If you have completed your medical education from a medical school outside of the United States, you are considered an International Medical Graduate (IMG). While some IMGs may have either a US citizenship or a Green Card (GC), most IMGs require a visa to enter and practice in the US. This post gives a brief outline of the different types of visas available for IMGs.
The B1/B2 visa – Electives
This is the most common category of visas applied to by people visiting the US for short trips for business/tourism.
This the the visa that will be required by most IMGs to enter the US for electives and observerships.
Note, this visa lets you stay in the US for a maximum of 6 months at a stretch.
Find out more about how to apply for the B1/B2 visa here.
The F (Student Visa) – Electives
While this is rare, some elective/ clerkship programs may require you to have an F1 visa in order to complete the elective.
I personally know some programs in Texas that require an F visa. If you have more insights on this, you can mention it in the comments section below as it will help your fellow IMGs.
Visas required for Residency Training.
While the above two visa categories are required for completing electives and observerships over the short term, you cannot complete your residency training on these visas.
There are two types of visas that are accepted for residency training – J1 and H1B. Both have their pros and cons and are discussed below.
The J visa
The J1 visa is a temporary “non-immigration” visa given for the purposes of educational training.
It is sponsored by the ECFMG, which is the body that deals with international medical graduates.
Most residency programs now accept only J1 programs. This is especially true for the more prestigious University programs that almost always accept only J1 visas.
It is easier to get a fellowship on a J1 visa as compared to an H1B visa. This is especially true for competitive fellowships like Gastroenterology and Cardiology. The reason is that even fewer fellowship programs sponsor H1Bs as compared to J1 visas.
The J1 visa is limited to the duration of training (maximum of 7 years)
After you finish your residency training, there is a requirement to go back to your home country and work for a minimum of 2 years before you can seek a job and permanent residency in the US
The only way to bypass the home requirement is to do a J1 waiver. Which requires you to serve in an underserved/ underrepresented area in the US for a minimum of 3 years. You can find out more about J1 waivers here.
The H1B visa
This is a temporary work visa.
It is sponsored by residency programs that are willing to do so. (This means additional expenses for the residency programs to have immigration lawyers, hence very few offer H1B visas.)
They are generally offered by large community programs. And fewer programs are offering H1Bs every passing year.
It is limited to a period of 3 years with an extension available (up to 6 years)
Requires you to have Step 3 before you can apply for an H1B visa. This will be mentioned on the website of the residency programs that sponsor H1B visas.
Does NOT have the 2 year home residency requirement and therefore no question of a waiver job.
The Bottomline
Although making a choice about visas can be really tough, here are the things to consider.
If you have your heart set on doing a competitive fellowship like GI or Cardiology, a J1 visa may be better for you.
If you only want to train in big University programs, most will only accept J1 (They do not sponsor H1B visas, with some exceptions)
If you are not hell bent on training in a University program and you would like to do a relatively non competitive fellowship like Nephrology, Infectious Diseases, etc choose the H1B as it does not have the home residency requirement and you can transition to a green card faster.
This article provides only the most basic overview of the different types of visas. I would love to hear your perspectives and questions in the comments section below.
We are now offering USMLE Consultation. For a FREE seminar on USMLE as well as for various personalized consulting options check out our USMLE consultation page.
This article has been written by Dr. Rohit Nathani who is a medical resident at NYC. Ask your questions in the comments section below.
To submit your USMLE experience, go to the Contribute page. Your experiences can help other IMGs in their journey! You can also email us at theindianmedicalstudent@gmail.com
Interview season is here! To all those who aspire to be joining a Residency Program in the United States, this statement means a multitude of things- relief, at what seems to be the last leg of a rather long and dizzying process; excitement, at the chance to interview at the programs you’ve been vying to be a part of for what seems like eternity and nervousness, at feeling somewhat powerless at this stage in the journey.
It also meant the chance to travel the length and breadth of the US and take in all the sights and sounds of the country and along with it, the various programs in a specialty of your choice. This year, with the pesky virus taking trips around the world instead, things look a little different.
Interviews, like most other aspects of 2020, are going virtual. While that may mean good and bad things for applicants, it is definitely going to be unlike any other interview season prior to Match. Therefore, it goes without saying that it requires applicants to be prepared for all the ups and downs of selling themselves and evaluating programs from across a screen.
At the end of the day, a Residency Interview is a chance to showcase yourself as a good fit for the Program while you objectively evaluate whether you truly will be one.
Through a screen or not, the basic tenets of the interview remain unchanged. Here are a few tips I gathered from my experiences at various interviews across the country, that I am sure will go a long way in helping out applicants this year too, albeit the changed nature of the exercise:
1. Introspect well enough to be able to articulate who you are.
I cannot overstate the importance of this step. It is crucial to look inward and know yourself well enough so that you can express clearly to a third party( aka the Interview Panel) what makes you unique– your interests, what you are looking for in a program, your goals, aspects of your personality that make you stand out, your strengths, your weaknesses, and your quirks.
Almost every interview that I attended began with the overused and predictable start- “Tell me about yourself”. Use this as an opportunity to provide a concise, clear introduction to pave the way for the rest of the exchange. I would recommend having two versions of the answer to this question- short and long and using either after reading your audience.
2. Be confident in who you truly are and portray it.
If there was ever a time to unapologetically be yourself, this is it. You most likely won’t get away with trying to be a person you’re not and in the off chance that you do, you don’t want to fool the Program Director into thinking you’re someone you aren’t and matching into a Program only to discover that it does not align with what you truly seek.
This will only lead to unhappiness and a sense of restlessness for the following three years and Residency is hard enough without that. So stay true to yourself, what you believe and what you aspire for.This implies that in retrospect, you were honest in all parts of your application process and can vouch for everything you (claim to) have done.
Be self assured without seeming overconfident. ( fine line to tread yes, but easier than it seems). In short, be an advocate for your true self.
3. Be able to tie in past experiences with future goals.
In being able to draw in from situations and circumstances that you have been through and linking them with your targets for the future, you create a picture of someone who is not merely a passive participant in their lives but takes effort to synthesize purpose from opportunities presented to them.
It doesn’t need to be a tear-jerking story of an ill child or an old grandfather. It just needs to be a coherent stream of thought explaining why your passion lies where it does and where you see it going in times to come.
4. Do your homework regarding the program and what it has to offer.
As much as applicants should want to do this purely because it gives them a sense of the program they’re likely to match into, it doubles up in creating a good impression with the Interview Board.
Know what stands out about the program- the Fellowship match rates, the top-notch Cancer Research Center, faculty whose work you’ve been closely following or even the city it is located in. When someone asks why you want to match into a program, they’re looking for these specifics rather than generic responses tooting their horns but could interchangeably be used for any other program you are interviewing at.
5. Evaluate the program and what it has to offer objectively.
Another extremely important aspect of Interview Season is the chance it offers applicants to take a score of the program to help them create their rank list at the end of the season.
So this is a pretty important day for the Programs too- they want to be liked as much as you do. So use your power wisely- be observant to the schedules, the didactics, the research opportunities, the people around you- faculty and fellow applicants, current Residents( very important ), food and accommodation( ARGUABLY THE MOST IMPORTANT LOL) and ask questions if you need to clarify.
Make sure your questions are well thought out and are not aspects of the program clearly delineated on their website or explained in a presentation that was just delivered. As always, do not ask a question just to ask a question.
6. Be friendly with those around you.
May seem like the most obvious tip to give but Interview fatigue is a real thing. By the end of the season, it may feel like a chore to smile and be amiable. While feigned enthusiasm is easy to spot, it does help to reach within and find some energy to create a good rapport with those around you be it fellow applicants, Residents, or faculty.
Programs are looking for those who are and will be good team players as patient care is not a one-man job. You will make some friends through the journey and can expand your network.
While this may seem like a lot and may overwhelm you, with some practice, I can safely say most applicants will check off most, if not all of these boxes. It is a rather exhilarating journey at the end of the day and will create memories you will cherish for a long time.
It is an important time for you all, be sure to place your best foot forward during the culmination of your efforts.
Want more such tips for interviews? We are now offering practice virtual interview sessions by current residents who have been through the interview process and thoroughly researched on how to succeed in interviews. Find more information here.
From the Author – Dr. Keerthana Haridas I am a first-year Internal Medicine Resident in New York City. I was raised in Bangalore, where I also went to medical school. I am interested in Endocrinology as a clinical area of practice but look forward to contributing to healthcare in a larger sense through participation in the fields of public health and policy in the future.
To submit your USMLE experience, go to the Contribute page. Your experiences can help other IMGs in their journey! You can also email us at theindianmedicalstudent@gmail.com
Yes! Residency interviews are going to be virtual this year, I am sure you all know that by now. It is a new game with new rules and chances are that you have never taken virtual residency interviews before. Here are a few tips to help you be better prepared for this process.
Technology – Let it be your friend and not your enemy
The Software
While you may be totally prepared in every other aspect, having a “technical glitch” on the interview day does not sound like something you would want to happen. So make sure you get this right.
Most programs will use the standard video conference platforms like Zoom to conduct interviews, however, once you get the interview invitation, it is always good to confirm which software is going to be used. Download this before hand and make sure it is compatible with your device.
Next, ask a friend to download the app and make sure you are able to connect and that you figure out where all the different buttons are. You do not want to be muted when you introduce yourself!
The Hardware
WiFi / Internet Connection
Please make sure you have high speed Wi-Fi connection that does not keep going off. This is the time to invest in a good internet provider. I cannot stress the importance of this enough. PLEASE INVEST IN a HIGH-SPEED INTERNET.
Laptop v/s Phone
Always always always please use a laptop unless you are in a situation when that is absolutely not possible, you can use your phone. There are a few reasons for this
It looks more professional
The laptop is easier to navigate, especially when you are in high pressure situations
More stable, you do not want to be holding your smart phone or have it fall in the middle of an interview
Generally has more updated hardware
Fewer distractions. You do not want to keep getting whatsapp notifications in between the interview!
Webcam v/s built in camera
Depending on your device, it may be a good idea to invest in a good webcam. Especially if you have an older device, damaged camera or one that gives poor quality images.
Note: Make sure the poor video quality is not due to poor internet connection before you buy devices.
Headphones?
There is no right answer for this one. You have to look at 2 factors aesthetics v/s being heard clearly.
I would say give more preference to being heard clearly when you talk. Without the headphone/ microphone, your voice may echo. Again, make sure you test this before the interview day with a friend/ family member and ask them for feedback.
If you have really bulky headphones that cover your head, it may be a good idea to invest in earphones like airpods that are aesthetically more pleasing.
Make sure that any devices that you may be using (eg. webcam, headphones/ microphone) are compatible and work with the software being used.
Set the Scene
The room
Make sure you designate a particular room in your house for interviews. This is your “interview room”, make sure everyone in the house knows about it so that they don’t disturb you or walk into the room on interview day.
Other factors to consider when choosing your interview room are
Connection to Wi-Fi!
Good natural light
Free from loud sounds
Your comfort level
Minimum distractions
The Background
Make sure you have a relatively neutral background. It may be better to start of by selecting a spot that has a white (or any other subtle color) background.
You can leave the background plain or you may chose to have some decor. But, make sure it is not too busy and has things that distract the interviewer or display political/ religious preferences.
It may be a good idea to have a plant, a subtle painting, etc. It is your space and you can get creative with it. Once again, make sure you do this before hand and not a day before the interview.
Lighting
Lighting is a one of those things that is easy to over look and something that can make a huge difference in your presentation.
Try to maximize natural lighting to ensure your face is well lit and there are no shadows. This will mean having the light coming from the front and falling on your face. A light source from the side will create a shadow on the opposite side.
Use a 3 point lighting system: Imagine a clock, if your face is at the 12 position, place lights at 10 and 2 o’clock positions.
If you want to take it a step ahead, invest in a ring light.
So basically to sum it up, take care of your Lights, Sound, Camera………….. ACTION!
Want help with interviews? We are now offering practice virtual interview sessions by current residents who have been through the interview process and thoroughly researched on how to succeed in interviews. Find more information here.
This article has been written by Dr. Rohit Nathani who is a medical resident at NYC. Ask your questions in the comments section below.
To submit your USMLE experience, go to the Contribute page. Your experiences can help other IMGs in their journey! You can also email us at theindianmedicalstudent@gmail.com
You’ll probably be applying for a residency in the US soon(even if you will be applying later this post is relevant to you). One of the most important supporting documents that you need as part of your application will be Letters of Recommendation.
It can be quite tricky understanding how and when to approach a letter writer to write you a recommendation. But, here are a few basic guidelines.
Work Hard, Show Interest.
Before you even think of asking someone to write you a letter of recommendation, they should be convinced that you are someone who is worth putting their reputation on the line for.
Be genuinely interested and work hard wherever you are. Not just so to impress people but because you want to learn. People will notice you.
If you seem to be passionate and hardworking, people will be more than happy to write you a letter of recommendation.
Let your actions speak for you.
When should I ask for a letter?
Although there is no right time, I think it is best to ask for a letter at the end of your time working with the faculty member. Electives/Observerships/ Research positions are a great way to connect with faculty and you can ask them for a letter at the end of your rotation.
If you have already finished your rotation, ask as early as possible. Once they agree to write you a letter, send them the letter request through ERAS as soon as the ERAS token becomes available in June of the application cycle.
In-person or via email?
Although it can be intimidating for some to ask for a letter of recommendation, you have to do it if you want to get a residency position. The people in the US know the system and it is not something they will be hearing for the first time. Its okay!
It is always best to ask for a letter in person. If you are an international medical student, ask for the letter before you head back to your home country. Request an appointment with your mentor by email or through their secretary and go meet them.
If you are not able to meet them in person and if you have come back home, it is okay to ask for a letter of recommendation via email. It is preferable not to ask over text/Whatsapp. Email is a more professional way to communicate.
In person meetings are always the best when asking for a letter of recommendation.
What should I say?
Remember, you don’t want just a “Letter of Recommendation”, you want a “Letter of Recommendation that gets you a residency spot”.
So, make that clear when you ask for a letter. You want them to talk positively about your academics, clinical skills, patient interactions but most importantly, how you are as a person. Trust me this last point can sway a residency spot in your favor.
Also be very clear. There is no right way to ask for it. But here’s what you can do.
Start off by telling them thank you for the opportunity to do the elective and tell them what you really liked. Be genuine. Do not try to butter things up. The can read right through it.
Let them know you will be applying for a residency position this year.
Tell them that since you have worked closely with them, it will really help your application if they can write you a “strong letter to support your application”
Carry a copy of your CV and other supporting documents with you and also tell them you will email them a copy.
Thank them.
Rejected?
Although most people agree to write you a letter, they are not obligated to do so just because yo have rotated with them.
If the letter writer feels that they have not had the opportunity to get to know you in that period to write you a letter, that is completely okay.
Thank them anyway and think of it as a blessing that they told you upfront rather than write you a generic letter.
Remind them.
Physicians are busy people. They will sometimes forget about your letter. Send them a reminder if they haven’t uploaded your letter. However wait at least 2-3 weeks before doing so. Do not badger anyone to write you a letter.
Send a “gentle reminder” :p
If you found this post helpful, don’t forget to share it with someone who may benefit from it. Also, remember to pay it forward. Submit your experiences or posts that will help other IMGs at theindianmedicalstudent@gmail.com
If you have any questions, use the comments section below. For personalized consultation and help with your timeline, resources and strategies, fill out the consult request form and I will get back to you.
This article has been written by Dr. Rohit Nathani who is a medical graduate from Seth GS Medical College. Ask your questions in the comments section below.
The ERAS application submission for MATCH 2021 has started from September 1. Most applicants must have been working on their applications already, but if not then it’s time to buckle up and get started.
Here’s a checklist to ensure you don’t skip out on anything:
First and foremost, make sure you’ll be done with all the USMLE Step exams (and OET if applicable) and have your scores in time. Get your credentials verified so that you can get your ECFMG certification. You can read our article about the verification of credentials to know more about the process.
Using ERAS start researching programs and list those that you intend to apply to. The program list can be exhaustive for certain specialties so keep working on it from time to time.
MyERAS application – uploading and assigning documents
Contact your medical school for the Medical School Performance Evaluation (MSPE) and the Medical School Transcripts.
Make sure your ECFMG Status Report has been uploaded.
Authorize the release of your USMLE transcript.
Send requests to your letter writers for the Letters of Recommendation and follow up with them.
Start writing your Personal Statement and get it reviewed by your family, friends, colleagues etc. especially for grammar and spelling.
Fill in your personal information and other details in the application section to create your CV. Think about everything you did in medical school and put in relevant information. The ERAS CV is quite extensive so begin early.
Get a professional Photograph clicked and upload it.
Make sure all the documents are accurate and meet program requirements. Keep checking your emails and the message center on MyERAS for updates. Don’t rush to certify and submit your application until you’re satisfied. According to the latest ERAS update, all applications submitted on or before October 21, 9 am ET will display the application date as ‘October 21’ to programs. Only those submitted after October 21 will be date stamped in real time.
Lastly, check that you have uploaded all the required documents using this checklist and then wait to hear from the programs. All the best!!
This post was written by Dr. Shreya Sodhani, MBBS who wants to pursue a Pediatrics residency in the US. Ask your questions to the author using the comments section below.
To submit your USMLE experience, go to the Contribute page. Your experiences can help other IMGs in their journey! You can also email us at theindianmedicalstudent@gmail.com
If you have already graduated from medical school while applying for any of the USMLE Step examinations
Documents required for verification of credentials
Final Medical Diploma
Final Medical School Transcript
Transcript(s) to document transferred credit, if applicable
All documents that are not in English should be accompanied by an official English translation as per ECFMG’s requirements.
Final Medical Diploma
The copy of the diploma must be submitted in original language containing the date of issue and signatures of medical school/ university officials.
This can be done through the following methods:
Via the MyECFMG Mobile App
Download the app for free from App Store (iOS) or Google Play (Android)
Log in with your USMLE/ ECFMG ID and password
Go to Upload Credentials
In Document Selection choose ‘Final Medical-Original Language’
Either select the ‘Scan’ option and scan the document in the app itself or select ‘Pick a PDF’ to choose from your saved files.
Via mail – If you are mailing a copy of your final medical diploma, the photocopy must be 216mm x 279mm (8 ½ in x 11 in)
Name Verification
NOTE: If the name on your credentials does not match the name in your ECFMG record you need to submit acceptable documentation that verifies the name on your credentials is (or was) your name failing which your exam application will be rejected. The name on the documentation and that on your diploma/ transcript should be the same.
Documents for name verification include any one of the following:
Expired passport (including pages with your photograph and the expiration date)
Birth certificate
Marriage Certificate/ License
Official Court order/ Name change documentation
Official immigration document including U.S. Resident Alien card, U.S. Naturalization certificate, Permanent Residence card
Driver’s License
If you are unable to submit any of the above mentioned documents then ECFMG also accepts your medical school letter stating that both the names belong to one and the same person with the signature of the authorized official.
All these documents can be uploaded on the MyECFMG App in the same way as mentioned above for the diploma.
When ECFMG requests verification of diploma from your medical school, they will ask the school to provide your transcript.
Contact your medical school regarding fees for verification and mode of payment.
ECFMG will notify you twice; once when your diploma has been sent to your medical school for verification and the second, when ECFMG receives and evaluates the verification from your medical school.
You can always check the status of your medical credentials using OASIS or the MyECFMG App.
If you verification is taking longer than usual please contact ECFMG and follow up with them.
Now you can go ahead and get your certification or apply for Step Exams.
This post was written by Dr. Shreya Sodhani, MBBS who wants to pursue a Pediatrics residency in the US. Ask your questions to the author using the comments section below.
To submit your USMLE experience, go to the Contribute page. Your experiences can help other IMGs in their journey! You can also email us at theindianmedicalstudent@gmail.com
Contacts, contacts, contacts! You must have heard a lot of people tell you the importance of contacts in your USMLE journey. And, they are not wrong.
Contacts do play an important role in influencing your position in the eyes of the program director to get you an interview or ultimately to match in a residency program.
But, I don’t know any doctors in the US? A lot of IMGs have this fear. But, that does not mean you can’t develop contacts. Here’s how you can go about networking your way to a successful match.
Where can I find people to network with?
United States Clinical Experience
There are a number of clerkship opportunities out there. Depending on whether you have graduated or not, you may be eligible for electives or observerships.
Although electives are hands on and are considered more valuable than observerships, both provide an excellent opportunity to experience the US Healthcare system as well as network.
During these rotations, you get a chance to interact with faculty members, residents, interns, medical students, program coordinators…. over a long period (generally one month).
The list can go on and on. Each person you meet during these rotations is a potential contact. It all depends on you how you interact with these people and whether you can form a lasting impression.
Not to forget your fellow students who may also be on the same rotation. These people may be your co residents in the future and may be some of your best friends for life.
Any of these rotations whether clinical or research based are probably your best bet to make contacts and network as an International Medical Student.
Rotations in the US are your absolute best networking opportunity. So, make the most of it.
If you have done any kind of research, make sure you submit your abstract to conferences.
For example, if you have done some research in the field of Cardiology, google “Cardiology conferences in USA”. You will have to do a bit of surfing around the web.
Apply to a number of conferences so that your chances of getting accepted at any one increase.
The more prestigious meetings are attended by senior faculty from all over the States and can be a good opportunity to showcase your work and build contacts.
Talk to people from your med school who are in the same boat as you. Talk to people from your medical school or home country who are pursuing or have completed their medical residency in the US.
It doesn’t harm to shoot an email telling them that you are on the same journey and would appreciate help.
Don’t be disheartened if they do not revert back as many people may be busy. But, if they do reply, you have yourself a contact!
Family
Some international medical students will have family or relatives in the US. It will never harm you to reach out to them and ask them to connect you to someone they know.
Networking tips
Networking can go a long way in your journey to a medical residency in the US, if done right.
Remember you do not want to come off as too pushy and desperate.
Show genuine interest. Reach on time and contribute meaningfully to the team you are working with (if on a rotation).
If you are meeting people at a conference, discuss your research interest and let them know you will be interested in working with them in the future.
Highlight your accomplishments without bragging.
Always keep your eyes open for networking opportunities.
Follow up with the people you meet.
Email is generally considered a professional and non invasive way to reach out. So do not hesitate to ask for business cards and provide yours if you have one.
If you meet a residency program director, do let them know your interest in their program and send your CV across after talking to them and if they agree.
Networking is a double edged sword. So be pleasant. Do not try too hard to impress someone or push them too much to get their contact. Assess the conversation and take it ahead depending on the kind of rapport you are able to build.
Once again, I would love to hear your perspective on this topic and if you have any additional tips that will be helpful to your fellow IMGs do share them in the comments section below. Share this post with your friends on Facebook!
If you have any questions, use the comments section below. For personalized consultation and help with your timeline, resources and strategies, fill out the consult request form and I will get back to you.
This post has been written by Dr. Rohit Nathani who is a medical graduate from Seth GS Medical College. Ask your questions in the comments section below.
To submit your USMLE experience, go to the Contribute page. Your experiences can help other IMGs in their journey! You can also email us at theindianmedicalstudent@gmail.com
Dr. Arjun Chatterjee is back with his USMLE Step 2 CK Experience where he tells us how he scored 266 on the USMLE Step 2 CK in 2020!
Background
Some of you might know me from my USMLE Step 1 guide, and for those who took the time to read the full article, you know that I am all about minute details.
So sit back and relax because I am going to take you through my Step 2 CK journey. Don’t worry, this won’t be as long as that Step 1 post, but hopefully detailed enough to answer most of your questions.
I took my Step 1 in 2016 (3rd year Part I MBBS a.k.a. Final Year Part -1), then before starting my internship, I went for my electives in 2018, gave Step 2 CS after my electives, and after completing my internship, I took my Step 2 CK in February 2020.
Perspective
Let’s talk about mine. So before beginning any journey, be it a visit to the Eden Gardens to watch a KKR vs. RCB T-20 cricket match or preparing for Step 2 CK, I like to plan. The best way I found is to ask others who have done it before.
Finding parking and transportation can be tricky at 11 pm coming back from Eden Gardens, but if you know which road to park your car in, then you’ll have no problems, while others will wait till 1 am to find some sort of transport. Planning and apprehension are critical! The same goes for Step 2 CK.
If you know what resources to use, and when to use, you’ll save a lot of time and hassle. I have been un-officially preparing for Step 2 CK since I took my Step 1 in 2016. I have read a countless number of posts asking to take the Steps back-to-back else we will run of the risk of doing poorly. At the same time, others will ask to take it slow. I believe that one should take it when they are prepared.
So the obvious question is why such a massive delay between Step 1 (2016) and Step2 CK (2020)?
Skip to the next section if you’re only here to know my resources! Follow the headings you’ll find what you’re looking.
As I said, I took my Step 1 in 2016 so that I could apply for my electives with the score and go before my internship starts. After my electives, I took my Step 2 CS, that too before CK and I passed.
Then after coming back from the US after doing my electives, I started my internship. Calcutta National Medical College (CNMC) has one of the cruelest internships in India.
Although we interns in West Bengal are paid highly compared to the rest of India (23k INR). We are expected to do the work of 5/6 nurses, one ward boy, and one doctor.
I had a reverse mini-culture shock after returning from the US, seeing the way work was done in our hospital. I had got used to EMRs and looking at X-Rays on computer screens. Now for a year, I was being asked to draw blood, fetch reports, take the patient for USG, X-Ray, etc. Go to the blood bank. You name it, I have done it.
And after that if time permits go for the rounds. I used to come back to my house only to sleep. I had lost count of days, weeks and months too I guess.
Did I enjoy it? YES I DID!
Would I trade it for anything else, like applying this year for Match 2020 -NO! I wouldn’t.
The experience which I gained from doing so many varieties of work, and getting to do so much made me humble. I started witnessing the miracle, which goes on in the hospital. From ward boys to security guards, nurses, PGY-1s – I could see a small ecosystem functioning on its own.
And no, I thought of doing an externship with less workload, but the way CNMC has tested me (insults from seniors, doing work which we’re not supposed to do, Work-Sleep-Repeat for months), I am feeling confident for my residency. That’s if I match amidst this Corona scene.
So, in short, I didn’t have time to breathe; forget studying. I still somehow managed to finish UWORLD for Step 2 CK once during my internship. I did it in a system-wise tutor mode, taking fundamental notes.
Once my internship got over, I started my primary prep; details follow.
What did I do?
In this section, I will try to point out the ideal way of doing things. I wish someone would have told me this while I was in my final year. It would have saved me a lot of time and money, which I spent scouting for ideal resources.
If you read the step 1 article, you know that I don’t believe in using 15 different resources when the same can be achieved using one or two.
So instead of mentioning what I did, I am going to tell you what you should.
Basic Read – To get your feet wet (to get an overall idea of the CK syllabus)
FACT CHECK – You should pick and choose what to do based on your situation. You might have three months to prepare for CK, or you might just be starting.
You’re in bad luck! Unlike Step 1, there isn’t a single sized shoe which fits everyone. There is no First Aid to save your ass this time. I have nothing against MTB or First Aid, but I don’t think they are high-yield enough or detailed enough to help you gather basic info.
OnlineMedED – This is what you should use for your final year prep. Dr. Dustyn Williams has spent countless hours recording these free high-quality, high yield videos. This is the best resource to get your feet wet, to know what you’re up against.
The main advantage of using this is you get an excellent but yet detailed overview of the syllabus. The back draw being it’s time-consuming. Someone planning to prepare for CK in only three months shouldn’t use this. Did I mention that the videos are FREE? Also, if you install an ad-block to your browser, the annoying ads stop playing. Do consider supporting his work. I bought a mug from his website; you should too!
First AID for Step 2 CK – As I said before, I don’t rate this book highly. Although I owned it, I never bothered using it. This cannot be compared with FA for Step 1.
Master the Boards (MTB) 2,3 – I bought these after my Step 1, as there is thus big rumor going around. “Study IM from MTB 2 and Paeds, ObGyn, Surgery from MTB3. In my humble opinion, these books are shit.
Dr. Conrad Fischer is one of my human idols. But somehow, I didn’t like the way the book is organized and was trying to feed me information. You should try this before taking my word for it. Maybe you might find it useful, who knows?
Step Up to Medicine – This book is a good book to follow if you’re one of those Goljan guys. I always preferred Pathoma over Goljan as it was concise and to the point. A lot less information to remember. I prefer to make my notes from Onlinemeded and study them instead of going through a 600-page book, and eventually forgetting what I read the week before. This can be a useful resource if used during the final year, but not for Step 2 prep.
Paul Bolin Videos – Like I said, I spend a lot of time researching resources. Dr. Bolin’s Youtube channel has one of the best video collections when it comes to preparation. BUT AT WHAT COST? TIME! If you’re in your final year, you should consider using this. Else SKIP. Not enough High Yield for CK. I remember doing his Ob-Gyn videos during my final year.
Pestana Surgery Audio Lectures and Book – This is a must for most people. Do this, it won’t take you much time! Indians teach surgical methods in college instead of why an invasive procedure is being done. Even if you have a gold medal or honors in surgery, it won’t matter, as you won’t be asked the steps of excision of a sebaceous cyst, rather when should you intubate. The why is always more important than how. Once you know the why, the how is a piece of cake. Sadly “how” is what is taught, and not the why!
In summary, if you’re having time crunch, use Onlinemeded. Do it wisely. See where you stand. Are you an IMG practicing pathology for 15 years in Delhi, and now want to apply for residency in the US? You might need to watch the OB-Gyn, and Surgery videos! Play these at 1.5 speed and make your notes.
You might want to try MTB/FA for CK and see if you like it.
Advance Read – To nail the coffin (to prepare for CK)
UWOLRD – If you want to prepare for CK, you should do only one thing, and i.e., UWORLD. Like every other test taker, I am vouching for UWORLD being the highest yield resource. I did it twice. Once during my hectic internship days, and the second time during my dedicated prep.
A lot of people will tell you to do UWOLRD, but seldom people guide you on how you should use it. I found that doing Tutor-mode System wise 1st time is the highest yield.
Take your time to solve questions, read explanations immediately, and hammer them in your head. Make small notes of why you got the question wrong, instead of copying the whole screen.
2nd time do it in Timed-Random mode. Read the answers after you’re done with a block. Two things which I found extremely useful while solving UWorld is reading the last line of the question first to create an idea of what the problem is about, and the 2nd being reading the Educational objective at the end. Knowing the answer to the question is important, more important is to understand why the question is being asked in the 1st place.
If you’re one of those HOT-SHOTS, Know it all kind of chilled dude who will score 260+ with three months prep. Do Uworld twice; I am not that SMART, I guess!
UpToDate – This is the go-to resource. Long gone are the days when we used to quote “Harrisons 17th ed page 308 para three, 2nd line, 4th word”. Uptodate is the new Harrisons/Davidsons/anysons. It is one of the best resources out there. All the latest medical research is regularly incorporated into it. You’ll be surprised to see the similarity between Uworld and UpToDate.
Whenever you have a doubt, goto Uptodate, look up the topic. Now let me tell you how I used UpToDate. Read the summary section first. Then CNTL+F “Find function” your exact doubt. That way you’ll spend less time reading about stuff which you don’t need. Remember to use your time wisely. Read what you need, ignore the rest.
There are several ways of using UpToDate. Buy it, use a VPN to connect from Norway (Norway people have free UpToDate), apply for a free UpToDate account at better evidence, ask your friend who went for their elective in the US to set you up with a three-month free account.
AMBOSS Library – Amboss has both an online library and a qbank. Let’s talk about the library first. The main advantage AMBOSS has over UpToDate is that it’s exam-focused. It’s quite detailed but free. I used to search google “topicname_space_amboss” for e.g. “sunscreen spf amboss”. Use a pop-up blocker to get rid of that annoying overlay.
AMBOSS QBank – Having used UWolrd twice, and being well-versed with my own notes, I wanted to try something new. AMBOSS QBank is a lot more complicated than UWorld. It hammers in points and tests the depth of your knowledge. Do only if you have time. If you’re confused between the 2nd time of Uwolrd and Amboss qbank. Do UWORLD twice until you know it by heart.
CMS Forms – These are probably rejected/old USMLE questions, which didn’t make it into the real exam, so that have rebranded these as CMS Forms. I did Medicine, Surgery, Paeds, Neuro, Ob-Gyn, Psych forms, and made my notes for the questions that I got wrong (1200+ questions).
The questions which you’ll get wrong are the ones you have zero clues about. But these are very few. It’s not high yield, but for the perfectionists. I will repeat myself once again, to make it very clear.
Do only if you have time. If you’re confused between the 2nd time of Uwolrd and Amboss qbank. Do UWORLD twice until you know it by heart. If you’re unsure on which forms to do, see your weak areas and do those. My surgery was relatively weak.
NBME Forms – I did NBME form 7. NBME 7 – 264. I recommend taking an NBME before your real exam.
UWSA 1,2 – This is gold when it comes to predicting your score in the real deal. I don’t know what witchcraft they’re practicing in UWOLRD HQ, but UWSA 2 is the best predictor for CK out there. I got UWSA 1 – 271, UWSA 2 – 266. I took both of them on the same day, one week before my exam, to fire up my brain. The UWSAs are difficult and vague. Don’t worry if you get questions wrong. Most of us will. Save UWSA for the last few weeks!
Step 1 material – you should revise your Biostats from Step1 and if you have the time to do the UWorld Biostats review. I am quite well versed with my step 1 knowledge even after so many years, so I didn’t feel the necessity to revise from First Aid for Step 1. If you’re feeling a little low on the pharma and micro goodness, give it a quick read.
How much time will you need?
It depends on you, your goals, you timeline. Some will do everything within three months and be happy with a high 240s low 250s. Then there is the opposite end of the spectrum where I belong. So it’s totally up to you. NBMEs and UWSAs will tell you if you’re ready or not. Not me!
How should I prepare for this exam? Give me a summary, dude!
If you’ve around three months – Do Uworld twice. Properly! Consult AMBOSS library, UpToDate, as you prepare. Give an NBME, take UWSAs. You should be good.
If you have around 4-6 months – Do OnlineMedEd videos, take notes; UWorld Solve Tutor mode-Systematic 1st pass; UWolrd Solve Timed mode-Random 2nd Pass. Take relatively detailed notes during pass 1, and exactly why you got the questions wrong during 2nd pass. Consult AMBOSS library, UpToDate, as you prepare. Do CMS forms (areas where you’re weak). Give an NBME, take UWSAs. You should be good.
If you’ve >6months – Get a life. There is more to life than USMLE! Just kidding. Refer above, follow what I did!
With that, I come to the end of this thread. I would like to thank all the kind souls who stood out from the rest and helped me in my prep. I hope that beneath my arrogance and warped sense of sarcasm, you’ll find this post helpful, and share your knowledge with someone else.
I know what it feels like to be helpless; that’s why I put so much time and effort into writing these posts. Every week I have someone contact me on Facebook and ask me about USMLE. Not bragging, but just pointing that apart from the selected few institutes in India, Pakistan, Egypt, Lebanon, Jordan, Chile where giving USMLE is shared by batches over the years. Where seniors share their materials with juniors, there are many out there, ordinary students, just like me, who are hungry for some sense of direction. This post is dedicated to them!
About the author – Dr. Arjun Chatterjee
“I completed my MBBS and internship from Calcutta National Medical College. Having taken all steps and done my clinical electives, I plan to apply for residency in the United States of America (Match 2021). Right now, I am working as a Research Trainee in the Dept of GI at Mayo Clinic, my research interest being pancreatic cancer.”
Ask the author your questions using the comments section below.
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Let’s talk about TOEFL for International Medical Graduates (IMGs), i.e., Test of English as a Foreign Language
Background
TOEFL is a test of your ability to comprehend, listen, speak, and write English. This test is specially designed for non-native English speakers, i.e., those with another mother tongue other than English.
Like USMLE, GRE, GMAT it’s a standardized test and is taken by students all over the globe who wish to enroll in English-speaking universities.
Since I am writing this blog keeping medical students in mind, you must know that a lot of students from different backgrounds are going to be taking this test. From people wanting to do their MS (Masters in Engineering in the US) to someone who wants to study Psychology, you’ll find all sorts of people in the test center.
As I said, the test is standardized and has four sections – reading (R), listening (L), speaking (S), and writing (W). In this order. Each of these sections carries 30 marks. Total Score being 120.
After you’re done taking the test, you will receive a score, e.g., 92/120. (R-22, L-22, S-24, W-24)
Perspective
Arjun, we have done our boards in English, and we’ve heard TOEFL is a piece of cake from our cousin who took GMAT for his MBA 2 years back. We don’t need an essay on how to prepare for TOEFL. WHY ARE YOU EVEN WRITING THIS POST?
Well, I know what you’re thinking! I thought the same thing. Having studied everything in English for so many years, and especially after taking USMLE STEP 1, I didn’t think of TOEFL as a challenge.
I guess you know why you need to give TOEFL right. FOR ELECTIVES!
Guess what, search google for “NIH VISITING STUDENT MEDICAL ELECTIVE.” And see the criteria.
As of 11th May 2020, the official website states – Minimum total score of 108, a minimum score of 28 on the listening subsection, & a minimum score of 28 on the speaking subsection.
Other places like Cleveland Clinic will also ask for the TOEFL score, as well as Step 1 score before they schedule you for electives.
Believe me, getting 28 on the speaking subsection is not a joke, and without practice, you’ll end up in the mid 20s, if not lower 20s.
Yeah, I know, you’re the modern Indian who don’t use your mother tongue as it’s so MIDDLE CLASS. From your house to the shopping mall washrooms, English is what you breathe. Londoners will sometimes find your hold of the language mind-boggling. So why worry? Right? Just go unprepared. You’ll pass, right?
Good luck. Unlike USMLE, you’re able to take this test multiple times.
So a good time to prepare for this test is immediately after Final year Part-2 exams. It Will hardly take you two weeks, and you’ll have the score in hand while you apply for electives. This is the case if you plan to do your electives after your internship. In case you want to do the electives before starting internship, take TOEFL after Final year Part-1.
What I did
Well, I am the kind of person who doesn’t like to take chances. Especially with cut-throat competition, even while securing electives, I didn’t want anything to go wrong. I wanted to get that ELUSIVE 28 on speaking so that I would qualify for NIH.
LOL! I did get 28 in speaking. My score was R-29, L-30, S-28, W-27. 114/120.
It’s not great, but I qualified for NIH, and that what I wanted. The thing is NIH ended up rejecting me twice, LOL. So I don’t know what to make of my efforts. But if you are on the same boat and don’t want to take any chances. Prepare well, my friend, before you go for this test.
How much time will you need? Should I worry?
Realistically, not much. Two weeks for the average Joe is enough, but how you practice will determine your score. For most of us who made it this far, taking USMLE Step 1, getting through medical education in English, I firmly believe that you won’t struggle much in the reading section.
Well, now you can finally thank the Movies and other American TV Show actors for preparing you for the listening section—time to reap the rewards. The place where I found several others struggling or getting a relatively poor score was in the speaking part and writing.
No matter how good your English is, most likely, you weren’t born in the West, and believe me; there are several ways the same thing can be said. So for you to get higher marks, you’ll need to speak like an American. No, not the accent! You’ll never need the accent, not even in Step 2 CS, but your choice of words is what matters.
How should I prepare for this Exam? Give me the details!
Even before I start writing this section, I would like to thank Dr. Sitaram Chilakamarry from Kakatiya Medical College for his TOEFL guide. I followed his advice, and it was gold. Most of what I suggest is what he said in his original post.
READING SECTION: This is English comprehension. You can use a ton of resources. An excellent place to start is the Princeton Review. I used this and found it to be reasonably helpful. You can also consider the official iBT Toefl guide.
LISTENING SECTION: If you have watched Breaking Bad, Game of Thrones, House MD, or other TV Dramas. You should be good to go, but do practice from either Princeton or Official Toefl guide once to get the hang of it. The books usually come with a practice CD. You can use that to practice the listensing section.
SPEAKING SECTION: This is where the magic happens! Most of us are either worried or over-confident about this section. When in doubt, listen to yourself. NO LITERALLY! Take out your phone and record yourself speaking. The best and only way to nail this section. I practiced this way and was comfortable in the real Exam speaking on the microphone. Oh, did I forget to tell you that 25+ other people who are sharing the exam hall with you will start shouting at the same time your speaking section starts? So yeah, if you don’t practice for this. You’ll screw this up.
The other thing I mentioned before. You’ll need to choose the right words and put them in the proper structure. For this, the best but yet free resource out there is from this kind and gentle soul, Mr. Joseph. He shared his ingenious yet simple trick for forming brief sentences so that you can get the most out of the 30seconds. Here are the links to his free videos-
Speaking Section Overview
Speaking Question 1
Speaking Question 2
Speaking Question 3
Speaking Question 4
Speaking Question 5
Speaking Question 6
PRACTICE! Every day for two weeks and you’ll be good to go. You don’t need a professional tutor or service, but you’ll need to practice. There won’t be a better time to use the Recorder app for your phone. You’ll be surprised when you listen to yourself speaking. Suddenly the all fashionable New Yorker will start to fumble and start mumbling like giving three medical vivas at once. Don’t give up. Keep on recording and practicing. You’ll get that elusive 28 or more. If I could do it, you’ll do better.
WRITING SECTION: This is that unpredictable section, where your sense of creativity and depth of knowledge meets a real challenge. Thankfully we are not applying for Masters in English language but medical electives. So most places won’t mind a slightly lower score in this section. I used Joseph’s videos to prepare for this section. I am linking them below for you.
Writing Section Overview
Writing Question 1
Writing Question 2
Last moment advice
1. Don’t bother if you get <28 on the speaking or listening. NIH might reject you anyway!
2. Book the exam center early. Book a month in advance, and if possible, give the Exam in the Prometric center. Try to give it there. I have heard that the proctors are better in the Prometric than other centers. Also, in case of a power outage or other problems, the Prometric staff takes far better care than other centers. At least that is what the situation is like in Kolkata. I gave mine in Prometric, and my PC stopped working for some reason during the speaking section. JUST IMAGINE. Anyway, the proctors fixed it straight away.
3. Google common TOEFL speaking and writing topics. Make a list of 25-30 and practice them regularly. Don’t worry if you get something out of the blue during the Exam. You’d go in auto-pilot if you practiced well enough.
4. Grab your copy of Princeton/iBT Official guide or whatever book you find on Amazon and start practicing the reading and the listening section (from the CD)
It has been quite some time since I took TOEFL, but I will be happy to answer your questions down in the comments section.
That’s it—best of luck, everyone.
About the author – Dr. Arjun Chatterjee
“I completed my MBBS and internship from Calcutta National Medical College. Having taken all steps and done my clinical electives, I plan to apply for residency in the United States of America (Match 2021). Right now, I am working as a Research Trainee in the Dept of GI at Mayo Clinic, my research interest being pancreatic cancer.”
Ask the author your questions using the comments section below.
Liked this post ? Share it with your friends on social media!
This blog is made by imgs for imgs, so help out your friends by sharing your USMLE experiences. You can fill out the form on the Contribute Page or email us at theindianmedicalstudent@gmail.com.
United States Clinical Experience (USCE) is considered an important aspect of an IMG’s residency application in the US.
[Disclaimer: This post is based solely on the author’s personal experiences and views.]
Beginning on the first day as a first-year resident, an IMG will be a practicing physician who will be independently shouldering the responsibility of a patient’s care.
The idea of USCE is to familiarise oneself with the healthcare system that is different from the one that we’ve been trained in during medical college.
(USCE in any department is counted toward one’s application. However, it is preferred that it is in one’s field of interest.)
It is important to look at USCE as a learning experience and not merely a means to get Letters of Recommendations.
(Most programs require 3-4 letters, you can use letters from your home institution too but the ones that are from the US are valued better. Waived letters, ones which are directly uploaded by the attendings to the ERAS website, are also valued more.)
Let’s get the jargon right!
Rotations: Loosely translates to ‘postings’ in India. A third-year American medical student is required to complete their core (compulsory) rotations in the departments of Family Medicine, Internal Medicine, OBGYN, Neurology, Psychiatry, Pediatrics and General Surgery.
Electives: ‘Postings’ again, but ones which are undertaken by the fourth-year American medical students by choice in their fields of interest. If a student undertakes a second rotation in one of the core- rotation subjects then it is called an ‘advanced rotation’. If the elective is in a subspecialty (‘super-specialty’) department then the student is considered a Sub-Intern (a student who will be independently caring for 2-3 patients just as a first-year resident – an intern does).
As a final year medical student, you can also apply to these rotations through various University’s international visiting medical student programs.
These are very highly valued and provide you with hands-on learning opportunities with a structured didactic curriculum.
Note: These rotations are open only to final year medical students. The terminology gets a little tricky here and can result in some miscommunication. A final year medical student in the US is someone who is traditionally in the fourth year (MS4) of medical school, which is the same in India. However, considering we have a 5.5-year program with an internship year as a prerequisite to graduating, it is better to refer to ourselves as a final year medical student while we’re in the US and NOT as an intern. An intern in the US is a first-year resident.
Externship: These are rotations/electives that are not undertaken in the home institution. In the US, some medical students take up ‘away-rotations’ at different institutions from their own and ‘externship’ is probably an international medical student’s version of it.
Observerships/ Shadowing: During an observership or when you’re shadowing someone, you are not directly involved in the care of the patient and will only be a silent observer. This is probably the most popular way to gain USCE as an international medical graduate. This is probably not valued on par with rotations/ electives and is also poorly valued in the case of students applying to surgical programs.
2. Community Hospitals with residency programs that accept IMGs (Usually only observerships): A common way to get an opportunity is to send out cold emails to the attendings listed on their websites. Forbes’s article on writing a cold email was a helpful resource in drafting those emails. It may not be the most efficient way but every effort counts.
3. University adjunct professor’s private clinic (Usually only observerships): Cold emails or contacts.
4. Other private clinics (Most claim to be hands-on but are usually observerships): Cold emails, contacts, and agencies.
General tips to consider during the application
process
Read the requirements mentioned on the websites thoroughly and try to apply at least 6-8 months in advance. Most applications are great these days and so it’s also a matter of the available spots. Don’t take rejections personally.
Most hands-on opportunities require you to get liability insurance. Here are some services that you can use (Neither The Indian Medical Student nor the author is affiliated with these companies):
Academic Medical Professionals Insurance Risk Retention Group, LLC
Marsh USA
IPB Insurance
Willis Towers Watson Insurance
MDU Services Limited
QBE Insurance
Some rotations through agencies can require you to get liability insurance even though you may not be directly involved in patient care. Consider confirming with them if it is needed and it could save you some bucks.
Consider gaining at least 3-4 months of USCE if you plan to apply for a primary care specialty (Internal Medicine, Pediatrics, Family Medicine) and complete at least 5-6 rotations of USCE if you plan to apply for a surgical specialty.
If you will be rotating at a combination of different places – private clinics, community hospitals, and university hospitals, then I recommend that youschedule them in that order. This will help you be better prepared for your University rotations, where you can impress your attendings with not only your subject knowledge but the ease with which you integrate into the team. After all, good University LORs are always highly valued.
I hope this helps! It is needless to say that one’s performance during the rotation and relationship with the attendings after the rotation ends is just as important towards one’s success. Please leave any questions below and I will be happy to answer them. All the best! 🙂
This post has been written by Dr. Anmol Patted who is a medical graduate from KAHER’s Jawaharlal Nehru Medical College, India. She is aspiring to be an OBGYN. You can ask her questions in the comments section below.
If you find the posts on the blog helpful, pay it forward. Send in your experiences or any other posts that may be helpful to your fellow IMGs. Reach out to us at theindianmedicalstudent@gmail.com
