Doing USMLE Step 1 in Australasia

[sjkpark]

It's definitely doable.

I did USMLE Step 1 because:
1. I wanted to revise basic science (did poorly in pre-clinical years)
2. It would look good on my CV (hopefully)
3. I want to go to the US for fellowship training, after my specialist training here.

I'm from NZ and I did it between my honours year and 6th year. I took a year off between 5th and 6th to do honours year.

It took me about 3 months part-time (about 1-2 hours/day) + then prolonged break (didn't do anything for 6 months)+ then 2 1/2 months near full-time studying.

I got 244/99.

This is how I did it.
1. Feb 2006: Read through First Aid (FA).
2. March - April 2006:Watched Kaplan biochemistry DVD.
3. November 2006: Did USMLERx for a month -> went through all the questions very thoroughly and made notes on First Aid
4. December 2006: Read through First Aid thoroughly, then made notes on FA, only looking up textbooks when I didn't understand the stuff in the FA
5. Dec-Jan 2007: Did USMLEWORLD for a month -> again made notes on FA
6. Jan 2007: Really tried to memorise FA
7. Jan 2007: USMLE CD 2 days before the exam
8. Exam on 24th Jan 2007.

My advice:
1. Do well at school.
2. Try to sit the exam after you've done all the clinical runs. The knowledge I learned in OG & paeds were invaluable.
3. Step 1 is NOT a basic science exam, but it's an exam of clinico-pathological correlation. It is best to sit the exam after you've done the big exam at your medical school, because you know enough clinical stuff to do well in the Step 1, but you also retained enough basic science.
4. I think the biggest mistake people make when studying for USMLE is that they think medicine in US must be somehow different, so they concentrate too much on reading review books. However, you don't read Kumar and Clark cover-to-cover when studying for school exam, so why should you for USMLE Step 1?
5. Have confidence in your education! You learned everything. There's no need to learn new knowledge, it's all about fishing the stuff that's hopefully floating around deep in your brain somewhere.

Please do not PM me with questions, I won't answer them. But you're welcome to post replies on this thread, and I'll try my best to answer them.

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[driedcaribou]

Excellent advice bro. Congrats on the stellar score.

The only thing I'd add that reading review books helps if the course you are taking is lacking in breadth of knowledge.

i.e. some of the current curriculum at the graduate programs in Australia do not cover all the material that is tested on the USMLE.

Doing your USMLE Step 1 after you finish the course or are near finishing the course helps because by then, you will hopefully have covered more diseases/conditions.

 

[markdc]

It sounds like your study really only began November since reading First Aid and watching a DVD aren't that intensive. Your score sounds like a great advertisement for USMLErx. Had your program ended in November like most schools here? (ie. was Nov-Jan full days devoted to this?) Do you think 3 months of intense studying would be effective while still going through rotations?

It would have been great to know if you had done the Kaplan Qbank as well to get a first hand review comparison of the 2.

What was your reasoning with choosing USMLErx? Were your scores that high on their simulated exams?

 

[sjkpark]

It sounds like your study really only began November since reading First Aid and watching a DVD aren't that intensive.
You're right. However, I don't think I could have done so well if I didn't watch Kaplan biochem DVD. Also, I think I could've done a lot better if I had spent sometime reviewing microbiology. Not that our teaching is deficient, but there are many diseases endemic in the US that I've never heard.

Your score sounds like a great advertisement for USMLErx.
Not really! Mainly because I think USMLErx is too easy and should NEVER be used alone. Rx should be used in conjunction with either Kaplan Q-bank or USMLEWORLD. Rx prepares you very well for 70% of questions that are high-yield, but does not prepare you for the harder questions.

Had your program ended in November like most schools here? (ie. was Nov-Jan full days devoted to this?)
Yup. Studied full-time from November 1st till January 7th, taking Christmas day and New Years Eve off. Then I went back to school, but my supervisors were supportive and gave me lots of time off. Was able to study 5 days full-time immediately prior to the exam.

Do you think 3 months of intense studying would be effective while still going through rotations?
It will never be effective as 3 month full-time. Mainly because studying for USMLE is very, very emotionally draining, because you're isolated from rest of your peers. Rotations, as you well know, bring on other worries. You don't need them when you're studying for USMLE. I highly recommend spending at least 1-2 months full-time, until your prep is up and running.

It would have been great to know if you had done the Kaplan Qbank as well to get a first hand review comparison of the 2. What was your reasoning with choosing USMLErx? Were your scores that high on their simulated exams?

USMLERx: I chose it mainly because of the price (half that of Kaplan) and I liked the fact that it was all based on First Aid. I wasn't aiming for 99, I was aiming for >88, which is the national mean for US medical students. So my strategy was to know and understand everything in the FA inside out. And USMLERx was GREAT for such purpose. However, it will not prepare you for 30% of questions which are ridiculously hard and will throw you off.
I got 64% cumulative on USMLERx, 2 months out from the exam. Not very good, but because I used the questions as a learning tool, I remained calm and I think that is one of the reasons why I did well.

USMLEWORLD: The other end of the spectrum in terms of difficulty. Again, I chose it because of the price ($50/month when I signed up). It's ridiculously difficult and hence prepares you well (psychologically as well as knowledge wise) for those questions in USMLE which will throw you off. The real exam seems easy compared to UW. In fact, these questions were too hard, I only glimpsed through the explanations unless the question related to a key concept in First Aid. Therefore, use it in conjunction with First Aid, and don't sweat too much if the question relates to the concept that does not appear in FA.

 

[rice_boy]

The biggest hurdle i forsee in preparing for the USMLE is overcoming my insufficiencies in Biochemistry and Pathology - 2 topics that were hardly covered in the Australian medical course.

sjkpark - congrats on the fantastic score - can you give any advice on how to tackle these 2 gigantic areas?

I'm currently going through the kaplan biochem vids - it seems quite straight forward - is this really all we have to know? Or are the standards more inline with whats covered in the Lippincotts Illlustrated Review Biochemistry?

thx for any input.

 

[sjkpark]

Biochem - Kaplan+FA is more than enough.
Pathology - didn't spend a lot of time on review. Didn't need to after 5 years of med school in New Zealand. I started doing questions without initial review and for path I was consistently scoring over 70s-80s. Learned everything in FA and did lots of questions.

 

[driedcaribou]

Biochem - Kaplan+FA is more than enough.
Pathology - didn't spend a lot of time on review. Didn't need to after 5 years of med school in New Zealand. I started doing questions without initial review and for path I was consistently scoring over 70s-80s. Learned everything in FA and did lots of questions.

The New Zealand medical programs are still really good programs though.

If you get a hold of the Autumn 2007 issue #11 of PathWay put out by the Royal College of Pathologists of Australasia and look at page 36 to page 38, you can see that the University of Otago and the University of Auckland both have much more pathology contact hours than UQ and USyd. USyd inflates its pathology hours by adding '72 hours of self-directed learning topics'.

It claims Year 2 at Otago have 41 case-based sessions and lectures
Year 3 has 38 hours of case-based sessions
Year 4 and 5 have 50 hours per year

delivery: CBL, web, practicals, lectures, autopsies, tutorials

stand alone and integrated assessment


Auckland:
Year 2 63 hours
Year 3 60 hours plus, incorporated into integraded learning and 4 to 6 path lectures in each year
10 hours of tutorials and CBL in years 4 and 5
delivery: lectures, practicals, CBL, web, self-assessment, combined anatomy and pathology museum

stand alone and integrated assessment


Sydney:
26 pure path lectures
60 hours of practicals (we did???)
72 hours of self-directed learning topics in years 1 and 2
years 3 and 4 delivered off-campus in hospitals (if you are lucky)
delivery: PBL, CBL, practicals, lectures

integrated assessment - also note that Sydney only has ONE exam that counts at the end of year 2 and one at the end of year 3.
There are two integrated exams that don't count in year 1, one in year 2, and one in year 3.

USyd have 7 academic staff for pathology (who are all wonderful) but this is compared to what is listed as 35 path staff for Otago (is that correct?) and 15 for Auckland.

Data for the long-term outcome of graduates I am sure will be fine but in the short-term, for USMLE test prep, there could be problems.

 

[sjkpark]

Auckland:
Year 2 63 hours
Year 3 60 hours plus, incorporated into integraded learning and 4 to 6 path lectures in each year
10 hours of tutorials and CBL in years 4 and 5
delivery: lectures, practicals, CBL, web, self-assessment, combined anatomy and pathology museum

stand alone and integrated assessment

In fact, I think I got a lot more pathology teaching than that in Auckland. In years 4 and 5, we get tutorials in laboratory medicine which was very helpful for USMLE. We get a clinical vignette (very similar in format to USMLE), some lab values and discuss questions with pathologists - you learn to interpret laboratory test values. Almost all of pathology tutors were dual-trained in internal medicine, which was very good.

However, I don't think pathology teaching in 2nd and 3rd year helped a lot with USMLE prep. I think what helped a lot was a habit of always thinking about and trying to understand the pathophysiology of the conditions during clinical years.

 

[JoeNamaMD]

The six year programs in New Zealand and Australia prepare you extremely well for the USMLE exams, the four year graduate entry programs are not as good, your advice is relevant to those in 6 year courses because they have more basic sciences, but they are not relevant to those in the grad entry programs. Some of my friends going to medical school in the US have a much stronger education in the basic medical sciences. Recall the article about Australian medical students failing a basic anatomy test??

 

[greens]

Hello, I am wondering if this is who I was talking to a few weeks ago about the USMLEs. I lost your email address, etc. I'm the 4th year who was doing genmed three weeks ago. (Not using names cause who knows who reads this). Anyways, if it is you could you let me know so I can get your information again?
Thanks, oh and by the way great job on the exam.

 

[driedcaribou]

(Not using names cause who knows who reads this). .

I think you should know that residency directors in the US have been known to read the main forum.

In general, if you write in a public forum, you should always assume everyone is reading it.

It's akin to teenagers making lavish MySpace pages and then getting mad when their parents find it and ground them for underage drinking.

 

[rice_boy]

I think you should know that residency
It's akin to teenagers making lavish MySpace pages and then getting mad when their parents find it and ground them for underage drinking.