USMLE Questions

[itimebomb2]

Hi,

 

1) When in a 3-year program would be the best time to try to write the step-1 exam?

 

2) I've heard that studying for the USMLE is good even if you don't really have an interest in the states, simply because it is a great training/revision opportunity. How true is this?

 

 

Thank you.

[Ian Wong]

Step 1 is very heavily weighted to basic sciences. I went through UBC's 4 year program, and in that program, doing it after Med 2 is ideal, as it marks the transition from basic sciences to clinical work.

 

I would speculate that whenever you switch over from the classroom/PBL to being full-time on the wards is probably the best time. I would suspect that it may be a little more difficult, as you may not have a lot of time to study for it; most US med students will study for it over several weeks (which is doable during your break between Med 2 and 3 in a 4 year curriculum).

 

As far as it being a good review of the basic sciences, this is probably true, in that you have to digest an immense amount of basic science material to do well on this exam. A lot of this material isn't really relevant to the clinical medicine you'll encounter on the wards. I probably wouldn't take this exam solely to try to refresh this material. I WOULD take it to keep my US options entirely open. I think it's always handy to have the option to be fully licensed in the US; you just never know where your training and interests may take you.

 

Ian

[tooty]

Are USMLEs required if we want to do a fellowship in the States?

[leviathan]

When I wrote it in September, I'd say only about 5-10% of the questions were not clinically relevant. The majority of the questions are focused around the pathophysiology and diagnosis of disease, along with a lot of pharmacology and a bit of epidemiology (e.g. the most common cause of chronic renal failure in the US is...).

 

I think it was extremely helpful to have to write the Step before clerkship, as there was so much from med 1 that I hadn't seen since and thankfully it all came back really fast during my review. If you're just taking it for the review though, I'd save the ~$800 on the exam fee and just do some independent studying. If you have interests in practicing in the US or just keeping your options open, then I think it is worth it.

[Lactic Folly]

You can still do a fellowship in the US without USMLEs, but not having them will close the door to some institutions/states.

[A-Stark]

It was useful as a review during the early part of the fall, but I don't know if it's really helping anymore! In any case, do NOT write the exam simply for the purposes of review - it's way too expensive and you needn't bother. The USMLE is not necessary for fellowships in all states, so weigh it carefully. I'm glad I wrote Step 1, but I'm not sure yet whether I'll keep going.

[itimebomb2]

Thanks for all the responses - very helpful!

 

A-Stark - What does Step 1 get you if you don't do the others?

[leviathan]

I'm guessing if a state requires step 1 for fellowship/residency they would require all 3, so it won't get you anything. But if you're going to ever contemplate doing that in the US it's probably best to get step 1 out of the way right now while everything is fresh in your mind. Step 2 and 3 would be less difficult to review for and write even if 5-10 years down the road you decided you wanted to do something in the US and had to write them.

[coastalslacker]

Late reply to this - the only time I get on here anymore is when I'm seriously procrastinating studying - and right now I'm studying for the USMLE....

 

I would strongly urge ANY Canadian medical student to write the USMLE as early as possible. It opens up a significant number of fellowship options in the US. Yes, it is true that you don't need it in most states. However, as someone applying to US fellowships this summer, I'm writing it because many of the better programs DO require it. I would argue that if you write Step I at the end of your second year, you probably don't need to study that much. You don't need to do well unless you are thinking of residency in the States - you just need to pass to qualify for fellowships (they really don't care how you did at the fellowship level).

 

Again, just write it while all that basic science BS is fresh! I never thought I would need it and now I do! One truth that is hard for med students to accept is that life only gets busier. Residency is significantly busier than clerkship which is significantly busier than pre-clerkship. And real life stuff starts creeping up on you too. Worst case scenario is that you decide you don't need it down the line and you're out $500 bucks.

[DubZteR]

I'm guessing if a state requires step 1 for fellowship/residency they would require all 3, so it won't get you anything. But if you're going to ever contemplate doing that in the US it's probably best to get step 1 out of the way right now while everything is fresh in your mind. Step 2 and 3 would be less difficult to review for and write even if 5-10 years down the road you decided you wanted to do something in the US and had to write them.

 

Just a word of caution that many states require you to complete the entire Step 1 - Step 3 sequence within 7 years from the date of completion of your Step 1.

 

For more info, check out the FESB website.

[leviathan]

Just a word of caution that many states require you to complete the entire Step 1 - Step 3 sequence within 7 years from the date of completion of your Step 1.

 

For more info, check out the FESB website.

Thanks for the followup, I didn't know that! In that case yeah, you might just want to do all 3 steps if you ever want to consider a career in the US. I know people who have done it and are board certified in the US and they keep their certification active, but they still work in Canada and just keep it as an option.

[astudentis]

i have heard that in order to get paid for work in the states ever in the future, you need a visa which required that you have written the USMLE--Even though you may be US board certified.

[amedstudent]

Hi,

 

Long time lurker, first time poster

 

I am a medical student in Ontario, and will be finishing my 2nd year soon.

I have a few questions with regard to the USMLE and I was really hoping someone could help answer them

 

1. I will not have much time to study for the USMLE this summer. If I am to do poorly or even fail, does this impact my residency options for CANADIAN programs? i.e., must I report my USMLE step 1 scores on CaRMS if I write it?

 

2. Is there any benefit/merit to doing well on the USMLE as opposed to just passing it, if I am not interested in residency in the U.S.? (In case it is relevant, I may want to do a fellowship in the U.S. and would like to keep my options open for practicing there although that would be highly unlikely).

 

3. Is the USMLE step 1 good prep for clerkship?

 

Thanks so much in advance for all your help! I really wish I could give my 100% in studying for this test, but I will be abroad for most of the summer on an elective, and realistically, may not have much time to prep for the USMLE.

[amedstudent]

Hi,

 

Long time lurker, first time poster

 

I am a medical student in Ontario, and will be finishing my 2nd year soon.

I have a few questions with regard to the USMLE and I was really hoping someone could help answer them

 

1. I will not have much time to study for the USMLE this summer. If I am to do poorly or even fail, does this impact my residency options for CANADIAN programs? i.e., must I report my USMLE step 1 scores on CaRMS if I write it?

 

2. Is there any benefit/merit to doing well on the USMLE as opposed to just passing it, if I am not interested in residency in the U.S.? (In case it is relevant, I may want to do a fellowship in the U.S. and would like to keep my options open for practicing there although that would be highly unlikely).

 

3. Is the USMLE step 1 good prep for clerkship?

 

Thanks so much in advance for all your help! I really wish I could give my 100% in studying for this test, but I will be abroad for most of the summer on an elective, and realistically, may not have much time to prep for the USMLE.

 

To answer my own question # 1, I just called CaRMS and they said it was optional to report.

 

I'd still appreciate any help on questions # 2 and 3 though!

[leviathan]

#2 I'd check on the Studentdoctor forums (which is all Americans) to see what they think about score importance for fellowship. My guess is that it does matter and it does play a role, although your step 2 and 3 would probably be more important. However if you are just looking to get licensed and board certified in the US, then a pass is all you need.

 

#3 Yes it is. A common myth is that the step 1 is all basic sciences and not relevant to clerkship. While it is obviously heavier on basic sciences than the step 2 or 3, the majority of the questions are clinically relevant. An example of the difference between step 1 or 2 would be like this: a step 1 question might ask you what kind of imaging or other studies you'd need to diagnose someone with pulmonary embolus. A step 2 question would ask you who actually needs imaging or other tests done (eg D-dimer) to rule out PE or DVT.

[coastalslacker]

So disregard parts of my previous post on this.

 

#2) I've repeatedly told people that your USMLE scores do not matter for US fellowships. This is not true. After spending some time with the director of a fellowship program stateside in the last couple weeks, I know for a fact that it IS something they look at. They look at it because it gives them info about their American applicants vis a vis each other. Letters of reference, connections (huge...), not being a douche bag and research all go ALOT further than USMLE scores. Also, as a Canadian, they MAY understand that you don't actually have to write the USMLE. I'm banking on the fact that all four of my USMLE scores are going to come within a 6 month period right before fellowship applications are due!

 

This doesn't necessarily mean you should study for the USMLE and try to do really well. MOST states will accept Canadian credentials and you'll be able to get a J1 for fellowship. My personal reasons for doing writing my USMLE are that it is not unlikely that I'll work in the US for a little while and also that my program is well-connected to a couple very strong fellowship programs in States that don't recognize Canadian credentials.

 

My advice would be - if you're in residency don't worry about your score and just get through it. If you have the time to actually study a bit more because you're still in pre-clerkship or clerkship, take the time and do well. Many people don't bother studying for the MCCQE, but I suppose you could study for the Step II around that time and it would kill two birds with one stone.

 

#3) I disagree with leviathan - I don't think Step I is that useful for clerkship. Don't do it as "prep". Don't do anything as prep.

[ikant100]

Coastalslacker,

 

I'm a first year resident in Canada who is writing the USMLE for fellowship purposes. I've written Step 1, Step 2 CK already.

 

I have the LMCC Part 2 coming up in October this year. In your experience, when should I schedule my Step 2 CS and Step 3 to minimize my study time? i.e. should I do LMCC Part 2 concurrently with Step 2 CS or Step 3?

 

Thanks!

[Ian Wong]

I responded to your PM as well, but will post here too since this might be useful for others.

 

I think that Steps 2 and 3 are similar enough that you can take them fairly close together, as a lot of the material overlaps. LMCC Part 2 is heavily weighted towards the old exam questions, but there still will be some overlap with Steps 2 and 3. Therefore, I'd try to schedule them all fairly close to each other (if you could do all three within a few months, I think that would be ideal).

 

Step 3 is basically a general medicine exam, so people who intrinsically would have covered a lot of its material would include people doing Family Medicine, or those who might have just completed a PGY-1 general rotation year.

 

Ian

[coastalslacker]

Coastalslacker,

 

I'm a first year resident in Canada who is writing the USMLE for fellowship purposes. I've written Step 1, Step 2 CK already.

 

I have the LMCC Part 2 coming up in October this year. In your experience, when should I schedule my Step 2 CS and Step 3 to minimize my study time? i.e. should I do LMCC Part 2 concurrently with Step 2 CS or Step 3?

 

Thanks!

 

Can't answer that from experience, I'm writing my Step 2 in 6 weeks and planning to start studying in a couple weeks. I'll do the clinical skills two weeks after the multiple choice.

[leviathan]

#3) I disagree with leviathan - I don't think Step I is that useful for clerkship. Don't do it as "prep". Don't do anything as prep.

I never said to do step 1 as prep, only do it if you have to do it for licensing/fellowship/other reasons. Having said that, doing some sort of review of your first 2 years of med before you start clerkship definitely won't hurt. There's a strong correlation between your step 1 score and how strong your knowledge base is in clerkship, at least according to the attendings I have worked with.

[n00b]

How do Canadian medstudents generally do on the Step 1? Any stats on this?

[Lactic Folly]

I don't know of any stats, but if you are sufficiently motivated and prepare adequately, there is no reason why you can't score well.

[leviathan]

Average is 224 IIRC for both Cdn+US students, when you get your score report. They never split it up into Canadians or Americans but maybe if you go digging on the NBME website you might find something.

[ldnk]

I never wrote the USMLE but here is what I've been told by other CDN med students who wrote it and killed it:

 

You're writing it to keep your options open(ie rads is a tough match in Canada, less so in the USA). Thing is, you're Canadian which means you're gonna be more of a hassle for residency programs to take vs an American grad. To remedy this you need to COMPLETELY DEMOLISH the USMLE. To do this requires weeks of dedicated studying and reading the right sources with TONS of practice questions.

 

Go to SDN to get the scoop on what the top scorers had done. Then do that.

 

You're probably gonna have to work a bit harder than that too since Canadian medical education doesn't teach to the test like the Americans schools.

 

The flip-side is of course just passing the USMLE 1/2/3 to keep options open for jobs/fellowships in the future when your track record as an actual doctor mean a heck of a lot more if you aren't looking at the USMLE strictly for residency purposes.