Change in Step 1 Minimum Passing Score

The Step 1 Committee decided to raise the three-digit score recommended to pass Step 1 from 182 to 185. The new minimum passing score will be applied to Step 1 examinations for which the first day of testing is on or after January 1, 2007.

Kaplan Step 1 Video - 2007 edition

Step 1 In-center Video Lectures (2007)

Kaplan recently updated all of its video. The content is now available on videos instead of old fashioned tape library. Good for all USMLE takers. Now you can watch the Kaplan USMLE DVDs on your computer.

Newly Filmed Content

• Microbiology
• Physiology
• Behavioral Sciences
• Immunology
• Biochemistry

Read here about details of the changes in 2007 Kaplan videos:

Youel Step 2 Videos

I am receiving a lot of inquiries about Youel prep Videos for Step 2.
So I want to tell the facts I know about Youel Videos and then invite for your comments/feedback.

Youel is respected by many students for the quality of the lectures. Some say that Youel is much better than Kaplan for Step 2.

It is just 40 hours of high-yield review and covers the following topics:
EKG & Cardiology
Fundamental Facts
History & Physical
Lab tests
Medical Ethics
Symptoms, Signs, Syndromes
X-Rays & Pulmonary Disease

More information can be found here:
http://usmlestep.com/youelprep-step2.htm

Kaplan Med Essentials

Organized by organ system, the medEssentials book reinforces key ideas and concepts essential to your med school studies. Later, it can be used as a personalized guidebook for board preparation.

Download Kaplan Med Essentials now

USMLE Scoring - 2 digits vs. 3 digits

The USMLE phased out the use of a percentile based system in 1999. A score report is given as a three-digit and two-digit score. The three-digit score reflects the number of correct questions and the two-digit score is a representation of the three-digit score on a scale of 100%. A score of 182 or greater is required to pass. Those who take the exam on or after January 1, 2007, will need a score of 185 to pass in the exam. The national yearly average usually is around 220 with a standard deviation of around 20. Many residency programs have cutoffs for Step 1 scores below which applicants are unlikely to be interviewed.

General Hints for USMLE Step 3 CCS exam

General Hints for CCS

The part that is problematic with most people is the case simulation part. Below I will list a few hints of how to succeed.

You will have plenty of time to complete each case. 25 minutes of testing time is available. In the end you have to write your diagnosis. Obviously this test will have more common diseases, so thing about those first. Second, think what you would do if it was a real patient. This helped me a lot during the exam. The test also wants to make sure you are practicing safe medicine, so stay away from anything dangerous, especially drugs with too much toxicity, surgery without confirmatory tests and such.

Setting

In order to decide where to best treat the patient (office, ICU, ward), you have to determine 2 aspects: how sick is the patient and how rapidly does it have to be treated.

• Vital signs: watch for tachycardia, bradycardia and extremes in blood pressure. Also tachypnea should point to something more severe.
• Complaint or symptoms: severe pain, shortness of breath should raise red-flags.
• Age: very young and very old people tend to need to be hospitalized.
• Instability: any unstable vital signs, fluctuating levels of consciousness, severe blood loss should prompt an ICU admission.

Orders

For most people that have not had medical training in the US this might be a problem. To order medications you do NOT have to know the dose. You can write common tradenames and generic names. Also, consultation can be obtained, and these take little time. Remember about vital signs / ECG monitors, oxygen.

Radiology and Laboratory tests

Know why you are ordering every test. It seems trivial, but do not order something unless it is going to help you with the diagnosis. All tests in Step 3 take considerable time, even days. The less common the test you order, the more you will wait for a result.

Follow-up and interim histories

The system will not penalize you for seeing your patients too often. If you do not know how often to see patients, in hospital usually once a day. The system will let you know of new test results and developments in the case.

Physician salaries

While no one recommends selecting a specialty based on salary, it is one piece of data that medical students typically ask about. As seen below, physicians are paid quite well no matter what their field. However, specialists tend to make more than primary care physicians on average (specialists generally also require many more years of residency training than primary care physicians). It is important to note, though, that there are many cases of primary care physicians in ideal locations with excellent business practices earning significantly more than many specialists.

Bottom line: Specialize in a field that you find interesting and enjoyable. Don't worry about how much you'll be making; you'll be fine no matter what you choose.

Ten Most FAQ about USMLE Step 1 - from Tulane University

1. What is the national average USMLE Step 1 score?

The national average is a three-digit score between 215 and 220.

2. What is considered a “good” score on USMLE Step 1?

From my perspective, the test should be a pass/fail test. That is the way the test was designed. Having said that, specific scores are released. As a former residency director, I wanted residents to have passed Step 1 and Step 2 prior to matching with us. I did not really care about the score. Very competitive programs prefer applicants to have scores that are better than average. A commonly used benchmark for these programs is a threshold score of 220.

3. How are these scores used?

The scores are used for state licensure. You need to have passed all three or four steps of the USMLE within a designated time period (1 to 3 years following graduation depending on the state) in order to be licensed by the state board of medical examiners. Upon graduation from medical school, states issue “training licenses” for a limited period of time. Once these expire (within 1 to 3 years) you need to get a permanent medical license in order to continue residency training. To get a permanent license, all parts of USMLE must be passed.

4. Why are there two scores, one two-digit and one three-digit?

The USMLE provides a three-digit score for the exam. Some states require a two-digit score for licensure. The two-digit score is set such that 75 is a passing score. This is NOT a percentile. Percentile scores have not been released since 1999. The three-digit score is commonly used by residency programs and corresponds to overall performance on the exam. A three-digit score of 182 is passing and equates to a two-digit score of 75.

5. What is the maximum score?

This is hard information to come by. Theoretically it is 300. Scores above 280 are virtually unheard of. The high score this year for the class of 2006 was 259.

6. What do I do if I did not pass the exam?

You need to retake the exam. Typically students take one or tow months off during their third year. This time comes from the two months of “vacation” built into the clinical years.

7. Is it necessary to pass?

Beginning with the class of 2007, Step 1 must be passed prior to starting the fourth year and Step 2 CK and CS must be passed for graduation. Practically, it is difficult to match for residency without successful completion of Steps 1 and CS and CK. As mentioned, you need to pass all of the steps to complete your residency because of licensure requirements.

8. What was Tulane's average score?

I will get that information in May or June of 2004. We usually do about the national average and that appears to be the case this year as well.

9. What specialties rely on board “scores”?

ENT, orthopaedics, radiology, ophthalmology, and urology seem to rely on actual scores more than other disciplines.

10. If I want to enter one of these specialties and scored below average, am I doomed?

Hopefully not. Again, the scores are not meant to be used in this fashion. I would advise you to prepare hard for a higher score on Step 2. Additionally, many residency programs look at more than just scores (all should in my opinion). Do an away rotation, get the program to know you, do research in the field, do well on your clinical rotations. All of these things will help.

Goljan Pathology stuff for download

Have you heard of Goljan Pathology lectures? Some common misspellings are Goldjan, Golljen, Goldjen and Golgan.
I am sure you have heard the buzz that is going on about Goljan Pathology Lectures and wondering how can you get them?



There are 2 ways - one is free, another is not.

1. Free way to get Goljan Pathology Lectures - try searching as much as possible the internet. Most of the links are posted on rapidshare - so it might be a good idea to search for Goljan and rapidshare... If you are lucky and find the goljan download link -congratulations!!!

2. You can also obtain Goljan lectures by paying a small fee. For really small fee you can get the full set of Goljan Audio Lectures on Pathology, Goljan High-Yield Pathology Notes and Goljan Pathology Slides...

The small fee is just $16.99

Try here if you think that you can afford spending $16.99 and get them within next 10 minutes.

Advise how to improve your usmle step 1 result

I finished Step 1 a few months ago. My score was–99-- (I could not believe it when I was holding the card and I almost fainted).

I used so many resources for my study, but I have to say that KAPLAN IS THE BEST. I was working as a salesman, for a few months before I decided finally to stay home and study (of course I had some money saved aside at the time).

When I started to study, I though that getting over 85 is just a dream but I made it all the way to 99. It’s all about the resources that you use and the amount of concentration that you have when you sit down on your desk and study. If you want to score over 90 you will do it, but if you just want to pass, your score will be around the passing limit.

As much adrenaline as you have in your body when you sit down to study, as much added points to your score you will get.

Here is the list of my study materials:

1--Kaplan preparation center video lectures (about 194 hours) and it’s the latest edition in the center as of May 2005. I have to tell you that I would never have gotten this score without these video lectures.

2--Kaplan notes scanned on the external hard disc (2002 Edition and it has no markings). These notes helped my so much especially the few days before the test when I needed to review each subject in just one day.

3--A complete set of underground clinical vignettes. Understanding the clinical applications of Step 1 has helped me to read the questions on the test so quickly and even expect what they are asking me before reading the final part.

4--Dr. Goljan Notes and high yields facts and Pathology slides (all scanned on the hard disc). Dr. Goljan is the father of Pathology preparation for step 1 and his stuff is a must if you want to score high.

5-Kaplan Pathology library organized in body systems (I saw a lot of slides and picture on my test).

6--Kaplan Webpreparation with their own notes.

7--Pharmacology, Pathology and genetics live audio lecture recorded from Kaplan live lectures. I had these tapes from one of my friends who finished his step 1 and scored 94 and he encouraged me to use them if I want to ace these topics on the test and he was absolutely right.

8--One CD with more than 3500 questions in Pathology. It made Pathology for me like the air I breath.

9--My own tips and remembered high yield facts and topics that I personally saw on the test. I wrote down more than 2500 topics and tips the week right after the test.

10--Kaplan Qbank in Microsoft word format. ( AGAIN KAPLAN IS THE BEST)

11-NMS software for step 1 (6th Edition).

12—A Complete set of Rapid review CD’s (more than 3500 questions arranged by the subject).

13—Kaplan IV bank.

14—Pre-test books (only Biochemistry, genetics, Pathology and neuroscience).

15—More than 10,000 questions and tips remembered by other students that I used to concentrate on what to study.

16—Board simulator software for step 1.

17—Mnemonics that help you remember the hard to remember facts.

18—Some diagrams, charts and flash cards, I personally made during my 9 months study.

19_Gold standard audio review CD’s (55 CD’s) for step 1 (complete). I have used these CD’s during my exercise in the Gym and in other times when I was so saturated and bored from studying and needed a different format of studying.

20—Pass program notes (over 200 pages of tips, high yields, and high lights) it took me just 4 days to read all over these great material and I would say that it added at least 3-5 points to my score.

20__More stuff that I have prepared myself over the months during the time I was studying and even after I have finished my exam and before the results came in the mail. cheers

Posted by ashish

USMLE Step 1 Advice

What you NEED to have:

1) QBank, 2) First Aid, 3) BRS or other relatively high yield review books for most, if not all subjects. 4) BRS Micro Flash Cards and Clinical Micro Made Ridiculously Simple

Advice:

“You spend 20% of your time learning 80% of the material.” - Dr. Wiese

Don’t get hung up on minutiae. Details will get you nowhere without the big picture.

“Do QBank and First Aid and you’ll be fine.” – Maya Jones T4

Getting ready is actually pretty easy. There are excellent resources at your disposal. Below, I have some suggestions to maximize your return on these investments.

According to Dr. Markert, students will burn out if they schedule their Step 1 more than 3 weeks after they finish their shelf exams.

Burnout is something that should be respected. Three weeks of prep time is optimal. Trust me. You’ll go crazy with any more. 3 WEEKS.

Be humble. Do the work now so you can relax when you take the test.

Medical students are neurotic messes about this Step 1 thing and it gets ugly. Good preparation will make this a considerably less-painful experience.

Micro was not the strongest subject last year. Learn it yourself. Use the Clinical Micro book with the flash cards and you’ll be very well prepared.

Timeline:

Already you should be using your First Aid to help review for your block exams.

Working on current material is very important. Don’t cheat yourself out of learning the material well the first time.

Get registered for the Step in January. Plan a 3-4 day break after your shelf exams in June. Schedule your test day to give you 3 weeks to prepare for the Step.

In February, you should put together a schedule, giving yourself enough time to blast through a BRS in a week or two. Getting up to study is the hardest thing here. Make sure you spend time on your weaknesses!!!

Studying with a friend helps a lot as other people will constantly throw you great material. Don’t study with anyone who is overtly competitive or negative.

In March or so, start using QBank. There are pitfalls you can avoid: 1) using the “tutorial mode,” 2) doing short tests and 3) not checking answers. You MUST do FULL-length tests of RANDOM questions at the correct pace to build your stamina. Tutor mode and short tests give you a false sense of security. Checking the answers is essential because QBank tests 2,000 important factoids/concepts/buzzwords.

By April, you should be getting better results on QBank as you develop your test taking strategy (ie. get questions by eliminating wrong answers instead of knowing the right answer). Finally, use your QBank Percentage Right as a monitor of your improving test-taking strategy and knowledge. That Average Percentage Right means nothing.

Before your shelf exams, use the BRS books, and First Aid for Path and Pharm. Condensed material will help get through everything (remember Dr. Wiese’s advice).

AFTER the Shelf exams, take three or four days off. That’s right Turkey. You will need some rest.

If you finish QBank and are dying for more computerized questions, try USMLEasy.com. QBank is better, but these will help you on your test stamina and technique.

After a day off, take the Kaplan Full Length exam TWO weeks before your test day.

After a day off, take another full length test ONE week before.

Then blast through first year stuff you haven’t gotten to. Get through Pharm and Path again. In the last few days cram any memorization intensive stuff.

Take a day off before test day. Relax. Drive to your test center. Watch a movie. Have a good dinner. Get some sleep.

TEST DAY!!!! Bring some sandwiches, coffee in a thermos, fruit etc. Avoid things that will provoke a huge insulin surge. I suggest bringing 2 bottles of Fresh Samantha (the green stuff). Don’t stress on the first section as it’s notoriously difficult.

source

Is USMLESTEP a scam? Certainly not!

So, you have come across the http://www.usmlestep.com and wondering whether you will get the materials you want or not!

Couple of points here.

1. Hypothesis #1: The site is a scam as it does not has materials and just run away with money.

Let us test this hypothesis. USMLESTEP.com does have materials and this can be easily proved by reading some of the feedback here:
http://4usmle.net/forum/feedback-testimonials/

So - you can see that USMLESTEP.com does have the materials and there are people who have received it and started using them.

2. Hypothesis #2: The site is a scam - it does have materials but does not send them and just keep the money.

Let us test this hypothesis. If it will be the case - you will have a lot of people telling they have not received the package. What we see is quite opposite - 1 or 2 people claim that they believe this is a scam but they never tried this themselves. They know someone who knows for sure this is too good to be true.

You see my logic?
Again - go and read some of the feedback here:
http://4usmle.net/forum/feedback-testimonials/

Try PM the people who posted the feedback and talk to them.

Or you can just knock the MSN Messenger and ask for some freebies from USMLESTEP.com
http://4usmle.net/forum/members/admino.html

I am sure you will get them within 5 minutes...

Hope this helps.
Try checking http://www.usmlestep.com

KEEP TABS ON YOUR 'JUNK EMAILS' FOLDER !

Call it the bad side of technology or simply call it the non-human side of a computer - unfortunately, at times, the Interview Offer email may land up in your "Junk Emails" Folder on your email. Many of us, including myself, blindly go ahead and click on that "Clear Junk" tab without even going through what is being deleted.
Kindly refrain from that during the period from September 1st until the Match Day - You don't want to miss out any program emails!

Hotmail is known to do that a lot, yahoo at times - I personally love Gmail ..yet trust none of them to do your Junk email categorization for you .

Ofcourse, you should also receive the same email on your MyERAS messages section - but at times programs send regular emails, whereas some programs send out paper mail via post !! - e.g. FP program at University of Oklahoma at Tulsa did paper mails during the 2005-2006 season.

You can always change your email address preference on your MyERAS application, if you want to switch.

So , stay alert and ready for some picking-from-the-trashcan activity ;-).

Some of you may say this is aint something to make a big deal about, but I really would not want to miss out that one interview that would have mattered ... hmmm, just a matter of taking-no-chances

Update: Whoa ! Looks like ERAS folks have been reading this blog ;-) Coz recently this notice did show up within ERAS online system :

"Programs have two options of sending emails. They could send an email using the ERAS software or they could send an email using their own email software. If they use the ERAS software you will receive a copy of the email in your Message Center.

Depending on the email service you use, the possibility exists that the emails from programs may be interpreted as either Spam or Junk Mail and therefore they will not appear in your inbox.

Since ERAS has no control over this - we recommend that you check the Message Center regularly for your messages."

USMLE and residency

Introduction of the new work permit laws in the United Kingdom may mean that training opportunities have become tougher for international medical graduates. These sudden changes have left many doctors feeling anxious and uncertain about their medical careers. For this reason, further training in the United States, via a residency programme, is being considered a more favourable and secure option. The exam and selection process for a residency programme may seem long and arduous and discourage candidates. We aim to highlight how to make the process as smooth as possible, enhancing your chances of getting the residency programme of choice.

Why USMLE
All doctors wishing to practise in the United States have to take the United States Medical Licensing Exam (USMLE), irrespective of whether they are US graduates or international medical graduates. International medical graduates may take the USMLE to apply for a residency programme, research programme, or work in a superspecialised area. Once you have passed the USMLE and have been certified with the Educational Commission for Foreign Medical Graduates (ECFMG), there is no distinction between international medical graduates and US graduates when applying for programmes.

Whats is residency?
Residency is a period of training (equivalent to senior house officer level) an individual has to do after graduating from (US) medical school. It lasts three to eight years, depending on the specialty. For licensure in the United States you have to complete residency training and step 3 and have ECFMG certification. After this you can apply for a fellowship (equivalent to specialist training).

What is USMLE?
The USMLE has several steps: step 1, step 2 clinical knowledge and clinical skills, and step 3.

Step 1 is an eight hour multiple choice exam and tests basic medical sciences such as anatomy, physiology, biochemistry, and microbiology and their clinical applications. It is a computed exam and it can be taken in several parts of the world, including the United Kingdom.

Step 2 clinical knowledge is a nine hour exam and tests the clinical specialties such as internal medicine, surgery, obstetrics and gynaecology, and psychiatry. This is also a multiple choice computed exam, and it can be taken in several parts of the world including the United Kingdom.

Step 2 clinical skills tests an individual's clinical skills and ability to communicate with patients and can be taken only in the United States. Participants must register for the exam before 1 July and take the exam by 31 December to qualify for a residency starting the next year.

Step 3 tests the clinical management of patients and is administered only in the United States. The programme will normally specify if step 3 should be taken before or during residency.

The step 1 and step 2 exams may be taken in any order. To register for the exams go to www.ecfmg.org for steps 1 and 2 and www.fsmb.org for step 3. All associated costs are listed on the application form.

USMLE Scores
Scoring highly in the USMLE step 1 and step 2 clinical knowledge exams makes the difference between getting a cutting edge residency programme and an average one. In general, scoring 75 percentile (60% to 70%) is enough to pass step 1 and step 2 clinical knowledge, but may not be enough to get into a residency programme. Exams cannot be retaken to improve a score once an individual has passed. You should aim for percentiles in the late 80s and early 90s for an internal medicine residency and late 90s for a surgical residency.

USMLE Preparation
Preparation times range from three to six months for step 1 and step 2 clinical knowledge and one to two months for step 2 clinical skills. It is worth starting study by January 2007 for a residency starting in July 2008. Generally residency programmes like candidates to have less than five years' experience after graduation, so starting the USMLE process soon after graduation is advantageous. However, this varies from programme to programme and scores on the USMLE are particularly important, as are further degrees such as membership of the Royal College of Physicians and strength of the application.


How to apply for residency programme
Before applying for a residency programme you have to be ECFMG certified. This requires your medical degree, medical school transcripts, and step 1 and step 2 clinical knowledge and clinical skills scores.Then you need to enrol in the National Resident Matching Program and apply for a residency programme using the Electronic Residency Application Service. There is no limit to the number of programmes you can apply for, but each application has to be paid for. Programmes rank candidates and in turn candidates rank programmes through the matching programme, essentially leading to a "match." The matching programme main match is defined as "an impartial venue for matching applicants' preferences for residency positions with program directors' preferences for applicants." Matching takes place in March, and both the candidate and the programme are legally bound to the outcome of the match. Residency programmes prefer candidates who have some US hospital experience, so enrolling for an elective in the United States may be something worth thinking about. A letter of recommendation from a US consultant is high on the list for a residency match, but letters from UK consultants may be the next best thing. A detailed personal statement is also required.

Timeline
Ideally a candidate should spend about two years preparing for residency. However, this depends on the individual and in some cases preparation can be achieved in a year. The following guide is for candidates wishing to start a residency in July 2008²:

• Begin study for step 1 and step 2 clinical knowledge in January 2007 (January 2006 at the earliest and March 2007 at the latest)
  
• Step 2 clinical skills should be applied for before 1 July and taken before 31 December 2007
  
• Complete step 1 and step 2 clinical knowledge exams by August 2007
  
• Consider attending observerships in the United States before submitting an application for residency as this is a bonus point on your curriculum vitae
  
• Submit residency application by October 2007 as interviews are generally held in November or December
  
• Scores for step 1 and both steps 2 should be submitted by December 2007 at the latest
  
• Rank programmes in February 2008
  
• Match in March 2008
  
• Residency starts in July 2008.
  

You should allow enough time for getting letters of recommendation from referees. You may also need to get advice on writing a personal statement and interview preparation. If you are not called for interview it is highly unlikely that you will be offered a residency position.

Matching
There are three opportunities to match. The main event is the match in March. After this there is a post-match scramble, where a list of unfilled vacancies from the match is posted on the Electronic Residency Application Service and unmatched candidates have an opportunity to obtain a position. Lastly, www.findaresident.com also posts unfilled positions.

Preparing in UK
You can obtain USMLE videos and notes from this site:
http://www.usmlestep.com/

Usmle - Pass Program Notes

Usmle - Pass Program Notes

Are you looking for Pass Program Notes or Pass Program Videos?
This shall be 300 pages of notes that are accompanying 72 hours of video.

The Pass Program Notes will cover the following topics from USMLE Step 1 and USMLE Step 2:

1. Biochemistry
2. Microbiology
3. GI
4. Renal
5. Cardiac
6. Pulmonary
7. Immunology
8. Physiology
9. Vitamins/Metabolic/EKG
10. Neurology / Endocrinology
11. Hematology

Try here first

INTERNAL MEDICINE RESIDENCY PROGRAMS
IMG Friendly Residency

Carraway Methodist Medical Center : Selection Criteria

Montgomery Internal Medicine Residency Program: IMG Criteria
Visa: H1b + J1

University of Alabama, Birmingham : Application Criteria
Visa: J1 + H1b (Case-by-case)
Prematches: No

Review of Pass Program course by Dr. Francis

1) PASS program is less expensive and less time. ($3K vs $7K+...4
weeks vs 6 weeks from what I've heard)

2) Kaplan course sits you down 8 hours a day in lectures and gives you
huge notebooks of things to memorize. PASS is also about 8 hours a day
with decent breaks but then has individual tutoring and teaches you
how to systematically learn all the material instead of just giving
you thousands of pages of material and saying "memorize this!"

3) PASS program has a VERY high pass rate with students who are
retaking the boards (which speaks well if you haven't already had the
experience of failing...) Dr. Francis was actually investigated by the
USMLE people for cheating at some point because he had so many
students passing (he was cleared).

4) The PASS program still highly recommends that you do the qbank and
works with you in individual tutoring sessions to develop a style of
answering questions quickly and accurately.

How to Prepare for the USMLE: Which QBank is the Best?

For most of us, it’s also the first time we’ve ever taken a test like this on a computer. Like most, I have my habits of underlining key words in a question stem, putting *’s by things that I have to skip now but may get later, putting an “X” next to a question that I could never answer correctly, etc. That I’ll be staring at a mouse, keyboard and glowing screen on test day is an unnerving thought.

To get over all of this, we look for practice questions. The good news is that there are thousands of practice questions on Al Gore’s internet and the companies worth their salt have some great supporting software. There are free questions and expensive questions and you get what you pay for. Let’s look at some free/semi-free sources first.

Free/Semi-free sites

• Official USMLE tutorial and practice questions (2007)
  • Gives you four blocks of 50 questions for practice with the testing interface FRED. No explanations for answers and reviewing your questions is awkward.
• Tulane’s Medical Pharmacology Exams
  • I wish I had known about this site when I took Pharmacology. The questions are broken down by subject with explanations of all answer choices. Straightforward multiple choice and great for review.
• Web Path
  • I used this site religiously when I took Path and it was an enourmous help. I recommend it to anyone and everyone. Great questions, great pictures, great format.
    
• Anatomy at University of Michigan
  • I used this site throughout anatomy and I still thanks to this site, I understood enough to really enjoy the subject. Surface anatomy, gross anatomy, radiology, and Anatomy Jeopardy. After the Boards, I owe these guys a bottle of wine and a nice card.
• Lipincott Williams and Wilkins
  • 350-question comprehensive USMLE test, available to anyone that has registered with the site. If you have bought one of their books (Physio BRS), there is an access code in the jacket.
• Student Consult
  • I have access to this because of the two Rapid Review books that I bought (Gross and Developmental Anatomy, Microbiology and Immunology). This site also has 350-question tests for you to use (with the scratch-off code, of course).
• Facts in a Flash
  • Not USMLE format, but if you like working on flashcard questions without the rubberbands and mess, this might be for you.

So after looking at those sites you decide that, while very good for your normal review, you need some professional help for the Boards. You need this enough that you’ll part with some loan money. Whichever company you choose, you should look for the following:

1. Their question bank (QBank) should have enough questions for you to give yourself a fair evaluation, there should not be so many questions that you could not comfortably do them all, and the quality of the questions should be more important than the quantity.
2. The questions are given in the FRED computer format that you are going to see on the USMLE, complete with question marking, annotation, highlighting and strikethrough.
3. Detailed explanations for right and wrong responses.
4. Questions broken down by both subject and system, i.e. Cardiovascular Pharmacology.
5. The software shows your strengths, weaknesses, progress, and performance against all other students using the same questions.
6. THE HOLY GRAIL: The questions are of equal or greater difficulty compared to those on the USMLE.

Question Bank Subscriptions

• KAPLAN ($279, 3 months, 2100 Qs, FRED)
  • This was likely the first company that sprang to mind. Kaplan runs review courses where you live in a hotel for 6 weeks cramming, they have online course content, video lectures, on and on. This company has worked the USMLE inside and out, and it seems a right of passage that students slog through the 2100+ questions before sitting for the exam. I was a little wary of this company, though, as people told me that by the end of the course, they were scoring in the 90s on each block and that the actual USMLE was much harder.
• USMLE WORLD ($110, 3 months, 1730 Qs, FRED)
  • I had never heard of this program, but three people that I consider intelligent (each scored 95+) told me that UW’s questions were more difficult than the actual USMLE. Each of them also subscribed to Kaplan, used its program, and found the programs to offer the same features. After hearing this, visiting their site, and considering the prices, I had to take them seriously. It seemed like a great deal (less than half of Kaplan with a higher rating). The reviews at Prep4Usmle were positive as well. I also like that UW let’s you try their product for a month and if you like it, you can buy more months at a discount.
    
• USMLE Rx ($199, 3 months, 2000 Qs, FRED)
  • Written by the same authors of the First Aid for the USMLE. On glance, they seem to be doing everything correctly. They let you test their product and they offer integration between their online product and the First Aid book. The reviews that I have found put it on par with Kaplan. I’m intrigued.
• SCORE 95 ($99, 3 months, 4300 Qs, FRED?)
  • That this site is slick and has a string of testimonials (which read like a third grader’s homework assignment) is not impressing me. I am also having a lot of trouble actually learning about their program (does it run off your computer, what features does it have, etc.). What I am impressed with is their accompanying note set, that they show you the breakdown of their questions, and that they offer a daily podcast to anyone that wants to listen to a new subject each day. The reviews I was able to find online say that the program is poor and the questions are disappointing. Quantity > Quality. In fact, the number of questions scared me off well before my research. 4,300 questions comes to 360 questions a week for 12 weeks. I currently average 150, and that pace is keeping me busy. I cannot fathom the amount of work it would take to complete these questions, so why have them?
• EXAM MASTER ($179, CD, 8,700 Qs)
  • Absolutely not. On first glance: no. After reading reviews: no. If this program helps your score, it’s probably a placebo effect.

So where does that leave us? If you’re going to start doing questions 3 months before the exam, anything more than 2500 questions isn’t practical. You have to realize that you’ll be spending all day learning the material, and that it might take 3 days to cover a topic. At a reasonable pace, you can expect to do 150-200 a week (which will take you 3 hours and 15 minutes, remember). Anything more than this might burn you. So let’s just throw Exam Master and Score95 right out.

If you believe the worst reviews of the anonymous, Kaplan, UW and Usmle Rx are the same difficulty. If that’s true, then you should go with the cheapest program: UW. If you believe the best of the reviews, UW is harder than Kaplan and Rx, and you should go with UW. Though it has fewer questions, I got the strong feeling that the Quality >>> Quantity, and since I only have so much time to devote to questions, I want them to challenege me and teach me something new. I dropped the $110 and am incredibly happy with it. The questions are stout, and with all my over-preparing for each section, I have yet to crack an 85% in any discipline. This was a good choice for me.

However, if you don’t have much time, are planning on putting all your eggs in the First Aid basket, and would benefit more from reasonably challenging questions (whereas harder Qs might hurt your confidence more than help your score), then I can see a strong case for buying the Rx. It’s twice as expensive as UW, but the formats are indistinguishable and the integration with the First Aid book is appealing. If this wasn’t priced at $199, I might have bought this after finishing UW.

I’m sorry to beat up on Kaplan here, but after going through their QBook and the questions in their Lecture Notes, I’m just not impressed. I have consistently felt that the questions were either written to make me feel good about owning the notes, or that the notes were written to prepare me for those exact questions. Either way, I never had the feeling that Kaplan’s questions were independently difficult (if that makes sense) and from what I’ve read and heard from others, my concerns have merit. And for $279! Get over yourself, Kaplan.

So those are my thoughts on picking a QBank. I assure you that all the research was anecdotal and supplemented with gossip. I suggest heading over to the forums to read for yourself, and if you have any comments on these products, I’d love to hear them.

Kaplan vs. Pass Program

1) PASS program is less expensive and less time. ($3K vs $7K+...4 weeks vs 6 weeks from what I've heard)

2) Kaplan course sits you down 8 hours a day in lectures and gives you huge notebooks of things to memorize. PASS is also about 8 hours a day with decent breaks but then has individual tutoring and teaches you how to systematically learn all the material instead of just giving you thousands of pages of material and saying "memorize this!"

3) PASS program has a VERY high pass rate with students who are retaking the boards (which speaks well if you haven't already had the experience of failing...) Dr. Francis was actually investigated by the USMLE people for cheating at some point because he had so many students passing (he was cleared).

4) The PASS program still highly recommends that you do the qbank and works with you in individual tutoring sessions to develop a style of answering questions quickly and accurately.

Factors that correlate with the U.S. Medical Licensure Examination Step-2 scores in a diverse medical student population

Objective:
To assess factors that correlate with performance on U.S. Medical Licensure Examination (USMLE) Step-2 examination. Our hypothesis was that demographic factors, faculty assessments and other standardized test scores will correlate with students' performance on USMLE Step 2. Study

Design:

A comparison of standardized examinations and demographic factors with USMLE Step-2 scores as the outcome varoble was accomplished using the educational records of 171 medical students.

Results:
Mean USMIE Step 2. USMLE Step 1, NBME-OB/GYN and MCAT scores, respectively, were 190.63, 1943.53, 67.47 and 24.03.

Positive correlations of USMLE Step 2 were:

• USMLE Step-1 scores (r=0.681, p=0. 000);
  
• MCAT scores (r=0.524, p=0.000)
  
• NBME-OB/GYN scores (r=0.614, p=0.000);
• year of OB/GYN rotation (r=0.432, p=0.000);
  
• faculty grades (r=0.400, p=0.000);
• undergraduate GPA (r=0.287, p=0.000);
• and science GPA (r=0.255, p=0.002).

Negative correlations of USMLE Step 2 were

• students increasing age (r=0.405, p=0.000),
  
• increasing number of MGAI attempts (r=-0.182, p=0.000)
  
• and increasing number of NBME-OB/GYN attempte (r=-0.310, p=0.000).
  

There was no correiction with gender or race. Logistic regression analysis showed that a failing NBME-OB/GYN score (p-0.008), failing USMLE Step-1 score (p=0.01), failing faculty grade (p=0.029) and muttiple MCAT attempts (p=0.033) independently increased the risk of failing USMLE Step 2.

Conclusions:
Premedical test-taking abilities (MCAT scores), results of preclinical standardized tests (USMLE Step 1) and performance on clinical rotations (MBME-OB/GYN score and findings may assist educators in selecting medical students at risk of performing poorly on the USMLE Step-2 examinations.

Source

Residency World - Cardiology

Residency world - Cardiology

This is another popular and competitive IM subspecialty. It also is considered one of the three most procedural subspecialties in IM (sharing the honor with GI and Pulmonary/critical care). Cardiology is a 3 year fellowship, with at least 2 years of required clinical training time. The rest of the fellowship can be spent in research or additional clinical time. The clinical practice of cardiology is highly varied, and it allows for a large number of areas of subspecialization. Cardiologists can do angiograms, angioplasties (with interventional training), right heart catheterization, echocardiograms, manage heart failure, coronary artery disease, hypertension, treat arrhythmias, treat pre- and post- heart transplant patients, and manage adult patients with congenital heart disease, just to name a few. Some cardiologists will choose to do further subspecialty training. After cardiology fellowship, graduates can do a 1-year fellowship in interventional cardiology, where they get trained in such things as angioplasties, coronary artery stenting, valvuloplasty, and even things like pulmonary artery stenting. Another certified fellowship that cardiology grads can do is a 1-year fellowship in cardiac electrophysiology, where fellows are trained in pacemaker placement and interrogation, intracardiac defibrillator placements, cardiac resynchronization therapy, and VT/VF and afib/flutter ablation techniques, among other procedures.

Source: http://www.usmlestep.com

What is "fast-tracking?"

What is "fast-tracking?"

Fast tracking, or short tracking, is an option that some residents do who are interested in pursuing academic medicine in a certain subspecialty. People who fast track complete their IM residency in 2 years, instead of 3 years, and then start their fellowship after their second year. The catch to it is that they have an extra year of research added on to their fellowship, so it does not save them any overall time. Advantages of fast tracking include: the ability to pursue a more in-depth research project as a fellow in order to jump-start one's academic career; and less overall clinical training time (some may view this as a disadvantage). A major disadvantage is that in order to fast track, the resident must pretty much know which subspecialty they want to pursue before they even start residency, because they will have to apply for fellowships early in their intern year, and they will not have enough time to adequately explore most subspecialties. Most people who fast-track have MD/PhD's or have already done extensive research in their intended subspecialty. In order to short track, you must get permission from your residency program, then apply and get accepted to a fellowship program as a short-tracker. You do not have to stay at the same institution as your residency in order to short track, although that is the most common way to do it.

Source: http://www.usmlestep.com

Which IM subspecialties are more competitive to get into then others?

Which IM subspecialties are more competitive to get into then others?

Right now, most people agree with the following order of competitiveness:

Most Competitive:
Cardiology
Gastroenterology
Allergy and Immunology

Moderately Competitive:
Pulmonary
Nephrology
Hematology/Oncology

Mildly Competitive:
Infectious Diseases
Endocrinology
Rheumatology
Geriatric Medicine

REVIEW OF STEP 1 MINIMUM PASSING SCORE

September 29, 2006

The USMLE program recommends a minimum passing level for each Step. Medical licensing authorities may accept the recommended pass/fail result, or they may establish their own minimum passing requirements. The recommended requirements to pass USMLE Step 1, Step 2 Clinical Knowledge, and Step 3 were originally identified in the early 1990’s and the Step 2 Clinical Skills standards were first identified in November 2004.

The USMLE Step Committees are responsible for the design and development of the Step examinations, as well as establishing and monitoring standards. These committees are made up of physicians and scientists who bring educational, licensing, and practice perspectives to this process. Every three to four years a Step Committee is asked to complete an in-depth review of standards. This process is about to begin for USMLE Step 1. The current recommended minimum passing score of 182 was most recently reviewed in 2003.

The Step 1 Committee is scheduled to assess the minimum passing score at its meeting on December 12-13, 2006. In its review of the minimum passing score, the Step 1 Committee will consider information from multiple sources including: 1) results of surveys of various groups (e.g., state licensing representatives, medical school faculty, samples of examinees) concerning the appropriateness of current pass/fail standards for Step examinations; 2) recommendations from independent groups of physicians and scientists who will participate in content-based standard-setting activities late in 2006, 3) trends in examinee performance; and 4) score precision and its effect on the pass/fail decision. The decision of the Step 1 Committee will be posted at the USMLE website. If the Committee determines that a change is appropriate, the new recommended minimum passing score will become effective for all examinees who begin their Step 1 examination on or after January 1, 2007.

Blueprints

Blueprints Obstetrics and Gynecology (Blueprints)

Download from 4usmle.net


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Blueprints Pediatric Infectious Diseases (Blueprints)

Download from 4usmle.net


Designed as a quick read for both students on a pediatrics rotation and others who want to
know more about the specialty, Blueprints Pediatric Infectious Diseases covers the
essentials of pediatric infectious diseases that every practitioner will need to know.

Pocket-sized and practical, these books will cover the most common conditions students are
likely to encounter. Each guide focuses on the essential content students need to know
during a rotation allowing for a fast, easy read. The text emphasizes pathophysiology,
diagnosis, and treatment. Twenty-five multiple-choice and matching review questions are
included to help students test their understanding of the subject.

The book also features valuable appendices on career and residency opportunities,
commonly prescribed medications, and a list of suggested additional reading for those who
would like to learn more.

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Blueprints Pediatrics (Blueprints)

Download from 4usmle.net


More than just Board review for USMLE, Steps 2 & 3, Blueprints Pediatrics, 3rd edition can help you during clerkship rotations and subinternship. The new edition has been updated with the help of residents to maintain a student-to-student approach. Features include:

* Concise, accurate, clinical high-yield content covering all you need to know for the USMLE and rotations
* USMLE style questions with full explanations provided in the answers
* Key Points in every section highlighting the most important, high-yield information for each topic
* Color-enhanced design to increase the usefulness of figures and tables

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Blueprints Medicine (Blueprints)

Download from 4usmle.net

Can help you during clerkship rotations and subinternship. They are especially helpful
when studying areas outside your specialty. Physician assistants, nurse practitioners
and osteopaths find Blueprints a helpful companion to their study materials as well.