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Bracing yourself for third year? Lock down your clerkship and Step 2 CK study timeline.

**This blog post was updated July 2019.** Life as a third year medical student is an all-consuming whirlwind:

1. You’re finally applying what you’ve learned.
2. You’re working long hours and getting paid negative dollars.
3. You’re forgetting to eat normal human food.
4. You’re getting sick on your pediatrics rotations.
5. You’re feeling sick on all your rotations because #2 and #3.
6. You’re pressed for time and therefore cannot study the same way you once did.And yet you’re learning.

It might not feel like you’re learning, because most of the time it doesn’t feel like anything at all (except maybe damage control).

But, alas, you’re learning (!!), because:

“The best teacher is experience, and not through someone’s distorted point of view.” — Jack Kerouac, On the Road


This largely explains why—as you may already know—most students score higher on the USMLE Step 2 CK than they score on the USMLE Step 1.

Well, that and the Pyruvate Dehydrogenase Complex. But, I digress.

Students tend to score higher on Step 2 CK because the process of preparing for the exam is more consistent with what we know to be true about adult learning styles. Namely, that adult learning requires hands-on experiences that enable us to apply what we know in various situations. What can be frustrating is that, at times, this process butts up against the “success algorithm” lurking in the back of our brains.

Success algorithm?

You know. The thing in the back of our minds that tells us we need to put in X number of hours answering X number of questions in order to achieve X score. The thing that says, “Seriously? A 5pm admission? You’re cutting into my valuable study time, man!!” The thing comprised of all the parts of us that struggle to operate within a system that is not directly and clearly tied to us achieving our personal goals so that we can just go home already.

Third year is hard.

Plus, your classmates pretty much all turn into crazy versions of their former selves.
Double hard.

And you’re attending social work rounds. And running to the pharmacy to get prescriptions filled in order to discharge your patient before sign-out. And somehow, you’re still hoping to find time to study conventionally, because at the end of everything is yet another standardized benchmark designed to assess how well you’re retaining all this information.

So when should you take Step 2 CK?

And, more importantly, how does one build “studying for Step 2 CK” into the hectic life of a third year medical student? Here’s my advice:

1. Remember that caring for patients and preparing to the take Step 2 CK are NOT mutually exclusive. Taking care of your patients is one of the best ways to prepare for Step 2 CK!

2Carefully consider the order in which you did (or will do) your clerkships:

Some clerkships (i.e. internal medicine) are foundational, and you will carry the principles you master during these into every subsequent rotation.

 Other clerkships (i.e. Ob/Gyn, pediatrics, and psychiatry) tend to stand alone, like an episode of Seinfeld. If you did the stand-alone clerkships at the beginning of third year, you may need to budget more time on the back end before feeling prepared to take Step 2 CK.

 This means that, if you have a say in setting up your third year schedule and plan to take Step 2 CK immediately after third year ends, you should probably save the less-broadly applicable clerkships with difficult shelf exams for closer to the end.

 If family medicine is a required clerkship at your school, save it for the end, because the shelf is quite challenging and great Step 2 CK prep!

3During each clerkship, you should put your limited free time to good use by maximizing active learning styles:

 Download the USMLE World application onto your mobile device. Work on this throughout the day during down time. Your goal should be to complete the question bank once during third year.

Make flashcards from your UWorld questions and, again, drill them during your down time throughout the day. I personally am a huge fan of Anki (I usually use AnkiWeb).

 The Case Files series is great, especially for “stand-alone” topics (see below) such as Ob/Gyn and Pediatrics. It contains short chapters on specific topics, complete with questions (active learning!).

 The PreTest series also has bountiful questions, but they may not be as high yield as the two resources above, and tend to vary according to the clerkship in question, so prioritize the first two!

4Evaluate your exam goals:

 Are you trying to make up for a lackluster performance on the USMLE Step 1?

 Or did you do well on Step 1, and simply hope to maintain?

5Plan to take Step 2 CK immediately after third year ends.

It’s tempting to postpone Step 2 CK, but the less time you place between the end of third year clerkships and your test date, the less time you’ll need to study. The less time you need to study, the more time you have to do other things. Because fourth year should be fun.

6Determine how much uninterrupted time you need to study.

 You may be familiar with the adage, “Two months, two weeks, two pencils,” referring glibly to the ideal preparatory strategy for tackling the USMLE Step 1, Step 2 CK and Step 3, respectively.
 If you successfully tackled the USMLE Step 1 after a 4-6 week study period, you’re probably fine with spending two solid weeks of 10-12 hour days preparing for Step 2 CK.
 If you required extra time to prepare for Step 1, it’s probably safer to budget a full month for Step 2 CK prep. If this isn’t possible, get a head start on your study period by budgeting 1-2 hours during the final month of your clerkships for USMLE prep.

7Take a practice exam!

 No matter what your goals are, take at least one NBME practice exam. Many students I’ve worked with overestimated their clinical knowledge. This is especially important if your school doesn’t use standard NBME shelf exams to assess your performance after clerkships.
 If you’re trying to make up for a lackluster Step 1 performance, I recommend taking all the NBME practice exams, starting with the oldest (and least predictive) one, to be sure that you’re ready!
Good luck! (And watch out for the flying cows!)


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