The USMLE and You:
A lovers guide
Haley Cochrane,
Stage 3
Sydney Medical Program
NAMSA President
SUMS International Rep
Overview
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The USMLE Steps
Resources
My experience
Tips
The USMLE exams
• USMLE Step 1
• USMLE Step 2
– Clinical Skills (CS)
– Clinical Knowledge (CK)
• USMLE Step 3
Things you need
• ECFMG registration – Your document
collection, exam registration, and residency
application center
• Can be done anytime, need to send the
documents off at least 6 months before rego
• Money.
• Resources!
• Time, determination, and iron will.
Step 1
USMLE Step 1
• Computer based MCQ exam
• 322 questions, 46 questions per block x 7 blocks
of 1 hour
• 15min tutorial (optional), 45 mins of break time
• 8am – 4pm roughly
• Test taken in any country
• Sydney Prometric test Center – Downtown near
Town Hall
• Cost - $820 + $200 to write outside NA
USMLE Step 1
• Most important score for
American Residency
• Can write anytime after
2 years of medical school
• Can only write it ONCE if
you pass, no option to
discard score
• Score only valid for 7 yrs
USMLE Step 1
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Topics Covered
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25%–35% General principles, 65%–75% Individual organ systems
hematopoietic / lymphoreticular
nervous/special senses
skin/connective tissue
musculoskeletal
respiratory
cardiovascular
gastrointestinal
renal/urinary
reproductive
endocrine
immune
Process
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20%–30% Normal structure and function
40%–50% Abnormal processes
15%–25% Principles of therapeutics
10%–20% Psychosocial, cultural, occupational, and environmental considerations
Scores
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188 pass
Avg ~220,
IMG’s should AIM for 230-250
Released 4-8 weeks after test date
Step 2 – Clinical Knowledge
Scumbag Macrophage
USMLE Step 2 CK
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368 questions, 8 blocks, 46Q, 60min
9 hours of testing
Can be written anywhere, same as Step 1
Cost - $820 + $200 to write outside N.A.
Step 2 CK
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Content
General Principles
Infancy and Childhood
Adolescence
Senescence
Medical Ethics and Jurisprudence
Applied Biostatistics and Clinical
Epidemiology
Systems-Based Practice and Patient
Safety
Infectious and Parasitic Diseases
Neoplasms
Immunologic Disorders
Diseases of the Blood and Blood-forming
Organs
Mental Disorders
Diseases of the Nervous System and
Special Senses
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Cardiovascular Disorders
Diseases of the Respiratory System
Nutritional and Digestive Disorders
Gynecologic Disorders
Renal, Urinary, and Male
Reproductive Systems
Disorders of Pregnancy, Childbirth,
and the Puerperium
Disorders of the Skin and
Subcutaneous Tissues
Diseases of the Musculoskeletal
System and Connective Tissue
Endocrine and Metabolic Disorders
Congenital Anomalies
Conditions Originating in the
Perinatal Period
Symptoms, Signs, and Ill-defined
Conditions
Injury and Poisoning
Step 2 - Clinical Skills
USMLE Step 2 CS
• History/PE, Critical thinking, Note taking
• Patient Interaction
• English Proficiency
• 11-12 stations with 12 standardized patients (SP’s)
– 10 scored by SP’s and Physician
• 15 minutes for history, 10 minutes patient note
• 5 stations, 30 min break, 4 stations, 15 min break, 3 stations
• Can only be written in the USA, 5 centers
– LA, Philly, Chicago, Houston, Atlanta
• Cost $1440 + flight and accomodation (~$80 in LA/night)
• Eligibility: a medical student officially enrolled in, or a graduate of, a
medical school outside the United States and Canada and eligible
for examination by the ECFMG.
USMLE Step 2 CS
• Book 1 year testing schedule, book early via
ECFMG
• Centers are closed in May-June (Graduation)
• Can write anytime after “2nd year” (4yr
program), I recommend end of 3rd/start of 4th
(4 yr program)
• Resources: First Aid for Step 2 CS (~$40)
– Online patient note example
• Requires 2-4weeks preparation
USMLE Step 3
• 3 steps: clinical encounter frame, physician task,
and normal conditions and diseases
• MCQs and Computer Based Case Simulations
• 480 MCQ, blocks of 36-48Q’s
• 45-60min per block
• ~12 Cases, one per block. 10-20min to complete
case
• Step 3 is administered in two eight hour testing
sessions, usually done in State you will register
Eligibility for Step 3
• To be eligible for Step 3, prior to submitting your application, you
must:
• obtain your MBBS Degree
• pass Step 1, Step 2 CK, and, if required based upon the rules
referenced below, Step 2 CS,
• obtain certification by the ECFMG or successfully complete a "Fifth
Pathway" program if you are a graduate of a medical school outside
the United States and Canada (information on Fifth Pathway
programs is available in ECFMG’s Information Booklet, and
• meet the Step 3 requirements set by the medical licensing authority
to which you are applying.
• Does not need to be completed for start of residency
• Does need to be completed for visa H1B
Other Costs
• Extension of Eligibility (Step 1 and CS) - $65
• Step 2 CS reschedule – $0-400
• Rewrites – Original Cost
My Experience
Preamble
• N=1
• No right or wrong way to study for this exam
• Background degree/experience will make
some things easier for you than others
• Selective memory
My Test Day
• 7 sections, ~8hours, 30 min break (+15 min opt. intro)
• Did first 4 sections back to back (was only going to do
3)
• Took ~30 min lunch break
• 2 sections
• ~10 -15 min break
• 1 section
• Finished Early on all but 1 section, had ~15 min extra
time
• Full day of exhausting brain hurt, feel like you did
terrible and have to wait ~4 weeks for results
Resources – The good
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First Aid for USMLE step 1
USMLE World Q bank
Goljan pathology Audio Lectures,Goljan Notes
Pathoma
Deja Review USMLE Step 1
Experience overall
• Good
– Done early
– Good USYD exam Prep
– Amazing Foundation for
clinical years
– More on par with North
American Grads WRT
knowledge
– You get out what you put
in
– Not looming over you
– Look like awesome
rockstar medical student
badass at hospital
• Bad
– Lose a whole summer (6
weeks)
– EXPENSIVE (final cost
~$2500)
– Grinding, depressing,
maddening long term
study
– Grief cycles
– No clinical experience to
help with vignettes
– Non-writing USMLE
classmates hate you
If I could do it again tips:
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Do as many questions as you can
?both Q banks
Doctors in Training Course > Kaplan
Focus extra hard on the material you hate
(Biochem)
• Study Friend
• Complete all resources
• Save a copy of your score reports!!
You Can Do it
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BE PREPARED!
Fear is your friend
It is expensive and full-on to motivate you
DO NOT go on forums before exams (eg. SDN)
and don’t feed the trolls, but great tips abound
• It will make you a better student and doctor
• Find what works, take advice with a grain of salt