When to take which Step: A Rough Guide of Scheduling the Exams

This post is intended to help IMGs when to take which Step in the USMLE.

*Disclaimer: This post is based on my personal experience and should not be taken "as is" by the readers. Every IMG has and wll have a different experience, and you must consider the risks and benefits if you were to apply the things that are written below.

Contrary to popular belief, one can take the USMLE Step 1 prior to graduating med school. Yes, people! Foreign medical students can take Step 1 prior to graduation. An excerpt from ECFMG 2010 Booklet:

"Medical School Students

To be eligible for Step 1, Step 2 CK, and Step 2 CS, you must be officially enrolled in a medical school located outside the United States and Canada that is listed in IMED, both at the time that you apply and at the time you take the exam. In addition, the “Graduation Years” in IMED for your medical school must be listed as “Current” at the time you apply and at the time you take the exam. An authorized official of your medical school must certify your current enrollment status; instructions will be provided at the time of application. As soon as you graduate and receive your medical diploma, you must send two photocopies of your medical diploma and one full-face, passport-sized, color photograph to ECFMG (see Provision of Credentials and Translations). The photograph that you send must be current; it must have been taken within six months of the date that you send it. A photocopy of a photograph is not acceptable.

In addition to being currently enrolled as described above, to be eligible for Step 1, Step 2 CK, and Step 2 CS, you must have completed at least two years of medical school. This eligibility requirement means that you must have completed the basic medical science component of the medical school curriculum by the beginning of your eligibility period."

With that cleared up, I will now give you two (2) ways to take which USMLE:

1] The American Way

~~Take Step 1 before entering your third year in med school.

AMGs treat the USMLE boards differently compared to IMGs because MOST (if not all) American med schools require their students to pass Step 1 prior to starting the junior year. Also, some US schools have cut-off grades for Step 1, meaning that if their student did not make it to their cut-off score, that second year medical student will be barred from enrolling to that particular med school on his/her third year. Yes, the stakes are very high!!!

Advantages: The Step 1 is all about the basic sciences - Anatomy, Physiology, Histology, Pharmacology, Microbiology, Immunology, Pathology, Ethics & the likes (I may have omitted some subjects; if I did, these subjects too are included.) The first two years of medical school tackle these areas, and if you will take USMLE, you will still have all of these "fresh" in your mind. Students will also be less likely to be confused as their minds are still geared to the basic science and not the clinical sciences.

Disadvantages: Even when Step 1 is about basic sciences, clinical experience will still be a plus factor in helping a student answer some clinical questions in Step 1. Although clinical questions are less emphasized in Step 1 compared to Step 2, this may matter as an addition to obtaining higher scores.

~~Take Step 2 CK and CS during or after core clinical clerkships.

Again, American med schools require their students to pass Step 2 CK and CS prior to graduation. AMGs usually schedule their exam/s during or after their clerkship. And, as written in the ECFMG 2010 Booklet:

"Although you may apply for and take the examinations after completing the basic medical science component of your medical school curriculum, it is recommended that you complete your core clinical clerkships, including actual patient contact, before taking Step 2 CK and Step 2 CS."

Advantages: Step 2 is all about clinical sciences. CK tests your theoretical knowledge in clinical subjects such as IM, Psychiatry, FM, GS, Pediatrics, OB-GYN and others. (Again, I may have omitted some subjects; these are included too.) CS tests your ability to take a good history and make a good physical examination, and proper medical documentation. Clerkship is one of those years when a student sees so many patients that clinical knowledge and skills are a reflex. Students will also be less likely to be confused as their minds are now geared to the clinical sciences.

Disadvantages: More patient exposure means that a graduate is more comfortable in handling cases, and will be more likely to retain/remember clinical situations that may be applicable to the said exams. Say, if an IMG did a 1- or 2-year internship in their home country, they are more likely to have some advantages, and their "reflex" may even be sharper.

~~Take Step 3 during the first year US residency or AFTER completing the whole program.

Again, most American hospitals require their residents to pass Step 3 prior to entering their second year of residency.

Advantages: Step 3 is all about proper diagnosis and management of the patient. Working in the hospital will instill in a graduate's mind the proper medical procedures, and these will help the examinee in remembering certain hospital procedures during the exam.

Disadvantages: Step 3 tests a graduates' ability to survive as a doctor without supervision. The test gears toward primary care medicine. Recall won't be easy (and may not be applicable) for the residents who took Psychiatry, Pathology, Radiology, Rehab Medicine and other more "specialized" specialties.

2] The IMGs Way

The IMGs way is somewhat thought as more of a "short cut". The medical graduate will review and take all the Steps either a) after graduating from med school, b) after his/her 1- or 2-year internship in their own country, or c) after their training in their residency program of choice.

*Note: There are a couple of advantages and disadvantages of these three options, but I will write them some other time as this blog is already too long.

This is the typical schedule for an IMG who are preparing for the USMLE:

  • Step 1 - 6 to 9 months of review, taken on January, February or March
  • Register for Step 2 CS at least 6 months in advance
  • Step 2 CK - 3 to 6 months of review, taken on March, April or May
  • Step 2 CS - 1 to 3 months of review, taken on May, June or July (at most)
  • Step 3 - 1 to 3 months of review, taken on June, July or August
  • Match starts in September

Many IMGs will not take Step 3 because it is not a requirement for the Match; however, many IMGs will still take Step 3 because it increases their eligibility and the US programs may take that into consideration. Some IMGs with very high grades will take Step 3 at the end of the year to qualify for the H1B visa sponsorship of the programs. Still, it is still a more common phenomenon that IMGs take Step 3 as an addition to their credentials when applying for the match.

The first schedule written above is typically used by those IMGs who are want to spend less than two years reviewing for the exams. This second schedule written below is for those who wanted to take more time:

  • Step 1 - 6 to 9 months of review, taken on January, February or March
  • Register for Step 2 CS at least 6 months in advance
  • Step 2 CK - 3 to 6 months of review, taken on June, July or August
  • Step 2 CS - 1 to 3 months of review, taken on October, November or December
  • Step 3 - 1 to 3 months of review, taken next year on March, April or May
  • Match starts in September

*Please take note that the schedules are meant only as a rough guide on when to take which exam. Every IMG is different and may have a different schedule compared to what is written above. Please do not take this blog "as is", and ask from friends, family members and/or colleagues to tailor the schedule of your exam for your convenience.

I would like to ask the readers to share their experiences in scheduling their exams. Leave a comment below about your exeriences, blog about it or discuss it with fellow IMGs on the forums. Let's help each other! IMGs rock!

PS. Again, I only learned about this experience because I went through it "the hard way". I had no one to ask, and none of the people I know who took the exam were kind enough to help me get through this difficult journey.

Hope that I helped somewhat! Peace out, Girl Scout!

Views: 4530

Tags: 1, 2, 3, cs, guide, match, program, rough, schedule, scheduling

Add a Comment

You need to be a member of UsmleRockers to add comments!

Join UsmleRockers

Comment by Abdulhadi Alkeylani on March 19, 2012 at 4:30am


Comment by docgod on October 9, 2011 at 2:15pm
Also I have a history of failure in med school, but on the flip side also have research done with research scholarships .... I just started studying for Step1 .. how much of an impact will that have on my residency application & will I be questioned about it on the interview ..
Comment by docgod on October 9, 2011 at 2:11pm
My schedule is step1 october - march (5 months), step2 march - June (3.5 months) step2 cs june-july (2-3 weeks), step3 august - january ( 5  months) - studying while doing observerships. My question is whether my scheduling is good enough for an average IMG  ... whether I will be able to finish Step2 cs before september ( afraid of delays ??)
Comment by sonelbhardwaj on August 23, 2010 at 2:34pm
hey thanks for ur info, its really valueable advice that has been posted...............but if u dont mind i have 1 correction to make....'nowadays step 1 also has become clinically oriented'...
Comment by Rah, M.D. on July 31, 2010 at 5:57am
Soroush, welcome to USMLE Rockers!

You will receive your Step 1, Step 2 CK and Step 3 results in three to six weeks after you took the exam.

As for Step 2 CS, please click this link.

Hope that helped somewhat!
Comment by soroush on July 31, 2010 at 1:44am
hi friends

how long would it take to receive the result of each step roughly?how many weeks or months?

Comment by Rah, M.D. on March 29, 2010 at 8:02pm
Hello there, dr. Sohail!

I personally know two IMGs who took Step 2 CK first before taking Step 1, but they took it in 2008. As of this date, I believe ECFMG still allows it.

Hope that helped somewhat! Good luck in your USMLE journey!
Comment by doctor sohail on March 29, 2010 at 7:48am
thanks for such a useful guideline. would you please tell me that ... can any international medical graduate go for STEP 2 CK before STEP 1? As me wish to go for step2 and then later for step 1.
Comment by Rah, M.D. on March 3, 2010 at 10:05am
Welcome to USMLE Rockers Ranjana!

Step 1 in October is great. The general suggestion is that take Step 2 CK in December 2010, then take Step 2 CS in February or March 2011 so that you'll be just in time for the Match in 2011. Additionally, you can take Step 3 in June (being the latest) to get all of your results before August 2011 so that you'll have time to prepare for the Match in 2011.

Hope that helped somewhat. Good luck in your USMLE journey! IMGs rock!
Comment by Rah, M.D. on March 3, 2010 at 9:47am
Hello, Ivette!

First and foremost, I wish you the best of luck in your upcoming Step 1 exam.

To answer your question: Matching starts in September of every year. It means that by August, you must already have the results of Step 1, Step 2 CK and Step 2 CS at the very least. It would also be better if you have the results of Step 3 and preferably you have done researches and USCEs.

Since the latest that you can take Step 1 is May and you have yet to take Step 2 CK and CS, you will be probably late of the Matching which will start in September 2010. What I do suggest is that utilize the time you have right now and complete the exams up to Step 3, then participate in the match next year. That will give you ample time to complete many, many things that is USMLE related.

Hope that helped somewhat! IMGs rock!

Latest Activity

United States Medical Licensing Examination (USMLE) is a joint program of the FSMB and the NBME. The FSMB and NBME are not affiliated with this site.
Read our complete Disclaimer here

© 2015   Created by Dreaming Minds.

Badges  |  Report an Issue  |  Terms of Service