Stepcrusher
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I just took Step 1 and Step 2 on consecutive days, so I feel reasonably well qualified to comment on the differences in style and substance between the two steps.
When it comes to the pool of knowledge required, the actual diseases and bugs and drugs that one needs to master in order to have the best chance of answering the questions correctly, the differences are small. I don't believe that there was a single factual point that was consided "fair game" for Step 2 but "off-limits" for Step 2. Some of the most obscure details of Internal Medicine or OBGyn or Surgery could and did show up on Step 1.
The reverse, that anything that was fair game on Step 1, including details of molecular biology, gross anatomy, physiology, etc., was also fair game on Step 2, was almost equally true. The only exception is that I didn't see any of the intermediates of the metabolic pathways on Step 2, while they did show up 5 or 6 times on Step 1.
There was some difference in the level of overlap between the two steps, however. Overall, I think that being well-prepared for Step 2 helped me on 40-50% of the Step 1 questions, but being well-prepared for Step 1 helped me on only 20-30% of the Step 2 questions.
When it comes to style, the differences between the steps were dramatic, far more than I was anticipating. In summary, Step 1 is almost pleasant to take if you've prepared well and learned most of the material in the popular sources, such as First Aid, Kaplan Notes, etc. Most of the time, you can read the one paragraph question in about 10 seconds, look for the answer you expect to find in the choices, review the other choices to make sure you can safely eliminate them as possibilities, then move on. Even if you stumble onto a question where you either never knew or completely forgot the information being tested, you can quickly determine that's the case and guess and move on. If you want to sit there for 3 minutes and agonize over which of the choices you can't eliminate is the best, you can, but it's stricly your choice. Repeatedly agonizing over the questions you don't know is just about the only thing that will get you into time problems on Step 1.
There are the occasional off the wall questions that will make you wonder what kinds of whips and chains the question writers must be using when they make up the questions, but they are the exception and not the rule. At least 70% of the questions could be answered pretty quickly if it were an open book test and you could take your study materials with you to the test. Hopefully, if you've prepared well most of the time you can just retrieve the answer from your memory and bank the point.
Step 2 is another story altogether. On this one you KNOW that the question writer committee must have been convening in various torture chambers when they came up with the questions. There are only 46 questions per 60 minute block, as opposed to 50 per 60 minute block on Step 1, but don't let this fool you. The average number of words per question is at least 3 times the average number of words on Step 1. What's worse, most of the words are overtly designed as red herrings to distract you, fool into the wrong answer, or force you to waste valuable time.
On Step 1, although there were a few questions that were virtually impossible to answer, even if you had access to world's greatest medical library, I don't remember a single one that had no other purpose than to force you to slog through hundreds of words of extraneous information just to force you to waste time. On Step 2, fully 2/3 of the questions are in this category.
Maybe 10-20% of the Step 2 questions are in Step 1 style, where if you know the material cold you can read the question and get the correct answer within 10-15 seconds. Then there are a few where there are several paragraphs of information that you can skip just by reading the last sentence of the question and realizing that nothing in the question can help you get the answer (e.g. a long vignette followed by a question like: What is the most common cause of death in the X-Y age group?).
With the vast majority of the questions, however, even if you know the material cold you will be forced to spend at least a minute reading the question in order to be able to get to the right answer. This is not a slow cautious read I'm talking about either; I'm talking about speed reading.
No small number of them will even require you to click on the normal reference values screen in order to find the normal range. I'm not referring to normal values for Na and K and Hct either that most people should already know - I'm referring to some of the most obscure numbers on the reference table that almost nobody will have memorized, especially since there are both US and SI units given in the table. It wouldn't be so bad if spending 20-30 seconds looking up the reference value gave you the answer, but many times you'll look up 3 to 4 numbers only to find out that all this effort allows you to eliminate only one of the answer choices. In some cases both the wording of the question and the bogus answer choices make it obvious that they are trying to punish anyone too lazy or too time-constrained to look up the normal values.
The result is that even if you get the answer right, in the vast majority of cases it will take a significant bite out of the remaining time on the clock. I don't care how well prepared you are or how fast a reader you are - you will feel time pressure on Step 2. There simply are too many words that have to be read and understood in 60 minutes, and the questions are explicitly designed to force you to read every word, even if many of them prove not to be germane to the answer. You can choose to not read the questions thoroughly, but it will definitely cost you the ability to get the right answer in many cases.
So, assuming that you wade through all of the extraneous verbage in the Step 2 questions and get to the information actually required to answer the questions: Are the questions actually more difficult than on Step 1? I think the answer is a qualified yes. Although many of the same obscure diseases show up on both steps, more often on step 2 you'll be forced to go into a level of knowledge of the disease beyond what you find in the First Aid and Kaplan notes and other common review books. Also, the wording of the answer choices is more frequently obscure, ambiguous or obviously intending to trick you into the wrong answer if you aren't 100% confident of your correct answer choice. I'm not saying this doesn't happen on Step 1, but they make an art form of it on Step 2. You just can't help but get the idea that it's a different group of people writing the Step 2 questions with a different set of ground rules.
Another difference between the Steps: Step 1 rarely has more than 5 or 6 answer choices; Step 2 routinely offers 10 or 15. Obviously, if you are sure of the answer this doesn't really matter, but if you are forced to guess at all your odds go down when you have to choose 1 out of 15 rather than 1 out of 5.
Another point I hadn't seen elsewhere is that Step 2 has 8 1 hour blocks and Step 1 has 7. Combined with the fact that virtually everybody will need all 60 minutes in the Step 2 sections while sometimes you can complete a Step 1 block in 45-50 minutes, endurance becomes a much larger factor on Step 2. In my case, I started Step 2 at 8:30 am and finished at 5:00 pm without taking a lunch break. With Step 1 I started at 8:30 and was out by 3:30 despite an extended lunch break.
It also follows from the extra block on Step 2 (and the 46 rather than 50 questions per block) that there are a total of 18 more questions on Step 2 than Step 1. If it is true that the raw number of questions correlates pretty well with the final score (ie. a score of 200 translates into 200 questions answered corrected), then this could account for the greater difficulty of Step 2, since in this case you could miss an additional 18 questions and get the same score. This is the only reason that I can't be sure that I scored higher on Step 1 than Step 2, despite what I think is the obviously higher degree of difficulty of Step 2.
What are the implications for people trying to prepare for Steps 1 and 2? My advice for Step 1 would be to use the traditional materials like First Aid, Kaplan notes, etc. and put all of your study time into mastering them as best you can.
In contrast, for Step 2 I'd be inclined to rely less on the review books and spend more time with Cecil's or Harrison's or some other textbook where you might learn a page of detail about a particular disease rather than 2 sentences. Although there is no way around the challenges of the clock on Step 2, what ultimately will help you the most is arming yourself with as much factual detail as possible so that you won't have to agonize between two or three promising sounding answer choices, even for a few seconds. For those diseases where I had read Cecil's, it paid off for me big time in terms of time savings.
In terms of specific details, there's not much point in trying to list all of the diseases and bugs and drugs that showed up. This is already a long post but it would be ten times longer if I tried to do that. The only specific point that I would note is that there were probably at least a couple of dozen questions that dealt one way or another with sexually transmitted diseases. And there are many more questions that mentioned things like: "The patient has sex only with her husband" or "The patient has had five sex partners in the last year" or "The patient masturbated to orgasm" only to ask about something other than STDs or sexual function. It's all part of the theme of forcing you to wade through gobs of extraneous material to get the answer right.
I hope some of you find this information/editorial opinion helpful. I haven't posted before but I have benefited from this forum and wanted to try to give something back as best I can.
Good luck in your preparation.
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| mjl1717
Forum Hero
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Stepcrusher good luck and thank you very much for the info!
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| PsychDr2B
Forum Elite
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Thank you Stepcrusher. Your comparisons have been the most real and sincere I have seen to date. I wonder why I always hear about IMGs passing Step2 versus Step1 on first attempts. Perhaps, that may have been the case in the past versions of Step2. Now, with the elimination of TOEFL, I guess they try harder to test language comprehension, as well, by using these long verbose question stems. At any rate, I pray for your and all our success in our steps to being in one of the most respected professions in the world.
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| alfie58
Forum Newbie
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Very good post. Thank you for sharing. You answered so many of my questions.... even though I did not like the answer.
Good luck.....
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| adeelmd
Forum Elite
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u answered a question before i even asked it. and don't worry... if step 2 is indeed harder, it will be harder for everyone... hence it will be marked accordingly. I think the reason people score higher on step one than step two is that they spend much much much more time on step one, and then try to rattle of step 2 asap. (at least cases i've seen)... but ur post was very eye opening and i will try to adjust my step 2 studies accordingly. thank you.
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| FH
Forum Senior
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Thank you for the real time step1 nad 2 comparison. Its really eye opening and very intimidating.
Good luck for your future ventures. Keep us posted with the same detailed experiences of CS and step3.
Thanks again.
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