Step II 2 Observations From 3rd Year (so far)

[clement]

1. I rotate at some hospitals that are IMG sweatshops. Lots of the residents are super-stars when it comes to boards. I know of one very humble resident that got >270 on Step 1 and beyond. This resident insists that when IMG's rock the boards, they rock it harder than US grads that rock the boards. The resident attributes this to Kaplan.

I shunned Kaplan for Step 1, but I know it's big with IMG's all-around. There aren't too many threads devoted to Kaplan notes, but the qbanks for both steps don't get rave reviews. I know some IMG's may take longer to study for the steps too, so that may play into it. SDN seems to be heavy on Uworld, FA, Secrets/Crush, and BW.
That's nothing new, but any takes on Kaplan for Step 2? I think I shunned Kaplan because I was being snobby and because it always seemed like the guy that used Kaplan on SDN had like 4 posts.

2. Disillusionment--
Finally hit the wards...Residents do ALL the work, attending comes in for an hour to write notes, some don't even SEE the patient. I don't want that to be me in 20 years. "Loud" patients are frequently ignored. Granted, some are known to be screaming for callous reasons, but sadly, I found myself becoming accustomed to the culture of "oh, it's just another scream from patient X" (after only a few weeks).😱

 

[Jonathan13180]

1. I rotate at some hospitals that are IMG sweatshops. Lots of the residents are super-stars when it comes to boards. I know of one very humble resident that got >270 on Step 1 and beyond. This resident insists that when IMG's rock the boards, they rock it harder than US grads that rock the boards. The resident attributes this to Kaplan.

I shunned Kaplan for Step 1, but I know it's big with IMG's all-around. There aren't too many threads devoted to Kaplan notes, but the qbanks for both steps don't get rave reviews. I know some IMG's may take longer to study for the steps too, so that may play into it. SDN seems to be heavy on Uworld, FA, Secrets/Crush, and BW.
That's nothing new, but any takes on Kaplan for Step 2? I think I shunned Kaplan because I was being snobby and because it always seemed like the guy that used Kaplan on SDN had like 4 posts.

2. Disillusionment--
Finally hit the wards...Residents do ALL the work, attending comes in for an hour to write notes, some don't even SEE the patient. I don't want that to be me in 20 years. "Loud" patients are frequently ignored. Granted, some are known to be screaming for callous reasons, but sadly, I found myself becoming accustomed to the culture of "oh, it's just another scream from patient X" (after only a few weeks).😱

I must admit I have not heard too much regarding kaplan for step 2, although I can relate to rotating at a hospital that is predominately FMG's. In talking with my resident, I learned somewhat how difficult it can be for FMG's to fill a spot in any program in the US. My resident told me how hard she had to study, not only so that she could match in the US, but more so because most of the people from her country were applying as well and so it was even more competitive. She also told me how for her, it was ALL about scores (in terms of getting a spot here) and so she became VERY independant in terms of her studying. Maybe Kaplan is well suited for this reason? Who knows.

Get used to patients screaming nonsense on the floors.

 

[clement]

I must admit I have not heard too much regarding kaplan for step 2, although I can relate to rotating at a hospital that is predominately FMG's. In talking with my resident, I learned somewhat how difficult it can be for FMG's to fill a spot in any program in the US. My resident told me how hard she had to study, not only so that she could match in the US, but more so because most of the people from her country were applying as well and so it was even more competitive. She also told me how for her, it was ALL about scores (in terms of getting a spot here) and so she became VERY independant in terms of her studying. Maybe Kaplan is well suited for this reason? Who knows.

Get used to patients screaming nonsense on the floors.

Yea, I've gained a new level of respect for IMG's, especially those that come from countries/schools that are not necessarily geared toward training for the USMLE. 270s at the hospital where I am at are *casual.* While it's true they mostly go for IM and become the workhorses at a lot of places, I guess the sponsorship aspect is what demands those higher scores. Anyway, I may give Kaplan a look...

 

[SouthernSurgeon]

1. I rotate at some hospitals that are IMG sweatshops. Lots of the residents are super-stars when it comes to boards. I know of one very humble resident that got >270 on Step 1 and beyond. This resident insists that when IMG's rock the boards, they rock it harder than US grads that rock the boards. The resident attributes this to Kaplan.

I think it is largely due to the sheer amount of time and effort put in, not the actual source of information used. I think anyone (IMG or otherwise) who gets >270 would get that score with the same amount of effort regardless of whether they used Kaplan, FA, USMLE world, etc. Kaplan isn't some magic secret - if Kaplan made it easy to get a killer score every single person would use it.

The thing with IMGs who get great board scores is that they typically have a TON of time (often on the prep4usmle website you will see people with yearlong study plans).

Yea, I've gained a new level of respect for IMG's, especially those that come from countries/schools that are not necessarily geared toward training for the USMLE. 270s at the hospital where I am at are *casual.* While it's true they mostly go for IM and become the workhorses at a lot of places, I guess the sponsorship aspect is what demands those higher scores. Anyway, I may give Kaplan a look...

I'd take this with a grain of salt. Look at the NBME data for IM and international applicants. Last year only 25 total IMGs matched with a board score of >260. So unless they somehow all matched at your program, that is not a commonplace score.

 

[Noeljan]

I think it is largely due to the sheer amount of time and effort put in, not the actual source of information used. I think anyone (IMG or otherwise) who gets >270 would get that score with the same amount of effort regardless of whether they used Kaplan, FA, USMLE world, etc. Kaplan isn't some magic secret - if Kaplan made it easy to get a killer score every single person would use it.

The thing with IMGs who get great board scores is that they typically have a TON of time (often on the prep4usmle website you will see people with yearlong study plans).




I'd take this with a grain of salt. Look at the NBME data for IM and international applicants. Last year only 25 total IMGs matched with a board score of >260. So unless they somehow all matched at your program, that is not a commonplace score.

I agree with you. While I have met amazing intelligent FMGs I take their board scores with a grain of salt. Some get a year off of classes just to study!!! A good friend of mine is a US citizen in a carib school and he has an entire 6 mos semester of board review time or something like that. In the US wehave what 4-10 weeks max? I would think there was something strange if you studied for a year nonstop, went to Kaplan study camps, etc and couldnt break 260.

 

[clement]

I agree with you. While I have met amazing intelligent FMGs I take their board scores with a grain of salt. Some get a year off of classes just to study!!! A good friend of mine is a US citizen in a carib school and he has an entire 6 mos semester of board review time or something like that. In the US wehave what 4-10 weeks max? I would think there was something strange if you studied for a year nonstop, went to Kaplan study camps, etc and couldnt break 260.

I agree that the duration of their studying time has something to do with it- but with US grads having higher pass rates overall, I think IMGs should be performing better across the board if duration of study is the most significant variable between the two groups? Then again, IMGs are such a diverse group in terms of curriculum that I'm certain that plays into it as well. The ones at my program are mainly from India, with the rest being Pakistani or Cuban grads. Certainly I take what they say with a grain of salt, but just watching them respond like a walking talking Harrison's when they get pimped is pretty damn humbling. Anyway, I am fairly certain this particular program only takes 99ers based on its housing and sponsorship type benefits, so these guys are likely NOT representative all-around.

Judging from my own experience, the *secret* is sheer discipline, whether we're talking 12 weeks or 6 months (I went the 12-week route for Step 1, and burn out and retention issues certainly factored in). Plus, in my class plenty of people were/are using FA and Uworld well before a designated board study period of 6-12 wks. I just wonder why Kaplan kinda isn't cool on SDN and without stepping into the realm of the un-PC, I figure it is because some of us associate it with the "IMG way of studying."

 

[tfom08]

I have worked with some great FMGs' in medical school, but I disagree that FMG's do better than American grads on Steps 1 and 2.

Step 1/Step 2 for matched US grads: 225/231
for unmatched US grads: 216/216

for matched independents: 217/221
for unmatched independents: 207/209

There are probably some DO's scattered in the independents, but I doubt they come close to the numbers of FMG's enough to skew the data (and probably DO's actually score as high or higher than FMG's). Probably the FMG's in the hospitals you are in did better than their American colleagues because the Americans with the higher scores are in more competitive programs.

Yes they have longer to study for USMLE's on average, and no, 270 is not a common or "casual" score in your hospital. The fact that it is >2 SDs above the mean and the majority of FMG's score below the mean necessitates that it is not common.

As for kaplan for step 2, I used a couple of the books and thought they were good. It just depends on how much time you have really and what your goals are. It's not popular with Americans because not a whole lot of people really care that much about step 2. Although I will say that of the sources I looked at, Kaplan is one of the best for step 2. For step 1, I thought there were better sources out there for most topics.

 

[clement]

I have worked with some great FMGs' in medical school, but I disagree that FMG's do better than American grads on Steps 1 and 2.

Step 1/Step 2 for matched US grads: 225/231
for unmatched US grads: 216/216

for matched independents: 217/221
for unmatched independents: 207/209

There are probably some DO's scattered in the independents, but I doubt they come close to the numbers of FMG's enough to skew the data (and probably DO's actually score as high or higher than FMG's). Probably the FMG's in the hospitals you are in did better than their American colleagues because the Americans with the higher scores are in more competitive programs.

Yes they have longer to study for USMLE's on average, and no, 270 is not a common or "casual" score in your hospital. The fact that it is >2 SDs above the mean and the majority of FMG's score below the mean necessitates that it is not common.

As for kaplan for step 2, I used a couple of the books and thought they were good. It just depends on how much time you have really and what your goals are. It's not popular with Americans because not a whole lot of people really care that much about step 2. Although I will say that of the sources I looked at, Kaplan is one of the best for step 2. For step 1, I thought there were better sources out there for most topics.

I certainly don't think there are numerous people that nailed >270 on both Steps at this hospital, but I believe what this resident was getting at was when US grads rock the boards and IMGs rock the boards, IMGs tend to tip the scale a little further in that range. I'm not sure how he quantifies that statement precisely...I do kind of see needing six months to a year to study for the USMLE if my classes weren't geared toward preparing me for it (and if my medical education spans ~7 years rather than taking the exams after 2-3 years of med school?) Hell, I'm already forgetting stuff.

Like I say, plenty of people use FA, Goljan, etc to compliment coursework all through out 2nd year, the 6-12 weeks we use to study are generally review. Also, there are no US grads at this progam in this hospital due to location and sweatshop nature, seeing as they could care less about the class of Visa sponsorship, housing perks, or the fact that it always takes some of its own for cards, GI, and the like-which is what makes it "cut-throat."

The thing is, the stats don't break down IMGs by country. US off-shore grads likely don't use Kaplan as much either. Anyway, bottom line, I know Kaplan isn't a magic 270+, but curious as to how it got kind of marginalized based on demographics.

 

[tfom08]

I certainly don't think there are numerous people that nailed >270 on both Steps at this hospital, but I believe what this resident was getting at was when US grads rock the boards and IMGs rock the boards, IMGs tend to tip the scale a little further in that range. I'm not sure how he quantifies that statement precisely...I do kind of see needing six months to a year to study for the USMLE if my classes weren't geared toward preparing me for it (and if my medical education spans ~7 years rather than taking the exams after 2-3 years of med school?) Hell, I'm already forgetting stuff.

Like I say, plenty of people use FA, Goljan, etc to compliment coursework all through out 2nd year, the 6-12 weeks we use to study are generally review. Also, there are no US grads at this progam in this hospital due to location and sweatshop nature, seeing as they could care less about the class of Visa sponsorship, housing perks, or the fact that it always takes some of its own for cards, GI, and the like-which is what makes it "cut-throat."

The thing is, the stats don't break down IMGs by country. US off-shore grads likely don't use Kaplan as much either. Anyway, bottom line, I know Kaplan isn't a magic 270+, but curious as to how it got kind of marginalized based on demographics.

I'm not sure what the resident meant by rock the boards either. Statistically, Charting Match Outcomes 2009 shows that only around 70 independent applicants scored >260 on step 1. On the other hand, hundreds of US allopathic grads scored >260. So unless all 70 of he independent grads (some of which were DO's) scored 280, and the US allo grads all scored between 260 and 263 (which, of course, is statistically improbable), then the assertion that FMGs who rock the boards somehow score higher than US grads who rock the boards is not likely true.

I know people in my class who scored >270 on step 1 and I know even more who scored >270 on step 2.

As for why more FMGs use Kaplan, maybe they are familiar with Kaplan because it is a huge corporation with lots of advertising money so it is bigger in other countries than the more independent publishers that gain popularity largely by word of mouth at US med schools. Also, it seems like most of the people who spend big money on long, intensive prep courses are FMG's, so they must hear about Kaplan when they are researching these courses. Like I said, I think Kaplan's books for step 2 are great resources if you have the time. The qbank is pretty good, but UW has better explanations (and actually most FMGs I know used UW for qbank even if they used the kaplan books).

 

[agranulocytosis]

There's also the "score unknown" variable which can likely contain some higher scores as well.

 

[agranulocytosis]

double post

 

[PlutoBoy]

Hi. Im a medical student from the Dominican Republic.

All you are saying prompted me to become a member, just to explain something to all of you... Granted, there's a lot of people that take a year or two to pass all the boards, because that is not part of the curriculum in most foreing schools. FMG dont study in school to pass the boards, and our curricula is not geared to meet american needs. So maybe you know about RMSF... but how much do you know about dengue fever and malaria, which is endemic in my country?? I'll never see RMSF in here, Lyme disease is out of the question, but I do see dengue a lot, so be careful with what you say... Maybe you can teach me about RMSF, but I can teach you about leptospirosis, dengue, malaria. Bottom line: you get to med school and as somebody pointed out you get your BRS, Secrets, FA, Lippincott's biochem, etc... because you know that the boards are coming sooner or later. Is not true you study 4 weeks.

Second, sorry if im overreacting, but I cant help feeling that some are looking at us down for the above mentioned reasons. As I said, I did a clerkship in NY. The students I met were nothing impressive... I thought students were going to be much better in the US, but to my surprise, they weren't. You guys are supposed to read more because of the boards (I support the board exams, they force you to study and learn), but I didnt see that great amount of knowledge. One 4th year was surprised because of an ascites in the GI elective... hehehe. Although I have to recognize that the mean in the US is better prepared than the mean in my country if your measuring scale is the boards, but again, you are supposed to, its your system...

Lastly, as a fan of the US system, hehe, since I got into med school I studied "the american curriculum" sort to speak... I knew I wanted to go to the US. Result: I already passed step 1 with above average score, and Im on my way to pass step 2, with a high score I hope! (610--241 NBME Form 2), 69% 82nd percentile USMLEWorld, 73% USMLERx. Got a rotation at NY... What does all this means? Im above average in here, and I'll probably be above average there also... the only thing needed was getting involved in the system as you guys are... so a little more respect, please. We work hard to get it, as you guys do. Peace!

P.D.: Note that I did not take anytime off to pass my boards and Im still in med school and getting high grades here (3.4 GPA), and good grades in the boards. Not to mention I had to do research as a requisite to graduate, and year long internship...

 

[FutureDocDO]

Agreed. They study for months, even years for the steps while most US students have only a couple of weeks of straight board studying.

I think it is largely due to the sheer amount of time and effort put in, not the actual source of information used. I think anyone (IMG or otherwise) who gets >270 would get that score with the same amount of effort regardless of whether they used Kaplan, FA, USMLE world, etc. Kaplan isn't some magic secret - if Kaplan made it easy to get a killer score every single person would use it.

The thing with IMGs who get great board scores is that they typically have a TON of time (often on the prep4usmle website you will see people with yearlong study plans).

 

[hj0517]

I agree with the majority of what you say, its worth bearing in mind that the international students have already graduated so naturally they have whatever time they wish to allocate towards the boards.

I'm a final year student in the UK and I had roughly 6 weeks for step 1 (and I used up 2 weeks whilst on a rotation on top of that) and now I've got about 4 weeks for step 2ck so by no means is it a "catch all" term that all international students spend up to a year on boards.

 

[PlutoBoy]

I agree with the majority of what you say, its worth bearing in mind that the international students have already graduated so naturally they have whatever time they wish to allocate towards the boards.

I'm a final year student in the UK and I had roughly 6 weeks for step 1 (and I used up 2 weeks whilst on a rotation on top of that) and now I've got about 4 weeks for step 2ck so by no means is it a "catch all" term that all international students spend up to a year on boards.

And thats my point...

 

[lasvegasDO]

...........

 

[lasvegasDO]

I still think it is quite an accomplishment to break 260 even with a year off. Most people say they would do that if they had that much time off but most of you wouldn't and you know it. You would slack off, sleep, do other activities aside from studying due to the temptation of freedom. It requires a lot of discipline to put in that amount of effort consistently for a years time so it's an amazing accomplishment. The difference is U.S. students realize they don't have to kill the boards to get most residencies and are not as motivated to study for it but most IMG's need to get a great score just to match in some community programs or IM at a community program. In my experience, it all comes down to board scores. Everyone talks about personality, work ethic and clerkship performance but that is b.s., they will take the IMG with a 260 over the U.S. student with a 210 every time.