Aiming for a competitive specialty? How to study for USMLE Step 2

Chris Hornung, MD
5 min readJan 29, 2024

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This post is part of How to med school for competitive specialties, click the hyperlink to see my other posts in the series

Step 1 used to be an exam to differentiate yourself from your peers. It was the organic chemistry of medical school that weeded out potential applicants to competitive specialties. Now Step 2 is that exam. Especially with pass/fail curriculums being common in the preclinical and clinical years, it is paramount that you do well on Step 2 if you are planning on applying to a competitive specialty since it is one of the few objective metrics you will have to stand out from your peers. In this article, I will tell you the strategy I used during my third year of medical school to score in the 90th percentile on Step 2.

Photo by Lukas Blazek on Unsplash

If you want to do well on Step 2 then you will not be able to cram in all of the required knowledge in your dedicated study period. You need to study systematically throughout your entire third (and in some ways second) year. The best predictors for Step 2 score are your NBMEs (r = 0.77), Step 1 exam (r = 0.75), and clinical systems blocks (0.517) [Jacobpayaril 2022]. Read about how to approach studying for Step 1 here. The latter two can be considered your preclerkship performance while the former is your third-year performance. Sign up for the exam sometime in December of the year before you plan on taking it (I recommend taking it before you start your sub-i’s and away rotations). This will let you take it when you want to as opposed to when there are dates available. You don’t want to wait until the last minute to sign up and be unnecessarily stressed because you can’t find testing center openings.

Before the Rotation starts

Watch the relevant Emma Holiday YouTube video (link to these videos and other helpful resources during your third year) to get a general sense of the high-yield information for the rotation. After you have watched the video, unlock the corresponding Anki cards in Anking.

ex. tag:#AK_Step2_v11::#Resources_by_rotation::IM::emma*

I also converted the audio from the YouTube videos to MP3 and uploaded them to my Spotify account so that I could listen to them while driving/working out. Spotify does not allow the sharing of local files so I can’t post them. Google how to do this if you are interested in doing the same thing.

During the Rotation

Do not immediately jump into using Uworld at the beginning of each rotation. Realistically, you will not know most of the material and will just end up getting obliterated by the questions. Instead, read through the topics specific to your rotation in the OME notes (PDF is in the document in the link above) and unlock the corresponding cards (tag:#AK_Step2_v11::#OME::01_Cardiology::01_Coronary_Artery_Disease*). Once you have read all of the relevant topics and unlocked all of the cards, start doing Uworld questions. To make sure you are covering an appropriate amount of new cards and Uworld questions per day, use this. As you are doing Uworld questions, unlock additional Anki cards for the questions you get incorrect or that you mark. You can typically find these cards by searching with keywords. If the cards do not exist within Anking, make your own cards. Complete all of the shelf Uworld questions for each of your rotations. Once you have done all of the questions, retake the questions that you got incorrect. After you have retaken all of the questions you got incorrect, take at least one practice shelf exam from the NBME website, even if your rotation does not have a shelf exam at the end of it. You can compare your score to national standards with this website. Aim to score above the 90th percentile for each rotation. It is easier to relearn material during your dedicated period than trying to learn it for the first time.

Dedicated

Upon starting dedicated, you should have made it through your first pass of Uworld. During dedicated make your second pass but with a more detailed review of incorrect and marked questions. Keep up with your Anki reviews. You should aim to take UWSA1, UWSA2, NBME’s 9–12, and the USMLE Free 120 questions. I ended up moving up my exam date and didn’t have time to do NBME 12. My order of taking them was UWSA1, NBME’s, UWSA2, Free 120. There is a lot of discussion about the order you should take them in. In general, make sure that you take UWSA2 and Free 120 last. UWSA2 is supposedly most predictive of your score on test day. Free 120 since it is written super similarly to the actual exam and some of the questions will show up in the actual exam. Use this Excel file to keep track of your progress on practice exams. There is a score predictor that you can use based on your practice exams. When I took tests, I marked questions that I was not 100% sure of the answer. I kept track of how many questions I marked for all of my practice tests and it correlated to the number of total questions I got incorrect. This ratio will allow you to have a general idea about how well you did on the actual test based on how many questions you marked.

For all of the questions that you get incorrect or mark during the questions you do on Uworld or the practice exams, note them in an Excel spreadsheet. You can do this using this Excel file. Mark any question in which you know you need to dig into the topic a little bit on Amboss to make sure you know it well. In general, you should take time to review the high-yield topics on the exam. These include acid/base, shock, fluids, and electrolytes. I found it helpful to go back and review basic physiology of the major organ systems so that I could reason through questions rather than feel like I had to memorize every potential patient presentation. Unlock, reschedule to New, or make new Anki cards for all of the questions you got incorrect or marked. On the last week before taking the real test, make a Word doc organizing the information you originally put in the Excel file with your incorrect and marked answers. Study off of this for the days leading up to the exam. The week of your exam, go through the bio stats and ethics questions in Amboss. Do not study anything except the Word doc the day before and the day of your exam.

Godspeed!

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Chris Hornung, MD

A twin in the Twin Cities. EVMS Otolaryngology Resident. Former MCAT Instructor. I really like tracking things.