USMLE- how I crushed it!

Now in order for an International Medical Graduate (IMG) to practice medicine in the US he/she is required to complete a series of examinations and to have his/her medical credentials verified as well by the Educational Commission For Foreign Medical Graduates (ECFMG).
I took some time in making a decision about this matter. I wasn't quite sure whether I would want to practice in the US or go back home. But this is my life now and I started to fall in love with Chicago.

I stumbled into this awesome forum for USMLE takers. It is a place mostly for IMGs where info and tips can be shared, advices can be sought and given and most of all a source of inspiration for many. I have maintained journals all throughout my prep and have met amazing people who helped me tremendously in my quest. I bonded with a bunch of people and are now even friends on FB. Prep4usmle


STEP 1: Basic Sciences


Once I decided on this I sat down and created a time table. I've always been an organizer and this attribute has always been one of my strong points. Since I was working full time, I decided to allot 5 months for this. I then started my research on the best review materials to use. I came up with the following:



Kaplan Step 1 Lecture Notes

First Aid for Step 1

USMLE WORLD Qbank

Webpath for Pathology Slides

BRS Physiology- as supplement

High yield Anatomy- as supplement

Google search and Wikipedia for queries



My schedule was tight but my spirit was very strong. I considered First Aid (FA) to be the most important material along with UWorld. I studied every chance I got- at work, commuting to work (I started taking the train so I could read), even in the john. But of course, I gave myself some R&R: dinner or movie with hubby on the weekends, watching my favorite TV shows after I finish my assigned chapters that night. It was tough, I have to admit, because I only had 3-4 hours to study on weekdays and 8 hours on the weekends and not to mention the contents of the study: Anatomy, Physiology, Biochemistry, Pathology, Pharmacology, Behavioral Science, etc. , who would find these subjects FUN?! Surprisingly, I was able to meet all my "deadline." I was so ready for the exam. I wasn't aiming for a 99 but I was hoping for at least a 90.


My husband and I planned a trip to Mexico as a reward for my hard work. So I took 3 weeks vacation from work: 2 weeks for intensive review and 1 week for MEXICO. On my second day off (12 days before my exam) I received a devastating news: my grammy had passed. It was one of the saddest moments of my life. My grams practically raised me to be who I am today. There was no way I could miss her funeral. I needed to see her for closure. A decision was made. I left for my home country the next day and moved my exam to another week. We also cancelled our Mexico trip. I was away for a week.


When I came back, my jet lag (which I never got over) got worse. I had to waste 3 more days for my clock to wind back to normal. I was getting very anxious about the exam. But I resumed where I had left off and I think the last week of my review saved my leg.


Exam day came, 8 hours long of staring into the computer screen and trying to dig deep inside my brain for the "BEST" answer. And finally it was over...I went home with a huge feeling of relief yet with a gnawing feeling in my stomach that I could have done better. But what's done is done. Now comes the hard part: waiting 2 weeks for the result.


My score: 224/93



STEP 2 Clinical Knowledge (CK): Clinical Sciences


Studying for this exam proved to be sooooo much more easier than the first. I guess it's because I found the subjects more exciting. I spent 4 months and used the following materials:
Kaplan CK Lecture Notes

USMLE WORLD Qbank

Google search and Wikipedia for queries


Yup. That's it.

I spent most of my time on my laptop, trying to get used to answering MCQs.

I thoroughly enjoyed studying for CK. Thankfully, nothing major happened during my prep: no deaths, no work issues, no family conflicts. It was smooth sailing until the day of the exam. I started a journal at this point which helped me stay focused and grounded. A lot of people came to visit and boosted my confidence and made me feel that I was not alone in this journey.


Just as I expected, the exam was very vague. I felt more uncertain of my answers compared to when I was sitting for step 1. All of the choices were correct, I had to choose the BEST answer for that specific scenario. I had to hustle as I only had 60 minutes to answer 46 items most of which are 7-10 lines long. And there were also sequential item sets and matching sets.


After 8 grueling hours, it was over. It was a bitter sweet moment for me. I knew for sure I was going to pass, but as to my score? I had no idea. Another 2 weeks of agonizing uncertainty.


My score: 258/99



STEP 2 Clinical Skills


This exam was......different. Its goal is to prove that future US MDs can speak English, have good interpersonal skills and have a stern clinical eye for subtle cues. And who do we test these skills on? Actors as standardized patients (SP).

In the beginning of my prep I was very unmotivated, even unwilling to waste 2 months of my life to practice on these skills. But it is a requirement and I needed to do what I needed to do. So I complied.

 

Materials I used:

First Aid For Step 2 CS

USMLE WORLD

Skype

My husband






The cornerstone of my preparation was PRACTICE. I practiced with as many people as I could. I used Skype since most of my partners were from out of town. I also had a live practice with a partner. We practiced twice and we did all the components of the exam: the patient encounter and writing the patient note. We also timed ourselves since we are only given 15 min for the patient encounter and 10 min to write the patient note. In creating your patient note you have the option to type or write. I have the worst handwriting ever so I decided to type which actually proved to be my best option and this decision helped me garner a star (*) on my patient note evaluation.

For most of my physical exam (PE), I practiced on my poor hubby who had no choice but to comply. I didn't do an extensive practice on my PE as this was the least of my concern. The key is to do a "focused" PE. Which means just focus on the system of concern. No need to do a complete PE which is impossible in 15 min since you will be spending most of your time taking the history. And mind you, some of the SPs can be difficult....



The day before my exam I noticed that the rubber on the right ear piece of my stethoscope was torn! I didn't have time to buy a new one.




My good friend Deb came to the rescue. She lent me hers. Thanks Deb!


Exam day came. It was one of the longest day of my life and all throughout the encounters I had a throbbing headache! They did provide breaks and lunch/dinner. Now if you are very picky with food I suggest that you bring your own. If you get my meaning ;)....


We had 12 cases. Thankfully, I was able to finish the encounters with 2-3 min to spare except on 2 cases which were very vague. I heard the end of the encounter announcement as I was about to explain the diagnostic tests but tried to make up on my patient note.


The SPs were very good. They played their roles quite well. I even had one who was empathetic enough to give me more details than I expected an SP to give away without me prying them out of her. Some SPs were uncooperative so it would be up to you to say the right words in coaxing him/her to give you their attention. It can be very tricky. Very tricky indeed...


Finally it was over. I was soooo happy to be done! Did I pass? I hoped so. I did all the things I needed to do: I filled out the differential diagnoses and work-up; I was courteous, reassuring, empathetic, confident and brief on my PE; I asked all relevant and useful questions; etc, etc, etc. So now comes the hard part again. And this time I did not wait for 2 weeks but 12! But to be honest, there were days when I even forgot I still haven't gotten my result. I was preoccupied with other things that came along during the 12-week waiting period. It's either a pass or a fail. No scores, no grades.


My result: PASS with all components on Higher Performance Level.



I finally got my ECFMG Certificate.

I'm done! But not quite....There is still the matter of Step 3 which I did start to study but decided recently to not take it until I find out if I matched or not. Some people take it during their residency which is tempting but I do want this exam out of the way so I may take it sometime in May. I only need a pass. That's it.

In retrospect, I realized that my USMLE journey was not an obstacle along the path of attaining my goal. But it was the first and a very important step in molding me into the best physician that I can be. Knowledge and skills are very important but good values and attitude are very essential as well. This journey was a form of self-discovery. I met a lot of good people along the way. And realized what the things that I truly value in life are.