IMG Info: Timetable and Tips for Taking USMLE Step 1 as an IMG

By Sarah Wesley

Of the three USMLEs, the Step 1 is perhaps the most intimidating. The Step 1 exam requires a revisiting of basic anatomy, physiology, embryology, pharmacology, and biochemistry.  For a medical student attending an institution where the majority of others are not taking the Steps, it can be difficult to juggle your home institution’s exams with the USMLE tests. Moreover, for an IMG who is already out of medical school and working, it can be difficult to find the time to relearn everything. Here are a few tips for success:

  1. Where:  I recommend that students and graduates take the Step 1 exam in their home country if possible or in the same place where they studied. Studying in one location and then flying elsewhere to sit the exam can make an already stressful exam that much harder. Prometric is the company that administers the tests, and their procedures, as well as the quality of their testing centers, is standardized throughout the world.  While it is slightly more expensive to take the exams outside of the U.S., it is well worth it to avoid the added stress of an unfamiliar place and issues such as jet lag.
  2. When: Start by creating a reasonable calendar of study that suits your schedule and responsibilities.  Most medical schools will have covered the topics you need for the Step 1 before starting the senior cycle of the medical degree (usually the summer before the last two years of medical school). Some people will study for the exam over several months while they work, others will take time off work or use a summer holiday period to “get it over with” quickly in five to eight weeks.  Moreover, while it is not advisable to wait too many years after graduation to apply to residency, there is no use taking it and failing or getting a poor score. If you need more time, do not be afraid to push the exam back, even if it means delaying your application by a season.  It would be better to take a year off after medical school, do subinternships in the US, and study well for the Steps than to apply early without competitive scores. As an IMG, you have the liberty to wait a year and work as a physician in your home country while applying.
  3. Study partner:  It is important to have an accountability buddy, whether that person is a fellow classmate taking the exam or an online study partner (you can make arrangements for an online study buddy through a number of the student medical forums).  The material is dense, and it is common for people to lose focus. Some even give up altogether if they don’t have support.
  4. Balancing Medical School Work and Step Studying: Depending on where you are in school, you will likely not have the advantage of a medical curriculum that caters to the material on Step 1.  For example, your school may have focused heavily on biochemistry and anatomy but breezed over pharmacology.  I would recommend supplementing your school’s curriculum with First Aid for the USMLE Step 1 material in order to fill in any gaps from the beginning.  However, I cannot emphasize enough that doing well at your home institution often means doing well on Step 1. Neglecting work at your medical school in order to study for Step 1 is generally a bad idea as you might miss out on a more holistic approach to medical education and understanding that cannot be replaced by reading a test review book.
  5. State of Mind:  Finally, relax and be good to your body while studying.  Adequate sleep cannot be underestimated for retention of knowledge.  Daily exercise while you study is also critical, both for stamina and for better retention outcomes.  While this test might seem like the “be all and end all” of your chances at residency in the U.S., the people who do the best are the ones who keep things in perspective and don’t let the anxiety of the test consume them.  Pace yourself and best of luck!


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