Exploring Preparation for the USMLE Step 2 Exams to Inform Best Practices.

INTRODUCTION:The United States Medical Licensing Examination (USMLE) Step 1 will transition to a pass-fail format in 2022. This is likely to result in an increased focus on Step 2 Clinical Knowledge (CK) scores. Thus, academic advisors must provide evidence-based guidance for preparing students. While prior research has examined the utility of academic indicators to predict student performance on the USMLE exams, no significant scholarly effort has described or evaluated students' study approaches. The research study's goal was to understand what strategies and resources students utilized when preparing for the Step 2 CK exam and investigate the relationship(s) between these approaches and performance. METHODS:Students at a single US medical school were surveyed about their Step 2 CK preparation. We analyzed self-reported exam preparation strategies and the use of specific resources to determine their relationship with Step 2 CK score. RESULTS:Student performance on Step 2 CK was correlated with performance on previous exams, including school-specific examinations, National Board of Medical Examiners clerkship shelf exams, and Step 1. Two study strategies were positively correlated with Step 2 CK score in preliminary analyses: completing more working practice questions, and the proportion of a question bank completed. In hierarchical regression, only completing more working questions remained predictive, after controlling for demographic variables and Step 1 performance. CONCLUSIONS:Faculty and staff can optimize students' Step 2 CK performance by encouraging them to work through case-based, clinically-focused questions. Further study is needed to describe optimal preparation strategies better.