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Honesty

February 21, 2012 1 comment

The New York Times reported that the football coach at Yale University resigned because his resume had said that he had been a candidate for a Rhodes scholarship which was false. The media checked into his claims and found the Rhodes scholarship program did not have a record of his application. The football coach, later said in a statement that he had never applied for the Rhodes scholarship. For this individual, a promising career is now derailed because of a false claim on a resume.

As per ERAS, you must “Ensure that the information provided is accurate and truthful” on your application.

At the end of your ERAS application you must certify the following statement:
“I certify that the information contained within the MyERAS application is complete and accurate to the best of my knowledge. I understand that any false or missing information may disqualify me from consideration for a position; may result in an investigation by the AAMC; may also result in expulsion from ERAS; or if employed, may constitute cause for termination from the program.”

The message is, be careful what you list in your application. Make sure everything that you state is absolutely true. You don’t want something in your application to derail your career.

Be sure that your publications (if you have them) are listed properly.

Publications can be listed as published, in press or accepted. Some also list submitted papers. If the publication is not a basic science or clinical science study, you should make it clear that the publication is a letter to the editor, a case report or an abstract that was presented. Make sure the author list is correct and in the correct order. Only list your name if it appears on the publication as an author. If you were acknowledged but are not listed as an author do not represent yourself as an author. You can state in the description of the research that your efforts were acknowledged in the publication. Publications are easy to verify – make sure yours are correct.

The views expressed in this post are those of Kenneth Christopher, MD and do not necessarily reflect the views of Dr. Christopher’s employer Partners HealthCare.

Medical Student Electives

February 10, 2012 1 comment

If you are a student in medical school outside of the US and you are looking to do residency training in the US, I strongly suggest that you do some clinical time in the US while you are still a student. Some medical schools outside the US encourage their students to do rotations abroad. Some medical schools outside the US have agreements with US medical schools. Some students will do rotations between the end of medical school but before their diploma is granted. It is best to do these rotations while you are a final year student.

US clinical experience as a student is extremely valuable because you are part of the team and allowed to follow, examine, speak to and present you own patients. You will find that the US system may be quite different from where you rotated at home.

Further, a rotation (also known as a clerkship) as a medical student is true “hands-on” experience and your evaluations or letters of reference can comment on your clinical skills.

When I was a medical student, I did month long rotations in Ireland, Scotland and Hungary. I came away from my experience rotating in other medical systems with new friends and an appreciation of how some things in hospitals are different but many things are the same. I also saw a lot of interesting cases.

The AAMC provides a list of medical schools that will host students from a medical schools outside the United States.
From the site “Choose the “Search Schools By ‘Geographic Region’ or ‘State/Canadian Province'” option to search by additional criteria, including the presence or absence of application fees for electives, of other tuition/fee charges for electives, or of elective opportunities for students enrolled at international medical schools.”

The schools may charge tuition and you will be responsible for living and travel expenses.

I may be biased but Harvard Medical School offers a terrific student elective program “Harvard Medical School Exchange Clerk Program” that allows final year students from other medical schools to participate in clinical electives at the Harvard Hospitals (Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital or Massachusetts General Hospital).

The views expressed in this post are those of Kenneth Christopher, MD and do not necessarily reflect the views of Dr. Christopher’s employer Partners HealthCare.

Those without interviews

January 30, 2012 1 comment

For those of you who are without interviews you need to take a step back and really evaluate yourself as a candidate.

The fixable reasons for no interviews are the following:

No US clinical experience
Application submitted after October 1
Not ECFMG certified at time of application
Application only to a limited geographical area
Not applying to enough community hospital programs

Non-fixable reasons for no interviews are the following:

Poor scores (below 210 on Step 1 or 2 or any exam fail including Clinical Skill exam).

If this is not your year, think about what you might be able to do to fix the problem. You can’t change your scores if they are low. A good score on Step 3 will not rescue a poor score on Step 1 or Step 2 or a CS fail.

Now I know of a candidate this year with low scores who got a pre-match and several candidates with amazing scores who got pre-matches. Hopefully many more of you will match this year.

Anyway, if your scores are over 210 and you have no interviews but you have no US clinical experience, well you need to get some US clinical experience and reapply. If there are things you can fix (other than scores/ attempts) then fix them.

Observerships at places that take IMGs may be helpful. If you do an observership at a place that takes primarily IMGs then the program gets to see you for days at a time and get a sense of you as a person. The observership wont allow you to see patients and show your clinical skills but people can get to know you. You may very well get an interview at that program if they liked you. Observerships at university hospitals give you an opportunity to see a big hospital in action.

The process is difficult and will only get more difficult over time. In the past, about 75% of applicants got in to a residency over 5 years of applying.

If after fixing what is fixable and you have applied without interviews then it is time to start thinking of doing something else or going home to practice.

The views expressed in this post are those of Kenneth Christopher, MD and do not necessarily reflect the views of Dr. Christopher’s employer Partners HealthCare.

Repeat Applicants

January 21, 2012 1 comment

I came across an interesting study in Academic Medicine called Participation in U.S. Graduate Medical Education by Graduates of International Medical Schools where investigators from the ECFMG, ERAS and the NRMP looked at the outcome of IMGs who applied to residency.

The study followed 10,328 IMGs certified by the ECFMG between July 1, 2005 and June 30, 2006. The authors stated the following:
“Of the entire 10,147 graduates without a residency in 2006, 5,407 (53%) failed to find a residency position in that year. Many applied again in 2007 and subsequent years, but with each passing year the success rate of the remaining graduates declined. Of those who remained in 2007, 41% were successful; in 2008 only 17% of those remaining were successful. After the close of the 2009 cycle, 76% of the original cohort had obtained residency positions, and it is likely that a few more will be successful in years to come.”

In the cohort ninety-one percent of US IMGs were successful, but only 73% of non-US IMGs were.

In a different study looking at ECFMG applicants from 1995-2004 the following was found: U.S.-citizen IMGs have lower pass rates on Step 1 and Step 2 Clinical Knowledge than do IMGs who are not U.S. citizens. The study authors note that:
“given the array of factors that come into play in the selection process, U.S.-citizen IMGs, as a group, are still more likely to eventually obtain graduate training positions.”

So the message is apply again if you don’t succeed in this match. I would emphasize that especially if there is something in your application that you can improve. If you are applying again, rewrite your application using this document as a guide. I would add that it will be more competitive over the next 5 years compared to the 2006-2009 time frame as noted in a prior post.

The views expressed in this post are those of Kenneth Christopher, MD and do not necessarily reflect the views of Dr. Christopher’s employer Partners HealthCare.

Sample ERAS application

December 31, 2011 3 comments

I found a link to a sample ERAS application here. Although written by an American medical school, I think that this document can be quite helpful to the IMG community. It includes sample CV, sample MyERAS and sample personal statements. It also includes interview tips.

The document gives insight into how to report your experience, your activities and your hobbies.

Pay particular attention to how the CV template looks and how the sample ERAS application reads.

The descriptions of activities is very well phrased, note how short they are. If you can model your ERAS application after the sample provided, your application will benefit.

The document also has a “how to write your personal statement” section which is quite helpful as well (page 33). The document also has several sample personal statements which gives you an idea of how to style your statement.

Also see a CV related post on the University of Washington School of Medicine site here.

The views expressed in this post are those of Kenneth Christopher, MD and do not necessarily reflect the views of Dr. Christopher’s employer Partners HealthCare.

IMG Friendly Internal Medicine Program List

December 20, 2011 2 comments

For those of you new to the matching game and those of you who are looking ahead to next year I wanted to share a free list of IMG friendly Internal Medicine Programs posted by sama-sd.org. I don’t have a personal or professional relationship with sama but have not seen such detail on IM programs posted before so I thought it best to bring the list to your attention.

While not complete in every detail, the list includes programs that have historically matched IMGs. Note that the contact person and phone numbers may not be up to date. The urls that I tried worked. Some of the programs only take a few IMGs some programs take mostly IMGs. The university programs will take fewer IMGs than the community hospitals. Some university programs take very few IMGs, some take more.

The list was put together by sama-sd.org. I have not verified the content or information on the list. It is up to you to decide where to apply and what Program criteria fit you. Look at the “Internal medicine programs according to percentage of IMGs” list as well to see which programs have high percentages of IMGs.

The list is meant to be a starting point in your quest for an interview in internal medicine. I hope that the information is helpful.

The following links are excel and word files where you can find the information. Alternatively you can visit the sama site here.

IMG Friendly Programs Application List

Internal medicine programs according to percentage of IMGs

The views expressed in this post are those of Kenneth Christopher, MD and do not necessarily reflect the views of Dr. Christopher’s employer Partners HealthCare.

Warning from California on “Externships”

November 5, 2011 2 comments

I see letters from individual physician offices lauding the practice of an individual who has done an “externship.” As I have stated before “externships” are meaningless. Program directors are smart people and they know that these letters and experiences are not very worthwhile.  A letter from a private physician office is suspect in many ways.  First off, the physician has most likely been paid by an agency who received money from the extern.  The letter written in support of the extern is biased as the physician is paid on behalf of the extern.  Even if the physician states to the extern otherwise, the letter is a formality.  I have never seen a critical letter from a private physician’s practice of an extern’s performance. I have seen critical letters from physicians in hospitals where IMGs do observerships. Remember, the ideal US clinical experience (and only useful clinical experience) is a clinical rotation in the US at a university hospital while you are a medical student or Non-ACGME Clinical Fellowships or training programs.

Any physician who allows an extern to do anything above what a high school educated medical assistant can do is assisting in the unlicensed practice of medicine. The unlicensed or unauthorized practice of medicine occurs when an unlicensed person does something that is part of the legal definition of “medicine.”  Florida Statute § 458.327(1)(a) makes “[t]he practice of medicine or an attempt to practice medicine without a license to practice in Florida” a felony of the third degree. My personal physician has a medical assistant who takes my blood pressure and asks me how my shoulder feels. That is the extent of what a medical assistant does. She most certainly does not do a physical exam on me. Anything beyond blood pressure measurement and “chit-chat” may be the unlicensed practice of medicine. The unlicensed practice of medicine puts the physician the extern is working with and the extern in a potentially compromising situation. A physician who allows an extern to do more than a medical assistant may violate state licensing provisions. A residency program that “requires” you to do an externship may be unknowingly encouraging you to practice medicine without a license. The California Board of Medicine has issued a warning to physicians who allow externs to see patients. (See “Don’t assist the unlicensed practice of medicine.” on page 5) The AMA also has a post on their website on the issue where they highlight that both the supervising physician and the IMG can face sanctions.

Unfortunately, there is a great deal of misinformation regarding this topic. Ten years ago the concept of an extern did not exist. Companies saw a potential market to exploit IMGs to gain experience in the US when observerships became scarce. These companies charge big money to place IMGs in doctor’s offices.

So where does one get US clinical experience?  Here is a up to date list of observer opportunities. There is a great post on US clinical experience by MLE and Residency tips called types and opportunities for USCE.  Further, some hospitals have Non-ACGME Clinical Fellowships or training programs that one may be eligible for. Examples of such programs can be found here and here.

While I realize that not everyone can travel to the US as a student I see plenty of applications where individuals have delayed their medical degree to come to the US and do elective rotations as students.  I hope this message reaches those who are thinking of doing training in the US early in their thought process so they can plan to do US rotations while they are still students.

The views expressed in this post are those of Kenneth Christopher, MD and do not necessarily reflect the views of Dr. Christopher’s employer Partners HealthCare.

Categories: Application