The complete Guide to Studying for the USMLE Step 1 & Step 2 CK

Everything you need to know to study for the USMLE Step 1 & Step 2 CK

Table of Contents

A USMLE Step 1 studying agenda.
USMLE Step 1 study books.

How do I study for the USMLE Step 1 & USMLE Step 2 CK ?

If you are reading this, then you are probably in that stage of your professional career when you are expected to take the most important examination of your career. The USMLE/COMLEX are without a doubt some of the most important exams that you will take in your entire life. These exams are not only a huge factor in your residency application, but they also influence your fellowship applications, job applications and medical licensure. Given the lifelong implications of these exams, it is of utmost importance that you make a good study plan and follow it through. However, this is easier said than done. Planning a perfect study agenda can be a daunting task. The reason for this is multifactorial. First, there are almost an unlimited amount of study resources available, yet most medical students have a limited amount of time available to study for step. Second, medical students typically do not have a lot of time to review the insanely large amount of content covered in Step exams. Third, medical students have a tendency to follow the advice of other medical students. While this is a very useful strategy for succeeding in medical school, it isn’t necessarily good when it comes to formulating your study agenda. This is because the methods which worked for one person, may not be the best for someone else. There is a huge diversity in the way that medical students learn and this is reflected by the large amount of study resources available. While it useful to listen to what worked for others, it is important to always consider what has worked for you before you considering what has worked for others. 

While only you truly know what study technique and study resources are best for you, in this article we will lay a framework from which you can build your perfect study agenda. We will discuss the most common techniques that medical students who excelled in their board exams employed and also answer the most important questions which present themselves when planning your step studying agenda. The contents of this article apply mostly to the USMLE Step 1 and USMLE Step 2 CK as well as to the COMLEX equivalents of these exams. 

When should I start studying for Step 1 & Step 2 CK?

The ideal time to start your study agenda should depend on two factors, how much dedicated study time you have available and what is your baseline level of preparedness for the examination. Your target score is also an important factor, but for this discussion we will assume you are striving for the best possible score. So what is dedicated study time? Dedicated study time is the amount of days that are free from any form of clinical or classroom obligation and can be fully allocated to studying (10-12 hours of daily studying). Most medical students have anywhere between 3-5 weeks of dedicated study time available. What is baseline preparedness level? Baseline preparedness is exactly what the name suggests, it is the level of preparation that a person has for an exam before actually studying for it. How do you determine your baseline preparedness level? The best way to measure this is by taking a practice assessment under test conditions before you start actively studying for your exam. A score of 220 or more in this exam is an indicator of good baseline preparedness. 

So now that we have an idea of what these two factors are, how do you use these factors to determine when to start studying? Simple, the higher your baseline preparedness level, the less time you can afford to study and the more dedicated study time you have, the later you can afford to start your study agenda. However, regardless of these parameters, you should dedicate at least 6 weeks of study time, 3 of them being dedicated weeks. Six weeks of study time should be the bare minimum and is easily achievable. On average (from the author’s estimate) medical students who scored 240+ on their exams started studying approximately 3 months before their exam date, with at least 5-4 weeks being dedicated weeks. 

So for example, if you only have 3 weeks of dedicated study time and a low baselines preparedness level, then it is in your best interest to start studying at least 3 months (if not more) before exam date. While it is useful to err in the side of caution when it comes to board studying, it is typically not useful to start studying more than 6 months before exam date as it is likely that most of the material you learn in the first few months will be forgotten. While it sounds counterintuitive, your goal should be to try to review every exam topic close enough to the exam date so that the information is still fresh in your head. Old information is hard to remember, and when you do remember it, there is a high risk that you remember it wrong. 

What if you have a lot of dedicated study time? If you are fortunate enough to be in a program which allows 5-6 weeks of dedicated study time, then you may be able to push back your study agenda closer to the exam. A good strategy would be 4 weeks of regular (non-dedicated study) followed by 5 weeks of intense dedicated studying. Another way to think about it is to allocated enough time to complete at least 1 full pass of UWorld Step 1 question bank, 1 full pass of First Aid Step 1 (cover to cover) & and 1 full pass of another resource of your choosing (such as Pathoma or Sketchy).

In summary, the question of when to start studying depends on two factors, your baseline preparation level and the amount of dedicated study time available. Students with a high level of baseline preparedness and a lot of dedicated study time can afford to push their study agendas back while students with low baseline preparedness and little dedicated study time should start studying very early on. Starting your study agenda less than 6 weeks before exam date is considered a relatively short time to cover all the exam topics adequately, while starting your study agenda more than 6 months before exam date is considered too early to adequately recall the topics learn early on. The sweet spot for the average medical student should be about 3 months of studying, with at least 4 weeks of those three months being dedicated weeks. 

Should I take Step 1 or Step 2 CK First?

The option to take Step 1 or Step 2 CK first will soon disappear as starting in 2022, the USMLE will require test takers to take Step 1 before Step 2 CK. However, if you are planning to take your exam before this timeframe then this is a legitimate consideration. Generally, it is ideal to take the exam which you have the weakest grasp of first, because typically, you have the most time and energy to study for this exam. Given that most medical schools are requiring that medical students take Step 1 and Step 2 CK at the end of their third year, usually medical students take Step 1 and then take Step 2 CK 1 or 2 months after Step 1. For this reason, you usually have more time to study for the first of these exams because you will be expected to take the second exam soon after the first exam. 

Given this fact, most medical students choose to take Step 1 before Step 2 CK, because Step 1 is seen as the harder exam by virtue of it having a greater focus on the basic sciences. However, this is not set in stone and plenty of people take Step 2 CK before Step 1 and end up doing well in both exams. At the end of the day, this isn’t a really powerful determinant of exam success. In theory, it is better take the exam which you feel the least prepared for first because this is the exam which you will have the most energy and time to study for. Typically, medical students are exhausted from the first exam and don’t exert the same level of energy  for the second exam as they did for the first exam.

 

How do I schedule Step and are there any deadlines?

In order to schedule any USMLE exam, you must contact your school’s department of academic affairs and inform them that you wish to take the exam. Your school must “certify” you for the exam which is fancy way of saying that your school must provide evidence to the NBME (the people who make the USMLE) that you are eligible to take the exam. Usually, your school does this automatically and you will receive an email stating that you are eligible to take the exam. Once you are eligible, then it is a matter of going to the USMLE website and registering for the exam. The USMLE Step 1 exam costs $645 and the USMLE Step 2 CK exam costs $645 as of 2020. It is a good idea to schedule your Step 1 and Step 2 CK at least 5-4 months before exam date as any time after this, you are liable to not find a spot in your closest test center. An important thing to know is that unlike Step 1 and Step 2 CK, Step 2 CS should be scheduled 8-9 months ahead of time because the spots for this exam fill extremely quick, much quicker than the spots for Step 1 and Step 2 CK. The price for Step 2 CS is $1,300.

How should I plan my Step studying period?

Figure 1. A common approach to studying for board exams. 

A common strategy for studying for the USMLE Step 1 and Step 2 CK.
A common question that medical students have is how to study for Step. Naturally this is a very subjective question as there is no “best way” to study. However, a common technique which the author found extremely useful in terms of feasibility and content coverage is shown in the illustration above (Figure 1). This technique focuses on using a limited amount of high quality study resources and developing a routine of completing a set amount of each resource on a daily basis for a set amount of time. The amount of content to cover each day depends on the study situation. During non-dedicated studying (shown in yellow) a typical daily goal would be 20-30 NBME style practice questions (such as UWorld) coupled with another resources such as 2-3 videos (such as Pathoma, Sketchy Etc), or a textbook (such as First Aid Step 1). During dedicated (10-12 hours daily studying), a typical goal would be 40-60 practice questions, 3-4 videos, and 10-15 daily pages. During dedicated studying, doing 3 resources in parallel is reasonable, but not more. While it is hard to establish hard rules on how to study for board exams (since everyone is different), a good general rule is to not overload yourself with resources. You could end up spending an entire lifetime studying for Step if you decided to use all the resources available. Generally, you should never do more than 3 resources in parallel, otherwise you risk putting yourself in situation in which you won’t be able to finish every resource in time. Another relative rule is that you should finish every resource you start before moving on to another one. Most of the popular study resources available today are of extremely high quality and do a great job at giving you the knowledge you need to for the exam. However, the most important rule of all, is to be very wise with the resources you pick. We are going to discuss some of the most popular resources available in the section below.  Generally, you should pick high quality, USMLE proven resources which you enjoy doing and feel like you learn a lot from. After selecting a handful of resources that you are comfortable with, next you need to see how big that resource is and how long it will take you to complete that resource given your average study pace. For example, it takes most people about 2 hours to complete a block of 20 UWorld questions, about 1 hour to watch 2 video (depending on length of the video) and about 1 hour to read 4 pages (depending on the density of the pages). If a resource is so long that you will not be able to finish it within your designated study time given your study pace, then you should not use this resource (only exception to this rule is UWorld). Generally, most of the popular resources available are easy to complete within a 2-3 month study agenda given a reasonable pace and daily time allocation.  Table 1 shows the average amount of time required to complete popular Step 1 study resources.

In summary, when planning your Step studying agenda, there are several things to consider. Number 1, what study resources are best for your style of learning. Number 2, what is going to be your study routine during non-dedicated and dedicated studying. Number 3, given this routine, will you be able to complete all these study resources in time for your exam. Number 4, stick to your study routine, if you have to change your routine, try to do it in the way that disrupts the original plan as least as possible. 

Table 1. Average time to complete popular Step 1 study resources. 

  • UWorld Step 1 Question Bank, 40 questions/day: ~3.5-4 months
  • Pathoma, 3-4 videos/day: ~2.5-3 months 
  • Sketchy Micro, 3-4 videos/day: ~1.5-2 months 
  • First Aid Step 1 2020, 10 pages/day: ~3.5-4 months

What resources should I use to study for Step?

This is an extremely popular question. While it is not possible for us to name the specific resources which are best for your learning style, we will name some of the most well reputed and proven resources available. There are generally 4 main families of study resources, they are; question banks, video lectures, written materials such as textbooks and flash cards, and full study packages such as Doctor’s in Training (DIT) and Kaplan Medical. Generally, you should pick one resource from the 3 first families (unless you pick a full study package such as DIT since these packages already bring videos, questions and written materials). You should pick one good question bank such as UWorld, one good video series such as Pathoma, Sketchy or Board and Beyond and one good textbook such as First Aid 2020. We have reviewed and ranked the best USMLE step 1 video resources, questions bank and books

Regardless of what type of resources you favor, always include a high quality question bank such as UWorld. Again, there are not many hard rules when it comes to Step studying, but this is another one of these rules. The reason for this is because there is no other way to gain the familiarity and critical thinking skills required to answer the NBME style questions that you will encounter on exam day. UWorld and other question banks do a great job at replicating the style and content of the questions in the actual exam, therefore these resources are invaluable to any good study agenda. Figure 2 shows an illustration of the ideal combo for Step studying. The reason that we favor a multi-resource approach is because we believe that learning the same content from different avenues simultaneously (i.e. question explanations, video lectures, and textbooks) increases overall knowledge retention. Regardless of what combination you pick for Step studying, always include a high quality question bank such as UWorld, even if you believe you will not complete it all.

The amount of questions in UWorld Step 1 varies between 2900-3100 however, even if you only complete 75% of the entire questions, you will still have a great advantage. A good question bank is a staple of any good study agenda. Couple this question bank with a high quality review textbook such as First Aid and your choice of video lecture series and you have a solid study agenda. 

Figure 2. Common combination of resources used to study for Step 1. 

USMLE Step 1 Study Books, USMLE Step 1 Study Videos & USMLE Question Banks, aka the standard combo.

How do I study while in clinical clerkships or classes?

If you are planning to start studying before your dedicated study period, then there is a good chance that you will have to balance Step studying with some other kind of responsibility such as clerkships or classes. While this may seem overwhelming at first, it is actually possible to do (in most cases). The most important factor for accomplishing this is the relative time consumption of your other commitment. For this reason, it is ideal whenever possible, to schedule light clinical rotations during the months immediately before your exam. An ideal situation would be a clinical rotation which ends before 3 PM. This would leave you with enough time to get home and study for at least 3-4 hours.  If you are unlucky enough to have a heavy rotation right before your exam, another option is to bring a small tablet such as an iPad mini and with your attending’s permission, complete a small UWorld block of 15-20 questions in between patients. Most attendings will be sympathetic to your situation (heavy clinical rotation right before your Step exam) and will allow you to do some light studying in between patients. Lastly, if this is not possible at all, and you feel like you need more time to study for your exam, reach out to your school’s office of academic affairs and request for extra time. These requests are not uncommon and most schools have options for students who need more time to study, after all, your school wants you to do well in your Step exams as this reflect well on them. 

Medical student studying with ipad.

How do I know if my studying is working?

We said earlier that a high quality question bank such as UWorld is essential for any Step study agenda, well there is another essential component to a study agenda that we have not yet talked about. This component is self assessments. What is a self assessment? A self assessment is a simulation of the actual exam and is identical to the real exam in almost every way. The biggest different between a self assessment and the actual exam is the question number. A self assessment typically has between 160-200 questions whereas the actual USMLE exam typically has 280 questions. The highest quality self assessments available are those that are made by the NBME (who are the same people who make the USMLE). Anyone can purchase these self assessments by visiting the NBME website. A link to the website is posted here. These self assessments cost $60 each and are considered to be identical to the actual USMLE in every way except question number. 

So how does the self assessment play into your study agenda? Well there are two main reason for taking self assessments. The first reason is that self assessments are the only objective measure of how prepared you are for the exam. There is no other way to measure the effectiveness of your study plan than by taking a self assessment and seeing how your score responds to your studying. The second reason for taking a self assessment is that it helps you practice essential test taking skills such as question timing, eliminating wrong answers, and becoming familiar with the style of NBME questions. It is our recommendation that you take a self assessment at the start of your study plan and then monthly until the month before your exam, at which point you should take them biweekly. So assuming you plan to study for a total of 3 months, you should take 1 assessment before starting, 1 assessment at the end of the first month, 1 assessment at the end of the second month and 2 assessments somewhere in the last month before your exam. 

Why so many self assessments? The reason for this is because you want to be confident about the information which the self assessments tell you and since self assessments tell you how ready you are for the exam, you want to be very confident about this information. Money spent on self assessments will pay off for the rest of your life when you match into the residency of your dreams. Usually the NBME only has about 5-7 self assessments available for purchase at any given time. For this reason, we recommend the UWorld self assessments which are typically included for free with the purchase of any of their question banks. We recommend these self assessments only after you have exhausted all the NBME self assessments as these are superior to the UWorld ones. 

So when do you know if your studying is working? Simple, you should expect to see an improvement (even if small) from your baseline self assessment to your first self assessment after 1 month of consistent studying. You should consider yourself ready for the exam when at least one self assessment is within 0-5 points of your target score. For example, if you absolutely need to get a 250 or higher, then it is reasonable to take the actual exam when at least one of your self assessments is 245 or higher. You can expect to get the highest self assessments score during the last month of dedicated studying. Of note, self assessments should always be taken under real test condition and under timed conditions. Taking a self assessment under non-exam conditions or not timed is a waste of a self assessment as you can easily accomplish this by just doing UWorld questions in tutor mode. 

When should I consider rescheduling my exam?

While many people will typically reach their target score during their self assessments, you should also have a contingency plan about what to do if this does not occur. This is especially true if you are aiming for an extremely high score (260+) and you are not an excellent test taker. However, not reaching your target score does not necessarily mean that you need to reschedule your exam. For example, if you are aiming for a 260 and your best self assessment is a 250, then you should highly consider taking the exam and settling for a 250 since this is a very respectable score for any residency program. However, if your target score is 240 and you are scoring below 220 consistently, then you should consider taking action. Depending on where you are in your study agenda and how much dedicated study time you have left, you may not need to reschedule. Generally, if you have 1 month of dedicated study left, you should consider re-adjusting your studying and retaking a self assessment 1 or 2 weeks before. If you are still scoring below 220, then it may be a good idea to reschedule your exam by 3 or 4 weeks and contacting your school for additional study time. It is good practice to always schedule your exam slightly earlier than your school mandated exam deadline so in the case where you have to reschedule, you still have room to push the exam back by a few weeks. Even 2 weeks of extra studying can make an impact. 

What should I do two or more months before exam date?

Just keep studying. At this stage you should focus on developing your routine and sticking to your original study agenda. Do not worry about poor self assessment score at this level. 

What should I do the month before exam date?

This is when things are starting to heat up. By this time, you should at least see a decent uptrend in your self assessment scores. If you have not seen an uptrend at this stage then you should consider changing your strategy and start making arrangements to reschedule your exam if the situation persists.   

What should I do the week before exam date?

By this time, everything is almost set and done. You should have reached a score you are happy with in at least one of your self assessments. This is the time to wrap up UWorld or any resource which you have not yet finished or have fallen behind in. Do not slow down just because you have reached your target score. Generally avoid taking a self assessment this late in your study agenda unless you are extremely confident that you are going to see improvement. 

What should I do the day before exam date?

At this point you should close all your books and put away all your study resources. It is best to relax, go to the gym and prepare yourself for a restful sleep. 

What should I do after taking Step?

Do not overthink the exam. You have 3-4 weeks of time in which you will not have to worry about the exam. USMLE exams are renown for making you feel awful and as if you failed the exam immediately afterwards, however, these sentiments are rarely true as most people end up performing very well. 

What should I do if I am not happy with my score?

In the unlikely event that you are not happy with your score, there is not much you can do unless you failed. If you fail any USMLE exam you will be allowed to retake the exam. However, if you pass the exam with a low score, you will not be allowed to retake it. That will be your score forever. If you find yourself in this situation, then learn from it and try to make up ground in Step 2 CK. Consider other strong aspects of your application and focus on those. Step exams are a large part of your residency application, but they are not everything. In the overwhelming majority of cases, people who fail a USMLE exam, end up retaking the exam, passing it, matching into a residency program and becoming licensed physicians. 

I just took Step 1, now how do I study for Step 2 CK?

Fortunately, Step 1 and Step 2 CK have a lot of content overlap. The only new thing which Step 2 CK brings to the field is a greater focus on the clinical aspects of medicine.  For most people, this is appreciated as it is closer to “real” medicine. If you feel like you did a great job studying for Step 1 and got a good Step 1 score (240+) then studying for Step 2 CK will be a breeze (for most people). However, this doesn’t mean that you don’t need to prepare at all. Step 2 CK is still a very important exam. The strategy for Step 2 CK is to allocate at least 6 weeks of solid studying provided you performed very well in Step 1. If you performed well in Step 1 (240+) and perform equally as well in a Step 2 CK self assessment, then you should not need to study more than 2 months for Step 2 CK unless you really need a 260+ in Step 2 CK. The resources for Step 2 CK are not as straightforward as those for Step 1, but a good strategy that we recommend is to complete at least 75% of the UWorld Step 2 CK question bank and complete 2 Step 2 CK self assessments with satisfactory scores. 

If you performed poorly in Step 1, then you should consider devoting significantly more time to Step 2 CK. In this scenario, you should consider at least 3 months of Step 2 CK studying with at least 2-3 weeks of dedicated Step 2 CK studying. 

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