Step 2 Retrospective

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Billiam95

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Hi y'all,

I've really enjoyed lurking here over the years and have benefitted greatly from some of the advice I have read here; I have had several threads bookmarked for years. I'd been kicking it around in my mind to do a write up on longitudinal step 2 prep in the post step 1 p/f world, assuming I got a competitive step 2 score. I had this idea for a couple reasons: 1) based on bad advice I've heard over the years and 2) seemingly poorly organized (in comparison to step 1) study strategies for step 2. I figured this could be my way of contributing to this little online community. I got my score today - 27x - which is high enough for me to feel confident giving advice on S2 prep.

For MS1/2s:
Don't sleep on step 1 and treat it like it is still scored. I had been told that step 1 was easy to pass and that it wouldn't require much effort to simply pass. I didn't take this advice but I think some of my classmates did, a lot of whom really struggled in dedication and many failed on their first attempt. My advice: use the tried and true methods for preparing for step 1: UFAPS B&B (uworld, FA, Anking, Pathoma, sketchy, and B&B). Not only will you be better prepared for your NBME exams, but you will cruise through step 1 dedicated. Additionally, excellent step 1 prep is critical for answering shelf exam questions in MS3, pimp questions on the wards, and the fundamental medical knowledge is essential for doing well on S2.

For MS3s:
You can't outrun your shelf exam scores, and your percentile on shelf exams will highly correlate with your eventual S2 score. In other words, put yourself in the best position to succeed on S2 by completing uworld for each rotation, finishing as many 2-4 hammer questions on Amboss as you possibly can, and taking all practice shelf exams (and studying the questions, answer explanations, and concepts in depth in the weeks leading up to your exam).

For Step 2 dedicated:
I had 3 weeks of dedicated for step 2, which was adequate. My biggest, and least intuitive advice, for step 2 dedicated is to complete as many questions written by the NBME (retaking CMS forms, NBME practice exams, and free 120) as possible and to study the answer explanations/concepts in depth. Entering dedicated, I had planned to maybe complete a 50% 2nd pass of uWorld; however, S2 is as much about test taking skills as it is content and uWorld questions have very little in common with NBME step 2 question formats. In fact, I would posit that it is possible to have a very high % correct on a 2nd pass of uworld in dedicated and end up with a below average score, as the question format and style between uw and NBMEs are 2 completely separate entities. My advice for uworld in dedicated - use it as a spot check if you find yourself weak in a specific area - and do not attempt to make a complete 2nd pass of uworld in dedicated. Retaking CMS forms and taking NBME practice exams should take absolute priority.

Recommended S2 dedicated resources:

CMS forms
NBME practice exams (9-14)
Free 120 (new and old)
Amboss 'high-yield ethics' study block (approx. 50 questions)
Amboss '200 concepts that appear on every exam' study block

Final thoughts:
For step 1, I matured approximately 29k cards of the Anking deck, which I found useful for step 1 and would highly recommend. I kept the step 2 tagged cards for 3rd year from step 1 and unsuspended step 2 cards as I went through each rotation. However, I found the step 2 anking cards to be much less useful compared to those for step 1. I would go so far as to say that Anking for step 1 is mandatory, and is a soft optional for step 2. I generally found much more benefit from my homemade cards from amboss/uworld/CMS/NBMEs to be of greater benefit (only around 3.2k for all of 3rd year and 700 for S2 dedicated). I suspect this may change in the future, as I expect S2 resources to improve in quality to cope with increased importance of S2 nowadays.

Anyway, relieved to have step 2 behind me and to be able to continue to focus on my AIs for the rest of the fall. I hope someone may find this useful.

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Don't sleep on step 1 and treat it like it is still scored. I had been told that step 1 was easy to pass and that it wouldn't require much effort to simply pass. I didn't take this advice but I think some of my classmates did, a lot of whom really struggled in dedication and many failed on their first attempt.

Yeah, as someone who worked my but off just to get a below average score on step 1 in the olden days, I am baffled that people think it doesn't take an enormous amount of effort to just pass.
 
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Yeah, as someone who worked my but off just to get a below average score on step 1 in the olden days, I am baffled that people think it doesn't take an enormous amount of effort to just pass.
Yeah it’s very weird now that solid advice like in the OP is basically to study hard for high-stakes career deciding exams. I would say the vast majority of people who scored above the 50th percentile when it was still scored started studying at least 9 months out.
 
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Thanks for this. Any additional advice on how to boost shelf scores? I'm still struggling to break 50th percentile.
 
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Hi y'all,

I've really enjoyed lurking here over the years and have benefitted greatly from some of the advice I have read here; I have had several threads bookmarked for years. I'd been kicking it around in my mind to do a write up on longitudinal step 2 prep in the post step 1 p/f world, assuming I got a competitive step 2 score. I had this idea for a couple reasons: 1) based on bad advice I've heard over the years and 2) seemingly poorly organized (in comparison to step 1) study strategies for step 2. I figured this could be my way of contributing to this little online community. I got my score today - 27x - which is high enough for me to feel confident giving advice on S2 prep.

For MS1/2s:
Don't sleep on step 1 and treat it like it is still scored. I had been told that step 1 was easy to pass and that it wouldn't require much effort to simply pass. I didn't take this advice but I think some of my classmates did, a lot of whom really struggled in dedication and many failed on their first attempt. My advice: use the tried and true methods for preparing for step 1: UFAPS B&B (uworld, FA, Anking, Pathoma, sketchy, and B&B). Not only will you be better prepared for your NBME exams, but you will cruise through step 1 dedicated. Additionally, excellent step 1 prep is critical for answering shelf exam questions in MS3, pimp questions on the wards, and the fundamental medical knowledge is essential for doing well on S2.

For MS3s:
You can't outrun your shelf exam scores, and your percentile on shelf exams will highly correlate with your eventual S2 score. In other words, put yourself in the best position to succeed on S2 by completing uworld for each rotation, finishing as many 2-4 hammer questions on Amboss as you possibly can, and taking all practice shelf exams (and studying the questions, answer explanations, and concepts in depth in the weeks leading up to your exam).

For Step 2 dedicated:
I had 3 weeks of dedicated for step 2, which was adequate. My biggest, and least intuitive advice, for step 2 dedicated is to complete as many questions written by the NBME (retaking CMS forms, NBME practice exams, and free 120) as possible and to study the answer explanations/concepts in depth. Entering dedicated, I had planned to maybe complete a 50% 2nd pass of uWorld; however, S2 is as much about test taking skills as it is content and uWorld questions have very little in common with NBME step 2 question formats. In fact, I would posit that it is possible to have a very high % correct on a 2nd pass of uworld in dedicated and end up with a below average score, as the question format and style between uw and NBMEs are 2 completely separate entities. My advice for uworld in dedicated - use it as a spot check if you find yourself weak in a specific area - and do not attempt to make a complete 2nd pass of uworld in dedicated. Retaking CMS forms and taking NBME practice exams should take absolute priority.

Recommended S2 dedicated resources:

CMS forms
NBME practice exams (9-14)
Free 120 (new and old)
Amboss 'high-yield ethics' study block (approx. 50 questions)
Amboss '200 concepts that appear on every exam' study block

Final thoughts:
For step 1, I matured approximately 29k cards of the Anking deck, which I found useful for step 1 and would highly recommend. I kept the step 2 tagged cards for 3rd year from step 1 and unsuspended step 2 cards as I went through each rotation. However, I found the step 2 anking cards to be much less useful compared to those for step 1. I would go so far as to say that Anking for step 1 is mandatory, and is a soft optional for step 2. I generally found much more benefit from my homemade cards from amboss/uworld/CMS/NBMEs to be of greater benefit (only around 3.2k for all of 3rd year and 700 for S2 dedicated). I suspect this may change in the future, as I expect S2 resources to improve in quality to cope with increased importance of S2 nowadays.

Anyway, relieved to have step 2 behind me and to be able to continue to focus on my AIs for the rest of the fall. I hope someone may find this useful.
This is excellent advice! wish i had followed more of it!
just took step 2 as well, increased my nbme scores by >30 points during dedicated and beat my score prediction by 13 points on test day by focusing on nbme materials and test taking approach in the final stretch.

one thing i'll add, i didnt complete a full pass of uw (~60% complete) or amboss (80% complete) during third year and rarely used anki.
I decided to abandon uw and amboss during dedicated to focus on nbme materials with boards and beyond/divine intervention at 2-3x for weak areas. i focused on quality over quantity of questions with an emphasis on figuring out why i got something wrong and where my NBME specific illness scripts were fuzzy or my dx & tx algorithm was weak. i probably took >12 hours to review each nbme form

sadly my biggest score improvement was a deliberate effort to intentionally use premature closure and anchoring bias as nbme test taking strategies after some disappointing initial nbme scores secondary to overthinking, broadening my differential too much, or relying on actual clinical experiences for testing and treatment plans.

I jumped ~25 points in 3 days and cut an average of >30s per question by deliberately reversing my test taking strategy. instead of reading carefully I skimmed the vignette for buzzwords/main idea, or jumped straight to the last sentence or two on long passages, then skimmed bottom up for associations, picking the ans with the strongest association. i stopped highlighting or marking questions.

basically shut down any attempt at clinical reasoning. i went from below avg nbme scores to above average in 1 week using this approach, and replicated it on two subsequent nbme forms and the new free 120 before my exam. on test day I stuck to that strategy despite the discomfort.

it was frustrating how effective this technique was, and it highlighted the limitations of our exams and why these biases are so pervasive and difficult to shake in actual practice.
 
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Thanks for this. Any additional advice on how to boost shelf scores? I'm still struggling to break 50th percentile.
for shelf scores, learn the material, integrate it with your clinical experiences, do all available CMS forms leading up to your shelf, and pay attention to developing your illness scripts. don't neglect test taking strategy. in addition, try to do as many questions as possible throuhgout the block without sacrificing clinical experience/reading about patients or CMS forms.
 
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Thanks for this. Any additional advice on how to boost shelf scores? I'm still struggling to break 50th percentile.

In general for shelf exams, I think deeply studying a few resources is better than making a more surface level pass on many different resources. More specifically, I would make 2 passes through uworld (usually a full 2nd pass, sometimes only incorrects depending on time constraints/burnout), complete as many 1-4 hammer amboss questions as I could, then start on the CMS forms the weekend prior to shelf exam.

I never really used any of the review resources, such as OME or B&B, for the shelves. I trialed OME for my first rotation and generally found it to be unhelpful and never really got around to exploring B&B. Instead, I used uworld as a learning tool and made sure to make a deep dive on topics I didn't fully understand with the amboss library; I also think that making homemade Anki cards for incorrects/foreign concepts to be very helpful.

Amboss I thought generally fluctuated in usefulness - excellent for some rotations (esp surgery, psych), subpar for others (fam med).

Finally, just as in focusing on NBME questions in dedicated, taking the CMS forms in the week leading up to the shelf put me in the 'NBME frame of mind.' By that, I mean that NBME questions generally do not try to trick you like uworld sometimes will. In addition, uworld will give you all the info you need to rule out or in each answer choice. NBME questions, however, will give enough information to paint a picture but will rely on developing a gut instinct for what the question is asking. When actually taking the shelf exams, I would constantly think to myself 'they're not trying to trick you' so as to not overthink a question like uworld would have you do.

For each rotation, there seem to be 'highly recommended' textbooks or alternative q banks - Pestana's and DeVergilio for surgery, Uwise for OB/GYN, etc. I tried a few of these in my early rotations, found them to be of no help, and never explored them again.

The day before the exam, I would recommend just briefly looking over the CMS forms one last time before taking the rest of the day off to clear your mind and go in to the exam as fresh as possible.

Tldr; deep dive on high quality q banks (uworld, amboss), reading up on foreign concepts on the amboss library, and committing to the CMS forms in the week leading up to the exam.
 
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I jumped ~25 points in 3 days and cut an average of >30s per question by deliberately reversing my test taking strategy. instead of reading carefully I skimmed the vignette for buzzwords/main idea, or jumped straight to the last sentence or two on long passages, then skimmed bottom up for associations, picking the ans with the strongest association. i stopped highlighting or marking questions.

basically shut down any attempt at clinical reasoning. i went from below avg nbme scores to above average in 1 week using this approach, and replicated it on two subsequent nbme forms and the new free 120 before my exam. on test day I stuck to that strategy despite the discomfort.
I would absolutely agree. When reading an NBME question stem, the first answer that popped into my mind became my 'null hypothesis,' and I would have to absolutely rule it out 100% for it not to be my final answer.
 
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