Proven Strategies to Ace USMLE Step 2 CK with a 90th Percentile Score

Having scored above the 90th percentile on Step 2, students often ask “How do I get a high score on Step 2?”, “How long should I study for Step 2 CK?”, and “What’s the best study plan for Step 2 CK?”

Mastering this exam is a combination of knowing specific facts and being able to interpret medical information to choose “the next best step” in patient care. I will share the most important ways to excel in these areas, as well as my specific journey to a >90th percentile Step 2 score.

I want to emphasize there is no magic on this journey and it will often feel difficult. Consistent and intentional studying throughout medical school (2-3 years) are key to building solid foundations and clinical reasoning skills that are necessary to perform well on this exam.

How to Learn the Specific Facts

Study well for your preclinical curriculum and Step 1

While Step 1 is difficult, recently pass/fail, and arguably less fun to study for than Step 2, it is critical to master this information to perform well on Step 2. Some of the tedious material (biochemical pathways, B cell receptor recombination, roots of the brachial plexus) aren’t explicitly tested on Step 2 in the same way as Step 1, but everything you learn will help you with material on Step 2 and support your path to a high score. Give your best effort here!

If you are reading this and have already completed your preclinical years and Step 1, it’s not too late! Keep reading. 

UWorld for Step 2 Prep

UWorld is the single most important source of facts to learn for Step 2. Every time you answer a question, the explanation will feature certain words in bold, possibly a table, and if you’re lucky a picture to supplement your learning. Every question you answer contains a learning objective. When you complete a question (right or wrong), go straight to the learning objective and be honest with yourself. Did you know this fact? If not, find a way to review it for later. This can be using the UWorld flashcards built into the app, Anki (my preferred method), quizlet, or a “fact sheet” you review frequently. Wherever you store this fact, you must review it at a later time. If you save this information and never look at it again, it will not help you.

Additionally, if UWorld gives you a table or a figure, you can be sure you will see a variation of the same question again with a different fact from the media. Take a second and imagine different ways the test makers could ask you about this table/image.

Ex: Instead of a patient with a mechanical valve needing antibiotic prophylaxis before the dentist, it could be a patient with an unrepaired congenital heart defect having surgery for heart prosthetics. 

Spaced Repetition

Even if you have sworn off anki, some form of spaced repition is non-negotiable for a high score on Step 2. You absolutely need to be reviewing the material you’ve learned in some structured manner. As above, you can use UWorld flashcards built into the app, anki, quizlet, homemade paper notecards – whatever your preferred method the most important thing is that you review this material daily. 

Study well for your shelf exams

While shelf exams may be slightly more detailed than Step 2, most of the information you learn for Shelf exams is fair game for Step 2. So, while you are studying for shelf exams, you are also studying for Step 2. Do yourself a favor and do your best on shelf exams, which will help you both in clinical rotations and on Step 2 (win-win). 

High-Yield Supplements

Listening to or watching (reputable) high-yield material can really help solidify specific facts that you might not think about often. Divine intervention, Emma Holliday, and med-bullets podcast are a few that I listened to (2-3x weekly) leading up to Step 2.

How to Choose the Next Best Step on Step 2 Questions

Get your priorities straight

When answering a Step 2 question (and in medical practice!) it is key to know what your priorities are because there will often be competing interests in question stems to confuse you between answer choices. In general, the patient’s vital signs are top priority. Even if you know they need surgery at some point, if the question stem involves a trauma and hypotension and one of the answer choices is to establish IV access – that needs to be your priority.

Goals of care can also come into play here. For a hospice patient, their comfort and quality of life are the most important considerations in their care. If a patient with advanced pancreatic cancer on hospice is diffusely jaundiced and pruritic, you should be choosing to put in a stent to maximize their quality of life instead of a whipple and aggressive chemotherapy.

Learn about lab and imaging tests

What exactly is included in a CBC? How long does an MRI take compared to a CT scan or an ultrasound? What are the limits of a transthoracic echo compared to a transesophageal echo? Does a positive ANA mean a patient has lupus? Which test will get me the information I need at the lowest possible financial cost and inconvenience to the patient?

These are the kinds of questions test makers are thinking about when writing questions and answers and the kinds of things you should be paying attention to in questions and in clinical rotations.

Just because you can do something, should you?

This question will show up both on this exam and in your practice as a doctor. As a medical professional, you will have the ability to prescribe medications and tests. But should you? On Step 2, ethical principles will be explicitly and inexplicitly tested.

Someone who has had extensive medical workup with persistent symptoms – where is the limit and how do you convey this to the patient? When is it ok to prescribe opioids as pain control? How do you balance beneficence with autonomy in a suicidal patient? The best way to answer these questions correctly is to expose yourself to different ethical dilemmas and learn about how providers handle these situations with regard to the law and the patient’s best interest.

My Path to a >90th Percentile Step 2 Score

As I reflect on my own journey to achieving a >90th percentile score on Step 2, I realize that it was the culmination of years of intentional studying, dedication, and a willingness to learn from my mistakes. While there was no single “magic bullet” that guaranteed my success, I attribute my high score to a combination of consistent effort, strategic use of resources, and a deep understanding of the exam’s format and content. In the following section, I’ll share my personal story of how I approached Step 2 preparation, from my pre-clinical years to my dedicated study period, and the specific strategies and habits that helped me achieve a score above the 90th percentile.

Pre-clinical didactic years

During my pre-clinical years, I was fully invested in my school’s curriculum and committed to performing well on assessments. To master and retain the content, I relied on a combination of medical school lectures, Anki (using the Anking deck), Sketchy, and Boards and Beyond. I established a consistent study routine, dedicating around 8 hours daily to studying, and made sure to take at least half a day off on Sundays to recharge. I prioritized getting enough sleep and made time for things that were important to me.

Step 1 Preparation

When it came to preparing for Step 1, I focused on UWorld and Anki, supplementing my studying with targeted Boards and Beyond and Sketchy videos as needed. Once I felt confident after passing a practice exam, I used the remainder of my dedicated study period to solidify key concepts that I knew would be essential for the rest of medical school and clinical practice.

Clinical Rotations

During clinical rotations, I created a new Anki deck using Step 2 material from Anking and my incorrect UWorld questions. Each day, I made it a point to complete 15-20 UWorld questions and create Anki cards for the ones I got wrong. I also added 30-50 new Anki cards daily, plus reviews, to keep the material from past rotations fresh in my mind throughout the year.

To maximize my time, I’d listen to relevant episodes of Divine Intervention or Medbullets Step 2 podcast during my commute to clinical rotations. About 1-2 weeks before each shelf exam, I’d finish the corresponding UWorld shelf sections and review my incorrect questions. I also made sure to take all available NBME practice exams to gauge my progress. Throughout this process, I did my best to perform well on shelf exams and scored >90th percentile (or very close) on my shelf exams.

Step 2 Dedicated Study Period

About six weeks before my Step 2 test date, I took a practice test to establish a baseline and identify areas for improvement. From there, I tackled my weak spots first, reviewing all my incorrect questions and problem areas. I then reset my UWorld Qbank to the Step 2 setting and started daily question blocks of 60-80 questions. My focus wasn’t just on completing the questions, but on honing my thought process and reasoning skills. I analyzed why I chose one answer over another, and looked for ways to refine my approach.

Thanks to my existing Anki deck, I had a solid foundation of specific facts, which saved me time and effort when reviewing UWorld figures and tables. To make the most of my daily commute to the library, I’d listen to Divine Intervention podcasts. Throughout the dedicated study period, I took a practice exam every week to track my progress and identify areas that still needed work. And, to avoid burnout, I made sure to take one day off each week to recharge.

Final Advice on How to Score >90th Percentile on Step 2

• Consistency is key. Invest time in figuring out how you study best, come up with a plan,  and be consistent. 
• Quality over quantity. Be honest with yourself about what you are learning. It’s better to tackle a smaller number of questions, truly understand the concepts, and retain them for the long haul, rather than rushing through a large volume of questions and retaining nothing.
• Schedule breaks. Studying for Step 2 is a marathon, not a sprint. Burning out and not being able to study at all is worse than planning breaks and taking them. 
• Decide why you want this. What are your goals? What are you working towards? This can be a difficult process and it’s important to come back to your reasons to work hard for this.

Have questions? Check out this blog post for another perspective and contact EMP for a consultation with a Step 2 tutor!