Usmle presentation final

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Practicing medicine in the USA - Information evening

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Usmle presentation final

  1. 1. Working in the USA Majd Protty, Jaidev Nath, and other USMLErs
  2. 2. USMLE <ul><li>Three parts: </li></ul><ul><ul><li>Step 1 (Preclinical MCQ) – 8 hours </li></ul></ul><ul><ul><li>Step 2 </li></ul></ul><ul><ul><ul><li>Step 2 CK (Clinical MCQ) – 9 hours </li></ul></ul></ul><ul><ul><ul><li>Step 2 CS (Clinical OSCE) – 8 hours (Only in the USA) </li></ul></ul></ul><ul><ul><li> ECFMG Certification* </li></ul></ul><ul><ul><li>Step 3 – 16 hours (Only in the USA) </li></ul></ul><ul><ul><ul><li>To be taken after you start working </li></ul></ul></ul>
  3. 3. USMLE Step 1
  4. 4. Format <ul><li>Step 1 </li></ul><ul><ul><li>Basic mechanisms and principles </li></ul></ul><ul><ul><ul><li>Anatomy (+Histology/Embryology) </li></ul></ul></ul><ul><ul><ul><li>Physiology, Pathology + Pathophys </li></ul></ul></ul><ul><ul><ul><li>Immunology and Microbiology </li></ul></ul></ul><ul><ul><ul><li>Biochemistry </li></ul></ul></ul><ul><ul><ul><li>MiS and Psychiatry* </li></ul></ul></ul><ul><ul><li>322 questions, 7 blocks </li></ul></ul><ul><ul><li>One day, 8 hours </li></ul></ul>
  5. 5. Schematic of Exam Register Tutorial (15 min) Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7 Survey Break time = 45 min
  6. 6. Marking <ul><li>Step 1 </li></ul><ul><ul><li>Passing mark: 188 (3-digit) = 75 (2-digit) </li></ul></ul><ul><ul><li>Average mark (US Seniors): 222 ( + sd of 20) </li></ul></ul><ul><ul><li>Most scores fall between 140 and 260 </li></ul></ul>
  7. 7. Scoring scales for Step 1 (2009)
  8. 8. Set yourself a target Median USMLE Step 1 score for matched US seniors ( + IQR)
  9. 9. Timing and cost <ul><li>Step 1 </li></ul><ul><ul><li>Cost $780 + $170 (to take in UK) = $950/ £600 </li></ul></ul><ul><ul><ul><li>Books </li></ul></ul></ul><ul><ul><ul><li>Qbanks ($200) </li></ul></ul></ul><ul><ul><li>Timing = You can take the exam any day you like. </li></ul></ul><ul><ul><ul><li>Best to take it during Year 4 . </li></ul></ul></ul><ul><ul><li>Where? All over the world. UK = London + Cardiff* </li></ul></ul>
  10. 10. Registration <ul><li>Very well laid out in </li></ul><ul><ul><li>First Aid </li></ul></ul><ul><ul><li>ECFMG ( www.ecfmg.org ) </li></ul></ul><ul><ul><li>USMLE ( www.usmle.org ) </li></ul></ul><ul><li>If taking in US = 6 months in advance </li></ul><ul><li>If taking in UK = 3-4 months is plenty </li></ul><ul><li>MAKE A PLAN AND REGISTER </li></ul><ul><ul><li>Adds a little fear when £ £ £ is on the line </li></ul></ul><ul><li>Can reschedule with some restrictions and possibly £ £ </li></ul>
  11. 11. Typical timeline
  12. 12. Summary 1/2 – Step 1 <ul><li>Format: 8 hours, 7 blocks, 322 questions </li></ul><ul><li>Marking: Pass=188, Average + sd = 222 + 20 </li></ul><ul><li>Set yourself a target score </li></ul><ul><li>Cost = $1000-$1500 </li></ul><ul><li>Needs months of preparation </li></ul>
  13. 13. Resources
  14. 14. Resources
  15. 15. Resources <ul><li>Don’t buy too many </li></ul><ul><li>Mainstream resources: </li></ul><ul><ul><li>First Aid (aka: FA, or “THE BIBLE!”) </li></ul></ul><ul><ul><li>Qbank </li></ul></ul><ul><ul><ul><li>USMLE World Qbank (aka: UW) </li></ul></ul></ul><ul><ul><ul><li>Kaplan Qbank (2000+ Qs) </li></ul></ul></ul><ul><ul><li>Kaplan Notes for Step 1 </li></ul></ul><ul><ul><li>Kaplan Videos for Step 1 </li></ul></ul><ul><ul><li>Others: </li></ul></ul><ul><ul><ul><li>Goljan audio pathology, BRS, Rapid Review (RR) </li></ul></ul></ul>
  16. 16. Sample question (Easy) <ul><li>The use of broad-spectrum antibiotics can produce a bleeding diathesis characterized by hematomas, hematuria, melena, and bleeding from the gums by decreasing the normal gut flora and inducing a deficiency of which of the following vitamins? </li></ul><ul><li>Vitamin A </li></ul><ul><li>Vitamin B1 </li></ul><ul><li>Vitamin B6 </li></ul><ul><li>Vitamin C </li></ul><ul><li>Vitamin K </li></ul>
  17. 17. Sample question (Medium) <ul><li>The use of broad-spectrum antibiotics can produce a bleeding diathesis characterized by hematomas, hematuria, melena, and bleeding from the gums by decreasing the normal gut flora and inducing a deficiency of which of the following coagulation factors? </li></ul><ul><li>Fibrinogen, VII, VIII and IX </li></ul><ul><li>Prothrombin, VII, IX and X </li></ul><ul><li>II, V, IX and XI </li></ul><ul><li>II, VI, X and XI </li></ul><ul><li>Prothrombin, VI, X and XI </li></ul>
  18. 18. Sample question (Hard) <ul><li>The use of broad-spectrum antibiotics can produce a bleeding diathesis characterized by hematomas, hematuria, melena, and bleeding from the gums by decreasing the normal gut flora and inducing a decrease in which of the following processes? </li></ul><ul><li>1-alpha hydroxylation </li></ul><ul><li>Gamma carboxylation </li></ul><ul><li>Alanine transamination </li></ul><ul><li>Xanthine oxidation </li></ul><ul><li>Cytosine deamination </li></ul>
  19. 19. Summary 2/2 – Step 1 <ul><li>Format: 8 hours, 7 blocks, 322 questions </li></ul><ul><li>Marking: Pass=188, Average + sd = 222 + 20 </li></ul><ul><li>Cost = $1000-$1500 </li></ul><ul><li>Needs months of preparation </li></ul><ul><li>Don’t use too many resources </li></ul><ul><li>Main resources are FA + Qbank (UW) </li></ul><ul><li>Enjoy it </li></ul>
  20. 20. Step 2 <ul><li>2 parts </li></ul><ul><ul><li>CK = Clinical Knowledge (Written Exam) </li></ul></ul><ul><ul><li>CS = Clinical Skills (OSCE) </li></ul></ul><ul><li>Content </li></ul><ul><ul><li>Internal Medicine </li></ul></ul><ul><ul><li>Surgery </li></ul></ul><ul><ul><li>Pediatrics </li></ul></ul><ul><ul><li>Obs & Gyne </li></ul></ul><ul><ul><li>Psychiatry </li></ul></ul>
  21. 21. Step 2 Clinical Knowledge <ul><li>9 hour exam with 352 questions </li></ul><ul><li>8 one hour blocks of 44 questions each </li></ul><ul><li>15 minutes intro + 45 minutes break </li></ul><ul><ul><li>Cost $780 + $190 (to take in London) = $970/ £610 </li></ul></ul><ul><ul><li>Passing Score = 189/75 </li></ul></ul><ul><ul><li>Mean & SD = 230 +/- 23 with most scores falling between 140 and 260 </li></ul></ul>
  22. 22. Step 2 Clinical Skills (OSCE)
  23. 23. Step 2 Clinical Skills <ul><li>Has to be done in America </li></ul><ul><li>Cost - $1355/ £850 </li></ul><ul><li>8 hour OSCE with 2 breaks (30 min + 15 min) </li></ul><ul><li>12 standardized patients (actors) </li></ul><ul><li>15 minutes for history + examination </li></ul><ul><li>10 minutes to write a patient note describing the findings, initial differential diagnosis list and a list of initial tests </li></ul><ul><li>No scores, just pass or fail </li></ul>
  24. 24. Step 2 Resources
  25. 25. Step 3 <ul><li>Don’t even think about it yet! </li></ul><ul><li>Not necessary to apply and is usually taken during intern year after you start your job </li></ul>
  26. 26. Pass rates
  27. 27. Summary for USMLE <ul><li>3 Parts </li></ul><ul><li>Only require 2 to be ECFMG certified </li></ul><ul><li>Step 1 and Step 2 CK = London </li></ul><ul><li>Step 2 CS = USA </li></ul><ul><li>Cost = Approx $1000-$1400 per exam </li></ul><ul><li>Prep time: “2 months, 2 weeks, 2 days” </li></ul>
  28. 28. The Match <ul><li>1 common application which includes a personal statement </li></ul><ul><li>Cost = $300 for first 30 programs and $25 per program afterwards </li></ul><ul><li>Application opens up on September 1 </li></ul><ul><li>Important to finish Step 1, Step 2 CK and CS by mid July all scores are available by Sep 1 </li></ul><ul><li>APPLY EARLY!!! </li></ul>
  29. 29. The Match Timeline <ul><li>Sep 1 – Apply </li></ul><ul><li>Sep to Dec – Receive Interview Invites </li></ul><ul><li>Oct to Jan – Take off a few weeks to attend interviews </li></ul><ul><li>Feb 22 – Deadline to rank programs </li></ul><ul><li>March 16 – Find out where you matched  </li></ul><ul><li>July 1 – Start Residency </li></ul>
  30. 30. My timeline <ul><li>August 2010 (yr 4) – Started Step 1 Prep </li></ul><ul><li>February 2011 (end of 4 th year) – Step 1 </li></ul><ul><li>July 2011 (beg of yr 5) – Step 2 CK & CS </li></ul><ul><li>Sep 1, 2011- Applied to 115 Pediatric Residency Programs out of 198 </li></ul><ul><li>Cost = $2500/ £1500!! </li></ul><ul><li>Nov & December – Interviews during 4 weeks of SSA + 2 weeks of Christmas Break </li></ul><ul><li>Planning to attend 13-15 Interviews </li></ul>
  31. 31. The Specialties <ul><li>Easiest Specialties = Psychiatry, Neurology, Pediatrics, Internal Medicine and Family Medicine </li></ul><ul><ul><li>Aim for USMLE scores 220+ </li></ul></ul><ul><li>Medium = Anesthesiology, Surgery, Obs & Gyne, Emergency Medicine (A&E) </li></ul><ul><ul><li>Aim for USMLE scores 230+ </li></ul></ul><ul><li>Super Competitive = Plastic Surg, Ophtho, Derm, Radiology, Neurosurg, Ortho </li></ul><ul><ul><li>Aim for USMLE scores 240+ </li></ul></ul>
  32. 32. Tips <ul><li>Do well on USMLEs </li></ul><ul><li>US Clinical Experience ( ELECTIVE or Work Experience) </li></ul><ul><li>Recommendation Letters – US>>>UK </li></ul><ul><li>Do well in medschool </li></ul><ul><li>Research, Publications & Poster Presentations </li></ul><ul><li>Volunteer, Leadership & Extra-curricular </li></ul><ul><li>Prizes & Awards </li></ul><ul><li>Apply on or around Sep 1 st </li></ul>
  33. 33. QUESTIONS? Jaidev Nath - [email_address] Majd Protty - [email_address]
  34. 34. THANK YOU

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