Choosing between USMLE/PLAB

“First it’s having a dream, then it’s setting a goal, then it’s working hard to get it .”

In this blog, Two main medical licensing examinations: USMLE ( The Gateway to your American Dream) and the PLAB ( Road to the UK) are discussed. 

Firstly, let’s take a deep dive into USMLE. 

What is USMLE?

The United States Medical Licensing Examination is a three-step examination for medical licensure in the U.S. It means it’s an exam that allows you to practice in the United States.

 It is the same for everyone, whether you are IMG or you did your med school in the United States.

In a nutshell, it means it is a licensing exam to practice medicine and to do fellowships in the United States.

 It is considered as one of the toughest medical licensure exams. So, it’s always better to start early for this exam. It is also a very time-consuming process but you get trained from one of the best healthcare systems in the world. Opportunity, research, and academics are a lot edgier in the USA.

Moreover, apart from scores of the exam, other crucial things such as research, publications, Letters of recommendations, and relevant extracurricular activities also play a significant role to get matched in the top program.

IELTS is not required.

Single-Attempt.

However, if you fail then only you can give the second attempt. Like PLAB, you are not allowed to give the subsequent second attempt to improve the score. Once you give the exam, your scores are locked for the next seven years.

“ It’s a beautiful day to save lives”

Dr. Derek ( Grey’s anatomy )

Overview of the USMLE exam structure :

It comprises of three steps:

• Step 1
• Step 2 Clinical Knowledge (CK),
• Step 2 Clinical Skills (CS)
• Step 3

All three steps are very important. However, the scores of step 1 and step 2 play a very important role to match into a top residency program in the United States.

The first two steps can be taken by a med student either during the third or final year of the medical school, but step 3 can only be taken after completing the graduation. 

Step 1

The USMLE Step 1 is a test that assesses your knowledge and understanding of the core concepts of basic sciences. The test focuses on the principles and mechanisms of various diseases, health and modes of therapy, genetics, and even biostatics.

It is an eight-hour-long exam. It is divided into seven 60-minute blocks of up to 40 questions each. You will get a minimum of 45 minutes to break and you can utilize this break time to either rest or grab something to eat. But the time duration of the break time is increased based on how fast you finish each block, i.e. finish the block before the given allotted time.

Step 1 comprises of the following subjects :

• Anatomy 
• Behavioral sciences 
• Biochemistry 
• Biostatistics & Epidemiology 
• Microbiology 
• Pathology 
• Pharmacology 
• Physiology

Apart from this, it also involves content from aging, genetics, immunology, molecular & cell biology, and nutrition. 

Popular resources :

• First Aid – It is considered as the Bible by many of the USMLE aspirants.
• World
• B&B
• Kaplan lecture notes and many others. 

Questions are often reverse engineered to make each choice correct at least on some level.  

Step 2

DON’T take Step 2 before Step 1 , as the knowledge gained during the step 1 preparation proves very helpful during step 2. 

Now this step is further divided into 

• Clinical Knowledge (CK)
• Clinical skills (CS)
• Clinical Knowledge (CK)

 This step consists of questions about organ systems and the questions are divided into physiological and pathological processes. This exam component aims to assess whether you can apply medical knowledge, skills, and understanding of clinical sciences essential for the provision of patient care under supervision.

Step 2 Clinical Skills (CS)

·   It covers content similar to that covered by the Step 2 CK 

Duration of the exam:

Step 2A :It is a nine-hour exam consisting of 8 blocks that are each 60 minutes long.

Step 2B: Approximately, eight hours which consists of twelve patient encounters, lasting for about 15 minutes each. 

What is the difference between CK and CS?

· CK tests the candidate‘s ability to apply related medical knowledge and skills which is crucial for patient’s care and safety. While CS focuses on a candidate’s ability to take a patient’s history and perform a physical examination using various procedures and tools with the correct method. 

 Step 3 

Final exam of the USMLE series.

· The exam is a two-day event. On the first day, the exam will consist of 233 questions which are divided into 6 blocks. You will be allotted 

60 minutes per block, and including a break and the entire exam lasts for about 7 hours.

· On the second day, you will face a nine-hour exam consisting of 180 questions divided into 6 blocks. After that, you will have to undergo 13 cases where you’ll be allotted 10 or 20 minutes to complete.

“Never give up on a dream just because of the time it will take to accomplish it . this time will pass anyway. “ 

Topics covered related to clinical medicine will test whether you can apply medical knowledge and understanding of biomedical and clinical sciences which are essential for the unsupervised practice with proper emphasis on patient management in ambulatory settings. Moreover, the residents mostly preferred to take Step 3 at the end of their first year of residency. 

After the ECFMG registration is done, only then are you eligible to give the Step 1, Step 2 CK & CS, and Step 3.

For more updates about the eligibility criteria, the number of updates and the pass/fail criteria for step 1 : Click here

Pathway of the USMLE journey :

1. Decide to give the test. 
2. Prepare a proper timeline.
3. Start preparing for Step 1.
4. Give the step 1.
5. Do an observership and give the step 2 
6. 6.  Apply for the match, as mentioned here.

Tips to boost your CV:

-Score very high in Step 1
-Have good letters of recommendation. 
-Do publication/research papers

 Moreover, for IMG getting into top specialty is tough but not impossible. Some of the IMG friendly specialties include internal medicine, family medicine, psychiatry, pediatrics.

Source: http://www.nrmp.org/wp-content/uploads/2017/06/Main-Match-Results-by-State-and-Specialty-2017.pdf 

PLAB (Road to UK)

The Professional and Linguistic Assessments Board test, known as the PLAB test

It’s not a degree or certificate, however, it makes you eligible to apply for the GMC registration. 

What is GMC registration?

General Medical Council (GMC)- This council maintains a register of qualified physicians, doctors, and specialists in the UK. In short, the GMC will only recognize the degree and not grant you a subsequent degree.

Unlike USMLE, it consists of two steps and both the steps are compulsory to be eligible to practice in the United Kingdom.

However, passing PLAB doesn’t guarantee you a job or a residency.  

Unlike USMLE, IELTS is required.

You must have a 7.5 overall or ‘B’ in OET (Occupational English Test) to give the PLAB test. 

To know more about OET – Click here 

Unlike USMLE, there are multiple attempts and you can thereby improve your score.

Who needs to take the exam?

Any medical student graduated outside of the UK, European Economic Area (EEA) or Switzerland. 

The PLAB test consists of two parts:

• PLAB part 1
• PLAB part 2

PLAB Part 1

This test comprises 180 multiple-choice questions. It is a written test spanning over three hours. It tests your medical knowledge and consists of case-based questions rather than direct medical questions.

You can take this question anywhere around the world. 

To know more about the available locations and the preferable dates – log onto :

PLAB Part 2

It is an OSCE (Objective structured clinical based examination).

It consists of 18 case-based questions lasting over eight minutes. 

You can take this step any time throughout the year but it can be taken only at a particular center ( the clinical assessment center). It takes place only in Manchester, UK.

Medicine at the end is not only about cramming facts and memorizing the appropriate treatment regimens for a particular disease, but it is more about applying the relevant clinical knowledge for the care of the patient. 

You must answer the OSCI questions based on appropriate guidelines for the treatment plan for a particular disease and published evidence and not based on your local arrangements in your respective country. 

The practical skills such as suturing, administering the intramuscular and subcutaneous injection, checking the blood pressure and inserting a cannula into a peripheral vein, etc will be evaluated.

Moreover, the interpersonal skills such as communicating with the patients, giving relevant instruction on discharge, and even breaking the bad news to the patients and their relatives will be evaluated.

 To know more about the up-to-date first-line and alternate drug of choice and which is being referred for this particular step of the exam – Click here

To know more about the professional and clinical skills, important topics and procedures which are expected from the doctors in the UK – Click here

Duration of the test :

Well compared to the USMLE test, this test is only three hours and ten minutes and you will get only 1.5 minutes between each OSCI question to read and understand about the patient’s history and the necessary instruction for the particular question.

 Pathway of the PLAB journey :

1. Obtain a medical degree in your respective country.
2. Complete the internship.
3. Give IELTS/OET. (Make sure to score the required scores)
4. Give the PLAB 1 test.
5. Verify your medical degree.
6. Give the PLAB 2 and also simultaneously apply for the UK visa.
7. Apply for the GMC registration. ( for more details, check out its official website )
8. Get a job.

“Our greatest weakness lies in giving up . The most certain way to succeed is always to try just one more time. “

Moreover, the first job in the UK is a non –training job, while in the US, the first job is a training job .

Also, the training duration varies in both countries. 

Moreover, talking about salaries, pay in the UK isn’t as good as that in the US.

Brief comparison between USMLE and PLAB: 

Both USMLE and PLAB  are unique in their ways. Both the exams require sheer dedication, passion, sincerity, and hard work to achieve and get into your choice of specialty. 

However, the choice of USMLE or PLAB varies from person to person . It depends on various factors.

It all depends upon what stage of life you are in, your choice of living in either of the countries, relatives staying in the country, cost of the exam, preparation time, and also visa availability.

In the end, you need to remember one thing, to succeed in either of the exams, you need to research well, stay updated, need to have a proper plan so that you work in the right direction, stay connected with your seniors who have already given the exams and thus stay informed. 

“Never give up on a dream just because of the time it will take to accomplish it . this time will pass anyway . “ 

There is no time limit between graduation and passing the entrance exam in the UK, however for the USA, you need to give all the steps within 3-5 years of graduating, or else it will look negative on your CV.

If you decide to give USMLE, don’t do a house job as it is considered to be a waste of time as you won’t be able to give much dedicated time towards the preparation. While if you decide to give PLAB, you can do a house job as you can study well even during the job. 

Competition level: Less competition in the UK as compared to the USA.

Visa process: Easy and very straightforward in the UK as compared to the USA.

In the end, to practice in the USA two main factors that play a keen role are: USMLE scores and Visa status.

Moreover, if you are a citizen of the USA or a green card holder, it is much easier as you don’t have to go through the hustle of the visa process and you can even match with a low USMLE score.

Jobs availability: In the UK , jobs are easily available as compared to the USA.

The preparation time for each exam varies from person to person. But, the USMLE exam requires more preparation time.      

GOOD LUCK !