1. The USMLE and You: A lovers guide Haley Cochrane, Stage 3 Sydney Medical Program NAMSA President SUMS International Rep

2. Overview The USMLE Steps Resources My experience Tips

3. The USMLE exams USMLE Step 1 USMLE Step 2 – Clinical Skills (CS) – Clinical Knowledge (CK) USMLE Step 3

4. Things you need ECFMG registration – Your document collection, exam registration, and residency application center Can be done anytime, need to send the documents off at least 6 months before rego Money. Resources! Time, determination, and iron will.

5. Step 1

6. USMLE Step 1 Computer based MCQ exam 322 questions, 46 questions per block x 7 blocks of 1 hour 15min tutorial (optional), 45 mins of break time 8am – 4pm roughly Test taken in any country Sydney Prometric test Center – Downtown near Town Hall Cost - $820 + $200 to write outside NA

7. USMLE Step 1 Most important score for American Residency Can write anytime after 2 years of medical school Can only write it ONCE if you pass, no option to discard score Score only valid for 7 yrs

8. USMLE Step 1 Topics Covered – 25%–35% General principles, 65%–75% Individual organ systems – hematopoietic / lymphoreticular – nervous/special senses – skin/connective tissue – musculoskeletal – respiratory – cardiovascular – gastrointestinal – renal/urinary – reproductive – endocrine – immune Process – 20%–30% Normal structure and function – 40%–50% Abnormal processes – 15%–25% Principles of therapeutics – 10%–20% Psychosocial, cultural, occupational, and environmental considerations

9. Scores 188 pass Avg ~220, IMG’s should AIM for 230-250 Released 4-8 weeks after test date

11. Step 2 – Clinical Knowledge Scumbag Macrophage

12. USMLE Step 2 CK 368 questions, 8 blocks, 46Q, 60min 9 hours of testing Can be written anywhere, same as Step 1 Cost - $820 + $200 to write outside N.A.

13. Step 2 CK Content General Principles Infancy and Childhood Adolescence Senescence Medical Ethics and Jurisprudence Applied Biostatistics and Clinical Epidemiology Systems-Based Practice and Patient Safety Infectious and Parasitic Diseases Neoplasms Immunologic Disorders Diseases of the Blood and Blood-forming Organs Mental Disorders Diseases of the Nervous System and Special Senses Cardiovascular Disorders Diseases of the Respiratory System Nutritional and Digestive Disorders Gynecologic Disorders Renal, Urinary, and Male Reproductive Systems Disorders of Pregnancy, Childbirth, and the Puerperium Disorders of the Skin and Subcutaneous Tissues Diseases of the Musculoskeletal System and Connective Tissue Endocrine and Metabolic Disorders Congenital Anomalies Conditions Originating in the Perinatal Period Symptoms, Signs, and Ill-defined Conditions Injury and Poisoning

14. Step 2 - Clinical Skills

15. USMLE Step 2 CS History/PE, Critical thinking, Note taking Patient Interaction English Proficiency 11-12 stations with 12 standardized patients (SP’s) – 10 scored by SP’s and Physician 15 minutes for history, 10 minutes patient note 5 stations, 30 min break, 4 stations, 15 min break, 3 stations Can only be written in the USA, 5 centers – LA, Philly, Chicago, Houston, Atlanta Cost $1440 + flight and accomodation (~$80 in LA/night) Eligibility: a medical student officially enrolled in, or a graduate of, a medical school outside the United States and Canada and eligible for examination by the ECFMG.

16. USMLE Step 2 CS Book 1 year testing schedule, book early via ECFMG Centers are closed in May-June (Graduation) Can write anytime after “2 nd year” (4yr program), I recommend end of 3 rd /start of 4 th (4 yr program) Resources: First Aid for Step 2 CS (~$40) – Online patient note example Requires 2-4weeks preparation

17. USMLE Step 3 3 steps: clinical encounter frame, physician task, and normal conditions and diseases MCQs and Computer Based Case Simulations 480 MCQ, blocks of 36-48Q’s 45-60min per block ~12 Cases, one per block. 10-20min to complete case Step 3 is administered in two eight hour testing sessions, usually done in State you will register

18. Eligibility for Step 3 To be eligible for Step 3, prior to submitting your application, you must: obtain your MBBS Degree pass Step 1, Step 2 CK, and, if required based upon the rules referenced below, Step 2 CS, obtain certification by the ECFMG or successfully complete a "Fifth Pathway" program if you are a graduate of a medical school outside the United States and Canada (information on Fifth Pathway programs is available in ECFMG’s Information Booklet, and meet the Step 3 requirements set by the medical licensing authority to which you are applying. Does not need to be completed for start of residency Does need to be completed for visa H1B

19. Other Costs Extension of Eligibility (Step 1 and CS) - $65 Step 2 CS reschedule – $0-400 Rewrites – Original Cost

20. My Experience

21. Preamble N = 1 No right or wrong way to study for this exam Background degree/experience will make some things easier for you than others Selective memory

22. My Test Day 7 sections, ~8hours, 30 min break (+15 min opt. intro) Did first 4 sections back to back (was only going to do 3) Took ~30 min lunch break 2 sections ~10 -15 min break 1 section Finished Early on all but 1 section, had ~15 min extra time Full day of exhausting brain hurt, feel like you did terrible and have to wait ~4 weeks for results

23. Resources – The good First Aid for USMLE step 1 USMLE World Q bank Goljan pathology Audio Lectures,Goljan Notes Pathoma Deja Review USMLE Step 1

24. Experience overall Good – Done early – Good USYD exam Prep – Amazing Foundation for clinical years – More on par with North American Grads WRT knowledge – You get out what you put in – Not looming over you – Look like awesome rockstar medical student badass at hospital Bad – Lose a whole summer (6 weeks) – EXPENSIVE (final cost ~$2500) – Grinding, depressing, maddening long term study – Grief cycles – No clinical experience to help with vignettes – Non-writing USMLE classmates hate you

25. If I could do it again tips: Do as many questions as you can ?both Q banks Doctors in Training Course > Kaplan Focus extra hard on the material you hate (Biochem) Study Friend Complete all resources Save a copy of your score reports!!

26. You Can Do it BE PREPARED! Fear is your friend It is expensive and full-on to motivate you DO NOT go on forums before exams (eg. SDN) and don’t feed the trolls, but great tips abound It will make you a better student and doctor Find what works, take advice with a grain of salt