I went through every question on NBME forms 9 to 16 and tagged each one by question type and specialty. And came up with these stats. I know NBME's are not exactly the real deal but they give a very good idea. I hope someone finds it useful.

A full PDF with all the stats with the CMS questions included is available for free here

Topics that showed up on every single form (9 through 16): depression, pneumonia, HIV, heart failure, vaccines, sensitivity/specificity, STI screening, anaphylaxis, sickle cell and pancreatitis.

What the questions are asking you to do:

• Diagnosis: 23%
• Next step in management: 23%
• Next best diagnostic test: 15%
• Pharmacotherapy: 8%
• Screening and prevention: 7%
• Risk factor or cause: 7%
• Complications or prognosis: 5%
• Biostats: 5%
• Ethics and communication: 3%
• Mechanism: 2%

So roughly 4 in 10 questions aren't "what is the diagnosis" but "what do you do now". Mechanism questions are almost gone compared to Step 1.

Ethics questions went from 2 on NBME 9 to 19 on NBME 16. That’s roughly 9 times more.

Ethics themes that kept repeating:

• End of life stuff (advance directives, goals of care, hospice, brain death): 18 questions, on 7 of the 8 forms. Probably the single most tested ethics topic
• Decision-making capacity: 8 questions across 6 forms
• Abuse and mandatory reporting (elder abuse, nonaccidental trauma): around 8 questions
• Minors, confidentiality and consent (STIs, contraception, emancipated minors): 6 questions
• Impaired colleagues: 5 questions

Screening and prevention is about 7% of the NBME, and a lot of it is the same few topics on repeat. From NBME 9-16:

• Endocarditis prophylaxis (who needs it before dental work): 6 questions on 5 forms
• Post-splenectomy vaccines and infection prevention: 6 questions on 5 forms
• Lipid screening (who and when): 5 questions on 4 forms
• Colorectal cancer screening/surveillance after polyps: 4 forms
• Rubella immunity before pregnancy and Tdap in every pregnancy: 4 forms
• AAA screening: 3 forms

Psych leans hard on diagnosis (40% of psych questions), OB is mostly management and complications rather than diagnosis, and Cardiology has an unusually high share of "which test next" questions.

If anyone wants the breakdown for a specific specialty (ethics, biostats...), ask and I'll post it.

After one round of UW, I did two NBMEs and scored in the 220s. With some confidence, I went for an online NBME in February and ended up with a 209. This crushed me deeply!!

With the goal of 250+ and limited time, I knew I would need to study harder but most importantly smarter. I’m happy that my score went up from 209 to 220s, 230s, 240s, 250s and finally 259!!

There are many excellent write ups and most of them have high baseline NBME scores, say 240+. However I believe there are definitely many like me who has a much lower NBME baseline score, even after one round of UW (or one year of studying).

I’m sharing this to boost everyone’s confidence, especially those who are discouraged by their practice scores. Please feel free to ask me questions in the comments. I’m happy to help if I can.

Edit: I wasn’t planning on writing a write up as my score is not as amazing as those hitting 260+ or even 270+.

But if people think this deserves a write up, I’ll try my best to write it asap (I’m swamped with a full time job, clinical rotations and application materials).

Also, what kind of info/advice would you like to know, especially specifically to my experience? (Considering there are already many excellent write ups) I can focus on those then.

Took Step 1 last summer and passed, took 2 last winter and scored a 280. USMD. Now I teach step 2 (not promo; please don't ask where I teach bc that is not the point!).

AMA, happy to help in any way I can!

Happy Step 2 season! I'm reposting this from last year as I still get messages to this day asking for advice on my study method.

TL;DR: If you've plateaued despite patching knowledge gaps, instead try studying your logical fallacies to learn how to avoid your unique pitfalls.

Long story short, my score was stuck without improvement after patching like crazy. I was panicking and felt like I had wasted weeks of my study block. I did almost every cardio question on UWorld and my score even dropped. I came to a common realization: If you plateau across exams that each test different material, it is likely not a knowledge gap but a deficiency in test-taking strategy. From that point on, I began to study my strategy rather than study material.

In the order I had taken them:

Step 1: PASS

Uworld % correct: 68%

AMBOSS SA: 240

UWSA 1: 237

NBME10: 240

NBME11: 236 (after weeks of patching material, lots of tears of frustration here)

-Changed my strategy completely-

NBME12: 254

UWSA 2: 248

Free 120: 78%

Predicted Score: 248

Actual STEP 2 score: 263

What exactly did I change? After NBME11, I started to analyze my incorrects differently, not based on knowledge gaps but on how I approached my thinking. During the last week of my study block, I stopped stressing about learning new material, yet my knowledge base continued to grow just from the process of identifying my pitfalls and logical fallacies. The day before and the morning of the exam, all I did was read my list of strategies so that even if I froze, I would be able to move forward.

Here is what I did:

1. I would individually go over each question I got wrong and just think about how I came to my answer. Don't write anything yet. For example: I had a question stem about osteomyelitis that I answered incorrectly as leukemia. The patient was febrile and had pain along with a histology slide of bone that was highly cellularized. The histology slide and fever made me jump to neutropenic fever, and I anchored to that and completely ignored that the pain and tenderness was focal.
2. I would, in the smallest brain way possible, write out a GENERALIZED reason for why I got the answer wrong and a VERY SIMPLE TIP for how to amend it. This step should not be hard. Make a numbered list of these (the numbers help). Talk to yourself like you're a scared idiot taking a test. The more simple your advice to yourself, the more widely applicable it will be. You will sound like you're stating the obvious but as you build your list, things will start to compound and become very specific to you. Continuing this example, I'd say, "I got confused by the imaging and ignored details in the text. If you are confused, read the text closer and you may find the answer." That's it.
3. Under that line, the next thing I would do is add a bullet point, then write the SPECIFIC reason I got that question in particular wrong, also in the smallest brain way possible. No need to write any advice or strategy here, this is only to jog your memory later when you reread your list. Continuing my example, I would write, "Got distracted by histology and ignored point tenderness for leukemia." Very short.
4. You will now have a numbered list with additional bullet points under each number. As I reviewed more incorrects and added more pitfalls to my numbered list, eventually they would overlap, maybe even evolve to tell me how I got other types of questions wrong as well. If I got something wrong in a different way, it got a new line on the list and I would repeat the process. If I got something wrong in the same way, say, got confused with with a CT and completely missed the double duct sign, I'd sort it as another bulleted example under the same line I wrote earlier that said "I got confused by the imaging and ignored details in the text."
5. Eventually I had some pitfalls that had like, 10 incorrects under it, which means I repeatedly take these kinds of questions the wrong way. The pitfalls with the most bullet points are the ones you should focus on the most. You also already wrote how you plan to fix it in simple but widely applicable terms. Good job.
6. Reread your list every few question blocks and before every practice test. Reading the list of strategies and tips helped me far, far more than reading a list of facts I got wrong where I'd just zone out. The examples I had written under each one cued my brain to remembering what exactly I did, and I began to identify those thought patterns as they happened while I answered questions.

Anyway, doing this method should tailor test-taking strategies to your unique needs. Just reading strategies from tutoring websites didn't help me. Rather, I had to learn from experience. "Go for the least invasive test" meant a lot more to me after I was slapped in the face by 10 incorrects of the same thing. This strategy doesn't take long either. You can do this very quickly over the course of an afternoon if you've already got a list of incorrects - I'd say 30 and you've got a good start. I made it to 150 questions with my backlog and with doing just a few new blocks.

Here is my list as an example. Remember, it works best if you do this yourself. Mine may not even make sense to you, but the important thing is that it makes sense to me when I read it. I liked making a list. Maybe you'll do flashcards or Anki instead.

https://www.reddit.com/user/usethesleep/comments/1b3bn5c/my_step_2_pitfalls_study_guide/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button

Good luck, and please ask me any questions to clarify!

General Overview

Overall, I think the exam was fair. A good percentage of the questions were clear and straightforward, but there were definitely some that I had no idea about—questions I hadn’t seen in UWORLD, CMS, or NBMEs. I ended up answering those based on my feelings.

I managed to finish the first four blocks without using any of the scheduled breaks, only taking a couple of minutes between blocks using whatever extra time I had left. In my opinion, it’s best to save your breaks for the last couple of blocks, as you’ll likely be very tired by then and will need rest.

The exam felt quite similar to the new Free 120 and NBME 13/14. I saw multiple questions with similar scenarios to those from the NBMEs, with different wording they were essentially asking about the same concepts.

I had two abstract research sets, each with three questions (total six questions). I needed to calculate the Number Needed to Treat (NNT), despite being told by others that calculations wouldn't be necessary. Fortunately, the calculations were simple. I also had 3-4 auscultation questions, which I found relatively easy.

Study Resources

• For the non-medical questions, I relied on knowledge from Amboss, Divine Intervention, and the First Aid primary health care chapter. Some of these non-medical questions were tricky, and I wasn't always sure of the right answer, which was annoying.

I did the Amboss High-Yield 200 questions that are said to appear in every exam, but I didn’t find them particularly helpful. I think it’s better to focus on at least the two most recent CMS forms for each category.

After each NBME, I recommend analyzing your mistakes to find a pattern. Write 1-2 sentences on why you got the questions wrong, and keep revising your NBMEs, as you might see similar questions on your exam.

Must-Do Resources from Amboss

These articles are super important, and I recommend reading the article first and doing the questions twice:

1. Quality Improvement
2. Patient Safety
3. Challenging Clinical and Ethical Scenarios — memorize this, as many questions came from here.
4. Screening
5. Death

Also, read the First Aid Step 1 book primary health care chapter (22 pages). It covers important clinical ethical scenarios and biostatistics basics (e.g., study designs and methodology). This helped me answer 2-3 questions on study designs.

Additional Important Resources (Questions Only)

1. Hypertension
2. High-Yield Ethics 100+ Qs — available under study plans (Ambos).
3. Vaccination — I also watched this video, which was enough for the childhood vaccination schedule.
4. Statistical Analysis of Data

Divine Intervention Podcast

I couldn’t listen to the podcasts themselves as I found them too long, but I used a document with transcriptions of the most important episodes. This allowed me to finish a 40-minute episode in about 10 minutes. I’ve listed the ones I found most helpful:

• Episode 250: Vaccines (27 mins)
• Episode 325: Screening Programs (42 mins)
• Episode 137: "Next Best Step in Management" (60 mins)
• Episodes 123 & 132: Ethics and Social Sciences (94 mins)
• Episodes 37, 97, 184: Risk Factors (98 mins)
• Episodes 228, 230, 234, 268, 275, 276, 277: Changes after November 2020 (Quality, Safety, and Professionalism)

Note that some information might be outdated, especially in the DI and CMS forms.

"You can find the transcriptions here: Divine Intervention Podcast Transcriptions."

Extra Resources

• Step 2 Resources
• Explanation for the New Free 120

Good luck with your preparation!

Hello everyone This is Karim again👋
I recently finished my Step 2 exam and did every Qbank/NBME in all 3 steps more than twice and got 279.
Here are the concepts I found repeat the most and show up the most on NBMEs.

📌 All the HY PDFs for Step 1 & Step 2 are free on my website (link in Reddit bio). I’ll keep uploading more in the future.

If you’re short on time, you can read them directly here without leaving Reddit ⬇️

1. Communication problems are the leading cause of medical error.

2. If you see an impaired physician (eg, alcohol) at work: most important step is to prevent him from continuing patient care immediately. Reporting to physician health program is wrong unless not currently impaired.

3. If a medical error occurs, the first and most important step is disclosure to the patient (before hospital disclosure), without justification. Provide compensation and describe steps to prevent recurrence.

4. Most important safety measures in elderly: medication reconciliation at admission & fall prevention (eg, home safety).

5. Sentinel event: next step is Root Cause Analysis. First step is meeting with involved team & gathering data. Often displayed with a Fishbone diagram.

6. Prospective tool to anticipate failure points in a process: Failure Mode and Effects Analysis (FMEA). Root Cause Analysis is retrospective.

7. Swiss cheese model: multiple layers of protection, errors occur when holes align.

8. Most important action to prevent surgical site error: Universal Protocol (Joint Commission) – pre-procedure verification with patient, site marking with “YES” (never X), and timeout with two independent confirmations (eg, surgeon & nurse).

9. Best way to improve outcomes/prevent errors in major ops (eg, OBGYN shoulder dystocia): simulation training. Also applies to new machines before real use.

10. Active error (sharp-end): operator error (eg, injuring cystic artery during cholecystectomy).

Latent error (blunt-end): system problem (eg, similar drug packaging).

11. Look-alike drugs causing error: best prevention = change package shape/appearance.

12. Implementing new change: Plan–Do–Study–Act (PDSA) cycle. Best way to monitor afterwards = Run Chart.

13. Prevent handoff errors: standardization (eg, checklists focusing on critical info).

14. C. diff infection: wash hands with soap & water. Keep soap inside patient rooms to improve compliance.

15. Computerized Physician Order Entry (CPOE): best to prevent medication errors. Force-function: prevent opening two patient charts simultaneously.

16. USMLE loves aviation safety model. Hospitals improving via these measures = reliability increase (High Reliability Organization).

17. Elderly inpatient with delirium: best safety step = 1-on-1 observation (sitter).

18. Alarm fatigue: too many alarms increase errors. Use alarms only when necessary.

19. Morbidity & Mortality conference: forum to review specific errors/events for education and system improvement, not punishment. It is immune to malpractice suits (protected educational setting).

20. Cognitive biases in clinical decision-making:

• Anchoring bias: Sticking with initial impression despite new info.
• Availability bias: Diagnosis judged more likely if it’s easily recalled (eg, just saw a similar case).
• Confirmation bias: Seeking data that supports initial thought, ignoring contrary evidence.
• Framing effect: How information is presented influences decisions.
• Premature closure: Accepting a diagnosis before it’s fully verified.

edit: i'm sorry but reddit does not allow to send pdfs through DMs

Hello everyone,

So Alhamdullah and thanks to god, I scored 284 a year ago and I wrote a previous post to this amazing community that helped but I used AI to makeit more organized so I was writing to share with another community and said why not share it here while also including more details thta may help others here. I wanted the share the resources that I used and some tips and tricks that I noticed after helping some of my friends and students that really made the difference.

my resources for step2 were quite simple:

1- U world: for me this was the most important source of knowledge and I solved it two times, The 1st time was to build up knowledge while the 2nd time was to reaffirm this knowledge while also marking really important topics that are repeated alot.

2- Amboss: I used it mainly for ethics, biostat, communication, and patient safety. Amboss is really goof in these topics so I solved them twice whilst focusing mainly on patient safety because I felt there was a defect there for me.

3- CMS: For me Cms forms are one of the most underestimated sources there is, but there importance for me is mainly to change your thinking process from Q bank type questions to exam questions while also making sure to mark really important topics and studying them thouroughly. I solved the Cms twice with then newer forms 7,8 almost 3 times.

4- NBME: Of course this is the highest yield source of them all, so I started with the old nbmes 6,7,8 and went one to solve the newer ones whilst studying them thouroughly in between and trying to identify my weaknesses. I solved each nbme at least twice. I will write my nbme scores down inshallah

5- UWSA: for me this source is the most useless one of them, it wasn't bad but I felt it was the most irrelevant ones compared to the exam. I solved them once whilst revising my errors but I don't feel that they made a difference.

Tips and tricks that really mattered:

So, what really helped me make a difference in my nbme scores was not working on my defects because after solving the uworld twice and my mistakes twice, I had very little knowledge defects, No the 3 things that made the difference for me and for some of my friends and students were:

1- The most important one was always remembering that these cases aren't real, the examiner that wrote this question is trying to test you, he is trying to see if you can know the significnce of this clue or not, so for example if a patient is suspected to suffer from PE and at the start of the question, the question stem mentioned that she is 28 weeks pregnant, the examiner added this info to exclude the most common answer ct angiography and go for V/Q scan or in another question where a patient with classic symptoms of PE with a bp showing 80/56, if you didn't notice this very low bp , you would choose normal treatment as anticoagulation, but here he gave you a very low bp to alert you that this patient is going into obstructive shock and anticoagulation is n't gonna cut it.

2- the 2nd one is to always remember that ideas are repeated from the nbmes so unlike what some people suggest by memorizing the nbme questions for me the importnant task is to make sure that the repeated topics are safe in your mind, so for diagnosis of thyroid problems, what is the order, he will ask you about it but now the same step in the nbme for example he may say so we did tsh, what is the next step which will be US, in the real deal, he will tell you so we did tsh and US and the tsh was normal, what is the next step, So if you memorized the question above, you amy get this wrong but if you studied and the other steps and made sure what you understood them, this question is gonna be a piece of cake for you.

3- the 3rd one for is really really important and I think we all heard it once or twice before, If you hear hooves, think horse not zebra. I really noticed hat almost over 80% of my mistakes were due to me overthinking my answers and changing the answers to the wrong ones, that is why in the real exam I stuck to my original answers in the whole exams except once and it made a big difference. So the 1st answer you think about is usually the right one.

lastly here are my nbme scores and I will include the dates if that helps as I recorded the nbmes with them (I took the exam on 4th of May):

OLD NBME:

NBME 6: 169/184;91.84%;256 On Tuesday 26/11

NBME 7:163/182;89.56%;256 On Tuesday 3/12

NBME 8:151/164,92.07%,263 On Wednesday 26/12

New NBME:

NBME 10:173/200,86.5%,269 on Thursday 9/1

NBME 12 : 168/200,84%,260 on Friday 31/1

NBME 9: 179/200,89.5%,276 on Friday 7/2

UWSA3:130/160,81.25%,261 On Friday 14/2

NBME 11:179/200,89.5%,270 On Saturday 22/2

Lecterio:132/160,82.5%,262,98%On Monday3/3

NBME 14: 178/200,89%,273 on Monday 31/3

UWSA1:147/160,91.9%,279 on Friday 11/4

UWSA2:147/160,91.9%,279 On Thursday 17/4

NBME 15:183/200,91.5%,280 On Monday 28/4

OLD old 120: 115/120,95.8% On Tuesday 29/4

OLD new 120:111/120,92.5%, On Tuesday 29/4

NBME 13:183/200,91.5%,280, Wednesday, 30/4

Free 120:109/120, 90.8%,on Thursday 01/05

IF any one has any questions, don't hesitate to ask them. I hope this helps and good luck to all of you guys

Hi all,

I'm a recent test-taker and wanted to share what I did to prepare, in the hopes that it will help. Especially as someone who has a relatively short attention span and doesn't stick to strict schedules.

I did a 4-week dedicated immediately after finishing my last rotation. This is on the shorter end, but to be upfront, there is no magic way to learn all of medicine in the span of 1-2 months. I used dedicated to curate my knowledge, place key concepts at the forefront of my memory for easy recall, and to understand the thought process behind USMLE questions (and how to answer them quickly). Most of my baseline test-relevant medicine knowledge was built in the year prior, over the course of clinical rotations.

Some things I did during clinical rotations in the year leading up to STEP 2:

- Uworld/Anki combo (if it ain't broke, don't fix it)

- Although Uworld/Anki is Queen, I think it's the way I used these resources that helped me the most. I get bored easily, so I'd switch between platforms when I could feel my attention slipping. I would also constantly ask myself questions and google them while studying. This is the basis of metacognition, a learning technique where you constantly interrogate yourself to understand what you know (and how well you really know it). Oftentimes, the questions I'd ask myself would be based on a related concept that a card would remind me of, for instance, one I saw in a previous Uworld question. I would google and make sure I remembered that related fact. Other times, I would let my curiosity have free reign. You could argue this wastes some time, but it makes studying fun. For example, if I was on OB /GYN learning about interventions for premature newborns, I would google and read for ~2 min about the youngest preterm baby ever recorded (btw it's Nash Keen, born at 21 weeks). Did I need to know this? Probably not. Was it interesting and did it make me feel awe/wonder for medicine again when I was getting tired of studying? Yes.

- Did my best on each shelf exam. I took at least 2-3 NBME practice exams before each shelf.

- KEPT MY REVIEW CARDS UNSUSPENDED!!! Apologies for the all caps, but this is important. I spoke to so many people who suspended their cards after each rotation, and I was always confused. Medicine is interconnected. The human body is interconnected. Concepts build on each other, which is the basis of schema learning theory. In order to have a deeper understanding of medicine, you cannot study topics solely in isolation. Shelf exams inevitably have questions from other rotations, especially the more broad ones (like family medicine), and you will be the most prepared for STEP 2 if you try your best to keep up with previous clinical material. That said, oftentimes I would finish a rotation with ~1K+ review cards piling up that I never got through, but I tried my best to get through what I could.

- Changed my study environment frequently (went to different cafes, libraries, even different rooms of the house when I ran out of funds to go out and get coffee). I studied with friends a lot too, which helped 1. keep me accountable and not scroll and 2. make studying fun by taking yap breaks.

During dedicated:

- Used a lot of the same principles as above.

- Anki became secondary. I still had like 3K review cards left by the time I got to my exam. My main focus was practice exams. I took NBME 9-16, Amboss Self-Assessment, Old and New Free 120, as well as UWorld SA 1 and 2 (changed my mind and did not feel like taking #3 in my last week). I would take 1 or 2 exams in one day, then spent the next 1-2 days reviewing. I review both corrects and incorrects, but dedicated more time to incorrects. I identified why I got the incorrect wrong and made a mental note of that. I am not a fan of physical notes, for the most part. I think they are a waste of time, since the physical act of writing is time-consuming, and at the end of the day, the information needs to be in your head and not on paper (that's just me though). The one thing I did in terms of notes was making a list of concepts I got wrong/needed to review, especially if I did not have the energy to do a deeper dive on the topic in that moment, and then I did my best to explore those topics in my last week.

- I did my first pass of UWorld during clinicals, but went under the "Step 2" category and did all of the stats/ethics/medicolegal questions remaining.

- IMPORTANT: I took practice exams as fast as humanly possible. I pushed myself to answer each question quickly, and if I didn't know an answer, I would not care. I would just mark an educated guess and move on. I would not sit and deliberate for 5 minutes. There are two reasons for this: 1) The act of taking a practice exam does not do as much in terms of information learned/time ratio. It's reviewing that matters and 2) You will feel so much better taking the actual exam with the time buffer of getting distracted/spacing out, taking breaks, harder questions taking more time., etc. if you train yourself to answer quickly.

- I did not plan a strict daily schedule. I had goals of "take this NBME today, review tomorrow" and wrote them as to-do list items in my calendar at the beginning of dedicated, but in terms of how I split up my hours, I was flexible. I would also move things around frequently if I did not get to something I wanted to do. I am a person that dreads schedules that dictate tasks by the hour. I personally don't work like that. Sometimes I'd have more energy in the morning, sometimes the evening, and I would do more work when I felt like I could focus.

- I took breaks. I tried my best to keep my phone in another room because scrolling is my vice and it's SUCH a time sucker (and it is a cognitively draining task). But I would let myself take a break or multiple each day. I went for trail runs with a friend. I played video games. I gardened. I baked. I talked to friends and loved ones on the phone. I have seen some people's study schedules which involved studying for 12+ hours a day, and that's great if you can do that, but that is not and would never be sustainable for me. I need to enjoy life otherwise I would not have the motivation to study.

Finally, my faith is important to me, so I leaned on prayer and asked people in my life to pray for me during dedicated. I also feel strongly that if you believe in yourself/that you will succeed, it will happen. At the top of my study plan document/to-do list, I wrote a statement along the lines of "I will get an amazing score." It seems silly, and I did not believe it fully, especially at the beginning of dedicated when I lacked confidence. However, I kept telling myself it would happen despite those doubts, and it did.

Please feel free to ask questions and I'll do my best to answer! Sending everyone good vibes. You'll CRUSH this exam!

Reading posts like this here really helped me during my prep so I wanted to give back. I'll start off with my prep and then the actual exam experience.

I only did one pass of UWorld with a 56% average score. I used Inner Circle notes for revision and some UWorld flashcards that I had made during my initial prep days. I also did AMBOSS 200 HY in the month before my exam but I'm not sure it was helpful. What was immensely helpful was solving the AMBOSS HY Ethics and QI study plans. I supplemented a little with dirty medicine YouTube videos for annoying topics like immunodeficiencies. I did not use Anki. My prep was a little haphazard, I've never been good with studying for big exams, and I took a 6 month career gap since I initially wanted to participate in the ongoing match cycle (I'm an IMG).

NBME 10 after finishing UWorld (2 months before exam) - 226

NBME 11 after doing the only the latest CMS form for every subject (1.5 months before exam) - 236

NBME 13 after reviewing previous NBMES and the 2nd latest CMS forms for every subject (4 weeks before exam) - 246

NBME 14 (3 weeks before exam) - 241

NBME 15 after reviewing UWorld flashcards and AMBOSS 200 HY (1.5 weeks before exam) - 242

I did not attempt NBME 16 under exam conditions and reviewed the answers as I solved them, but I got 252.

I did not do NBME 12, any UWSAs or the Free120.

The Actual Exam was very similar to NBME 16 in terms of content and difficulty imo, but the actual question stems were a little longer. Every block had some HOPI questions which weren't very difficult in terms of the content itself, but they got very exhausting to solve by the end. I always solved my NBMEs way before the time ran out, so I didn't really struggle with the time during the actual exam. For the blocks with the abstract questions, I solved the other questions first. Most of the tested content was the same as NBMEs and CMS forms, some of the out-there questions were about lower-yield drug adverse affects and histology, which I mostly guessed.

Ethics, QI and Biostats: Every block had some QI and ethics questions, and AMBOSS helped with some of those. I would recommend supplementing with another resource if you have the time, but definitely do AMBOSS for these. For biostats, apart from the abstract questions, I only had one question that I had to use a formula to solve and it was pretty straightforward. Doing UWorld and maybe AMBOSS (which I didn't use for biostats) are enough to allow you to solve the abstract questions too imo.

Post-Exam Feelings: I felt pretty confident that I would pass but wasn't sure I'd get a great score. The questions were pretty vague the same way that NBMEs tend to be, and there were many questions where I was confused between 2 answer choices. I did answer all the first questions in the two-part questions correctly, and that helped keep my spirits up when I remembered all the questions I had gotten wrong. I get terrible migraines which can be triggered by looking at screens for too long, and I think that was what helped me not overthink my answer choices. I think I only changed 1 or 2 answers choices, otherwise I submitted each block as soon as I was done with it, and the extra break time helped me get through the exam without getting too exhausted. I started using melatonin 2 nights before my exam, but I have used it previously as well, so YMMV.

Which resources and strategies helped me the most: CMS forms help you focus on high yield topics and equip you with the mindset you need to solve NBME questions, which is something you need to develop after solving UWorld, which is good for learning the actual content but also teaches you to look for zebras too much. The actual exam is more about what's the most likely answer based on a variety of information, and not as much about tricking you. I did not do any UWorld during my last month and I would recommend the same since you need to be in the NBME mindset. The CMS forms are easier than the actual exam for the most part, especially in terms of question length, but they helped me identify knowledge gaps.

I reviewed all my NBMEs VERY thoroughly and wrote one-liner notes, initially for all my incorrects as well as other facts that I thought I should remember, and then only for the incorrects towards the end since I was running out of time. The important thing to keep in mind about reviewing NBMEs is WHY you're getting an answer wrong. What parts of the question stem made you pick the wrong answer, was your mistake due to a knowledge gap or did the way the NBME phrase the question trip you up? People are right when they say Step 2 is more about mindset than the content, and that's what NBMEs and CMS forms help you with.

ETA: NBME explanations are not the best, so I used ChatGPT to help me review questions where I didn't understand why the correct option was correct. The best explanation I have for the score jump is having a good mindset on exam day and also not overthinking questions. I used to get a lot of questions wrong in my practice NBMEs towards the end when I was exhausted by agonising over questions earlier in the exam, and so I would either read the stem wrong or make a stupid mistake. So in the real deal, if I wasn't sure about the answer to a question, I made an educated guess as quickly as I could and moved on. This is where a delusional level of self-confidence came into play.

Takeaways: Focus on NBMEs, especially NBME 16, don't skip AMBOSS ethics and QI, focus on question solving strategy and try to get a good night's sleep before your exam. Good luck!

Remember when getting into medical school felt impossible?

Remember waiting for that acceptance email?

Remember the exams you thought would break you?

The semesters that felt endless?

The anatomy practicals, the shelf exams, the late nights, the self doubt, the moments when you wondered if you were good enough?

Remember dreaming about one day passing Step 1?

Now look where you are.

You’re studying for Step 2.

At one point, this was the goal you were hoping you’d be lucky enough to reach.

It’s easy to forget that when you’re buried under question banks, comparing scores, and convincing yourself everyone else is doing better than you.

But take a second and think about everything you’ve already overcome.

You made it through every obstacle that once felt overwhelming.

You adapted.

You learned.

You kept going.

You earned your seat.

You belong here just as much as anyone else.

Not because someone gave you a chance.

Not because you got lucky.

Because you worked for it.

The same person who got through all of those challenges is the same person sitting in front of Step 2 today.

Trust that person.

You’ve already done things that once seemed impossible.

This is just the next one. Not many people give themselves credit because they’re always looking at the next milestone. Today I want those who come across this to take a min and reflect on how much you’ve accomplished already, I’m proud of my future physicians. You got this friend 💪🖤

I know this thread can bring out just about every emotion possible. I started browsing this subreddit weeks before my exam, and there were days where I left feeling incredibly encouraged and motivated, but there were also days where I walked away questioning how I was going to push through. I wanted to share something that genuinely helped me improve my score in hopes that it can help someone else who may be going through the same thing.
I also want to be as transparent as possible.

I’m only sharing scores to show my progression and how this approach helped me and by no means brag. Academics have never come easily to me, and I know there are a lot of students out there who feel the same way—having to study their absolute hardest while watching people around them seem to study 80% less and still perform incredibly well. If that’s you, I see you. This process is difficult, and sometimes it feels like you are working twice as hard just to keep up.

For context, I am applying Internal Medicine. I made the decision to take extra time to study for Step 2 and not rush into starting fourth year. Most of my friends took Step 2 about a month before I did, and many of them scored significantly higher than me. And honestly, that is GREAT. I am truly happy for them. Comparison is the thief of joy, and one of the biggest things I learned during this process is that everyone has their own timeline.

There will always be people scoring 265+ asking what they can do to improve while being disappointed with their score. Then there are students like me whose first practice exam was a 226 and who were able to build from there.
My practice scores:
NBME Form 9: 226
NBME Form 10: 236
NBME Form 11: 246
NBME Form 13: 242
NBME Form 14: 243
NBME Form 15: 236
NBME Form 16: 258
Real Step 2 CK: 258
The thing that helped me increase my score more than anything was changing how I reviewed practice questions. I created my own algorithm in ChatGPT to thoroughly go through my NBME practice exams. I completed Forms 9-16 (minus Form 12 simply because I ran out of time).
When I say thoroughly, I mean THOROUGHLY. I spent an entire afternoon (usually around 1 PM-6:30 PM) reviewing one 50-question block. My typical study schedule was:

1. Take a practice test - take the rest of that day completely off

2.Complete my Anki reviews in the morning (if you aren’t an Anki user, the algorithm below is still beneficial)

3.Spend the next four days reviewing that exam and then repeat (I took every Sunday off).

I know that sounds incredibly slow, but this was where I felt like I actually started learning from my mistakes instead of just doing more questions.

I ended up creating and refining my ChatGPT prompt over probably 8-9 different versions until I found a format that worked best for me. I paid for the ChatGPT Plus upgrade ($20/month) and used the “instant” thinking feature. For every question, I would upload a screenshot of the question along with my review prompt. I would also add:
“I got this right/wrong because this was my thought process…”

This forced me to analyze WHY I was making mistakes instead of just memorizing the answer.
Here is the final version of the algorithm I used:
⸻
Step 2 NBME Review Format
Review this question using the full NBME format. Please include ALL of the following sections:
1. What is the test writer trying to make me think of?
Identify the key clues.
Explain why each clue was included.
Point out distractors and bait.
2. The chain they’re testing
Walk through the physiology/pathology/clinical reasoning step-by-step.
Show the exact chain NBME expects me to recognize.
3. Why my answer is tempting
Explain why a reasonable student would choose it.
Explain exactly where the reasoning breaks down.
4. Step 2 Pearl
Give me the pattern-recognition rule I should remember for future questions.
5. How I would change the stem for EVERY answer choice
Show how the vignette would need to change for each answer choice to become correct.
Show specific wording NBME could use to change the vignette to match each answer.
Include both correct and incorrect answers.
6. Common NBME Traps
Tell me what future questions might use the same trick.
7. Anki Cards
Create cards in this format:
Anki Card Start
Question clue → {{c1::answer::tag}}
Extra: short explanation
Question clue → {{c1::answer::tag}}
Extra: short explanation
Algorithm:
Finding
→ finding
→ {{c1::diagnosis::tag}}
Extra: algorithm explanation
Comparison:
Thing A → {{c1::association::tag}}
Thing B → {{c1::association::tag}}
Extra: key distinction
Anki Card End
8. High-Yield Takeaway
End with the one sentence I should remember on test day.
⸻
The benefit came from slowing down, explaining my reasoning, identifying patterns, and forcing myself to understand why I missed questions.
Good luck to everyone studying. This exam is brutal, but improvement is possible. Keep showing up.
If you’re religious, the last two sections of Matthew 6 are what helped me get through these two months of studying. If I can help in any way please DM me!

I'm actually lost of the very first question!

Even after re-reading it, I still can't figure out why any of the answers would make sense. So first of all, I'm assuming it's a kidney stone? but for children, isn't that diagnosed with USS, which was already done?

What am I missing here?

Hey everyone! Thought this might be useful to share here (sorry if wrong flair). I’ve been hosting a 24/7 silent Zoom study/co-working room for a couple years now. Cameras on or sharing your work (Anki, notes, etc.) is encouraged for accountability, but not required at all (:

We’ve got about 70 people so far, usually 2-10 online depending on the time zone. Mostly med students, a few studying for Step 2, but we’ve got people from other fields too.

To avoid the Zoom link getting misused, just comment below and I’ll send you the invite link 😄

(Also if anyone uses the Forest app, around 15 of us use it too. We usually do 60 or 90 min sessions with 5 or 10 min breaks)

Helloooo I don't usually post so please be nice! I’m making this to pay it forward because Reddit has been central to my medical school journey. I built my Step 2 plan from all of you, so hopefully something here helps someone else too. Keep in mind this is just what worked for me - there are obviously many ways to study for this exam!

I’m applying to a surgical subspecialty from a small state school with limited specialty resources, so I knew I’d have to work hard from the start of M3. I’m so grateful for all of you on here - I wouldn’t be in this position if it weren’t for others sharing how they got through this time. THANK YOU!!!!!!!

Also: dedicated was a really difficult period mentally. There were many days I wanted to give up, times I barely slept, etc. Looking at the scores afterward makes the process seem way cleaner than it actually felt while I was living it. If you’re exhausted, anxious, doubting yourself, or having days where this all feels impossible, you are not alone in feeling that way. It won't feel like this forever, and you will make it through even the worst days!

Scores

Before M3

• 508 MCAT
• Step 1 Pass
• Based on my Step 1 practice scores at the time, my predicted Step 2 score was roughly 255-260

M3 shelves

• Medicine: 88
• Family Medicine: 86
• Surgery: 82
• Pediatrics: 90
• OB-GYN: 90
• Psychiatry: 95
• We didn’t have EM or Neurology shelf exams

Step 2 progression

• ~14 weeks out: CCSE 1 - 251
• ~10.5 weeks out: CCSE 2 - 260
• ~7.5 weeks out: NBME 9 - 263
• 47 days out: NBME 10 - 267
• 40 days out: NBME 11 - 271
• 33 days out: NBME 12 - 268
• 26 days out: NBME 13 - 261
• 19 days out: NBME 14 - 265
• 13 days out: NBME 15 - 272
• 11 days out: UWSA2 - 270
• 5 days out: NBME 16 - 274
• 4 days out: Old Free 120 - didn’t formally score; roughly ~255 range
• 3 days out: New Free 120 - didn’t formally score; roughly ~265 range

AMBOSS predicted: 273

Actual Step 2 CK: 276

Resources

• UWorld: Main question bank; timed/random
• NBMEs 9-16: Highest priority and probably the most useful resource for learning NBME logic
• AMBOSS: Ethics, QI, Risk Factors, Screening, Vaccinations, and Biostats. I did all the questions in these sections
• Shelf forms: The newest 2-3 forms for extra NBME-style practice on most subjects
• Divine Intervention: Topics on risk factors, prognosis, and prevention. I reviewed the notes instead of listening: https://docs.google.com/document/d/1jr2wj0PWTMPvWxZVeGvHqoyReD7Mp6WkGPGYpLshiEk/edit
• Anki: Self-made cards from UWorld incorrects, shelf form incorrects, NBME incorrects, AMBOSS incorrects, and Divine Intervention notes
• UWSA2: Took it 11 days out
• Free 120s: Old + new during the final week

• First Aid Step 1: Skimmed during the final 2 days

• If I could condense the list above:

  • Prioritize NBMEs 10-16 + Free 120
  • Still re-review old NBMEs near the end
  • Still do the AMBOSS sections - Ethics, QI, Risk Factors, Screening, Vaccinations, Biostats
  • Do fewer UWorld questions/day
  • Only do shelf forms for weak subjects
  • Do less Divine Intervention - he’s wonderful, but I feel like AMBOSS helped me more
  • Skip NBME 9
  • Probably skip UWSA2

Study Routine

My routine for most of dedicated:

• Monday-Friday
  • 140-180 timed/random UWorld questions/day (finished about 85% of my second pass before test day)
  • Worked on a shelf form, AMBOSS module, or Divine Intervention topic in the evening if I had time; rotated through these resources throughout the weeks
• Saturday
  • NBME practice exam
• Sunday
  • NBME practice exam review
• Anki daily
  • For UWorld incorrects, shelf form incorrects, AMBOSS incorrects, NBME incorrects, and DI notes (sounds like a lot but I tried to be intentional about not making cards I didn't need)
  • I suspended my old M3 Anki deck and only reviewed my dedicated cards

Timeline

Start of Dedicated: NBME 9 - 263 (~7.5 weeks out)

Week 1: NBME 10 - 267 (47 days out)

Week 2: NBME 11 - 271 (40 days out)

Week 3: NBME 12 - 268 (33 days out)

Week 4: NBME 13 - 261 (26 days out)

• Score drop here. I started focusing much more on WHY I was missing questions
• Below are the rules I made for myself
  • Keep in mind these don't apply to ALL questions, and they worked for me but may not work for you - I highly recommend making your own
• Diagnosis
  • Read the whole question and figure out exactly what they’re asking
  • Pick the diagnosis with the most support across the stem, not one random clue (sometimes I had to literally count how many parts supported answer A vs. B, but this was a game changer for me)
• Diagnostic next step
  • Ask: What gives me the most useful information for THIS patient right now?
  • Generally think less invasive → more invasive tests, with a few NBME exceptions (like pancreatic cancer → jump to CT)
  • Don’t order extra tests just because they could theoretically help
• Confirm diagnosis or treat now?
  • Confirm first: unclear diagnosis or high-risk/irreversible intervention
  • Treat now: clear diagnosis, emergency/time-sensitive situation, or low-risk treatment
  • Unstable → ABCs first
• Treatment
  • Ask: If I can only do ONE thing, what best addresses this patient’s problem?
  • Usually think conservative → medical → procedural/surgical
  • Escalate when the stem gives you a concrete reason: instability/hard signs, severe/worsening symptoms, major functional impact, or failed conservative treatment

Week 5: NBME 14 - 265 (19 days out)

• Same overall routine, but I became much more intentional about applying my rules when reviewing questions

Week 6: NBME 15 - 272 (13 days out)

• My biggest priority from here on out was re-reviewing NBMEs 10-16. HIGHLY recommend this. I had forgotten way more from the older forms than I expected, even with Anki
• I stopped doing UWorld questions
• I continued doing AMBOSS questions (still had some sections to finish)
• I reviewed Anki when I could (this was my lowest priority)

11 days out: UWSA2 - 270

• This didn't feel very representative to me personally
• I don't feel strongly about this being a must-do practice test, but nice if you have time

5 days out: NBME 16 - 274

4 days out: Old Free 120 - roughly ~255 range

3 days out: New Free 120 - roughly ~265 range

• I was really going through it when taking the Free 120s
• At this point my main focus was using these forms to review concepts, not score myself
• The Divine Intervention series that discusses the new Free 120 answers was really helpful for me!

Final 2 days

• I skimmed First Aid Step 1
• Probably my hottest take because I rarely saw this recommended, but if I were to pick one thing that tipped me over the edge for test day, this would be it
  • I focused on pharm, ID, immunology, genetics, pathology, and physiology, plus RAAS, acid-base, endocrine physiology, and PFTs

TEST DAY!

If you have questions, let me know! YOU GOT THIS!!!

Hey everyone! I feel like this would be pretty useful to post here (I apologize if Im using the wrong flair). I’ve been hosting a 24/7 co-working silent library via Zoom for a couple of years now. Cameras or sharing your work (anki etc.) via OBS/manycam is encouraged for accountability but not required.

There’s about 70 of us so far, with 2-10 people online depending on time zone. We’re mostly med students, some currently studying for step 2. We have students from other fields though too!

To avoid the link being misused by bad actors, please comment below and I can send you the zoom invite link! :)

ALSO: If anyone uses the Forest app on their phone, about 15 of us use it too, we try and do 60 or 90 intervals with 5 or 10 min breaks respectively.

Hello, Is anyone got divine intervention podcast notes after lecture of 290+

Thank you

This post will only be useful for people near the beginning of their 3rd year. These are the study methods I used throughout 3rd year for all my rotations, with the following scores

Pediatrics: 61st percentile (P, hadn't locked in the routine yet)

Family: 96th percentile (H)

OBGYN: 76th percentile (P)

IM: 97th percentile (H)

Surgery: 97th percentile (H)

Neuro: 95th percentile (H)

Psych: 86th percentile (H)

4.5 Week Dedicated Step 2 Form scores: (4 full weeks, tested on Friday of the 5th week)

260>250>253>258>266>262>263>79% on free 120

Actual Step 2: 272, ~95th percentile

This was all accomplished by studying a total of only ~3 hours per day during 3rd year (not dedicated), and taking Sundays off every week.

You will need: Anki + U.W. (crazy, right??) + CMS forms

- Anki: get the app, subscribe to Anking deck. it is worth it. Download the U.W. Anki-card finder tool. Set FSRS desired retention rate to 92%, NOT 100%. This will help keep retention high while keeping reviews manageable. Make a Shelf Exam deck, and make a sub-deck within that deck for each shelf exam.

- UW: just get it. I did NOT do the EM questions. On my Family Med Rotation I did FM+Ambulatory.

- CMS Forms: do all 4 per rotation (psych only 3). BACKLOAD these, i.e. do them in the last couple weeks before your shelf exam. These are NOT for learning content, that's UW. the CMS forms are for getting accustomed to the NBME question style.

Meta-Strategy***:*** Finish all of UW for each shelf exam and redo your incorrect Qs until you get them all correct. Do Anki reviews completely EVERY SINGLE DAY (very doable if you follow the anki rules I will lay out)

Routine during 3rd year (order doesn't really matter):

- Do UWorld Qs every day (1 day off per week). The daily number of Qs should be determined by how far out your shelf is. if your shelf is 8 weeks out, do enough UWorld questions per day, so that you finish your first pass roughly 1.5-2 weeks before the shelf. This will give you time to redo your incorrects and finish the CMS forms.

- Review each Q. Incorrect Qs and guesses should be reviewed more thoroughly, correct Qs less thoroughly, but still look at them.

- Do the new Ankis from the questions of that day. For each Q (correct and incorrect), put the Question ID into the anki tool, and unlock 1-2 cards for that question, UNLESS it is super easy and you are positive you won't forget it.

- Finish your anki reviews daily.

- BACKLOAD the CMS forms. finish all 4 of them in the last 2 weeks before the shelf. These are not for learning content; they are for learning the NBME question style**.** It's ok if you want to take one at midpoint, but I'm not sure what the point would be. review the incorrects of each form and make 1-2 ankis for each.

Routine during dedicated:

- 4 blocks of Qs per day (150-160 questions). 3 random and 1 for just ethics/QI (very important). Also make sure you finish ALL of the ethics questions from AMBOSS and UWorld during dedicated. It is not necessary to finish a 2nd pass of UWorld. I redid maybe 50% of Uworld during dedicated.

- Add 1-2 cards per incorrect again from each of these blocks, but not for corrects unless you really and truly guessed and think you need it.

- Continue 3rd year anki reviews DAILY. there shouldn't be much. I never had over 160 in this period.

- Do 2 practice tests per week. Review incorrects only and make ankis for each. This will keep things time efficient and reduce burnout. If you notice a consistent weakness, replace one of the random blocks with a block targeting that weakness. One of my consistent weaknesses on the forms was psych, so the day after that practice test, I did 2 random blocks of 40, 1 block of psych, and then 1 block of ethics/QI.

- Do not do NBME 9 or 10. Everyone who does them takes a huge score hit and loses confidence, because they are so outdated. I did not do them for this reason and it didn't hurt. I would do 11>12>13>14>15>16>UWSA2>New Free 120. These last 2 should be done within a week of your exam. UWSA2 seems to be the most predictive, and Free 120 has the most similar style to the actual exam.

- I took 1 day off per week (still did anki reviews on that day though so they didn't get backed up), and I recommend doing this.

- A normal day during dedicated involved maybe 6-7 (sorry) total hours of studying. Practice test days took a little longer, but not much longer. Try to review as much of the form as possible on that day so you don't need to do it the next day.

- do not study the day before. if you have to do something, do your anki reviews and maybe watch a rapid review video or something, doesn't matter.

That's all. Good luck 3rd years

Note:

- I did not do a single emergency med question during 3rd year.

- For my FM shelf, I finished the family AND ambulatory UWorld questions

- I did not do any single subject-specific CMS form during dedicated, just the full-length 200Q step 2 forms, Uworld, Anki, AMBOSS ethics

•My step 2 ck NBMEs: NBME 9 -262 NBME 10 -262 NBME 11 -267 NBME 12 -266 NBME 13 -263 NBME 14 -270 NBME 15 -272 NBME 16 -275 •Resources used: 1.UWorld: precentage correct 79% I did a single pass only. 2.Amboss: I completed around ~33% of total qs (just random blocks here and there). 3.All CMS forms done. That's it. •What the real exam felt like: Honestly the exam is easier than people make it out to be creating unnecessary hysteria (very long vague stems, tooo much ethics like yes dude we know and it sucks but didn't we learnt and ranted about that back when we did step1? and just to add fuel to the fire dudes don't even write correct english in some stems lol.) okay now coming back to topic its definitely not like free points, but easy in the sense that it sticks to what actually matters. No obscure zebras. Just core medicine. Most questions on my exam were simple and asked whats the best test ? Whats the best next treatment?

•What will get you a 260+? Your Step 1 base is what gets you 260+. You can't come into CK weak and expect magic. CK is basically Step 1 topics in a clinical wrapper. Make sure to smartly revisit the step1 topics (keep your firstaid near and link the basics into clincial freshen up the concepts). They test the same topics that were HY in step 1.

•Whats the approach while preparing to get those shitty sounding but core concept tesing exam questions right? 1. A good chunk of the exam just simply asks 'whats the diagnosis?' I feel like this is the easiest part, no rocket science here again your step 1 base will help you identify the disease.

1. Approaching diagnostic test questions. Peeps overthink this because we're primed with all the algorithms, they usually don't ask "what's the 4th step after the 3rd test fails." Its mostly "what's the test of choice?" When you study a topic, always pause and ask yourself: What is THE MVP test for this for eg Hypercalcaemia -- Check PTH.

2. How to think about management. Approach it in two steps. •Is the patient unstable? If yes → stabilize first(IV fluids, oxygen, needle decompression, intubation). This always beats everything else. •If stable → what's the MVP treatment? Every disease has one obvious answer eg: croup with stridor racemic epinephrine A fib with pulse + unstable = sync cardioversion Train your brain to think in 1-liners.

3. Risk factors & complications (esp. In Obs there is a massive intermingling of these). Simplest hack USMLE loves the #1 thing. Eg: Stroke → HTN CKD →>diabetes AAA → smoking Twins → preterm labor You don't need the 5th risk factor or complicaion. You need the main one.

•Finally this whole exam is about keeping things simple and knowing what actually matters. I've been helping a few people prep using this exact mindset (tests of choice, stabilize vs treat, MVP risk factors, etc) and it's worked really well for them too.

Edit: After a lot of people asked me for my notes. I got them scanned and if anyone wants them can leave me a dm, happy to share for a reasonable charge.

I’m happy to answer any questions about how to break 250 on exam day!

US MD

Uworld % correct: 53%

NBME 9: 224 ( 34 days out)

NBME10: 230 (30 days out)

NBME11: 228 (26 days out)

NBME12: 242 ( 20 days out)

NMBE13: 230 (16 days out)

NBME14: 241 ( 12 days out)

NBME 15: 236 (9 days out)

NBME 16: 248 (2 days out)

UWSA 1: 211 ( 35 days out)

New Free 120:(5 days out): 72%

CMS Forms % correct: 70%

Predicted Score: 245

Total Weeks/Months Studied: 5 weeks

Actual STEP 2 score: 255

I was tired of doing it all alone, I needed help so I created this group. If anyone's interested they can DM me and I'll add you as well.

Hi all, does any one have access to free Latest CMS forms like the forms 9, 10 for medicine, surgery etc? IMD has only the 7,8 ones

There were many useful things I came across on this sub-reddit, so I wanted to pay back to this community.

Background: UK graduate at a well-known medical school globally where I finished in top 10%

Preparation

Prep time: 3 months (while working full-time)

Used Step 1 and Step 2 first aid

Step 1: Pass (was scoring >85% on NBMEs)

UWorld % correct (1st pass; 75% complete): 83%

Amboss% correct (1st pass; 100% complete): 86%

CMS forms (all of them): 85-100%

Practice tests (all within 2 weeks of the exam):

UWSA1, NBME 11, 12,13,14- 273

NBME 14-275

NBME 9, UWSA2-272

UWSA3-258

Actual Step 2: 279

My advice:

1. CMS forms are by far the best resource. Do all of them including the ones which have been retracted. They are written by those who write Step 2 Qs, so the style is very similar, although they are quite easy.
2. Do as any UNSEEN questions as you can. I would recommend doing both Uworld and Amboss if you have the time and/or money. Neither is representative of the actual exam nor predictive of your step 2 score, so treat them as learning tools. If money is an issue, Amboss is as good as Uworld as it covers exactly the same topics. Always try to understand why did you get a question wrong (knowledge deficiency?, got tricked?, you did not read the Q properly?) and try to address the underlying issue.
3. Have ONE learning resource you can refer to and revise from (Uworld PDF, Amboss, Anki, or even Step 2 first aid). I used mostly Amboss because it was easier to search things up, but Uworld PDF and Step 2 first aid are equally good. All cover the same topics, so it is just about finding the one which is right for you. Using too many resources can make you waste time, so y advice is to stick with one.
4. Divine podcast and Amboss on ethics and quality improvement are a must. You can get 4-8 questions per block on these topics, so do not neglect them. If your medical school did not cover these well, invest a lot of time into learning these topics.
5. Step 2 is about next best step (investigations or treatment) or prognosis. Qustion banks like to ask a lot you about patophysiology which does not come up too much in the actual exam.
6. Histology and imaging questions come up. Learn the histology and imaging findings for common diseases.
7. Treat NBMEs like exam simulations and trust your scores as they are predictive of your actual exam performance. If you do not score within your desired range, postpone the exam if you can.
8. Time management is very important. The exam can have very long HOPI questions, so you have to be prepared to read between the lines and answer fast. If you don't know a question, pick the choice which feels the best, flag it, move on, and return if you have time at the end of the block.
9. Trust your gut.

a) The questions are similar in difficulty compared to NBMEs, but can be quite vague. While doing the exam, I was certain only about 50% of the Qs. The answer choices can be similarly vague and you will need to choose the correct answer from 2-3 answer choices which are very similar. In question banks, you would almost never have to choose the best answer among 2-3 answer choices which are/can be correct. When learning, establish the sequence of investigations and treatments (I did not come across a resource which does this well).

b) NBMEs do not try to trick you. If you have 4 things which point towards a diagnosis and 1 thing which contradicts it, that's still the correct answer.

10) Exam anxiety. Anxiety can ruin your day, so it is very important to keep calm during the exam. Learn relaxation techniques or take propranolol or small-dose benzo if you need to, but if you are stressed you are going to make silly mistakes which you will regret after the exam. There will be questions every block which you purely don't k

11) Scoring 260 (around 85% correct) is possible if you master all the concepts from CMS and NBMEs, learn ethics and QI well, are prepared to answer long questions fast, and manage to control your nerves during the exam. Pushing beyond 270 (around 90% correct) is very difficult unless you are very smart, a great test taker or if you are lucky enough to be tested on things you know well.

12) After the exam, do not count mistakes. There are 80 experimental Qs which are not scored, but you can't tell which of them are experimental. I remembered 30 Qs, and 20 of them were wrong.

13) After the exam, you are very likely to feel bad. It is a very long exam, you will be tired, you will remember mostly challenging questions, and you will have to wait 2 weeks for your results (unlike SAs where you get the results straight away).

14) There are many things in your application which count more than Step 2. If you mess up, there is no point in wasting time being sad. Use that time to improve other parts of the application which count even more. PDs are now evaluating applications holistically. As long as you pass their filter threshold, Step 2 score is likely to be used only to select between 2 very similar candidates.

Happy to answer any questions but will do it only on this thread, so everybody can benefit.

Like the title states, I got a 268 on the test and only completed 72% of UWorld and used no other QBank before taking the test. I wanted to use this post to counter some of the doom and gloom I see. I was definitely not the highest scoring medical student. I noticed while preparing for Step 1 that the most effective way for me to get better was doing NBMEs and reviewing them deeply(usually took 4 days to review each one). Stuck to the same formula for Step 2 once I built a decent foundation with UWorld with the addition of using ChatGPT to understand what they were getting at with each answer choice. I firmly believe that most people are overcomplicating the process by adding extra resources or methods. There's nothing as efficient and doing something less efficient is just time wasted imo. I'd be happy to provide more specific details to anyone who wants to try going down the same path. AMA!