CRACKING THE USMLE

 

Advitya Malhotra ('96)

Research Fellow, Hepatology, Yale University, Connecticut, USA

(Posted 03/04)

I am compiling material on some of the key issues regarding the ever-evolving process of applying for a residency in the USA. The database we generate here would be helpful to GMCites preparing for coming to the USA.

It has been a year since I came to the USA, and during this year I have experienced life as a graduate MPH student (on F1 visa), as an ad-hoc worker, and now, as a Post-Doc fellow (on H1B (research) visa) at Yale, one of the most prestigious university in the USA. It was on the advice of a friend, that I applied for research and finally got this position. I have realized the importance of proper and timely advice. Hence I will try to emphasize the importance of all the steps involved in securing a residency position in a top notch program. Coming from a middle class family, I know this whole process can be a big financial burden, but proper planning and advice can certainly cut down unnecessary expenditure.

The USMLE steps should be taken at the earliest possible and cleared with decent scores (90+). I would encourage everyone to take the USMLE during internship. I believe that both the steps can be taken easily within 7 to 9 months, along with the GRE in another month. Scores definitely help in getting into a better program and low scores are usually not entertained by good programs. But this should not discourage people with low scores, since eventually almost everybody gets into some kind of a residency program (and then, one always has the option of moving on to a better program). I will not be discussing any visa issues here, but I would like to mention the fact that non green card holders/non US citizens should try to come here via the GRE route, if possible. I feel it is the safest and best option and certainly the most rewarding. Try not to risk CSA/visitor visa unless you are in early in your graduation or have been to US before.

I am aware of the fact that people read and learn from different books; hence books mentioned here are not definitive. But since I meet applicants and have friends with 99 in both steps, and almost all of them have read more or less the same books, I think there is certainly some sort of concordance here.

USMLE step 1 exam has increasingly become simple because of the availability of some good quality review books and Kaplan notes. Kaplan is helping a lot of students to score high 90s. But there is also a downside of just reading Kaplan. The book contains a lot of information and exam-oriented material, and without going to the Kaplan class it means that you end up mugging the facts. So the preparation for Step 1 should start with text and review books, and then supplemented with Kaplan notes. I have made an effort here to list some of the books that are easily readable and have excellent reproducibility (for scores).

USMLE STEP 1

Anatomy

High Yield (gross +, embryology +, neuroanatomy +++, cell & molecular biology ++, histology + (must read first 20 pages))

Kaplan Anatomy (good for revision)

Physiology

BRS (graphs, especially CVS)
Kaplan (initial pages are a must read)

Bio-Chemistry

Kaplan (nucleotide metabolism, rate limiting reactions, hereditary metabolic disorders, storage diseases)
Lippincott (good for figures, but difficult to revise)

Pharmacology

Lippincott (mechanism of action, important side effects, important drug interactions)

Kaplan (only good after you know Lippincott)

Microbiology

Jawetz OR Anthnarayan (both are good, can use either)
Kaplan (good for revision)

Immunology

Kaplan (must read)

Pathology

BRS (leukemia slides)
Robbins (difficult to revise)

Behavioral Sciences

BRS (ethics)
Kaplan

Genetics, Cell & Molecular Biology

Lippincott (read chapter)

Biostatistics

High Yield (only concepts, no numericals)

Kaplan notes are fantastic for behavioral science, ethics, biochemistry, immunology and physiology. All Kaplan notes should be revised with the text/review books.

Clinical Vignettes

Excellent resource to understand the type of questions that crop up in step 1 and 2, I will say must read books.

USMLE 1 First Aid (Backbone of your preparation)

CDs

Kaplan (helpful explanations, great practice)
BSS (option of preparing your own test)
USMLE (must do)

I have heard Kaplan Q book, is good for practicing questions and has informative explanations. It would be nice to hear from somebody who has read the book.

Good step 1 preparation lays down the foundation for achieving success in step 2, and even in Indian PG entrance exams.

USMLE STEP 2

Medicine forms the core of Step 2; emphasis is laid on diagnosis and management. Try to build up clear and good concepts.

Medicine

CMDT (indispensable)
Blue Prints (fast for revision)

Pediatrics
Blue Prints (good, but doesn’t cover few topics like adolescent diseases)
Lange (look up only adolescent medicine)

Psychiatry
BRS (read it thoroughly)
Kaplan Saddock handbook (DSM-IV criteria)
High Yield (excellent book for revision)

Obstetrics & Gynecology
BRS (excellent coverage, perfect for the exam)
Blue Print (few students prefer reading it, I don’t have much experience with it)

Surgery/Orthopedics

Kaplan

Questions

Kaplan CD, USMLE CD and Kaplan Q book.

Apart from the above mentioned books, Kaplan Step 2 is an excellent resource to prepare for the exam, but I feel relying just on Kaplan for step 2 could be disastrous.