Ranking and Marketing: Getting a Residency Match as a Foreign Medical Graduate

Registering for The Match through the NRMP begins September 15, 2018. International Medical Graduates (IMGs) should have ECFMG certification in progress, as it is due by the rank order list deadline of February 20, 2019. The ECFMG provides the NRMP with confirmation that USMLE exams have been passed and that applicants are eligible for The Match. It serves as a Dean’s office for all foreign students to ensure that they meet the standards to qualify for a residency program.

The Match

The NRMP facilitates the ranking and placement of medical students into residency programs, but they are not in charge of program requirements or supported visa types. Applicants to each program must pay careful attention to whether or not the program accepts IMGs and the deadlines for sponsoring visas if applicable. The majority of residencies participate in the NRMP, but it is not a requirement.

Do IMGs have less opportunity for a match?

Foreign medical graduates have a history of obtaining less first-year residency matches than U.S. medical graduates, but the numbers are improving. First-year residency matches went from a 53.3% match rate in 2017 to a 56.5% match rate in 2018. This rate has been steadily increasing over the past decade.

The reasons for the lower number of first-year residency matches may not be warranted, but they still exist. Some program directors may have unfounded judgements about the quality of training abroad, but this is a stigma based on archaic thinking rather than facts. A more reasonable explanation may be that international programs differ from U.S. programs, so they are difficult to compare. Transcripts and academic achievements from different countries with different curricula are challenging to fully understand because they differ from the standard U.S. curriculum. While this creates a challenge to obtaining a match, it also opens a window of opportunity to market oneself during the application and interview process.

Market your Abilities and Stand Out Above the Rest

Applications are a starting point to combat any biases that may emerge during the application process. Program directors need to know that an applicant has proper training, skill and experience. A high score on the USMLE may be the first thing evaluated on an application from an IMG, but there are additional ways to stand out. Another way to stand out is by submitting letters of recommendation by U.S. doctors with whom an applicant has worked closely. Letters that clearly explain clinical abilities and provide examples of it will have a big impact on program directors. Supporting documents such as letters of recommendation and transcripts will be transmitted to ERAS applications through ECFMG.

A second way to improve the odds of a match is aggressive marketing. Applying to many schools is one tactic to increase odds, but 5 to 10 top picks deserve extra attention. Contact program directors and coordinators of these programs for introductions and tips prior to the interview. Those who wrote letters of recommendations may also contact program directors and give verbal recommendations. Ultimately, when applicants make themselves present in the lives of the people in the program, their applications become more meaningful, which increases the odds of a match.

Ranking Strategies

There are many strategies for ranking residencies for The Match. The ECFMG instructs applicants to rank them in the order in which they most want to attend them, which exercises the full purpose of the Match but may not yield a match. A quick internet search will provide lists of IMG-friendly specialties. Applying based on this may not be the best option for long-term career choices. There is not one clear-cut method that will guarantee a match, but some recommend a mix of high-competition residencies and low-competition residencies to improve the odds. Others recommend applying to as many residencies as possible. While one ranking strategy may work for some and not others, the application process combined with smart ranking choices will yield more positive results for Foreign Medical Graduates.

Rank Order Lists

Twenty programs are allowed to be listed on the rank order list (ROL), and 20 more can be listed on the supplemental ROL. Extra fees can be applied to place more programs on the ROL, but there can be no more than 700 listed for one applicant. The deadline for certification is 9 p.m. February 20, 2019. No changes can be made after this time, and matches are binding.

The Foreign Medical Graduate Prospective

As mentioned previously, the matches among foreign medical graduates are growing in number. Physician shortages and increased knowledge sharing from organizations such as the ECFMG are facilitating matches by matching the need for more providers with the surety that applicants are trained and skilled in their profession. It is a difficult process for all medical students and graduates, but it is a process that can be a success if a person provides proper evidence of their education and skill through documents and interviews.

Need help with residency placement? Contact us today!

Understanding the Differences between the ERAS and the NRMP

For foreign medical graduates, there’s no denying the complexity of the process of landing a position in a US medical residency program. From the day you start brainstorming your personal statement to the final hours of Match Week, it is essential to make sure that you stay on top of all the requirements and check all of the necessary boxes so that you can end up in the program of your dreams. One of the things that can initially be confusing is the fact that there are two separate organizations that are heavily involved in the overall process of landing a US medical residency: the ERAS and the NRMP. Read on to learn about the role that each of these organizations plays in the process as you go from a foreign medical graduate to a US medical resident.

The Key Distinction between the ERAS and the NRMP: A Question of Purpose

As you try to land a US medical residency, you will work with both the Electronic Residency Application Service (ERAS) and the National Resident Matching Program (NRMP). Perhaps the most significant distinction between these two organizations is that they differ in their fundamental purpose. Specifically, the ERAS is the system through which you will submit all of your residency application materials, while the NRMP is the organization that facilitates the actual matching process, once all of your documents have been submitted to your programs of interest.

From a practical perspective, this means that you’ll be focusing primarily on ERAS requirements during the first part of the process, while the NRMP takes over during the second half. With the ERAS, your goal is to make sure you get all of your application materials into the system so that they are sent out to the programs of choice–complete and on time. Once the programs have evaluated these materials and you have had the chance to interview with interested programs, the NRMP facilitates the creation and submission of ROLs, and it generates the results that you end up receiving at the start of Match Week, and it coordinates the SOAP process until the final results are announced on Match Day.

Comparing the 2018-2019 ERAS and NRMP Timelines

Because the ERAS and the NRMP are two different organizations, they operate on two separate  timelines. They have different registration start and end deadlines, and they separately set other key dates as well. If you are looking to participate in the 2018-2019 application and matching process–that is, if you want to start your US medical residency program in July 2019–it is important to be familiar with the schedules of both the ERAS and the NRMP for the 2018-2019 season.

The ERAS 2018-2018 timeline is already underway. It started on June 7, 2018, when it first became possible for applicants to register on MyERAS and start preparing their US medical residency applications. If you haven’t started the registration process, now is the time. In less than a month–on September 5, 2018–applicants can start sending their applications to ACGME-accredited residency programs through the ERAS system. These programs start receiving the application materials ten days later, on September 15, 2018

Conveniently, that date coincides with the start of the 2018-2019 NRMP timeline. At 12:00 p.m. Eastern time on September 15, 2018, applicants for 2019 US medical residency programs can register with the NRMP. Registration remains open for the next two and a half months, until 11:59 p.m. Eastern time on November 30, 2018. After that date, candidates are required to pay a late fee alongside their main registration fee.

The last important date for the ERAS is October 1, 2018–the day that Medical Student Performance Evaluations (MSPEs) are released to residency programs. That means you have to be absolutely sure that your medical school has submitted your MSPE by that date. Alternatively, as a foreign medical graduate, you may need to submit the MSPE yourself, so you should make sure that you are ready to meet that deadline.

After that, no more documents will be submitted through the ERAS. However, the MyERAS 2019 season technically continues alongside the matching process facilitated by the NRMP. As a result, MyERAS will remain open until May 31, 2019, so you’ll always have easy access to your documents if you need them.

As the role of the ERAS essentially ends in the fall, the NRMP basically takes over in the winter and early spring, which means there are a series of important dates you need to be aware of in the lead-up to Match Day. First, on January 15, 2019, Rank Order List (ROL) entry opens at 12:00 p.m. Eastern time, and candidates have until 9:00 p.m. on February 20, 2019, to certify their ROLs. Match Week begins on March 11, 2019, when candidates find out if they got matched and the Supplemental Offer and Acceptance Program (SOAP) opens for those who did not. It all ends on Match Day–March 15, 2019–which marks the end of the NRMP timeline.

The Bottom Line: ERAS vs NRMP

The bottom line for foreign medical graduates is that the ERAS and the NRMP differ in both their purpose and their timelines, but understanding and working effectively with both organizations is essential for landing the residency position of your dreams. FMG Portal is here to help you with all of your needs when it comes to the residency application and matching processes. Contact us today to learn more about all of our services for foreign medical graduates!

The Value of Mentorship for Foreign Medical Graduates


Once you have earned your medical degree, you might not be sure if you really need another mentor in your life. After all, throughout your academic career and early professional experiences, you’ve probably already had countless mentors–from your kindergarten teacher to your high school sports coach to your favorite college professor to the dean of your medical school. However, as a foreign medical graduate looking to get matched to a US medical residency program, you can still benefit from the mentorship of an attending physician in a graduate externship experience. Here are a few of the top reasons why:



  • A mentor can familiarize you with their particular specialty area.


When you apply for a US medical residency program, you need to be ready to show the program that you are truly committed to the specialty area that you have selected. A mentor can offer insight on specialty (and subspecialty) areas that goes far deeper than what you experienced during your rotations in medical school. As a result, when it comes time for you to apply, you’ll have a better sense of what you do (and don’t) want from your medical career. For instance, a mentor may have done a residency in internal medicine before choosing a more specific subspecialty for their fellowship, like infectious disease, and they can help you learn about both–and decide which one is right for you, or whether you want to pursue something else altogether.




  • A mentor can help you with professional networking.


If you decide you want to pursue the same specialty or subspecialty as your mentor, they can help connect you with top clinicians and researchers in the field. Alternatively, if you want to go in a different direction, a mentor may already have a broad network that can help you access the resources you need.



  • A mentor can help you get “back in the game” if you have taken time off after medical school.


More than ever, foreign medical graduates are choosing to take time off to work or start a family before shooting for a US medical residency. As a result, it can sometimes be challenging to jump straight back into a clinical setting. The guidance of a mentor in a graduate externship program can help smooth the transition, so you’ll be well-prepared and ready to go when you finally get matched to a US medical residency program.



  • A mentor can help you understand what it means to be a true medical professional.


You might not realize it, but when it comes to professionalism, there are important differences between being a medical student and being a practicing physician. Once you’re a medical resident, you’ll have more responsibilities, which means you’ll be held to higher standards of conduct. Before you start your US medical residency program, you need to be ready for the change, and a mentor can help you rise to the challenge by modeling professional behavior and offering their honest perspective on what it means to be a professional physician. This guidance can help you smoothly make the professional transition from medical student to medical resident.



  • A mentor can help you get a better idea of what your life outside of work would be like as a physician in their specialty area.


Your relationship with a mentor during your graduate externship is fundamentally a professional one, but that doesn’t mean you won’t have conversations about everyday life. In fact, a mentor can be a great source of information about what day-to-day life looks like for a professional in their specialty area. For instance, they may be able to help you understand how they make time in their schedule for family and/or recreational activities. A mentor may also be able to offer insight on lifestyle opportunities in particular regions of the United States, which can be helpful if you’re not familiar with the different parts of the country.



  • A mentor can be a valuable asset in the residency application and matching process.


Today’s US medical residency application process is increasingly competitive, so you need to be ready to capitalize on your strengths and compensate for your weaknesses. After spending months working with you during a graduate externship, a mentor can often offer you frank advice on the strengths you should highlight in your application and the areas you should try to improve on in the future. Depending on your relationship, a mentor may also be able to advise you on program selection, help edit your personal statement, and/or write you a letter of recommendation, all of which can be invaluable as you try to land the residency of your dreams!


FMG Portal offers graduate externships around the country for foreign medical graduates who want to get matched to a US medical residency program. We also provide assistance throughout the application and matching process. Contact us today for more information about all of the services we offer!


Questions to Expect in Your US Medical Residency Interview: A Guide for Foreign Medical Graduates


When it comes to your interview for a US medical residency program, it’s important to be prepared. Not only do you want to have a good idea of what to expect in terms of the interview day schedule–as we discussed in the previous post–but it can also be helpful to know what might be coming when you go into the formal interviews themselves. Although the specific interview questions can vary between programs (and between individual interviewers within a single program), there are certain questions that you’re probably going to be asked. Read on for a list of the most common questions and some ideas on how you might approach them in your US medical residency interview.

Common Interview Questions for Foreign Medical Graduates

As a foreign medical graduate, here are a few of the US medical residency interview questions that you are most likely to be asked:

  • Can you tell me a little bit about yourself?

This is the standard opening question for a US medical residency interview, and it can help set the stage for your whole conversation. When you’re responding, your goal is to be informative, but succinct. You should provide a brief personal and educational background (where you grew up and went to medical school), as well as a short description of how you got interested in medicine, but you don’t need to go into too much detail. After, all, you don’t want to start giving answers to questions that might be asked later in the interview and end up repeating yourself.

  • Why do you want to do your medical residency in the United States?

This is a question that only foreign medical graduates get asked, and your answer can help you stand out from the other candidates. Your interviewer will probably be genuinely interested in what brought you to this decision, so you should be ready for it.When faced with this question, it is important to be honest because there is no “right” answer. The most important thing is to offer a thoughtful, well-reasoned response that tells the interviewer a little more about you and your goals. If possible, try to tell an illustrative story that highlights the factors that played into your decision. .

  • What do you envision yourself doing after completing your residency?

As you answer this question, it is especially important to remember to avoid a “canned” response: make sure you aren’t just listing the professional goals from your personal statement. The interview gives you the opportunity to expand on what you wrote and offer a more personal perspective. Whether you dream of advancing your career in the United States or hope to eventually return to the country where you completed medical school (or another country altogether), you want to show your interviewer that you have clear goals and a high level of motivation to achieve them.

  • Why are you interested in this particular specialty area?

With this question, you have two objectives: to show that you are well-informed about your chosen specialty area and to demonstrate your genuine passion for the field. It offers an excellent opportunity to expand on some of the specialty-related experiences that you listed on your CV, such as student electives and graduate externships. In the interview, you have the chance to explain to your interviewer how meaningful these experiences were to you personally and how they shaped your professional goals for the future.


  • What is your favorite book/movie/TV show?


When you get a question like this, you might feel pressured to reference an American show that you think your interviewer has heard of–and if that’s the truth, no problem. However, if you love an obscure TV show that only airs in your home country, don’t be afraid to talk about it! With these types of questions, interviewers are looking to hear about your interests outside of your academic and professional life, so your sincerity is more important than the specific book/movie/TV show you choose. Plus, your interest in foreign media could help demonstrate a way in which you could contribute diversity to the program!

Getting Ready for Your Interview

As you prepare for your interview, you may want to do a trial-run with a friend or colleague, and they can ask you some of the questions listed above. However, as you practice, you want to make sure that your answers don’t sound scripted. Even if you’re expecting one of these common questions, you still want your real interview to be a conversation, not a performance. This is especially important for foreign medical graduates from non-English-speaking countries, since interviewers may be evaluating your language skills, and you don’t want your interviewer to think you simply memorized a well-written speech. Therefore, remember to engage with your interviewer and be genuine with your responses–don’t just recite what you planned out in advance.


FMG Portal is here to help foreign medical graduates at every step of the US medical residency application and preparation process. Contact us today for more information!

The Residency Interview Days: Making the Most of Each Event


The interview process for a US medical residency program offers a variety of valuable opportunities for foreign medical graduates who are hoping to match in the spring. Not only do interviews allow you to show why you are a good fit for the program, but they also give you the chance to learn more about different programs and decide how you might rank your options on your ROL in the winter. Usually, the interview process lasts for one or two days, and every event on the itinerary counts. In order to make the most of these these events, it can be helpful to know what to expect. Read on to learn more about the structure of the interview days and how you can make the most of each event.

Interview Day Events to Expect

Every residency program has a unique itinerary for its interview day(s), but there are some general similarities that you can count on. As a candidate, knowing what to expect from each event–and how you can get the most out of it–can help you successfully navigate the interview day(s):


  • Orientation / welcome presentation. The official start to most interview days is a welcome presentation by an administrative leader, during which you and the other hopeful candidates are given an overview of the program. You’ll typically hear about the daily expectations for residents, the educational structure of the program, and any research opportunities that may be offered. The presentation also usually covers logistical details related to salary, benefits, services, and lifestyle (like housing and transportation). It can be helpful to take notes during this session, but most of the information will probably be available in information packets provided by the program. Instead of frantically trying to copy every word, keep a pen handy to jot down the side notes and anecdotes that you won’t be able to find in the official paperwork.
  • Formal interviews. Of course, the formal interviews are at the heart of the interview days. Depending on the program, you might find yourself interviewing with faculty members, current residents, or both. The number of interviews also varies between programs, but you can typically expect anywhere from two to six formal interviews. As we discussed in an earlier post, there are key do’s and don’ts that can help you through the interview. As you prepare, you may also want to set up a practice run with friends, colleagues, mentors, or other candidates from your medical school.  
  • Tour of the facility. The extent and scope of the tour can vary significantly depending on the size of the facility, but it always gives you the chance to get a feel for the general atmosphere of the institution and the surrounding area. It can be challenging to take notes as you walk during the tour, and you probably won’t notice as much if you’re focused on your notebook. Instead, focus on observing observing your surroundings and write down what you remember later.
  • Informal meals and social events. Often, aspiring residents will have the chance to sit down to an informal meal with current residents and/or staff. It could be a breakfast in the hospital cafeteria, dinner at a nearby restaurant, or even drinks after all the interviews are complete. These events can be fun, but you should also remember that they are still part of the interview process, so you don’t want to make a poor impression. Instead, try to get to know the residents and staff, find out what it’s like to live in the area, and take the chance to ask about informal topics like apartment options and nearby recreational opportunities.
  • Opportunities for resident shadowing. Although not included on the itinerary for all US medical residency programs, there are some programs that give you the chance to shadow residents during rounds or resident reports. This can help you get an idea of the workplace atmosphere and the daily life of residents in the facility. However, if you’re considering several different specialty areas when you are constructing your ROLs later in the winter, it’s important to remember that a few hours of shadowing may not provide enough information for you to develop a comprehensive understanding of the differences between specialites. For that, you may want to consider a longer graduate externship program. On the interview days, you should focus on the atmosphere in the facility and the general experiences of the residents so you can decide if it is the kind of place where you would enjoy working.
  • Exit interviews or closing presentation. Formal exit interviews are less common, but there are some programs where you will briefly meet with an administrative official before the conclusion of the interview days. There are also programs where a one-on-one exit interview is replaced by a general closing presentation from a hospital administrator. Either way, this closing event isn’t the time to try to cram in details about your previous experiences or plans for the future. Rather, an exit interview or closing event gives you the chance to make one final, positive impression–so remember to be friendly, indicate your sincere interest in the program, and smile!



If you’re a foreign medical graduate looking to get matched to a US medical residency program, FMG Portal is here to help you at every step of the process. Contact us today to learn more about everything we offer!


Preparing Your Rank Order List: Do’s and Don’ts for Foreign Medical Graduates


Now that you’ve finished your initial application, completed your interviews, and finalized your registration for the 2018 Match, there is only one thing left to do: prepare your Rank Order List (ROL). Earlier on the blog, we talked about the basics of ROLs — what they are, how they work, and what foreign medical graduates need to know from the start. Today, we were going to go further in-depth and talk about some of the Do’s and Don’ts for creating an ROL. That way, when the Rank Order List Entry opens on January 15, 2018 (mark your calendar!), you will have the tools you need for success.

DO’s for Creating Your Rank Order List (ROL)

When it comes to creating your rank order list, there are key things that you should make sure to do.


  • DO rank programs in the order of your true preference. The ROL is the place where you get to tell the NRMP where you want to train. After spending months or even years scoping out programs and trying to get a feel for the different training options, this is your opportunity to let the NRMP know which programs you think will best support both your personal and professional goals. Even if you worry that a particular program might be a “reach” for you, you should rank it at the top if it is the place where you would most like to complete your training!
  • DO include a both competitive and less-competitive schools on your ROL. While you should definitely rank your preferred programs at the top — even if they are highly competitive — you should also try to include programs with less competitive profiles on your list. That way, if you don’t end up getting matched to some of the more competitive programs, you won’t run the risk of not getting matched at all.
  • DO remember to certify your ROL before the deadline. In order for the match algorithm to process your ROL, it needs to be certified within the R3 system by 9:00 pm Eastern Standard time on February 21, 2018. Also, you should note that the R3 system is notorious for running slowly in the last few days before the deadline, so if you have your ROL ready in advance, DO upload it early.
  • DO remember that you can change ROLs that have already been certified. If you decide to upload your ROL early, you still have the chance to change your mind before the February 21 deadline — as long as you remember to recertify your ROL. The Match algorithm will only process the last certified ROL.

DON’Ts for Creating Your Rank Order List (ROL)

Preparing your rank order list might seem simple enough, but don’t be fooled! There are a variety of pitfalls that you can easily fall into if you’re not careful. Here are a few major DON’Ts for foreign medical graduates who are preparing their ROLs:


  • DON’T rank programs where you aren’t interested in training. When creating your ROL, you may be tempted to rank all the programs where you interviewed, and that’s a great plan if you feel comfortable training in any of the programs. However, if you have misgivings about a program and are only including it because you feel desperate to get matched, you might want to think twice about adding it to your ROL. When you certify your ROL, you make a binding commitment to train at any program where you get matched, so you should only rank programs where you would feel satisfied about (and celebrate!) a match.
  • DON’T include programs where you did not interview. As you already know, the Match is a computer algorithm. It won’t recognize any programs where you did not interview as options for a match. Therefore, it’s not worth the time to include any of these programs on your ROL.
  • DON’T wait until the deadline to enter your ROL into the system. Creating an ROL requires more than just writing down a list of programs — the R3 system can initially be confusing, so you should give yourself enough time to figure it out. Also, the NRMP warns that its servers tend to get overloaded in the last few days before the deadline, so it’s a good idea to give yourself extra time to make sure that you won’t have to worry about unexpected technological glitches.
  • DON’T forget to save your ROL after making changes. When you add a new program to your list or change the order in the R3 system, you have to click the “save” button before you leave the system if you want to return to your ROL the way you left it. It is important to note that saving an ROL is different from certifying it. Saving your ROL allows you to develop and change your ROL as the deadline approaches, but it is only finalized and ready for processing by the match algorithm when you certify it.
  • DON’T try to import an ROL on a mobile device. These days, you can use your smartphone or tablet for just about everything. Unfortunately, that doesn’t include every part of the residency matching process. In order to import an ROL in the R3 system, you need to be using a traditional laptop or desktop computer.



Whether you’re anticipating the last few months of the 2018 NRMP Match, gearing up for the 2019 Match, or looking ahead to future years, FMG Portal is here to help you every step of the way. Contact us today for more information!


Considering Advanced Studies in Interventional or Metabolic Cardiology


In the United States and around the world, cardiovascular disease is the number one cause of death, so there is a high demand for physicians with expertise in cardiology. Last week on the blog, we went over the steps that you need to take to become a cardiologist in the United States. After earning your medical degree, you must complete a three-year residency in internal medicine, followed by a three-year cardiology fellowship. After that, you have the option of completing a subspecialty cardiology fellowship in a particular area of interest.

Two subspecialty options within the field of cardiology are interventional cardiology and metabolic cardiology. For interventional cardiology, you can complete an ACGME-accredited subspecialty fellowship program after your first cardiology fellowship. There are also opportunities for advanced studies in metabolic cardiology. Read on to learn more about these two subspecialty options and why you might want to consider completing a graduate externship in one of them before you apply for a US medical residency program.

Introduction to Interventional Cardiology

Interventional cardiology is a subfield that focuses primarily on coronary artery disease, which is the most common form of cardiovascular disease in the United States. Specialists in this subfield are trained to conduct complex diagnostic procedures and design long-term health management strategies for patients with chronic and acute coronary artery disease. As an interventional cardiologist, you would also conduct percutaneous intervention procedures and put in percutaneous ventricular assist devices. If you’re looking to truly make a difference in the lives of patients who require immediate care for complex cardiac conditions, interventional cardiology could be a great subspecialty option for you.

Introduction to Metabolic Cardiology

Metabolic cardiology is a relatively new subfield that promotes an unconventional approach to the prevention, management, and treatment of congestive heart failure. Instead of relying on traditional interventions, this approach emphasizes an integrative approach based on nutrient supplementation. According to proponents of metabolic cardiology, the underlying cause of heart disease is the lack of sufficient energy for the heart to function at an optimal level. This problem can be addressed by providing the body with nutrients that support the production of enough ATP to support heart health.

Thus, experts in metabolic cardiology seek to prevent and treat cardiovascular disease through the targeted supplementation of four key nutrients that are involved in ATP production

  • D-ribose, which is required for the de novo synthesis of ATP
  • Coenzyme Q10 (CoQ10), which is involved in ATP recycling and reuse


  • L-Carnitine, which is also involved in ATP recycling and reuse
  • Magnesium, which plays a role in more than three hundred enzymatic reactions, many of which are related to energy production

Metabolic cardiology is widely viewed all-natural, less expensive alternative to traditional treatment methods for cardiovascular disease. If you’re interested in an innovative approach to cardiology, advanced studies in metabolic cardiology could be a great opportunity for you.

Reasons to Pursue Graduate Externships in Interventional and Metabolic Cardiology

As a foreign medical graduate, you might be wondering why you would want to complete a graduate externship in interventional or metabolic cardiology. After all, you still have to get through a three-year internal medicine residency and a three-year general cardiology fellowship before you have the chance to subspecialize. However, there are actually a lot of good reasons to choose such a highly specialized area for a graduate fellowship. Here are just a few:

  • In the personal statement on your residency application and in your residency interview, you need to be able to articulate clear plans and goals about your educational and professional future. When you are applying for an internal medicine residency, it’s one thing to say you want to be a cardiologist and possibly subspecialize interventional cardiology, but when you have months of clinical experience to back it up, it’s a lot more believable to an application reader.
  • A graduate externship in a subspecialty area can help you build on your existing clinical and research interests. While completing a fellowship in interventional or metabolic cardiology, you may be exposed to cutting-edge research and innovative clinical techniques, which could shape your future educational and career interests. Again, these are things you could include on your personal statement and talk about during your interview.
  • A graduate externship in a highly specialized area can actually help you make decisions about your future education and career. Sometimes, it can be hard to determine whether or not you want to dedicate your studies and professional life to a subspecialty area just by reading about it. In a graduate externship, you would have the chance to learn what day-to-day life as a specialist physician is like. That way, you can feel confident as you make decisions about steering your future toward a specialty area of cardiology.


FMG Portal offers graduate externships in both interventional and metabolic cardiology, among a wide range of other specialty and subspecialty areas. Contact us today to learn more about our offerings!


Medical Specialty Spotlight: Cardiology


Cardiovascular disease is the number one cause of death around the world. According to the World Health Organization, cardiovascular disease accounts for about 31 percent of all deaths — a total of around 17.7 million people per year. In the United States, the prevalence of cardiovascular disease is similar. According to the US Centers for Disease Control and Prevention, about 1 in 4 deaths are caused by heart disease — a total of around 610,000 people per year. Moreover, about 47 percent of Americans have one of the top three risk factors for cardiovascular disease: high blood pressure, high cholesterol, and/or a history of smoking.

As a cardiologist, you would have the opportunity to dedicate your career to supporting cardiovascular health and combating cardiovascular disease. The United States can be a great place to get the training you need through residency and/or fellowship programs. Read on to learn what foreign medical graduates need to do to launch a career in cardiology.

Completing a US Medical Residency Program in Internal Medicine

After earning your medical degree, the first step toward a cardiology career is a medical residency program in internal medicine. According to the National Residency Matching Program (NRMP), internal medicine is the most common residency specialty for foreign medical graduates, and the proportion of FMGs who choose internal medicine has been on the rise in recent years, jumping 6.4 percent from 2011 to 2015.

An internal medicine residency program can provide the preparation you need for a wide range of medical careers, including cardiology. In a three-year internal medicine residency program in the United States, you will get broad training in the diagnosis and treatment of the diseases and disorders that affect all organ systems. This training will include a mix of clinical practice and classroom-based seminar. You may also have the opportunity to conduct laboratory or clinical research in an area of interest, like cardiology. At the end of your internal medicine residency program, you are eligible to take the certification exam offered by the American Board of Internal Medicine (ABIM).

Completing a Fellowship in Cardiology

After earning certification from the ABIM, you can continue toward a career in cardiology by starting a three-year cardiology fellowship. During a fellowship in cardiology, you will have the chance to study a wide range of cardiac conditions, procedures, and prevention strategies. In most programs, you will also have the chance to apply your knowledge and skills in multiple settings, including inpatient and outpatient settings. Research is also an integral aspect of many cardiology fellowship programs. Just as in your internal medicine residency program, you may have the chance to choose between research in laboratory and clinical settings, depending on your specific interests.

Subspecialty Cardiology Fellowships

If you are passionate about a particular topic within the field of cardiology, you may consider completing a one- to two-year cardiology subspecialty fellowship after you have finished your three-year general cardiology fellowship. In a subspecialty fellowship, you have the opportunity to gain focused clinical and/or research experience in a particular cardiology subfield. The ACGME-accredited subspecialty options for trained cardiologists include:


  • Interventional Cardiology Fellowship. In this subspecialty fellowship, your focus would be on treating coronary artery disease, the most common cardiovascular condition in the United States. Topics of study can include diagnostic procedures, percutaneous coronary interventions, and management strategies for patients with coronary artery disease. Interventional cardiology fellowships last one or two years.
  • Electrophysiology (Heart Rhythm) Fellowship. In this subspecialty fellowship, your training would focus on the diagnosis and management of disorders characterized by irregular cardiac rhythms. For this, you would gain expertise in the implantation of pacemakers and other medical devices, lead extraction, and epicardial mapping, among other procedures. Electrophysiology fellowships last one or two years.
  • Advanced Heart Failure Fellowship. This subspecialty fellowship would provide training in the management strategies for complex heart failure, such as transplant and implantation of artificial heart devices. You would also learn about pre- and post-operative care for patients who undergo these procedures. Advanced heart failure fellowships last for one year.

Although Interventional Cardiology, Electrophysiology, and Advanced Heart Failure are the only ACGME-accredited subspecialty options in cardiology, there are also unaccredited subspecialty fellowship options in other cardiology subfields, such as Advanced Imaging and Metabolic Cardiology. Even though these programs are unaccredited, they may still provide valuable education that can support your career success.

Pre-Residency Preparation Options for Aspiring Cardiologists

As an aspiring cardiologist with a degree from a foreign medical school, there are many things you can do to get ready for the residency application process that will launch your career in cardiology. One great way to gain clinical experience in a US medical setting is by completing a graduate externship experience. You can choose a graduate externship in general cardiology or a subspecialty area like interventional cardiology or metabolic cardiology. When writing your application for an internal medicine residency in the United States, you can draw on this experience to explain your passion for the field of cardiology and demonstrate your commitment to career success. In some cases, graduate externships can also help you make connections with potential reference writers at US institutions, which you may need to get matched in certain residency programs.
FMG Portal offers graduate externships in a wide range of medical specialty areas, including cardiology, interventional cardiology, metabolic cardiology, and internal medicine, among others. Contact us today for more information!

Preparing for the USMLE Step 2 – CS: What NOT To Do


Over the last few weeks, we’ve been talking about the USMLE exams, which are essential for earning ECFMG certification and becoming eligible to apply for a medical residency program in the United States. In one of these posts, we introduced you to the USMLE Step 2 – CS, which tests your clinical skills. In another post, we took a more specific look at what you can expect in the two types of encounters on the USMLE Step 2 – CS: the Standardized Patient and Physical Examination and the Telephone Patient Encounter. Going into the USMLE Step 2 – CS, it is important for you to know what the examiners expect you to do — but you also need to know what NOT to do. That way, you can avoid making mistakes that cost you valuable time and/or points off your score. Read on to get tips on what NOT to do on the USMLE Step 2 – CS patient encounters.

What NOT To Do On the Standardized Patient and Physical Examination Encounters

Here are a few things that you definitely want to avoid during the in-person encounters on the USMLE Step 2:


  • Do NOT perform any of the prohibited tests. The testmakers specify that you should not conduct rectal, pelvic, genitourinary, inguinal hernia, female breast, or corneal reflex examinations. Also, you should not swab the patient’s throat for a throat culture. If you think that the patient needs any of these tests, you can call for them in the diagnostic workup you propose in your Patient Note.
  • Do NOT ask the patient for consent for other physical examinations. Aside from the above-mentioned prohibited tests, you can assume that you already have patient consent for all physical examinations. This includes femoral pulse exams, inguinal node exams, back exams, and axilllary exams. Asking for the patient’s consent on any of these exams will unnecessarily take up valuable time.
  • Do NOT be overly forceful with the patient with the patient. You need to be gentle during the physical examination avoid being too forceful when conducting maneuvers that involve palpating or percussing. You will lose points if you apply more than the appropriate amount of pressure when conducting an abdominal examination, examining the gallbladder or liver, using an otoscope to examine the ears, examining the throat with a tongue depressor, or examining the gall bladder and liver.
  • Do NOT forget about the patient’s modesty. During the exam, you must treat the patient just the way you would treat a patient in a real-life situation. Therefore, it is important to take the time to consider their personal comfort during the physical examination. For instance, if part of the exam requires a female patient’s bra to be moved or loosened, you should ask her before doing it yourself. It only takes a few seconds, and it will demonstrate your ability to remain courteous and professional, regardless of the time constraints of the exam.

What NOT To Do On the Telephone Patient Encounters

These are some things to avoid on the Telephone Patient Encounters:


  • Do NOT play around with the buttons on the phone. During the Telephone Patient Encounter, all you need to do to place the call is  press the yellow speaker button. After that, touching any buttons could disconnect your call. When you are ready to end the call, press the yellow speaker button again.
  • Do NOT try to call the patient back after ending the call. Once you end the call, the encounter is over. Even if you think of another question for the patient, you cannot reach them again. Trying to call the patient back will only cut into the time you have for the Patient Note, so you should just do your best with the information you have.
  • Do NOT make assumptions based on your previous test experiences. This tip actually goes for both the Standardized Patient and Physical Examination Encounters and the Telephone Patient Encounters. If you are taking the USMLE Step 2 – CS for a second time, you may notice similarities between an encounter on your exam and an encounter on one you have taken before. However, you should NOT assume that the correct diagnosis or treatment strategy is the same as the one on your previous examination, as the test preparers often make slight changes between exams.
  • Do NOT make assumptions about whether or not an encounter counts toward your score. You may know that some of the twelve patient encounter are unscored — that is, they are only used for test development purposes. However, it is a bad idea to try to guess which encounters are unscored. Even if a particular encounter seems to stand out as easier or harder than the others, it may not be one of the unscored encounters. You should treat each one of the encounters — including both the in-person and telephone encounters — with equal seriousness.



Following these tips can help you avoid potential pitfalls when taking the USMLE Step 2 – CS. For more help preparing for a U.S. medical residency program, contact FMG Portal today!

Getting Ready for the USMLE Step 2 CK: A General Overview


Over the last few weeks, we’ve been talking about the USMLE Step 1 and Step 2. As an aspiring medical resident, you have to pass both of these exams before you can move on to USMLE Step 3. Success on all three USMLE exams is a prerequisite for ECFMG certification. Therefore, if you’re a foreign medical graduate looking to get matched to a residency program in the United States, passing these exams should be one of your top priorities.

The USMLE Step 2 consists of two parts. As we discussed in two previous posts, the USMLE Step 2 – CS tests your clinical skills during real-life patient encounters. The second part of Step 2 is the Clinical Knowledge (CK) section. Like the USMLE Step 1, the USMLE Step 2 – CK is a written test that requires you to demonstrate your expertise in the field of medicine. Read on to learn more about the content of the test and the format of the questions.

The Content of the USMLE Step 2 – CK: What To Expect

Put simply, the USMLE Step 2 – CK tests your knowledge of the concepts of clinical science that the USMLE committee members have decided are the most important for medical residents to possess. The specific material can vary slightly from year to year, but the general content tends to remain the same. There are two ways that the the content of the exam can be broken down: in terms of Scientific Topics and in terms of Physician Tasks and Competencies.

Scientific Topics

When approached from the perspective of Scientific Topics, the USMLE Step 2 – CK can be broken down into three categories, each accounting for a certain proportion of the exam. The first category, General Principles of Foundational Science, typically takes up 1 to 3 percent of the exam. The second category includes Biostatistics, Epidemiology, Population Health, and Interpretation of the Medical Literature. These topics typically take up 1 to 5 percent of the exam. That means that the vast majority of the USMLE Step 2 – CK is dedicated to the third category, which encompasses body systems and tissues. This category accounts for 85 to 95 percent of the exam. The topics that fall within this category include:

  • Behavioral health
  • Cardiovascular system
  • Circulatory system
  • Endocrine system
  • Gastrointestinal system
  • Lymphoreticular system
  • Musculoskeletal system
  • Nervous system and special senses
  • Pregnancy, childbirth, and the puerperium
  • Renal System
  • Reproductive system (male and female)
  • Respiratory System
  • Skin and subcutaneous tissue
  • Urinary system
  • Multisystem processes and disorders

Physician Tasks and Competencies

Another way to divide up the content of the USMLE Step 2 – CK is in terms of Physician Tasks and Competencies. Approaching the exam from this perspective can help you understand exactly what aspects of the Scientific Topics you will be tested on. Each of the four competencies accounts for a significant proportion of the exam.

  1. Medical Knowledge / Scientific Concepts

This competency makes up 10 to 15 percent of the test. Questions that fall in this category are direct, straightforward questions about the Scientific Topics listed above.

  1. Patient Care / Diagnosis

This competency makes up 40 to 50 percent of the test. Questions that fall within this category examine your ability to:

  • Interpret information from a patient’s medical history and physical examination
  • Interpret information from laboratory and diagnostic studies
  • Make a diagnosis
  • Provide a prognosis
  • Determine expected patient outcomes
  1. Patient Care: Management Health Maintenance / Disease Prevention

This competency makes up 30 to 35 percent of the test. The questions that fall within this category will test your knowledge of:

  • Clinical intervention strategies
  • Pharmacotherapy
  • Mixed management
  • Surveillance techniques to prevent disease recurrence
  1. Professionalism

This competency takes up only a small proportion of the exam: between 3 and 7 percent. Questions within this category will assess your knowledge of:

  • Professional conduct for health care providers
  • System-based practice
  • Patient safety
  • Practice-based learning and skill development

Question Types on the USMLE Step 2 – CK

All of the questions on the USMLE Step 2 – CK are multiple choice questions. Some of the questions are single-item questions, while others are sequential item sets. For the single-item questions, you will be provided with a short vignette that ends with a question, and you will need to choose the best answer from among a set of lettered choices. For the sequential item sets, you will be given a vignette that is followed by several multiple-choice questions that assess your knowledge of different aspects.

The way that the questions are framed can vary depending on the scientific topic or physician competency that is being assessed. Some questions ask you directly for information about a scientific concept. Others provide a story about a clinical situation that you might encounter as a physician. Still others provide a research abstract that you will need to interpret. Being prepared to see all of these question types is crucial for success on test day.
Looking for more advice on the steps you have to take to get matched to a U.S. medical residency program? Contact FMG Portal today!