Step 2 CK Preparation Guide

MD Class of 2025
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Table of Contents

INTRODUCTION ....................................................................................................................................... 3
PREPARING FOR STEP 2 CK ................................................................................................................. 4
EXAM STRUCTURE .......................................................................................................... 4
APPLYING FOR ACCOMMODATIONS............................................................................................... 5
CONTENT REVIEW .......................................................................................................... 5
Access Medicine ................................................................................................................................ 5
AMBOSS.............................................................................................................................................. 6
Anki Flashcards .................................................................................................................................. 6
Boards and Beyond .......................................................................................................................... 6
Divine Intervention Podcast ............................................................................................................ 6
Dr. High Yield ..................................................................................................................................... 7
Emma Holliday Videos ..................................................................................................................... 7
First Aid for the USMLE 2 CK ........................................................................................................... 8
Kaplan .................................................................................................................................................. 8
Pathoma .............................................................................................................................................. 8
Sketchymedical .................................................................................................................................. 8
QUESTION BANKS (QBanks) ........................................................................................... 8
AMBOSS.............................................................................................................................................. 9
BoardVitals.......................................................................................................................................... 9
Kaplan .................................................................................................................................................. 9
USMLE-Rx ............................................................................................................................................ 9
UWorld ................................................................................................................................................ 9
BUILDING YOUR EXAMINATION ENDURANCE ............................................................. 10
Step 2 Considerations .................................................................................................................... 11
The weight of your Step 2 score. .................................................................................................. 11
Practice test quantity and timing .................................................................................................. 11
Step 2 CK is a test of endurance................................................................................................... 11
Practice environment ...................................................................................................................... 12
STUDY SCHEDULES + FINDING BALANCE AMID THE STRESS ....................................... 12
Study schedules ............................................................................................................................... 12
Ordering topics ............................................................................................................................... 12
Balancing time on subjects............................................................................................................ 12
Follow your energy flow ................................................................................................................. 13
Focus on mental well-being. ......................................................................................................... 13
Study environment. ......................................................................................................................... 13
Silence your cell phone .................................................................................................................. 13
Do not be an island ......................................................................................................................... 13
Study partners .................................................................................................................................. 13
Time off from studying ................................................................................................................... 13
Comparing self to others ............................................................................................................... 13
Step 2 CK Scheduling Permit. ....................................................................................................... 13
Additional study time. Avoid the urge to push back the test date. ....................................... 14
Reach out to your Emory School of Medicine Resources. ....................................................... 14
CREDITS AND ACKNOWLEDGEMENTS .......................................................................................... 14

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INTRODUCTION

As you begin to study in earnest for the USMLE Step 2 Clinical Knowledge (CK) Exam,
choosing the right approach to your studies is important to your success.

Herein are resources and ways of framing your Step 2 studies. Ideally, you will start early with
question banks during clinical rotations, but setting up a plan that works for you and adapts
between clerkships is not always simple, as time and energy can be limited.

This brief guide is meant to provide an outline, suggested strategies, and answers to
frequently asked questions about studying for Step 2 CK. While you should seek out advice
from others, you know yourself better than anyone. Devise a study plan that works best for
you. The Center for Holistic Student Success is here to help.

This guide is organized according to three basic areas to improve Step 2 performance:
• Content review through targeted, interleaving of subjects in a strategic manner.
• Question Strategy through analysis of not only what you miss, but why you miss it.
• Exam Endurance through practice and simulated testing environments.

Advice from Emory SOM classmates

“I had a dramatically better performance on Step 2 than my Step 1 (using my NBME

diagnostics). I attribute that to changing my study style to incorporate all the new
resources and technology out there.”

“For Step 2, I think the crucial determinate is space repetition throughout the whole
M3 year. That could look like a Master Anki deck, or it could look like structured
sessions that repeat concepts from previous rotation; but that is the key to building
retention and what the majority of my dedicated was focused on.”

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PREPARING FOR STEP 2 CK

Multiple references are listed below; however, it is important to limit the number of
resources you use to 2-3. Additional resources quickly become overwhelming and can
contribute to anxiety and lack of focus. We also know there are less Step 2 resources
available than there are for Step 1. As such, choosing the best resources for you is important.
As you review the following resource options, we have included advice from fellow Emory
School of Medicine students to help guide your study strategy formulation.

EXAM STRUCTURE
Step 2 CK is a one-day examination divided into eight 60-minute blocks and administered in
one 9-hour testing session. The number of questions per block never exceeds 40. The total
number of exam questions will not exceed 318. For students with testing accommodations
with extra time, the exam will be split into two days.

Step 2 CK assesses an examinee’s ability to apply medical knowledge, skills, and

understanding of clinical science essential for the provision of patient care under
supervision and includes emphasis on health promotion and disease prevention. Step
2 CK ensures that due attention is devoted to principles of clinical sciences and basic
patient-centered skills that provide the foundation for the safe and competent practice
of medicine under supervision (USMLE, 2022).

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APPLYING FOR ACCOMMODATIONS

If you are applying for Step 2 accommodations, please reach out to Dr. Christen Hairston
(christen.hairston@emory.edu) ASAP to begin the process. Dr. Hairston can sign your
Confirmation of Previous Accommodation form and assist you in reviewing your essay and
materials. For more information on USMLE Step 2 CK accommodations, see USMLE
accommodation website.

Advice from Emory SOM classmates applying for Accommodations.

“Get your paperwork together earlier than you think you need to!”

“You will submit your request when you submit your 3-month time slot
request…however, you want your paperwork ready well ahead of this because you
might find out you need new neuropsychology or psychoeducational testing, other
road bumps, etc.”

“If you received accommodations for step 1, the process for renewal of the
accommodations is much easier and faster.”

“If you receive accommodations over two days, [it is possible] you will need to call in
directly to schedule your 2 dates to take the exam. The 2 days do not have to be
directly back-to-back, but they do need to be at the same site.”

CONTENT REVIEW
When approaching Step 2 CK studying, identify your areas of greatest strength and
weakness. For some clerkships, you may need to review intensive content; for others, merely
using Qbank review will help you recall and reinforce. For those areas that require content
review, the following section offers popular resources.

This guide is not an endorsement of one product over another; nor should one believe that
the higher the price, the higher the quality. These are merely popular resources that have
helped students to see success, and we are providing them to guide you in your choices.
Pricing is provided in green.

Access Medicine
http://pid.emory.edu/chkns
FREE subscription through Emory Health Science Library

Access Medicine is not only a resource to over fifty medical texts, but it also contains
study tools with review questions, flashcards, and play Showdown! Create an account
to access the study tools which are located under Study Tools tab. Emory has
subscriptions for AccessSurgery, AccessEmergencyMedicine, and
AccessPhysiotherapy.

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AMBOSS
https://www.amboss.com/us
$10.75/month billed yearly; $14.99/month billed monthly; Free 5-day trial available

Includes content review using unlimited library access, Anki add-on and smart study
tools, as well as interactive medical imaging with overlays. Includes “phrasionary, table
quizzes, charts, radiological images with overlays, videos, SmartZoom samples and
other images that illustrate key points on different topics” all on a digital platform.”

Anki Flashcards
https://apps.ankiweb.net/
Android version free; iOS version $25
Some students use flashcards extensively, and others never use them. For those who
benefit from flashcards (e.g., a quick review of material prior to bedtime or first thing
in the morning) this is a popular option—Zanki Step 2 CK is an option for Step 2, the
flashcard version of First Aid.

Advice from Emory SOM classmates

“I also want to specify that Anki is not as necessary for Step 2. Do it if you like it, but
do not feel like you need to force yourself to use it.”

“I also used the Anki AnKing deck for my missed UWorld questions. I would
unsuspend cards related to the information I would have needed to know to have
answered the question correctly. I didn’t spend more than 20 mins a day on Anki
cards.”

Boards and Beyond

https://www.boardsbeyond.com/
Subscriptions range from $24.00 for one week to $399.00 for 2 years.

Step 2 CK resource includes 260 videos, PDF copies of the slides and Qbank of 1300
questions. Covers content review and Qbank with one subscription.

Divine Intervention Podcast

https://divineinterventionpodcasts.com/category/usmle-step-2-ck/
Offered as a FREE Podcast

Focuses on high yield concepts. This podcast allows you to choose specific topics to
supplement learning deficits. Because it is a podcast, it can be listened to during
commutes, while running errands, or even during exercise.

FREE Crowd-Sourced transcripts of these podcasts have been written by medical

students such as yourselves and can be found online at the Divine Intervention
website: https://divineinterventionpodcasts.com/notes/. The list of podcasts broken
down by subject is also found at this website.

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Divine Intervention Step 1, 2, and/or 3 Test Taking Strategy Courses

https://divineinterventionpodcasts.com/

Multiple options are available at various prices.

Focuses on high yield concepts through an interactive class format via zoom. He offers
Step 1-3 courses, Step 2/3 and one for Step 1 only.

Dr. High Yield

https://www.youtube.com/channel/UC0Asdp7ukEshW7sZgC27EtA/videos

FREE

High yield YouTube videos covering topics including IM, Peds, OBGYN, Surgery and
Psych. There are books you can purchase that go alongside the videos or potentially
find online crowd-sources written transcripts for some of these videos.

Advice from Emory SOM classmates

“Absolutely listen to this series [Dr. High Yield] as a review the week before your
Step 2 CK exam, you will not regret it. He explains things in a concise way and is
now comparable with Emma Holiday on the level of usefulness. You can choose
to use these right before the shelves as well as in the beginning of your
dedicated as a high-yield baseline.”

Emma Holliday Videos

https://willpeachmd.com/emma-holliday-lectures
FREE
Videos of physician Emma Holliday, MD who provides high yield videos on certain
Step 2 topics. This website also includes PDF slides and even Anki cards if you find
these useful for your learning style.

Advice from Emory SOM classmates

“I strongly recommend Emma Holiday videos (underrated resource) for

reviewing the material before your shelves or before starting dedicated. These
are 2-hour interactive lectures going through all the content you need to know
for surgery, IM, pediatrics, and psych. If you can just do one, do the IM one (My
score went up 30 points just by watching and studying the internal medicine
one). Strongly recommend if you consider yourself a big picture person and
would like a good baseline before diving into detailed questions (which are
great but they def give you a fragmented understanding of the material).”

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First Aid for the USMLE 2 CK

(Book)
Approximately $25 to rent; $40-$65 to buy; available used starting at $10.

The book is separated into three sections:

Section 1: Guide to Efficient Exam Preparation
Section 2: Database of High-Yield Facts
Section 3: Top-Rated Review Resources

Kaplan
https://www.kaptest.com/usmle
Prep Course on Demand $1199; Live Online $3999; New York In-Center $7499

Options videos, quizzes, “warm-up and post-test questions,” 2 simulated exams and
accompanying lecture notes. See Qbanks below for additional Kaplan Step 2 CK
offerings.

Pathoma
http://www.pathoma.com/
PathomaFree version is free and does not include the textbook or all videos.
PathomaPro starts at $84.95 and offers the textbook, and 3-, 12-, or 21-month
subscriptions to videos for every chapter of the book.

While Pathoma offers a Step 1 review, they do not offer a formal Step 2 CK review.
This resource covers high-yield pathology information for all organ systems in shorter
videos. For those who prefer, reading the Pathoma textbook may be faster than
reviewing the videos. The textbook has many color images like those on Step 1 and 2.
Often considered an essential resource.

Sketchymedical
https://sketchymedical.com/
$299.99 for 6 months; $399.99 for 12 months; $599.99 for 24 months

A visual mnemonic series for microbiology, pathology, and pharmacology. Sketchy

“helps you create a memory palace by associating medical topics with memorable
visual elements.”

QUESTION BANKS (QBanks)

As an advanced medical student, you are familiar with the value of question banks to improve
your test taking strategy. Recognizing effective Step 2 studying is both an art and science,
Qbanks are helpful in identifying areas of need for you as a learner.

Working with the Center for Holistic Student Success, we seek to help students use the tools
below to refine their ability to: (1) identify what the question is asking, (2) identify distractors,
3) work through the best possible answer, (4) choose it and (5) move on. The following
QBanks are popularly used for Step 2 CK.

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AMBOSS
https://www.amboss.com/us
Full Qbank access is in addition to the monthly membership; ($149) for one month;
($189) for three months; ($229) for six months, ($299) for twelve months.

Over 3150+ Step 2 CK questions and corresponding articles.

BoardVitals
https://www.boardvitals.com/
Subscriptions are available for 1 ($159), 3 ($219), or 6 ($359) months.

Over 1400 USMLE Step 2 board review practice questions with explanations available.
Create an account to access test banks to create customized practice tests and review
advanced statistics.

Kaplan
https://www.kaptest.com/usmle
QBank - 1 month ($159); 3 month ($199); 6 month ($299); 12 month ($399)

USMLE-Rx
https://www.usmle-rx.com/
QMax (2300 questions) - 1 month ($59); 3 months ($99); 6 months ($169); 12 months
($199); 24 months ($229)

Question bank for Step 2 CK by the authors of First Aid.

UWorld
www.uworld.com
30-day ($319), 90-day ($439), 180-day ($479) or 360-day ($559) subscriptions

• Identify ways to gain optimal benefit from this essential resource. UWorld Step 2
CK builds upon your Step 1-tested knowledge with a greater focus on clinical
skills, patient-centered care, disease prevention, and clinical science.
• Integrate high yield topics gleaned from UWorld questions and reading answer
explanations into your own list of high-yield topics for additional review (i.e., Anki
cards, First Aid annotation, excel documents or other creative way you have
identified).
• Review incorrect questions. Should you read the explanation for each answer
option for every question? For the sake of efficiency, probably not. Rather, read
the explanation for any answer option you get wrong, “guessed right” or
considered as possibly correct.
• Plan to do a set amount of questions/day during dedicated study time. While it is
true that there is an advantage to completing as many questions as possible, be
sure not to rush through questions at the expense of learning from the questions.

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• Reflect on your strengths and weaknesses – be sure to take the time to review what
you have learned from them.

Advice from Emory SOM classmates

“Aim to complete all the UWorld questions during your third year, so when it is
time for dedicated, you can reset the bank. The subjects for the Step 2 Review
question banks on UWorld are Medicine, OBGYN, Pediatrics, Psychiatry, and
Surgery.”

“The shelf review question bank has a slightly different way to categorizing these
questions and includes Neurology. Do all the UWorld questions for the specific
rotation you are in (i.e., when you are on the Surgery rotation, do all of the
Surgery questions.) This will also be helpful for studying for shelf.”

“To my knowledge, some rotations including Adult Primary Care and Pediatrics
have an Aquifer exam at the end instead of a shelf. You should still make sure to
do all of the questions during your rotation even if it an Aquifer exam. It will help
you solidify your knowledge. I would alternate between doing my questions in
tutor mode and not in tutor mode.”

BUILDING YOUR EXAMINATION ENDURANCE

Taking practice tests is the best way to improve your endurance for a 9-hour exam. One
consideration is the endurance of sitting. Since joining your clinical rotations, you are less in
the habit of sitting for prolonged periods. As such, you will need to rebuild your endurance.

We recommend:
• Take one practice exam at the beginning of the study period plus 2-3 additional
practice exams during the study period. Strategically place them to optimize and
not deflate your experience.
• To improve endurance, wake up every day and study at the time you’ll take the
exam. It will help you feel mentally awake and prepared for the early rise.

NBME Shelf Exams ($20)

(https://www.nbme.org/examinees/nbme-self-assessments/clinical-mastery-series)

Especially consider for clerkships where you took an Aquifer exam. Shelf exams can help you
prepare for Step 2 content areas. Shelf self-assessments available in the following subjects:

• Clinical Neurology • Obstetrics and Gynecology

• Emergency Medicine • Pediatrics
• Family Medicine • Psychiatry
• Medicine • Surgery

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Multiple Question Blocks. Use QBank blocks one after the other with breaks simulating the
testing environment. (Included in whatever QBank you choose)

UWorld. 4 blocks of forty question practice exam. (Get 1 test with 90-day access; 2 tests with
180-day and 360-day options)

CCSSA. NBME’s Comprehensive Clinical Science Self-Assessment (CCSSA) ($60):

Kaplan. Kaplan offers a 3-hour free diagnostic exam. (Free)

USMLE Practice Examination. ($75)

(https://apps.nbme.org/CBTPSRegistrationWeb/jsp/usmle_CBTPS_registration.jsp)

NBME Free 120 (FREE)

(https://orientation.nbme.org/Launch/USMLE/STPF2)

Step 2 Considerations

The weight of your Step 2 score. We recognize that with Step 1 going pass/fail, Step 2 CK
now has greater weight than ever before for residency applications. Depending on your
preferred specialty, this can be a source of great distress. Please make sure you learn from
residency directors and program open houses as to the average score accepted by
programs. This will help guide you on your goal score.

Practice test quantity and timing. Plan to take a couple of practice tests – some students
take more. Completing the test at the standard pace allows you to practice getting through
the exam in the time allotted. Taking a practice test at the midpoint period gives you a sense
of where you are in terms of preparation, serving as a diagnostic tool to identify areas of
strength and weakness, which may help you to adjust your schedule during the remainder of
your study period.

Reviewing material repeatedly through questions also helps to consolidate information and
helps with retention. A low score may lead to undue anxiety while a high score may
contribute to a false sense of security. Do not get fixated on your score! Practice exams help
with endurance and time management skills as well as feedback on areas of need. The score
matters in terms of seeing progress but be mindful that you are on a journey of improvement.
With each practice, you are moving forward towards your ultimate goal of success.

Step 2 CK is a test of endurance. There are eight one-hour blocks of 40 (or fewer)
questions; nine hours are allotted to complete the test. The total number of questions will not
exceed 318. Forty-five minutes of break time is automatically allocated. In addition to the
exam blocks, the test begins with a 15-minute computer tutorial. However, the tutorial is
identical to the one online - https://orientation.nbme.org/Launch/USMLE/STPF2. It is best to
skip it on test day and take those 15 minutes as additional break time. This allows you to
begin with 1 hour of break time, which you may take between sections at any point during
the day. Also, if you finish an exam block early, the remaining time is added to your break
time.

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Some complete a couple of sections at a time and then take a prolonged break, while others
choose to take a five-minute break at the end of each section. Do not let the hours of testing
wear you out. Do all those smart test-taking things (bring [and eat] snacks, use your break
time, etc.). Give each question consideration, but if you are unsure, pick an answer and move
on or skip the question and plan to return to it. A subsequent question may help to trigger
the answer to a previous question that you skipped. Remember that there may be what you
find to be easier questions at the end of the block – and you do not want to run out of time.

Practice environment. You may want to consider taking a practice test at the Prometric test
site. Details are at https://proscheduler.prometric.com/scheduling/testInformation. Within
your 90-day eligibility period, Prometric offers a practice session with a brief tutorial section
and three 1-hour blocks of approximately forty multiple-choice test items each. Upon
completion a printed percentage correct score is provided. The opportunity to become
familiar with the testing site may help decrease anxiety on the test day. Contact your local
Prometric Testing Center for costs.

STUDY SCHEDULES + FINDING BALANCE AMID THE STRESS

Study schedules. Following a study schedule will help you to stay on track. That said, you
may not reach all the goals you set out to meet in the beginning. Be flexible, adapt
throughout, do not beat yourself up and move on. Include several flex-days for “catch-up” or
more time on a particular topic. Allow more time for review towards the end of dedicated
study time – reviewing material helps with retention and more rapid recall during the exam
itself. It is easy to get stressed if you get behind schedule and to ignore the importance of
food, sleep, exercise, family, and friends. A daily routine helps to maintain sanity and
decrease burnout.
• Additional tips and sample study schedules are at
https://firstaidteam.com/schedules/. (Free)
• Many students also like Blueprint's Med School Study Planner (formerly Cram Fighter)
for a daily Step 2 study schedule.
1 month ($29/month); 3 months ($60); 6 months ($95); 12 months ($119).
(https://blueprintprep.com/medical/med-school/study-schedule). You enter all the
resources you will use, the time you have before the test, and it gives you a daily
schedule. If you do not finish something in one day, it rolls over and updates daily.
• Your mentors and student success resources can support you in outlining your Step 2
schedule for dedicated as well as throughout the curriculum.

Some examples of Study Schedules from the Class of 2023 and 2024
Step 2 CK Panelists' Study Strategy_2.7.2023

Ordering topics. Begin with your weaker topics and schedule accordingly, allowing more
time for these topics.

Balancing time on subjects. Schedule more time to review those topics which tend to be
more heavily emphasized on the exam. Please review page 4 of this document for an outline
of the percentage represented by discipline.

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Follow your energy flow. Schedule the most challenging part of your study day when you
are most alert (i.e., if you are a morning or evening person, please schedule accordingly).

Focus on mental well-being. Schedule therapy check-in sessions, ensure that you are
connecting with others, and remember that you are the vessel taking this exam. The more
well you are, the better you can perform. CAPS, Student Health Psychiatry, as well as
community providers are all here to support you.

Study environment. Find a good place (or places) to study. What setting is least distracting
and absent of anxiety-triggers? Home, library, school, coffee shop, etc. Connect with your
fellow classmates to create optimal, supportive study environments.

Silence your cell phone. Turning off all phone and computer notifications will aid in your
ability to concentrate. Plan to check your phone and email at specified times as part of your
study schedule.

Do not be an island. Humans need connection and dedicated study time can be very
isolating. Make sure that you are engaging with others in some way throughout the entire
dedicated study time.

Study partners. Many students benefit from a study partner. Plan, for example, to meet with
a classmate to review a topic, ask one another questions, present a topic to one-another, etc.
Find a whiteboard and give “lectures” to one another.

Time off from studying. A study schedule must include study breaks – time off makes for
more effective study. Take at least one full day off a week (e.g., one full day, two mornings, or
two afternoons). Schedule a five-minute break at least every 45 minutes as this simulates the
testing scenario. Go outside for breaks, when possible, to get fresh air and sunshine. During a
break, remove yourself from any study materials and do your best to truly relax – no flash
cards or podcasts on the treadmill. It is better to study 8 “good hours” than 12 “non-
productive hours;” respect your limit and stop studying. Continue to do all the things that
keep us healthy—exercise, meditation, hydration, nourishing food, and sunshine.

Sleep. Get on a sleep schedule that will model the wake time on test day. Practice like you
play.

Comparing self to others. There will always be someone studying more than you (and less
than you). While you should listen to the advice of others, you best know yourself and the way
you are most productive studying. Do not be stressed by how other people are studying - be
confident and do what works best for you. Extending your study time in an unreasonable
fashion is counterproductive.

Step 2 CK Scheduling Permit. You must bring the scheduling permit you receive in an email
from the NBME to the Prometric testing site on the day of the exam. (Be sure to open the link
and print the actual scheduling permit). You will be expected to present this permit along
with an unexpired, government‐issued photo identification with your signature (e.g., current
driver’s license). Your name on the photo ID must exactly match the name appearing on
the scheduling permit.

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Additional study time. Avoid the urge to push back the test date. There comes a point in
time where additional study is counterproductive. Although the thought of an additional
week of study time may be tempting, be confident in your ability and in the effectiveness of
your study schedule. Changing the test date can negatively impact your confidence and
contribute to anxiety. You will never feel totally prepared; most students “peak” at 5-6 weeks.
If you are considering moving your exam due to feeling unprepared, please reach out to Dr.
Hairston to discuss.

Reach out to your Emory School of Medicine Resources. You are not alone in this journey;
it takes a village, and we are here to support you! Please feel free to reach out to Dr. Christen
Hairston, Associate Dean of Student Success; Dr. Stacy Higgins Associate Dean of Student
Affairs, Clinical Services, your Small Group Advisor, Dr. Gordon Churchward, Assistant Dean
for Medical Education and Student Affairs, Dr. Ira Schwartz, Associate Dean, Medical
Education and Student Affairs and/or Dr. Bill Eley, Executive Associate Dean of Medical
Education and Student Affairs for support. If you have any questions about this guide or need
support in connecting to Step 2 resources.

CREDITS AND ACKNOWLEDGEMENTS

The original version of this document was a Step 1 Guide written by Paul Catalana, MD, MPH
and Christen Hairston, Ph.D. at University of South Carolina School of Medicine Greenville. It
has been modified and updated specifically for Emory School of Medicine MD students
preparing for the USMLE Step 2 CK examination by Christen Hairston, Ph.D. with edits and
input from Stacy Higgins, MD, Erica Brownfield, MD, Gordon Churchward, Ph.D., Jen Spicer,
MD, Bill Eley, MD, Gerry Lee, MD, Kristen Liberty Zecca (CL24), Eudora Olsen, (CL24), Geffen
Treiman (CL24), Chiara Bettale (CL24), Fayzan Rab (CL24), David Ebhomielen (CL24), Emily
Generally, MSM, Klevi Golloshi (CL24), and Becky Cox (CL24).

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