USMLE exam format
- Approximately 70-80% of the questions are based on clinical vignettes.
- Two question formats are used: the one best choice type with five to 10 options and the matching type. They have stopped using questions with a negative word or phrase in the question.
The exam takes one day and has:
- 350 questions given to you in seven blocks, each having one hour to complete.
- Exactly how grades are computed is not clearly indicated to us. They often include questions that they are field-testing but they are dropped from your overall % performance. Generally, 60 - 70% accurate responses equal a pass score.
Content is described in your CD-ROM under different body systems as:
- normal and abnormal processes
- principles of management of diseases
It would serve you well to look through this material to get an overview but not to cover every detail mentioned. Actual content of each exam or groups of exams vary since they tend to mix up content with varying proportions of each in different exams.
A common sense approach is to consider all your second year courses as having content that is vital to passing the test. Then you must work backwards to relate this content to your first year courses for background material. We are confident that we cover the material required of you to pass but don't be surprised to find many questions for which you have no clue what the answer is!
- For more details, review your CD-ROM (copies are available in the Office of Student Records)
USMLE approach to preparation
There is no magic wand we can wave over your heads and get you ready for this exam. In January, your big sibs will tell you that as you are going through the second year, you are engaged in this preparation for USMLE by studying the material well and doing well in the course exams.
As and when you get free time, start your additional preparation by reviewing systems/disciplines using review books. Use question-answer books periodically to check your level of understanding of the reviewed materials. Go back to the review if you find that you have not answered a block of questions satisfactorily. You will go through this cycle many times for each system/discipline.
Students have often said that it is best to use the systems approach because it serves best to Integrate:
- the normal with the abnormal
- mechanism with the pathology
- pathophysiology with principles of management and therapeutics
However, certain hard-core subjects like Microbiology and Pharmacology may require a discipline and disciplined approach. Those of you who found Biochemistry to be hard may want to review it by itself in the beginning.
Use either First-Aid or Step-up, or parts of both as your guide to study. All materials you gather from the review books are best put together with these guides in some manner that you prefer. Create one additional resource book/set of cards/other that you can go back to during the last two weeks when you are cramming.
Test taking skills
You may by now have figured out for yourself how to approach a standardized exam. Content is essential but, in addition, you have to know how to smartly approach a question. There are tricks to eliminating incorrect answers, honing in on the most crucial sentence/phrase/words in the clinical vignette, guessing when you don't know the answer etc. Try this out with him after you have reviewed some of the content and tested yourself.
What more can we do for you?
Stress Reduction Techniques
Dr. Rodolfa has created a small handout for relaxation techniques:
TEST TAKING STRATEGIES: A PSYCHOLOGIST’S PERSPECTIVES
Emil Rodolfa, Ph.D.
UC Davis Counseling Center
- Excessive tension and anxiety will interfere with performance when studying and during the test. Reduce anxiety and stay alert and focused.
- Concentrate on what you know rather than spending time catastrophizing about the unpleasant consequences of possibly failing the exam.
- Do not fight the exam! The exam is the same for everyone and no one is out to get you. Energy wasted on blaming the test/test maker is energy spent in the wrong direction.
- Do a brief relaxation exercise: For instance, inhale on three counts, hold for two counts and exhale for three counts. Slow steady breaths will help you stay calm.
- Practice a muscle relaxation exercise. See attached exercise.
- Visualize yourself completing the test successfully. If you can’t see yourself accomplishing the task, the task becomes much more difficult.
- Regard lapses of memory as normal, key the question and return to it later.
- Focus on only one question at a time. Anxiety might cause you to jump from question to question.
- Don’t rush and don’t spend too much time on any one question.
- Be aware of the worry cycle and intervene if it is activated:
Five Steps for Success by Martin Jollie, M.D. at UMKC
More information will follow for the workshop and practice MOCK board examination.
UC Davis performance in USMLE
As an introduction, you need to know that historically, UC Davis has done very well compared to other schools in the past for first time test takers and our school’s average score.
As always, there are exceptions. Failing the USMLE Step 1 is NOT the end of the world! It will cause you some inconvenience since it will lead to deferral of one clerkship to give you time to prepare for the retake. You will take the deferred clerkship during the first 2 months of your fourth year.
Our bylaws require that you take and pass the USMLE Step 1. The deadline for successfully completing the test is the last day of fall quarter in order to continue your enrollment with third year clerkships in winter quarter. The bylaws also require that students take and pass USMLE Step 2 to meet the School’s graduation requirement.
What does your performance in USMLE mean?
USMLE is a standardized exam that requires recall of facts and concepts, integration across subjects and application of this knowledge to problem solving. It is a necessary evil to deal with, conquer and move on. There will be many such tests in your lives as a student, resident and a physician.
Most of the available literature suggests that your USMLE score at best predicts how well you will perform in similar standardized tests in future. It does NOT predict what kind of a physician you will make.
Despite this, some subspecialties place a heavy emphasis on these scores in residency selection. However, in most cases, the score is less important than your clerkship grades, Step 2 scores, dean's letter and other letters of recommendations you will submit for your residency application.
A caveat: the knowledge base you access to perform well in these exams is what you will draw on to do well on the wards and to be competent physicians. The difference is that you will not need to carry around the details in your head. As information is expanding at a rapid pace, none of us will be able to have a walking knowledge that is complete. However, the big picture you construct in your brain, connect and modify with more experience and knowledge is absolutely essential to your success as a competent physician.
A common sense approach? Look upon the preparation for the USMLE as a transitional step that allows you to reconstruct in your brain a framework for the knowledge you have gained so far in a manner that will allow retrieval in the future when you are faced with a patient problem.
USMLE Step 2
The USMLE Step 2 is now required from the School as part of your graduation requirement. Please go to www.usmle.org and click on Clinical Skills Exam for further information and updates.
The application to take the United States Medical Licensure Examination Step 1 is on-line and interactive. It is simple to complete considering the importance placed on the test. Students seem to find the most difficult part of the application is deciding which time period or block works best in their plans.
When are the best dates?
There are a few things you should consider when choosing a date and these are:
- Post-final leisure period
- Study/review period
- Personal activity time before the start of clerkships
Students taking the USMLE Step 1 later than June 30 either postponed the first clerkship or went on leave. Most important is choose a date that best you’re your personal study and style or preparation and not forgetting to factor in rest and relaxation before the start of clerkships.
Which block should I select?
The blocks are organized in 3-month periods and within that period you will have the option of selecting a SPECIFIC date to take the exam. Blocks 18 and 19 are the most popular among UC Davis students. Those blocks fit the periods after spring quarter finals and the start of third year clerkships. Students planning to postpone one or more clerkship may consider block 20 or one of the later blocks.
- Once you have selected a block period and mailed your application the National Board of Medical Examiners will send you an orange colored permit. This permit will allow you to contact Prometric (formerly known as Sylvan Centers) Test Center and request a test date. Our students have not had many problems getting the test date or the site they have requested (Fair Oaks or Walnut Creek). If you plan to take the exam at another location, PLAN AHEAD. The competition for test dates/sites may be different from our experience when compared to your peers in Southern California, the Bay Area or locations outside of the state.
Changing a test date or block period
Sometimes unexpected situations arise and it may become necessary for you to change your original test date. If this happens changing a date within a block may not be a problem but you should make these changes AS SOON AS you become aware of your circumstances, otherwise there might be a cost-penalty or worse ― no available dates. If your circumstances make it necessary for you to choose another block the National Board may require you to pay the entire non-refundable application fee again! Choosing a date is important ― think this through carefully.
You may have noticed a slight increase in your financial aid checks in the ‘books and supplies section’. Because of federal policies, financial aid is distributed over a 4-quarter period. The increase in your aid is the cost to take the USMLE ($425 is spread over 4 quarters). Plan ahead because you will probably register and pay for the exam BEFORE the last financial aid distribution is made.
Financial aid will ONLY provide support for board review books and/or programs and at the direction of the Committee on Student Progress. These situations are most likely when the student fails either Step 1 and/or 2.
Special examination accommodations
- Students with learning or other disabilities (permanent or temporary) must submit an application to the NBME for special accommodations. The application for this request is also located on the Web site www.usmle.org and go to Special Accommodations.
Helpful hints for a perfect application:
- Go to www.usmle.org website and follow the prompts to log on for an application for USMLE Step 1. Note your login I.D. and/or password until you have completed the application
- Use ONLY the name and address currently on your Driver’s License or other official identification when making your application. PLEASE NOTE your identification name and address must match the name you used on your application. Do not use nicknames, shorten names etc. and if you plan to marry or just want to change your name do it after you have taken the boards.
- Arrange to get or have a 2 x 2 photo of taken. The photo must be affixed to your application.
- Take your completed application in person to the Office of Student Records. The records office staff will need to certify your identification and stamp your application with the School of Medicine seal.
You should expect to hear from the National Board within 4-6 weeks after you have mailed your application. If your orange permit has not arrived within 6 weeks, call the NBME at (215) 590-9500 and ask about your application. The NBME staff should be able to let you know if/when your application was received and if your permit was mail and where it was sent.