If you’re worrying about when to take Step 2, you’re not alone. Med students everywhere are going through the same thing.
After the National Board of Medical Examiners (NBME) made Step 1 pass/fail, your Step 2 score has increased importance on your residency applications as it will be your first USMLE exam that is scored.
Step 2 is also quite different in nature from its predecessor. Instead of the emphasis seen in Step 1 on basic metabolic/genetic pathways and microbiology trivia, Step 2 focuses on clinical diagnostic concepts and patient management practices. Considering the differences between exams, your prep for Step 2 may look quite different than Step 1, and should be planned accordingly.
With that said, deciding when to take Step 2 is an important factor in itself. In this post, we’ll break down how to know when to schedule your exam and set yourself up for success.
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When to Take Step 2: What to Consider First
While your medical school may have some predetermined time by which you need to take Step 2, you might have some wiggle room as to when you actually schedule it during your clinical years.
Between taking Step 2, completing your sub-internship and away rotations, and submitting residency applications, you will no doubt have a lot on your plate. Finding the best time to take Step 2 depends on your individual needs.
Here are a few factors to consider:
1. How much time do you need to prepare?
This will depend a lot on your overall readiness for Step 2 and will be influenced by your Step 1and shelf exam performance. Remember, all the time spent on your clinical rotations and studying for clerkship exams have been preparing you for Step 2. Stellar performances on prior exams may mean you can dive into the exam after a shorter dedicated period.
That said, don’t let lower shelf exam scores bring you down. A properly planned dedicated study period for Step 2 can allow you to flip the narrative. Identify which subject areas were more challenging for you and do a deep dive into understanding those concepts. Having extra time during your dedicated can allow you to strengthen your knowledge in those areas and efficiently build up your Step 2 score!
2. Does your med school predetermine when you can take Step 2?
Some medical schools have a marathon dedicated period after the core clinical clerkships during which time you have to take both Steps 1 and 2. If this is the case, then you might not have a lot of flexibility when it comes to your Step 2 date.
Many programs, however, require that medical students complete Step 1 prior to advancing to their clinical clerkships and leave the Step 2 date open-ended. In this situation, you may have some options regarding when to take Step 2 in the post-clerkship phase. (That is a period packed with many big deadlines that we’ll touch on in the next two sections!)
If you’re able to, it’s nice to have some space in between your Steps 1 and 2 study periods. Otherwise, it becomes very monotonous continuously studying for both exams.
3. How can you position yourself to excel on sub-internships and away rotations?
Sub-internships and away rotations are your chance to impress your attendings and residents and prove to them why you deserve a spot at their program. Unfortunately, the hours may make it challenging for you to follow your study schedule. This can certainly hinder making meaningful progress preparing for Step 2.
As such, it may be suitable for you to try and complete your Step 2 exam before or after these rotations. Perhaps there are some easier electives you can schedule after your core clerkships which would be more amenable to Step 2 studying. Your medical school may even offer virtual electives that are less time intensive and allow for a more flexible schedule during the day.
As a general rule, try to avoid scheduling your sub-internship at the same time as you’re studying for Step 2. This will enable you to give both tasks their proper due diligence!
4. Are you taking a year off?
It’s becoming increasingly common to take a year off after the core clerkships to pursue research or another academic degree. If that’s your plan, it may suit you to take Step 2 earlier during your enrichment year, closer to completion of the third year rotations.
There’s a lot of content tested on the exam and some of the finer details can be forgotten with time. Try to take the exam while all the information is still fresh in your mind. You might also enjoy your year a lot more if you get Step 2 out of the way earlier!
5. Are you approaching the residency application deadline?
It’s highly recommended you sit for your Step 2 exam before submitting your residency applications. Since Step 1 is pass/fail, Step 2 provides an objective measure that many residency programs use while reviewing applications.
In some cases, there may be extenuating circumstances which cause you to delay your exam. If that happens, be sure to check with your medical school regarding what the best next steps are for you. Also, keep in mind that medical schools normally require the exam to be completed prior to your graduation.
Final Thoughts
Step 2 may feel like a daunting task you have to overcome before applying to residency. However, remember you’ve been indirectly studying for this exam during your entire year of clerkships! I fondly recall when my attending on my internal medicine rotation was asking me about screening guidelines for a certain patient population type and much to my surprise, that exact question appeared on my exam. Believe in yourself and all the knowledge you’ve gathered over your time in medical school.
While Step 2 is only a part of your application, doing well on it can open doors when it comes to residency. As such, be sure to put yourself in a position to excel on the exam.
The time after your clerkships rotations is an exciting one with a lot going on. With some thoughtful planning ahead of time, you can position yourself for success and give proper attention to all the important tasks ahead of you.
And for some Step 2 study tips, check out this post written by my colleague: How I Scored a 267 on USMLE Step 2
