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!