An Overview of the USMLE Step 2 CS for Foreign Medical Students and Graduates

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If you are a foreign medical student or graduate and you want to get matched to a residency program in the United States, the first thing you need to do to prepare is to get certified through the Education Commission for Foreign Medical Graduates (ECFMG). Before your certification can be verified, you must pass all three steps of the United States Medical Licensing Exam (USMLE). In two previous posts, we provided an overview of the USMLE Step 1 and advice on how to construct a study strategy to prepare yourself for success on test day. Today, we are going to start talking about the USMLE Step 2.

The USMLE Step 2 is actually divided into two parts: Step 2 CS (Clinical Skills) and Step 2 CK (Clinical Knowledge). Today’s post is going to focus on Step 2 CS. Read on to learn more about this essential exam!

The Basics of the USMLE Step 2 CS

Both parts of the USMLE Step 2 evaluate your ability to apply your knowledge of medicine in practical clinical settings. One these exams, you will be expected to show that you can implement strategies to prevent disease and promote health and wellness through effective patient care.

As the name implies, the Step 2 CS focuses specifically on examining your clinical skills. The test focuses on three aspects of clinical practice:

  • Obtaining health-related information from patients
  • Conducting physical examinations
  • Effectively communicating patient information to other health care providers

By demonstrating your competency in these areas, you can get the passing score you need to earn ECFMG certification.

The Format of the USMLE Step 2 CS

Unlike the USMLE Step 1, the USMLE Step 2 CS is not a written exam. Instead, it is a real-world exam where you are evaluated on the skills you demonstrate in mock scenarios of patient encounters. Essentially, test day simulates a day in the life of a physician in clinical practice. The exam itself is divided into three major sections. The On-Site Orientation, the Patient Encounter, and the Patient Note.


  • The On-Site Orientation

Some of the details of the USMLE Step 2 CS inevitably vary depending on the facility where the exam is given — such as how you are expected to move between rooms during different protions of the test. But you don’t need to worry, because everything will be explained during the on-site orientation. You are not scored on anything during this part of the exam, so all you have to do is listen to the instructions and familiarize yourself with the expectations for the facility. That way, when your patient encounters begin, you won’t feel lost or uncertain about where to go or what to do.


  • The Patient Encounters

In total, you will complete twelve patient encounters during the USMLE Step 2 CS. You will have a total of 15 minutes for each one, but you may be able to complete them in less time. It is important to note that not all twelve of the encounters are scored — some are pilot test cases that will be used by the test-makers for research purposes — but on test day, you will not be able to distinguish between them. There are two types of patient encounters on the USMLE Step 2 CS: the Standardized Patient and Physical Examination, and the Telephone Patient Encounters. In both, you will be expected to act professionally and apply clinical skills to the patient-centered problem you face.


  • The Patient Notes

Immediately following each one of the twelve Patient Encounters, you will need to complete a Patient Note. The Patient Note is the only written part of the USMLE Step 2 CS. This part of the exam involves using a computer to record details about the Patient Encounter in the patient’s medical record. Essentially, it is the same thing that you would do as a physician after meeting with a patient in a clinical setting or talking to the patients on the phone. For each Patient Encounter, you will be given ten minutes to complete the associated Patient Note. However, if you finish your Patient Encounter early, you can spend the additional time working on the Patient Note.

USMLE Step 2 CS Scheduling

Because of the complex format of the USMLE Step 2 CS, it is only offered on certain days and in certain places. You can find calendar and scheduling information on the ECFMG website after you obtain your identification number. From there, you can choose the date and location that work best for you! It is important to note that the USMLE Step 1, USMLE Step 2 CS, and USMLE Step 2 CK can be taken in any order, so when you choose your test date, the order of these three exams does not make a difference.

Need more help with the process of getting matched to a U.S. medical residency program? Contact FMG Portal today to learn more about all of the resources we offer!

Medical Specialty Spotlight: Nephrology


Kidney disease is a growing problem around the world, but if you are looking to specialize in nephrology, one of the best countries to train in is the United States. According to the National Institutes of Health, about 14 percent of the American population has chronic kidney disease (CKD), as compared to only 10 percent of the world population as a whole. In total, about 661,000 American have kidney failure. About 468,000 of these patients are on kidney dialysis, and about 193,000 have a functioning kidney transplant. According to the American Journal of Kidney Diseases, the prevalence of CKD in the United States is expected to increase by 27 percent by 2030.

The two most common causes of CKD are high blood pressure and diabetes, with almost half of CKD patients reporting that they have been diagnosed with one or both of these conditions. That’s why CKD is so common in the United States — because of the high prevalence of cardiovascular disease and diabetes. However, its is important to note that changing lifestyles in developing countries are also raising the rates of these diseases worldwide, especially as the number of elderly individuals in countries like China and India grow. Therefore, in the future, there will probably be a high demand for nephrology specialists around the world.

If you are looking to become a nephrologist — that is, a physician specializing in the treatment of kidney disease — it just makes sense to complete your residency and fellowship in the United States, given the high rate of CKD in the country and the likelihood that it will rise in the future. Read on to learn more about the educational pathway to becoming a nephrologist.

Internal Medicine Residency: The First Step on the Path to Nephrology Career

Because nephrology is a specialization within the field of internal medicine, the first step to becoming nephrologist (after finishing medical school) is to complete an internal medicine residency program. These programs last for three years, and they are particularly popular among foreign medical graduates. Of all the foreign medical graduates who were matched to residency programs in the United States in 2015, 67.3 percent were matched to internal medicine programs, according to the National Residency Matching Program (NRMP).

In an internal medicine residency program, you can expect to gain a broad background education in the diagnosis, treatment, and management of disease and disorders that affect all of the internal body systems — including the renal and urinary systems. In addition to your clinical and didactic training, you may also have the opportunity to engage in research. If you are hoping to become a nephrologist, you may be able to conduct advanced research in nephrology, which can help you prepare for the specialization later on in your career.

Once you finish your internal medicine residency program, you will be prepared to take the American Board of Internal Medicine (ABIM) certification exam. After you pass the exam, you will be eligible to apply for a fellowship in nephrology in order to pursue your dream of becoming a specialist in the field.

Completing a Nephrology Fellowship Program

During a nephrology fellowship program, your studies will focus specifically on kidney-related diseases and disorders. As previously mentioned, CKD is the most common kidney disease in the United States and around the world, but as an aspiring nephrologist, you will also gain expertise in other kidney conditions, including:

  • Kidney stones
  • Polycystic kidney disease (PKD)
  • Acute renal failure
  • Glomerulonephritis
  • Pyelonephritis
  • Bartter syndrome
  • Dent disease
  • Nephronophthisis
  • Gitelman syndrome

Depending on your area of interest, a nephrology fellowship program can last anywhere from two to four years. If you choose to focus your fellowship on clinical training, it will typically last for two years. In addition to learning about the treatment of the conditions listed above, you may also have the chance to learn about cutting-edge clinical treatment options, such as home-suitable dialysis. You will also gain expertise in related areas of clinical care that you will likely encounter in your practice, such as geriatric care and palliative treatment.

Alternatively, you can choose to focus your fellowship on research — either clinical research, translational research, or basic science research. For aspiring researchers, a nephrology fellowship typically lasts three to four years. If you choose the clinical research pathway, you may be able to earn a master’s degree over the course of your training. As a nephrology research fellow, some of the topics you might study include:

  • Epidemiology of kidney disease
  • Public health strategies to improve access to CKD treatment in developing countries
  • Drug development for rare kidney disease
  • Cancer-related signaling pathways in kidney cells

After you finish the fellowship program, you can take the optional Nephrology Certification exam offered by the ABIM to demonstrate your expertise in the field. From there, you start your career as a nephrology-focused clinician, researcher, your researcher/practitioner.

If you are a foreign medical student or graduate, getting a job as a nephrologist might seem like a long way off, considering the years of preparation that are required, but it’s never too early to start preparing yourself! A clinical externship in nephrology can be a great way to get a feel for the field and establish connections with medical professionals in the United States before you apply for an internal medicine residency. Contact FMG Portal today to learn more about how this opportunity and the other ways we can help you get matched!

Developing a Study Strategy for the USMLE Step 1


Last week on the blog, we provided an overview of the USMLE Step 1, discussing the format of the test and its general content. Passing this exam is the first major hurdle for foreign medical graduates who are applying for ECFMG certification, so if you are a foreign medical student or graduate considering applying for a U.S. medical residency in the future, getting a good score on the USMLE Step 1 can help you on your way to achieving you goal. To get that passing score, you need to come up with a study strategy that properly prepares you for test day. Read on to learn more about what you need to do to get ready for this crucial exam!

Knowing What You Will Be Tested On

In general, the USMLE Step 1 covers the basics of medical science and organ systems. Therefore, regardless of the country where you attended medical school, you have probably been exposed to most of the concepts on the test at some point in your education. Given that the content of the test will probably be familiar to you, the main goal of studying for the USMLE Step 1 is not to learn new things, but to refresh your memory on the subjects that the test emphasizes.

Not all subjects are given equal weight on the USMLE Step 1. The group of American and Canadian teachers, researchers, and clinicians who design the test believe that some academic concepts are more relevant for today’s physicians than others, and the USMLE Step 1 is structured according to their believes. There are two ways that the test specifications of the USMLE Step 1 may be divided, according to the test makers: based on Systems and Processes and based on Physician Tasks and Competencies. Knowing how the content of the USMLE Step 1 is divided within each of these schemes can help you design an effective study strategy.

If you are looking at the USMLE Step 1 through the lens of Systems and Processes, the test can be broken down based on the specific nature of the content on which you will be tested.

The following are the systems that you will find on the USMLE Step 1, along with the proportion of the test that each one takes up:

  • General principles of foundational science: 15% – 20%
  • Organ systems: 60% – 70%
  • Multisystem Processes and disorders, biostatistics and epidemiology / population health, social sciences: 15% – 20%

These are the processes that you will be tested on when you take the USMLE Step 1, along with the proportion of the test that each one takes up:

  • Normal processes: 10% – 15%
  • Abnormal processes: 55% – 60%
  • Principles of therapeutics: 15% – 20%
  • Other processes: 10% – 15%

Another way to approach the USMLE Step 1 is through the lens of Physician Tasks and Competencies. From this perspective, the test designers break down the USMLE Step 1 into the following competencies:

  • Medical knowledge / scientific concepts: 55% – 65%
  • Patient care: diagnosis (including laboratory / diagnostic studies, diagnosis, and prognosis / outcome): 20% – 30%
  • Patient care: management (including health maintenance, disease prevention, and pharmacotherapy): 7% – 12%
  • Communication and professionalism: 2% – 5%
  • Practice-based learning and improvement: 4% – 8%

Now that you know about the two ways in which the content of the USMLE Step 1 is organized, you can design a study strategy that focuses specifically on the topics that are most heavily emphasized on the test and the topics that you may not remember well from medical school. However, you also need to prepare yourself for the way in which questions will be asked on the test.

Preparing for the Questions on the USMLE Step 1

All of the questions on the USMLE Step 1 are multiple choice, but don’t let that fool you into thinking it will be easy. In most cases, the test questions will not ask you directly about specific medical facts. Rather, you will be challenged to apply your knowledge to solve problems, interpret data, and address real-life scenarios. Therefore, in addition to brushing up on your knowledge of medical science, organ systems, and basic physician tasks, you should make sure that you are familiar with USMLE Step 1-style questions before test day. As you develop your study strategy, you should block out a good proportion of time to completing practice questions. That way, when test day finally comes, you can successfully navigate the toughest questions with a sense of ease and familiarity.

It is important to note that the USMLE Step 1 is a timed test, so some of the practice tests you complete should be timed. Usually, timed practice tests should come late in your study schedule. That way, when you first start working on practice questions, you won’t feel undue pressure to rush through them. Later, as the test approaches, you can learn how fast you need to work through each section to complete the test within the time limit.

Overall, if you are familiar with the structure of the USMLE Step 1 and the types of questions you will see on the test, you can develop a study strategy that will get you ready for success on test day — and well on your way to earning ECFMG certification and getting matched to a U.S. medical residency!


Need more help with the residency match process? Contact FMG Portal today to learn about all of the resources we offer!

An Overview of the USMLE Step 1 Examination for Foreign Medical Graduates


As a foreign medical graduate, your application process for a U.S. medical residency differs slightly from that of a student who completed their education in the United States. Most importantly, before you can apply for a residency, you must get certification from the Educational Commission for Foreign Medical Graduates (ECFMG). In another blog post, we covered the basic requirements for ECFMG certification, but today, we are going to focus on one of the most important aspects of the process — passing the USMLE Step 1. After you submit your initial application for ECFMG certification, passing the USMLE Step 1 becomes the next task on your list of things to do. Read on to learn more about what you can expect from this essential examination.

About the USMLE Step 1

The United States Medical Licensing Examination (USMLE) consists of three steps. The first test is the USMLE Step 1. You might also hear it simply referred to as “Step 1.” The USMLE Step 1 is a joint program of the Federation of State Medical Boards of the United States, Inc and the National Board of Medical Examiners. Although you do not need to pass the USMLE Step 1 before taking the USMLE Step 2, you must achieve a passing score on both exams before you become eligible to take the USMLE Step 3. Also, you must pass USMLE Step 1 Step 2, AND Step 3 before your ECFMG certification becomes official.

The Format of the USMLE Step 1

The USMLE Step 1 is a one-day examination, lasting a total of eight hours. It is divided into seven blocks, each of which is 60 minutes long, and there are short breaks between each one of the blocks. There is no set number of questions on each block of the test — instead, the USMLE guarantees that there will be no more than 40 questions per block and no more than 280 questions on the exam as a whole.

All of the questions on the USMLE Step 1 are single-item multiple choice questions. That means that each question consists of a short vignette followed by four or more lettered response options (labeled A, B, C, D, E, etc). From these options, you must choose the best answer. Only one answer is correct.

The Content of the USMLE Step 1

The USMLE covers the basics of medical science. In general, you will be tested on the information that you would learn in the first two years of medical school in the United States. During these years, the training for U.S. medical students consists primarily of didactic coursework and laboratory exercises (as opposed to clinical training). However, you should be aware that in some countries, the medical training does not align with that of the United States — in terms of timing and/or content — so you need to tailor your study efforts specifically for the USMLE, not necessarily reviewing everything you learned in medical school.

That’s because the questions on the USMLE are created by examination committees made up of medical experts from institutions in only two countries: the United States and Canada. These experts — including medical school faculty members, teachers, research investigators, and clinicians — come together to decide what it is important for future U.S. medical residents to know about basic medical science.

In general, the USMLE Step 1 covers the broad principles of basic science and the functioning of human organs and organ systems. More specifically, it includes questions within 8 traditionally defined disciplines and 5 interdisciplinary areas.

The traditionally defined disciplines are:

  • Anatomy
  • Behavioral Sciences
  • Biochemistry
  • Biostatistics and Epidemiology
  • Microbiology
  • Pathology
  • Pharmacology
  • Physiology

The interdisciplinary areas are:

  • Aging
  • Genetics
  • Immunology
  • Molecular and Cellular biology
  • Nutritional sciences

Not only do you need to be able to recall information on these subjects but you also need to be able to read and interpret relevant graphs and tables, identify pathologic and normal specimens (including both microscopic and pathologic specimens), apply your knowledge to specific clinical problem-solving questions.

You should also be aware that there is a heavy emphasis on how these topics apply to organ systems — these types of questions typically make up between 60 and 70 percent of the total content of the test. The following organ systems are covered on the USMLE Step 1:

  • Blood and Lymphoreticular System
  • Behavioral Health
  • Cardiovascular System
  • Endocrine System
  • Gastrointestinal System
  • Nervous System and Special Senses
  • Renal and Urinary System
  • Reproductive System (Male and Female)
  • Respiratory System
  • Skin and Subcutaneous Tissue
  • Musculoskeletal System

Clearly, the USMLE Step 1 covers a lot of academic territory, so if you are hoping to get matched to a U.S. medical residency program in the future, be sure to study! While in medical school, you might also want to consider broadening your knowledge on particular topic areas of interest by completing a student elective program in the United States. A student elective can help you decide what specialty area you want to pursue in your residency, and it can also connect you with physicians in the United States who may be able to provide letters of reference for your future residency application.

FMG Portal offers lots of resources for foreign medical students and graduates who are interested in U.S. medical residency programs. Contact us today for more information!

Medical Specialty Spotlight: Infectious Diseases


All over the world, infectious diseases are on the rise. Every day on the news, you might hear a breaking story about the discovery of a novel virus that has the potential to wreak havoc across the globe. At the same time, you might be hearing about infectious diseases that have been around for centuries but are somehow making a comeback. Consider some of the most recent developments in the field of infectious diseases:

  • The Zika virus has gained traction in South American countries like Brazil, and it has also been carried to other countries, like the United States. The effects of the virus are not well understood, but it has been shown to cause microcephaly in infants after their mothers have been infected.
  • Between 2014 and 2016, the most recent outbreak of Ebola ravaged countries in West Africa, causing a worldwide health scare.
  • Over the last two years, there have been measles outbreaks across Europe, especially in Romania, where over 3,400 cases have been reported since January 2016. Some suggest that the increase in measles, mumps, and rubella has resulted from unwarranted fears about the safety of vaccines for children.
  • Scientists have recently reported that the number of new flu viruses is increasing each year. This is making it increasingly harder for scientists to develop effective vaccines.

If stories like these capture your academic interest as a physician, you may want to consider becoming an infectious disease specialist in the future. Read on to learn more about working as an infectious disease specialist and what you need to do to become one.

Working as an Infectious Disease Specialist

An infectious disease specialist is a physician who is an expert at diagnosing, treating, and preventing the spread of illnesses that are transmitted from person to person. Infectious diseases may be caused by bacteria, viruses, parasites, or fungi, and they can affect many different parts of the body. Although some infectious diseases, like the common cold, are relatively easy to diagnose and treat, most infectious disease specialists focus their work on infections that are particularly difficult to treat or have not been fully studied.

As an infectious disease specialist, your job could involve aspects of clinical practice, scientific research, and public health efforts. Depending on your interests and training, you might spend some of your time working directly with patients, providing them with vaccinations against infectious diseases and/or therapies to treat infections that they have already contracted. You might also choose to spend some of your time in the research lab, developing and conducting rigorous studies with the goal of finding new prevention and treatment strategies or identifying new strains of a deadly infection. If you are interested in public health, you could also find yourself using your medical knowledge to develop and direct large-scale efforts to address and eradicate infectious diseases in a broader community.

The Steps to Becoming an Infectious Disease Specialist

Regardless of the particular aspect of infectious disease in which you are most interested, the basic components of training for this career are the same. After you finish your training in medical school, you must complete a three-year medical residency in internal medicine. If you are specifically interested in becoming a pediatric infectious disease specialist, you will also need to complete a medical residency program in pediatrics. Although it can be tough for foreign medical graduates to get matched to U.S. medical residency programs, it is important to note that internal medicine and pediatrics are two of the specialty areas in which foreign medical graduates are most commonly matched. To increase your chances of getting matched, you might also want to consider completing a student elective or a clinical externship program in infectious diseases, internal medicine, and/or pediatrics before you apply for your residency.

After you finish your residency, you can get the expertise you need to become an infectious disease specialist by completing an ACGME-accredited fellowship program in infectious diseases. Depending on the location, these programs can last for either two or three years. In most programs, fellows divide their time between clinical training with patients and research training in a particular area of interest. Research within the field of infectious diseases tends to vary widely, and it may fall into any of the following categories:

  • Basic science
  • Translational science
  • Clinical trials
  • Epidemiology / public health
  • Global health studies

Upon completion of one of these programs, you will be prepared for the Infectious Disease subspecialty certification exam offered by the American Board of Internal Medicine (ABIM). From there, you can start an exciting career as an infectious disease specialist!
FMG Portal offers valuable resources for foreign medical graduates who are looking to pursue careers in a wide range of specialty areas. Contact us today for more information about how to get matched to the U.S. medical residency program of your dreams!