Medicine and Man

The USMLE Step 1 exam covers the contents of the first 2 years of medical school (pre-clinical sciences). The subjects include:-

• Gross Anatomy
• Pathology
• Neuroanatomy
• Pharmacology
• Histology
• Microbiology
• Embryology
• Immunology
• Physiology
• Behavioral Science
• Biochemistry
• Biostatistics
• Genetics

This may appear mind boggling at first sight but actually many are subtopics in the major subjects. The reason for this classification is that many books are written for these specific topics separately.

Time to prepare for the exam depends from person to person. Generally IMG’s prepare for about 3-6 months for the exam.

Exam Registration

The application for the USMLE exams may be submitted online or via regular mail as described in the introduction.

Once registered the applicant receives the Orange permit card which is used to register for the exam either by phone or online (Prometric centers). Along with the permit the examinee will also receive a CD containing 3 blocks of sample questions and the software tutorial.

Exam Design

Step 1 is a one day exam. The total exam duration is 8 hours. The exam consists of 7 blocks of 50 questions each which have to be finished in 1 hour. So the actual exam time is 7 hours. There is a 15 minutes tutorial to let applicants get familiar with the software and 45 minutes of break time. So the total duration of the exam totals to 8 hours.

Applicants are allowed to take a break after finishing a block but not during a block. The applicant may take as many or as few breaks as he likes as long as he does not leave the exam room in the midst of a block. Also note that once a block has started, it has to be finished before the applicant may take a break. If a block is closed without completing it there is no way in which it may be opened again.

If the tutorial is finished earlier then the remaining time gets added to the break time. Similarly if a block is finished earlier then also the time gets added to the break time. This extra time cannot be used to extend the time of some other block.

Each block will contain a mix of questions from the various subjects. No particular subject is more important than others. To put it crudely every subject is as important as the thickness of the book used for exam preparation and therefore every book should be read thoroughly.

Questions on the exam

Questions are multiple choice type and may carry between 3 to 10 choices per question. Most of the questions are framed in a clinical scenario. All questions carry equal weightage and there is no negative marking.

A point to note is that not all questions on the actual exam will be scored. They are there for experimental purposes to analyze if they are suitable to be scored in future exams (e.g. some questions may be too tough, too easy or wrongly framed). According to the USMLE website anywhere between 10-20% of the questions on the exam may not be included in the final score. So if you are talking a long time on a particular question, you may want to select your favorite letter and move on.

Result Reporting

The results of the exam are generally reported between 4-6 weeks after taking the exam. The results of the exam are reported in a 2 digit and a 3 digit score.

The United States Medical Licensing Examination (USMLE) is a series of examinations which medical undergraduate, postgraduate and professionals need to take in order to enter into a residency in the United States.

There a total of 4 exams:-

Step 1 – Covers pre-clinical subjects (e.g. Anatomy, Physiology etc)

Step 2 CK (Clinical Knowledge) – Covers clinical subjects (e.g. Medicine, Surgery etc) with emphasis on diagnosis

Step 2 CS (Clinical Skills) – Clinical case encounters with simulated patients

Step 3 – Clinical subjects with more emphasis on actual management (Not required to enter into residency)

Eligibility Criteria and Application

The USMLE exams can be taken anytime after completion of at least 2 years of medical school or the basic science medical component. These exams may be taken in any order which the applicant chooses. For e.g. Step 2 CS may be taken first followed by Step 1 and then Step 2 CK.

Please note that that there is no requirement that an applicant needs to complete his/her medical school before taking the exam. Essentially this means that anyone can take the Step 2 CS exam after passing the basic science years (The ECFMG website recommends but does not enforce that the applicant should have completed their core clinical rotations before taking the exam).

All international medical graduates (IMG) need to apply for these exams through the ECFMG (Educational Commission for Foreign Medical Graduates). The ECFMG provides both an online and paper based application form. The online form is generally processed much faster than the paper based version. Also one should note that even the online version of the form requires you to print the “Certification of Identification form” (Form 186) after completion of the online part and send it by regular mail.

When an applicant registers for an exam, they are required to select a 3 month period during which they will take the exam. After receiving the registration (orange card), the applicant needs to contact Thomson Prometric by either phone or register online to set up a date to take the exam. The exam can be taken throughout the year except on Saturday and Sunday.

ECFMG Certificate

The ECFMG certificate is awarded after the successful completion of Step 1 and 2 (CK and CS). This certificate is necessary to participate in the National Residency Matching Program (NRMP) or the Match and therefore to enter into a residency program.

Costs Involved

The whole process to get into a residency in the United States is an expensive affair. Lets make some rough calculations -

So the whole process for the IMG approximately costs between $8000 – $12000.