Askdoc's USMLE Blog

Old IMG Have Not Studied for an Exam for a Long Time

meliza — Sat, 04 Feb 2012 00:03:22 +0000

A lot of times, people presume that with my double 99, prepping for me was a breeze. That I did not go through the same problems every Old IMG went through in my own prep. Nothing was further from the truth.

When I was starting my prep, one of my biggest problem was that not only have I not sat for an exam for a long time, I have not done any kind of long term studying for some time already. It was very hard to get into studying mode and read for long hours.

I went thru a lot of false starts. Studying a few days to weeks, then sputtering to a stop. This went for about a year before things finally began to settle down into a routine. The fact I had to work at the same time did not help the situation. In the end I was able to get into focus and finished my prep.

Is there really a short cut to get back into studying mode? I don’t think so. You have to get back into the habit of studying for long hours before you can seriously prepare for the USMLE. And like all habits, it takes sometime before it becomes routine to you. It will probably be easier if you are in a group where all of you are older grads and in the same boat. That would keep you motivated.

I have been thinking of forming an old IMG club, where old IMG’s gather together weekly, keep each other motivated, swap experience, until they get to the point that they can study for long hours on their own. If you feel you want to join up, post your name in the comments section. If we get at least 10 people, I will set up a forum for Old IMG members to meet up.

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Changes to the Step 2 Clinical Skills (CS) Examination

meliza — Wed, 01 Feb 2012 05:48:08 +0000

To further enhance the testing methods used in the Step 2 Clinical Skills (CS) examination, changes will be introduced in Step 2 CS for examinations and will be delivered beginning June 17, 2012.

The reporting schedule for examinees testing from June 17, 2012 through November 3, 2012 will be 2-3 weeks longer than for examinees testing during other periods.

Below is the Step 2 CS Score reporting Schedule for 2012:

Step 2 CS 2012 Reporting Schedule
Testing Period	Reporting Period
For examinees who test	Reporting start date	Reporting close date
Jan 1 through Jan 28	Feb 29	Mar 28
Jan 29 through Mar 24	Apr 25	May 23
Mar 25 through May 19	Jun 20	Jul 18
All test centers closed. No testing May 20 through June 16
Jun 17 through Aug 25	Oct 3	Oct 31
Aug 26 through Nov 3	Dec 5	Jan 2, 2013
Nov 4 through Dec 31	Jan 30, 2013	Feb 20, 2013

Changes to the assessment of Communication and Interpersonal Skills (CIS)
The CIS subcomponent of Step 2 CS has been redesigned to assess a fuller range of competencies. The new approach divides communication skills into a series of functions. These functions have been further divided into sub-functions. Beginning June 17, 2012, the Communication and Interpersonal Skills (CIS) scale will focus on five functions:

Fostering the relationship
Gathering information
Providing information
Making decisions: basic
Supporting emotions: basic

Several additional functions are still under development; these include making decisions: advanced; supporting emotions: advanced; and helping patients with behavior change. A list of the functions and sub-functions is available.

Changes to the patient note
Also beginning June 17, 2012, a new patient note will be introduced. The patient note is completed by the Step 2 CS examinee after the encounter with the standardized patient. In the new note, examinees will continue to be asked to document relevant history and physical examination findings and to list initial diagnostic studies to be ordered. Examinees will also be asked to create a reasoned, focused differential (maximum of three diagnoses) listed in order of likelihood and to indicate the evidence obtained from the history and physical examination that supports (or refutes) each potential diagnosis. The new patient note provides examinees with an opportunity to document their analysis of a patient’s possible diagnoses. A sample of the new patient note is available for review.

Practice materials
Updated practice materials for Step 2 CS will be posted to the USMLE website in March 2012. These include the Step 2 CS Content Description and General Information Booklet, onsite orientation video, sample patient notes, and a simulation of the program for typing patient notes.

*You can also visit the ecfmg website for information on usmle news.

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Congratulations Lilibeth, USMLE Step 1 Score 206

askdoc — Sun, 04 Dec 2011 15:23:20 +0000

I would like to congratulate Lilibeth for passing the USMLE Step 1 with a score of 206 which she took last October 28,2011. Lilibeth is a member of Askdoc’s USMLE Step 1 Prep Course. We wish her well as she prepare for the USMLE Step 2CK.

• Why You Need Three Phases in USMLE Prep – I

• Is the USMLE getting tougher every year?

• What to Do on the Day of the USMLE Exam

• Other AskDoc Student’s who Passed the USMLE

Congratulations, Masuma. USMLE Step 1 Score 99/230

askdoc — Mon, 01 Aug 2011 14:05:14 +0000

I would like to congratulate Masuma for passing the USMLE Step 1 with a score of 99/230 which she took last July, 2011. Masuma is a member of the April, 2009 batch of Askdoc’s USMLE Step 1 Prep Course. This was a long and arduous process for her and her score is well deserved. We wish her continued success in the future.

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Is First Aid Alone Enough For USMLE Step 1 Review?

askdoc — Mon, 09 May 2011 14:14:59 +0000

When I first started my prep for the USMLE, it seems everyone else was using First Aid for the USMLE Step 1 and swearing it’s the best book ever written for the USMLE. Of course, now that I have finished my own examination and have time to reflect not only on my experience but on the experiences of countless people I have talked to in my blog, the various forums and in my courses, my own take is that although it is a very important book for the USMLE, it falls far short of the acclaim people seem to heap on it.

First Aid for the USMLE contains a listing of high yield concepts that will be tested in the USMLE. The problem is, it does not contain enough details for you to really do well in the exam. If you are a third year medical student and already know those details, then First Aid as a quick high yield review, together with an online Q Bank may be enough to pass. And depending on the quality of your medical school and how much prep they have given you for this exam, that may be even enough to get a high score.

First Aid is a good starting point in learning what the USMLE is about. It provides a good introduction to the USMLE. A good list of topics tested in the USMLE and a list of books and courses for the USMLE. Therefore, it is worth going through it just for that. Just don’t use it alone in prepping for the USMLE.

Related Posts:

• How to Score 99′s in the USMLE

• Why You Need to Master the USMLE Step 1

• How to Master the USMLE Step 1 – an Introduction

• NBME Self Assessment Tests and USMLE Review

• What to Study for the USMLE – Part I

• Using Q Banks effectively for USMLE Review

• Is Kaplan enough for Step 1 Review?

USMLE Step 1 or Step 2 CK – Which Exam should I take first?

askdoc — Mon, 02 May 2011 12:52:45 +0000

People preparing for the USMLE have been asking this question since as far as I can remember. Way back in 2004, when sitting for the USMLE was just a thought for me, there were very sound arguments for taking either one of this exam first.

If you are an AMG you may be wondering what the debate is all about, since you are required to take the USMLE Step 1 first. But for an IMG, who can take either exam first, this is a big questions which can have an impact in their performance in the exams. This is especially true for the Old IMG.

My recommendation for IMGs is to take USMLE Step 1 first before taking USMLE Step 2 CK as this can help you perform better overall in the Steps. If you want to know the reason why, then read on.

Why Take USMLE Step 1 First?

The reason you take USMLE Step 1 first before taking Step 2 CK is the fact that 20 to 25% of Step 2 CK is composed of topics covered in Step 1. This includes pathophysiology which are listed as mechanisms of disease in Step 2 CK. Both pharmacology and microbiology as well as immunology are also included in Step 2 CK.
If you take USMLE Step 2 CK first, you still need to study those topics in Step 1. By studying Step 1 first, you make sure you have covered those topics before you take Step 2 CK. It’s just more efficient that way. It is also important to note that all three topics are also covered in Step 3. Therefore it makes sense to make sure you study all of them very well during your Step 1 prep.

What About Clinical Vignettes?

Now what about clinical vignettes, you may ask. Isn’t it better to start with Step 2CK so it will be easier for me to diagnose clinical vignettes?

The clinical cases in Step 2CK is slightly different from the clinical vignettes in Step 1. Clinical vignettes in Step 1 are usually classical in presentation. In Step 2CK be prepared for cases with atypical presentations.

Whereas cases in Step 2CK are mostly common cases albeit with both common and atypical presenthttp://blogs.askdoc-usmle.com/wp-admin/post.php?post=546&action=editation, Step 1 cases can be common or rare albeit with classical presentation most of the time. The determining factor in Step 1 is if the case illustrates an important basic science concept. For example, Prader Willi and Angelman syndrome are very rare. Therefore, it’s less likely to appear in Step 2CK although it will in Step 1 because it illustrates the concept of imprinting in Genetics.

So, in conclusion, it is highly recommended that you take Step 1 first before Step 2 CK for the reasons cited above.

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Congratulations Aragon, USMLE Step 1 Score 83

askdoc — Sun, 24 Apr 2011 14:34:03 +0000

I would like to congratulate Aragon for passing the USMLE Step 1 with a score of 83 which she took last March. Aragon is a member of the January 2010 batch of Askdoc’s USMLE Step 1 Prep Course. We wish her well as she prepares for the USMLE Step 2 CK. If you want to read her exam experiences click on this link.

RELATED ARTICLES:

Why You Need Three Phases in USMLE Prep – I

Advice for the Old IMG taking the USMLE

Which NBME Self Assessment Form to Use for USMLE Step 1

How to Master the USMLE Step 1 – an Introduction

How to Create a Study Plan for the USMLE

What is the USMLE?

askdoc — Fri, 08 Apr 2011 12:55:47 +0000

The United States Medical Licensing Examination or USMLE is a series of 4 examinations you need to take and pass in order to be licensed to practice medicine in the United States. The USMLE Step 1, USMLE Step 2 CK and USMLE Step 2 CS is required to enter any residency program in the US. While USMLE Step 3 is required in order to be licensed to practice medicine independently in the US.

” The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care. Each of the three Steps of the USMLE complements the others; no Step can stand alone in the assessment of readiness for medical licensure. Because individual medical licensing authorities make decisions regarding use of USMLE results, physicians seeking licensure should contact the jurisdiction where they intend to apply for licensure to obtain complete information. Also, the FSMB can provide general information on medical licensure.”

- from the USMLE website

USMLE STEP 1 covers the Basic Medical Sciences and includes 7 subjects:

Anatomy
Physiology
Biochemistry
Pathology
Microbiology and Immunology
Pharmacology
Behavioral Sciences

It covers 7 blocks, with 46 multiple choice questions per block. You have 1 hour to finish each block plus 1 hour total for breaks for a total of 8 hours.

USMLE STEP 2 CLINICAL KNOWLEDGE (CK) covers the Clinical Medical Sciences and includes 6 Subjects:

Internal Medicine
Pediatrics
Obstetric and Gynecology
Surgery
Psychiatry
Preventive Medicine

It covers 8 blocks, with 44 multiple choice questions per block. You have 1 hour to finish each block plus 1 hour total for breaks for a total of 9 hours.

USMLE STEP 2 CLINICAL SKILLS (CS) assesses whether you have the fundamental clinical skills essential for safe and effective patient care under supervision. This comprises of 12 Standardized Patients (SP) from which you will obtain a medical history, do a physical examination and write a patient note.

USMLE STEP 3 assesses your ability to practice medicine independently and without supervision. It covers the same subjects as Step 2 CK but with emphasis on diagnosis, therapy and continuing care. Includes multiple choice questions and Clinical Case Simulations (CCS). This is the only 2-day examination in the USMLE.

You can visit the USMLE website at http://www. usmle.org for additional information.

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Problem of the Old IMG – Relearning What Have Been Forgotten

askdoc — Tue, 05 Apr 2011 15:43:58 +0000

When I started my own prep way back in 2005, the biggest problem I faced is the fact that I have forgotten most of what I had studied before. This is especially true for the basic sciences. Even for the clinical sciences, although I am very familiar with cases found commonly in clinical practice, there is a big problem with rarer cases as well as atypical ones. Therefore, I realized that there was a need for me to relearn all the things I have forgotten before I can even begin to achieve the level of mastery needed to do well in the USMLE.

The same thing holds true for most old IMG. They differ only in the amount of things they have forgotten and this is mainly a function of how long ago they graduated and have been out of medical practice.

It is a maxim that you cannot review what you do not know. You cannot master what you have not learned. Therefore if you have a lot of medical concepts that you are unfamiliar with, you need to learn them first. And learning is best done using textbooks and lectures not reviewers. Reviewers are used primarily for review and therefore not suitable for learning concepts.

The Need for a Prolonged Learning Phase

So old IMGs need a prolonged learning phase. If you would recall the three phases of USMLE prep includes learning phase, mastery phase and test preparation phase. While most new grads can dispense with the learning phase altogether and some US third year medical student can even dispense with part of the mastery phase (that’s why First Aid and Q bank alone can work with them) most old IMG have no choice but to do all three phases.

What to Do During the Learning Phase

Starting from the basics can be daunting but old IMGs have no choice but to do so. The best way to relearn the basic sciences is exactly how it was done in medical school.

First, read through anatomy and physiology, trying to understand the concepts as much as possible. Remember the learning phase is where you seek to understand what you are reading rather than memorizing in detail. The goal here is to be able to explain the concept without going into details.

For example, can you explain the brachial plexus and it’s clinical importance. What syndrome arises from it. For physiology, can you explain acid base balance. At this stage all the details and inter-relationship should be left for the second round.

Second, this is important. Do structure and function integration between anatomy and physiology. For example anatomy of the heart including valves in physiology of blood flow and heart sounds. Do this on a second round reading.

Third, read through biochemistry, one round again basically just understanding concepts. Then integrate with anatomy and physiology as appropriate.

Fourth, read through Pathology again first round just to understand the concepts. Follow through a second reading by integrating into Anatomy, Physiology and Biochemistry as appropriate.

Fifth, read through Microbiology and Immunology. Integrate with appropriate section in anatomy, physiology, biochemistry and pathology.

Sixth, read through Pharmacology. Integrate first with biochemistry. Then integrate with Microbiology and Immunology. Then finally with Pathology.

Lastly, study Behavioral Sciences.

You can opt to do one more round of pathology, integrating it to anatomy, physiology and biochemistry. Remember every pathology results from the disruption of anatomic structure or physiologic and biochemical processes and attempt of the body to restore function or compensate for loss of function. Once you understand that, you can now integrate the pathology to pharmacology. Therapeutics is about restoration of function or compensation if unable to restore function. Therefore you need to understand how drugs do this.

Once you have done all the above steps, you are ready for the mastery phase and test preparation phase. For recommended textbooks to use and other tips, look for it in future posts.

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The Key to Getting a 99 in the USMLE

askdoc — Fri, 01 Apr 2011 14:43:55 +0000

Since I can remember, everyone wants to know the secret on how to get a 99 in the USMLE. Everyone wants the magic bullet, the one secret weapon that can insure you can get a 99. I had always thought there isn’t one, but after years of reflection, getting my own double 99 and teaching hundreds of people how to pass and score high in this exam, I realize there is a surefire way to get a 99 in the USMLE. The problem is, can you do it?

There are things you need to be able to do and if you are able to do it, then you will be able to get a 99. If you can’t do it then you won’t.

I wonder how many of you have watched the exercise video P90 or Power 90 that promises to give you an incredibly ripped and muscled body in 90 days so long as you follow the video. I thought it was another one of those infomercials that was all hype and no substance. That is until I saw the video. Then I realized that they were right. If you are able to do what they are telling you to do on the video, you will get that body in 90 days. But you know there is always a catch. And the catch is, can you do it? Watching the video, you know most people won’t be able to do it. Either they will find it too hard or some other reason for not being able to do it and thus fail. But if you are able to do what it asks, it’s almost sure that you will get that well-toned body.

The same holds true for the USMLE. If you can do this one thing, then you can get your 99 in the USMLE. But based on my experience, most either can’t or won’t do it. For those who can’t, there is actually little we can do. But for those who won’t, which surprisingly is a large number, I guess it’s just kind of sad.

So What is the key to getting a 99 in the USMLE?

There are actually 3 ways you can get a 99 in the USMLE;

You get a 99 by luck. It also involves some hard work but its mostly luck and that is how most people get their 99.
By cheating. Some people get caught, some don’t.
You get a 99 by insuring you do what is needed to get a 99. And you know this is the key to making sure you get a 99. And there are a number of people who got their 99 this way including me.

It is a maxim that the more medical concepts you know the higher your score. However, it is more accurate to say that the more medical concepts you know that come out in your exam, the higher the score you get.

With only 300++ questions appearing in the exam set and literally thousands of medical concepts that can appear in the test, the exam is at most a sampling of what you really know. Therefore as with any sample, sampling error can occur. Since, it’s almost impossible to know everything, the more closely the exam set questions match what you know, the higher your score. The opposite is also true. If the exam set questions are filled with medical concepts you have not studied well, then you can get a lower score. Even if the total number of medical concepts you actually know is equal in both cases.

You Can’t Study Everything

You can’t study everything that may come out in the exam. First, there is really no detailed list of everything that can come out in the exam. Second, most people won’t have the time. Third, even if you have the time, do you have the intelligence and memory capacity to absorb, retain and recall a large amount of information. Lastly, people do burn out from studying too much and too long. And for most IMGs there is still Step 2 CK to worry about.

Getting a 99 by Luck.

For most people who got a 99, they usually start out studying high yield materials. Then supplement it with online q banks that include both high yield and low yield materials. Then if they are lucky what they retain and recall is what mostly comes out in the exam.

Of course to get a 99, they also needed to study hard and have good memory as there is a minimum amount of medical concepts you need to know to get a 99. But luck plays a role because they did not make sure they studied enough that no matter what exam set they got, they will still get a 99. There are many people who studied hard and have good memory who never got a 99.

Getting a 99 by Cheating.

Of course, there is that group of people that cheat by studying actual exam questions they happen to get their hands on. This way, they study not only the exact medical concepts that will come out in the exam, but even the exact questions that will be asked. Suffice to say cheating is not only dishonest and puts your ethical standards to question, your exam results may be nullified and you may be banned from taking the USMLE ever again.

Getting a 99 by Covering All your Bases

Then lastly, there are those who got their 99 by making sure they cover all the bases. That whatever questions do come out, they have studied enough to make sure they will get a 99. Therefore the key to getting a 99 is both simple and hard at the same time. It requires you to overstudy. Not to study everything. As I said it is impossible to study everything but to cover enough of the topics tested that no matter what happens, you get your 99.

There is a catch of course. The catch is, can you study everything needed to ensure that you will get your 99, no matter what? For most people, they actually can’t do it. But for a surprising number of people who didn’t get a 99, actually they could.

First, they need to study harder and cover enough topics in their prep to get a 99. In other words, they need to overstudy.

Second, they need to study correctly to improve retention and recall. Remember you have just over a minute to read through the question, recall what you know, reason out the correct answer, then choose your answer.

Third, they need to anticipate how questions will be asked in the exam and study for it.

Fourth, they need to train themselves to answer USMLE type questions fast and in time.

Fifth, they need to be able to diagnose diseases. Do not underestimate how clinical vignettes can affect your score.

Lastly, they need to do things right the first time, as making mistakes in preparation wastes time. This can lead to burn out, especially if you have to redo your prep to correct errors.

Of course, there is always that genius with a photographic memory that can breeze through everything and get their 99. If you are one of those, ignore everything I have to say about this topic as it does not apply to you.

We will discuss the above in more detail in future posts. Even if you have the various limitations discussed in the post ‘Can You Get a 99 in the USMLE?‘ there are various methods you can use in order to compensate for those weak points and insure you get your 99. But it takes time effort and determination. Can you do it? Will you do it?

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