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

QUESTIONS?

Jaidev Nath - jrn772@bham.ac.ukMajd Protty - mxp635@bham.ac.uk

THANK YOU