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If you want to practice medicine in the USA at any time in the future, the United States Medical Licensing Examination (USMLE) is your gateway. Read on for a detailed primer on everything you ever wanted to know about the USMLE but didn’t know the answers to!

Basic Facts

The USMLE is a three-step exam:

  1. Step 1 tests basic knowledge of the medical sciences. It is an 8-hour exam, that has approximately 300 questions. A lot of the material covered in Step 1 requires a detailed understanding of the subjects you would have learnt in Year 1 and 2 of your MBBS degree.

  2. Step 2 of the USMLE is divided into two parts. Step 2 – CK (where CK stands for Clinical Knowledge) has a structure similar to Test 1, but the subject matter covers the clinical sciences. It tests the diagnostic ability and knowledge of the appropriate treatment for different conditions. A lot of the content in Step 2 – CK tests material that you would have covered in Years 3 and 4 of your MBBS degree.

    Both Step 1 and Step 2 – CK can be given in India, at test locations. However, Step 2 – CS (CS = Clinical Skills) has to be taken in the USA. It involves face to face interaction with up to ten “patients” (who are actors simulating various conditions) and tests assessment ability, communication ability, and ability to accurately and quickly write a short note on these.

  3. Step 3 is the final exam in the set of USMLE tests. It checks whether your skills are at a level of maturity advanced enough so you can practice without supervision. It can also be taken only in the USA.

Why should you take the USMLE?

The USMLE offers great opportunities for Indian medical students. First, it is the only way to practice medicine in the USA. Whether your aim is initially a Residency or a Super Specialty, a good USMLE score is mandatory.

Therefore, if you want to take advantage of the huge – and growing – demand in the US for qualified doctors, the USMLE is an essential first step. Many factors make the US an attractive destination to practice medicine, as compared to India. The quality of life and the higher salaries are clear benefits, but there are other, less clear, positive points as well. Exposure to the latest and greatest in your chosen field is one definite factor. The quality of medical research and the funding for the same are both at their peak in the USA. In addition, your career growth trajectory can be even faster in the US than in India, given consistent performance.

The USMLE is competitive as well. There are fewer than 20000 residencies in the US available for international graduate applicants, and there are more than 30000 international students who typically give the USMLE every year. If you are able to get through the steps with flying colours, you can be confident that you are in the very top percentile of your chosen field.

If you can get a Residency offer in the US after your USMLE, you should definitely take it.

How do you register for the USMLE?

First, you need to sign up on www.ecfmg.org, or directly on https://secure2.ecfmg.org/emain.asp?app=iwa. This creates an online account with the Educational Commission for Foreign Medical Graduates.

You will first need to apply for a USMLE / ECFMG identification number. While entering personal information, you must ensure that all data is exactly as it is on your passport. Anything that does not match with your original documents will lead to problems on test day, and you do not want to miss out on an exam appointment because of documentation issues.

Next, you log in with your ID number and password set by you. You will fill a form for ECFMG certification; this takes about 30 minutes to fill. Once you review and submit this, you can download Form 186; this is a form of proof of your ECFMG certification.

Now, you complete the online part of your USMLE application on the same site. You have 14 days to save changes to the online application, after which you must start afresh.

Once this is done, your current medical school must directly provide Status Verification to the ECFMG; this is ideally done online, in case your medical school has created an online account with the ECFMG. The Status Verification certifies, to the ECFMG, that you are indeed a registered student of the medical school. You will be notified of successful verification on the same portal.

Finally, you have to provide additional documents at the time of your examination application. These usually have to do with degree certificates, whether final or provisional.

Your online application is completed once you enter all the data above, and pay the exam fees. The base fee for Step 1 is $820, with an international test delivery charge of between $130 and $330. Therefore, the total fee can range from $950 to $1150. Step 2 – CK also has a similar fee.

Once all three steps are completed, ECFMG processes your application, usually within successful completion of all three steps above.

How can you do well in the USMLE, as an Indian medical student/graduate?

There are a few keys to success in the USMLE. First, you should start your prep early; starting as early as the first or second year of your MBBS will give you an edge over the competition. Finally, by the time you reach Step 3, you will need to prove that you are clinically skilled and that you are an all-rounder. Therefore, clinical research experience, along with volunteer hours at a hospital (200-500 hours is ideal), and knowledge of a foreign language (Spanish is especially useful in the US) will all help you stand out as a candidate. You will also need recommendations from the US, so work or observation in the US will improve your chances of this.

The USMLE is a very important step in building a career in medicine in the United States. As such, success in this examination is a multi-year process, and involves 1.5 to 2 years of pure exam prep, along with practical excellence. If you want to learn more about the USMLE, and about becoming a hot-shot surgeon in the US, get in touch with Jamboree today!

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