How to get into an

American Training Program

Bazak Sharon, MD *
US Academic/Training ladder: Med School: 3rd yr: Clerkship 4th yr: Electives Residency Specialty training (3-5yr) Intern Resident Chief Resident Fellowship Subspecialty training (2-3yr) Faculty: Assistant Professor Associate Professor Professor ECFMG Certification: Required for an IMG who wishes to enter residency or fellowship programs. Required to sit for USMLE step III and to obtain an unrestricted license to practice medicine. Requirements for ECFMG Certification: MD (or equivalent) from a WHO recognized medical school. Exams: USMLE Step I USMLE Step II (Clinical Knowledge [CK] & Clinical Skills [CS]) USMLE III Required for a medical license (necessary for H1 working visa). Given by each state, can be taken everywhere. Time limit to complete the USMLE is established by the state medical boards (Usually 7yrs) for completion of the full USMLE sequence. (http://www.fsmb.org/usmle_eliinitial.html)

Dr Sharon is a fellow in training at the Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota Medical School and Center for Infectious Diseases and Microbiology Translational Research, Minneapolis. He completed Pediatric Residency at Nationwide Childrens Hospital, Columbus, Ohio and he is a board certified Pediatrician. Dr Sharon graduated from Semmelweis Medical School, Budapest Hungary (Class of 2002). Contact info: sharo011@umn.edu

Applying for Residency: Your pursuit of a residency position involves three separate organizations: 1. ERAS Support Services at ECFMG 2. The Electronic Residency Application Service (ERAS) administered by AAMC 3. National Resident Matching Program (NMRP, the Match. Timeline (2009 Match) July (2008): ERAS Opens. August (2008): NRMP opens. September (2008): ECFMG starts transmitting documents to ERAS. Application for individual programs opens. October (2008): Programs starts selection for interviews (Oct-Jan). November (2008): Registration deadline. February (2009): Rank order list certification deadline. March (2009): Results of Match announced. Matched/Unmatched Post-match scramble Positions announced July (2009): Residency Starts.

Proposed (my) Timeline: 5th yr: Clinical rotation at Columbus Childrens Hospital (1/2001). Made the decision (2nd semester). Applied for step I (5/2001). 6th yr: Studied for step I during easier rotations (10wks 12/2001). Researched programs, applied for Step II/CSA, Applied for ERAS. Graduation 10/2002. Post-Graduation: Worked on documents, sent applications, contacted programs. Studied for step II (10wks 11/2002). Studied for CS (3wks 12/2002). Interviews (12/2002-1/2003). Took the Israeli Exam (2/2003). Matched (3/2003) Worked on visa. Started residency 1/7/2003

Residency Statistics

Application Process 1. Research and contact the programs of interest to determine their minimum eligibility criteria. 2. Register at ERAS (first you need to get a token from ECFMG). 3. Begin work on your Common Application Form (CAF), Profile, and Personal Statement. 4. Send supporting documents to ERAS Support Services at ECFMG. 5. Track the documents received by ERAS Support Services at ECFMG via ECFMGs OASIS. 6. Select programs and sent supporting documents. 7. Monitor the status of your ERAS application via the Applicant Document Tracking System (ADTS). 8. Register to NRMP.
Useful links: http://ecfmg22.securesites.net/eras/myeras.pdf http://ecfmg22.securesites.net/eras/index.html http://www.aamc.org/students/eras/guideline/start.htm

Research for Programs Contact the programs you are interested in to find out more about their requirements and deadlines. Most programs have Web pages with information for prospective applicants. IMG friendly?? Make personal connections!! Do a clinical rotation (of some sort) prior to the interview season. Get n LoR from a faculty member of you top programs. Supporting Documents: USMLE Transcript. Personal Statement.
http://www.ama-assn.org/ama/pub/category/6700.html http://www.studentdoc.com/personal-statement-tips-1.html http://www.residencyandfellowship.com/page3.html

Letters of Recommendation (LoRs). Photograph. Medical School Transcript. Medical Student Performance Evaluation (MSPE). California Letter. Fifth Pathway certification.
http://ecfmg22.securesites.net/eras/documents.html

Interviews Interview Season: Oct-Jan. Groups of 2-10. Schedule (the usual): Early morning meet director/chief. Meet the residents. Tour of the hospital. One-on-one interview/s with faculty. Lunch The single most important factor in your application. Never Ever Be Late!!! Dress appropriately (exam suit may come handy). Make an impression (to the right person), but dont push it. The residents, even the chiefs have little to do with the selection process. The secretary has A LOT to do with the process. The directors see hundred of applicants they remember the best and the worse, try to have an angle that no one else has and present it. Questions: Prepare questions in advance and dont ask them all in the first 5min youll end up having awkward moments. Direct the questions at the right people. Dont be afraid to ask the same question again (just not to the same person). If you have several interviews, start with your LEAST favorite program to gain experience. Know yourself and know the program. Research the program and staff. Review your application. The courtesy game. Summarize pros and cons immediately. Second look. Never forget that if you are a competitive candidate they need you as much as you need them, if not more!!! Enjoy the interview. http://www.ama-assn.org/ama/pub/category/6701.html http://www.rushu.rush.edu/studentlife/career/medint.html http://www.residencyandfellowship.com/page6.html

Pre Match: During the interview season, IMGs are often offered positions out ot the Match, also known as pre-match offers. If the program offering the position is a place you would like to go to, TAKE IT!! If in doubt (any doubt), ask for time to think. All depends in how competitive you feel you are and what are your options. Rank order List (ROL) In the end of your interviews you submit a list of programs you can see your self in. ROL is in order of your preference NOT in the order of likelihood. More programs you list, better chance you have to get a residency. The MATCH: Each program submit its own ROL of applicants. A computer software calculate all applicants and programs ROLs and come up with the perfect Match. (No one really knows how it works) Match results are published to all programs and applicants at the same time. Once youve matched in a program, it considered unethical to withdraw!!! (It will be hard to get a good position after that) Post Match Scramble: All applicants who did not match with a residency program may participate in the post-Match Scramble. You can contact program that didnt fill and send them your application. The Scramble starts on match day @ noon and last for 2 days. Apply as soon as the list of unfilled programs has been posted at www.nrmp.org at 12:00 noon.

Visa / Work permits J1 (Training) Visa Educational exchange visa, most common one for IMGs. Allows a IMG to train in the United State. Lasts as long as the physicians are in training (max 7yr). Dependants are eligible for the J2 visa which allows them to work and live legally as the J1 visa lasts. After completion must return to home country for at least 2yr (2yr requirement). Not allowed to change the legal status unless get a waiver: Persecution. Exceptional hardship to a United States citizen (or legal permanent resident) spouse or child of an exchange visitor. Working in an underserved area / population for 3yrs. To get your J1 visa, you will need documentation from the government of your country explaining your desire to return after your training ends. Once the physicians have the visa petition, they must present that document to the local US Embassy at their home countries to get the stamp in their passports. Must be renewed annually, including the stamp in the passport (pain in the A#$). Easier to get, harder to get ride off. Ideal if you plan to go home one day. H1 (Working) Visa: Has the purpose of allowing foreign professionals to work legally in the US. Must hold a medical license to obtain it. Lasts as long as you are hired (max 6yr). Not obliged to return to the home country. A visa with duel intent, which means that people under a H1B can request a change in their legal status to a permanent resident as long as they obtain a sponsor. No waiver application is required if the physician decided to remain in the US after the visa expired. H1B visa is harder to obtain and is more expensive. If they really want you theyll offer it. Dependants are eligible for the H4 visa, which allows them to live but not work in the US. Once the physician has the visa petition, he/she must present that document to the local US Embassy at the home country to get the stamp in their passports.

Take Home Points

Prepare well and do well on your boards. Board oriented learning as soon as possible. Make sure this is what you really want and put 110% into it. Make a long-term plan (timeline, money, location). Have a plan B. Location flexibility goes a long way. Realize that the second your leg steps in a US residency you are no longer an IMG you are an American resident. DO AT LEAST ONE CLINICAL ROTATION IN THE US!! Use as much information as you can (the web). Trust only trustworthy resources. Find people who went trough the process (successfully) and seek their help. Plan ahead rgd visa type. Know your limitations but also your strength. Get at least one US LoR. Research the all available programs. DO AT LEAST ONE CLINICAL ROTATION IN THE US!! Enjoy your time in Budapest Youll miss it!!

American Clinical Experience: Helps you learn about US residency. The best way to obtain a LOR from a US faculty. Prepare you for your exams, application, interviews, etc. Helps you make the necessary connections. Change your status from just a face on an IMG application to Dr Smith. The single most important thing youll ever do to get into an American Residency! Ideally should be completed prior to application. Most places wouldnt assist you in housing, materials, transportation, etc. It might get very expensive. Hands-on (Externships / Mini-residency): Offer a time at a hospital during which you can attend conferences, rounds. Be present or even participate during clinical encounters. May have eligibility requirements (step I). Structured program may be offered by selected hospitals (Mt Sinai, Miami; Emory, Atlanta; Rochester, NY). Should be your top priority to get one of those if possible. Observerships (shadowing) No hands-on experience. You can attend conferences, lectures, etc. You are not allowed to have direct contact with patients, you can only observe. Less structured so your goals and requirements will be between you and the one you are shadowing. Easier to get. Three ways to get rotations: 1. Search the internet/ask around for programs that offer elective positions and send a formal application. 2. Use pre-standing connection your university (or someone you know) has in the US. 3. Personally ask to participate in an elective rotation (it sounds extremely bold, but it works). You must show that you are a trustworthy and enthusiastic person, offer to: participate presenting a case, prepare conferences about any topic, take calls, etc. Make the impression that you are a non-complainer hard working physician by being the first to arrive and the last to leave the hospital, attend during weekends, holidays, never complain about excessive work. Always smile to all staff no matter position, and be very friendly and polite all the time. Don't forget to ask for a LOR to the physicians that mentored you during the rotation, once you feel that enough confidence has been established.

Glossary: ECFMG: Educational Committee for Foreign Medical Graduates. IMG: International Medical Graduate. FMG: Foreign Medical Graduate. WHO: World Health Organization. CK: Clinical Knowledge. CS: Clinical Skills (CSA Clinical Skills Assessment). IWA: Interactive Web Application (ECFMG). ROL: Rank Order List. ERAS: Electronic Residency Application Service. NRMP: National Residents Matching Program. OASIS: On-line Applicant Status and Information Service (ECFMG). LOR: Letter of Recommendation. MSPE: Medical School Performance Evaluation (Deans Letter). CAF: Common Application Form. Educational Commission for Foreign Medical Graduates ECFMG (www.ecfmg.org) National Residency Matching Program NRMP (www.nrmp.org) Electronic Residency Application Program ERAS (http://www.aamc.org/students/eras/) Fellowship and Residency Interactive Database FRIEDA (http://www.ama-assn.org/ama/pub/category/2997.html) United States Medical Licensing Examination USMLE (www.usmle.org) Google Good Luck!!!!! Bazak Sharon sharo011@umn.edu

All the information, point, and advices in this presentation are based on my own personal opinion and experience, and should be viewed accordingly.