Category: U.S. Medical Residency

In the last few posts, we have talked about the USMLE Step 1, Step 2 CK, and Step 2 CS. In order to get ECFMG certification, you need to have passed all three of these exams. These three exams are also the prerequisites for the USMLE Step 3 exam, which you need to pass in order to earn a license to practice medicine in the United States. As a foreign medical graduate, you have the option of taking the exam before submitting your application to a U.S. medical residency program or taking it after your residency has started. Depending on your personal situation, there are benefits and drawbacks to both approaches. Here three critical questions you need to ask yourself when making this decision:

Question 1: Do you have enough time to prepare for and take the USMLE Step 3 before applying to a residency program?

Before you take the USMLE Step 3, you already need to have passed the USMLE Step 1, Step 2 CK, and Step 2 CS. As a foreign medical graduate, you also need to have fully completed the ECFMG certification process. Your timeline for meeting these requirements can help you determine whether or not you want to take the USMLE Step 3 before you apply for your residency. You need to remember that preparing a successful residency application takes a great deal of time and effort, and you don’t want to rush through it because you are trying to study for the USMLE Step 3 at the same time — not to mention balancing the residency application process with the other responsibilities in your life.

However, if you have completed the requirements well in advance and feel like you have more than enough time to prepare yourself for success on the USMLE Step 3 before applying for your residency, it can reduce pressure once you start your residency. In most states, you need to pass Step 3 before the third year of your residency program, which can be a challenge as you balance residency program requirements, personal responsibilities, and adjusting to life in the United States. So if it’s easy to fit the USMLE Step 3 into your schedule before you apply for a U.S. medical residency, you may want to consider it.

Question 2: Do you have the medical background you need for success?

Like the USMLE Step 1 and Step 2 CK, the first part of the USMLE Step 3 consists entirely of multiple choice questions. The second part is somewhat similar to Step 2 CS — it tests your clinical skills, but instead of interacting with real-live patients, your performance is evaluated on a series of computer-based case simulations.

But don’t be fooled by these structural similarities. The USMLE program recommends that applicants have completed at least one full year of post-medical school training before taking the Step 3 exam. Therefore, many American and foreign medical school graduates use the first year of residency training as preparation for the USMLE Step 3.

However, some foreign medical graduates who apply for U.S. medical residency programs have already gained additional educational or work experience after medical school. For instance, you may have completed a post-graduate education program in your home country and/or completed a graduate externship in the United States. If that is the case for you — and you did well on the USMLE Step 1, Step 2 CS, and Step 2 CK — you may have the foundation you need for success.

Question 3: Are there logistical issues that you need to consider?

In some cases, whether or not you take the USMLE Step 3 before applying to a U.S. medical residency program can come down to logistics. These three logistical issues commonly come into play:

• Immigration status. In order to apply for an H1-B Visa sponsorship, you need to have passed the USMLE Step 3. If you plan to apply for this type of visa, you should plan to take the USMLE Step 3 before applying.
• Cost. The USMLE Step 3 can be cost-prohibitive for some students. If you can’t afford the $875 fee, you should wait until after you can save some money from your first year of residency work.

 

• Location. The USMLE Step 3 is only offered at Prometric test centers in the United States and its territories. If traveling to the United States from your location is too expensive or difficult, you should probably just wait until you start your program. Alternatively, if you are already in the United States — whether for a graduate externship, to visit family, or to see the sights — it may be convenient to take the test.

 
If you need more help making decisions about the residency application process, FMG is here to help. Contact us today for more information!

When you are preparing to take the Clinical Knowledge component of Step 2 of the U.S. Medical Licensing Exam — also known as the USMLE Step 2 – CK — your success depends on your familiarity with two things: the content on which you will be tested and the format of the exam. In a previous post, we provided a general overview of the exam that included a description of both. Today, we’re going to do a deep dive into the formatting of the questions you will find on the USMLE Step 2 – CK. That way, on test day, you won’t be surprised by any of the questions you come across.

When it comes to formatting, there are two different ways you can divide up the questions on the USMLE Step 2 – CK. You can divide the questions between Single-Item Questions and Sequential Item Sets, or you can divide them between Patient Vignette questions and Abstract Format questions. Read on to learn more about the different types of questions you will find on the USMLE Step 2 – CK.

Single-Item Questions vs. Sequential Item Sets

If you take the USMLE Step 2 – CK after you take the USMLE Step 1 (which is the way most foreign medical graduates do it, although it is not required), you will recognize the Single-Item Question format. And even if you haven’t taken the USMLE Step 1 yet, the Single Item Question format will be familiar because it is exactly what you would expect from a multiple choice question: a short text background followed by a single question. Pretty simple.

The one thing that does distinguish the Single-Item Questions from traditional multiple choice questions you might have seen at other points in your education is the formatting of the answer options. There can be as few as 3 answer options or as many as 26. They are lettered (A, B, C, D, etc), and the options are arranged in either alphabetical order or logical order. It is important to note that some of the options might be partially correct, but you can only select one, so you have to choose the best possible answer.

When it comes to question formats, the primary difference between the USMLE Step 1 and the USMLE Step 2 – CK is that the latter exam also contains sequential item sets. That means that a single text — that is, either a Patient Vignette or an Abstract (both of which we will get to later) — must be used to answer either two or three consecutive questions, instead of just one. Like the Single Item Questions, these questions are multiple choice questions with 3 to 26 possible options, and you have to choose the single best answer.

Although each question in the Sequential Item Set directly relates to the text, they are designed to test your knowledge of different aspects of the text. Also, it is important to note that they are designed to be answered in sequential order, so a question may build on the one preceding it. Because of this design element, you will not be able to change your answer to an earlier question after you click the button to move on to the next question.

Patient Vignette Questions vs. Abstract Format Questions

The majority of the questions on the USMLE Step 2 – CK are Patient Vignette questions. The Patient Vignettes provide an overview of a clinical situation that you might encounter in your practice as a physician. Then, you are asked one or more multiple-choice questions about it (depending on whether it is associated with a Single-Item Question or a Sequential Item Set). For instance, you might be given a brief medical history of a patient followed by a description of an abnormal test result and then asked to identify the most likely cause of the result.

While the Patient Vignette questions test your ability to apply your knowledge and skills to clinical situations, the Abstract Format questions examine your ability to understand and interpret information from clinical investigation. Each of these items consists of a summary of an experiment or investigation in the form of an abstract — the kind you would find for a peer-reviewed research study published in a medical journal. It is essential for doctors to be able to read, understand, and analyze abstracts in order to effectively engage in evidence-based practice.

On the USMLE Step 2 – CK, you will be required to interpret an abstract in relation to various relevant topics. For instance, you may find questions about:

• Biostatistics and epidemiology
• Pharmacology and therapeutics
• How to use diagnostic studies in clinical practice
• How to use the information from the abstract to make decisions about care for an individual patient

 

Every step of the US medical residency application process — including the three Steps of the USMLE — can be challenging for foreign medical graduates, but FMG Portal is here to help. Contact us today for more information about our services!

Last week on the blog, we talked about the United States Medical Licensing Examination (USMLE) Step 2 – Clinical Skills (CS). In order to earn ECFMG certification, which is required for all foreign medical graduates who are applying for a residency in the United States, you need to pass all three steps of the USMLE. The USMLE Step 2 – CS tests your ability to perform professionally and effectively in clinical settings.

After the On-Site Orientation to the exam, you will be faced with twelve patient encounters. Each encounter will last for fifteen minutes. Most of the encounters will be Standardized Patient & Physical Examinations, but some of them will be Telephone Patient Encounters. Read on to learn what you can expect — and what is expected of you — in each of these two types of encounters.

The Standardized Patient & Physical Examination

In the Standardized Patient encounters, you will meet with a live patient. Within the fifteen-minute encounter, the you will be expected to do three things: come up with a preliminary diagnosis (or several diagnoses) for the patient, develop a basic work-up plan, and establish a positive and effective relationship with the patient.

In order to make the correct diagnosis and propose an appropriate treatment plan, you will need to utilize multiple strategies, including:

• Asking the patient questions about their current condition
• Asking the patient questions about their medical history
• Conducting a physical examination

However, because you only have fifteen minutes available for each patient encounter, you will not have time to get a complete picture of the patient’s medical history or even conduct a comprehensive physical examination. Instead, you have to be strategic and pursue the most promising leads as you obtain more information from the patient.

However, coming up with the correct diagnosis and an adequate preliminary treatment plan is not the only thing you are being evaluated on when you take the USMLE Step 2 – CS. You also need to demonstrate your professional and interpersonal skills. That means relating well with the patient and establishing a good rapport, regardless of the time pressure. Some of the keys to earning a good score include:

• Speaking to the patient in a courteous manner
• Exhibiting empathy toward the patient
• Responding appropriately to the patient’s questions, comments, and body language
• Maintaining an awareness of the patient’s modesty during the physical examination

The Telephone Patient Encounter

In the United States, telemedicine — that is, the provision of remote clinical services, often by phone — is becoming increasingly common. Through some telemedicine platforms, it is possible for a patient to call a doctor from their home to discuss a medical issue without having to come to a clinic. In other cases, a physician might talk on the phone to a patient who is at a medical facility where staff and services are limited, such as a clinic in a rural area. As the prominence of telemedicine grows, a doctor’s ability to communicate effectively with patients on the phone is an ever more relevant skill — which is why it is important to perform well on the Telephone Patient Encounters on the USMLE Step 2 – CS.

For the Telephone Patient encounters, the general expectations are the same as they are for the Standardized Patient encounters. Specifically, you are expected to develop a basic diagnosis and treatment plan, and you need to communicate with the patient in an appropriate, effective, and caring manner. The main difference between the two types of encounters is that it will not be possible for you to perform a physical examination during the Telephone Patient encounters. Instead, you will have to rely solely on oral communication with the patient. This can may seem like a major obstacle but rest assured that the USMLE Step 2 – CS is designed so that the Telephone Patient encounters are challenging — but not impossible. Still, as long as you can quickly assess the relevant information and identify the most promising leads, you can come to a conclusion that will earn you a passing score.

The Patient Note

After each one of the twelve patient encounters — including both the Standardized Patient Encounters and the Telephone Patient encounters — you will have ten minutes to write a patient note. The content of the note is expected to be the same as what a practicing physician would write in a patient’s medical record after an in-person or telephone meeting. Just like the patient encounters, you will be under pressure to complete the note within the allotted time, but if you finish a patient encounter early, you will have extra time to write the note.

Ultimately, success on the USMLE Step 2 CS is one of many steps on the way to getting matched to a U.S. medical residency. For more help with the process, contact FMG Portal today!

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!

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!

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!