How to Crush Step 2
By Paul Clancy, MD MBA
Hey all,
If you’ve finished your core rotations and are about to embark on your dedicated period for Step 2 (and potentially Step 1), then pat yourself on the back - the hardest part of medical school is now behind you!
When I went through dedicated I had a ton of questions and uncertainty trying to figure out what to do. I put together the things I learned to hopefully make it easier for y’all to navigate.
I think if you're going to take someone's advice, transparency is really important. Background of my journey: I started studying the second week of November. My initial practice score ~1 week in was a 233, which made me push my test back 10 days from mid-December until right before New Years. My final score was a 264 (85th percentile in 2023), over 30-point improvement from my baseline.
I did well but if I had approached it correctly knowing what I know now, I’m confident I could’ve hit >270 and saved a couple weeks during my study time. For reference I’m not a genius, I averaged ~75% on all our schools pre-clinical unit exams and high 70s to low 80s on NBME core clerkship shelf exams.
I created AdmissionsAcademy.org to make resources for pre-medical and medical students. I despise gatekeeping and want to make success in healthcare education more accessible and equitable. I want to make this more polished but I know that dedicated is starting so I wanted to get something out for y’all.
High-Yield Resources
- Example Study Schedule Template
This spreadsheet links to a Google Sheets template you can use to create your own study schedule. First, make a copy of this template in order to edit it.
The goal of a templet like this is to make sure you complete the required material and stay on track. By having a set amount of information to do each day, it provides structure and also allows you to be done, so you can enjoy the rest of your life and not feel like you need to study 24/7! This is an essential part of your study period to reduce guilt and burnout.
- Put your test date at the bottom of the page in column B, and then backfill the days to whatever the current date is
- Do this with days of the week as well in Column C. After you've done that, you now have a day-by-day calendar of what you can do going forward!
- Look on the Available Study Materials tab to easily copy and paste. This has the UWorld question blocks, practice exams, and NBME blocks separated into the number of questions that are available.
- UWSA = UWorld Self Assessment (Full Length Practice Exam)
- NBME CBSSA = Step 1, Form 28-34 available ($62 each)
- NBME CCSSA = Step 2, Form 9-16 available ($62 each)
- NBME CCMSA = Step 2, Form 6-8 available ($62 each)
- Depending on the time of year, you may need to adjust the schedule for things like holidays or breaks. The default template includes a weekly practice exam, the next day spent reviewing the practice exam, and then a break on Sunday.
- Clinical Learning Resources
- Helpful Guides/Notes
General Tips
The Single Most Important Thing Is Figuring Out Your Plan and Sticking to It.
- The last 11 months people have told you what to do and where to be and now you have two months completely unstructured. It's okay to take some time for yourself to recuperate, but if you lack structure during dedicated, it's going to be a lot harder to do well.
- Use the schedule template to plan out what resources you plan to complete, in a setup that is achievable. FYI, it’s unlikely you’ll do 160 questions per day for 2 months (unless you really are built like that)
- If you want to stick to your plan, it's going to be really helpful if you tone down all your other commitments for the next one to two months. I was trying to balance dedicated with a couple other things in my professional life, and this ultimately proved to be a distraction and made me more stressed out. As much as you're able to, tone down any other professional commitments so you can focus on just getting this done.
Test Scheduling
- Make sure to schedule test and figure out transportation/accommodations
- If your school did not do Step 1 before clerkships and you have a dedicated period to take both Step 1 and 2, then the most common plan is to take Step 2 before Step 1, while clerkships are still fresh in your mind and you’re not burned out
- Be careful of continually pushing your test back due to nerves
- If you’re genuinely performing bad, then it is okay
- For the love of gosh, take Step 2 during dedicated. Lock in for the next 2 months and get it over with. Some people kept pushing it back and it’s way too stressful to deal with this during 4th year
Not Burning Out Is Paramount
- Take at least one day off per week, prioritize self care
- Make time for friends, family, and physical exercise
- Take off the day before your shelf
- Can take off days for mental health if necessary
General Study Tips
- Making sure you're doing a thorough review of questions and tests and actually learn from your mistakes is the most important thing. Don't just try to do as many questions as possible without reviewing because the goal should be that for every question you learn from it.
- For every question you're not confident on (whether or not you got it correct or incorrect) make sure that you are reviewing every portion of the question you’re unsure of.
- A good way to do this is to try teaching the question to yourself or to a study partner if you have one. This will quickly show where your gaps are.
- For things that you struggled on, make sure you have some way that you'll be able to review this material again. This could be things like writing out a flashcard or writing your notes. Make sure you have a way that you'll review this information over a period of time.
- Do practice questions in a mix of random and system based to nail weak spots
- Can keep notes/anki concepts you struggle with, and periodically review
- Divine intervention is great to listen to in the background; can do general Step 2 review or do specific podcasts
- Especially in the last 2-3 weeks, work on mixed blocks and preferably under time
- Average study period is 3-8 weeks, which varies based on goal score and background.
- AMBOSS can be good for a targeted review of certain topics
- AMBOSS is a great resource for QI/ethics/biostats, which are heavily tested
- Step 2 now has more and more step 1 content on it, so good to get a general base
- You don’t necessarily need to do a full 2nd pass of UWorld - many average 2-4 blocks per day
- Can use OME or Amboss resources to review topics you’re struggling in
- First Aid for Step 2 is good; FA for Step 1 can also be useful for baseline concepts
- Compared to step 1, step 2 has more emphasis on critical thinking and reasoning than buzzwords and rote memorization
- Almost every sentence in vignette has a purpose
- Always consider each sentence in context with one another
- After reading initial presentation, start thinking about the answer instead of waiting until the end of the stem
- If overthinking NBMEs, choose the answer that the majority of the question supports
- General resources (see more detailed ones below)
- Dr. High Yield/Emma Holliday can be good overall review
- Divine intervention podcasts are goated
- Listen to high yield things more than once if possible
Test Taking Strategies
- A lot of questions you get wrong aren’t due to content errors, but strategy
- Understand why you got a practice question wrong. This can be due to a variety of things and often is a combination of more than one thing. For example, maybe you simply didn't know the content, maybe misread the question, maybe you second-guessed yourself, maybe you interpreted data incorrectly, etc. While test-taking strategy can be really helpful, it cannot be a complete replacement for not knowing the content.
- Develop approach to process questions; read last sentence first, skim answer choices
- Focus on understanding every question - don’t let yourself skip over something
- Understand NBME question style; they often are trying to tell you the answer
- Make sure you have good time management
- If you get flustered during exam, close your eyes and take a deep breath
- Can vary study environment, but make sure you’re still in a quiet space with minimal distractions
- Specific Test Taking approach
- Focus on timeline/age presented in question
- Consider associated things (if they just had surgery they probably got meds)
- Treat critical issues first
- Horses > Zebras
- Don’t consult ethics board or make the pt someone else’s problem
- In milestone questions, kids often have normal development
- Learn vaccination schedule, risk factors, screening, etc
- Good to learn specific lab values so you don’t have to continually reference sheet
- When taking test, can have lab value sheet pulled up, which makes the viewing window shorter so your eyes don’t have to scan back and forth
People will do better/worse than their practices. Think positive thoughts, you got this!
Practice Tests and Questions
Question Banks
- No matter which question bank you go with, just pick one and stick with it. You can do great using UWorld or AMBOSS, one isn’t necessarily better than the other.
- UWorld is obviously great
- Can initially start doing system/subject based to get good review, but should transition to random
- Don’t need to finish all of 2nd pass
- Many start at 2-4 blocks, however consider ramping up to 5 before test day to practice mental fatigue
- Going through blocks will often get faster later in your dedicated as you get more correct
- Read every word of the explanation while reviewing
- Rule in each correct answer choice and rule out incorrect ones
- AMBOSS is non-inferior to UWorld
- Can sort questions based on 1-5 hammer difficulty
- May consider doing 1 hammer difficulty for reinforcement of simple concepts
- CMS forms (shelf exams) are a bit easier than the real Step 2
- Consider questions learning tools rather than diagnostic tools. It’s okay if you struggle if that means you’re learning
- Use practice tests to gauge how you’re doing
Practice Tests
It can be confusing to figure out what’s available - as of the end of 2026, there are 3 UWorld Self Assessments available, and 7 NBMEs (Form 9-16). The first 2 UWSAs are included in the 180-day Qbank access, while the 3rd UWSA is available in the 360-day Qbank access or can be purchased individually for $50. You can purchase the UWorld products here.
The NBME exams are only accessible through logging into the NBME examinee portal. Go to Purchase → Comprehensive Clinical Science Self-Assessment (CCSSA). You’ll see a dropdown menu where you can select forms 9-16. Each form is $62. Login and purchase the practice exams here.
The other practice test that is recommended is the Free120, which is also published by the USMLE. You can find a link here.
- In general, aim for the more recent practice exams, since they’ll be the most representative. If you have extra time, you can do more recent ones.
- Proposed order: NBME 12, NBME 13, UWSA1, NBME 14, UWSA2, NBME 15, UWSA3, NBME 16, Free 120
- NBMEs are written differently than UWorld practice banks; the simplest answer is often correct. This is true to how the actual step exam is.
- Do at least 1 practice test per week, more depending on your schedule and what you want to fit in
- Try to replicate testing conditions (start at 7:30). Normalize sleep schedule during dedicated
- Can review tests/answers same day or next day depending on your stamina
- From Reddit, here is an NBME 3-Digit Score Converter along with a Step 1/2 Score Predictor
- UWorld Practice tests are 4 blocks of 40 questions (160 total); NBME are 4 blocks of 50 questions (200 total). UWorld has better explanations
- Updated Current NBME Forms (Shelf Exams) ($20 each) (As of 2024)
- Neuro: Forms 5, 6, 7, 8
- EM: Forms 1, 2
- Family Medicine: Forms 2, 3, 4, 5
- Medicine: Forms 5, 6, 7, 8
- OB/Gyn: Forms 5, 6, 7, 8
- Peds: Forms 5, 6, 7, 8
- Psych: 5, 6, 7
- Surgery: 5, 6, 7, 8
- CCSSA (Step 2) ($60 each): Forms 9, 10, 11, 12, 13, 14
Study Resources
Recommended Divine Intervention Podcasts
- Spotify may not have all old podcasts - all of them can be found on website however
- Per the man himself: “2CK-If you're limited on time, at the very least, go through the videos I have for each clerkship AND the risk factors (Ep 37/97/184) and Military Podcasts (204, 231). Then consider Biostats as well (Ep 143).”
- Rapid review series is good when you’re just driving around
- Step 2/3 CK Exam Topics Podcast List
- How to use Divine Podcasts
- Pro tip - you can download the podcasts as Mp4 files and upload them to a podcast player, so you don’t have to have your phone/computer open to the DI website. I use a Mac and used the app Downie to download the video as an audio file, then used the podcast player Overcast (you have to pay $20/year for premium to do this) and uploaded it as my own podcast. I do this for YouTube videos as well and I’d highly recommend it!
- Specific podcast links that are helpful
- USMLE Radiology (26)
- Ophtho (36)
- Military Micro (236)
- Vaccines (250)
- Clutch Risk Factors 1 (37)
- Clutch Risk Factors 2 (97)
- Clutch Risk Factors 3 (184)
- Clutch BioStats Review (143)
- Military 1 (204)
- Military 2 (231)
- Bias in Biostatistics (197)
- Next Best Step (137)
- Updated Screening Guidelines (325)
- Quality & Safety/Legal Stuff (230)
- Transition of Care (234)
- Diagnostic Errors (275)
- Ethics (276)
- Palliative Care 1 (228)
- Palliative Care 2 (268)
- Medicine Shelf 1
- Medicine Shelf 2 (YouTube)
- Medicine Shelf 3 (YouTube)
- Medicine Shelf 4 (YouTube)
- OBGyn Review
- All Shelf Exams YouTube Playlist
Other Resources
- YouTube channel “stepprep1500” has good biostatistics review
- Stepprep.org website has NBME explanations
- Random Google Drive with notes that might be helpful
- YouTube guide to setting Anki intervals for studying
Reddit Threads Detailing Strategies
- 279 Write-Up
- 199 -> 252 with every practice test in the 230s. Comprehensive write-up
- I scored a 281 on Step 2 CK, AMA
- "Must Listen" Divine Intervention Podcasts - All Linked Here!
- How to Use The Divine Intervention Podcasts (from Divine)
- Step 1: 242 --> Step 2ck: 265 How to study for step 2ck
- 270 Step 2 Write-Up with Study Calendar
- A Step 2 CK Write-Up: 268 – "How DivineIntervention's Divine Intervention Saved the Day"
- USMLE Step 2 High-Yield Study Guide
- 266 step 2 WRITE UP
- Free CK notes + RF (including Military) + Amboss Ethics articles/screening + HY Derm/Ophtho
- How I Scored 100th Percentile On Half Of My Shelf Exams
- THE SECRET TO SCORING 250/260+ YOU CAN LEARN RIGHT NOW: QUESTION INTERPRETATION
- An efficient approach to a 270+ on Step 2 CK