FAQ#12: After housemanship

I received an email from a house officer who is about to complete his housemanship:

"I am a houseman now who is about to finish  housemanship in 4 months time, so I m thinking all this while about my future, where and who I want to be.

Mrcpch and usmle are my choice of option now.

In your opinion, how many years do I need before I pass all the exam and start my residency in the US?

And which pathway could be faster to become a specialist?

Do I need to complete all 3steps before I start applying for residency?"


1) How many years do I need before I pass my exams?
I would estimate about 1 year of part time studying.

2) Do I need to complete all 3 steps before I start applying for residency?
You will need to complete Step 1, Step 2 CK, and Step 2 CS.

3) Which is the fastest pathway to become a specialist?
I am assuming you would like to be a pediatrician, given your interest in MRCPCH.  Following the Malaysian path, I assume that you may take about 2 years to complete your MRCPCH.  You will then proceed to gazette for 1.5 years, and you will be a General Pediatrician.  So as a final year HO, you are looking into about 4 years before becoming a General Pediatrician. 

If you were to take the U.S. path, you will take about 1 year plus to complete USMLE, and about 6 months in the whole application process.  That would be about 1.5 years before starting Pediatric Residency.  You will then enter into a 3 year Pediatric Residency program, where you will rotate through all the core specialties in Pediatric from neonatology to pediatric outpatient clinic.  After that, you will become a General Pediatrician.  This means about 4.5 years if you take the U.S. path.

Now, the question you need to ask yourself is, do I want to go beyond General Pediatrics?  In Malaysia, how fast do you think you can be a Pediatric Gastroenterologist?  These are questions you may want to ponder.  Perhaps two to three years after working as a General Pediatrician, you apply for a subspecialty training program in University Malaya? You can self sponsor for your MRCPCH, but you cannot do that for a subspecialty training program, which means you most likely need to receive scholarship from the Ministry of Education or the Ministry of Health, for which you will be bonded for another 2-3 years after your subspecialty training.

If you choose the U.S. path, in your second year of residency, which is about 3-4 years from now (for you), you will be given the option to apply for a subspecialty training program, otherwise known as a Fellowship.  Fellowships generally ranges from 2-3 years.  The first day of fellowship training (July 1st) starts on the day after your last day in residency (June 30th), and there is no time gap between residency and fellowship training.  Immediately after fellowship training, there is no bond or contract, and you can choose to work in whichever academic or private facility as you would like.

I would recommend that you think of what is your end goal.  Do not limit yourself to your surroundings and know that, everything is possible if you have the determination.

FAQ#11: Plans for a final year European medical student

Question for a medical student from overseas:

"I am a final year medical student from Malaysia studying in Europe, and I would like to take the USMLE exam, therefore, I would like to seek your opinion, should I take the Step2 CK first since you mentioned in your blogs that the clinical knowledge are still fresh in mind? If so, when and where can I sit for the exam? I have read most of the FAQs written on your blog, that I can take the exam in Kuala Lumpur. As I am still in Europe, is it better for me to take the exam somewhere in Europe, for e.g Germany? 

I am JPA sponsored student, therefore, my initial plan was to go back to Malaysia, work as a houseman and then only seek to specialise after getting experiences from housemanship years, however, like yourself, I am interested in living in the US, and due to the issue of overflow of housemen in our country, do you think that I should just sit for the exam, which I have not planned and studied for it, yet. Therefore, I do not know if my plan to take the USMLE is good for me, Or, I should start my work as a houseman in Malaysia, and study for the USMLE as a part time job?

In your articles, you used US dollar $ in answering questions regarding the exam fees, do you mean RM or it really was in US dollar? I'm asking because for me the fees are expensive. :( 

When should I register myself to sit for the USMLE exam? If I register in May, I can take the exam in September in Kuala Lumpur for example? My graduation day will be in June, I will be staying in Europe in July, and most probably head home in early August, and then I can sit for the exam in September in Kuala Lumpur? where can I get the details of the location? 

I know you mentioned the website ECFMG for registration, get a USMLE ID, and then what's next? I have to make the payment online?

I apologise for all these questions, or rather my expression of confusions in taking the USMLE exams. I hope you can help me to make them clear and guide my visions in taking the USMLE examinations."

Dear Europe Med Student,

I will try to answer your questions one by one.

1) Should I take the Step 2 CK first?

Since you are a final year medical student, I see that it would be more advantageous for you to go for the Step 2 CK first.

2) Is it better for me to take the exam in Europe?

The location for where you take the exam doesn't really matter.  Just choose the exam location based on your convenience.

3) Cost of exam fees?

The exam fees change from time to time, but would cost around USD$800 to 900.  Yes, it is expensive if you convert it to Malaysian ringgit.  When I paid for my Step 1, I used the cost of it to motivate me to study harder and put in longer number of hours.  I am glad that I took it, as now that I am an internal medicine resident here in the U.S., earning salary in USD, and getting awesome training here, I was glad that I didn't let the cost of the exam deter me from taking it.  What you are worried about is that if you did poorly in the exam, you would have wasted all your money.  Let me tell you this, regardless of how well you do in the exam, you will have gained precious medical knowledge and have cultivated in yourself the hardworking spirit as you brace through the preparation process for this exam.

4) When should I register for my exam?

Ideally, you should register about 3-4 months prior to the date you plan to take it.

5) Should I start housemanship and study for the USMLE as a part time job?

That is definitely possible, but you will have to allocated more months in the preparation process.  Instead of 3-4 months full time, you may want to study it for 6-7 months part time.  This means the preparation process starts today.

6) Where is the location of the test center?

It is in K.L.

7) What's the step after getting the USMLE I.D.?

You will have to make the payment for the exam.  Once the payment goes through, your medical school will be sent a letter for them to prove that you are their medical student.  Once all is done, you will be allowed to schedule your exam.