Working in the USAMajd Protty, Jaidev Nath, and other USMLErs
USMLE
• Three parts:• Step 1 (Preclinical MCQ) – 8 hours• Step 2
• Step 2 CK (Clinical MCQ) – 9 hours• Step 2 CS (Clinical OSCE) – 8 hours (Only in the
USA)
ECFMG Certification*
• Step 3 – 16 hours (Only in the USA)• To be taken after you start working
USMLE Step 1
Format
• Step 1• Basic mechanisms and principles
• Anatomy (+Histology/Embryology)• Physiology, Pathology + Pathophys• Immunology and Microbiology• Biochemistry• MiS and Psychiatry*
• 322 questions, 7 blocks• One day, 8 hours
Schematic of Exam
Register
Tutorial (15 min)
Block 1
Block 2
Block 3
Block 4
Block 5
Block 6
Block 7
Survey
Break time = 45 min
Marking
• Step 1• Passing mark: 188 (3-digit) = 75 (2-digit)• Average mark (US Seniors): 222 (+sd of
20)• Most scores fall between 140 and 260
Scoring scales for Step 1 (2009)
Set yourself a target
Median USMLE Step 1 score for matched US seniors (+IQR)
Timing and cost
• Step 1• Cost $780 + $170 (to take in UK) =
$950/£600• Books• Qbanks ($200)
• Timing = You can take the exam any day you like.• Best to take it during Year 4.
• Where? All over the world. UK = London + Cardiff*
Registration
• Very well laid out in • First Aid• ECFMG (www.ecfmg.org)• USMLE (www.usmle.org)
• If taking in US = 6 months in advance• If taking in UK = 3-4 months is plenty• MAKE A PLAN AND REGISTER
• Adds a little fear when £ £ £ is on the line
• Can reschedule with some restrictions and possibly £ £
Typical timeline
Summary 1/2 – Step 1
• Format: 8 hours, 7 blocks, 322 questions
• Marking: Pass=188, Average + sd = 222 + 20
• Set yourself a target score• Cost = $1000-$1500• Needs months of preparation
Resources
Resources
Resources
• Don’t buy too many• Mainstream resources:
• First Aid (aka: FA, or “THE BIBLE!”)• Qbank
• USMLE World Qbank (aka: UW)• Kaplan Qbank (2000+ Qs)
• Kaplan Notes for Step 1• Kaplan Videos for Step 1• Others:
• Goljan audio pathology, BRS, Rapid Review (RR)
Sample question (Easy)
• The use of broad-spectrum antibiotics can produce a bleeding diathesis characterized by hematomas, hematuria, melena, and bleeding from the gums by decreasing the normal gut flora and inducing a deficiency of which of the following vitamins?
1.Vitamin A 2.Vitamin B1 3.Vitamin B6 4.Vitamin C 5.Vitamin K
Sample question (Medium)
• The use of broad-spectrum antibiotics can produce a bleeding diathesis characterized by hematomas, hematuria, melena, and bleeding from the gums by decreasing the normal gut flora and inducing a deficiency of which of the following coagulation factors?
1. Fibrinogen, VII, VIII and IX2. Prothrombin, VII, IX and X3. II, V, IX and XI4. II, VI, X and XI5. Prothrombin, VI, X and XI
Sample question (Hard)
• The use of broad-spectrum antibiotics can produce a bleeding diathesis characterized by hematomas, hematuria, melena, and bleeding from the gums by decreasing the normal gut flora and inducing a decrease in which of the following processes?
1.1-alpha hydroxylation2.Gamma carboxylation3.Alanine transamination4.Xanthine oxidation5.Cytosine deamination
Summary 2/2 – Step 1
• Format: 8 hours, 7 blocks, 322 questions• Marking: Pass=188, Average + sd = 222 +
20• Cost = $1000-$1500• Needs months of preparation
• Don’t use too many resources• Main resources are FA + Qbank (UW)• Enjoy it
Step 2
• 2 parts• CK = Clinical Knowledge (Written Exam)• CS = Clinical Skills (OSCE)
• Content• Internal Medicine• Surgery• Pediatrics• Obs & Gyne• Psychiatry
Step 2 Clinical Knowledge
• 9 hour exam with 352 questions• 8 one hour blocks of 44 questions each• 15 minutes intro + 45 minutes break• Cost $780 + $190 (to take in London) =
$970/£610• Passing Score = 189/75• Mean & SD = 230 +/- 23 with most scores
falling between 140 and 260
Step 2 Clinical Skills (OSCE)
Step 2 Clinical Skills
• Has to be done in America• Cost - $1355/ £850• 8 hour OSCE with 2 breaks (30 min + 15
min)• 12 standardized patients (actors)• 15 minutes for history + examination• 10 minutes to write a patient note
describing the findings, initial differential diagnosis list and a list of initial tests
• No scores, just pass or fail
Step 2 Resources
Step 3
• Don’t even think about it yet!• Not necessary to apply and is usually
taken during intern year after you start your job
Pass rates
Summary for USMLE
• 3 Parts• Only require 2 to be ECFMG certified
• Step 1 and Step 2 CK = London• Step 2 CS = USA
• Cost = Approx $1000-$1400 per exam• Prep time: “2 months, 2 weeks, 2 days”
The Match
• 1 common application which includes a personal statement
• Cost = $300 for first 30 programs and $25 per program afterwards
• Application opens up on September 1• Important to finish Step 1, Step 2 CK
and CS by mid July all scores are available by Sep 1
• APPLY EARLY!!!
The Match Timeline
• Sep 1 – Apply• Sep to Dec – Receive Interview Invites• Oct to Jan – Take off a few weeks to
attend interviews• Feb 22 – Deadline to rank programs • March 16 – Find out where you
matched • July 1 – Start Residency
My timeline
• August 2010 (yr 4) – Started Step 1 Prep• February 2011 (end of 4th year) – Step 1• July 2011 (beg of yr 5) – Step 2 CK & CS• Sep 1, 2011- Applied to 115 Pediatric
Residency Programs out of 198• Cost = $2500/ £1500!!• Nov & December – Interviews during 4
weeks of SSA + 2 weeks of Christmas Break
• Planning to attend 13-15 Interviews
The Specialties
• Easiest Specialties = Psychiatry, Neurology, Pediatrics, Internal Medicine and Family Medicine• Aim for USMLE scores 220+
• Medium = Anesthesiology, Surgery, Obs & Gyne, Emergency Medicine (A&E)• Aim for USMLE scores 230+
• Super Competitive = Plastic Surg, Ophtho, Derm, Radiology, Neurosurg, Ortho• Aim for USMLE scores 240+
Tips
• Do well on USMLEs• US Clinical Experience (ELECTIVE or
Work Experience)• Recommendation Letters – US>>>UK• Do well in medschool• Research, Publications & Poster
Presentations• Volunteer, Leadership & Extra-curricular• Prizes & Awards• Apply on or around Sep 1st
THANK YOU