How tough is medical residency

Most of the people ask me about postgraduate residency programs in United States and a majority of these people are Nizhnians. There are also a few from Volgograd. I’ve already written about postgraduate studies in Australia, Malaysia, New Zealand, UK and other countries and I might as well write about United States. Please keep it in your mind that what I write can be wrong. So, you can verify everything on your own for further assurance.


1. Some people think that clearing the qualifying medical tests are enough for start practicing medicine in United States or that Medical Licensing Examination (USMLE) is enough for getting a residency. Even though, USMLE plays a pivotal role for residency in US, but just passing it’s Step 1, Step 2 CK (Clinical Knowledge) and Step 2 CS (Clinical Skills) are not enough for getting you a residency in US. The application involves med school insignia - literally a pain – and Step 3, which is mostly taken during or before the start of residency.

2. Exams accessories – they are of extreme importance. You have to select exceptional review books for revising USMLE. There are some brilliant USLME revision programs that include Kaplan and question banks (Kaplan, NMBE, USMLERX, USMLE World), which are really helpful for your practice. Make sure you don’t miss any of them, as they have been helpful to many people. People have been found spending big amounts on these, which range from $800 to 5000.

3. USCE or United States Clinical Experience is highly regarded in residency programs for interviewing residency candidates. And most of the candidates are required to have at least 2 Letters of Recommendation from US physicians. For getting a Letter of Recommendation, a candidate is required to take externship / subinternship/ observership programs, which eventually take a notable time. On the other hand, some scientific / clinical researches pay more attention to International Medical Graduates (IMGs).

4. Getting into United States – this is certainly tough as it is handled by bureaucrats and US embassy / consulate. IMGs need to have traveled to US for at least thrice before they could start their residency. They have to come to US for Step 2 CS, USCE, and finally for residency interview. Performing all these steps costs a lot of money and you are really going to hate it. But what you would hate more are Visas. Some people might get visitors’ visa, which is later declined most of the times. For residency Visa, you have to choose H1B or J1. H1B is for 6 years of employment and J1 is for a 7 years education. You need to be extremely good for employment in US and you must also possess letters from Ministry of Health for your J1 Visa. In most of the cases, people prefer J1, as it is much easier than H1B.

5. Application process to a residency program – this is a pretty painful process, which I haven’t yet been able to understand completely. It includes all those things which you might hate the most - pre-match, scrambles, NRMP, ERAS, interview processes, final applications, ECFMG certifications and several others.
6. Interviews – Mostly, IMGs apply for a small number of programs for interview, which ranges from 10 to 20. And a simple profile of an IMG has is 4-5 years post graduation, 2 USCEs at least along with a few LORs, 80th percentile and above for USMLE Step 1 and Step 2 CK scores, passed Step 2 CS on first try.
7. Specialties – some specialties are absolutely useless for IMGs, which include radiology, ophthalmology, anesthesiology and dermatology. Majority of IMGs opts for Internal Medicine and Family Medicine because American Medical Graduates (AMGs) choose an easier field with higher pays to be able to manage their medical school debts. Internal Medicine and Family Medicine residency usually lasts for 3 years. Many IMGs pursue their fellowship programs for their subspecialties, as the J1 visa is only valid for 7 years. Therefore, 3 years of residency along with 2-4 years of fellowship is good enough for an IMG to be called specialist.

8. Competition – It’s extremely competitive and there are some programs that can only be picked by those with 90th percentile or above for residency interviews. Moreover, some specialties including neurology, neurosurgery and surgery are even more complicated and tough for average people. You have to be extra smart and very intelligent to have completed all these courses with distinction. If someone’s is the most acknowledged surgeon in a foreign country, he might end up becoming family medicine physician in United States.

Okay, I guess it was the shortest possible summary that I could give you about residency in US. My knowledge is not even 10 percent as compared to the knowledge of several other IMGs, but I just tried my best to share with you all that I could after witnessing so many people discussing this topic on several online forums.

So, if you too are inspired to work in United States after watching all that charisma and brilliance in TV serials like Grey’s Anatomy and Dr. House, you should think about it again. Because it is very tough and takes a lot of hard work before you finally start living a perfect life of your dreams. Besides, it is a bad idea to look for fame, respect and money, as it won’t really be possible for majority of people. The work hours would be long and tiring, plus there would always be someone on yelling on your back as your supervisor. You will have to sacrifice a lot of friends; and you will also be away from your family and friends. So, if it takes all that, one should better become a nurse.


And for those who are inspired by fame, respect and money; you definitely won’t get any of that! What you get is probably long-hours of strenuous working with yelling supervisors, sacrificing your time and being very far from your family and friends, changing who you are and many other negative stuffs.

medical education

Residency matching tips

Hello everyone,
This should catch the Residency Match 2010 and maybe it will be of some help to those preparing for the same. It might even come in handy for the later generations of aspiring US residencies.
This is just what I did:
1. I sent in my applications for a total of some 150 Medicine programs – It is getting more and more competitive as each year passes, especially for the IMG programs. They say that the IMG-friendly programs got some 3,000 applications this year and this has been growing over the years. Probably because each applicant applies for more than 100 programs. That’s what I thought also and so I applied for 150 programs. I also intend to apply for Family Medicine if I don’t get enough interviews for Internal Medicine. Good thing I don’t have to apply for FM also. No point in applying for programs that you aren’t eligible for. Their software itself will probably filter the ineligible ones. Applying for more programs isn’t going to get you any more interviews. Apply only for those you’re eligible for.
2. J1 Programs – I’d wanted to apply only for the H1b programs, but as they say beggars can’t be choosers, and so best keep your options open and apply for both eH1b and J1 programs.
3. Credentials – Most programs use the USMLE scores as a selection criteria. Get a good score by working hard. You want to know what a good score is? Well, that’s pretty tough. For IM a score of 90 would be good, but then there are a good number of double 99s running around. Try and get the maximum scores for Step 1 and Step 2ck. Understand that Step 3 scores are not that important, but I’m not sure. I got 86 and one of the program directors mentioned that that was a pretty good score.
They say that a double 99 is a must for a good program. Don’t think that’s true. I got 95 and 99 and the 95 didn’t do me bad. Scores are just to filter applicants. Once the grain is separated from the chaff, the whole application is given a go through. So don’t give up because of low scores. Don’t lose heart. Some with even a score of 79 have got through. Try to pass at the first attempt. Suppose you fail. So what? That’s not the end of it. There are still some guys who got in after multiple USMLEs. There’s a light at the end of the tunnel, always.
Year Of Graduation – They say that most programs have a preference for freshers, but there were quite a lot of fellows who’d finished their PGs in their home countries. I think that programs prefer guys who’d completed their residency in their home countries. But that doesn’t necessarily mean that you should complete your PG to improve your credentials. No point in wasting time doing stuff that isn’t going to be recognized here in the United States of America. Quite a lot of fellows have got into residency straight off from under-graduation.
ECFMG and Step 3 – I’d got my ECFMG certification and had finished Step 3 when I applied for residency programs. Step 3 scores just might come in handy to get a few extra interview calls. Specifically if your Step 1 and 2ck scores are low. I’m not asking you to wait till you get your Step 3 scores before applying.
Research – There is difference between University and Community programs, University programs expect some sort of research activity on your CV, or publications. Publications in the US are more preferable, carry more weight. Update – I didn’t do any research anywhere, just participated in the ones in the hospital where I did my USCE.
USCE (Clinical Experience) – Clinical experience is something they look for in your CV. This is used as a filtering criteria by many PDs. Some do and some don’t consider just observership as US clinical experience. But don’t bother. Getting a observership is just as competitive and difficult at present. Apply for both observership and externship. Expensive but worth it. More the clinical experience the better.
Sep. 1 – Important! No compromise allowed! Get your LOR and MSPE documents ready and have them sent to ERAS by August. Also get your CV and your Personal Statement ready and out by Sep. 1 (00:00 AM EST). Go through your exams and be ready by Sep 1. Have at least your ECFMG ready by then. You’ll get a good number of interviews with just your Step 1 scores. Don’t take any risks. Better apply with all you scores by Sep 1.
The Mercy Of God – A short testimony. As far as I am concerned, the most important factor. It wasn’t my credentials but solely the mercy of God that I got all the interviews that I got. This is not an idle statement. I’ve experienced a lot of miracles and have surmounted some obstacles over the last two years on my way to a US residency. It is purely on God’s mercy that I’m even writing this blog, because until recently, I was nothing but a symbol of failure.
You wouldn’t believe it but I got my US visa only on my fifth attempt (rejected four consecutive times). I’ll soon enough blog on my US visa experiences. I now believe that it was God’s plan for me. Suppose that I’d got my visa the very first time I applied? I’d probably gone over my head, sitting on my own capabilities. Actually I’m only an average student and it is because of God that I am where I now am. This has only strengthened and will strengthen more my faith in God. Obstacles and problems take us closer to God.
I’ll now confess. All my research and USCE opportunities were nothing but the miracles of God. If not, I’d not have got even the 10 of the 26 that I did get.

Residency match interview

Though I am a fresh to the field of residency, I have made it a point to meet a couple of people and asked them for some tips on approaching an interview.

Fair Interviews And Chances :

Suppose you get a Fair Interview call, that is, you are invited to appear for an interview without having any previous contact with the particular program or without having applied for the program, then you really have a good chance of landing a place in the program. Just think about it – 1,000 to 1,200 applicants for a position and you are selected for an interview. Makes you really wonder, doesn’t it? But don’t be complacent and go for the interview without preparing yourself in every way. I’ve seen quite a number of them go unprepared and fail. So, my advice would be to prepare thoroughly.
Interview Through The Electronic Residency Application Service(ERAS) : If you got invited for an interview through the Electronic Residency Application Service(ERAS), then it is definitely a fair interview because it is an electronic program that has all your details and you have been selected without any bias.
Interview Based On Recommendations Or Contacts : It is a common belief that if you get an interview call either through your contacts or through recommendation, it is just to satisfy you. But just think about the others who would also have had contacts and would have been invited for the interview. So you should take this also seriously and prepare as diligently as possible.

VARIETIES OF PROGRAMS

Big University Programs : These are programs on the lookout for some really good candidates. Candidates with good communication skills. The do not query you on the professional or the technical aspects of the program with clinical based questions or any Multiple Choice Questions (MCQs). But that should not keep you from preparing for the interview.
Try to bone up on topics related to emergency medical situations. These interviews would typically be general in nature probing into your interests, future goals and objectives and hobbies and such things. Typically, the questions could include:

A preliminary introduction and general questions regarding your journey to the interview venue and whether you experienced any difficulties and such banal stuff.
What your interests are.
The reason why you have selected the particular program and what you think about it.
What would your contribution be to the program that someone else could not contribute.
Whether you are a practitioner or an academician.
Whether you have done any research, if yes, what were your interests in the subject of research.
Your future plans in relation to fellowship, research and private practice.
Your future affiliations to the particular program. This is where they will evaluate you on your commitment to the program. So try to get settled in the place where you are going to do the program and let them know about it. Let them know that you are committed to the program and that you’d be remaining in America and possibly join the same faculty. They wouldn’t like to train you and see you migrate to some other place. It would be advantageous if you were either a citizen or a green card holder.
There may be something special in your Curriculum Vitae(CV). So be prepared to go into its details.
Possibly, there might be someone on the interview board who has done some research in the same area that you have specialized in. Don’t try to impress them or create a conflict of interests. These people have spent time doing their research and it will be difficult to get them out of their fixed ideas. You can’t change them and there is no point in jeopardizing your chances. All they are interested to know is whether you will perform your duties as a resident.
Do not attempt to foray into controversial areas like New Research and Development etc.
Do not let them get the impression that you are a typical Type-A personality. If you do not understand their query ask them to elaborate.
Speak clearly. It is not necessary that you should have an American accent. And never close with the statement "You know what I mean…".
Never give up. Even if at a particular stage you feel that you might not make it. Nothing is finished till the interview is concluded. The last answer you give might turn the tables.
Community Hospitals : These community hospitals have the tendency to ask professional and technical questions. You might be asked to take a small Multiple Choice Question session and your clinical skills may be put to test. As such you should be prepared for such an interview. The questions generally relate to the fields of Emergency Medicine, OB/GYN or Cardiology.
Old Graduates (7 to 15 years) : A special question that many old graduates face is "What have you been doing since graduation?". Especially those who might have omitted to mention this in their Curriculum Vitae. If you had been practicing medicine, it would be an easy one to answer; if not, it would be a tough one.
What To Do If You Are Called For An Interview For A Program In Which You Have No Background Experience : Assuming that you have never done psychiatry and you are called for a residency program in psychiatry, what should you do? The best advice would be to prepare yourself thoroughly in the subject. Read and bone up on whatever material that you can lay your hand on in that particular specialty. The first question that you might possibly face would be just what you would do in a residency in which you have no experience at all? You can satisfy them by showing them your knowledge on the subject by giving examples and by a comparison of general medicine with the specialty that you intend to do residency in. If you can show them that you have a strong foundation, you can definitely impress them.

Your Response To An Interview Call :

Thank the program Director or the Coordinator for the call in writing.
Before settling for an interview date, call on the current residents and try to learn about the psychology of the program Director or the Coordinator and how they have conducted previous interviews. Whether there is a tendency to select older candidates or from the newer ones.
If possible find out the people who would be your interview board and their psychology. Learn about their position vis-à-vis the particular program, their interests and if they have published any papers recently and if possible get and read them. You can make them feel good if you can talk about their fields of interest.
Get to the hospital two or three days before the interview and familiarize yourself with the hospital atmosphere and talk to the interns and residents already there. You can always bring in the fact that you have already familiarized yourself with the atmosphere of the hospital and that you like the place. Try to get to know the Chief Resident and become friendly with him because there is a very good chance that he might be on the interview board.

Dressing For The Interview

For Gentlemen : A formal suit preferably in the darker colors of dark charcoal grey, dark blue of black will be admirable. A white shirt will be most suitable. Complement it with a conservative tie and keep the shoes also formal. Keep your hair short. Pony tails are not generally relished.
For Ladies : A mid length skirt with a blouse, or a shirt and a jacket would just be fine. Alternatively, one can wear a pair of full length pants. A black or dark brown or burgundy portfolio for keeping documents should do. Shoes would be preferred over stilettos. Try to look like a business executive lady.
Essentially, Be Punctual.

Preparing For An Interview

Find and read the book "First Aid For Residency Match And Interview" authored by Vikas Bhushan. The library should hold residency interviews on video. Get them and watch them. Interactive videos that test your interview skills should be available in the public libraries, so also material on general interview techniques.
If you feel that your communication skill may not be up to the mark, try to listen to the radio, watch TV and make friends with Americans. Learn a few slang words. There may be an interviewer or two who like to share jokes with you. Do not get overenthusiastic. Remember, he’s the program Director or a member of the interview board.
The key points to getting a residency are confidence and not arrogance and strength and enthusiasm and not weakness and indifference. You must exude the confidence that you will get the residence and sound as if you are the one who is trying to evaluate their program. Be energetic and think positively. At the end of the interview you must leave the impression that you are a right and strong candidate and that the program will be losing a very good resident if you are not selected.
Some of the questions that were asked in an interview in a Virginian hospital are given below so that you can get a grasp on the kinds of questions that you may expect:

Why this specialty and not another?
Why choose this program?
How do you picture yourself a decade or a decade and half from now?
What are your research interests?
What are your hobbies and what are your future goals?

Interview Tips From The Magazine - "New Physician"

Personal Approach : Meet the people at the place of your interview before the interview and see that your program Director gets to see your face before the interview. Make contact with the Chief Resident and the other residents. Get in touch with the first year interns and ask them about their interview experiences. They have gone through what you are going to go through. Get tips from them.

Interview Preparation

When you go to an interview, be well groomed but comfortable. A conservative dress is the best choice and as such, dark suits and dresses and dark blazers are the in things. If your interview is on the east coast, dress warmly.
Arrive at the destination of your interview punctually. As in most cases, you will be treading unfamiliar ground, arriving early will help you find your way around the place and also make you feel comfortable.
The Internet is a large source of information, use it to gather information of the University or teaching hospital that you intend to do your residency in and your intended program. All the details that you require should be available in the University’s dedicated website. You can always refer to the most up-to-date telephone directory or get a campus map and ask your way around the University or the hospital.
Keep in mind that all questions are not appropriate at interviews. You cannot, for example, ask nitty-gritty questions about patient contact to the program Director. That is left to the residents. You could ask about the program, where it started from, where it is and where it is headed.
There are some questions that you may be asked that could be uncomfortable for you to answer, it may even be illegal. These are queries about family, race, nationality, religion, child care, birth control and physical disabilities.
It is also against National Resident Matching Program(NRMP) regulations that you be asked questions such as "If we offered you a position today, would you accept?". If such a question is asked you are encouraged to report it to the NRMP.
The following are the kind of questions that you may be asked or that you might ask during an interview.

The Questions That You Could Be Asked:

Have you got any questions?
Tell us something about yourself?
How do you spend your spare time?
If you were given a choice of being a cell in the human body, which cell would you choose to be and why?
Assuming that your house was burning, what are the three articles that you would save?
What are your strengths and your weaknesses?
Why should we select you in preference to the others?
What would you enjoy most in your residency and what would the least be?
What kind of individuals do you like working with(or not working with)?
What types of patients would you have trouble relating to?
Who are your heroes?
Your energy levels, what are they like?
What, in your opinion, are the main shortcomings in your medical training?
How would you explain… (leave of absence?, low grades?, poor clinical narratives?)
Are you capable of doing your best and have you done so in your past?
How well do you work under pressure?
We’ll give you five minutes to teach us something.
What have you learned most and from which patient did you do so?
Have you ever made any errors in patient care? If yes, what is it?
Which rotation or subject did you find most difficult?
Why this specialty?
Do you consider yourself to be fit for this specialty?
Your reasons for applying to this particular program?
What is your opinion of (current topics or current events)?
How would you react if your best friend was stabbed by a patient?
How would you project yourself in the next five or ten years?
How would you evaluate the health care system in the 21st century?
What, in your opinion, would be the problems that this specialty would face in the next five or ten years?
Have you been interviewed elsewhere?
What if you do not qualify?
Is there anything else that you’d like to say?


What You Can Ask The Interviewer:

What is your general view of the program?
What kind of general training will I get?
Does a major hospital conduct the program?
What kind of qualification do the teaching and the attending staff have? Are they full time staff of part time?
Are the conferences and the rounds conducted by the attending staff? Is the major portion of the teaching done by the other residents?
At what times do the conferences take place? Is the time for conferences reserved?
Do the house staff get separate teaching conferences?
Can the house staff conduct research programs? If yes, who funds the program? Are they allotted a separate period of time for such research work? Do you have faculty mentors?
Are there any subspecialty rotations in the program?
What are the offered electives? The periods in the program allotted for them?
Do you encourage residents to attend regional and national conferences?
Have there been any failures in the program? If so, what is the reason?
Are any changes planned by the Chair for the near future? Will the Director continue till the end of this program or will he retire during the program?
What are the possibilities of getting a permanent local practice on completion of the residency?
Does a pyramid system exist? What kind of cuts are made every progressive year?
What is the economic situation of the institution?
Has there been a denial of accreditation for any program conducted by the institution? The reasons thereof?
What is the opinion of the Director of the programs conducted by other establishments? Which of them would he recommend?
How many residents have passed the most recent in-training exam? Is there a minimum pass mark for promotion to the next year?
Questions To Ask The House Staff:
What is the opinion of the Chief of the house staff regarding the program?
Is a medical library located nearby and does the library stock adequate number and selection of the most recent journals and books? Is it hooked up to the Melvyl catalogue of the University of California? Who does the photocopying?
Is there adequate exchange of teaching staff with other establishments?
Are the conferences valuable?
Is there a routine conducting of chart rounds?
How many patients are under the care of each house officer, on an average?
Who teaches the clinical procedures and do the house staff get enough exposure to these procedures?
What are the clinic’s timings? Does a continuity clinic function?
Does the physician-in-charge attend the clinic?
What is the opinion of the Chief of house staff about the Chair? What is the reputation and background of the Chair? Is he genuinely interested in teaching the house staff? Can the house staff readily meet the Chair?
Are emergency services always on hand?
Are EKG machines and cardiac arrest machines available in each of the wards?
Is there a radiologist available on call?
Is the hospital provided with blood and IV drawing teams? Are the results in the lab computerized?
What are the timings for the rounds and when does that normal day end?
Is there an on-call schedule? Is there any change in the on-call schedule during the senior years?
Is there permission to moonlight? Are there facilities for this in the community?
Is there a discount on the meals provided for the house staff? Is an evening meal available? Is there food at all times of the day?
Are there facilities for parking? Where?
Do they provide uniforms free of cost to the residents and what about laundry services? Is it free also?
Is there sufficient disability and malpractice insurance? Does this include HIV coverage? Are life and health insurance subsidized by the hospital?
The availability of housing and its cost on an average? Are there any staff quarters? Where? If most of the staff are commuting, what is the average travel time? Are safety measures necessary in any of the areas?
Does a house staff association exist and what kind of a relationship does it enjoy with the administration?
What kind of climatic and general conditions can be expected in the community?
Does the hospital have a pleasant atmosphere to work in?
What is the opinion of the Chief of the house staff’s regarding the programs offered by other institutions?

Keep a note of your experience of the interview. It is imperative that you follow up the interview with a thank you card with the names of the members of the interview committee mentioned in it. Writing the thank you is preferable to telephoning them because they will be busy during the time of interviews. If any additional information was required from you during the interview, see that it is sent to them without any delay.