269 Write Up

Hi All,

I tested 2 months ago and wanted to share some thoughts about the exam. As a long-time lurker (not from this account to keep anonymity), I figured it was time to contribute.

Background Information: I'm a US MD student and have always been an average performer. My scores never surpassed 80 on shelf exams, and my in-house exams were similarly mediocre. Despite not being a top student, I want to highlight how achievable it is to excel on Step 2, regardless of past academic performance. I dedicated 8 weeks to prep.

Materials Used:

  • 50% of UWorld for main systems
  • 40% of AMBOSS Qbank
  • STEP 3 Free 120s + practice exam
  • All CMS forms
  • All NBME exams

Schedule: During the first month, I focused exclusively on UWorld, averaging 80 questions daily. My routine was as follows:

  • Morning: One block of UWorld + content review/making Anki cards
  • Afternoon: Repeat the morning routine
  • Evening: Review Anki cards

I spent considerable time on Anki, which, in hindsight, was a mistake. Anki led to passive learning and an overemphasis on specific facts. I often missed questions if the fact I memorized wasn’t explicitly mentioned. I remember getting a question wrong on a topic that I had done anki for over 10x, and at that point i said screw this.

After a month in, I had one main problem: my retention rate was shit. Like seriously. I was still missing questions on MI and PE. No matter how many times I went back to the AMBOSS library and studied a certain disease, I would still get questions wrong no matter how thoroughly I reviewed. For this, I implemented a new strategy that increased my retention rate by a huge margin. I bough physical notebooks and began writing notes. Not on a laptop, not typing, not going through anki cards. I quickly found that ACTUALLY WRITING down notes helped me remember material a lot better. I literally had 10 notebooks filled by the end of dedicated. Before people ask, i would try to review a book every night just looking through my notes, but honestly i didnt spend too much time reviewing them. So why write them down if youre not going to review them? TBH the only thing I can say for me was that the process of writing them down engrained the material in my head. Every time I got a question wrong, I would go to AMBOSS and retake notes on that topic, even if I had already done so in the past.

Thoughts on UWorld: I found UWorld overrated and unrepresentative of NBME-style questions. Despite high averages on UWorld, my practice exam scores didn’t reflect this. Their style was way too different than NBMEs, so I ditched it.

My next 4 weeks were different. For the first 2.5 weeks,I dropped uworld and instead I spammed all the CMS forms + content review. I did the last 3-4 for all nbme subjects. I found that the much older ones were too easy and no way representative of the practice exams I was taking. I was paying special attention to any topics that kept getting repeated on CMS forms and made sure to write notes for that. After finishing the CMS forms, I actually decided to do STEP 3 exam questions. I did the most recent NBME for it, and I also did the last two free 120s. IMO it was great and not too far off from step 2 content.

My last week and a half was a little crazy. At this point, I scored a 260 on NBME 14 a week out. I was happy with the score, but I really wanted to reach my max potential. I had run out of CMS forms (minus the old ones which I wasnt going to waste time doing) and I was NOT going back to uworld from how trash I thought it was. So I decided to buy the AMBOSS qbank and i RAN THROUGH it. I was literally spamming questions from the moment I woke up until I slept, while jotting down notes for any question I got wrong and kept going. I was NOT going into details for the topics I got wrong. I simply needed the exposure. IMO amboss qbank was WAY better than uworld. It covered a lot more range of topics, and even weird topics (which NBME loves). I literally remember having a question on jellyfish which showed up on my actual thing. I peaked at 300 questions per day during these 7 days. I saved the free 120 for two days before my exam. The day before my exam, I chilled, did some light review, and around 5 pm I went for a 3 hour walk (no phone, no music, nothing) and came home and knocked out.

Ethics and QI: Three days before the exam, I dedicated a whole day to ethics and quality improvement, using AMBOSS Qbanks and their high-yield notes.

Biostats: idk. Randy neil was amazing, but other than that I really have no advice. It's stupid.

NBME Scores:

  • NBME 9 (35 days out): 235
  • NBME 10 (30 days out): 264 (lucky guesses)
  • NBME 11 (23 days out): 256
  • NBME 12 (17 days out): 252
  • NBME 13 (13 days out): 261
  • NBME 14 (9 days out): 260
  • NBME 15 (3 days out): 260
  • Real Deal: 269

Reviewing Exams: Reviewing mistakes was crucial. I categorized errors into:

  1. Big picture: I missed the big picture. Example, a question paints the picture of a patient with ischemic colitis, but one sentence throws me off and I go with ulcer. You have to be able to identify the big picture. I had my specific technique to help me with this.

  2. Content gap: Pretty simple, I didnt know the content, never heard of the disease, etc.

  3. Chose an answer contradictory to what I knew. Nothing pissed me off more than these. I found A LOT of questions I was getting wrong because I chose an answer choice that I CONTRADICTS WHAT I KNOW simply because I didnt know the answer.

  4. Didnt read the question properly. Stupid mistake, happens to all of us.

  5. Failed to identify hidden question. Now these were the very tricky questions where they want you to pick between two choices that both seem like they can be the right answer. Iykyk.

  6. Failed to critical think. Questions where I was unsure of, but had I thought about it a littler harder, I feel like I would have arrived at the right answer. These are the questions where you are down to two possible choices, but choose the wrong one.

Exam Day: I went in with a bag of chips, some nuts, and two monsters. Thats what I was doing with my practice exams, so I stuck with it. Exam felt reasonable, but it was very random. This whole process in the end is random. I had two fucking questions on rett disease and no questions on stroke to put things in perspective. Two fucking questions on rett. Thats why after all this, I realized the biggest thing is exposure. Exposure. Exposure. Do as many questions as you can, even if you only see a topic once. My last few days of Amboss came in clutch because I got exposed to so many topics in a little time.

I'm more than happy to answer any questions yall have. Ill try my best. I could also start offering tutoring sessions (areas you are weak in and test taking strategies and how to get in the mindset of and think from the perspective of NBME). If people are actually interested, dm me.