USMLE Step 2

[Guest summervirus]

Hi everyone,

 

I've been trying to find out some information regarding the USMLE but I have a few questions that I can't find answers for (yet). I was hoping that maybe someone here could help me out. I wrote the USMLE step 1 (and passed) after my second year of med school. Now that I'm in my fourth year, I'm thinking of writing the USMLE step 2. But, I was quite shocked to find the price to be nearly $1500 USD (not including airfare and accomodations)! So, I'm trying to find out whether or not it would be worthwhile for me to attempt 'step 2' after all. I don't have intentions of going to the USA right now but I want to keep my avenues open in case I need to move there in the future for yet unforeseen reasons.

 

1. If I don't write step 2 (and eventually step 3), will my step 1 results eventually "expire"? (It would be shame to have it all go to waste...)

 

2. Will I be able to qualify for the FACP examination (e.g. in internal medicine) with only the step 1 in the future when I'm done residency, or will I need to have completed all three steps of the USMLE?

 

Thanks. I hope someone out there is able to answer these questions!

 

SV

[Guest Lactic Folly]

Hi summervirus,

"Most medical licensing authorities require completion of USMLE Steps 1, 2, and 3 within a seven-year period, which begins when you pass your first Step."

www.usmle.org/faqs/faqusmle.htm#Do

www.fsmb.org/usmle_eliinitial.html

It does add up to a lot of money, that's for sure. Good luck with your decision and hope someone else can address your second question..

[Guest summervirus]

That's great. Thanks so much, Lactic Folly!

[Guest Ian Wong]

I would echo what Lactic Folly said. The 7 years starts once you take Step 1. I think it's worth it to get Step 2 done after CaRMS in Med 4. It'll be the same sort of material as MCCQE Part 1.

 

It may very well be that you won't ever need Steps 1-3, but life is unpredictable, and there may well come a time when a key fellowship or job opportunity is open in the US. Having Steps 1-3 completed opens you up to the possibility of getting an H1B visa, which can let you moonlight in the US while doing a residency or fellowship, and opens the door to getting a green card if you have any designs on staying in the US to practice medicine.

 

I think you can probably do the US IM boards without the Steps. That should be relatively easy to determine by contacting the American Board of Internal Medicine. However, having USMLE Steps 1-3 is required for state licensure unless it's a state that recognizes the LMCC as equivalent (which I think many/most do). I'm not sure how the LMCC plays into getting a visa.

 

I do know that having Steps 1-3 definitely opens the door for an H1B visa. I'm not sure if having the state recognize your LMCC as equivalent to Steps 1-3 will be enough to convince the US immigration folks to give you an H1B visa.

 

Ian

[Guest summervirus]

Thanks for the clarification about licensure. I've decided to sign up for Step 2 earlier this month even though the cost of the exam is pretty scary -- especially because I'll have to fly to the USA for the CS portion. Like you said, I don't know if it will come in handy one day... and it would be nice to get it done with now!

[Guest summervirus]

I thought I would write an update here for anyone that is interested and might be thinking of going through it like me.

 

I finished Step 2 (CK and CS) now and I found them both to be quite straight forward. I did both exams after completing my fourth year of medical school during the break between med school and residency. Like me, a few of my classmates also took the Step 2.

 

My impression of the Clinical Skills (CS) portion of the exam is positive. I felt like the scenarios were fair. Each case was either something extremely common that everyone would need to know about (e.g. a 60 year old patient with dull retrosternal chest pain) or something that would be dangerous if missed (e.g. a 40 year old hypertensive patient with a suddent onset "worst headache ever"). The exam itself consists of 10-12 OSCE stations (with 2 possible experimental stations). I was given 15 minutes to take a history and perform a physical examination. Afterwards, I had to document everything in a note (either on paper or a computer -- I personally chose to use the computer) which would also be graded and scored. This portion was 10 minutes long.

 

Unlike other OSCE's I've had in the past, I felt as though I had ample time to finish everything. Only once did I feel rushed (and that was because my computer suddenly crashed in the middle of the exam so I had to write on paper instead). There was something that I felt was very odd though. The patient encounter portion of the exam is graded entirely by the patients themselves with no examiner in the room. The patients are all lay-people and not medical doctors (nor even medical professionals). Rather, they are trained to score us based on how we perform different physical exam maneuvers or what questions we ask about the history. That frustrated me a little because I was afraid that I would be wrongly penalized (e.g. if I perform a pivot-shift maneuver on the knee differently than the way they were shown).

 

Overall, I felt the exam went well and that I was well prepared. At the University of Alberta, we are given two comprehensive exams at the end of the year: one is written, the other an OSCE. I think that the UofA's exam was (by far) more difficult than the USMLE. I also used the First Aid book to prepare for the Step 2 and I think the cases listed in the book are very representative of the material I encountered on the exam. To be honest, I actually thought it was a fun exam!

 

The Clinical Knowledge (CK) exam was also a pleasant experience. Unlike the horrible Step 1, which I felt to be one of the most difficult exams (possibly THE most difficult exam) I've written, the Step 2 CK was fairly easy (maybe one of the easiest exams I have written in the last two years)! The exam itself consists of 8 blocks, each 60 minutes long with 40-something questions per block. I was frankly exhausted and my eyes hurt by the seventh hour because the entire exam is computer-based.

 

The biggest difficulty I encountered was my unfamiliarity with the units and measurements on the exam. A list of "normal ranges" is given within the computer program itself. I felt like I was constantly looking up even the simplest things like creatinine, glucose, BUN, etc. Honestly, I felt rushed to finish some of the sections, which surprised me. But, later on, I figured out it was because I was wasting so much time looking up nearly every single lab value.

 

Unlike the LMCC, the USMLE assigns questions fairly randomly and the difficulty level of the questions remains fairly consistent throughout. There were no big surprises. (On the other hand, the LMCC scores each set of questions immediately and issues the next set of questions based on how well the student performs. For example, if I were to answer one question set entirely correctly, my next set will be more difficult. If I answer wrong, I will get an easier set of questions next. I was very happy that the USMLE is not like that).

 

Before writing the USMLE, I wrote both the LMCC and the UofA's comprehensive exam, both of which (I felt) were much harder! So, in comparision, the USMLE was quite easy. I also used the First Aid book to prepare for the CK sections.

 

In summary, I thought that the Step 2 CS and CK were very straight forward exams. I did not spend any extra time preparing for the CK or CS sections. I studied entirely for my school's final exams and the LMCC. I did use the First Aid books to supplement my readings and hoped that there would be enough overlap between the Canadian and American exams, and indeed there was. Looking back, I think I made the right decision. Most (maybe all?) Canadian grads shouldn't have a problem with the Step 2, especially if you're writing it around the same time as the LMCC. Don't be scared by memories of Step 1. (While the Canadian curriculum doesn't teach the material that's represented on the Step 1 very well, it's a completely different story for the Step 2).

 

I hope this is helpful to whoever is reading this.

[Guest satsumargirl]

Thanks Summervirus!

 

Very helpful

[Guest Lactic Folly]

Thanks SV, I'm writing Step 1 soon (eep) - good to know the U of A prepares us well for Step 2 at least!

[Guest muchdutch]

Very insightful and detailed. Be sure to update the boards on how step 3 goes in the future....

[Guest summervirus]

I'm glad that my little summary helped.

 

I know that this message board has really helped me out a lot in the past; I think that it's only appropriate that I try to help out a little too!

[EJL]

I am interested in applying to both the US and Canadian Matches for 2007. I wrote Step I last year. In terms of writing Step II, If I want to be considered for residency there, when is the optimal time to write the exam? Does it have to be in the fall before the US interviews? or can I put it off until winter? If anyone knows/can suggest something, please let me know.

Thanks,

EJL

[Ian Wong]

If your Step 1 was strong, then there's no need to write Step 2 prior to matching. US program directors primarily use Step 1 to stratify applicants. If your Step 1 score was lower than average for the specialty you'd be applying to, then it may be beneficial to take Step 2 early and try to crush it.

 

US med students typically either take Step 2 immediately after Med 3, or else just after they've matched.

 

US interviews can start occurring anywhere from October to December (for the early matches, such as Neurosurgery, Ophthalmology, Neurology, and Urology), or from October/November to early February (for regular match specialties, pretty much most specialties).

 

When you put together your US application, there's a check where ERAS asks if you want your USMLE scores forwarded to programs (this will automatically send the results of any Step exams you've completed). There's an additional option where if you haven't yet completed these, it will ask whether you want those results auto-forwarded to the programs whenever they are available. If you decline that option, you need to send those results manually, and as a result, you have the power to with-hold these scores so that programs won't know whether you've taken Step 2, nor what those marks are.

 

It's therefore possible to apply to ERAS with just Step 1, and take Step 2 early. If you bomb it, don't release the marks. Otherwise, release them ASAP if you like your results. However, this is a little sneaky, and while it is theoretically possible to pull off, you potentially risk getting asked about Step 2 during your interview (although this is relatively unlikely).

 

Bottom line, if you have a strong Step 1, hold off on the Step 2 untill you've finished interviews. Otherwise, go after Step 2 early and try to crush it.

 

Do note that you need to have Steps 1-3 completed and successfully passed in order to apply for an H1B visa. If you are happy with a J-1 visa or already have a green card/dual citizenship, this is less important.

 

Ian