Categories
Electives USMLE

TOEFL for International Medical Graduates (IMGs)

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!


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Categories
Electives USMLE

United States Clinical Experience (USCE) 101

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.

Where can you get USCE?

1. University Hospitals with international visiting student programs. Best bet: Check out this post on Electives without Step 1 scores and Electives with Step 1 scores for a comprehensive list of places you can apply to.

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

  1. 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.
  2. 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
  3. 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.
  4. 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.
  5. If you will be rotating at a combination of different places – private clinics, community hospitals, and university hospitals, then I recommend that you schedule 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

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Categories
USMLE

Pathway to a Medical Residency in USA for IMGs

Pathway to Medical Residency in USA

Are you an international medical student who is planning to pursue a medical residency in USA? If yes, I understand that this may have been a big step for you, as many international medical students are often confused whether to pursue a residency in their home country or abroad.

Great! But, now what? How do I go about it? There are so many exams, research, clerkships…….. how do I go about all this stuff!!!???

Before you freak out, this post provides the most basic overview of the pathway to a medical residency in USA. Throughout the post I will leave links to other relevant sections which have more information.

However, having an overview will help you get a basic understanding of the requirements so you can plan your timeline accordingly.

ECFMG Certification

The Educational Commission for Foreign Medical Graduates (ECFMG) is the organization that deals with the certification requirements for international medical students to be able to apply for a medical residency in USA.

In order to apply for a medical residency in USA, you need to be ECFMG certified.


In order to be ECFMG certified, you need to clear some exams known as the United States Medical Licensing Exam (USMLE). There are various parts to this exam known as the “Steps” and you need to clear the following steps in order to apply for ECFMG certification

  • Step 1 : This computer based exam tests you on basic sciences. You can check out our posts related to USMLE Step 1 here. This exam can be taken in your home country if there is a Prometric testing center (Prometric is the organization that conducts the computer based examination)
  • Step 2 CK : This computer based exam tests you on your Clinical Knowledge. You can check out posts related to USMLE Step 2 CK here. Can be taken in home country.
  • Step 2 CS : In this exam you will examine standardized patients and test your clinical skills as a physician. This examination must be taken in the US. People generally take this exam when they visit the US for elective/ observerships in US.

You absolutely must take these exams in order to be eligible for ECFMG certification.

There is also a Step 3, but it is not required for ECFMG certification and to be able to apply for a medical residency in USA

For most international medical students, the USMLE exams are the biggest milestones on the path to a medical residency in USA.

These exams require you to have a strong understanding of the basic sciences and the clinical subjects. You should also be able to integrate the knowledge and apply it to clinical cases on the exam.

Your performance on these exams are one of the key factors considered by program directors in selecting applicants whom they want to interview.

There are some more requirements by the ECFMG, for example, your medical school should be listed in the World directory of Medical Schools. You can read more about ECFMG certification requirements here.

It’s now time to apply!

Applications to residency programs are made through an online portal called ERAS (Electronic Residency Application Service).

To access ERAS, you will have to purchase an ERAS token which is usually available on the website in June of every year.

Once you purchase the ERAS token, you have access to the ERAS portal that allows you to upload your CV, personal statement , other supporting documents as well as apply to Residency Programs.

You can begin applying to programs on September 6 each application season. Programs can begin downloading your application September 15 onward.

Read more about ERAS here.

Interview Season

After you have submitted your application, residency programs download it based on their selection criteria. The program will view your application holistically and decide whether they want to grant you an invitation to interview at the program.

Interview invitations are generally given out from November to January of each year. This is the time when you will visit the programs where you have an interview call from.

After the interview season is over, you will have to create a Rank order List of the programs you interviewed at. This is basically a preference list of the programs where you interviewed and would like to match at.

The deadline for the submission of this rank order list is generally in February.

The Match

The applicant and the programs both prepare rank order lists that are run through “the match algorithm” that matches candidates and programs based on their rank order lists.

The 3rd Friday of March is generally called the “Match Day”. This is when applicants come to know which program they have matched at.

Conclusion

As I mentioned at the start, this post is a very brief overview of the pathway to a medical residency in the US in its most basic form.

There are a lot of intricacies to this process. Many of these things like research, electives, etc are discussed throughout the website. These things are required to improve your CV and application in order to be a competitive applicant.

Hopefully this post gave you a rough idea of the process. If it helped you, do share it with your friends who may benefit from reading this post.

Read other posts about USMLE here.

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.

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

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Step 1 USMLE

Which is the Best time to take the USMLE Step 1 for IMGs?

Best time to take the USMLE Step 1 for IMGs

The USMLE Step 1 tests you on the basic science subjects namely Anatomy, Physiology, Biochemistry, Pathology, Pharmacology, Microbiology, Bio statistics and Epidemiology and Behavioral sciences. A common question IMGs have is “Which is the best time to take the USMLE Step 1?

The timeline for American Medical Graduates (AMGs) is relatively standard and most AMGs take their Step 1 at the end of their second year in medical school and take Step 2 in their fourth year.

The situation for International Medical Graduates (IMGs) is quite different as the medical school curriculum in your home country may not be geared to taking the USMLE Steps.

This creates a lot of confusion about when to give the exam. Also, your medical school may schedule their own exams throughout the year. Considering all these factors, there is no fixed time when IMGs take the Step 1.

Having completed medical school from India, the tips that I provide in this article are in context to the medical education system in India. I would love to hear your perspectives from different countries in the comments section below. However, these tips can be adjusted to suit the timeline of your home country. Here is what I recommend.

The AMG route – Step 1 at the end of second year of medical school

The first two years of medical school in India cover the basic science subjects mentioned above that are tested on the Step 1. While many IMGs may not even have decided whether they want to pursue their residency in the US, if you have taken your decision early on then this is the best time to take the exam. Here’s why:

  • You are relatively fresh with the basic science subjects.
  • Second year of medical school in India is long (1.5 years) and you have plenty of time to study for Step 1 apart from your medical school exams and clinics.
  • USMLE rules are changing. The board has announced that you will not be able to take the Step 2 CS without first passing Step 1. Note however, that this change will not come into effect before March 1, 2021. Check for announcements on the USMLE website.
  • You will have a strong foundation in the basic sciences which will be an advantage before you enter the clinical years in medical school.
  • It is rather frustrating to come back and study the basic sciences from scratch once you have already entered the clinical years in medical school.
  • Having completed Step 1 early on, you have enough time in the later years of your medical school to engage in research, electives, and other extra curricular activities.

Considering these factors, I think that the best time to take the USMLE Step 1 is at the end of your second year or the beginning of your third year in medical school.

There are two pre requisites to this:

  • You need to take a call early on and decide that you want to pursue USMLE and a residency in the US.
  • You need to be able to make a timeline around the requirements of your medical school and find time to study for Step 1.

Update : Starting in January 2022, the board has decided to score the USMLE Step 1 as Pass/ Fail rather than the 3 digit score. Considering this, it will be best to get done with your Step 1 early on as you just need to pass. Note however, the 3 digit scoring is still valid for those taking the exam before USMLE officially declares the date of the change.

Read our article on the change in Step 1 scoring to Pass/Fail here.

Taking a decision early and planning out your USMLE timeline to fit your medical school schedule can go a long way in ensuring that you have enough flexibility to accommodate everything.

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.

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

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Uncategorized

Factors affecting pain perception & risk factors for chronic pain

One of the most widely accepted definitions of Pain given by The International Association for the study of pain is ‘’an unpleasant sensory & emotional experience associated with actual or potential tissue damage , or described in terms of such damage’’.

Everything from our genes to our psychological makeup can affect our sensitivity to physical pain. What might be considered one person’s niggle might be another person’s nightmare! A simple blood pressure cuff with increasing pressure may cause tingling pain in those susceptible and might not be discomforting at all for a few.

Thus what can be deciphered as a baseline to this is that “pain threshold “(the level at which we feel a stimulus is painful)  & ‘’pain tolerance” ( how much a person can take pain before breaking down )  aren’t always the same.

For example, chronic pain patients can have a lower pain threshold because they process pain very quickly, but a higher pain tolerance as they are used to living with pain and adapted to it. Pain itself is not just a reflection of noxious input but also an expression of plasticity in the brain.

Factors affecting pain perception in individuals includephysical, psychological, emotional, neurological & genetical, cultural, lifestyle induced to name a few.  The reason why some people are more sensitive than others comes down to how our body modulates pain — from the skin to the brain — and the structure of the brain itself.

Reasons

It all begins with a bunch of sensory receptors (known as nociceptors) detecting an unpleasant stimuli. These are transformed into pain signals that are then conducted throughout the central nervous system via a series of ‘pain pathways’.

There is a pathway that falls from the periphery (the skin), into cell bodies contained in the ganglion and up the spinal cord. From there, the fibres ascend to the brain. Firstly, individuals each have a different expression of the receptors that respond to a particular stimulus — whether this be thermal (for example, heat) or mechanical.

Secondly, the pain pathways are complicated. In each of these layers through which the information passes, there can be some modulatory effects (even in the cortex in the brain) that either reduce or increase the level of pain experienced. This is where our emotional status comes in. There are connections between various areas in the brain that can modulate this system as well.

Factors associated with chronic pain can be modifiable or non modifiable.

Modifiable Factors

1. Pain: It is perhaps the most important clinical risk factor for chronic pain. The more severe the acute pain, greater the number of pain sites, the more likely it is that chronic pain will develop

2. Mental Health: Anxiety, depression & catastrophising beliefs about pain have been associated with poor prognosis in patients with chronic pain.

3. Multimorbidities: Upto a Third of people with coronary heart disease experience chronic pain & almost a similar percentage of patients with chronic obstructive pulmonary disease experience similar symptoms. Conditions like diabetes, hypertension have shown to reduce pain thresholds.

4. Smoking: Heavy smokers tend to report more pain locations and increased intensity compared with those who have never smoked. Although some have postulated  that the direct aversive physiological effects of smoking cause or aggravate painful conditions , concurrent depressive symptoms may also mediate the effect of smoking on chronic pain outcomes.

5. Obesity: The relationship is much more complex than simply mechanical overload where familial (environmental & genetic) are significant contributors to the association. It is the impact of pain on functional status and health related quality of life that is greater in the obese than in those with normal BMI

6. Nutrition:  findings from a recent research suggest that dietary omega-3/omega-6 ratio may have significance for inflammatory pain. Increasing omega-3 intake (found in fish) reduces patient-reported joint pain intensity, morning stiffness and the number of painful joints in patients with rheumatoid arthritis or joint pain secondary to inflammatory bowel disease.

 Knowing that the central nervous system has specific nutritional requirements, clinical studies suggest that reducing polyamine-containing foodstuffs (e.g. bran, nuts, soyabean) may reduce hyperalgesia and has shown some early promise in cancer patients with metastatic disease.

Other dietary constituents that show early promise include some flavonoid compounds, alpha-lipoic acid (found in broccoli, spinach, yeast) and vitamin E for diabetic neuropathy. 

On the other hand, there is some preliminary evidence to show that medically supervised modified fasting (300 kCal/day) for a defined and limited period (7–21 days) could be useful as an adjunctive therapeutic approach to enhance mood in chronic pain patients who are often affected by depression and anxiety.

Non-modifiable factors

1. Old age :  There is generally a higher prevalence of chronic pain in old age,and the occurrence of more severe disabling chronic pain increases with age.

2. Female sex: Chronic pain syndromes generally have a higher prevalence in women. They are found to have lower pain thresholds and lower pain tolerance, experience greater unpleasantness (or intensity) with pain and have different analgesic sensitivity.

3. Influence of ethnicity and cultural background: Pain is a complex personal experience influenced by multiple interactive biopsychosocial processes. However, there exists a similarity in the prevalence of chronic pain between developed (37%) and developing countries (41%) according to WHO World Mental Health Surveys.

4. Genetics: It is clear that there is no unique ‘pain’ gene, but that a complex combination of genetic factors interacts with the psychosocial and lifestyle factors to produce chronic pain. Genes may act at a number of levels to influence the expression of chronic pain, including biological processes and behavioral and emotional responses. Identifying specific genes and their roles, and distinguishing these from other sources of variation (gender, ethnicity, socio-cultural, psychological, etc.) is currently an important challenge.

Take home messages

  • The existence of both individual-level and population-level risk factors for the onset or persistence of pain suggests that opportunities for intervention exist at more than one level.
  •  Chronic pain management dominated by analgesic medication will fail to address adequately the role of activity, psychological factors and social factors in maintaining daily function.
  •  Clear opportunities exist for all health professionals to facilitate changes in lifestyle that have the potential to improve morbidity and function in patients with chronic pain, simultaneously reducing the risks and impact of common co-morbidities.
  •  Further research is required to identify the most effective approaches, and this should be a priority for all health services.

This article has been written by Dr. Aishwarya Aiyar who is a Physiotherapist from Seth GS Medical College.

Ask your questions/ Comment in the Comments section below.

Categories
Step 1 Step 2 CK USMLE

How to be more productive during your USMLE Step preparation

Productivity hacks for the USMLE Steps

Studying for the USMLE Step examinations can be a daunting and often tiring task. You can put in hours and hours of study and still not see a visible improvement in your performance on practice tests. Here are a few tips so that you are more productive in the time you spend preparing for these exams.

Spend more time reviewing

The number of questions solved has been associated with the score one gets on the test. However, not spending enough time reviewing the explanation for the questions is something you should avoid.

Make sure you are reviewing not only why the correct answer is the right choice but also why the other options are incorrect.

It ultimately boils down to UWorld being a practice tool and not a testing tool. Make sure you take down notes or save flashcards from the explanation so you can come back and revise what you have learned.

Be selective about Resources!

It can be tempting to jump from one resource to another thinking that the more you do, the better you will score.

The reality however is that, high scorers are often more selective about the resources that they use. Then make sure you master these resources and know them 100%.

Make sure you spend enough time with First Aid and UWorld.

Have a timeline in mind

Have a rough timetable over the long term and short term. You do not need to account for every minute but, having a structure in your head helps you be more organized.

Also, once you have booked your exam date, try not to postpone it unless you have an emergency or you are doing very poorly on practice tests.

Simulate the testing environment

While solving blocks of UWorld or any other Question bank, make sure you approach each block as though it was your final exam.

Have enough practice solving questions in timed mode. Also, make sure that you have good practice in solving tests which involve multiple systems that is random questions.

It is easy to get the answer if you know the block is only about Cardiovascular system. Train your mind to think of each question as it comes.

Study Groups

If you are someone who studies well with other people, form a study group.

Keep in mind however, to find partners whom you are comfortable with. That means, make sure they aren’t too slow or fast and are at the same general knowledge level as you.

If you find that you are not benefiting from these sessions, be quick to understand and act on it.

Rest and Exercise

This is probably the most important but least spoken about productivity hack. The USMLE exam prep can be a stressful period and can lead to burnout if you do not give your body adequate rest.

Make sure you get enough sleep to wake up fresh and study each morning. Also, any form of exercise, even a short 15 minute walk in fresh air will go a long way in improving your productivity.

If you have any questions, use the comments section below. For personalized consultation 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.

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Step 1 USMLE

USMLE Step 1 Pass Fail – Meaning and Impact on IMGs

USMLE Step 1 Pass Fail

In February of 2020, the USMLE parent organizations (FSMB and NBME) approved the change of USMLE Step 1 scoring outcomes from a 3 digit score to Pass/Fail. This post aims to provide a better perspective on this change and how the USMLE Step 1 Pass Fail will affect IMGs.

Major changes made:

  • USMLE Step 1 Scoring from 3 digit score to Pass/Fail
  • You must take Step 1 and Pass prior to taking Step 2 CS
  • The number of attempts on any USMLE exam is reduced from 6 to 4

As you can see the major change is the shift from a 3 digit score on the USMLE Step 1 to Pass Fail.

The USMLE Step 1 Pass Fail will not be implemented before January 2022

Why the change to a Pass/Fail reporting?

The idea was debated several times before it was passed. The main reasons to change from a 3 digit score on the USMLE Step 1 to Pass Fail were:

  • The content tested on USMLE step 1 does not correlate well with how good a clinician you will be. Although you need to have a good understanding of the basic sciences to have solid clinical concepts, knowing them does not necessarily mean that you are a good clinician.
  • Student well being and burnout prevention.

Here are some of the pros and cons of USMLE Step 1 Pass Fail that were discussed and are available on the website.

PROSCONS
USMLE offers highly reliable, objective assessment of relevant competencies. A national standard.A passing score on USMLE demonstrates minimum competency. Pass/Fail reporting suffices for this.
Mitigates the reliability challenges of some medical school assessmentsLicensure requires only a Pass/Fail outcome
May stimulate student preparation more than a Pass/Fail outcomeFocus on numeric scores negatively impacts student well-being
Incremental numeric USMLE performance correlates with other valued measures
e.g., specialty board certification, state board disciplinary actions, improved practice		Standardized test scores best predict other standardized test scores (vs. clinical performance)
Offers a “level playing field” for all examinees, including those from international and new or lesser known schoolsMaintaining 3-digit score reporting may limit diversity within various specialty programs
If no USMLE numeric score exists, and the demand for a national assessment remains, what fills the gap?Maintaining 3-digit score reporting has an opportunity cost due to students’ heavy focus on maximizing USMLE scores (e.g., less time for research, volunteerism)

USMLE Step 1 Pass Fail – Overall Impact

Since its inception, the USMLE Step 1 three digit score was used as one of the main factors in screening residency applicants. With that factor now gone, here are a few things that will become more important.

  • Step 2 CK score. There has been no change in the 3 digit score reporting for Step 2 CK. Step 2 CK is a much better reflector of a good clinician and residency program directors will place more emphasis on the Step 2 CK score.
  • Medical School and Letters of Recommendation. Prestigious medical schools and the quality of letters of recommendations from renowned faculty members will become much more important in differentiating applicants.
  • Research. Although research is currently cited lower on the list of factors that program directors consider while chosing applicants, with the introduction of USMLE Step 1 Pass Fail system, research publications will be considered more strongly.

Basically, you application as a medical student will be looked at in a holistic fashion considering a lot of variables that were originally masked by good Step scores.

How does the USMLE Step 1 Pass Fail affect IMGs?

The short answer is – USMLE Step 1 being Pass/ Fail affects competitive IMGs negatively. (Notice the word competitive.)

If you see the trends of matches in different specialties and compare American Medical Graduates (AMGs) to International Medical Graduates (IMGs) you will notice that for the same spot, an IMG has a higher step 1 score as compared to an AMG.

This Step 1 score was one of the important factors that helped IMGs stand out when it came to competitive residency applications. By removing that factor, the game is now tougher for IMGs.

So what can IMGs do to improve their chances?

Firstly, these changes will come into effect no earlier than January 2022, so if you will be applying prior to 2022, you have no reason to worry.

For the IMGs who will be taking the USMLE Step 1 post 2022, here are some things to keep in mind.

  • If you are reading this and haven’t yet entered medical school, work hard. Try to get into the best medical school that is recognized widely.
  • If you are already in medical school, be awesome. Work hard on your grades to get great transcripts and deans letter.
  • Take Step 1 early. Many IMGs used to take Step 2 CS as their first exam. With the new rules, this will not be possible unless you first finish Step 1. It is best to take your USMLE Step 1 immediately after you have finished you basic science years in medical school. Remember, you only need to pass now, no stress 😛
  • Focus on your clinical subjects and score really well on USMLE Step 2 CK. Check out my book on How to Crack the USMLE Step 2 CK for guidance on how to study for this beast.
  • Keep electives in mind and apply early. You can do hands on electives as a final year student. Apply atleast 6-8 months before you plan to do the elective. Read my posts about electives here.
  • Approach your application holistically. Remember to do research during medical school and publish. Get involved in volunteering and other leadership opportunities.
  • Try to take USMLE Step 3 before you submit your rank order list. This has 2 advantages. One, you have something that distinguishes you. Two, you qualify for an H1B visa if the program offers it.

Although this may seem like a lot and may seem unfair, remember that IMGs have always been a part of the US healthcare system and if you are good, you will find a residency spot.

If you have any questions, use the comments section below. For personalized consultation 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.

To submit your article, go to the Contribute page.

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Electives USMLE

Finding Accommodation for Electives

Accommodation for electives USA

Congratulations on getting that elective acceptance letter after months of applications and running in and out of offices to get your paper work in order! But, hold on! You still have to look for accommodation during your elective. Although this may seem like a daunting task, here are a few guidelines to keep in mind.

Things to keep in mind when deciding on accomodation

Location

Remember, in order to make the most of the elective time you have, you need to be able to spend more time at the hospital. So, if it is possible, financially and logistically, try to choose a place closer to the hospital. This is also very important if your rotation requires you to be on call and travel to the hospital at odd hours.

Safety

This is often a huge factor you need to consider when choosing accommodation during electives. Although, safety is quite variable depending on the neighborhood your hospital is located in, it is always better to find out more about this aspect and select your accommodation accordingly. Do not hesitate to reach out to people you know in the city and even the elective coordinator to find out which neighborhoods to avoid.

Although the US is a developed first world country, there are always pockets of bad neighborhoods that you should be aware of. There have been instances where people doing electives have faced safety concerns.

Cost

This is a major factor (especially for IMGs) and is often a trade off with the location and safety aspects. Meaning, locations closer to the hospital and safer neighborhoods are going to cost you more. This is a major expense to consider when you are calculating the total cost of the elective ( Read our article on How much do Clinical Electives Cost? )

Keep in mind though, if you aren’t on a tight budget, it will be a good idea to spend on a good accommodation as you will have the peace of mind being in a safe locality in a foreign land.

Split the cost if possible!

When you get that acceptance letter, reach out on facebook groups or other forums. You will be surprised at how many people are in the same boat as you. Not only will it bring down the cost of accommodation during your elective but you will also have an additional safety net.

Inspect before paying

If you have friends or relatives in the area, have them go and check out the place before you make a payment. Do not always rely on the pictures and information put up on the website by the advertiser.

How do I find accommodation during electives?

The above points gave a brief overview of the factors to consider while looking for places to stay during electives. Here are a few ways to help you find these accommodations!

Talk to Friends/ Family

This is probably the best way to find an accommodation for your elective. Talk to your friends and relatives who live in and around the city where your elective is. They will have an idea of places to stay and will guide you about the safety and other logistical issues.

Ask if is is possible for you to stay with them as a paying guest. Often times you may have a friend living with a few other flatmates, ask if anyone will be out of town and is willing to sublet their apartment to you for a month.


Talk to the elective coordinator

Most often, the elective program will either have a formal accommodation or a list of places that you can try out. These places are generally in the vicinity of the hospital. If it fits your budget, these are good options.

AirBNB

This is probably your best bet after the above two options. The listings on the app are verified and you will have full support from AirBNB in case you run into any troubles.

You can set filters for the place, price range, etc. Remember to read the reviews before. Also, whenever possible look for “superhost” while making a reservation as these hosts are more experienced.

IMPORTANT : Do NOT make reservations outside of AirBNB.

Use this link to get $40 off on your first booking through AirBNB. Check out AirBNBs – Click Here.

Third Party Websites

These are websites like Sulekha, Craigslist, etc. A word of caution, be careful and extremely mindful when booking through these websites. A common fraud is when the advertiser tells you that they are out of town and will not be able to meet you/ show you the house. Do NOT pay money without being sure of the person. Also, always ask for an official contract stating that they are renting out the room to you along with the dates and the amount paid.

Find more articles on USMLE and Electives.

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.

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USMLE

NEET (Indian PG) v/s USMLE

NEET (Indian PG) vs USMLE

If you are a medical student from India, this question often pops up. What is the difference between NEET (Indian PG) v/s USMLE. The purpose of this article is not to determine which exam is better/worse rather it highlights the fundamental ways in which these two exams are different. Pick the one that works best for you!

1. Cost!

This is the number one factor that must be considered. Giving the USMLE is a long process and apart from the exam itself you are looking at a number of other expenses including electives, interviews, stay abroad, etc.The costs can be exorbitantly high.

2. Sprint v/s Marathon

NEET PG is a one day exam with 300 odd questions over 3 hours spanning 19 subjects. These are the subjects that you cover throughout your MBBS.

People usually begin preparing during their last year (Internship). Think of this as a sprint where you have to have one solid effort to crack this exam.

The USMLE on the other hand is divided into different steps that you need to give before you can apply for a residency – Step 1, Step 2 CK and Step 2 CS.The process is generally quite long. Each exam is between 8-9 hours in duration.

3. The type of Questions

Although both exams test you on the basic stuff that you learn (or are supposed to learn) throughout medical school, they are different in the way the questions are framed.

The questions in NEET PG are generally shorter and ask you a direct question. For example “What is the most common cause of pleural effusion in India?”. You either know the answer or you don’t. Even the conceptual questions can be solved quickly within a few steps since it is a shorter duration exam.

Most questions on the USMLE are presented in the form of a clinical scenario with a brief history and some labs. At the end of this you will be required to make a diagnosis or answer a question. You have to put together multiple steps to have a differential diagnosis and then answer the question.

This article was written to help you get an idea of the ways in which the two exams NEET PG v/s USMLE are different from each other. Ultimately, the goal for you will be to crack whichever exam you choose to take. All the best!

To read more of my USMLE posts click here. You can also check out my eBook on How to Study for USMLE Step 1.

Let us know your thoughts on this in the comments section below. You can also ask us your questions below or email at theindianmedicalstudent@gmail.com

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Research

Choosing a research topic : Guide for Medical Students

Our previous blog posts dealt with why you should do clinical research and a basic outline of how you can do research in medical school.

As medical students, we are often confused about choosing a research topic and deciding what we want to research about. This post will help you with that process – Choosing a research topic.

Choose a topic that aligns with your clinical interest.

If you have a special interest in any field and have questions related to that subject, that is where you should try to focus your research.

Don’t have a question in mind already? Don’t worry, find faculty who are involved with research and read up about their research interest and the papers they have published.

You never know what you may find interesting! If you still don’t find anything interesting but still want to have some exposure to research you can always ask a guide to give you a topic to work on.

Try to do clinical research (preferably not meta-analysis)

While all kinds of research have their own place in the medical field, as a medical student/ resident, you goal is to learn how to do good research.

A meta-analysis will not give you exposure to actually researching about the disease or condition you want to know more about. Even a simple in-depth research project has great learning potential.

Try to focus more on the research rather than just doing data collection.

There is a lot of hard work that goes into collecting data. While this is a key aspect to conducting any research, make sure you are not doing only the scut work.

Make sure you get exposure to researching other papers and writing the paper.

Retrospective v/s Prospective

As a medical student doing retrospective studies that involves reviewing already collected data makes more sense due to the limited time you may have at that institution.

A prospective study with a long follow up period may not be the best option for you. However, if you feel that you will be able to finish a long term study then there is absolutely no harm in pursuing that.

These were just some things that you should consider while choosing a research topic as a medical student.

If you have any more suggestions or questions, use the comments section below. You can also email us at theindianmedicalstudent@gmail.com.

To write an article for our blog, email us at theindianmedicalstudent@gmail.com