USMLE GUIDELINES
The road for an Indian doctor to get certified in the US and join a post-graduate program is a long, hard, and expensive one. While diligence and dedication are essential to ensuring success, this guide aims to make the process a little easier by trying to answer your questions and concerns, providing advice and tips from those who have successfully completed the process, and laying down the road map and timeline to help you better and more efficiently plans your efforts.
There are three broad steps in this process – getting certification, being accepted at a residency program, and obtaining the proper visas. The first step of getting certification involves clearing a set of examinations, namely the United States Medical Licensing Examination (USMLE), the Clinical Skills Assessment test (CSA), and the Test of English as a Foreign Language (TOEFL). This if followed by applying to residency programs, interviewing, and matching, which comprise the second step. And thirdly, getting the proper immigration authorization or visa to join the residency program. In addition, there are issues of cost and how to time these different steps as well has a host of related issues that are addressed separately. Please see the left sided frame for specific topics.
Contents
General Overview
USMLE is the United States Medical Licensing Examination. It is administered by the Educational Commission for Foreign Medical Graduates (ECFMG) and comprises of three steps – Step 1, Step 2, and Step 3. Medical graduates from outside the US, or International Medical Graduates (IMGs), have to clear Steps 1 and 2 in order to be eligible for certification in the US and to apply for residency programs, the equivalent of the Indian PG programs. While American medical graduates also take the same USMLE exams for licensing, in their case they are a part of their basic medical curriculum and are taken in the second and fourth year of medical school.
All the USLMLE Steps are multiple choice question type exams and are now all administered on the computer, or Computer Based Test (CBT). The Step 1 and 2 exams are both one day exams and are available throughout the year and in many cities worldwide at Sylvan Technology Centers.
The USMLE Step 3 is different than the first two in that it is not required for certification and in fact can only be taken after ECFMG certification has be obtained. It is typically taken at the end of the first year of residency, but many IMGs take it before applying for residency so as to qualify for an H-1B visa status (refer to Visa Issues). The Step 3 is administered by the Federation of State Medical Boards (FSMB) and is offered only in the US. While it is also a CBT, it is given over two days.
Step 1 - Assesses the understanding of basic biomedical science and the ability
to apply its key concepts, with an emphasis on principles and mechanisms of
health, disease, and modes of therapy. This part therefore focuses on the application
of basic sciences.
Step 2 - Assesses the understanding of clinical science and the ability to
apply it in clinical scenarios with an emphasis on health promotion and disease
prevention, considered essential to practicing medicine under supervision. This
part therefore focuses on diagnosis and application of clinical sciences.
Step 3 - Assesses the understanding of biomedical
and clinical sciences considered essential for the unsupervised practice of
medicine, with an emphasis on patient management in ambulatory settings. This part is application of both of the
above for management in various family practice settings
Application process
Applying for USMLE
Step 1 and 2
Applying for the USMLE Step 1 and 2 involves getting the application materials, meeting the eligibility requirements, filling in the forms, and scheduling the date and center location.
Getting the
Application Forms
For International Medical Graduates (IMGs) the application materials for USMLE Step 1 and 2 can be obtained from ECFMG. You can fill in the application form for Step 1, Step 2, or both at one time. There is a separate application form for Step 3 and the CSA. The application materials can be obtained by writing to ECFMG or by downloading it off their web site. Their contact information is,
Education Commission for Foreign Medical Graduates (ECFMG)
3624 Market street,
Philadelphia, PA 19104-2686
(215) 375 1913.
For mail requests it typically takes 2-3 weeks to receive the application materials. Downloading from the web is the recommended and fastest way of getting the forms. Also, to ensure that one gets their preferred examination center and date, the application should be filled in and sent preferably 2months before the desired test date. With the test becoming computerized the issue of getting the right center and date has become much easier, but applying earlier is always better.
Eligibility Requirements
Eligibility requirements for the USMEL Step 1 and 2 are:
A medical student officially enrolled
in , or a graduate of Foreign Medical school and eligible for examination by
ECFMG for it’s certificate.
The medical school must be listed in
World directory of medical schools , published by World Health Organization.
A candidate must have completed at
least two years of medical school to be eligible for step 1 examination.
A
candidate must be within 12 months of completion of full didactic
curriculum.
If a candidate is still a student in
his/her medical school , his application must be certified both by student and
the dean /Vice dean/registerar of the medical school.
Graduates must submit a copy of their
medical diploma with the initial application. If the medical diploma has not
been issued, application must be signed by Dean/Vice dean/ Registerar ,
confirming that the candidate has graduated from the medical school.
Filling out the Forms
Along with the form you will need to attach a copy of your MBBS degree, unless you are applying for Step1 in your third year of medical school in which case it is not required. The application has to be verified by either your medical school dean/principal, notary public, or an official from US consulate. Most medical schools do many such applications a year and therefore are comfortable verifying the applications fairly quickly.
The form also has an associated fee of $610 This needs to be remitted with the form
You will receive an acknowledgement of the receipt and would receive a scheduling permit. This permit would contain a identification number and telephone numbers of Sylvan Prometric Inc., an agency which conducts the exam.
Scheduling a Date and Center
Once you have received your permit with the identification number on it, you are then ready to schedule your test date and center. You can do this by calling Sylvan Prometric at the given number. They ask you for and then allow you to pick your desired location and date.
It is important to note that your scheduling permit will specify a period within which you are required to call Sylvan and select your test center and test date(s). You can always change your test dates, and this is done free of cost upto 5 days prior to your selected test date. Thereafter you have to pay a rescheduling fee for the same service. Your rescheduled date however must fall within a testing period mentioned on your scheduling permit.
You can find the different locations of Sylvan Technology centers at
www.sylvanprometric.com. In India, there are nine testing locations in Ahemadabad, Allahabad, Bangalore, Calcutta, Chennai, Hyderabad, , Mumbai, New Delhi, and Trivandrum.
Scoring system
Step 1 and 2 Scoring The USMLE Step 1 and 2 exams are computer-based MCQ exams. There is no negative marking for incorrect answers, but all parts of the examination have to be completed in order to get a score. It usually takes 1-2 weeks for the scores to be reported from the date of the examination and they are only sent by post and not revealed over the phone or to any other third party. The score report sent to the candidates has two scores – the raw score and the percentile. The raw score is your actual score in the test in terms of questions answered correctly.. While this is an important metric, it is really the percentile score that is more widely used and taken as the effective USMLE score. The passing score for both the exams is determined in percentiles and has been fixed at 75 percentile. The score report breaks down your performance into the various indivudal topics and sub topics on the exam. What is a percentile score?A percentile score is a standardized representation of your performance. It places your raw score in perspective of how other students fair in the exam to give you a relative score and in doing so normalize for differences across centers and dates. For example, based on the scoring pattern over the past few years, if you attempt about 55 % of the questions correctly then your percentile score should be approximately 75. However, this is a rough guide and standardization varies from year to year. So only your final percentile score tells you how well you performed vis-à-vis other candidates and is taken as your effective USMLE score. This standardization is in place because the examination varies from year to year and there is a need to give a fairly accurate estimate about how well or worse a person performed in relation to the average American Medical Graduate. What is a good score?
While it is difficult to say what is a good score and what is not, there are certain benchmarks with regard to residency admission averages that one can look to for a sense of relative performance. 75 percentile is the minimum score required to clear the USMLE Step 1 and 2 for both American graduates as well as IMGs. However, a combination of residency programs becoming much more competitive, the number of IMGs applying for residencies increasing, and a wide stated preference for American graduates has made the definition of a “good” score for an international graduate even more demanding. A score above 85 is generally considered very good and a safe bet. Even residency programs that apply USMLE score cut offs for interview calls usually do not exceed 85, though some have now started going as high as 90. A score between 80 and 85 is considered a gray zone where the strength of the rest of the application becomes more important. It is important to remember that the USMLE test scores is just one part of the application. While they play a very important role, they are not the sole determinants of admission and so should not be looked upon as such. It is often that candidates with lower USMLE scores are taken over those with higher ones. How to make your overall application stronger is discussed in the Residency section.
Cost
USMLE is a costly preposition. Costs primarily consist of
- Exam and application costs
- Travel costs
There are also a lot of small associated expenses such as books, mailings etc., but those can vary a fair amount and usually are not a considerable amount.
Exam and application costs
These costs consist primarily of the registration fees that need to be paid with most of the exams and application services that a candidate needs to take or get. These costs are:
Exam costs
USMLE Step 1 $ 610
USMLE Step 2 $ 610
TOEFL $ 110
TOEFL acceptance fee $ 40
CSA Exam fee $1,200
USMLE Step 3 $ 465
Application costs
ERAS application material fee $ 60
NRMP registration fee $ 90
ERAS application fee $ 160 (For 20 programs)
Total $3,345 (or Rs. 1.5 lakhs approx.)
Travel and living costs
There is also a fair amount of travel and time spent in the US associated with the whole process. Both for the USMLE Step 3 and the CSA, as well as for all the interviews, the candidate will have to be in the US and travel to different cities where the residency programs are located. The cost for this part varies depending on whether you have relatives or friends that you can stay with or not. The example costs below assume that you stay with a family or friend for the majority of the stay but then spend some time in moderately priced hotels when you are traveling for your interviews. It also assumes that your base city is the New York/New Jersey area and the costs will vary depending on where you spend the majority of your time. These costs come to:
Roundtrip travel from India to US (New York) $ 1,000
Roundtrip travel from NY to Philadelphia $ 250 (Amtrak)
Travel for interview process (assume 4 trips) $ 1,250 (By air)
Boarding and lodging for interview process $ 750
Spending money for stay with friends/relations $ 3,000 (minimum 2 months)
Total $ 6,250 (or Rs.3 lakhs approx.)
It is important to point out that these costs, unlike the registration costs, can be significantly reduced based on how you manage your itinerary and your spending level in the US.
The process for dollar payments is fairly straightforward. You can go the foreign exchange division of any bank with a copy of the application, your passport, and the equivalent sum in Indian rupees and they can issue a draft in US dollars that can send along with the application. An alternative available now is the international credit cards which can also be used and save the person a trip to the bank.
For traveling to the US, the candidate should just take travelers’ checks or cash from India that can be obtained from any bank again with a copy of your ticket and passport.
The one thing that must be kept in mind is that an Indian national is only entitled to US$3000 a year of foreign exchange. This is tracked through entries in your passport whenever you have foreign exchange issued. Since the USMLE process extends up to two calendar years that entitles you to $6000 on your own name. If students need more than that, then they can have the remainder issued on their parents, sibling, or some friend’s passport.
Timeline
This is a standard time line of taking the USMLE exams, getting certification, applying for residency programs, and then finally joining the program you get selected for. For the purpose of this timeline we have assumed that the candidate initiates the process at the same time as his internship, but as mentioned before, many students do so only after their internship is over. Also, the timeframes are based on average time taken and students can take shorter or longer based on their preparation and effort. The last year of activity, i.e., the applications, interviewing, and match, however, follow a fixed timeline and cannot be done in less.
In addition, some of the activities can be done in a different order. For example, the Step 2 exam can be taken before the Step 1 or the TOEFL taken much earlier. Also, the process can end sooner if the student is offered a pre-match that he is willing to accept. Therefore, this timeline represents a general outline and there can be variations from case to case.
Suppose you join internship in January 2001, then:
January 2001 Decide about USMLE, Start preparing for Step 1
March 2001 Ask ECFMG for application materials
May 2001 Fill up application form for Step1
August 2001 Appear for Step 1 exam
Mid-August 2001 Results of Step 1 made available (take two weeks)
September 2001 Start preparing for Step 2; send applications
December
2001 End of
Internship
January 2002 Appear for Step 2
Mid-January 2002 Step 2 scores received
February 2002 Appear for TOEFL
March 2002 Apply for CSA
April 2002 Schedule
CSA for June/July 2002
May 2002 Get visitor’s visa for CSA; plan your trip
June 2002 Appear for CSA
July 2002 Get your ERAS application material; register for the match
August 2002 Complete ERAS application for residency programs
September 2002 CSA result; ECFMG certification done
October 2002 Apply for Step 3; schedule for November end 2002
October/November 2002 Study for Step 3; appear for residency interviews
November end 2002 Take Step 3 exam
November-December 2002 Complete interviews
Mid December 2002 Receive Step 3 scores
January 2003 Complete ROLIC list - programs in your order of preference
March 2003 Match results announced
April 2003 Fill up visa forms; Apply for visa
July 2003 Residency begins
.
Please mail at [email protected]
for any comments.