I’m going to tell you exactly how I went from honoring absolutely ZERO classes to becoming a Shelf exam/USMLE Step 2 CK test-taking wizard. My Shelf exam scores went from 68% -> 74% -> 78% -> over 90% for the rest (high honors).
We are not all born with Hermione Granger’s abilities (I definitely felt more like a Ron at many points), but we can learn how to have her work ethic! I gave a brief summary in my first article on how I went from a USMLE Step 1 of 226 to a Step 2 CK score of 260, which I parlayed into interviews at some of my “dream” residency programs. The main gist is to learn off questions, don’t sit there reading books but only reference sections to understand specific unclear topics, and remember info with Anki. Now I am going to break everything down step by step.
Note: all my M3 rotations were 8 weeks long, so that is how I am going to write everything out. Did I need that entire time to study? Lol no. Sometimes I slacked off for the first few weeks “recovering” from my last rotation, making extra trips to The Three Broomsticks, etc. So it is definitely doable in less time. If yours are shorter you can condense the schedule, and if yours are longer, I hope you have some fun on your free days!
WEEK 1: Get the Lay of the Land
Clinical: This is a priority whenever you start a new clerkship. Learn the ropes of your new rotation, such as learning to do a proper H&P, how to write a note, how not to contaminate the sterile field, where the nurses’ stations are that have the life-sustaining PB and crackers…
Remember, one of the best ways to learn is off of your patients – look up the relevant disease, pathology, presentation, workup, treatment, etc.
Anki: Assuming you did the Step 1 deck already, start the first day of the rotation by doing the Step 2 deck relevant to the rotation. Do ~15-25 new ones/day and try to get through them all soon so you can start adding your own new ones without totaling up too many new cards a day. You will have dead time throughout the day, so make a point to do some cards here and there when you have small breaks between patients or cases. All those free minutes add up, and it feels amazing if you get all your cards done before you leave for the day!
UWorld: Only for Internal Medicine clerkship – start doing some questions, related to what you have seen so far on the wards. There is a monster amount of them and you may not finish them all before your shelf, which is fine. (If only we had time-turners. Wait, maybe not… if the Cursed Child taught us anything.)
WEEK 2: Hello Again UWorld
Anki: Continue Alec’s pre-made Step 2 rotation-specific cards until all have been learned. If you did not do the Step 1 deck before starting M3 year like me, then do what I did – when I started doing UWorld questions, I would search for the topic and pull them in if they existed, before I spent time to make a new card on the topic at hand. For example, for Psychiatry, there were many super high yield cards from the Step 1 Neuro and Behavioral deck, and many from the Neuro Pharmacology deck (those Potions masters lovveee testing the drug side effects – plus this helped me get attending pimp questions right multiple times).
UWorld: Start doing the rotation-specific questions (for Family Medicine, consider doing AAFP questions). Go over them thoroughly the first time, making Anki cards to remember key concepts, and flagging the ones you want to review. There are seriously such limited questions for Surgery and Psych that you can finish those in a week easily. Obgyn and Pediatrics have more, so say 2-3 weeks.
Remember, (and I wrote about this in my first article and my QBank one) it is critically important to work on improving your test taking skills first by question interpretation, and then by learning off them from understanding the key concepts (learn the pathogenesis to presentation, instead of just memorizing). Every single question is an opportunity to become a better question-taker.
If I had been doing the above consistently, I would have started honoring classes earlier! I had gotten overwhelmed trying to learn the giant breadth of info for Family Medicine (my 1st rotation) and Internal Medicine (my 2nd rotation), and would end up rushing through questions. I would try to follow the interpretation steps that Alec and I went over during my tutoring sessions, but would lapse repeatedly. It was not until my Surgery clerkship (3rd rotation) that I really made a dedicated effort. Though I did not honor that one, I was close, and my score was better than the last two.
WEEK 3: Add One Other Question Book/QBank
Anki: Continue reviewing + adding new cards from UWorld.
UWorld: Continue until finish. Unfortunately, the UWorld questions alone (besides for IM) are not enough to honor the Shelf exams! You need to supplement with a deeper level of knowledge and granularity gained by doing one other full question book from front to back.
Other Question Book/QBank: The good thing is you only really need to do one for most. Do these questions and do not spend as long on them. Usually they go fast because the question stems and answer explanations are much shorter. Important – I had a word doc open at all times, and would type in my short-hand notes on the questions that I missed. I also used the highlight feature to mark topics that I thought were high yield (yellow), that kept coming up (turquoise), or that I wanted to ask someone else about (red). Don’t get carried away! Make it short and to the point. But this was highly valuable. I did this so I did not clutter my Anki decks with an excess amount of cards that would be useful for the Shelf but not for Step 2. I only added Anki cards off of UWorld at this point.
I used these books/qbanks for the rotations I honored:
Psychiatry = Lange Q&A book (you don’t need to do the Legal and Ethical Issues chapter or the Psychological Treatment and Management one, but make sure you do the rest including the two practice tests at the end)
Obgyn = Online UWise QBank questions (our school provided these, do them for both OB and gyn)
Pediatrics = Pretest
Like I said, I did not get Outstandings on my Family Med, IM, or Surgery N.E.W.T.s (aka honors on those Shelf exams). That being said, this is my advice for those rotations:
Family Med = since this one is so broad, if you can help it, take that rotation near the end of the year. I really did not like FM Case Files, and wish I did the AAFP questions instead. Even if many of those were going to be outside the scope of what you need to know, just be able to recognize when to move on when you encounter those ridiculous ones.
IM = UWorld. Can use the new MKSAP/IM Essentials if you have an extra long IM rotation and need more questions.
Surgery = Pestana’s book+Pestana’s online pdf (different than book) – since there are really not many questions in those two, this is the only rotation that it would highly behoove you to also do one other book completely, in this case Pretest.
WEEK 4: Keep On Keeping On
Anki: Continue reviewing + adding new cards.
If Internal Medicine -> UWorld
All other rotations -> Finish UWorld if still haven’t. If have, continue doing Other Book/QBank questions
WEEK 5: Keep On Keep On Keeping On
Anki: Continue reviewing + adding new cards
If Internal Medicine -> UWorld (my experience: at this point, IM was like a dementor leaching out my life force heh heh… sigh)
All other rotations -> Continue doing Other Book/QBank questions
WEEK 6: Master Has Given Dobby an NBME
Anki: Continue reviewing + adding new cards. Consider adding topics that you think are high yield/see come up repeatedly, even if not from UWorld.
If Internal Medicine -> UWorld
All other rotations -> Continue doing Other Book/QBank questions
Yeah, if you can tell – even if you have a shorter rotation, it’s very doable to have finished all questions by last week, and then have some time before final reviewing. But somehow work expands to fill the time we have available to do it… amirite.
Early in week: If you are going to do all four NBME’s – do NBME 1, go over all your incorrect answers with friends who also took the exam/ask your preceptors (they will be happy you are showing interest). If you are only going to do three, do either 1 or 2 (exceptions – Psych only has 3, and there are none for Family Med).
Option – Later in week: Take NBME 2, review
WEEK 7: More NBME’s and Reviewing
Anki: Continue reviewing + adding new cards. Consider adding topics that you think are high yield/see come up repeatedly, even if not from UWorld.
Early in the week: Take NBME 3, review
Later in week: Wait 3-7 days from last one, then take NBME 4, review
I personally think doing all the NBME’s was invaluable in getting those last few tricky questions that really push your grade over the edge. This is especially true for the later ones that tested on some topics not found in UWorld, and they have a different question format – overall, they were most representative of the real Shelf exams.
If Internal Medicine -> UWorld (my experience: need a patronus! halp!)
All other rotations -> Continue/finish doing Other Book/QBank questions
Saturday: Start reviewing all your flagged UWorld questions to make sure you understand it and would get the topic right if you had another question on it. (For every rotation but FM and IM, I also really quickly read the bottom learning point for every single question I didn’t flag).
WEEK 8: Reviewing… and Finally, it’s Time to Take the Shelf Exam/Catch the Golden Snitch!
Anki: Continue reviewing every day
Sunday: Continue reviewing UWorld
Monday: Continue/finish reviewing UWorld
Tuesday: Go through your Other Book/QBank word doc entirely, focusing more specifically on the highlighted parts.
Wednesday: Finish going through your Other Book/QBank word doc
Thursday: Review all your wrong NBME answers, review any last topics that you think are your weakest
Friday: Shelf exam! YAY YOU’RE DONE. Go let loose and/or sleep in, before it’s on to the next one…
Phew. I sincerely hope this helps. As always, let me know if you have any questions and I wish you all the best!
Mischief managed,
– Melody
