I m doing my general surgery masters from PGIMER india. I m confused n fear of stucking in between the process. plz help me. - USMLE Forums
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Old 02-21-2014
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Unhappy I m doing my general surgery masters from PGIMER india. I m confused n fear of stucking in between the process. plz help me.

Hello friends and seniors,
Plz help me decide what to do? I m doing my general surgery in PGIMER chandigarh. Now in second year, i wanted to continue my career in surgical field, but i have already read about the conditions for opting general surgery in US. But i dont want to give up. So i have lot of fear that what if i stuck in mid way. As such i also have encouraging thoughts n i have met the one of program director for general surgery who is from india, Dr. Vijay Mittal who has visited PGIMER. But then i also want to be little flexible if i dont get general surgery then i m ready to go surgical fields in other countries like australia, will this usmle has any value or will this usmle exam helpful for me for doing so. And if yes how ? plz guide me. Other important factor which i m considering is time period. I m 28 now, so i want to get residency as soon as possible. once if i get it then i ready to spend time period required to complete residency. Please help me, guide me.
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Old 02-21-2014
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Quote:
Originally Posted by Kirangaikwad7 View Post
Hello friends and seniors,
Plz help me decide what to do? I m doing my general surgery in PGIMER chandigarh. Now in second year, i wanted to continue my career in surgical field, but i have already read about the conditions for opting general surgery in US. But i dont want to give up. So i have lot of fear that what if i stuck in mid way. As such i also have encouraging thoughts n i have met the one of program director for general surgery who is from india, Dr. Vijay Mittal who has visited PGIMER. But then i also want to be little flexible if i dont get general surgery then i m ready to go surgical fields in other countries like australia, will this usmle has any value or will this usmle exam helpful for me for doing so. And if yes how ? plz guide me. Other important factor which i m considering is time period. I m 28 now, so i want to get residency as soon as possible. once if i get it then i ready to spend time period required to complete residency. Please help me, guide me.
My personal opinion only!!
1. If you start something, don't go back finish it.. in your case leaving two years of General surgery experience means you wasted two years of your time!! If you get your surgery degree from India, it will definitely add something to your resume.. People say any experience outside the US doesn't count!! Well maybe true, but you will not have to prove to the program director that you are interested in surgery, because you are already a surgeon, so you only need to convince him to accept you.

2. Anything from the US versus International surgery??? People are usually money minded, so they'd rather choose surgery, make piles of money in their countries while offering suboptimal care to their patients.. They pile the money but can't use them as they are always restricted to a special type of lifestyle in their home country.

Bottomline is: Although choosing where you wanna live and your lifestyle will definitely influence your choice. What I would personally do is first continue what I started (surgery residency) then I'd do the USMLE's and apply for surgical fellowships in the US and if not possible, start all over again as a surgeon in the US, if it doesn't work you either go back to work as a surgeon in India or move on to some other specialty.. Is it a waste of time to do surgery in India? No it will definitely add something to your knowledge.. Is it a waste of time to do the USMLE's then not use them?? No, it will definitely make you a better doctor.. Is it necessary to consider what I said? No, the choice is definitely yours at the end :-)

good luck Dr.
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Old 02-21-2014
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Correct Answer Thanks waynemdmd

I, definitely gonna finish my MS general surgery here, because it will be like a security for my future prospects. Its like a baseline and definitely surgery from PGIMER in INDIA is definitely comparable to surgery residency in US. I will definitely complete this degree here. And I have plans to appear for USMLE after that. So i need to start preparing for mle right from now on. OR atleast i have to decide whether to go for super-specialization (neurosurgery-that's what i ultimately wants to become) in INDIA itself or to appear for usmle. So i have to make up my mind. USMLE always drags me. I keep rebound on it though sometime i feel not to go for it. And if i start usmle so i need to know the midway rescue strategies. Anyways baseline will be general surgery in INDIA.
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Old 02-22-2014
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Quote:
Originally Posted by Kirangaikwad7 View Post
Hello friends and seniors,
Plz help me decide what to do? I m doing my general surgery in PGIMER chandigarh. Now in second year, i wanted to continue my career in surgical field, but i have already read about the conditions for opting general surgery in US. But i dont want to give up. So i have lot of fear that what if i stuck in mid way. As such i also have encouraging thoughts n i have met the one of program director for general surgery who is from india, Dr. Vijay Mittal who has visited PGIMER. But then i also want to be little flexible if i dont get general surgery then i m ready to go surgical fields in other countries like australia, will this usmle has any value or will this usmle exam helpful for me for doing so. And if yes how ? plz guide me. Other important factor which i m considering is time period. I m 28 now, so i want to get residency as soon as possible. once if i get it then i ready to spend time period required to complete residency. Please help me, guide me.

Hey Kiran,
Good to see somebody here from PGI Chandigarh.
I think you need to sit down and think this through first. Try to answer the following questions for yourself:
1) Why do you want to move out of India?
2) What specialty do YOU want to do?
3) Where do you want to live and work longterm?

If you have a genuine reason to go to US (ie not just because it is America) and are seeking a better education then I would advice the following:

1a) General overview of USMLE and chances of surgical residency in US - chances of residency in US are not the highest esp in top notch programmes. This is especially so with Surgical residencies. The longer you are out of medical school the lower your chances of getting into surgical training. Many of the programmes I have looked at applying to have an outright eligibility criteria that says something along the lines of "If you are > 5 years out of medical school you will not be considered". From what I understand you are probably close to this 5 year limit. While the above quote is from one of the top 5 Gen Surg programmes, many of the other lesser known programmes also prefer younger candidates. One of the main factors cited by Programme Directors is that they don't like surgeons who have already been trained in a set way ie they want to mould you in their way and the younger you are the better. This also means that since you are already in surgical training it may/may not be that advantageous to your residency application. If you really want to go to US then you would need to start your STEPs as soon as possible.

b) Other criteria - Apart from your USMLE marks, your LORs and CV are also very important. Given that you are in PGI and have met the programme director it would be wise to develop the relationship with PD further and also seek some good references from other people in PGI who may be somewhat known in US. You have higher chances of getting into the programme where Dr Vijay Mittal is the PD than anywhere else as you have met him and he has some knowledge of training in PGI.

c) Surgical Subspecialty Chances - From what I understand you are thinking of Neurosurgery? If General Surgery is hard to get into, Neurosurgery is impossible to get into as an IMG. The seats are limited, the STEP scores needed are much higher and most people who apply have many publications, exceptional LORs and previous experiences that set them apart from the rest of the applicants. I am not saying you can't get onto Neurosurgery or Cardiovascular/thoracic Surgery but you have to be exceptional. I know of quite a few people who all got into Ivy League training programmes but they had all had incredible CVs - most had STEP scores >250-260 and their references were written by some really well known individuals (one even had a health minister write him a reference as he had worked in policy making). So you will be competing against an incredible talent pool which means you need to set out on your path even earlier.

d) Switching specialty - I think many people who are a bit stuck think that being flexible with their specialty choices may increase their chances of residency acceptance but this is not always true ie if you apply to "other specialties" outside of general surgery it can make you look non-committant. Many countries and programmes (esp in the West and including Australia) will think that you are not the type of person who is GENUINELY interested in that specific specialty as you are switching just for an easier acceptance. Unfortunately this is more true for surgery than IM and FM.

e) Alternate options is Australia/NZ - This topic has arisen quite a few times on this forum and I will one day try to write a full advice for IMGs re this option since I myself trained and work in this part of the world. For now all I will say is that it's not as easy an option as many believe it to be.

While you can use your USMLE scores, you will need to take an extra practical/OSCE exam - the pass rate of which is anywhere from 35%-less than 50%. I have come across dozens of people who have not passed the test once, twice, thrice and even on fourth try! Having said that though nobody really cares about the number of attempts you take to pass the exam and neither does your score on USMLE mean much as long as you pass! The problem lies in (1) passing the exam esp the clinicals/OSCE (2) then finding a House Officer position in a hospital - this is getting harder and harder as the number of medical seats have arisen and more locals are graduating by the day.

Once you have passed the above two hurdles and spent ~3-4years as House Officer you can apply to get into training programme for specialties/residency. There are no exams etc so many people feel that it makes things easier. Personally I think it makes things even harder esp for IMGs. The selection criteria is solely based on your references from Australasia/Interview/CV. The chances of getting into IM or FM are higher (relatively but not absolutely) when compared to Surgical Specialties. Here are the rough figures I remember from top of my head for last few years (these numbers change every year and are only rough estimates - you can probably find better figures on Royal College website):
Number of Cardiothoracic Surgical trainees accepted into training programme - 2 to 3 for combined Australia/NZ/??Singapore
Number of Neurosurgery Surgical trainees accepted into training programme - 2 to 3 for combined Australia/NZ/??Singapore
Number of General Surgery trainees accepted into training programme - 8 to 20 NZ, ~30ish for Australia
Number of Ophthalmology trainees accepted into training programme - 1-2 NZ every 1-2year, <5 for Australia

As I said these are rough numbers but the point I am trying to make is that the total number of training/residency positions are low so the competition is high and since there is no exam it automatically disadvantages you as most of the applicants have worked with professors in their respective subspecialties since medical school on research projects or during their clinical rotations. Also in the recent years many people who have applied to surgical programmes have first gone and done a PhD in that field to increase their chances of getting accepted (however I also know of people who have done a PhD and then didn't get accepted in that surgical specialty).

All in all this is not an easy option and definitely not the shortest route. It has probably less guarantee than US residency as in US you will know shortly after taking all your STEPs whether you got into a residency or not instead of doing an extra exam, then spending 3-4-5 years doing House Officer years and maybe doing a PhD for 4-6 years and then applying to surgical programme (with no guarantee of admission).

Summary - Figure out why you want to leave India esp since you are already doing Surgery which seems to be something you are interested in (also if you are going to apply overseas - no matter where, US or Australia - people will ask you the same question). If you want to go to US you need to start really soon and take your STEPS. Surgery is hard to get into and you will need a good STEP score + LORs and CVs and the younger you are the better. If you want to go to Australasia you don't have to worry as much about your STEP marks but you still need to hurry as it's getting harder to become a House Surgeon. You would also have to then spend considerable time working on your CV/local references etc and meeting the eligibility criteria which can take time.

I hope none of this has discouraged you. I just wanted to present the true picture as I see it. As with anything involved there are always probabilities involved - as I said quite a few people I know have gone to Ivy Leagues and other top programmes for residency trainings - and you can only work hard and smart to make sure the probability lies on your side.

Goodluck! I will try to post a full overview of the Australasian scenario at some point.

Last edited by quackmd; 02-22-2014 at 07:18 PM.
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Old 02-23-2014
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Correct Answer Thanks quackmd, Gradually I m getting more clearity about my things i wanted to do.

Quote:
Originally Posted by quackmd View Post
Hey Kiran,
Good to see somebody here from PGI Chandigarh.
I think you need to sit down and think this through first. Try to answer the following questions for yourself:
1) Why do you want to move out of India?
2) What specialty do YOU want to do?
3) Where do you want to live and work longterm?

If you have a genuine reason to go to US (ie not just because it is America) and are seeking a better education then I would advice the following:

1a) General overview of USMLE and chances of surgical residency in US - chances of residency in US are not the highest esp in top notch programmes. This is especially so with Surgical residencies. The longer you are out of medical school the lower your chances of getting into surgical training. Many of the programmes I have looked at applying to have an outright eligibility criteria that says something along the lines of "If you are > 5 years out of medical school you will not be considered". From what I understand you are probably close to this 5 year limit. While the above quote is from one of the top 5 Gen Surg programmes, many of the other lesser known programmes also prefer younger candidates. One of the main factors cited by Programme Directors is that they don't like surgeons who have already been trained in a set way ie they want to mould you in their way and the younger you are the better. This also means that since you are already in surgical training it may/may not be that advantageous to your residency application. If you really want to go to US then you would need to start your STEPs as soon as possible.

b) Other criteria - Apart from your USMLE marks, your LORs and CV are also very important. Given that you are in PGI and have met the programme director it would be wise to develop the relationship with PD further and also seek some good references from other people in PGI who may be somewhat known in US. You have higher chances of getting into the programme where Dr Vijay Mittal is the PD than anywhere else as you have met him and he has some knowledge of training in PGI.

c) Surgical Subspecialty Chances - From what I understand you are thinking of Neurosurgery? If General Surgery is hard to get into, Neurosurgery is impossible to get into as an IMG. The seats are limited, the STEP scores needed are much higher and most people who apply have many publications, exceptional LORs and previous experiences that set them apart from the rest of the applicants. I am not saying you can't get onto Neurosurgery or Cardiovascular/thoracic Surgery but you have to be exceptional. I know of quite a few people who all got into Ivy League training programmes but they had all had incredible CVs - most had STEP scores >250-260 and their references were written by some really well known individuals (one even had a health minister write him a reference as he had worked in policy making). So you will be competing against an incredible talent pool which means you need to set out on your path even earlier.

d) Switching specialty - I think many people who are a bit stuck think that being flexible with their specialty choices may increase their chances of residency acceptance but this is not always true ie if you apply to "other specialties" outside of general surgery it can make you look non-committant. Many countries and programmes (esp in the West and including Australia) will think that you are not the type of person who is GENUINELY interested in that specific specialty as you are switching just for an easier acceptance. Unfortunately this is more true for surgery than IM and FM.

e) Alternate options is Australia/NZ - This topic has arisen quite a few times on this forum and I will one day try to write a full advice for IMGs re this option since I myself trained and work in this part of the world. For now all I will say is that it's not as easy an option as many believe it to be.

While you can use your USMLE scores, you will need to take an extra practical/OSCE exam - the pass rate of which is anywhere from 35%-less than 50%. I have come across dozens of people who have not passed the test once, twice, thrice and even on fourth try! Having said that though nobody really cares about the number of attempts you take to pass the exam and neither does your score on USMLE mean much as long as you pass! The problem lies in (1) passing the exam esp the clinicals/OSCE (2) then finding a House Officer position in a hospital - this is getting harder and harder as the number of medical seats have arisen and more locals are graduating by the day.

Once you have passed the above two hurdles and spent ~3-4years as House Officer you can apply to get into training programme for specialties/residency. There are no exams etc so many people feel that it makes things easier. Personally I think it makes things even harder esp for IMGs. The selection criteria is solely based on your references from Australasia/Interview/CV. The chances of getting into IM or FM are higher (relatively but not absolutely) when compared to Surgical Specialties. Here are the rough figures I remember from top of my head for last few years (these numbers change every year and are only rough estimates - you can probably find better figures on Royal College website):
Number of Cardiothoracic Surgical trainees accepted into training programme - 2 to 3 for combined Australia/NZ/??Singapore
Number of Neurosurgery Surgical trainees accepted into training programme - 2 to 3 for combined Australia/NZ/??Singapore
Number of General Surgery trainees accepted into training programme - 8 to 20 NZ, ~30ish for Australia
Number of Ophthalmology trainees accepted into training programme - 1-2 NZ every 1-2year, <5 for Australia

As I said these are rough numbers but the point I am trying to make is that the total number of training/residency positions are low so the competition is high and since there is no exam it automatically disadvantages you as most of the applicants have worked with professors in their respective subspecialties since medical school on research projects or during their clinical rotations. Also in the recent years many people who have applied to surgical programmes have first gone and done a PhD in that field to increase their chances of getting accepted (however I also know of people who have done a PhD and then didn't get accepted in that surgical specialty).

All in all this is not an easy option and definitely not the shortest route. It has probably less guarantee than US residency as in US you will know shortly after taking all your STEPs whether you got into a residency or not instead of doing an extra exam, then spending 3-4-5 years doing House Officer years and maybe doing a PhD for 4-6 years and then applying to surgical programme (with no guarantee of admission).

Summary - Figure out why you want to leave India esp since you are already doing Surgery which seems to be something you are interested in (also if you are going to apply overseas - no matter where, US or Australia - people will ask you the same question). If you want to go to US you need to start really soon and take your STEPS. Surgery is hard to get into and you will need a good STEP score + LORs and CVs and the younger you are the better. If you want to go to Australasia you don't have to worry as much about your STEP marks but you still need to hurry as it's getting harder to become a House Surgeon. You would also have to then spend considerable time working on your CV/local references etc and meeting the eligibility criteria which can take time.

I hope none of this has discouraged you. I just wanted to present the true picture as I see it. As with anything involved there are always probabilities involved - as I said quite a few people I know have gone to Ivy Leagues and other top programmes for residency trainings - and you can only work hard and smart to make sure the probability lies on your side.

Goodluck! I will try to post a full overview of the Australasian scenario at some point.
Thank you so much quackmd.

Believing in myself and the almighty god, here i start my journey into USMLE. Right from today. And also other important aspect i wanted to ask is
* How about the cost incurred? as i know its a very costly affair.
*and please let me know the australian present scenerio..
*what are the things i can do right now, to increase the weightage of my CV? As i think i should try to have some paper publications and anything else ?
*Is the sub-specialities(Neurosurgery) available directly through USMLE ?
And i would ask subsequently as i get the quiries..
Thanks alot sir.

Last edited by Kirangaikwad7; 02-23-2014 at 05:47 AM.
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