USMLE Step 2 CK Books And Study Strategy

I recently took USMLE Step 2 CK, which explains my absence from blogging on here. While I do not have my score yet, I figured I would share my study strategy as well as the books and resources I used to prepare for the exam. Relative to USMLE Step 1, preparing for Step 2 CK is a much shorter, much more straightforward process. Of course, people may have different goals and needs for their Step 2 score, but I think for most people it ends up being a test you simply have to pass to continue with your training as a physician in the United States.

USMLE Step 2 CK Study Schedule

With regards to a study schedule, someone mentioned the saying "2 months, 2 weeks, 2 days" to me, meaning that one should take 2 months to study for Step 1, 2 weeks for Step 2, and 2 days for Step 3. And, from what I know so far, I think that is roughly correct. I'd say I spent about 2 and a half weeks studying for the exam. For the first week or so, I simply read through a review book on Step 2 concepts (more on that below). For the remainder of the time, I simply did qbank questions. The schedule was pretty packed, but it worked out well in the end. I don't think spending any time over 3 weeks would have been worthwhile. Some people may be considering taking a review course. If you feel like your basic science and clinical knowledge are not as strong as you want them to be, or feel like passing may be a challenge, then it is worthwhile to consider. However, for most test takers, a Step 2 review course should not be necessary if you simply are studious, read a bit, and complete a qbank.

USMLE Step 2 CK Books

As with any major exam, everyone always wants to know what is *the* book to use to study. When I was looking, the main options people seem to gravitate towards were First Aid for the USMLE Step 2 CK, Crush Step 2, and USMLE Step 2 Secrets. Honestly, any of the three books would be fine, I think. However, I first narrowed it down between Crush and Secrets. You may note that both books are actually written by the same author, Adam Brochert. I can't imagine they would contain very different information, so I went with Secrets over Crush (I guess I like having Secrets more than Crushes? I don't know). Then, I compared First Aid for the USMLE Step 2 CK and USMLE Step 2 Secrets. Initially, I thought I would go with First Aid, given how much I liked First Aid for the USMLE Step 1. As I read through the comments though, I noticed that many people found that First Aid for the USMLE Step 2 CK was not clinically-oriented enough for their tastes, which matters as Step 2 CK is more of a clinical exam. Therefore, I ultimately decided to go with USMLE Step 2 Secrets.

USMLE Step 2 Secrets was indeed well-written. The book follows a format of questions and answers a la the Socratic method. The material is divided into chapters based roughly on organ systems, but with a few exceptions thrown in (such as preventive exams and smoking). For students who feel a bit rusty on their clinical material, the book provides a good, broad refresher. However, if you were recently on clinics, or feel generally comfortable with your knowledge base, I think it is debatable whether one needs to read a book to prepare for Step 2 CK at all. What no one is debating though is the value of doing a question bank.

USMLE Step 2 CK Q-Banks
While there are many qbanks for USMLE Step 1, I think the right choice is much clearer for USMLE Step 2 CK. Sure, there are still just as many options, but I think there is much more broad consensus about using USMLE World. Similar to Step 1, the Step 2 CK UW software is a downloadable application written in Java that mimics the FRED Software used by CK. It contains approximately 2300 questions (which translates into about 50 practice sections). It took me about 2 weeks to go through all 50, although I must admit I was rushing a bit at the end. If you were to do 4 sections a day and review each one, then it would take about 6 to 8 hours per day, and about 12 to 14 days to complete the entire qbank. Clearly, doable, but it requires you to be very committed to finishing. I wish I had budgeted a little more time to review the questions I missed, but I think it was fine.

USMLE Step 2 CK Test Day
Again, just as with Step 1, the exam is on a computer at a Prometric Testing Center. Registration is done months beforehand, similar to USMLE Step 1 registration. While Step 1 had 7 sections of 50 questions each, Step 2 CK has 8 sections with 46 questions each. After signing in at the test center, you can place your belongings in a locker. The proctor then calls you into the anteroom, check your ID, takes a photograph, and gives you a laminated sheet and dry erase marker for notes. After entering the testing room, you are assigned a computer and the exam begins. You have a total of 9 hours from this point. The first section is a tutorial that is budgeted at 15 minutes, but you can skip through this if you are familiar with the FRED software, giving you 15 extra minutes of break time. The next 9 hours are just... tedious. You can take up to an hour of breaks, scheduled however you want them, in between any of the sections. I chose to take a 15 minute break after section 2, a 30 minute break for lunch after section 4, and a 5 minute break after section 6 just because my eyes were getting tired. Although Step 2 is longer than Step 1, the test day felt much better simply because I was not as stressed. You'll be tired at the end of the day, but glad to be done. Good luck!


Updated 2015-12-18

25 Things I Learned From Studying And Taking USMLE Step 1 and 2 CK

Excuse my absence the last few weeks, but I was busy studying for USMLE Step 2 CK. Going through review books and practice questions, I came to realize that I had learned many important stereotypes and other truisms from this exercise, of which I'd like to share a few with you. 

1. Anyone who visits Connecticut gets Lyme disease (Borrelia burgdorferi infection).
2. Anyone who visits Arizona has coccidiomycosis.
3. Young African American female? Lupus.
4. Young African American without Lupus? Sarcoidosis.
5. Farmers have no clue how to use organophosphates properly.
6. Shipbuilders work primarily with asbestos to make ships. 
7. No matter what disease you have, quitting smoking will make it better. 
8. If you have Hashimoto's disease (lymphocytic hypothyroidism), you're way more screwed than you might have originally thought.
9. Foreigner with a cough? Tuberculosis.
10. If you are ever bitten by a scorpion, the only organ system that will be affected is your pancreas. 
11. Anyone stung by a bee goes into anaphylaxis, so everyone should have an epinephrine pen. 
12. Everyone from the Mediterranean has thalassemia until proven otherwise.
13. Every old person over the age of 65 has cancer until proven otherwise.
14. Every woman has autoimmune disease, gynecological cancer, or osteoporosis until proven otherwise. 
15. If you do not have a DSM IV psychiatric diagnosis, something's wrong with you. Don't believe me? Check out what new addiction is being added to DSM V. 
16. Children only have 4 orthopedic problems: development dysplasia of the hip, Legg-Calve-Perthes disease, Slipped Capital Femoral Epiphysis, or Osgood-Schlatter disease.
17. No matter what the ethical dilemma is, never consult your hospital's ethics committee - you know ethics better than they do, or the dilemma really isn't that perplexing.
18. No matter how ridiculous the patient is, you will never fire the patient and always respond calmly and professionally.
19. Pathology slides on questions are to be ignored because the answer is usually in the prompt. 
20. Ditto for x-rays. 
21. The number of drug interactions you need to know is the square of the number of drugs you know. 
22. Your patients will always have 5 possible diagnoses of which you choose one that seems most appropriate. 
23. Medicine is too general and too specific all at once. 
24. The test-making business is a pretty sweet racket if you can get in on it. 
25. Doctors never make mistakes.

Heh, my facetiousness aside, I do sometimes wonder how all this repetition of stereotypes affects how we ultimately end up viewing patients when we go into practice. Hopefully we're still able to keep our eyes open to things that don't fit the 'classic' picture. 

Would More Medical Students Choose Primary Care if They Received Specialist Salaries?

This is a guest post by James over at poorMD.com

Fewer and fewer medical students are choosing to go into primary care fields despite the emphasis and growing need for more internists and family practitioners. When choosing a medical specialty, medical students have many factors to consider: lifestyle, personality match, competitiveness, length of training, and salary (compensation) are some of the major considerations. Let's break down each of the considerations a poor medical student must make when choosing a career: 

Lifestyle: The generalist's lifestyle, while not the greatest, is also not the worst.  In terms of hours worked, it is not as demanding as something like surgery or obstetrics.  

Personality: All sorts of personalities could fit into a primary care field such as family practice, internal medicine, or pediatrics.  Wasn't the whole reason for going to medical school was so you could help patients?

Competitiveness: If you choose not to go into family practice because of competition, you probably never should have made it into medical school.

Length of Training: With generalist training only needing three years as opposed to the five plus years required of specialists, this should be considered an incentive to go into primary care.

Salary (Compensation): The average earnings of a primary care doc is about 55% of the average earnings for all other non-primary care specialties.  Here, I think we've identified a reason for the primary care shortage.

There are many reasons why fewer med students are choosing to go into primary care, but the financial aspect must be a huge consideration.  If I'm graduating with $180,000 of medical student loans, having deferred gratification by going to college, med school, and then residency, and am looking to buy a house and raise a family in the near future, why would I go into primary care, when I could make double or even triple as much as a specialist?

According to the AAMC, family practitioners can expect to make about $142,200 after three years of residency where as a radiologist's salary can see $325, 438 after five years of residency. Sure, the training to become a radiologist is two years longer, but for those extra two years, you can potentially see more than a doubling of your income. 

The fact is, medical training is long and grueling.  Individuals pursuing a medical degree have made huge investments into our futures and hope to see a good return on investment or ROI.  Specializing takes just a few more years and produce greater returns; I've already come this far, what's a few more years?  Show me the money!  So to answer the question posed in the title of this article, YES more medical students would choose primary care if they were compensated better!

The American College of Physicians in their "State of the Nation's Health Care 2009" said:

Medical students and young physicians should make career decisions based on their interests and skills, instead of being influenced to a great extent by differences in earnings expectations associated with each specialty. Yet there is extensive evidence that choice of specialty is greatly influenced by the under-valuation of primary care by Medicare and other payers compared to other specialties.

As the old adage goes, "Do what you love and the money will follow."  I wonder how much in student loans that guy must have had or how long he spent in school.  While I enjoyed my family practice and pediatrics rotations in medical school, I also enjoyed radiology and orthopedic surgery.  But after evaluating what was most important to me, I decided that spending time with and supporting my family would bring me the most fulfillment.  Luckily, I loved radiology and so far it has happened to be a perfect fit.

James, a radiology resident, runs poorMD.com, a website dedicated to providing financial tips and other practical advice to medical students, residents, and fellows. If you're interested in reading more about the situation with primary care, check out Why Incentives Matter (Even For Physicians), A Shortage of Primary Care Physicians?, and Why Primary Care Matters.