The third year of medical school is one of the hardest years of medical training. You’re waking up at the crack of dawn to make it to the hospital before your residents, witnessing applied pathophysiology for the first time, and navigating the complex emotional and social elements of medicine. On top of all that, when you get home, you have to study for your shelf exams! By the end of my clinical year, I was quite exhausted. It didn’t help that I had an even harder task awaiting me: figuring out how to study for Step 2.
Fortunately, my institution allowed medical students to take a dedicated Step 2 study month, which was incredibly useful for putting together everything that I had seen and learned. Having emerged from the other side of Step 2 mostly unscathed, I can tell you firsthand that preparing for it isn’t easy. And yet, I learned a lot along the way, which I’d like to pass along to you!
Here are the top 10 pearls I’d like to share.
How to Study for Step 2: My Top 10 Tips
1. Start studying early!
If you think about it, you really start studying for Step 2 the moment you start your first clinical rotation. In many ways, Step 2 is just a massive shelf exam, made up of every topic you’ve learned throughout each of your rotations. So don’t wait for your dedicated study period to start studying. Treat each of your rotations (and shelf exams) as Step 2 preparation!
It’s important to understand that the goal of your Step 2 study period isn’t to fill massive content gaps. Rather, the goal is to take all the knowledge that you’ve slowly accumulated over many months and synthesize it, learning how all the puzzle pieces fit together!
Whether you like waking up and enjoying a set of practice questions alongside your breakfast, prefer a working lunch with other students, or you’d rather end your night reviewing questions with a TV show in the background, doing a little bit of Step 2 prep everyday will go miles in maintaining your sanity.
Most of all, it’s important to remember that the best studying comes from our patients. Talking to your patients every morning and reading about their conditions on UpToDate, preparing for your surgical cases, asking your residents and attendings questions about why you’re doing the things you’re doing, is all more valuable than any set of practice questions. Contextual learning is powerful, and it reminds us of why we chose to do the work we do.
2. Study plans are GREAT! But they’re not perfect.
Having an outline was the push I needed to mentally convince myself to start studying. After 12 months of thinking critically every day, it’s incredibly helpful to have a day-by-day outline that lays out for you what you’re going to study, and how you’re going to study it. That way, all you have to do is wake up every day and do what the plan tells you.
I outlined a four-week plan with the goal of realistically getting through 80 questions a day. Most days, that worked great. But some days, I just wasn’t feeling it, and that’s okay. It’s going to happen. In fact, in retrospect I wish I would have built more rest days into my schedule.
On rest days, I still did a bit of work. I’d listen to podcasts or do some ethics questions. Anything that felt easy on my brain but kept me minimally productive. After taking a bit of a break, I’d pick back up on serious studying the following day.
Establishing a daily routine can also make things feel less overwhelming. Find one that works for you, and build in some “you” time (even on study days). For example, I woke up in the morning, made my iced coffee, and then sat down to do two Qbank blocks in tutor mode. After reviewing those questions, I would eat dinner, go on an evening walk with my family, and then get back into some targeted content review (podcasts, review videos, specific study plans) before getting ready for bed.
3. Don’t overload yourself with resources.
As I’m sure you’ve learned with Step 1, there are a plethora of resources out there for you to use. It can be incredibly overwhelming and time-consuming just to go through them all. Which are best to focus on? In my view, the key to mastering Step 2 is doing a lot of practice questions. That’s really the secret sauce.
Do your best to finish and review all of your Qbank questions for a clerkship the week prior to your shelf. I acknowledge that’s hard to do (and it’s not always feasible) but try your best!
If you’re able to access an additional resource, that’s a great alternative too. Realistically, I only had time to go through my Qbank while on my clerkships, but during Step 2 studying, it was nice to switch to an additional Qbank to see practice questions I hadn’t done earlier in the year.
The myriad of resources you hear about on the internet are really to help you bridge targeted content gaps, acquire last-minute buzzword associations, and develop frameworks for learning different topics. Throughout my third year, I played around with a LOT of different resources. (You name it, I’ve tried it!)
I listened to Divine Intervention podcasts on targeted topics throughout a clerkship, then completed NBME practice exams, and then watched Divine Intervention and Emma Holliday clerkship review videos the week of the shelf. Use your first few clerkships to play around with what you like, so when it’s time to figure out how to study for Step 2 dedicated, you’ve found learning tools that work for your brain.
Hot take: I didn’t use Anki to study during my third year, and I also didn’t use it to study for Step 2. However, I concede that it’s a magical tool for long-term content retention. If you’re an Anki fan, and it makes you feel accomplished to keep your Anki streak going every day, I’m here to support you on that journey.
4. Develop consistent test-taking strategies.
By the time we start studying for Step 2, we’ve made it through at least the MCAT, Step 1, and several shelf exams. We fundamentally understand that part of doing well on them has less to do with how smart we actually are, and more to do with how to get into the minds of the people who write these exams! This is where developing a consistent test-taking strategy comes into play. The goal is to maximize the number of questions you get correct in the time frame that you’ve been given.
One strategy I found particularly helpful was to triage whether I knew the answer to a question or not by reading the last sentence of the question stem first. If it was a question on spinal cord syndromes that I knew I wasn’t the best at, I’d flag it, mark down a random answer choice, and make a note to come back later.
This helped me answer questions I knew the answer to as quickly as possible, while leaving more time to reason through the trickier questions.
Whatever you decide, practice like it’s game day. Use your strategies until they become muscle memory.
5. Lean into your weaknesses.
I think this is the hardest part of figuring out how to study for Step 2. You’ve gained all this clinical knowledge, and it shows when you can answer OB/GYN questions in your sleep. Inevitably, though, there’s always one clerkship that just didn’t go as well as you’d hoped.
Maybe you did internal medicine first, and even though you learned a lot on that rotation, the shelf exam was too broad for you to master everything in time. Or maybe, like me, you took surgery early in the year and had no idea that you should’ve maybe reviewed some internal medicine before your shelf. Wherever you feel weakest is a great place to start during Step 2 study period.
I began with targeted surgery Qbank blocks, really focusing on the specific subtopics that I didn’t understand. Then, once I got a feel for those topics, I started integrating them back into my mixed daily Qbank practice. Initially it’ll make your brain hurt to only work on the things you don’t know, but the effort will pay off in the long run.
6. Track your progress.
There’s no way to know if your studying is doing you any good unless you track your progress by taking practice exams. For me, these tests came with a great deal of crippling anxiety. I felt a lot of pressure to hit a certain score on practice exams each week, and as a result, I procrastinated when it came to taking them.
I wish I would’ve reminded myself that practice tests are just that—practice! Nothing matters until test day, and every practice test is just a way to get more reps in.
When it comes to tracking your progress, it’s important to understand your scores won’t always progress in a linear fashion. They’ll probably fluctuate up and down a bit. And you don’t have to do every practice question out there to feel ready for Step 2. I completed ~60% of my Qbank before taking my exam, and for you, that number might look different, but know that it doesn’t have to be 100%.
7. Nothing mimics the exam better than the NBME.
If there’s one thing that’s definitely worth spending your money on it’s NBME resources. Be sure to get their CMS forms for each shelf exam and the CCSSAs for Step 2. Though a lot of the content tested is the same as what you’ll find in your question banks, the NBME has a way of catching test-takers off guard and making us second-guess ourselves about things we know. Doing these specific practice tests allows you to get into the mentality of “Step” thinking and will increase your confidence on test day.
About a week out from my exam, I also took the Free 120, which is available online. I feel like it came the closest to mimicking the difficulty level of Step 2.
One caveat: While there are 7 CCSSA practice tests available, that doesn’t mean you absolutely have to take them all as timed practice tests. Some can be used as pure practice questions, others as timed tests to track your progress. You get to build into your study plan what you feel works the best for you! Remember, the goal is to get enough reps in, and to learn something from every question. As long as you’re doing that, you’re doing it right.
8. Be prepared for ethics, QI, and biostatistics!
This was an underrated set of topics that I didn’t study super thoroughly during my clerkships, and to be completely real, there’s enough clinical medicine to learn from month to month without adding this into your Qbank blocks. I’d even argue that we apply ethics, biostats, and QI material each day on the wards without explicitly labeling it as such, because they’re such crucial components of how we take good care of patients.
However, a substantial part of Step 2 (worth three to five points) is focused on these topics. I used an entire week of my dedicated Step 2 study period to master this content. I completed custom study plans for QI, ethics, and biostatistics. I also made targeted sets of these topics on my Step 2 Qbank to ensure that I reviewed every single relevant question. Finally, I listened to Divine Intervention podcasts on these topics the week of my exam, which helped keep different terminology fresh in my head for test day.
9. It’s okay to push your test back.
In some ways, Step 1 feels like a bonding experience. You spend the first part of medical school going to lectures with your classmates every day, and afterwards, everyone’s in the trenches together. Step 2 isn’t really like that. Everyone’s taking this exam on their own timeline, squeezing it in between away rotations, sub-internships, and residency applications.
I was the last of my friends to take Step 2, and it was quite isolating. I wanted more than anything for it to be over with. At the same time, my “dedicated” Step 2 period fell at the start of the summer, when my cousin was having her sweet 16 and my closest family friend was getting engaged. I really didn’t want to miss out on these special occasions. So I made the decision to push my exam back by two weeks. I knew that while I valued being able to move past this monstrous exam, I equally valued being there to celebrate the people I loved.
Did those two weeks suck? Maybe a little. But was it worth it? Definitely—I ended up scoring a 267 on the exam!
The best judge of how ready you are is you, and a couple days in the grand scheme of the rest of your life is probably worth it. Don’t compare yourself to the people around you and do what feels right in your gut.
10. Ask for help!
There is absolutely no way that I would have made it through my studying process without leaning on my colleagues, friends, and family. I can’t even begin to tell you how much a home-cooked meal meant to me after a long day of studying, or how thankful I am for my friends who took the exam a few weeks before me so I could pester them with questions every day. It takes a village to become a doctor. Acknowledge that, lean on your loved ones, and remember to tell them how thankful you are for them.
From a nitty-gritty standpoint, sometimes we don’t know what we don’t know, and that can really hinder our studying. Asking for help, whether through academic success resources at your institution or through formal tutoring services (like Blueprint) can help you transform your studying and achieve your goals.
Final Thoughts
I leave you with these parting thoughts: as medical students and future physicians, we’re hard-wired to care deeply about standardized tests. This is not only because they’re an important part of proving to ourselves that we’re ready to take care of our patients, but also because they do carry some weight in determining where we go to residency.
At the end of the day, though, remember that Step 2 is one exam, and it’s just one stop on the long road you’ve traveled to become a physician. Don’t let one number, good or bad, change that!
