No Fixed Schedule, No Excuses: How I Scored 261 on Step 2 While Working at One of Asia's Largest Government Hospitals

Rutvi Shah, MBBS

I had just called a code, and the patient didn't make it. It was one of five that night. When things settled, I walked back to my station, picked up my iPad, and started a UWorld block.

That wasn't a strategy, it was just what my life had become. I was a medical officer at Civil Hospital Ahmedabad, one of the largest government hospitals in Asia, juggling ICU shifts with Step 2 prep for the exam I knew would decide my future.

The Job That Came With No Off-Switch

Only twenty-five people across the entire state of Gujarat are selected for the medical officer role at Civil Hospital each year, chosen on final-year academic merit. I was lucky enough to be one of them. There was no fixed routine - only rotating weekly schedules: night shifts, day shifts, evening fever OPD, ICU shifts, and VIP duty, where I served as primary care for visiting dignitaries and accompanied them on their travels

USMLE was its own journey entirely. The moment I chose to pursue it; I knew I had to give it everything – for my future and for the doctor I wanted to become. It felt like my path to a more balanced life and to the kind of patient care I wanted to provide, care that might or might not be possible back home. But with Step 1 pass/fail, all the pressure landed on Step 2. Scoring high was the only way to widen my chances.

Studying in the Gaps

It was a relentless stretch; long hospital hours followed by the library, not home. I studied in ambulances during VIP convoys, in the gaps between OPD patients, and in the pauses between codes during ICU shifts. It wore me down physically and mentally, and because work and study consumed everything, my social life dropped to nearly nothing. That was the biggest sacrifice.

But looking back, it was never about motivation, motivation runs out. It was about consistency: showing up every single day, even exhausted, even unwilling. Going to the library on Saturdays, on Sundays, on my only days off - arriving at 7 a.m. and not leaving until 9 p.m. That discipline, more than anything else, is what got me to a 261 on Step 2.

A lot of credit goes to the real-world exposure I was getting on the wards, which shaped the way I approached questions. The clinical experience I'd done earlier helped too. As an emergency medicine medical officer, I developed a real instinct for the stable-versus-unstable-patient vignette – the kind of pattern recognition no textbook can fully teach.

The System: Fewer Notes, More Questions

My study schedule was far from ideal, but on my days off, I pushed for everything I could get. I sat for my exam during a stretch when people who'd scored well on NBMEs were struggling on the real thing because of a shift in the question pool. But I held onto one belief throughout: the exam isn't really testing knowledge - it's testing the instincts of a better physician. So, I solved as many questions as I possibly could: all of UWorld, plus Amboss three- and four-star questions. I used AI constantly to understand the reasoning behind each topic, always asking why. That question - why? - was the key to the whole exam.

A strong Step 1 foundation mattered too. Even though Step 1 is pass/fail, I made sure I understood every topic at its core, not just memorized it. When you understand why, you don't need to cram it, you already know it. So even though I didn't start Step 2 prep until six or seven months after Step 1, I had a solid base to build on.

I barely touched notes. I went all in question banks because every high scorer's advice on YouTube said the same thing: do questions, even when it's uncomfortable. I kept a running list of every question I got wrong, understood exactly why the wrong answer was wrong and the right one was right, and refused to move past a weak topic until I'd truly mastered it. Once I understood a missed concept, I'd ask ChatGPT to fire off rapid, back-to-back questions on similar vignettes until the knowledge was locked in.

The Isolation Nobody Talks About

One of the things I love most about the USMLE is that everyone's timeline is their own — you sit for the exam when you're ready. But life doesn't pause for anyone else's timeline. Everyone around you keeps living theirs, while you're alone in a library that emptied out even during festivals, down to three or four other people. It's an isolating road, and I won't pretend otherwise.

The Breaking Point

The real turning point came during my last NBME and my second UWSA, where I scored my lowest, the low 250s. I cried. It was nowhere near my average of 260, and my Amboss-predicted score dropped to 258. Everything felt like it was unravelling. But instead of burning out, I got angry- in the best way. I did 600 questions in three days. I ran through CMS forms. Wherever I was weak, I drilled it. That week was the turning point. I came close to pushing my test date back, but I knew another six days of that pace would only burn me out further.

My family's support carried me through, they stayed up when I did. My sleep dropped to under three hours a night in that final week. I tried to build a rhythm: wake at 5 or 5:30, study hard until 11, get tired, sleep, repeat. There was no room left for overthinking. Who am I kidding, I overthought plenty anyway. My sister would sit beside me and have me say my thoughts out loud, just to quiet my mind and pull my focus back to the questions. I kept a small Radha Rani idol wherever I studied; whatever helps you get through it, you use. I couldn't eat - the nausea, never let up, so I lived on milkshakes and whatever liquids I could get down.

I want to be honest about something: this pace wasn't sustainable, and I don't think it should be anyone's model to copy exactly. Three hours of sleep and skipped meals got me through one brutal week, not a whole prep timeline – and I paid for it physically. If you're in the final stretch and recognize this in yourself, it's worth building in real breaks and asking for help before you're running on fumes, not after.

Exam Day, on Autopilot

I didn't sleep the night before the exam, and I was running on fumes by test day. I went into near autopilot for blocks three, four, and five, then stepped out for a break and told myself I still had six, seven, and eight blocks left to fight through. But what carried me through that fog was the sheer repetition of the instinct I'd built from months of relentless question-solving. I didn't even have to think about it, my hands just knew what to do. Breaks felt too short, so I'd finish blocks five minutes early just to bank a little extra time, made possible only by the instinct that all that practice had built into me. The long breaks were what let me reset and stay calm.

Crossing 260

After the exam, I felt hollowed out, the way I think everyone does once the adrenaline drops. I tried to forget about it for a while: I took a trip and let myself enjoy something for once. When the score posted, my fiancé saw it before I did. I remember crying happy tears on the phone. Six days earlier, my last UWSA had put me at 250. Crossing 260 after that still doesn't feel entirely real.

What Actually Got Me There

In the end, it wasn't the practice assessments that got me there. It was the resilience - everything I poured into that exam. I'm proud of doing this alongside a full-time job: managing patients, staying steady, and not letting the anxiety win. Showing up every single day and choosing the harder path, that's the real formula for scoring high.

If you're studying through chaos right now – a job, a family, a schedule that never sits still – you don't need a perfect routine to get a great score.

You need to show up on the days you don't want to, ask why until the concept makes sense, and give yourself.