Askdoc's USMLE Newsletter

Why IMGs Have to Study Harder Than AMGs


Happy to have you back. As an IMG, the USMLE is really way much harder for me than it is for most AMGs. More so, being an old IMG.

Two issues ago, we talked about how a lot of people underestimate how hard the USMLE actually is. Even though they claim to know that it is hard, the way they prep for it makes it seem like they think it is easy. There really is a need to walk the talk if you want to do well in the USMLE Steps.

I Know. It Sucks to be an Old IMG.

I know what it feels like to have people look down upon you just because you are an old IMG. Being an old IMG, everyone made sure that I know that my chances of passing the USMLE is nil and the most I can hope for if by some miracle I do pass it is a very low score. In the vicinity of a 75 or 76. As one person told me, you will never match with a 75. Why bother?

It seems most people have the opposite opinion about old IMGs altogether. The exam is easy but old IMG's will find it hard to pass it. The reasons given were varied. The kinder ones were that you can't teach old dogs new tricks. Or that older IMG's were busier in life so can't prep properly. There are implications that schooling is an important factor so unless an old IMG go back to medical school, no way he can pass this.

The more nasty comments include, Old IMG are old and therefore dumber. Or they are obsolete and a total failure. ( if they are successful, why would they want to go to the US to practice Medicine) In fact this attitude is not only prevalent among those taking the exam but even among some program directors. One program director remarked to me during an interview "Can't make it in your own country, huh?" even though I got double 99's and I co- own a chain of multi-specialty clinic and diagnostic laboratory in my own country.

I remember a post in one of the forums that went like this.

You old IMGs should all go home now. If you were any good, you would now be a success and don't have to take the USMLE.

A Fresh Grad IMG

"You old IMGs should all go home now. If you were any good, you would now be a success and don't have to take the USMLE."

And this was from a fresh grad IMG. Lol and Wow.

In 2005, searching through hundreds of exam experiences of IMGs, I found only a few dozen from old IMGs. And the highest score was an 82 or about 200 at that time. And that is someone five years out of medical school, not 16 years like me. Most failed. You can imagine how demoralizing it was for me to hear and read about this.

Therefore, for a lot of people, USMLE is easy for fresh grads, but tough for old IMGs. Not because they get different exams. It's the same exam. But because of difference in intellect and capabilities.

But of course, the fact that I and a lot of other old IMGs have aced these exams have proven that these people are wrong. But up to now, I still see those claim cropping up once in a while in forums. I guess that was a good thing, because it forced me not to take it easy.

The failure rate for first time takers among IMGs is between 30-40% while for American Medical Students, it is less than 10%. Why the big difference? In fact, when I was doing my research, one persistent myth keeps on circulating among IMGs and I addressed it in a blog post. (See "Is the Version of the USMLE for IMGs Harder Than For AMGs?") However, it is actually the same exam. So what accounts for the difference?

Why the USMLE is Harder for IMGs

I remember someone calling me crazy in my blog for saying that you need on average 3 to 6 months to pass this exam. Even if you are a fresh grad. He said that AMGs have only 4 to 6 weeks to prepare for this exam, and if they need months of prep, then they can't finish medical school in the allotted four years.

Well, first AMGs take their Step 1 on their third year of medical school not after graduation. When basic medical science is still fresh in their mind. Are you a third year medical student?

Second, American medical schools make sure that their students can pass the USMLE. They even give them special prep for this exam not to mention that the entire first two years is devoted to insuring this. Why? Because medical schools maintain their accreditation only if a large enough percentage of their students pass their country's medical boards. So unless you are studying in an American medical school, your school's curriculum and focus is on you passing your country's medical board. And the requirement is vastly different for different countries.

For example, in my home country we see thousands of cases of Dengue fever and PTB each year. So they are studied very well and in detail. And yet you will hardly find that covered in the USMLE. Most physicians in my home country will probably never see a case of sickle cell anemia or Tay-Sach's disease and yet these are important diseases in the US. So you need all those extra time to study those differences.

Third, AMGs are used to answering USMLE type questions since most of their shelf exams are developed by the USMLE. That means they need less time to practice and get used to answering USMLE type questions. That means they also know or are taught how to study correctly in order to be able to answer USMLE type questions.

We will talk about how to study for and answer USMLE type questions in a future issue and how even if you know the topic being tested, if you study it the wrong way, you still won't be able to answer the question. I will include examples.

Lastly, half of behavioral sciences is medical ethics and law which is culture-based. And unless you have spent the past 5 years or more living in the US, your culture is not US culture and so you need to study that.

So maybe for third year American medical students, they need only a short review compared to everyone else, since most of them just need a short high yield review to pass this exam. In fact the high-yield component of my study plan which accounts for 25% of my study plan can be finished in 2 to 4 weeks compared to the 4- 6 weeks American medical students have to prepare to do this exam.

That is why IMGs need to study harder and longer than their American counterpart for the USMLE. Not because of a difference in intelligence or skills. But more of a difference in training emphasis and culture. Believe me, just as many AMGs will fail your country's medical board if they try to sit for it.

And yet even with all that advantage, 1 out of 10 American students fail this exam. I know because some of them wind up in my prep course and after a few months, they finally passed. Only 15 out of a hundred gets a 99 or above 240 and only 1 out of a hundred gets above 255.

To be Honest It Sucks Just a Little Bit Less to Be a Fresh Grad IMG

There is one more important reason why IMGs need to study harder than AMGs for the USMLE Step 1. Failing the USMLE will not harm the AMG much. All they need is to pass and they will get a residency position. For the IMG, failing means they can kiss goodbye to residency.

Fail once and your chance of getting an interview falls to almost 0. Same thing with scoring below 210. To have a decent chance of getting at least 5 residency interviews (the average required to get into a residency program), you need at least an 88/218(Average is 216 in 2006) . It may be even higher now since the mean have risen from 216 to 229 in 2015. Even with higher scores, your chances for an interview is way much smaller than an AMG who barely pass the USMLE. It's even worse for old IMGs.

I remember sitting in a room for an interview. There were 8 IMGs in the room including me. The lowest score among the IMG was an 87. There was one AMG and her score was 78. Everyone in the room including the chief resident of the department who is also an IMG acknowledge that she has the best chance of getting a position even if I have a double 99 and there were 2 others with high 90's. It's that bad.

Therefore, IMGs need to study harder than AMGs because they need higher scores to get interviews and land residency positions than AMGs. The minimum AMG score to land a surgical residency interview is 82. For IMGs, it's 92.

So acknowledging that studying for this exam is going to be tough is the first step to prepping right. Especially for the IMG. And yet too many IMGs prefer to use the study plan used by AMGs. Why? Because it's an easier and shorter prep.

Although, these IMGs use an AMG study plan, they study the same way they studied for their country's medical board. An IMG study plan should be longer and entail studying more details. It needs to use more detailed reviewers and occasionally textbooks. However, IMGs should study them like AMGs do, so they can answer USMLE type questions much, much better. Remember, there are study methods that help you study the medical concepts in such a way that you can answer USMLE type questions better.

The only thing that makes life unfair is the delusion that it must be fair.

Steve Maraboli
Author and Behavioral Scientist

We will discuss how to create a study plan, what study materials to use and how to study so you will find answering USMLE type questions easier in future issues of this newsletter. So stay tuned.

That is all for now. In a future issue we will discuss "What Makes the USMLE Step 1 Hard." Just knowing that the USMLE Step 1 is hard will not help you overcome the problems. You need to know in detail what makes the USMLE Step 1 hard so you can formulate specific strategies to overcoming them in your prep.

If you have not yet downloaded a copy of my free ebook "How to Create a Study Plan for the USMLE´╗┐." Please do so.

Hope to see you all again next issue.


P.S. You may want to check out my book "How to Master the USMLE Step 1: Askdoc's Method of USMLE Prep." It covers everything we discussed and will be discussing in this series of newsletter. It's available at Amazon in both Kindle and Paperback edition.

P.P.S. Next issue, we will discuss How We Learn. By understanding how we learn, we can implement study methods that will increase our speed and efficiency of learning several fold.

Better Prep.

Easier Exam.

Higher Scores.

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