The beginning; USMLE Step 1

In my opinion, the USMLE is without a doubt one of the toughest medical exams a medical student will ever student. In fact one of my seniors at med school once joked that after sitting both Step 1 and 2, you’ll never be scared of another exam due to their sheer difficulty. I am unsure whether this difficulty stems from the fact that the questions are in fact difficult and require students to evaluate several different things at the same time, or it is due to the pressure that all students face when sitting the exam. After all this single exam will either open doors for your future or potentially (god-forbid) shut them.

As I sit here writing this, at the beginning of my long journey through the multiple steps of this exam, what scares me the most is the fact that this is an all or nothing type of exam in a way. Once you pass, albeit even on the border (currently a score of 192) you may not retake the exam, which means that any job you apply for in the US will be on the basis of that score. Not only that but it will decide whether you can apply into a certain specialty or not.

Being an FMG (foreign medical graduate – actually student at the minute), I think I am more scared of the fact that first, I will have to score on average 10-15 points higher than my colleagues who graduate from the US and secondly, of whether I am being taught similar to them. The USMLE for med students in the US and Canada, is infact integrated into their curriculum, whereas for those internationally based have to work that much harder to ensure they are on the same standard. 

So what is the USMLE?

For those who may not know, the USMLE (US Medical Licensing Examination) is an exam which must be sat by anyone hoping to practice medicine in the US, be it they are Americans and graduating from US medical schools, or any other nationality and graduating from a med school abroad.

Since I am an FMG, I will be detailing the steps for those studying for sitting the exam abroad. But as a matter of fact the only difference for us is the application process, with the preparation and actual exam being the same for all those sitting the USMLE.

The USMLE consists of three parts or ‘Steps’ as they are commonly referred to. Step 1 is typically the core/basic knowledge paper, Step 2 being a clinical paper and Step 3 often take after the first year of residency (tbf I don’t really understand Step 3 very well, so I’m kind of glad it’s a bit far off).

USMLE: Step 1

Step 1 is the basic/core knowledge paper, and many books, and indeed the USMLE website itself, mentions key domains which are tested for including; Anatomy, Behavioral Sciences, Pathology, Microbiology, Physiology, Pharmacology, Biochemistry and several interdisciplinary units (Nutrition, Genetics, Immunology, Ageing). In addition to that in recent years there has also been a focus on Epidemiology, Ethics and Patient Safety.

The paper takes a whole day as it is 8 hours long consisting of some 300 questions. The paper must be sat in its entirety and once you begin, you shouldn’t really stop or leave half way through. The questions are divided into 7 sections of equal number of questions (~40) which lasts 1 hour. The final hour is for breaks (lunch, bathroom, in general). Should you finish any section early the time left over will be added to the break time, but once you complete a section you cannot change its answers!!

One of the most common questions is when to sit the Step 1? That is a question I don’t really have an answer to. I have heard multiple ways and times to sit it, many people saying to sit it after Year 2, when you finish pre-clinical medicine, others advising to take it after Year 3, so you have atleast one year of clinical knowledge. Though the exam is not meant to test clinical questions, it does help to have that knowledge. Personally I am sitting it after Year 3, which because I am in the UK, means I will have finished my pre-clinical course along with rotations in the chest, abdomen and head & neck (neurology/psychiatry) units.

USMLE: Step 2

At the minute I am prepping to sit the first step of the exam so I’m not too focused on the second step yet but as any good student I have researched it. It consists of two subdivisions. There is a written clinical knowledge paper (Step 2CK) and a clinical skills paper (Step 2CS).

I’m not sure if other med schools have similar curriculums to the UK, but for us the Step 2CS is basically the OSCE (Objective Structured Clinical Examination). Basically it involves being put into stimulated clinical situations to see how you would perform on rounds in hospitals or as a GP. Personally I have been told the Step 2 is very much like the final exam taken by students in the UK before they graduate and so to sit that exam around about the same time, as you are prepping the same material.

Now we know about the USMLE, and we’ve decided to take it. What’s the next step?

I have literally just begun and sort of scared myself a little truth be told. To gather as much information as possible I read and went to every website that even remotely mentions the USMLE. I have thus come to the conclusion that to get a good introduction one should solely look at the Wikipedia page (trust, it’s actually a good source) and the official USMLE page. For now, for all those applying from internationally, whilst you’re preparing I feel likes it’s not too important to check the websites and ways to apply this early (I don’t think I will be sitting the Step 1 within the next 12 months!), but for those interested all relevant information for FMG’s is here. 

 

Thus this has been my rapid fire post detailing some brief introductions to the USMLE. I shall keep you all hopefully updated with my journey, and any extra resources I use! To all those who are sitting/intend to sit the USMLE soon, best of luck! :)