Posts Tagged ‘USA’

Application for Residency in US

Monday, August 31st, 2009

The residency application season generally begins from the 1st of July each year when MyERAS opens. MyERAS is a centralized post-office which receives all the applications from applicants and then distributes it to the various residency programs participating in the match.

IMG’s need an ERAS token to open an account with MyERAS. This token may be obtained from ECFMG. (Applicant need to login to the ECFMG website and request an ERAS token from there). Once the MyERAS account is created, applicants may begin to work on their application.

Please note that virtually all programs accept applications exclusively by ERAS.

ERAS timeline


Common Application Form

The “Common Application form” or CAF is a 12 page form to be filled by the applicants. As per the ERAS website these 12 pages require the following information:-

Page 1 General Information
Page 2 Education
Page 3 Medical Education
Page 4 Previous Residency/Fellowship
Page 5 Experience
Page 6 Publications
Page 7 Exams
Page 8 Licensure Information
Page 9 State Medical Licenses
Page 10 Race
Page 11 Ethnicity
Page 12 Miscellaneous Information


Required Documents:

  • USMLE Transcripts – This is automatically sent once the option is selected on the ERAS website
  • Personal Statements (PS)
  • Letter of Recommendation (LOR)
  • Color Photograph – wallet size (Optional)

PS and LOR need to be sent to MyERAS by regular post (As of 2006-2007 application season ERAS will accept only original MSPE and LOR’s). Also ERAS takes about 3 weeks to scan and upload the documents to their website for distribution. Therefore it is advisable to send the documents by August 1st week so that the applications are sent out to programs when ERAS starts distributing the applications.

ERAS is implementing a new “Return of Documents Service” (RODS) by Feb 2007 so that the original documents may be returned to applicants who request them.

ERAS Document Submission Guide

A quick google search of “Personal Statement” Residency (with quotes) turns up a lot of examples and help in writing the PS.

Once the application is complete, the candidates need to decide which programs they wish to apply. FRIEDA is an online directory which provides detailed information about the programs participating in the match.

The East coast and mid west region of US are considered to be IMG friendly. Also candidates should look up the list of current residents on the programs website to confirm if that particular hospital/University has taken IMG’s in the past. Finally candidates may write to the programs directly. Please do not write asking “Is your program IMG friendly?” Most programs will reply in the affirmative. A better way is “Does your program require a US clinical experience?”

It is always a good idea to apply to as many programs as one can afford. People generally apply to 50-70 programs.

On September 2nd each year, ERAS starts distributing the applications to the programs. The earlier the programs get a candidates application, the more likely he/she is to get an interview call.


Interviews

The interviews start in November and continue till January end. Candidates should be dressed professionally for the interview. Many programs also have an informal resident dinner the day before the interview.

The whole idea of the interview process is to see if the candidate will fit in the program and with the current residents. If a candidate is called for the interview that means he/she has all the necessary credentials to enter that program. What matters is – “who will fit in best in the program” and how interested is the candidate in that program. The opinion of the residents formed during the resident dinner also counts.

After the interview, it is a good idea to send a “Thank you” card to the program director and/or to the interviewer. Candidates should also keep in touch with the program preferably via email if they are really interested in the program.


The Match

The last date to register for the match (NRMP) is Dec 1st every year. Registration with late fees is possible till 3rd week of February (See Match Schedule). Please note that registering for ERAS does not register the candidate for the match. NRMP is a separate organization and candidates need to register separately for it otherwise they will not be able to participate in the match.

After the candidates finish their interviews they are required to submit a “rank list” to the NRMP. This is essentially a list of hospitals in order of the candidates preference. The deadline is generally the 3rd week of February. Also the candidate should have the ECFMG certificate by this deadline otherwise they will not be eligible to participate in the match.

The programs also submit their preference (rank) list of candidates to NRMP. The NRMP then analyzes the lists and matches the candidates and programs as per their preferences.

The results of the match are generally released during the 2nd week of March.

Some IMG’s may be offered “Prematch.” This essentially means that the candidate (if he/she) choses may not go through the regular match and sign the contract with the program to join there.

“Post match scramble” is a 2 day process after the match, for candidates who have not matched. NRMP releases a list of hospitals that have unfilled programs and candidates apply to them by ERAS, phone, fax, or email during these 2 days. I have been through the post match 2 times (once for myself and the 2nd time for a friend) and can assure that it is a “living hell” for IMG’s.

NRMP timeline

Medical Residency Visas for IMG’s

Monday, August 31st, 2009

The two most common visas granted to International Medical Graduates (IMG) for a residency are the J1 and H1B.


J1 – Visitor Exchange Visa

The J1 visa is given more often than H1B by programs. In fact most university based hospitals offer only J1. The main problem with a J1 visa is that the candidate is required to return to his/her home country after the completion of residency. This home country requirement is for 2 years.

If a candidate wishes to continue to work in US then he may obtain a J1 waiver. For this the candidate is required to serve for a period of 3 years in a medically under served US area. After this the candidate is given H1B status.

The advantage of a J1 visa is that it is easy to get into a fellowship after the completion of residency. However the candidate will have to go through the same waiver process after completion of fellowship if he/she wishes to stay in US. Please note that the waiver process is a one time process and may be taken after the residency or fellowship.

Candidates who plan to do a fellowship and then return to their home country may prefer a J1 as it will be easier for them to get into a fellowship.


H1B Work Permit

This visa is a more difficult to get in comparison to J1 as there are fewer hospitals sponsoring it. The advantage of H1B is that after the completion of residency the candidate may take up a job and then apply for a green card.

The disadvantage of this visa is that it is very difficult to get a fellowship. The reason is that the H1B visa is valid for 3 years and can be extended for another 3 years only. Therefore most fellowship programs do not want to take the risk of having a candidate leave the fellowship program in between.

USMLE Step 3 Exam

Monday, August 31st, 2009

The USMLE Step 3 exam is not a requirement to enter into a residency. However, if a candidate has taken the exam, it may increase the likelihood of getting more interview calls and an H1B visa (this varies with the programs).


Eligibility

The eligibility criteria to take this exam vary from one US state to another. There are some state medical boards (e.g. Connecticut, New York) which allow candidates to take this Step after they get the ECFMG certificate.

The subjects tested on this exam are similar to USMLE Step 2CK but the questions focus heavily on management of patients. This exam essentially tests the ability of the candidate to manage patients in an unsupervised primary care setting.


Exam Registration

The registration of Step 3 is through FSMB. The candidate is required to select a state medical board to register for the exam. If a candidate wishes to take the exam before the match then it is advisable to select a state board (e.g. Connecticut) which permits the exam to be taken after the candidate is ECFMG certified. Subsequent process is similar to registration of other steps.

Once registered the applicant receives the Orange permit card which is used to register for the exam only by phone. Along with the permit the examinee will also receive a CD containing 3 blocks of sample questions and the software tutorial and practice Computer based case simulations (CCS).


Exam Design

Step 3 is a 2 day exam. The 1st day consist of 7 block containing 46 multiple choice questions each, to be finished in 8 hours (with 1 hour of break time).

The 2nd day consists of 4 blocks of approximately 36-37 multiple choice questions to be finished in 45 minutes each.

After this the examinee has to solve 9 computer based case simulations (CCS) in 4 hours. Of the 9 CCS only 8 are scored. 1 CCS is for experimental purpose, however the candidate will not be given any information on which case is not being scored.

Each CCS lasts for 25 minutes. The examinee will be given an actual 20 minutes to manage the case and another 5 minutes to close the clinical encounter. This essentially means that during the first 20 minutes the examinee needs to take a history, perform physical examination, order relevant diagnostic tests and manage the patient in a simulated time period of hours to months depending on the case. Once 20 minutes are over, then 5 minutes are given to put the final orders (e.g continued medication & counseling). The cases tested here are the common cases seen by a primary care physician (e.g. MI, acute severe asthma, foreign body aspiration etc).


Result Reporting

The results of the exam are generally reported between 4-6 weeks after taking the exam. The results of the exam are reported in a 2 digit and a 3 digit score.

USMLE Step 2 CS Exam

Monday, August 31st, 2009

The USMLE Step 2 CS (Clinical Skills) exam is conducted only in the United States. It is clinical case taking exam where the examinees are required to take a proper history, conduct a focussed physical exam and counsel the patient. After this a patient report needs to be written.


Exam Registration

Similar to the previous steps, applicants may register for Step 2 CS either online or via regular mail with the ECFMG. Once applicants are registered for the exam they are alloted a 1 year period during which they may take the exam. Since there are only 5 centers in US to take this exam, it is advisable to book the exam date 3-4 months in advance.

The centers at which the exam may be taken are – Philadelphia, Los Angeles, Chicago, Atlanta and Houston.

The candidates should be dressed in a professional attire and should wear a clean white coat without any identification on it. Men should preferably wear a tie.


Exam Design and content

There are 12 clinical encounters on a single exam day. All patients are normal people and are trained to simulate actual patients. The examinee is given 15 minutes for each clinical encounter followed by 10 minutes to write the case report. Out of the 12 encounters only 10 are scored. One clinical encounter is for experimental purpose.

The cases which an examinee faces are generally those which are frequently seen by primary care physicians in the United States. Therefore most of the clinical scenarios belong to one of the major clinical realms tested on Step 2CK (E.g Chest pain, Abdominal pain, drug refill, STD’s, cough, pediatric telephone encounter with mother, depression etc).

One point to note is that pelvic, rectal and female breast examination is prohibited and mention of this should be made in the case report if the examinee wishes to perform it.

The examinees are evaluated by the simulated patients (SP). These SP’s are given a checklist of all the necessary questions and physical examination related to the particular case and they tick the ones which have been performed by the examinee.

The examinee is tested in the following areas:-

  1. Integrated clinical Skills
  2. Spoken English Proficiency
  3. Communication and interpersonal Skills

The candidate is required to pass in all these areas separately. The time required to prepare is generally 1 – 2 months.


Result reporting

The Step 2CS exam result is reported as Pass / Fail status. There is no 2 or 3 digit score as in Step 1 or Step 2 CK.

USMLE Step 2 CK Exam

Monday, August 31st, 2009

The USMLE Step 2 CK (Clinical Knowledge) exam covers the clinical topics covered in the final 2 years of most medical school curricula. These subjects include:-

  • Medicine
  • Pediatrics
  • Surgery
  • Psychiatry
  • Obstetrics & Gynecology
  • Public Health

Time to prepare for the exam depends from person to person. Generally IMG’s prepare for about 3-6 months for the exam.


Exam Registration

The application for the USMLE exams may be submitted online or via regular mail as described in the introduction.

Once registered the applicant receives the Orange permit card which is used to register for the exam either by phone or online (Thomson Prometric). Along with the permit the examinee will also receive a CD containing 3 blocks of sample questions and the software tutorial.


Exam Design

Step 2 is a one day exam. The total exam duration is 9 hours. The exam consists of 8 blocks of 46 to 47 questions each which have to be finished in 1 hour. So the actual exam time is 8 hours. There is a 15 minutes tutorial to let applicants get familiar with the software and 45 minutes of break time. So the total duration of the exam totals to 9 hours.

Applicants are allowed to take a break after finishing a block but not during a block. The applicant may take as many or as few breaks as he likes as long as he does not leave the exam room in the midst of a block. Also not that once a block has started, it has to be finished before the applicant may take a break. If a block is closed without completing it there is no way in which it may be opened again.

If the tutorial is finished earlier then the remaining time gets added to the break time. Similarly if a block is finished earlier then also the time gets added to the break time. This extra time cannot be used to extend the time of some other block.

As with Step 1 each block contains a mix of questions from the various subjects.


Questions on the exam

Questions are multiple choice type and may carry between 3 to 10 choices per question. Almost all questions are framed in a clinical scenario. All questions carry equal weightage and there is no negative marking.

The exam concentrates heavily on making a correct diagnosis. The questions are generally very long and have a lot of unnecessary detail in them. There are some questions which test the ability of the examinee to differentiate between diseases presenting with similar signs and symptoms. These questions generally have the same set of options.

A point to note is that not all questions on the actual exam will be scored. They are there for experimental purposes to analyze if they are suitable to scored in future exams (e.g. some questions may be too tough, too easy or wrongly framed). According to the USMLE website anywhere between 10-20% of the questions on the exam may not be included in the final score. So if you are talking a long time on a particular question, you may want to select your favorite letter and move on.


Result Reporting

The results of the exam are generally reported between 4-6 weeks after taking the exam. The results of the exam are reported in a 2 digit and a 3 digit score.