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Studying for Step 2 and Shelf Exams During Rotations

We explain the best strategies medical students recommend for creating the perfect third-year study plan.

Third year means the start of rotations, shelf exams, and Step 2. Third year may seem overwhelming, but it doesn’t have to be. Having a third-year study plan is the key to acing your exams and managing the stress that comes with them. Pavan, a student at Touro College of Osteopathic Medicine in Harlem, says “a couple of friends told me they were stressing out by March of third year because they hadn’t studied all year. They were just going to their rotations and looking things up on Up to Date from time to time. Once Step 1 is over, you’re not in class all day. It’s a work day. For me, I would have more time to come home and relax, but I also knew it was important to stay fresh.” Pavan says that, if you are well-prepared, “third year can actually be a less stressful year than you might expect.”

Below are three recommendations for keeping your stress level low and staying fresh on exam material while on rotations.

Focus on repetition and consistent practice

“It’s easier said than done, but the key thing is to stay consistent,” says Pavan. “For me, coming home from work at 5:00pm, sitting in front the TV and doing flashcards was engaging and relaxing at the same time.”

We asked Pavan to describe how he structured his daily practice. “After a long day on rotations, I felt coming home and having to read would have been too much,” he says. “So I did flashcards and questions instead. I would use Memorang every day. If there was a topic I needed to review, I’d go to Up to Date. Using Cram Fighter, I was able to know how many questions I needed to do every day. Early on I was only doing 10 or 15 a day.”

Caroline Schrodt, a medical student at Texas A&M, agrees that working on question banks from the beginning of third year was the best approach. For Caroline, this strategy had the benefit of preparing her for Step 2 while she was preparing for Shelf exams. “My Step 2 preparation ended up coming from studying for all of the Shelf exams,” she says, “Step 2 is heavy on Internal Medicine, so I started using UWorld Internal Medicine questions early on.”

Pavan began devoting more time to Step 2 studying midway through third year. “I started switching to Step 2 mode around February or March,” he says, “I was still taking Shelfs, but I was increasing the daily number of questions I was doing to 100 to 150 questions per day. I was also backtracking to review other material. When it came time to study for Step 2, I had already completed all of Memorang. I had already been through all of my QBanks at least once. Repetition was key.”


Consider rearranging your rotations

If your school allows you to change the order of your rotations, you can choose an order that helps you better prepare for Step 2. “A lot of people try to do the Internal Medicine rotation first. They feel it’s the core foundation of medicine. My schedule worked out differently, and Internal Medicine was at the end,” says Pavan, “I thought Internal Medicine would be a nice refresher at the end. Internal Medicine ties everything together.”

Pavan For me, coming home from work at 5:00pm, sitting in front the TV and doing flashcards was engaging and relaxing at the same time.

Pavan, Touro College of Osteopathic Medicine in Harlem, NY

Alternatively, some students give themselves time for a dedicated Step 2 study period. “I had a month off in the middle of third year, not at the end,” says Pavan,” but I know some students gave themselves a month at the end before Step 2. They achieved this by putting their Pediatrics rotation last.”

Have smaller plans within your larger plan

Caroline chose to create an overarching, yearlong study block for Step 2 and several smaller two-week study blocks for rotations. “At Texas A&M, I followed a longitudinal program” she says, “meaning we studied the material over the course of a whole year instead of one or two months blocks. In my situation, I would be studying one area for two weeks and a different area for the next two weeks,” Caroline says. “So I created two-week long study blocks, but I also created a much larger study block for my Step 2 studying, in which I put a lot of internal medicine questions. Cram Fighter was very helpful for these overlapping blocks of time.”

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