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Licensing Exams USMLE MCCEE/MCCQE. Licensing Examinations. United States USMLE Step 1 (US Medical Licensing Examination) USMLE Step 2 Clinical Knowledge (CK) USMLE Step 2 Clinical Skills (CS) USMLE Step 3 Canada MCCEE (Medical Council of Canada Evaluating Exam)
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Licensing Examinations • United States • USMLE Step 1 (US Medical Licensing Examination) • USMLE Step 2 Clinical Knowledge (CK) • USMLE Step 2 Clinical Skills (CS) • USMLE Step 3 • Canada • MCCEE (Medical Council of Canada Evaluating Exam) • MCCQE Part 1 (Medical Council of Canada Qualifying Exam) • MCCQE Part 2
Taking these tests • USMLE (Steps 1 and 2) • Should be taken by everybody • WHY? • Canadian students should be aware that it is much easier to get a residency (at this point in time) in the United States when compared to Canada • MCCEE / MCCQE • Should be taken by those who would like to do a residency in Canada • MCCEE must be taken before MCCQE and cannot be taken until 9 months prior to graduation
Outline • USMLE Step 1 • Can be taken any time after second year • What is it? • What does it test? • When should I take it? • How should I study for it?
Step 1 – What is it? • The purpose is to “determine if an examinee understands and can apply important concepts of basic biomedical sciences, with special emphasis on principles and mechanisms underlying health, disease, and modes of therapy”
Step 1 – What is it? • It’s a one-day, 7-hour, multiple-choice exam, that you take in “blocks” of 60 minutes • Each block consists of 50 questions • Items tested will vary randomly from subject to subject
Step 1 – 7 “core” subjects • Anatomy • Biochemistry • Includes: Cell biology, genetics (molecular and macro), metabolism and nutrition • Behavioural Sciences • Psychiatry, psychology, epidemiology, sociology • Microbiology/Immunology • Physiology • Pharmacology • Pathology
What does it test? • “principles and mechanisms underlying health, disease, and modes of therapy” • These are typically integrated across the 7 core disciplines • The exam expects you to know the “what” and thus asks “why”.
Example • A 24-year-old woman presents with a 3-day history of fever, chills, chest pain, and cough productive of rust-colored sputum. Past medical history includes a splenectomy 1 year ago. A chest x-ray film indicates consolidation of the right lower lobe. Blood cultures are positive for alpha-hemolytic gram-positive diplococci. Immunity to the causative organism is based on A. alternative complement pathway activation B. antibody to an alpha-helical coiled fimbria C. IgA antibodies to C carbohydrate D. IgG antibodies to C carbohydrate E. IgG antibodies to a surface acidic polysaccharide
Answer • The correct answer is E. • The patient in this question has pneumococcal pneumonia (Streptococcus pneumoniae), which must be considered in any patient with chills, fever, chest pain, and cough productive of purulent, rust-colored sputum. • The only recognized virulence factor of S. pneumoniae is its carbohydrate capsule (which contains acidic polysaccharides).
USMLE Step 1 - Scoring • About 3-4 weeks after you sit the exam you’ll get your score report. • The minimum passing score is 182. • There is a 3 digit score and a 2 digit score • The two-digit score is derived from the three-digit score. It is used because some medical licensing authorities have requirements that include a “passing score of 75”. Thus, a passing score,182 = 75. • The 2 digit score IS NOT YOUR PERCENTILE • Thus, exam scores are reported as 182/75
When Should I take Step 1? • Step 1 and Step 2 CK/CS can be taken any time after 2nd year • In the US, 2nd year medical students take USMLE step 1 during the summer between 2nd and 3rd year. • GMP international students are allowed to take 1 4th year rotation off to study for USMLE (any step)
When should I take Step 1? • Option 1 • Summer between 2nd and 3rd year • Option 2 • After mid-year break in 3rd year • Option 3 • First rotation in 4th year • May be taken off or done during 4th year rotation • Option 4 • Doing Step 1 and Step 2 at same time
Logistics • USMLE step 1 can be taken any time after you’ve completed 2nd year • Go to ECFMG website and register to take Step 1 • You nominate a 3 month “window period” • Must be at least 2 months away. • You nominate a region which you CANNOT CHANGE • You must therefore decide where you want to take it • Must pay upon registration
How should I study for it? • Discipline Approach • Study the 7 core disciplines separately • PROS: • The vast majority of books are organized by discipline • The vast majority of question banks are organized by discipline • CONS: • Difficult to integrate • Systems Approach • Study the 7 core disciplines as a system • PROS: • Good integration • Useful to approach with GMP • CONS: • Many items are difficult to place into a “system” (e.g., basic pathology, genetics, strange microbiology questions)
3 step method for the disciplines • Basic Terms and Definitions • Core vocabulary • Use of associational memory • Study Plan: brute force memorization • Central Concepts • Meaning of concepts • Use of reconstructive memory • Study Plan: diagrams, tables, pictures, discussions • Apply the Concepts • Questions, questions and more questions
Resources • ?GMP • Review books • Review courses • Question books/websites
GMP and USMLE • Pathology can be interpreted several ways • GMP offers good overall structure • Poor on rare (but frequently tested) syndromes and associations • Bugs and Drugs • Pharmacology is used to integrate many basic science concepts • Learn pharmacology early • Microbiology and immunology are high yield and neglected by the course • Biochemistry • 1.01, 1.02, 7.05 and 7.06 are it. • All the metabolic and genetic diseases need to be learned (there’s more to biochemistry than PKU!)
Books • Buy early and use often • First Aid for USMLE Step 1 • Key! • Cannot be your only source • Use the library books before purchasing • An extensive number of current USMLE texts are available • Don’t just go with one series • Board Review Series (BRS) • Rapid Review • High Yield Series • Underground Clinical Vignettes • Platinum Vignettes
Review Courses • Kaplan • WebPrep • Approx. 70 hours of lectures on the internet • $800 US • Access is for 3 months • Centre Prep/Deluxe Prep, etc • Approx 120 hours of lectures either on video at the Kaplan centre or in person • 70 hours is already on the webprep • $3500-$6000 • Princeton Review
Questions • Kaplan • Most like the USMLE • QBank (2200 questions) • Integrated Vignettes QBank (1100 questions) • Various options for subscription over the web • QBook (800 questions available in September) • Rapid Review • Each text comes with a CD of 300-500 questions • One text devoted to questions (1000 questions) • Available in the library • NMS • Robbins
Where do we go? • How to study for each section • Study techniques for USMLE step 1 • Memory techniques • Question answering techniques • Case Studies • USMLE Step 2 • MCCEE/MCCQE