USMLE® Step 1 & 2

USMLE high-yield topics: In the eye of the beholder?

Brendan Murphy , Senior News Writer

In your time as a medical student, the scores you record on the United States Medical Licensing Examinations (USMLE®) will play a large role in determining your options for residency programs.

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The AMA offers a series of test-prep questions for the USMLE Steps 1, 2 and 3 exams.

When formulating a study plan, the first question many students want to know is: What’s on the test? That’s the one USMLE-related question that no one person can answer.

“The reality is that most faculty or more senior people are mostly right about what they think is on the test,” said Christopher Cimino, MD, chief medical officer, Kaplan Medical. “No one person, outside of the USMLE, truly does know exactly.”

Yet there are methods and subjects in what are considered high-yield areas. Here’s what students need to know about those topics.

The first taste of boards for students is the USMLE Step 1 exam, a multiple-choice test that many take at the conclusion of the second year of medical school. That exam is generally considered one that covers basic science.

Taken about a year later, Step 2 is broken into two parts. Step 2 CK is a multiple-choice exam that covers the application of the basic sciences highlighted in Step 1. Step 2 CS is a simulated patient exam.

As far as subjects covered, Dr. Cimino painted with a broad brush.

“The general wisdom is that Step 1 has a significant portion of the test on physiology, pharmacology and pathology,” he said. “And some questions will have a combo of two or all three as part of the question.

“For Step 2 CK the dominant area is going to be internal medicine. Even for things like the surgery questions, a fair number of them have internal medicine principals,” Dr. Cimino said.

“For example, things like nutrition are in the surgical domain. They are surgical principles, but because they don’t involve cutting students tend to think of them as internal medicine. So the internal medicine aspects of all the disciplines are probably a good place to focus on in Step 2 CK.”

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There’s no one question or one area that is guaranteed to be on either the Step 1 or Step 2 CK exam.

The National Board of Medical Examiners (NBME), which authors the test, offers an outline of material that will appear across all phases of the Step exams—Step 3 is administered during residency. It is 30-plus pages and consists of 300-plus topics. It also cautions that “each Step exam will emphasize certain parts of the outline, and no single examination will include questions on all topics in the outline.”

If you dig into the outline, you can make inferences.

“If you simply count the number of items in cardiovascular disease, there’s more items than other areas,” Dr. Cimino said. “They won’t all be on the test but there is going to be slightly more. That outline provides a useful road map of what you should cover. That sort of gives you a personal road map to follow.”

As far as identifying other keys, speaking to your peers and instructors can offer some insight.

“If a student wants to figure out what’s on the test, they should meet with other students and talk about it,” Dr. Cimino said. “If they reach a consensus, they are probably right.”