Residency Advisor
It’s 11:47 p.m. You’ve got UWorld open in one tab, a dozen Reddit threads in the other, and five different board prep books in your Amazon cart. Everyone around you swears their book is “essential.” Your group chat is split: Sketchy diehards, Anki cult, First Aid loyalists. You can feel it already—if you pick wrong, you’ll waste months.
Let me be blunt.
The people who crush Step/Level—not “I did fine,” but 250+ Step 2, Honors shelf after shelf—are not using 15 different resources. They’re using a ruthless shortlist, and they actually finish it. Faculty know this. Chief residents know this. Program directors can tell who tried to brute-force 20 things vs the ones who mastered 4.
I’m going to walk you through what those shortlists actually look like. Not the marketing. Not the Reddit fantasy where people “used everything.” What high scorers really lean on when no one’s watching, rotation by rotation and exam by exam.
We’re talking concrete, resource-by-resource truth.
The First Big Truth: Books Are Now Secondary Weapons
Let me start with something most attendings won’t say out loud: the era of “books-first” board prep is over.
On the back end, when we talk about students in committee—who’s sharp, who has board-level thinking—you hear the same pattern:
- “She finished UWorld twice and lived in Anki.”
- “He made his own deck off OnlineMedEd and UWorld notes.”
- “They barely opened the big review books but killed every NBME.”
The engine of top scores is question banks + spaced repetition + targeted video. Books are satellites now. Still useful. But not the sun.
So what are books actually doing for top scorers?
Three things, mainly:
- They fill concept gaps you keep missing in questions.
- They give you more structured, narrative learning early on.
- They serve as a compact, curated “map” so you’re not lost mid-questions.
If you’re reading a book cover to cover and barely doing questions, you’re prepping like it’s 2009. And your scores will look like it.
The Core Shortlist: What High Scorers Actually Use for Step 2 / Level 2
Let’s get specific. When we look at the 240–260+ crowd on Step 2 and high 500s+ on Level 2, their resource list usually looks boring. That’s the tell. Too many resources is always a red flag.
Here’s the pattern I see over and over.
| Component | Resource |
|---|---|
| Question Bank | UWorld (primary), +/- AMBOSS |
| Spaced Repetition | Anki (mature deck or custom) |
| Core Text | Step-Up to Medicine *or* Case Files |
| Videos | OnlineMedEd, Boards & Beyond (select) |
| Extra Cases | UWorld CMS + NBME/COMSAE forms |
Notice what’s missing? No seven-book series. No full Kaplan library. No “one book per subject” nonsense.
Now let’s dissect the book side of that.
Internal Medicine: The Real Workhorse Book (and its limits)
If you’re going to own one clinical book during clerkships, it’s this: Step-Up to Medicine.
People love to complain it’s too dense. And they’re right. It’s not light reading. But you’ll hear the same thing from residents who crushed IM:
“I didn’t read Step-Up to Medicine. I mined it.”
That’s the correct mindset.
How top scorers actually use it:
- During your IM clerkship, they don’t read 600 pages. They go targeted:
- Cardio, Pulm, Renal sections early, cross-walking with UWorld blocks.
- GI, Endo as they start to see patients and miss questions in those systems.
- They use it as a reference when UWorld exposes a gap. Missed a question on aortic stenosis? They spend 10–15 minutes in that specific topic.
- Before the shelf, they skim the tables and algorithms at the end of each chapter—those high-yield differentials, diagnostic workups, and management steps.
Who actually benefits from cover-to-cover here? The unicorns. People with time, fast reading speed, and strong base. For everyone else: selective, problem-driven reading.
The quiet truth from attendings: when we see a third-year who’s talking workup and management in neat Step-Up language—“Given her CURB-65 score…”—we can tell they actually opened the book. Those students stand out on rounds and on shelves.
When Step-Up to Medicine is a bad idea
If you barely survived pre-clinicals and you’re already drowning on the wards, trying to “do Step-Up” on top of UWorld will bury you. Those students end up halfway through the book, behind on questions, and anxious as hell.
In that scenario, you’re better off going lighter: more cases, fewer encyclopedia chapters.
The Case-Based Favorites: How Top Scorers Use Case Files and BRS-Style Books
Here’s the part students constantly misunderstand.
Case Files is not a full curriculum. But high scorers love it for one reason: it matches how questions are actually written—patient vignette, labs, next best step. It’s board thinking in story form.
How the 80th+ percentile group uses Case Files (IM, Surgery, Peds, OB/GYN, Psych):
- Early in the rotation: 1–2 cases per night, not 10. They do it before diving into heavy UWorld blocks.
- Before shelves: they flip to topics they’re weak on. Bad at OB triage? They do the L&D-related cases only.
- They focus more on the “discussion” and “clinical pearls” than on memorizing every line.
Same story with Blueprints or older BRS-style clinical books. They’re lighter, more outline-based, and good for students who need a structured starting point before hitting big banks.
But let me be honest: on the back end, among the people who really impress us on shelves, we hear “I did every UWorld question and some Case Files,” not “I read all of Blueprints cover-to-cover.”
Specialty by Specialty: What the Top Test-Takers Actually Use
Time to get brutally concrete.
Internal Medicine Shelf + Step 2 Core
Shortlist of what the high performers actually use:
- UWorld IM questions (multiple passes of incorrects)
- Step-Up to Medicine (targeted)
- Case Files: Internal Medicine (selective cases)
- Sometimes: OnlineMedEd notes as a bridge
How it looks in reality: They’re doing UWorld blocks daily and using Step-Up only to patch holes. The book is not driving the studying. It’s supporting it.
Surgery Shelf: The Most Over-Book-Studied Exam
Surgery is where people waste the most time with the wrong books. The truth from surgeons: the shelf is mostly medicine, fluids, electrolytes, and peri-op management. Not you playing mini-chief in the OR.
The students who crush surgery shelves usually do this:
- Primary: UWorld surgery + a lot of IM questions (especially GI, trauma, ICU-type cards)
- Books actually used:
- Case Files: Surgery – widely used, very aligned with shelf.
- Dr. Pestana’s Surgery Notes – small, sharp, still useful; good 1–2 reads.
- Some will add Surgery: A Case Based Clinical Review if they’re trying to impress surgeons or they’re truly interested in the field, but that’s enrichment, not necessary for high shelf scores.
Surgery attendings will rave about big textbooks, but when they quietly ask the MS3 who honored, that student almost always says: “Pestana, Case Files, UWorld.”
Pediatrics: Light Book, Heavy Questions
For Peds, the top scorers generally keep it simple:
- Case Files: Pediatrics – very common, often called “enough” if paired with questions.
- Sometimes BRS Pediatrics or Blueprints Pediatrics, but these are increasingly optional.
Pattern I see: UWorld + NBME practice + Case Files. Done. They don’t go hunting for the perfect peds compendium.
OB/GYN: Where Case Files Really Earns Its Reputation
This is one rotation where I’ve consistently seen Case Files: OB/GYN make a real difference.
The top OB shelf scorers:
- Do all of UWorld OB/GYN.
- Read Case Files OB early in the rotation, then re-read high-yield areas (L&D, hypertensive disorders, bleeding, prenatal testing) before the exam.
- Some will add Blueprints OB/GYN, but again, it’s usually secondary to Qbank + Case Files.
The behind-the-scenes reality: OB shelf has a certain style—triage, “next best step” for pregnant patients, lots of algorithmic decision trees. Case Files trains your brain into that flow.
Psychiatry: The One Rotation Where A “Book-First” Approach Sometimes Works
For Psych, the high performers often say something like:
“Honestly, I read through Case Files Psych and did UWorld and that was enough.”
Why? Psych shelf is pattern recognition and criteria-based. Diagnostic frameworks are king.
Common pattern:
- Case Files: Psychiatry or First Aid for the Psychiatry Clerkship early on.
- Then UWorld and NBME or COMAT practice forms.
Books here are more manageable and the shelf is a bit more forgiving content-wise. You can get away with a little more reading up front.
The Myth of the “Master List” and What People Actually Finish
Students always ask for “the best books” like there’s some Platonic ideal combo. That’s not how this works.
Inside faculty conversations, what we quietly track in our heads is not who used which brand of book, but who:
- Finished their primary Qbank for that rotation.
- Actually reviewed incorrects instead of just marking them.
- Used one or two written resources deeply instead of skimming ten.
Let me show you how the time really plays out when you map books vs questions.
| Category | Value |
|---|---|
| Question Banks & Review | 45 |
| Spaced Repetition (Anki) | 25 |
| Books & PDFs | 20 |
| Videos | 10 |
You see the imbalance? Top scorers are spending most of their time in active work: questions and retrieval. Books are a minority slice.
So the real “shortlist” that separates people isn’t just which titles they own. It’s which ones they actually finish:
- One primary Qbank: completed.
- One primary clinical text or case book per core rotation: at least 60–80% used in a targeted way.
- One consistent note or Anki system: not abandoned halfway.
Everything else is noise.
What About COMLEX / Level 2? Do DO Students Need Different Books?
Here’s the off-the-record answer DO students always get whispered to them by residents, not faculty:
If you want competitive programs—especially in non-primary care—you study like a USMLE taker first, then layer OMM.
Which means: your book shortlist looks basically the same as the Step 2 people, but you add an OMM resource.
Common pattern from DOs with strong matches:
- Use UWorld + sometimes AMBOSS as the core.
- Use the exact same books: Step-Up to Medicine, Case Files series, maybe Blueprints.
- Then add:
- Savarese OMT Review as the OMM bible.
- COMBANK/TrueLearn for COMLEX-style question reps.
They don’t waste time hunting for “COMLEX-specific” books outside OMM. That stuff tends to be watered-down rebrands of USMLE material anyway.
M3-M4 Year Flow: When to Use Books vs When to Drop Them
You can’t treat all months of third year the same. This is where a lot of people shoot themselves in the foot.
Early in the year (first 1–2 rotations):
- You’re still figuring out how to even study in the clinical world.
- A structured book like Case Files or a lighter outline text gives you a base layer so UWorld isn’t completely foreign.
- Reading a chapter or case per night before diving into heavy question volume works.
Mid-year (once you’ve survived IM or Surgery):
- You should be flipping that ratio.
- Questions become your primary, and books become “consults” when you don’t understand something.
Late year (Step 2 / Level 2 dedicated):
- This is where the top scorers diverge sharply from the mid-range.
- The best of the best:
- Don’t start new books.
- Maybe re-skim high-yield sections from Step-Up to Medicine or their clerkship notes.
- Spend almost all their time on:
- UWorld reset or incorrects
- NBME/COMSAE practice
- Tight Anki review of weak topics
The students who tank dedicated are usually the ones proudly saying, “I bought X, Y, Z new review books for Step 2,” two months before the exam. It’s too late for that game.
The Quiet Role of PDFs, Notes, and “Illegal” Resources
Let me address what you’re already thinking: “What about all the PDFs people pass around? The 200-page high-yield things? The NBMEs with explanations?”
Faculty know those exist. Residents definitely use them. Program directors mostly don’t care what you used, only what you scored.
Here’s how strong students treat those:
- They never let random PDFs replace core vetted sources.
- They cherry-pick certain legendary ones:
- A concise shelf review document passed down within the school.
- A Step 2 “high-yield rapid review” that synthesizes UWorld concepts.
- They use them as checklists and final-week polish, not as main teaching tools.
Bottom line: if your main study plan is a Google Drive of mystery origin, you’re playing with fire. Use those as supplements, not foundations.
How to Actually Build Your Own Shortlist (Without Lying to Yourself)
Enough theory. Here’s how a rational, high-yield list should look for you, if you’re serious and not trying to impress anyone with how many spines are on your shelf.
Step 1: Pick One Primary Question Bank
For Step 2 / Level 2, that’s UWorld. If you’re DO, add a COMLEX-specific bank but don’t replace UWorld with it.
Step 2: Pick One Clinical Book per Major Rotation
Something like:
- IM: Step-Up to Medicine or Case Files IM (if Step-Up is too much for you)
- Surgery: Case Files Surgery + Pestana
- Peds: Case Files Peds
- OB/GYN: Case Files OB/GYN
- Psych: Case Files Psych or First Aid Psych Clerkship
Notice the theme: one main book, max two if they’re short and case-based.
Step 3: Commit to a Retrieval System
Whether that’s Anki (a mature deck, not 15 new ones) or your own running outline you constantly quiz yourself with—pick one and stick with it.
Step 4: Ruthlessly Kill Extras
If a book has sat untouched for 4 weeks, stop pretending it’s “part of your resources.” It’s dead weight. Take it off your mental list and stop feeling guilty about it.
Visualizing a Smart M3 Study Plan
Let me show you how a top-performing student often structures one core rotation—say, Internal Medicine.
| Step | Description |
|---|---|
| Step 1 | Week 1: Start Rotation |
| Step 2 | Light Case Files or Step-Up sections |
| Step 3 | Begin Daily UWorld IM Blocks |
| Step 4 | Identify Weak Topics from Incorrects |
| Step 5 | Targeted Reading in Step-Up or Cases |
| Step 6 | Make/Review Anki or Notes on Weak Areas |
| Step 7 | NBME Practice 1 |
| Step 8 | Refine Weak Areas with Qbank + Targeted Reading |
| Step 9 | NBME Practice 2 + Final Review |
See the role of the book? Always secondary. Always guided by data from your questions.
FAQ (Exactly 4 Questions)
1. Do I really need Step-Up to Medicine, or can I skip it?
You do not need Step-Up to Medicine to score well. Plenty of high scorers use only UWorld + Case Files + a good video series. Step-Up becomes valuable if: you’re targeting internal medicine as a specialty, you want deeper understanding for rounds, or you keep missing nuanced management questions. If you buy it and never open it, you’ve lost nothing but money. If you do use it, use it surgically—topic-driven, not front-to-back.
2. Is it a mistake to read Case Files before I start doing questions?
It’s not a mistake early in the year. For your first one or two rotations, reading a few Case Files cases before diving into questions can prevent you from feeling totally lost. The problem is when people stay in that mode all year—reading and “preparing to prepare” instead of just doing questions. After you’re oriented, you should flip it: questions first, Case Files as support and consolidation.
3. How many books is “too many” for Step 2 / Level 2?
For most people, more than 2–3 total written resources (excluding question banks and Anki) is already slipping into fantasy land. A realistic, high-yield stack might be: Step-Up to Medicine, a couple of Case Files volumes, and maybe one dedicated Step 2 review book if you actually have time. Once you start adding Kaplan sets, extra specialty texts, and multiple “comprehensive” guides, you’re just diluting your focus and guaranteeing you’ll finish none of them.
4. Are there any “secret” or under-the-radar books top scorers use that no one talks about publicly?
Not really. The “secret” is not some obscure text; it’s how efficiently they use the same common resources everyone knows about. The only semi-hidden things are usually internal school review packets or hand-me-down PDFs for shelves, and even those are just condensing concepts from UWorld/NBMEs/standard texts. If you’re chasing magical hidden books instead of mastering the ones in front of you, you’re running from the real work.
Key points to walk away with: top scorers don’t drown in resources; they weaponize a shortlist. Books are now supporting actors to question banks and spaced repetition. And your job is not to own the “best” stack—it’s to actually finish a lean, realistic one.
