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"For the scum disappears like forth cast out; while that which is for the good of mankind remains on
the earth." Quran 13:17
Khaled Abd-ElMaksod
Tanta Medical School, Egypt.
YOG: 2014
Exam date: October 2015
Score: 269
Contents:
A- Abbreviations
B- Summary
C- Stages
D- UpToDate
E- Clinical Mastery Series
F- Playing sport
G- CK Qs pattern
H- Exam experience
I- Tips
J- Miscellaneous topics
K- Final word
A- Abbreviations:
Kaplan: KL
FA-1: First aid for step 1
CMS: Clinical mastery series
UW: Usmle World Qbank.
KQB: Kaplan Question Bank.
MTB: Master the Boards
MTB 2 CK 2nd ed: MTB-2
MTB for step 3: MTB-3
UpToDate: UTD
Obstetrics and Gynecology: O&G
Q: Question
B- My experience summary:
For those who will whine and complain that my experience is too lengthy, here is the
summary. I wrote this detailed experience as I am sure it is going to be helpful to someone.
I cleared step 1 with a score of 259 before preparing for CK, and this helped me a lot during
preparing for CK exam.
I studied for 9 months. First 6.5 months, I worked as GP in rural health care unit, 3days
weekly on average. I studied 6-8 hours/ day, and at work days 4-6 hours/ day. Last 2.5
months I studied with full dedication and that was the period in which my performance
improved significantly. I studied for 8-10 hours/ day.
My 1st read was MTB -2 mainly for IM, I compared it with KL IM to discover there is no
significant difference. O&G: KL mainly + blue print Qs Surgery: MTB3 + KL in trauma, Ortho,
Pre and Post Op. Psychiatry, biostats: FA-1
Then I subscribed to UW for 6 months. I did it online timed random from the start. UW
cumulative score 79%. I did half of wrong Qs after that. So I did the Qs of UW one time only.
While doing UW timed random, I did my 2nd read of books and after each subject I did CMS 2
exams of this subject. My scores in CMS was 80%-90% most of the time, except psychiatry
which was so difficult, I scored in 70s.
Then in the last month, I focused on my weak points, I revised the UW tables (especially the
difficult ones) again and again, I did NBMEs.
NBME 4+6 at the same day (to simulate exam) 12 days before exam:
NBME 4 online 269/ 12 wrong Qs
NBME 6 offline 12 wrong Qs
NBME 7 offline 8 days before exam 21 wrong Qs
UWSA + FRED at the same day 4days before exam
UWSA +265/ 15 wrong Qs
FRED 90%
C- Stages of my preparation:
1st stage 1st read of books:
What I did:
1- IM 1st read:
The period of preparation was 9 months. I started the preparation 2 and half months after
step 1 exam. 1st thing I did as usual is reading tons of experiences of Top scorers. When I
started studying, my aim was to integrate step 1 contents with CK, so I planned to take the
info related to step 2 CK from FA-1 and then I annotate it in MTB-2 as I decided to make it
my primary source in Internal medicine. To be honest, my problem with CK is that I wanted
to study it with the preparation method I used in step 1. That is to have a book as the
primary source, FA in case of step 1 and MTB 2 CK (for IM) in case of CK, and then I annotate
from UW and other sources into MTB 2 CK, exactly like what I did in step 1. This turned to be
wrong and time wasting. And I will clarify why later. To continue, I found that taking notes
from FA-1 into MTB is an obsessive act and it will waste my time. My excuse was that I
wanted to make MTB 2 CK in IM an ultimate source, exactly like FA in step 1. I realized later
that Step 2 CK curriculum is much bigger than step1 and no source can cram all the info and
you should work to develop your skills and increase your concentration, your stamina, your
time management ability and to focus on high yield info better than spending months
making an ultimate comprehensive source for CK which if I managed to do will turn out to be
a book with thousands of pages which I won't find time to cram and when I finish reading I
will discover I forgot most of its content. I did this as I didn't trust my memory to be the
ultimate source, I have strong points, but my memory was not one of them. There was no
problem in step 1 regarding this as FA is comprehensive and at the same time summarized
and to the point. I discovered later that MTB was not the problem, but simply there is NO
source in CK like FA in step 1. Lesson after lesson and many mistakes and struggling while
preparing for CK made me realize that I am in front of a new challenge, and my old tricks, my
old methods which I used to do well in FA will no longer help me. I should EVOLVE to face
the new challenge. I will elaborate about this later. To continue, I realized that annotating FA
into MTB is an impossible mission so I came to an agreement with myself to refer to parts I
wanted to revise in FA while studying for CK. I was studying IM from MTB 2 CK and I faced 2
problems. First problem is the outdated info in it, and second problem that I compared
every chapter in IM with Kaplan IM, to discover at the end that Kaplan IM has no significant
additional info to add to MTB 2 CK and I should have ignored it. Later when I did UW, I
realized that tons of info in MTB is outdated. And that made me not trusting this book at all
few months before exam, so that I always read it with caution and try to use UpToDate as a
reference to correct old info, but that was not in my first read. To summarize, my plan in IM
was to read the system in MTB-2 and compare to KL and annotate extra info and also to
read the analogous part in FA step 1 which I realized in the middle of the 1 st read that FA
thing is overkill. I used to do a block of KQB after each chapter I finish. The sum of all blocks I
did in IM was around 5-8 blocks not more than this. This is because my plan that I described
was time consuming to a great extent. If you asked me what was the advantage of these few
blocks I did from KQB? I will say that the long Qs stem is good to get adapted to exam long
Qs stem.
2- Pediatrics 1st read: I asked seniors about whether to study pediatrics from Kaplan and
to use it as my main source or to use MTB step 3. I decided to make MTB3 my main source
and to annotate Kaplan Peds into it. Again a time-consuming stupid plan, and again trying to
simulate my step 1 plan. The annotating from Kaplan into MTB3 was so exhausting as a lot of
info in Kaplan were not in MTB3. So after a few chapters, I decided to make KL my main
source in Peds. What made me refuse this at the start is the way in which is the info is
presented in KL. KL is not organized and boring. You feel that each topic is formed of some
random phrases not connected to each other so the yield you get from reading it is so low,
not to add that KL is so outdated just like MTB or even worse. So the yield from reading KL
was yield in contrast to the yield from UW explanations. In UW, They write the explanation
in a professional manner, linking the disease pathophysiology and management. They make
you feel that the disease is one unit no just random phrases. And UW always takes care to
explain everything to you. Why we use this investigation before this investigation, Why the
algorithm started with this step, Etc. So they don't overwhelm you with info that is not
organized and a significant part of it is not even hi yield. The KL I used is the 2013-2014
edition which is present as PDF and on most bookstores in my country. And you should know
that Kaplan LNs are not updated, and the editions don't differ to a significant degree. Even
MTB-2, I read some reviews that mentioned that the 3rd edition is not that different from the
2nd one. The problem that after I finished Peds from KL, I felt I am not left with a good source
to revise it quickly later but that I am left with a burden that will make my steps slower. I
planned at the beginning of my preparation to do the analogous chapter in IM and Peds
together, I did this in some chapters and removed the common info between IM and peds
from KL Peds. Again I was obsessed here with the idea to make an ultimate source and to
remove any duplication which exhausted me as topics are repeated in IM and Peds and then
in surgery. Removing the duplications is also time-consuming, leaving the books as they are
will make it harder for me to revise again. In Peds, I did some chapters along with IM, and
some chapters I did separately. Some I removed the common diseases from peds and some
chapter I just read without the comparing troublesome mission which was in vain when I
look back. I planned to do KQB 1 block after each chapter, but I was running out of time.
4- Obstetrics and Gynaecology 1st read: Kaplan book in O&G was highly recommended by
many seniors. And in fact, they were right, it is way better than KL Peds and KL surgery. I
read it and didn't read MTB3 in O&G. I was sick of comparison and annotating blah blah
blah. But I should say it has the common disadvantages in KL books, not updated, many low
yield info that you feel that you can't grasp anything after you finish reading it. I used to
highlight the info I don't know as I go through Kaplan, so that in the 2nd read, I will read the
highlighted info only, and that made my 2 nd read of KL O&G quicker. At that time, exam
takers said they had many O&G Qs in the exam, so I wanted to supplement KL. I asked a
friend, and he recommended Blue prints in O&G. I had no time so I did only the part of Qs
and explanations that followed each chapter. I took notes from half of the chapters I did but
had no time to take notes from the other have or to revise the notes I took from the 1 st half
later lol. But they were not bad, at least a practice. Some will ask is it a must, my answer is
no although you don't know in exam if that Qs was easy for you due to a Q u did months
before it or not. Why I didn't do UW instead, that is because I wanted to save it for the 2nd
round.
5- Psychiatry 1st read: Psychiatry I found Kaplan to be bad and not even updated to DSM-
V, so I stuck to my step 1 source in psychiatry, which is FA for step 1. I used my notes in
Biostats plus FA. In Ethics, I used my notes which were a summary from 100 cases by Conrad
Fischer, In addition to some notes from UW-1. So in Psychiatry, I didn't do anything more
than what I did in step 1. I discovered weeks before exam that my sources in psychiatry were
not enough and I should supplement. I will come to that later.
I kept looking for a good source for studying in CK and the source was beside me from the
start, but I didn't notice. NO book is good, UW TABLES should have been your primary books
and I should have annotated any extremely important info from other books to them. You
will ask from where I can get these tables, these tables were collected by more than1 group
member and posted on the group. Why should I use UW TABLES instead of MTB or KL.
Simply as UW is the most updated source, so have a look on updated so that when you read
from other sources, the right info is stored first and based on which all info in other books is
revised and scrutinized. The other cause is that UW curriculum is vast, so either you read
thousands of pages to remember nothing at the end or you FOCUS on the highest yield info,
that is UW tables and then you can use UW, CMS, NBME Qs as a guide to your weak points
to revise from UW or if not in UW from UpToDate. So, reading outside the core curriculum
presented by UW should be guided by Qs from the afore-mentioned sources, so that UTD
doesn't become a tool which waste your time.
1- IM: So, In IM I would have made UW tables my main source and I will read MTB 2 CK and
add any extra important info into the book I will make from UW tables. Even if you used
MTB for reading only without annotating it, there is no harm. The MTB and KL are not for
last-weeks revision for the reasons I mentioned above. I would have done KQB, 1 block
following each chapter IF I had time.
2- Peds: I would have used UW tables as a main source and Read KL Peds quickly to scan for
any extra DISEASES (like those in Cardio chapter), not extra info. And even this is not that
important! My performance was bad in Peds after 2 times read of KL, one focused revision
of UW Peds was way better and more helpful. To do UW in Peds and then do many Qs like
from CMS to highlight your weak points which you will study from UW and use UpToDate to
look for info that r not present in UW, this is better than reading KL Peds again and again
But this applies more like most of my experience- to those who cleared step 1 before CK, as
some info that is not well illustrated in CK Peds sources, yet frequently asked- comes from
genetics, metabolism, immunology, etc.
3- Surgery: What I did is the best plan. Study surgery from MTB-3 plus Trauma, Ortho,
Pre&Post op. chapters from Kaplan.
4- O&G: I would have done the same, except to make UW tables my main source and to
make reference to important topics in KL not in the tables and this should be done with
caution so as not to annotate the whole KL into the UW tables. Again, this will save you from
memorizing some outdated algorithms or old management protocols then replacing these
with new info later when you do UW! As correcting an old info in your brain is usually more
difficult than memorizing for the first time.
5- Psychiatry: I would have made FA step 1 + UW tables my primary source. I also would
have used UpToDate to know the sequence in which drugs are given in each psychiatric
disease as this was outside step 1 scope, so it was not in FA-1. In the end, I will post the link
of some notes I made in psychiatry which supplemented my primary sources.
So my plan was to do UW timed random. That is why, I subscribed to UW for 6 months! And
I don't regret that. Each block took me 3 days to annotate (by the last third of the bank I
would finish 30 Qs per day). I used sticky notes in MTB and Kaplan (depending on the
assigned primary source in each subject). The sticky notes were alternative to the method I
used in step 1 when I wrote down the notes inside the FA book and page looked disgusting
after annotating KL and UW into it. While doing the Qs timed random, I would read with my
study partner the books of MTB or KL for the 2nd time, along with the UW that are annotated
along the journey. And I did CMS after each subject I read for the 2nd time. All of this I did,
but most of my daily studying at that stage (70%) was focused on UW.
Now it is a suitable time to talk about my crisis with UW. I found that many seniors with
+255 and +260 scored above 80% in UW 1st time. So I couldn't remove from my mind the
idea that if I scored below 80%, I will score in 240s in exam. I finished 70% of the bank and
my cumulative score is 77%. Some can consider it good, but when I compared it with them, I
was so anxious. After doing sport in the last 2 months, and after copying all difficult to
memorize tables from UW, sticking them to the walls of my room and revising them again
and again each time I felt bored and not able to study from books or to do Qs, after that, my
score in UW got stabilized above 80% or even 85% but this was only in the last 12 blocks of
the bank.
When I finished the bank for the 1st time which was 5.5 months after I subscribed to UW, I
was done with 2nd read of the books and also was done with CMS. The sport + revising tables
stuck to the wall + scoring in 80s at the last couple of blocks made me feel I am ready, so I
decided not to postpone. I felt I am ready, even before doing any NBME. That was a feeling,
and I asked my seniors for advice and they encouraged me not to postpone. I had 3 weeks
left before exam only.
But let's go 2 weeks back. At this time, I had around 5 UW blocks left, and CMS of IM and
O&G. I decided to do CMS 2 exams followed by 2 blocks on NBME 3. I had 16 mistakes in
these 2 blocks of NBME 3!!!, and this SHATTERED me. I almost got into despair and felt that
world is falling around. But looking back, this painful experience motivated to change my
way of reading the Q. My old method from step 1 was to read last line then the whole stem
then the choices. After I recovered from NBME 3 shock, I kept thinking what should I do to
decrease the distraction while reading the stem. I came with an idea to screen the choice
after reading the last line, so that when I get back to the stem, I know what I am looking for
so that distraction can decrease. I told Khayri Shalhoub about this approach, he said it will be
good and added that I should read the main complaint also as it is important. So my
approach was to read last line to know what is the Q asking about (btw they knew we do this
so the last line now is not of great help yet it is important to read) then read the 1 st line to
know the MAIN COMPLAINT then the screen the choices then go back to read the whole
stem. To add, in step 1 I read the Q without using the highlighting option but I decided to
use it in CK as Qs were longer with more distractors, so I tried to do the highlighting and see
if it will improve my score or not. This was after I did 1/3 or 1/2 of UW -I don't remember-,
the important thing that I did this earlier because simply don't try a new approach in exam,
you should test it earlier. So this was my approach in exam which helped me do the Qs faster
without losing focus.
Now I have 3 weeks left. I get past the NBME 3 crisis when in the following 2 weeks I tried
the new approach for doing Qs + sport + UW tables stuck to the wall + UW score stable
above 80% or 85%. I finished UW with a cumulative score of 79%. I calmed myself with the
fact that NBME and UWSA are the real predictors and not UW cumulative score.
D- UpToDate: I thank God that I heard from seniors that UpToDate is an important
tool. In fact this is the most important reference in CK. UW explanations are COPIED from
UpToDate. The advantage of this reference is that it has the MOST UPDATED guidelines,
algorithms for diagnosis, and treatment protocols. It is sad how people study CK from
outdated sources and take the exam without having UpToDate online subscription. But
having an active subscription also can be a curse, as others can leave the main track and
keep digging and go beyond the required info for CK.
So, this is how I used it. I used it to clear my doubts i.e to read about these parts I always get
confused about. I will search for the concept that will help me differentiate between
seemingly similar diseases. But this doesn't mean to read the whole topic. Also, read the
summary and recommendation of the topic you want to read and if you still need to read
more go to the text. Most of the time, SUMMARY and RECOMMENDATIONS are enough.
Also, UpToDate contains helpful algorithms and tables, but again study what you need. Don't
make this source lead you. Also, I used UpToDate to revise the outdated data I found while
going through MTB. The third use of UpToDate was to use it to look for trusted answers for
Qs of NBME and CMS if I can't find in UW- instead of looking on the groups and get
exposed to people giving answers without a reference. At the end, when you search for the
answer yourself, it is better and the more you depend on yourself, the more self-confidence
you get and the less time you spend arguing on the groups.
E- Clinical mastery series: Before 2015, nearly no one used CMS or even heard
about. It started when some +260 scorers praised them. These are Qs designed by the same
faculty who write NBME Qs, so these Qs are more or less near to exam pattern and more
focused on CK curriculum than KQB for ex. After I finished the first read of MTB and KL, and
while doing UW online timed random, I used to make these CMS exams as a motivator for
me to do the 2nd read of the subjects along with reading notes of UW Qs I did. Then after I
finish each subject, I would do the 2 CMS exams on this subject. And I mentioned above, I
used UTD to look for the trusted explanations for doubtful Qs in most of the exams.
I- Tips:
1- Don't and I mean, Don't underestimate CK. Don't think that CK will be a piece of cake after
step 1. That is a LIE. I know people who score -10 and -20 from their step 1 score. Also, u can
notice from my experience that I suffered and changed my way many times to get a good
score in CK, although I got 259 in step 1.
1- If you found that there is a Q you have no idea about, don't waste your time with it,
freaking out and being stubborn will compromise the whole block as you r taking time to this
Q from other Qs which u could have done right if u had enough time.
2-DO 15 or 20 before going for exam to warm up, so that initial stage of dumbness many of
us face when we start doing Qs is skipped.
3- Know that what can lower your score is the easy Qs u do wrong due to anxiousness or lack
of concentration or enough time. Make your priority always during preparation not to do an
easy Q wrong.
4- Qs with media (Pics or sounds): You can sometimes depend on the stem to do it right
without fully identifying the photo for ex.
J- Miscellaneous Topics:
1- Vaccination tables: source CDC
These are immunization schedules for everyone (more simplified than these for Health care
professionals)
http://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf
http://www.cdc.gov/vaccines/who/teens/downloads/parent-version-schedule-7-18yrs.pdf
http://www.cdc.gov/vaccines/schedules/downloads/adult/adult-schedule-easy-read.pdf
4- Empiric antibiotics:
https://www.facebook.com/notes/usmle-step-2-ck-study-group/empiric-antibiotic-
therapy/1040897549274057
5- Pain management:
https://www.facebook.com/groups/usmle2ck/1011728895524256/
6- Patient safety: from Kaplan LNs for behavioral sciences
http://www.mediafire.com/view/jdcrzjlcdoa8jr7/Patient_safety_-_Kaplan_behavioral.pdf
http://www.mediafire.com/view/s26biixretrkcbf/Health_care_delivery_systems_-_Ch._16_-
_Kaplan_behavioral.pdf
7- Bias:
https://www.facebook.com/groups/usmle2ck/989204984443314/
8- Chemotherapy for Hem/Onc diseases:
https://www.facebook.com/groups/usmle2ck/1014480515249094/
9- ECG: ECG made easy. If you are short in time, study it from ECG tutorial topic in UTD
10- Normal values mnemonics, based on UW normal values:
http://www.mediafire.com/view/la8bvb5akv3dd9c/Normal_values.pdf
I want to thank all friends and colleagues who helped me: (arranged alphabetically):
AbdulHaq Yousufzai AbdulRahman Alnakeeb - Ahmed Azmy Ahmed Elzanaty Ahmed
Marey Ahmed Zaghloul Danny Markabawi Faeq Alkoukhon Fatima Syed Khaled
Hamada Khayri Shalhoub Lewis Forad Maymona Mohammed Mohammed Ismail.
I hope I didn't forget anyone of those who helped me.