US & Canadian Licensing Exams 19th April 2007

1. US & Canadian Licensing Exams19th April 2007

2. Agenda • FOOD & DRINKS!!!!! • Info about NAMSA • Intro by Executive Board • NAMSA website – Brandon Baraty • Canadian Exams – Sameer Vakani • American Exams – Trylon Tsang • Q&A with 4th years

3. What is NAMSA? MISSION STATEMENT • The North American Medical Student Association is committed to improving health care and healthcare delivery to all people; promoting active improvement in medical education; involving its members in the social, moral and ethical obligations of the profession of medicine; assisting in the improvement and understanding of world health problems; contributing to the welfare of medical students, interns, residents and post-MD/DO trainees; and advancing the profession of medicine.

4. It’s History • Began 3 years ago. • (To gain funding) Became an official University of Sydney club last year • (Like most other clubs) Lost funding this year due to VSU • Perceived to be a sector of American Medical Student Association. • Has an exec board and 6 chair positions

5. What NAMSA has done so far... • Instrumental in the appointment of International Sub-Dean • Provided a platform for the North American students of GMP to lobby their cause. • Survival Manual for American Residency Training (SMART) • Research into Elective opportunities and Steps towards entering Residency • Maintain North American Alumni connections • Many information events (including tonite’s) • Charity Events • Website: www.namsa.med.usyd.edu.au

6. Future NAMSA Events • Welcoming first years (DONE) • USMLE/MCCQE information night (NOW) • Electives night • Annual General Meeting (AGM) • Help to better inform anyone who is taking the Necessary Exams • Attract Interesting and helpful speakers

7. 2007 Executive Officers • Ali Raza President araz0786@gmp.usyd... • Sameer Vakani VP svak4483 • Tyler Chan Treasurer tcha5664 • Phu Vu Secretary phvu7839 • Bryan Schnabell Rotations bsch0621 • Elliot DeYoung Residency elde5934 • Talbot Bowen Education wbow2407 • Brandon Baraty IT bbar0107 • ????? Alumni -----------

8. Ali Raza - Prez • GMP 4 Student – RPAH Clinical School • BS Elec Engineering – Cornell University • MS Elec Engineering – Univ. of Pennsylvania • 7 years of Wall Street Experience – Bond Derivatives Trading • JP Morgan & DLJ • 1 year of Dot Bomb Experience • 3 years of own consulting business • 3 bosses at home (1 adult & 2 mine-meeeees)

9. Sameer Vakani - VP Work along side the president and other NAMSA executive members to ensure that we fulfill our mandate . • GMP2 • BSc Biochemistry from McMaster University • Part of the Central Clinical School, RPA • Also the International Students’ Rep on MedSoc

10. Tyler Chan - Treasurer • GMP 2 • Clinical school: Westmead • Volunteer medic • Hometown: Portland, OR • BSc Neurobiology at Berkeley • Post-Grad: Research @ UCSF

11. Phu Vu - Secretary Take notes and look pretty at meetings • GMP 2 • BSc at University of Victoria • MS Engineering at U of Toronto • Northern Clinical School - Hornsby

12. Bryan Schnabel - Rotations Compile list of and assist with rotations in North America. • GMP 2 • BSc. Biochemistry from Western Washington University • Part of Western clinical schools; centered at Nepean Hospital • Volunteer Medic

13. Elliot DeYoung - Residency • GMP 2 • Originally from Southern California • Majored in psychology at USC • Plan on going back either directly or after 1year of internship.

14. Talbot Bowen - Education • GMP 2

15. Brandon Baraty – IT Officer Develop and maintain the website of the society: gather and comply all info pertaining to the society or website. • GMP 2 • BSc. Biology from University Of British Columbia • Part of Western clinical schools; centered at Nepean Hospital • Volunteer Medic

16. Canadian Licensing Exams Sameer Vakani

17. Licensing Examinations • Canada • MCCEE (Medical Council of Canada Evaluating Exam) • MCCQE Part 1 (Medical Council of Canada Qualifying Exam) • MCCQE Part 2

18. What is the MCCEE? Required examination for all International Medical Graduates applying to PGY1 programmes in Canada: • 300 MC Questions, 7 hours • Tests basic medical knowledge of the principal disciplines, including Medicine, Obstetrics and Gynaecology, Paediatrics, Psychiatry and Surgery. • 3 test dates a year (2007 dates are in Jan, May, Sept.) • Written after graduation or towards the end of 4th year

19. Required examination for all Medical Graduates applying to PGY1 programmes in Canada: 7 sections, 196 MC, 3.5hrs 60 Clinical reasoning skills cases, 4hrs, 1-4 q’s per case. Some “short menu” q’s and some written in answers. 2 test dates a year (2007 dates are in April/May and Oct/Nov) Written after graduation or towards the end of 4th year, must have passed the MCCEE What is the MCCQE part 1?

20. What is the MCCQE part 2? OSCE that assesses the competence of candidates, specifically the knowledge, skills and attitudes essential for medical licensure in Canada, following a minimum of 12 months’ supervised postgraduate clinical medical training • ~ 3 hours long • We will go into more detail in the MCCQE information sessions • Taken after PGY1

21. Strategies for USMLE Step 1: Experiences of a Sydney Uni Student Trylon M Tsang 19 April 2007

22. Prologue • Who am I? Who are you? • Thanks to NAMSA • Special thanks to • Jody Tversky and • Stephen Thompson • Support NAMSA

23. What is the USMLE? • The United States Medical Licensing Examinations are a series of exams one takes to become a licensed physician in the United States

24. What is the USMLE? • Step 1 (Basic Sciences) • – Basic mechanisms and principals • 350 q / 7 blocks, 8 h • Step 2 Clinical Knowledge • – Diagnosis and pathogenesis • 400 q / 8 blocks, 9 h • Step 2 Clinical Skills • Step 3 (Clinical Management) • - 500 q 10 blocks 2 d, 16 h

25. What is the MCCEE? • Canadian exam: • MCCEE (Medical Council of Canada Evaluating Exam) • Must be written before a J1A visa can be obtained for a residency in the US • www.img-canada.ca/en/licensure_overview/mccee.html • www.mcc.ca

26. The Scoop (Who/What) • Who? • 2nd year student or greater • What? • assesses whether you understand and can apply important concepts of the sciences basic to the practice of medicine, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of not only the sciences that provide a foundation for the safe and competent practice of medicine in the present, but also the scientific principles required for maintenance of competence through lifelong learning. • Translation: a lot of work for you • See: http://www.usmle.org/step1/intro.htm

27. The Scoop (When 1/2) • Step 1 – after 2nd Year • Step 2 – before residency • Step 3 – during residency • For us? When you are ready. • Refer to other presentations

28. The Scoop (When 2/2) • Time limit • ‘Effective June 14, 2004, applicants must pass Step 1, Step 2 CK, and Step 2 CS within a seven year period for ECFMG Certification; this new seven year requirement applies to applicant whose earliest USMLE passing performance that is valid for ECFMG Certification took place on or after June 14, 2004, as described below.’ see www.ecfmg.org

29. The Scoop • ECFMG registration due at end of month before eligibility period • e.g. Rego for April 1, 2006 - June 30, 2006 is due February 28, 2006 • Change once without fees charged. • Prometric Centre in Sydney only has availability 3 months in advance. • Where? • Sydney or Melbourne • www.prometric.com

30. The Scoop • How? • www.usmle.org www.ecfmg.org • Why? • Need ECFMG certification to apply for residency in the US • Need it for an application for a fellowship • If you can get through all the paperwork, then you can succeed  • Where do you plan to live? • How Much? $695 US

31. Let’s get started • 1 day computer based test (CBT) with 7 blocks of 50 questions • 15 minute tutorial • 7 hours of 60-minute question blocks • 1 question per 72 seconds • 45 minutes of break time • Break time cumulative • cannot go back to do previous sections • cannot leave during a section

32. Content • http://www.usmle.org/step1/intro.htm • Topics by system • see above link • Topics by subject • Anatomy • Biochemistry • Cell and molecular biology, genetics, metabolism and nutrition • Behavioural Sciences • Psychiatry, biostatistics • Microbiology/Virology/Immunology • Pathology • Pharmacology • Physiology

33. Step 1 - Scoring • What do the scores mean? • Step 1 scoring • May 2006: Date of my exam • Mean: 216 SD: 24 • Scores: 140-260 • Pass: 182 • SEM: 6 points

34. Scoring Scale

35. Performance Profile • (removed for privacy reasons – sample can be found online and in First Aid for the USMLE Step 1)

36. Step 1 Scoring • Importance • connections > reference letters > research > CV • + Step 1 score • Do not get obsessed with score unless you are aiming for a competitive specialty

37. What is competitive? • Competitiveness is a combination of training positions available (need), lifestyle, money, interest • Fluctuates over time • Important to choose what you enjoy • Programs competitiveness is different from specialty competitiveness

38. What is competitive? • Dermatology, Radiation Oncology, PRS • Ophthalmology,Urology, ENT, Orthopaedic surgery, Radiology, Neurosurgery • Anaesthesiology, Emergency Medicine, General Surgery • Physical Med and Rehabilitation, Obs & Gyne • Neurology, Pathology • Internal Medicine, Psychiatry, Family Medicine, Paediatrics • Subspecialties in Internal Medicine are competitive!

39. How to know what to choose? • READ: • ‘The Ultimate Guide to Choosing a Medical Specialty’ Brian Freedman ISBN: 0-07-141052-X • Iserson’s Getting Into a Residency: A Guide for Medical Students Kenneth V. Iserson ISBN: 1-883620- 30-9

40. Dr.Cox: I became a doctor for the same four reasons that everybody does: chicks, money, power, and chicks What does Dr. Cox think?

42. Preparing for Step 1 at USyd • Main difficulty: • USyd GMP program versus US curriculum • Must learn 2 curriculum concurrently • Style of assessment differs • Important thing to remember- pass the Barrier! • Become a knowledgeable (good – not just nice) doctor!

43. Preparing for Step 1 at USyd • Over prepare for PBL so it is a review session • Course is based on PBL and a relatively small number of diseases in the first 2 yrs • Know your physiology solid – good foundation for the course (and med for life) • As a student, you have the most time to read everything –d on’t buy the “you’ll learn it later” excuse

44. Preparing for Step 1 at USyd • Converse of that -> don’t try to memorize everything but be aware of its existence • You can only find something if you know what to look for • Recalling something is much easier than learning something for the first time • This is against the philosophy of the course that you can “look it up” when you need to • Learning is different –you may not be able to recall or spontaneously produce information but you can recognize it when it comes up

45. Preparing for Step 1 at USyd • MOST IMPORTANT: • Buy First Aid for the USMLE Step 1 and actually read it !!!!!! • Hindsight is 20/20

46. What curriculum? • Order of Importance: • For USMLE Step I: (in order of importance) • Pathology • Pharmacology • Physiology • Microbiology/Virology/ Immunology • Biochemistry/Molecular Biology • Neuroscience • Behavioral Science • Anatomy

47. Pathology • breadth of diseases • know common themes

48. Pathology • A 15 mo y.o. girl is brought to ER by parents, 1/52 wk hx of malaise, poor feeding, mild fever and diarrhea. PE unremarkable. 6th visit to GP. PMHx repeated infections – Candida, CMV, MAC. CBC (FBC) remarkable for low lymphocyte count. Ig levels normal. Lymph node biopsy- Paracortical cell depletion otherwise normal. What is the most likely diagnosis? • Bruton congenital agammaglobulinemia • Chronic granulomatous disease of childhood • Severe combined immunodeficiency • Thymic hypoplasia • Wiskott-Aldrich syndrome

49. Pharmacology • you don’t learn much in the course • exposure • classes of drugs • repetition • learn mechanism

50. Pharmacology • A 32 y.o man has been taking a medication for a fungal infection on his arm. He develops gynecomastia. Which is the most likely medication he is on? • amphotercin B • caspofungin • fluconazole • ketoconazole • flucytosine