Transcript Road map to U.S. Residency A seminar on how to tackle the

Road map to U.S.
Residency
A seminar on tackling the match.
Dr. Muhammad Ali Khan
Dr. Faraz Khan Luni
Dr. Isra’a Khan
Dr. Muhammad Faraz Masood
Road map to us
residency
Muhammad Ali Khan
Dow Medical College
Batch of 2008
Definitions
• ECFMG: Education Commission for Foreign
Medical Graduates.
• ERAS: Electronic Residency Application
Service
• NRMP: National Residency Matching Program
• FSMB: Federal State Medical Board
What is a Match?
 Match
 Process of getting into a US residency program.
 Handled by NRMP
 ROL (Rank Order List)
 Ranking of programs by candidates.
 Deadline: End of February.
 Residency programs submit their ranking of
candidates.
 Finally the MATCH is declared on Monday of 3rd week of
March.
What is a Pre-match?
What is a Post-match?
• Pre-match
– Signing up of residency contract before the match is
announced.
• Post-match
– Unmatched candidates are provided a list of programs
having vacancies. They can then apply there to get
residency.
Pre-match vs Match
Pre-match
Match
• Can start the visa
• Visa processing
• Most University
• All programs enter
processing before
hand.
programs do not
offer pre-matches.
begins by mid to late
April.
the match.
Pre-match vs Match
Pre-match
Match
• Peace of mind that
• You May or May Not
• Small programs do
• University programs
you have got the job
not usually lead to
competitive
fellowships.
match.
lead to all sorts of
fellowships (especially
if you are on J-1)
Post-match Scramble
• Starts on Tuesday and ends on Thursday of the
match week.
• One should ideally be in the U.S. to participate in it.
• Realistic for people who have contacts in that
particular program, have green cards or are citizens
of United States.
Components of a
successful Match
•USMLE Scores - filters
• Certification
• U.S. Clinical Experience & LORs
• Networking in the U.S.
• Research experience (University calls)
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•
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Personal Statement
Time since graduation
Interview – Communication skills
Step 3
Medical school transcripts
1st & 2nd Years
• Concentrate on your basic sciences and
•
•
•
•
•
academic achievements.
Extracurriculars like volunteer
organizations.
Learn research methodology: use step 1
BS, attend workshops
Make a professional CV and email
address
Identify mentors
Start on a research project
3rd & 4th Years
• Concentrate on clinical knowledge, Hx and PE skills.
• Utilize elective slots to do more research projects &
clinical electives (local or international)
• Start applying to US universities for electives which
you will do in 4th and final years.
3rd & 4th Years
• Start building a contact/alumni list
• Present research at seminars
• Step 1 if possible
• Towards end of 4th year at least have an
idea of what you probably want to
specialize in.
Final year
• Concentrate on Medicine and Surgery rotations
• Best time to take Step 2 CS is during the period of
clinical electives in US
• Should have some published research by now.
• By the end of final year should have done at least
two U.S. electives (the more the better)
• If not then do electives immediately after you
graduate.
After graduation
• Concentrate on Steps
• Aim for certification
• Keep in touch with LOR attendings
• Pakistani citizens should do house job.
• Prepare documents for the match.
• Clinical observerships
U.s. clinical electives
• Best time to do them?
• Should know how to present using SOAP
format
• How to search for them?
– US news
– https://www.aamc.org/students/medstudents
/vsas/
– Seniors/Alumni/Faculty
– Google is your best friend
• Step 1 requirement
U.s. clinical electives
• Cost estimate for 2 months - $2000-4000
• Apply at least 6 months in advance.
• Common errors: inappropriate email
address, informal writing style, informal
CV
• Alumni can be a big help
How to get good lors
• Plan to spend enough time with two attendings
• Show enthusiasm and interest – be inquisitive
but not excessively
• Cover at least 2 patients daily and read about
their conditions
• Be a team player
• Volunteer to give RELEVANT presentations/talks
how to get good lors
• Be friendly and make small talk too
• Don’t call everyone SIR!!
• Show independence in assessing patients
• Don’t try to answer too many questions
and make other students/residents look
bad
How to get good lors
• Ask for feedback at the end of your interaction with
attending.
• After feedback, explain to them your goals of postgrad training. Request LOR
• Supply them with CV for LOR.
• Waived vs Un-waived
• Make good friends with the secretaries of the
attendings!
• Stay in touch
Local letters
• Ideally
- U.S. trained physician
- Personalized LOR from any senior
consultant.
• No Generic letters!!
- Useless
• IM applicants need one letter from Chief of
Medicine & four in total.
Research
opportunities
• Local opportunities:
– Identify faculty at AKU, SIUT, Dow
– Initiate your own project
– JPMA , CPSP & Ayub Medical College Journals.
• International opportunities:
- mostly unpaid.
- best for people who have green cards or are citizens.
- if you get an opportunity GRAB IT, it might not knock again
Student conferences
• Oral presentations are better.
• Matter need not have been published.
• Try to participate in conferences which are
related to your specialty.
Personal statement
• Big opportunity to emphasize your
strengths!
• Why did you choose this specialty?
• Your personality, your strengths.
• Your experience in the US
• Should be one page: font Arial, size 12
Personal statement
• Get at least 6 reviews done on PS
• Will go through at least 6 drafts, so
start working early
• Common errors: making it your CV,
spelling/grammatical errors
• DO NOT COPY, you will get caught
for PLAGIARISM.
Usmle Step 3
• Essential for H1b visa.
• Best time to take it as soon as you reach US
for interviews.
• Best prep is giving it soon after Step 2 CK
• Format: 2 day test – MCQs and CCS
• Can influence match favorably if used
properly
Official Timeline
• July 1, 2010
•
•
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- MyERAS Web site opens to applicants to begin
working on their applications.
- ERAS Support Services at ECFMG will begin generating
and distributing tokens to IMGs.
September 1, 2010
- Applicants may begin applying to ACGME accredited
programs.
- ACGME accredited programs may begin contacting the
ERAS PostOffice to download application files
November 1, 2010
- MSPEs are released to ACGME accredited program.
March 2011
- Scramble.
- NRMP Match results will be available.
My timeline
• June
– Start working on your personal statement.
– Start searching programs.
– Get to work on your LORs, you need 4 at
least.
• July
– Buy the online token of ERAS. The window
opens from July 1.
– Start sending your LORs to ECFMG for
uploading them on ERAS
My timeline
• August
– Your LORs should have been uploaded at your
ERAS office.
– Should ideally be certified by August 31.
• September
– Apply to programs on September 1.
• October to January
– Interview season.
MY TIMELINE
• February
– Submit your Rank Order List.
• March
– Match declared on Monday of third week of
March.
– Post match scramble for three days after the
match.
Program types
• Internal Medicine
– Categorical
– Prelim
• General Surgery
– Categorical
– Prelim
• Family Medicine
– Categorical
• Pediatrics
– Categorical
• Neurology
– Categorical: 3 years neurology + 1 year prelim IM included
– Advanced: 3 years neurology
Choosing programs
• One of the most important step of your
application.
• First have a budget in mind.
• ERAS fee
– Number of Programs per Specialty
– Up to 10: $75
11-20: $8 each
21-30: $15 each
31 or more: $25 each
Choosing programs
– Example 1: A candidate applies to 30 IM
programs and 30 Pediatrics programs. Total
cost would be $305 for IM and $305 for Peds
i.e. $610.
– Example 2: A candidate applies to 60 IM
programs. Total cost would be as follows.
The first 30 costing him $305 and after that
every program costs $25 i.e. his cost for the last
30 programs is $750 and total is $1055.
Choosing programs
• Dowites usually apply to 70+ programs,
AKU people apply to 40 programs.
• Make a spectrum of programs when you
apply
– _____% University.
– _____% University affiliated Community.
– _____ % Community.
• Do not follow anyone blindly. Do your
research before you apply to programs.
Choosing programs
• What to look for in a program?
– Description (university, community or combo)
– Residents in the program (any dowite)
– Faculty (any dowite)
– Visa offered (J1, H1 or only green cards)
– Fellowship offered & success rate of
fellowship placements among its graduates.
– Some programs will take AKU grads only from
Pakistan (so be prepared for this bias)
Choosing programs
• My suggestions
– Work as a team. Researching programs can
be very tiring at times.
– Decide your budget.
– Apply very well, it is an investment.
– Start calling up programs by end October &
November.
– Thank you cards.
Visas
• J 1 Visa (Exchange Visitor Visa)
– All programs which take IMGs sponsor it.
– All university programs.
– Fellowships are easier to find.
– Stamped for 1 year & status valid for 7 years.
– After 7 years, return to home country for two
years.
Visas
• J1 Visa continuation
– Only during the first year you can return to
Pakistan.
– After that you cannot exit US or else you need
to get it re-stamped.
– Does not get converted to a Green card.
– Need to do a waiver for three years to convert
it into H1b visa.
– If you do not want to do a waiver job……..get
the hardship waiver, costs around $50007000.
Visas
• H1 b visa (Temporary worker’s visa)
– Stamped for 1 or 3 years & status valid for 6 years.
– If you get a 3 year stamp you can enter & exit US
during the 3 year period.
– Gets converted to a Green card.
– If you have had problems with visa clearance you
may get your B1 visa converted to H1 status while
living in the US
Visas
• H1b visa continuation
– Can be an expensive visa but is totally worth
it.
– Premium processing fee $1225 + (lawyer fee
$2000-3000 if University does not pay)
– Few University programs sponsor H1b.
– More Community Programs sponsor it.
– Fellowships are harder to find.
Total expense
• Electives ………………………… $2500
• USMLE STEP 1…………………. $ 920
• USMLE STEP 2CK …………….. $ 935
• USMLE STEP 2CS …………….. $1355
• Application ………………………. $1200-2800
• Interview season……………….. $3000-5000
• Two tickets to the US ………… $2200
• Total
$12,110/-
My Pearls
• The 3 P’s for this whole process.
• P: Party hard
• P: Practice harder
• P: Pray the hardest
• Why I chose this background?
• You should always aim as high as the sky.
• Your efforts should be comparable to the
vastness of an ocean.
• In the end it is your dream, your efforts will
pay off.
All the best
Thank you !