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Your Path to Practicing Medicine in the United States: Preparing for the USMLE Exams

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Becoming a licensed medical professional is no easy feat - years of studying, internships, research, residency, and possibly a fellowship lie in your path. But all of this is doable and you can achieve your goal of becoming a practicing physician. If that path leads you to the United States, you'll need to pass the United States Medical Licensing Examination, or USMLE, to be allowed to practice medicine. The USMLE® is a series of exams which all must be passed before you apply for a license to practice medicine in the United States. Step 1 and Step 2 CK (Clinical Knowledge) are multiple-choice examinations with questions based on patient-centered vignettes. Step 2 CS (Clinical Skills) consists of a series of patient simulations. Step 3 is a combination of the two: you will face both patient-centered vignettes and virtual patient interactions. The following information will help you prepare for your future as a doctor and for acing the USMLE Step 1 exam.

Am I eligible to take the USMLE exams?

If you attended a medical school outside of the United States, you'll need to make sure your school is listed in the World Directory of Medical Schools and that you meet all ECFMG eligibility criteria. Technically you are able to take Steps 1, 2 CK, and 2 CS while you are still a student; however, to take Step 3, you must have already passed all other steps, met ECFMG certification criteria, and it is also recommended that you have already completed or will soon complete at least one year of postgraduate training at an accredited program that meets US State Board Licensing requirements. As an international medical graduate (IMG), there are additional hurdles to jump over to complete this process.

Which topics are covered on Step 1?

The USMLE Step 1 exam is designed to test your knowledge of foundational science concepts. This can include topics such as anatomy, embryology, biostatistics, immunology, microbiology, histology, pharmacology, pathology, and physiology. For a full overview of the testing specifications, visit the USMLE Step 1's content specifications webpage.

How can I prepare for Step 1?

When preparing for Step 1, it is important to give yourself enough time to not only review the content, but to also simulate a few exam scenarios. Mentally preparing yourself for test day should not be forgotten. One great way to do this is to utilize a Question Bank as a study tool. If you haven't been using a Qbank throughout your studies, it isn't too late to start! Before you begin, create a Step 1 Study Schedule. There are many schedules online, or you can develop your own by calculating how many days you have to study, how many hours per day you can allot to studying, and the topics you need to review. Leave a few extra days (2-3) for practice tests, and give yourself a few days off throughout the process - you don't want to get too burnt out before the exam. Once you have determined your study schedule, start working with a Qbank. Set a 40-question block (give yourself 60 minutes to complete it), and go through the questions like an exam. Once you're done with the block, take a short break, then dive back in. This time, go through each question one by one, review the content presented, and make sure you understand why the correct answer was correct. Spend about two hours reviewing the concepts, consulting resources such as online video lectures or a reference text, and making notes of what you need to review later. At the end of this full "block," you've gone through an important topic on Step 1. Give yourself an hour or so now, perhaps for a walk, a workout, or a meal - then repeat this block style again with another question block. Throughout your study process, it is important to keep track of your progress. One way to do this is via the NBME Self-Assessments. They can be purchased and utilized completely online. The NBME is the same body that writes the USMLE exams, so you're likely to find familiar wording come test day. Though of course there is a lot of time, energy, dedication, and work that goes into studying for an eventually passing the USMLE Step 1 exam, with the right study plan and resources, you're sure to be on the path to practicing medicine in the United States.

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