I think most people would agree that Step 2CK doesn't have near the weight that Step 1 carries towards obtaining your residency. So people tend not to stress about this exam nearly as much as they do Step 1. That's not to say that Step 2 is easy, it's pretty rough actually, but even at its best, its not Step 1. It's one section longer than Step 1, the amount of time you have to prepare is generally less, so, it is challenging in more of the deadline meeting, cramming way, rather than the sheer enormous mountain of stupid information that is Step 1. However it should be noted that most (not all) students who took Step 1 get a higher score on Step 2 on average. So one way to think about it is if you're going to try to equal your Step 1 score on Step 2CK; you could theoretically imagine a study intensity requiring about 10 points less than what your scored on Step 1 to get an equivalent score. While many of you are aware that students killing Step 1 hit around the 250's, it's not unheard of to get a Step 2 to hit the 270 range.
That being said there are a couple reasons why people do sweat bullets about Step 2 CK. For one, you may not have done stellar on Step 1, so this is the chance to redeem yourself to some extent. Some FMG or IMG programs look better if they have Step 1 and Step 2 completed with high scores thus giving the student more credibility. Finally you might just be that standard gunner who's trying to kill Step 2CK rather than chasing that blonde girl walking down the street before that last year leading up to internship (if you want my advice, chase the girl). Whatever the reason may be hopefully this will be able to guide you towards getting a score you want, and suggesting the most effective materials to do so.
I believe that there's a couple ways to approach this exam. The first way is going into it roughly trying to match your Step 1 score, which is really not the worst thing. It's the neutral approach, i.e. if you're happy with your Step 1 score, and you don't want something too competitive for residency this is totally fine to do. The other way, is to go about it like an animal and try to kill Step 2CK, which is fine, you just have to realistically determine whether you need to do this or if you have the energy to do this considering the intensity of 3rd year in general. That being said the rest of this post will be written assuming you do want to kill your Step 2CK exam.The idea of this post assumes you are starting from day 1 of 3rd year.
The fundamental problem with the approach to Step 2CK is the ambiguity. Unfortunately unlike Step 1 there is no godsend of a resource like the First Aid for USMLE Step 1. The resources available are just no where near the quality of what's out there for Step 1, so get used to this reality. Again as mentioned in my post on how to do well on Step 1, The USMLE Step 2 CK First Aid book has an appendix grading Step 2 resources on an ABCDF scale. While I think the USMLE Step 1 First Aid guide is pretty spot-on, I question some of the ratings in the First Aid CK book. There are some A resources listed, I've looked at a lot of these, and my impression is that this is not the case. There isn't one inclusive review book out there that I would give higher than a B rating, with the exception of USMLE World Step 2 and MKSAP 4 being pretty good study guides for internal medicine. Toronto Notes are also up there. I will go into which books I think are the best as you continue to read, but just to start this off, you do need to realize that to some extent the gathering of high-yield information on this exam is a lot of the time up to you and not the review books. Studying is largely dependent on what you get out of your hospital experience, don't take this point lightly because you'll regret it at the end of the year.
Getting your routine down starting with the clerkship
Step 2CK really begins with the start of 3rd year, the time of clerkship. At this point, you're fresh out of Step 1, you feel like you know a lot, but as soon as you hit the ward, you realize how much you don't know. It's almost demoralizing that the doctor doesn't really care that you know that some stupid virus is an icosohedral member of the togaviridae family. That's nice you know it, but you'll end up pissing off your attending rather than impressing him, because knowing what an icosohedron is has absolutely no bearing on the indicated management, differential diagnosis, or treatment of that virus, which is what he wants to hear and also exactly what you'll be asked on Step 2.
Second point, you're probably going to be in the wards for several hours each day. For me in internal I woke up at 5:30, and got home around 5:00 every day. It's a long day, you're going to be very tired, and the last thing you're going to want to do is study. My suggestion is to make a routine. You will have a lot of down time at the hospital, use this time to your advantage. Many doctors will be late due to their own busy schedules, have your study guides readily available and use this time to work on your board studying/shelf prep. You can get up to 1-2 hours a day of studying done just due to this. It's easy to sit around socializing with your friends because you will be tired, but your time is much better spent doing work. When you get home, you're going to want to go straight to bed. Don't do it. Sit down at your desk and study until you can't really concentrate. On a good day I can get about 2 hours out of this at most. The idea is to have at least 1 hour a day during your rotations dedicated to studying, Doctors In Traing (DIT) also recommends this. The rest of your evening might be spent doing a patient write-up, a presentation, or drinking a beer.
In my Step 1 prep-post I mentioned cutting class and self study. You don't have this luxury 3rd year, you have to go to the hospital to gain clinical experience and to learn from your residents and attendings. There's really no way around it, however that doesn't mean you can't be efficient, which is essentially what 3rd year is all about. So I'd like to re-emphasize a point from my Step 1 post. Reading Harrison's is NOT the way to prepare for the boards. If you really think you're going to digest 6000 pages in 3 months then I suggest you become president of MENSA, because it's a joke to think that you'll efficiently absorb everything in this book, or that you'll even come close to approaching the last page. This is something the residents read and are responsible to know over a 4 year period. Of course they will suggest a book like this for you to read, because it is THE premiere book of internal medicine, however it's simply not efficient, remember you have 1 hour a day after the hospital to really learn stuff, lets keep it simple and efficient all the time. That's not to say you have to ignore Harrison's - if you have a presentation, then you should probably use Harrison's but as far as board prep goes, don't be a clown and think you're going to conquer a book like that.
What Sources To Use for The Boards
MKSAP Vs. USMLE World Vs. Kaplan
USMLE First Aid Step 2CK
This book is very solid because it is a complete board review book which includes internal as well as the other represented disciplines. Its pretty well organized however I'd say as far as content there's a lot of stuff missing. Many of these books don't list the gold standard for every pathology or indications for studies. They do for a lot, but not all, and it can lead to confusion. This is true not only of this book but almost all the resources, and this is why I say that there isn't a "perfect source". Some people don't like the idea of using a book like this as a primary source for medicine (ie a review book). I disagree, as I've said in my Step 1 post and as I've also reiterated in this post, you're going to be lectured all day on what's important in medicine. A book like this should solidify the important points, indications, differentials etc. Harrison's isn't going to get you anywhere fast unless you spend on taking 4 years to do 3rd year. The graphics and pictures are this book's strongest asset, but you will have to supplement with USMLE World annotations just like you did in Step 1. Again if you're using this book and are in the final stages of review and just need more questions, USMLE Rx is the qbank that complements this book, but should be used *secondary to World.
Step Up to Internal Medicine Vs Step Up to Step 2CK
Step Up to Medicine book is probably the most solid internal review book out there in other words the best summary of Harrisons. The issue is when it comes to reviewing other subjects such as OBGYN etc. you'll have to use something else. My suggestion is to use the related book Step Up To USMLE Step 2. It's by the same company, it has a more abbreviated but solid version of IM within it and it also includes all the other core clerkships. This is the book I used for my boards. The reason I like it so much is because it is the book supported by DIT. Again I don't think DIT for Step 2 is particularly good but at crunch time, it helps meter you out and review the book in an organized way. The big issue with these books is even though they are some of the better sources for reviewing the boards, there's still a lot of missing info in these books. In particular you're going to have to tackle what the gold standard is for imaging and treatment for most pathologies, please don't overlook this point because it can cost you around 15-20 point come test day if you don't have these facts organized. While it lists what all the treatements are it doesn't say what the gold standard is per se, and this is probably one of the most high yield pieces of information you need to know. So as long as your aware of the deficit going into 3rd year, you can compensate by writing in the appropriate notes from World about the gold standards etc. The other downside is that the pictures and the diagrams are not as good as USMLE First Aid. Again the reason I chose this book is because of the DIT review and because I think it is the lightest and most concise board review book. It's eerie at first how thin this book is, but as I said this is something I look for. You're brain is going to be overloaded with lots of information any ways why complicate things. Keep it simple with concise book rather than a giant thick Harrison's that you cant retain at all by the the time you're done reading the chapter. For this book I'd also consider looking up the errata because there are a couple typos that can be annoying. Take care of thee before reviewing the book so you don't absorb any incorrect information. A simple web search can bring this up, alternatively if you plan on doing DIT they have an errata built in to the curriculum you can utilize as well. I personally feel that DIT and Step Up to Step 2 is the most organized and efficient system out there.
Master the Boards Step 2CK by Conrad Fisher
This book isn't as widely used but people who use it love it. This book was authored by Conrad Fischer who is notorious for his eccentric board prep videos. This is a solid book, things are well organized, however a downfall again is that it doesn't always include the gold standards (someone correct me if I am wrong), and it also is missing a lot of information. If you've been 100% Kaplan up until now ie using Kaplan videos for step 1, this is not a bad review book. Kaplan's Step 2 Review videos are by Conrad Fischer so this is a good source to use if you want a video lecture series to complement your book. I still prefer the DIT method because its more active and has all those additional questions, however Conrad's videos are no where near as boring since he is so animated. It's really up to you but again I know people that have used either First Aid, Step Up or Conrad Fischer's book, and all have done well. Go to a book store and compare them yourself to see which format you like the best after reading through this.
Clerkship Primary Sources to Accompany your Review Book
At this point I feel like I am beating a dead horse when I say not to use books like Harrison's as your primary sources for clerkship. My philosophy is to keep things simple and dense, I don't need fluff, I need the facts and to organize them as quickly as possible so I can be prepared for my shelf and the boards. Efficiency adds points to your board score not fluff. What I would like to suggest as primary sources are merely more extensive board review systems than what I listed above. The first one is the Toronto Notes series. I think these are incredible. They are concise and list the gold standard and primary imaging studies needed for every pathology. The algorithms are great, and its a very streamlined. Again I use this for my initial read through a clerkship. My second read is with the board review book I chose above in which I add in info from the primary source. I will go into the whole system of how I do that later on, but this really constitutes as an A source for your primary texts. The best part is there's a section for each core clerkship and you can print each one out. What I would suggest is printing these books out with each clerkship, and bring them in with you to the hospital. Annotate in the book as you go through lectures and read along. This way you'll get a lot of the lecture and it will be a very active session. Bring this book home and as you're doing World questions, open your Toronto notes to the relevant page and annotate any high yield points (most importantly the gold standards). Some people do the same thing with the Kaplan note series. Again I am not the biggest Kaplan fan so I won't be talking to much about these however, I mention it just for those people that prefer this source know it's around. The bootleg PDFs for both these sources are out there circulating on the internet, I'd suggest downloading them and saving some money.
Phase 1 - Specific advice for each clerkship leading up to the Boards
To give you an idea of how important IM is for the boards, you can expect about half of all your questions to be IM. There really is no other option than to do well in this unit if you plan on doing well on the boards. USMLE World Step 2 CK has 2234 questions (as far as when this was written), 1165 of those are IM, OBGYN has 165, Pediatrics has 288, Psychiatry 126, and Surgery 128. To me that was pretty sobering the first time I saw that. Assuming that USMLE World is accurately portraying the distribution of questions on the real thing, which is pretty close, IM is obviously the most important, and Surgery (which tends to be one of the most miserable clerkships), doesn't have anywhere near the weight, in fact paying attention more in Peds would be a wiser idea than worrying about Surgery!
As a primary text I mentioned Toronto Notes being very good but for this section it might be better to use Step Up to Medicine (as opposed to Step Up to Step 2). Bring your primary text to the hospital and annotate in it during lecture and read along with it during lecture. You're going to be tired just listening to someone talk and talk will make you fall asleep. At least this way you'll be doing some active learning using a board review style book. When you get home start doing your questions, open your primary book to the relevant page and copy the important points from your primary text (ie Step Up to Medicine) and your questions into Step Up to Step 2. This process will seem repetitive using both Step Up books at this time, but that's a good thing since you'll be crystallizing the important points over and over again. By the end of your clerkship you should have all your questions done, and you should have done quite a comprehensive review of internal medicine. If there's still time you can continue the process using MKSAP 4.
Also I'd suggest getting a tablet computer for your clerkship. You'll be rounding a lot and wanting to look stuff up. I use a kindle but now that the ipad mini is out, that's a great option too. For internal medicine the hospital reference books I'd suggest include Oxford handbook of IM and Pocket Medicine (colloquially called "cheese and onions" by the British due to its color scheme), The Mass General Hospital Handbook of IM, Tarascon Pocket Pharmacopoeia. If you can't find an ebook version I can guarantee you there's plunty of bootleg versions circulating around the internet. You might even want to put a bootleg Harrison's on there for reference. Great apps for your device include Epocrates for quick pharm information, Diagnosaurus, and obviously the Qbank World app is great to have for when you have down time. A lot of good rotation-specific advice is provided on DIT's advice page.
Surgery sucks, because you usually (obviously depending on the school) spend a long time on this rotation and as far as the boards it's just not that high yield. Recall that USMLE World has about as many questions dedicated for psychiatry as they do for surgery. Frustrating to say the least. Your time is better off reviewing internal medicine for the boards during your surgery rotation than spending all that time dedicated to surgery. Unfortunately what's good for the boards isn't always good for your shelf. So you have to weigh your personal needs (ie do you want a surgical residency -- thus doing well on your clerkship) versus do I want I high board score? The truth is, much of the surgery shelf, in fact a very large chunk of the surgery shelf is really internal medicine style questions, so mixing in some IM into your world prep for surgery is a great idea. Thus here' a chance to catch up. If you have 8 weeks in surgery like I did, and you have only 126 surgery questions total in world, you might consider doing 500-800 questions in IM to keep yourself fresh and if you didn't finish your questions during your IM clerkship, you can now. I'd also suggest supplementing the lack of surgery questions with the Kaplan Qbank pdf file which has about as many questions as world to be prepped for the shelf. The NBME shelf was pretty rough from what I remember, so doing questions both IM and surgery during this time is pretty important.
The same system as far as preparing this section should be followed. Read your primary source and then go to your secondary source such as Step Up to Step 2 to fill in the details. If you are using Step Up to Step 2 you will notice how little is covered in surgery. Again I know it's disconcerting but you have to realize that Step 2 CK really doesn't consider surgery that high yield, that that is reflected in whatever board reviews you use. You will have to rely on the standard of care provided by your primary text to fill in the blanks, and to annotate your secondary text. I think that DIT's clerkship advice recommendation of Surgical Recall is an expensive and relatively worthless tool for your surgery rotation. Its question answer style is good in theory, but it's pretty hard to internalize anything. Dare I say for the first time that this book is just too simple? It gives basic facts, but it misses all the stuff asked on the boards in terms of gold standards and worst it lacks organization. I think I am in a unique position to critique this book considering one of my professors helped author the book and thought himself that Toronto Notes was much better.
Again, many sources can't beat the concise but high yield nature of Toronto Notes. The surgery section of this resource is great, and you can really internalize a lot of the information in this book much more effectively and the important points can be copied into Step Up for Step 2 for repetition. Also the whole concept of note taking into the Toronto Notes during lecture time applies here, as for all the rotations I will discuss. I will say however, DIT's study plan as far as the questions for surgery isn't bad especially with pretest qbank, but don't do this at the expense of World. Just use things like Pretest and Kaplan to supplement, especially as I mentioned in the context of the shelf.
For the sake of not sounding repetitive, the same general advice in regards to surgery applies to peds. Perhaps the only thing more I might have to add is that according to World peds is about twice as high yield as surgery, just look at the stats. Again get your World questions done, keep fresh with some IM questions, and look at some Pretest or Kaplan if you need some supplements with the q's. Toronto Notes is also very solid for Peds as a primary source. The Step Up to Step 2 section of this again is small, and probably the worst section of the book. Add what you need to from Toronto Notes to make it up to par. I know what I'm saying is discouraging about Step Up, but realize that none of the other review sources for Step 2 are that much better. Remember even though surgery is low yield, do a couple of the wrong answers in world when your doing peds to just to keep it fresh.
Again, I'd have to refer to what I said about Surgery for OBGYN. People promote the Beckmann online question bank. I really can't comment on this because I didn't utilize it, but it could be a good supplement to the world questions, I've heard it is but I can't say for sure. I did fine on the shelf just doing my same old method - Pretest is always solid too. You should be doing occasionaly wrong answers in surgery and peds at this time too.
Ok this is your big break. This is not a hard subject. The second major phase of your year has now begun, your second round on World should probably have started by now assuming that this is your last rotation like it was mine.
Phase 2 - Preparing for CK at the end of your clerkship
At this point, you've been keeping up with World all year. You should have now completed the qbank ideally. If you haven't which is understandable, start crushing questions. This should be roughly 2 months or a little less before your exam. Your constant review should be keeping you relatively fresh. Now its time to buckle down. Spend an hour or so reading a section of Step Up to Medicine. Do a section of world related to that topic. If you have time do 20 wrong answers in random categories, that's very productive. Obviously any question you do should be reviewed if you got it wrong and review the relevant annotations in the book. As a quick efficiency tip, USMLE World Q Bank has an area in each section that allows you wrote notes. Use this section of the question to write down the page number your annotations are on in Step Up (doing this from the beginning of the year will make referring back to the book a very quick process by the time phase 2 rolls around). It will save you lots of time you'd be surprised. Doing 60-80 questions per day (and more if you feel like you can handle it) will get you doing 1800-2400 q's over the course of a month right in the range of the entire q-bank. Not easy, but doable you just have to sit down and write up a schedule that works with what you're doing at that time.
Phase 3 Final Month of Prep
At this point you have come a pretty long way. Hopefully you have these last couple weeks off, without the interference of clerkship, if not, then I suggest starting earlier for your board review. You have a month left, and you need to come up with a good schedule that balances review as well as question prep. This is where the DIT course comes into play. DIT is designed as the last push for board review. As I mentioned, compared with DIT for Step 1, this is no where near as good, however there's not many other options out there. There is Conrad Fischer's Kaplan review videos however they don't have an accompanying question book for active review, and they don't go through a board review book systematically like DIT does with Step Up to Step 2. Thus if you've been using the Conrad Fischer book in conjunction with his videos you will have to plan out your own schedule that takes into account reading the book once through, and getting through a large chunk of board questions (if not all of them) in time. I will only be commenting on the DIT method because that's what I did. If you have a month left, you're in good shape. If you do on average 2 videos per day you will have gone through Step Up one more time and doing about 2 sections of World per a day, you would have also gotten close to finishing off World again. Thus reflecting on all the work you've done so far, you've annotated your Step Up to Step 2 and read through it several times doing so. You've done it again with DIT. You've been through World almost 3 times. That's a good place to be in. There's no time to take off, remember you also have the USMLE World practice exam at the beginning of Phase 2, take this for baseline to see where you are. Realize that the USMLE World exam is slightly inflated, so its nice to take first for some ego building. By the final month take one per week. There are 4 NBME Practice exams total, one for each week of review. Some people get a lot of anxeity about taking these. Don't put these off because of that. Obviously this is very stressful, but don't let your stress interfere with what you need to do. Also note that feedback for the NBME exams are limited. There's only one with expanded feedback available meaning that it will tell you if the answer is right or wrong, but not why. If you need to look up answers, they all exist just type the question verbatim into Google, and a your results should include discussion forums debating the correct answer.
If you're keeping up with this demanding schedule, you should be pulling 12 hour-14 hour days for the last couple weeks. Its grueling, but necessary, the CK is even longer than Step 1, its 8 sections as opposed to 7 sections. You have to keep in mind one critical aspect of preparing for this exam is stamina, you will become mentally fatigued. If you follow this schedule, it will be like training with a weighted bat, once you take the weight off the real swing will be a lot easier.
If you're doing 2 DIT vids per day, you should have a little spare time in the last week. Some of these days will be taken away by doing the practice exams. With everything said and done, you should have maybe 2-3 days left. Spend those last couple days skimming through everything you just covered in DIT, run through the Step Up to Step 2 book really quick just to keep that recall fresh. On your last day, don't think about your exam, go to the beach, whatever it is that you enjoy do that. Have a good meal. This last week you also need to get on a regular cycle. Wake up as early as you would on exam day. The night before get to bed early, even if that requires popping an ambien. Have a bag prepared with everything you need for the day. Don't eat foods with a high glycemic index, and eat small quick snacks between sections. You don't need to be dealing with a food coma in the middle of a 9 hour exam. Bring all those emergency creature comforts too Visine, Imodium, whatever it may be to ensure that your day is smooth as possible.
This whole method is loosely based off of a friend from Yale who wrote the Step 1 First Aid book a couple years back. I say loosely because DIT didn't exist when he told me his method. I think DIT incorporates the same type of last minute review, but you have the input of an expert lecturing you as well. I know this is demanding, but this is what people do to kill their exams. Take from it what works for you. However my biggest advice of all is, no matter what you decide, once you have created your schedule, stick to it. There are many people who will tell you what they are doing to study. Don't be pressured or listen to them. Be confident in your own abilities and know that this plan is a solid one. The worst thing you can do is set up a plan and then at the last minute deviate because another plan sounds better. It will end up making you feel less confident, and destroy the continuity of whatever you had already set up for yourself.
Best of luck!