Never have I ever come across an examination like the USMLE – United States Medical Licensing Examination; its uniqueness is in its intricacy and practicality. The Becker Professional Education’s program about this examination was not just enlightening; it was an eye-opener. It held on the 19th of September, 2018 and took place in the Old Great Hall of the College of Medicine, University of Lagos. It was a well anticipated event as over 250 medical students were in attendance, including those of the Lagos State University Teaching Hospital.
This event, which was gracefully compered by Chukwudi Akubueze, kicked off at 12.30pm. The outstanding guest speaker from Becker Professional Education is Dr. Adedayo Adeboye, an invasive cardiologist. He is currently an associate professor of Clinical Medicine and the associate program director for the Cardiology Fellowship Program at the University of South Carolina School of Medicine. He thoroughly did justice to the perplexity of most medical students concerning the procedure of taking the USMLE.
The USMLE is a three-step series taken by indigenous or foreign medical students or doctors that aspire to become licensed to practice medicine in the United States. It appraises their ability to apply the knowledge gained from medical school and demonstrate basic patient-centered skills. It is organized and funded by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME).
Dr. Adeboye explained that the Step 1 multiple-choice examination comprises questions on eight disciplines of basic medical science – Anatomy, Biochemistry, Behavioural Sciences, Physiology, Pharmacology, Pathology, Biostatistics and Epidemiology, and Microbiology. It is an eight-hour, computer-based examination that tests the examinee’s ability to apply these disciplines to clinical scenarios. He advised that four to ten months should be used to prepare for this step, but using less than five months is better in order to conquer forgetfulness as far as their consistency. The current minimum passing score for this step is 194. Moreover, it is highly advisable to aim at attaining exceptional scores in all the three steps as one’s scores are the most important, determining factor of becoming a licensed physician in the United States. According to Dr. Adedayo Adeboye, “Good scores speak for you and open doors for you.”
The second step of this examination consists of two tests: Step 2 Clinical knowledge (CK) and Step 2 Clinical Skills (CS). The Step 2 CK examination assesses the examinee’s ability to apply clinical science to patient care and treatment. It is a nine-hour, computer-based, multiple-choice examination that comprises questions related to Obstetrics and gynecology, Paediatrics, Psychiatry, Preventive medicine and Surgery. He advised that three to four months are needed to prepare effectively for this test. Step 1 and Step 2 CK can be taken outside the United States; Nigerians and other West Africans mostly take these tests in Ghana. Furthermore, the step 2 CS examination is an intriguing aspect of the USMLE as it involves a real doctor-patient interaction. It is only taken at Clinical Skills Evaluation Collaboration test centers in the United States. It is an eight-hour pass or fail examination that involves twelve standardized patient encounters supervised by a program director. The patients are actually well-trained actors who mimic diseased patients. The exam is graded based on spoken English proficiency, communication and interpersonal skills, and integrated clinical encounter. Basically, the examinee should have good bed-side skills to pass this step. He advised that one to two months be used to prepare for this test.
Finally! The ultimate step that paves the way to getting licensed is Step 3. This unsupervised examination uses computerized versions of patient encounters to appraise the examinee’s ability to take history, order diagnostic tests, manage the patient and choose the needed primary treatment correctly. It is a two-day, computer-based, multiple-choice examination that focuses on patient management, lab and diagnostic studies, history and physical, diagnosis, prognosis and pathophysiology. Dr. Adeboye advised that three to four months be used for preparation of this step.
After the detailed explanation about the procedure of the examination, he discussed the tips and tricks to life after USMLE. After passing the examination, the medical doctor is expected to apply for various residency programs. This is the time when exceptional scores start to open doors for one especially if one is a foreigner. Interviews are then held with the various programs that are of one’s interest. Thereafter, these programs will be ranked according to one’s preference. Finally, match day arrives when the new residents discover the residency training, they will attend subsequently.
Under normal circumstances, citizens of the United States have a higher chance of getting admitted. He explained that indigenous medical graduates of the United States apply for subspecialties that are more rewarding financially such as dermatology, neurosurgery, radiation oncology and orthopedics, in order to hasten the payment of their debts acquired from the huge expenses of medical school and loans taken to pay these fees. Therefore, these are some of the most competitive subspecialties for both indigenous and foreign medical graduates.
The next segment of the program required us to put on our ‘clinical thinking caps’ as we attempted USMLE-styled questions. We answered questions on valvular problems, myocardial infarction and atrial fibrillation, to mention a few. I was beyond awed as I saw videos on new medical inventions such as when a percutaneous valve replaced a damaged valve of the heart without surgery. All these made me appreciate the advancement and involvement of technology in medicine.
Some medical students were definitely set aback by the intricacy of the USMLE until he finally expatiated on how Becker Professional Education can help us turn our dreams into reality. It trains aspiring examinees to be confident, organize thoughts and think like the examiner. It compresses large books, making it easier to prepare for the examination. Moreover, it designed web-based and phone-based applications to help the student track his/her progress, have access to his/her books online, watch explanatory videos, and visit the question bank of USMLE-styled questions that have detailed explanations including references to Becker textual content. It also offers live online classes and mock examinations. Fortunately, Nigerians are eligible to register at a discounted price using a promo code.
Before the program, I was probably one of the most confused people seated in the hall that had multiple questions concerning the USMLE, having made conjectures and believed hearsay. He did not just inform me about this examination; he made me believe that with utmost determination and hard-work, I can defeat its intricacy and get exceedingly high scores. I am uncertain about where I want to do my residency program in future, but I definitely am aware of the tips and tricks of the USMLE which creates a stepping stone for me to consider pursuing my residency in the United States.