Creating Rank Order Lists for the 2018 Residency Match: What Foreign Medical Graduates Need to Know

In an earlier post, we discussed the timeline for the 2018 Residency Match. Even though you have made it through some of the toughest parts of the process — preparing your personal statement and CV, submitting letters of recommendation, and surviving the interviews — there is still work left to do. When the Rank Order List Entry opens (January 15, 2018 — mark your calendar!), you have a little more than a month to create your list and get it certified electronically in then NRMP Registration, Ranking, and Results (R3) System. In order to participate in the 2018 Match, your rank order list must be complete and certified by 9:00 pm Eastern Standard Time on February 21, 2018. Read on to find out what foreign medical graduates need to know about creating and certifying an Rank Order List (ROL).

The Basics of the Rank Order List (ROL)

The Rank Order List (ROL) is the place where you, as an aspiring medical residents, have the chance to provide the NRMP with a list of programs in which you are interested, ranked in order of preference. After residency interviews are complete, candidates and program directors both create ROLs, and the information on the ROLs is used to determine the outcome of the Match.

There are two types of ROLs: primary ROLs and supplementary ROLs. On the primary ROL, you can list categorical, preliminary and/or advanced programs. If you rank an advanced (PGY-2 level) program on your primary ROL, you can also submit supplemental ROLS of preliminary programs that are linked to that advanced program.

Considerations When Creating Your Primary ROL

The NRMP allows candidates to list 20 different programs on the primary ROL and 20 different programs on each supplemental ROL. After that, you have to pay a fee. However, it is important to note that most foreign medical graduates interview with far fewer schools, so you probably do not have to worry about exceeding the limit.

That being said, foreign medical graduates who have ranked a larger number of programs within their preferred specialty have a higher likelihood of getting matched. According to data from the 2016 residency match, the average number of contiguous ranks for matched candidates was 6.3, as compared to 2.5 for those who were not matched.

When creating your primary ROL, you should also consider the competitiveness of the programs to which you are applying. The NRMP recommends that foreign medical graduates apply to a range of programs that vary in their levels of competitiveness.

Another opportunity you may want to consider is ranking programs as a couple with another applicant. If your partner or close friend is also applying to residency programs in the United States, you can link your ROL with that person in order to increase the odds that you will be matched to programs that are in the same geographic area. Whether your partner is another foreign medical graduate or a graduate of a US medical school, ranking programs as a couple can be a great way to ensure that your Match outcome fits with both your career goals and your personal priorities.

Beyond the Primary ROL: Creating a Supplemental ROL

If you included an advanced (PGY-2 level) program on your primary ROL, you need to include a supplemental ROL with a list of preliminary (PGY-1 level) programs. Getting matched in this way would mean simultaneously securing both a preliminary and an advanced position at the same time. This can relieve stress for foreign medical graduates because it guarantees that you will have the opportunity to complete a “full course of training.”

In most cases, the preliminary programs on your supplemental ROL are tied to the geographical location of the advanced program, so your supplemental ROL may look significantly different from your primary ROL. However, you should note that the matching algorithm will only consider your supplemental ROL if you get matched to the advanced program on your primary ROL. If not, the information on your supplemental ROL will not be considered in the matching process.

Finalizing Your ROL(s): The Certification Step

Once you have finished an ROL (either a primary ROL or a supplemental ROL), it must be certified. That means you have to click the “Certify List” button in the R3 system, at which point you will be prompted to enter your username and password. This confirmation should not be taken lightly — when you certify an ROL, you make a binding commitment to enter any program at which you match.

Nevertheless, it is still possible to change an ROL after it has been certified — as long as the February 21 deadline has not yet passed. When you have made a change, you must re-certify the new ROL so that it can be properly processed by the Match algorithm.

Getting matched to a US medical residency program is a long and challenging process, but FMG Portal is here for you every step of the way. Contact us today to learn more about everything we offer!

Important Dates for the 2018 Residency Match

For foreign medical graduates who are looking to be matched to a US medical residency program in 2018, the winter months of waiting for Match Day can feel just as hard as the application process — but you need to remember that there are still a few key deadlines you need to meet. If you are participating in the National Residency Matching Program (NRMP) Main Residency Match in 2018, there are several important dates that you should keep in mind as you look ahead to the new year.

January 15, 2018 — Rank Order List Entry Opens

In less than a month from now, the rank order list entry opens at 12:00 pm Eastern Standard Time. Even though there is another month after that before the rank order list entry closes, it is important to start thinking about your rank order list in advance. That way, you will be able to dedicate enough time to the development of a strong rank order list, and you won’t end up feeling rushed as the deadline approaches.

When you participate in the Main Residency Match, you will submit a primary rank order list that may include a combination of categorical, preliminary, and advanced programs. Depending on your interests and career goals, you may also decide to submit a supplemental rank order list of preliminary programs that are linked to more advanced programs, which would enable you to lock down a PGY-1 and a PGY-2 position at the same time. It is important to take the time to explore these options before and during the period in which the rank order list entry is open.

As we discussed in an earlier post, the number of programs on your rank order list may also matter if you are a foreign medical graduate. According to data collected by the NRMP after the 2015 Main Residency Match, foreign medical graduates who ranked a larger number of programs within their preferred specialty area were more likely to be matched within that specialty area. Specifically, the average number of contiguous ranks for those who were matched was 6.3, as compared to only 2.5 for those who were not matched.

The NRMP also advises foreign medical graduates to include a combination of more-competitive and less-competitive programs on their rank order lists. Right now is a great time for you to start exploring the options and considering the competitiveness of your programs of interest, while also accounting for personal considerations, like institution locations. That way, by the time January 15 rolls around and the rank order list entry opens, you will already have a solid list of programs in hand.

February 21, 2018 – Three Major Deadlines

Five weeks after the rank order list entry opens on January 15, you need to have your list finalized. At 9:00 pm Eastern Standard Time on February 21, 2018, all rank order lists must be certified. Make sure yours is in by the deadline!

That same date — February 21, 2018 — is also the late registration for the 2018 Main Residency Match. The regular registration deadline was November 30, 2017, but if you missed it, you still have the opportunity to participate. Unfortunately, you have to a late fee of 50 dollars alongside the regular registration fee, but that is a relatively small price to pay if you are truly committed to pursuing a US medical residency in 2018.

This deadline also applies to Match withdrawals. If you elected to participate in the 2018 Main Residency Match but want to withdraw your application for any reason, you have to do so by February 21, 2018. Withdrawing your application from the Main Residency Match is a serious decision, considering all of the hard work you have already put into the residency application process, so you need to make sure you give yourself enough time to fully consider your options before the withdrawal deadline arrives.

Match Week: March 12 – March 16, 2018

Match Week starts on Monday, March 12, with the start of the Supplemental Offer and Acceptance (SOAP) program. At 11:00 am Eastern Daylight Time, you will find out whether you got matched. If not, you can participate in the SOAP until it concludes on Thursday, March 15.

Friday, March 16, 2018, is the day you’ve been looking ahead to for months — Match Day! At 1:00 pm Eastern Daylight time, Match results are sent to applicants by email and posted in the R3 system. On that day, you will find out if you made it into the program of your dreams and are on your way to a US medical residency program in July 2018.
If you’re a foreign medical graduate looking to make that dream a reality, FMG Portal is here to help you at every step of the process. Contact us today for more information about what we offer!

More Lessons from the 2016 Residency Match Data: Are Outside Experiences Important?

Last week on the blog, we discussed the NRMP report on the outcomes of foreign medical graduates in the 2016 Main Residency Match. To create this report, the NRMP tracked the rates of match success for foreign medical graduates based on a number of key measures, such as program ranking choices and test scores. As we mentioned in last week’s post, there are clear lessons that you can learn from the data on ranking choices and test scores as a foreign medical graduate preparing for a U.S. medical residency.

However, when it comes to the report’s information on foreign medical graduates’ outside experiences, the implications of the raw data are less clear. Read on for more about how you can understand the numbers and apply the information to maximize your chances of match success as a foreign medical graduate.

Statistics on the Outside Experience of Matched and Unmatched Foreign Medical Graduates

As a foreign medical graduate, you might find yourself asking the question of whether or not it is important for you to get outside research and/or work experience before you apply for a U.S. medical residency program. At the outset, the data in the NRMP report doesn’t seem to provide much help in answering that question. For all the different types of outside experiences that the NRMP measured, the average numbers for matched and unmatched foreign medical graduates was almost exactly the same. Consider the following statistics:

For foreign medical graduates who were matched in 2016, the mean number of research experiences was 2.2. For those who were unmatched, the mean number of research experiences was also 2.2.
For unmatched foreign medical graduates, the mean number of abstracts, presentations, and publications was 6.4 — slightly higher than the same statistic for matched candidates, which was 6.1.
The mean number of work experiences was 5.3 for matched foreign medical graduates and 5.5 for unmatched candidates.
For foreign medical graduates who were matched, the mean number of volunteer experiences was 3.5, as compared to 3.4 for candidates who were unmatched.

When you look deeper into the data and examine these same statistics broken down by specialty area, the numbers only get more confusing. For some specialty areas, the mean number of experiences reflects the overall average — about the same for matched and unmatched candidates. There are only a few where the average number for matched candidates significantly outweigh those for unmatched candidates. There are even some specialty areas where the average number of experiences is considerably higher for unmatched applicants.

What the Statistics Mean for You as a Future US Medical Residency Applicant

Considering these statistics can be daunting for foreign medical graduates. Based on the data, it just isn’t clear whether having more outside experiences — or any at all — can truly help you in the matching process.

One of the reasons why it is so hard to draw conclusions from the data is that averages are prone to skewing. Consider the data for abstracts, presentations, and publications. While the average for both matched and unmatched candidates was around 6, nearly 40 percent of the of the applicant pool of foreign medical graduates in 2016 had no publications at all. This indicates that certain applicants are skewing the data, so if you have less than 6 publications, it doesn’t mean you fall short of the “average” applicant.

Ultimately, the main takeaway from the NRMP data about outside experiences is that the number of outside experiences you have does not really matter. What matters is the quality of the outside experiences — and your ability to illustrate that quality on your application. An outside experience can be worthwhile if you can weave it into your personal statement — writing about how it has prepared you for your residency and how it has influenced your career goals — or if you can get a letter of recommendation from a supervisor or mentor who can speak to your excellent performance during the outside experience. Otherwise, if the outside experience is just a line item on your CV, it probably won’t make much of a difference for whether or not you end up getting matched.

Thus, one of the best options for an outside experience is a clinical externship in the United States. Completing a clinical externship in the United States is ideal because it shows residency programs that, as a foreign medical graduate, you are already comfortable working in a clinical setting in the United States. After completing a clinical externship, you may also be able to get a letter of recommendation from an attending physician in the United States, which is preferred (or even required) by many U.S. medical residency programs.

If you’re interested in completing a clinical externship before you apply for a U.S. medical residency program, FMG Portal offers 3-month and 6-month externship options in a wide range of specialty areas. Contact us today for more information!

Lessons for Foreign Medical Graduates from the 2016 Main Residency Match

During the 2016 residency matching process, the National Resident Matching Program (NRMP) monitored the outcomes for all graduates of foreign medical schools. Specifically, they kept track of match success, specialty preference, ranking information, and applicant characteristics. The data they collected provides valuable information for future applicants. If you are a foreign medical graduate looking to apply to a U.S. medical residency program in the future, there are several key lessons that you can take away from the NRMP report.

Program Ranking Choices: The More the Better

The NRMP report can be particularly helpful if you are a foreign medical graduate trying to figure out how to best to rank programs on your application. According to the NRMP, foreign medical graduates who were successful in matching to their preferred specialty were more likely to have ranked a larger number of programs within their preferred specialty. Specifically, the NRMP reports that, on average, foreign medical graduates who were matched had longer lists of contiguous ranks than those who were not — 6.3 continuous ranks for matched foreign medical graduates, as compared to only 2.5 for those who were not matched.

As a foreign medical graduate, you might be tempted to limit the number of programs you rank within your top-choice specialty area and add a greater number of programs in non-preferred specialty areas that you think will be easier to get into. While the NRMP does recommend applying to a mix of competitive and less-competitive programs, the data suggests that applying to more programs within your specialty area of interest could increase the odds that you will be matched at all. Instead of spending your time trying to locate the less-competitive programs, you should focus on polishing your application show that it demonstrates that you are truly passionate about the your top-choice specialty area.

At the same time, if you do plan to apply to a particularly competitive specialty, it can be helpful to identify an alternative specialty and rank your preferred programs within that specialty area, according to the NRMP. Based on the data, whether or not you choose to do this will probably not have a significant effect on your odds of getting matched. The mean number of distinct specialties ranked by foreign medical graduates who got matched in 2016 was 1.3, whereas the mean was 1.4 for those who were not matched — practically no difference at all. So you shouldn’t be worried that identifying an alternative specialty will reduce your odds of getting matched.

The Importance of Test Scores

Another key takeaway from the NRMP report is that there are two tests that can make a significant difference in determining whether or not you get matched: the USMLE Step 1 and the USMLE Step 2 CK. For both of these exams, the average score for foreign medical graduates who were matched was substantially higher than the average for those who were not matched. It is also important to note that, among the foreign medical graduates who were matched, those who matched to their preferred specialties had higher scores, on average, than those who matched to programs in non-preferred specialty areas.

On the USMLE Step 1, the mean score for foreign medical graduates was 233.8, with a standard deviation of 17.0. The NRMP notes that this is “well above” the minimum passing score in 2016, which was 192. Similarly, on the USMLE Step 2 CK, the mean score for foreign medical graduates was 238.8, with a standard deviation of 15.6. Again, this was considerably higher than the 2016 minimum passing score of 209.

Looking at this data, there are a few key lessons for foreign medical graduates. Most importantly, it makes sense to dedicate a lot of time and energy to studying for the USMLE Step 1 and USMLE Step 2 CK exams. However, if your scores aren’t as high as those reported above, don’t despair! The data are all based on averages, and there are lots of other places in your application where you can make up for a lower score and show that you are ready for success in a US medical residency program.

Also, even though the data shows that the USMLE Step 1 and Step 2 CK can significantly impact the matching process for foreign medical graduates, you should not forget the importance of the USMLE Step 2 CS. It may not play as large a role on your application, but it is still considered by application readers. Moreover, it is essential for ECFMG certification, so you need to make sure you are ready to pass when test day arrives. Similarly, if you make the choice to take the USMLE Step 3 before you begin your residency, you need to make sure that you are well-prepared so that your score reflects your knowledge and abilities in the field of medicine.

As 2017 comes to a close and the 2018 residency match draws near, FMG Portal is here to help! Contact us today to learn more about what we offer!

Considering Advanced Studies in Interventional or Metabolic Cardiology

In the United States and around the world, cardiovascular disease is the number one cause of death, so there is a high demand for physicians with expertise in cardiology. Last week on the blog, we went over the steps that you need to take to become a cardiologist in the United States. After earning your medical degree, you must complete a three-year residency in internal medicine, followed by a three-year cardiology fellowship. After that, you have the option of completing a subspecialty cardiology fellowship in a particular area of interest.

Two subspecialty options within the field of cardiology are interventional cardiology and metabolic cardiology. For interventional cardiology, you can complete an ACGME-accredited subspecialty fellowship program after your first cardiology fellowship. There are also opportunities for advanced studies in metabolic cardiology. Read on to learn more about these two subspecialty options and why you might want to consider completing a graduate externship in one of them before you apply for a US medical residency program.

Introduction to Interventional Cardiology

Interventional cardiology is a subfield that focuses primarily on coronary artery disease, which is the most common form of cardiovascular disease in the United States. Specialists in this subfield are trained to conduct complex diagnostic procedures and design long-term health management strategies for patients with chronic and acute coronary artery disease. As an interventional cardiologist, you would also conduct percutaneous intervention procedures and put in percutaneous ventricular assist devices. If you’re looking to truly make a difference in the lives of patients who require immediate care for complex cardiac conditions, interventional cardiology could be a great subspecialty option for you.

Introduction to Metabolic Cardiology

Metabolic cardiology is a relatively new subfield that promotes an unconventional approach to the prevention, management, and treatment of congestive heart failure. Instead of relying on traditional interventions, this approach emphasizes an integrative approach based on nutrient supplementation. According to proponents of metabolic cardiology, the underlying cause of heart disease is the lack of sufficient energy for the heart to function at an optimal level. This problem can be addressed by providing the body with nutrients that support the production of enough ATP to support heart health.

Thus, experts in metabolic cardiology seek to prevent and treat cardiovascular disease through the targeted supplementation of four key nutrients that are involved in ATP production

D-ribose, which is required for the de novo synthesis of ATP
Coenzyme Q10 (CoQ10), which is involved in ATP recycling and reuse

L-Carnitine, which is also involved in ATP recycling and reuse

Magnesium, which plays a role in more than three hundred enzymatic reactions, many of which are related to energy production

Metabolic cardiology is widely viewed all-natural, less expensive alternative to traditional treatment methods for cardiovascular disease. If you’re interested in an innovative approach to cardiology, advanced studies in metabolic cardiology could be a great opportunity for you.

Reasons to Pursue Graduate Externships in Interventional and Metabolic Cardiology

As a foreign medical graduate, you might be wondering why you would want to complete a graduate externship in interventional or metabolic cardiology. After all, you still have to get through a three-year internal medicine residency and a three-year general cardiology fellowship before you have the chance to subspecialize. However, there are actually a lot of good reasons to choose such a highly specialized area for a graduate fellowship. Here are just a few:

In the personal statement on your residency application and in your residency interview, you need to be able to articulate clear plans and goals about your educational and professional future. When you are applying for an internal medicine residency, it’s one thing to say you want to be a cardiologist and possibly subspecialize interventional cardiology, but when you have months of clinical experience to back it up, it’s a lot more believable to an application reader.
A graduate externship in a subspecialty area can help you build on your existing clinical and research interests. While completing a fellowship in interventional or metabolic cardiology, you may be exposed to cutting-edge research and innovative clinical techniques, which could shape your future educational and career interests. Again, these are things you could include on your personal statement and talk about during your interview.
A graduate externship in a highly specialized area can actually help you make decisions about your future education and career. Sometimes, it can be hard to determine whether or not you want to dedicate your studies and professional life to a subspecialty area just by reading about it. In a graduate externship, you would have the chance to learn what day-to-day life as a specialist physician is like. That way, you can feel confident as you make decisions about steering your future toward a specialty area of cardiology.

FMG Portal offers graduate externships in both interventional and metabolic cardiology, among a wide range of other specialty and subspecialty areas. Contact us today to learn more about our offerings!

Medical Specialty Spotlight: Cardiology

Cardiovascular disease is the number one cause of death around the world. According to the World Health Organization, cardiovascular disease accounts for about 31 percent of all deaths — a total of around 17.7 million people per year. In the United States, the prevalence of cardiovascular disease is similar. According to the US Centers for Disease Control and Prevention, about 1 in 4 deaths are caused by heart disease — a total of around 610,000 people per year. Moreover, about 47 percent of Americans have one of the top three risk factors for cardiovascular disease: high blood pressure, high cholesterol, and/or a history of smoking.

As a cardiologist, you would have the opportunity to dedicate your career to supporting cardiovascular health and combating cardiovascular disease. The United States can be a great place to get the training you need through residency and/or fellowship programs. Read on to learn what foreign medical graduates need to do to launch a career in cardiology.

Completing a US Medical Residency Program in Internal Medicine

After earning your medical degree, the first step toward a cardiology career is a medical residency program in internal medicine. According to the National Residency Matching Program (NRMP), internal medicine is the most common residency specialty for foreign medical graduates, and the proportion of FMGs who choose internal medicine has been on the rise in recent years, jumping 6.4 percent from 2011 to 2015.

An internal medicine residency program can provide the preparation you need for a wide range of medical careers, including cardiology. In a three-year internal medicine residency program in the United States, you will get broad training in the diagnosis and treatment of the diseases and disorders that affect all organ systems. This training will include a mix of clinical practice and classroom-based seminar. You may also have the opportunity to conduct laboratory or clinical research in an area of interest, like cardiology. At the end of your internal medicine residency program, you are eligible to take the certification exam offered by the American Board of Internal Medicine (ABIM).

Completing a Fellowship in Cardiology

After earning certification from the ABIM, you can continue toward a career in cardiology by starting a three-year cardiology fellowship. During a fellowship in cardiology, you will have the chance to study a wide range of cardiac conditions, procedures, and prevention strategies. In most programs, you will also have the chance to apply your knowledge and skills in multiple settings, including inpatient and outpatient settings. Research is also an integral aspect of many cardiology fellowship programs. Just as in your internal medicine residency program, you may have the chance to choose between research in laboratory and clinical settings, depending on your specific interests.

Subspecialty Cardiology Fellowships

If you are passionate about a particular topic within the field of cardiology, you may consider completing a one- to two-year cardiology subspecialty fellowship after you have finished your three-year general cardiology fellowship. In a subspecialty fellowship, you have the opportunity to gain focused clinical and/or research experience in a particular cardiology subfield. The ACGME-accredited subspecialty options for trained cardiologists include:

Interventional Cardiology Fellowship. In this subspecialty fellowship, your focus would be on treating coronary artery disease, the most common cardiovascular condition in the United States. Topics of study can include diagnostic procedures, percutaneous coronary interventions, and management strategies for patients with coronary artery disease. Interventional cardiology fellowships last one or two years.

Electrophysiology (Heart Rhythm) Fellowship. In this subspecialty fellowship, your training would focus on the diagnosis and management of disorders characterized by irregular cardiac rhythms. For this, you would gain expertise in the implantation of pacemakers and other medical devices, lead extraction, and epicardial mapping, among other procedures. Electrophysiology fellowships last one or two years.

Advanced Heart Failure Fellowship. This subspecialty fellowship would provide training in the management strategies for complex heart failure, such as transplant and implantation of artificial heart devices. You would also learn about pre- and post-operative care for patients who undergo these procedures. Advanced heart failure fellowships last for one year.

Although Interventional Cardiology, Electrophysiology, and Advanced Heart Failure are the only ACGME-accredited subspecialty options in cardiology, there are also unaccredited subspecialty fellowship options in other cardiology subfields, such as Advanced Imaging and Metabolic Cardiology. Even though these programs are unaccredited, they may still provide valuable education that can support your career success.

Pre-Residency Preparation Options for Aspiring Cardiologists

As an aspiring cardiologist with a degree from a foreign medical school, there are many things you can do to get ready for the residency application process that will launch your career in cardiology. One great way to gain clinical experience in a US medical setting is by completing a graduate externship experience. You can choose a graduate externship in general cardiology or a subspecialty area like interventional cardiology or metabolic cardiology. When writing your application for an internal medicine residency in the United States, you can draw on this experience to explain your passion for the field of cardiology and demonstrate your commitment to career success. In some cases, graduate externships can also help you make connections with potential reference writers at US institutions, which you may need to get matched in certain residency programs.
FMG Portal offers graduate externships in a wide range of medical specialty areas, including cardiology, interventional cardiology, metabolic cardiology, and internal medicine, among others. Contact us today for more information!

Preparing for the USMLE Step 3 Exam Before Your Residency

Last week on the blog, we went over they key questions you need to ask yourself when deciding whether or not to take the USMLE Step 3 before you apply to a US medical residency program. Unlike the USMLE Step 1, Step 2 CK, and Step 2 CS (which we have also been discussing in recent weeks), the USMLE Step 3 is not required for ECFMG certification or for success in the residency application process. However, as mentioned in the previous blog post, you may consider it as an option, depending on your circumstances.

If you have made the decision to take the USMLE Step 3 before applying for your residency, there is nothing more important than ensuring that you are well-prepared to ace the exam on test day. There are several key reasons why:

If you fail the exam, the attempt appears on your transcript, which may cause concern for admissions officials when they review your application.
Some post-residency fellowship programs consider your USMLE Step 3 score as one of the factors in the admissions process.
If you are taking the exam in order to qualify for an H1-B Visa sponsorship, you need a passing mark.

Given these high stakes, it is essential to make sure you are ready before you take the USMLE Step 3. Read on to learn more about the basics of the exam and what you should do to get ready.

The Basics of the USMLE Step 3

The USMLE Step 3 is the last test in the sequence of exams that you need to pass to gain a license to practice medicine in the United States. It is a two-day exam that is designed to determine if you have the biomedical knowledge and clinical skills you need for success as a physician. The test includes both multiple-choice questions and computer-based case simulations.

On day 1, you take the USMLE Step 3 Foundations of Independent Practice (FIP) exam. This part of Step 3 lasts for seven hours and consists entirely multiple-choice questions. It is divided into six 60-minute blocks (38-40 questions per block), with short breaks in between blocks.

Much of the content on the exam is presented as patient case studies, but some of the items also ask you to interpret medical research abstracts or pharmaceutical advertisements. Some of the topics that are covered include:

Applications of basic biomedical science
Understanding of biostatistics, epidemiology, and population health
Communication abilities and interpersonal skills
Medical ethics
Systems-based practice
Patient safety
Knowledge of history and physical examination
Interpretation of diagnostic studies

On day 2, you take the USMLE Step 3 Advanced Clinical Medicine (ACM) exam. This part of Step 3 lasts for nine hours and consists of a mix of multiple choice questions and computer-based case simulations. It starts with six 45-minute blocks of multiple-choice questions (30 questions per block), followed by 13 case simulations (each of which lasts between 10 and 20 minutes).

On the computer-based case simulations, you will be evaluated on your performance in two settings: an office / health center and an emergency department / inpatient facility. For the multiple-choice questions, there are some areas of content overlap between the FIP and the ACM, but the main difference is that the ACM focuses much more heavily on diagnosis and management. You can expect to be tested on:

Prognosis and patient outcome
Health screenings
Health maintenance strategies
Therapeutics
Decision-making in the clinical setting
Knowledge of history and physical examination
Interpretation of diagnostic studies

Getting Ready for the USMLE Step 3 Before Your Residency Program

In order to do well on the USMLE Step 3 before starting your residency program, there are two main things you need to do:

Ensure that you have comprehensive understanding of the content of the exam.
Familiarize yourself with the format and the question types.

The USMLE website offers a comprehensive overview of the USMLE Step 3, as well as practice questions for the computer-based simulations. You can also find a variety of other study aids on the internet. Most of the content should be familiar from medical school and any clinical experience that you may have had — like a student elective or a graduate externship experience — but it is extremely important to familiarize with the test specifications so that you will be ready to apply your knowledge!

Even after you start studying, you should remember that you can always decide to wait to take the USMLE Step 3 until after you start your residency program. After all, in most programs, you have until your third year to pass the exam. If you start studying and realize that you do not have enough time to study for the exam and prepare a stellar US medical residency application, it’s probably better to wait. And you won’t really have wasted time, because any studying you did do will only benefit you when you take the USMLE Step 3 as a medical resident!

Need more help with the US medical residency application and preparation process? Contact FMG Portal today!

Deciding Whether to Take the USMLE Step 3 Before Your Residency Program

In the last few posts, we have talked about the USMLE Step 1, Step 2 CK, and Step 2 CS. In order to get ECFMG certification, you need to have passed all three of these exams. These three exams are also the prerequisites for the USMLE Step 3 exam, which you need to pass in order to earn a license to practice medicine in the United States. As a foreign medical graduate, you have the option of taking the exam before submitting your application to a U.S. medical residency program or taking it after your residency has started. Depending on your personal situation, there are benefits and drawbacks to both approaches. Here three critical questions you need to ask yourself when making this decision:

Question 1: Do you have enough time to prepare for and take the USMLE Step 3 before applying to a residency program?

Before you take the USMLE Step 3, you already need to have passed the USMLE Step 1, Step 2 CK, and Step 2 CS. As a foreign medical graduate, you also need to have fully completed the ECFMG certification process. Your timeline for meeting these requirements can help you determine whether or not you want to take the USMLE Step 3 before you apply for your residency. You need to remember that preparing a successful residency application takes a great deal of time and effort, and you don’t want to rush through it because you are trying to study for the USMLE Step 3 at the same time — not to mention balancing the residency application process with the other responsibilities in your life.

However, if you have completed the requirements well in advance and feel like you have more than enough time to prepare yourself for success on the USMLE Step 3 before applying for your residency, it can reduce pressure once you start your residency. In most states, you need to pass Step 3 before the third year of your residency program, which can be a challenge as you balance residency program requirements, personal responsibilities, and adjusting to life in the United States. So if it’s easy to fit the USMLE Step 3 into your schedule before you apply for a U.S. medical residency, you may want to consider it.

Question 2: Do you have the medical background you need for success?

Like the USMLE Step 1 and Step 2 CK, the first part of the USMLE Step 3 consists entirely of multiple choice questions. The second part is somewhat similar to Step 2 CS — it tests your clinical skills, but instead of interacting with real-live patients, your performance is evaluated on a series of computer-based case simulations.

But don’t be fooled by these structural similarities. The USMLE program recommends that applicants have completed at least one full year of post-medical school training before taking the Step 3 exam. Therefore, many American and foreign medical school graduates use the first year of residency training as preparation for the USMLE Step 3.

However, some foreign medical graduates who apply for U.S. medical residency programs have already gained additional educational or work experience after medical school. For instance, you may have completed a post-graduate education program in your home country and/or completed a graduate externship in the United States. If that is the case for you — and you did well on the USMLE Step 1, Step 2 CS, and Step 2 CK — you may have the foundation you need for success.

Question 3: Are there logistical issues that you need to consider?

In some cases, whether or not you take the USMLE Step 3 before applying to a U.S. medical residency program can come down to logistics. These three logistical issues commonly come into play:

Immigration status. In order to apply for an H1-B Visa sponsorship, you need to have passed the USMLE Step 3. If you plan to apply for this type of visa, you should plan to take the USMLE Step 3 before applying.
Cost. The USMLE Step 3 can be cost-prohibitive for some students. If you can’t afford the $875 fee, you should wait until after you can save some money from your first year of residency work.

Location. The USMLE Step 3 is only offered at Prometric test centers in the United States and its territories. If traveling to the United States from your location is too expensive or difficult, you should probably just wait until you start your program. Alternatively, if you are already in the United States — whether for a graduate externship, to visit family, or to see the sights — it may be convenient to take the test.

If you need more help making decisions about the residency application process, FMG is here to help. Contact us today for more information!

Question Types on the USMLE Step 2 – CK: What You Need to Know

When you are preparing to take the Clinical Knowledge component of Step 2 of the U.S. Medical Licensing Exam — also known as the USMLE Step 2 – CK — your success depends on your familiarity with two things: the content on which you will be tested and the format of the exam. In a previous post, we provided a general overview of the exam that included a description of both. Today, we’re going to do a deep dive into the formatting of the questions you will find on the USMLE Step 2 – CK. That way, on test day, you won’t be surprised by any of the questions you come across.

When it comes to formatting, there are two different ways you can divide up the questions on the USMLE Step 2 – CK. You can divide the questions between Single-Item Questions and Sequential Item Sets, or you can divide them between Patient Vignette questions and Abstract Format questions. Read on to learn more about the different types of questions you will find on the USMLE Step 2 – CK.

Single-Item Questions vs. Sequential Item Sets

If you take the USMLE Step 2 – CK after you take the USMLE Step 1 (which is the way most foreign medical graduates do it, although it is not required), you will recognize the Single-Item Question format. And even if you haven’t taken the USMLE Step 1 yet, the Single Item Question format will be familiar because it is exactly what you would expect from a multiple choice question: a short text background followed by a single question. Pretty simple.

The one thing that does distinguish the Single-Item Questions from traditional multiple choice questions you might have seen at other points in your education is the formatting of the answer options. There can be as few as 3 answer options or as many as 26. They are lettered (A, B, C, D, etc), and the options are arranged in either alphabetical order or logical order. It is important to note that some of the options might be partially correct, but you can only select one, so you have to choose the best possible answer.

When it comes to question formats, the primary difference between the USMLE Step 1 and the USMLE Step 2 – CK is that the latter exam also contains sequential item sets. That means that a single text — that is, either a Patient Vignette or an Abstract (both of which we will get to later) — must be used to answer either two or three consecutive questions, instead of just one. Like the Single Item Questions, these questions are multiple choice questions with 3 to 26 possible options, and you have to choose the single best answer.

Although each question in the Sequential Item Set directly relates to the text, they are designed to test your knowledge of different aspects of the text. Also, it is important to note that they are designed to be answered in sequential order, so a question may build on the one preceding it. Because of this design element, you will not be able to change your answer to an earlier question after you click the button to move on to the next question.

Patient Vignette Questions vs. Abstract Format Questions

The majority of the questions on the USMLE Step 2 – CK are Patient Vignette questions. The Patient Vignettes provide an overview of a clinical situation that you might encounter in your practice as a physician. Then, you are asked one or more multiple-choice questions about it (depending on whether it is associated with a Single-Item Question or a Sequential Item Set). For instance, you might be given a brief medical history of a patient followed by a description of an abnormal test result and then asked to identify the most likely cause of the result.

While the Patient Vignette questions test your ability to apply your knowledge and skills to clinical situations, the Abstract Format questions examine your ability to understand and interpret information from clinical investigation. Each of these items consists of a summary of an experiment or investigation in the form of an abstract — the kind you would find for a peer-reviewed research study published in a medical journal. It is essential for doctors to be able to read, understand, and analyze abstracts in order to effectively engage in evidence-based practice.

On the USMLE Step 2 – CK, you will be required to interpret an abstract in relation to various relevant topics. For instance, you may find questions about:

Biostatistics and epidemiology
Pharmacology and therapeutics
How to use diagnostic studies in clinical practice
How to use the information from the abstract to make decisions about care for an individual patient

Every step of the US medical residency application process — including the three Steps of the USMLE — can be challenging for foreign medical graduates, but FMG Portal is here to help. Contact us today for more information about our services!

Preparing for the USMLE Step 2 – CS: What NOT To Do

Over the last few weeks, we’ve been talking about the USMLE exams, which are essential for earning ECFMG certification and becoming eligible to apply for a medical residency program in the United States. In one of these posts, we introduced you to the USMLE Step 2 – CS, which tests your clinical skills. In another post, we took a more specific look at what you can expect in the two types of encounters on the USMLE Step 2 – CS: the Standardized Patient and Physical Examination and the Telephone Patient Encounter. Going into the USMLE Step 2 – CS, it is important for you to know what the examiners expect you to do — but you also need to know what NOT to do. That way, you can avoid making mistakes that cost you valuable time and/or points off your score. Read on to get tips on what NOT to do on the USMLE Step 2 – CS patient encounters.

What NOT To Do On the Standardized Patient and Physical Examination Encounters

Here are a few things that you definitely want to avoid during the in-person encounters on the USMLE Step 2:

Do NOT perform any of the prohibited tests. The testmakers specify that you should not conduct rectal, pelvic, genitourinary, inguinal hernia, female breast, or corneal reflex examinations. Also, you should not swab the patient’s throat for a throat culture. If you think that the patient needs any of these tests, you can call for them in the diagnostic workup you propose in your Patient Note.

Do NOT ask the patient for consent for other physical examinations. Aside from the above-mentioned prohibited tests, you can assume that you already have patient consent for all physical examinations. This includes femoral pulse exams, inguinal node exams, back exams, and axilllary exams. Asking for the patient’s consent on any of these exams will unnecessarily take up valuable time.

Do NOT be overly forceful with the patient with the patient. You need to be gentle during the physical examination avoid being too forceful when conducting maneuvers that involve palpating or percussing. You will lose points if you apply more than the appropriate amount of pressure when conducting an abdominal examination, examining the gallbladder or liver, using an otoscope to examine the ears, examining the throat with a tongue depressor, or examining the gall bladder and liver.

Do NOT forget about the patient’s modesty. During the exam, you must treat the patient just the way you would treat a patient in a real-life situation. Therefore, it is important to take the time to consider their personal comfort during the physical examination. For instance, if part of the exam requires a female patient’s bra to be moved or loosened, you should ask her before doing it yourself. It only takes a few seconds, and it will demonstrate your ability to remain courteous and professional, regardless of the time constraints of the exam.

What NOT To Do On the Telephone Patient Encounters

These are some things to avoid on the Telephone Patient Encounters:

Do NOT play around with the buttons on the phone. During the Telephone Patient Encounter, all you need to do to place the call is press the yellow speaker button. After that, touching any buttons could disconnect your call. When you are ready to end the call, press the yellow speaker button again.

Do NOT try to call the patient back after ending the call. Once you end the call, the encounter is over. Even if you think of another question for the patient, you cannot reach them again. Trying to call the patient back will only cut into the time you have for the Patient Note, so you should just do your best with the information you have.

Do NOT make assumptions based on your previous test experiences. This tip actually goes for both the Standardized Patient and Physical Examination Encounters and the Telephone Patient Encounters. If you are taking the USMLE Step 2 – CS for a second time, you may notice similarities between an encounter on your exam and an encounter on one you have taken before. However, you should NOT assume that the correct diagnosis or treatment strategy is the same as the one on your previous examination, as the test preparers often make slight changes between exams.

Do NOT make assumptions about whether or not an encounter counts toward your score. You may know that some of the twelve patient encounter are unscored — that is, they are only used for test development purposes. However, it is a bad idea to try to guess which encounters are unscored. Even if a particular encounter seems to stand out as easier or harder than the others, it may not be one of the unscored encounters. You should treat each one of the encounters — including both the in-person and telephone encounters — with equal seriousness.

Following these tips can help you avoid potential pitfalls when taking the USMLE Step 2 – CS. For more help preparing for a U.S. medical residency program, contact FMG Portal today!

Year: 2017