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IMG/FMG Forum International Medical Graduates Forum.


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  #1  
Old 05-29-2014
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Default Overwhelmed

Sorry I don't know if this is the correct place, please mods delete it if it's in the wrong place
So over the past few days I've been reading about USMLE and the matching process and how it's infinitely more difficult for IMGs to get the best specialties.(im not even a graduate btw)
A little background first, I'm a medical student in Egypt. Here there's there's no premed, you have 6 years to graduate first three being the equivavent of pre-med, last 3 equivalent of med and an extra year as compulsory clerkship(?) year. I'm a 2nd year (pre)med student and I've always wanted to have a job in the US. I get pretty good grades, last year I was one of the top of my class. So recently i started reading here got to know all the abbreviations and stuff, and honestly I can't say I'm not depressed. This seems much harder than I thought especially since I'm more interested in the more prestigeous specialties which I guess goes to AMGs. My father is also a top Ob/Gyn here and I don't think he'll be happy if I can't get something good. I think I'm losing my mind, I'm not even an official "med" student and I wasted 2 whole days reading stuff here and I have an upcoming important test next monday. I guess I could stay here and get whatever specialty I want but for me that would be giving up a dream I had ever since I was a little kid and I don't wanna give up without trying so I have a few questions that I hope would help my anxiety:
1) Which one of these specialties I have a good chance of getting assuming i get really good Scores? Ob/Gyn, Cardiology/Radiology/General surgery. My favorite would be surgery by far ofc but I have no idea how hard that would be. I heard some people say its doable other say impossible for IMG. Also I don't want general surgery, I want to specialise in something, maybe GI.
2) As a student who still didn't finish all the basics yet (will take pharma, immunology, pathology next year), what do some of the experts here suggest I do. Many people in my uni take the USMLE step 1 after the third year. I wanted to start early so any insight would be helpful.
3) I read that USCE is really important, and that clinincal electives can only be done in your senior year, for me does that mean the 6th year or the final clership year?
4) Also since the electives can only be done for 1 year (senior year), how am I gonna get the 3-6 months experience or even the 1 year research that I see here? I can't just take several 1 month vacations from uni in the middle? And electives are only for pre grads, am I missing something here?
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Old 05-30-2014
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Thanks for sharing your dilemmas. I think many of us go through similar worries because getting a US residency position is a challenging road for IMGs. Just breathe and take it one step at a time.

1. Out of the specialties you mentioned the most IMG-friendly specialty would be internal medicine (then going into cardiology subspecialty), then gen surg, obgyn then radiology. The match data from 2013 for non-US citizen IMGs:
IM - 1690/6612 positions went to non-US citizen IMGs
General surgery - 158/1185 (if you want to focus on GI, you would do a colorectal fellowship after getting through gen surg)
Radiology (diagnostic) - 66/1143
Ob/Gyn - 62/1237

Don't get too bogged down by the stats though. They just indicate that you have to be a great candidate to have a chance at some specialities. So I wouldn't say it's "impossible" to match in any specialty if you position yourself as a good candidate.

2. I'd suggest that you incorporate your Step 1 study into your curriculum as early as you can. That would mean buying First Aid and referring to it as you study. You can also study Step 1 curriculum in parallel using a variety of resources (you can read the resource section on First Aid and read forums etc to get a feel for what would be helpful).

3. I'm not exactly sure about USCE timing in 6th yr or clerkship yr. I would ask your school to be sure. Are you still considered a medical student during your clerkship year? For a student clinical elective, you have to be a medical student and not a graduate.

4. If you do decide to get USCE as a student (which is wise), then you may just need to prolong your final year by a little bit. Delaying graduation by a few months in the scheme of things isn't that bad if you can actually get involved in a good quality USCE that leads to excellent letters of recommendation. LORs are very important! After you graduate, it becomes much harder to obtain good quality USCE.

I hope that helps and good luck!
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Old 05-30-2014
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Wow thanks man for the reply, it was really informative and I'm grateful.
I think that the clerkship is after the graduation, I'm gonna ask there just to make sure. But assuming it is, if I do choose to take breaks in the middle, can I take the electives
1) In the summer vacation between the 5th and 6th years? How does the med school im going to know I'm a senior anyway?
2) In the winter vacation? Are they available all the time or just for a fixed period of time
3) Assuming the above options are unavailable, if i take vacations in the middle of univ, do I have enough time there to study there? I dont wanna fall behind in my uni especially since the 6th year is really important.

how much month experience as an elective to match a decent gen surgery program? And after I for example take a 1 month elective, does that mean I cannot have USCE anymore? Are externships, observerships, and other stuff to do after grad not considered USCE? Because if they are, i can keep trying if I dont match first time, I can come back to egypt, do my residency here and travel for observerships (or anything that doesn't take too much time in the states) in the middle, and improve my CV and see if i get it the following year. Or does applying twice hurt my chances?
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Old 05-30-2014
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I didn't do a medical school elective myself (I actually arranged an observership after I graduated) but from what I know,
-you have to be officially a medical student for a med student elective. They will ask for documentation when you apply.
-electives are available at different times of the year.
-you will want to work really hard during your USCE because you will be getting letters of recommendation from it. I think the time you have to study will depend on what USCE you do. USCE can also help with Step 2CS prep.
-duration of USCE varies widely.
-different residency programs have different USCE duration requirements and they define USCE differently as well. There's a range of opinion about how useful observerships and externships are as USCE. In general, the best USCE is med student clerkship.
-applying twice does not necessarily hurt your chances, but remember the process is costly both financially and emotionally, not to mention hard work when you have to figure out what you have to do for another year.
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  #5  
Old 06-06-2014
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Sorry, I have been busy with my tests lately. I really appreciate your help

So i have another question. Now that I'm still a 2nd year (pre-med) who still didn't have any clinincal education/experience at my university, what can I do right now? I'm already preparing the books for the USMLE, but can I for example start doing observerships at the moment? I have a friend at my uni who goes on observerships to universities in Germany in the summer but I have no idea if that's possible in the US. I wanna start as early as possible so I get enough USCE by the time I graduate. Financial issues are not a huge problem and I can pay I guess but I don't know if that's beneficial (heard program directors look down upon it).
Also, are observerships to top universities for example harvard and the like, attainable or are they still super competitive/need connections?
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Old 06-07-2014
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Good questions. I think you should first and foremost focus at this time on your basic sciences (which I assume is what is in your curriculum during pre-clinicals). You should keep studying USMLE materials at the same time as you're doing.

Letters of recommendations should be recent, ideally within the past year. So it's not actually that advantageous from a LOR point of view to do any formal clinical experience too early. Observerships at top-tier institutions do have an application process and they can cost a lot of money. I would really think hard about going to places like Harvard, which is very expensive for what it is. What you do get is to observe at one of the best institutions in the country. What you will probably not get is a compelling letter of recommendation, which is ultimately one of the things you may want out of the experience since many residency programs want IMGs to have USCE. You may get some connections, which may or may not help you.

If you're still a student, I would strongly encourage you to think about doing an elective rotation in the US when you are a final year student. There is an application process for this as well, of course. You will get hands-on clinical experience that can possibly lead to stronger letters of recommendation. After you graduate, the easiest way to obtain this sort of hands-on experience is may be through an externship company. These are difficult to find yourself.

Another thing. You may want to think about what resonates with you now regarding contributing to the medical field. Meaningful activities such as research/publications, participation in student-sections of academic organizations/interest groups and volunteer work can be fulfilling for you and add to your competitiveness on your CV.
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