usmle cs...

To be certified by ECFMG, international medical graduates must, among other requirements, satisfy the clinical skills requirement. Step 2 Clinical Skills (Step 2 CS) of the United States Medical Licensing Examination™ (USMLE™) is the exam currently administered that satisfies the clinical skills requirement for ECFMG Certification. A time limit for passing Step 2 CS for ECFMG Certification may apply.
The definitive source of information on Step 2 CS is theUSMLE BULLETIN OF INFORMATION . For additional information on the USMLE, refer to the USMLE WEBSITE.
For detailed information on taking Step 2 CS for ECFMG Certification, refer to the applicable edition of theECFMG BOOL LET .
To apply for examination, useECFMG INTERACTIVE APPLICATION .
Applicants who passed the former ECFMG CSA
Effective June 14, 2004, USMLE Step 2 CS replaced the former ECFMG CSA for the purpose of ECFMG Certification. Applicants who have passed both the former ECFMG CSA and achieved a score acceptable to ECFMG on an English language proficiency test (such as the Test of English as a Foreign Language™ [TOEFL®] or the former ECFMG English Test) can use these passing performances to satisfy the clinical skills requirement for ECFMG Certification.
Applicants who have passed the former ECFMG CSA should refer to VALIDITY OF EXAMINATION entry to medical graduate education in the applicable edition of the ECFMG Information Booklet for information on the validity of their CSA passing performance for entry into programs of graduate medical education and eligibility for permanent validation of their CSA passing performance.

usmle flash cards....

USMLE Flashcard Secrets
Proven USMLE Test Flashcard Study Systems Use Repetitive Methods of Study to Make Difficult USMLE Test Questions Easy to Understand
Dear Friend,
Here's a little "secret" about the USMLE: the USMLE is what we in the test preparation field call a "content driven" test.
While some tests are looking to see what you are ABLE to learn, the United States Medical Licensing Examination Step I and Step II exams are designed by the Federation of State Medical Boards (FSMB) of the United States, Inc. and the National Board of Medical Examiners (NBME) to test your understanding of what you have already learned. It basically checks to make sure you have a minimum competency level to protect the integrity of the licensing process and protect patients, and also allows international medical graduates to become qualified by the Educational Commission for Foreign Medical Graduates (ECFMG).
In other words, it's more about what you know than your ability to solve clever puzzles. This is good news for those willing to work hard, because it boils down to a very simple strategy:
You can succeed on the USMLE by memorizing as much information as possible so that you are prepared for as many possible questions as might come up on the test.
Memorization is a process that rewards those willing to work hard, which means that passing the USMLE is within the reach of virtually anyone willing to invest the time in learning the material.
This is great news! It means that if you've been worried about your upcoming USMLE, you can rest easy IF you have a good strategy for knowing what to memorize and how to memorize it.
But it also creates another set of problems.
If you tried to memorize every single possible thing you can for the USMLE, the field of possible things to memorize would be so huge that you could not hope to cover everything in a reasonable time.
That's why I created the USMLE Flashcard Secrets program: I have taken all of the possible topics and reduced them down to the concepts you must know to guarantee passing the USMLE.
I wanted this system to be simple, effective, and fast so that you can pass your USMLE in a minimum of time spent preparing for it.
Here are some of the features of our USMLE Flashcard Secrets program
Study after study has shown that repetition is the most effective form of learning- and nothing beats flashcards when it comes to making repetitive learning fun and fast
Flashcards engage more of your senses in the learning process- you "compete" with yourself to see if you know the answers to the questions, and the flipping action gets you actively involved in the learning process
Our cards are printed on heavy, bright white 67 lb. cover stock, and are laser printed at 1200 dpi on our industrial printers- these are professional-quality cards that will not smear or wear out with heavy usage
We cover all of the major categories of the USMLE test (see the list below)
Our flashcards include an edge that is micro-perforated, which means that you are much less likely to have a painful papercut on your fingers when moving quickly through the cards
Our cards are portable, making it easy for you to grab a few and study while waiting for the bus or the doctor, or anywhere where you have a spare moment that would otherwise be wasted
Our USMLE exam cards are written in an easy to understand, straightforward style - we don't include any more technical jargon than what you need to pass the test
The cards are a generous size- 3.67 x 4.25 inches- they fit perfectly in your hands and they aren't so small that you have to use a magnifying glass to read tiny type- all questions and answers are in a normal-size print for easy studying
Our cards include in-depth explanations- you won't see any "one word" answers on our cards that require you to go get a textbook to understand why your answer was wrong- all of our cards include generous, thorough explanations so you not only get it right or wrong- but you also know why!
We use a font created by Microsoft to make reading easier- this will enable you to absorb more information painlessly during late night study sessions
Our system enables you to study in small, digestible bits of information- unlike using boring textbooks, flashcards turn learning into a "game" you can play until you've mastered the material
It's easy for a friend to help you study- they don't even have to know anything about the USMLE- if they can read, then they can quiz you with our flashcards!
Now, let me explain what USMLE Flashcard Secrets is not. It is not a comprehensive review of your education. There's no way we could fit that onto flashcards- if we claimed to, it would be an insult to what you know.
Don't get us wrong: we're not saying that memorization alone will automatically result in a passing USMLE score- you have to have the ability to apply it as well. However, without the foundation of the core concepts, you cannot possibly hope to apply the information. After all, you can't apply what you don't know.
USMLE Flashcard Secrets is a compilation of the critical concepts you must understand to pass the USMLE. Nothing more, nothing less.
Here's Exactly What You Get With USMLE Flashcard Secrets
When you place your order for USMLE Flashcard Secrets, you'll get our set of hundreds of flashcards specially selected to give you the most USMLE performance improvement for the least time. This is just a small sampling of the topics covered on our USMLE Step 1 exam flashcards:
Pathology
Biochemistry
Micro- biology
Pharmacology
Anatomy/ Physiology
Hirschsprung's Disease
Start and Stop Codon
Primary Immune Responses
Adrenergic receptors
Brainstem
Diabetes Mellitus
Transcription
Human papilloma- virus (HPV)
Decongestants
Respiratory Control Center
HIV and AIDS
Prokaryotic Gene Regulation
Immuno- globulin Isotypes
Cephalosporins
Femoral Triangle
Kienböck’s disease
Southern blotting
Key Antibiotics
Anti-viral Drugs
Hypospadias
Systemic Lupus Serythemtosus
Hardy-Weinberg Equilibrium
Chlamydia
Aspirin
Kidney Structure
First Degree AV block
Competitive Inhibition
Phago- cytosis
Opiods
Lumbar plexus
Myasthenia Gravis
Protein Structure
Risk Factors of Infection
Cholinergic Drugs
Receptor Types
Ischemic Heart Disease
Coenzymes
Nosocomial Infections
Uricosurics
Portal Vein System
Glioblastoma multiforme
Dietary Carbohydrates
Neisseria meningitidis
Anti-thyroid Drugs
Peyer's Patches
Bell's Palsy
Anaerobic Glycolysis
Auto- Immunity
Anti-gout Drugs
Spinal Tracts
Multiple Sclerosis
Cholesterol Formation
Salmonella enterica
Methylxanthines
Internal capsule

Step USMLE step1 assesses whether medical school students or graduates understand and can apply important concepts of the sciences basic to the practice of medicine. As of 2007 it covers the following subjects, in both systemic (general and individual anatomical characteristics) and procedural (functional, therapeutic, environmental, and ab/normality) theme
anatomy,
physiology,
behaivoral sciences,
biochemistry,
pathology,
microbilogy,
immunology,
interdisciplinary topics, such as nutrition,genetics, and aging.
US medical students usually take Step 1 at the end of the second year of medical school. It is an eight-hour computer-based exam consisting of 350 multiple-choice questions (MCQs) divided into seven blocks each consisting of 50 questions. Beginning in the summer of 2008, some questions will include audio and video. Each block must be finished within an hour. The remaining hour is break time. An optional tutorial about how to use the computer program of the exam is offered at the beginning of the exam and takes 15 minutes. This time is deducted from the hour of allotted break time.
The scores are reported with a three digit score and a two digit score. As of January 1, 2007, the passing score has been raised to 185 from a previous score of 182. The average score is approximately 215. If the student passes the exam, he or she may not repeat the exam to achieve a higher score. Theoretically, the maximum score is 300 . However, scores above 280 are virtually unheard of.
While not recommended by the creators of the USMLE, the Step 1 score is frequently used in medical residency applications as a measure of a candidate's likelihood to succeed in that particular residency (and on that specialty's board exams). More competitive residency programs usually accept applications with higher Step 1 scores. The Step 1 exam is arguably the hardest and most important examination a medical student will take during his/her career.
The USMLE score is just one of many factors considered by residency programs in selecting applicants. The median USMLE Step 1 scores for graduates of U.S. Medical Schools for various residencies are charted in Figure 4 on page 11 of "Charting Outcomes in the Match" available at

Step 2
USMLE Step 2 is designed to assess whether medical school students or graduates can apply medical knowledge, skills and understanding of clinical science essential for provision of patient care under supervision. US medical students typically take Step 2 during the fourth year of medical school. Step 2 is further divided into two separate exams.

Step 2-CK
USMLE step 2 CK is designed to assess clinical knowledge through a traditional, multiple-choice examination. It is a 9 hour exam consisting of 8 blocks of 46 or 47 questions each. The subjects included in this exam are clinical sciences like Internal Medicine, Surgery, Pediatrics, Psychiatry and Obstetrics & Gynecology.

Step 2-CS
USMLE syep 2 CS is designed to assess clinical skills through simulated patient interactions, in which the examinee interacts with standardized patients portrayed by actors. Each examinee faces 12 STANDARDIZED PATIENTS(SPs) and has 15 minutes to complete history taking and clinical examination for each patient, and then 10 more minutes to write a patient note describing the findings, initial differential diagnosis list and a list of initial tests. Administration of the Step 2-CS began in 2004.
The examination is offered in five cities across the country:
PHILADELPIA(PA)
CHICAGO (IL)
ATLANTA (GA)
HOUSTON (TX)
LOSANGELS(CA)
Before 2004, a similar exam, the clinical skills assesment (CSA) was used to assess the clinical skills of foreign medical graduates.

Step 3
USMLE Step 3 is designed to assess whether a medical school graduate can apply medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine. Graduates of US medical schools typically take this exam at the end of the first year of residency. Foreign medical graduates can take Step 3 before starting residency in about ten U.S. states.
Step 3 is a two-day examination. Each day of testing must be completed within eight hours. The first day of testing includes 336 multiple-choice items divided into blocks, each consisting of 48 items. Examinees must complete each block within sixty minutes.
The second day of testing includes 144 multiple-choice items, divided into blocks of 36 items. Examinees are required to complete each block within forty-five minutes. Approximately 3 hours are allowed for these multiple-choice item blocks. Also on the second day are nine Clinical Case Simulations, where the examinees are required to 'manage' patients in real-time case simulations. Examinees enter orders for medications and/or investigations into the simulation software, and the condition of the patient changes accordingly. Each case must be managed in a maximum of 25 minutes of actual time.
Approximately forty-five minutes to one hour is available for break time on each of the two days of testing

CT scan

This page tells you about CT scans. CT scan (or CAT scan as it is sometimes called) stands for Computerised (Axial) Tomography scan. This just means a scan that takes pictures from all around your body and uses a computer to put them together. This page has information on

How a CT scanner works

A CT scanner uses X-rays. Like an X-ray, it is painless. The CT machine takes a lot of pictures of your body from different angles. These pictures are fed into a computer. The computer puts them together to give a series of cross sections or 'slices' through the part of the body being scanned. A very detailed picture of the inside of the body can be built up in this way.

Together these cross sections give a very accurate picture of where a tumour is and how big it is. They also show how close major body organs are to the area that needs to be treated or operated on.

A CT scanning machine is a large machine that is shaped rather like a doughnut. There is a couch that you lie on.



The couch can slide backwards and forwards through the hole of the doughnut. The pictures are taken as you move through the machine. Below is a CT scan of the pelvis marked for radiotherapy treatment.

What will happen

When you arrive, you check in with the receptionist so the radiographers know you are there. Then you usually take a seat in the waiting room until someone calls you for your scan.

When you are called, you may first go to a cubicle to take off your outer clothing. You may have to strip down to your underwear and put on a hospital gown. If you are just having a CT of your head, you may not be asked to undress. You must take off any jewellery that is in the area to be scanned because metal interferes with the machine.

When you are ready, the radiographer or helper will take you into the scanning room. You will probably have to lie down on the machine couch on your back. Sometimes the scan is done with you on your side or lying on your front. You need to lie as still as you can, but breathe normally.

Once you are in the right position on the couch, the radiographer will leave the room. This is because there will be X-rays in the room and it would be dangerous for the staff to be exposed to these. They see patients having X-rays and CT scans all day, every day and if they stayed in the room, would be exposed to far more X-rays than any patient.

The radiographer will be able to see you on a TV screen and you can talk to each other through an intercom. The radiographer will control the position of the couch from outside. The couch can move automatically through the CT scanner so that the part of the body to be scanned is in the machine. The radiographer will tell you that he or she is about to start the scan and remind you to keep as still as you can. When the scan is over, the radiographer will come back into the room and help you down from the couch.

Most scans take about half an hour. A lot of that is for setting up the scan, rather than actually taking it. Lying still for that long can be uncomfortable. If you are getting stiff and need to move, tell the radiographers through the intercom. During the actual scan, you have to try to keep as still as possible, and not cough or swallow, particularly if your head is being scanned. Mostly, you can breathe quietly but normally throughout the scan. For some scans, your radiographer may ask you to hold your breath at various times during the scan. If this is going to happen, they will tell you beforehand. You should be able to go home as soon as the scan is over.

Suggestion
Some people feel a bit claustrophobic ('closed in') when they
are having a scan. If you think you are likely to feel
this way, tell the radiographers before the
day of your appointment.

If necessary, you can have a tablet or injection to calm you down before the scan. If you need a sedative, it needs to be organised in advance so do ring the department if you think you'll need one. If your radiographers know you are nervous, they will take extra care in making sure you are comfortable and understand what is going on. Keeping your eyes closed sometimes helps.

Preparation for the scan

Some CT scans need special preparation beforehand. This is explained below for scans of different parts of the body. For some scans, you will have a drink or injection of 'contrast medium'. This is a sort of dye that shows up body tissues more clearly on the scan. Before you have this, the nurse or radiographer will ask you about allergies or asthma as some people can be allergic to it. The injection may make you feel hot and flushed for a minute or two.

Abdominal CT scans

If you are having a CT scan of your abdomen, you may be asked

• Not to eat or drink after midnight the night before the scan
• To drink a liquid 'contrast medium' 24 hours before the scan
• To drink more of the liquid in the X-ray department

You may have the contrast medium by injection either instead of, or as well as, the drink. The contrast medium makes the digestive system (gut) show up more clearly in the scan. It does not have any side effects.

CT scans of the head

For some brain scans, you may be given an injection of the 'contrast medium' dye beforehand to make the scan clearer.

CT scans of the chest

For some chest (thoracic) scans, you may be given an injection of the 'contrast medium' dye beforehand. This is to help show up the tissues in the area containing the cancer, for example blood vessels. It may help to show whether the cancer can be removed with surgery or not.

Pelvic CT scans

If you are having a CT scan of the pelvis, you may be asked

• Not to eat or drink after midnight the night before the scan
• Have an injection of 'contrast medium' just before the scan

Depending on the part of your pelvis being scanned, you may have an injection of a drug to slow down the normal movement of your bowel. This movement (called 'peristalsis') can distort the scan and make it more difficult to read.

Occasionally, for a rectal scan, you need to have an enema of the 'contrast medium' dye. This shows up on the X- ray and makes the outline of the bowel stand out more on the scan. This 'rectal contrast' isn't used very often. It may make you constipated. Your first couple of bowel motions will be white, but there are no other side effects.

There is a very detailed scan of the bowel called a 'virtual colonoscopy'. If you are having one of these, you will be asked

• Not to eat or drink for 36 hours before the scan
• Take 2 doses of a strong laxative the day before the scan

If you are diabetic, your doctor may want you to come into hospital for the day or two before this. It may not be sensible for you to avoid eating and drinking for 36 hours without medical supervision.

Just before the scan, you'll have two injections. One is the 'contrast medium' dye to show up the body tissues more clearly. The other is a drug to slow down the normal movement of your bowel which can make the scan less clear. You will also have a tube put into your back passage. The radiographers will put air through this tube to inflate your bowel and make the scan clearer. Apart from the obvious and slightly embarrassing after effects of having air pumped into your bowel, there are no other side effects of this. Try to take it all in your stride. The staff are professionals and are used to doing this type of test. They won't be embarrassed by it so there is no need for you to be.

For virtual colonoscopy, you will have two scans - one on your back and one on your front.

Spiral CT scans

This is a newer type of CT scan, also known as a 'helical' CT scan. It is faster than a standard CT scan and gives an even more detailed picture of your organs and tissues, including blood vessels. This can make it useful for picking up very small tumours. It's called a spiral scan because the X-ray beam rotates around you during the scan in a spiral shape. This gives the radiographers a continuous picture, with no possible gaps between the 'slices' of the scan.

Can a CT scan be dangerous?
Like any X-ray, you should not have a CT scan if you are pregnant as it could be dangerous for the baby. Other than this situation, a CT scan is not dangerous. It does involve being exposed to some radiation. This is why doctors are reluctant to undertake any scans without good reason. But it isn't a large enough amount of radiation for you to have any ill effects. The scan provides useful information to your doctors about your condition, or about how it has responded to treatment. The benefits of this outweigh any potential risk. Doctors like to keep the number of scans you have to a minimum because this also keeps your radiation exposure down to a minimum.

Very, very rarely, someone has an allergic reaction to the contrast injection. The reaction most often starts with weakness, sweating and difficulty breathing. It is possible to react to any injection in this way, and the doctors and radiographers will know what to do if you do have this type of reaction.

The results

It can take time for test results to come through. How long will depend on why you are having the scan. Usually, the scan is examined by a specialist in radiology and a report typed up. The report is then sent to your specialist, who will then give the results to you. If your GP has sent you for the test, the results will be sent directly to their surgery.

RADIOLOGY

Radiologist training

United States

Diagnostic radiologists must complete prerequisite undergraduate training, four years of medical school, and five years of post-graduate training. The first postgraduate year is usually a transitional year of various rotations, but is sometimes a preliminary internship in medicine or surgery. A four-year diagnostic radiology residency follows. After successful completion of their residency, the new radiologist is eligible to take board examinations (written and oral) given by the American Board of Radiology.

Following completion of residency training, radiologists either begin their practice or enter into sub-speciality training programs known as fellowships. Examples of sub-speciality training in radiology include abdominal imaging, thoracic imaging, imaging, and women's imaging. Fellowship training programs in radiology are usually 1 or 2 years in length.

Radiology is currently considered a highly competitive field. Radiologists generally enjoy good compensation as well as a good balance between time required at work and time spent away from work. The field is rapidly expanding due to advances in computer technology which is closely linked to modern imaging.

The exams are usually performed by eadiologist technologists, (also known as diagnostic radiographers) who in the United States have a 2-year Associates Degree and the UK a 3 year Honours Degree.

Veterinary radiologists are veterinarians that specialize in the use of X-rays, ultrasound, MRI and nuclear medicine for diagnostic imaging or treatment of disease in animals. Veterinary radiologists are certified in either diagnostic radiology or radiation oncology by the American College of Veterinary Radiology.

Australia and New Zealand

Radiology training begins after completion of medical degree (6 years) and at least 2 years of hospital residency (internship and junior house medical officer (JHMO) ). It then comprises 5 years , one of which can be a fellowship.

medical tourism

India

India is known in particular for heart surgery, hip resurfacing and other areas of advanced medicine. The government and private hospital groups are committed to the goal of making India a world leader in the industry. The industry's main appeal is low-cost treatment. Most estimates claim treatment costs in India start at around a tenth of the price of comparable treatment in America or Britain.

For example, "Howard Staab, a self-employed, uninsured, middle-aged carpenter from urban North Carolina," needed surgery for acute mitral-valve prolapse, which would have cost him a fifth of a million dollars in his home state. Staab was treated in New Delhi, India, for less than $7,000US by an Indian doctor trained at New York University.Another comparative example involves preventive health screening. At one private clinic in London, a thorough men's health check-up that includes blood tests, electro-cardiogram tests, chest x-rays, lung tests and abdominal ultrasound costs £345 ($574, €500). By comparison, a comparable check-up at a clinic operated by Delhi-based health care company Max Healthcare costs $84.

Escorts Heart Institute and Research Center in delhi and faridabad, India performs nearly 15,000 heart operations every year, and the post-surgery mortality rate is only 0.8 percent, less than half that of most major U.S. hospitals.

Estimates of the value of medical tourism to India go as high as $2 billion a year by 2012.India has good,modern medical infrastructure that, in some places, can be comparable to medical infrastructure in the West. The Indian government is taking steps to address other infrastructure issues that can serve as a deterrant to the country's growth in medical tourism.

The south Indian city of CHENNAI has been declared India's Health Capital, as it nets in 45% of health tourists from abroad and 30-40% of domestic health tourists.