Canadian Citizens Should Not Go to Caribbean Medical Schools

From my observation, I have seen a lot of Canadian students fall in despair because they do not have American citizenship or US Green card.  After they do all their basic science classes and clinical clerkships they realize that being a legal US resident would give them an upper hand.   All residency programs will choose American medical graduates than any other, and then they'll look at non-American graduates that already has US citizenship or a green card.  Sponsoring J-1 visas require a lot of paperwork and fees and most residency programs will do their best avoid that by avoiding applicants that need it.

Unless you score extremely high on the USMLE tests, or have inside connection to the residency director, you will have a hard time getting a residency if you are a Canadian citizen.  The Caribbean medical schools were initially created for US citizens who couldn't get a seat at a US medical school.

If you are a Canadian citizen, I strongly recommend you try to get into a Canadian or a US medical school.  If you are already in a Caribbean medical school, then the only option is to find a way to get a US green card or a US citizenship.  I have seen one medical student marry a US citizen in order achieve that, but I'm sure there are many couples who did that.  If you do marry a US citizen, you can tell your US citizen partner that your country can give free healthcare since
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How to Pass the USMLE Step 2 CS

I passed the USMLE Step 2 CS a while back but I just got around to write this post. The Step 2 CS is not a walk in the park, if you were told that.  May be it was easy before the latest changes but now you have to have a bit of more knowledge than just knowing English. Step 2 CS is made up of three parts, ICE, SEP, and CIS.  Most people do very bad on the ICE part and sadly, a small handful of people fail due to that part.  In order to pass Step 2 CS you have to pass all three parts.

SEP (Spoken English Proficiency) is the section of weather you can speak English or not; it's a tough section for the non-English speaking people who have accents.  Be very clear with your accents, if you have one, they are listening to how you pronounce your words.

CIS (Communication Interpersonal Skills) deal with how good you can communicate with the patient. It'll test you on how well you can ask questions to the patients and how well you can establish a rapport with the patient.  This section also grades on your professionalism.

ICE (Integrated Clinical Encounter) section deals with data gathering from the questions you asked and the physical exam you conducted.  ICE also includes your patient note, in which you have to give 3 differential diagnosis and 2-3 reasons per diagnosis if applicable.  ICE is where it gets tough; however, if you completed all of your core rotations then ICE shouldn't be as challenging.

The test is composed of 12 cases, with 25 minutes per case.  Each case is divided with 15 minutes for history and physical, then you have 10 minutes to type up your notes.  After the first 5 cases you get a 30 minutes break, then you do 4 cases, then you get a 15 minutes break, then you do the last 3 cases and you are done.

When to Take Step 2 CS
I recommend you schedule Step 2 CS 6 months before you take, because it takes at least two months or more for the scores to come out.  Also, if you can schedule it correctly, I recommend you take your Step 2 CK first before you take your Step 2 CS.  Step 2 CS will test on your "basic" clinical knowledge so it would be alot easier for you to study if you took it after CK.

Studying with a Partner
I highly recommend you partner up with someone who is taking the test at the same time as you. That way both of you will be at the same pace and both you will motivate each other because studying for CS is painfully boring.

What Resources to Use
I recommend you just stick with the lastest version of the First Aid for Step 2 CS.  It's basic and it is a proper guide.  It may not have all the cases you will encounter in the real test but it's enough.  You can also add Kaplan's Step 2 CS book to solidify your studying.

How to Practice
Simulate the test when you practice, as in one partner is sitting down in a room, while the other partner is next to the door.  Start your timer at 15 min and practice, practice, practice from the CS books.  Know how to do every physical and what is stands for if it's positive and what to rule out if it's negative.  Remember physical counts part of ICE.  After that 15 minutes, take 10 minutes and type up the notes you wrote from your history & physical in your encounter.  PRACTICE TYPING; 10 minutes is not enough, and you have manage your time to get every detailed typed up. Your handwritten notes will not count until you put the information in your computer notes.  Your digital notes also counts toward ICE.

At the end of the day, few of your diagnosis could be wrong, but if you ask relevant questions, and if you are CONFIDENT, then you are good to go. The key to passing this test is showing confidence toward the patients, that's why I mention to practice as much as possible.

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Start Early to Study for the USMLE Step 2 CK

USMLE Step 1 studying was simple, after you are done with videos you just rely on First Aid and USMLE World QBank (UW for short). It's not the same for the USMLE Step 2 CK.  Step 2 CK has no one source in order to fully understand the material.  Unfortunately you have to make your notes your primary source. It's unfortunate that even to this day there is no one source that is a full comprehensible source.

USMLE World QBank for the Step 2 CK is NOT enough, especially if you have a big gap since you took Step 1. UW has all the main things you need to do well but unfortunately, it's just one piece of the puzzle to crack the Step 2 CK. When it comes to books, I strongly suggest you stick with your First Aid for the USMLE Step 1, and add notes to it. You need your Step 1 notes for Step 2 CK. Unfortunately MTB doesn't have the pathophysiology explanations that you need in order to understand why you conduct the proper management.

I noticed you get the hang of things when you do as many questions as possible. As in, do as many Qbanks as possible.  Do not jump to UW without some background reading, otherwise you'll be lost. If you are into question based studying like me, then start off with Kaplan QBank. Go through Kaplan Qbank first with a a book. MTB 2 and 3 is goes hand in hand with Kaplan QBank. 

Additional sections you should add to your First Aid are Surgery, OB/GYN, and Pediatrics. Other than the sections mentioned, and additional diseases, the only other thing you basically need to add to your First Aid for the USMLE Step 1, are diagnosis and treatment info. Don't waste your money or time on too many sources. I admit, some treatments change every year, which you should update your self on it, and for the USMLE World updates it constantly.

NOTE: Basic Science concepts will be re-tested on USMLE Step 3.  So save your Step 1 Notes.

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