A Guide to the USMLE for UE Grads By: Warren and Patty (Batch 2006-A)

So you want to train in the States for residency? Don’t know where to start? Don’t worry, you are not alone. A lot of UE grads have gone before you and have been as confused. Hopefully this short piece will help get you started. This is not meant to be the end-all source of your USMLE preparation, it’s just a start. We hope it helps…

Scheduling the Exams:

The earlier the better, but this really depends on when you decided to pursue training in the States. If you’re fresh out of the local boards, the ideal timing is around October-November of the year prior to your Match application. (e.g. If you plan to apply for the match in 2009, ideally you should take the first exam in October or November of 2008). Why? It gives you leeway for postponing the exam, gives you time to schedule the other exams earlier, or for others, it’s going to be an advantage because you can study for the boards and the MLEs at the same time. Which test to take first really is up to you. If you’re confident with your basic subjects, take step1, if you’re confident with your clinical knowledge, take step2ck. It’s up to you.

Points to remember when scheduling the exams:

1. Don’t think one exam at a time when scheduling. Plan all three exams early on. (meaning step1, step2 CK and step2 CS).

2. You want to schedule them in such a way that you have your ECFMG certificate before September 1. Meaning you should be done with your exams around June or July. This is important because some programs will not entertain your application if it is not yet complete.

3. When scheduling your Step 2 CS, think ahead. You will have to go to the States for this exam, might as well try to do an observership/externship also. The UERM Alumni MARVADC Chapter will be able to help you out with this. The schedule for the release of results can be found in the ECFMG website. You want to schedule your CS to make sure that the results will come out by July or August. Why? Because you have to prepare all documents for submission by August 1 in order to make it to the September 1 application. (more on this later) The ECFMG certificate should be available 2-3 weeks after you pass all 3 exams.

You might also want to consider the plane fare when taking the CS. PAL’s rates go down in Feb but again rises mid-March. I’m not too sure about the other airlines though. In my opinion, I think sticking to one airline is best since you earn mileage which you can claim by the time you have to finally settle in the US for residency.

4. Only take the exams when you are confident enough that you will get a high score. Don’t take an exam unprepared. When you schedule an exam, you are given a 3 month period within which you can take it. You can postpone an exam if needed without additional fees if you set it within your eligibility period. Remember, these exams are expensive. Also, some programs set a limit to the number of times an applicant retakes a particular exam (e.g. Program A requires that in order to qualify for an interview, applicant must have passed Steps 1 and 2 CK on first attempt with a minimum grade of 85). Of course, not all programs have this requirement but 85 is a common cut-off grade. You don’t want to limit your choices just because you didn’t do well in your exams.

5. Step 3 can only be taken once you are ECFMG certified. Although not a requirement for applying to a residency position, it does have its perks, (e.g. Looks better on your resume, can apply for an H1 visa). Keep this in mind. If you’re not in a rush to join the match right out of med school, take time to sit this exam beforehand.

Review materials:

We are actually hesitant in suggesting some of these reviewers since everyone has a different approach to taking exams and preparing for them. So take these suggestions with an open mind, don’t limit yourselves to these books. These worked for us, might not work for you.

STEP1:

1. Kaplan reviewers (with videos) – from my experience, the must haves are the following

a. Physiology (book and video)

b. Pathology (book, supplement with Goljan audio)

c. Anatomy (book and video)

d. Biochemistry (book and video)

e. Pharmacology (book and video)

f. Biostat/Ethics (book)

2. First Aid for Step 1 (be careful with this book though, there are some typos in some editions)

3. USMLEworld online review – this is money well spent in my opinion. Take either a 1 or 2 month course. Start it after your first reading, but make sure you have time to complete all the questions in their Qbank. This prepares you for the real thing because as you will realize later on, the questions in the MLE are very different from those in the local boards. UW also uses a software that is almost identical to the USMLE software, so that’s another advantage. http://www.usmleworld.com/

Total Cost for Step 1: $695 exam fee + $130 off-shore fee + $99 one month USMLE world + cost of reviewers + cost of coffee (hehe) = $924++

STEP2CK:

1. First Aid for Step 2 CK

2. Crush the USMLE Step 2 CK by Adam Brochert – the latest edition is available in Fully Booked at the Fort; or if you are in the US, it’s available in Borders or Amazon

3. USMLEworld online review –again, money well-spent. I did this for 2 months so I was able to go thru all the questions twice.

The 2 books and the online exam were enough, in my opinion. The important topics and must-knows are repeated over and over in USMLEworld so don’t be alarmed if you don’t come across some topics in the 2 books. Just take down notes from the Qbank and hopefully, you’ll retain the info.

Total Cost for Step2 CK: $695 exam fee + $145 off-shore fee + $90 one month USMLE world (or $120 for 2 months) + cost of reviewers + cost of coffee (hehe) = $930++

STEP2CS:

1. First aid for Step2 CS – this is all you need, with lots of practice. Get a partner, time yourself, rinse and repeat.

Total Cost for Step2 CS: $1200 exam fee + plane fare + accommodations if needed

**Expected cost for Steps 1, CK and CS = $3024++ (not including whatever charges UE will request for processing transcript, MSPE, etc..)

Points to Remember when choosing reviewers:

1. Much like the local boards, don’t spread yourself too thin. Choose one reviewer and master it. If you started with Kaplan for Anatomy, stick to it. Watch the videos again if you have to. If you choose to read Katzung for Pharma, stick to it. Like we said earlier, whatever book works for you should be your decision.

2. Get the latest edition of reviewers if possible.

3. Use the USMLE World questions and explanations to supplement your reading, not just to test your knowledge. There is a lot of material in the USMLEworld Qbank that come out in the actual tests.

4. You don’t need to spend a lot for the reviewers. Be resourceful. Borrow from previous batches if you can, or you may reuse some of the reviewers from the local boards. This is the part of the whole process where you can actually save money because the other fees are fixed!!!

5. When taking the USMLEworld exams, keep in mind: a good fast internet connection is a must since you can opt to time yourself during the practices to simulate the actual exam. A lot of places in Manila now have free wifi if you cannot study at home.

Miscellaneous pointers:

1. Take scheduled breaks. Watch a movie. Go out of town if you must. The point is basically, do not burn yourself out because this is a long process. Studying for 3 exams in a row is not an easy task.

2. Get in touch with the UERM Alumni early on if you plan on doing an observership/externship in the US. Our alumni are very busy and are just taking time out to help us.

3. Moonlighting. This is always a case-to-case thing. Is it possible to moonlight while studying? The answer is yes, if you are disciplined enough to stick to your schedule.

a. Advantages:

i. Clinical experience looks good on your resume. You can tell interviewers that you managed to juggle moonlighting while studying for the MLEs etc..

ii. Money is always welcome. We all know that the MLEs are expensive in their own right. If you plan on moonlighting, look for a high paying job to help pay for your expenses. If you’re going to be making less than P2000/duty for example and you end up too tired to study when you’re from duty, don’t bother. Just focus on doing well in the exams instead.

iii. Moonlighting can be a source of LORs. In our case, we were able to get LORs from 2 consultants in the hospital where we worked, one of them was even an IM resident in UE when we were JIs.

b. Disadvantages:

i. Time spent working is time not spent studying. We actually thought that clinical experience will help out in studying for the Step2 CK but it didn’t necessarily work out that way. Some subjects for the step 2 CK, notably Psych, aren’t seen in the typical ER in the Philippines.

4. Aim for a 99. Why not? The Match gets more competitive every year. So many IMGs are getting 99s. We want to be competitive in order to get those interview invitations. Of course there are other factors that programs consider when inviting applicants, but due to the bulk of applications they get (usually over a thousand) and the number of slots available for interview (ranges from 60-150), the computer program sometimes screens out those applicants who don’t have grades in the 90s range. We want our applications to be reviewed, so aim high!

5. Kaplan Review: The fact that so many people are trying to get a hold of those reviewers and videos means that their materials are very good. If you have the funds and believe that their system will work for you, then by all means, go for it. But if you are to choose if you should enroll in the review program for Step 1 or Step 2 CK, we would advise that you choose Step 1.

6. Most important of all is to PRAY. We can only do so much. The rest is up to HIM.

To share our own experience, this is the schedule that we ended up with. This is actually not ideal as we ended up getting our ECFMG certificates in November due to our late CS and some problems with paperwork from UE.

Decision to take USMLE: October 2007

Step 1: last week of April 2008; 4 months preparation (originally scheduled for end of March. Postponed one month for USMLEworld)

Step2CK: 2^nd week of July 2008; 2 months preparation (because step1 was postponed for a month, instead of 3 months studying step2, we only ended up with 2 months. Subscribed to MLEworld at the start of the review period unlike step1)

Step2CS: 3^rd week of August 2008; less than one month preparation (this was also the time when we were cramming to finish our Personal Statements and CVs, requesting and composing LORs)

We did moonlight while studying. We were doing 1-2 duties a week for a while and also moonlighted in Boracay for 2 weeks. We were very lucky to still do well in our exams in spite of the crammed schedule that we ended up with. The very reason that we are writing this down is for you not to repeat our mistakes. J

We hope this short primer will help. We still advise you to consult the website of ECFMG and to also download sample exams available in their site to familiarize yourself with the testing software.

God Bless everyone!