Like any exam how you prepare is very personal and may not apply to everyone but for UK ortho trainees most information about the exam is word of mouth.  Below is my thoughts on the exam.


The USMLE for UK orthopods (who had a great bar job at medical school and slept through a load of lectures)

Before you take the exam consider why are you taking it? Do you have a potential fellowship pencilled in or at least contacts that can make it possible?  The only thing I can think of worse than studying for the exam is taking the exam and not using it.  It’s a pretty lonely existence studying for an exam most people think you are mad for doing.  For most fellowships a passing mark is all that is needed; however, you may need to score well if you are applying blindly without personal support or good links.  Think about what you are sacrificing and if it is worth it.  In the time to take the exam you could have written a dozen papers, studied for the FRCS, done a part-time degree, spent similar money on visitations, courses or gone on holiday!

It takes about 3 months to be registered to take the exam by the time you have obtained your medical school transcripts and had them processed. Consider what job you are doing in which hospital.  Ideal jobs are those that either you really enjoy and therefore not emotionally or physically drained by the end of the day to study OR a rubbish job in a subspecialty you have no interest in at a hospital where you aren’t planning to impress.  Bosses may not understand your excuse of why you haven’t read up on today’s theatre list because you were studying biochem pathways!

Part I- miserable-imagine memorising the most tedious biochemical pathways, enzymes etc. I took about 6 months alongside an enjoyable job but as you can imagine with my 50% medical school passing there was a whole load of medicine I had to learn from scratch.  For my 1st attempt I started the USMLE World questions late and used the Kaplan videos religiously but they did not provide adequate detail and wasted a huge amount of time.  Certain lectures maybe useful for extra explanation or to provide some baseline knowledge but that’s about it.

Use USMLE world questions. Doctors in Training for Step I is excellent and easy watching.  Know Step 1 First AID inside out.  If you are scoring well on USMLE World you will be fine for the exam.

I don’t recommend taking the exam a week after changing hospitals and 2 weeks after buying and moving into a new house! My 2nd attempt at part I was fine.

Part II CK- a little easier but still includes some tedious topics including psych, obs&gynae and paeds. USMLE world questions all the way.  I took about 3 months and taking part I recently helped.  If you are on a tight deadline you could take part I and II at the same time or closer together.

Part II CS- Book the CS exam early as particularly during the Spring/Summer months the slots are fully booked up by US graduates.   As a UK ortho reg I found the clinical skill exam difficult to prepare for.  It is a very artificial exam and even if you find your inner medic(!) the exam is somewhat daunting due to the artificial nature of it.  There are 12 patient encounters.  15 minute history, exam, explanation and 15 minute typing up a patient note.  I did around 4 weeks of prep.  I spent a short time seeing cases with a medical consultant but although the PACES version they teach gave me a little confidence that my medical understanding was not awful the US exam is more artificial.

Read First Aid Step 2 CS-only book you need.

YouTube has some good mock scenarios and candidate experiences which can help. I paid. £50 for the USMLE world CS access which helped demonstrate videos of the concise examinations and odd things like appropriate draping.

Practice with someone who has done the exam. At the very least go through the First Aid scenarios with a mate that is happy to act as a patient.

Be prepared for the ‘patients’ to use trade drug names in their drug history.

Practice typing the patient note within the time frame using their structure. If you are slow at typing get some practice in.

There is a 3 month delay in getting your results. Fellowship applications through the San Fran match are almost 2 years prior to fellowship start.

Costs:   Approx. £4K

Step 1 $865 + $180

Step 2 CK $865 + $205

Step 2 CS $1500

USMLE world access $200-$300

Flights and hotel £1000


If you have any questions or need help particularly for part 2 CS let me know.