prep4usmle
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Hello,
A new file is now available in our download area:
On being an international medical graduate, tips for success.
My special thanks to Dr.Renu Mittal for the efforts in helping IMGs.
Regards!
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| ivyc
Forum Newbie
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Hello,
I loaddown the document, but I can not open it. Could you tell me that document is Word?
Thank you very much!
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| prep4usmle
Administrator
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Yes it is a word document but first you need to dearchive it (use a rar program).
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| Dane
Forum Senior
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Why post documents in ways that, unless you are a tect guru, can't be opened.
As you can see from my comment, I still can't open the thing.
So NO it's not helpful.
Very angry.
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| prep4usmle
Administrator
Topics: 288
Posts: 1,187
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"Dane" wrote:
Why post documents in ways that, unless you are a tect guru, can't be opened.
As you can see from my comment, I still can't open the thing.
So NO it's not helpful.
Very angry.
Hi,
The reason it was placed in the downloads is because it has some tables which cannot be posted on a forum message. Also the download section allows the file to be rated and recommended by visitors.
Sorry for the problems you have opening the file; here is the text content:
On Being an International Medical Graduate, Tips for Success
Graduates of foreign medical schools have been immigrating to America for decades, filling a healthcare gap and fulfilling their own personal and professional goals. Most have crossed many hurdles to enter medical school in their own country of origin, and face many more on entrance to this country. Once they have completed the residency years, these physicians enter the workforce, attending to not only the medical needs of the population but also by becoming community leaders, educational spokespersons and adding to the richness of cultural diversity that is seen in this country as a whole.
Before being eligible for the residency position sought, the International Medical Graduate (IMG) needs to complete many examinations. During the early 70's, physicians were being actively recruited by hospitals. They were ensured a smooth transition of immigration with support in the areas of visa, family and friends. These actions have changed tremendously over the years. The Educational Commission for Foreign Medical Graduates (ECFMG), which certifies IMGs for entry into US postgraduate clinical training, was formed in 1956. Since then, the IMG has been required to take a variety of examinations exemplified by the following plethora of acronyms, ECFMG, VQE, TOEFL, FLEX, and now USMLE and CSA. All these are used as objective evaluation tools for program directors. The hurdles continue in the form of licensing requirements for the different states here.
The National Resident Matching Program (NRMP) has experienced a significant increase in the number of positions offered over the years. There was a peak in the fill rate in 1997, and now the rate is again beginning to increase. Perhaps some of these shifts could be due to events of 9/11.
* 2004 2002 2000 1997 1993
Positions offered 21,192 20,602 20,453 20,209 20,598
Positions filled 19,391 18,447 19,391 18,007 16,896
% of positions filled 91.5 89.5 89.3 89.9 82.0
% filled by US MGs 57.8 61.1
57.3 55.5 67.4
% filled by non-US IMGs 22.5 21.0 25.1 30.7 20.6
**% filled by US IMGs 8.0 8.7 8.7 5.6 3.1
*Data from NRMP
**US Undergraduates with offshore medical school training: e.g. Caribbean schools usually have rotations in America.
AMA sources indicate the countries of origin of the IMGs. India is the leading supplier of physicians to the US workforce.
Countries of origin of IMGs % of IMGs
India 19.25%
Philippines 9.6%
Mexico 5.8%
Pakistan 4.4%
It has always been perceived that residencies aim to fill with as many US trained graduates as possible. However, the inevitable occurrence is that many programs need the IMGs to enable their program to function. This may be due to multiple factors including location of program and specialty.
What is it that an IMG applicant can do to enhance his/her chances for an interview?
Application: This is now usually through the computerized ERAS system (Electronic Residency Application Service). One should always check that it is completed correctly and in time.
Exam results: These are always important and are in fact the only objective evaluation that the program has on the application. Many programs will have a minimum score as a criterion. Multiple attempts at the exam do not bode well. It definitely seems worthwhile only taking the exam if the candidate is well prepared and is confident of achieving a high score. Many enroll in review classes before the exam. These classes also serve as good networking and support opportunities.
Medical School: Accreditation of the school is a requirement. It seems worthwhile checking on this before enrolling into the medical school. This is relevant since many Americans of Indian Origin are sending their children overseas for medical education. Also there maybe a licensing deficiency, for example, 4 weeks of psychiatry (this actually often is a blessing, since then the applicant would be eligible for an externship, which will add US experience to the application). The number of years is also often an important criterion.
US experience: This has been increasingly difficult since many states do not allow externships (voluntary experiences where the applicant does have responsibility and direct patient contact). Most programs would like the applicant to have had clinical experience where they can document direct patient contact, including, taking a history and physical and developing an assessment plan. This is definitely preferable to a research position or an observership.
Once an interview has been granted, the program may evaluate the candidate in many areas:
Presentation: A dark suit and well-groomed applicant is acceptable.
Language skills: The interviewer should be able to understand what the applicant is saying. Many program directors cite this as a problem and have advised accent reduction class. They will also evaluate comprehension skills by asking questions which may not be medically related.
Knowledge of the residency: It is important to know a little about the program one is interviewing in. This information is often found on the Internet. The applicant should be able to discuss why that particular specialty was chosen and why that specific program is where s/he wishes to work. There has been a recent study stating that the attrition rate of IMGs is higher than US MGs. ("I'll take what I can get and change into the specialty of my desire later").
Personal goals: The applicant should be able to indicate his/her potential long and short-term goals. This shows an understanding of the medical system
Behavioral skills: The applicant maybe asked questions regarding ability to cope with stress, conflict resolution, teamwork, and work ethics.
Once the candidate has been accepted, there are many adjustments and stresses that they may encounter. After polling many residents and practicing IMG physicians some of these areas that were identified included:
Integration: This obviously varies between programs and individuals.
Cultural differences: This may be social ("I need to go home to my family" vs. "Let's go out for a drink after work"), but this does not suggest one has to relinquish one's identity. Professional differences can occur, for example, in the areas of care of the elderly, informed consent, and end of life issues.
Lack of support: Maybe seen amongst colleagues, (USMG Vs IMG), lack of faculty mentoring, frequent feelings of being the scapegoat and being held to a higher standard. This may all lead to a decrease in self-esteem and less than optimal performance.
Interpersonal skills: The hierarchical system seen in many countries is not as pronounced here, so learning how to appropriately interact with nurses, secretaries, ancillary staff is important.
Computer skills: These can be easily learnt if the applicant is proactive. Consider asking to spend some time in the program before the official start date, to orient on how to look up laboratory results etc.
Behavioral medical skills: Interviewing skills are emphasized during medical school training. There is a system of writing notes, which differs from IMG training, for example S.O.A.P and the P.O.M.R format. Again these are simple techniques that can be learnt prior to the start date.
Often the whole experience can be daunting but the IMG should realize that they have many strengths. They have many attributes and experiences that can be used to enrich any program.
Clinical exposure: The types of syndromes learned in the US may be very different to what the IMG will encounter in residency; for example malaria and malnutrition are not as common in America.
Stamina: Often admission into medical school in the country of origin is much more competitive than here. Along with this, the IMG should realize their strength in taking the challenge of starting afresh in a new country.
Clinical diversity: The IMG is able to broaden the cultural knowledge of the program and often attract patients of different ethnicity to the program. America is the melting pot of the world and a culturally diverse group of physicians can better serve a culturally diverse population.
The applicant should continue to network with seniors of the program, and alumni of their specialty. Medical school associations and national groups such as AAPI (American Association of Physicians of Indian Origin) may aid in guidance for career choices.
What could be the role of AAPI? We were all in this position at some time in our lives; so moral support and encouragement is always a plus. Maybe a list of those AAPI members who have experience in residency teaching can be made available to applicants, so they may get some guidance. Those members that are able to offer "hands on experience" to the applicant, not just "research" could also make themselves available. After the resident has graduated, AAPI may have contact numbers so the newly graduated physician may discuss opportunities for career enhancement, fellowship advice, and practice opportunities. They also maybe able to discuss licensure hurdles.
The number of physicians that are IMGs and of Indian origin are increasing. Many IMGs and USMGs are in fact the children of IMGs and I feel that our role for the next generation of doctors in the workforce needs to be that of continuing encouragement and support. The immigrant IMG should be proud of the challenge they have taken to start new lives in a foreign country. Their hard work and stamina is appreciated by the millions of patients that they serve and the community they benefit.
Renu Mittal M.D. California
Edited by prep4usmle on 05/25/05 - 11:23 PM
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| ananth.shankar
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Dear Dr. Mittal, I found your passage very interesting and encouraging. I am currently wrapping up my internship from LNJP Hospital in Delhi and have done my MBBS from MAMC. I am very keen to work in some research based programs and be involved in teaching later in my career. Right now, I am trying to get to the US as I believe that my best options are there. I have given my USMLE Step 1 and am awaitig results. I am also about to give my TOEFL and GRE shortly. I would really appreciate it if you could guide me. I'm confused about whether I should appy for an observership (so I can get a VISA with minimum fuss and utilize it to give my MCAT), or should I apply for an MPH (a tried and tested route my seniors have used). I basically would prefer to get my feet into the American Medical System, before I apply for a residency. I think is important to point out here that finances are a problem at my end, and I would need to support myself. I cannot show the basic minimum fee for a year that most MPH degrees require in my bank account. Irony is that I need to show the money to get there, after which I get a schloarship. Any ideas on how I can get through this ?
Eagerly awaiting your response.
Thanks and warm regards
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Dr. Ananth Shankar
ananth.shankar@rediffmail.com
IMG, India
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| thinktank
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thank u for the excellent advice thank u 
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| drv
Forum Newbie
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dear dr . mittal
this has been the first encouraging thing i have heard after entering USA. i am dr. vishal kapadia. i have done my MD pediatrics in india and i have passed my step 1 with score of 99/253. now preparing for step2. i have many queries and only doctors who are currently in medical system of us can help me
1. is pediatric a bad choice in USA? i have heard about low pay , hard life and not much satysfying job in short. i love pediatrics but it was pediatrics of india not of here. work load is never provblem for me as we have served like 25 patients in a day in PICU. BUT I FOUND MANY OF MY SENIORS HAVE CHANGED THEIR BRANCH FROM PEDS TO INTERNAL MEDICINE..WHAT IS UR RTUE OPINION?
2. DO U HAVE ANY PEDIATRCIAN IN MIND WITH WHOM I CAN TALK WITH?
3. I M INTERESTED IN DOING MY RESIDENCY IN CALIFORNIA BUT PEOPLE HAVE TOLD ME THAT CALIFORNIA LETTER REQUIRES 6-8 MONHS N ITS COSTLY WHERE TOP PROGRAMS ARE
I WILL BE GREATFU; IF U POST UR REPLY OR MAIL ME ON DRVISHALKAPADIA@GMAIL.COM
THANKING U IN ADVANCE
THANKS FOR LIFTING MY SPIRITS
HOPING TO WRITE A SIMILAR POST FOR MY FELLOW IMGS IN COMING YEAR
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| cgr2005
Forum Senior
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Posts: 161
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Hi drv - thre's a lot of info the process at www.internationaldoc.com - should be helpful to you.
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