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Step Up To Medicine: How One Book Can Carry You Through Third Year and the USMLE Step 2 CK

In my experience with medical education, I have yet to find a resource as versatile as Step Up to Medicine. I first purchased this text as a third year medical student on my internal medicine clerkship and was instantly impressed with both the level of detail present and the organized flow that takes you from how a disease presents through how it is diagnosed and managed.

Needless to say, I gave this book a lot of credit for how well I did on my IM shelf, and when several of my classmates told me how much medicine was on the surgery shelf, I used it again to obtain a very high score. This resource later came in handy for studying for my family medicine (the ambulatory and infectious diseases chapters are very high yield) and neurology shelf exams. Naturally, given the positive results that I had throughout third year, it felt like a no-brainer utilizing Step Up to Medicine again to prepare for Step 2 CK.

While I am far removed from my shelf exam days, I still recommend this text to students I meet on rotation and to the students I work with as a tutor. For the most part, my students really enjoy this resource and feel that it does a great job preparing them for their medicine shelf. However, I almost always encounter the question:

“How do I efficiently utilize Step Up to Medicine to prepare for Step 2 CK?”

I think having previous exposure to Step Up to Medicine is very beneficial if you are planning to use it to prepare for CK. It is a very long (and some would say dense) resource that can be complicated to efficiently work through if your first exposure is during your dedicated study period. For students with less than 3 weeks of dedicated study time and no prior exposure to this text, I would recommend using it only on a prn basis for subjects that you struggle with. If possible, try to get through this book in conjunction with your internal medicine rotation or prior to your dedicated study time.

Another thing to remember is that Step Up to Medicine is NOT a comprehensive text for Step 2 CK.

It does not contain a review for pediatrics, psychiatry, obstetrics and gynecology, and most of the surgery specific material. As such, you must still find a second text (I often have students use Step Up to Step 2) and make sure to schedule time to review these subjects. I’ve definitely seen a few students get so wrapped up in this text that they don’t make enough time for the rest of the test.

If you do use this text during your dedicated study period, I would suggest reading a chapter per day.  Additionally, rather than working through the book in a chronological order, I would encourage you to start with the subjects that you feel the weakest on in order to have more time with them or a second pass if needed. Furthermore, I recommend pairing each chapter with a corresponding block (or blocks) of UWorld questions designed to provide objective assessment of your comprehension.  Stronger students may opt to complete these questions prior to reading as a way to focus on weaker areas whereas others will want to complete the questions after reviewing the chapter.

Finally — do not fall in the trap of liberal note taking while using this resource.

As it is a very long text, I have definitely seen students waste too much time essentially copying the book down. Aside from a few longer sections, you should not be spending more than 3 hours per chapter. Rather than taking too many notes, give yourself extra time to review chapters and consider utilizing the Internal Medicine Shelf and Step 2 CK sets on Memorang as they do a great job presenting the high yield material of each disease in a similar fashion.

Hopefully you can find the same value in this text that I did and use it to carry yourself through 3rd year and Step 2 CK. Stick to the aforementioned advice and you could be on the way to some very high scores.