Tips and Tricks for IMGs To Succeed on the USMLE®

Tips and Tricks for IMGs to Succeed on the USMLE Exams

By Michael Zobel, MD

There’s no doubt that preparing for the USMLE requires medical students to navigate a confusing maze of question banks (QBanks), practice tests, flashcards, and other study resources. For that reason, it’s normal for any medical student to wonder, “Am I doing this right?” 

In addition to the usual challenges, international medical graduates (IMGs) often have their own unique concerns, including curriculum differences and non-native English skills. As someone who tutors IMGs during their USMLE preparation, I’ve found some important tips and tricks that have helped many IMGs achieve the best outcome possible on test day.

1. Familiarize yourself with multiple-choice standardized exams

Simple strategies for multiple-choice tests should not be taken for granted. In many countries around the world, standardized exams are not typically given in a multiple-choice format. In European medical schools, especially, students’ knowledge is often tested via oral exams where medical students answer or discuss questions directly with a test proctor. If you are an IMG whose medical school uses this testing model, do not assume that you will immediately be comfortable with a multiple-choice exam. 

Aside from being unable to get partial credit on multiple choice questions, one of the major challenges of multiple choice exams is the presence of different (and often tempting) answer choices. These can cause test takers to hesitate or doubt their original thought process, ultimately resulting in getting the question wrong. To better your performance on multiple choice questions, start doing practice questions as early as you can with a trusted QBank such as UWorld; this will help you familiarize yourself with the multiple choice format long before you have to dedicate all your efforts to reviewing the test material.

2. American MS2 ≠ IMG MS2

Most American medical schools follow a curriculum model that allows students to take their USMLE Step 1 at the end of year 2 (MS2) and their USMLE Step 2 CK at either the end of year 3 (MS3) or the beginning of year 4 (MS4). International medical schools do not usually work on the same timeline. In Europe, Asia, and the MENA (Middle East and North Africa) region, it is not uncommon for medical school to last six years or more. 

It is thus critical for IMG students to make sure they have actually learned the material necessary for the specific USMLE step prior to their test date. For some IMGs, this may mean waiting until they have completely finished medical school to take the USMLE. However, depending on your school’s curriculum, it may be a better idea to take Step 1 and/or Step 2 CK while you are still in medical school because the content will be fresher in your mind and easier to review. You’ll just want to be sure that your curriculum has covered all the topics on the test.

3. Take an OET Medicine course if you need one

The USMLE steps are timed exams offered only in English, with questions set up by a sometimes lengthy vignette. To gain ECFMG certification to take the USMLE, IMGs must first get a satisfactory score on the Occupational English Test (OET) for Medicine. 

IMGs for whom English is their second language frequently report difficulty getting through all the exam questions in the allotted time because ites a loer to read and understand what’s being asked. While most medical terminology is the same or similar across languages, it can be beneficial for students struggling with English to take advantage of the free OET prep resources that will help toward both ECFMG certification and USMLE success.

4. Talk to students who have already taken the USMLE

Assuming you went to an accredited medical school, chances are that you are not the only student at your institution who has ever wanted to take the USMLE. Get in touch with peers or alumni who recently took the USMLE (eg, within the last three years) and ask them about their experience. Here are a couple of insightful questions to ask:

  • What year in medical school did you take each USMLE step?
  • While studying for the USMLE, did you encounter anything you didn’t remember learning in your regular medical school curriculum?
  • Is there anything you would do differently if you had to retake the exam?

5. Check if your medical school offers any USMLE prep resources

Many institutions (especially large international medical schools) are beginning to offer USMLE prep courses or resources to students who want to take the exams. At some medical schools, these programs are robust and bring in trusted test prep providers like Kaplan or Elite Medical Prep to conduct USMLE courses. Other medical schools may provide access to test advising or a small stipend to support students in a prep option of their choosing. Either way, it’s worth checking with your medical school to see how it can help you. You may be surprised at what’s available.

6. Yes, you’re an IMG, but everyone is taking the same test!

In my experience tutoring IMGs, I have found that many worry they need to use different (or additional) USMLE prep resources from those US medical students use because there is greater pressure on IMGs to get a high score. While the pressure is legitimate, ultimately, you are taking the same test as your American counterparts, and the same basic rules for preparation apply. 

Whether you’re an American student or an IMG, overloading yourself on USMLE resources can actually do more harm than good. Therefore, regardless of where you completed your medical education, you should follow these same key steps to prepare for your exams:

  • Make sure your curriculum has covered all the content included on the exam by the time you begin your dedicated study for your exam. 
  • Do a QBank-centered review supplemented by a video learning resource, flashcards, and periodic practice exams (to measure progress).

Unfortunately, there is no singular formula for guaranteed success and no way around the truth that your performance on the USMLE Step 1 and Step 2 CK examinations is critical to your ability to successfully match into a US residency program. However, the USMLE steps can be seen as opportunities to level the playing field with US graduates, with excellent scores being a significant difference-maker in matching. If you follow the above tips, you should be in a good place to do your absolute best on the USMLE. Good luck!