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USMLE Step 2 CK and CS

by Mohammad Hajighasemi-Ossareh, MD, MBA
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    00:00 Welcome back to the 4th Year of Medical School lecture series. Today, we're going to discuss "What is the USMLE Step 2 Clinical Knowledge exam? When do you take the Step 2 CK? How do you study for Step 2 CK while on your clinical rotations?" We'll also discuss "What is USMLE Step 2 CS, Clinical Skills, when do you take it, and how do you study for it?" So, what is the USMLE Step 2 Clinical Knowledge or CK exam? Well, the CK exam is a multiple choice exam that students, at least within the US, take after their 3rd year of medical school. The exam test clinical and basic science material that was taught during the first 3 years of medical school in the form of questions that are formed in clinical vignette. The exam itself is divided into eight 60-minute blocks. Each block contains 40 or actually less questions. So your maximum test-day total can be 318 questions. Now I say 40 or less because when I took Step 2 some questions had 38. So the max you got 40 per block but you can have 1 or 2 less. Now, on exam day, they will give you 45 minutes of complete break time but there is a 15-minute tutorial at the beginning of the exam that you can choose to skip and that 15 minutes can be thrown on to the 45 to give you an hour break. And of course if you finish a section early, however much time you had left will get added to your break time as well. Now, if you've taken USMLE Step 1 this all sounds very familiar and it's supposed to be. It's a same system and same characteristics. The exam for Step 2 CK is taken at least in the US and even globally now at Prometric Testing Centers. If you remember from Step 1, Prometric is a very uncomfortable and sterile and awkward testing environment but that's how they ensure security. Now, again, this all sounds pretty horrible. This mini blocks, little bit of break time, Prometric all got a hay to that place but it's not. Studying for the exam and even taking it can actually be a fun challenge if you have the right mindset and if you prepare properly. Think about it. You're going to have to take Step 2 anyways. It's part of what you're doing. You might as well have a strategy to make it a bit better for yourself. Why suffer for no reason? So, when do you take the Step 2 CK? It's best to take USMLE Step 2 CK at the end of your 3rd year of medical school after you've completed all of your core clinical rotations or you could even take it right at the start of 4th year. It's often better to take it at the end of your 3rd year of medical school though because the 4th year of medical school is often the time of doing your sub-internships and the beginning of 4th year is often competitive of getting home and away sub-internships so it would be bad if you missed a good opportunity to do a sub-internship at the beginning of your 4th year because you are gone taking Step 2. Now, make sure you take your Step 2 as early as you can. You want your residency application to be complete and not pending your Step 2 score. In the old days there was this technique of you did really well in Step 1, you applied the residency, you interviewed and then at some point your Step 2 score rolled in sometime thereafter you match. Those days are over, you now have to have a completed Step 2 score in order for your residency application to be complete. Also, you want to take the exam what I would argue in the grind of your 3rd year rotation when you have a lot of that material already in your mind. When we talked about in the 3rd year lecture series, studying for 3rd year clinical rotations and Step 2, we talked about the importance of studying for rotations and Step 2 resources simultaneously. So if you did that, and we'll go more into this shortly, the best time to take the test is towards the end of 3rd year because you have all of that material fresh in your mind. So let's discuss, "How do you study for USMLE Step 2 CK?" Studying for Step 1 was actually a bit easier. You were in the basic science years and you went to lecture and then you came home and you study. Now you’re in the clinical years of medical school. You have to work in the hospital then you got to come home and study and you also got to study on your day off. The earlier lectures we discussed that the study for clinical shelves and exams and how to balance the schedule. We talked about coming home, reading about patients, doing Qbank on your day off. Well, first things first. You really should focus on your 3rd year clinical rotations. That's the first step to do and grade on Step 2. Get the most out of each rotation and study well for each clerkship shelf. I mean that makes sense. When you're in the moment, try the best you can. If you remember for our Step 1 lectures we said the same thing. The best thing I want you to do is to try really hard in your 1st and 2nd year classes for Step 1. Same thing here for Step 2, really focus on your rotations and shelf exams. Now, studying for USMLE Step 2 is actually similar to studying for your clinical shelves. That only benefits you. The only difference is that you need some degree of dedicated study time so you can do the question bank extensively in a single book for writing notes when it comes to studying for Step 2. Now, your schedule is going to be absolutely very important for Step 2. Similar to a study schedule that you design for USMLE Step 1, you need to do the exact same for Step 2. What you need to do is map out how many days you have open to study for Step 2 and how many questions you have to do on your question bank. Map out each day how many blocks you'll do and then study the questions in the same thorough manner as described of how we did it for Step 1. We talked about extensively how to accurately and carefully use a Qbank the same thing here. Now, the resources that you'll use to study for USMLE Step 2 are vital. During the 3rd year, it's recommended that you have a video lecture series similar to what you're seeing now on Lecturio to study as you go through each rotation. So you should have access to a question bank also to test your knowledge.

    06:16 So you should have a question bank, the video is running in the background, and we also recommend that you have 1 single textbook for your Step 2 reference to write all your info in. Many of you for Step 1 used First Aid for Step 1. Now you can use any book you like for Step 2, there is no golden reference here. Now, studying for Step 2 CK usually takes on average 1 to 2 months. You need to look at your 3rd year schedule and determine when you'll take the USMLE exam and how much time you have in your schedule for full dedicated USMLE time. Everyone's 3rd year schedule is different and you can arrange your vacation time or pick kind of light rotations where you can kind of create a dedicated USMLE study time. Now let's discuss what is USMLE Step 2 CS, Clinical Skills. Well the Clinical Skills exam is a real life exam. The students go to this testing center where they have like an office with all these rooms with standardized patients inside.

    07:16 What the students will do on the CS exam is go in, speak with the patients, examine them, come back, and write a note and actually see patients in real life. The whole purpose of the Step 2 CS exam is to test to see if students are able to gather information from patients, perform physical exam, and then communicate their findings to the patients and then communicate those findings in the form of a written note. Now, testing centers are located in 5 locations in the United States. These are known as Clinical Skills Evaluation Collaboration Centers or CSEC Test Centers.

    07:54 The test centers are located in Georgia, Illinois, Texas, California, and Pennsylvania. If you don't actually live in one of these cities, you will have to travel to a testing center. The one in California is located in Los Angeles. I happen to be in Los Angeles so I got lucky, I could just drive to it but there were kids there who had to fly in from different parts of the world. So if you don’t live in one of these states, think to yourself. How am I going to arrange travel and boarding and it's completely up to you, there's no one to help and you also have to fund all the costs. So ahead of time start planning for this because when you have to travel, you need more free days beforehand. Now, the CS exam is structured as an 8-hour exam. The exam day has 12 individual patient encounters, so you'll see 12 patients that day. Each total time with the patient is 25 minutes long. They will give you 15 minutes to see the patient and they also give you 10 minutes then to write up the note. You will have 50 minutes of total break time. You will have 10-minute break following your 3rd patient encounter and will give you a 30-minute break which is your lunchtime break in which they'll give you mediocre sandwiches after your 6th patient encounter and finally you'll have a 10-minute break after your 9th patient encounter. Be aware, these break times are controlled by the testing center and not in your control. If you think back to your Step 1 exam or your Step 2 CK exam when you kind of control what your break time are on the different blocks, this is not the case here. The whole day is structured when you will see the patient, when you will go in the room, they'll ring a bell for you to come out, come write your note, they'll tell you when to go to break so the whole day is under their control, just follow along. But really, the exam day is quite simple. The testing center is structured similar to a physician's clinic. Exam rooms are present and students are played outside the door. There's a piece of paper outside the door with a chief complaint of the patient, the patient's name and the vitals and then students are given a piece of paper to take notes on and then they'll start the timer and let off the noise and then you'll be able to knock on the door, open, go inside, greet the patient, interview the patient, perform your exam, and then you have 15 minutes to do all of these and then another sound will go off and then you'll have to immediately come out of the room, close the door, go sit down the computer, and write your note and you have 10 minutes to do that. Now if this sounds similar to what you've been doing in your everyday clinical life in medical school, you're absolutely right. They're not trying to trick you or make your life any harder, this is not a challenging process. It's simply testing, "Do you have the basic ability to see, interview, examine, and write a note on a patient?" This is the absolute core and basics of doctoring. All of you will do great and even better, USMLE Step 2 CS is greater on a pass or fail basis, there is no numeric score. So all of you should do fantastic because this is the basis of doctoring. They just want to have a standardized measure of making sure everyone can do the basics. Now, when do you take and how do you study for this USMLE Step 2 CS? Well you should take Step 2 CS shortly after you take CK or at least as close to it as you can. Most students give themselves roughly just 1 week to study for the Step 2 CS exam if they took the CK exam within the last month. This is actually going to work to your benefit because all of the knowledge that you studied for the CK exam is still fresh in your mind and you can apply that to all the clinical scenarios on the CS exam. Now, how do you actually study for Step 2 CS? It's super simple.

    11:34 All you need to do is purchase 1 book. Most students will use either First Aid for USMLE Step 2 CS and then just open the book and you'll realize it will just have a bunch of cases in it. All you should do is read the case in each book, see what questions or the pertinent questions you should be asking for each case and what are the pertinent exams you need to perform and how do they want you to write your note. You can read all the cases, become very familiar with everything within a week and the reason why you can do it so quickly is you've been doing this all 3rd year.

    12:06 You've been seeing patients, you've been seeing complaints, and you know how to work up patients and the cases they're going to give you on CS are going to be bread and butter medicine, nothing esoteric, nothing random. Now, if you are traditional medical student you will have more than enough experience, like I said, interviewing and examining patients but if you do not have enough experience with patients or you have or you've been out of practice for a while and you're taking these exams reach out to your medical school or reach out to physicians you know to get back in there and warming yourself up to practicing and interviewing. That's critical to this exam.

    12:44 Now let's summarize what we've talked about. The USMLE Step 2 CK exam is a multiple choice exam taken at the end of your 3rd year of medical school and test the knowledge or the first 3 years of medical school. You should take your Step 2 CK exam at the end of the 3rd year or beginning of your 4th year. Get it done early so it's complete. Studying for the Step 2 CK exam by first diligently setting for each of your clinical rotations and shelf exams and then use a dedicated question bank to study high-yield material for Step 2 CK, that's all you need. Now, Step 2 CS exam is an interactive exam where you will interview, examine, and write notes on standardized patients in a mock clinical setting. You should take the Step 2 CS exam as close to after the CK exam as you can while all that medical knowledge is fresh in your mind. Now, study for the Step 2 CS exam by getting just a single book that has a bunch of Step 2 CK cases presented in it and just see what are the important questions to ask and what are the important physical exam findings to perform and what do they want you to write on the note. Best of luck on these exams.

    13:53 Thank you.


    About the Lecture

    The lecture USMLE Step 2 CK and CS by Mohammad Hajighasemi-Ossareh, MD, MBA is from the course Med School Year 4. It contains the following chapters:

    • USMLE Step 2 CK and CS
    • When to Take USMLE Step 2 CK
    • How to Study for USMLE Step 2
    • What Is USMLE Step 2 CS
    • When to Take and how to Study for USMLE Step 2 CS
    • Lecture Summary

    Author of lecture USMLE Step 2 CK and CS

     Mohammad Hajighasemi-Ossareh, MD, MBA

    Mohammad Hajighasemi-Ossareh, MD, MBA


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