I will divide this section into 3 parts:
a) As a doctor
b) As a clinical student
c) As a pre-clinical student
As a doctor
It is never too late to start preparing for the USMLE. I
know of a couple of my seniors who only started preparing for the USMLE only after
graduation. The few of my seniors in
the U.S. are now doing their subspecialty (fellowship) training in the U.S.,
while most of their peers are still waiting to get into Masters program, and
some just completed MRCP and have years before they can enter a subspecialty
training.
It is important to
know that in the U.S., subspecialty (fellowship) training is immediately after
your specialist (residency) training. There is no such thing as gazettement or
bond right after residency. The hardest part is just to get in. Once you are in, it is almost smooth sailing for you up till your subspecialty or superspecialty. Even if you wish to work in a private setting right
after residency, it’s up to you.
While I was in the U.S. interviewing, I also met many who have worked in their home country for 3-7 years, before finally deciding to come to the U.S. Some already completed their specialist back home, but decided to head to the U.S. to set up a life in the U.S. - almost like how some of our consultants will migrate to work in Australia/UK. In the U.S., regardless of how senior you are, you still have to undergo residency training again. I remembered one of the applicants which I interviewed with was a 52 year old gastroenterologist from South Korea.
How should you begin your preparation? There are two
options. You can either sit for the USMLE Step 2 CK first, or the Step 1 first.
If you are fresh out of clinical school, I would suggest that you sit for the
Step 2 CK first because your clinical knowledge is still fresh in your mind. If
it has already been a while since medical school, I would suggest that you
study for the Step 1 first, and immediately follow that up with the Step 2 CK.
Once you complete Step 1 and Step 2 CK, you should head to
the U.S. for the Step 2 CS. Upon completion of this 3 exams, you are then ECFMG
certified and may apply for the upcoming “residency match” in September.
How fast/slow you should study depends on when do you want
to apply. Application opens in September 15th every year, and you
should have all your exams done before that date. The interview season runs
from November to January. Results will be out on the middle of March, and you
will begin your residency training in June-July.
As a third-fifth
(clinical) year medical student
If you are a final year medical student, I would suggest
that you study and sit for the Step 2 CK first because your knowledge of the
clinical disciplines are still fresh in your mind. I sat for my CK while I was
in my pediatrics rotation as a final year student. My final year pediatrics
rotation is one of the more “relaxing” rotations in my medical school. However,
I did start my preparation for the Step 2 CK for about 4-5 months before that.
Immediately upon completion of your Step 2 CK, you should
start preparing for the Step 1, and you can sit for this exam after graduation,
when you feel ready.
If you are a third/forth year medical student, I have no
recommendations as to whether you should sit for the Step 1 or Step 2 CK first.
This really depends on how intense your clinical years is in your medical
school, and whether are you willing to give up time learning in the hospital
and just studying at home for the USMLE. I know of one who did his Step 1 while
he was a forth year medical student, and scored 256 for Step 1. However, I also
know of one who did poorly in the Step 1 when she did her Step 1 as a forth
year student. If you have a period of a long break during your 3rd
and 4th year, you may consider to use that break to sit for the Step
1. Of course, you need to start your Step 1 preparation way before that break.
The reason I emphasize on using holidays to sit for Step 1 is because you can
afford to give in 8 hours of preparation time during holidays as a final push
before sitting for the Step 1. Unlike the Step 2 CK, the final phase of
preparation for the Step 1 is more intense. Immediately upon completion of your
Step 1, you should start preparing for Step 2 CK, with the aim of sitting for
it in your final year.
Optional : If you have yet to schedule your electives, I
would suggest that you consider going to the U.S. for one-two months
of electives. This way, you can obtain letters of recommendation from doctors
in the U.S., which will really help you get a training position at one of the
top hospitals in the U.S. Furthermore, you can make use of this trip to sit for
the Step 2 CS. Don’t worry if you have not taken Step 1 or 2 CK, because the
Step 2 CS is really easy. You only need about 2 weeks of preparation for it.
As a first/second year
(pre-clinical or basic sciences) medical student
You should start preparing for the Step 1 as early as you
can, and aim to sit for the Step 1 during a major break - right after you
complete your basic sciences, or during a major holiday in an early phase of
your clinical years.
The best time is to sit for it is right after your final
exam for your basic sciences, and before transitioning into your clinical
years. This is because you don’t want your clinical rotations to distract you
from studying biochemistry or pathology. However, you should also make sure
that you have a period of at least 3-4 weeks right before the exam date where
you can give 80%-100% of your time and energy to focus on the question banks.
Otherwise, it is also a good idea to sit for it during a major break while in
the early phase of your clinical years.
During your clinical years, you should consider going to the
U.S. for an elective. You can utilize this period to sit for the Step 2
Clinical Skills (CS), and also get letters of recommendation from U.S. doctors.
If you choose not to go to the U.S. for electives, you can sit for your Step 2
CS later, perhaps right after your graduation.
As for the Step 2 CK, you can sit for it either
during your final year as a clinical student, or right after your graduation.
Be sure to prepare for this throughout your clinical years, alongside your
clinical rotations.
- Jamie -
