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Please Consider Taking The Usmle.


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To all med students, especially those that just got admitted (congrats!):

 

Even if you never thought of working in US, or would not work there for whatever reason, PLEASE consider taking at least Step 1 while in med school. Aside from few hundred dollars you won't regret it. And one day, for whatever reason, you wish/need/fancy to work in the US, even for some temp gig, and is in need of a H1B visa, you'll thank yourself for having done Step 1 while in med school

 

PS. Wannabe surgeons: in case you haven't heard, job market in Canada is generally not too hot. Don't get stuck as a PGY-15.

 

 

While the ambiance of this post is not that of the classical specimen attributable to the poster, it is an outpouring of genuine solicitude towards those that may be affected.

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As an incoming medical student, I am slightly concerned that you were sufficiently motivated to make this post.

 

That being said, I am reluctant to write the USMLE as I really don't see myself living in America, nor anticipate pursuing a specialty with a poor job market. (Of course this is all tentative--but I'm about as certain as I could possibly be at this point).

 

It would also be a bit of an annoyance writing it during a 3 year program.

 

I guess for anyone who has written the USMLE, is it like the MCAT where its difficulty is often exaggerated or is it really as ridiculous and oriented towards basic science minutiae as suggested (step 1)?

 

Thanks. 

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If I have not seen and heard from many residents (including surg, ICU, GI) about how difficult they are finding jobs, and how it's making their life miserable despite overcoming hurdles starting from the days of MCAT, then I wouldn't be so inclined to write.

 

Also in case you haven't noticed, due to budgetary constraints many provinces are coming down hard on MDs. Just do a quick Google search on the negotiation in ON and you'll get a good feel as to how far governments are willing to go.

 

Lastly, Step 1 is difficult for many reasons. I think the biggest reason is you can only write it once (unless you fail, which is even a bigger problem then)

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Also in case you haven't noticed, due to budgetary constraints many provinces are coming down hard on MDs. Just do a quick Google search on the negotiation in ON and you'll get a good feel as to how far governments are willing to go.

But not really though....

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Does it matter what score we get on the Step 1 or do we just need to pass?

If we fail the Step 1, does it have 0 effect on us if we just decide to stay in Canada forever at that point? Does a poor score have any implication for CaRMS (they see the score, right?)?

When would a CMG study for it and write it? Summer after 2nd year?

 

I wasn't considering writing it before but I might give it more serious consideration now...

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As an incoming medical student, I am slightly concerned that you were sufficiently motivated to make this post.

 

That being said, I am reluctant to write the USMLE as I really don't see myself living in America, nor anticipate pursuing a specialty with a poor job market. (Of course this is all tentative--but I'm about as certain as I could possibly be at this point).

 

It would also be a bit of an annoyance writing it during a 3 year program.

 

I guess for anyone who has written the USMLE, is it like the MCAT where its difficulty is often exaggerated or is it really as ridiculous and oriented towards basic science minutiae as suggested (step 1)?

 

Thanks.

The mcat is a joke compared to step1. It is a beast of an exam and requires proper dedication.

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Does it matter what score we get on the Step 1 or do we just need to pass?

 

If we fail the Step 1, does it have 0 effect on us if we just decide to stay in Canada forever at that point? Does a poor score have any implication for CaRMS (they see the score, right?)?

 

When would a CMG study for it and write it? Summer after 2nd year?

 

I wasn't considering writing it before but I might give it more serious consideration now...

If taking step 1 to do a us residency, you need a strong score. If just for fellowship/employment, a pass is generally fine. But with anything, if youre gonna do it dont half ass it. Give it a good attempt.

 

Zero bearing on carms

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The best time to write it is the summer after 2nd year (in a 4 year school). For a pass, consider about 2-3 months of study. For a top score, consider at least 1 year of studying, if not from day 1 of med school, 

 

It does not affect CaRMS. While failure on any Steps have minimal effect in Canada, many states limits the total attempts per Step, so try to pass it the first time.

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If you want to do primary, generalist medicine - ie FM, EM is it really necessary to write it? It seems like only surg and some IM subspecialties require it

 

It's neither required nor necessary per se. But I view it as a backup, a safety net kind of idea: you do it once, you get it over with, and it's good for the rest of your life. It's kind of like learning how to drive and getting your driver's license even though you may not own a car right now, plan to own a car in the immediate future, or is against driving for whatever philosophical reasons, etc. Some day you just might be in a situation where you need to operate a car, and the fact that you have some skill and certification related to driving comes in handy.

 

You never know, maybe some day there's some sweet gig you happen to come across, and you US license comes handy.

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The best time to write it is the summer after 2nd year (in a 4 year school). For a pass, consider about 2-3 months of study. For a top score, consider at least 1 year of studying, if not from day 1 of med school,

 

It does not affect CaRMS. While failure on any Steps have minimal effect in Canada, many states limits the total attempts per Step, so try to pass it the first time.

Any advice for 3 year programs?

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If you want to do primary, generalist medicine - ie FM, EM is it really necessary to write it? It seems like only surg and some IM subspecialties require it

 

It's not really required period, just a very good idea for some career paths. If you're never, ever going to move to the US, for any reason, the USMLE has little value above being a way to study pre-clerkship material.

 

The USMLEs I would highly recommend for those who intend to move to the US at some point (duh), those considering specialties with very poor domestic job markets (like many surgical specialties), and those who want an academic-focused career (due to unique fellowship opportunities in the US). If you're sure none of these apply to you, the USMLE likely won't make much of a difference.

 

The trouble is knowing for certain before the optimal opportunity to write Step 1 comes at the end of pre-clerkship. Career paths for most people are still pretty fluid at that point, so the safe bet is generally to write the USMLEs just in case. I'd agree that for FM and EM, it's not going to be that useful, whereas for surgical specialties and IM (depending on desired subspecialty) it's more useful, but most people aren't 100% sure which side they're on before clerkship.

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Any advice for 3 year programs?

My general thoughts:

 

To pass: Read First Aid for Step 1 for 1-2 months, then do UWorld for 1-2 months, maybe between 1st and 2nd year, but preferably before heavy rotations like surgery/CTU.

 

To ace: Start from day 1, preferably daily studying with First Aid and use UWorld at least once a week to complement FirstAid. Look for other online resources or books and pay attention to tips on forums like SDN. If confident after 1st year may attempt.

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Is only Step 1 necessary?

 

For H1B you must pass all 3 steps. But because Step 1 is arguably the most difficult and least clinically relevant, doing it early is advisable. 

 

Also if you are thinking of doing US electives or even participating in the NRMP Step 1 is a must. People don't realize many US schools require you to have passed Step 1 to register for electives there.

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The best time to write it is the summer after 2nd year (in a 4 year school). For a pass, consider about 2-3 months of study. For a top score, consider at least 1 year of studying, if not from day 1 of med school, 

 

It does not affect CaRMS. While failure on any Steps have minimal effect in Canada, many states limits the total attempts per Step, so try to pass it the first time.

A few schools are starting to have step 1 written after the first clinical year too, so maybe writing it after core rotations are done isn't a terrible idea either. Pros and cons of course, but benefits of actually being in the system and learning drugs/pathophysiology/mgmt plans on a daily basis will really hone in on the clinical aspects. Minutae may be forgotten, but thats brute force most of the time anyways.

 

Just a matter of seeing if you have the time. Anecdotally, seems to be some improvements in score ranging from those who do it a year later than usual after some clinical experience under their belt.

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It's not really required period, just a very good idea for some career paths. If you're never, ever going to move to the US, for any reason, the USMLE has little value above being a way to study pre-clerkship material.

 

The USMLEs I would highly recommend for those who intend to move to the US at some point (duh), those considering specialties with very poor domestic job markets (like many surgical specialties), and those who want an academic-focused career (due to unique fellowship opportunities in the US). If you're sure none of these apply to you, the USMLE likely won't make much of a difference.

 

The trouble is knowing for certain before the optimal opportunity to write Step 1 comes at the end of pre-clerkship. Career paths for most people are still pretty fluid at that point, so the safe bet is generally to write the USMLEs just in case. I'd agree that for FM and EM, it's not going to be that useful, whereas for surgical specialties and IM (depending on desired subspecialty) it's more useful, but most people aren't 100% sure which side they're on before clerkship.

Just a nitpick: EM is pretty competitive in Canada, and going to be very difficult to match in the US due to visa issues(j1 SON will only sponsor 4 year programs, while majority of US EM programs are 3 year programs, though things are shifting, current US 4 year EM programs are generally very difficult to match to for anyone).

 

 

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My general thoughts:

 

To pass: Read First Aid for Step 1 for 1-2 months, then do UWorld for 1-2 months, maybe between 1st and 2nd year, but preferably before heavy rotations like surgery/CTU.

 

To ace: Start from day 1, preferably daily studying with First Aid and use UWorld at least once a week to complement FirstAid. Look for other online resources or books and pay attention to tips on forums like SDN. If confident after 1st year may attempt.

Taking step 1 after first year, is not advisable. It covers 2 years worth of material - if you are somehow competent to do well on step 1 after M1, then you essentially covered the breadth of M1 and M2, and can just phone it in for year 2. Very unlikely. While a lot of what is on Step 1 is "teaching to the test" - doing very well on it generally requires very strong fundamentals and breadth of common concepts that would be gained over both preclinical years etc.

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Just a nitpick: EM is pretty competitive in Canada, and going to be very difficult to match in the US due to visa issues(j1 SON will only sponsor 4 year programs, while majority of US EM programs are 3 year programs, though things are shifting, current US 4 year EM programs are generally very difficult to match to for anyone).

 

 

 

Not sure I understand the relevance of this. EM is competitive in Canada, yes, but why does that matter? For those interested in EM, there's a natural back-up to remaining in Canada through the FM+1, which, while being competitive, is far more reliable than going to the US and trying to get a difficult 4-year position plus an extra year of training required for Royal College certification back here in Canada. Heck, even if you don't get the +1, you can still work a fair bit of EM if you're willing to go rural. Going the US route, especially on a J1, can easily lead to the difficult situation of being unable to work in the US (due to the J1 requirement to leave the country) but not be able to work in Canada because of insufficient training time, even if you get a 4-year program. 

 

Sure, for those wanting to work in the US, it could make sense to do residency there, but that's a bit of a moot point - of course those individuals should write their USMLEs. For those intending to practice in Canada, US residencies are really not a great option for EM period and there are far better alternatives here in Canada for those that don't match to a Royal College EM program.

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Not sure I understand the relevance of this. EM is competitive in Canada, yes, but why does that matter? For those interested in EM, there's a natural back-up to remaining in Canada through the FM+1, which, while being competitive, is far more reliable than going to the US and trying to get a difficult 4-year position plus an extra year of training required for Royal College certification back here in Canada. Heck, even if you don't get the +1, you can still work a fair bit of EM if you're willing to go rural. Going the US route, especially on a J1, can easily lead to the difficult situation of being unable to work in the US (due to the J1 requirement to leave the country) but not be able to work in Canada because of insufficient training time, even if you get a 4-year program.

 

Sure, for those wanting to work in the US, it could make sense to do residency there, but that's a bit of a moot point - of course those individuals should write their USMLEs. For those intending to practice in Canada, US residencies are really not a great option for EM period and there are far better alternatives here in Canada for those that don't match to a Royal College EM program.

Oh no, we are in agreeance, I misread what you meant re: EM and was implying the same that it doesnt make sense the same to do usmles for EM.

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Taking step 1 after first year, is not advisable. It covers 2 years worth of material - if you are somehow competent to do well on step 1 after M1, then you essentially covered the breadth of M1 and M2, and can just phone it in for year 2. Very unlikely. While a lot of what is on Step 1 is "teaching to the test" - doing very well on it generally requires very strong fundamentals and breadth of common concepts that would be gained over both preclinical years etc.

 

The person asking the questions referred specifically to a 3 year program, mind you. For some they will be on heavy rotations by M2. 

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The person asking the questions referred specifically to a 3 year program, mind you. For some they will be on heavy rotations by M2. 

Right, good point -maybe still worth it to maybe write it after 1.5 years? Very hard to say when an appropriate time would be for a 3 year program. Maybe even more worth it to just wait until all 3 years are done and write it, in order to back up with the US if CaRMS didn't work out for them for their specialty.

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I agree with Shikimate that its a good idea to write Step 1 during med school after 2nd year.

 

I would say it is the hardest test I have ever written but I only studied ~ 5 weeks (NOT full time, was working as well part time). I still managed to pass comfortably (didn't ace it but got just below avg). I was only looking to pass anyways :)

 

I'd also really recommend also writing Step 2 CK with the MCCQE part 1, as the material your studying is pretty much the same (although Step 2 CK is more IM and Surgery heavy). That being said I focused on the MCCQE heavy topics (OBGYN, Peds, Psych) and managed to pass Step 2 CK easily as well (this one I managed to get an avg score!) with only 3 weeks of real studying.

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