I am honestly baffled by how many people come on SDN who are scoring in the 250's and 260's either on practice exams or the real exam... yet are disappointed with their scores, feel unprepared, have feelings of inadequacy, and have a sense of impending doom as if their careers are shattered. Are you guys not aware that scoring in the 250's and higher places you among the top 30% of medical students in the WORLD?! I can't think of any specialty in which a score of 250 would eliminate you from contention (perhaps in Derm, Ortho, & Plastics you would just be "average" which is still phenomenal considering the quality of candidates that go into those fields). You guys should be proud of yourselves and filled with confidence that you've accomplished a very special feat that very few people in our line of work ever achieve! Not depressed and filled with anxiety. Seriously, come onnnn people!! lol
Anyway, now that my rant is out of the way. In regards to your question... I just took CK two months ago and I scored similarly to you on both my UWORLD self-assessments. My advice to you is this:
1) The UWORLD practice exams are the best predictive metric available to us at this moment. They appear to have a good track record of predicting the real score FOR MOST PEOPLE. Of course there will be outliers, but that is just how life goes. No predictive measure is perfect. Test day performance is important - some people freak out on test day and abandon the entire plan and strategy they have practiced for months and under perform. Others will get lucky with a favorable test form that tests to all their strengths, and be on point with all their guesses; they will over perform. We can't predict these things. But for the most part, many will agree that your real CK score will most likely fall in a range between the average of the two UWORLD self-assessments + or - 10 points. If you can live with any score in that range then you are ready and you should take the exam.
2) You absolutely should activate UWORLD self-assessment 2 and take it. Don't ever save resources for "fear of wasting the resource too soon." So many people do this (and I used to do this same kind of thing back in the day), but it really is a terrible strategy. If you ultimately decide to delay your exam for whatever reason then you can retake them at a later time. But you should not be preparing with the mindset of "I might delay" because this gives yourself an excuse to not work hard and power through this last week before the real thing! Rather, you should be aggressive and do what you can to stick with your planned schedule. Only delay if absolutely necessary (this is quite subjective and depends on your goals and target score obviously... in my opinion 254 is a great score and you are performing well, but in your opinion you might feel that 250s is inadequate for your career goals... so it's really your call). I'd say 3-4 days before the real exam is a good time to take the last practice exam. How else can you know if your 254 on the first practice exam is just a fluke or a legit score without taking multiple practice tests? If you are able to score in the 250s again on UWORLD self-assessment 2 then you will have displayed consistency, and this is compelling evidence that you are ready for the real thing.
3) Regardless of how much you study or how prepared/under-prepared you feel at this moment in time, I can assure you that the real Step 2 CK will feel extremely challenging, exhausting, frustrating, and deflating. There is no way around this! Just expect to get upset and go through a roller coaster of emotions on test day. I already took the exam and I've seen the questions. If they offered me the opportunity to take it again I don't think I would change anything about how I prepared and I don't think I would be able to change my score by much. I can't even think of any resource I could use that would help me answer the difficult questions with any less difficulty. The test writers are masters of their craft and they have an uncanny ability to structure questions in a manner that forces us to make difficult clinical decisions and use our best clinical judgement to answer questions rather than regurgitating memorized facts. The purpose of this exam is to assess clinical decision making/judgement ability and critical thinking skills, not memorization ability. Once you accept this fact, you will not feel anxiety about not knowing every word in First Aid, MTB, or UWORLD explanations. Rather, you should adopt the mindset of "I am going to be faced with a bunch of scenarios i'm unsure about, all the facts I've memorized over the past couple months of studying are my toolbox that I am allowed to bring with me to the test, and I will use the tools I have to come up with educated and plausible solutions to these wacky scenarios to the best of my ability." And then you just live with the results, not much more you can do.
The question stems I thought were pretty straight forward (very similar to UWORLD self-assessments) and most of the time I knew the condition/disease the patient has... however, the difficult questions (and most people will agree with me) are difficult because:
a) 2 or 3 answer choices will all seem plausible as managements and you have never had to decide between those 3 things before. So you are forced to guess.
or
b) you will be reading a question and get all excited because you totally know this disease and you are positive about how to treat/manage the condition and then you get to the answers and BOOM, the answer you want is not even an option! Once again forced to guess.
or
c) you read the question and/or read the answers and have no freakin' idea what the hell they are talking about. Guess and move on. Although I must say this scenario happens much less on Step 2CK compared to Step 1.
UWORLD was absolute gold for Step 2 CK and you will be able to answer about 70% of the real exam confidently from UWORLD explanations. The other 30% of the test, unfortunately, you will be dealing with the three difficult scenarios I listed above. No way around this, that's just the nature of the beast.
