The
USMLE Step 1 tests whether students understand and apply concepts and principle
of basic sciences to the practice of medicine. In contrast to what most of
international medical students are taught (especially in the third world), this
test never test isolated facts that many students tend to memorize. For such
students (I was one of them), the test can be a curse.
It’s
a nightmare for many students, especially, those who go to medical schools,
which don’t prepare them for the test, don’t integrate basic sciences to
clinical practice or don’t do both. Students with high failure rate in the
USMLE Step 1 indicate and reflect poor teaching technique in basic science in
the school they attended. Schools and academic staffs should be accountable for
low percent of students passing USMLE 1.
A
study was published in the Advances in
Medical Education and Practice, showed that releasing USMLE Step 1 medical
schools’ scores increases the accountability and the national standards in these
schools. Eltorai 1.
Although,
USMLE Step 1 for some is a blessing, especially those who score high. It opens
many doors in choosing their selected residency training programs, indicates
how dedicated the candidate for research and science and increases the chances
for the newly graduate physicians to get accepted in some jobs (for example in
Saudi Arabia.)
High
score in USMLE showed strong correlation with passing the in-service exam
during the residency training (this is good indicators for many program
directors) and for the final board. Kay, Jackson, Frank 2.
Most
American Medical Graduates have from 4-6 weeks to prepare for USMLE Step 1.
Some students attend commercial coaching courses, but a study was done on 468
students showed those who attended commercial courses, score no higher than
those who self studied (P-value<0.05). Werner, Bull 3.
But,
when it comes to International Medical Graduates (IMG), the story is totally
different. I have seen more International Medical Graduates fail the test or
score lower, especially in Step 1. All the previous above studies can’t be
applied to IMGs, as the population is different than the USA students.
I summarize
why IMGs score lower or fail USMLE Step 1:
1.
Taking a test
different than your tongue language, would definitely affects some exam takers.
2.
Studying Basic
Science during or just after studying English Language during the beginning of
University study.
3.
Poor teaching
techniques in Medical Schools and lack of awareness among medical students
about the importance of the USMLE Step 1. For instance, I personally didn’t
know about the test until I reached my third year in medical school. A friend
of mine knew about the test in his internship. The later students know about
the test, the more difficult it’s for them to have the time to prepare.
4.
Comparing to
their counterpart IMGs, American Medical Graduates take Step 1 just after few
weeks of finishing the basic science courses. While many IMGs take the test
after they graduated from medical school or even after practicing for few
years. Thus, for many, trying to rehabilitate them with commercial courses (like
Kaplan, Falcon and etc.) will not help, because those courses are meant to
coach and brush up your knowledge, not to teach basic sciences from scratch.
5.
Many IMGs (even
some AMGs) underestimate the importance of practicing cases. Since the
beginning of USMLE, the exam evolved greatly to be more clinically oriented.
That’s why even Step 1 has more than half of the questions start with clinical
description. All these efforts to mimic the real life physician-patient
encounter and catch students whom memorize isolated facts.
6.
Don’t have
coach/advisor or don’t ask reliable students who already took the test before
them.
7.
Rush to take the
exam (You can’t retake the exam to make up for low score, unless you fail,
which is pernicious picture).
8.
Take too long to
prepare for it. Usually taking too long time leads to burnout or erodes your
self esteem
In conclusion, USMLE Step 1 is not an easy test, but
still doable. The difficulty of the test becomes apparent when students
underestimate the time needed for preparation, don’t understand how the test
evaluates students or don’t practice enough to apply basic science principles
and concepts on multiple-choice questions. Commercial courses are to coach and
not to rehabilitate students with dusty ill-founded background on basic
sciences. Thus, think critically before you invest your money and time.
references
1. Eltorai AE. Publishing medical schools'
USMLE Step 1 scores: increase preclinical education accountability and national
standards. Advances in medical education
and practice. 2013;4:135-136.
2. Kay C, Jackson JL, Frank M. The Relationship
Between Internal Medicine Residency Graduate Performance on the ABIM Certifying
Examination, Yearly In-Service Training Examinations, and the USMLE Step 1
Examination. Academic medicine : journal
of the Association of American Medical Colleges. Jan 2015;90(1):100-104.
3. Werner LS, Bull BS. The effect of three
commercial coaching courses on Step One USMLE performance. Medical education. Jun 2003;37(6):527-531.