The Big Picture: Preparing Your Step 2 CK Strategy

  • /Reviewed by: Amy Rontal, MD
  • Step 1 study periods are usually pretty straightforward. You finish your basic sciences coursework and your medical school, if it was anything like mine, will intimately guide you through the registration process. Our school went so far as to mandate meetings between each student and a member of the faculty to make sure we had built an appropriate study schedule heading into our six week study block. Talk about hand-holding!

    Then Step 2 CS and CK came around. For guidance this time, we got a terse email that said, “Here’s the link to the NBME website. Take the test by October 1st. Goodbye and good luck.” All of the variables were in our hands. Take time off to study? Study on top of other electives? Which electives to schedule before the test? Does CK prep really only take two weeks? So many unanswered questions…

    In case you find yourself in a similar situation, up the creek without a paddle, we are here to drop some knowledge on what has worked and what hasn’t for the myriad students we’ve seen through the process.

    Do I need a dedicated study block for Step 2 CK?

    We wish there were a simple one-word answer for this. While we can’t give you the absolute yea or nay, we can discuss some important factors to consider when making this decision. First, how important is your Step 2 CK score to you? How important is it to your desired residency programs? (VERY.)

    A look at the Program Director survey from 2018 shows that Step 2 CK score is the 4th most important factor in granting interviews! This dispels the rumor widespread among medical students that Step 2 isn’t all that important. In developing their rank lists, the Step 2 CK score is a not-too-distant 7th on the list. This data has been steady over the last 4 years; Step 2 is and has been important.

    In some respects, all of this is a moot point. You should strive to make this indelible three-digit number, which you will carry with you throughout your professional career, as high as possible through dogged efforts. Why just do alright when a little extra effort can bring you to greatness?

    Be honest with yourself. Would a two or four week block without electives be of great service to you? Did you do not-so-hot on Step 1 and want to show the world, “Hey, I’m better than that!” If so, then do what it takes to get there and take some extra time off  – no more than 4 weeks – if you need it.

    If you are the kind of student who does better under pressure and is able to make great use of free time when provided the outside structure of rotation, then don’t take the time off. One of the best strategies is to meet in the middle, scheduling an easy elective during the time leading up to the test. You get the best of both worlds: structure and free time. Ask upperclassmen in your school which electives are less intense so you have the means for extracurricular studying.

    What time of year is best to prep for Step 2 CK?

    The big question here is whether you want your score to appear on your application that gets submitted to programs. Remember from above, the score is very important for getting an interview.

    In the past, we’ve made recommendations to take the test so that you are not forced to disclose your score if its not great. As the competition continues to grow stiffer, we’ve changed our tune a bit.

    It’s a great idea to take the test as soon as you are fully prepared. An application with a great Step 2 score is stronger than an application without a Step 2 score. Don’t leave prospective residencies wondering how you will do. Perform well and get a great score to them as soon as possible.

    What clerkships should I schedule near Step 2 CK?

    Whether or not you take time off to study for CK, there are two clerkships that most lend themselves to the tested material.

    The first is obvious: internal medicine. This classic core clerkship will have you exposed to patients with all of the bread and butter medicine you will be tested on: pneumonia, anemias, kidney and liver disease, pulmonary pathology, etc. Additionally, most of these patients will carry diagnoses from other disciplines. Maybe your surgical cholangitis patient is scheduled for a lap chole. Or your psych patient in alcohol withdrawal has a history of stroke. You will see patients on all of the psychiatric drugs you had to memorize. Internal medicine is really the catch-all of disciplines. Taking it late in third year will help keep the knowledge fresh for CK.

    The one big schism between internal medicine and the test is, ironically, the art of diagnosis. By the time patients arrive on the floor, they typically already carry a diagnosis. Who is making this call? Your colleagues downstairs in the emergency department. A rotation in emergency medicine can be incredibly valuable. You will get experience working up patients from scratch. You can work up ten totally different patients in the course of a shift, and you’ll be the doctor ordering that all-important first round of tests, instead of simply repeating yesterday’s tests for trending purposes. Experience as the first provider will help you cross the gap, and ultimately land you more correct answers on Step 2 CK.

    As a side note, emergency medicine experience is 100% translatable to Step 2 CS. The tests actually run much like an EM shift: seeing patient after patient, coming up with differentials and workups, then wiping your mind clean before seeing the next one. EM can also afford you some time on slow days (or nights) to cuddle up with your Step 2 book or question bank, killing time by getting smarter.

    Everyone’s particular situation is different, but in the end, the advice is simple. Take time off if you need it, do as well as possible on the test (it counts!) and try to align these high-powered clerkships with the test. Above all else, remember the importance of the test, and don’t listen to fellow students who tell you that it doesn’t really matter.

    For more Step 2 CK study resources, read on!

    Does USMLE Step 2 CK Matter if I Aced Step 1?

    Rotations are Beginning. Your Step 2 CK Study Plan.

    How I Scored a 284 on the USMLE Step 2 CK 

    Besting the USME Step 2 CK Beast: A Comprehensive Resource Review

    The Pros and Cons of Taking Step 2 CK Before ERAS 

    3 Tips to Handle a Clerkship/Step 2 CK Scheduling Mismatch

    Clinical Thinking: Preparing the Mind for Step 2 CK – FB Live Q&A