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:
hi,
i graduated in 1995 . did CSA in Sept. 2005, postponed CK several times did not step 1 yet… i want to finish Step 2 ck and Step 1 before December 2010 other wise tension and anxiety keeps on building up… wht do u suggest me to study for ck and step 1 which is high yield and short…
thanks askdoc
Hi Mike,
Question is do you want to pass. No way to pass with short and high yield review only unless you are a third year AMG. So I don’t recommend it. The best high yield and short review is FA. But as I said, you need to be third year AMG to have a chance at passing using that alone.
Askdoc
Hello I am an old IMG graduated back in 1992, not in medicine last 2 1/2 years, could you send me the format of preparation you took for the usmle exams, I am preparing for the step 1 but still think I am not ready, thanks for the help.
hello ask doc, still wanting to know if you guide me a little with my question posted about a week ago
thanks
Jorge
Hello Mike,
I am a US citizen who came to South America in the 90′s to study medicine. I made it to my 5th year of a 7 year program and for family reasons needed to drop out. I kust started medical school at my old college a week ago at advance standing. I have 3 years plus internship to complete. Can you share your experience with me as any advice would be very helpful. I have passed all my basic sciences many years ago and am currently auditing Semiology (Physical dx), Pharmacology and Pathophysiology which I had already passed and am taking Clinical Immunology and Clinical Nutrition. Next semester I will begin Internal Medicine with a full course load of clinical sciences. Should I focus on step 1?
hi askdoc want ur suggestion
i m an img graduated in 2007,with step1 score of 82/200
step2 score of 224/95,cs and step3 are yet to be completed
stil in crossroads of my life do i have i go forward and give cs and step3 or quit usmle and stay in my home country and do my postgraduation? many of my friends told me u wil waste ur time in US since ur step1 score is low,,dont knw what to do kindly suggest me i m intrested in internal medicine or pediatrics wil i able to secure a residency?dont have much contacts in US kindly reply
Hi Mike,
I am a very very old IMG graduated in 1987. I am preparing for Step 1. I am reviewing basics from Kaplan lecture notes and videos. I am very much interested in doing residency and only residency/not Ph D. I am understanding the concepts and hope that I will be able to achieve good scores. Sometimes I am haunted by the thoughts- what if I am not selected?
Pl advise
Hi RAD,
Very hard to say. It’s different for different people. The pros are that you have just finished basic sciences and you would remember most of them for the exam. The cons are that you have a full course load and that could cut into your review time. So it depends on what works for you.
Askdoc
Hi anie,
In your case very hard to say. But I still think it is worth a try. A good step 2 CK score can get you interviews, then it depends on how you fare in the interviews. I guess it depends on how badly you want to get a US residency. It’s not impossible, but it won’t be that easy either.
Askdoc
thanx askdoc for ur reply…..god wil bless u for helping others,yup i badly want to join internal medicine.i was plagued by fever and forced to write step1 and i was running out of dates here i m with a low step1 score.always performed well in my med school,but i can give my best in step3 and CS…doing residency in internal medicine in US is my dream….since u have travelled to US and the amount of experince given to u and i m sure u wil know better than me thats why i asked ur suggestion…reeling thoughts of uncertainity,fear of not getting interviews and securing residency keeps me awake in night just because of my low step1 score..not fair
Dear Askdoc,
This is a very interesting site-thank you for maintaining such uplifting blog for people like me who have already abandoned the hope of clinical medicine. Like ajmal, I am also an old IMG, not practiced medicine since 1994 and working in epidemiological research. Recently I have and decided to read basic science. To my surprise, I remember large amount of pathology, microbiology and some pharmacology. Immunology, biochemistry and neuroanatmy are to a large extent erased from my memory. I would appreciate your advice and guidance.
Dear Raji,
I think one has a right to do what he likes at any stage or age in life. A friend of mine told me that when he appeared for Step 1, he saw a doctor turned lawyer who now wanted to rejoin medicine. Guess! he was 60. In my case, I graduated in 1987 worked in a teaching hospital in Pakistan for three years and then switched. I have worked in social development sector and remained out of touch with medicine practice for quite a few years. Right now I have started studying and felt the joy of medicine practice. Hope some way will come out.
Some people, however, say that situation in US has changed and IMGs find it difficult to get residency with even above 90% score. Will somebody shed light!
Hi anie,
I know how that feels. But all we can do is try our best. There is a saying, ” You miss 100% of the balls you do not shoot.” So we need to try.
Askdoc
Hi Askdoc,
I am old IMG (2005), I got my education in Ukraine. I have 6 failed attempt of USMLE 1.On 5th attempt I got 74.186, on 6th I got 73.185(this November), I don’t know what to do, should I even try 7th time or not, is it any chance at all to get a residency? I saw some states requirement are unlimited USMLE attempt.
Please, tell me if it any hope in my situation?
Thank you beforehand.
Tatyana
Hi Tatyana,
It depends on how badly you want to practice in the US. I will be honest with your chance is very low unless you get a really high score on your 7th attempt. And try to do Step 2 CK in 1 attempt. My suggestion is if you really want to practice medicine in the US, then make sure you get a really good score on your Step 1. Do not take the exam unless you are getting predicted score of 90 in the NBME or high 60′s in Uworld qbank. You need to understand also what you have been doing wrong with your prep. There is always something wrong. If you have a language problem, then you might need to improve your English. Needing to translate the questions in your head can adversely affect your scores.
Askdoc
hi doc, i really disappointed on getting my step 1 result ,i got 63/168,i an an international graduate of 2006, i had gone thru uworld and by the end i was scoring between 80 and 90, wen i got to know about nbme i had no time left, wen i gave my step 1 i was expecting to pass ,now how shud start my prep so that this time i can surely make it,please help me,
Hi doc, I finished Medical School 3 years ago, never practice, and wanting to start studying again.
I dont want, YET, commit to any course or a lot of expenses, since I want to be first scheduled again. I wanna ask you if you could pls email me, I would like you to plan a study program with certain amount of hours, and if you could explain some things that are still not very clear for me about USMLE, all these names…(EFCMG, NBME, etc) etc etc
Im sure willing to pay (if I hopefully can afford it!) for this private advice.
lrssteps@gmail.com
Thank you so much!
if you were really scoring 80 90 on uworld, i dont think u will score 63. be honest with yourself.
yes i did, but i repeated those mcqs almost three times, my average started from 55 and by the end it was 70 and in individual tests i score 80 or 90 percent,only in UW,wat i have found repetition of the same content was not enough for this exam, they are really tough and need very good concepts,one has to work really hard
Hi maha82,
Well, you just answered your own question. When I did the UW qbank the 2nd time around I was averaging 99.5%. when I shifted to Kaplan qbank the next day which I have never done before, I was down again to a realistic 82%. So taking it the 3rd time around and just averaging 80 to 90 is very, very poor, no wonder you failed. I cannot tell you what you should do because you did not mention how you reviewed before. I suggest you read all the articles on my blog and come up with a proper study strategy.
Askdoc
Hi lrs,
You need a long learning phase. However, as of the moment I am very busy and cannot give private advise. I’ve been offered amounts ranging from US$ 150 to US$ 200 per hour and I had to turn them down. I am planning to provide a club of some sort for Old IMG’s probably next year. There will be twice monthly group chat session where you can ask questions and get them answered, plus forum support for members. It will be on a subscription basis. You may want to wait for that instead. Until I can clone myself, I cannot do one on one as of the moment.
Askdoc
hi,
can you please advise me? i am an old IMG having phD doing clinical research with publications in a very reputated US medical school. I tried my 4th attempt of USMLE 1 in 2001 but failed. want to try again . can you please advice what is the chances of getting residency.
thanks, mami
hi,
need advice; old IMG (about 20 yrs back)) have phD doing clinical research in a well known medical school with publication and holding faculty position
failed to pass 4th attempt usmle l no attemt any other step.
Any hope getting residency. if so what should be the minimum score needed for it
Hi,
I graduated in 2005 and I only did 1 and half year volunteer with the pediatrician in my home country and now I am living in Canada and soon will be the Canadian citizen.I am going to do my residency in US.
Do you think I have any chance to get mach there?
Also where can I find the information about the visa I need to get?
Can I stay in US after I finish my residency?
hi
aiam an old IMG ASKING 4 ADVICE IN STEP1
I an IMG graduated 2006. want to start studying for Step 1 June 1st. Intends to take the exam November 15th. Please i need a detailed advice on how to go about with my preparation. I have enfolled in Kaplan live lecture 7weeks and centre prep. I know i need a lot of reading because it has been years since i left basic sciences. Please give me a sincere advice. thanks.
Hi Chime,
Most of the advise I have to give are in the blog posts already. The actual detailed preparation you need to do depends on your situation and there is no one size fits all program. Although Kaplan programs are quite good, the problem is that they are one size fits all programs. They are geared for the average student. Of course the average student could pass this exam without enrolling in an expensive program. So I suggest you find someone who can coach you. Look through your specific problems and guide you accordingly. That is actually the way my prep course is set up. The actual course materials each student goes through are varied and includes Kaplan, USMLE World, etc. So, there is a general method of studying with guidelines on what textbooks, qbanks to use, how to use etc. If you need to enroll in a live prep class because you need a structured environment for studying, I do recommend that to my students if needed.
Again, I suggest you find someone to work through with you your particular situation and organize a program that will fit you.
Askdoc
Hi AskDoc,
You are an inspirational person. Thank you for your posts and your encouragement for many people.
I am also a old graduate 2003 from carribean med school. I just have a question on Residency Chances. My attempts at the Steps are as follows
Steps 1 Step 2
1999 fail 2002 fail
2003 fail 2004 fail
2004 fail 2006 fail
l
signed up for june 2011 2009 passed 77
I am doing better prepping for step 1 and feel much better about it than all other times. My question is it worth it to do all this. Lot of people are telling me to do something else cause I wont get residency. Can you please help me no one can tell me and am just discouraged with all these attempts.If I had known the cutoff criteria for some states i would have not even taken the exam. Can you please shed some light on this. I would be grateful. Also where can I find info on your prep classes. Thank you and God Bless you
hi askdoc
hey m shelly …
graduation in 2001 MBBS
post graduated in biochemistry …2003–2006
taught biochemistry and worked in lab—2006- till date
USMLE step 1 scores : 99/244 ( 2011)
research publication : one in indexed national journal
clinical expereince : out of touch since 2001 …:(((
wat are my chances of getting a residency in US
kindly guide
shelly
HI , i am an indian post graduate with MD in internal medicine. graduated in 2006 and completed my post graduation in 2010. wat are my chances of getting residency in internal medicine if i write usmle, wat scores are required.
HI AskDoc
iam old IMG graduated (1992)have master dgree in my country(2001) and iam starting month ago to study usmle step 1 ,i just stop working and i have free time for studying Kaplan lectures and dvds ,i just need ur advice and if there a especial sequence for studying these lectures ..thanks
I love this site.. makes me feel that I still can do something for my self… thak you AskDoc for your time.
Thanks for all the good advice. Good to be experienced doc, not so good to have to start over..
When/how can I hear about your Old IMG Club?
Hi AskDoc!
I’ve been reading your web site, which I find extremely interesting. I am an old IMG (graduated from medical school in 2000 in Portugal, my home country) and have already completed my residency in Internal Medicine (which in Portugal takes 6 full years), so I am now a board certified Internist in Portugal. I’ve been thinking about moving abroad, namely to the U.S. What I would like to know is, besides the USMLE-123, what should I do in order to get my specialist training recognized – if at all possible.
Thank you and keep up with your excellent work!
Hello askdoc I am an old graduate of 2006.I am an IMG candidate with a GC …But I have just passed step 1 at first attempt with 195/79.With low step 1 scores what should I do now to improve my CV and increase chances of getting interviews for family medicine or pediatrics? Thanking you in anticipation for your suggestions…
Dear Askdoc I have only one regret that I came a cross with your blog so late. I failed my step 1 and now I’m puzzled and have a lot of questions in my mind – what should I do now and from what side approach my task. Some information about myself – I graduated in 1996 from Russian Medical Academy, worked as a gynecologist and GP. Since I moved in USA I’v been learning English for 3 years(I think I’v made some progress in it) and starting to prepare for USMLE almost simultaneously.
My exam was 11.13.11 and now I need some advice and probably some direction from you.
HI Elena,
First, take it easy, relax then start your prep again. This time make sure you prep correctly. Most common reason for failing the USMLE is wrong prep. You need to understand what you did wrong in your preparation, make the necessary correction, then do it right this time.
Askdoc
Hi Anu,
First, get a really high Step 2 CK score at least 95 and up. Better yet also get a good step 3 score at least 90. Externships in the appropriate field will help, especially if done in the institution you are applying or at least in the same city. LORs unless from very prominent physicians are not very useful. Better LOR’s from physicians who practice in the city or community you plan to apply.
Askdoc
Hi Sergio,
That’s the problem, they usually don’t give that much weight to whatever foreign training you have done, although it helps vs people without any specialist training. That’s all.
Askdoc
Hi
I AM A GRAD OF 1998
PASSED USMLE 1 79 IN 1999
PASSED USMLE 2 90
CSA FAILED ONCE
TAKING CS NOW IN AUG 2012
STEP 3 LATER
PASSED MRCP 1
NO US EXP
HOW TO INCREASE MY CHANCES OF GETTING MATCHED SHOULD I SATND A CHANCE OR SHOULD I QUIT AND CONTINUE ON MRCP
THANKS IN ADVANCE
hello askdoc
i am an older img….graduated in 1992….finished pediatric residency and moved to the states in 2003…..have not passed the step 1….tried 3 times no luck….sent inquiries about pediatric fellowship programs who may accept img who has done residency abroad and one actually responded stating they do and they will review my application if i am interested….however i know i need to pass usmle first….you think it’s worth taking another chance? i kinda have almost given up on it after reading most forums saying how hard it is for older imgs to make it into any of the residency training….until i received this email just today…your insight will be well appreciated.
Hi everyone
I am 1994 grad. I moved to US in 2000. I never appeared for usmle any time. Do u think it is worth trying out? I am out of medicine since long. Please give me advice. I am very desperate to do the exams. I couldn’t do it because of the family situation. Now I feel I am too old to go through this. Please respond. Emotional turmoil please help.
Hi Jyo,
I guess whether you can do it or not depends on how badly you want to be a practicing physician in the US. Is it possible for you to restart a medical career in the US after a long absence in Medicine? The answer is yes. Is it going to be easy? The answer is no. You need to do a lot of work and you need a lot of patience if you want to do this. Is there a guarantee you will succeed? No. Has other people successfully done it? Yes, a lot. But they did what was needed to succeed. First, you need to get some volunteer work or externship in a medical setting. Next you need to get a good score not just pass the USMLE. If you are a US Citizen or Green Card Holder, you have a better chance at getting an interview. If you worked in a medical environment, ie medical research then your chances are also better. But in the end, the most important determinant is how badly you want to do this and how much you are willing to sacrifice to make it work.
Askdoc
Hi jica,
For me, its simply this. If you pass the USMLE, then getting a residency remains a possibility. If you don’t pass USMLE then it’s impossible. It depends whether you want to keep your option open. It’s really hard to get a residency if you are an old grad. But not impossible. A lot of old grad managed to get residency, even those more than 10 years out of medical school. The question is how badly do you want it and what you are willing to go through to get it.
Askdoc
Hi pachi74,
My opinion is that your chance of a US Residency is low but not impossible. I suggest take the CS to keep your options open but concentrate on MRCP.
Askdoc
Thanks Askdoc
I really appreciate that. I want to practise no matter what because I feel guilty about it. I have no confidence because of that. As a child I always dreamed about it no matter in which country. I just couldn’t do it because of several problems. Now I am at the edge of the cliff as far as medicine is concerned. I certainly do not want to die with this burden. I am a US citizen. Now please can you tell me what’s the best way to prepare? To score high how did you study and what prep material did you use? I might need some intensive course. What’s your advise?
Hi
When can I enroll for you online course? How long it should take normally to finish other material?Thanks.
Dear Askdoc,
I am curious about your opinion. I failed my first and last by far Step I exam back in 2001 (was not ready and shouldn’t take it on the first place), then my professional interests took me elsewhere. However, life realities brought me back to the ECFMG certificate track (how crazy is that?). I am an [almost] expert in HOW to prepare, but was never able to organize/push myself through this properly, plus the materials I read/about were mainly for fresh graduates. Any motivational/reading materials suggestions? Thank you in advance!