My COMLEX LEVEL & USMLE STEP 2 Write-Up

Outlined below is the study strategy and plan that I used to prepare for COMLEX LEVEL 2 & USMLE STEP 2 medical board exams. This strategy is a continuation of how I studied for LEVEL & STEP 1. I recommend reading that article as well, since I will avoid repeating myself here.

I relied heavily upon the AnKing deck and AnkiHub for studying. The AnKing team is amazing. They are truly revolutionizing medical education. I personally purchased a lifetime membership for AnkiHub as soon as it was released, and I also paid for their Bronze Tier VIP Membership. I used these resources to keep my content up to date and be as efficient as possible on Anki. The AnKing team is working hard (even while in residency!) to continuously improve Anki. By the time you’re reading this, Anki will likely look a little different than how I’m describing it, or how it looks in the YouTube videos linked below. 

M3 Study Strategy

After completing LEVEL & STEP 1 exams, I suspended all my AnKing cards and started M3 with a blank slate. I did this to spend less time reviewing Anki each day.

Before starting M3 rotations, I created a spreadsheet (Image 1) and designed a plan for how I would study for my COMAT exams (the DO-equivalent of a Shelf) throughout the year and simultaneously prepare for LEVEL & STEP 2.

I used AMBOSS as my primary learning tool throughout M3, saving UWorld (UW) for dedicated. The weekend before I started a new rotation, I would calculate how many questions I’d have to do each day to complete 100% of the relevant COMAT questions. To do this, I simply divided [total number of questions] by [total number of days I planned to study]. I would look at my calendar and literally hand count the days I wanted to study on. My goal each block was to complete all the questions about 3 days before the COMAT, and then use those final days to watch review videos from Dr High Yield, Emma Holliday, or Divine Intervention.  

How to Determine Total AMBOSS Questions:

1. Open the AMBOSS Qbank.
2. Filter for unanswered questions within the Shelf (i.e., COMAT) subject of interest.
3. Make sure to select all 5 hammers of difficulty to see all available questions.
4. See the question count at the bottom.

I completed questions on Study Mode so that I could take my time. Also, when you're in the hospital/clinic, you only get random, short periods of time to study. Study Mode is most conducive to that start-stop environment.

One great feature of AMBOSS’ Qbank is the ability to filter by question difficulty. During the first few days of a rotation, I would only do 1-3 hammer questions. When I noticed that I was getting the 1-hammer questions correct nearly all of the time, I would then start doing 2-4 hammer questions only (removing the 1-hammer questions, adding the 4-hammers). As I felt more confident in the material, I would add 5-hammer questions. This helped to boost my confidence early and gradually increase the difficulty as I approached the COMAT.

As I worked through the Qbank, I would unsuspend AnKing or create new cards as needed. The goal was to unsuspend ≤3 cards per question to maintain a low daily review count. For reference, during IM, I was averaging around 100 review cards a day and 40 questions a day. Every rotation thereafter, I was averaging about 50 reviews a day and 10-20 questions per day.

I spent about 1.0-2.5 hours studying every day. This includes Anki reviews, AMBOSS questions, and unsuspending and reviewing new cards.

Some people, including the AnKing, recommended unsuspending random cards in the Cheesy Dorian (M3) deck to learn new information, but I thought this was ineffective and a poor use of my time. More cards to review meant less time for myself and my family, so I ignored this advice. Instead, I only unsuspended or created new cards based on missed questions.

I NEVER suspended cards upon completion of a rotation. When I started a new rotation, I would create a new filtered deck to help compartmentalize my studying. For example, while on my Pediatric rotation, I would have a unique filtered deck for only cards related to Pediatric Missed Questions (based on tags), then I would review all the other cards together from previous blocks (i.e., IM + OBGYN). I started every day by reviewing my filtered deck at a comfortable pace to help retain the most information. Then, I would review the comprehensive deck at a slightly faster pace, since it wasn’t necessarily relevant to my upcoming COMAT, but still relevant for LEVEL/STEP 2.

Dedicated Plan

Again, I took the time to create a plan for Dedicated and recorded everything in a spreadsheet (Image 3). I scheduled STEP 2 on June 12 and then LEVEL 2 on June 28 (16 days later). For my DO colleagues, I recommend STEP first so you can cram OMM material in between. I think 7-10 days in between exams is enough. You will likely feel fatigued and/or burnt out after taking STEP 2, and will want to get LEVEL 2 over with quickly. 

I had about 5-6 weeks 0f "true" Dedicated study. I always took off at least one day each week to allow myself to recharge and come back fresh and motivated.

My goal during Dedicated was to do as many questions as possible from UW Qbank and self-assessments (SAs). Volume, volume, volume! I also wanted to simulate Test Day conditions so it wouldn’t be such a shock mentally or physically. I began with completing and reviewing 3 UW blocks (of 40 random questions) per day and worked my way up to 4-5 blocks per day over the first 2 weeks.

I completed the blocks back-to-back on Exam Mode to practice pacing myself, taking 10-minute breaks between each. Then, I would review them and unsuspend relevant Anki cards (as opposed to completing one block, then reviewing, then completing a second block, then reviewing, etc.). When reviewing, notes on questions should be 3-5 sentences long, answering: why X right + why Z wrong + objective. If I got the question correct, then I only read or took notes on the objective. See Image 4, below, for an example.

Self-Assessments (SAs)

On days I took a SA, I would complete the exam in Test Day conditions. I started the exam when STEP 2 was scheduled to begin. I took appropriate breaks between blocks. I stayed off my phone. I ate the snacks I planned to eat on test day. And so on.

After completing a SA, I would look at my score and then try to relax the rest of the day, reviewing the SA on the following day. I did this because I personally couldn’t do both without feeling totally exhausted towards the end of the review, which diluted the quality of my learning. However, I was able to take UWSA 1 & 2 and review them same day.

I wanted to complete as many SAs as possible, so I created a schedule to space them out (Table 1). I looked at my calendar and blocked off time for each SA in advance and built my daily schedule around it. For clarity, Timing refers to x weeks out from Test Day.

OMM Material

These final 16 days of Dedicated looked quite different. I would only do about 1-2 blocks on TrueLearn of random questions, or I’d filter for specific subjects like stats, law/ethics, OMM, etc. After reviewing them, I would watch Dirty Medicine’s OMM and Law/Ethics playlists (linked above), making sure to create Anki as needed for both.

My LEVEL 2 dedicated days were remarkably easier than the STEP 2 days that preceded them. I simply didn’t feel as motivated. Also, after spending so much time exclusively using NBME and UW resources, TrueLearn felt like a breeze. My percent-correct on TrueLearn was consistently ≥80%, compared to UW's 65%. (Not that the number matters at all anyway. Point here being that TrueLearn was far less challenging for me.)

General Advice & Test-Taking Strategies

After watching the Dr High Yield video on test taking tips (linked above), I created my own modified list that I would read every single morning:

• God is in control. (Trust the process)
• Rule out the other answers.
• If you know one of the answers to be true, and unsure, pick the one you are sure about.
• If you don't know, pick the most common thing—even if you initially crossed it off!
• Keep it simple.
• If you don't know, then move on quickly to save time to get the rest correct.
• Age & Timing are important.
• Put the whole picture together.
• When you narrow it down to 2 answers, try to reject one of them.
• Don't assume a dx w/o evidence (e.g. if there's no elevated lipase or imaging, then it's not pancreatitis).
• Determine the most common cause of c/c given pt demos.
• Read the entire vignette quickly; flag and return to at end if click & move.
• Trust your gut (if ultimately not sure, then it's often the one you initially selected).
• They're telling you the answer.
• Stay calm and read carefully; don't rush.
• Assume they're not trying to trick you; sometimes they will, but mostly they're not!
• Think like a clinician.
• If you must guess, do the least invasive thing.
• Don’t get frustrated; ask yourself, "what do I know?"
• Use the calculator and confirm the lab values!!
• Oftentimes I just need 1-2 blocks to warm up. That’s OK.
• Your life DOES NOT depend on this exam. Approach with care-free attitude (loosen up).
• Be standardized and unemotional. Have rules for how to approach questions and execute.
• Visualize yourself being successful. Your thoughts have powerful influence. Be bold, but not cocky.

Post-Exam Thoughts

My Stats

I have shared my stats below. I think it helps to see what can happen, but please remember that these are just numbers. There are always outliers. I've heard of people who consistently score on the lower end on SAs during Dedicated, and then significantly outperform on Test Day, and I've also seen the opposite. I am a case of the latter.

After Action Report

In the end, I scored a 240 on STEP 2 and a 647 on LEVEL 2 (about 26^th and 89^th percentiles, respectively). I did great on LEVEL 2, but significantly underperformed my predicted score of 250+. 

I realized that I had put an immense amount of pressure on myself to perform well on STEP 2, which, in hindsight, I regret. I was so fatigued after STEP 2 that I decreased the amount of studying I did every day to avoid burning out before LEVEL 2. In my mind I justified this by thinking (rightly, or not) that programs didn't care much for my LEVEL 2 score any way. This had the unintended effect of relieving stress and freeing up space in my mind to learn and perform better on LEVEL 2. If I could go back in time, I would try to work on ways to do this sooner for STEP 2. I wish that I had listened to The Divine Intervention episode below before Dedicated; I highly recommend everyone listen to it.

I was devastated when I got my STEP 2 score back. I know that many would do anything a 240, but I was preparing to apply for Diagnostic Radiology (DR), a competitive specialty where the average STEP 2 CK score of a matched applicant according to 2024 NRMP Charting Outcomes for MDs vs DOs is a 256 and 252, respectively (see page 49). I became extremely nervous about my odds of matching into DR.

My advisors would tell me that I should dual apply IM and DR because, based on the data, my chances of matching into DR were not great. I can’t blame them for that. They made their best recommendation based on the data—that’s all they can do. They also have to hedge their bets, and recommending that an applicant dual apply is the safe play. Against their advice, I chose not to dual apply.

At the time I’m writing this, I have completed 7 DR interviews and 12 preliminary/TY interviews, which means that my STEP 2 score was good enough for many programs. Would I like to have a longer Rank Order List? Of course. But that's just for my ego. I am blessed to have received interview invitations from all my top choices, and some impressive programs that I never thought would be interested in me. If I were to have more interviews, they would just be added to the end of my current Rank Order List, since there is no place I'd rather be than the programs I've already interviewed with.

Match Day 2025 is right around the corner. I am undeniably anxious, but optimistic about my chances of matching. During my interviews, many Program Directors (PDs) said that if I received an invitation to interview, then it means I was deemed good enough to become a radiologist—the interview is just a means for the program to determine if we're a good fit for each other. This validation offers me some peace of mind.

In summary, data is helpful in assessing your odds and determining if you're "in the ballpark" range of success, but it only gives you an idea of what the average applicant looks like. Most importantly, it does not show you the outliers who successfully match. Just because you may not have all the best stats on paper, it doesn’t mean it’s impossible to match. 

There are strategies to help increase one's odds of successfully matching, but I'll save that for a separate post. I also plan to share an inspiring story from one of my colleagues who, against all odds, will almost certainly Match DR this cycle with over 20 interviews despite failing STEP 1.

Please let me know what you think and leave a comment below!