Stepping Up to Step 2

By Loren Deutsch 

The USMLE Step 2

The USMLE Step 2 is a one-day exam that assesses the application of medical knowledge and clinical reasoning skills with an emphasis on health promotion and disease prevention. Step 2 has a maximum of 318 questions (8 sixty-minute blocks with up to 40 questions per block, and 60 minutes allotted for standard completion time).

A minimum of 45 minutes is available for self-directed break time between blocks. Break time may be increased by accruing time in two ways: finishing a question block before the allotted time expires and completing the optional tutorial at home before exam day. Step 2 requires stamina, pacing, accuracy, and other variables. Preparation necessitates a plan. For Step 2 specifics, visit USMLE.org.

LAS Test Prep

LAS test prep plans are designed to deepen knowledge, increase accuracy and efficiency during test-taking, and enhance achievement outcomes. All LAS test prep plans are based on a daily practice commitment, defined by interconnected practice blocks of targeted questions, maintenance questions, and self-assessments.

• Targeted blocks – Practice blocks by topic (All specialties + 1 organ system or topic). Completed in timed and test mode with a first-pass achievement goal of 70% or above.
• Maintenance blocks – Practice blocks comprised of all completed topics at 70% or above. Completed in timed and test mode, maintenance blocks maintain knowledge, hone test-taking skills, and enhance clinical decision-making.
• Self-assessments – Weekly practice tests comprised of all specialties and all organ systems. Practice forms are available through the NBME or your personal Q-Bank. They may include previous questions and are used to track progress.

LAS test prep uses recall practice to deepen knowledge, hone test-taking skills, and increase accuracy and efficiency of recall. Each plan is individualized with clear learning objectives and measurable goals, and uses weekly coaching for structure, support, and accountability.

Sample workflow – Let’s say you are currently working on cardiovascular practice questions that pertain to hypertension and coronary heart disease. The goal is to complete these questions in blocks of 10-25Qs in timed and test mode at 75% or above. Remember, this may require multiple attempts.

• After achieving 75% or above on the hypertension and coronary heart disease questions, you will add them to the maintenance blocks for ongoing practice. 

• The maintenance blocks are comprised of an ever-expanding number of used practice questions that will be reused several times before your Step 2 test date. A maintenance block is comprised of 30-40Qs and is used to maintain knowledge, hone test-taking skills, and enhance achievement outcomes. This block is a priority!

• Implement maintenance blocks 2-4 times per week depending on your timeline. As the remaining Q-Bank questions are completed at 75% or above, they are added to the maintenance block.

• During test preparation, the number of daily targeted blocks decreases as the number of daily maintenance blocks increases. The process of targeted learning, recall practice, and maintenance is repeated until all cardiovascular questions are completed at 75% or above and then restarts with the next organ system.

This plan is intended to be an adaptive roadmap for learning and achievement. It provides a framework for standardized test prep in medical education. Test preparation involves a significant study and practice commitment (approximately, 4-5 times per week) and for Step 2, is defined by the content outline at USMLE.org. Personal resources will vary. Below are examples of LAS test prep plans from Phase I (during clerkships) and Phase II (during dedicated preparation).

Phase I

Phase 2

I recommend starting Step 2 prep with your first clerkship to align content and test-taking skills with your NBME shelf exams. This approach provides actionable steps to maintain knowledge and hone test-taking skills during and between clerkships, reusing your digital Q-Bank questions. Don’t worry if your process didn’t include maintenance between clerkships. Now is the time to begin!

In an early post “How and When to Study for Step 2” we reviewed information about the LAS Medical Coaching Model™ and how to develop a study plan. For more information about LAS Coaching services, contact LAS.