Frequently Asked Questions FAQs about USMLE and Residency by Dr. Naeem Majeed

 by Dr Naeem Majeed

1.       Go to ECFMG website
2.       Get your USMLE/ECFMG ID using the Interactive Web Application Service (IWA)
3.       Once you get the ID (in your email inbox), you can apply for the desired exam.
4.       You need not apply for a separate ID each time. The same ID account will be used for all your exams, and for residency
application using ERAS. Multiple IDs are not permitted.
5.       When you apply for the first time, you will have to submit a printed form 183 or 186, after getting it verified from your medical institute.
6.       Form 183 will be used if you are still a medical student at the time of applying,
7.       Form 186 will be used if you have graduated
8.       Once done with the application online and mailing (through courier/physical mail), you will have to wait to get your eligibility period
9.       After you get the eligibility period and scheduling permit, you have to go to the Thomson Prometric website and get the desired dates
Read carefully the information provided at ECFMG, USMLE and Prometric websites, to avoid undue confusions at later stages!

If you can manage it with your studies, it is best recommended to take the step 1 as early as possible, after you are eligible for it, and have completed the relevant subjects in your medical college curriculum. In the Pakistani System being currently practiced, the best time is from the early days of final year to the mid of final year.
If you cannot manage, which is the case with most of the students, keep reading standard books for the college studies. As soon as your final professional ends, start preparing for step 1. Follow the schedule for the preparation available here, or make a similar schedule for yourself, depending on your absorption powers. Some people prepare and score well in as little as 3 months, and some may take up to a year.
Legal Issues: Eligibility::
You become eligible for step 1 as soon as you get the result of first professional (in the Pakistani System). The minimum requirement is to have completed two years of education at a medical college. Thus, legally you can take step 1 in 3rd Year.
Then why not take it then? Reason: Step 1 tests you in Anatomy, Physiology, Biochemistry, Pharmacology, Behavioral Sciences, Microbiology and Pathology. In our system, we are taught only anatomy, physiology and biochemistry by the end of 2nd Year. Which means, though legally eligible, we are not prepared to take the test after 2nd Year.

What are the costs involved in the whole USMLE-Match-Residency Process?

Step 1
Step 2 CK
Step 2 CS
 $300 for 30 programs (increases with more no of programs you apply)**
Visa: B1
Flight to US
Local Travel in US
$1000 [highly variable from person to person]*
Food & Stay
$1000-3000 [highly variable from person to person]*
Step 3
Health License
USCIS & Legal Processing (if applying for H1)
$9135 - 11335
*Costs for travel and stay, food etc can be saved if you have relatives.
** The first 10 programs cost $60 per program, 11-20 cost $8 per program, 21-30 cost $15 per program, and from 31 onwards, each program costs $ 25. A calculation made to clear the things:

         10 progs=$60 (total)
         20 progs= $140
         30 progs= $290
         40 progs= $540
         50 progs= $790
(this is for one specialty... each sp will be counted separately... ie; if u apply to 10 progs in IM and 10 in peds, u pay $120).

Note: These are just estimates. Actual costs may vary depending upon the circumstances. Please refer to relevant websites before making your final decisions.


What additional things should I do, to make a stronger resume?
1. United States Clinical Experience, called USCE for short, is an important factor, besides your step scores. With the rising competition in the ERAS Match, Program Directors look for candidates who have exposure to the US System of Health.
The best USCE is the elective experience, which is a clinical rotation in any teaching hospital other than your own medical school. In terms of USCE, electives are done in US Hospitals. Read a detailed overview of electives here.
Other forms of USCE are: (in order of decreasing preference): Externship, Observership, Research Experience.
For further details and state wise information on USCE, please see here:
2. Publications: If you perform some researches, try to get them published in recognized journals. The more well reputed a journal is, the more is the credit given for that publication. Wasting time on research which doesn't get published is just a waste of time.
3. Voluntary Activities/Extra Curricular Activities/Participation in seminars and conferences: Usually, this does NOT help in getting interview calls, but it does help you in the interview, once you get a call. 

I do not understand the scoring system. What's with the two digit and three digit scores? How are they calculated? Which is more important?
The two and three digit scores are just scores. They are for step 1, 2CK and Step 3. Step 2 CS is just a pass/fail exam. No scores are reported for step 2 CS. Few important points:
 - Two digit score is not a percentile. It is not a percentage either. It is just an arbitrary correlation score that correlates the 2 and 3 digit scores. The correlation between the two scores varies from time to time. Highest 2 digit score is 99. Two digit score below 75 is reported as a failed exam.
- Three digit score is NOT the number of correct answers you give on the exam. Again, it is an arbitrary scale, and only ECFMG knows how it is calculated.
With the rise in competition in the recent years, three digit score is gaining more importance - as one can get 99 on two digit scale even with a three digit score of 236, while one with three digit scores as high as 280+ is also given a two digit score of 99.

What are NBME Forms? How important are they?
NBME form 1-4 are 4 sets of sample exams for self assessment, each exam comprising 200 mcqs (ie each form has 200 mcqs). Each of these forms costs $ 45.

Is my college recognized for the USMLE ?
Students from all colleges listed in the IMED, provided by FAIMER are eligible to take the USMLE Exams, provided the fulfill other exam requirements. For details and to apply, see here.

Is house job a requirement for the USMLE Exam? How does the house job help in the residency/match process?
House job is not a requirement for the Exam. Clinical Experience within home country gives some edge over having no experience at all, but still it is not so important as to risk your scores over house job!


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