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When to start thinking about USMLE?

Discussion in 'General Residency Issues' started by jane2, Nov 20, 2005.

  1. jane2

    jane2 Member
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    I'm starting at medical school in either the UK or Ireland in 2006. I would like to know when I will have to start thinking about the USMLE, given that I already know that I want to do a US residency immediately after my 5 year medical school degree.

    I know there are various parts to the USMLEI - two of which I believe can be done outside the USA, and one which can't - right?

    Any insight into the timeline would be appreciated.

    Thanks.
     
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  3. (nicedream)

    (nicedream) Fitter Happier
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    US students take Step 1 immediately following their 2nd year (in a 4yr curriculum). Step 2 is taken after the 3rd year. You must have Step 1 completed by the time you apply for residencies - some require step 2 as well I believe. Step 3 is taken at end of 4th year I think.
     
  4. valedictorian

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    You need to have an MD (or equivalent) to take step 3. I guess you could study for it in fourth year and take it right after graduation. I hadn't thought of that. Might consider it. But I think most people take it in residency.
     
  5. f_w

    f_w 1K Member
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    One thing to keep in mind is that you don't want to have more than 7 years between step1 and step3 (requirement by various licensing boards).

    Look at your curriculum and the step1 syllabus and decide when you have the stuff covered. As a foreign grad, you want to achieve outstanding scores in order to get a shot at a competitive residency. So after you have covered the subjects in school, take a block of dedicated time to study only for the USMLE.

    step1 and step2ck can be taken anywhere in the world.

    step2cs and step3 have to be taken in the US.
     
  6. jane2

    jane2 Member
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    The 7 year thing is useful to to know.

    Eligibility for Step 3 can't really require an MD for FMGs since you only get these in the US (well, you can do it as a post-grad extra thing in the UK but I know that it's not necessary in order to get a training position in the USA.)

    thanks...any more info from anyone?
     
  7. jane2

    jane2 Member
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    I have a couple more specific questions which hopefully someone can help me with....
    Firstly, does all this sound about right:

    - USMLE consists of the following steps:
    1 (which can be taken in the UK at the end of second year),
    2CS
    2CK (both of which can also be taken at the end of second year, but are based on clinical knowledge and skills so probably should not be taken at this point....) and
    3.

    What's Step 3 about? When do you guys take it? I understand that ECFMG certification is necessary for eligibility for Step 3, yet this cannot be awarded until medical school has been completed, and Step 1 & 2CK have been passed.

    It seems to me as though my basic timeline will be looking something like this (please correct me if I'm wrong

    Year 1 Medical school (studying for USMLE Step 1)
    Year 2 medical school (studying for USMLE Step 1)
    - After Year 2, take USMLE Step 1.
    Year 3 Medical school (studying for USMLE Steps 2CK & 2CS)
    Year 4 Medical school (studying for USMLE Steps 2CK & 2CS)
    Year 5 Medical school(studying for USMLE Steps 2CK & 2CS)
    After graduation take Steps 2CK and 2CS. Will be given ECFMG certification upon passing these exams. Apply for Step 3 at this point.

    It seems like the timeline here is quite similar for US students so do you guys usually have to take a year out inbetween graduating med school and starting your residency?

    Or would I be able to apply through ERAS in the fall of my final year, go to interviews (hopefully!) in January/February, sit my final exams in June of that year, sit Steps 2CK and CS in say July of that year, get ECFMG certified hopefully by, say, August? That doesn't leave me very much time to sit my Step 3 before starting a residency. I'm presuming that residencies usually start in September?

    Phew. Sorry for all the words. Thanks so much for the assistance.
     
  8. f_w

    f_w 1K Member
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    > Eligibility for Step 3 can't really require an MD for FMGs since you only get these in the US

    It requires graduation from medical school, whatever the title is they give you (MBBS, diplomat medicien.....)

    > - USMLE consists of the following steps:
    > 1 (which can be taken in the UK at the end of second year),

    Correct. You have to be in school for 2 years in order to enroll.
    It asks mainly pre-clinical sciences such as pharmacology, pathology, microbiology, behavioural science and the like.

    > 2CK (both of which can also be taken at the end of second year, but
    > are based on clinical knowledge and skills so probably should not be
    > taken at this point....) and

    You want to take 2ck after you have had some exposure to the clinical subjects such as medicine surgery and the like.

    > 2cs

    A practical exam with actors playing the part of the patient. It tests whether you speak enough english to interview a patient and whether you have very basic clinical exam skills. It also tests whether you are able to syntesize the results of your history and physical and bring it onto a piece of paper in a semi-congruent fashion.

    > What's Step 3 about?

    It is about understanding US medicine in the context of US society. The subject matter is essentially limited to family practice. The key is to understand that the medically correct answer might not be the one desired by society. There are plenty of 'scenarios' where you have to click your way through fake clinical cases and 'order tests' and other entertainment.


    > When do you guys take it?

    During internship (PGY-1, first year of residency, doesn't have to be in internal medicine).

    > I understand that ECFMG certification is necessary for eligibility for
    > Step 3, yet this cannot be awarded until medical school has
    > been completed, and Step 1 & 2CK have been passed.

    You don't have to pass step3 in order to start a residency. 1,2ck,2cs are sufficient. However, if you are not a US citizen or permanent resident (green-card), you have to deal with the issue of visas. And in order to be eligible for the more interesting H1b visa, you need to be 'eligible for licensure'. And the immigration authorities here interpret passing of step3 to be evidence of this.


    Year 1 Medical school (studying for USMLE Step 1)
    Year 2 medical school (studying for USMLE Step 1)
    - After Year 2, take USMLE Step 1.
    Year 3 Medical school (studying for USMLE Steps 2CK & 2CS)
    Year 4 Medical school (studying for USMLE Steps 2CK & 2CS)
    Year 5 Medical school(studying for USMLE Steps 2CK & 2CS)
    After graduation take Steps 2CK and 2CS. Will be given ECFMG certification upon passing these exams. Apply for Step 3 at this point.


    Reasonable timeline. However, you might want to take 2ck and 2cs during your last year of medschool .

    > It seems like the timeline here is quite similar for US students so do
    > you guys usually have to take a year out inbetween graduating med
    > school and starting your residency?

    US medstudents only need step1 in order to apply for residencies (historically you didn't take the then step2 until the end of 4th year). They don't need the extra step of ECFMG certification.


    > go to interviews (hopefully!) in January/February, sit my final exams
    > in June of that year, sit Steps 2CK and CS in say July of that year,

    As a foreign graduate, you will have a hard time to get any interviews if you are not ECFMG certified by the time you apply. The bar is a bit higher for FMGs in that respect.

    > That doesn't leave me very much time to sit my Step 3 before starting
    > a residency. I'm presuming that residencies usually start in September?

    They start july 1st. As I mentioned, while for visa reasons it can be advisable to pass step3 before starting residency, it is not a requirement.

    If you are from the UK, it might be worthwhile to do a pre-registration house officer year or a foundation year. That way, you have some clinical experience which helps you to get interviews and it also gives you a time period to finish up the paperwork such as step3 (it also makes you eligible for full GMC registration. This might be worthwhile if you ever intend on going back to the UK).

    And oh, these things change all the time, so todays knowledge might not apply 7 years from now when you hit the real world. When I started out in the certification process, there was still the 2 part FMGMS (costing about $600 total). By now it is a 4 part exam (costing about $2800).
     
  9. valedictorian

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    ....or EQUIVALENT....i.e. MBBS or whatever else Johnny Foreigner earns in medschool. :p
     
  10. jane2

    jane2 Member
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    Thanks for all the replies. It was just the way MD was so specifically cited, when there are actually a few other ways a doctor can qualify abroad, that made me think for one awful moment that perhaps it was like law ie you basically need to study in a US institution for a year to be able to work there.

    Sounds like a 'gap year' of sorts after uni would be a good plan then. I'll probably be able to use a break, by that point, anyway.......
     

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