1) The USMLE exam has 3 steps - Step 1, Step 2 (with 2 parts), and Step 3. Step 1 and 2 are required to obtain ECFMG certification. 2) Step 1 is a one-day, 8-hour exam with 322 multiple choice questions covering basic sciences. The average score is 222 with a passing score of 188. 3) Preparation for Step 1 requires months of study using resources like First Aid, UWorld question bank, and costs $1000-$1500 total.

1. Working in the USA Majd Protty, Jaidev Nath, and other USMLErs

2. USMLE Three parts: Step 1 (Preclinical MCQ) – 8 hours Step 2 Step 2 CK (Clinical MCQ) – 9 hours Step 2 CS (Clinical OSCE) – 8 hours (Only in the USA)  ECFMG Certification* Step 3 – 16 hours (Only in the USA) To be taken after you start working

3. USMLE Step 1

4. Format Step 1 Basic mechanisms and principles Anatomy (+Histology/Embryology) Physiology, Pathology + Pathophys Immunology and Microbiology Biochemistry MiS and Psychiatry* 322 questions, 7 blocks One day, 8 hours

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. Marking Step 1 Passing mark: 188 (3-digit) = 75 (2-digit) Average mark (US Seniors): 222 ( + sd of 20) Most scores fall between 140 and 260

7. Scoring scales for Step 1 (2009)

8. Set yourself a target Median USMLE Step 1 score for matched US seniors ( + IQR)

9. Timing and cost Step 1 Cost $780 + $170 (to take in UK) = $950/ £600 Books Qbanks ($200) Timing = You can take the exam any day you like. Best to take it during Year 4 . Where? All over the world. UK = London + Cardiff*

10. Registration Very well laid out in First Aid ECFMG ( www.ecfmg.org ) USMLE ( www.usmle.org ) If taking in US = 6 months in advance If taking in UK = 3-4 months is plenty MAKE A PLAN AND REGISTER Adds a little fear when £ £ £ is on the line Can reschedule with some restrictions and possibly £ £

11. Typical timeline

12. Summary 1/2 – Step 1 Format: 8 hours, 7 blocks, 322 questions Marking: Pass=188, Average + sd = 222 + 20 Set yourself a target score Cost = $1000-$1500 Needs months of preparation

13. Resources

14. Resources

15. Resources Don’t buy too many Mainstream resources: First Aid (aka: FA, or “THE BIBLE!”) Qbank USMLE World Qbank (aka: UW) Kaplan Qbank (2000+ Qs) Kaplan Notes for Step 1 Kaplan Videos for Step 1 Others: Goljan audio pathology, BRS, Rapid Review (RR)

16. Sample question (Easy) 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? Vitamin A Vitamin B1 Vitamin B6 Vitamin C Vitamin K

17. Sample question (Medium) 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? Fibrinogen, VII, VIII and IX Prothrombin, VII, IX and X II, V, IX and XI II, VI, X and XI Prothrombin, VI, X and XI

18. Sample question (Hard) 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? 1-alpha hydroxylation Gamma carboxylation Alanine transamination Xanthine oxidation Cytosine deamination

19. Summary 2/2 – Step 1 Format: 8 hours, 7 blocks, 322 questions Marking: Pass=188, Average + sd = 222 + 20 Cost = $1000-$1500 Needs months of preparation Don’t use too many resources Main resources are FA + Qbank (UW) Enjoy it

20. Step 2 2 parts CK = Clinical Knowledge (Written Exam) CS = Clinical Skills (OSCE) Content Internal Medicine Surgery Pediatrics Obs & Gyne Psychiatry

21. Step 2 Clinical Knowledge 9 hour exam with 352 questions 8 one hour blocks of 44 questions each 15 minutes intro + 45 minutes break Cost $780 + $190 (to take in London) = $970/ £610 Passing Score = 189/75 Mean & SD = 230 +/- 23 with most scores falling between 140 and 260

22. Step 2 Clinical Skills (OSCE)

23. Step 2 Clinical Skills Has to be done in America Cost - $1355/ £850 8 hour OSCE with 2 breaks (30 min + 15 min) 12 standardized patients (actors) 15 minutes for history + examination 10 minutes to write a patient note describing the findings, initial differential diagnosis list and a list of initial tests No scores, just pass or fail

24. Step 2 Resources

25. Step 3 Don’t even think about it yet! Not necessary to apply and is usually taken during intern year after you start your job

26. Pass rates

27. Summary for USMLE 3 Parts Only require 2 to be ECFMG certified Step 1 and Step 2 CK = London Step 2 CS = USA Cost = Approx $1000-$1400 per exam Prep time: “2 months, 2 weeks, 2 days”

28. The Match 1 common application which includes a personal statement Cost = $300 for first 30 programs and $25 per program afterwards Application opens up on September 1 Important to finish Step 1, Step 2 CK and CS by mid July all scores are available by Sep 1 APPLY EARLY!!!

29. The Match Timeline Sep 1 – Apply Sep to Dec – Receive Interview Invites Oct to Jan – Take off a few weeks to attend interviews Feb 22 – Deadline to rank programs March 16 – Find out where you matched  July 1 – Start Residency

30. My timeline August 2010 (yr 4) – Started Step 1 Prep February 2011 (end of 4 th year) – Step 1 July 2011 (beg of yr 5) – Step 2 CK & CS Sep 1, 2011- Applied to 115 Pediatric Residency Programs out of 198 Cost = $2500/ £1500!! Nov & December – Interviews during 4 weeks of SSA + 2 weeks of Christmas Break Planning to attend 13-15 Interviews

31. The Specialties Easiest Specialties = Psychiatry, Neurology, Pediatrics, Internal Medicine and Family Medicine Aim for USMLE scores 220+ Medium = Anesthesiology, Surgery, Obs & Gyne, Emergency Medicine (A&E) Aim for USMLE scores 230+ Super Competitive = Plastic Surg, Ophtho, Derm, Radiology, Neurosurg, Ortho Aim for USMLE scores 240+

32. Tips Do well on USMLEs US Clinical Experience ( ELECTIVE or Work Experience) Recommendation Letters – US>>>UK Do well in medschool Research, Publications & Poster Presentations Volunteer, Leadership & Extra-curricular Prizes & Awards Apply on or around Sep 1 st

33. QUESTIONS? Jaidev Nath - [email_address] Majd Protty - [email_address]

34. THANK YOU