block. Don’t bring anxiety from one block to the next.

COVID-related Concerns

• Yes, you do have a wear a facemask for the entirety of the exam. If you’re nervous about this, practice wearing a face during an exam at home. It sounds silly, but on Test Day you want to minimize any distractions (i.e. the mask feeling uncomfortable or slipping). I personally used a cloth one, but my classmate who took the exam the same day used a surgical mask.
• Confirm your appointment. I called the local Prometric center to check on the status of my appointment 8 days (5/13/20) before my exam. They picked up right away, confirmed my appointment, and told me they didn’t foresee any future cancellations. I also received a confirmation phone call the day before my exam. I highly recommend calling your local Prometric site beforehand to confirm your exam, if possible.
  
  

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Hope that was helpful! I’m happy to answer any questions- just comment below! Good luck!

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