General Strategies and Tips to Pass USMLE

Dear Med. students/ Med.grads.: Pls. note that some info in this section might be about the paper/pencil based USMLE exam..dont worry exam questions are still the same only pattern has changed for exams
USMLE is a series of exams step-1, step-2, CSA (clinical skills), TOEFL and step-3 which leads you to USA medical licensure. step-1 and 2 can be taken in most countries in the world through sylvan technology centers. it is computer based but NOT YET ON INTERNET.
CSA (clinical skills) is a new test which is now required by foreign med grads (FMG)to get their ECFMG certificate. It is only conducted in philadelphia, USA.
If an IMG/FMG passes step-1 and step-2, english (TOEFL) and CSA, he is eligible for applying to a residency program in USA, which is really hard to get unless you have superb scores on the steps.
Step-3 can be taken right now only in USA. it is usually taken during or after the first year of residency because most states require to complete one year of traning to sit in this exam but some states including new york, new jersey, louisiana, tenessee and some other allow med. grads to take this exam without one year residency. when you pass step-3 you are eligible to apply for licensure in USA but 99% of states ask you to finish the residency requirement before applying for licensure.
Right now the situation here in USA is bad for the residency positions, so all I want to say is that, prepare well for USMLE exams and try to get good scores (ATLEAST 85%). Whenever you start studying for these exams, focus and concentrate on getting good scores. I am writing all this because whatever problems I have faced, you could avoid those and have a very good time when you work in USA.
General things for USA system and residency:
1. My personal experience says that you should do house job (INTERNSHIP) and preferably at AGHA KHAN HOSPITAL, Karachi, Pakistan or AIMS, DELHI, INDIA or some very recognized hospital in your country wherever you belong to. If you are already in US, then try to get some experience in research (preferably Clinical) because research papers/experience puts a very good impression on your resume not a guarantee for residency though. Try to get your name on some publications (Research paper).
2. Most of the times it is observed that the opening question of the residency interview is “What have you been doing since your graduation”. So you have to tell them that after your graduation you have been involved somehow with your profession (medicine). If you are an old graduate (more than 5-7 years), then you have to be prepared well for these kind of questions and believe me unless you answer this question satisfactorily, your chances of getting an offer for residency are less.
3. Don’t rush there is so much competition that I would suggest you to take these USMLE exams very seriously and then try to score as much as possible.
4. The USMLE is computer based but do not worry too much, computer based exam comprises the same course and questions and step-1 and step-2 exam are gonna be just one day exams.
5. Plz. before coming to USA learn computers, at least the word processor soft-wares and the Internet related stuff.
General strategies:
1. The REVIEW COURSES, which I have mentioned at the end, are important especially when you do not have a group of friends in USA and you have a habit of group studies. If you are a very old graduate (5-7 yrs.) then I would strongly recommend these review courses.
2. Plz. Try to stick to one book for each subject. Do not try to jump on different books and waste time. Do not try to change books and be the master of one subject. This exam is not the exam of your knowledge but it is just to check how you apply your knowledge. If this is your 2nd or 3rd attempt, then plz. Read the same books, which you read previously unless they are 3-4 yrs. older editions.
3. Do as many MCQs (multiple choice questions) as you can, especially the ones which I mentioned and plz. try to time yourself because timing is everything (45-55 seconds/MCQ).
4. READ THE LAST LINE OF MCQ FIRST SO THAT YOU KNOW WHAT IS BEING ASKED. The 10 line question is sometimes waste of time, so read the last line first to have an idea whether it is about diagnosis, management or some other thing.
Study Planning:
Best time to take the step-2 exam is during the House-job (internship) because the clinical knowledge is at the peak. After completing the internship, study for 3-4 months for step-1 exam and for CSA, I would recommend at least 2-3 months of Observership/ Extern-ship at a teaching hospital in USA.
1. 3-4 months is sufficient time for either step 1 or 2. Before starting try to get all the materials (books and helpful notes), so that you should not waste time after that.
2. Make sure that the difficult subjects and topics should be revised at least twice, once in the beginning of prep. and then later near the exam.
3. After starting your studies and picking up the pace (after 1 week), try to do 60 MCQs/day with timing. Do the MCQs in the morning when you are fresh and do them actively not passively. Read the explanation of only those MCQs, which are doubtful or you have correct them by chance. The best way to do an MCQ is to read the question and then try to mark an answer for that, only after you have marked the answer look for the correct answer from the answer list and explanation.
4. Increase the no. of MCQs to finally 100-120 /day with short breaks in one sitting, just like original exam. By going this way, you will make a habit and would find it easy on the day of exam.
5. Throughout your preparation days, do not over study or over burden, just keep up your pace and go according to the schedule (7-9 hrs./day at least).
6. As you are approaching near the exam day, cut down your hours of study in last 10 days and make sure that “YOU SHOULD NOT READ A SINGLE WORD ON THE DAY BEFORE THE EXAM”. In the last ten days make a habit to see the histo/patho diagrams, ct-scans and x-rays (2 hrs./day).
7. In the last 10 days, you should only concentrate on MCQs, I would say no theory at all.
Review courses
1. Kaplan, phone: 1800-527-8378, CLICK, KAPLAN owns NMSR and Arc Ventures review course programs.
2. The Princeton Review, phone: 1800-2review, CLICK
These all courses are equally effective and plz. take one of these because:
1. These courses discipline and schedule your studies and give motivation.
2. Their teachers are mostly professors of US medical schools and they teach very good and tell you best test taking strategies.
3. The books provided by these review courses are very up to date and gives current knowledge and trends plus specific points as far as USMLE is concerned.
4. If you have a habit to study in groups.
5. If you have done your medical degree 5-7 years back then I would strongly recommend to do one of the courses.
During the Exam:
1. some people just want to passs the exam because they already have an offer for residency for them, never give up during the exam until the last question. Do every question with full attention and concentration and never think that you are gonna fail. Always go to the exam with an open mind and positive attitude that you will pass it. For people who don’t have any offers and they are doing USMLE for their bettter future , i would advise not to take it unless you are sure of good scores. Even during exam if you think sincerely that you are not gonna make it or you will barely pass it, I would advise to fail it. because you know once you pass it you are stuck for seven years with that passing scores. AIM IS TO GET A HIGH SCORE.
2. During the exam, if you think that you are doing every 3-4 question correct for sure then it is pretty normal. Nobody knows all the questions for sure, it is always a game of chance and intelligent guessing. If you do not know an answer just mark an answer and keep going. Do not stuck at any stage. Normal probability is that you will correct every 3-4 question for sure. Think Positive.
3. During lunch time, do not eat too much, other wise you will feel dizzy and sleepy in the next session. Just take some light food and coffee. If you feel sleepy, just go out to bathroom and wash your face with cold water and come back fresh again.

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3. USMLE & ECFMG Rules in General
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