Timeline for USMLE Step 1: Average time for preparation: 7-8 months if you are studying regularly without clinical rotations and without any time off in the middle [i.e. during your year after graduation. You can either do nothing besides studying during this time or take up a part time job in either research, teaching or an internship at a hospital where schedule is not busy so that it allows you enough time to study every day. The latter is obviously preferred]. If you are planning to take your step 1 while still in medical school, it can take anywhere from 8 months to over an year depending on how much you are able to study during your clinical rotations. In that case, please plan accordingly. First read: Around 3 months (Can take up to 4 months if you are doing First Aid with this read as well). 1. Start with reading Kaplan Lecture Notes for Anatomy, Physiology, Biochemistry, Pharmacology, Microbiology/Immunology and Behavioral Sciences. 2. Do videos along with the books for at least Biochemistry, Pharmacology and Behavioral Sciences. For the rest of the subjects, the videos are not very important but in case you are weak in a particular subject, you can definitely refer to the videos. 3. For Anatomy, do BRS for Head and Neck if you have time, Kaplan is a bit insufficient for this topic. 4. For Pathology: Do Pathoma along with its videos. It is an extremely good and efficient way to cover pathology. Goljan is not important since it is very extensive and covers a lot of other subjects besides Pathology so it kind of wastes time. You will be exhausted! Pathoma + First Aid + Uworld will prepare you extremely well for the exam. If you need to do more, you can do Goljan Audios which discuss just the important points and will save you a lot of time (but again, not too important). 5. I will highly recommend going through First Aid for USMLE Step 1 right from the first read. Once you have read a topic from Kaplan, go through First Aid and read that topic from it as well. If you feel some important points are missing in First Aid, annotate those points from Kaplan on First Aid. 6. I recommend doing First Aid from the start because towards the end, First Aid will be your go to book and you will not have time to go through all the Kaplan books again. Hence, the more times you read First Aid, the better it is. 7. Tip: No need to rattofy Kaplan word to word. Just get the basic concepts. You will not remember minor details in Kaplan towards the end anyway. Just get the bigger picture and build concepts during this read. You will start retaining stuff with subsequent reads! A. Physiology: Finish it in around 10 days. B. Biochem: 14-18 days. Watch the corresponding videos and make notes of the extra stuff on your Kaplan. Do GENETICS really well, it is not covered as nicely in First Aid.
C. Anatomy: 12-14 days. This includes Gross Anatomy, Histology and Emrbyology. a. Do Head and Neck Anatomy from BRS if you have time, Kaplan is insufficient for this topic. b. Some people also did High Yield Neuroanatomy, Histology and Embryology. I personally think it is not needed. Neuroanatomy is covered very well in Kaplan and First Aid while Histology and Embryology are not highly tested subjects anyway. However, if you are weak in any of these subjects, going through High Yield might help. D. Microbiology: 10-12 days. E. Immunology: 3 days (Do not do tables at the end of the book if short on time, not really needed). F. Pharmacology: 10-14 days. Do videos! G. Pathology: 12-14 days. Do pathoma WITH VIDEOS! Make notes on the book if necessary. H. Behavioral Sciences: 7 days. Do videos! a. For ethics, also go through Dr. Conrad Fischer’s book for ethics, it is a tiny book and will only take a few hours. b. For biostatistics, also go through Uworld biostatistics course. It is really good. I have the offline version which I would be sending you along with this document. This will not only help you in Step 1 but also in Step 2 CK and Step 3. Second read: 2 months Just multiply the time for each subject in first read by 2/3, no need to watch videos again unless really required. Do Kaplan PLUS First Aid. If you are picking up First Aid for the first time, do it really well. Pick a question bank and start practicing questions. Pick either Kaplan Qbank or First Aid Q and A or both. I did Kaplan and liked it but people are shifting more towards First Aid Q and A. You decide. If practicing questions helps you retain, you can start practicing questions from the FIRST READ as well! See what suits you the most! These little things vary for every individual. Third read: 15-20 days. Read only First Aid. This is your bible now. Rattofy it! You would have annotated important stuff from Kaplan already so no need to go back to Kaplan except for some topics every now and then. This read is very very important! Make sure you do it properly. Meanwhile, keep on practicing questions from Kaplan Qbank or First Aid Q and A. After this Start Uworld! Always solve Uworld questions in Timed Mode. You can practice a few blocks in an untimed mode initially but switch to timed mode after 5-6 blocks or so. Uworld is the most comprehensive Question Bank for USMLEs. Always do it ONLINE! Go to www.uworld.com to buy it, you will have to register (i.e. make an account) and make the payment through a credit card. There are around 50 blocks in Uworld (44 questions per block). It will take upto 3-4 weeks to finish it depending on how many blocks you can do per day. I personally averaged 2-2.5 blocks per day. Some people can do up to 3. See how much you can do but 2 should be a
MINIMUM! Do not go into insane details of Uworld though! Keep going through First Aid and revise stuff which you got wrong or if you do not remember something. This is how I approached Uworld: I solved around 42 blocks and kept the last 8 blocks for practice towards the end. Once you are done with Uworld Revise First Aid again! Give this around 10-12 days. Revise Uworld again Give this around 1 week! Revise marked/difficult questions and important concepts. Last 10 days I solved the remaining 8 blocks of Uworld in one day. This helped me prepare for the real exam which would be very long and tiring. I skimmed through the explanations in the next 1.5 days. Do Uworld Self Assesment (UWSA) Exams, there are two of these, 4 blocks in each. It will take you two days to finish these two exams with explanations. UWSA will give you an estimate of your 3 digit score but it is usually an OVERESTIMATION by 10-15 points. Do the latest NBME exams, again 4 blocks per NBME. 2-3 NBMES are more than enough. Try doing these online if you can afford it. NBMES are more accurate in predicting your real score; usually +/- 5-10 score in your real exam. You can also solve one or two NBMEs a bit earlier if you want to know where you stand, no hard and fast rule for this. Do the latest NBMES (15, 16, 17). If you have time to do older ones, 7 and 11 are the best amongst them. You can do 7 and 11 offline if you are doing the latest ones online. If you need these offline versions (for 7 and 11), let me know through email and I will forward these to you. The NBME exams can be bought from https://nsas.nbme.org/home. Select Comprehensive Basic Science Self Assessment (CBBSA) for Step 1. Revise anything you might be weak at. Most people like going through Kaplan Genetics again. Take the exam! Miscellaneous: 1. Look at CTs n MRIs from the following link: http://www.med.wayne.edu/diagradiology/anatomy_modules/Abdomen.html It has a lot of details; all you have to do is get the gist of the anatomy. 2. Do not forget to practice the questions on the following link: http://www.usmle.org/practice-materials/ Clichéd advice: 1. Do not waste time. You need to be at your best for the majority of days to ace this exam. Yes, you will have bad days every now and then, but they should be as few as possible.
2. Do not think that you can leave anything for tomorrow. If you have not met a target for a day, you have most likely delayed your exam by a day. You cannot cover for the previous days since every day’s plan is already the maximum you can do. 3. Sacrifice your social/family life during this time if you need to, it may sound a bit harsh but it would be worth it. 4. Step 1 is probably the most difficult and most important exam. So work really hard, life does get easier after you are done with Step 1. 5. The above timeline is not meant to be followed exactly as it is written. See what suits you the most as you progress. You can skip something and pick up another thing if you feel that would help you more. There is no absolute rule for anything. My scores: Uworld average: 85% UWSA 1: 265 (265 is the maximum you can get in UWSA) UWSA 2: 265 NBME 7: 249 NBME 11: 252 Final Exam: 255
Timeline for USMLE Step 2 CK: Tip: The lesser the gap between taking Step 1 and Step 2 CK, the better it is! There is a lot of stuff in CK that is related to Step 1 and it really helps to not waste time after Step 1 and start preparing for CK as soon as possible! Average time for preparation: 3-4 months. Again, if not a lot of time has elapsed since you took step 1, it will take you lesser time to get done with CK. I studied for only 10 weeks since I started preparing for it right after Step 1. If it has been 46 months since you took step 1, you might even need more than 4 months. 1. Most of us start with Master the Boards (MTBs) by Conrad Fischer. Read MTB-2 for Internal Medicine and Emergency Medicine. Read MTB-3 for the rest of the specialties including Surgery, Pediatrics, Obstetrics and Gynecology etc. Remember that Internal Medicine forms the major chunk of your exam; almost 60%! 2. Solve Kaplan Question Banks from day 1 along with MTBs. I found these very helpful. You can get these books from Urdu Bazaar (as for Step 1). Solving these are useful because the question stems for CK are relatively longer and solving this Q bank will help you prepare more before you start Uworld so that you can ace the latter. However, these are a little outdated. If you find contradictions between Kaplan Q banks and Uworld, always follow Uworld! 3. Kaplan Lecture Notes are not very important if you have taken step 1 recently. Also, solving Kaplan Q banks will cover a lot of stuff in Kaplan books anyway. However, I will highly recommend going through Kaplan Surgery. It is a tiny book but with a lot of high yield information. You can easily finish it in a day or two at most so you will not waste a lot of time anyway. Having said that, you can resort to Kaplan for subjects you might be weak at or if you took Step 1 some time ago. For e.g. a lot of people go through Kaplan Pediatrics or Obstetrics and Gynecology if they feel they are not doing well in these subjects. 4. Uworld! Again, DO IT ONLINE! This is the best Uworld when compared to Uworld for other USMLE exams. Do it really well. Do it at least twice! Again, I solved around 42 blocks initially and kept the final 8 blocks to practice towards the end. 5. Keep referring to First Aid Step 1 for important tables/flowcharts or any other topics that you might come across in Kaplan Q banks and Uworld. A. So, you start with MTBs + Kaplan Surgery + Kaplan Q banks give this around 4-5 weeks. B. Follow this with Uworld give this around 4-5 weeks. Again, there are a total of almost 50 blocks. Do at least 2 blocks everyday!
C. Revise MTBs! This is very important to reintegrate everything you have learnt so far. You can easily finish this in 3-4 days now since after Uworld, you will know majority of the stuff. This read will just help to reinforce your knowledge. D. Revise Uworld 1 week. E. Solve UWSA 4 blocks, will take one day with explanations. F. Solve the questions available on: http://www.usmle.org/practice-materials/ I did not solve any NBMEs due to lack of time but you can solve one or two if you would like to. From what I have heard, NBME 4 is the best one for Step 2 CK. Take the exam! Some myths regarding Step 2 CK: 1. MTBs do not help/they are useless: I wholeheartedly disagree with this myth. MTBs are not perfect by any means but they are the best resource we have considering we usually do not have a lot of time to prepare for CK. It gives you a lot of high yield information. From my perspective, people have this opinion because they never revise MTBs. They just read it once and forget about it. If you revise MTB once after solving Uworld, you will see how much information there is in MTB and will understand what I am talking about. 2. Kaplan Q banks are useless. Again, I disagree. By all means, it is not as good as Uworld, but it has some very important information which also helps you practice before you start Uworld so that you can ace the latter. Also, by solving Kaplan Qbanks, you are getting high yield stuff from Kaplan Lecture Notes so you will not feel that you are missing out on a lot by not going through the Kaplan books. Lastly, it will also help you to identify your weak areas and you can work on them before you start Uworld. My scores: Uworld average: 82% UWSA 1: 265 Final Exam: 268
Timeline for USMLE Step 3: USMLE Step 3 is an exam which is not required for the residency application and is usually taken in the intern year. However, there are multiple advantages (especially as an IMG) of taking Step 3 as soon as possible. To be eligible to take the Step 3 exam, you need to be ECFMG certified which means you should have taken Step 1, Step 2 CK and Step 2 CS and also should have graduated from your medical school. Step 3 is a two days exam; you can schedule both the days consecutively or you can have a gap between them but it should not be more than 14 days. Lastly, the exam is available in all the states and pretty much all the cities in the US. For those who have graduated, the ideal time would be to take Step 3 before submitting your residency application. If you have taken Step 3, you might just get a few extra interview invitations especially from community programs. Also, if you get a good score in Step 3, that might help slightly to compensate for a relatively low Step 1 and/or Step 2 CK score. However, you can only take this exam in the US so it might not be very convenient to take multiple trips especially for Step 3 and then for the interviews. In that case, try leaving for your interviews somewhere around mid of October and take this exam before you start your interviews. You will get your result after 3 weeks and you will still stand a chance to acquire a few extra interviews since it would only be November till then. Average time for preparation: Anywhere between 4-8 weeks depending on how much you want to study. The ideal time to prepare for Step 3 is right after you take Step 2 CK. If that is the case, MTBs would still be fresh in your mind (if you studied those for CK that is). If you have followed the above described pattern for CK, you would have done MTB 2 for Internal and Emergency Medicine while MTB 3 for the remaining specialties. Now for Step 3, you just need to go through MTB 3 for Internal Medicine quickly. If you can, go through MTB 2 for Internal Medicine as well since I felt there are a few things missing in MTB 3. Also, revise other specialties from MTB 3 if you have time. This should take no more than 7-10 days since you recently took your CK exam! If it has been a while since you took CK, you can give more time to MTBs, maybe a couple of weeks! Following that, you just need to do Uworld now. There are only 35 blocks for this exam. If you do 2 blocks per day, you will be done in 18 days at the maximum. There is an additional component in Step 3 called Computer based Case Simulations (CCS). Here, you will need to practice simulated cases on a software. There will be a clinical scenario and you will have to manage the patient accordingly. Uworld is more than enough for this component as well. There are 52 case simulations which you will practice on the software and a readout material for 41 cases which will be available to you on the Uworld website once you subscribe to CCS. Around 5-6 days are good enough to practice and master this component. Give yourself 5-7 days to revise Uworld and anything else that you may like. Take the UWSA, just one for this exam as well, 4 blocks, will take a day with explanations. Take the exam!
My scores: Uworld average: 74% UWSA: 250 Final exam: 236 Suggestions: 1. If you are short on time or tired and just want to get this exam out of your way, doing Uworld only should suffice as well. A lot of people have done reasonably well by just doing Uworld. 2. The score for Step 3 does not matter much since it is not an essential requirement for the residency application. However, it is a relatively tough exam and any score above 220 is considered pretty good. If you have slightly lower scores in Step 1 or Step 2 CK, getting above 230 might be a boost to your application. The passing score for this exam is 190. 3. Taking step 3 makes you eligible for the H1 visa for your residency training. There are a lot of advantages of H1 over J1. Firstly, it is easier to get a green card on H1. On J1, you will have to find a waiver position which is usually 3 years. Secondly, on H1, you can moonlight in your spare time during 2nd and 3rd years of residency and make some extra money in case you have loans to pay off or want to support your family back home financially. Thirdly, in case you end up marrying someone with a green card or citizenship, you will not be able to change your status on J1 and will still have to do a waiver while on H1, you can change your status quite easily. The only drawback of H1, however, is the difficulty in finding fellowships right after residency. Majority (95%) of the fellowship programs take the IMGs on the J1 visa. Hence, you might have to wait for a year or two on H1 before applying for fellowships (so that you can get your green card during this time). During this time, you can work as an attending so there won't be any gaps. However, it would also be important to get involved in academics in some capacity if you want to pursue a fellowship. Once you get the green card, the opportunities for fellowship might increase as compared to the J1 (since you have a green card now!). Lastly, there are very few big programs that sponsor the H1 visa. However, majority of the community programs do sponsor it! So if you do end up matching in a program that sponsors H1, you would not want to miss this opportunity. And if you have taken this exam, you would not have to worry about it in your intern year during which it is a big hassle to study because of the busy schedule. I hope this helps. Feel free to let me know if you have any questions regarding USMLEs or anything else pertaining to residency. My email address is
[email protected] and you can also reach me through Facebook. All the very best! Ali Khawaja, The Aga Khan University, Class of 2013.
