How should I get started on my USMLE journey?

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 15^th 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 3^rd and 4^th 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 -