Residency and Fellowship.com - USMLE & Residency

USMLE, Medical Residency & Fellowship in the United States.

USMLE, residency, ERAS and fellowship applicants are often faced with several hurdles and conflicting information in their search for an ideal medical residency program and career. We have posted several relevant medical articles on these vital topics and plan to keep you informed of events in the field of Medical education. International medical graduates (IMGs), medical students and ECFMG applicants will also benefit from the valuable medical information presented here. Our ultimate aim is to make all essential information on USMLE, medical residency, fellowship and the ERAS / NRMP match available in one place – our website. We dedicate this website to all Physicians-in-training.

Medical Residency Forum is an informal discussion community, where you can post residency information that you think may benefit other USMLE, residency and fellowship applicants. You can also post your questions and comments on ERAS, NRMP match, USMLE Step 1, Step 2, Step 3 exams and specific problems faced by International Medical graduates (IMG). This is also the place to share information about your residency interview experience and your thoughts about specific medical residency programs. Physicians currently participating in residency or fellowship programs can also participate in the discussion of their residency programs.

USMLE & ECFMG.

Education Commission for Foreign Medical Graduates - ECFMG, was established to assess the competence of Foreign Medical Graduates (FMG) to enter medical residency and fellowship programs in the U.S. In order to join a medical residency program, you will need a ECFMG certificate. All foreign medical graduates are required to take the United States Medical Licensing Examination (USMLE) to get ECFMG certified. By issuing this certificate, ECFMG certifies that you have completed all requirements to begin your internship, residency or fellowship. The USMLE exam consists of three components: Step 1, Step 2, and Step 3.

USMLE Step 1

USMLE Step 1 tests your knowledge of the basic medical sciences. Though the content of this exam is predominantly fact-based, most questions are now given in the context of a clinical scenario. These “patient encounter” questions are given in a multiple-choice (MCQ) format.

USMLE Step 1 is a one-day computer based test, given over 8 hours. Step 1 consists of 350 Multiple choice questions (MCQs) which are divided into seven blocks. Each block lasts for 60 minutes and there is one hour of break time, which can be split up and used in-between blocks, as you like. The USMLE Step 1 exam can be taken at Prometric centers, in the U.S. and several countries around the world. Click here to view USMLE Step 1 Prometric test center locations. The test is given continuously, through out the year.

U.S. medical school students usually take USMLE Step 1 in their second or third year. If you are an International Medical Graduate (IMG), it is advantageous for you to take this after completing your medical school. You will be able to recognize the clinical scenarios given in the question better, after you have finished your medical school. Download USMLE Step 1 sample questions

Minimum USMLE pass scores.

The minimum score to pass the USMLE exams is 75 on the two-digit scale. To achieve a minimum score of 75, examinees must answer about 60 to 70 % of the MCQs correctly. It is in your interest to get a good USMLE score, to increase your chances of getting into a good residency program. A good USMLE score also helps to get into the highly competitive specialties like Radiology, Orthopedics and Dermatology.

USMLE Step 2.

USMLE Step 2 tests your medical knowledge and its application to patient care. Step 2 predominantly assesses the clinical subjects, with the bulk of questions from Internal Medicine. Other areas tested include surgery, OB/GYN, Pediatrics, Orthopedics, Psychiatry, ENT, Ophthalmology, and medical ethics. USMLE Step 2 exam is a one-day computer based test, given over nine hours. The exam consists of 370 MCQs, which are divided into eight blocks. Each block lasts for 60 minutes and there is one-hour break time, which can be split up and used in-between blocks as you like. The USMLE Step 2 exam can be taken at Prometric centers in the U.S. and in several countries, around the world. Prometric USMLE Step 2 test center locations. The test is given continuously, through out the year

U.S. medical students usually take the USMLE Step 2 exam in the final year of medical school. If you are a Foreign Medical Graduate (FMG), you should plan to take this test after your medical school, and preferably after you have completed your Internal medicine rotation. Most MCQ questions give clinical scenarios and ask you to make medical diagnosis and clinical decisions. Obtaining a good score is vital for matching to a good medical residency program. USMLE Step 2 sample questions.

Changes to USMLE Step 2 exam.

ECFMG has announced the following changes to USMLE Step 2 exam. These changes are likely to take place in mid-2004.

USMLE Step 2 examination will consist of 2 parts.
USMLE Step 2 CS (Clinical Skills) will replace the existing ECFMG CSA.
USMLE Step 2 CK (Clinical Knowledge) will replace the existing Step 2 MCQ exam
The fee will remain the same ($1200)

ECFMG’s Clinical Skills Assessment (CSA) .

The purpose of the CSA is to test your medical communication skills, English proficiency, history, physical exam and diagnostic skills. CSA is a one-day exam that lasts for approximately 8 hours. You will be given about 10 patients to examine. You will have the opportunity to interact with them for 15 minutes each. You will then have 10 minutes to write a brief medical case history, physical findings, differential diagnosis and treatment plan. It is not computer based. It is a live exam with paid actors portraying patients. At present ECFMG’s CSA is given only at two centers in the U.S. - Philadelphia, PA and Atlanta, GA. You will have to travel to these cities to take ECFMG’s CSA exam. Learn more about ECFMG CSA & USMLE Step 2 CS.

ECFMG recently announced that the CSA exam will be replaced by USMLE Step 2 CS (Clinical Skills) in June 2004. There are plans to open up additional Step 2 CS test centers. When these changes are completed, ECFMG hopes to have the following five test centers for USMLE Step 2 CS / CSA …

Philadelphia, PA - June 2004
Atlanta, GA - July 2004
Los Angeles, CA - August 2004
Chicago, IL - September 2004
Houston, TX - September 2004

ECFMG CSA will be administered for the last time on April 16, 2004. USMLE Step 2 CS starting June 1, 2004 will replace this. Between April 17, 2004 and May 31, 2004, no tests (CSA / Step 2 CS) will be available.

The new USMLE step 2 CS will consist of three components.

Integrated Clinical Encounter consisting of data gathering and patient notes
Communication / Interpersonal Skills
Spoken English Proficiency

Candidates must pass all three components to pass USMLE Step 2 CS. There is no limit on the number of attempts to pass the Step 2 CS. There is a minimum wait period of 60 days between consecutive attempts and a limit of three attempts in a 12-month period.

Once the USMLE Step 2 CS (clinical skills) is implemented from June 1, 2004, the present English language proficiency test (TOEFL) will be eliminated as a requirement for ECFMG certification.

To stay on top of these changes, sign up for the free e-newsletter “ECFMG reporter”. This information can also be obtained from the official USMLE website.

ECFMG Certification.

When you have completed USMLE Step 1, Step 2, and CSA you will be eligible for ECFMG certification. Click here for other requirements for ECFMG Certification. You will initially be given a “standard ECFMG certificate” with an expiry date. If you don’t join a medical residency or fellowship program before the date printed, your ECFMG certificate will expire. Once you join an internship or residency program, complete and mail the required Form 246, for permanent validation of ECFMG certificate. Do this ASAP after starting your residency. You will require your residency program director’s signature on the form. ECFMG will now send you validation stickers by mail. Once these stickers are placed on your ECFMG certificate, the expiration date is cancelled and the certificate becomes “valid indefinitely”.

Getting into a medical residency.

To join an internship or residency, you should have the standard ECFMG certificate and apply to medical residency programs in the U.S. Most residency programs participate in the Electronic Residency Application System (ERAS). ERAS is a simple and pain-free way of applying to several residency programs, in different residency specialties, with the click of a mouse from your home computer. This is an excellent service for medical residency applicants. ERAS website for medical residency applicants.

You will be required to upload your CV, Personal statement and other information from your computer to the ERAS website. Medical school transcripts and letters of recommendation (reference letters) should be mailed to the ERAS office. These will be scanned and uploaded by ERAS staff. You will then have to select the residency specialty and specific residency programs that you wish to apply to. Once this is done and fee is paid to ERAS / NRMP, the application and supporting documents are sent electronically to the designated residency programs. You will have to register with both, ERAS and NRMP by paying separate fees.

The residency program directors and secretary will now screen your application and determine whether to call you for a medical interview. If you are chosen, you will be informed either by e-mail or Postal mail. If you wish to take part in the residency interview, you should call the residency program secretary and arrange for a mutually convenient time for the medical interview. You will then have to make your own travel arrangements (at your own expense) and attend the residency interview. Click this link for medical residency interview tips.

You can, and should plan to attend as many residency interviews as you can. This gives you more choice in selecting a residency program and increases your chances of a successful ERAS / NRMP match. The residency interview season comes to an end by the last week of January. You will then be required to submit a rank order list to ERAS / NRMP for the match. This is your final ranking of the residency programs, in your order of preference.

Medical residency programs will also rank the residency applicants according to their preference and submit it to ERAS / NRMP. Now the National Residency Matching program (NRMP) takes over. NRMP computers will now match individual residency program’s preferences with your preferences and come up with the final list. NRMP website for medical residency applicants.

2004 NRMP residency match schedule – simplified.

ü February 25, 2004, 11.59 pm ET - Rank order list deadline

ü March 15, 2004, 12 noon ET – Residency applicants get to know if they matched or not. No further information available. Residency Program name unknown.

ü March 16, 2004, 11.30 am ET – residency programs get to know if their positions were filled or unfilled.

ü March 16 2004, 12 noon ET- names and location of residency programs with unfilled positions released. The scramble begins. Unmatched residency applicants now contact unfilled residency programs to find a spot.

ü March 18, 2004, 1 pm ET – The residency Match day. Applicants get to know the location and name of the residency program they matched to.

After the NRMP residency match.

Your residency program will contact you, in a few weeks, with details on their intern orientation, ACLS course, Visa processing, and the state medical license application. The NRMP residency contract also needs to be signed by you and the residency program director. Most residency programs start their Intern orientation in the third week of June. You should be prepared to move to your new place by the second week of June. This will give you adequate time to get used to the new city, furnish your apartment and get settled in. Network with the third year residents (PGY 3) to find out about specific apartments and houses. Remember that they are preparing to leave, and may be trying to sell their furniture and medical books. You can get a great deal on these, besides some free advice on your residency.

USMLE Step 3.

USMLE Step 3 exam is designed to test your medical knowledge, its application to patient care and clinical decision-making. In other words, USMLE wants to make sure that you will do fine, practicing medicine independently and without supervision. You must be ECFMG certified to be eligible to apply for USMLE Step 3 exam. To obtain a permanent medical license from any state medical board, you should have successfully completed USMLE Step 3 exam. Visit FSMB website for USMLE Step 3 eligibility info of different state medical boards.

Step 3 exam is a two-day computer based test, given over eight hours, each day. The exam consists of 480 MCQs, which are divided into several blocks of 35 to 50 items. Each block may last from 45 to 60 minutes. There is one-hour of break time, which can be split up and used in-between blocks as you like. The test also includes nine Computer-based case simulations (CCS) given over four hours, on the second day. USMLE Step 3 & CCS sample questions.

USMLE Step 3 exam can be taken at Prometric centers in the U.S. only. Step 3 is not available outside the United States. Click here to view USMLE Step 3 Prometric test center locations. The test is given continuously, through out the year.

If you don’t require a H 1 visa to join a medical residency program in the U.S., then don’t be in a hurry to take the USMLE Step 3 exam. Generally, residents take the Step 3 exam at the end of their first year of internship or residency (PGY 1). Step 3 is not just an assessment of your medical knowledge. It is mainly an assessment of your clinical decision-making ability and medical management skills. You will be proficient at this, by the end of your first year of residency and that is the best time to take USMLE Step 3 exam. Click here for USMLE Step 3 & CCS tips .

Medical licensure.

Individual State medical boards grant medical licenses for practicing medicine within their jurisdiction. The requirements vary widely and details can be found at the American Medical Association (AMA) website. State medical board requirements for medical license and USMLE Step 3 information. Most state medical licenses take a few weeks to obtain. However, if you are applying to Texas, California or Florida, be prepared for a long wait (about 6 months).

Contact Residency and Fellowship.com.

When writing these articles, we have avoided stating the obvious, and instead focused our attention on the important and often overlooked areas of medical residency and medical education. We have spent hundreds of hours of research, to make sure that all the essential information has been included. However, if you feel that certain aspects of medical residency need more coverage, or if you have any suggestions to improve our website, please let us know. We appreciate all input from you. Contact Residency and Fellowship.com.

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