USMLE Step 2 CK – 240 | Bobur

Hi everyone! I am Bobur. I am an endocrinologist, who took Step 2 CK on 29.09.2024 and scored 240. Here, I would like to share my Step 2 journey.

Well, the preparation lasted for 14 months, full-time. I followed the advice of MD who scored 284 on Step 2 CK. Based on his advice, the study materials I used were:

1. UWorld Step 2 CK - 3 times, all random (scored between 85-95% in the 3rd round)
2. UWorld Step 3 - 2 times, both random (scored between 80-87% in the 2nd round)
3. IM Essentials - 1 time
4. Amboss Shelf-Surgery - 1 time (85%)
5. Tried some questions (~300-400) from Amboss Step 2 and a few questions from CMS, NBME
6. Used original guidelines to better understand the management of different diseases.

Self-Assessments

Amboss - 264

UWSA1 - 268

UWSA2 - 272

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Exam

I took the exam in Istanbul. Unlike my Step 1, this time, in Step 2, I felt much more confident and calmer, so I slept, really well, for 8 hours (usually being able to sleep well before something serious is my biggest problem). There was nothing extraordinary I could tell during that time..

Exam questions

Honestly, based on my preparation (materials used, individual test scores, and SAs) I believed I would score +270-280. Unfortunately, most of the questions were totally different from usual step2 Qbanks (CMS, NBME, UWorld, Amboss); different from what I learned during my whole preparation. Only in 3 blocks questions resembled UWorld, which felt easy and the other 5 was almost new. I did not know most of them so just guessed. Those questions were beyond my knowledge. Just after the exam, I knew, I felt my score would not be high. One of the main reasons I scored much lower than my expectation is that there were a lot of quality improvement questions and behavioral questions, both of which often seemed to be 10-15 in every block. Well, I am going to summarize what I particularly found difficult and unusual about the exam:

1. Questions were too long and given different style, they say, SOAP note-style. This change has been appearing since late August- September, 2024, according to the examinees in reddit step2 community. Of course, this type of question does exist in UWorld or NBME, but they are much more straightforward and easier than the real exam. They included a lot of information in the case, and reading till the end took more time than even UWorld Step 3 does (which usually has longer questions). Because too many things about the patient were given, finding necessary/relevant information was difficult. I did a lot of mental effort to solve a single question. I mean if you practice enough, you will develop pattern recognition, which is a kind of combination of knowledge and highly developed mental skill. With pattern recognition, we solve questions (in real practice we make diagnoses) smoothly, without thinking, and it feels that you read questions and without conscious effort, you choose the right answer. Every Qbank teaches you patterns; I purposefully worked on that. However, the exam breaks those patterns. Now I say those question makers are so smart. How do they break the patterns? Modified case presentation and answers.
2. Modified case presentation and answers. This was the main difficulty many step2 takers are encountering. First, they gave very few symptoms and these symptoms were non-specific and vague, which i have never seen before. For example, I remember the diagnosis of acute cholecystitis: a patient has some general GI issues and almost normal vital signs. In that case, the only evidence of acute cholecystitis is a positive Murphy's sign. UWorld or Amboss, does not matter which, they present diseases classically (for acute cholecystitis, high fever, RUQ pain started after a meal + risk factors 4F , female, forty, fat, fertile). CMS and NBME are even more straightforward. So I would say the exam was non-classic, and I mostly did not know what type of problem they were asking. In addition, modified answer options were really problematic. For example, when I knew the problem: the next step in the management of a female, 24, with a breast mass, I was expecting the answer options e.g. A) US B) Mammography C) Core needle biopsy, but their answer options were not this simple; they always added something into these answer options, like A) reassurance now and US after 2 weeks and B) US now and something else added. As a result, I always had to think to come to a conclusion. You can't choose anything automatically because the options are not similar to what "your eyes got used to" during your preparation.
3. Question types they asked. A huge part of UWorld, Amboss, CMS, and NBME is about making a diagnosis. In my questions, most patients did not have active symptoms, they either just came for follow-up or already had a diagnosis, and the next step in management was asked. So I almost did not see questions requiring to make a diagnosis. Again, the answer options felt totally new to me, I did not recognize any patterns I learned, so I just guessed them. I often tried to see if the concepts from cancer screening and vaccinations were the right answer, but those concepts did not match. I learned algorithms from UWorld (often read original guidelines) well enough but was not tested on those things. I felt pediatrics and social sciences made up the most questions. It seems that i almost did not see questions from Surgery and Psychiatry.

Advices and Gratitude

My only regret about the preparation is that I should have used additional materials for topics on quality improvement. Because now this topic makes up a huge part of the exam. Otherwise, I believe I did everything well. Although I almost did not practice NBME or CMS, i am sure, they would not have helped me with the questions I faced at all. These two Qbanks, NBME and CMS, share similar concepts and topics as UWorld and give cases in a really classic and straightforward way, they do not trick you. So if you do well in UWorld, you will do even better in these Qbanks. Most people's NBME and CMS scores are much higher compared to that of their UWorld or Amboss.

Although my exam experience is negative, i do not want to discourage or scare you. I cannot generalize that everyone will have the questions that I did. No. I have been reading others' experiences too: someone says their exam was like Step 1 and scored +260/270, another says their questions were similar to their practice questions (UWorld, CMS or NBME) and got a good score, or someone has vague questions like I faced but the percentage of those vague questions was very small. Based on their words, I can say examinees will have different "packages of questions": easy ones like NBME or CMS, similar to Step1, vague or difficult and new or ethics-heavy. There are these variations. It is also luck what combination you will face...

I would like to thank my family who understand my career and support me.

I would like to thank Farkhod aka, who always has been an example for many of us, for the step-takers.

I would like to thank my friends and everyone with whom I often discussed questions in 2CK preparation (a group in Telegram).

If any question, feel free to reach https://t.me/TheeeDiamond