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.
Related Posts:
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Three Phases of USMLE Prep
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What to Do in Step 2 CK
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NBME Self Assessment Tests and USMLE Review
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Guide to Self-Evaluation in USMLE Prep
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What to Study for the USMLE – Part IV
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
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
Thanks a lot askdoc.. i’ll surely join.. & thanks a lot for a great blog.. its helping me to identify my weaknesses well..
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
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
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.
thax askdoc will read kaplan then uworld
Hi sameer,
You are welcome. Don’t forget to build algorithms.
Askdoc
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
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.
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
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
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
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
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.