The Tests that Keep Us Here – USMLE Steps

Yesterday I took the USMLE Step 2 Clinical Knowledge here in Redlands  and I thought, “What better time to write a little information post about my experience with the tests medical school requires?”

I’ve also linked the official websites for each test so you can read more about them.


When I started medical school, I knew there would be tests.

I had vaguely heard of Step 1. I assumed there were more steps; otherwise why would you number them?

Beyond that, I was lost.

So, because many of you may be planning to go to medical school, or you’re already here but haven’t taken Boards yet, or you’ve done Step 1 but not Step 2, or you just like reading these things because you’re related to me – here’s what little I know from experience about these tests.


MCAT: Gets you in to medical school.

USMLE Step 1, Step 2 Clinical Skills, Step 2 Clinical Knowledge, Step 3: Let’s you keep going and become a doctor.

MCAT: Medical College Admission Test

Information: AAMC

First things first.

As a pre-medical student, this test felt like the most important thing in the world.

It’s offered multiple times a year, computer based, and has sections on Verbal, Physical Science and Biological Science. When I took it (4 years ago) it also had an essay section, but I heard they’re changing the format with that a bit.

I took it in May after my Junior year of college. I crashed my car into a school bus the week before. Things happen.

I had to go about an hour away from my house to the test center, so I stayed in a hotel right down the street the night before – traffic stress is the last thing I needed.

And I watched the season finale of Grey’s Anatomy the night before. That was a great decision.

The most important thing I can say about the MCAT is that practice counts. It was definitely worth it to have study materials that included computer practice tests.

I spent a summer teaching the Kaplan MCAT course before I came to medical school, and while I have nothing but sorrow for the students who were forced to listen to me all summer [because of my poor lecture ability, not the content], I know they had a good chance of doing well simply because there is SO much practice built into that course. I self-studied out of a Kaplan book and that was right for me, so it depends on your study style of course.

And while it is 100% important to take and do the best you can in terms of going to medical school, there’s so much more ahead it becomes very small in retrospect.

And the best part is that once you’re in, you can forget Organic Chemistry almost completely.

USMLE Step 1

More information from USMLE.

This exam is taken after the second year of medical school. It is generally a requirement to pass both this and Step 2 before you will be allowed to start residency.

Here at Loma Linda, as in most places I expect, you must pass Step 1 before you continue on to Year 3. The school gives us the benefit of the doubt and lets us start rotations while we wait for scores to return, but students then leave rotations to take it again if a passing score isn’t earned.

You register for the test the winter of the year you will take it – so for me I think I registered in January and took it in May. Test sites do fill up – the nearest one for us is the Sylvan Learning Center on Palm in Redlands.

It covers basic information from the first two years and is arguably the most difficult and requires the most focused study time.

How to Prepare: You can get truckloads of differing opinions on this. I would say that the UWorld Question Bank and First Aid are pretty much the ones no one will argue with you about. Everything else is take it or leave it depending on your style. Just study.

The Format:

-Computer based testing. You will have a locker for belongings that you are allowed to access at breaks. Food, drinks, notes, your phone – it’s all fair game at break time. Personally I couldn’t bear to look at notes during the test, but some of my classmates are all about it.

-Blocks: The number of questions in each block may change from year to year. For me it was 7 blocks of 46 questions each.

-Timing: You have a set amount of time for each block, 15 minutes dedicated to a tutorial [which you can skip for extra break time], and 45 minutes of break time.

-Breaks: You choose when to take your breaks and how long they will be. I did this:

Block 1, Block 2

10 minutes

Block 3, Block 4

20 minutes

Block 5

10 minutes

Block 6

10 minutes

Block 7

If you finish a section early, it adds to your break time. I found it hard to take extra break time though. About 10 minutes and I was antsy to get to the next block. Hydration and food are important of course, but it’s a balance. If you hydrate too much your bladder will distract you from the test, and if you eat too much at once you may fall asleep. I sipped a little from thermos of tea at each break and had a small snack to avoid too much volume at once.

There was a guy [from a different school] who had a gallon of milk and a whole loaf of bread with him. I have no idea.

-Managing disaster: I also had a quasi-break during Block 7 because the power went out. The room went completely black, including all our computer screens. That was highly stressful, but the test gets constantly saved to a server, so we were able to start again where we left off and there were no problems with scores later on. The LLU School of Medicine administration really came through for us and made us feel like everything would be okay. Still, I was pretty much a stressed basket-case for like 4 days after.

-Passing scores and average scores vary from year to year. Check the link at the top for the most updated information.

USMLE Step 2 Clinical Knowledge

More information from USMLE. 

This test is typically taken after Year 3 and focuses on the clinical science we’ve covered in the past year. There is more of a focus on diagnostic process and treatment in addition to disease process.

How to prepare: Again, piles of opinions on this. The UWorld Question Bank is #1. First Aid is less ubiquitously used – personally I found that studying sources I was already familiar with was best for me, so I used Step Up to Medicine, because that’s what I used for the Medicine clerkship, and I supplemented other topics from the question bank. You do have a fair amount of knowledge from rotations too – maybe more than you think. I liked USMLE Step 2 Secrets too for the days right before – it’s just a very quick easy read of high yield information. Then again, I don’t have my score yet, so this advice may very well turn into “How you should not prepare,” – I’ll let you know.

Format: Step 2 is similar to Step 1 in terms of computer-based, block format.

It’s a 9 hour test – 8 one-hour 44 question blocks with a 15 min tutorial and 45 minutes of break time.

I broke it up like this:

Block 1, Block 2

10 minutes

Block 3, Block 4

10-15 minutes

Block 5, Block 6

10 minutes

Block 7

10 minutes

Block 8

Sometime in Block 6 was when my eyes started feeling really unfocused. It’s normal. Blink. You can do it.

I would say it didn’t feel as rough as Step 1 – but I can’t really compare because with the power outage in my Step 1, it’s hard to know the real source of my distress. And again, I don’t have my score, so I really don’t know. It certainly got very hard by my last block – maybe it was fatigue, but I genuinely think I had more questions at the end I just had no idea about.

USMLE Step 2 Clinical Skills, USMLE Step 3

More information: Step 2 CS, Step 3

These are still in my future, so they’ll have to be a later post. Step 2 CS is on August 16 for me, so I’ll keep you posted. Step 3 is taken during residency, so I’m going to just not worry about that for a while.


Questions? The Dean’s Office is a great resource, and of course I or any of the upperclassmen are happy to answer questions. I got a lot of advice from those ahead of me before I went through it.

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