Introduction to USMLE

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So You Want To Do Residency in the USA

Hi everyone! This is my first post and I am excited to join the Learning Surgery Online family! I am a final year medical student in the UK and I originally hail from Singapore. Being an international student who studied in an American high school and is now in the UK, I have had the privilege of learning in many education systems. I also don’t call one place home, so I started looking into my options for pursuing my specialty training in other countries such as Singapore, Australia and the USA. Fortunately, my British medical degree allows me to practice medicine anywhere except for the States. This led me to start my USMLE journey. If you are new to this or want to know more about the US residency program- continue reading!

What is the USMLE Step exam?

  • 4 part exam consisting of Step 1, Step 2 CK, Step 2 CS and Step 3
  • Step 1 is a preclinical 8 hour MCQ exam usually written after 2 years of medical school.
  • Step 2 CK is a clinical 9 hour MCQ exam usually written after 3-4 years of medical school.
  • Step 2 CS is an OSCE style exam testing clinical skills with patients.
  • Step 3 is an exam you take after you get a residency job in the US.

What is the end result of studying for these exams?

  • After completion of Step 1, 2 CS and 2 CK, you are eligible to apply for a specialty training program in the USA. This is equivalent to core specialty training in the UK after the Foundation program.
  • Anyone who wants to work in the US, including those who graduate from US universities and those who graduate from other countries, takes these exams.
  • All exams need to be completed in a 7 year continuous period AND you need to apply to US residencies in that period. After 7 years, your test scores are no longer valid.

How long does it take to study?

  • All the exams test niche details and medical knowledge that might not be covered in your medical curriculum, especially if you don’t study in the US
  • It took me 11 months to prepare for Step 1 and 3.5 months to prepare for Step 2 CK.
  • The last 2-3 months of both exams were dedicated periods, where I stopped attending clinical placement and solely focused on studying for the exam 12-14 hours a day. You can see how this would be difficult for a working doctor!

What resources do I use?

  • Question banks are excellent and form the basis of all students’ preparations.
  • Flashcards aid students retain thousands of facts at their fingertips.
  • Videos made by doctors aim at the pathophysiology, pharmacology and microbiology knowledge required for the exam

Is it hard?

  • Yes, it is very difficult. I didn’t know more than 30% of the information I needed to know when I first started my preparation. There is a lot of detail that isn’t emphasized on in UK medical schools.
  • However, it is extremely worth it if you know for sure that the US is your calling and if you are motivated enough to fight for what you want.
  • It is also extremely useful for your regular medical school studies and training as it is still medical knowledge at the end of the day! You will know so many more details about different diseases, microbes, pharmacology and physiology!

What are my first steps?

  1. Check that your medical school meets the Educational Commission for Foreign Medical Graduates (ECFMG) certification requirements in their World Directory- most schools in the UK do but check anyways.
  2. Apply for a USMLE/ECFMG Identification number.
  3. Apply for ECFMG certification online using an IWA form on the ECFMG website. The last step of this process will give you Form 186.
  4. Fill out Form 186, and if you are still a medical student, get authorisation from your medical school through this form as well.
  5. Get a notary online (they provide you with an appointment for one) before you submit your Form 186.
  6. Once you get confirmation of your ECFMG status, you can apply for your first exam.
  7. This entire process takes 1-2 months so you could start studying for the exam while doing this, but you cannot book a test date or pay for your exam until you finish this application process.

How much does it cost?     

  • All the exams combined and the resources you use to prepare cost a ton of money.
  • Estimates include 1500 USD for each exam.
  • You also need to travel to the US for Step 2 CS so factor in flight costs.


In addition to the Step exams, what are the other requirements for entry into a US residency program?

  • Letters of recommendation
  • Clinical experience in the US
  • Publications, research
  • Leadership, proven interest in chosen specialty
  • Personal statement

This was a quick summary of the process. Feel free to add any comments or follow my Instagram @bawsestudent where I discuss more about how I studied. I hope to make future blog posts about this so let me know what YOU would like to hear!

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