USMLE - related Update/Repost/Follow-up

As I published the post about USMLE Step 2 CK, it dawned on me that as informative posts go it was not that informative. I’ve found my older tumbr post about Step 1 and it was even worse. So here goes my attempt to shed some light on the jungles of medical diploma evaluation in the US, sort of an intro. If you are a medical student/graduate considering practicing in the US this could help.

USMLE (United States Medical Licensing Examination) is a set of licensing exams that US trained doctors take during their med school and residency years. The overall objective is similar to all other standardized tests — to establish and quantify level of knowledge in particular area.

As an international medical graduate(IMG)/foreigh medical gradute(FMG) you will be going through licensing with ECFMG (Educational Comission for Foreign Medical Graduates) so the first step for you will registering with them and here is an amazing post that sums up nicely the registration step-by-step.
Forum itself is a bit crowded and full of ads but while you go through Step 1 prep it could be useful, but not so much for the rest of them. It seems that people who go through the test successfully loose their interest in it.

There are four exams — Step 1, Step 2 CK (clinical knowledge), Step 2 CS (clinical skills), Step 3. First two are computer based multiple choice question type tests. You can take them in any convenient Prometric center (test centers around the world that organize taking all sort of exams, including USMLE).
For me the closest and most convenient was Prometric center located in Bangkok (fifty minute flight vs. Singapore — almost three hours + visa paperwork trouble).

Step 1 assesses your basic science knowledge. One day; 15 minute optional tutorial (you could skip it and the time will be added to your break time, although I would advice against that — at very minimum its worth the time to check that your headphones work properly); minimum 45 minutes of break time (you could take in between blocks as you wish); 7 blocks of questions; each block up to 40 questions; time for each block 60 minutes; overall, it takes up to 280 questions and 8 hours. Passing score is 194 (passing score can change).

Step 2 CK is a test of clinical knowledge. One day; 15 minute optional tutorial; minimum 45 minutes of break time; 8 blocks of questions; each block up to 40 questions; time for each block 60 minutes; overall, it takes up to 318 questions and 9 hours. Passing score is 209.

Step 2 CS uses twelve standardized patients to check your clinical skills, namely ability to collect patient’s history, carry out physical examination and convey the gathered information to the patient and colleagues. You could take it in a dedicated test center in one of five cities in the US — Atlanta, Chicago, Houston, Los Angeles, Philadelphia. It takes one day.
It consist of two parts — Patient Encounter for which you’ll have 15 minutes (you might have patient on the phone as well) and Patient Note for which you’ll have 10 minutes. You will be evaluated on three separate points: Communication and Interpersonal Skills (CIS), Spoken English Proficiency (SEP), and Integrated Clinical Encounter (ICE) which then will be combined into overall pass/fail note.

Step 3 is a two-day exam basically testing your ability to function as an independent general health care professional. First day — Foundations of Independent Practice(FIP): 5 minutes optional tutorial; 45 minutes of break time; 6 blocks multiple-choice questions; each block 38–40 questions; time for each block 60 minutes; overall 233 questions and 7 hours.
Second day — Advanced Clinical Medicine (ACM): 5 minutes optional tutorial; minimum 45 minutes of break time; 6 blocks; each up to 30 multiple-choice questions; time for each block 45 minutes; 180 overall questions. It also includes CCS tutorial followed by 13 case simulations each of which allotted 10 to 20 minutes.

So I have only went through half of the tests and am now in the beginning of my prep for Step 2 CS. On my “path” through the exams, I have have used the following

Step 1
- First Aid for the USMLE Step 1 is indispensable
- Firecracker cards
- UWorld question bank
- NBME all forms (question sets to assess yourself for areas of particular weakness)
- Kaplan test simulation (only did it because it was the only question bank with exam simulation of 7 hours or so, mostly to check my endurance, timing and have a taste of it, as it were).

The better level of foundational science you’d gathered in med school the easier it all go with you. If your foundations are a bit shaky better take your time and dedicate more attention to those areas where you know you are weak.

I must say that looking back at it I should have probably chosen Brocencephalon Anki Card Pre-Clinical card collection: not only I found while using Bros’ Clinical Collection for Step 2 CK it to be very helpful but also fitting my studies nicely — with Firecracker it was rather messy, its interface was tricky and when I occasionally found an error it took ages to reach and ask for mistake to be corrected, also some folks in support were either overloaded with work or kind of condescending and uninterested.

The other thing is that while not perfect, First Aid is quite good and some folks recommend to take notes into the book itself but then again you’ll write it down and have to go back through 800 something pages and find it and repeatedly read it to remember. Instead you could create a new Anki card deck with things you personally find confusing or keep forgetting and it will be there for you to repeat and repeat and hopefully retain.
So all in all, I’d say all hail Brosencephalon for this titanic humanitarian effort!

With UWorld I purchased both question bank and exam simulation forms. I found it to be an excellent source and rather close to the real test questions. Another thing about it that I liked were tables, schemes and illustrations — all well made and comprehensive. Highly recommend it.

Step 2 CK
- UWorld
- Anki cards deck from Brocencepalon
- Master the Boards by Konrad Fischer
I’ve got First Aid for this one too, but did not really used it.

After you read these please go through USMLE website — it will do you world of good. There is a lot of information, particularly useful are bulletins, procedural nuances and questions samples.

Tiny update: I have found a wonderful video on the efficient methods of studying. Also here you can find an interesting YouTube channel about all sorts of subjects related to medicine from anatomy and physiology to pathophysiology and pharmacology.

I plan on adding new information to this post as I am working through the rest of the licensing procedure.