Step 2: The New Normal

Abstract

"Eh, it is just 'Step 2'. I will do fine!" This is a common
sentiment seen in most medical students and
graduates. After all, Step 2 is about what we learn on
our clinical rotations. It is mostly about practical
knowledge that is meant to be ingrained in us, thanks
to hours of clinical practice. This leaves little need for
the endless cycles of mugging and regurgitation.
Besides, Step 1 is the 'real beast' we need to sweat
over. That is the one program directors really look at!
Well unfortunately the glory days of Step 1 are over.
With the recent cancellation of Step 1 scores, it is a
mere qualification exam and it is finally time for the
much- overlooked Step 2 to shine.
Now that all of a sudden Step 1 scores do not matter,
medical students and graduates will have to scramble to
make their Step 2 scores exemplary. This is doubly true
for international medical graduates (IMGs). Why is
that? One may wonder!
Well, most IMGs come from curriculums which are
somewhat different than the medical schools in the
USA. Hence the transcripts do not hold much value, as
it is impossible for the program directors to fairly
compare the grades given by the different medical
schools all over the world to the ones obtained by US
medical students [1]. Letters of recommendation
(LORs) tend to be subjective (even from US
physicians). So the only objective data program
directors can assess now are the STEP 2 scores. So how
do we go about making sure it is outstanding? By
studying of course! But how?
The answer first and foremost still does lie within Step
1. The better prepared you are for step 1 the better
prepared you will be for Step 2. There has been in fact,
a continuous positive correlation between Step 1 and
Step 2 scores [2,3,4]. So even if Step 1 scores do not
matter, even if one just has to pass, it is much more
prudent to read up and get a strong hold on all Step 1
concepts, as they are the building blocks on which Step
2 questions are based. So, prepare for Step 1 and
pretend to aim for a high score even though there isn't
one. This will make you that much more prepared for
Step 2, which does give a scored report.
When it comes to preparation for Step 2 my go-to has
been the U world Q banks. Every single possible detail
that can be asked in the test, tends to be covered in U
World. But it is not enough just to solve the questions.
The real treasure of the U World questions is in the
explanations. It is important to read through every line
of each explanation and take notes of it. These notes
should be your bible. Read it re-read it, understand it,
and remember it. And unless you have an eidetic
memory, repeat the questions. The more times you
repeat it, the more you will remember and the more
you will instinctually know what the right answer is.
Other than that it is important to sit down and practice
all the 'National Board of Medical Examiners' (NBME)
self-assessment tests as they are the best indicator of
real day test scores time and time again [5].
So take a deep breath and remember, at the end of the
day this is just an exam. Hundreds of students have
been giving it and performing well. It is most certainly
not an impossible feat and as long as you are
consistent, good scores are achievable. Lastly good luck
and remember you got this!