Integration of the USMLE (United States License Examination) training system into the Curriculum Fergana Medical Institute of Public Health

. The United States occupies a leading position in the world in terms of the level and effectiveness of scientific research. Health care in the United States is provided with the most modern medical equipment, medicines and consumables. Today, most of the Nobel Prizes in medicine go to the United States - 18 of the last 25 recipients were American citizens or visiting scientists. Americans account for half of all drugs created in the last 20 years. In American medicine, a quality control system for services has been established, the rights of the patient and his relationship with the doctor are regulated by a serious legislative framework. Medical school usually consists of four years of study and study in the USA. Traditionally, the first two years consist of basic science and clinical medicine courses such as anatomy, biochemistry, histology, microbiology, pharmacology, physiology, cardiology, pulmonology, gastroenterology, endocrinology, psychiatry, and neurology. USMLE Step 1/COMLEX Level 1 medical licensing commissions are accepted upon completion of the preclinical phase of the study.


Introduction
The third and fourth years consist of clinical rotations, sometimes called clerkships, where students see patients in hospitals and clinics.These rotations are usually at teaching hospitals but are occasionally at community hospitals or with private physicians.Mandatory rotations in third year are often obstetrics and gynecology, pediatrics, psychiatry, family medicine, internal medicine, and surgery.During the third year, medical students take Step 2/Level 2 of the medical licensing boards.Fourth year rotations typically allow students to choose several electives and finish required rotations.It is also used as a period of auditioning for residency programs [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16].
The US Medical Licensing Examination® (USMLE®) is a three-part US medical licensing exam.The USMLE assesses a clinician's ability to apply knowledge, concepts and principles, and to demonstrate core patient-centered skills that are important to health and disease and that form the basis of safe and effective patient care [6].
Controversially, In Uzbekistan, upon a detailed examination of the systems, one can notice the observance of the standard approach -this is to give concepts in the field of fundamental subjects, then form clinical knowledge around this laid foundation.It would seem, at first glance, that everything is done correctly, but why in In this case, the quality of medical care varies greatly between countries?What lays the secret, for example, that most of all Nobel Prizes in the field physiology and medicine received the United States, and noone is in the list of prize winners from Uzbekistan?
This article main aim is not to create extraordinary system in terms of medical education in Uzbekistan, instead integrating well-known and proved USMLE training system into Uzbekistan health care system to be particularly Fergana Public Health Medical Institute.
Relevance: As mentioned above, for the development of the healthcare system in Uzbekistan, as well as medical education, it is enough to find an appropriate system.However, the USMLE preparation system seems to be the best option, which has already proven itself in many developed countries.In this system, students not only study only pathetic fundamental subjects such as anatomy, histology, physiology, but also study the clinical aspects of these subjects in the first year of medical universities.

Methods
Nowadays, the main task of higher educational institutions is to train specialists who are able to develop adapted, flexible and timely solutions in a rapidly changing world.It is for this purpose that innovative teaching methods are used to prepare students for future professions at the university.Let's look at some of them.
Portfolio method (Performance Portfolio or Portfolio Assessment) is a modern educational technology based on the method of reliable assessment of educational and professional activity results.This method is often associated with education, although in the broadest sense of the term it is applied to any activity related to practice.
Academic and professional portfolios are distinguished according to the types of practical and effective activities of the university.
The problem-solving method is a method in which the teacher defines the task using various resources and tools, formulates the cognitive task before presenting the material, and then determines the evidence system, compares points of view, different approaches, and shows the method of solving the problem.Students become witnesses and partners of scientific research.
The project method is a learning system in which students gradually acquire knowledge and skills in the process of planning and carrying out more complex practical tasksprojects.
Problem-searching methods of teaching (acquisition of knowledge, development of skills) are carried out in the process of partial search or research activity of students; this method is carried out with the help of oral, visual and practical teaching methods, it is explained when setting up and solving a problem situation.
Scientific-research work integrated into the educational process of students -this work is carried out in accordance with the curriculum; The results of all types of research activities of students participating in the educational process are monitored and evaluated by the teacher.
Problem-based learning: 1. Technology aimed primarily at "stimulating interest".Educational activities consist of creating problem situations, identifying and solving such situations during the joint activity of students and teachers with the optimal independent work of students and under the general guidance of the teacher; 2. Active learning in development based on the organization of research activities of students, on the basis of identifying and solving real or educational contradictions.The basis of the study of the problem is the presentation and justification of the problem (a complex knowledge task of a theoretical or practical nature) [3].
Practically oriented projects -a distinctive feature of this type of project is the preliminary formation of a clear, meaningful result for the student, which has practical value in material form.The development and implementation of this type of projects requires a detailed study of the structure, definition of the roles of the participants, intermediate and final results.This type of project is characterized by strict control of the coordinator and the project author.
Creative projects are unique because they do not have a predetermined and detailed structure.In a creative project, the teacher (coordinator) only sets general parameters and shows the best ways to solve problems.A prerequisite for creative projects is clear statement of a meaningful, planned outcome for students.
Before the integration of this training system, teachers of the Fergana Medical Institute of Public Health, who have IELTS certificates, prepared for the USMLE program and lectured to them by teachers of the Medcloud Education Center, who had already completed USMLE steps 1 and 2. The first problem is the integration and implementation of subjects in the USMLE program into the local institute curriculum.It is solved by reducing secondary subjects that are far from medicine, such as philosophy, history, etc.For the first time in the history of the institute, students are given a more flexible curriculum.Students study only three compulsory subjects one after the other, such as Embryology, Gross Anatomy including Neuroanatomy and Histology, each subject lasts approximately 2-6 months.The second hurdle is how to teach local USMLE students in English and what teaching materials should be used.Teachers prepare presentations in English and all teaching materials are given to students only in English, but they conduct classes in Uzbek, using everyday English-Uzbek vocabulary related to this lecture.The leadership of the Fergana Medical Institute of Public Health, Pakistani and Indian guests supported the students by bringing a lot of fundamental and highly profitable clinical books.This year, 314 students have been admitted to the Fergana Medical Institute of Public Health.In total, 192 students of the Faculty of Medicine and 6 teachers are involved in the program.192 students are divided into 11 groups and one teacher leads about 2 groups.The remaining 122 students continue to study the subjects of the local system without integrating the clinical aspects of fundamental subjects.After the completion of the first embryology course, an embryology competition is held to test students' understanding of the subject in English.All competition materials are prepared in English.

Results and discussion
For the first time in the history of the institute, students are provided with a flexible curriculum.The institute management chooses three subjects for first-year students, namely: embryology, gross anatomy, including neuroanatomy and histology.Embryology and histology lasts 4 months, while macroanatomy lasts 6 months.All subjects are allocated 10 hours per week.Students first complete Embryology and Histology and then they complete Gross Anatomy as well as Neuroanatomy (Fig. 1).A two-month training period for embryology students improves listening and reading skills.Most of them begin to read and understand medical books in English.We test students' understanding by giving them embryology tests.On the first attempt, when students are given tests, approximately 77 students (40%) were able to pass the exam out of 192 students (Table 1).The remaining 115 students take an oral exam, first they are given tickets with questions written in English, then they are given time (about 2 minutes) to understand and prepare the questions.Some students who do not understand the questions are helped by translating some of the words.However, we do not force students to answer questions only in English, the use of the Uzbek language is also allowed.As a result, 92 students (80%) were able to pass the exam, 14 students (15%) answered all questions in English.The 23 students who fail are given a second chance and allowed to try again in a month (Table 2).All subjects are interconnected -this makes it easy to consolidate the acquired knowledge in different courses.In teaching, special attention is paid to the clinical aspect and mechanisms of the disease (pathology), thereby maintaining interest in medicine.Contact zones are associative, and the axial one is the construction of clinical thinking.Students are already mentally prepared for the clinic and by the end of the second year of study have basic clinical skills.In addition to this, studying medicine in English from the first year of medical school provides students with an excellent opportunity to gain in-depth knowledge and expand their horizons in developed countries in the near future.

Fig. 1 .
Fig. 1.Curriculum of the first year students of Fergana Public Health Medical Institute.