Transcript - SlideBoom

January – April 2012 Semester
Sajeet Sohi
[email protected]
A Little Bit About Myself
• Undergraduate: The University of Toronto
• MD1 (Sept. 2007) – Graduation April 2011
• Residency starting July 2012 at Greater
Baltimore Medical Center in Baltimore,
Maryland in Internal Medicine.
• “Every day you may make progress. Every step
may be fruitful. Yet there will stretch out
before you an ever-lengthening, everascending, ever-improving path. You know you
will never get to the end of the journey. But
this, so far from discouraging, only adds to the
joy and glory of the climb.”
- Sir Winston Churchill
“It Couldn't Be Done”
By: Edgar Guest
• Somebody said that it couldn't be done, But,
he with a chuckle replied that "maybe it
couldn't," but he would be one who wouldn't
say so till he'd tried.
So he buckled right in with the trace of a grin
on his face. If he worried he hid it.
He started to sing as he tackled the thing that
couldn't be done, and he did it
• Somebody scoffed: "Oh, you'll never do that;
At least no one has done it"; but he took off
his coat and he took off his hat, and the first
thing we knew he'd begun it.
With a lift of his chin and a bit of a grin,
without any doubting or quiddit,
he started to sing as he tackled the thing that
couldn't be done, and he did it.
• There are thousands to tell you it cannot be
done, there are thousands to prophesy failure;
There are thousands to point out to you one
by one, the dangers that wait to assail you.
But just buckle it in with a bit of a grin, Just
take off your coat and go to it;
Just start to sing as you tackle the thing that
"couldn't be done," and you'll do it.
• http://www.youtube.com/watch?v=nNSSS3pt2c0
Goals for the Semester
• Provide you with a “First Hand Experience” of
being a student of the island, completing the
examinations/rotations, and then ultimately
the residency application process.
• Discussing the Myths vs. Reality
• Try my best to help you on your process to
realize your goals
• I want to provide you with the honest reality
of the situation so you can make the best
decisions.
• You should be aware of the positives and
negatives so you can have a comprehensive
understanding of today’s reality.
Objective
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The presentation is directed towards:
1. USMLE Step 1
2. Clinical Clerkships (Rotations)
3. Residency Application
Ultimately this is about what it takes to get
into Residency.
• This presentation does not discuss our roles
and duties to society as care providers helping
society.
Outline
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General Information
Medical Organizations (All those acronyms)
Canada
Visa Information for Non-US Citizens or Green Card
Holders
States and Medical Licensure
The USMLE
Clinical Clerkships
Residency Application Process and Issues
New US MD/DO Schools and Residency Positions
Academic Literature and The USMLE – Residency
Process
• The information presented in the following
slides is based on:
• 1. Official Reports From Various Organizations
• 2. My personal experience as a student
• The information is the “truth” so sometimes it
may be a bit harsh so to speak...
General Information
• This is a “do or die” situation... As there is
practically no career option for an individual
who graduates from the school except
residency.
• If you do not have the right plan you are
wasting your time, engery, and money.
IMG - International Medical Graduates
• Definition: Graduates of medical schools
outside of Canada/US/Puerto Rico are not
licensed by the LCME (Liaison Committee on
Medical Education)
• An older term is “Foreign Medical Graduates”
• Caribbean Medical School graduates are
International Medical Graduates
• Another term to refer to Caribbean Medical
Schools is “Offshore Medical Schools”
• We are all classified together with medical
school graduates from India, Pakistan, Africa,
South America. Any non-Canadian/US medical
school graduate is an IMG.
“Where no counsel is the people fall, but in the
multitude of counsellors there is safety.”
Proverbs 11:14
Advice About Advice
• Just because a senior individual has told you
something that does not mean it is necessarily
true.
• Recognize bias as an individual may be
associated with a company where he or she
may benefit from your participation.
• There are countless companies offering
“assistance” for USMLE
Prep/Rotations/Residency
• “Common Sense is Not Common”
• For each decision we make there are always
positives and negatives.
• An honest individual should be able to tell you
both sides of the stories, if you hear only
positives or only negatives then there can
some other underlying issue.
“Quality Information”
• From the rumors on the internet to what you
hear from your friends and family how can
you decide what is the truth and what is false?
• First use common sense as that should
eliminate most of the “noise”
• Questions relating to the content of the
USMLE. I have used an approach: “If it is in
First Aid/Kaplan it is high yield”
• Read the official reports from the
organizations like the NRMP/ECFMG etc.
• There is a lot of “half-truths” on the internet,
it is good just to verify what you read with a
reference to an official source.
The Path to Success
• Premed/MD to MD4, then MD5 (ICM)...Then
USMLE Step 1.
• 72 Weeks of Clinical Rotations which includes 48
weeks of “Core Rotations” and 24 weeks of
Elective Rotations
• After the completion of the Core Rotations,
students generally complete USMLE Steps 2
CS/CK
• After completing rotations, obtaining Medical
Diploma, and Step 2 CS/CK you can apply for
ECFMG Certification and be eligible for residency
The Golden Ingredients
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1. Desire:
Passion
Fire
Willpower
Self-discipline
“Killer Instinct”
There are many names for this... If you want it
bad enough you will reach your goals.
• “Intelligence” and “IQ” are just subjective
measures and are irrelevant
• 2. Interpersonal Skills:
• While, passing the exams requires a significant
dedication to comprehend all of the book
knowledge.
• Life involves getting along with people and
working in teams. As a physician you work
with nurses, residents, medical students, and
other members of the health care team.
• Who would you rather hire?
• Person 1: Strong academic record but does
not get along with people very well or is not
very sociable.
• Person 2: Average academic record but is well
liked by staff and patients.
• Try to focus on improving your weaknesses.
Academic Achievements
+
Interpersonal Skills
=
Success!
Many individuals like the idea of becoming a
physician but few are willing to work hard
enough to reach their goals.
Medicine is a lifestyle it is not a 9 – 5 office job,
if you are ready for the battle then proceed...
If not you should choose an alternative path
for your occupation
Motivations
• We have all entered the school with different
mindsets and goals, stay true to your
motivation and you will reach your goal.
• One student maybe motivated due to a
personal experience and another may want to
create a medical related business.
• Use your motivation as a guiding light.
Aureus (Aruba) and You
• The relationship between a student and the
school is simply to attend the class upto MD4
and prepare well for the USMLE. That is it.
• Visa - DIMAS
• After the completion of MD4. You never have
to come back to the island again if that is what
you choose
• Only when you are on the island is when you
interact with the Aruba campus.
Aureus (New Jersey) and You
• The New Jersey office is the administrative
side of the school.
• Tuition payments, transcript requests,
USMLE/MCCEE paper work goes through
them, MSPE (Deans Letter) for Residency
Application, Letters of Good Standing,
authorizing clinical rotations.
• Clinical Coordinators forward your evaluations
from the rotations to The New Jersey Office
• Throughout your medical student career and
residency application process you are in
contact with New Jersey.
Student-Aureus Relationship
• You are a student
• You are not an administrator, professor, dean,
clinical coordinator, or an owner
• The majority of the administrative or financial
issues are beyond the scope of a student and
individuals like myself.
• A student should focus on their USMLE
prep...
• You should have a professional and business
relationship with the school.
• In this “transaction” in exchange for tuition
payments you have the right to write the
USMLE, conduct clinical rotations, and apply
for residency.
• Do not become emotionally invested in the
school with what is or is not happening with
the school.
Personal and Financial Status
• Although, all of our focus is placed on the
exam prep. We must also appreciate that we
are living a life.
• Becoming a physician is a long term process
and the minimal time to become a fully
licenced physician is 7 years. (4 years medical
school + 3 years residency)
If you have personal or financial issues to deal
with it will most likely interfere with your
process.
• Personal: The individuals who are most close
to you must understand that becoming a
physician is a shared sacrifice. Many people
may not understand that you are studying
hard for exams... And when the exam is over
you are back to studying, as it never ends.
• Your “reward” for the studying and graduating
medical school... Residency @ 80 hours /
week.
• Financial: There is as you know a significant
financial cost for the MD program. It maybe
wise to budget a bit more money than you
think as you never know when a large expense
may occur, and you may or may not get a
residency on your expected timetable.
• If you are getting financial support from a
family member that is great, if not try to
explore all possible options. (Private /
Governmental, Loans, Lines of Credit, Personal
Savings)
• A reference rage for a Resident’s salary ranges
from $45 000 to $55 000 depending on the
program and geographic location.
Loans
• I personally do not know of which banks do
and do not offer loans for us. That is
something to ask the school and former
students who have had a loan.
Personal Health
• We are all human and some students may be
suffering from common conditions such as
Anemia, Hypothyroidism or a more serious
condition.
• Please have your medications filled at home
and bring them to the island.
• Your personal health is the most “high yield”
activity.
• If you have to leave the island for a health
reason you should leave ASAP. Your health and
welfare is the most important activity
• A good night’s rest goes a long way to help
you study, if you cannot sleep try your best to
improve your sleep hygiene.
• Common conditions like anemia can have a
detrimental effect on your memory retention
skills.
• Message: If you take a pill at home for a
condition, continue taking the medications on
the island.
“Island Depression”
• “Familiarity Breeds Contempt”
• Despite living on the “One Happy Island”
which is a major tourist destination where
individuals come to relax from around the
world and pay thousands of dollars for a few
days stay.
• The vast majority of students will at one time
or another feel home sick or possibly
depressed
• This represents a lack of mental toughness
and desire.
• The process to residency is long and tough
and sacrifices have to be made to reach your
goals.
• It is natural to sometimes feel a bit lonely or
low, but your studies should be consuming
your time and you should not have enough
time to be down.
• Toughen Up!
Aureus Transcript
•Your transcript has letter grades for the basic sciences
(A,B,C,F,R). There are no percents or percentile on your
transcript.
•Your transcript has the terminology of Excellent/Honors,
Good/Superior, Satisfactory. I do not think a student has
ever failed a rotation.
Island Academic Achievement
• Since each foreign medical school has their
own marking criteria. There is no true and
honest way to compare transcripts from
different schools.
• A 70 at Aureus is equivalent to a “C” but a 69
is a fail, at another school a 70 can be a “B”
and a 69 a “C”... Or at a third school all marks
can either be “Pass/Fail”.
• This make our basic sciences marks relatively
“low yield” in the analysis of our residency
application.
• Thus, without standardized marking schemes
residency programs are forced to use USMLE
Step 1 Scores for IMGs as the barometer of
your basic sciences academic achievements.
• This is the situation for all non-US/Canadian
medical schools.
• USMLE Performance is infinitely more
important than island marks on your
transcript.
• Message: It is not the end of the world if you
got a B or C instead of A.
• Please don’t complain to your profs that you
need 2 more marks or something like that.
• You cannot control the marks distribution in
the class or the effect of a bell curve
Bell Curves
http://people.math.sfu.ca/~hebron/archive/1999-2/claw/faq/bellcurve.html
• A professor can curve the marks to his or her
expectations
• It is possible that using a bell curve may give
students a false positive reflection of their
academic achievement.
• Your competence cannot be properly assessed
by a “Curved” mark
• Message: Do not worry too much about your
mark.. USMLE, USMLE, USMLE is what matters
Aruba Basic Sciences and The
USMLE
• Aruba Basic Sciences is The USMLE
• If you do well in your classes you will do well
on the USMLE
• There is nothing magical that happens after
MD4 or in MD5.
• It is not logical to think that you can be a bit
lazy on the island and then become a studying
machine at home.
• It is great to see that many students are
receiving many academic achievements.
• It is logical to assume that students who are
doing well in their basic sciences will do very
well on the USMLE, since it is the same
information.
• You should keep in touch with these
individuals as their strategies are working. I
am sure they will have some very good tips for
you.
How many hours a day should I
study?
• A general rule of thumb is for each minute of
class, you should study 1 minute after class.
• There is no standard amount of study
required, we each understand the same
concepts at different speed.
ICM and Final Basic Sciences Exam
• The New York ICM course and the final basic
sciences exam was not offered during my time
so I do not know about it.
• I understand you have to pass this test to be
allowed to apply for USMLE Step 1.
PDI – Physical Diagnosis and
ICM – Introduction To Clinical
Medicine
• These two courses are relevant after passing
Step 1. It is not part of the USMLE Step 1
content, but represents your first opportunity
to apply your knowledge on clinical scenarios.
• PDI and ICM is not covered in First Aid, Kaplan,
or USMLEWorld.
• It is “low yield” so to speak for Step 1, but is
“high yield” because it is your only clinical
exposure before rotations begin.
• I hope you can understand this distinction
USMLE Preparation Courses
• It is always a controversial issue of taking or
not taking a course.
• There is no official recommendation either to
take or not take a course.
• There is no study to my knowledge that has
indicated a preparation course has increased
individual’s performances.
• The effectiveness of the course from what I
hear is more related to an individual’s
knowledge prior to the course
• These are “Review” courses not “Learning For
The First Time” courses, thus students who
prepare well during MD1-4 will most logically
benefit from a course.
“Break Time”
• If we assume that the break between
semesters is approximately 2 weeks and a
semester is approximately 15 weeks.
• That means between MD1-2, 2-3,3-4,4-5 there
are 8 possible weeks which can assist you on
your path.
• Literally half a semester of time is given as a
break during the MD program.
• There are three general options for this time:
• 1. Going Back Home: After all the studying
required each semester it is always good to
see your friends and family... Recharge for the
next semester.
• 2. Stay on the Island: One can study through
the break, continue the momentum of the
previous semester.
• 3. Research / Volunteer: With these “8
weeks” one can definitely be involved in an
activity related to their field of interest.
• There is no official or proven option which is
better than another, each individual will have
to make a decision which suits your interests.
• There are arguments to be made for and
against each option
White Coat Ceremony
• It is a great chance to have a group
celebration “ceremony” with your island
friends and family
• This event is a sentimental occasion and is
not a graduation
• It has no relevance to the USMLE/Clinical
Rotations/Residency. It is relevant as
completion of your first two years.
• Passing the island is just the introduction
chapter to your story!
Reality Check
• An interesting exercise will be to see what has
happened to the graduates from “My Time”
• Class That Began MD1 (Sept 2006 – May 2007)
That batch had 8 students:
1 in Residency... 5 in “rotations”.. 2 Missing in
Action
• My Class MD1 (Sept 2007):
1 in Residency... 3 in Rotations.. 4 Missing in
Action
• I am not doing this to shock you or to point
out people who have not played the game the
right way.
• It shows that our school has generally had a
“bipolar” type of outcome which is
representative of Caribbean Medical Schools.
• Those that prepare well on the island will
make it no doubt
Reality and Baltimore Rotations
• Since I began rotations in June 2009 in
Baltimore:
• 20 ASUM/Aureus affiliated individuals have
completed or are currently completing
rotations in Baltimore
• 8 of those individuals are transfer students
from other Caribbean/European medical
schools
• 12 are actually students who completed
Aureus basic sciences.
• 9 of those 12 individuals are Canadian....
The 2010 and 2011 Generation...
• There seems to be a disturbing trend of
students either not attempting or failing the
USMLE.
• NONE of the individuals in the previous slides
includes ANYONE who completed basic
sciences since April 2010. Nearly 2 years of
silence... As this semester ends in April 2012.
• This means there is either a significant lack of
effort doing basic sciences or a lack of focus
on the USMLE preparation during the island
time.
• It would be interesting for you to contact
these students since many of them would be
among your friends and colleagues.
• Find out what they would have done
differently, ask them “If you had to do it all
over again, what would you do?”
• It is important to learn from other individuals
success and failures.
“Trying to Make The School Better”
• I am sure that many of you have probably
tried to organize your fellow students or
propose new ideas “to make the school
better”
• Your intentions maybe have not been realized
since most good ideas involve large financial
investments or a significant commitment
from the students
• Remember you are a student who is supposed
to be studying/preparing for Step 1.
• The history of the school has shown that the
students who were serious about their
education did excellent on the
USMLE/Rotations and eventually got into a
residency.
• You do not really need any more resources
than you currently have to be successful
• A school cannot teach passion and desire!
• The single best activity you can do to improve
the school is to do well throughout your
medical school career and get into residency.
• If hospitals out there see that Aureus students
are well prepared that will help the future
students tremendously.
How I Would Improve The School
• The current structure of the school favors an
individual who is self-motivated and does not
need much guidance.
• “The Lone Warrior” is good way to describe
the type of person who has succeeded so far.
• These individuals have done it their own way
with minimal to no guidance.
• The reality is that most individuals do require
a structured path to reach their goals
• If you want US Medical School facilities or
resources you will have to pay US Medical
School tuitions...
• If I was you (the student body) I would focus
on logical and cost effective initiatives
• Possible ideas are related to:
• Curriculum, Examination, and Marking Reform
Always Remember
• No one deserves anything, you got to earn it.
• Even if you pass and do well on the USMLE
that just means you are among 1000s of other
IMGs who have done well.
• People out there are doing very on the USMLE
compared to before due to the proliferation of
USMLE preparation products. I have even
heard of “USMLE Grade Inflation”
• This is a long term battle and you must stay
the course to make it.
• If you play the game the right way meaning:
• 1. Pass the USMLE Step 1 with a solid score in
a reasonable time after MD5
• 2. Perform well on the clinical rotations
• 3. Obtain excellent letters of reference
• I have no doubt that you will reach your goals
Medical Organizations
The American Medical Association
“Since 1847 the American Medical Association (AMA) has had one mission: to
promote the art and science of medicine and the betterment of public health.
Today, the core strategy used to carry out this mission is our concerted effort to
help doctors help patients. We do this by uniting physicians nationwide to work on
the most important professional and public health issues.
In 2011 our strategic plan focuses on five areas that encompass the central elements
in health system reform:
Access to care
Quality of care
Cost of health care
Prevention and wellness
Payment models
These topics represent the major areas of emphasis in which the AMA carries out its
mission in the current environment. Our proposed actions are not only directed at
solving reform issues at the policy level, but also at helping physicians adapt to—
and adopt—changes in a productive way.”
• http://www.ama-assn.org/
AAMC – Association of American
Medical Colleges
• https://www.aamc.org/
• “Founded in 1876 and based in Washington, D.C., the
Association of American Medical Colleges (AAMC) is a not-forprofit association representing all 136 accredited U.S. and 17
accredited Canadian medical schools; nearly 400 major
teaching hospitals and health systems, including 62
Department of Veterans Affairs medical centers; and 93
academic and scientific societies. Through these institutions
and organizations, the AAMC represents 128,000 faculty
members, 75,000 medical students, and 110,000 resident
physicians.”
LCME - Liaison Committee on Medical
Education
• “The Liaison Committee on Medical Education
(LCME) is the nationally recognized accrediting
authority for medical education programs
leading to the M.D. degree in U.S. and
Canadian medical schools. The LCME is
sponsored by the Association of American
Medical Colleges and the American Medical
Association.”
• http://www.lcme.org
World Health Organization Avicenna Directory
• http://avicenna.ku.dk/
• “Why a new database?
• The mission of the AVICENNA Directories will be to facilitate
transparency in understanding of the human resources for
health, and of the educational background of health
professionals. Fundamental information will support
improvement of the quality of education, especially by
providing information on the quality of education and training
and by guiding users to other sources containing more specific
and detailed information.”
ECFMG - Educational Commission on
Foreign Medical Graduates
• http://www.ecfmg.org/
• In traditional medical schools, your dean’s office
handles all the inquires related to examinations,
residency applications etc.
• Aureus (New Jersey) is responsible for processing
some of our paper for various exams and ECFMG
Certification, but ultimately everything goes
through the ECFMG
• For IMGs the ECFMG is our designated deans
office.
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“Through more than five decades of certifying IMGs, ECFMG has developed unparalleled expertise
on the world’s medical schools, the credentials they issue to their graduates, and the verification of
those credentials. ECFMG has expanded this expertise to include credentials related to
postgraduate training and registration/licensure through its primary-source credentials verification
service for international medical regulatory authorities. And now, through an upcoming initiative,
we are preparing to bring this expertise to individual physicians and the entities that license, train,
educate, and employ them.
ECFMG’s commitment to promoting excellence in international medical education led to the
establishment of its nonprofit foundation, the Foundation for Advancement of International
Medical Education and Research(FAIMER). FAIMER has assumed responsibility for, and expanded
upon, ECFMG’s programs for international medical educators and ECFMG’s research agenda.
Through FAIMER, ECFMG offers training in leadership and health professions education; creates and
maintains data resources on medical education worldwide; and conducts research on international
medical education programs, physician migration, and U.S. physician workforce issues.
ECFMG is a private, nonprofit organization whose members are: American Board of Medical
Specialties;American Medical Association; Association of American Medical Colleges; Association
for Hospital Medical Education; Federation of State Medical Boards of the United States, Inc.;
and National Medical Association.”
http://www.ecfmg.org/about/index.html
FAIMER - Foundation for Advancement
of International Medical Education and
Research
http://www.faimer.org/
“FAIMER is a non-profit foundation committed to
improving world health through education.
• FAIMER was established in 2000 by
the Educational Commission for Foreign Medical
Graduates (ECFMG®). In partnership with ECFMG,
FAIMER promotes excellence in international
health professions education through
programmatic and research activities.”
IMED - International Medical
Education and Research
• http://www.faimer.org/resources/imed.html
• “The International Medical Education
Directory (IMED) is a free web-based resource
for accurate and up-to-date information about
international medical schools that are
recognized by the appropriate government
agency in the countries where they are
located. FAIMER is not an accrediting agency.
Listing of a medical school in IMED does not
denote recognition, accreditation, or
endorsement by FAIMER.”
NBME - National Board of Medical
Examiners
• “The NBME develops and manages the USMLE. While
the individual licensing boards grant the license to
practice medicine, all medical boards in the US accept
a passing score on the USMLE as evidence that an
applicant demonstrates the core competencies to
practice medicine. As a result, healthcare consumers
throughout the nation enjoy a high degree of
confidence that their doctors have met a common
standard. The NBME and the Federation of State
Medical Boards co- sponsor the USMLE, and the
Educational Commission for Foreign Medical Graduates
is the third collaborator in the USMLE program.”
• http://www.nbme.org/
ERAS – Electronic Residency
Application Service
• https://www.aamc.org/services/eras/
• “Electronic Residency Application Service (ERAS®) is a
service that transmits applications, letters of
recommendation (LoRs), Medical Student
Performance Evaluations (MSPEs), medical school
transcripts, USMLE transcripts, COMLEX transcripts,
and other supporting credentials from applicants and
their designated dean's office to program directors.
ERAS consists of MyERAS, Dean's Office Workstation
(DWS), Program Director's Workstation (PDWS), and
ERAS PostOffice.”
NRMP - National Resident
Matching Program
• http://www.nrmp.org/
• “The National Resident Matching Program
(NRMP) is a private, not-for-profit corporation
established in 1952 to provide a uniform date
of appointment to positions in graduate
medical education (GME) in the United
States.”
ACGME - Accreditation Council for
Graduate Medical Education
• http://www.acgme.org
• “ The Accreditation Council for Graduate
Medical Education (ACGME) is responsible for
the Accreditation of post-MD medical training
programs within the United States.
Accreditation is accomplished through a peer
review process and is based upon established
standards and guidelines.”
FSMB - Federation of State Medical
Boards
• “The Federation of State Medical Boards
(FSMB) is a national non-profit organization
representing the 70 medical and osteopathic
boards of the United States and its territories.
The FSMB leads by promoting excellence in
medical practice, licensure, and regulation as
the national resource and voice on behalf of
state medical and osteopathic boards in their
protection of the public.”
USMLE – United States Medical
Licensing Examination
• http://www.usmle.org/
• “The United States Medical Licensing
Examination ® (USMLE®) is a three-step
examination for medical licensure in the
United States and is sponsored by
the Federation of State Medical Boards
(FSMB) and the National Board of Medical
Examiners® (NBME®).
• The USMLE assesses a physician's ability to
apply knowledge, concepts, and principles,
and to demonstrate fundamental patientcentered skills, that are important in health
and disease and that constitute the basis of
safe and effective patient care. Each of the
three Steps of the USMLE complements the
others; no Step can stand alone in the
assessment of readiness for medical
licensure. Find out more about the USMLE »”
Canada
Aureus and Canada
• There has always been a large minority to a
majority of students in the school from
Canada.
• So it is important to take sometime to look at
the situation to obtain residency in Canada.
http://www.carms.ca/pdfs/2010_CSA_Report/CaRMS_2010_CSA_Report.pdf
PCRC - Physician Credentials
Registry of Canada
http://www.pcrc.org/en/
MCC - Medical Council of Canada
• “Strategic goals:
• Provide the qualification (Licentiate of the Medical Council of
Canada) for entry into practice.
• Initiate and promote, with partners, a national integrated
strategy of assessment of physicians throughout their careers.
• Initiate and promote innovation, research and development in
assessment and evaluation.
• Maintain the Canada Medical Register and promote, with
partners, the development of a national registry.
• Maintain and promote liaison with competent provincial,
national and international organizations in assessment and
evaluation.
• Be an open, transparent, responsive and accountable
organization.”
RCPSC - Royal College of Physicians
and Surgeons of Canada
• http://www.royalcollege.ca/public
• “The Royal College sets the highest standards
for specialty medical education in Canada. At
the same time, we support lifelong learning
for specialist physicians and promote sound
health policy.”
Canadians Only - MCCEE
• We must pass this exam as part of the visa
requirements for the J1 visa.
• It is similar in content to USMLE Step 2 CK.
Students generally take it soon after writing
the CK.
• The primary requirement is completion of
Core Rotations.
• Q – Bank: http://www.canadaqbank.com
• Toronto Notes (As reference)
http://www.mcc.ca/en/exams/ee/
CaRMS – Canadian Resident
Matching Service
http://carms.ca/eng/index.shtml
https://w1c.e-carms.ca/pdws/jsp/pd.do?p=p1&m=1
Canadian Match Results
• 1920 IMGs applied for Residency and 380
matched. Resulting in a 19.8% match rate.
• Contrast it with a 40% Match rate for non-US
Citizen IMGs.
• You have twice the chance to get residency in
USA than Canada... Even for Canadians.
• If you complete Residency in the US you can
go back and practice in Canada you just have
to check the procedure with your province.
• Since I am from Ontario I will just highlight the
agency that works to integrate IMGs back into
Ontario.
• Each province has their own agency and
procedures.
http://www.healthforceontario.ca/jobs/accesscentre/img.aspx
http://www.health.gov.on.ca/english/providers/ministry/recruit/repat/docs/ros_guidel
ines.pdf
Visa Information for
Non-US Citizens or
Green Card Holders
Clinical Rotations and B-1 Visa
• All non-US Citizens and non-Green Card
Holders must have a B-1 visa for the clinical
rotations.
• The school or a Clinical Coordinator can write
a letter for you and you present it at the US
Border (any entry point) and you will receive
the Visa. The visa processing fee is $6 USD.
• It can be renewed at a border crossing with
another letter.
• You are not eligible for a Social Security
Number. It is a visitor visa.
http://travel.state.gov/visa/temp/types/types_1262.html
Visa Sponsorship and Residency
• All non-US Citizens and non-Green Card
Holders must have a visa sponsorship for
residency
Exchange Visitor Sponsorship
Program (EVSP) and J-1 Visa
• http://www.ecfmg.org/evsp/
• “Foreign national physicians who seek entry into U.S.
programs of graduate medical education or training must
obtain an appropriate visa that permits clinical training
activities. One visa commonly used by foreign national
physicians is the J-1, a temporary nonimmigrant visa reserved
for participants in the Exchange Visitor Program. As a public
diplomacy initiative of the U.S. Department of State, the
Exchange Visitor Program was established to enhance
international exchange and mutual understanding between
the people of the United States and other nations.”
H-1B Fiscal Year (FY) 2012 Cap
Season
•
http://www.uscis.gov/portal/site/uscis/menuitem.5af9bb95919f35e66f614176543f6d1a/?vgnextoid=4b7
cdd1d5fd37210VgnVCM100000082ca60aRCRD&vgnextchannel=73566811264a3210VgnVCM100000b92ca
60aRCRD
• “The H-1B Program
• U.S. businesses use the H-1B program to
employ foreign workers in specialty
occupations that require theoretical or
technical expertise in specialized fields, such
as scientists, engineers, or computer
programmers.”
http://www.ecfmg.org/evsp/3112009.pdf
http://www.ecfmg.org/evsp/presentations/berry.pdf
States and Medical
Licensure
http://www.fsmb.org/pdf/GRPOL_SpcCmt_Eval_Undergrad_MedEd.pdf
New York
• Since we are not a “New York” approved
school we are eligible to conduct up to 12
weeks of rotations there. We are though
eligible to get a residency there.
• My interpretation of the rule is that it refers to
the opportunity to complete long-term
(greater than 12 weeks) not residency or
licensure.
California
• The school is not California approved thus we
cannot obtain a residency in any state that
follows the California list including to my
knowledge (there is no official list I could find,
best to contact these states):
• Arkansas, Alabama, Alaska, California, Indiana,
Kansas, New Mexico, Oregon, Tennessee
• http://www.mbc.ca.gov/applicant/schools_recognized.html
Texas
• Another complicated state, but I know that
some students have completed rotations
there.
• It is unclear to me the exact status, but we are
not on their approved list
http://www.tmb.state.tx.us/
So What Does it All Mean
Regarding These States
• It seems as though these state “specific” rules
does not exclude us from practising in these
states .
• Rather, we are excluded from first year
residency positions in these states.
• But, a glance at a states licensure
requirements shows that if you have 1 – 3
years of residency in any state you are
practically eligible for each state.
• Our goal is to get into “a residency” it may not
be in your desired area or speciality but once
you are part of the system so to speak you can
weave your ways to your goals.
http://www.fsmb.org/usmle_eliinitial.html
The USMLE
• The USMLE is designed for US medical
students after completion of their second year
final exams.
• Their first two years are equivalent to our MD
1 – 5.
• They generally take 4 – 6 weeks to study for
the exam in the summer before starting their
3rd year in the late summer/September.
• The optimal USMLE is designed to be a shortterm intensive preparation.
• The exact opposite of what most individuals
are currently doing
• “Step 1 has 322 multiple-choice test items,
divided into seven 60-minute blocks,
administered in one eight-hour testing
sessions”
• http://usmle.org/pdfs/bulletin/2012bulletin.p
df
USMLE Scores
• There is a two digit and three digit score
• The three digit score is related to your
performance on the test
• The two digit score is relative to your three
digit score and the current passing score
• The two digit score is NOT a Percentage or
Percentile
• Since July 2011, only your 3 digit score is being
reported to residency programs. The 2 digit
score is now going to be used only for state
licensing requirements.
• “When you take Step 1, Step 2 CK, or Step 3,
the computer records your responses. After
your test ends, your responses are transmitted
to the NBME for scoring. The number of test
items you answer correctly is converted into
a three-digit score and an associated twodigit score. Both scores are used for scorereporting purposes.”
• “All score users are urged to rely on the three digit
score since its equivalence is maintained over time
through statistical procedures. The two-digit score
is derived from the three-digit score and the current
passing score. Consequently, two-digit scores are
not equivalent over time across the entire scale.
The two-digit scale is used in score reporting because
some medical licensing authorities have
requirements that include language describing a
"passing score of 75." The two-digit score is derived
in such a way that a score of 75 always corresponds
to the minimum passing score. The USMLE program
has begun the process of limiting the reporting of
scores on the two digit scale.”
• http://usmle.org/pdfs/bulletin/2012bulletin.pdf
IMGs and The Obsession of USMLE
Scores
• The USMLE is an integral part of our residency
applications, but do not forget that your
performance in clinical rotations/research
opportunities/publications etc. Are all part of
your residency application.
• Since the individuals that actually make it to the
residency application stage generally all have a
similar range of scores.
• It is the other factors such as strong Letters of
Reference/Publications that make a difference.
• https://iwa2.ecfmg.org/overview.asp
• Applying for the USMLE Step 1 involves an
online and paper application.
• A requirement is that you will have to pay
your first clinical rotation tuition when you
apply for the Step. That is the school policy.
http://www.usmle.org/cru/
• "There are three kinds of lies: lies, damned
lies, and statistics.“
• - Benjamin Disraeli
USMLE Pass Rates
• We all including myself would like to know
what the first time passing rates are.
• The problems with any reported percentages:
• When an individual signs up for the USMLE, he
or she has the right to not disclose their score
to the school.
• How to account for an individual who has
failed a test? How to account for a small
portion of a graduating class that has passed
the test?
• For example: After 1 year a graduating class of
20 individuals, 4 individuals have written and
passed the exam.
• Is the passing rate truly 100%? It is also
important to what has happened to the 16
other individuals.
• Or if those 4 individuals passed but on their
2nd attempt... Is the passing rate 0% or 100%
or 4 / 20 = 20%?
• Solution: We should focus on what the
individuals who have made it to residency
have done and contrast that with the other
individuals who have not been as successful.
• Do not get caught up in the numbers game.
Each individual’s experience is dependent on
your own input a.k.a. your own hard work.
• There is no one way to succeed, just because
one individual did the process a certain way
does not mean that is the only way. Rather,
we should gather as much information as
possible and tailor it to your learning style
and personality.
• It is also important to know that students not
schools make scores... Ultimately success and
failure is an individual responsibly.
• This is the real world and you are Men and
Women. The next generation of physicians!
• While scores are important, you are not a step
score.
• Achievements on a test may indicate you are
good in a multiple choice environment,
USMLE scores do not always correlate with a
physicians competence.
• A patient will not ask you your score!
• At the end of a day... It is just a test. Important
in the short not long term but just another
hurdle for you to go through.
http://www.ecfmg.org/resources/ECFMG-2010-annual-report.pdf
http://www.nbme.org/PDF/Publications/Annual-Report.pdf
http://usmle.org/transcripts/score-conversion.html
http://usmle.org/transcripts/score-conversion.html
“210/90”
Baltimore
Pass
Aim Here
>95 is a
realistic
goal
+
http://www.nrmp.org/data/chartingoutcomes11.jpg
USMLE Preparation
• There are several well recognized review
series which cover the USMLE:
• Kaplan
• Falcon
• Doctors in Training
• BRS
• Goljan
• First Aid
•
•
•
•
Question Banks:
USMLEWorld
Kaplan
USMLERx
•
•
•
•
Reference Books:
Robbins Pathology
Netter’s Anatomy
Lippincott's
• There are many other resources which are
not listed.. The question then becomes which
ones to use.
• Remember time is your friend but it is also
your enemy!
• In my experience of meeting fellow Aureus
students and students of other Caribbean
medical schools in the rotations I can make a
general consensus on what people are using in
their preparation:
• 1. First Aid for The USMLE
• 2. USMLEWorld
• 3. Goljan
• 4. A review resource: Kaplan/Falcon/DIT
• **** You are attempting to pass the exam
with an excellent score on your first attempt.
The exam is general in nature and covers the
content which you have already studied
during the MD courses. ****
• This is not just an anatomy or pathology test
thus traditional reference review books
should be used just as a reference.
• You all have a great advantage as everyone
practically “knows” what to study, which is
very different from the past
• I personally only used Kaplan/Goljan during
my island time. I wish someone told “my
generation” all this information when I
stepped off plane for the first time in
September 2007.
• Thus, we must not only focus on what to
study but now onto how to study!
Study Partners
• Depending on your nature and personality
studying with someone or atleast “bouncing”
questions off them is a great way to study
• “Quizzing” each other is a great way to study
since you can realize your weakness and
strength.
• If you do not know something do not take it
personally, it is a chance to see your weakness
• You can be “pushed” and then you can “pushback” since your comfortable with that person
Analyzing USMLE Questions
•
•
•
•
•
•
•
1. Age
2. Gender/Ethnicity/Occupation
2. Past Medical/Surgical History
3. Patient recent activity
4. Onset of condition
5. Differential diagnosis
6. Assessment and plan of the situation
• The USMLE is based on classical situations
and “stereotypes”.
• There is a reason why in the questions they
state the details about who the patient is. You
should use these details to frame your
mindset to the right type of answers.
• The questions / answers generally focus on
“Why” and not just “What”.
When you can answer a multiple choice
question without looking at the answers that
is sign that you have a comprehensive
understanding of the content.
• The USMLE is a test of the basic sciences
knowledge, it tests your understanding of
applying concepts to clinical scenarios
generally.
• A key roadblock for many individuals
especially on the island is to apply concepts
when they have not even seen them in “real
life”
• USMLE concepts are generally easier
understood if you can think abstractly as
courses like biochemistry and microbiology
are generally based on understanding and do
not follow simple memorization.
• Memorization is the first step to
understanding concepts. Most individuals
stop at the memorization stages, thus forget
over the long-term or do not truly
comprehend the information
The Optimal USMLE Preperation
from MD1-4
• Start First Aid review/USMLEWorld in MD1..
and follow along with your courses. So that by
the end of MD4 you will have completed First
Aid/USMLEWorld.. and use a USMLE review
(Kaplan/Falcon/DIT etc) as a reference.
• Use your MD5 as a review semester and write
the Step as soon as you can.
• The Official 2012 USMLE Step 1 Outline:
• http://usmle.org/pdfs/step1/2011_ContentOutlines.pdf
• 2012 USMLE Bulletin of Information:
• http://usmle.org/pdfs/bulletin/2012bulletin.p
df
• Must read!
Myths
• “The Longer I Study for Step One the Better I
Will Do”
• “I will memorize all the questions/answers”
• “It is easier/harder at a certain time of year”
• “If I write it again.. Atleast I saw the questions
once”
• “My friend wrote the test and so I expect X, Y,
Z on my test”
• “If I do well on the USMLE I am equal to a US
med student”
• “If I do well on the USMLE I will apply to a
speciality”
• “If I do poor on the USMLE I will apply to
family medicine because it is guarenteed”
Clinical Clerkships
USCE – United States Clinical
Experience
• The one advantage of a Carribean Medical
School vs. Medical schools in other parts of
the world is the opportunity to conduct
clinical clerkships in the US as a 3rd and 4th
year medical student.
• There are two general ways IMGs can get the
valuable USCE and obtain Letters of Reference
for residency.
• 1. Clinical Clerkships: As 3rd and 4th year
medical students completing 72 academic
weeks of rotations in hospitals in the USA.
During clerkships you interact with patients,
write notes, and are the most junior member
so to speak of the patient care team.
• 2. Observerships / Externships: After
graduating from a medical school usually
though a private company. You pay a very high
weekly fee to literally “Observe” patient, you
are not allowed to interact with patients. This
is what medical graduates from other
countries (non-Caribbean) have to do to get
USCE.
• Oberserverships/Externships are generally
not considered USCE by many programs!
Performing Well in Rotations
• Just put an honest effort forward.
• If someone tells you to read something,
please do that.
• We are the most junior member so you must
understand your position
• “Respect Your Seniors”
(Intern/Resident/Physician)
• Dress Code: Whitecoat, Dress Shirt/Pant, Tie
(males), Dress shoes
• It is a process where the more you do the
better you will become.
Aureus Clinical Rotations
• After passing Step 1 you are eligible for the
clinical clerkships which is a formal term for
rotations. The clinical sites includes:
• Baltimore, Maryland
• Chicago, Illinois
• Seattle, Washington
• Atlanta, Georgia (I do not know anyone)
• Dallas, Texas
• Orlando, Florida (Internal Medicine rotation)
• Interesting to note, if an individual has the
possibility and takes the initiative to create
their own rotations. It is approved by the
school, as the rotations in Seattle and Dallas
have been set up by individual students
respectively.
• An individual who can deal with the hospital
bureaucracy can be their own clinical
coordinator so to speak, but this is very rare.
Core Rotations
•
•
•
•
•
•
•
12 Weeks Internal Medicine
12 Weeks Surgery
6 Weeks Family Medicine
6 Weeks Psychiatry
6 Weeks Ob/Gyn
6 Weeks Pediatrics
48 Weeks
Elective Rotations
• You have 24 weeks to practically do anything
you desire.
• For the Canadians, during your electives you
would have to on your own initiative set up
electives in Canada. Important for those who
want to apply for Canadian Residency.
• You can complete current electives that are
already set up through the various clinical
coordinators. Or set up your own rotations.
• There is a chance to do a research electives at
The Johns Hopkins Hospital and The National
Institutes of Health.
• There are two general theories about
electives:
• 1. “An individual should do their electives at
hospitals where you would like to do
residency, thus you would be ‘auditioning’ for
them as a student.”
• 2. “You should do whatever interests you as
this is a chance to explore new opportunities
as this is a your final opportunity before the
grind of residency.”
• Each side has a valid and fair argument, a
person just has to use their discretion on what
they think is right.
• A small amount of people do in fact match at
a location where they have done residency,
but most will match somewhere they have not
done anything.
“Greenbook Rotations”
• Greenbook refers to rotations occurring at an
institution that either sponsors or participates
in a residency.
• For example, an Internal Medicine rotation
occuring at a hospital that has an Internal
Medicine residency means it is Greenbook.
• The “Greenbook” is online and available at:
• http://www.acgme.org/adspublic/
Baltimore Rotations
• I completed my rotations in Balimore,
Maryland. I did not do rotations in the other
cities so I cannot honestly comment on those
rotations.
• Your rotations are not only conducted with
Aureus students you will meet students from
several different offshore medical schools
including: Ross, AUA, AUC, Saba, MUA,
Oceania and others.
Baltimore Clinical Rotations
Locations
•
•
•
•
•
•
Family Medicine – Union Memorial Hospital
Ob/Gyn – Harbor Hospital or Doctors Hospital
Surgery – Union Memorial Hospital
Pediatrics – Federal Hill Medical Clinic
Psychiatry – Mosaic Community Services
Internal Medicine – Harbor Hospital or
Northwest Hospital
• All core rotations are by definition
“Greenbook”
“Brand Name Hospitals” Elective
Rotations
• IMGs can apply to electives at practically any
hospital in the USA, certain hospitals restrict
electives to LCME approved medical schools
or schools that have a formal agreement with
the hospital. The websites of the hospitals
show their polices and application process.
• Competition is incredible tough to get a
rotation at a “Name” hospital, all you can do is
apply and hope for the best.
The Johns Hopkins Hospital
Elective
• We are eligible for an elective there not a core
• 6 Aureus students including myself who done
an elective there. After passing CK you can
apply for it.
• Students from non-LCME approved are not
eligible for clinical based rotations at Hopkins,
only research based rotations . The research
can either be chart-review type or lab based.
• 5 students including myself did a Pediatric
Hematology elective and 1 did Opthalmology
elective
The National Institutes of Health
• It a research facility and we can apply for
clinical based electives which are generally 4
weeks.
• I understand that 3 Aureus students including
myself have done electives there ranging from
Cardiology, Endocrinology, and Informatics.
Hospital Terminology
• Academic Medical Centers: Refers to large
hospitals typically in large urban centers which
are primarily affliated with a US School of
Medicine. These hospitals are the primary
hospitals of a Medical School. There is a heavy
research emphasis including basic sciences
and these hospitals receive referrals from a
wide geographic area.
• Examples: The Johns Hopkins Hospital,
Massachusetts General Hospital, Hospital of
The University of Pennsylvania
• Community Hospital: A hospital that is
primarily focused on serving a local
community which could in a urban or rural
environment.
• University Affiliated Hospital: A hospital which
has an official arrangement with a medical
school. They share resources, residencies, and
patient population. A community hospital can
be university affiliated.
• Teaching Hospital: A hospital where medical
education occurs via residency programs and
medical student clerkships. Both university
and community hospitals can be a teaching
hospital.
• Non-university community (Non-Teaching)
hospital : A community hospital which is
“freestanding” and does not have a formal
agreement with a medical school.
Residency Application
Process and Issues
http://www.ecfmg.org/news/page/3/
IMGs vs. US MD/DO Applicants
• It is always a complicated issue, the
competition is fierce and despite your hard
work it will and always has been a struggle to
obtain a residency.
• US graduates are preferred over IMGs. If this a
bias or they are more culturaly adapated is a
controversial issue.
• US Citizen IMGs are preferred over non-US
Citizen IMGs. There is no advantage being
Canadian, its USA vs. World so to speak for
Visa issues.
What Activities Will Get Me Into
Residency?
•
•
•
•
The two single most important factors:
1. Strong USMLE Performance (no fails)
2. Strong Letters of Reference
All other activities are a supplement and not
required such:
• 1. Research
• 2. Volunteering
• 3. Your past education/accomplishments
Research / Volunteering
• There are only 24 hours in a day. With USMLE
Preparation being “all-consuming” and then
Clinical Clerkships/Step 2 occupying your time.
• Thus there is limited opportunity for research
and volunteering.
• The final decision resides with individual
regarding these activities
• If you do choose a Research or Volunteer
oportunity make sure you are aware of the
time commitment and your responsibilities.
• If you think that doing some for 1 or 2 weeks
will be the reason you get a residency, you are
wrong.
• On the other hand, a short term opportunity
mave give you a new insight into medicine and
motivate you further to your goals.
• It is generally recommended that our elective
rotations be a minimum of 4 weeks, so I would
use that as a minimum time commitment to
any extra activity.
• For individuals who are interested in the
speciality residencies (Radiology, Orthopedics,
etc) then pursuing research opportunities
maybe integral to your applications.
• There is no right or wrong answer.
Relevant Activities
• Programs want to see that you have an
interest in their respective fields.
• Make sure that your Research or
Volunteering is relevant to your field of
interest.
• For example, if you want to get into surgery
doing research in psychiatry about bipolar
disorder is not going to assist you. The first
thing they will ask, “You like psychiatry? Not
Surgery?”
“Genuine” Activities
• Regarding extracurricular activities ask your
self the question:
• “Would I do this activity even if it did not help
my residency application?”
• If you would answer ‘yes’ then that means you
are truly passionate about the activity and will
excel no doubt.
• If you would answer ‘no’ that is okay as well,
then you should just focus on the USMLE and
Clinical Rotation performance those are the
activities that will get you a residency.
• Extracurricular activities are integral to US
MD/DO students not as relevant to IMGs,
since “we” do not have AOA (Alpha Omega
Alpha) and other types of groups.
• There is no way for residency programs to
verify activities that occur outside the United
States or with organizations they are not
familiar with.
Publications
• If you have the opportunity to publish a case
report, present a poster at a professional
meeting, or be part of a study that would be a
great addition to your application.
• If you have the opportunity to publish in a
“Peer-Reviewed” journal that would be a
tremendous acomplishment.
• Non-peer-reviewed or online only publications
are not as impressive, but something is better
than nothing.
“Helping People” vs. Reality
• It may be disheartening to know that
individualistic activities such as USMLE Scores,
Letters of Reference, Publications, and
Research have much more “weight” in
residency applications than activities that are
about “helping people”
• We all supposedly want to make a difference
in the world, but we must understand what
exactly programs are looking for. This will
avoid wasted effort.
What Activities Will Not Get Me
Into Residency?
•
•
•
•
Student Council / Student Body Leadership
Local Arubian “Health Initiatives”
Clinical experience outside of USA/Canada
Creating IMG Businesses like a clinical rotation
company or residency application assistance
service
• Creating websites/blogs like I have
• Being a “Visiting Professor/Teacher”
• Being a medical office assistant, lab tech, etc.
• It is very good to help the community, but I
am just talking about activities relevant to
residency applications.
• Please understand that distinction.
• Of course the “Worst” situation:
• Several USMLE attempts / Weak Letters of
Reference
My Personal Viewpoint on What
Programs Look For (Opinion)
• In order of most weighted (importance) to
least weighted. For the US Match:
• 1. Location and Reputation of Medical School
• LCME vs. IMG
• 2. Visa Status
• US Citizen/Green Card vs. Non-US Citizen
• 3. USMLE Scores
• Any fails? Meets the program cut-off?
• 4. Letters of Reference
• Relevance to the field? Recency? Clinical
Based?
• 5. Medical Student Performance Evaluation
• Is there consistency in the student’s
performance? Weakness and Strengths?
• 6. Research/Transcripts/Extracurriculars
• Length? Relevance? Responsibilities?
Residency Application
•
•
•
•
•
•
•
•
USMLE Scores
Letters of Recommendation
Personal Statement
Medical Student Performance Evaluation
Official Transcript
Photo
Online ERAS Application
Registration with NRMP for The Match
Common Residency Interview
Questions
•
•
•
•
•
•
These are the kinds of questions I was asked:
Why did you choose our program?
Why did you choose this field?
What inspired you to choose this field?
Where else are you interviewing?
Why would you choose this program over
other programs
• Do you have any plans for fellowships?
• What are your future plans?
• Tell me an interesting case you have
encountered
• Why did you go to school in Aruba?
• Did you apply to medical school in Canada?
• Do you plan on practising in Canada or USA?
http://www.nrmp.org/nrmpannualmeeting2011.pdf
• Meaning a program / hospital have to decide
whither to give all their positions in the match
or through a prematch. It is unclear exactly
what the effects would be but most likely
there will be significantly less prematches in
the future.
http://www.nrmp.org/nrmpannualmeeting2011.pdf
Aureus Residency Placements
• The Golden Question... After all the hard work
and struggle, does an individual get the
reward?.. The answer is yes!
• I know many individuals from the 2011 match
who have “matched” and from the current
2012 match some have already “prematched”
while others are in the match for March.
• The match results that are posted on the
school’s websites are from individuals who
finished the island before I even came. So I do
not know who those people are and I do not
know exactly what they did to get their
positions.
• For the 2011 and 2012 match that is a
different story...
2010 Match
2011 Match
Canada (2 both Family Medicine)
• Northern Ontario School of Medicine
• University of Saskatchewan
USA (4)
• Family Medicine (3): Kentucky, Iowa,
University of North Dakota, Pennsylvania
• Preliminary Surgery (1): University of North
Carolina
2012 Match
• The residency match season is currently
ongoing. It is great to report that 3 individuals
including myself have “prematched”. There
should be more matches in Match.
• USA – (All 3 Internal Medicine)
Staten Island University Hospital
Greater Baltimore Medical Center (2)
Characteristics of The Unsuccessful
a.k.a “What Not to Do”
• “Spend every Saturday/Sunday recovering
from the night before.”
• Having a mindset that USMLE prep begins
after leaving the island.
• Expecting that “Kaplan Course will prepare
me, so I won’t study as hard on the island.”
• Studying 24/7 only during exam period... Then
rest until the next exam period.
• Failing the step is among the worst outcomes
for a student. The process of preparing for
the exam involves such an intense effort, you
must measure your progress with practice
tests such as the NBMEs.
• You must do everything possible not to fail
• No Aureus student so far that I know of who
has failed a Step has gotten into residency so
far.
Characteristics of The Successful
a.k.a “What to Do”
• Common characteristics:
• Put an honest effort into the MD1 – MD4
classes.
• Attempted to complete USMLE Review
resources on the island.. Of course the regular
course work is in itself a lot of work.
• Passed Step 1 within 8 months after
completion of MD5 on the first attempt.
• Completed USMLE Step 2 CS and CK on the
first attempt generally after the completion of
the Core rotations.
• Completed the rotations and were able to
obtain letters of reference for applications.
• Applied to realistic type programs.. Meaning if
you have an “average” application you may
want to aim for Family or Internal Medicine
instead of Dermatology and Radiology
• They have understood the game!
“Non-Academic” Factors
• Just like in any job there are other factors
which maybe the deciding reason why an
individual gets the position.
• Residency programs are lead by human beings
and not robots!
• The human being is well known to have
established viewpoints and biases.
• What you can do is to maximize your strengths
and minimize your weakness.
“Personal Connections”
• If you know someone personally connected to
a residency program. Personal phone calls go
a long way to improve your chances.
• If one of your parents or close contacts is a
physician or in the medical system they will be
a tremendous help for you, since they can
navigate the system for you.
• This is what generally gives the children of
physicians advantage over most applicants.
• You cannot have too many physician
contacts, just too few.
GME - Graduate Medical Education
• GME is the formal term for residency
education
• Residency is the training you will receive after
graduation.... This is our goal. Only after
completing a licensed residency an individual
is eligible to practice medicine in USA or
Canada.
Residency Terminology
• PGY = Post Graduate Year it refers to the year
of residency an individual is in. For example, a
second year resident is referred to as PGY 2.
• Intern = First year resident
• An intern is sometimes confused with the
term “Internist” which someone who has
graduated from an Internal Medicine
residency
• Junior Resident = First Year Resident
• Senior Resident = An individual in their final
year of a residency program
• Chief Resident = An individual in their final
year of a residency program also responsible
for administrative duties. In some programs
an extra year of residency is dedicated to this
position.
• Attending Physician = An individual who has
completed a residency and is a practicing
physician.
• Program Director = A physician who is the
leader of a residency program, integrated into
the Resident selection process and medical
education
Results of the 2010
NRMP Program Director Survey
• A very insightful report into the minds of the
Residency Program Directors into what they
are looking into.
• An “official insight” into the system
• A must read:
http://www.nrmp.org/data/programresultsby
specialty2010v3.pdf
NRMP Results and Data: 2011 Main
Residency Match
• A comprehensive annual report regarding the
match it is released annual after the match in
March.
• Details regarding all types of residency and
programs across the country.
• http://www.nrmp.org/data/resultsanddata20
11.pdf
Pre-1980: There were more
residency positions than
applicants.. Thus “as long
as you pass the exams”
you could get a residency
Applicants > Positions
Post-1980: Now there are more
applicants than positions for residency,
thus the competition is increasing.
Many IMGs are going “unmatched”,
the situation is getting tougher every
year especially with the US Budget
problems and new US Medical
Schools
http://www.nrmp.org/data/Main2011.jpg
New US MD/DO Schools
and Residency Positions
New US Medical Schools
• http://www.lcme.org/newschoolprocess.htm
• December 2009 Issue. 122(12):1156-1162.
Medicare and Medicaid Programs
Fund Graduate Medical Eduation
• Medicare and Medicaid are US Federal
Government Health Care Plans which fund
residency programs.
• Due to the current US Federal Government
Budget difficulties, residency funding is among
several programs which may see a significant
cut.
• There will be more residency applicants every
year from the US Medical Schools and IMGs
and there will not be a corresponding increase
in residency positions.
• The competition level will be even greater as
each year passes.
• The best case scenario is if residency funding
can remain stable or a minor cut.
• This represents the largest contradiction you
will ever experience. The physician shortage is
well documented and is becoming worse, yet
every year it becomes harder and harder to
get to our goals.
• The overall message is then:
• “Just to make it you have to be excellent.”
http://www.nejm.org/doi/pdf/10.1056/NEJMhpr1107519
Academic Literature and
The USMLE – Residency
Process
• I would like to highlight some interesting
academic papers related to the USMLE Step 1
and Residency Applications.
http://www.ncbi.nlm.nih.gov/pubmed/15583484
http://www.ncbi.nlm.nih.gov/pubmed/12787375
http://www.ncbi.nlm.nih.gov/pubmed/20881702
http://www.stfm.org/fmhub/fm2010/February/Jira105.pdf
http://www.ncbi.nlm.nih.gov/pubmed/20881715
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2830045/pdf/MEO-15-4880.pdf
http://www.ncbi.nlm.nih.gov/pubmed/19704209
http://www.ncbi.nlm.nih.gov/pubmed/21694557
http://www.ncbi.nlm.nih.gov/pubmed/16926941
http://www.ncbi.nlm.nih.gov/pubmed/20502974
http://www.ncbi.nlm.nih.gov/pubmed/19240447
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931222/?tool=pubmed
http://www.ncbi.nlm.nih.gov/pubmed/19594918
http://www.ncbi.nlm.nih.gov/pubmed/21364111
http://www.ncbi.nlm.nih.gov/pubmed/20224023
http://www.ncbi.nlm.nih.gov/pubmed/21292219
http://www.ncbi.nlm.nih.gov/pubmed/19059170
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951766/pdf/i1949-8357-2-3-316.pdf
Summary
• The competition for residencies is intense but
those who have studied hard in their basic
sciences semester have done well on the
USMLE and have obtained residencies in both
Canada and USA.
• There are significant issues like government
funding for residencies and new schools which
we do not have control over.
• Put an honest effort forward and you will be
rewarded.