U.S. Medical Residency

The Benefits of a US-Based Clerkship for Foreign Medical Students

No matter where in the world you are earning your medical degree, you have to meet a certain set of core credit requirements — but you also have the opportunity to make choices when it comes to how you earn your elective credits. If you have your sights set on entering a US medical residency program after medical school, fulfilling elective credits with a clerkship in the United States offers a wide range of benefits, from both an academic and a practical standpoint. Read on to learn more about why foreign medical students are choosing US-based clerkships for their clinical electives.

Enhancing Your Academic Experience in Medical School

A clerkship in the United States offers an exciting and challenging academic experience that you can’t always get from the standard electives offered at your medical school. For instance, while you are completing your medical school courses, you may discover a passion for a medical subspecialty in which few physicians in your area have significant expertise. By choosing a US-based clerkship as a clinical elective, you could spend three months gaining hands-on experience with three different Attending Physicians who have dedicated their careers to the subspecialty. This would enable you to explore the subject in-depth and gain real-world experience that you wouldn’t be able to get at your medical school.

Alternatively, if you haven’t yet decided on your subspecialty area, there are clinical clerkships in the United States that empower you to explore three different specialty areas over the course of three months. Again, some of these clinical experiences could be in specialty/subspecialty areas that aren’t available in your area. In a US-based clerkship, you may also have the chance to decide between inpatient and outpatient availabilities — another choice that is not available at every foreign medical school.

Even if your medical school does offer electives in your specialty area of interest, it still makes sense, from an academic standpoint, to complete a US-based clerkship if you plan on applying for a US medical residency program in the future. A clinical elective also offers a real-world introduction to the complexities of the US healthcare system, which is a valuable learning experience for foreign medical students who aspire to enter US medical residency programs. The healthcare system in every country is different, and you can learn a lot about what it truly means to practice medicine in the United States over the course of a three-month clerkship.

Practical Considerations for Your Residency Application

For foreign medical students who are planning to enter a US medical residency program after graduation, earning clinical electives through a US-based clerkship makes even more sense from a practical standpoint. Completing a clerkship does not guarantee that you will be matched to a US medical residency program, but it can give you opportunities that will make you a more competitive candidate and help you throughout the application process. Here are a few of the things you would get to do during a clinical clerkship:

Make connections with US-based Attending Physicians. Some US medical residency programs require at least one Letter of Reference to be written by an Attending Physician in the United States. During a clerkship, you may be able to develop a positive working relationship with an Attending Physician who could potentially write you a letter of reference in the future.

Gain experience in a subspecialty area (or multiple areas) of interest. When you are writing your Personal Statement, you need to be able to lay out a clear set of professional goals and explain why you are a great candidate for a US medical residency program. If you already have experience working in the United States in your specialty or subspecialty area of interest, you can make a much stronger argument.

Start preparing for the USMLE. Before you can apply for a US medical residency program, you need to get certification from the Educational Commission for Foreign Medical Graduates (ECFMG) — and for that, you have to pass the USMLE Step 1, Step 2 – C2, and Step 2 – CK exams. The knowledge and skills you gain in a clerkship can help you prepare for success on these exams.

Learn what it’s like to live in a certain region of the United States. Because the United States is a large country with diverse regions, it is impossible to give a simple explanation of “what it’s like to live in the United States.” During a clerkship, you will have the chance to find out about the lifestyle of a medical resident in a particular location, which may help you narrow down your residency application choices based on regional considerations or a preference for an urban or rural residency program.

FMG Portal offers top-notch US-based clerkships for foreign medical students who want to earn elective credits in the United States. Contact us today to learn more about what makes our programs stand out!

Participating in the SOAP Process: A Guide for Foreign Medical Graduates

The Supplemental Offer and Acceptance Program (SOAP) occurs during Match Week. As a foreign medical graduate looking to enter a US medical residency program, there are two ways in which you might end up participating in SOAP: if you don’t receive any interview offers, or if you find out on the Monday of Match Week that you weren’t matched by the algorithm after submitting your ROL. Read on for more information about each of these situations, and find out what you can expect from the SOAP process in 2018.

Next Steps if You Were Not Offered Interviews

After working hard on your application, it can be disappointing to find out that you were not offered any interviews. However, that does not mean that you won’t be starting a US medical residency program in July. You are still eligible to participate in the SOAP process during Match Week, so there is a still a good chance that you can find a spot in an unfilled program.

If you did not receive any interview offers, the only thing you need to do during the fall and winter is to register for the Main Residency Match. For the 2018 Match, the regular deadline passed on November 30, 2017, but the late registration deadline is February 21, 2018. If you haven’t yet registered, you will need to pay a late fee of 50 dollars, but you can still participate in the 2018 Match. Although the late registration deadline is the same as the deadline for creating a Rank Order List (ROL), it is important to note that you do not need to worry about creating one if you were not offered any interviews, because the algorithm will not match you to a program anyway. All you have to do is get registered and wait for Match Week to arrive!

Participating in SOAP During Match Week

If you did not get any interview offers for the fall or winter, you will know before Match Week that you will be participating in SOAP. However, you might also find out at 11:00 am Eastern Time Monday of Match Week (March, 12, 2018), when the NRMP releases the Main Residency Match results. SOAP begins when the results are released and candidates find out whether or not they got matched. If you find out that you did not get matched, SOAP is your best option.

At 12:00 pm Eastern Time on the Monday of Match Week, you can start preparing your SOAP application in the AAMC ERAS system. It is important to be prepared, because programs can start reviewing your application at 3:00 pm, and they can start contacting you as soon as they receive your application. Communicating directly with a program on the first or second day of the SOAP process can significantly boost your chances of getting matched to an unfilled program, since programs start preparing their SOAP preferences lists at 11:30 am the next morning (Tuesday, March 13). The deadline for programs to certify their preference lists for Round 1 is 11:55 am on Wednesday, March 14.

Five minutes later, at 12:00 pm Eastern Time on Wednesday of Match Week, SOAP participants receive the Round 1 offers. At that point, you have two hours to accept or reject your Round 1 offers, and at 2:05 pm, SOAP Round 2 begins. This time, programs have only 50 minutes to alter and re-certify their preference lists, and you will receive your Round 2 offers at 3:00 pm. Again, you have only two hours to accept the offers, reject, or wait for Round 3 offers.

Programs have all of Wednesday night to alter and re-ceritfy their preference lists, which means that SOAP applicants get their Round 3 offers at 9:00 am on Thursday, March 15, 2018. SOAP ends two hours later (11:00 am Eastern Time), which is the deadline to accept or reject the Round 3 offers. After Round 3, SOAP officially ends.

After Soap: The Post-Soap List of Unfilled Programs

Once SOAP ends, candidates have the opportunity to access the post-SOAP list of unfilled programs. At 12:00 pm Eastern Time on Thursday of Match Week, candidates who have not yet accepted an offer can access the list of unfilled programs, including programs that decided not to participate in SOAP. If you have not yet been matched, you can take a look at the programs on the list and immediately start contacting any program about a possible offer.

Preparing to Participate in SOAP

Clearly, participating in SOAP (or post-SOAP matching opportunities) is a highly a complex process with a tight schedule. In order to be successful, you have to be prepared — regardless of whether or not you were interviewed, since you might find out on Monday of Match Week that you were not matched. Going into Match week, you should have a strong familiarity with the schedule discussed above, and you should be ready to provide programs with an updated CV and other information that shows them exactly why you are an excellent candidate for a US medical residency program.

If you’re a foreign medical graduate looking for success in the matching process, FMG is here to help. From the moment you start considering a US medical residency program to the day you get matched, you can count on our resources to help you through. Contact us today for more information!

Creating Rank Order Lists for the 2018 Residency Match: What Foreign Medical Graduates Need to Know

In an earlier post, we discussed the timeline for the 2018 Residency Match. Even though you have made it through some of the toughest parts of the process — preparing your personal statement and CV, submitting letters of recommendation, and surviving the interviews — there is still work left to do. When the Rank Order List Entry opens (January 15, 2018 — mark your calendar!), you have a little more than a month to create your list and get it certified electronically in then NRMP Registration, Ranking, and Results (R3) System. In order to participate in the 2018 Match, your rank order list must be complete and certified by 9:00 pm Eastern Standard Time on February 21, 2018. Read on to find out what foreign medical graduates need to know about creating and certifying an Rank Order List (ROL).

The Basics of the Rank Order List (ROL)

The Rank Order List (ROL) is the place where you, as an aspiring medical residents, have the chance to provide the NRMP with a list of programs in which you are interested, ranked in order of preference. After residency interviews are complete, candidates and program directors both create ROLs, and the information on the ROLs is used to determine the outcome of the Match.

There are two types of ROLs: primary ROLs and supplementary ROLs. On the primary ROL, you can list categorical, preliminary and/or advanced programs. If you rank an advanced (PGY-2 level) program on your primary ROL, you can also submit supplemental ROLS of preliminary programs that are linked to that advanced program.

Considerations When Creating Your Primary ROL

The NRMP allows candidates to list 20 different programs on the primary ROL and 20 different programs on each supplemental ROL. After that, you have to pay a fee. However, it is important to note that most foreign medical graduates interview with far fewer schools, so you probably do not have to worry about exceeding the limit.

That being said, foreign medical graduates who have ranked a larger number of programs within their preferred specialty have a higher likelihood of getting matched. According to data from the 2016 residency match, the average number of contiguous ranks for matched candidates was 6.3, as compared to 2.5 for those who were not matched.

When creating your primary ROL, you should also consider the competitiveness of the programs to which you are applying. The NRMP recommends that foreign medical graduates apply to a range of programs that vary in their levels of competitiveness.

Another opportunity you may want to consider is ranking programs as a couple with another applicant. If your partner or close friend is also applying to residency programs in the United States, you can link your ROL with that person in order to increase the odds that you will be matched to programs that are in the same geographic area. Whether your partner is another foreign medical graduate or a graduate of a US medical school, ranking programs as a couple can be a great way to ensure that your Match outcome fits with both your career goals and your personal priorities.

Beyond the Primary ROL: Creating a Supplemental ROL

If you included an advanced (PGY-2 level) program on your primary ROL, you need to include a supplemental ROL with a list of preliminary (PGY-1 level) programs. Getting matched in this way would mean simultaneously securing both a preliminary and an advanced position at the same time. This can relieve stress for foreign medical graduates because it guarantees that you will have the opportunity to complete a “full course of training.”

In most cases, the preliminary programs on your supplemental ROL are tied to the geographical location of the advanced program, so your supplemental ROL may look significantly different from your primary ROL. However, you should note that the matching algorithm will only consider your supplemental ROL if you get matched to the advanced program on your primary ROL. If not, the information on your supplemental ROL will not be considered in the matching process.

Finalizing Your ROL(s): The Certification Step

Once you have finished an ROL (either a primary ROL or a supplemental ROL), it must be certified. That means you have to click the “Certify List” button in the R3 system, at which point you will be prompted to enter your username and password. This confirmation should not be taken lightly — when you certify an ROL, you make a binding commitment to enter any program at which you match.

Nevertheless, it is still possible to change an ROL after it has been certified — as long as the February 21 deadline has not yet passed. When you have made a change, you must re-certify the new ROL so that it can be properly processed by the Match algorithm.

Getting matched to a US medical residency program is a long and challenging process, but FMG Portal is here for you every step of the way. Contact us today to learn more about everything we offer!

Important Dates for the 2018 Residency Match

For foreign medical graduates who are looking to be matched to a US medical residency program in 2018, the winter months of waiting for Match Day can feel just as hard as the application process — but you need to remember that there are still a few key deadlines you need to meet. If you are participating in the National Residency Matching Program (NRMP) Main Residency Match in 2018, there are several important dates that you should keep in mind as you look ahead to the new year.

January 15, 2018 — Rank Order List Entry Opens

In less than a month from now, the rank order list entry opens at 12:00 pm Eastern Standard Time. Even though there is another month after that before the rank order list entry closes, it is important to start thinking about your rank order list in advance. That way, you will be able to dedicate enough time to the development of a strong rank order list, and you won’t end up feeling rushed as the deadline approaches.

When you participate in the Main Residency Match, you will submit a primary rank order list that may include a combination of categorical, preliminary, and advanced programs. Depending on your interests and career goals, you may also decide to submit a supplemental rank order list of preliminary programs that are linked to more advanced programs, which would enable you to lock down a PGY-1 and a PGY-2 position at the same time. It is important to take the time to explore these options before and during the period in which the rank order list entry is open.

As we discussed in an earlier post, the number of programs on your rank order list may also matter if you are a foreign medical graduate. According to data collected by the NRMP after the 2015 Main Residency Match, foreign medical graduates who ranked a larger number of programs within their preferred specialty area were more likely to be matched within that specialty area. Specifically, the average number of contiguous ranks for those who were matched was 6.3, as compared to only 2.5 for those who were not matched.

The NRMP also advises foreign medical graduates to include a combination of more-competitive and less-competitive programs on their rank order lists. Right now is a great time for you to start exploring the options and considering the competitiveness of your programs of interest, while also accounting for personal considerations, like institution locations. That way, by the time January 15 rolls around and the rank order list entry opens, you will already have a solid list of programs in hand.

February 21, 2018 – Three Major Deadlines

Five weeks after the rank order list entry opens on January 15, you need to have your list finalized. At 9:00 pm Eastern Standard Time on February 21, 2018, all rank order lists must be certified. Make sure yours is in by the deadline!

That same date — February 21, 2018 — is also the late registration for the 2018 Main Residency Match. The regular registration deadline was November 30, 2017, but if you missed it, you still have the opportunity to participate. Unfortunately, you have to a late fee of 50 dollars alongside the regular registration fee, but that is a relatively small price to pay if you are truly committed to pursuing a US medical residency in 2018.

This deadline also applies to Match withdrawals. If you elected to participate in the 2018 Main Residency Match but want to withdraw your application for any reason, you have to do so by February 21, 2018. Withdrawing your application from the Main Residency Match is a serious decision, considering all of the hard work you have already put into the residency application process, so you need to make sure you give yourself enough time to fully consider your options before the withdrawal deadline arrives.

Match Week: March 12 – March 16, 2018

Match Week starts on Monday, March 12, with the start of the Supplemental Offer and Acceptance (SOAP) program. At 11:00 am Eastern Daylight Time, you will find out whether you got matched. If not, you can participate in the SOAP until it concludes on Thursday, March 15.

Friday, March 16, 2018, is the day you’ve been looking ahead to for months — Match Day! At 1:00 pm Eastern Daylight time, Match results are sent to applicants by email and posted in the R3 system. On that day, you will find out if you made it into the program of your dreams and are on your way to a US medical residency program in July 2018.
If you’re a foreign medical graduate looking to make that dream a reality, FMG Portal is here to help you at every step of the process. Contact us today for more information about what we offer!

More Lessons from the 2016 Residency Match Data: Are Outside Experiences Important?

Last week on the blog, we discussed the NRMP report on the outcomes of foreign medical graduates in the 2016 Main Residency Match. To create this report, the NRMP tracked the rates of match success for foreign medical graduates based on a number of key measures, such as program ranking choices and test scores. As we mentioned in last week’s post, there are clear lessons that you can learn from the data on ranking choices and test scores as a foreign medical graduate preparing for a U.S. medical residency.

However, when it comes to the report’s information on foreign medical graduates’ outside experiences, the implications of the raw data are less clear. Read on for more about how you can understand the numbers and apply the information to maximize your chances of match success as a foreign medical graduate.

Statistics on the Outside Experience of Matched and Unmatched Foreign Medical Graduates

As a foreign medical graduate, you might find yourself asking the question of whether or not it is important for you to get outside research and/or work experience before you apply for a U.S. medical residency program. At the outset, the data in the NRMP report doesn’t seem to provide much help in answering that question. For all the different types of outside experiences that the NRMP measured, the average numbers for matched and unmatched foreign medical graduates was almost exactly the same. Consider the following statistics:

For foreign medical graduates who were matched in 2016, the mean number of research experiences was 2.2. For those who were unmatched, the mean number of research experiences was also 2.2.
For unmatched foreign medical graduates, the mean number of abstracts, presentations, and publications was 6.4 — slightly higher than the same statistic for matched candidates, which was 6.1.
The mean number of work experiences was 5.3 for matched foreign medical graduates and 5.5 for unmatched candidates.
For foreign medical graduates who were matched, the mean number of volunteer experiences was 3.5, as compared to 3.4 for candidates who were unmatched.

When you look deeper into the data and examine these same statistics broken down by specialty area, the numbers only get more confusing. For some specialty areas, the mean number of experiences reflects the overall average — about the same for matched and unmatched candidates. There are only a few where the average number for matched candidates significantly outweigh those for unmatched candidates. There are even some specialty areas where the average number of experiences is considerably higher for unmatched applicants.

What the Statistics Mean for You as a Future US Medical Residency Applicant

Considering these statistics can be daunting for foreign medical graduates. Based on the data, it just isn’t clear whether having more outside experiences — or any at all — can truly help you in the matching process.

One of the reasons why it is so hard to draw conclusions from the data is that averages are prone to skewing. Consider the data for abstracts, presentations, and publications. While the average for both matched and unmatched candidates was around 6, nearly 40 percent of the of the applicant pool of foreign medical graduates in 2016 had no publications at all. This indicates that certain applicants are skewing the data, so if you have less than 6 publications, it doesn’t mean you fall short of the “average” applicant.

Ultimately, the main takeaway from the NRMP data about outside experiences is that the number of outside experiences you have does not really matter. What matters is the quality of the outside experiences — and your ability to illustrate that quality on your application. An outside experience can be worthwhile if you can weave it into your personal statement — writing about how it has prepared you for your residency and how it has influenced your career goals — or if you can get a letter of recommendation from a supervisor or mentor who can speak to your excellent performance during the outside experience. Otherwise, if the outside experience is just a line item on your CV, it probably won’t make much of a difference for whether or not you end up getting matched.

Thus, one of the best options for an outside experience is a clinical externship in the United States. Completing a clinical externship in the United States is ideal because it shows residency programs that, as a foreign medical graduate, you are already comfortable working in a clinical setting in the United States. After completing a clinical externship, you may also be able to get a letter of recommendation from an attending physician in the United States, which is preferred (or even required) by many U.S. medical residency programs.

If you’re interested in completing a clinical externship before you apply for a U.S. medical residency program, FMG Portal offers 3-month and 6-month externship options in a wide range of specialty areas. Contact us today for more information!

Lessons for Foreign Medical Graduates from the 2016 Main Residency Match

During the 2016 residency matching process, the National Resident Matching Program (NRMP) monitored the outcomes for all graduates of foreign medical schools. Specifically, they kept track of match success, specialty preference, ranking information, and applicant characteristics. The data they collected provides valuable information for future applicants. If you are a foreign medical graduate looking to apply to a U.S. medical residency program in the future, there are several key lessons that you can take away from the NRMP report.

Program Ranking Choices: The More the Better

The NRMP report can be particularly helpful if you are a foreign medical graduate trying to figure out how to best to rank programs on your application. According to the NRMP, foreign medical graduates who were successful in matching to their preferred specialty were more likely to have ranked a larger number of programs within their preferred specialty. Specifically, the NRMP reports that, on average, foreign medical graduates who were matched had longer lists of contiguous ranks than those who were not — 6.3 continuous ranks for matched foreign medical graduates, as compared to only 2.5 for those who were not matched.

As a foreign medical graduate, you might be tempted to limit the number of programs you rank within your top-choice specialty area and add a greater number of programs in non-preferred specialty areas that you think will be easier to get into. While the NRMP does recommend applying to a mix of competitive and less-competitive programs, the data suggests that applying to more programs within your specialty area of interest could increase the odds that you will be matched at all. Instead of spending your time trying to locate the less-competitive programs, you should focus on polishing your application show that it demonstrates that you are truly passionate about the your top-choice specialty area.

At the same time, if you do plan to apply to a particularly competitive specialty, it can be helpful to identify an alternative specialty and rank your preferred programs within that specialty area, according to the NRMP. Based on the data, whether or not you choose to do this will probably not have a significant effect on your odds of getting matched. The mean number of distinct specialties ranked by foreign medical graduates who got matched in 2016 was 1.3, whereas the mean was 1.4 for those who were not matched — practically no difference at all. So you shouldn’t be worried that identifying an alternative specialty will reduce your odds of getting matched.

The Importance of Test Scores

Another key takeaway from the NRMP report is that there are two tests that can make a significant difference in determining whether or not you get matched: the USMLE Step 1 and the USMLE Step 2 CK. For both of these exams, the average score for foreign medical graduates who were matched was substantially higher than the average for those who were not matched. It is also important to note that, among the foreign medical graduates who were matched, those who matched to their preferred specialties had higher scores, on average, than those who matched to programs in non-preferred specialty areas.

On the USMLE Step 1, the mean score for foreign medical graduates was 233.8, with a standard deviation of 17.0. The NRMP notes that this is “well above” the minimum passing score in 2016, which was 192. Similarly, on the USMLE Step 2 CK, the mean score for foreign medical graduates was 238.8, with a standard deviation of 15.6. Again, this was considerably higher than the 2016 minimum passing score of 209.

Looking at this data, there are a few key lessons for foreign medical graduates. Most importantly, it makes sense to dedicate a lot of time and energy to studying for the USMLE Step 1 and USMLE Step 2 CK exams. However, if your scores aren’t as high as those reported above, don’t despair! The data are all based on averages, and there are lots of other places in your application where you can make up for a lower score and show that you are ready for success in a US medical residency program.

Also, even though the data shows that the USMLE Step 1 and Step 2 CK can significantly impact the matching process for foreign medical graduates, you should not forget the importance of the USMLE Step 2 CS. It may not play as large a role on your application, but it is still considered by application readers. Moreover, it is essential for ECFMG certification, so you need to make sure you are ready to pass when test day arrives. Similarly, if you make the choice to take the USMLE Step 3 before you begin your residency, you need to make sure that you are well-prepared so that your score reflects your knowledge and abilities in the field of medicine.

As 2017 comes to a close and the 2018 residency match draws near, FMG Portal is here to help! Contact us today to learn more about what we offer!

Preparing for the USMLE Step 3 Exam Before Your Residency

Last week on the blog, we went over they key questions you need to ask yourself when deciding whether or not to take the USMLE Step 3 before you apply to a US medical residency program. Unlike the USMLE Step 1, Step 2 CK, and Step 2 CS (which we have also been discussing in recent weeks), the USMLE Step 3 is not required for ECFMG certification or for success in the residency application process. However, as mentioned in the previous blog post, you may consider it as an option, depending on your circumstances.

If you have made the decision to take the USMLE Step 3 before applying for your residency, there is nothing more important than ensuring that you are well-prepared to ace the exam on test day. There are several key reasons why:

If you fail the exam, the attempt appears on your transcript, which may cause concern for admissions officials when they review your application.
Some post-residency fellowship programs consider your USMLE Step 3 score as one of the factors in the admissions process.
If you are taking the exam in order to qualify for an H1-B Visa sponsorship, you need a passing mark.

Given these high stakes, it is essential to make sure you are ready before you take the USMLE Step 3. Read on to learn more about the basics of the exam and what you should do to get ready.

The Basics of the USMLE Step 3

The USMLE Step 3 is the last test in the sequence of exams that you need to pass to gain a license to practice medicine in the United States. It is a two-day exam that is designed to determine if you have the biomedical knowledge and clinical skills you need for success as a physician. The test includes both multiple-choice questions and computer-based case simulations.

On day 1, you take the USMLE Step 3 Foundations of Independent Practice (FIP) exam. This part of Step 3 lasts for seven hours and consists entirely multiple-choice questions. It is divided into six 60-minute blocks (38-40 questions per block), with short breaks in between blocks.

Much of the content on the exam is presented as patient case studies, but some of the items also ask you to interpret medical research abstracts or pharmaceutical advertisements. Some of the topics that are covered include:

Applications of basic biomedical science
Understanding of biostatistics, epidemiology, and population health
Communication abilities and interpersonal skills
Medical ethics
Systems-based practice
Patient safety
Knowledge of history and physical examination
Interpretation of diagnostic studies

On day 2, you take the USMLE Step 3 Advanced Clinical Medicine (ACM) exam. This part of Step 3 lasts for nine hours and consists of a mix of multiple choice questions and computer-based case simulations. It starts with six 45-minute blocks of multiple-choice questions (30 questions per block), followed by 13 case simulations (each of which lasts between 10 and 20 minutes).

On the computer-based case simulations, you will be evaluated on your performance in two settings: an office / health center and an emergency department / inpatient facility. For the multiple-choice questions, there are some areas of content overlap between the FIP and the ACM, but the main difference is that the ACM focuses much more heavily on diagnosis and management. You can expect to be tested on:

Prognosis and patient outcome
Health screenings
Health maintenance strategies
Therapeutics
Decision-making in the clinical setting
Knowledge of history and physical examination
Interpretation of diagnostic studies

Getting Ready for the USMLE Step 3 Before Your Residency Program

In order to do well on the USMLE Step 3 before starting your residency program, there are two main things you need to do:

Ensure that you have comprehensive understanding of the content of the exam.
Familiarize yourself with the format and the question types.

The USMLE website offers a comprehensive overview of the USMLE Step 3, as well as practice questions for the computer-based simulations. You can also find a variety of other study aids on the internet. Most of the content should be familiar from medical school and any clinical experience that you may have had — like a student elective or a graduate externship experience — but it is extremely important to familiarize with the test specifications so that you will be ready to apply your knowledge!

Even after you start studying, you should remember that you can always decide to wait to take the USMLE Step 3 until after you start your residency program. After all, in most programs, you have until your third year to pass the exam. If you start studying and realize that you do not have enough time to study for the exam and prepare a stellar US medical residency application, it’s probably better to wait. And you won’t really have wasted time, because any studying you did do will only benefit you when you take the USMLE Step 3 as a medical resident!

Need more help with the US medical residency application and preparation process? Contact FMG Portal today!

Deciding Whether to Take the USMLE Step 3 Before Your Residency Program

In the last few posts, we have talked about the USMLE Step 1, Step 2 CK, and Step 2 CS. In order to get ECFMG certification, you need to have passed all three of these exams. These three exams are also the prerequisites for the USMLE Step 3 exam, which you need to pass in order to earn a license to practice medicine in the United States. As a foreign medical graduate, you have the option of taking the exam before submitting your application to a U.S. medical residency program or taking it after your residency has started. Depending on your personal situation, there are benefits and drawbacks to both approaches. Here three critical questions you need to ask yourself when making this decision:

Question 1: Do you have enough time to prepare for and take the USMLE Step 3 before applying to a residency program?

Before you take the USMLE Step 3, you already need to have passed the USMLE Step 1, Step 2 CK, and Step 2 CS. As a foreign medical graduate, you also need to have fully completed the ECFMG certification process. Your timeline for meeting these requirements can help you determine whether or not you want to take the USMLE Step 3 before you apply for your residency. You need to remember that preparing a successful residency application takes a great deal of time and effort, and you don’t want to rush through it because you are trying to study for the USMLE Step 3 at the same time — not to mention balancing the residency application process with the other responsibilities in your life.

However, if you have completed the requirements well in advance and feel like you have more than enough time to prepare yourself for success on the USMLE Step 3 before applying for your residency, it can reduce pressure once you start your residency. In most states, you need to pass Step 3 before the third year of your residency program, which can be a challenge as you balance residency program requirements, personal responsibilities, and adjusting to life in the United States. So if it’s easy to fit the USMLE Step 3 into your schedule before you apply for a U.S. medical residency, you may want to consider it.

Question 2: Do you have the medical background you need for success?

Like the USMLE Step 1 and Step 2 CK, the first part of the USMLE Step 3 consists entirely of multiple choice questions. The second part is somewhat similar to Step 2 CS — it tests your clinical skills, but instead of interacting with real-live patients, your performance is evaluated on a series of computer-based case simulations.

But don’t be fooled by these structural similarities. The USMLE program recommends that applicants have completed at least one full year of post-medical school training before taking the Step 3 exam. Therefore, many American and foreign medical school graduates use the first year of residency training as preparation for the USMLE Step 3.

However, some foreign medical graduates who apply for U.S. medical residency programs have already gained additional educational or work experience after medical school. For instance, you may have completed a post-graduate education program in your home country and/or completed a graduate externship in the United States. If that is the case for you — and you did well on the USMLE Step 1, Step 2 CS, and Step 2 CK — you may have the foundation you need for success.

Question 3: Are there logistical issues that you need to consider?

In some cases, whether or not you take the USMLE Step 3 before applying to a U.S. medical residency program can come down to logistics. These three logistical issues commonly come into play:

Immigration status. In order to apply for an H1-B Visa sponsorship, you need to have passed the USMLE Step 3. If you plan to apply for this type of visa, you should plan to take the USMLE Step 3 before applying.
Cost. The USMLE Step 3 can be cost-prohibitive for some students. If you can’t afford the $875 fee, you should wait until after you can save some money from your first year of residency work.

Location. The USMLE Step 3 is only offered at Prometric test centers in the United States and its territories. If traveling to the United States from your location is too expensive or difficult, you should probably just wait until you start your program. Alternatively, if you are already in the United States — whether for a graduate externship, to visit family, or to see the sights — it may be convenient to take the test.

If you need more help making decisions about the residency application process, FMG is here to help. Contact us today for more information!

Question Types on the USMLE Step 2 – CK: What You Need to Know

When you are preparing to take the Clinical Knowledge component of Step 2 of the U.S. Medical Licensing Exam — also known as the USMLE Step 2 – CK — your success depends on your familiarity with two things: the content on which you will be tested and the format of the exam. In a previous post, we provided a general overview of the exam that included a description of both. Today, we’re going to do a deep dive into the formatting of the questions you will find on the USMLE Step 2 – CK. That way, on test day, you won’t be surprised by any of the questions you come across.

When it comes to formatting, there are two different ways you can divide up the questions on the USMLE Step 2 – CK. You can divide the questions between Single-Item Questions and Sequential Item Sets, or you can divide them between Patient Vignette questions and Abstract Format questions. Read on to learn more about the different types of questions you will find on the USMLE Step 2 – CK.

Single-Item Questions vs. Sequential Item Sets

If you take the USMLE Step 2 – CK after you take the USMLE Step 1 (which is the way most foreign medical graduates do it, although it is not required), you will recognize the Single-Item Question format. And even if you haven’t taken the USMLE Step 1 yet, the Single Item Question format will be familiar because it is exactly what you would expect from a multiple choice question: a short text background followed by a single question. Pretty simple.

The one thing that does distinguish the Single-Item Questions from traditional multiple choice questions you might have seen at other points in your education is the formatting of the answer options. There can be as few as 3 answer options or as many as 26. They are lettered (A, B, C, D, etc), and the options are arranged in either alphabetical order or logical order. It is important to note that some of the options might be partially correct, but you can only select one, so you have to choose the best possible answer.

When it comes to question formats, the primary difference between the USMLE Step 1 and the USMLE Step 2 – CK is that the latter exam also contains sequential item sets. That means that a single text — that is, either a Patient Vignette or an Abstract (both of which we will get to later) — must be used to answer either two or three consecutive questions, instead of just one. Like the Single Item Questions, these questions are multiple choice questions with 3 to 26 possible options, and you have to choose the single best answer.

Although each question in the Sequential Item Set directly relates to the text, they are designed to test your knowledge of different aspects of the text. Also, it is important to note that they are designed to be answered in sequential order, so a question may build on the one preceding it. Because of this design element, you will not be able to change your answer to an earlier question after you click the button to move on to the next question.

Patient Vignette Questions vs. Abstract Format Questions

The majority of the questions on the USMLE Step 2 – CK are Patient Vignette questions. The Patient Vignettes provide an overview of a clinical situation that you might encounter in your practice as a physician. Then, you are asked one or more multiple-choice questions about it (depending on whether it is associated with a Single-Item Question or a Sequential Item Set). For instance, you might be given a brief medical history of a patient followed by a description of an abnormal test result and then asked to identify the most likely cause of the result.

While the Patient Vignette questions test your ability to apply your knowledge and skills to clinical situations, the Abstract Format questions examine your ability to understand and interpret information from clinical investigation. Each of these items consists of a summary of an experiment or investigation in the form of an abstract — the kind you would find for a peer-reviewed research study published in a medical journal. It is essential for doctors to be able to read, understand, and analyze abstracts in order to effectively engage in evidence-based practice.

On the USMLE Step 2 – CK, you will be required to interpret an abstract in relation to various relevant topics. For instance, you may find questions about:

Biostatistics and epidemiology
Pharmacology and therapeutics
How to use diagnostic studies in clinical practice
How to use the information from the abstract to make decisions about care for an individual patient

Every step of the US medical residency application process — including the three Steps of the USMLE — can be challenging for foreign medical graduates, but FMG Portal is here to help. Contact us today for more information about our services!

Preparing for the Two Types of Patient Encounters on the USMLE Step 2 CS

Last week on the blog, we talked about the United States Medical Licensing Examination (USMLE) Step 2 – Clinical Skills (CS). In order to earn ECFMG certification, which is required for all foreign medical graduates who are applying for a residency in the United States, you need to pass all three steps of the USMLE. The USMLE Step 2 – CS tests your ability to perform professionally and effectively in clinical settings.

After the On-Site Orientation to the exam, you will be faced with twelve patient encounters. Each encounter will last for fifteen minutes. Most of the encounters will be Standardized Patient & Physical Examinations, but some of them will be Telephone Patient Encounters. Read on to learn what you can expect — and what is expected of you — in each of these two types of encounters.

The Standardized Patient & Physical Examination

In the Standardized Patient encounters, you will meet with a live patient. Within the fifteen-minute encounter, the you will be expected to do three things: come up with a preliminary diagnosis (or several diagnoses) for the patient, develop a basic work-up plan, and establish a positive and effective relationship with the patient.

In order to make the correct diagnosis and propose an appropriate treatment plan, you will need to utilize multiple strategies, including:

Asking the patient questions about their current condition
Asking the patient questions about their medical history
Conducting a physical examination

However, because you only have fifteen minutes available for each patient encounter, you will not have time to get a complete picture of the patient’s medical history or even conduct a comprehensive physical examination. Instead, you have to be strategic and pursue the most promising leads as you obtain more information from the patient.

However, coming up with the correct diagnosis and an adequate preliminary treatment plan is not the only thing you are being evaluated on when you take the USMLE Step 2 – CS. You also need to demonstrate your professional and interpersonal skills. That means relating well with the patient and establishing a good rapport, regardless of the time pressure. Some of the keys to earning a good score include:

Speaking to the patient in a courteous manner
Exhibiting empathy toward the patient
Responding appropriately to the patient’s questions, comments, and body language
Maintaining an awareness of the patient’s modesty during the physical examination

The Telephone Patient Encounter

In the United States, telemedicine — that is, the provision of remote clinical services, often by phone — is becoming increasingly common. Through some telemedicine platforms, it is possible for a patient to call a doctor from their home to discuss a medical issue without having to come to a clinic. In other cases, a physician might talk on the phone to a patient who is at a medical facility where staff and services are limited, such as a clinic in a rural area. As the prominence of telemedicine grows, a doctor’s ability to communicate effectively with patients on the phone is an ever more relevant skill — which is why it is important to perform well on the Telephone Patient Encounters on the USMLE Step 2 – CS.

For the Telephone Patient encounters, the general expectations are the same as they are for the Standardized Patient encounters. Specifically, you are expected to develop a basic diagnosis and treatment plan, and you need to communicate with the patient in an appropriate, effective, and caring manner. The main difference between the two types of encounters is that it will not be possible for you to perform a physical examination during the Telephone Patient encounters. Instead, you will have to rely solely on oral communication with the patient. This can may seem like a major obstacle but rest assured that the USMLE Step 2 – CS is designed so that the Telephone Patient encounters are challenging — but not impossible. Still, as long as you can quickly assess the relevant information and identify the most promising leads, you can come to a conclusion that will earn you a passing score.

The Patient Note

After each one of the twelve patient encounters — including both the Standardized Patient Encounters and the Telephone Patient encounters — you will have ten minutes to write a patient note. The content of the note is expected to be the same as what a practicing physician would write in a patient’s medical record after an in-person or telephone meeting. Just like the patient encounters, you will be under pressure to complete the note within the allotted time, but if you finish a patient encounter early, you will have extra time to write the note.

Ultimately, success on the USMLE Step 2 CS is one of many steps on the way to getting matched to a U.S. medical residency. For more help with the process, contact FMG Portal today!

Category: U.S. Medical Residency