Dr. Joel Ramirez from MedSchoolCoach details what students can expect on USMLE exam Test Day, and provides tips for how they can prepare and succeed.
Since Step 2 CS has been suspended until at least August 2020, the NBME teased that they are aggressively exploring a digital version of the exam, which would be entirely computer-based and would focus on telehealth encounters. There is understandably a lot of frustration and speculation regarding this teaser but no new clear details as of yet. However, it seems safe to assume that a virtual or digital version of Step 2 CS is around the corner.
HOW TO STUDY FOR COMLEX LEVEL 1
The first two years of medical school can be incredibly daunting. Attending lecture after lecture, taking two to three exams every week, and spending nearly every minute of the day looking at Powerpoint slides with topics ranging from parasitic tapeworms to the Krebs cycle. And then to top it all off, just as you’ve trudged through that last final exam and are ready to plunge into the world of clinicals, you realize that you only have four to six weeks to study for, arguably, the most difficult exam of your scholastic venture to date: COMLEX Lev el 1.
You’re exhausted and intimidated by the mere idea of the 16+ hours a day you still need to dedicate in order to achieve the score you want. Your future career depends on it. I’ve been there. I’ve survived.
I successfully took and actually overshot my desired score. My purpose in writing this brief blog post is to give you a few simple tips that will help you succeed in getting the score you want on test day.
Mark That Calendar with Your COMLEX Level 1 date
My first piece of advice is about time management and consistency. Grab a calendar, mark when you’re test date is, and write down the number of weeks until test day. I started studying for COMLEX Level 1 in January of my second year. This was incredibly stressful for me, as I was already devoting most of my time to keeping up with current lecture material. So I had to take a step back and set up some realistic expectations. I started by devoting 30 minutes-1 hour a day to Level 1 studying. This meant doing about 20 questions from UWORLD, or reading through sections of First Aid. As March approached, I began to devote a total of 90 minutes to two hours daily. By this time, I was used to setting aside concrete studying time for COMLEX Level 1 on a daily basis, so extending that time by thirty minutes once not nearly as daunting. With each progressive week and month, I again lengthened my dedicated study time until finally finishing my second year curriculum. This brings me back to my first piece of advice: mark that calendar, and set up an arbitrary amount of time you will study each day. Make it realistic. Don’t start with three hours. Realize that there will be some days that you will not study as much, and other days that you will have more free time and can study more. Once your lecture workload lessens, add more time. The key to success is consistency.
My next piece of advice is related to the first: don’t sacrifice your grades for your COMLEX Level 1 score. Realize that when you start studying, you probably haven’t finished courses like Pharmacology, Pathophysiology, and Microbiology, which will make up the bulk of your exam. A common error I see with second years is that they feel like they need to devote five-six hours a day reviewing everything they’ve forgotten in first year. They feel that grades don’t matter as much, and will cram the night before the exam. Instead of internalizing and really learning the material, they’re memorizing, and will forget the new material the moment they leave the testing center.
This is why it is crucial to start with a small amount of time for Level 1 studying on a daily basis, and work your way up. If you dedicate the time to actually learn the new material, you’ll save more time in the long run.
Instead of learning a bunch of new material a month before the exam, you will be doing your second or third pass at it. You’ll have a better understanding and will perform better on test day. One way I combated this error was by annotating First Aid alongside my second year material. For instance, the night before a Pharmacology test for Cardiology, I used my dedicated Level 1 studying time that day to read and annotate the Cardiology Drug section in First Aid. By so doing, I reinforced knowledge I already had to prepare for my exam, and also added in pearls from class notes to review at a future time when studying for Level 1. It is indeed possible to study for exams and the boards at the same time!
Pick the Right Materials for COMLEX Level 1
Finally, a few words regarding study materials. As you’ve probably realized, there are a lot of products that are marketed for Level 1 studying. The most important advice I can offer is to choose two or three, and stick with them! If you dive into ten different books, you’ll end up skimming and not actually internalizing the information. Most books are designed to cover all of the material you’re likely to see on test day.
One obvious must-use is First Aid for USMLE Step 1. This is the most comprehensive material out there. It is very dense and daunting to get through the first time.
I’d recommend getting through a first pass before your dedicated study time for COMLEX Level 1, perhaps by annotating alongside your second year curriculum. Passes two and three will be a lot faster if you do it that way. Next, you need two to three solid question banks. UWORLD is absolutely crucial. It not only assesses knowledge, but allows you to learn material in the process. I’d recommend starting with 10-15 questions a day with subjects you’ve already learned. Don’t include subjects like Neurology if your school hasn’t covered them yet! You’ll just waste time and get frustrated in the process. Also, some students recommend using Anki Flashcards or a google document to write down questions you’ve missed and review them on a regular basis. This is a fantastic way to reinforce material you are weaker on. If you’re the type of learner that needs help motivating yourself to study on a daily basis, using a program like MedSchoolCoach with private tutoring is a great option. Having individualized attention can aid in the learning process and keep you accountable in studying every day.
COMLEX Level 1 is an incredibly difficult exam, and perhaps more daunting than test day is the weeks and months leading up to it.
I hope that what I’ve mentioned here helps in some way to calm your nerves, but also to convince you to take action now to start making a study plan. Start small, with a bit of time each day, but stay consistent. Don’t neglect your second year curriculum. And finally, fully invest in just a few books or Question Banks instead of dabbling in a dozen. Doing this will help you in getting the score you want to get that dream residency. If you need COMLEX Level 1 tutoring, check out MedSchoolCoach.
Benjamin Massenburg is a MedSchoolCoach USMLE and medical subject tutor who shares with us the best Step 1 Advice he ever received.
The months leading up to Step 1 can be stressful. You are still in classes that you hope will be relevant to your upcoming national board examination, and doing dedicated Step 1 studying in your free time. There is a frenzy among all of your classmates, and competition is at an all-time high. Everyone is using different resources. The older students are full of advice, often unsolicited. In an era when most of the basic science classes in medical school are pass/fail, Step 1 assumes an even more powerful role in your future residency application.
You begin to wonder:
Am I using the right resources?
What is she using over there? I haven’t seen that before!
This happens to everyone. You are not alone.
At some point during my time studying for Step 1, an older medical student approached me and said,
“Don’t take anyone’s studying advice. You have made it this far, and you know what studying techniques work for you.”
What he meant was, we should put our time and effort into gaining the base of knowledge necessary for the exam and by doing practice questions, not into worrying about what everyone else may be doing. This couldn’t have been more true and helpful for me, and carried me to my success on that and future examinations.
This may sound strange, as this post about advice is urging you not to take any.
However, I am just encouraging you to stay focused and not to worry about what others may be doing. If flashcards work for you, use flashcards. If group studying works for you, study in groups. If tutoring works for you, find a strong tutor. If you don’t know what your weaknesses are, do practice questions and exams.
This exam is not testing your intelligence or your capabilities as a doctor, it is basically testing how much effort you are able to put into something. This score does not define who you are as a medical student, and does not mean that you are smarter or dumber than any of your classmates. However, with the proper amount of time and effort put into preparation and studying, you will earn a high score. Stay focused, and don’t worry.
We sat down with Dr. Amy Chen, a MedSchoolCoach tutor and expert on the USMLE Step 1 and 2 exams. We asked her for some advice for students who are currently preparing for the USMLE Step 2, specifically how students could ace the exam! Included below are also very helpful USMLE Step 2 CK references for our students.
How should someone best prepare for the USMLE Step 2 CK exam? Are there any resources that you suggest? Is there any schedule that one should follow?
In terms of resources, I don’t think it’s necessary to have too many resources. There’s a lot out there. You could potentially study from 5-7 different resources. I’d suggest keeping your number of resources down to 3-4 just because it can focus your concentration. I’d say UWorld is definitely the #1 Resource. That is 100% necessary and definitely key to really learning a lot of information. Another resource I really like is Step Up to Medicine. This has a detailed overview of Step 2 CK for internal medicine topics. I think it does a really great job of breaking down the topics and the key information you need to know for each different disease. It also has a lot of nice diagrams and information. It does go into a little bit of detail but I do think it gives you a comprehensive overview of internal medicine. For the other topics like surgery or pediatrics, I think Master the Boards is a good resource to use. I would use Step Up to Medicine for internal medicine topics. Some people find OB-GYN is not covered very well on Master the Boards. If you’re struggling with OB-GYN and you would like a more detailed overview of the subject, I would recommend Case Files’ OB- GYN for that particular topic.
Alright. Is there any specific way you suggest studying from these resources? Would you suggest looking at the topics first and then answering questions? Or is there another way?
Yes, I think before you start studying, it’s good to get a sense of your own weaknesses and strengths and to kind of start studying from your weaknesses. You can identify those multiple ways. Some people already have a handle just from their classes and their rotations, about what they maybe strong in or what they don’t do so well in. Or you can take an NBME and kind of get a break down of your score. So I would say, start with your weaknesses and start with kind of reading and learning the material. I actually like to do the questions simultaneously with the material. I don’t think you need to finish reading a chapter before you start doing the questions. I think there’s a lot of learning that occurs just from looking at the question and looking at the explanation and really kind of reading and digesting and trying to remember the explanations; then go back and annotate on your textbook the notes from the UWorld questions.
“I think before you start studying, it’s good to get a sense of your own weaknesses and strengths and to kind of start studying from your weaknesses.”
Is that the same way you studied?
Yes. That’s the same way I studied for them. I would focus on Step Up to Medicine because internal medicine is such a big part of the exam. It’s more than 60% of the questions. So I would start there. Make sure you brush up on all your internal medicine topics. Feel comfortable with that and then you can go on and branch out to other topics like pediatrics, psychiatry and surgery and so on.
Great! Then, are there any other mock tests you suggest taking?
Yes definitely. There are 4 NBMEs available. You can buy them – I think they’re like $50 each to buy them online. That way, you can take them in a timed environment and it gives you a score at the end. Otherwise, if you don’t want to buy them, try googling to see unofficial NBMEs. You can get the questions and the answers but the disadvantage is you don’t really get a score at the end. It doesn’t score automatically. You have to score it yourself. But NBMEs are a must. They’re great at assessing your progress. There’s also the 131 Step 2 Questions booklet. It’s a PDF that can be found online. It’s an official resource put out by the USMLE with 131 sample CK questions. Those are also good to go through for practice and they give you the answers as well.
Is there anything one should keep in mind while scheduling the test?
I don’t think there is anything in particular you have to keep in mind. I think it depends on when you’re applying for residency. Many residency programs will want to see that CK score back by the time you rank in February; by the time you submit your rank lists. Keep in mind though that it can take a month or two for those results to come back. You want to take it with enough time that your results are back by the time your rank list is due in the year you’re applying to residency. Other than that, there isn’t too much scheduling consideration you need to do. It depends on the individual person and when they’re freest in their schedule. I want to say you want to give yourself at least a month to study, but ideally more than that. But it depends on what your goal score is and how well you did on Step 1. But ideally, you’d have some time where you wouldn’t be studying as well with an intense rotation. Also, if you’re an international medical student or foreign medical student, you do need to have your Step 2 score by the time you apply; so by the time you submit your application. For that you would need your score back by September 15, instead of February.
That’s good information. Would you suggest any schedule that students should follow?
I think it really is student-dependent. I think it really depends on how they are already doing and how far they are away from their goal score in terms of studying. But as I said, you need at least a month to prepare for it and ideally more time.
That makes sense. What’s the best advice you got for the USMLE Step 2 CK? After taking it, what do you think you could have done better? And what would your suggestions be based off of that?
I have a couple of ideas of what’s helpful to keep in mind while studying for Step 2. One of the things that’s really challenging for many people is time management. You only have a certain amount of time to answer each block of questions and it’s very easy to get bogged down and then run out of time by the end of each block. The way I encourage people to approach their questions is, when you’re reading the question, you should be actively thinking of differential diagnoses. By the time you reach the end of the question stem, you should already have a most likely diagnosis in your mind before you even look at the answer choices. I don’t think it’s advantageous to look at the answer choices first or read the question and look at the answers and think about the diagnosis. I think you end up using a lot of time in trying to go back and reread the question and so on. Be able to train yourself to have a clear diagnosis by the end of every question because that helps a lot with time management. Also, be very familiar with the lab values. You can lose a lot of time if you always have to go and check if this value is a normal value, if it’s high, or if it’s low. If you can do a good job of learning the normal lab values, that will also save a lot of time. You should know what does it mean when someone has hypernatremia, what are the specific diseases that could cause that? What does it mean when someone has elevated gluten levels? A lot of the times you can get the diagnosis just from the labs. They’re very very helpful. Being sure that you feel comfortable with EKGs and chest X-rays – those are often overlooked but Step 2 will test you on whether you know how to read an EKG and can identify abnormalities in X-Rays. Don’t forget about those as well while you’re studying.
Is there any other advice you’d like to give?
Practice is really important. So just practice as much as possible. Practice with the UWorld Question Bank, practice with your NBME exam. Try to find resources out there that encourage active learning so that you can test yourself with some questions. I think that’s really the key. Get used to the format of the test and used to how the questions are asked; get used to time management and just get used to answering this many questions in 8 hours essentially.
Step 2 CK can be an extremely important test. More and more residencies are interested in your score on this test in order to establish your competency within clinical medicine! Step 2 CK becomes especially important if you haven’t performed as well as you liked on Step 1. We sat down with Dr. Mili Mehta, a University of Pennsylvania Chief Internal Medicine Resident and Former Member of the Columbia University admissions committee to ask her about her experience taking Step 2 CK.
Having taken the USMLE Exams, could you provide some key strategies for preparing for the Step 2 CK Exam?
The step 2 CK exam is a combination of what you learn during the course of your clinical year of medical school, with some Step 1 knowledge thrown in there. While there are a lot of good books out there with the outline of various topics of medical school, I found that the best way to study was to constantly do questions from the UWorld Question Bank during the school year. You can purchase it and you can use it to study for your shelf exams and then when you’re taking Step 2 you can repeat these questions, because there’s going to be a long enough interval between the Step 1 and Step 2 exams. I usually do the questions on tutor mode first, and then I take the time to read through explanations, and read through what I got wrong. If you have any Step 2 books for studying, you can take the time to look over the information in there as well. Just as important, before the actual exam, when you’re studying for the exam, you should practice timed questions. This can be very tricky as there are a lot of questions to answer in a small amount of time, and pacing yourself is important.
“While there are a lot of good books out there with the outline of various topics of medical school, I found that the best way to study was to constantly do questions from the UWorld question bank during the school year. “
And is there a particular study schedule you suggest following?
Not really; It depends on what other things you’re doing if you’re on a rotation. I would say the most important thing is to practice questions on tutor mode, and then read the explanations. You should also get comfortable doing questions in timed mode.
Remember, practice makes perfect. Make sure to do plenty of practice questions. Check our MedSchoolCoach’s USMLE Step 2 Tutoring for additional information on how you can ace your exam!
We asked Dr. Davietta Butty, MedSchoolCoach advisor and pediatrician, what resources she found very helpful to study from during medical school and while studying for the USMLE.
When I was studying for the MCAT I definitely used the Kaplan system. I went to the classes for a semester or for however long it was and I used the practice tests. I thought that was really important in terms of getting prepared for the format of the test and the type of rigor that the test was going to have. Then as far as the
USMLE is concerned, there are many different resources you can use. I think I remembered studying from First Aid and Goliath lectures. But what was important for me was the group anxiety about Step One in particular where somewhere in January when everyone in my medical school class was getting very excited and anxious and all they talked about was Step One. If that’s something that motivates you then that’s great but if it’s something that’s contagious and increases your anxiety then I think making sure that you are able to remove yourself from that environment to study and stay clear headed is also important because you don’t want to get psyched out by other people’s anxieties or worries.
We sat down with Dr. Marinelli, MedSchoolCoach advisor and former admissions committee member at University of California Irvine School of Medicine. She shared with us some secrets about doing well on the USMLE exams!
Could you tell us a little about the different USMLEs (Step 1, Step 2 and Step 3) and you would recommend a student approach Step 2 specifically
Sure, so Step 1 is taken after your second year of medical school. I think that is probably the hardest step test that most students will take, just because the material and the volume of information on that test is very large and it is weighted heavily on the residency program. So kind of like the MCAT is for medical school admissions, the USMLE step one is similar for residency admission. It’s very heavily based and depending on your score really reflects what type of residency program you will get in, in a large majority of residencies. USMLE Step Two, also is a lot of information, but since it’s more about clinical skills and about clinical practice, most people find this one a little bit easier to take and this is usually taken in your fourth year of medical school. Then finally USMLE step 3 is the last step thankfully and that is most often taken in the first year after medical school. That one is, I would say from my experience and talking with most of my peers, usually the easiest. It’s a very lengthy test, it’s actually two days long, but since that one is the easiest, people don’t normally prepare much for that. That’s because again- in clinical practice- you are really using your skills that you are using every day in practice; you are using those on the test, so it’s a little bit less stressful and then you’re done at that time. USMLE Step 2 consists of two parts, so there is the CK which is the written part where you are actually being tested on clinical knowledge and it’s more question- answer multiple choice based, that most medical students are used to. The CS part or the clinical skills, is a test that does exactly as it sounds. It tests your clinical skills, so it is a test that’s based on using twelve standardized patients and you are graded on several different things including your ability to communicate with patients, ability to think through a differential diagnosis and then also your ability to write patient encounter notes after the visit with the standardized patient.
In terms of diagnosing patients in the USMLE Step 2 CS test, is there any specific material or any specific preparation students should do when they begin to study for the step two?
I was thinking of kind of three strategies on how you should really best prepare for this exam, so I broke it down into three parts. First, you want to plan for the exam. So when you plan it of course you are scheduling the exam, there are only certain test centres throughout the United States that offer the test, so students have to fly to certain test centres, to take the exam. When you do plan out your test, make sure you check out the USMLE website where they have information on hotels and they also have information on updates on the test site, if there are any changes or anything that you should know. Then also, I think that since a lot of people have to go to different cities and different areas to take these exams, make sure when you arrive there the day before, or the day of, make sure you know where you are going, you know where parking is, you know exactly what time you are going to arrive. It’s going to really really remove a lot of stress on the day and on the day of exam you don’t want to show up late too, so just make sure you just really plan your exam day and that’s going to help you really prepare. I think another big huge part in preparing for this test is going to be practice. So all through medical school, your first two years of medical school, you are going to be seeing standardized patients, where you have people that come into the medical school and are actors and they act out having certain symptoms or certain diseases and you as a medical student have to treat them and pretend that they are actual patients presented with actual diseases and symptoms. So this is very similar to what the USMLE Step two CS is going to consist of, so practice using those scenarios. Definitely take advantage of your medical school standardized patient testing, because most medical schools have what they call OSCEs, where they use standardized patients to test you. So take advantage of those, take those seriously because those will be preparing you for the CS. If you have the chance, have your friends help you and have them be standardized patients, it’s very easy to have somebody pretend that they are a patient and most people actually enjoy pretending that they are a patient. I also recommend practice doing limited physical exams on a time limit. On the real exam day, you are allowed 15 minutes to perform a history and physical exam on the patient. So you should have somebody pretend that maybe they are presented with stomach pain and you have to perform a history that is completely related to stomach pain and an exam that is related to stomach pain and limited at that. You are not going to perform a full neurological exam or a full muscular skeletal exam, only unless it is applicable and practice that in that constrained time limit so you make sure you have that down on the actual test day. Finally, I think practice writing timed notes, the USMLE website for Step Two CS, has a great page that has a sample note that they expect you to put in their format. They give you ten minutes on the actual test day, to write a patient encounter note, so practice writing the note in that time limit. Make sure you are writing thorough notes, you are writing all pertinent positive and negative findings that you have discovered on your physical and history exam. Also, make sure that you are being able to discuss thorough differential diagnosis and what tests and treatments to order. Finally, I think the last thing and I will be brief on this, I want to just say on the actually day after you have prepped and you’ve practiced the last thing is actually to perform. You are really an actor, a player, because you are walking in on this test day and you are acting like you are a doctor. That’s what you are doing, you are seeing people that are actors and you are supposed to act like you are their doctor. You should really walk into the room and be confident that you have had the last three or so years of training, to know how to evaluate patients and know how to perform a thorough and comprehensive history, physical and obtain relevant information. Then also, make sure that you are empathetic, and that you are patient and kind to all the people, to all the patients. If they are frustrated, if they are angry with you, make sure that you are constantly compassionate and understanding, because that is something that you are going to be graded on during the exam as well.
That’s very useful, thank you. Can you share with us a little bit about how the exam is scored?
Yes, luckily the exam is a pass or fail, so you are not going to be graded specifically with a scoring system like the CK or Step One, you are going to receive a pass or fail. That does relieve a lot of anxiety for most people. But the breakdown of the scoring system is in three different parts so, you are going to be graded by qualified examiners selected form the USMLE on Communication and Interpersonal Skills, so that’s pretty self-explanatory there. It’s how well you are able to talk with patients and communicate ideas with them and respond to their needs or their questions. The next area that you are graded on is Spoken English Proficiency, so this test was somewhat designed to measure the students ability to speak English clearly, so that is going to be assessed here. Then finally you are going to be graded on what they call ICE or Integrated Clinical Encounters. This is really where you are going to be graded on how well you interpret the patients’ history, physical, in order to parade a knowledge of differential diagnosis, also your ability to write notes and make relevant clinical decisions.
Alright. Is there anything else that you think will be important for students to know while they either prepare for the exam, or advance towards their journey of becoming a doctor?
I think in terms of the Step 2 CS, I think take it seriously, a lot of people don’t take it seriously, and I have heard of people that don’t pass. I think it’s rare that most people in the US medical schools don’t pass. There is a very good pass rate for students in MD schools here in the United States, but it is something to be taken very seriously, because you don’t want to fail this exam. It’s expensive, you don’t want to have to take it again, it’s a long day, something you want to take once and put it behind you. Make sure you do take it seriously.