USMLE

USMLE BASIC INFORMATION

The United States Medical Licensing Examination is jointly administered by the NBME and LCME. The fundamental purpose of the USMLE is to assess the suitability of a candidate to practise medicine in the United States.

USMLE step 1 assesses your knowledge of pre-clinical subjects. This is important from a pubic health standpoint to make sure that you understand the fundamentals of medicine, such as anatomy and physiology, and disease processes and pathology, and the microbiology of the pathogens that cause disease, and the pharmacology of the medications that you will be using. Many residency program directors give more importance to your step 1 scores as compared to your step 2 scores.

USMLE step 2 CK assesses your knowledge of clinical medicine. You will be tested on your knowledge of medical facts and also your ability to analyze and interpret clinical data. Clinical data includes history and exam findings and results of investigations.

USMLE step 2 CS tests your ability to perform a history and examination under simulated settings, it also tests your spoken English and communication skills, and it tests your ability to competently take patient notes.

The written parts of the USMLE ie step 1 and step 2 CK are administered through the internet. You can take these exams at test centres that are owned by Prometric. These centres are available around the world. Step 2 CS is available only in US centres. Step 3 is available at Prometric centres in the United States. You do not need step 3 to start in a residency program,

Q: What will be covered on Step 3 of the USMLE?

A: Step 3 continues to be quite different than the first two steps. First, USMLE Step 3 is a two day exam. The test is usually taken by those who are in a residency training program. This portion of the test will determine whether a student can apply their medical knowledge and understanding of basic and clinical sciences that are necessary for unsupervised practicing of medicine. This portion of the test has a particular emphasis on patient management, physician tasks, initial patient evaluations, continuing care, and emergent care.

This portion of the test is also different in that it is administered by the medical board of the state that the student is in. Each of the two days involves an eight hour testing time. On the first of the two days you can expect 350 multiple choice questions. These questions are divided into blocks of 25 to 50 questions, with each block needing to be completed within 30 to 60 minutes, depending on the block. On the first day you will need to finish the actual testing within 7 hours. This testing time also allows for a 45 minute break and a 15 minute tutorial for those who want to take it.

The second day of testing will bring with it 150 multiple choice questions as well as computer based simulations. The 150 questions will be divided up into blocks of 25 to 50 questions. The sets will take anywhere from 30 to 60 minutes, but the test must be completed in a maximum of three hours. After each multiple choice question there will be a computer based case simulation tutorial, for which there are 30 minutes allowed. The computer based case simulation is then followed up by nine case simulations. These case simulations are seen in one or more cases per block and three hours and 45 minutes are allotted for them.

Q: I have had many coworkers and resident doctors tell me different things about how long I should take to prepare for the USMLE Step 1. How long should I prepare?

A: How long one takes to prepare for any exam is all based on personal learning styles, ability to retain knowledge, and ability to apply knowledge to a test. Most students spend anywhere from five to nine months preparing USMLE Step 1. Many people find that they simply are not well prepared if they study for less than five months, and yet for those who spend more than nine months studying, retention may be a problem or they may find that they over think even the simplest things, making the exams more difficult than they need to be.

Q: I know I need to take USMLE Step 1 exam but I really don’t know what materials will help me prepare to the best of my ability. Where do I start?

A: There are countless products and tools that will help you prepare for the USMLE exam, and each person may find that one product is better than the next. Some of the most popular USMLE study guides include but are not limited to:

Kaplan Series
USMLE World MCQ’s
USMLE Total Review software
First Aid

Jawetz will help with immunology and microbiology readiness

Goljan will provide plenty of information to help prepare you for pathology

Snell’s Anatomy will provide you with all of the diagrams and tables that will help with Anatomy

Q: Does it really matter what I score on the USMLE exams as long as I take them?

A: Absolutely. The general rule of thumb is not to take the exams unless you think you can score a 95 or above. The reason is that there are going to be many people who are taking the same exams and vying for the same positions that you will be. Freshly out of school it is hard to say who will be the best for a job, so many employers will look at USMLE scores to help them decide which applicant is right for the position. If you don’t have the best score possible, you’ll find it hard to win out against the competition.

Q: Is it worth my time and energy to take USMLE practice exams?

A: Absolutely. One of the best ways to prepare for any test is to take practice tests. These tests can be a great tool to show you where you are excelling and where your areas of opportunity may lie. Having this information will help you study in a more focused manner. Today there are many free or very affordable practice tests that will help you prepare as well as possible for all three USMLE exams.

Q: I’ve been reading about NBNE forms and am a bit confused. Which ones do I use and what are the differences?

A: There are a lot of details that go into the USMLE exams, and the NMBE forms are actually self assessment forms. Many people struggle with determining which form to use. The easiest way to understand these self assessment forms is that the higher the number, the more difficult it will be. It is a good idea to take two different assessments, but for those who can only afford to take one, it’s a good idea to take the NBME form four or five as they are middle of the road in terms of difficult. Ideally, every student will be able to use at least two NBME forms. The first would be from the easier set from one to four and then the second would be from the harder form set ranging from five to seven. Using two forms will allow you to see the averages.

Q: Is the USMLE question pool the same as the question pool of the NBME forms?

A: This is a common question or concern. The short answer is no. The question pool is not the same, yet the questions are testing on the same content, so using the forms is a great way to know where your strengths and weaknesses lie before taking the exam.

Q: If the NBME forms do not offer the same questions as the USMLE, why take it?

A: This is a fair question. The reason that you want to use the NBME forms before you take the USMILE exams is that the self assessment tests will actually predict your probable USMLE score. This will allow you to see where your knowledge or application of your knowledge is lacking. Based on the probable prediction of your score, you can decide if you should sign up to take the exam now, or if you need more prep time.

Q: As an AMG do I really need to take Step 1 before I move onto the other steps of the USMLE?

A: You don’t have to take Step 1 first, although it is a good idea. The reason for this is that it will allow you to see how the USMLE testing works, and the materials covered may actually help you do better on the next steps. About 20% of Step 2 is information that was covered in Step 1, so it is a great way to determine what areas you may need to work harder in if you want to be as well prepared for Step 2.

Q: I keep hearing the phrase “high yield” in relation to the USMLE exams, yet I can’t seem to find exactly what this is referring to. Is it something I need to be concerned about?

A: Great question. The term high yield, whether it is reviews, topics, or questions, is referring to those concepts that are most frequently tested on in the USMLE. It stands to reason that if you understand the high yield content that you will stand a better chance of doing well on the exam. It’s been said that as much as 70% of the material covered in the exams are high yield and so more and more students are focusing on these areas of study. While this is a viable study option, it is also important to have a well rounded knowledge base, including the lower yield concepts. There are many high yield study guides that can guide you on this topic, but remember that at least 30% of the test will involve low yield concepts.

Q: Is it true that the test for IMG’s is more difficult than the one that the AMG’s will take?

A: There are many myths associated with the USMLE exams and this is one of them. The short answer is no, one test is not technically harder than the other. Yet, it is important to understand that every state will educate their students to pass their medical boards. Therefore, many IMG’s find the test more difficult than an AMG would because of the differences in education from one area of the world to another.

Q: I’m confused and overwhelmed. Which is truly the best material for studying?

A: There is not a clear cut answer. Many students are asking if one prep material is enough. The bottom line is that you have to understand what you are reading, what you are testing for, and you have to be able to take in the information and retain it. No prep material is enough to get a 99 if you are not reading the information or allowing enough time to read the information and truly understand it. It’s important to realize that it is not necessarily which guide you use, but that you use it to its fullest capabilities until you know the information forwards and backwards. If you do this, your chances of doing well on the exam are much higher.

Q: I got a low score on Step 2 and I don’t know where I went wrong. Can you help?

A: There are many common mistakes that students make where Step 2 is concerned, all of which can be corrected. Many people who breeze through Step 1 assume that they will be able to do the same for Step 2. The fact of the matter is that only about 20% of the information from Step 1 will appear in Step 2. Therefore, one has to really take the time not to just study, but to study in detail. Just having a brief review of topics will not be enough.

Another common issue is that students do not know enough about the mechanisms of the diseases that are covered in Step 2. This is why studying pathology and pathophysiology is so important before one takes the Step 2 exam. One also needs to remember that the content that is covered is more clinical in nature and you will need to be able to set up algorithms to truly do well on the exam.

Q: I am so frustrated. A friend and I studied the same material, for the same amount of time and I failed Step 2 and he did not. What went wrong?

A: This can be very frustrating and it happens more than you might think. It is important to remember that the way that every person learns is different. Even if two people have all of the same information, the way that they study, the way that they are able to retain the information, and the manner in which they approach the test will vary slightly, if not markedly, and this will obviously impact the scores of any of the USMLE exams.

Q: After failing Step 2 I am really not sure how to proceed. Where do I go from here?

A: Study more and in depth. Many people make the mistake of rushing into Step 2. you need to stop and refocus and don’t retest before you are really ready. Use all of the resources available to you and then look at your q-bank averages. This will let you know when you are truly ready to retest and see a much better grade on the exam.

Q: I am starting to think most people simply cannot pass the USMLE exams. I hear so many horror stories of people spending all of their money and all of their time preparing, only to fail. What percentage of people actually pass these exams?

A: It is very common to feel like there is no way that you can possibly pass these exams, and yet there are many people who do! The pass rates are actually quite high:

The passing rate for Step 1 is 91% of US and Canadian graduates and 63% of international medical graduates
The passing rate for USMLE Step 2 CK is 94 percent for US and Canadian graduates and 74% of international medical graduates
International medical graduates
The passing rate for USMLE Step 2 CS is 97 percent for US and Canadian graduates and 70% of international medical graduates
The passing rate for USMLE Step 3 is 94 percent for US and Canadian graduates and 71% of international medical graduates

These questions and answers are representative of the most frequently asked USMLE questions and concerns, but is by no means an exhaustive list of every question that can and has been asked. The USMLE exams are very in depth and require a vast amount of knowledge, studying, and retention of such knowledge. This need to retain, understand and apply so much information may cause a lot of anxiety, and hence the worries and need to understand just how to prepare and pass the USMLE exams.

Q: I’ve heard that there are multiple parts to the USMLE test. How many tests will I need to prepare for?

A: There is a lot of information and misinformation available about the USMLE, so it is important to know what you will really come up against through this testing. The fact is that there are three steps, with each one covering different areas of knowledge. While many students don’t like the idea of having different steps, it is actually a nice way to break up what would be an exhausting test if it was taken as one complete test.

Q: What can expect in USMLE step 1?

A: Step 1 is a computer based test that will take place in one day. It is often taken at the end of a students second year of medical school. This portion of the test really covers all of the most basic science principals such as anatomy, behavioral science, biochemistry, microbiology, pathology, pharmacology and physiology. Step 1 of the test also covers areas including genetics, immunology, and nutrition. While all of these areas are covered in the test, they are presented at random, so any one testing period could contain information from all interdisciplinary areas.

This portion of the test will run the duration of eight hours. This is broken down by seven 60 minute blocks. In each 60 minute period you will have to answer about 50 questions. These questions are one question best answer formatted, so there is no need to worry about matching or essay responses. It is important to note that you can go back and forth between questions, but only those questions that are in the block of 50 that are currently being worked on. Once the allotted time for that block is up, you will not be able to go back to those questions.

Q: What can I expect in USMLE step 2?

A: Like step 1, step 2 is a one day computer based test. This test covers clinical science and will determine whether you are able to apply the knowledge you have been given and that you have an understanding of clinical sciences. This ability to apply and understand clinical science is needed to begin providing patient care under supervision.

Step 2 has an emphasis on health promotion and disease prevention. It will cover some topics in detail such as diagnosis, prognosis, as well as preventative measures that need to be taken in a clinical setting. The specific areas that are tested in step 2 include obstetrics, gynecology, pediatrics, preventative medicine and public health, psychiatry and surgery. This portion of the test includes 400 questions and the test will run nine hours in length.

The testing time is broken up into eight 60 minute blocks, with 50 questions in each block. As is the case in Step 1, these questions are not asked by subject, rather they are random. Additionally, the ability to move from one question to the next and back again is possible during testing, but only within the 50 question block that is being tested. Once a 50 question block is up, you will be unable to move back and forth between previous blocks.

Unlike step 1 of the USMLE test, the second portion has questions that are sorted by format. There are three different question types which are single best answer, matching, and pick N format. For every question there are as few as three but as many as 26 answer choices. Generally speaking the questions will describe a patient or medical situation and you will be required to identify the mechanism of disease, propose a diagnosis, order diagnostic studies, or even initiate treatment.