Once a minor hurdle on the road to Match day, the USMLE Step 2 CK is now required by many residency programs prior to ranking applicants. For those with less-than-stellar Step 1 scores, Step 2 CK is even more critical now. It represents a student’s only opportunity to compensate for poor Step 1 performance. Although happy with my Step 1 score, I planned to take Step 2 CK well before applying for IM residency. Ultimately, I was pursuing a highly competitive subspecialty: Gastroenterology. I knew I had to make my Step 2 CK score count.

One Wednesday four weeks after my test day, I received my results. I was shocked; I scored a 281! Many with high scores will say that the key to their success was putting in a superhuman amount of time and effort. However, I took a more strategic approach to Step 2 CK. Personally, I believe this was the main factor that contributed to my success on test day.

Make Every Rotation Count

Proper preparation for shelf exams during rotations is key to establishing a solid foundation for Step 2 CK. You might find this challenging because what you learn on the wards may not have any relevance to how you are assessed on the shelf. It may seem obvious, but it’s important to recognize that test-taking requires a fundamentally different skill set from practicing medicine. This is where OnlineMedEd comes in.

For me, OME was the missing link between the wards and the exam. Dr. Williams’s videos offer the foundation of knowledge you need to do well on the shelf. The wards alone simply cannot provide this. If you think about it, what you see and are taught on the wards is essentially random. When you correctly answer a tricky question on the shelf, you often find yourself saying, “I’m lucky I had seen that one time!” But you won’t excel if you leave content mastery, a key component of test prep, to luck.

To do well on these exams, you need a comprehensive foundation, such as OME provides, because it allows you to reason through scenarios on test day that you hadn’t seen on the wards. In addition to the UWorld Qbank, I did every exam in the NBME Clinical Mastery series prior to the relevant shelf, and cross-referenced OME to fully understand each question I had gotten wrong. If you watch all the OME videos during your third year, like I did, your UWorld and NBME question-based studying during rotations will also be far more effective. And then, by the time you start studying for Step 2 CK, you’ll be way ahead.

Master a Few Key (Question-Based) Resources

Besides OME, the only resources I used for Step 2 CK were the UWorld Qbank and Self-Assessments, and the NBME Comprehensive Clinical Science Self-Assessments (CCSSAs). For UWorld, I did blocks of random topics in the “Timed” mode, as this most closely simulates test-day conditions. I found that “Tutor” mode and doing questions by subject can create bad habits, such as answering questions carelessly because you’re used to seeing the answer immediately, or relying too heavily on the context of a question’s subject area.

Moreover, in my eight years as a test-prep tutor, I’ve learned that the key to standardized tests is not only doing practice questions, but also thinking like the test maker, always asking “what are they testing here?” and approaching questions from that perspective. This doesn’t always come naturally, but as a USMLE tutor, I’ve found that it’s definitely teachable. Furthermore, students often use too many resources without reviewing any of them in sufficient depth. It’s much better to review the most well-done and high-yield resources like OME, UWorld, and the NBMEs thoroughly, rather than give a cursory glance at ten resources, some of which are of relatively lower quality.

Another common mistake for those starting out is to avoid question-based resources, believing that you should “save” questions for when you’ve built a solid knowledge base through reading. Reading results in much poorer information retention than does answering and reviewing practice questions. All the content you need to master for Step 2 CK can be found in the UWorld explanations, and OME is a great way to learn that content in a more efficient, less painful way. In addition to mastering content, test-taking technique is crucial for USMLE success, and unless you have the option of tutoring, the only way to hone these skills is to do practice questions.

 Address Your Weak Spots

To maximize efficiency, you should reflect on which areas are your weakest and target your preparation accordingly. As I worked through UWorld, I saw that I was scoring the lowest in the pediatrics sections. This wasn’t entirely surprising to me, as pediatrics was the clerkship that I struggled in the most. Consequently it also was the shelf exam for which I felt the least prepared. To compensate for this, I rewatched all the OME pediatrics videos during my dedicated study period. This brought my pediatrics knowledge more into line with other subject areas. But even for my weak areas, I never used textbooks or subject-specific resources like Case Files or PreTest. UWorld, the NBMEs, and OME were all I needed to master the content tested on Step 2 CK.

Don’t Overwork Yourself

Some claim the only way to ace the USMLE is to study 14 hours a day. I disagree. Yes, you need to study a lot, but not so much that you’re sleeping fewer than 8 hours a night. Take frequent, short (15-minute) breaks. Take at least one day off every week from studying. Exercise and maybe even try meditating. Stay attuned to when you feel overworked. Cut back accordingly. It’s okay to do only 50% of the UWorld Qbank during your Step 2 dedicated period if you already did all the questions during third year (that’s what I did!).

If you’re something of a workaholic and grinding through UWorld two times really makes you happy, that’s okay, too. Don’t try to change your way of life dramatically during your dedicated study period. You’ve already come so far to get to this point in medical school and had your fair share of successes. Do what you can to stay true to that best version of yourself.

 It’s Okay to Change Your Test Date, But for the Right Reasons

I had initially planned on taking four weeks to study for Step 2 CK. I booked my test date accordingly. Then, about five days before my exam, what had started out as a pesky dry cough turned into acute bronchitis. The coughing was so frequent at night that I essentially wasn’t sleeping at all. So I chose to change my test date to give myself a few days to recover. For such an important exam, the change fees were money well spent. Ultimately, everything worked out.

While you should not hesitate to move your exam date if you’re not feeling 100%, I would strongly discourage changing exam dates in response to self-doubt. The boards can cause extreme anxiety. It’s okay if you’re terrified and worried about performance. We all have self-doubt. It’s not a flaw. It is a natural, evolutionarily anachronistic instinct. But once you have a study plan and test date, stick to it and motivate yourself to keep it! OR, you can find yourself constantly pushing back your test date and self-doubting, sabotaging the most efficient study plan, and risking forgetting what you’ve learned and becoming emotionally and mentally exhausted.

We all worry we might fail. I worried, and yet I ended up getting a 281.


Alyssa is a medical student currently in-between her 3rd and 4th years at Harvard Medical School. She is conducting translational hepatology research full-time at Massachusetts General Hospital. Alyssa plans to apply for Internal Medicine residency this coming cycle, with the ultimate goal of pursuing Gastroenterology. Excelling on her shelf exams, clinical rotations, and the USMLE, she was able to score a 262 on Step 1 and a 281 on Step 2 CK. She is passionate about medical education and has spent more than 400 hours tutoring students in medical and pre-medical subjects over the past eight years. Ms. Ehrlich is the founder of USMLE Pro Tutors (www.usmlepro.com), which offers personalized 1-on-1 online tutoring for the USMLE Step 1, Step 2 CK, shelf exams, and medical school coursework. Alyssa developed a unified test-prep teaching method that all tutors at USMLE Pro utilize, which incorporates evidence-based principles of adult learning in order to help students study more efficiently, perform better on standardized exams, and overcome test-taking anxiety. She strongly believes that personalized education and test-taking support services should be available for all medical students, and created a program through which USMLE Pro Tutors offers subsidized tutoring to need-based financial aid recipients. When she is isn’t working in the lab, tutoring, or spending time with friends and family, she enjoys practicing vinyasa yoga and learning improv and sketch comedy.