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Discussion Starter · #1 · (Edited)
Hello everyone!

I have never written big posts about my exam experience, but I think the time has come to do that.

I want to share my USMLE road up to the match season with those who are just in the beginning. However, before March I can’t say that my experience was really successful.

Background – I’m IMG from eastern Europe, no US visa or green card, 3 years after graduation, home residency in peds. Step 1 - 240< (in 9 months), Step 2 - 245<, CS – first (CK+CS in 7 months), Step 3 – 230< (in 2 months). In short – typical average applicant of the 2016 Match season (hard to admit, but scores are really average for this particular season).


I think that before you even open book for USMLE steps you should clearly understand what you want as a result of your efforts. Try to understand that whole road will take:
1) Huge amount of time
2) Around 7 000 – 10 000 $ (fortunately during 1,5-2 years)
3) Readjustment to different culture, and desire to leave your home country for at least 3 years of training
4) Most likely it will be nearly impossible to work or study full time during these years
5) You can’t afford fails (even one failed exam can kick you out of the road easily)
6) Strong supportive system (family, friends or whatever…)

The main message I’m trying to deliver in this paragraph – if you know for example that you want to build your own private family practice on the south of USA it will make your life much easier because you will know what you are suffering for. Moreover, it will help you to plan you study time and scores and you will avoid that disappointment of getting USMLE step 1 score of 200 while you want to be a neurosurgeon… Yes, that is not easy but the sooner you understand who you want to be in this life the better.


Believe me – this is the hardest part of USMLE road for several reasons:
1) You don’t know the exam system really well, which means it’s easy for other people to fool you that without certain resources it’s impossible to that.
2) You are overwhelmed that you need to put everything you learned couple years ago about basic sciences into your head again. Sometimes, dependent on your med. school, you will learn stuff that you have never heard before.
3) The exam is really hard like hell.
4) You still don’t believe that you can to that.

Now, considering everything said above, I’ll try to give you couple advices which I’d give to myself had I the time machine…
1) It doesn’t matter how much time you spend studying and what resources you use. That’s true IF you know HOW to study and use really GOOD resources. The main message here is – that doesn’t matter how much time John with triple 260s spent during his preparation, and how many times he did UWorld…
2) You need to develop your own system that suits you really well. For example, if you are lazy like me – find a serious study partner who will keep you going. If you feel sick with reading thick books – concentrate on tests. If you experience hard time retaining the information in your head – make a handwritten notes and take them with you everywhere – you can read it in the public transportation, during boring meeting etc. – the main thing is that while doing notes you readjust information in the form that is much easier for your brain to retain (worked for me). So message is – be honest, you know which methods work for you well, be creative. You know very tiny background information about people posting their “success” experience and their methods – could not work for you. There is NO universal approach.
3) If you have real problems with money (I know – majority of people from developed countries will never understand me), don’t be shamed to use torrents for what you need for your success. Believe me if you use 2 years old material you still will be able to pass at the same score. Of course if you have money it’s easier (the main reason) to use paid online resources. The things I spent money for during my preparation – UWorld one month for all steps, FA for step 1, MTB 2 and 3. If you try to go my way – you should extract all the information from UW in form of notes in one month which is really hard and takes a lost of time.
4) Live your life. It’s better to keep doing something except exam on part time basis. Meet you friends, have days without preparation, have a fun. However, at some point you will find that you have nothing to talk about with your non medical friends except your exam (which is boring) … In reality you don’t need more than 5 days/week and more than 4-8 hours/daily of studying. Brain needs time to process the information… I found myself more effective doing it this way, however – everybody is different.
5) And couple my answers to anticipated questions (again it worked for me which doesn’t mean it’ll work for you).
5.1) Start with lectures. Pathoma is really good and covers a huge part of the exam. Make sure you made notes of everything you didn’t know. The second/third time I’d repeat Pathoma before exam.
5.2) FA – your main tool. The point is that the book lacks of explanations but is very informative. This means that you need to clear everything what confuses you (no point in memorization without understanding – too much info). Use Kaplan and Pathoma or google to clear things (sometimes you will get controversial results – in this case just use your brain)
5.3) UW is the best qbank, you don’t need others. But do it in time and mixed mode, read every word of explanation but pay attention only to the things you didn’t know or understand (on 1st run it will save you plenty of time), make notes. Then read your notes couple times marking things you feel you’ve mastered and reading just those you still don’t now. Do it until you feel you know your notes inside out. After that do a second run on UW again time/mixed. Should be 95%< if you did everything right. Then again back to notes up to the exam.
5.4) Kaplan is worth doing just selectively - lectures on biochem (2010), and when you feel that you don’t really understand what is written in FA.
5.5) So from my standpoint the best approach is to do Pathoma-Kaplan biochem-FA-UW-notes-FA-UW-notes-Pathoma-notes-exam. But this just in general.
5.6) NBMEs – you will hardly meet same or similar question on the exam. That means – use them just as assessment tool. And remember – you can’t redo the exam. If you use NBMEs offline you should generally do them at least 80% correct to say that you are ready for exam (I think it correlates with score around 230). But again – if you have a goal – study as long as needed to get YOUR score. I wouldn’t recommend to have a goal <230 whatsoever (a lot of good scorers this season), but if you want to go to surgery or you want to be a cardiologist (means you need a good internal medicine program), you need scores 250<…. the higher the better. But scores are NOT everything (I’d say half of your application). I think every participant of this Match will agree with me.
5.7) If you stuck with score and can’t improve it. Successful USMLE taker is able to do TWO things – learn the material AND do the tests. Identify which area is suffering and work on it. That doesn’t mean you need to do 20 000 of tests if you “always pick a wrong answer”. You need to try to solve the tests in different way. I’d recommend to take 4-5 blocks of unfamiliar tests and try to do every block separately with different technique. E.g .1st block – try to read question and answer first and give pick an answer ASAP; 2nd block – read the question from the beginning; 3rd block – try to answer questions just looking at the answers (no kidding); etc…. The point is – try different approaches and work on your weaknesses. The more you do that the more effective you do your work. If problem is in knowledge – try different memorization techniques, meditation, everything that you think might enhance your memorization/processing capabilities. I was crazy, I even tried some medications/vitamins IV… Do whatever works… if you win nobody will be interested how.


Much easier… what a relieve to have a step 1 score. You already know what to do and how to do. You’ve already faced a “real one” – you know that it’s not as tough as people who failed described. Just do your thing and put as much as possible efforts to achieve your desired score. My goal was 265<. Why I scored 245<? The answer is I think - I studied too much. 2 months before exam I felt completely exhausted and needed to take a 2 weeks break which didn’t help much to be honest. So the advice is – know your capabilities.
Couple advices about resources to use:
1) The exam not as much about your knowledge but it’s heavy on your thinking. The problem is that it testes your clinical judgment. Here you will meet much more controversy between different books than in step 1.
2) Pick one book you trust more. Stuck with that book (MTB 2 is okay).
3) UW again is as always enough. Moreover you already know how to use it.
4) Keep learning medical literature except USMLEs… Medscape is very helpful resource. UpToDate is another very good by paid source of medical information.
5) If you can get any clinical experience get it. It helps with preparation tremendously. After you have taken care of 1-2 patients with CHF you will know the disease and its management cold and will not need to memorize everything.
6) This is the best time to find observership (check Cleveland clinic) or hand on externship (if you have money). I used Chicago Clerkships – was very satisfied (they were really helpful because once you paid for their rotation they help you with personal statement and CV preparation for the Match (which I think is a good deal). However, you should do your own research on this topic.
7) Resources I think you need are – MTB-2/MTB-3 – UW-notes-UW-notes-MTB-2/MTB-3-notes-exam. I found it useful to read both books from cover to cover.


Have you ever been to theatre? You just need to know your role. This part of USMLEs is easiest if you prepared to it (don’t underestimate). My advices are:
1) Practice as much as possible via skype and if needed - in person. Try to use standard phrases – nobody expects you to speak as Shakespeare. The cases from FA (big ones) are enough. Just do them all with partner at least 4-5 times each. Important is to find partner who can give you as negative feedback as possible so that you will know what to work with.
2) On real exam nobody really cares of how many points of heart/lung auscultation you used or whether you washed your hand or used gloves. The point is to earn points for some actions. The point is to appear confident and professional. From my personal feeling it was much more important to express worrying about patient symptoms and address them during closure than everything else. Just make them to feel human inside you and try to earn their trust – you will pass.
3) Patient notes – very important to write them quickly and use copy/paste as much as possible to save some time. Again the practice is a key, no point to stress tiny details. Examples from FA are more than enough.
4) The exam is like an answer to the question – “do you look and write as a doctor or not?” So behave like one!
5) Remember you need just pass. 1-1,5 months of dedicated preparation are more than enough for IMG (I say it as IMG from the country where nobody including medical school speaks English).


After your experience with other steps (say you passed them less than a year ago), you are USMLE master and can pass this exam easily. Advices:
1) If you received your ECFMG certificate yesterday – your exam should be scheduled in a month or two.
2) The only thing you should add to your step 1/ck/cs knowledge is CCS cases. UW CCS are more than enough – do them twice.
3) Do UW Qbank once to understand what topics are stressed more in this particular exam (a little different from CK). Then I would repeat CK notes and boom – you’re ready.
4) But if your other steps scores are suck – you probably should spend 3-4 months of dedicated preparation.

I hope that my thoughts about USMLEs will be helpful for somebody. Feel free to ask any questions...

Wish everyone who is on this road the best of luck, believe me you need it!!!:happy:
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