Step 2: The New Normal

Abstract

"Eh, it is just 'Step 2'. I will do fine!" This is a commonsentiment seen in most medical students andgraduates. After all, Step 2 is about what we learn onour clinical rotations. It is mostly about practicalknowledge that is meant to be ingrained in us, thanksto hours of clinical practice. This leaves little need forthe endless cycles of mugging and regurgitation.Besides, Step 1 is the 'real beast' we need to sweatover. 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 amere qualification exam and it is finally time for themuch- 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 tomake their Step 2 scores exemplary. This is doubly truefor international medical graduates (IMGs). Why isthat? One may wonder!Well, most IMGs come from curriculums which aresomewhat different than the medical schools in theUSA. Hence the transcripts do not hold much value, asit is impossible for the program directors to fairlycompare the grades given by the different medicalschools all over the world to the ones obtained by USmedical students [1]. Letters of recommendation(LORs) tend to be subjective (even from USphysicians). So the only objective data programdirectors can assess now are the STEP 2 scores. So howdo we go about making sure it is outstanding? Bystudying of course! But how?The answer first and foremost still does lie within Step1. The better prepared you are for step 1 the betterprepared you will be for Step 2. There has been in fact,a continuous positive correlation between Step 1 andStep 2 scores [2,3,4]. So even if Step 1 scores do notmatter, even if one just has to pass, it is much moreprudent to read up and get a strong hold on all Step 1concepts, as they are the building blocks on which Step2 questions are based. So, prepare for Step 1 andpretend to aim for a high score even though there isn'tone. This will make you that much more prepared forStep 2, which does give a scored report.When it comes to preparation for Step 2 my go-to hasbeen the U world Q banks. Every single possible detailthat can be asked in the test, tends to be covered in UWorld. But it is not enough just to solve the questions.The real treasure of the U World questions is in theexplanations. It is important to read through every lineof each explanation and take notes of it. These notesshould be your bible. Read it re-read it, understand it,and remember it. And unless you have an eideticmemory, repeat the questions. The more times yourepeat it, the more you will remember and the moreyou will instinctually know what the right answer is.Other than that it is important to sit down and practiceall the 'National Board of Medical Examiners' (NBME)self-assessment tests as they are the best indicator ofreal day test scores time and time again [5].So take a deep breath and remember, at the end of theday this is just an exam. Hundreds of students havebeen giving it and performing well. It is most certainlynot an impossible feat and as long as you areconsistent, good scores are achievable. Lastly good luckand remember you got this!