PERCEPTIONS AND REALITIES OF THE UNITED STATES MEDICAL LICENSING EXAMINATION STEP 1 & STEP 2

Purpose: To examine the correlation between preparation strategies for the United States Medical Licensing Examination (USMLE) Step 1 and Step 2-Clinical Knowledge (CK) and Clinical Skills (CS)-and the achieved results, considering students' perceptions and expectations before and after the test. Methods: A survey based on 26 multiple-choice formatted questions was emailed to the graduating class of 2014 inquiring about the resources utilized, the perceived efficacy, degree of confidence in a successful outcome, and the extent of representation of individual disciples on the USMLE. An analysis was conducted on the collected data to determine the statistical significance. Results: Question Bank (U Bank) and 'First Aid' were the most commonly used resource for Step 2 Clinical knowledge (CS). Commonality and peer suggestion were the primary factors in the selection of resources for the Step 1, in contrast to the comprehensive nature of the resource for Step 2. Pathology and internal medicine were perceived as the key disciplines in the preparation for the Step 1 & 2 respectively. The confidence in a successful outcome was greater for Step 2. The most difficult aspects of the USMLE Step 1 were the comprehensive nature of the test as compared to length of the test for USMLE Step 2. Most respondents felt that the USMLE accurately tested their knowledge. Under-tested subjects for Step 1 were physical diagnosis and anatomy and similarly emergency medicine, family medicine and general surgery for Step 2. Nearly one third of the respondents chose biochemistry while another third selected pathology as over tested disciplines. Respondents felt that obstetrics and gynecology and internal medicine were over-tested for the Step 2. Most students indicated that they took time off to prepare for the Step 1 but not for Step 2. The residency choice appears to be the single most important motivating factor for taking the Steps 1 and 2. Conclusions: Students devote considerable effort and funds in their preparation for the USMLE Step 1, Step 2 CK, and CS. This study shows that Question Bank used extensively and for the longest period of time by students and perceived as a key factor in their success. First Aid was the most used resource for Step 2 CS. Students perceived expectations were met for the Step 2 CK more than for Step 1. We believe the findings can serve as a guide for future USMLE participants to select the most efficient resources for a successful outcome.