An increasing number of young Indian doctors are looking to emigrate to the USA either for improved career opportunities, developing better skills as a clinician, or for better income.In the Sunday series today we bring to you a popular article from the arcives  where a  young doctor  who pursued his his externship in the USA takes readers through the details of USMLE and the steps involved.

The United States Medical Licensing Exam (USMLE) is one of the world’s most commonly opted exam and the only way to enter the United States and eventually be a part of the American Medical fraternity. The major steps are outlined below:

• ECFMG certification
• USMLE Step 1 
• USMLE Step 2 CS & CK
• USMLE Step 3
• Medical Residency Match
• Interview Applications

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ECFMG (Educational Commission for Foreign Medical Graduates)

The ECFMG certification is a mandatory step in starting the process for all the below-mentioned examinations. After you are certified, you can schedule and appear for all the “Steps”. There are three examinations which comprise the USMLE. 

Step 1

The USMLE Step 1 can be grouped into 18 primary areas; comprising of foundation subjects and principles across organ systems. These are as follows:

• Standard Topics:
  • Anatomy
  • Biochemistry
  • Physiology
  • Pathology
  • Pharmacology
  • Microbiology
  • Biostatistics and Epidemiology
• Interdisciplinary Topics:
  • Behavioural Sciences
  • Genetics
  • Ageing
  • Nutrition
  • Molecular and cell biology

 

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Pointers to keep in mind for Step 1:

1. The allowed time period to give the exam is:

• During Medical School
• After securing the (Bachelor of Medicine and Surgery) MBBS degree

2. This exam can be only taken once in seven years and 194 is the minimum passing score. Therefore, if you are unsatisfied with your score even if it is >194, you cannot retake the exam for that time-period.
3. However, if you fail (score <194), then re-examination is possible. In such a case, you can only make a maximum of three attempts in 12 months and, can retake Step 1 six times in total.
4. The USMLE step 1 costs around $610.
5. The Step 1 exam comprises of seven 60-minute blocks of around 40 multiple choice questions with a total time-period of 8 hours.
6. The scores are declared after 3-4 weeks of the examination.

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Step 2: Clinical Skills (CS)

1. This exam is also a time-sensitive 8-hour exam with 12 patient encounters.
2. Students are scored under 3 separate subcomponents:

• Communication skills
• Integrated clinical encounter
• Spoken English proficiency

3. The students have to take relevant clinical history, perform a physical examination, and analyze the data. Step 2 has 12 patients in total and the schedule is:

• 15 minutes for each patient
• 10 minutes to write patient notes
• 10-minute break after the 3rd patient encounter
• 30-minute break with light lunch after the 6th patient encounter
• 10-minute break after the 9th patient encounter

4. Students must travel to one of the six testing centres:

• Chicago
• Houston
• Philadelphia (2)
• Los Angeles
• Atlanta

5. The application fee of the exam is $1565.

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Step 2: Clinical Knowledge (CK)

1. Step 2 CK comprises of 18 subjects:

• General principles
• Immune system
• Blood and lymphoreticular system
• Musculoskeletal system
• Cardiovascular system
• Respiratory system
• Male reproductive system
• Pregnancy, childbirth, and puerperium
• Gastrointestinal system
• Renal and urinary system
• Skin and subcutaneous tissue
• Nervous system
• Behavioural health
• Biostatistics
• Endocrine system
• Female reproductive system and breast

2. The exam is again divided into eight 60-minute testing blocks and is administered in 9 hours.
3. The test comprises of 318 MCQs and the number in each block will not exceed 40 items.
4. The test describes clinical situations and requires one to answer:

• Prognosis
• Diagnosis
• Mechanism of disease
• Next step in medical care

5. The minimum passing score is 209.
6. The application fee of the exam is $910.

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Step 3

1. It is a 2-day test and is basically taken after the first year of residency or after having given the other steps provided you are eligible.
2. The test includes computer-based patient simulation and multiple choice questions.
3. The two parts of the test are:

• Foundations of Independent Practice (FIP)
  • Taken on the first day
  • Comprises of 235 MCQs
  • Divided into six 60-minute blocks, each with 40 questions
  • The time allotted for the entire test is 7 hours
• Advanced Clinical Medicine (ACM)
  • Taken on the second day
  • Includes 180 MCQs
  • Divided into six 45-minute blocks, each with 30 questions
  • This is followed by 13 patient simulations (similar to Step 2 CS), each of which is allotted a maximum of 20 minutes

4. The qualifying mark for Step 3 is 196.

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ERAS (Electronic Residency Application Service)

1. An online pre-described form is filled, asking your step scores, letters of recommendation, choice of program, program directors.
2. After this, interviews are scheduled with the institutes which pick you based on your overall performance.
3. The institutes can also be shortlisted at your end based on the criteria suiting you as mentioned in the form.
4. The application process is open the entire year and ends in the first week of September.

Interviews

1. The interview calls happen between September of the match cycle and March, which has the match day.
2. After interviews, you will be expected to rank the interviews you attended base don preference, from most desired to least desired.
3. Similarly, programs will send out a ranking list of candidates they interviewed.
4. Match day is the day where you (the candidate) are matched to your preferred speciality. This is done using a computer algorithm that matches the highest ranking program on your list to the one that offers the position.
5. Programs that Indian medical graduates match easily with are:

• Pathology
• Internal Medicine
• Neurology
• Family Medicine
• General Surgery

4. The next 2-3 months require you to complete any visa formalities and most residencies begin in June.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The article was originally published on 14.12.18