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USMLE

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Some key players and acronyms to know first:

 

 

  • USMLE = United States Medical Licensing Exam.

    • A three-part exam series (Step 1, Step 2 Clinical Knowledge, and Step 3) needed to be licensed to practice medicine in the United States. ​

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Step 1

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Is generally the first USMLE exam that people take. It consists of seven 60-minute question blocks with 40 questions per block for a total maximum of 280 questions. Depending on your university Step 1 can be a requirement to progress from one year to another.

 

This exam is considered the hardest of the USMLE and is often mocked for the abundance of irrelevant medical facts.

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Changes to the Step 1

 

Currently, its score serves as a cut-off for many residency programs when screening residency applications. However, on February 12th 2020, the USMLE announced that Step 1 results will be reported in a Pass/Fail manner, leaving behind numerical scores. This will be implemented starting in January 2022.

 

On that same announcement, they clarified that Step 2 CK and Step 3 will retain their numerical results. Does this mean that US residency programs will switch their “cut-off filter” to Step 2 CK scores? That is what many people were commenting on social media when USMLE made their announcement. We’ll have to see what happens for the Match of 2023 since they will be the first cohort applying after the Pass/Fail changes have been implemented.

 

[Since the changes will occur in January 2022 just a little over 2 months before Match Day 2022 it can be safely assumed that all applicants for Match 2022 will be applying with a numerical Step 1 score]

 

Resources

 

I will list some resources available for the USMLE Step 1 but I will not provide a review on them since each person would find different things useful. Here is a website that lists the popularity of some of the sources. Reviews can also be found on forums like Facebook groups and Reddit threads.

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  • Material

    • First Aid for the Step 1

    • First Aid for the General Sciences: General Principles

    • First Aid for the General Sciences: Organ Systems

    • Kaplan Step 1 Books

    • Fundamentals of Pathology (aka Pathoma) + their videos

    • Sketchy

    • Boards and Beyond

    • Anki flashcards

  • Question banks

    • NBME 25, 26, 27, 28, 29, 30

      • You might hear about older NBMEs that were available prior to March 2021. These are no longer available and from March 2021 onwards NMBE have only made it possible to purchase 25-30 through their website, each for 60$.

    • UWorld

    • USMLE-Rx

    • Amboss

    • Kaplan Qbank

    • Firecracker

 

According to popularity, the two indispensable resources are First Aid for the Step 1 and UWorld. People then use other resources in addition to those to complement their knowledge.

 

To give you an idea about the content covered in this exam, I will go through the format of the First Aid (FA) for the Step 1 book which consists of 16 chapters: The first 6 known as General Principles and the other 10 known as Organ Systems. First Aid provides a summary-style of most of the content covered in Step 1. For more detailed and explanation-oriented content First Aid has a separate book for General Principles and one for Organ Systems.

 

  • The chapters known as General Principles are Biochemistry, Immunology, Microbiology, Pathology, Pharmacology, and Public Health.

  • The chapters known as Organ Systems are Cardiology, Endocrine, Gastrointestinal, Hematology & Oncology, Musculoskeletal, skin, and connective tissue, Neurology, Psychiatry, Renal, Reproductive, and Respiratory.

 

Question banks then provide Step 1-style questions on these subjects. Sometimes they will either test something not on the FA or will provide additional information on the explanation to their questions so people generally add said information into their FA to have everything compiled in one place. That way when it’s time to review it’s easier to keep track of the material.

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Timing

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Some medical schools will allocate a “Step 1 dedicated study period” for their students. However, most IMGs do not have this option, so they tend to either integrate the Step 1 material into their university’s curriculum and study both in parallel, or take the opportunity during vacations or after graduation to sit for their Steps. Any option is valid as long as it works for you and is done in time to get ECFMG certification for the Match year you are aiming for.

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Registering

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This website lays down the steps on how to register for the Step 1 exam as an IMG. It is a long process so start it ahead of time.

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In summary it goes like this:

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  • If you are an IMG you will book your Step 1 through ECFMG. If you are an AMG you will book it through USMLE.

  • You will first select an eligibility period and pay for the exam (there is a surcharge for taking it outside of the USA unfortunately). Eligibility period is a 4-6 months period when you will be allowed to sit for your exam.

  • If you do this as a medical student they will contact your school to confirm you are a student. If you do this as a graduate applicant you need to send in your Medical Degree to the address posted after you finish your eligibility application. They will then contact your medical school to confirm this.

  • Once your application has been processed by ECFMG/USMLE and your medical school you will receive your Exam Permit (this might take weeks - months).

  • This Exam Permit will contain a unique number that you will input at the Prometric website (link will be written in your Exam Permit) to check for availability of testing days at predetermined testing centers. You can then go ahead and book a date for no surcharge.

  • For certain fees you can change your Step 1 date and your eligibility period through either USMLE/ECFMG's or Prometric's website.

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Test Day

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  • You will have 60 minutes for breaks that you can distribute at your convenience in between question blocks.

  • Make sure you take snacks and beverages with you since the exam lasts at least 7 hours.

  • Remember to print your Exam Permit and have your unexpired ID with you.

  • Upon returning to the examination after each break you will be asked to sign in (showing your ID, lifting your sleeves, pants, emptying your pockets, etc). This might take a minute or two so take this into consideration during your breaks.

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Step 2 Clinical Knowledge

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Section coming soon.

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Step 2 Clinical Skills (now cancelled)

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Section coming soon.

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Step 3

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Section coming soon.

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