Not so long ago, students took the USMLE Step 1 the old-fashioned way, rifling through paper test booklets with No. 2 pencils clenched firmly in hand. By 1999, however, the Step 1 exam had become fully computerized, and in 2006 the USMLE completed its transition to computer-based testing with the introduction of FRED, its new test delivery software.

So what do FRED and the computer-based format mean to you?

To a large extent, the significance of computer-based testing hinges on your level of computer expertise. If you’re an unabashed geek, chances are you’ll adapt quickly to the FRED test interface. But if you’re downright computer-phobic, blanch at the sight of a Windows platform, or are slow to adapt to new software, you may want to hone your test-taking skills by tackling a few practice questions.

The good news is that to practice the exam, you need look no further than the CD-ROM you’ll receive upon registering, which contains approximately 150 sample questions presented in the FRED test delivery format. You can also download the same questions directly from the USMLE Web site at www.usmle.org/Orientation/2008/menu.html. Alternatively, for a fee of $42, you can opt to take a timed practice exam at an actual testing center. Note, however, that the test questions you’ll be asked will be no different from those available to you online. For more information, go to https://apps.nbme.org/CBTPSRegistrationWeb/jsp/usmle_CBTPS_registration.jsp.

Questions for the USMLE Step 2 Clinical Knowledge are prepared by faculty, clinicians and committee members who are prominent in their respective field. Generally, test questions focus on concepts and topics which medical students should master prior to starting their postgraduate training. According to the USMLE website, questions  are comprised of two dimensions:

• Dimension 1:  Normal Conditions and Disease categories – Questions from this dimension focus on normal growth and development, basic concepts, and general principles.
• Dimension 2: Physician Task – Questions from this dimension focus on several tasks performed by physicians. They include:
  • Promoting Preventive Medicine and Health Maintenance – This section challenges students on their ability to understand and apply their knowledge of primary and secondary preventive measures.
  • Understanding Mechanisms of Disease – This section focuses on etiology, pathophysiology, and effects of treatment for diseases.
  • Establishing a Diagnosis – This section measures the student’s ability to interpret history and physical findings, results of laboratory, imaging, and other studies to determine the diagnosis or the most appropriate next step in diagnosis.
  • Applying Principles of Management

For more information, please see:

PDF version of Step 2 CK content description and sample test materials

Study Resources:

Step 2 CK Qmax has everything you need to ensure success on the USMLE Step 2 CK exam:

• 2,000+ top-rated USMLE-style questions with detailed explanations
• NBME FRED-style interface for true simulation
• Customizable by test mode, subject matter, and question reuse
• Create half or full day simulations
• Detailed performance feedback
• Accessible 24/7 anywhere
• Pass the Step 2 CK with USMLERx or we’ll double your subscription! See Terms and Conditions for details.

Or Visit:

http://www.usmlerx.com/USMLEFlash/step2.aspx

The Step 2 Clinical Skills (CS) exam uses “standardized patients [SP] to test medical students and graduates on their ability to gather information from patients, perform physical examinations, and communicate their findings to patients and colleagues” (USMLE).

To get started, register for the exam at one of five regional centers. Plan ahead as sites fill quickly:
http://www.usmle.org/Examinations/step2/step2cs_registration.html

The exam itself lasts about 8 hours, with 2 breaks (30 minutes and 15 minutes), and includes approximately 12 patient encounters. As you interview patients, you are observed through a one-way window for scoring and quality assurance. You will have 15 minutes to gather a history and conduct a focused physical exam, followed by 10 minutes to complete a PN (written or typed, your choice). A 5-minute warning is provided during the patient encounter.

Practice typing in a patient note (the “PN”), which includes the History, Physical Exam, Differential Diagnosis and Diagnostic Workup:
http://www.usmle.org/Orientation/2010/PatientNote/EntryFrame.htm

Familiarizing yourself with the PN in advance will help you to organize your thoughts accordingly during pre-examination practice cases with the help of review texts or your friends.

First Aid for the USMLE Step 2 CS, Third Edition was recently released in October 2009. This review text contains reviews of each of the five regional centers, including advice on travel and accommodations as well as tourist destinations. Particularly if you must fly out to reach a site, you may as well stop to enjoy the trip if possible! The book also contains insights into the exam, minicases, and 41 full practice cases complete with SP guidance and PN.

Finally, relax. According to the latest performance data (2008), 97% of MD candidates in the US/Canada will pass this test on the first go. There is considerably more anxiety among IMGs, for whom the rate is 72% (the CIS and SEP scores are often the culprits), but as with any of the USMLE exams, adequate preparation is the key to confidence and success.

Beginning in April 2009, the sponsors of the USMLE program agreed, in response to concerns about the spread of pandemic novel H1N1 influenza, to waive their fees for eligibility period extensions. This temporary fee waiver was intended to give examinees flexibility in scheduling examinations during the influenza outbreak.

…Therefore, applications for eligibility period extensions received after May 31, 2010 will require payment of the eligibility period extension fee. In addition, examinees will be subject to the eligibility period extension restrictions in place prior to April 2009 (i.e., examinees will be permitted only one, three-month eligibility period extension, contiguous with the original eligibility period). The fee and restrictions apply to both already registered examinees as well as examinees who will register in the future.

Click here for full announcement

When preparing to take the USMLE Step 1, you may feel overwhelmed by the sheer volume of test-taking advice available. Everyone has an opinion! It seems as though test preparation “tips and tricks” are virtually everywhere — from relevant Web sites to online discussion forums to board review texts. And to make matters worse, each putative source seems to have a different slant on what constitutes the “best” study guide, strategy, or technique.

How are you supposed to figure out what works best for you??

This is one of the most important exams of your career so you want to make sure you do what’s best for you – don’t just follow someone else’s advice. You’ve been taking exams for years; you know your study style and what it takes to achieve the best results. Don’t stray from this.

There are several studying options. You can go it alone, or you can find a study partner –the perfect size for a study group is 2 people because you will be constantly engaged, or you can join a larger group. But the most important thing to do is PLAN.

Know your strengths and weaknesses and study accordingly. Know how you study best and don’t change it up for this exam. Know how much time you have and set a timetable – and stick with it!

If for some reason you need to change your scheduled test date, all is not lost.

If you need to change your test date to another day that falls within your three-month eligibility period, you can either call Thomson Prometric at 1-800-MED-EXAM or visit their Web site. Either way, you must request a change by noon EST five business days before your appointment to avoid incurring a rescheduling fee.

If, on the other hand, you need to pick a test date that lies outside your eligibility period, you will have to submit a new application along with yet another application fee (and no, they won’t refund your old one).

Even if you have no need to reschedule, the NBME cautions that scheduling a test date with Prometric will not guarantee you that a given test time or location will remain open. On rare occasions, a test center or time slot may become unavailable after you have scheduled your appointment. Should this occur, Prometric will try its best to notify you in time to reschedule your appointment. To play it safe, however, you should confirm your appointment with Prometric a week before your scheduled test date.

The USMLE publishes a set of practice exams for Steps 1, 2 CK, and 3 in both FREDv1 and FREDv2 formats. For those interested in scoping out the test site prior to the actual test date, these practice exams can be taken in the testing environment at the Prometric center of your choice. The fee for the computer-based testing (CBT) practice session is $48.

How is the practice day organized (Steps 1 and 2 CK)?
The duration of the practice exam session is 3.5 hours, which is divided into three 60-minute blocks of 50 multiple-choice test items. On the actual exams, however, blocks consist of only 48 questions. Working through the practice exam will give you an opportunity to read the tutorial on a day other than your actual exam day. The remaining time allocated for the tutorial is transferred to your total break time, as is time remaining at the end of each block of questions.

Upon completing the practice session, you will receive an on-screen (and later, printed copy) score report with the percent correct for each of the 3 blocks. In addition to serving as a nice baseline to your USMLE study preparation period, it will give you the chance to familiarize yourself with the test atmosphere, actual FRED software, and Prometric site (where the restrooms and lockers are located, estimated travel time, etc.).

Note also that, although the official Bulletin states that study materials can be kept in your locker (Rules of Conduct #4), the Prometric centers often prohibit “studying” during breaks. As a practical note, you should relax during your breaks and not worry about the exam!

Practice exams can be scheduled by visiting https://apps.nbme.org/CBTPSRegistrationWeb/jsp/usmle_CBTPS_registration.jsp

Now that you’ve mobilized your resources, here are some quick tips to help keep you on track.

• Practice, practice, practice. Drawing from the test resources we’ve described to you, take as many practice exams as you can, both computerized and paper-based. As previously noted, you might also consider taking a simulated test at a Prometric testing center.
• Pace yourself. As you take your practice exams, learn to keep pace. Get in the habit of keeping your eye on the clock.
• Learn from your mistakes. Use your practice sessions to identify weaknesses not only in your body of knowledge but also in your test-taking skills. If multiple-choice questions aren’t your forte, try out a variety of approaches until you learn what works best for you.
• Don’t get stuck. Try not to dwell on difficult questions. Instead, give them your best shot, mark them for review, and come back to them later if you have time.
• Don’t leave questions blank. As you go through your practice tests, bear in mind that on the actual Step 1 exam, no penalty will be imposed on you for wrong answers. So don’t leave any questions unanswered; instead, answer them with your best hunch.

In years past, the Step 1 exam was organized around seven major content areas: anatomy, behavioral science, biochemistry, microbiology, pathology, pharmacology, and physiology. Over the past decade, however, the exam has shifted its focus to reflect a more integrated, multidisciplinary approach. Thus, tests of more recent vintage have concentrated not only on the general principles underlying the seven major disciplines (40–50%) but also on an understanding of individual organ systems (50–60%).

Over the years, Step 1 has also become more and more clinically oriented. As a result, an increasing number (some 65–70%) of Step 1 questions are being presented in the form of clinical vignettes.

Many test questions require that you be able to interpret black-and-while and color illustrations. These may include gross photographs, electron micrographs, radiographs and other forms of imaging, and simple line drawings. Still others may include tabular material.

Prospective examinees who wish to take Step 1 should start at the beginning: by going to the NBME Web site — and obtaining an application. This application will allow you to select one of 12 overlapping three-month periods (e.g., April-May-June or June-July-August) in which you would prefer to take the exam. After your registration has been processed (which may take up to four weeks), you will receive a bright orange scheduling permit that will allow you to make an appointment at a Prometric testing center. (Note: If you are an IMG, you will need to go to the ECFMG Web site to get your application.)

Bear in mind that Prometric schedules appointments for Step 1 as long as six months in advance of your eligibility period. Because test dates are scheduled on a first-come, first-served basis, however, we recommend that you phone Prometric as soon as you receive your scheduling permit. What this means is that if you want to take the test in June (the window of choice for most U.S. medical students), you should aim to fill out your application in November to ensure that you get your scheduling permit — and book your test date — before the end of the year. Registering early will also help ensure that you get your test center of choice (locate test sites near you).

Oh, and one more thing: Don’t lose your orange scheduling permit! It contains your candidate identification number, without which you will not be able to access your exam on test day.