Gabriel
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Posts: 19
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Hello Fellow IMGs:
My Name is Gabriel Ruiz, I am a foreign graduate and I would like to share my story; perhaps, it will help someone go through those, sometimes dark moments, we as IMGs go trough in the path to fullfil our dream. This is a long post, so take your time.
Who I am
I graduated in 1998 from medical school and was not able to start my residency right away. In my country, residencies are not paid, so the majority of residents have to live with their parents or be sponsored by their wifes/husbands, coming from a humble family, and being single, that was not my situation.
I immigrated to the US in 2002, and started to re-learn English, those were tough times, no job, no english, and not a single clue about how to continue with my education. Finally after spending 2 years learning english and understanding the intrincacies of the ECFMG Certification - Match I decided to start, by then I was already 28 Years old, been out of medical school for 5 years, and the worst part, I wanted to do Surgery.
Talking to a lot of people, I quickly realized that things were going to be harder than I thought, I got a job as a computer programmer (!), and started from there, the long hours in front the computer, so far from what I love (my patients) made study every day a difficult task. after a couple of months fighting against the routine I was able to get started.
Setting up goals
The first thing I did, which, I think was key to success, was to stablish a detailed plan, all the way from Step 1 to residency. I joined several forums and was aquainted with the general timing of the exams, I learned that in order to be ready and on time, I would need to have my last exam done by the end of September (1st Rule of thumb), and that would allow me to start my residency by june Next year.
I decided to go in order, Step 1, CK, CS, that mean that I would tackle the hardest one first and would work my way through Step 2 without much problems.
Step 1
I decided to study for a full 8 months for step 1, and here comes my second rule of thumb for the USMLE: You will never be as ready as you would like to be for the Exam, just set a timing goal and adhere to it, if you wait to set the dates for the exam once you are ready, most likely that time is going to be more than what you really need.
After gathering the materias, I took the kaplan 150 question practice exam just to see and gauge an starting point. The results were not any good, I was close to 38%!!! in some of the areas, and my best score was not better than 60%. I took the decision to distribuite the time as follows:
6 months reading the Kaplan Lecture notes (3 Huge books by then)
1 month reading and reviewing First Aid
1 final month exclusively doing practice questions.
In between I started doing the Kaplan Qbank in tutor mode, that helps a lot, but in the end that final month was to be done simulating the actual conditions of the exam, in weekdays I use to do timed blocks of 50 questions and in the weekends try to do as many blocks as possible. In the final days of review I was doing an average of 75% in kaplan, enough to pass the Exam, I took the exam in the end of 2004 and got 85. It was not the score I would like to have, but I was relieved it was over.
Getting into a hands on clinical possition - Possible?
Just after getting my results on the exam, I was told by a friend that there was a position available for Foreign Graduated Physicians in a Hospital in Miami, the position is called House Physician, the state of Florida let people like me work as physician, mostly doing History and Physical exam in patients that either are going to surgery or are admitted in the wards. I was able to secure a position and started seeing patients again. Check in your state with the local department of health, they may have this type of position available.
Step 2 -
I Started to study for Step 2 a few weeks after taking Step 1. for step 2 I used only Kaplan Lecture notes and USMLEworld, after reading the book I did every single one of the 2000+ questions, and was able to repeat at least 800 of them. My final score for USMLE World was 58%, I was confident that this score would guarantee at least 90 in the exam. I spend 5 months preparing the exam, and I still remember taking Step 2, Everything seemed so easy, I got 92, almost 93.
Having fun, that's what matter
By then I had been on my job as a physician for 6 months, doing at least 12 - 15 Cases a day, Step 2 CS was going to be a breeze, I prepared the exam for 15 days, mostly reading the material of First Aid, and the USMLE video, took the exam in Atlanta, in September, Last year, just as I had envisioned 2 years before... The first case was difficult, because I was very nervous, as soon as I exit trhough the door, somehow I realized that my dream was fulfilled, there were only 11 doors, between me and my ECFMG certificate, I just needed to have some fun in between. Results arrived 4 weeks later, I was a certified physician now.
Here comes the difficult part... maybe not
Getting into Surgical residency was going to be hard, I knew, my scores were not perfect, I had no research experience, and my age (30) and the time after my graduation (7 years) was a handicap in my application, but first I needed to get the Letters of recommendation, and after receiving 2 negative answers from attendings, I was able to get letters, from the chairman of the Surgical department at my hospital, a prominent Laparoscopic surgeon and the medical director of the hospital.
Next step was to compose my Personal Statement, it got to be something that while being true to myself also allow me to get the attention of the committees, I received help from a friend who was able to capture my ideas, and at the end the result was better that I was hoping for. I applied for a whooping 92 programs nationwide on the national residency matching program, spending close to $2000 in the process, I did this trying to cover my deficiencies with a massive ammount of program applications.
and then I started to receive emails from the different programs, the first 30 Emails were negatives, something like "thank you very much for applying, but you are not getting an interview here" It was November last year, when a friend told me that someone got into surgery after completing an Observership in a very big and important hospital in my city. despite everybody telling me that it was going to be near impossible to get a position in such that institution, I decided to try to sign up for an observership.
I was lucky enough to fill a position of someone who had already signed up but was unable to attend, that was the only spot that was available for the next 6 months in the trauma unit of the hospital, I was there 3 months, Dec, Jan and Feb, working around the clock with the Surgery intern and the Senior Resident.
At the same time I applied for residency in that hospital, and talked to the Senior Resident, letting him know that I wanted to stay for my residency. Somehow, they called me for interview, I was astonished. it was the end of 2005 when I got my interview, minutes before I was going to talk to the program director, the Senior resident Popped in and talked to him privately for a couple of minutes. My interview was a breeze.
Now, after writing this, I am heading to Jackson Memorial Hospital in Miami, FL; to finish the paperwork and to do the physical, I signed the contract in December,2005; 3 months before the match, and I will be starting my residency in General Surgery in June... Although I am anxious, I know that everything is going to be all right, I am confident that with hard work and the help of who is now my wife, that has supported me since I was in my country, I am going to be able to go through my residency, being successful, but most of all, having fun, enjoying it, as I have enjoyed every single step of the way, experiences, that happen only once, but last for a life time.
By the way, I was called by 13 different programs across the nation, never went to a single interview.
Gabriel Ruiz, MD
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| zziggy
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Thank you for your very kind and true words and your story - it really helps seing such an example. Thank you and congratulations for your success and your determination that lead you here! All the best in what comes next
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| certi
Forum Junior
Topics: 7
Posts: 22
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amazing and encouraging story. Thanks for sharing it. You really deserve it. Good luck with your residency training.
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| surgery
Forum Junior
Topics: 0
Posts: 30
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Really amazing story
Its kind of stimulating for me
Good lick with your future endeavours.
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| chemamr
Moderator and PGY1
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thanks for sharing Gabriel, it's encouraging.
i think almost all of us (foreign -mainly who need a visa-) have to struggle in this process to succeed. It's not easy, nothing at all. And it's encouraging to hear stories like yours that it's possible to do it.
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Any time something is written against me, I not only share the sentiment but feel I could do the job far better myself.
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| robin082006
Forum Hero
Topics: 471
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Thank for sharing your experience. I have a strong stimulus after rading your story.
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The Key to Succeed is Patience.
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| gv5
Forum Senior
Topics: 28
Posts: 178
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hey that is a very inspiring story for imgs who are interested in surgey.i ve sent u a p.m plz look into that also when u ve the time.thanx
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| Gabriel
Forum Newbie
Topics: 4
Posts: 19
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Thanks guys for your kind words. Remember, you have already done great things, you are the very best of your country and have passed countless exams just to get your MD degree, this is jus ome more step, just focus, you will be albe to achive it.
Mousa, dont, know if you have time to get into next years match, deadlines are to tight at this moment of the year, let me know where you are in terms of Exams and Study, and what are your plans, sure we all be able to help you go through the process.
Gabriel
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| spitmetal
Forum Guru
Topics: 25
Posts: 635
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hey gabriel where are u from? jejejeje what a stupid question but i would like to know
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NEVER REGRET IF U DID YOUR BEST--"THE PEOPLE WHO CAN'T DO SOMETHING WILL KEEP SAYING THAT YOU CAN'T DO IT.....BUT REMEMBER YOU CAN DO IT!!" by Dr. Luck a member of this forum
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| spitmetal
Forum Guru
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Posts: 635
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im from mexico  if anyone matters
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NEVER REGRET IF U DID YOUR BEST--"THE PEOPLE WHO CAN'T DO SOMETHING WILL KEEP SAYING THAT YOU CAN'T DO IT.....BUT REMEMBER YOU CAN DO IT!!" by Dr. Luck a member of this forum
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| Gabriel
Forum Newbie
Topics: 4
Posts: 19
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Born in Colombia.
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| Gabriel
Forum Newbie
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By the way, I know at least 2 mexican or mexican trained physicians that complete surgery here in my area.
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| spitmetal
Forum Guru
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Posts: 635
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thanks that's awesome news
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NEVER REGRET IF U DID YOUR BEST--"THE PEOPLE WHO CAN'T DO SOMETHING WILL KEEP SAYING THAT YOU CAN'T DO IT.....BUT REMEMBER YOU CAN DO IT!!" by Dr. Luck a member of this forum
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| littlerock
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tonight i was about to cry and ready to cry all night long.. cos i am so slow in my study..i learn slowly..hopeless..and read in another forum that grad over 5yrs or 10 yrs are not able to get into residency programs,i am a 13 yr old grad...your adventure/ experience Gabriel inspired me a lot..lit a little candle in my dark usmle site.thank you very much
by the way , if someone can make this assumption(grad yr-res match relationship) clear for me, i will be very happy..thanks in advance
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| Gabriel
Forum Newbie
Topics: 4
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Dr. Littlerock,
Thanks for your words, I was through very dark moments during the process of getting the residency. Do not give up, in cases like yours it helps a lot to start doing practice questions, get a qbank in whatever company of your choice and start, reading the questions and the explanations for the answer help a lot persons that are not very fast USMLE learners, it helps you get up to speed, of course, the majority of the time would be devoted to read your books, but with the questions is easier to diggest material. So try it an hour a day for the next month you will see the results.
I guess people wonder why I seem to know about what's best for this and for that, the reason is because for the las three years, I have shared with at least a 20 maybe more people who are IMGs preparing for their exams, most of them have gotten their licenses in that time, there are some that keep on repeating the same mistake, and have not made much progress, and there are some, like my wife, who after a bad start, have started to make modifications on the way they approach the exams and have made significant changes.
I don't assume to know everything, I work in a hospital with a very high number of IMGs holding different possitions, from Flebotomists, and Monitor Techs, to House Physicians, research fellows and surgical assistants, currently there are more than 50 IMGs at my hospital. And in these years, I have seen a lot.
I will not disclose full names, but I can tell you that I have seen cases, like Dr. GG, he is 51 years old, was a great Internal Medicine Physician in his Country, Scored on the Upper 80s in Step 1, 92 in Step 2, he was offered a Prematch Family Practice position at a very important Hospital in Illinois, now he is about to start his second year of residency.
There is also, Dr. F. L. More than 13 years after his graduation, Failed the exams, once, all of them, he is one of my colleages at the hospital, and will be working until next tuesday because he got a position in Pediatrics in a hospital in NY prematch.
I have also mentioned the case of the two other guys that matched for surgery one of them has more than 5 years after his graduation.
Dr. K. Q. This case is really encouraging, more than 10 yrs after his graduation, took the steps several times, EACH. after having his ECFMG Certificate, he worked for 1 year at a Teaching hospital in my city, and was accepted this year for the program of Internal Medicine, will be starting in June.
I see there is no hard coded rule, that define who gets a residency and who does not, people that fails, always fail because they gave up, nothing else. my theory is that, like most things in this country, everything is set to test your commitment, this persons I have mentioned had something in common: they set their goal, they did not give up, they always believed.
Fellow Img, do the same, keep on, you will get your residency, I am sure about that.
Gabriel
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| chemamr
Moderator and PGY1
Topics: 703
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you are an excellent motivator Gabriel  , it's encouraging to read your comments. Thanks ! 
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Any time something is written against me, I not only share the sentiment but feel I could do the job far better myself.
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| yolanda
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WOW,
Hi Gabriel, thank you for taking the time to share your experiences with this forum, people like you, sharvil, malinda, aimudia, bbb, just to mention a few, really motivate and give us a new perspective of this long, hard, costly, but like you say, enjoyable process or journey.
You have made me stop and think a little bit about what I am doing. When I first joined the forum I always asked about if I could make it to 2007 match or 2008. I have waisted 5 years after graduating, well, not completely wasted, I've gain experience and met US physicians that will help me get a clerkship and wonderful letters of recomendation, but I've done timelines to study since 4 years ago, and it is April and I am just starting to study.
I am planning to do my step 1 in mid Sep, do step 2 CS 15 days after this, so that I can apply in mid october with two grades for 2007 match, but I am worried bcause I need to score in the 90's and will only have 4 months to prepare for step 1, and I am a very slow reader.
So after reading your experience, I feel confused, because I do not want to let another year pass, another year of barely making ends meet, on working in a bad, underpayed job, not being able to afford to fix the plumbing in my house or to get healt insurance for myself or my family, and since I've already procrastinated for 4 almost 5 years now, I feel that one more year can turn in to another two.
I guess my best move or decision is to prepare for step 1 in Sep, and to do nbme exam a couple of weeks before, and if and only if I don't score high enough, well I will have to re-schedule my step 1exam, and that will mean that I would have to force myself to take the 2008 match.
Because like many in this forum have told me, I can't risk my future chance of getting into a residency just because I want to save a year.
What do you think?, I would love to know your opinion.
By the way I am from Mexico.
Congrats!
Yolanda
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| xavier
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Hi there! I am a new member on this forum. My heartiest Congratulations to Gabriel for getting his desired residency. Thank you Gabriel for all the shared info and the pep talk too.
Keep up the good work.
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| Gabriel
Forum Newbie
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Yolanda,
Thanks for your kind words,
I think you have not procrastinated during the last five years, specially if you already have some contacts and have the option to get your LORs. That is as important for the residency, as the Exams themselves.
You are right, 4 months to get Step 1 right is a very tight deadline. Taking NBME test a couple of weeks before the Exam will let you know if you are ready or not.
However, I think that taking more time to prepare the test would be the best option as it will let you get a better chance at passing on the first attempt. Thinking about it it really makes no difference to your application that you go for your residency this, or the next year. If you postpone your application for the next year, you will also have the opportunity to save some money and request a leave of abscense for a good 3 month rotation in the Hospital(s) of your choice Just before the Interview rounds take place, thus making your application more solid
Taking that decision implies its risks though. Working under the pressure of a tight deadline will keep you focus, delaying the process for one year, will risk leaving things for later one more year, Running a House and a Family and Studing can be difficult at a times. You have to take the desicion of your life here.
Whatever decision you take, keep in mind that you have to plan very carefully and take day after day, (Always ask this question: What do I have to study today?. Have I completed my Assignment yet? )setting your goals to study at that level will help you stay organized and build Study habbits.
Good Luck! we are with you, I am sure that you will finish your test and get into residency in no time.
Gabriel
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| anne06
Forum Elite
Topics: 11
Posts: 103
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hey gabriel,
congrats!!!i m just startn 2 study n well can u tell me if its o.k 2 give step 2 before step 1?
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| Gabriel
Forum Newbie
Topics: 4
Posts: 19
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Anne,
Difficult to say, I always suggest this:
If you are somewhat insecure or a slow USMLE Reader, go backwards, depending on your english level, I would go for Step 2CK, Step 2CS and finally Step 1, The reason: It will help you build confidence on a process that relies greatly on self study, and how good you control your fears of taking an USMLE Examination.
If you are a good self confident USMLE Student, go all the way for Step 1, Step 2CK, Step2CS.
Gabriel
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| yolanda
Forum Elite
Topics: 18
Posts: 247
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Thank you Gabriel for taking the time to reply, I really appreciated.
I just didn't understand the following paragraph that you wrote:
"If you postpone your application for the next year, you will also have the opportunity to save some money and request a leave of abscense for a good 3 month rotation in the Hospital(s) of your choice Just before the Interview rounds take place, thus making your application more solid"
You mean that it is a good idea if we contact the hospital that we want to do residency in, to see if we can get an observership or clerkship with them?, would they do that even without a visa, or only after ECFMG certification?
Thank you
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Recognize that you have the courage within you to fulfill the purpose of your birth. Summon forth the power of your inner courage and live the life of your dreams - Gurumayi Chidvilasananda
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| yolanda
Forum Elite
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Posts: 247
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oh!, I forgot to mention that the reason that I am so concerned to try to make it to the 2007 match, besides of what I have already mentioned, is that I am concerned that I am going to have more years in the gap, I would not make the 5 year gap that many residency programs have for application to their programs.
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Recognize that you have the courage within you to fulfill the purpose of your birth. Summon forth the power of your inner courage and live the life of your dreams - Gurumayi Chidvilasananda
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| Gabriel
Forum Newbie
Topics: 4
Posts: 19
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Yes, you are right, an Observership in an Institution that could potentially offer you a position is a must. Not only you are getting experience but also you are being known by the faculty and surely, if you work really hard, someone would step up and either give a letter of recommendation or talk to the program director on your behalf. The requisite: Be honest and let everybody know up front that you want to do your residency.
In summary, do your research, contact the programs, apply, pick a handfull of the most probable options and call them and ask them if there are any Observership opportunities. If you nail it the way I did last year, your application will be rock solid and your chances of getting into residency will grow exponentially.
Hope this helps.
Gabriel.
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| Gabriel
Forum Newbie
Topics: 4
Posts: 19
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ahh, by the way, the 5 year gap will knock you off several hospitals at the time of applying, that is true, but having a bad score or having a failed attempt will also be a serious handicap on your process of getting into residency. It is a very risky situation, but, if somehow you are able to pull some good scores in such a short time, the chances of getting into a program of your choice will be bigger.
Gabriel
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