Ever since getting my Step 1 score back,  I knew that I had to improve to have any chance of matching into a residency. 3rd year was all about getting the best experience and figuring out what I wanted to do with my life while at the same time studying and preparing for step 2 CK.

In this post, I will focus on the dedicated study period I allotted for myself. I was on a January class schedule/track so the timing of my core rotations ended around June allowing for significant study time however even for August class tracks, I believe making time for dedicated study is more important than squeezing in a sub-i or 4th year rotation.

It may appear like I overloaded on resources but at it’s core, I focused on UWorld with reading of MTB and Step Up to Medicine 3 complete times during dedicated study.

I planned for 6 weeks total of dedicated study time.

I began to repeat and reset UW after completing them through core rotations once already. I would go through about 3 blocks a day, timed random, 2 blocks in the morning back to back to build up 2 hour endurance, go over the 2 blocks and break for lunch. Afternoons, I would do the one block and review and then the remainder of the afternoon and evening reviewing content. I would try to get through a complete chapter/ topic of MTB or Step Up a day. I would alternate between pure content from those books and review slides from UT and Kaplan. Everyone studies at a different pace so obviously set your schedule as your pace allows. All the resources I used were high yield resources. Any intricacies that would be tested, I hoped I remembered from core/shelf studying but this was no longer the appropriate time to learn them.

I did my first NBME after 4 weeks. At this point I had gone over more than half of UW twice and went through both texts at least once completely as well as seen the review slides from Kaplan and UT at least 2 times each.

Based on my progress I had to push back my exam. I had the option of pushing it back longer but I chose 2 weeks because it would extend study time without taking the pressure off. I had learned my lesson from Step 1. I did not want to extend it too far and peak in performance before I could sit for the real exam.

I continued for another 2 weeks before taking an NBME as progress. At this point I knew I was on track and proceeded with the same study strategy. I increased my pace to 4 blocks a day, 2 AM and 2 PM, making sure all questions were done between 8a and 4p. I knew this was when I would be taking the real exam so it made sense to only use my brain for questions during those hours. That would also block out enough time to get review time in during the evenings. If I had reversed that order and studied in the afternoon and done questions at night, I would be too tired to do the question properly and would underestimate or falsely skew my blocks. On the contrary, it could also overestimate if I had just read notes on a certain topic that randomly showed up on a block. By doing questions first, I would be relying on information at least 24hours old in my brain which would solidify memory rather than pure short term recall.

At this point I was getting to the point where questions were exhausting so about 1 day a week instead of doing blocks, I would speed through OnlineMedEd content. For an entire day I would go through videos and notes and make it an OME day. I would go through entire systems over the course of 2-3 hours and cover maybe 2 systems a day. Some systems are larger than others so times varied but I aimed to get through all of OME content at least one complete time by the time I took the exam. Again, if you choose to do this plan according to your style and schedule.

After the 2 NBMEs, I did UWSA 1 and 2 over the course of the last 10 days before exam day. I saved UW for last because although people have mixed thoughts and say it’s not a good representation, my experience during step 1 was that the average of the 2 UW scores most accurately reflects my real score.

And even during step 1, I was told not to trust UWSA scores over NBME scores.

Unfortunately the UWSA scores did not comfort me in any capacity however I knew what my scores were trending and I knew where I was mentally. I would peak soon and I could not risk the same mistakes as I did during step 1 prep. I chose to commit to taking the exam on my scheduled date no matter what happened the rest of that week. I did not think about the what if’s and did not second guess my decision. I don’t believe in taking risks but I do believe that you need to know what you are capable of and you need to be confident in your decisions.

In hindsight and even at the time, I knew I wasn’t making the smartest objective decision to take this exam however there is a subjective component of knowing what feels right. I truly did not have a timeline I had to finish this by because like I said, I was tracked for the Jan class and I could have easily taken another 4 weeks if I had to but I knew that was not the right decision for me, because again, I knew what happened during step 1.

A lot of this is personal style and a judgment call you will have to make based on how you feel. If your numbers say you’re ready, you’re ready. My numbers weren’t promising however I knew my trend and I knew how much energy and capacity I had left.

For the last 3 days before the exam, I knew I had endurance for the exam and I knew I had reviewed everything I wanted to. I focused on my weaknesses based on the breakdown from UW and NBMEs. I went back through all the high yield notes I could fine, 1 liners, word associations anything I could find. MTB and Step Up To Medicine both have high yield boxes scattered through the book. Similarly, Kaplan has their own set of high yield sheets you can buy or borrow from friends who have them.

In the end, I scored better than I did on step 1 and I believe the upward trend was enough not to draw the attention of program directors to my mediocre step 1 score.

Things I could have done differently: I had access to DIT and Kaplan Step 2 videos, I chose to stick to OME because it was familiar from 3rd year however I think I would have benefited from also using Kaplan during 3rd year to add additional perspective on the same topics. OME is superficial, significant but still superficial.

Other than that, I truly don’t regret my decisions during this study process. I admit it was a bit risky objectively however my personal data supported the fact that I was capable of passing and that was enough to convince myself to go into this exam with confidence. By eliminating the doubt and hesitation, I eliminate the biggest source of stress and anxiety during exam day.