Is the version of the USMLE for IMGs harder than for AMGs?

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Along with “the USMLE is getting harder every year” claim, these 2 are probably the longest running and most persistent myth in various USMLE forums since 2005. The examination for IMGs (International Medical Graduates) and AMGs come from the same pool of questions and are more or less the same. The only difference being that only AMG performance is use to calculate the passing score for the examination. The passing score is set at that score where 90% of AMGs will pass the examination. Hence, every time the passing rate for AMG starts creeping up, the USMLE raises the passing grade. The performance of IMGs are never considered in the process.

The usual basis for this observation is that while over 90% of AMGs pass the USMLE Step 1, only 65% of IMGs pass the USMLE Step 1 on their first take. However the real reason for this occurrence is manifold.

First, all medical schools train their students to pass their own medical boards. This is because board passing rate is an important criteria for these schools to remain open. The US is no different from other countries in this regard. And unless your country’s medical school is specifically geared to graduating medical students for practicing in the US, you will tend to do better in your own country’s medical board exam. AMGs will probably have a lower passing rate as a whole when attempting to take another country’s medical board.

Second, the disease prevalence in different countries are of course quite different and your medical school will naturally focus on the most prevalent diseases in your area which may be quite different from the US. For example, Sickle Cell is a disease that primarily strikes the Black population and if you come from European or Asian country you may not have ever seen a single case. Cystic Fibrosis is a predominantly Caucasian disease and will not be well studied in Asia or Africa. Dengue might be prevalent in Asia but is quite rare in the US while the opposite is true of Histoplasma. Therefore, AMGs will have an advantage in that the information they have mastered is the one actually being tested in the USMLE.

Thirdly, there is a cultural bias which, depending on how different your cultural values are can impact your scores. I am of course talking about Behavioral Science in step 1 and Ethics in Step 2 CK and Step 3. Again, this can impact an IMGs score tremendously as Behavioral Science can cover up to 10% of your step 1 score.

And so, although both IMGs and AMGs are taking the same set of examinations, IMGs will find the exam harder than most AMGs.

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