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Most Common Mistakes in Step 2 CK Prep

People have been badgering me for sometime now on writing more about how to prep for Step 2 CK. Some even wants me to start a Step 2 CK prep course. However, due to time constraints and the Step 1 Prep Course, it has not come to pass.

Lately there had been too many people asking questions about their Step 2 CK preparation and problems they are encountering. Although I still don’t have time to write a full article on it, I have decided to tackle the 4 most common reason that people do poorly in the Step 2 CK. I am also reposting an article about “What to do for Step 2 CK” an older post that needs some rewriting but is still relevant.

1. Not Studying Enough Detail. The most common mistake people make in studying for Step 2 CK is not studying enough detail. You see so many reviewers in the market that purport you can ace the exam by studying the little material it contains. That is a lot of bull. Medicine is a very broad subject and Step 2 CK covers all the most common and even some rare cases.Those little reviewer just does not give you enough detail to do well in this exam. An exception is Kaplan Notes. Very good detail. However, you need to know 85% of it in order to know enough to pass. Higher if you want a higher score. And that is impossible to do unless you do a minimum of 3 revisions. I will discuss the various study materials you can use in another post.


2. Difficulty with next best step in management type of questions. Next best step in managment type of questions acount for about 20% of Step 2 CK. This type of questions involve cases that describes the management done on the patient so far and asks what you think is the next best step in dealing with this particular patient. Remember the next best step depends on what was the result of a previous diagnostic workup or response to treatment. There is a big difference between knowing how to treat and managing a patient. There is also a big difference between knowing what lab tests to perform and working up a patient. Treating a patient  involves knowing what drugs and treatments to use. Managing a patient takes into consideration patient response, adverse reactions and other factors and altering the treatment accordingly. Working up a patient involves knowing implications of positive and negative results of previous tests and what lab or diagnostic test should be ordered next.

Most people study for step 2 CK by reading reviewers or books. And that is the appropriate way to study the clinical content for the Step 2 CK exam. But one needs to do the extra step of constructing algorithms in order to be able to master next best step in management style of questions. You can answer the next best step in management type of question without using algorithms but it will take longer and more analysis to be able to answer them. And as we know, in the USMLE time is what you lack. I will write more on how to write algorithms in another post

3. Knowing too little pathophysiology or mechanisms of diseases. One of the biggest reason why I emphasize pathology and pathophysiology in Step 1 aside from the fact that it is the biggest subject in Step 1 is that it is also very important in Step 2CK and Step 3. This accounts for 20% of Step 2 CK and covers mostly systems pathology unlike in Step 1 where the main emphasis is in general pathology. Also in Step 2, the pathophysiology tested are more clinical in nature, ie how they account for various signs and symptoms and complications of diseases. Cases will also include what I would call “Applied pathophysiology”. I have written examples of this in an earlier article. This is usually a problem for those older grads who decide to take Step 2 CK ahead of Step 1 and did not bother to brush up on pathology. Also for those who took Step 1 first but did poorly in pathology. The solution is therefore to make sure that you are solid in pathophysiology. Goljan’s Rapid Review for Pathology is a short but good book to brush up on pathophysiology, although it covers general pathology as well which is not needed in Step 2 CK.

4. Atypical presentation of common diseases. According to Cecil’s Textbook of Medicine, there are four types of cases you normally encounter in clinical practice. In order of frequency, they are (1) common diseases with typical presentation, (2) common diseases with atypical presentation, (3) rare disease with typical presentation and (4) rare diseases with atypical presentation. They also occur roughly in the same number in Step 2 CK with slightly more type 2 cases than normal

In Step 1, most of the cases you encounter presents classically. But in real life you rarely see classical cases where all the key signs and symptoms are present. Even in Type 1 cases, not all the signs and symptoms will be there. However, enough will be present so diagnosis is not so difficult. The big problem in Step 2 CK for most people is type 2 cases where common diseases presents atypically. For example, although sarcoidosis is most common in young, black female. They do occur in males, older people and other races. So in Step 2CK a sarcoidosis patient may be an old, white male instead. You need to be able to diagnoses the case even with atypical presentation or you won’t be able to answer the questions. These is usually a problem with medical students with limited clinical experience and old grads who have not practiced medicine for some time.

Other ways clinical cases are tougher in Step 2 CK is the addition on both relevant and irrelevant normal findings. The addition of irrelevant abnormal findings that will not change the diagnosis. You need to be able to discern what facts are important and what are not. Remember in an actual live patient, they may present with symptoms that is irrelevant to their main complaint and you need to decide what is relevant and what is not.

The best way to correct this problem is to study classical cases and know what symptoms and signs are absolutely essential in making a diagnosis. When doing qbanks and you misdiagnose a case, it may make sense to find out where you got it wrong and write down the minimum symptoms and signs you need to make the diagnose, so you don’t make the same mistake again.

These 4 are the most common reason for getting low score. Although there are other less common weak points that can cause lower score, they will be discussed in another post.

 

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37 comments to Most Common Mistakes in Step 2 CK Prep

  • shiea

    Thank You Ask doc for writing about preparation for Step 2 CK.. Its definitely helping me to start studying in the right way..

  • Hi shiea,

    You are welcome

    Askdoc

  • shiea

    hi ask doc,
    Is there any chance that you’ll also have a prep course for step 2 ck? I had written here earlier & I have failed both step 1 & ck.. Planning to take ck now as I had studied for it recently but now im confused which one to take.. which one will u suggest? plz advice..

  • Hi shiea,

    I am trying to get a step 2 CK course running before the end of the year. I would suggest you take Step 1 first. The main reason is that 20% of Step 2 CK is pathophysiology and that is best studied during Step 1. If you proceed to Step 2 directly, you still have to study this pathophysiology.

    askdoc

  • shiea

    Thanks a lot askdoc.. i’ll surely join.. & thanks a lot for a great blog.. its helping me to identify my weaknesses well..

  • Gupshup

    Hi, i just found out I failed ck. I have 5 weeks to study and need advice on what sources to use. I was considering first aid for ck and uworld questions. I am a slow learner. If u have any advice, I would be very thankful.

  • Hi Gupshup,

    I don’t know how you will pass Step 2 CK in 5 weeks. Even I can’t do that. If you want to pass CK and you need to read Kaplan Notes.

    Askdoc

  • samer

    Hi askdoc, any idea when u will start usmle step 2 ck online course, I am waiting.

  • Hi samer,

    OK, if I get the help I need, which may be as early as April this year. The course could be up by June or July. There is more than 80% chance of that happening.

    Askdoc

  • sameer

    hi askdoc…i have got 2008 edition of kaplan notes for ck …is it good enuf to start the preparation or shud i join in kaplan for new edition notes….and what about master the boards by fischer for ck????? many of my friends have started uworld directly without even studying kaplan notes….is it a good idea what is ur suggestion

  • Hi Sameer,

    It should be no problem. Kaplan notes does not really change much year to year or even 5 years. Master the boards by fischer is a good learning tool, will recommend it. Starting uworld without reading Kaplan may work for recent AMG grads but for most IMG it is a risky strategy. There are people who can make it work and pass, but understand not everyone could and they are in the minority. So chances are its too big a risk for you to do it that way. If you want a high score, than just using uworld directly is a no-no. Still recommend that you read Kaplan, make algorithms, then do Uworld.

    Askdoc.

  • sameer

    thax askdoc will read kaplan then uworld

  • Hi sameer,

    You are welcome. Don’t forget to build algorithms.

    Askdoc

  • mohamed

    hi askdoc
    I want to sit for step 2 ck and I am preparing with only kaplan notes 2008-2009 Is that enough
    also I want to sit for step 2 ck before step1 is that a good idea also

  • Manka

    Wow, you are pretty thorough. And your advice is sound and unbiased… too bad you didnt give the MCCEE for canada, thats what i need advice on.

  • alessandro arduini

    My compliment dear doctor for this wonderful blog. I am preparing for usmle 2 ck and I read kaplan notes 3 times than first aid 2 than the book of conrad fischer and the usmle 2 made ridiocusly simple and a pass to step 2. Than I did the qustion books like usmle secrets, mock exam, lange 2, pre test.Than I saw thw kaplan videos and time Qbank on line. Is that enough about you? Thank you

  • alessandro arduini

    My compliment dear doctor for this wonderful blog. I am preparing for usmle 2 ck and I read kaplan notes 3 times than first aid 2 than the book of conrad fischer and the usmle 2 made ridiocusly simple and a pass to step 2. Than I did the qustion books like usmle secrets, mock exam, lange 2, pre test.Than I saw thw kaplan videos and time Qbank on line. Is that enough about you? Thank you very much.

  • Hi allessandro,

    The study materials you are using are certainly enough to do well in the examination. But remember, studying the right things is just a small part of doing well in the exam. You need to study the right way to insure you can retain and recall what you have studied. Be able to interpret and analyze correctly the cases presented to you. And understand in detail how to manage the cases, diagnostically and therapeutically. So even if two people use the same materials but study differently, the results will differ.

    Askdoc

  • Bella

    Hey Askdoc.. i m not sure u remember me..
    just to refresh yr memory.. i got a poor nbme correlation last september and was totally burnt out and didnt kno wht to do since exams were a few days away. I had a lot of pressure on me to finish it soon..instead I took yr advice and cancelled it..took a month’s break and started all over again. I finally finished it this march and scored 241/99. I am very thankful for providing me that kind of advice.. else i would have to settle with a poor score and never have a chance at a competitive program. Your advice to really master the subject and kno the ins and outs of it kind of stayed with me and tht’s exactly what i did whn i restarted my prep.
    I took my CS within 2 weeks of my step 1 and passed that too..
    I m onto CK now and i have my exam scheduled in 1st week of october..
    My main resources are UW, MTB-ck and i keep looking into CMDT if i need more information.
    I intend to take a self assessment exam soon and i would appreciate your recommendation between UWSA and NBME.. please let me kno which order i should take the tests and which exam has the highest correlation. Also, i d appreciate if u could let me know how helpful MTB-3 is?
    Your blogs have been very helpful..and i want to take this opportunity to Thank you for giving me sound advice when i needed it most.
    Bella

  • Hi Bella,

    Have not really used MTB for Step 2 CK. Would still recommend Kaplan Notes. CMDT is very helpful in understanding diagnostic steps and therapy. You still need to use NBME for step 2 CK more than UWSA. Would be best if you can tell me your current average in qbank.

    Askdoc

  • Bella

    My current average is 65%.
    I plan to take an nbme by the end of this week.. It will help if you could let me know which order i should take the tests and which exam has the highest correlation.
    Thanks

  • annie

    Hey askdoc. You are doing a great job.

    i have just graduated and doing my clinical rotation in the hospital. i recently gave PLAB 1 which was all about clinical knowledge ,and i’m planing to give step 2 ck next within a few months .i hav’nt given step 1 as yet pls guide me if i should give step 2 ck before step 1.

  • wahid mardenli

    Hi , I’m an old IMG’s, I live in Canada , and I have the opportunity to pass ( for the second time ) the USMLE step 2 CK , in a short time period ( 3 months ), using the Kaplan lecture notes 2008 , is it enough ? and comparing to the canadien EECMC exam , which one would you advise me ?
    Thank you very much

  • Hi Waheed,

    I am unsure I understand your question. You have passed Step 2 CK or are you going to take it? To be honest I don’t know much about the Canadian EECMC exam.

    Askdoc

  • Jeraldo

    Good afternoon wherever you are Mr. Askdoc. I am an IMG who passed step 1 last year with a 226/82 (under the new scoring system.)

    I am now preparing to study for step 2 which I will be taking in exactly 12 months from now. I know this is a long time, but how would you suggest preparing for someone in my situation? Perhaps I can give you a bit more background so you can understand how my situation is slightly unique…

    I finished step 1 in November with a VERY good understanding of pathophys…. perhaps my strongest subject. I used Goljan RR w/ audio to prepare and this got me in a great place for the step 1. I then however had to take 5 months off before I could start rotations because well… I went to a bad Caribbean school and they gave me the run-around for a while before they actually scheduled me for rotations.

    Now I have finally started and I find that I have forgot A TON!!!!!!! of pathophys and pharmacology.

    Currently I am trying to decide if I should be reading Goljan RR again during my clinical rotations to prepare for step 2. I also plan on using Kaplan Videos, the Conrad Fisher book, and FA Step 2.

    Hoping you could give me some advice, because in reading your other posts you seem VERY knowledgeable on the subject!

    Best Regards,
    J

  • Hi J,

    Goljan RR is good for Step 1 but is not really recommended for Step 2CK. Kaplan videos is good only for understanding concepts. You can’t memorize videos. Conrad Fisher book is for high yield review, which is really the last step in the review process. You need to make sure you cover all the materials first. Or you will go to the exam feeling all the questions are familiar but somehow you can’t answer them. Same with First Aid. You will be committing the error of not studying enough details. Probably reading Kaplan Notes, add Step Up Medicine then either conrad Fisher book or FA. Dont really need both. Then Q banks. Even Fisher’s book is not complete in terms of topic. Either supplement with Washington Manual of CMDT.

    Askdoc

  • Srinivasan.R

    Hello Sir,
    I’m an intern from India. Finished mt final year dis February. I would like to pursue M.D Internal Medicine and specialize in oncology in the US. I have 2 questions
    1. The 1 question that may probably irritate U – Should I take up step 2 first?
    2. People here advice me to read Books, and not notes, is it even feasible?

    With Regards,
    Srinivasan.R

  • Hi Srinivasan,

    There really is no hard and fast rule that you cannot take step 2 first. Except it is more advantageous to take Step 1 first overall. But if you have a good reason why Step 2 first (aside from the claim that since you just finished your clinics, take step 2 CK first is easier) then its better to take Step 1 first for the reasons I have cited in one of my posts.

    As to the second question, if you lack understanding of the main topics tested, you need to read books to understand them, not notes. However, come time to memorize details, you need to read notes. because notes present the same information from textbooks in more compact form. Compact info means easier to memorize, retain and recall for the exam. For example, which is easier memorizing a five page discussion of the coagulation cascade or a one page illustration. In reality it is easier and faster to memorize and recall the illustration, but unless you understand coagulation cascade, you can’t make heads or tails of the illustration unless you read the 5 page discussion. Books for understanding, notes for memorization.

    All that is explained in my book, How to Master the USMLE Step 1. So I suggest you go to Amazon to buy it and read it. Even if you are studying for Step 2 CK. the study methods are the same except all my examples from the book are for Step 1. For Step 2, you use the same study methods except for one addition. Algorithms for diagnostic workup and treatment protocols, which is important in Step 2 and Step 3. Otherwise all other study methods are the same.

    Askdoc

  • Francisco

    Hi doc.

    Let me give you my context. I’m doing my finak year of kedical school in the US at a hospital; doing rotations to gain clinical experience and letters of recommendation. I took step 1 on dec. 2009, scoring 219. I’m planning to do pediatrics at a children’s hospital. I still have one year of social service doing research before I can get my degree as an US IMG.

    Lately I’ve gotten the feeiling of taking step.2 ck this dec. But I’m not sure if I would be able to prepare myself enough with ksplan notes, videos and usmleworld, in the midst of rotations, or if I should wait until next year, when I’ll be free after 2pm every weekday to study. Should I concentrsge in my rotations and lesve step 2 study for later? If I were to ask for a full month off tjis year, would that be long enough to prepsre myself adequately? I plan to apply for the 2014 match.

    Thanks for your help!

  • Hi Francisco,

    Actually depends on how high a score you are aiming for. 4th year medical students could probably do with 2 months full time prep so long as they are doing well in medical school. Longer if you plan to ace it. I would say, start reviewing now, track your progress so you can make an estimate of how long you can be prepared, then schedule your exam.

    Askdoc

  • Laura

    Thank you for providing so much useful info! I was wondering if you are familiar with the Toronto Notes and have any thoughts on using them for Step 2 CK prep? I find them very useful to keep up with classes (I study in Hungary) and I’d like to continue and use them for Step 2. However I haven’t found much info from anyone who has used them as a main resource for USMLE prep. Any advice?

    Thanks very much!

  • Sreekanth

    Hi Ask doc,
    I am an IMG from India. I hae read the textbooks well during my rotations that includes the harrison’s, nelson’s, schwartz and williams and prepared notes of my own am quite sure I know the contents well. I wanted to know if I was ready and took the usmleworld question bank. I could answer more than 85% qs from internal medicine and pediatrics but things are not going great with surgery. I have not done psych and obg yet. Please tell me what i should do

  • how to get ecfmg sample step 2 ck questions.thanks in advance.

  • lophun

    askdoc
    i finished step 1 and my score is really bad 75. should i go for next step? can you help me sort out how to approach step 2 ck? what are my chances of residency if rest steps get better?

  • Hi Lophun,

    What will determine your chances for residency is the following in order of importance. 1 Your Step 2 CK score and Step 3 (you probably need at least 90′s to have a chance), 2. Your visa status (if you don’t need visa, you have a good chance, otherwise not too good) 3. The hospitals you apply to. Anyway, it will be hard but not impossible.

    Askdoc

  • mahwish

    hi i have been preparing for this exam since 4 months but seriously for 2 months plan to give exam next month . i did u world 1st time with average of 68% . i just want to know is this ok score for u world and how can i improve it ,i did kaplan 2 times long ago, but now i am using more mtb2 for IM and and rest of subjects i am using mtb 2 and 3 . tell me how can i improve my score in exam and how can i get better score in exam . i have plan to give u world assessment in 15 days \

  • aparna

    Hi Ask doc,
    I have a problem that has been bothering me for a long time now. I was evaluating my UW qbank for step2 ck and I found out that majority of questions that I got wrong are the ones answered by most people(60-80%) while many questions that most got wrong are answered by me(30-40%) .I don’t know where I am going wrong. I know I can ace the exam but for that I need to have a good hold over common questions. Please suggest me where am I going wrong and what should I do about it.
    Thank you,

    Aparna.

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