Strategies for the USMLE Step 1

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Strategies for the USMLE Step 1

• Experiences of a Sydney Uni Student

Trylon M Tsang 10 Aug 2006
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Prologue

• Who am I? Who are you?
• Thanks to NAMSA
• Special thanks to
• Jody Tversky and
• Stephen Thompson
• Support NAMSA

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What is the USMLE?

• The United States Medical Licensing Examinations
  are a series of exams one takes to become a
  licensed physician in the United States

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What is the USMLE?

• Step 1 (Basic Sciences)
• Basic mechanisms and principals
• 350 q / 7 blocks, 8 h
• Step 2 Clinical Knowledge
• Diagnosis and pathogenesis
• 400 q / 8 blocks, 9 h
• Step 2 Clinical Skills
• Step 3 (Clinical Management)
• - 500 q 10 blocks 2 d, 16 h

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What is the MCCEE?

• Canadian exam
• - MCCEE (Medical Council of Canada Evaluating
  Exam)
• Must be written before a J1A visa
• can be obtained for a
• residency in the US
• www.img-canada.ca/en/licensure_overview/mccee.htm
  l
• www.mcc.ca

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The Scoop

• Who? 2nd year student or greater
• What?
• - assesses whether you understand and can apply
  important concepts of the sciences basic to the
  practice of medicine, with special emphasis on
  principles and mechanisms underlying health,
  disease, and modes of therapy. Step 1 ensures
  mastery of not only the sciences that provide a
  foundation for the safe and competent practice of
  medicine in the present, but also the scientific
  principles required for maintenance of competence
  through lifelong learning.
• -Translation a lot of work for you
• See http//www.usmle.org/step1/intro.htm

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The Scoop

• When?
• Step 1 after 2nd Year
• Step 2 before residency
• Step 3 during residency
• For us? When you are ready.
• Refer to other presentations

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The Scoop

• When cont.
• Time limit
• Effective June 14, 2004, applicants must pass
  Step 1, Step 2 CK, and Step 2 CS within a seven
  year period for ECFMG Certification this new
  seven year requirement applies to applicant whose
  earliest USMLE passing performance that is valid
  for ECFMG Certification took place on or after
  June 14, 2004, as described below. see
  www.ecfmg.org

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The Scoop

• ECFMG registration due at end of month before
  eligibility period
• e.g. Rego for April 1, 2006 - June 30, 2006
• Is due February 28, 2006
• Change once without fees charged.
•  Prometric Centre in Sydney only has availability
  3 months in advance.
• Where?
• -Sydney or Melbourne
• -www.prometric.com

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The Scoop

• How?
• www.usmle.org www.ecfmg.org
• Why?
• - Need ECFMG certification to apply for
  residency in the US
• - Need it for an application for a fellowship
• - If you can get through all the paperwork,
  then you can succeed 
• Where do you plan to live?
• How Much? 695 US

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Lets get started

•  1 day computer based test (CBT) with 7 blocks of
  50 questions
• 15 minute tutorial
• 7 hours 60-minute question blocks
• -1 question per 72 seconds
• 45 minutes of break time
•  Break time cummulative
• cannot go back to do previous sections
• cannot leave during a section

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Content

• http//www.usmle.org/step1/intro.htm
• topics by system
• -see above link
• topics by subject
• Anatomy
• Biochemistry
• Cell and molecular biology, genetics, metabolism
  and nutrition
• Behavioural Sciences
• Psychiatry, biostatistics
• Microbiology/Virology/Immunology
• Pathology
• Pharmacology
• Physiology

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Step 1 Scoring

• What do the scores mean?
• Step 1 scoring
• May 2006 For my exam
• Mean 216 SD 24
• Scores 140-260
• Pass 182
• SEM 6 points

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Scoring Scale
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Performance Profile

• (removed for privacy reasons sample can be
  found online and in First Aid for the USMLE Step
  1)

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Step 1 Scoring

• Importance ( connections gt
• reference letters gt research
• gt CV ) Step 1 score
• Do not get obsessed with score
• unless you are aiming for a
• competitive specialty

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What is competitive?

•  Competitiveness is a combination of
• training positions available (need),
• lifestyle, money, interest
• Fluctuates over time
• Important to choose what you enjoy
• Programs competitiveness is
• different from specialty
• competitiveness

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What is competitive?

• Dermatology, Radiation Oncology, PRS,
• Ophthalmology,Urology, ENT, Orthopaedic
• surgery, Radiology, Neurosurgery,
• Anaesthesiology, Emergency Medicine, General
• Surgery
• Physical Med and Rehabilitation, Obstetrics and
• Gynaecology
• Neurology, Pathology
• Internal Medicine, Psychiatry, Family Medicine,
• Paediatrics
• Note Subspecialties in Internal Medicine are
• competitive!

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How do I know what I want to do?

• Read The Ultimate Guide to
• Choosing a Medical Specialty
• Brian Freedman ISBN 0-07-141052-X
• Isersons Getting Into a Residency A
• Guide for Medical Students
• Kenneth V. Iserson
• ISBN 1-883620- 30-9

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What does Dr. Cox think?

• Dr.Cox I became a doctor for the same four
• reasons that everybody does chicks,
• money, power, and chicks

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Preparing for Step 1 at USyd

• Main difficulty
• - USydMP program versus US
• curriculum
• - Must learn 2 curriculums
• concurrently
• Style of assessment differs
•  Important thing to remember- pass
• the Barrier!
• Become a knowledgeable (good not just
• nice) doctor!

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Preparing for Step 1 at USyd

• over prepare for PBL so it is a review
• session
• course is based on PBL and a relatively
• small number of diseases in the first 2 yrs
• know your physiology solid good
• foundation for the course (and med for life)
• as a student, you have the most time to
• read everything dont buy the youll learn
• it later excuse

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Preparing for Step 1 at USyd

• converse of that -gt dont try to memorize
• everything but be aware of its existence
• you can only find something if you know what to
• look for
• recalling something is much easier than learning
• something for the first time
• this is against the philosophy of the course
  that
• you can look it up when you need to
• learning is different you may not be able to
• recall or spontaneously produce information but
• you can recognize it when it comes up

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Preparing for Step 1 at USyd

• MOST IMPORTANT
• Buy First Aid for the USMLE Step
• 1 and actually read it !!!!!!
• Hindsight is 20/20

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What curriculum?

•  Order of Importance
• For USMLE Step I (in order of importance)
  Pathology Pharmacology Physiology
  Microbiology/Virology/ Immunology
• Biochemistry/Molecular Biology Neuroscience
  Behavioral Science Anatomy

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Pathology

• Pathology
• -breadth of diseases
• -know common themes

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Pathology

• A 15 mo y.o. girl is brought to ER by parents,
  1/52 wk hx
• of malaise, poor feeding, mild fever and
  diarrhoea. PE
• unremarkable. 6th visit to GP. PMHx repeated
  infections
• Candida, CMV, MAC. CBC (FBC) remarkable for low
• lymphocyte count. Ig levels normal. Lymph node
  biopsy-
• Paracortical cell depletion otherwise normal.
  What is the most
• likely diagnosis?
• Bruton congenital agammaglobulinemia
• Chronic granulomatous disease of childhood
• Severe combined immunodeficiency
• Thymic hypoplasia
• Wiskott-Aldrich syndrome

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Pharmacology

• you dont learn much in the course
• exposure
• classes of drugs
• repetition
• learn mechanism

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Pharmacology

• A 32 y.o man has been taking a medication for a
• fungal infection on his arm. He develops
• gynecomastia. Which is the most likely medication
  
• he is on?
• amphotercin B
• caspofungin
• fluconazole
• ketoconazole
• flucytosine

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Physiology

• no excuse not to know this well
• course over-emphasizes some stuff
• (I.e 5 lectures on RAAS !)
• weak on reproductive medicine
• lacks formula
• fortunately not a big part of USMLE
• but easy marks if one knows how to
• do the calculations

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 Microbiology/Virology/Immunology

• easy subject once basics understood
• brute memorization
• integrate with path and pharm
• if you are from a non-science
• background learn your cell biology!
• fungi and viruses poorly taught in
• course

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Microbiology/Virology/Immunology

• A 50 year old man returns from a vacation to the
  beach. While
• on vacation, his family had a diet consisting
  mainly of seafood
• including lobsters and raw oysters. Although
  other members
• of the family did not get sick, he developed a
  bullous rash in
• the lower extremities, hypotension and confusion.
  His PMHx is
• significant for liver disease and alcoholism. The
  most likely
• cause of this mans signs and symptoms is
• Aspergillus fumigatus
• Campylobacter jejuni
• Candida albicans
• Streptococcus (Group A)
• Vibrio vulnificus

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 Biochemistry/Molecular Biology

• know medically relevant biochemistry
• increasing emphasis on molecular
• biology
• difficult because concepts are not
• ones you encounter regularly
• genetics
• mode of inheritance, implications with diseases
• complicated concepts like crossover low yield

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 Neurosciences

• course teaches neuroanatomy well
• work hard during this block
• do not miss forest for the trees
• know clinical material who cares
• about the precise mechanism of
• Parkinsons
• yes you do need to know the Circle of
• Willis

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 Anatomy

• Anatomy
• know enough to impress your future
• patients
• know the clinically relevant anatomy
• learn it gradually but it isnt essential
• to passing
• embryology easier than you think
• but worth the time?
• if you are interested in surgery or
• radiology or other know it well

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 Neurosciences

• course teaches neuroanatomy well
• work hard during this block
• do not miss forest for the trees
• know clinical material who cares
• about the precise mechanism of
• Parkinsons
• yes you do need to know the Circle of
• Willis

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 Resources

• Board Review Series (BRS) versus High Yield (HY)
• BRS Pathology
• BRS Physiology
• BRS or HY Behavioural Sciences
• Lippincotts Pharmacology
• Clinical Microbiology Made Ridiculously Simple
• Lange Katzung and Trevors Pharmacology
• (too dry)
• Lippincotts Biochemistry (Im a nerd so I
  bought
• this)

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 Resources

• Kaplan Q-Bank
• HY Neuroanatomy
• BRS Neuroanatomy (not useful)
• HY Immunology
• HY Molecular Biology (nigh useless)
• HY Histology (good)

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 Resources

• Robbins Review of Pathology
• Other Series and Books
• -Look at back of First Aid
• -Rapid Review
• -Board Simulator Series
• -Kaplan Course
• -Underground Clinical Vignettes
• -Goljan notes
• -Pathophysiology for the Boards and Wards
• -Wheaters Functional Histology

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 How to study?

• Know yourself
• Plan of attack
• Study schedule
• Goal
• Study group?
• Do questions, questions and more
• questions

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 What happens after Step 1?

• take a break
• prepare for Step 2
• personally, burnt out
• others as well?

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 Conclusion

• Work hard!
• Stay motivated!
• Good luck!

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• Questions?