The ideal USMLE step 1 Strategy

Preparation time

6-9 months (if you are not doing anything else)

Material

USMLE world, Kaplan, first aid, Goljan Rapid review, High yield neuroanatomy, 100 cases of Fischer for ethics.

Pre USMLE world

I prefer preparation to be divided into pre U World and post U world phase. The pre U world phase is important for students who weren’t in touch with books for a very long time, but this phase rarely has similarities to real exams but you need to do this phase to clear your basic concepts for understanding UWorld.
It includes watching Kaplan videos and reading kaplan lecture at the same time every day except for pathology. For pathology, you need Goljan Rapid review book, Goljan Audios, Goljan subtitles and Goljan slides. I started with pathology and one more subject together in the beginning, I always used to study pathology everyday along with any other subject as pathology is 70% of the exam. So, it would be Pathology and other subjects turn wise, I ended up finishing all the subjects along with their videos in 3 months. I used to watch videos about a topic and then study the same topic from kaplan books. This made my reading speed higher, without boring long hours of just studying. Try to watch kaplan videos at a higher speed (1.7 X), there is no need to watch kaplan videos more than once except for behavioral science for which, the more you watch, the more you learn.
So, by the end three months you should be finished with one reading of your kaplan books (everything except pathology) once, kaplan videos once, Goljan entire material including Goljan Rapid review book, Goljan Audios, Goljan subtitles and Goljan slides (at least twice). I used High yield neuroanatomy (only because I love neuroanatomy) and 100 cases of Ethics by Conrad fischer for my ethics preparation.

USMLE world  (APP link here)

I took a 2 months subscription for USMLE WORLD, and this is the most important phase of your preparation. This is going to decide your score in real exam. Remember, this is an educational material not for assessment (for assessment you have NBMEs) so, go slow with UWorld. I started with 1 block a day in the beginning. What I used to do was, first do a new block in the morning, then read its explanation (thoroughly and making notes out of it), doing retrospective study of my kaplan material only of those topics that were tested in that block and reading 10-15 pages of First aid every day.
As time goes by, I made one block per day to three blocks in two days and finally to 2 blocks per day. You need to finish your First Aid at least three times during this Uworld questions. I also realized that, later on, the topics started repeating so I didn’t do the kapan retrospective study of the topics which I had done only few days back. I ended up finishing my entire Uworld with explanation, with prepared notes out of it, three times of first aid, my second revision of kaplan material and my third revision of Goljan material in 45 days.
After these 45 days, I gave my first NBME in which I had decent score. I studied the entire UWorld again along with first aid only this time and gave another NBME. I also gave UWSA along with other NBMEs.
In the last week of my preparation, I read my notes that I prepared from UW, first aid and also, I did the orientation material available on official website that helped me a lot during the real exam.

In the end, I just want to advise you to read from a few sources but repeat that again and again. USMLE WORLD is the key for good scores in the real exam. Don’t listen to lots of people, you are only going to get confused. The material I have mentioned is more than enough to get a really good score in USMLE step 1.

Tip: Try to google the images of CT scans, Xray, MRI, ECGs, Pathology slides and various clinical signs that you read from your text, it helps a lot. Try to listen to various heart and lung sounds from youtube, it will help you in a long run as well. You can’t do much about anatomy, embryology and histology. Behavioral science can be fully covered by Uworld (I got a star in it and I didn’t use any other source besides Uworld).
One day before the exam, don’t read anything. Go outside, watch a nice movie and hang out with friends.

Question bank: Only Uworld even if you have time for others.
Assessment exams: NBME 7, 12,15 (you can do as many you can afford)

Six things you can do in college before USMLE step 1 preparation

Also, The best iOS app for USMLE preparation – Dailyrounds.

The ideal USMLE step 2 CK strategy

Preparation time:

4-6 months is all you need for your USMLE step 2 CK. If you read it right after USMLE step 1, it can be done is lesser time. But don’t rush things if you think you are not prepared, the scores are the most important thing for your CV.

Material: Kaplan books, Mater the board two and three by conrad fischer, Usmleworld, USMLE step 1 kaplan to read behavioral science.

Pre USMLE world

I have divided my USMLE step 2 CK preparation into pre UWorld and UWorld time; pre Uworld is the phase when you will be reading everything from books. I started with kaplan books and I totally skipped kaplan videos this time (and I am glad that I skipped them) and finished them in 40 days. There is nothing much in them and I was advised in the beginning from my seniors that for USMLE step 2 CK, the read deal is MTB. So, I started reading both MTB 2 and 3 together topic wise. I gave enough time to them such that after 2 months, I was done with both of them. I read them very thoroughly, I gave a second read to both of them in 20 days. After finishing Kaplan and MTB 2 and 3, I watched USMLE step 1 kaplan Behavioral science videos by Dr. Steven Daugherty from chicago (highly recommended) and I read the USMLE step 1 Kaplan notes for behavioral science as well for my statistics and psychiatry as part of my exam. So, this phase lasted for me for almost 3 months in total. Then I started USMLE world.

USMLE world

This is the most important phase and the deciding factor of your scores the in real exam. Use this time very wisely, remember Uworld is the key for USMLEs. I started with doing 1 block a day in the beginning. What I used to do was, first do a new block in the morning, then reading its explanation (thoroughly and making notes out of it), doing retrospective study of my MTB 2 and 3. As the time goes by, I made one block per day to three blocks in two days and then finally to 2 blocks per day. I almost read the entire MTB 2 and 3 third time along with my entire UWorld, I was done with everything in 45 days and then I started doing UWorld again. I finished my second read of UWorld in 15 days and in the last few days, I just revised my notes that I made from Uworld. Remember this is an educational material, not for assessment (for assessment you have NBMEs and UWSA). So, go slow with UWorld and read the explanations thoroughly.
Tip: Try to google the images of CT scans, Xray, MRI, ECGs and various clinical signs that you read from your text, it helps a lot. Try to listen to various heart and lung sounds from youtube, it will help you in a long run as well.
Don’t forget to read the orientation and practice material available on ECFMG website.

Question bank: Only Uworld, even if you have time for others.
Assessment exams: I only did UWSA for this and I think that is enough.
All the best !

USMLE WORLD: Ideal strategy and don’ts for your USMLE preparation

The ideal USMLE step 2 CS strategy

Material

First aid and lots of practice with your study partner

Preparation time:

1 week to 1 month; it varies a lot. For some people, 1 week is enough and others want to be really sure before giving this exam, they sometimes give even two months for its preparation. Two months are little too much for this exam. In my case, my visa was expiring so I had to give this exam in 9 days and I got high performance in all the three sections of its assessment (Interpersonal skills, english proficiency and clinical skills).

The preparation

I advise you that during the last month of your elective rotation, start reading first aid and try practicing cases on skype with any study partner on weekends of that particular month. By the end of that month, you should be able to complete all the first aid cases (Major ones) and should have practiced all those cases with some skype partner at least once.
After that, when you are done with your elective rotations, then go to Houston (yes, schedule your exam in Houston if possible). There are many hotels there, where all the foreign medical graduates stay and prepare for the exam. There is an added advantage of getting a huge study group for free, you will get many study partners and it’s very important to practice with more than one study partner. One of the places is, “Venetian Inn” where I had stayed. It’s cheap and you can share rooms with other people easily and there are students always staying there.
Now it’s the time to read less and practice more. The more cases you practice in a day, the better for you. During this phase of your preparation, remember practicing notes, typing as well, early on in your preparation. People usually ignore it to the end and mess up the exam because of their low speed of typing of the patient notes. This is the main reason so far for failing in USMLE step 2 CS; people fail to complete their entire notes on time. There is a link where you can practice your note typing skills just like the real exam : www.usmle.org/practice-materials/step-2-cs/patient-note-practice2.html

And here are some sample patient notes: http://www.usmle.org/practice-materials/step-2-cs/patient-note.html

Always practice in the timed mode, try to make the environment as close as possible to the real thing, try downloading USMLE step 2 cs timer from youtube: https://www.youtube.com/watch?v=cCwuhkIc7Qw

In the last 1-2 days, try to do a mock test at Venetian inn. They make SPs sit in different rooms just like the real exam and let you knock at the door and make people start and stop the timer. They even practice telephone cases on the phone, so it is the closest to the real exam. The more you practice, the more confident you will become.

Things to remember on your Exam day/USMLE Step 2 CS exam day

• Wear formals and a white coat
• Eye contact and firm handshake is important
• Confident body posture
• Introduce yourself as Dr. your last name
• Do not hurry to enter in the room
• Try to gather all information from the door on your sheet of paper first.
• Do not wash hands, use gloves instead.
• Do not sit, try taking all patient history while standing
• Complete your history, examination and counselling in 13 minutes in every single case and then keep 2 minutes for any questions they might have from you
• Be respectful and gentle with the patients both with your tone of voice and your hands.
• Be extra gentle in handling gowns of the patient
• Listen to all four areas of heart if you are doing cardiovascular examination
• Don’t touch anything after touching an area below the knee. If you have to, then change the gloves
• In the patient note writing, write the differential diagnosis first with positive findings, do not worry if you don’t have all three differentials
• After differentials, write diagnostic studies that you need
• After that physical examination and finally the history
• During your practice sessions, always try to jot down notes from what your SP is telling and practice writing notes only from the rough notes you jotted down
• Always enter and leave the room with a smile on your face

In the end, I advise all medical students to practice as much as you can. Reading things won’t make a huge difference for this exam, it’s the practice that is the KEY

Cracking USMLE exams & precautions for the first journey to USA

The ideal USMLE Step 3 strategy

Material : Master the boards 2 and 3, USMLE world (NO NEED TO DO KAPLAN)

The Preparation

The preparation for USMLE step 3 is exactly like USMLE step 2 CK which includes:

Pre Uworld

I started reading both MTB 2 and 3 together, topic wise, I gave them enough time; such that after 1 month, I was done with both of them. I read them thoroughly. I gave a second read to both of them in 10 days. After finishing MTB 2 and 3, I watched USMLE step 1 kaplan Behavioral science videos by Dr. Steven Daugherty from chicago (highly recommended) and I read the USMLE step 1 Kaplan notes for behavioral science as well for my statistics and psychiatry part of my exam. Then, I started the USMLE world.

USMLE world

This is the most important phase and the deciding factor of your scores in the real exam. Use this time very wisely, remember Uworld is the key for USMLEs. I started with doing 1 block a day in the beginning, what i used to do was, first do a new block in the morning, then read its explanation (thoroughly and making notes out of it), doing retrospective study of my MTB 2 and 3. As the time goes by, I made one block per day to three blocks in two days and then finally to 2 blocks per day. I read the entire MTB 2 and 3 third time along with my entire UWorld. I was done with everything in 40 days and then I started doing UWorld again. I finished my second read of UWorld in 15 days. In the last few days, I just revised my notes that I made from Uworld. Remember this is an educational material, not for assessment (for assessment you have NBMEs and UWSA), so go slow with UWorld and read the explanations thoroughly.
Tip: Try to google the images of CT scans, Xray, MRI, ECGs and various clinical signs that you read from your text, it helps a lot. Try to listen to various heart and lung sounds from youtube, it will help you in a long run as well.

CCS

This is the main difference between USMLE step 2 CK and USMLE step 3. There will be 13 case simulations, each of which is allotted 10 or 20 minutes of maximum real time. Take my words, USMLE WORLD CCS is enough for its preparation, I didn’t do any Archer Workshop or anything else for my CCS. I started my CCS from UWorld when I was half way done with the question bank. About 95 cases in UWorld are more than sufficient, they give you the same virtual software which you are going to face in your real exam.
Uworld is enough to train you for your CCS cases and most of the cases in the real exam would be of the same concept.

Tip: Don’t worry about this new pattern for USMLE step 3 thing that includes that Foundation of Independent principles, you won’t be asked anything from USMLE step 1 except that you will have tons of biostatistics, ethics, psychiatry, abstract and research questions in every block so be prepared for them.

USMLE preparation: Easy steps to find clinical electives, residency programs in USA

Four reasons why you should give your USMLE step 3 before starting residency

There are many advantages on giving step 3 before 15th september:

1. You will be eligible for H1 visa: Every one wants H1 visa if possible. It doesn’t have any two year home residency rule, there will be no bond and you don’t have to apply for visa every time you come back to India.

2. Interview calls: Some programs who don’t even offer H1 visa prefer to send calls to people who are done with their step 3 already. This makes them sure that their residents won’t be taking time off during residency to prepare and appear for this exam. They would be sure that their residents have already passed.

3. Match: If you score well, then the program director will be sure that you not going to fail in the residency board exam and is not going to lower down their average passing rate. You are in the safe zone, already.

4. Busy schedule: Once you start your residency, it’s busy. You won’t get time for yourself, arranging time for your step 3 preparation would be more difficult. No matter how busy you are, before starting residency, you are not as busy as during residency

Special Tip for surgery applicants: J1 is a big trap for surgery residency, you are not going to match categorical straight away, and you can do only two years of prelim on J1 (you can’t repeat prelim year). If you don’t get matched in your third year and you are on J1, you have to go back to your home country, so try giving your step 3 before your application.

Also read – USMLE surgery residency program: Why should you choose H1B over J1 visa? &

USMLE preparation and aiming for surgery residency: Facts, myths and a detailed strategy

Tip: If you can’t give your exam before 15th september, try to give it after that, such that your results will be out around match day (15th march). Your results should be in hand at before 1st week of april and some programs will still consider you for H1B visa as they need your results before filing your visa. (Happened with me)

USMLE exam scores, matching and your interview calls

Food for thought: On exam day

This thing, is the most ignored by students but the most important and it makes a lot of difference. The test usually takes 8-9 hours in a row. This is beyond our normal daily routine so we need nutrition other than the daily routine. There are many things which are becoming common to take by test takers and should be completely avoided.

Things to be avoided

Red bull: Trust me you don’t want to drug your body that much when you need to concentrate the most
Soda: There is too much sugar in it. It will cause rapid hyperglycemia and then insulin surge followed by hypoglycemia
Too many chocolates: They are pure sugar as well, try to avoid simple carbohydrate.

Things to be taken

Lots of water: Nothing wrong in peeing at every break
Complex carbohydrate: Brown bread sandwiches
Lots of proteins: meat (chicken, turkey), nuts (trail mix)
Ideal strategy

The night before:

Don’t eat outside
Don’t take anything heavy
Try to eat your regular meal which you eat every day
Avoid any new food, any hot sauce, go easy on mayo

Breakfast

Coffee: A nice strong cup of coffee should be taken at least 45 minutes before the exam. Pack some with you to drink during the exam
Sandwich: Tomatoes, lettuce, turkey/chicken breast, brown bread, go easy on mustard sauce and mayo, eat one and take one with you for the exam
Juice: Don’t drink too much, just a glass of any juice is fine

Pack

Trail mix box: Peanuts, almonds, walnuts, raisins
An extra sandwich and a cup of coffee (mentioned above)
Dark chocolates
Water bottle

The idea should be to avoid too much sugar, too much caffeine and take lots of protein, lots of water and complex carbohydrates. The coupling of dark chocolates with nuts help to make instant increase in glucose levels and maintenance for stable glucose levels at least for an hour. The water prevents your brain from dehydrating while coffee and dark chocolates are doing their thing.

Tip: If you are a heavy smoker, don’t quit your morning cigarette on the exam day. If you like any particular thing in breakfast, then don’t skip that.

USMLE preparation: Everything you need to know about B1 visa

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