My Road to the USMLE…

Hello Guys,

So, yesterday I got my ECFMG Certificate. That magical piece of paper that will let me apply to the match on September. And to complete my happiness I’ll begin my observership next week. Everything seems to be working smoothly and hopefully I’ll be ready to take over for the 2013 Match Season.

I have a couple of days before starting my observership and I’d like to use them and write a little bit about the USMLE process.

First of all, let me be clear about this post. It is a “pseudo-guide” based on the experiences I, and some of my friends, have had over our preparation for the USMLE.

The Step 1

When I began studying there were no so many guides about how to study for the USMLE. Even last week I met a group of students that were trying to study but the had no idea where to begin. They were worried about all the stuff they have read on the internet forums, and they didn’t know what to believe. After thinking about it for a while I think I can give you some key points to begin studying right away and diminish your chances of get lost in the process.

  • Studying Materials: Try to keep your list of books to study to the minimum. Focus in the material that will help you for the exam and don’t get distracted by other publications that offer the same subjects or new “experimental” materials.The material my friends and I used were:

    -Kaplan Lecture Notes and Videos
    -Kaplan QBank
    -First Aid for the USMLE Step 1
    -Goljan Pathology Review
    -USMLE World Qbank

    I think the order is also important. Kaplan will give you a broad idea of the concepts you need to know for the exam, while First Aid and UWorld will pinpoint the High Yield concepts and facts you need for the step 1. Then, I suggest you to begin with the Kaplan materials, and then, at the end,  use FA and UWorld to fine tune and agile your processing time for the exam.

  • Evaluate yourself periodically: There are many tools to evaluate yourself along your studies timeframe and I really recommend them. NBMEs, UWorld Self Assessment, Lange Q&As, Kaplan’s Diagnostic Exams are the most important ones.You could probably find some  of this evaluation tools “offline”, even tough I’m not against them, I’d suggest you to pay for the real deal. This is because when you pay, you get a performance graph that will tell you exactly where you are; what are your strengths, and what are your weakness. And, my friends, that is priceless.

    Key point to remember:

    -Qbanks (Kaplan/UWorld/Rx) are studying materials, not self assessment tools. Please use them as such. Study and learn from them. Each question has at least 4 concepts you can learn that question.

    -NBME/UWorld Self Assessment/Kalan Diagnostic are evaluation tools, not studying materials. Don’t waste much of your time trying to figure out what questions you did wrong in your test and trust the performance graphs.Once you get your performance graph you can plan or modify your schedule accordingly to the results you got.

  • You will probably never feel ready for taking the actual test: Most of you will never feel ready, I never did. That’s when the self assessment evaluations come in handy. That will be the only way you’ll know for sure if you are ready or not to take the test.
  • Cheat yourself , screw yourself: This is fundamental, if you do Qbank once, there’s no need to do it again. The same goes for UWorld and the NBMEs. You know that going twice on a set of questions you will recall all the answers. Sure it feels great to have a nice score for time to time, but don’t fool yourself into thinking that you are getting better by doing that.
  • Set up a Schedule: Set up a REALISTIC time schedule to study, and I mean that you have to schedule a REALISTIC time frame per subject and a REALISTIC timeframe for each exam.From time to time you have to review your schedule as reminder of where you are and how much is left to get where you want to get to.

    You’ll notice that in many forums, people (specially Indians) tend to say, and suggest, that you only need 3 months to prepare for the Step 1. That you need nothing more than the First Aid or the UWorld to pass this test. Well, here is a fact, some Medical Schools around the world (especially Indian medical schools) have designed a curriculum based on the US Medical Education Examination, meaning that they study only to take the test during their medical education. Thus, it is true they only need 3 months to study, and little materials to practice, but this is not the rule for everyone,  especially if you come from a school from Latin America or Europe.

    The truth is that you will need as much time to study as you need to. This could go from 6 months to 3 years. Surprised? Yes, it can take that long. You have to have this in your mind at all times: THIS IS NOT A RACE. ENDURANCE, NOT SPEED, IS REQUIRED.

    As personal experience, it took me a year to be ready to take the Step 1. And I don’t regret it. I’ve seen people who study 4-5 months, and they fail or get a bad score (~70) closing the opportunities for any interviews by themselves. Just like that they’ve shut close most doors for any residence.

    Patience is probably the hardest part of the USMLE. It was hard for me, it has been hard for everyone I know, but believe me when I say this, it pays off.

  • How many hours a day should you study?: It depends on you, and solely on you. There’s and old saying “The brain catches on until the butt can’t hold it no more”.A good friend of mine has ADHD, he would sit down to study around 10:30 in the morning, but he would get distracted, by every person, bug, video, text, chat, anything, all day! At the end of the day, he would study only for 4 hours, but that was enough for him. He did really great on every exam he took.

    Personally, I had to sit down around 9am, take an hour break around 1pm and then get back to study until 9pm. At the end I did good in my steps too. But i was a really different method form my friend.

    It is up to you to find out out how many hours you’ll need to study every day and once you develop a routine you should stick to it until the end.If you realize that routine is not working for you, then change it as soon as possible and don’t waste any more time on an ineffective method.

  • Set up a Calendar: This one goes hand on hand with my previous point. I think this is an important step in you USMLE process.Basically,  if you don’t know when you want to apply to the Match you won’t know when to take your tests. Also, the application process for each test and to get your ECFMG Certificate takes some time and you have to anticipate for the worst case scenario (Like your medical school not responding to the ECFMG verification letter). You should also consider this if you have to apply for the PTAL (California Letter) too, because it takes an awful long time to be processed.

    In my experience, when I first started studying I did not put that much effort on studying, mostly because I didn’t set an my exam date. This was around January 2010 and my goal was to apply for the 2012 Match.

    My first 4 months went by without much progress on my scores in my QBank. After that I realized that if I keep loosing time I’d have to wait another year to apply for the match. With those four months lost I was aiming on finishing around early october at best. So, I had to plan my calendar to take my step 1 on early February 2011, so I could take my step 2 on early October 2011 and be able to apply for the 2012 Match in October 2011. This meant that I had 7 months left to go.

    I set up my calendar, I got my scheduling permit for February-March-April 2011, and I scheduled my test for the first week of February. It was not until I had my Scheduling Confirmation page in my bare hands that felt the pressure to focus on my studying. I took my NBMEs every 2-3 months but by mid – December 2010 I still didn’t like my score on my NBME. I decided to postpone my exam one more month and a half. By late January 2011 I was ready to take my test.

    Due to those 4 months I lost at the beginning I couldn’t be ready for my Step 2 CK until January  2012. It was too late to apply for the 2012 Match. A part of me regrets that I lost that time, but at the same time I feel happy tat I took my time to get the scores I got. And hopefully these scores will get me into a residency program in the 2013 Match.

    What I’m trying to say is that: Take your time to prepare yourself for your tests, it’ll be worth every second. And it is ok to take more time to prepare yourself when you really need it.

  • The USMLE is a bitchy mistress: The USMLE will take all your time, and it will eat your soul. The following paragraph will sound kind of harsh, but I need to say it.Don’t use your family, your girlfriend, or your job as an excuse to postpone your test. I know it is hard to dedicate yourself to study full time. You have to sacrifice, your family and your job, but you have to outweigh your benefits.

    When I first came to the US I got a job and I was trying to study in my spare time. By the third month, I knew that I wasn’t gonna be able to take my tests if I didn’t dedicate myself full time. I mean, it was good to have a job, earn money, and survive happily in LA. But when I thought about it, I saw that I was sacrificing $200k (on average) per year in the future for less than $10k a year now.  You don’t need to be on wall street to deduct the answer. I quit my job and went on studying full time. It was hard to make the transition. I supported myself since my 4th year of med school, and suddenly I had to ask my parents to support me once again for 2 more years!. I had to live on tuna and PBJ sandwiches for a long time, but soon enough it’ll pay off.

    I have friends that began studying around the same time I did. They got jobs, as I did. They liked being employed, next thing you know they bought a car, they ask for a loan to buy a house, they enjoy evenings with theirs families and trips to vegas. It’s been two years, and they haven’t taken their Step 1 yet. It is sad, but they’d rather have $20K a year now than $200k in a couple of years. The worst thing is they say they can’t renounce to that steady job because of all the reasons described above.

    Just think about it. You might suffer a little bit today, not for a day, not for a month, maybe for a couple of years, but soon enough you’ll se the profit of that investment.

    And please don’t get me wrong, there are examples of people that work and study and they do fine in their steps, but it is such a small number I wouldn’t bet on that. Well, I tried, and it didn’t work for me.

  • Last, but not least, know where is everything you need for your tests: You need to know where to apply for every test and how to fill out every form. Fortunately for all of us the ECFMG has made an effort to detail the instructions on how to fill out every form and they explain every step of the process carefully for us. Take your time to read all the instructions and when in doubt ask for help, specially to people ho have already done it.Sites you will need:

    http://www.ecfmg.org : Main gate way for the USMLE process. It is the organization responsible for all the International Medical Graduates accreditation process. Whithin this page you’ll need the following sites:
    -IWA: Apply for the scheduling permit for the Step 1, step 2 CK and CS.
    -OASIS: Review and follow your ECFMG Certification process.

    http://www.prometric.com : You’ll schedule your test on this site once you have your scheduling permit from the ECFMG website.

    Medical Board of California: if you plan to apply to California for your residency, you’ll need a Letter to be able to work as a resident and to get your license here. This is the Post Training Authorization Letter (PTAL) just google for it and you’ll find the form and the instructions and the  forms in the first results page. It takes between 4 and 6 months to be processed and you must finish the process within a year of initiating the application process (If you wait longer, they may destroy your file and you’ll have to start the process again, including the fees and school verification process). It also requires that you have passed your Step 1 and Step 2 CK to get it, so I suggest you to apply when you start studying for your step 2.

 The Step 2

 

Ok. Let me tell you about my step 2 experience and some other stuff that may be helpful for you.

    ~The Step 2 CS

 

After my step 1 I decided to take my step 2 CS right away. In case you don’t know about it, after each exam there’s a 3-week waiting period to get your test results. So, I decided that instead of just sitting around and wait for my test results I would practice and take my CS.

 

To be honest, It took me exactly 2 weeks and a half to practice for the CS. I borrowed the First Aid For the Step 2 CS from a friend, and he helped me practice. in two weeks we did the 42 cases from the FA twice. And I practiced making notes every date.

Luckily for me, during that time Kaplan hired new simulated patients for their CS assessments, and they needed to practice. So, in exchange for practicing, they offered a free CS assessment for whoever that wanted to participate. I signed in just in time. I took my CS assessment. I passed. That was good enough for me to take my CS.

I took my CS on Monday, and my Step 1 results came on Wednesday. I passed, and I could breath easily once again.

 

The CS examination is no more than an act. You have to learn the script and learn how to improvise when needed. You’ll learn everything you need from the First aid. You won’t need to diagnose the patients, but you’ll have to  come with a a pertinent differential diagnosis and tests. There’s no much to say about this exam, more that practice, practice, and practice!.

 

~The Step 2 CK

 

A lot of people think that studying and taking the Step 2 CK is easier. The fact is that there’s actually no exam easier than the other.  Once you study for one Step, either step 1 or step 2, the next time you’ll be more prepared on how to study, and you may feel like it was easier.

 

While it took me over a year to take my step 1, I had to study 7 months to take my step 2. The material I used was the following:

 

-Kaplan Lectures Notes and Videos ( Especially Internal Medicine)

-Kaplan Q Bank

-USMLE World Qbank

-First Aid for the Step 2 CK

-Master the Boards for the Step 2
The method was almost the same as for my step 1. I began with the Kaplan materials followed by Uworld, FA, and MTB. The last two months of my preparation were crucial. I studying from the FA in the morning, doing questions at noon, and relaxed at the end of the day with MTB.  IT was awesome and everything was running smoothly.

As well as with my Step 1 I set up a calendar, and a schedule. I followed it and it worked nicely. I suggest you to do the same.

 

And please, please, PLEASE!, don’t think that because you did well on your step 1, you don’t have to put the same effort on your step 2. You should improve your score  in your second exam, and in the third one as well. That’ll show the program directors that you can learn from what you do, to improve your results.

Some other stuff…

    ~The UCLA IMG Program:

 

The UCLA IMG Program  is a program designed for Latin American physicians to help the undeserved latin american population of California (that goes up to 1/3 of the general population of California). THis program is designed not only to provide general physicians to the population, but to provide fully Family Medicine Board Certified Physicians to the population of california.

 

This program is designed in three programs:

 

Program A: UCLA will help you prepare for the step 1 by paying for Kaplan Deluxe Prep Course in Pasadena, where you will spend more of your time. During this time you’ll also have to attend grand rounds and english preparation courses at the UCLA’s Family Healthcare Center (UFHC) in Santa Monica.

 

Program B: You’ll spend most of your time at the UFHC studying for the Step 2. THis time UCLA will not pay for Kaplan, but you’ll have to develop your own study plan to take the test. In addition to this, you will also have to participate in the Family Medicine/Ambulatory Care clerkship with the UCLA’s 4th-year medical students. You will also have to attend grand rounds and english classes. If needed you’ll need to assist the physicians by translating from the spanish speaking patient to the english speaking medical team.

 

Program C: Observership. For 3 months you’ll be in a clinical setting, and you’ll be part of the medical team and you’ll participate in all the medical activities. THink of this as a medical student rotating in the hospital. It is a great experience, with only one downside: You cannot touch the patients…. yet. A bill has been passed, that will allow IMG’s to touch patients when in the UCLA IMG Program. This bill will give every UCLA IMG the same rights and obligations as a US Medical Student. Sounds pretty neat, right? Well, there’s more. UCLA will also pay for Kaplan prep course for the Step 3, so you can take it before applying for the Match.

 

This is an awesome program, I’ve been part of it since program A, and believe me when I say, it is worth it. They will help you out in every step of your USMLE process. You will have colleagues to study together. And you’ll have access to all the resources from the UCLA Medical Library.

 

If you complete your program successfully you’ll receive 2 Letters of Recommendation from the Family Medicine Program Directors at UCLA. This LoRs will help you get interviews from the Family Residency Programs in California. If you don’t get the idea of how important these letters are imagine this: You are a musician and you get a letter of recommendation from Michael Jackson and Madonna. And if you do well in your observership you may also get a LoR from George Martin.

 

It is important to mention that once you finish your residency program you will have to work for three years in a undeserved area in California.

 

You have to understand what this programs does and what it doesn’t.

  • This program is for Family Medicine only, and you have to have this very clear before applying in the program.
  • This program does not support any kind of visas.
  • This program is for Latin American Physicians only.
  • This program won’t pass your steps. You have to do it. you have to study hard to pass every step, and that responsibility is yours and only yours.
  • Getting in the UCLA IMG Program doesn’t guarantee you a residency spot. Your USMLE scores, observership and LoRs will help you get into a residency. You’ll have to work hard to get all the necessary items to get in to a residency program. Almost 99% of the UCLA IMG program participants get into a family residency program in California. So, it’s up t o you.
  • UCLA will help you and will provide all the tools for you to succeed, but you have to work hard to get there.
If you are interested, do a google search and read all about this program. You could be the next participant and they can help you succeed.

 

~Kaplan Medical

 

Kaplan is a great tool is you know how to use it. For some Kaplan is considered like the Mc Donalds of Medicine education, and for others is a life saver.

 

In my own personal experience, I used their studying materials as much as I could. I tried to take every piece of information as my brain allowed me. I’m certain that all of that helped me to get to the place I’m now.

 

It’s pricey, much more expensive to what IMGs are used to in their countries, but gotta see this as an investment for your future. And if you really take advantage of everything has to offer, you’ll do very well in your examinations.

 

The only down side I noticed was that they don’t really help you schedule o set up a realistic calendar to  use their materials.  When I first walked in for my step 1, I was told to see a medical advisor. This person was an IMG, and I’m pretty sure she didn’t take her steps by the time I saw her. She asked me when I wanted to take my exam, and then she started talking non stop.

 

She suggested me to initiate with Live Lectures, and then the videos. She provided me a “calendar” that I could follow to study. That calendar said that I could study all Biochemistry in 8 days, I never touched it again. Then she told me to do Kaplan qbank and that was pretty much it. I was ready to take my step 1.

 

Once I stepped inside the computer lab, I was on my own. I talked to my friends, to people that already passed their step 1 with great scores. I developed a plan myself that I followed and that helped me achieve success. If you decide to go to kaplan I suggest you to tell your medical advisor what you want, and don’t let them decide for you what are you going to do. If your plan doesn’t feel right, tell them. You paid and awful amount of money, you should make it count. A good friend of mine, followed everything this medical advisor said… he failed at his first attempt.

 

Some of my friends say that when they had their live lectures one of the professors did an awful job in his class. They spoke up and they got an extra class with a different professor that could complete the job.

 

Don’t get me wrong, Kaplan is great, the material is awesome, and you’ll get a great foundation to take your steps, but be careful, and don’t risk  your opportunity.

 

A few last words

 

This process is hard, is long, and it’s probably hairy (no pun intended). Lots of times you’ll feel like you can’t continue, but you gotta keep going. Talk to your friends, talk to people you know. There’s a lot of people willing to help you out and cheer you up in those gray days.

 

I hope this page will help someone to get an idea of what the USMLE process is like. And hopefully someone will benefit from it.

 

 

 

If you have any questions, comments, concerns or congratulations  you can reach me in the comments section below or in my twitter account: @TimothyMD

Thank you guys for reading!

 

Peace.

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