The USMLEs (United States Medical Licensing Examinations) are a set of medical exams designed to evaluate your readiness to safely enter the American medical system. The organisation that watches over the application of foreign nationals to the American Medical system is the ECFMG (Educational Commission for Foreign Medical Graduates) and they administer the USMLEs outside of the USA.
USMLE are multiple choice exams that are now only held on computer. There are three parts, or steps, to completing the USMLE exams. The computers that you can take them are available in a large number of cities across the world on every working day of the year - you register with the ECFMG who administer the test internationally, and reserve a place at your local centre for a time when you feel ready to take the examination. Your nearest site can be found here.
The first part, New USMLE step 1, is a multiple choice exam consisting of about 336 items, divided into seven 60-minute blocks, with 48 items in each block. questions taken over eight hours in one day at the test center. A small number of multiple-choice items with associated audio and/or video clips has been introduced into the USMLE Step 1 Examination beginning in mid- to late May 2008. No more than 5 items with associated media clips will appear in a single examinationThe step 1 covers all of the basic sciences - Anatomy, Biochemistry, Physiology, statistics, Behavioural science, microbiology, pharmacology, pathology, ethics - and it is typically taken in the first half of the medical school curriculum at a time when these subjects have been covered. Scores are reported as two digit (NOT %) and three digit scores. The percentage required to pass is determined based not on a population curve, but on the relative difficulty of the items as determined by the test committee. That pass % is then set as being equal to a two digit score of 75. The mean three digit score is 200. Many programs look for two digit scores of at least 80-85 for entry. 66% of international medical graduates pass this exam with each sitting, while 91% of US medical students do.
The second part was recently divided into two parts, USMLE step 2ck (clinical knowledge) and USMLE step 2cs (clinical skills). USMLE step 2 ck+cs is the examination that American medical students take before being allowed to graduate from medical school. USMLE step 2ck consists of a similar one day computer based examination, and covers all of the clinical sciences including medicine, surgery, paediatrics, obstetrics and gynaecology, psychiatry, forensics, emergency care, ENT, ophthalmology, tropical health, ethics. It is usually taken in the final year of medical school, or beyond. 75% of international medical graduates/students pass this on first sitting, while 95% of american medical students do.
The USMLE Step 2CS examination is a newer requirement for ECFMG certification. The USMLE step 2CS is an expensive ($1200) examination is held in only a few American cities throughout the year. It brings examinees face-to-face with ten simulated ('standardized') patients - ie actors pretending to have specific complaints. You are tested on your ability to rapidly assess a patient, communicate your thoughts to them, and to write a note about your assessment and plans. Application is presently through the ECFMG only. As of November 2002 (when the exam was called the CSA), the pass rate was 80%, with 60% of failures being due to language difficulties. As a result of this new examination, the TOEFL will no longer be required. However the USMLE step 2cs will have an expiry date for the first time.
USMLE step 3 (application on FSMB) is taken by American students during their residency program within a year or so of graduation. International students only need to take the USMLE part 3 if they plan to immigrate on a H-1B visa (recommended over a J-1). This exam is only given in the United States, requiring you to travel here to take it. Also, only a few states (California, Connecticut, Louisiana, New York, Utah, or West Virginia) allow you to take the part 3 in their jurisdiction without being in an American residency program. It is largely similar in scope to the USMLE step 2 with more emphasis on practical management. The computerized test can be taken geographically in any US state at a testing center as long as you are sitting the test FOR Connecticut or New York. Application is through the state medical board. This means you can take the test in New Jersey having applied to the state medical board of Connecticut, and having passed the exam, use that result to start residency in Massachusetts.
The English Examination is not run by ECFMG any longer. If you have taken the CSA you will be required to take a TOEFL (test of english as a foreign language) examination. If you take the USMLE step 2cs, you do not have to take an additional english examination. The TOEFL is run in most countries by the Educational Testing Service. Click here for more information on the TOEFL examination.
2.The ECFMG Certificate
This sounds straightforward but can be unexpectedly time consuming. The ECFMG (Educational Commission for Foreign Medical Graduates) certificate is a document proving that you have fulfilled the education requirements needed to practice medicine in the USA.
The Necessary components are to have
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| 1. - your medical degree and transcript verified by ECFMG (can take a long time) 2. - passed USMLE 1 and 2ck 3. - passed the clinical skills assessment (or step 2cs) 4. - passed a TOEFL english examination (or step 2cs) 5. - paid ECFMG in full |
Remember that the ECFMG certificate is only valid as long as its components (eg USMLE step 1) remain valid; each component has an expiry date. Your ECFMG certificate must be VALID when you apply for a visa or start your training. The english examination component expires after two years. Remember that if you have to revalidate your english test, the results of a repeat english examination will take some time to be processed to revalidate your certificate (this delayed my visa application).
3. ERAS
The electronic residency application system (ERAS) is a method of centralised, computerised application for residency. After you have paid the required application fee and requested a 'Token' via the On-line Applicant Status and Information System (OASIS), ECFMG will send a unique identification number ('a Token') by e-mail. This Token will permit the applicant to access the AAMC's ERAS website to complete his/her ERAS application on-line. Simultaneously, you'll have to mail photocopies of your supporting documents to ECFMG. On this online site you have to
a. enter your personal details in a standardized curriculum vitae
b. enter a personal statement
c. designate the residency programs you wish to have your application sent to.
The supporting documents that you have send in the mail include
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| 1. your photograph 2. your examination transcript and 3. your letters of reference 4. your dean's letter /medical student performance evaluation |
Foreign medical graduates send these paper items to the ECFMG who act as your "dean's office". They scan your paper documents and photo, match it to your online application items and e-mail the lot to the residency programs you selected. You can select up to four letters of recommendation to each program. You can follow this process on the Automated Document Tracking System (ADTS) which allows you to see when your application documents are downloaded by the residency programs. ERAS, the ADTS and the NRMP are all run my the AAMC (American Association of Medical Colleges). You should complete all of the ERAS application procedures as soon as possible, but by December 1st in your year of application at the latest.
The question of where to apply is frequently asked. Almost all hospitals will take the best applicants they can get, no matter their origin. There is therefore no such thing as 'FMG friendly' hospitals, only hospitals that cannot recruit american graduates, and have a preponderance of FMGs working there. You would do well to try and avoid such institutions since there is often a reason that they are deserted by American grads. If you do want to find such places, you can find them listed in the unfilled list at scutwork.com. The best advice is to discuss your plans with colleagues who know your field, and get their advice about where you would best be suited. You can use resources on AMA's FREIDA online to narrow your search, and obtain contact information.
4. Interviews
The most difficult part in your application will be securing an interview. Many program directors find it difficult to evaluate foreign graduates, so are reluctant to make the effort to interview them: there is certainly little doubt that there is substantial variablility in the quality of graduates from disparate medical schools.
There are no guaranteed methods to getting an interview at any of the top hospitals. However you can increase your chances by
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| - doing an elective - getting good USMLE scores - doing well in your own medical school - having a research publication - having very strong letters of reference from your dean and referees |
Never assume that your application is actually being reviewed by the hospital you applied to. Make sure you get in touch with the program coordinator after you have seen them download your items from ERAS, asking when you can expect to hear about whether you will be given an interview. All program directors are listed in the AMA green book, and online at FREIDA. It is true that planning international travel is more complicated than local travel, so you really will benefit from an early decision. If you do get an interview, you should be able to negotiate a day that works in your interviewing schedule, but this can be variable.
The interview day itself usually starts the night before, where you'll be hosted to a casual dinner with members of that residency. This is where you get to ask all the hard questions about what life is really like working in that hospital and program. Many residency programs do look for feedback from those who have met you at these dinners, so be on your best behavior.
The actual interview day will usually involve hearing a presentation about the program, going to morning report/conference, and then meeting individually with some of the selection committee during the day. You may not be scheduled to meet with the program director themself, but it is worth asking (given you have travelled so far) to meet directly with them at the end of the day, to find out how you got on, and whether you're in with a good chance at this program.
Do follow up with the program director by email or letter after you have left to solidify your intent or interest.
5. The Match
The Match is a centralised computer program that matches a physician's highest ranked residency program with a hospital that ranks them highly.
It is organised by the National Residency Matching Program (NRMP) . Not all of the available spots are listed in the Match, and some of the more competitive specialities participate only in the "Early Match". See the NRMP site for more information. As an international applicant, you must register as an 'independent applicant' before December 1st of your year of application at the latest
What happens in the Match is .....
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| (1) You apply to the programs in the hospitals that interest you (2) those programs that are interested in you will invite you for an interview (3) after the interview, the hospital ranks you among all those they've interviewed (4) After all your interviews, you rank the programs that you want and (5) on a certain date in March, all of these preferences are chewed on by a computer and the hospitals are matched with the applicants. |
You will optimise your chances of matching by...
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| (1) Being organised and ready (2) having good grades, USMLE scores and references (3) performing well at interview (4) having done an elective at the hospital you're applying to (5) knowing about your visa plans |
Residencies can fill their positions in the match, before the match, or in a brief 'scramble' after the match. On the Monday of match week before the specific match results are available (always a Thursday), unmatched applicants and unfilled programs are told (by email) that they did not match/fill, and the listing of unfilled programs is released. Unmatched applicants then have those next three days to convince program directors of unfilled programs that they are the right candidate to fill that job. Most use faxes, and phonecalls since program directors are usually so overwhelmed as to ignore email.
You can obtain a position before the match too. This happens when programs are sufficiently impressed with you (or sufficiently desperate for applicants) that in the days or weeks after the interview, they offer you a position directly, providing you agree to withdraw from the match right there and then, and sign the paperwork. This works well for less competitive candidates who are very unsure about their potential to match through the ranking process, and are happy with the offer.
6. State Medical Licences
After you've successfully matched you need to secure your medical license and your visa. The medical license is specific to the state of your employing hospital. Information on contacting the state medical boards is included in the USMLE/ECFMG Bulletin of Information, and is also located at the Federation of State Medical Boards Web Page. States differ significantly on their processing times and requirements for licensure. You should check out the details, including requirements for USMLE 3 eligibility at the AMA GME handbook . (contact your residency program for further details)
7. Your Immigration Visa
Doctors who have graduated from foreign medical schools seeking U.S. residency training (who do not qualify for permanent resident status in the U.S.) usually seek either of two visas from the Immigration and Naturalization Service (INS), the J-1 or the H-1B visas. Several recent events affect the use of those two visas by foreign graduates.
7A. The J-visa
The J-1 non-immigrant visa permits completion of an accredited residency or fellowship program of up to seven years duration which leads to board certification. Following this, the resident *must* return to his/her native country or country of last residence for a period of at least two years. ECFMG issues a form called a DS2019 which tells the consulate that you are eligible to enter the US. The American consulate in your own country will decide whether to issue the visa.
Your governmental health office must sign a document indicating the need in your home country for physicians trained in your prospective speciality. Occasionally (this is often an issue for Canadians) the country does not recognize a need for residents in a particular area and refuses to issue the form, but for most it is a simple formality. J-1 visa applications are usually processed quickly, though some countries have a longer processing time due in part to the events of Sept 11, 2001.
It is important to note that coming to the US on a J-1 visa absolutely limits you to staying here only until the completion of any training (be that six months or five years) up to a MAXIMUM of seven years. This is a training visa, so you cannot use to practice independently as an attending. If you think there is a chance that you would like the opportunity to stay in the USA after your training, you should take the USMLE 3 and come on a H1B visa.
There are four ways to stay in the US on a 'waiver' of this two year home residency requirement. For most, the only practical way to avoid having to return to your home country is to agree to practice in an underserved area for three years after you have completed your training. These positions are competitive and the competition for them is expensive. Again, please consider coming on a H1B visa to avoid these problems.
7B. The H-1B Visa
The H-1B visa allows the prospective trainee to avoid the J-1 visa requirement to leave the U.S. for two years by petitioning for permanent resident status in the U.S. while in residency training. An applicant for an H-1B visa must be
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| (1) ECFMG certified (ie have passed USMLE 1, 2CK and 2CS); (2) must have ALSO passed USMLE step 3 AND (3) must hold a license to practice in a U.S. state before application (it takes about three weeks to get a training license after your match). |
Residency programs decide individually which type of visa they will support for their candidates for residency training. Previously most did NOT support H-1b applications, although the new visa laws passed in October 2000 mean that now many that previously did not offer them should do so. You should ask your programs directly which they will consider for you. Remember that many have the default position of refusing such visas (and even note such decisions on residency and hospital websites), but if you learn about them, and talk to the international officers at these institutions, many will reverse their decision and apply for this visa on your behalf.
Currently all academic institutions have unrestricted access to H1B visas, without a cap. This means that your H1B visa is likely to be easily available, and processed quickly (though some can still take up to six months). A standard H1b application can still takes about 2-3 months for processing, so to be ready for a July 1st start, you have to be quick about your license and your visa application right after you match, unless you use expedited processing which can be achieved by paying an extra $1000 , and the visa will be approved within approx 14 days.
You will have to think carefully about which visa is right for you. Note that the Match takes place in mid-March, and for a July start you would likely have only a short time to secure a state medical license and submit your H-1B visa application.
8. The Residency process:
How to start and go about the process of securing a residency position?
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1. Pick your desired residency (internal medicine, surgery, radiology etc.)2. Send away for an ERAS (Electronic Residency Application System) application
3. Research your destination hospitals (see AMA's FREIDA online)
4. Complete and dispatch the ERAS application to ECFMG
5. Register as an independent applicant with the National Residency Matching Program.
6. Watch the Automated Document Tracking System (ADTS) for the progress of your ERAS submission
7. Call/e-mail the hospitals that have received your ERAS application, and ask about interview schedules. Request early decisions based on your need to complete international travel
8. Attend for your interviews
9. Rank your favorite programs in NRMP's ROL (rank order list)
10. Submit your rank order list by internet to the National Residency Matching Program
11. While awaiting the match results, research your visa options and send for the licensing application packs for the states that you feel most likely to match with.
12. Obtain your match results (or enter the scramble if unmatched)
13. Sign and return your contract
14. If immigrating on a J1 visa, get the DS2019 form from ECFMG and apply through your local consulate. If immigrating on a H-visa, you'll need to get your state license completed first (requires your ECFMG certificate and a copy of the signed contract with the hospital)
15. Organize accommodation, flights, cargo etc.
What to look in an Residency porgtam before applying.. (ERAS)
Programs Review
1. Academic Affiliation – Are they university or university affiliated?
Academically affiliated programs let you work with medical students. These programs are also viewed as more ‘scholarly’, and as a result, can help you get into a sub-specialty, research, or academic medicine (that is, become an Attending). The negative is that the support (blood draws, IV sticks, patient transport), pay, and general treatment of residents are often worse than non-university programs. The reverse is true for community (non-university) programs.
2. Presence of other residencies/fellowships – These strengthen a program educationally because there’s more of a willingness by the other departments and sub-specialties to actually teach. Private doctors tend to be more interested in the bottom line ($$$) and less interested in helping you learn.
3. Board pass rate – This is for the qualifying exam that people in your specialty take after residency. Ask the program director for your specialty—about where you can find this information.
4. Stability of the program – These questions include
--Do they have full accreditation, and for how long (this can be found on www.acgme.org under ‘listings of accredited programs’)?
--Are they about to be merged with another residency program, and if so, how will this affect your training?
--How long has the program director been there? If he/she hasn’t been there too long, why did the old program director leave?
--Do the hospital(s) where the programs are located have enough patients (both number and variety) for your education, needs and interests. It goes without saying that important issues to you such as lifestyle, academic reputation, and location should be explored as well.
--Are the residents reasonably happy and content or do they persistently ‘bad mouth’ the program?
Program information can be found on the web or by writing the respective programs.
Doing externships in your first choice program can strengthen your chances of matching there. If not at that program, then one that is in that area of the country leading to increased familiarity with the other residency programs in the general area.
The argument against doing an externship at your first choice is that you could screw up and give the powers that be a negative impression of you. I believe it takes two people to make a negative impression. If your first choice is a place where either you were not comfortable working or they didn’t extend themselves to help you work, then maybe it shouldn’t be your first choice after all.
One last word regarding externships. Usually these are sub-internships on the general hospital wards. Sometimes you can arrange externships in sub-specialty rotations such as cardiology or nephrology. These can be a bit more laid back in terms of workload, but you are on the periphery of the residency program when you work in a sub-specialty. If you choose this route then you need to be more aggressive in talking with attendings and going to conferences in order to learn more about the program and to make a good impression.
So after you know what to look for and have gathered the facts, it is time to put together a balanced application list for ERAS. I divided mine into thirds; the “pie in the sky” dream programs, the solid good reputation programs, and the programs that were easier to get into.
After interviewing, write down your impression of the programs so you can remember them when you rank programs. Make sure to send thank you notes to the interviewers and program directors as soon as possible after the interview. If you are truly interested in a program after the interview (probably a top three choice), consider scheduling a second look tour by talking with the residency coordinator. This is usually a day spent with an in-hospital team and/or in the out-patient clinics. It allows you to get better acquainted with the program, and shows the program that you are very interested in it.
TYPES OF PROGRAMS
BIG UNIVERSITY PROGRAMS:
These programs are generally looking for good candidates, with good communication skills and they do not ask you technical or professional questions like some clinical vignettes and MCQs test before interviews, but that does not mean that you should not read anything.
Try to read something beforehand especially some Emergency medicine topics. These programs would have a very formal interview and would probably consist of your interests, hobbies, future goals, objectives and things like that. Typical interview questions would probably be:
1. Initial introduction, how was your journey, any difficulties and things like that.
2. What are your interests?
3. What do you like about our program and why you have selected our program?
4. What can you do about our program, which some one else can not do? (tough question).
4a. What type of person are you, means academician or practitioner?
5. If you have done some research, they might ask you what were your specific interests about this research?
6. What is your future plans? In terms of fellowship, private practice and some research interests.
7. Most of the programs would like to know about your future affiliations to their program. So try to establish a root with the city in which you are being interviewed and tell them your plans that you would be staying in USA and do your fellowship and then join the faculty. Green card holders and citizens have advantage on this part. They are interested to know, how long you will stay with them because nobody wants you to train and let you go.
8. They might ask you about something that is extra-ordinary in your CV, so be prepare for that.
9. In the interview board, there might be some people who have done research in the same area as yours. Please do not try to impress them or produce any conflict with them. Those people have spent their lives in research and your 20-30 minutes interview can not change their ideas instead it could hurt your chances. Those people just want to know that you are hard working and would perform the duties of a resident very honestly and comfortably.
10. Do not try to go into minute details of things like New research, development ad never discuss any controversial issue.
11. Do not show them that you are strictly Type-A personality. If you do not understand anything, you could always ask them to elaborate the question.
12. Please speak clearly. It does not matter if you do not have a very impressive American English accent but you should speak clearly and never end your statement with "You know what I mean".
13. If at some stage you feel that you will not be accepted, do not give up. Perhaps the last interview question might help you and you will be selected.
SMALL COMMUNITY HOSPITALS:
These hospitals have a tendency to ask technical and professional and they might take a small MCQs session and Clinical skills on some patients. So, for these you should always be prepared. Most of the technical questions are from Emergency Medicine, Cardiology or might be OB/GYN.
VERY OLD GRADUATES (7-15 YEARS)
You might be asked a special question "What have you been doing since graduation?". It is asked specially to those who have not mentioned it very clearly on CV. If somebody has been actively involved with his field then it is not a difficult question but for those who are not involved with Medicine, it might be a tough question.
WHEN YOU DO NOT HAVE THE BACKGROUND FOR THE SPECIALTY, YOU ARE BEING CALLED FOR INTERVIEW:
For example, you have not done pediatrics in your life and you are being called.
It is a tough situation and I would suggest that you should be technically and professionally prepared. Before going to the interview, try to read the important stuff in that specialty.
They might start your interview with the question that you have not done anything in Psychiatry or Pediatrics, so how you would do the residency. You can always satisfy them with your knowledge and by giving examples and comparing general medicine with pediatrics or any other fields. If you prove them that your general concepts are strong and clear then they would be satisfied.
WHAT TO DO WHEN YOU RECEIVE THE INTERVIEW CALL?
1. Send a thanks letter to the program coordinator or director.
2. Before calling them to set the date for interview, try to find out with the current residents or other people in the program about the psychology of the director in terms of earlier interview candidates and later candidates. Some programs have a tendency to select from earlier candidates and some have the opposite.
3. Before going to the interview, you should always try to find out about your specific interview board personals and try to know their psychology. You should also know about their position in the program, their research interests and if the have any recent publications. Sometimes they feel good if you have the same research interest as them and they start talking about it.
4. You should try to arrive at that city or the hospitals 2-3 days before the interview and speak with the chief resident, other residents and interns. When you are asked in the interview about the program, then always quote that you have been here for 2-3 days, observing the atmosphere with residents and you really like the place. Try to make friends with the Chief resident because one of the chief resident is also in the interview board.
DAY AND DRESS OF INTERVIEW:
Formal suit (no shiny stuff, try to be conservative), dark charcoal grey, black or dark blue, conservative tie and formal shoes. Preferably short hair, no pony tails and preferably white shirt inside.
FOR LADIES: We would also recommend ladies to wear something like a (dark conservative color) mid-length skirt suit with a blouse or a shirt and a jacket on top. a full length pair of pants is also a good idea. a regular port folio (black, burgundy or dark brown) for keeping documents. preferably shoes rather than pencil heels. Try to look like one of those business executive ladies.
PLEASE TRY TO BE ON TIME OR BEFORE TIME.
HOW TO PREPARE FOR INTERVIEW
Please find some time and read the book "First aid for residency match and interview" by VIKAS BHUSHAN.
You can find the residency interview videos from the library.
You can test your general interview skills with mock interview videos available in public libraries.
General interview techniques' videos are frequently available in the public libraries.
If you feel that your communication skills are poor then you surely have to make it better and for that try to watch TV, listen to Radio and make friends with American people.
Sometimes your interviewer might be funny person and would like to share jokes with you. Do not get over excited at that time because he is not your friend but a program director. Do learn a few slangs also.
Key point to get residency is that you have to be confident not arrogant, you have to be strong and enthusiastic not weak and indifferent, you have to give them an impression that you will get the residency anyway and you are here for just to evaluate the program. Don't feel weak and miserable be energetic and think positive. When your interview finishes the program should have an impression that you are a very strong candidate and if they miss you, they will make a big mistake.
Personal approach: meet people over there and try to show your face to the program director before the interview. Meet the chief resident and other residents. And ask the first year interns about the question of interview because they have gone through the same process.
Preparing for your Interviews
Remember to always be neat and well groomed, but comfortable, when going for your interviews. Conservative dress is still your best bet, so that means dark blazers, suits and dresses are appropriate.
If interviewing on the east coast remember to dress warmly. Always arrive at your destination early.
In most cases you will be on unfamiliar territory, so arriving early gives you the opportunity to find your way around the area and become comfortable with your surroundings.
The World Wide Web (WWW) has become a terrific source of information, especially about universities and teaching hospitals.
You can often find an up-to-date phone directory, campus map, and information about the surrounding community on a university's web site. Be prepared to ask and answer questions.
The following questions you should consider asking /answering during an interview.
Remember not all questions are appropriate for all interviewers. You would not ask a program director about the nitty gritty of patient contact. That question is more appropriate for residents. You would ask the program director questions about where the program has been and where it is going.
Remember you may be asked questions that are not only uncomfortable to answer, but illegal under state or federal law. These include questions about family, child care, birth control, race, nationality, physical disabilities, and religion.
What could you be asked?
1. Do you have any questions?
2. Tell me about yourself?
3. What do you do in your spare time?
4. If you could be any cell in the human body, which would you choose to be, and why?
5. If your house was burning, what three objects would you take?
6. What are your strengths and weaknesses?
7. Why should we take you in preference to the other candidates?
8. What would be the most enjoyable and least enjoyable aspects of your residency?
9. With what type of people do you enjoy working (not working)?
10. With what patients do you have trouble dealing?
11. Who are your heroes?
12. What is your energy level like?
13. What were the major deficiencies in your medical training?
14. How do you explain...(low grades?, leaves of absence?, poor clinical narratives?)
15. Have you always done the best work of which you are capable?
16. How well do you function under pressure?
17. Teach me something in five minutes.
18. Tell me about the patient from whom you learned the most?
19. What error have you made in patient care?
20. What subject or rotation was your most difficult?
21. Why do you want to go into this specialty?
22. Do you think you would be right for this program/specialty?
23. Why did you apply to this program?
24. What do you think of (current events topic)?
25. What would you do if a patient stabbed your best friend?
26. Where do you see yourself in five/ten years?
27. How do you see the delivery of health care evolving in the twenty-first century?
28. What problems do you think this specialty faces over the next five/ten years?
29. Where else have you interviewed?
30. What if you don't match?
31. Can you think of anything else you would like to add?
What to ask the Interviewer
1. What is the interviewer's general opinion of the program?
2. What is the general framework of the training program?
3. Is most of the program conducted in the major hospital?
4. What is the composition and caliber of the teaching and attending staff? Are they fulltime or part-time?
5. Does the attending staff participate in daily rounds and conferences, or is the bulk of the teaching performed by other residents?
6. What is the conference schedule? Is time for conference protected time?
7. Are there any teaching conferences specifically for housestaff?
8. Does the program allow for research by the housestaff? If so, does the department fund it? Is there an elective time in which to do it? Are there faculty mentors?
9. Are rotations in related subspecialties included in the program?
10. Which electives are offered, and at what periods during the program?
11. Are residents permitted or encouraged to attend regional or national medical conferences?
12. Have any graduates of the program ever failed to do well on the certifying exams and if so, why?
13. Does the chair plan any changes in the program in the near future? Is the director likely to retire shortly or remain as chair during your residency?
14. What are the chances of permanent local practice after residency?
15. Is there a pyramid system? How many cuts are made each progressive year?
16. What is the financial status of the institution?
17. Has the program or institution ever been put on probation or been denied accreditation for any reason?
18. What does the director think of the programs offered by other institutions? Which of them, if any, would the director recommend?
19. What were the results of the most recent "in-training" examination? Is a minimum score required to progress to the subsequent year?
What to ask the Housestaff
1. What is the housestaff officer's general opinion of the program?
2. Is there a medical library close to the hospital and does it contain an adequate selection of recent books and journals? Are there Melvyl hookups? Who photocopies for you?
3. Is there an adequate visiting professor program with other institutions?
4. How valuable are the conferences?
5. Are chart rounds conducted routinely?
6. What is the average number of patients for which each house officer is responsible?
7. Does the housestaff receive adequate clinical experience performing procedures? Who teaches these procedures?
8. What is the clinic schedule? Is there a continuity clinic?
9. Is an attending physician present during each clinic?
10. What does the housestaff officer think of the chair? What is the chair's background and reputation? Is the chair sincerely interested in teaching housestaff? Is the chair readily accessible to the housestaff?
11. Are emergency services readily available?
12. Do all wards of the institution have cardiac arrest carts and EKG machines?
13. Is a radiologist available 24 hours for consultation?
14. Does the hospital provide IV and blood drawing teams? Are lab results computerized?
15. When do rounds begin in the morning and at what time does the normal day end?
16. What is the on-call schedule? Does it change during the senior or chief year?
17. Is moonlighting permitted and is it available in the community?
18. Are meals provided free or at a discount for housestaff? Is there an evening meal? Is food available/provided at all hours?
19. Is parking provided? If so, where?
20. Are uniforms and laundry free of charge to the residents?
21. Is there adequate malpractice and disability insurance, including HIV disability insurance? Does the hospital provide health and life insurance?
22. What is the availability of housing and its average cost? Where do most staff live? If many staff people commute, what is the average commute time? Should there be a concern for safety in some areas?
23. Is there a housestaff association and what is its relationship with the administration?
24. What are the climate and general living conditions in the community?
25. What is the general atmosphere of the hospital? Is it a pleasant place to work?
26. What is the housestaff officer's opinion of programs at various institutions?
After your visit, make notes about your experience. You should follow up your interview with a thank-you letter, mentioning the names of your interviewers. Letters are better than phone calls because residency directors are very busy during interview time. Also be sure to immediately forward any additional information the program may have requested from you.
1) Prior to the interview, don't be afraid to schedule dates that maximize your travel plans. It is professional and expected that you do so. Once you agree to a date, however, make sure that a tour of the facility and an opportunity to speak to the current trainees is included. If not, arrange that separately.
2) Dress neatly and professionally. Grooming and demeanor count. It is better to be on the conservative side until you know more about the environment you are entering. Be pleasant and polite to EVERYONE. You are being judged every moment that you are there. Hold the door for people. Dispose of your trash properly, etc.
3) If you are late, apologize and explain honestly what detained you. Consider rescheduling but go through with the interview if at all possible. Even if you are late, take the extra time to compose yourself. Don't rush in and start screaming at the first person that is not able to instantly direct you to where you are supposed to be. You never know when you might be screaming at the program director's secretary
4) Appear EXCITED and INTERESTED. It doesn't matter that you just flew in on the "red eye" and you are completely sleep-deprived. When asked about a hot topic or a controversial case, think, then smile knowingly, and then slowly begin to answer as best you can. Your goal is to make the interviewer think that you have already thought about this issue in depth and you are now going to teach him or her. When relating the history of your interesting case, don't be shy. Get excited; use vivid descriptions of what else was going on at the time. "We were on call that night. It was bitter cold out. The hospital was dead quiet when suddenly everyone was called to the emergency department because of a bombing ..."
5) Prepare at least 2 interesting cases that you can discuss at length. Specific details about age, etc. are not as important as the principles that the case illustrates. Take care to prepare cases in different subspecialties. NEVER volunteer to discuss a case in a particular sub-specialty with a faculty member in that sub-specialty. Unless this is a fellowship interview then just be sure you know what you are talking about.
6) Be ready to ASK QUESTIONS. Be as challenging (but not confrontational) as you feel comfortable being. Show that you are observant by asking about something that came up during the interview day (perhaps in conference or in rounds). The curriculum, faculty, board passing rate, post training opportunities, unique features and future plans are all good questions and show your interest in the program. The worst thing you can say is, "No, I have no questions." This translates to "No, I have no interest."
7) Research the program as much as possible. Conduct a literature search of the faculty's recent publications to get a sense of the kind of work that goes on there. Will there be a conference for you to attend on the day of your interview? If so, read up on the topic of the day so that you can ask intelligent questions. Will there be a journal club for you to attend? If possible make sure you've read the article in advance plus any accompanying editorial.
8) Inappropriate questions for the "Do you have any questions?" part of the interview include: "How much vacation do we get?", "What's the on-call frequency?", and “What are the moonlighting opportunities”? These are all selfish questions. Have some faith that the program conforms to work hours regulations. On the other hand it is not unreasonable to ask about family leave policies and other benefits. You can always ask a current fellow about perks and work rules later when you are alone or better yet call one at home after getting their permission to do so.
9) If you have a heavy accent, speak slowly and clearly. You may want to practice in front of a mirror or with friends that are NOT from your country.
10) check out a national newspaper for the couple of days leading up to your interview. Be aware about any late-breaking news about health care or medical science.
11) If your special talent is something unusual, do you have something with you that will leave a lasting impression, Pictures, manuscripts original art? A physical object goes a long way toward planting a memory in the program director's mind. Interesting people make better fellows. Use what you have.
12) Try and get a sense of where the program is in the recruitment process. How many will they take? How may have already been hired? How many more will they interview?
13) Get directions to where you are going well in advance. If possible become familiar with the directions to the hospital the night before. Leave extra time to get there.
14) Try and debrief someone you know that was already at the place you are going. Find out what they asked, what else happened. Whatever you can.
15) PRACTICE being interviewed. Participate in mock interviews; go for interviews in places you don't want to go to just for the practice
Sample thank you letter: After interview
Send thank-you letter by E-mail to the program director and other people with whom you interviewed. Make modifications to this sample to suit your purpose.
SAMPLE THANK YOU LETTER
Quote:
Your Name123 Main St
Any Town
Ph/Fax : 406-535-2345
mm/dd/yy
Interviewer
Department of medicine
123 Main St
Any Town
Dear Dr. (Interviewer),
Thank you very much for interviewing me for the Internal Medicine Residency Program on (date). I really enjoyed meeting you and learning more about the position. I appreciate you taking your time out to talk to me about my qualifications and interest in the position.
After meeting you and Dr. (2nd interviewer) and seeing the hospital first hand, I am convinced that (name of the hospital) is one of the very best among the select few programs to which I have applied. I liked the program very much because of the wide spectrum of patients, its solid foundation in academics and research, the fellowship opportunities it provides and the dedicated faculty. I will definitely rank it very high in the Match.
Please let me know if you believe that a second meeting, or any other information I can give, would be helpful to you. I can be reached either by phone at (406-535-2345), or via email: (yourname@server.com.)
Thank you so much once again. I look forward to hearing from you.
Sincerely,
(Your Name)
(your eras number)
Subspeciality fellowships (internal medicine)
While selecting a residency, subspeciality opportunitues should be kept in mind. Plan your subspeciality according to your interest giving preference to those hospitals where that is available.
Specialty training is called fellowship training, and usually adds two to three years of training beyond the residency training.
Generally, applications for fellowship training are submitted during the second year of internal medicine residency training.
Subspecialties that require preliminary training in internal medicine:
Quote:
| Allergy and Immunology Cardiovascular Disease Endocrinology, Diabetes and Metabolism Gastroenterology Hematology Infectious Disease Medical Oncology Nephrology Rheumatology Pulmonary Disease |
At the completion of residency training, the American Board of Internal Medicine (ABIM) offers a special test that certifies expertise in internal medicine. Although not required, passing this test is beneficial to an internal medicine career, and most graduates take this examination to become "board certified" in medicine. A similar examination is offered by ABIM following completion of a subspecialty fellowship. Certificates of added qualifications recognize special expertise in areas of internal medicine.
An additional 2 years of training will get you specialised in the fields
Quote:
| Adolescent Medicine Clinical Cardiac Electrophysiology Clinical and Laboratory Immunology Critical Care Medicine Geriatric Medicine Interventional Cardiology Sports Medicine Adolescent Medicine |
Neurology is a separate residency in itself ( and not a subspeciality) , and only requires one year of Preliminary training in Internal Medicine, and the neurology match is held earlier than the main residency match. To join neurology, you will have to apply for both neurology (for the year after your prelim year) and prelim medicine year
List of all residency programs in Internal Medicine (ACP programs)
Note: List contains the most up-to-date information including contact info. and number of positions. (visit ACP website: Americam college of physicians)
TYPES OF PROGRAMS
What to ask the Interviewer
1. What is the interviewer's general opinion of the program?
2. What is the general framework of the training program?
3. Is most of the program conducted in the major hospital?
4. What is the composition and caliber of the teaching and attending staff? Are they fulltime or part-time?
5. Does the attending staff participate in daily rounds and conferences, or is the bulk of the teaching performed by other residents?
6. What is the conference schedule? Is time for conference protected time?
7. Are there any teaching conferences specifically for housestaff?
8. Does the program allow for research by the housestaff? If so, does the department fund it? Is there an elective time in which to do it? Are there faculty mentors?
9. Are rotations in related subspecialties included in the program?
10. Which electives are offered, and at what periods during the program?
11. Are residents permitted or encouraged to attend regional or national medical conferences?
12. Have any graduates of the program ever failed to do well on the certifying exams and if so, why?
13. Does the chair plan any changes in the program in the near future? Is the director likely to retire shortly or remain as chair during your residency?
14. What are the chances of permanent local practice after residency?
15. Is there a pyramid system? How many cuts are made each progressive year?
16. What is the financial status of the institution?
17. Has the program or institution ever been put on probation or been denied accreditation for any reason?
18. What does the director think of the programs offered by other institutions? Which of them, if any, would the director recommend?
19. What were the results of the most recent "in-training" examination? Is a minimum score required to progress to the subsequent year?
