2 Steps Closer to Residency


My number one priority during the past two months has been studying for my next set of medical licensing examinations. The exams, administered by the United States Medical Licensing Exam (USMLE) Service and commonly referred to as Step 2, are taken after the third year of medical school. While Step 1 is taken during or after the second year of medical school and focuses on basic science principles (read about it here), Step 2 focuses on clinical medicine. The Clinical Skills (CS) portion of Step 2 is a practical examination is comprised of 12 standardized patient encounters where students are evaluated on their history, physical, note-taking, and communication skills in a real-world setting. Step 2 Clinical Knowledge (CK) is a standardized, computerized, multiple-choice examination that tests students’ knowledge of common clinical scenarios, diagnostic tests, and clinical decision-making.

The first obstacle I encountered during Step 2 preparation was the simple act of scheduling my exams. Our institution gave us three weeks off in between third and fourth year. I had just finished an intense general surgery rotation (which didn’t leave much time for studying), so I chose to use this time as a bit of a stay-cation. I knew that I would soon be busy on my fourth year internal medicine rotations where I would be working hard for good grades and letters of recommendation, so I chose to take some time off. I was confident with my Step 1 score, and thus didn’t feel that there was a particular urgency to take my exams. I also wasn’t going to be tied up doing away rotations like some of my classmates. Ultimately, I decided to take my exams during during the school year.

I took Step 2 CS first, back in August. Since my first year, my medical school has provided us ample opportunities to interact with standardized patients in settings very similar to the USMLE exam. Admittedly, the exam did not involve an extensive amount of studying prior to the exam. I attended review sessions held by the physical diagnosis and clinical skills department, and chose a popular (and used!) review book, and on exam day, felt that this was more than adequate amount of preparation. In retrospect, the exam was long (8am-4pm), but not unlike a busy day spent in an outpatient clinic. While very low-key in terms, the exam has several downsides. It is expensive (over $1000.00) and administered at only eight centers nationwide, leaving ample room to rack up travel expenses.

Next came Step 2 CK. I took this exam after a rotating through one of the hospital’s consult services. The rotation had reasonable hours, and plenty of down time during the day which I used to study. As for study materials, I chose a kindle-version of First Aid for the USMLE Step 2  so I would have access to my study materials at all times in the hospital. I also used a USMLE World question bank, which I had purchased early in my third year to study for my end-of-clerkship examinations (also in mobile-friendly format!). I read most extensively about those topics on which I was a bit rusty, and completed all of the questions in my question bank prior to the exam. Admittedly, studying for this exam was again much more low-key compared to studying for Step 1, and I felt that many of the topics covered were scenarios that I had seen multiple times in real-world encounters. However,  I found sitting for the actual exam very difficult. After working in a hospital for over a year, it  was almost painful to sit in front of a computer for nine hours.

In the end, I walked away from both exams with a huge weight lifted from my shoulders. I am now two steps closer to becoming a resident.

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