Just took the test recently. I agree with the above in that it was heavy on biostats (felt like 20+ Q's). I felt that reading FA Step 1's Biostats section beforehand helped significantly. You still have to know pretty much everything in that section, including biases, type I/II errors, etc.
Lots of insane bioethical scenarios. Stuff you could never prepare for. It'll frustrate you, and you just have to deal with it.
Speaking of frustration, this test sucks. It felt like the faculty from my school wrote the Q's, not the masterminds I came to respect from Step 1. In Step 1, I was confident that the question conveyed all the necessary information to answer the question; failure to answer the question was my fault. In Step 2, I absolutely did not feel that way. As the poster above said, they really cut back on the tips they give you in the question stem in such a way that prevents you from choosing between two correct answers. But even more than that, I felt the problem was that two answer choices were correct depending on how you looked at it. You have to use a lot of clinical feeling to discern what's probably better. So frequently, I had to ask myself what they wanted me to know, or what they were probably testing in a given question. I felt this way in the NBME practice tests, but more so on the exam.
My test felt most similar to the NBME exams (not UWorld or the free 131), just with longer stems. I took NBME 4, 6, and 7 as well as the free 131. I felt that these 4 tests added a lot of value in my knowledge base by thoroughly reviewing my corrects and incorrects, and I encountered probably 10-20 Q's that were very similar on my real deal.
The time constraint is real. On the NBME's, I usually finished with ~15 minutes to go to review all the Q's in a block one time through. On the real deal, mostly because of how consistently long every question was, I only had 5-7 minutes per 42/44 Q block and was lucky if I got through my marked questions. On a test that so heavily emphasizes thinking and deliberation over mindless word associations, time constraints are stressful.
Sorry to be so negative. Guess I just wanted to add another warning that you'll feel like crap after the exam and that's normal. I could go on and say more, but I'll reserve it for when I get my score. Hopefully I'll be one of those people that gets like 20+ higher than their last diagnostic, lol. I'm happy to answer any questions that anyone has.
Ended up with a
260. Did NOT think I'd get that score walking out of the test center, as you can guess from my post above. I feel very lucky. Here's my prep and diagnostics:
USMLE Step 1: 260+
MS3 shelf exams: Mostly 80's
UWorld during MS3: 72%
UWorld during Step 2 prep: 85%
School NBME: 240 (3 weeks out -- baseline)
NBME 7: 254 (2.5 weeks out)
NBME 6: 267 (1.5 weeks out)
NBME 4: 258 (0.5 weeks out)
Free 131: 88%
Notably, the average of my last 3 NBME's perfectly predicted my score.
The resources I used, in summary, were USMLERx (50-60% complete, before dedicated), UWorld, and OnlineMedEd, with everything occasionally supplemented by UpToDate. I actually left a significant amount of my UWorld 2nd pass and OnlineMedEd incomplete in favor of reviewing my flashcards more.
USMLE Step 2CK, just like Step 1, is all about memorizing disease scripts. In Step 1 you had the script of "...female athlete with a BMI of 18.3" clinching that the question was about anorexia nervosa. On Step 2CK however, the scripts are a little more varied and subtle, and they always throw in some unique scenario modifier that changes the way you have to think about the question. That all just means that questions are once again very important for Step 2CK; the more you do, the more you memorize the key things they like to ask about:
-Intermittent abdominal pain in a kid = Intussusception, and the answer is probably air contrast enema
-Kid with a painful limp = Legg-Calve-Perthes vs. slipped capital femoral epiphysis until proven otherwise, then use age to differentiate
The sooner you get these knee-jerk reflexes down, the sooner you'll be able to delve deeper and think about 2nd and 3rd steps in management, or about situational modifiers.
USMLERx was just okay. Good to hammer in some points and to get experience memorizing disease scripts, as mentioned above. Most of the utility is sucked out of it by doing roughly half of it.
UWorld was very good, but not as good as it was for Step 1. Alas, it's all we've got. I felt that for Step 2, there was no need to read into every single word of every UWorld explanation as I tried to do for Step 1. Step 2CK is just too diverse and divergent of a test to put so much stock into one resource.
It's hard to say how helpful OnlineMedEd was. It was basically my "text" resource. I was told that one should have
some text resource, no matter what it is. So while OME scored me some points for sure, I don't know if Crush/SUTM/etc. could have done the same. I appreciated the logic that OME gives for things, which I feel is something a text doesn't often have. That logic (e.g. we do this because...) is important for that often-referenced
gestault/clinical feeling that you need for the questions on the real deal. I thought OME really shined in Ob/Gyn, as well as for Peds, but maybe it's because those were my two weakest areas.
Some general pieces of advice:
-
The "best next step in management" implies that you know when to proceed with a diagnostic step vs. proceed with a treatment step; as such, pay attention to empiric treatments. Iron therapy in infants with microcytic anemia, steroids in temporal arteritis, etc. There are certain scenarios when you proceed with treatment before the diagnosis is confirmed, whether it's because the diagnosis is so common that it's presumed (e.g. iron deficiency in infants) or because the consequences of not treating early are high-impact (e.g. steroids in temporal arteritis).
-
Bifurcations in management, especially when treatments oppose each other/contraindicate each other, are key. Example: In chest pain, you rule out MI and often empirically treat before MI is confirmed. But before you give a B-blocker, make sure it's not cocaine-induced. And before you give ASA, make sure it's not aortic dissection.
-
Looking closely at answer choices is far more important than for Step 1. Consider the scenario of baking a cake. The instructions after "add sugar" are "add eggs". So obviously you'd pick "add eggs" in a scenario that asks what the next best step is after adding sugar...unless you saw an answer choice that says "remove eggs from the refrigerator". You get the idea -- even if you see an answer choice that is classically the answer for a type of question, they may throw in another answer choice that technically supersedes.
-
Interpreting pictures is now important. I don't really have any advice on how to excel considering this point, but just be ready for it. Whereas in Step 1, they always tell you that you can answer the question without the picture, the picture is now sometimes the only thing you can use to answer the question. While studying, try to memorize the characteristics of a given exemplary picture.
Best of luck, everyone. As usual, I'm open to PM's for questions or further information in general, whether you're an MS-0 or a day before your Step 2. Alternatively, I tutor Step 1 and 2CK via Skype, so feel free to message me about that too (but don't feel obligated if you have some questions and don't want tutoring!).