How to Master the USMLE Step 1


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Advice for the Old IMG taking the USMLE

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Hi. I’m Mike, otherwise known as Askdoc. Some of you may already know my story. For those who don’t, well, I am a very old IMG, graduated way back in 1989. I took the USMLE Step 1 in April, 2006 and scored a 99/256 and USMLE Step 2 CK in November, 2006 and scored a 99/258. Subsequently I took USMLE Step 2 CS in March, 2007 and passed. Lastly I took USMLE Step 3 in August, 2007 and scored a 90/219.

I know what it is like to be an old IMG, about to take the plunge into this challenging exam called the USMLE. I know about all the naysayers, who say that you are too old. Even if you pass, how can you match with a low score. I know about the anxiety, the fear of not being able to make the grade and to fail.

Therefore, I have decided to start a series of posts advising Old IMG’s on how to tackle the USMLE. How to evaluate what they need to do in order to be able to do well in this series of exam. Don’t get me wrong. The challenges for an Old IMG in taking the USMLE exam is enormous. But it is not insurmountable.

With patience, determination and proper study methodology, you can pass the USMLE exam. Some of you may also be able to ace it. So see you as we go on this journey of discovery and feel free to write me if you want me to write about a particular topic.

The Series so far:


58 comments to Advice for the Old IMG taking the USMLE

  • EN

    get some external help, if possible, and think regular family isolation for a while (1-2 years, before/after work; 1 weekend can be study-free), sorry to say but it seems to be the only way… I couldn’t do it when my kids were little

  • Abdul rehman khan

    Dear askdoc, it’s quite relieving that something is left for old IMG’s. Your success story is and will always be a strong motivation for all IMG’s. Keep it up dear friend. What residency you are doing now?

  • Soledad

    Dear Askdoc,
    I am also an old IMG and think your website is very inspirational for people like us. I recently took the step 1, and passed with a low score 204/78, 2nd attempt, (i don’t know if int. medicine programs are still looking for the 2-digit scores?) Anyway, I am planning to take the CK in 6 wks I have already been studying since July reading MAster the boards and doing the UW (obtaining 50%), what I wanna do is take a online course either Kplan, FAlcon or DIT in order to complete my prep but I want it to know what course would you recommend me ? I graduate in 2007 and there are some concepts I have definitively forgotten but when I read the books I can refresh my knowledge the only problem is that the MTB is not such a detailed book, it just gives you main concepts.
    Please I hope you could give me some advice.

  • Hi Soledad,

    Sorry, as an old IMG with poor scores in Step 1 (and on second attempt), you need superb scores in Step 2 to even have a chance for an interview. Master the Boards are for fourth year medical students or fresh graduates who just want to pass CK. So you are using the wrong study materials and you are allocating too little time for your review. Moreover, you are an old grad and therefore you need more time and more detailed books to do well. Again most online prep courses are geared for fresh graduates who just want to pass this exam. If you just pass step 2 CK with your score in Step 1, you won’t even get interviews. Its just that competitive.


  • Dr.Scorpio

    Hi! Happy to hear your success story!!
    I am an IMG, YOG > 10 yrs, no Green Card . Step 1 – 258 and step 2 – 251, awaiting step 2 results. Going for match end of this year. Eager to hear your advise. Thank you!

  • dr jan

    That us very inspirational. I havent done any medical work in 3yrs. I am realky confused as to how to tackle ysmle step 1 which is the only one that worries me. I am very good at diagnosing and tx but not so with pathophysiology. I guess because were I went to school at the important thing was diagnose and tx. Im horrible in biochem studied for 1mth di dnt get it. Heres my situation I haven’t been a doctor for long and I haven’t been in the field for 3yrs. I have been in the situation of being almost homeless, nit being able to pay bills etc etc. I have very bad anxiety about the test which is what’s been holding me from taking it the fear of not passing and my life crumbling. I don’t do well on standarized test. I have started studying for it for about 1month and a half. One month only on biochem. I am not scoring well on my questions and I only have one shot to take it. Can u please give me some advise.
    Thank you

  • Rish

    Dear AskDoc,

    I’m an IMG that hasn’t graduated medical school as yet. I know your blog is generally for older IMGs, but could you give me any advice for studying for the boards? I haven’t done Step I or any other exams as yet, and I’m in 4th year in UWI, Jamaica. I was just wondering what advice you have regarding applications for residency, what to aim for and any tricks/advice you could give me. Thanks!

  • Med Katie

    Very Inspiring story. This is a great success story indeed. I am an old img,graduated in 2005, a mother of three. I am also an X-ray tech. I just started studying for USMLE, do I stand a chance to get residency?? Since I am a busy mom and also have a job, my problem is I know all the resources how to study, but I have limited time to study everyday. It can take me about three years to pass the 2 steps of USMLE. My question is; is it really worth it? I am a US citizen, do I stand a chance?? Any suggestion will be helpful. Thanks.

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