Archive for the ‘Internal Medicine Residency’ Category

Tips for the Residency Match

December 4, 2014 Leave a comment

I wanted to let the IMG community know about a book called “Tips for the Residency Match: What Residency Directors Are Really Looking For” written by program director colleagues of mine and including a chapter that I wrote on IMG issues. The book can be found here and ordered here. The book will be published in March 2015. I hope that it is useful for those searching for a residency as it gives insight into the process from those of us who are involved in the decision process.

Here is a bit on the text from the author
“I want to thank Dr. Christopher for inviting me to post on his site. I’m excited to announce our new book “Tips for the Residency Match” which has now gone on sale in electronic version on amazon and iTunes. I have often been asked what are the keys to successfully matching and what do residency directors really care about. To this end, we’ve brought together an amazing team of co-authors from every specialty and most of the major US institutions including Stanford, Harvard, Yale, John Hopkins, Duke, Penn, Columbia…… Each subspecialty section is written by a program director in that field. The authors discuss what is most important to ensure a great match including what board scores are needed and how to interview. Dr. Christopher has lent his considerable expertise and written dedicated IMG portions. I wish you all the best with the match and hope that this new book helps you along your journey!”
~ Justin Kung, MD, Associate Director, Radiology Residency Program, Beth Israel Deaconess Medical Center

The contents are noted below:

The Match Alphabet Soup; Specialty Selection – Where to Begin; The Specialties; Path to the Match; The Selection Process; – Theirs; The Selection Process – Yours; The Application; The Curriculum Vitae; The Personal Statement; The Interview; After the Interview; Match Week; International Medical Graduate Specifics.

The views expressed on this post are those of Kenneth Christopher, MD and do not necessarily reflect the views of his employer Partners HealthCare, his hospital, department or division.

UCLA International Medical Graduate Program

UCLA has an innovative program for IMGs from Latin America and or those who speak Spanish.

The goal of the UCLA IMG program is to provide bilingual (English-Spanish) family physicians for underserved rural and urban communities of California which include large Hispanic and other vulnerable populations.

The UCLA IMG program provides bilingual English/Spanish IMGs, who are committed to the care of our state’s underserved populations, with a comprehensive program to pass the USMLE Step 1, USMLE Step 2 CK, USMLE Step 2 CS and 3 months of Observerships at UCLA to compete for a California Family Medicine residency training program intern position.

Upon successful completion of the residency, the graduate will be required to spend 24 to 36 months in an underserved community providing care to those immigrants and low-income patients who face financial and language barriers for care. The service to the community after residency is a requirement for participation in the UCLA IMG Program.

The UCLA IMG site has a good amount of helpful information for the IMG community including a pearl “it is extremely important that you DO NOT take any of the United States Medical Licensing Examinations (USMLEs) without first achieving a minimum score of 500 on a National Board of Medical Examination (NBME) practice test.”

USMLE Step 1 Strategies

The following is a guest post from my friend Kene Mezue, MBBS, MSc who is a graduate of University of Nigeria and Anglia Ruskin University and who successfully matched in internal medicine in 2014. Thank you for this post Kene.

Step 1 Exam Experience.
1. Map out a workable plan/schedule right from the beginning based on your pace (from previous experience). Note that a 2000 item Qbank usually takes at least 200 hours to finish. A First Aid read can take about 10 days depending on your speed. Aim to read First Aid in detail at least twice.
2. When doing questions in practice, cover the answers (using your hands if necessary) first. Try to guess the answer to the question before looking at the options.
3. When you have long questions, read the last sentence first. Then read the whole question…then paraphrase the question, note as many aspects of the question as possible…think this way – if I was the one who wrote this question, what am I actually looking for?
4. Note the trigger words in the stem – the “CLUES”…they could be Age, Gender, Ethnicity, Pathognomonic characteristic, etc. USMLE questions tend to stay true to character and reality…very unlikely to have red herrings and that is a plus.
5. When doing question banks, do them random, timed.
6. Choose the obvious answer if it is there…most times, there is no “catch”.
7. Use a piece of paper to note your thoughts as you read through a question (a writing pad is provided at the exam centre for the same purpose).
8. Avoid fixation. When you read a question, don’t get stuck on ONE detail amidst others. Take the whole picture. If one detail stands at odds with the vast majority of details or the overall trend of thought of the question, ignore that potentially misleading detail.
9. A good number of questions and their options boils down to making “bets” and playing “odds”. Learn the art of making intelligent guesses…it helps.
10. Use the NBMEs both as a learning tool and an assessment tool. It is a learning tool because the concepts from the NBMEs are very frequently retested on the exam. Use online forum discussions to see the trend of thought of your other colleagues on the more difficult questions. The NBMEs are also the most reliable tools for assessment of your progress during study and your readiness for the exam. Do at least two of them and the last one at least two weeks before the exam to give you time for corrective study.
11. Use the commercial question banks as learning tools – not as assessment tools. Read through the explanations as thoroughly as you can. Remember that the exam is about concepts and trends of thought and not really about random facts.
12. Build your stamina…Step 1 is a marathon…8 hours is a LONG time…it really is.
Indispensable – First Aid, USMLEWorld Qbank, NBMEs, Discussion forums
Very Helpful – A second Qbank (e.g., USMLE Rx QBank, Kaplan QBank), Goljan Audio and Book, Pathoma.
May Be Helpful – Kaplan videos, Review programs (e.g. Falcon, DIT), WebPath slides.
Avoid – other mediocre Qbanks (waste of time), reading big textbooks (check only the most important stuff up), too many mnemonics (insist on understanding concepts).

The views expressed on this post are those of Kenneth Christopher, MD and do not necessarily reflect the views of his employer Partners HealthCare, his hospital, department or division. I have no relationship with any commercial entities associated with this post.

Publications and Honesty

November 22, 2013 Leave a comment

Interesting article in Academic Medicine (Acad Med. 2013 Nov;88(11):1719-22) regarding publications in ERAS applications. Duke University Medical Center investigators reviewed the 628 applications for their radiology residency program and found that a substantial number (82%) of them had listed publications on the ERAS application. Not surprising as radiology is very very competitive and Duke is a premier program. Applicants listed 1,431 manuscripts, 952 “published,” 64 “in press,” 95 “accepted,” 27 “provisional accepted,” and 293 “submitted.”

What was disheartening was what the investigators noted in their abstract:

“More than half of those listed as “submitted,” and approximately one-third of those listed as “accepted,” “in press,” or “provisional accepted,” remained unpublished after two years.” (Grimm LJ, Maxfield CM. Acad Med. 2013 Nov;88(11):1719-22)

What does this mean? I know from personal experience that not all papers submitted will appear in print, but half is quite high. What is more troubling is that 59 of the 186 manuscripts that were listed as “accepted,” “in press,” or “provisional accepted,” were not categorized appropriately. Any manuscript that is listed in this fashion should appear on PubMed within a year. It appears that candidates may be misrepresenting their publication record. I advise you to be honest as we have all seen fallout from loose handling of the truth. It only takes a phone call to the journal to determine if a manuscript is really “submitted”, “accepted,” “in press,” or “provisional accepted.” You should be very careful in what goes in to your application. As per ERAS, you must “Ensure that the information provided is accurate and truthful” on your application. Be honest.

The views expressed on this post are those of Kenneth Christopher, MD and do not necessarily reflect the views of his employer Partners HealthCare, his hospital, department or division.

How to Achieve High Step 1 Scores

November 22, 2013 Leave a comment

People ask me what to do to improve their application that has low step 1 scores. There really is very little one can do to overcome low step 1 scores. In general, the mean step 1 score is 225 with a standard deviation of 20. This means that if your score is 205 or below you are in the bottom 16% of all test takers. If your score is 225 you are in the bottom 50%. If you have a 245 you are in the top 16%. A score above 265 will place you in the top 2%. Remember that even high scores are not a guarantee of matching but in this matching climate, it is very hard to match with low step 1 scores.

I stumbled upon a very interesting presentation regarding how people are able to achieve high usmle step scores. A group from Albert Einstein College of Medicine in New York surveyed their own medical students to examine their study patterns relative to their step 1 scores. 96 of the 157 students completed surveys yielding a likely representative sample of this US medical school.

The results were interesting as it appears that the number of questions completed from question banks in addition to preclinical performance were robust indicators of step 1 score. What was interesting is that the number of hours of test prep study did not correlate with step 1 performance indicating that is not how hard you study for the exam but how smart you study. Answering questions activates learning as opposed to passive learning that occurs with reading or watching material without actively engaging with that material.

So my advice is to obtain and complete as many questions as possible. There are multiple online question banks that have thousands of questions. You should plan to do thousands (3000-4000) and plan to do them over time (1-2 years). The highest step 1 score I ever saw was from an IMG who did 10,000 questions over 18 months. In this match climate where you need strong scores, spend as much time as it takes to do as many questions as possible. Even if it means delaying your application by a year to get a higher score, do so. Programs would prefer an applicant with higher scores over an applicant with a more recent graduation date. Do your questions. Do more questions.

The views expressed on this post are those of Kenneth Christopher, MD and do not necessarily reflect the views of his employer Partners HealthCare, his hospital, department or division.


November 19, 2013 Leave a comment

I get asked the “should I do research” and “where can I do research” question often. From my look at the NRMP data about half of those who match have research which means half do not.

If you are going to do two years of research and delay your application and increase the distance from your year of graduation you better produce something like this. High quality research is difficult and takes a lot of time to produce. You need to join a productive group and bring something to the table. Few IMG applicants who do any research time without previous training (MPH, MSc, PhD) have much to show for it. Performing research to get into residency is not worth the effort. Pursuing research because of your passion to become an academic is a laudable act in my opinion.

If you think about it, most successful IMG applicants will match in community programs (there are just more spots).  In general community programs value your clinical acumen more than your research skill.  A program based at a Academic Medical Center with a large research budget may be more interested in your research potential. So, in most cases, the value for your time spent doing research is not in your favor. That being said, if research is your life (like mine) then by all means do as much as possible.

Now, the question of where. It is tough to get a research position as US research funding is harder to come by for those who will employ you. Fewer dollars mean fewer research positions. Institutions are making volunteer research positions a thing of the past.

The most important thing to realize is that if your step 1 scores are low or less than average, no amount of research will cause a program to ignore your low scores. A really good IMG application needs no research. A really good IMG application with exceptional research in the form of high quality publications is decidedly unusual.  This combination will be of interest to the best internal medicine programs. Unless you are in an MPH or MSc program at a top university or a top lab, you are unlikely to get the research you need to have exceptional research experience.  Truly meaningful research experiences usually happen during fellowship and are grounded in research methods education programs.

The views expressed on this post are those of Kenneth Christopher, MD and do not necessarily reflect the views of his employer Partners HealthCare, his hospital, department or division.

Its Tough This year

November 14, 2013 Leave a comment

I have heard from many people that I know well who are in the matching game this year. Very qualified people whom I have a high opinion of are struggling to get more than a few interviews. Some are not getting more than one. I tell those who are applying that you only need 1 interview to match. Remember that few people match as few people who apply are granted interviews

There is other bits of evidence that this year is more difficult. There is a forum post that has over 1 million views in 2 months regarding internal medicine interviews entitled “IM Invitation/Rejection status 2014“. A good number of people who have commented on that forum have noted that they are struggling to get more than a few interviews, or any.

I think that we are seeing a combination of factors. As projected from a figure from a prior post, the number of spots for IMG candidates appears to be decreasing. Residency programs are not adding training slots. As most residency training salaries are paid for by government funding I don’t see this situation changing soon. The strategies, information and question sources needed to attain high USMLE scores are ubiquitous. Candidates are better informed and better qualified in general. The competition is very very tough. Candidates who had several interviews in past years would have trouble this year. It is likely not to get any easier next year I am afraid.

The views expressed on this post are those of Kenneth Christopher, MD and do not necessarily reflect the views of my employer Partners HealthCare, my hospital, my department or my division.