Prepping for step 2 in a post step 1 p/f era

[Qwerty122]

So it looks like step 2 ck will be the new main metric that residencies will use to quantitatively judge and compare the relative candidacy of applicants. With this in mind, studying for step 1 by doing hundreds of anki cards a day, going through thousands of questions, and even spending 1-2 months for step 1 studying seems a bit overkill (though necessary to get a good step 1 score). It is absolutely important for students to get a good foundation, but not to the extreme extent that medical students were pushing themselves previously.

So then I am assuming the new main academic focus will be on third year. We want students to excel in their rotations, do well on shelf exams, and get a high step 2 ck score. I'm just wondering what are some ways that we can prepare current M1s/future medical students for this change. Earlier clinical exposure and training? More integration with step 2 relevant material during preclinical years? Combined ANKI deck that combines essentials of step 1 material with a significant focus on step 2? Phrasing step 1 questions/materials with a more step 2 approach like "What is the most likely diagnosis?", "What is the next best test?", "What is the MOA of this antibiotic?". These are just some ideas, if you have more, just post them below.

Or do you guys think building a solid foundation, to really internalize concepts taught in preclinical years rather than memorizing, is enough (i.e. the best place to learn how to excel in third year is during third year itself)? I think this can be valid too, just as others advise to not pre-study before medical school. Moreover, students have been able to still attain good grades in step 2 ck in the traditional curriculum, so why change it?

A follow up question might be: If clinical year curriculum is fine the way it is now (students still are able to do well in clerkships, rotations, step 2 ck, on top of the previous additional pressure of excelling in step 1), what would you recommend preclinical students do with all this "free" time away from hardcore step 1 studying?

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[slowthai]

what would you recommend preclinical students do with all this "free" time away from hardcore step 1 studying?

Study just as hard for step 1. They
recently made step 2 way harder than it used to be, and you only get one shot at it. There's no other step exam to bail you out anymore.

The other thing worth spending time on (as it currently is even with a scored step) is research. But if it came down to it, I'd prioritize step studying all the way. You can always do a research year. Step is forever.

 

[MilesDavisTheDoctor]

Watching this thread. As an M1 can we really start doing anything to prepare right now other than ace our classes? There is no anking-like deck for step 2 that we should start studying now is there?

 

[AnatomyGrey12]

The best prep for Step 2 is to know Step 1 material cold.

 

[MilesDavisTheDoctor]

The best prep for Step 2 is to know Step 1 material cold.

But you're not suggesting it makes sense to do something like one of the big pre-made decks like Zanki or Anking right? What would you do specifically if you were an M1 today?

 

[slowthai]

But you're not suggesting it makes sense to do something like one of the big pre-made decks like Zanki or Anking right? What would you do specifically if you were an M1 today?

I'm pretty sure he is, lol

 

[M&L]

So maybe unpopular opinion but I decided that it sort of doesn’t matter at all . You are still responsible for all material in step 1 and 2. So why just not do your absolute best in step 1, then step 2,3? I don’t understand the logic of “oh well it’s p/f so I don’t have to study as hard for step 1”?

 

[Lawpy]

I'm currently unsuspending Step 2 cards at the same time as Step 1. My school actually takes Step 2 the same year as Step 1, so I have to follow this approach anyways.

Watching this thread. As an M1 can we really start doing anything to prepare right now other than ace our classes? There is no anking-like deck for step 2 that we should start studying now is there?

Off topic but i usually get confused between you two and think you're the same person for some reason

I wouldnt prep for Step 2 now

 

[AnonymousDoctorGuyPerson]

I'm treating Step 1 as being scored rather than P/F, as I feel that'll optimize my Step 2 score. I'm actually at this very moment sweeping the AnKing deck unsuspending cards that I missed that were covered by the material I learned this last semester.

Some have Step 2 tags so after I take Step 1 I'll be suspending all the cards that don't have a Step 2 tag and start working my way through the Step 2 ones. I'm sure by 3rd year AnKing, or another deck, will be more comprehensive for Step 2 - especially with its importance increasing 10-fold.

EDIT: I am paying less focus and attention on minutiae that is Step 1-specific and irrelevant to clinicals/step 2. I keep them because I do like knowing things, but don't waste much time on them either.

 

[Qwerty122]

@Spetzler-Martin Wait so you're doing step 1 AND step 2 cards now? How many cards is that per day? 😳 You sure you're sleeping enough? Haha

I also agree with other posters saying the best prep for step 2 is having a good foundation in step 1, you can't just magically hope to learn everything you need to know for step 2 during third year. That's hopeful naivete. Why go to med school in the first place if you don't have the passion to learn medicine and do your best to gain knowledge? So my hope is that even if it's still all p/f, all students will still see the value in studying well for it instead of just winging it since it's p/f.

But I'm asking specifically comparing someone who got a 235 vs a 260, as opposed to implying that we should get 200s to pass step 1 (which is unwise). Traditionally, getting a 25 point increase would necessitate studying earlier than others, and giving a lot more effort. And it was justified, as the 235 vs 260 student are on completely different levels come residency. What I'm thinking of is that maybe we don't have to work as hard as the 260 to get a foundational, basic understanding of medicine to function well in clinicals. Maybe the knowledge basis of a 235 at step 1 might suffice.

Then, after getting a 235, we go through clinical year and this time to actually focus on honing your step 2 ck knowledge (Uworld, cases, etc). Hopefully, with good preparation and planning, the student will get a good step 2 ck score (260+). With this it frees up a lot more time (and mental burden/stress) which would have gone to doing really well on step 1, as just a good solid working knowledge level might be enough. Yes, we're simply postponing the stress of step 1 one year later to step 2, but it's better than stressing out for both exams right? I then thought, "why not just use some of that free time to tailor my learning to make my life easier when I prep for step 2?" or even do research like someone else mentioned.

Other things I'm thinking about:

1. Students who do well in step 2 do well because they have developed good studying habits and test taking skills from step 1. This could explain why higher step 1 scorers also score high on step 2, rather than owing that high step 2 score because of having a high degree of meticulous knowledge from their preclinical years (I'm sure 3rd/4th years have forgotten all about the different ILs or the details of paracoccidiodes brasiliensis)
2. I would like to hear the perspective of someone who got ~235 for step 1 and 260+ for step 2. How much of step 1 knowledge prepare you for clinicals? What did you do to improve your score by such a significant amount?
3. Similarly, for anyone who scored very highly on step 1 and step 2, how much of knowing the details of the materials tested on step 1 help during clinicals/step 2?

 

[Dr.JMoon]

The best prep for Step 2 is to know Step 1 material cold.

but even biochem or embryo though? From my understanding step 2 is more clinical focused, so what’s the point of memorizing all those enzymes

 

[Qwerty122]

but even biochem or embryo though? From my understanding step 2 is more clinical focused, so what’s the point of memorizing all those enzymes

Yeah, that's what I'm thinking about as well. There's a new hierarchy of importance to the preclinical materials, with things like antibiotic MOA, pathology, clinical presentation of disease, treatment options rising in importance.

 

[AnatomyGrey12]

But you're not suggesting it makes sense to do something like one of the big pre-made decks like Zanki or Anking right? What would you do specifically if you were an M1 today?

That’s exactly what I’m saying. I would do those cards and then when I was done for the day pound class to get a hogh

but even biochem or embryo though? From my understanding step 2 is more clinical focused, so what’s the point of memorizing all those enzymes

This might me the one place you can skimp. That being said, I had 4 straight up Biochem questions on my Step 2, and the only reason I know I got them right was because I remembered it from my Step 1 prep.

 

[AnonymousDoctorGuyPerson]

1. Students who do well in step 2 do well because they have developed good studying habits and test taking skills from step 1. This could explain why higher step 1 scorers also score high on step 2, rather than owing that high step 2 score because of having a high degree of meticulous knowledge from their preclinical years

This is the main reason I'm treating Step 1 as scored tbh, though the knowledge definitely plays a huge role.

 

[slowthai]

That’s exactly what I’m saying. I would do those cards and then when I was done for the day pound class to get a hogh

This might me the one place you can skimp. That being said, I had 4 straight up Biochem questions on my Step 2, and the only reason I know I got them right was because I remembered it from my Step 1 prep.

Honestly. My attitude, if I was an M1, would be to know everything, leave nothing to chance.

 

[AnonymousDoctorGuyPerson]

Honestly. My attitude, if I was an M1, would be to know everything, leave nothing to chance.

Especially if you're trying to end up somewhere/in something competitive and coming from a low-ranked school. That's my case, and I know I'm a great standardized exam taker (hello SAT, ACT, GRE, MCAT) so shining on Step is my best bet. Leaving nothing to chance.

 

[Qwerty122]

This is the main reason I'm treating Step 1 as scored tbh

Honestly same (@slowthai and @AnonymousDoctorGuyPerson), at least for now I'm learning stuff as if step 1 is still scored, I don't want to lose my critical thinking and test taking skills. I would rather err on the safe side and know too much unnecessary stuff rather than too little. And yeah, coming from a rather low-ranked school (but as of right now interested in rads, which is thankfully not that competitive), it's all the more reason to err on the safe side.

But I'm still curious. I want to get the opinion of others who scored mediocre in step 1/high in step 2 as well as high in both step 1/2. This is just to see the relative importance of honed test taking abilities vs. having very detailed information during step 1 prep in excelling in step 2. If let's say there is a consensus on having the minutiae covered in step 1 being quite useful come clinical years/step 2, then I and many other current M1s and future medical students would be more motivated to give it our best and treat step 1 like it was still scored.

 

[slowthai]

Honestly same (@slowthai and @AnonymousDoctorGuyPerson), at least for now I'm learning stuff as if step 1 is still scored, I don't want to lose my critical thinking and test taking skills. I would rather err on the safe side and know too much unnecessary stuff rather than too little. And yeah, coming from a rather low-ranked school (but as of right now interested in rads, which is thankfully not that competitive), it's all the more reason to err on the safe side.

But I'm still curious. I want to get the opinion of others who scored mediocre in step 1/high in step 2 as well as high in both step 1/2. This is just to see the relative importance of honed test taking abilities vs. having very detailed information during step 1 prep in excelling in step 2. If let's say there is a consensus on having the minutiae covered in step 1 being quite useful come clinical years/step 2, then I and many other current M1s and future medical students would be more motivated to give it our best and treat step 1 like it was still scored.

You can check out the 2020 step 2 thread to learn more. In the past, it was common for people that scored below average to average on step 1 to smash it on step 2 because they worked really hard to improve. I have no doubt that will become much more of a rarity because of how hard they've made it now. Interestingly enough, step 2 seems to rely much more on test taking skills and clinical gestalt than step 1. Like, on step 1, no amount of test taking skills will save you if you don't know the information. Moreover, you can brute force your way to a high score by just pounding the crap out of BUFAPS. But I will say that even though step 2 relies more on test taking skills, it appears that the prerequisite knowledge from a strong step 1 foundation has to be there for your test taking skills to even be of any use.

 

[Qwerty122]

@slowthai Makes sense, I'll check it out. And there's much more incentive now to make step 2 harder since that'll be the primary way to separate applicants quantitatively

 

[slowthai]

@slowthai Makes sense, I'll check it out. And there's much more incentive now to make step 2 harder since that'll be the primary way to separate applicants quantitatively

Exactly. I just hate that it had to be before step went p/f lol. So much for an "easy" step 2 haha. They used to say 2 months for step 1, 2 weeks for step 2, and a number 2 pencil for step 3. That saying is basically obsolete now lol

 

[Qwerty122]

Well, check back in 4 years to see how us guinea pigs turn out for residency, our cycle's going to be fun for others to watch but not fun for us M1s to go through.

Wait but yeah that's another good point that I didn't think of, since step 2 is harder now, there might be more reason to do some kind of prep to orient students in the preclinical years for shelf/step 2 readiness.

 

[AnonymousDoctorGuyPerson]

Well, check back in 4 years to see how us guinea pigs turn out for residency, our cycle's going to be fun for others to watch but not fun for us M1s to go through.

Wait but yeah that's another good point that I didn't think of, since step 2 is harder now, there might be more reason to do some kind of prep to orient students in the preclinical years for shelf/step 2 readiness.

Yeah, as of right now our schools schedule still has the same amount of time dedicated for Step 1 which is definitely unnecessary. Hopefully they shift things around to accommodate Step 2 and give us more dedicated flexibility around that time.

 

[AnatomyGrey12]

Who said that Step 2 is going to be harder now?

Step 2 is harder now than it was even 2 years ago.

 

[Dantes]

Who said that Step 2 is going to be harder now?

Just anecdotal reading people's experiences this year compared to prior years. For what it's worth, I took Step 1 this summer and it seems like it's getting more difficult and "out there" as well. They gotta keep changing things somehow I suppose.

 

[Ho0v-man]

This might me the one place you can skimp. That being said, I had 4 straight up Biochem questions on my Step 2, and the only reason I know I got them right was because I remembered it from my Step 1 prep.

I had a chromosome number straight recall on step 2. And a gene recall.

Ya’ll, step 2 is basically step 1 minus embryo, immuno, and cell bio.

Add in bizarre drug ad questions you don’t have time for and questions that are just convoluted and almost seem to be about nothing.

Drugs and bugs actually gear down to be focused only on useful stuff. You don’t have to know which virulence factor cleaves map kinase. Drug MOA almost never comes up

Step 1 knowledge is absolutely crucial to that beast of an exam. Although I do think after the low 240 range you’re prob not helping your step 2 score anymore. But the big thing is that if you don’t crush pathophysiology in preclinical, you likely won’t have time to catch up in third year.

 

[Ho0v-man]

Dang, this is why I frequent this forum. Would have never known about the changes in Step 2 otherwise.

It’s hard to say if it really has. I feel like everyone in the last step 2 thread who took it after June was like “wtf?!”. But that’s such a small sample. We could just be whinier than average lol. But I certainly found the exam MUCH harder than step 1

 

[Qwerty122]

Even if the increasing difficulty of step 2 is currently debatable, I feel like they're going to have to increase its difficulty in a couple of years. Or else, since current M1s will study for step 2 like their life depended on it (which isn't too far from the truth), I think the percent correct graph will be even more negatively skewed. Meaning that separation between those in the 80th to 90th percentile could go from like 15 questions wrong down to 8 questions wrong only. Imagine getting 8 questions wrong and that be the deciding factor for residency. (I did make up random numbers but that's the general idea). At that point, getting 90th percentile will seem to be more a matter of chance rather than owing it to thorough preparation.

And to prevent this, the NBME will have to make step 2 harder. And maybe one way of doing that is to incorporate more obscure details from step 1 (?). But they have to find a better way to separate middle-top and top applicants someway, or else this will 100% just become the next big complaint from students in the class of 2024. Their practice exams won't be representative to what they might get on the real thing.

But what @Ho0v-man said is true about really knowing pathophysiology during step 1 (shout out to costanzo). I believe that really prepares you for step 2 and even during residency and beyond. That's one thing that separates physicians from mid-levels. Maybe the new emphasis should be on pathophysiology now, instead of playing a memorization game for step 1.

 

[slowthai]

Maybe the new emphasis should be on pathophysiology now, instead of playing a memorization game for step 1.

I mean, pathophys makes up the largest component of step 1. Memorization and doing well on these exams are inextricably linked.

 

[MilesDavisTheDoctor]

damn this thread is depressing I was really hoping I wouldn't need to study for step 1 lol

 

[AnatomyGrey12]

It’s hard to say if it really has. I feel like everyone in the last step 2 thread who took it after June was like “wtf?!”. But that’s such a small sample. We could just be whinier than average lol. But I certainly found the exam MUCH harder than step 1

Divine commented on it multiple times. And supposedly the old free 120 was exactly like the exam, which obviously now is not the case.

 

[Ho0v-man]

Divine commented on it multiple times. And supposedly the old free 120 was exactly like the exam, which obviously now is not the case.

I’ve heavily repressed that period of my life. But wasn’t the old free 120 like stupid easy or am I confused?

 

[Ho0v-man]

damn this thread is depressing I was really hoping I wouldn't need to study for step 1 lol

With 6 weeks of dedicated, it’s easy to go from failing to passing step 1 because the resources today are really really good. But almost everyone needs to study beyond their curriculum to pass.

 

[FindersFee5]

The best prep for Step 2 is to know Step 1 material cold.

But you're not suggesting it makes sense to do something like one of the big pre-made decks like Zanki or Anking right? What would you do specifically if you were an M1 today?

90% agree with this. Knowing step 1 material cold AT ONE POINT is critical. I do think trying to keep up with the 30000+ card step 1 anki decks during rotations would have been counterproductive. However, being able to dig deep and pull out some half remembered facts was key on test day.

@Spetzler-Martin Wait so you're doing step 1 AND step 2 cards now? How many cards is that per day? 😳 You sure you're sleeping enough? Haha

I also agree with other posters saying the best prep for step 2 is having a good foundation in step 1, you can't just magically hope to learn everything you need to know for step 2 during third year. That's hopeful naivete. Why go to med school in the first place if you don't have the passion to learn medicine and do your best to gain knowledge? So my hope is that even if it's still all p/f, all students will still see the value in studying well for it instead of just winging it since it's p/f.

But I'm asking specifically comparing someone who got a 235 vs a 260, as opposed to implying that we should get 200s to pass step 1 (which is unwise). Traditionally, getting a 25 point increase would necessitate studying earlier than others, and giving a lot more effort. And it was justified, as the 235 vs 260 student are on completely different levels come residency. What I'm thinking of is that maybe we don't have to work as hard as the 260 to get a foundational, basic understanding of medicine to function well in clinicals. Maybe the knowledge basis of a 235 at step 1 might suffice.

Then, after getting a 235, we go through clinical year and this time to actually focus on honing your step 2 ck knowledge (Uworld, cases, etc). Hopefully, with good preparation and planning, the student will get a good step 2 ck score (260+). With this it frees up a lot more time (and mental burden/stress) which would have gone to doing really well on step 1, as just a good solid working knowledge level might be enough. Yes, we're simply postponing the stress of step 1 one year later to step 2, but it's better than stressing out for both exams right? I then thought, "why not just use some of that free time to tailor my learning to make my life easier when I prep for step 2?" or even do research like someone else mentioned.

Other things I'm thinking about:

1. Students who do well in step 2 do well because they have developed good studying habits and test taking skills from step 1. This could explain why higher step 1 scorers also score high on step 2, rather than owing that high step 2 score because of having a high degree of meticulous knowledge from their preclinical years (I'm sure 3rd/4th years have forgotten all about the different ILs or the details of paracoccidiodes brasiliensis)
2. I would like to hear the perspective of someone who got ~235 for step 1 and 260+ for step 2. How much of step 1 knowledge prepare you for clinicals? What did you do to improve your score by such a significant amount?
3. Similarly, for anyone who scored very highly on step 1 and step 2, how much of knowing the details of the materials tested on step 1 help during clinicals/step 2?

Definitely think prepping hard for step 1 = prepping hard for step 2, both in material and in test taking ability. Of the two, test taking ability is probably more important. The material is different (although I do think step 2 is moving more towards step 1 style super specific, high-end differentiating questions), but board question format is board question format. Hammering out 10000 practice questions for step 1 will give you an almost uncanny ability to break down every board question put in front of you.

You can check out the 2020 step 2 thread to learn more. In the past, it was common for people that scored below average to average on step 1 to smash it on step 2 because they worked really hard to improve. I have no doubt that will become much more of a rarity because of how hard they've made it now. Interestingly enough, step 2 seems to rely much more on test taking skills and clinical gestalt than step 1. Like, on step 1, no amount of test taking skills will save you if you don't know the information. Moreover, you can brute force your way to a high score by just pounding the crap out of BUFAPS. But I will say that even though step 2 relies more on test taking skills, it appears that the prerequisite knowledge from a strong step 1 foundation has to be there for your test taking skills to even be of any use.

I don't know if "brute force" is the way I'd describe it. Brute force memorizing is a great way to pump and dump knowledge. You need to finesse it a little bit, understand why you get things wrong, understand how test takers like to test concepts, understand how they like to confuse people. That's all metacognition that you won't get from doing the work alone, you need to think about what you're doing. Like you said though, all the metacognitive ability in the world doesn't help you out if you don't put in the work though.

 

[slowthai]

You need to finesse it a little bit, understand why you get things wrong, understand how test takers like to test concepts, understand how they like to confuse people. That's all metacognition that you won't get from doing the work alone, you need to think about what you're doing. Like you said though, all the metacognitive ability in the world doesn't help you out if you don't put in the work though.

Is there anything more you could add regarding the bolded that isn't already in your guide?

 

[AnatomyGrey12]

I’ve heavily repressed that period of my life. But wasn’t the old free 120 like stupid easy or am I confused?

Yeah it was. Which is probably where the idea that you only needed a half assed 2 week dedicated to go up on Step 2 from Step 1 came from. Those days are long gone.

 

[Qwerty122]

90% agree with this. Knowing step 1 material cold AT ONE POINT is critical. I do think trying to keep up with the 30000+ card step 1 anki decks during rotations would have been counterproductive. However, being able to dig deep and pull out some half remembered facts was key on test day.



Definitely think prepping hard for step 1 = prepping hard for step 2, both in material and in test taking ability. Of the two, test taking ability is probably more important. The material is different (although I do think step 2 is moving more towards step 1 style super specific, high-end differentiating questions), but board question format is board question format. Hammering out 10000 practice questions for step 1 will give you an almost uncanny ability to break down every board question put in front of you.



I don't know if "brute force" is the way I'd describe it. Brute force memorizing is a great way to pump and dump knowledge. You need to finesse it a little bit, understand why you get things wrong, understand how test takers like to test concepts, understand how they like to confuse people. That's all metacognition that you won't get from doing the work alone, you need to think about what you're doing. Like you said though, all the metacognitive ability in the world doesn't help you out if you don't put in the work though.

Oh what's up @FindersFee5, I was just looking at your step 1 prep post a few days ago. How did step 2 turn out for you?

 

[Qwerty122]

Do you guys think it's worth it to switch the dedicated studying periods for step 1 and 2? As in, for step 1 students will get 2 weeks and step 2 they'll get 6 weeks? In this case, clinical rotations will have to be moved up by a month as well, but the benefit is more studying time for step 2.

 

[AnatomyGrey12]

Do you guys think it's worth it to switch the dedicated studying periods for step 1 and 2? As in, for step 1 students will get 2 weeks and step 2 they'll get 6 weeks? In this case, clinical rotations will have to be moved up by a month as well, but the benefit is more studying time for step 2.

Yes.

 

[readmypostsMD]

Does step1 knowledge come up in rotations?

like if we just sort of passively studied for step1 so that we can pass, do you think we’d be screwed for rotations? Like as in we wouldn’t actually know a lot of stuff

 

[Matthew9Thirtyfive]

Yes.

I take step 1 in third year (about a year from now actually). It will be p/f. I get a 3 week break and then 6 weeks of dedicated. Would it be better to take like 2-3 weeks of that dedicated and then take step 1, then use the rest as dedicated for step 2 and try to take step 2 really soon after taking step 1? I forget if you need a score from 1 to schedule 2CK.

 

[Qwerty122]

Does step1 knowledge come up in rotations?

like if we just sort of passively studied for step1 so that we can pass, do you think we’d be screwed for rotations? Like as in we wouldn’t actually know a lot of stuff

I think that's the whole point of doing step 1 before our rotations, so we can have the foundational knowledge to function during rotations. But the thing is, I'm not convinced that we need a 260 step 1 level of knowledge to do well, maybe to answer some pimping questions, but that probably isn't worth the extra hours and effort spent to get that 260, as opposed to a 235 or a 240. I think a lower score should be good enough for us to be able to keep up during clinicals, but not as low as if you were only aiming to pass step 1 (200s). You're just setting yourself up for failure not only in clinicals but also in residency with a score that low.

Other factors such as how much time you take to learn outside of the hospital during clinicals (Uworld questions, anki, OME, etc), your attitude with the staff, and showing that you are eager to learn and help out whenever appropriate, etc. are also factors to consider to do well on clinicals, beyond just a very deep knowledge of step 1 materials. So technically you're not THAT screwed if your step 1 performance is subpar. Still screwed but not to the point of no return.

But my approach is to really understand and internalize the stuff I'm learning through my preclinicals, rather than a cram and dump approach for every exam. If by "passively studying for step 1" you mean to instead of going hard on Kaplan and Rx questions, but just going through class lectures and doing active learning (really engaging with the material), I think you'll be fine. That kind of learning actually sticks.

 

[ArdorAyurveda]

Setting yourself up for failure in clinicals and residency if you get 200s...you're not even in residency yet...

 

[FindersFee5]

Is there anything more you could add regarding the bolded that isn't already in your guide?

I don't think there's anything specific I would add. Those are more emergent properties of conscientious practice than they are skills that you directly train. The biggest specific thing you can do that will cultivate those skills is keeping a question diary to make sure you know why you're getting questions wrong. Another thing that can be helpful is taking notice of your emotions while you're doing practice questiosn, and trying to figure out the root cause of them. Are you feeling confused with a question? Why? Was it a missing fact in the question, an extra fact, an atypical presentation, confusing wording on answer choices? What is the smallest thing they could have changed in this question to make it not confusing?

Once you start to figure out how test makers like to add extra levels of difficulty to a question, your brain will start immediately mapping backwards and simplifying it for you. I talked a little bit in my guide about restating answer choices in your own words (ex: foamy macrophages in lamina propria -> Whipple's disease), which would essentially turn a 4th order question to a 3rd order question, but you'll also learn to do those simplifications as you're reading the stem as well (ex: older man coming in with confusion, headaches, and diarrhea -> GI and neurologic sxs). Finally, restate what exactly the question is asking into your own words as well (disease causing organism? pathophysiologic process? up/down endocrine question?). Often this reduces a 4th order question to a simple 1st or 2nd order. Training this skill until it's instinctual can free up working memory to actually figure out the answer and reduce test taking fatigue.

Oh what's up @FindersFee5, I was just looking at your step 1 prep post a few days ago. How did step 2 turn out for you?

Better than expected! I wrote a little bit up about my experience here.

 

[slowthai]

I don't think there's anything specific I would add. Those are more emergent properties of conscientious practice than they are skills that you directly train. The biggest specific thing you can do that will cultivate those skills is keeping a question diary to make sure you know why you're getting questions wrong. Another thing that can be helpful is taking notice of your emotions while you're doing practice questiosn, and trying to figure out the root cause of them. Are you feeling confused with a question? Why? Was it a missing fact in the question, an extra fact, an atypical presentation, confusing wording on answer choices? What is the smallest thing they could have changed in this question to make it not confusing?

Once you start to figure out how test makers like to add extra levels of difficulty to a question, your brain will start immediately mapping backwards and simplifying it for you. I talked a little bit in my guide about restating answer choices in your own words (ex: foamy macrophages in lamina propria -> Whipple's disease), which would essentially turn a 4th order question to a 3rd order question, but you'll also learn to do those simplifications as you're reading the stem as well (ex: older man coming in with confusion, headaches, and diarrhea -> GI and neurologic sxs). Finally, restate what exactly the question is asking into your own words as well (disease causing organism? pathophysiologic process? up/down endocrine question?). Often this reduces a 4th order question to a simple 1st or 2nd order. Training this skill until it's instinctual can free up working memory to actually figure out the answer and reduce test taking fatigue.

Thank you!!

 

[Qwerty122]

@FindersFee5 Damn you killed step 2! Thanks for sharing about your experience!

Just some of my thoughts below for anyone who wants to read. Feel free to agree or disagree

90% agree with this. Knowing step 1 material cold AT ONE POINT is critical. I do think trying to keep up with the 30000+ card step 1 anki decks during rotations would have been counterproductive. However, being able to dig deep and pull out some half remembered facts was key on test day.

(Regarding knowing step 1 material to prep for step 2/clinical years) -- I agree with this as well, especially the knowing stuff at one point part. I'm thinking that maybe doing class lectures + external board materials (Pathoma, BnB, etc) alongside the corresponding class lectures would satisfy this point. Anki could be another way to achieve this. You also touched upon this in your step 1 post, "preparing for class is preparing for step". If this is the case, then it seems like it's unnecessary to have up to 6-8 weeks of dedicated step 1 studying, since you've done your first pass and hopefully actually actively engaged with the material in the first two years of med school.

(Regarding the test taking strategies that you talked about in your step 1/2 guide and in your response above) -- I think that the test-taking skills you mentioned in your posts (how you approach the question, question diary, understanding the type of error you made, etc) are crucial to obtain as well prior to step 2. Sure there is a benefit of honing these skills earlier at the end of 2nd year for step 1, but I think these skills can also be intentionally honed throughout 3rd year and the (hopefully) longer dedicated studying block for step 2.

All this just to say, it seems like switching the dedicated studying time for step 1 and step 2 is recommended, without significant consequences. If pre-clinical students are actively engaging with class lectures while doing questions to solidify concepts, and if clinical students are honing their test taking skills throughout the year, this could set them up well for a solid step 2 ck score.

Other benefits of switching the dedicated periods might also include:

1. Clinicals moved up a month. In my school, this means ending 3rd year in mid-April instead of mid-May. This could be beneficial for students who are aiming for competitive specialties to do away rotations and get LORs. It might eat at their step 2 dedicated time but this is a new option that wasn't available previously.
2. Medical schools will definitely have to make this switch at some point, 6 weeks for step 1 (although is a very important foundational exam) seems overkill with the new rules at play. It seems like a matter of when, rather than if. Schools that can make the switch first will provide the biggest advantage to their students. Students from medical schools that don't change their curriculum for their class of 2024 will still have 2 weeks for step 2 ck, vs. 6 weeks for schools that changed their curriculum. As more schools adopt this switch, the scores will normalize again, but for the class of 2024, the schools that can adopt this change first will (in paper at least) give their students a significant boost to their scores if compared to other med students.

Also, just curious, what specialty did you end up applying for @FindersFee5, I'm just curious to see where the end of your med school journey is

 

[Doc Doc Doc Goose]

but even biochem or embryo though? From my understanding step 2 is more clinical focused, so what’s the point of memorizing all those enzymes

Because the knowledge build on itself. The more you can understand things conceptually and their relationships on multiple levels the easier it is to remember and recall. By doing so you’re relying less on straight recall aka rote memorization and more on spreading activation.

cognitive neuroscience coming into play here