As we know, Step 1 has changed to Pass/fail instead of a numerical score.

Hence Step 2CK has become

one of the most important objective parameters for residency application. Here, I would like to mention

my observations and recommendations for my junior fellows:

1) It's observed that now students are focusing on just passing Step 1. The approach is to "just

get it done and dusted" as soon as possible. This approach has its pros and cons.

Pros: Saves time and energy.

Cons: It can be detrimental in the long term. During the preparation of step 1, you build foundations for
medical knowledge. While strengthening the foundations, you can develop a "Knowledge
Pool/Knowledge bank" and a skill set that will help you throughout your career. However, passing the
Step 1 exam doesn't require much struggle, effort, knowledge, and practice. This way, you can pass the
exam quickly, but you will lack a deep understanding of the core high-yield concepts. Therefore, this will
damage you in the long run. Consequently, you will have to spend more time on score augmentation
while preparing for CK.

2) Another important point to make is, for CK, the resources are limited and aren't as good as for

Step 1. Furthermore, CK is a very unpredictable, vague, and complex exam; you feel

unprepared even the day before your exam (Here, I'm not trying to frighten you ). While this is

not the case for Step 1.

3) There is considerable overlap between Step 1 and Step 2 CK. So, if you master the

content related to Step 1, it would help you in CK, lessen the burden, sharpen your skill set to

approach a clinical vignette, and boost your confidence.

Bottom line:

SPEND A GOOD AMOUNT OF TIME SOLIDIFYING THE CORE HIGH-YIELD CONCEPT. DON'T RUSH. HASTE

MAKES WASTE. IF YOU INVEST SOME TIME AND ENERGY HERE, IT WILL PAY YOU OFF.

How to start CK preparation:

Unfortunately, there is no single Gold standard review book available out there for CK. In contrast, we
have a gold standard review book in the form of First aid for USMLE step 1. The First aid for CK is not
high-yield and hence not recommended. Similarly, you can use other books on and off to read a
particular topic. However, for CK passive reading and reviewing, books will not help you to augment the
score.

The best strategy for score augmentation

Your score improves by solving lots and lots of unique questions. And the best way to approach a Q bank
is "Random mode." Doing a Q bank in System-wise mode will not train you enough, so it's not
recommended. Rest, CK Clinical vignettes are long, so initially, you will face a problem in time
management.

 Don't worry if you are running short of time while at the beginning of preparation. With the

passage of time, you will develop an eye and approach to tackling questions, and your speed will

improve gradually.

 UW is the gold standard. Do it very well. You will see many of the same or similar concepts on
your exam.
 In addition to UW, do solve CMS forms; these are subject-specific questions and are very high

yield.

 In addition to Online CMS forms (36*50=1800 questions), currently, there are 4 online NBMEs

forms. These are a must to do. As they will train you for the real deal. In the real deal, you will see an

amalgamation of questions from very easy to questions about which you don't have any

idea. NBMEs forms have such questions, so it can help you train your brain.

 In addition, these are compiled by the persons who write the actual board questions, so by
solving these questions, you are reading the brain of the Board's question writer. Also, a unique
set of questions based on a particular concept (but with a different angle) will clarify that
concept, factoid, or clinical presentation.
 I would suggest solving them in timed mode. You can set the timer and try to finish the block
within or before the time limit. E.g., One CMS form has 50 questions, so try to finish it within 70
minutes instead of 75 minutes. This exercise will develop the stamina to tackle questions and
help you in time management.
 After solving the form, review it. Now, the NBME has provided explanations for each question,
so you can skim through the explanations if you need them (previously, there were no
explanations provided by NBME).

BOTTOM LINE

 Instead of passively reading Review books and notes, do loads of unique questions. Try to build
a skill set to approach a clinical vignette, endurance, and stamina.

Some general points:

1) Focus is the integral component. Try to practice being focused while solving questions. In the

real deal, there would be very, very, very easy questions that would make you think that

you are missing out or not interpreting the question correctly. Just don't overthink. Choose

an appropriate option and move forward. On the other hand, you will encounter some questions which
will throw you out without any clue. Whenever you face such a situation (and believe me, you will face a
few such questions in each block), don't be overwhelmed, don't lose your focus, give them a nice try by
excluding options, mark a likely option, and move forward.
2) Time management has a big role. Don't waste time on a question more than the

allotted time, i.e., 90 seconds. If you cannot reach a diagnosis, mark it and try to solve it

at the end of the block if you have some spare time.

3) If you encounter a sequential question, try solving it at the block's end. Sometimes, you

mark a wrong option in the first question of the sequential questions and then realize your

mistake while attempting the second question. This triggers a sense of guilt and displeasement

which can affect your performance in the rest of the block. So try to attempt them at the end of

the block. So that you can compose yourself during break time.

4) Solve abstracts and drug ads at the end of the block.

5) For biostatistics, ethics, doctor-patient communication, and patient safety, I would

recommend doing all the questions related to Steps 1,2, and 3. As biostatistics is usually a

shared weakness. We need to strengthen it by doing lots of questions.

5) Dirty medicine has very good and high-yield videos about doctor-patient communication.

Do watch them and try to learn the principles behind each case scenario.

6) Most of the time, the Board's examiners will not trick you. Playing tricks is a Q-bank

thing. You won't encounter it in the real exam. So, don't overthink. Overthinking is going to

damage you badly. Don't indulge in nitpicking. This is the worst mistake one can make on

exam day.

7) If possible, try to avoid Amboss. Amboss is full of Nit-picky details (particularly 4 and 5 hammer

questions), which will "Train you to overthink." Furthermore, you have UWORLD, CMS Forms, and
NBMEs forms, which are more than 7000 questions. So, if you do them well, you don't need anything
else. (Except for a few topics I have mentioned at the end).

8) Try to build a separate word or PDF file for the questions you got wrong in your NBMEs assessment

and CMS forms. Doing this will help you to look at your mistakes and to revise and review your weak

areas/mistakes, and it will save you time.

9)

Must do topics from Amboss

Few topics I would highly recommend learning and doing question practice from Amboss Qbank and
the library.

These topics and their links are given below:

I)

Health care system:

https://next.amboss.com/us/article/Np0-pS

II)

Infection prevention and control

https://next.amboss.com/us/article/WQ0PEf

III)

Patient communication and counseling

https://next.amboss.com/us/article/3K0STS

IV)

Overview of palliative medicine

https://next.amboss.com/us/article/3n0SGg

V)

Quality and safety

https://next.amboss.com/us/article/mp0VJS

VI)

Ethics

https://next.amboss.com/us/article/DO01uT

VII)

Palliative medicine (very important)

https://next.amboss.com/us/article/3n0SGg

VIII)

Death (very important)

https://next.amboss.com/us/article/vP0AgT

 You can access offline CMS forms and NBMEs via the following Telegram channel:

https://t.me/USMLENBME2CK
  (In some countries, telegram doesn't work sometimes, so use VPN while using a telegram
account)

Good luck. Please don't hesitate to contact me if you have any further queries.