Practicing in the US? USMLE & other questions.

[dr strangelove]

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Hi all,

I'm currently a medical student at Glasgow University, where I'll be going into 2nd year in September. I've always wanted to practice in the USA for a while, and I'm not too clear how to go about doing it.

What I know so far (stop me if I'm incorrect) is that UK and US medical degrees are not reciprocal, which is the reason you have to do the USMLE if you want to practice over in the States.

So, I was just wondering if anyone here is planning to take the USMLE. If so, when is it usual to sit them i.e. is it even too early in my medical education to think about taking them?

That's about it for now - if someone responds in the affirmative to the above question I've got a few more queries though. Any additional information that people could provide would also be appreciated, thanks. 🙂

 

[ASarz]

Most US students take the USMLE Step 1 after their 2nd year. Perhaps all of your questions can be answered here: www.usmle.org. FAQ section may be of particular help.

 

[leorl]

If glasgow is a 5-6 yr. program, most would take it after the 3rd or 4th year. Mainly after you finish all of your pre-clinical courses anyway, and definitely after you've finished pathology - that's for step I. depending on what you plan on doing for or after graduation, Step II can be taken during 5th or final year, or even after graduation.

 

[dr strangelove]

I haven't looked at the USMLE website in detail yet, but from what leorl says it seems I'd be better off waiting a while before attempting it. Glasgow's a 5 year course, but I've already picked up a BSc, so do you think it would be feasible to attempt it at the end of 2nd year?

I presume both of you have taken or are going to take the USMLE? If so when are you both planning to do it? Does a UK undergraduate curriculum prepare you sufficiently for what will come up in the exam, or do you need to do extra reading around?

Thanks for your replies. 🙂

 

[f_w]

Your medical degree is sort of reciprocal. But just like a US medstudent would have to write the PLAB in the UK to enter training, any foreign graduate in the US has to pass USMLE 1, 2ck and 2cs before they can start residency. USMLE step3 is typically taken during your first year of residency, however for a non-citizen it can be advisable to take it before you come (which makes you eligible for a different visa category. don't ask, it makes no sense).

Information on how to sign up for the tests and what credentials you have to provide:

www.ecfmg.org

USMLE is just like any other standardized exam. It has to be studied for in a very specific way. Just going there and taking it because you feel confident based on your knowledge would be a waste of time/money and could negatively impact your ability to get a good residency. You want to take time off, to prepare for the USMLEs, particularly for step1. You want to get a score that is well above average. Only by shining on the USMLE, you have a shot at competitive residency positions (anything but the lower tier programs of family practice, internal medicine and pediatrics.)



Don't take step1 too early. There is a maximum of 7 years between step1 and step3 allowable in a couple of states. So, if you don't go to the states right after finishing school, you might get into a situation where you are sort of 'forced' to do step3 at a time you weren't planning on it, just to keep the validity of your step1 result.

 

[leorl]

I am studying for Step I now, actually. I'm in a 5 year program as well (well, I was a direct entrant into the 2nd year of a 6 yr program, but they are changing the curriculum so that it is an actual 5 yr. program). I've just finished my 3rd year here (so their 4th yr.)

The UK system I feel does prepare you adequately for USMLE, but there are things that you will have to sort of teach yourself or go over extensively. I don't know your curriculum, but things like embryology and biostatistics/behavioural science which tend to be glossed over in our system will appear heavily on the USMLE, so make sure you prepare enough time to teach yourself (it's doable). Also, we are a bit weak on histology, but decent with histopathology.

I wouldn't take it immediately after your BSc, I'd wait another year because presumably, you're going into your first clinical year next year, right? Clinical encounters can help with the USMLE because some questions may be presented in a vignette style, where eg. 60 yo man presents with dyspnoea, mild chest pain, etc. and cultures of his BAL show clusters of small round bacilli, his pulmonary wedge pressure is X, etc etc etc. Yes, you learn those from books but seeing it in clinical practice helps you integrate it all together. Also, a lot of questions are 3 tiered - etc. A man is brought into ER (A&E) comatose with shallow breathing. A paramedic notices he has pinpoint pupils. What is the mechanism of action of the treatment you would use to reverse his situation, etc etc etc.

Anyway, there's no rush to take it. At the same time, I wouldn't wait too long because it's nice when the course material (pathology) is still fresh in your head.

 

[BlondeCookie]

Hmmm... I thought they changed the USMLE so that instead of their being two parts to step 2, there is only one part.

Is this right, so you would have to take:
USMLE 1 - taken anytime while in med school
USMLE 2 - taken in final year or after med school
USMLE 3 - taken during or after residency

 

[Miklos]

Hmmm... I thought they changed the USMLE so that instead of their being two parts to step 2, there is only one part.

Is this right, so you would have to take:
USMLE 1 - taken anytime while in med school
USMLE 2 - taken in final year or after med school
USMLE 3 - taken during or after residency

Step 2 consists of two parts:

Step 2 CK - a computer based exam like Step 1

and

Step 2 CS - a practical exam on standarized patients

 

[BlondeCookie]

Perhaps I was getting step 2 confused with something else. But, I thought that there was some test that they required of foreign-trained docs that they recently do not require.

So, can you take both parts of USMLE step 2 at the same time? Or when, is it required that they both be taken?

 

[Miklos]

Perhaps I was getting step 2 confused with something else. But, I thought that there was some test that they required of foreign-trained docs that they recently do not require.

The ECFMG CSA along with the TOEFL (both of which only IMGs were required to take) were eliminated and replaced with Step 2 CS for all applicants.

So, can you take both parts of USMLE step 2 at the same time?

No. You must schedule separate dates.

Or when, is it required that they both be taken?

In order to remain in the NRMP match, you need to take them before December 31 of the year prior to the match (along with Step 1). Otherwise, you will be automatically withdrawn from the match. However, in order to be more competitive, it would be advantageous to have completed these exams before then, to give residency programs more information to evaluate your application. (Many will not consider IMGs without Step 1 & 2 CS/CK completed.)

 

[dr strangelove]

One final question for anyone studying for the USMLE's at the moment: are you using any USMLE guide books to supplement your current curriculum, and if so, what one would you recommend?

 

[f_w]

> Perhaps I was getting step 2 confused with something else. But,
> I thought that there was some test that they required of
> foreign-trained docs that they recently do not require.

Are you talking about the FLEX ? That was something like 15 years ago.

It used to be (until 6/98)

step1
english test (TOEFLx2)
step2
--> ECFMG certificate with 2 year validity, to be extended with $100 TOEFLs

Then it was (until 04):
step1
english test (TOEFLx2)
step2
CSA
--> ECFMG certificate with 2 year validity, to be extended with $1200 CSAs

Now it is:
step1
step2ck
step2cs
--> ECFMG certificate with 2 year validitiy, to be extended with $1200 step2cs repeats

 

[BlondeCookie]

When is it advisable to take USMLE 3? I hear that some people take it before residency, some during residency, and some after residency?

If a person were to take it before residency, would that make the applicant more competitive in applying for a residency or does it matter?

 

[leorl]

One final question for anyone studying for the USMLE's at the moment: are you using any USMLE guide books to supplement your current curriculum, and if so, what one would you recommend?

I'd recommend that you keep following your class notes and reviewing periodically, so you don't do what I am doing a couple months before I take the USMLE going "Crap! I've forgotten all my anatomy. Crap! I've never heard of that syndrom before..." I would get First Aid for the USMLE and make sure you're covering all the things listed there, and annotate first aid with your own notes. For things that you need more expansion on (ie. behavioral science or cell bio) then when you come to study for the USMLE, get a couple High Yield books. It also might help if you look at Kaplan Qbook and see if you can practice some questions while you're doing the course ...i.e. look at some biochem questions during/after you've done biochem. Of course, everyone goes in with the intention of doing all this and it falls apart a bit 🙂

 

[dr strangelove]

Thanks for the tips!