V,IMP USMLE STEP 2 CK EXPERIENCE AND ADVICE REVIEWSTAVROS MATSOUKAS STEP 2 CK SCORE: 262 (> 1 SD, 85.5 Percentile)

International Medical Student Status of Career: Undergraduate Medical school: Aristotle University of Thessaloniki, Greece Preparation Time: 03/31/2017 - 01/24/2019 Minus 5 months due to sickness and rescheduling Minus 5 months due to last year in Medical School Exam Date: 01/24/201 Step 2 CK Score: 262

Contents: Dear IMGs from all over the world Which resources did I use -OBGYN Study Plan -Pediatrics Study Plan -Surgery -Psychiatry -Internal Medicine -Biostatistics -Interpretation of Literature How did I use my resources and Discipline-Targeted Approach UWorld for STEP 2 CK -How to study UW 2 -How to make notes UWORLD for STEP 3 KAPLAN QBANK Important clues, generally for STEP 2 CK and Test-taking strategies CMS and NBME - How important are CMS Tests and NBMEs and in what way UWSA 1 What was my biggest challenge How was my experience on the exam day How to register for the exam My Study Plan and Suggested Study Timeline Frequently Asked Questions, that haven’t been answered so far -Last Month Routine -What to Study for the last month (At least what I did) -How do you manage LONG stems -When time becomes valuable My scores Contact Information

Dear IMGs from all over the world, After a long time of preparation and anxiety, I would like to describe my experience about STEP 2 CK preparation and give some advice to all those people who are preparing for this exam. I will also try to answer all the questions that I you‘ve asked me. Which resources did I use? BOOKS: -Kaplan Books (OBGYN, Pediatrics, Surgery, Psychiatry; NOT Internal Medicine) -Master The Boards for STEP 2 CK -Master The Boards for STEP 3 -First Aid STEP 2 CK Q-Book -Kaplan Q-Book -Did NOT do First Aid Book for STEP 2 CK -Pathoma (very specific subjects, as a review to refresh some concepts) -Goljian Pathology (read a few pages only) -First Aid for STEP 1 (Read all at some point, but again, the most important subjects to consider reviewing from there are: Pharmacology Chapter from basic sciences, Pharmacology part from each organ chapter, Immunology tables, especially the immunodeficiency and autoantibodies charts, fungi, parasites, microbiology tables, microbiology pharmacology, maybe some pathology subjects, but don’t lose time with details, BIOSTATISTICS, Psychiatry, Neurology; Try to avoid losing time on Anatomy/Histology/Embryology/Physiology). How did I use my resources and Discipline-Targeted Approach OBGYN Study Plan I read Kaplan book first, with Kaplan lecture videos. Then I read MTB 3 and tried to note everything I could and have some concepts or whole chapters (e.g. menopause) noted completely on MTB 3. It’s totally impossible to transfer everything from Kaplan book to MTB 3. My advice to you is to read Kaplan first, then MTB 3 and then you can decide for each chapter individually. Continue with UW2 and UW3. They are both extremely valuable for your preparation and success. Pediatrics Study Plan I applied the abovementioned technique for studying pediatrics, as well. Interestingly enough, I found very detailed the ENT and Ophthalmology chapters, but UW2 covers all of those concepts completely, so don’t get stresses when reading these chapters. Also, I found the immunology chapter not helpful at all; instead I did those concepts from FA for STEP 1 and UW2. Also, UW2 and UW3 are extremely important.

Surgery Kaplan book is a very well written one, and I think it’s underestimated in our community. But the most important thing that I should point out is that the best part is the one with the clinical vignettes. All the information you need is right there. I also found Kaplan lectures very helpful here, understanding some concepts and pointing out some details. For example, through these vignettes and videos you will find out that there is a detailed approach to neck trauma, based on the location of the lesion, which is a concept that I didn’t find in UW2 or UW3. I personally read the first part, and then I did the part with the clinical vignettes. Whenever I wanted to revise surgery I only reviewed this part. Trauma chapter is excellent, and in combination with UW Surgery questions gives you whatever you want. From my point of view, the most powerful parts from Kaplan Surgery are Trauma and Breast Surgery. UW2 and UW3 should once again constitute integral parts of your arsenal. Psychiatry Basically, UW2 has everything you need. In addition, I highly recommend that you review the following, in order to prepare for everything. Some of the following have concepts, or important details that may not be present at UW2. 1. MTB 2 CK (esp. the pharmacology) 2. First Aid for STEP 1 (esp. pharmacology) 3. MTB 3 (I would suggest that you do only the QnAs; some of them are good and difficult, so use them to train your brain) 4. If you haven’t watched Kaplan lectures with Alina Gonzalez-Mayo I recommend that you do it; her lectures are extremely helpful in understanding basic concepts. 5. UW2 6. UW3 Internal Medicine Most important source is UW 2 and UW 3. I read MTB2 CK and I tried to note as much as I could from STEP 1. MTB 2 CK is good, but just for the beginning. It points out high yield concepts that you’re going to see in UW 2 and you need to clarify the in your mind very well. UW 2 will provide a stepwise management for both diagnosis and treatment of each disease, as well as pathophysiology and clinical picture information needed to be remembered in order to pursue a high score. UW 3 examines the same concepts, but from a different perspective. They ask you more about diagnosis and treatment approach, and you may encounter more details in management, compared to UW2. They also like to ask a lot of questions about the prognosis of a disease. What Kaplan Lectures to watch if you have time: Barone (hematology), Castro, Frank (Emergency Medicine, Infectious Diseases).

Biostatistics 1. First Aid for STEP 1 2. UW2 3. UW3 4. Kaplan Psychiatry book, relative chapter Interpretation of Literature -UW2 -UW3 -Kaplan Psychiatry Book, relative chapter UWorld for STEP 2 CK Obviously, this is the most important resource for the exam, as indicated by hundreds of examinees that have taken this exam. It has consolidated, high yield knowledge coming from published research. They also provide a lot of algorithms for diagnostic and therapeutic stepwise management in a clinical setting. How to study UW 2: I recommend the system–based management. Before I do any chapter, I reviewed all the other resources I was using, for example, MTB 2 CK, First Aid for STEP 1, and made sure I did a robust revision. Even after this, there were too many facts and questions that I didn’t know. Don’t panic. You’re doing this QBank to build solid knowledge and a clinical thinking to guide your stepwise management. At this point I feel that an important question you should ask yourself when struggling with a management vignette at STEP 2 CK, is the following: ‘’Will my selected option change the management of the patient?’’ Or: ‘’Will this have a mortality benefit?’’ If not, then that’s probably not the right answer, and you should consider reviewing the stem and choosing another one. Indeed, there are always questions that it takes a small detail to choose between 2 answer choices. How to make notes? Organization is key here. Had I know what I know now before I begin my preparation, I would have organized my notes a little bit better. Some concepts are mixed with others. For example not all pulmonary embolism or atelectasis questions may be encountered on the same block and one after another. So, my point here is to indicate that when making notes, try NOT to continue on the same page making notes for a different disease. Instead, leave all the rest of that sheet as a free space, and once you encounter again Pulmonary Embolism or Atelectasis, continue from where you stopped. This can furthermore be enriched by knowledge you have from other resources, like MTB 2 CK, MTB 3, STEP UP, Pathoma, Goljian, First Aid, or literally any other source. Making notes that way will help you have all the knowledge of every disease at one specifying place and not having to search to another 4-5 places. This will save you time and help you build better memory. You may also add the notes from UW 3.

UWORLD for STEP 3 As previously mentioned, this QBank takes the same cases and asks questions of a very different spectrum; yet high yield and important ones. For example, while UW2 would ask you to put a patient with essential tremor on propranolol, UW3 will require you to know when to start the medication, so you will need to be able to look at very specific indications in order to decide if you’re going to prescribe medications or if you’re going to just follow up the patient with subsequent appointments. Sometimes it gets really frustrating, especially after having done all these questions, to be still wrong or to be asked things you have no idea about. Again, don’t worry. Since you’re doing one QBank more and you’re taking your studying one step further, you’re in the right place for pursuing excellence. Keep it up! KAPLAN QBANK I did this QBank clearly for exercise purposes. I found interesting enough the following blocks: Pediatrics, OBGYN, Emergency Medicine, Surgery, Infectious Diseases, Renal, and Pulmonary. This Question Bank asks a lot of rare diseases and a lot of questions that are out of the spectrum of the exam. However I did an older version, and, as such, I don’t know if my saying is affected due to that or not. If you have time and patience, you can do it. Otherwise, I would say don’t even bother, or you may at least do the abovementioned blocks if you wish. Important clues, generally for STEP 2 CK and Test-taking strategies 1. When struggling with a management vignette at STEP 2 CK, think the following: ‘’Will my selected option change the management of the patient?’’ Or: ‘’Will this have a mortality benefit?’’ If not, then that’s probably not the right answer, and you should consider reviewing the stem and choosing another one. Indeed, there are always questions that it takes a small detail to choose between 2 answer choices. 2. When struggling with a stem try to give an answer before reading the answer choices. Then see the answer choices and begin to rule out as many as possible. Finally use your differential diagnosis skills to pick between the last 2-3 options. 3. How to build differential diagnosis skills is another concept: I found out that one of the best ways to train this skill is to write the given explanation for the wrong answer(s). For example, the vignette may be written in such a way that you need to differentiate between aspiration pneumonia and pulmonary embolism or CHF Exacerbation and COPD Exacerbation. The way that the vignette is written is what will make the differential diagnosis difficult, even for diseases that you couldn’t think of. So, you should note why the right choice is A and why choice B is wrong. After a few months of doing this, you will finally realize the virtue you created for yourself. It’s all yours, well done!!!

CMS and NBME I did them on April/May 2019. CMS tests are difficult from the perspective that they present a lot of clinical pictures in a very atypical way or they give conflicting evidence pointing to two different diagnoses, thus trying to make your differential diagnosis a nightmare. But as I said, building up differential skills is supposed to be no easy task. Your brain has to bleed through the process but it’s only a matter of time (in our case just a few months) for it to adjust to the applied task. It’s totally possible. Remember that the real examination gives atypical cases and conflicting evidence for a difficult differential as well. NBMEs were more straightforward in general but again they had difficult questions as well as many weird ones. You will understand what I’m saying once you do them. But generally they present decent cases. Sample QnAs are available on usmle website both as pdf and as an online test (differ only in approximately 10 questions). They are easy, straightforward and decently presented, provide answers without explanations and enable you to calculate your score as a percentage. How important are CMS Tests and NBMEs and in what way? First of all they offer a lot of concepts (and in many variations) that will be asked on the real exam, for example I found a pretty high number and variation of questions regarding TIAs and carotid stenosis, and its management. Secondly they prepare you for the test since you can take advantage of them to build test-taking skills and enhance your endurance and timing. Ultimately, they constitute another robust QBank altogether, making them an appealing source of learning for international students aspiring to pursue a high score on the exam. However, I can’t say that they’re predictive, and if you’re doing them offline it’s very difficult to calculate your score. I tried to do this seeking in posts of other students that had approximately the same number of wrongs with me. On top of that, it’s difficult to find the correct answers if you’re doing them offline, and even more difficult to find the explanations. UWSA 1 It was not difficult but not easy, too. No drug ad/research questions, with many QnAs being repeated. I did many wrongs that I shouldn’t have done (18), but I felt that many areas were unrepresented. It’s logical since it had only 160 stems. I didn’t do UWSA 2. What was my biggest challenge? The worst think that happened to me during this process is that I got sick 2-3 days before my examination day, subsequently I was hospitalized for a whole week and consequently I lost my examination. It was something not infectious with only acute phase, excellent prognosis and no residual defects or disease remnants, but it was enough to make me completely unable to take the exam. Please don’t ask me what it was, it doesn’t matter. I had to submit a waiver request to explain what happened,

providing the doctors’ opinion, and I finally got a 300$ discount when I registered again for the exam, since my request was approved. It takes quite a while for such a request to be reviewed and approved. First of all, the eligibility period has to end. Then, after 4 weeks the prometric center sends a letter to ecfmg saying that you did not go to your exam. Then it takes approximately 10-15 working days for them to review your request and give you a final answer. They did it approximately 3-4 weeks prior to the expected (i.e. faster than expected) but until everything became ready for scheduling (for the 2nd time) it took 5 more months until I finally took my exam. So, I was supposed to take my exam on August 23rd , 2018, and I finally managed to take it on January 24th, 2019. How was my experience on the exam day After the identification and fingerprint checking I started the test ASAP. I was a little bit nervous, but it’s ok to feel that way just before examinations of such importance. During the tutorial I checked only for proper headphone functioning, so that I could have a total hour for break time. At this point, I highly encourage you to see my video on YouTube regarding my STEP 2 CK experience, with more details, regarding the examination process: https://www.youtube.com/watch?v=q22CaljNU_g As for the content of the exam I have two important points to discuss: First of all, I contend that UW is the most important resource for this exam and that it allows you to develop a robust clinical knowledge and a stepwise clinical way of thinking, so that you can meet the requirements of the test. Secondly, I found that many of the concepts and diseases were unrepresented in the test, and I was expecting to see bigger variety. Instead, many diseases were repeated for 2-4 times and there were too many questions regarding hospital management, which I didn’t see on UW 2. Luckily, UW3 had enough of these questions so I regard that having it done was a pivotal point of my preparation. How to register for the exam The process is essentially the same as for STEP 1. If you‘ve already done STEP 1 you do NOT need to send again an offline part of your application. You just need to complete the online part, in which you also define the eligibility period. Just for the record, you should anticipate approximately 2 weeks from your registration for an email to be sent to your Medical School for verification of status. Once verification is done, it takes a week or maybe less for your permit to be available through OASIS. Once your permit becomes available, you can schedule your exam.

My Study Plan and Suggested Study Timeline 1. I began with Kaplan Pediatrics, with Kaplan Lectures. Then I did Kaplan OBGYN with Kaplan Lectures. The reason I started with these two subjects is that there were totally unfamiliar to me, so I wanted to have enough time to digest the knowledge. 2. Then I began doing MTBs. Having done STEP 1 a few months ago, I realized that the one part of Internal Medicine was already on my mind, i.e. the pathophysiology one. Then I had to learn the stepwise way of thinking for both Diagnosis and Treatment. Kaplan IM Book is useless to this. I began doing MTB 2 CK and I realized that it is a good book for the beginning. I enriched the book with many notes from Pathoma, Goljian and FA for STEP 1, to the point that there was no more space to write even a word. I found the QnAs of this book very helpful. Once done with this, I began doing UW 2, which took me about 2 months to complete and a lot of notes. While doing this I reviewed Psychiatry and I did Kaplan Surgery with Lectures. The second part of the Kaplan Surgery book with the case studies is extremely helpful. After I was done with UW 2 I felt that I wanted to do more vignettes for training. I did Kaplan QBank which had many rare and unrepresentative questions, but it also covered some important concepts, like neck trauma and location-based approach in neck trauma. I then did UW 3 (2014 edition) which took me 1 month to complete and approximately half the notes of UW2. Once done with it I found the 2016 edition available offline. I did it again. I found some conflicting questions between these two editions (No more than 10). I did the 2016 version in a block-based manner, organizing 9-hour tests. Simultaneously I made sure I did all the QnAs of Kaplan QBook and FA QBook. Revising the UW 2 Notes every day, on top of the previous, made it even more complicated and rigorous. As for the Kaplan IM Lectures, I highly recommend that you do the Emergency Medicine and Infectious chapters, as well as Dr. Castro’s Lectures. 3. Last but not least, after all of these were done and I was confident enough, I started doing the CMS Tests and NBMEs. 4. After it I did the sample Questions and scored 115/120. 5. I did UW2 for the 4th time only QnAs; not notes. It took me 2 weeks because I was really tired and I was feeling exhausted and not able to concentrate. 6. I continued for one week doing some extra notes from UW2 and reviewing the most high yield concepts. 7. I took UWSA 1 on June 31st and scored 273 (98 percentile, 89 percentage, 18 wrongs) 8. I did one last revision of everything and scheduled to take the exam on August 24th . 9. I got sick and lost the exam. 10. I started over, found the courage and repeated everything at least once. It was tiring. P.S.: Don’t get stressed about time. Everyone has his or her own rhythms and other duties as well. Try to find what rhythm fits best to your program and ambitions, try to maintain a normal lifestyle and not to completely ruin your personal life and get isolated as I did, because this may make you more pessimistic. Ultimately, try to do what you think is great work, because that’s what will bring you satisfaction at the end of the day. 

Frequently Asked Questions, that haven’t been answered so far.

Last Month Routine: -Wake up the same time every day (usually 2 hours before you are supposed to be at the prometric center, i.e. 7:00 am) -Eat a good breakfast -Eat healthy food and at logical hours -Sleep always at the same time, especially the last 10-14 days before the exam (I tried 11:00 pm) -Try to sleep for 8 hours -Go for a walk if you feel overwhelmed -See ONLY important people that give value to your life and make you feel great, forget your problems and your anxiety and make you laugh, no matter how pressure you had during the day -Go for jogging (I didn’t do it, but I highly recommend it) What to Study for the last month (At least what I did) -UW2 Notes -UW3 Notes (if no time, do only the important ones) -Pediatrics, OBGYN, MTB 2 CK, MTB 3, at least the important chapters, or those you that feel weaker at. -NBMEs, CMS Tests (because they have good concepts) -I made sure to review UW questions prior to one month before the exam, because it’s definitely a tiring task to review all those long and tricky vignettes How do you manage LONG stems? There are two techniques: 1. Read it all from the beginning to the end (Not Recommended) 2. Read the Question and the answers first, to get an idea of what they’re asking and what to search for, and then go to the stem from the beginning. This technique is highly recommended and from my point of view it really works always, and more specifically when your brain is tired from hours and hours of being tested. When time becomes valuable… ‘’How did u manage the time during exam? When I solve questions I just have to hurry at the end of each block, I don’t get time to read questions thoroughly and then I have to pick an answer randomly. Any advice?’’ Well, I face that problem too, so let’s say you asked the right question and at the right person. I can’t say I pick randomly when that happens, but I rather try to read fast, to think fast and not to lose time by staying too long on a question. I had a really hard time at the two blocks that had 38 Questions and a research/drug ad each. In the one block I did all the questions in the order they were, and I was extremely pressed during the next 25 questions having only 28 minutes for them. On the other block I

skipped the 3 questions and did the 15 remaining ones, having only 6-7 minutes for the ad. I put one of those three answers randomly because I didn’t have time and it seemed to me difficult at that point. Ultimately, this part of my test was as good as all the others, so I can say I did a pretty good job there. Unfortunately these blocks were the 4th and 5th, just before my 30-minute break, so I was a little bit tired. That’s why I always say to learn to read fast and build up endurance by organizing 9-hour exams with low-yield resources, like FA QBook or Kaplan QBook. Another technique to deal with this impostor called compressing time is to apply the technique for long vignettes described before. Read the question, have a look at the answers to guide your brain, then read the vignette and try to fish what they’re asking for! Everybody that I’ve talked to finds time really pressing, especially on STEP 2 CK. You have to learn to deal with it. If you would like to learn more details about my time management on the Test Day I suggest that you refer to my YouTube video regarding my STEP 2 CK Examination Day Experience. My scores: Discipline Score UWorld 2 82%, 2,306 Questions UWorld 3 75%, 1,502 Questions Kaplan QBank 81%, 2,121 Questions Kaplan QBook 83%, 850 Questions First Aid QBook 81%, 1003 Questions Sample Questions 96%, 120 Questions UWSA 1 89%, 98th Percentile, 18 Wrongs, 160 Questions CMS Internal Medicine 92%, 200 Questions CMS Neurology 88.5%, 200 Questions CMS OBGYN 88.5%, 200 Questions CMS Pediatrics 88.5%, 200 Questions CMS Psychiatry Surgery 85.5%, 200 Questions CMS Surgery 91%, 200 Questions NBME 1 93.5%, 184 QnAs NBME 2 92.5%, 184 QnAs NBME 3 91.5%, 184 QnAs NBME 4 95%, 184 QnAs NBME 6 100%, 184 QnAs, Same as NBMEs 1,2,3,4. NBME 7 93.5%, 184 QnAs

USMLE STEP 2 CK EXPERIENCE AND ADVICE REVIEW

STAVROS MATSOUKAS

STEP 2 CK SCORE: 262 (> 1 SD, 85.5 Percentile)USMLE STEP 2 CK EXPERIENCE AND ADVICE REVIEW

STAVROS MATSOUKAS

STEP 2 CK SCORE: 262 (> 1 SD, 85.5 Percentile)

USMLE STEP 2 CK EXPERIENCE AND ADVICE REVIEWSTAVROS MATSOUKAS

STEP 2 CK SCORE: 262 (> 1 SD, 85.5 Percentile)