USMLE Step1 exam!

the never ending saga of giving exams

Posted by Supreeth on January 31, 2020 · 9 mins read

244! That number is going make or break my future. At least that is what I’m told. “Your step 1 score is what is going to determine the residency you get into”. Sounds like a magical solution that I’ve been hearing for the past 10-15years. And all this seems like a sham to keep us up in the rat race! All this started in the 10th boards, get this great grades and it sort you for life. Like most things a decade ago and with some convincing thought this was the way for me. Little did I know that this was just the beginning for a long boring journey. The start of never ending saga of giving exams.

My decision to not stay in India stems from the fact that my professional and personal growth were just looking at stagnation. As a child we never stayed at a place for long, and now I was staring at my life in a sleeping ‘Retiree’s Paradise’. Not that I hate this place, but it makes me feel content and comfortable. That in my opinion is not a good thing. I’ve started to believe that constant learning and challenging yourself with new things and experiences is must to grow as a human being. And getting far away as possible made sense.

The decision at first was very easy, a buddy of mine showed me how much fun it might be. “If you are not doing anything here, then get out of here.” Sounded like a great idea. But upon giving it a serious thought, it was very complex. The final decision was taken as a family, with some heated exchanges at the dinner table. Understanding the implication of this was only understood once I had a conversation with my brother. Everything from my attitude to financial situation had to change. Things had to become more organized and less procrastinatory, for lack of a better term.

So lets start about how you prepare for the USMLE!

Before you start get your parent and siblings on board its is going to be long and slow journey. Kinda similar to writing the NEET but more expensive and with a couple of extra steps. You just finish your internship, now somehow decided to apply for the USMLE and you are 2 years late. Everyone in the country thinks that you must worry about PG after internship. It does help to prepare after internship as you’ll have some clinical experience. Nope that never works in my opinion.

Preparation for PG should start in the first year, in principal at least. Because we are prepared for some exam from day one, and its always the wrong exam we prepare for. First its the internals, then its the final exams then its NEET. No teacher ever showed us the importance of the stuff they were trying to teach. Everything was made so boring that you just want to get over it and never give a second thought about it. Keeping yourself updated about with old and out of portion material and topics becomes crucial. Having a broader idea about things makes you more curious to know more and makes you realize that you know only a little. So being up to date lays the ground work for everything else.

Ideally, Step 1 should be given in 3 year MBBS and Step2CK in the middle of internship. So that by the end of internship thing are ready and you are able to concentrate on other more important things, in my opinion. So let me explain the best thing you can do.

Step 1 preparation

USMLE is structured in 3 distinctive steps

  • Step 1: Syllabus includes 1st year and 2nd year subjects, with special emphasis on Physiology, pathology and pharmacology.
  • Step 2CK: Includes all the subjects form first to last year including most of the clinical and treatment aspects.
  • Step 2CS: This is an in person exam to be written in 5 US cities and runs about 8 hours and is more like practical exams with standardized patients.
  • Step 3: This is 2 day exam, required to be taken for the medical licensing. To be taken after the Step 2CS is complete and advisable for IMGs (International medical graduated) to be taken before match season.

First lets get some formalities out of the way. What would help later is thinking about getting a B1/B2 visa for the USA. This will help a lot when you eventually need to run to the US in a hurry!. As a student the visa would be granted much more easily. The would be to register yourself at ECFMG (Educational Commission for Foreign Medical Graduates). The ECFMG is where the official journey starts, get the ECFMG/USMLE ID cost about UD$ 135, getting a credit card at this stage also helps.

Step 1 in my opinion might take about 3-4 months of dedicated studying and close to 6-7 months for someone working full-time and studying. These are just an arbitrary time frame some do it in less and some take years. I would taking this in 3rd year as there is a lot free time to study and the USMLE preparation takes only 3-4 hours per day. There are 100s of resources out there but let me give you the gist of the ones to use.

  • UWorld: Kinda expensive but the best resource out there. People use it as a testing resource but it is far more than that. Doing it at least twice lets you solidify most of the scenario.
  • First-Aid: This is the book to read, concise and covers most topics that one might need. Only dive into it if you have a decent grasp on your subjects. Having said that, just because FirstAid has a piece of fringe info doesn’t mean you need to know them all. Know everything you might need to know in an emergency room or a clinic in real life, everything else is pointless.
  • AMBOSS: This a study and testing resource into one. I started using this late, but has great explanations and all the drill down details one might ever need. This is “one-size-fits-all” resource and you get access to everything. Priced reasonably.
  • Anki deck: Spaced repetition is the new king, queen and everything else. I think it is a great tragedy that more medical student in India don’t know about this. There are a few ready made decks with 20K+ thousand flash cards or you can make your own. Making your own hybrid deck would help a lot. Use the desktop app for the first review and then use the mobile app everywhere else.
  • Dirty USMLE: This dude is a one man army. If I wanted to fight a world war, I would have him on my side. A must watch for all those weird topics.
  • Osmosis: Excellent videos! Very artistic and simple explanation for everything.
  • Boards and beyond vs OME: I think the jury is still out. But if you are the kind how is used to the lecture style of learning either one is for you.
  • Pathoma or Gojian: I’m still really not sure. But read this if your pathology fundamentals are a bit shaky.
  • Kaplan: Can be used for some subjects like biochemistry and microbiology, but didn’t find it that attractive to use.