An Overview of the USMLE Step 2 CS for Foreign Medical Students and Graduates

If you are a foreign medical student or graduate and you want to get matched to a residency program in the United States, the first thing you need to do to prepare is to get certified through the Education Commission for Foreign Medical Graduates (ECFMG). Before your certification can be verified, you must pass all three steps of the United States Medical Licensing Exam (USMLE). In two previous posts, we provided an overview of the USMLE Step 1 and advice on how to construct a study strategy to prepare yourself for success on test day. Today, we are going to start talking about the USMLE Step 2.

The USMLE Step 2 is actually divided into two parts: Step 2 CS (Clinical Skills) and Step 2 CK (Clinical Knowledge). Today’s post is going to focus on Step 2 CS. Read on to learn more about this essential exam!

The Basics of the USMLE Step 2 CS

Both parts of the USMLE Step 2 evaluate your ability to apply your knowledge of medicine in practical clinical settings. One these exams, you will be expected to show that you can implement strategies to prevent disease and promote health and wellness through effective patient care.

As the name implies, the Step 2 CS focuses specifically on examining your clinical skills. The test focuses on three aspects of clinical practice:

Obtaining health-related information from patients
Conducting physical examinations
Effectively communicating patient information to other health care providers

By demonstrating your competency in these areas, you can get the passing score you need to earn ECFMG certification.

The Format of the USMLE Step 2 CS

Unlike the USMLE Step 1, the USMLE Step 2 CS is not a written exam. Instead, it is a real-world exam where you are evaluated on the skills you demonstrate in mock scenarios of patient encounters. Essentially, test day simulates a day in the life of a physician in clinical practice. The exam itself is divided into three major sections. The On-Site Orientation, the Patient Encounter, and the Patient Note.

The On-Site Orientation

Some of the details of the USMLE Step 2 CS inevitably vary depending on the facility where the exam is given — such as how you are expected to move between rooms during different protions of the test. But you don’t need to worry, because everything will be explained during the on-site orientation. You are not scored on anything during this part of the exam, so all you have to do is listen to the instructions and familiarize yourself with the expectations for the facility. That way, when your patient encounters begin, you won’t feel lost or uncertain about where to go or what to do.

The Patient Encounters

In total, you will complete twelve patient encounters during the USMLE Step 2 CS. You will have a total of 15 minutes for each one, but you may be able to complete them in less time. It is important to note that not all twelve of the encounters are scored — some are pilot test cases that will be used by the test-makers for research purposes — but on test day, you will not be able to distinguish between them. There are two types of patient encounters on the USMLE Step 2 CS: the Standardized Patient and Physical Examination, and the Telephone Patient Encounters. In both, you will be expected to act professionally and apply clinical skills to the patient-centered problem you face.

The Patient Notes

Immediately following each one of the twelve Patient Encounters, you will need to complete a Patient Note. The Patient Note is the only written part of the USMLE Step 2 CS. This part of the exam involves using a computer to record details about the Patient Encounter in the patient’s medical record. Essentially, it is the same thing that you would do as a physician after meeting with a patient in a clinical setting or talking to the patients on the phone. For each Patient Encounter, you will be given ten minutes to complete the associated Patient Note. However, if you finish your Patient Encounter early, you can spend the additional time working on the Patient Note.

USMLE Step 2 CS Scheduling

Because of the complex format of the USMLE Step 2 CS, it is only offered on certain days and in certain places. You can find calendar and scheduling information on the ECFMG website after you obtain your identification number. From there, you can choose the date and location that work best for you! It is important to note that the USMLE Step 1, USMLE Step 2 CS, and USMLE Step 2 CK can be taken in any order, so when you choose your test date, the order of these three exams does not make a difference.

Need more help with the process of getting matched to a U.S. medical residency program? Contact FMG Portal today to learn more about all of the resources we offer!

Medical Specialty Spotlight: Nephrology

Kidney disease is a growing problem around the world, but if you are looking to specialize in nephrology, one of the best countries to train in is the United States. According to the National Institutes of Health, about 14 percent of the American population has chronic kidney disease (CKD), as compared to only 10 percent of the world population as a whole. In total, about 661,000 American have kidney failure. About 468,000 of these patients are on kidney dialysis, and about 193,000 have a functioning kidney transplant. According to the American Journal of Kidney Diseases, the prevalence of CKD in the United States is expected to increase by 27 percent by 2030.

The two most common causes of CKD are high blood pressure and diabetes, with almost half of CKD patients reporting that they have been diagnosed with one or both of these conditions. That’s why CKD is so common in the United States — because of the high prevalence of cardiovascular disease and diabetes. However, its is important to note that changing lifestyles in developing countries are also raising the rates of these diseases worldwide, especially as the number of elderly individuals in countries like China and India grow. Therefore, in the future, there will probably be a high demand for nephrology specialists around the world.

If you are looking to become a nephrologist — that is, a physician specializing in the treatment of kidney disease — it just makes sense to complete your residency and fellowship in the United States, given the high rate of CKD in the country and the likelihood that it will rise in the future. Read on to learn more about the educational pathway to becoming a nephrologist.

Internal Medicine Residency: The First Step on the Path to Nephrology Career

Because nephrology is a specialization within the field of internal medicine, the first step to becoming nephrologist (after finishing medical school) is to complete an internal medicine residency program. These programs last for three years, and they are particularly popular among foreign medical graduates. Of all the foreign medical graduates who were matched to residency programs in the United States in 2015, 67.3 percent were matched to internal medicine programs, according to the National Residency Matching Program (NRMP).

In an internal medicine residency program, you can expect to gain a broad background education in the diagnosis, treatment, and management of disease and disorders that affect all of the internal body systems — including the renal and urinary systems. In addition to your clinical and didactic training, you may also have the opportunity to engage in research. If you are hoping to become a nephrologist, you may be able to conduct advanced research in nephrology, which can help you prepare for the specialization later on in your career.

Once you finish your internal medicine residency program, you will be prepared to take the American Board of Internal Medicine (ABIM) certification exam. After you pass the exam, you will be eligible to apply for a fellowship in nephrology in order to pursue your dream of becoming a specialist in the field.

Completing a Nephrology Fellowship Program

During a nephrology fellowship program, your studies will focus specifically on kidney-related diseases and disorders. As previously mentioned, CKD is the most common kidney disease in the United States and around the world, but as an aspiring nephrologist, you will also gain expertise in other kidney conditions, including:

Kidney stones
Polycystic kidney disease (PKD)
Acute renal failure
Glomerulonephritis
Pyelonephritis
Bartter syndrome
Dent disease
Nephronophthisis
Gitelman syndrome

Depending on your area of interest, a nephrology fellowship program can last anywhere from two to four years. If you choose to focus your fellowship on clinical training, it will typically last for two years. In addition to learning about the treatment of the conditions listed above, you may also have the chance to learn about cutting-edge clinical treatment options, such as home-suitable dialysis. You will also gain expertise in related areas of clinical care that you will likely encounter in your practice, such as geriatric care and palliative treatment.

Alternatively, you can choose to focus your fellowship on research — either clinical research, translational research, or basic science research. For aspiring researchers, a nephrology fellowship typically lasts three to four years. If you choose the clinical research pathway, you may be able to earn a master’s degree over the course of your training. As a nephrology research fellow, some of the topics you might study include:

Epidemiology of kidney disease
Public health strategies to improve access to CKD treatment in developing countries
Drug development for rare kidney disease
Cancer-related signaling pathways in kidney cells

After you finish the fellowship program, you can take the optional Nephrology Certification exam offered by the ABIM to demonstrate your expertise in the field. From there, you start your career as a nephrology-focused clinician, researcher, your researcher/practitioner.

If you are a foreign medical student or graduate, getting a job as a nephrologist might seem like a long way off, considering the years of preparation that are required, but it’s never too early to start preparing yourself! A clinical externship in nephrology can be a great way to get a feel for the field and establish connections with medical professionals in the United States before you apply for an internal medicine residency. Contact FMG Portal today to learn more about how this opportunity and the other ways we can help you get matched!

Developing a Study Strategy for the USMLE Step 1

Last week on the blog, we provided an overview of the USMLE Step 1, discussing the format of the test and its general content. Passing this exam is the first major hurdle for foreign medical graduates who are applying for ECFMG certification, so if you are a foreign medical student or graduate considering applying for a U.S. medical residency in the future, getting a good score on the USMLE Step 1 can help you on your way to achieving you goal. To get that passing score, you need to come up with a study strategy that properly prepares you for test day. Read on to learn more about what you need to do to get ready for this crucial exam!

Knowing What You Will Be Tested On

In general, the USMLE Step 1 covers the basics of medical science and organ systems. Therefore, regardless of the country where you attended medical school, you have probably been exposed to most of the concepts on the test at some point in your education. Given that the content of the test will probably be familiar to you, the main goal of studying for the USMLE Step 1 is not to learn new things, but to refresh your memory on the subjects that the test emphasizes.

Not all subjects are given equal weight on the USMLE Step 1. The group of American and Canadian teachers, researchers, and clinicians who design the test believe that some academic concepts are more relevant for today’s physicians than others, and the USMLE Step 1 is structured according to their believes. There are two ways that the test specifications of the USMLE Step 1 may be divided, according to the test makers: based on Systems and Processes and based on Physician Tasks and Competencies. Knowing how the content of the USMLE Step 1 is divided within each of these schemes can help you design an effective study strategy.

If you are looking at the USMLE Step 1 through the lens of Systems and Processes, the test can be broken down based on the specific nature of the content on which you will be tested.

The following are the systems that you will find on the USMLE Step 1, along with the proportion of the test that each one takes up:

General principles of foundational science: 15% – 20%
Organ systems: 60% – 70%
Multisystem Processes and disorders, biostatistics and epidemiology / population health, social sciences: 15% – 20%

These are the processes that you will be tested on when you take the USMLE Step 1, along with the proportion of the test that each one takes up:

Normal processes: 10% – 15%
Abnormal processes: 55% – 60%
Principles of therapeutics: 15% – 20%
Other processes: 10% – 15%

Another way to approach the USMLE Step 1 is through the lens of Physician Tasks and Competencies. From this perspective, the test designers break down the USMLE Step 1 into the following competencies:

Medical knowledge / scientific concepts: 55% – 65%
Patient care: diagnosis (including laboratory / diagnostic studies, diagnosis, and prognosis / outcome): 20% – 30%
Patient care: management (including health maintenance, disease prevention, and pharmacotherapy): 7% – 12%
Communication and professionalism: 2% – 5%
Practice-based learning and improvement: 4% – 8%

Now that you know about the two ways in which the content of the USMLE Step 1 is organized, you can design a study strategy that focuses specifically on the topics that are most heavily emphasized on the test and the topics that you may not remember well from medical school. However, you also need to prepare yourself for the way in which questions will be asked on the test.

Preparing for the Questions on the USMLE Step 1

All of the questions on the USMLE Step 1 are multiple choice, but don’t let that fool you into thinking it will be easy. In most cases, the test questions will not ask you directly about specific medical facts. Rather, you will be challenged to apply your knowledge to solve problems, interpret data, and address real-life scenarios. Therefore, in addition to brushing up on your knowledge of medical science, organ systems, and basic physician tasks, you should make sure that you are familiar with USMLE Step 1-style questions before test day. As you develop your study strategy, you should block out a good proportion of time to completing practice questions. That way, when test day finally comes, you can successfully navigate the toughest questions with a sense of ease and familiarity.

It is important to note that the USMLE Step 1 is a timed test, so some of the practice tests you complete should be timed. Usually, timed practice tests should come late in your study schedule. That way, when you first start working on practice questions, you won’t feel undue pressure to rush through them. Later, as the test approaches, you can learn how fast you need to work through each section to complete the test within the time limit.

Overall, if you are familiar with the structure of the USMLE Step 1 and the types of questions you will see on the test, you can develop a study strategy that will get you ready for success on test day — and well on your way to earning ECFMG certification and getting matched to a U.S. medical residency!

Need more help with the residency match process? Contact FMG Portal today to learn about all of the resources we offer!

An Overview of the USMLE Step 1 Examination for Foreign Medical Graduates

As a foreign medical graduate, your application process for a U.S. medical residency differs slightly from that of a student who completed their education in the United States. Most importantly, before you can apply for a residency, you must get certification from the Educational Commission for Foreign Medical Graduates (ECFMG). In another blog post, we covered the basic requirements for ECFMG certification, but today, we are going to focus on one of the most important aspects of the process — passing the USMLE Step 1. After you submit your initial application for ECFMG certification, passing the USMLE Step 1 becomes the next task on your list of things to do. Read on to learn more about what you can expect from this essential examination.

About the USMLE Step 1

The United States Medical Licensing Examination (USMLE) consists of three steps. The first test is the USMLE Step 1. You might also hear it simply referred to as “Step 1.” The USMLE Step 1 is a joint program of the Federation of State Medical Boards of the United States, Inc and the National Board of Medical Examiners. Although you do not need to pass the USMLE Step 1 before taking the USMLE Step 2, you must achieve a passing score on both exams before you become eligible to take the USMLE Step 3. Also, you must pass USMLE Step 1 Step 2, AND Step 3 before your ECFMG certification becomes official.

The Format of the USMLE Step 1

The USMLE Step 1 is a one-day examination, lasting a total of eight hours. It is divided into seven blocks, each of which is 60 minutes long, and there are short breaks between each one of the blocks. There is no set number of questions on each block of the test — instead, the USMLE guarantees that there will be no more than 40 questions per block and no more than 280 questions on the exam as a whole.

All of the questions on the USMLE Step 1 are single-item multiple choice questions. That means that each question consists of a short vignette followed by four or more lettered response options (labeled A, B, C, D, E, etc). From these options, you must choose the best answer. Only one answer is correct.

The Content of the USMLE Step 1

The USMLE covers the basics of medical science. In general, you will be tested on the information that you would learn in the first two years of medical school in the United States. During these years, the training for U.S. medical students consists primarily of didactic coursework and laboratory exercises (as opposed to clinical training). However, you should be aware that in some countries, the medical training does not align with that of the United States — in terms of timing and/or content — so you need to tailor your study efforts specifically for the USMLE, not necessarily reviewing everything you learned in medical school.

That’s because the questions on the USMLE are created by examination committees made up of medical experts from institutions in only two countries: the United States and Canada. These experts — including medical school faculty members, teachers, research investigators, and clinicians — come together to decide what it is important for future U.S. medical residents to know about basic medical science.

In general, the USMLE Step 1 covers the broad principles of basic science and the functioning of human organs and organ systems. More specifically, it includes questions within 8 traditionally defined disciplines and 5 interdisciplinary areas.

The traditionally defined disciplines are:

Anatomy
Behavioral Sciences
Biochemistry
Biostatistics and Epidemiology
Microbiology
Pathology
Pharmacology
Physiology

The interdisciplinary areas are:

Aging
Genetics
Immunology
Molecular and Cellular biology
Nutritional sciences

Not only do you need to be able to recall information on these subjects but you also need to be able to read and interpret relevant graphs and tables, identify pathologic and normal specimens (including both microscopic and pathologic specimens), apply your knowledge to specific clinical problem-solving questions.

You should also be aware that there is a heavy emphasis on how these topics apply to organ systems — these types of questions typically make up between 60 and 70 percent of the total content of the test. The following organ systems are covered on the USMLE Step 1:

Blood and Lymphoreticular System
Behavioral Health
Cardiovascular System
Endocrine System
Gastrointestinal System
Nervous System and Special Senses
Renal and Urinary System
Reproductive System (Male and Female)
Respiratory System
Skin and Subcutaneous Tissue
Musculoskeletal System

Clearly, the USMLE Step 1 covers a lot of academic territory, so if you are hoping to get matched to a U.S. medical residency program in the future, be sure to study! While in medical school, you might also want to consider broadening your knowledge on particular topic areas of interest by completing a student elective program in the United States. A student elective can help you decide what specialty area you want to pursue in your residency, and it can also connect you with physicians in the United States who may be able to provide letters of reference for your future residency application.

FMG Portal offers lots of resources for foreign medical students and graduates who are interested in U.S. medical residency programs. Contact us today for more information!

Medical Specialty Spotlight: Infectious Diseases

All over the world, infectious diseases are on the rise. Every day on the news, you might hear a breaking story about the discovery of a novel virus that has the potential to wreak havoc across the globe. At the same time, you might be hearing about infectious diseases that have been around for centuries but are somehow making a comeback. Consider some of the most recent developments in the field of infectious diseases:

The Zika virus has gained traction in South American countries like Brazil, and it has also been carried to other countries, like the United States. The effects of the virus are not well understood, but it has been shown to cause microcephaly in infants after their mothers have been infected.
Between 2014 and 2016, the most recent outbreak of Ebola ravaged countries in West Africa, causing a worldwide health scare.
Over the last two years, there have been measles outbreaks across Europe, especially in Romania, where over 3,400 cases have been reported since January 2016. Some suggest that the increase in measles, mumps, and rubella has resulted from unwarranted fears about the safety of vaccines for children.
Scientists have recently reported that the number of new flu viruses is increasing each year. This is making it increasingly harder for scientists to develop effective vaccines.

If stories like these capture your academic interest as a physician, you may want to consider becoming an infectious disease specialist in the future. Read on to learn more about working as an infectious disease specialist and what you need to do to become one.

Working as an Infectious Disease Specialist

An infectious disease specialist is a physician who is an expert at diagnosing, treating, and preventing the spread of illnesses that are transmitted from person to person. Infectious diseases may be caused by bacteria, viruses, parasites, or fungi, and they can affect many different parts of the body. Although some infectious diseases, like the common cold, are relatively easy to diagnose and treat, most infectious disease specialists focus their work on infections that are particularly difficult to treat or have not been fully studied.

As an infectious disease specialist, your job could involve aspects of clinical practice, scientific research, and public health efforts. Depending on your interests and training, you might spend some of your time working directly with patients, providing them with vaccinations against infectious diseases and/or therapies to treat infections that they have already contracted. You might also choose to spend some of your time in the research lab, developing and conducting rigorous studies with the goal of finding new prevention and treatment strategies or identifying new strains of a deadly infection. If you are interested in public health, you could also find yourself using your medical knowledge to develop and direct large-scale efforts to address and eradicate infectious diseases in a broader community.

The Steps to Becoming an Infectious Disease Specialist

Regardless of the particular aspect of infectious disease in which you are most interested, the basic components of training for this career are the same. After you finish your training in medical school, you must complete a three-year medical residency in internal medicine. If you are specifically interested in becoming a pediatric infectious disease specialist, you will also need to complete a medical residency program in pediatrics. Although it can be tough for foreign medical graduates to get matched to U.S. medical residency programs, it is important to note that internal medicine and pediatrics are two of the specialty areas in which foreign medical graduates are most commonly matched. To increase your chances of getting matched, you might also want to consider completing a student elective or a clinical externship program in infectious diseases, internal medicine, and/or pediatrics before you apply for your residency.

After you finish your residency, you can get the expertise you need to become an infectious disease specialist by completing an ACGME-accredited fellowship program in infectious diseases. Depending on the location, these programs can last for either two or three years. In most programs, fellows divide their time between clinical training with patients and research training in a particular area of interest. Research within the field of infectious diseases tends to vary widely, and it may fall into any of the following categories:

Basic science
Translational science
Clinical trials
Epidemiology / public health
Global health studies

Upon completion of one of these programs, you will be prepared for the Infectious Disease subspecialty certification exam offered by the American Board of Internal Medicine (ABIM). From there, you can start an exciting career as an infectious disease specialist!
FMG Portal offers valuable resources for foreign medical graduates who are looking to pursue careers in a wide range of specialty areas. Contact us today for more information about how to get matched to the U.S. medical residency program of your dreams!

Finalizing Your 2018 Medical Residency Application: A Checklist for Foreign Medical Graduates

It’s down to the wire — the final deadline for the 2018 ERAS application process is less than two weeks away. On September 6, 2017, foreign medical graduates can start applying to ACGME-accredited U.S. medical residency programs. A week later, on September 15, 2017, the programs start receiving applications. Two weeks after that, on October 1, your Medical Student Performance Evaluation (MSPE) will be released to the programs to which you applied.

As these deadlines draw nearer, you need to add all of your application components to your MyERAS account. That way, when medical residency programs receive your application, it will be complete and ready for the review process. Over the next two weeks, make sure that you have checked each of the following items off of your list of things to do:

You have provided proof of ECFMG Certification.

All foreign medical graduates applying to U.S. medical residency programs must demonstrate proof of certification from the Educational Commission for Foreign Medical Graduates (ECFMG). By now, 2018 ERAS applicants need to have already completed all of the requirements, but it is important to double check that there are no problems with your proof of certification. That way, you can avoid any glitches in the application process.

You have updated your curriculum vitae (CV) and uploaded the final version to MyERAS.

The curriculum vitae is a constantly evolving document, so there is a good chance that you will need to add your most recent activities before uploading the final version in your MyERAS portal. Before you send off your application, you want to be sure that all of your relevant educational and work experiences — especially student electives and clinical externships in the United States — are highlighted on your CV.

You have perfected your personal statement and uploaded the final version to MyERAS.

By this point, you are probably tired of poring over your personal statement. On the blog this summer, we have covered all of the steps of the writing process for the personal statement — from initial brainstorming to drafting to revising to final editing — and it can be a grueling process. But now that it’s over, you have a polished personal statement that can convince the application reader at your dream program that you are an excellent candidate. After reading over your personal statement one last time, upload it to your MyERAS account so it is ready for submission.

You have ensured that your letter writers know what to do to submit your letters of reference.

Even though do not write your own letters of reference, it is your responsibility to ensure that your letter writers have them done on time and know what to do to submit them properly. If your letter writer has not yet submitted the letter, don’t be afraid to send them a polite email reminder. You can also offer to help with any questions or problems they might encounter. Physicians have a lot of responsibilities to keep track of, so your letter writers will likely appreciate anything you can do to streamline the process.

Your Medical Student Performance Evaluation (MSPE) is complete.

This document is released to your chosen residency programs by the dean of your medical school on October 1, so you still have over a month until the deadline. If you have not yet met with the dean to discuss your performance over the course of your education, that should be a top priority. Also, if you went to a medical school where very few graduates apply to residency programs in the United States, you may want to send an email to the dean to check in, in order to make sure that they are aware of the upcoming deadline and are comfortable with the submission process.

You have narrowed down your list of programs and know where you want to apply.

There are lots of great residency programs in the United States, so it can be a challenge for prospective residents to narrow down the options. Foreign medical graduates most commonly apply for residencies in family medicine, internal medicine, and pediatrics, but there are a wide range of other specialty areas that you might want to consider, including newly added specialty areas that are available for the first time this year. In addition to specialty area, you might also want to think about the region of the country in which you want to live, as well as whether you prefer a residency program in an urban setting or a rural setting. In these last few days, make sure that you are excited about every aspect of the residency programs to which you submit your application.

By spending this week meticulously ensuring that every part of your application is polished and perfect, you can maximize your chances of getting matched. After finalizing your application, the only thing left to do is wait for Match Day!

Whether you are applying for a U.S. medical residency program in 2018 or looking ahead to future application cycles, FMG Portal is here to help. Contact us today for more information!

ERAS Participating Specialties and Programs: The 2018 Additions

As a student of medicine, one of the first things you learn is that there is always more for you to learn. The field of medicine is constantly evolving. Every day, new scientific papers are published in medical journals, providing novel insights that have the potential to revolutionize the way medicine is practiced in a wide range of fields. During your undergraduate education and medical school, you were probably exposed to much of this cutting-edge research. Today, it is being put into practice.

Based on the latest trends in medicine, universities and medical centers all over the United States are creating residency and fellowship programs to train residents in new specialty areas. The application process for these programs is coordinated by the Electronic Residency Application Service (ERAS). Thus, the number of specialty areas and programs that are available through the ERAS application process increases each year. In 2018, new specialty areas were added for almost all program types and application cycles

Understanding the ERAS Application process

The Electronic Residency Application Service (ERAS) is the organization responsible for the coordination of medical residency and fellowship programs in the United States. Through the ERAS online portal, aspiring medical residents and fellows can prepare and submit applications to the programs of their dreams — including newly added programs that provide training in innovative specialty areas.

For prospective medical residents, there is one application cycle each year, which runs from June to September. The deadline for the 2018 ERA application process is September 6, 2017, so mark your calendar! For aspiring medical fellows, there are two application cycles each year. The deadline for the first cycle — which is the one used by the majority of fellowship programs in the United States — is in July. The deadline for the second application cycle is in December.

For the 2018 ERAS application process, new specialty areas were added for each application cycle. Read on to learn more about the exciting opportunities that are opening up within the field of medicine.

MD Residency – September Cycle

As a foreign medical graduate looking to apply for a residency program in the United States, you have 50 specialty areas to choose from. The three most common specialties for foreign medical graduates are family medicine, internal medicine, and pediatrics, but for the 2018 process, there are also two new specialty areas that you might be interested in:

Family Medicine / Osteopathic Neuromusculoskeletal Medicine
Osteopathic Neuromusculoskeletal Medicine

MD Fellowship – December Cycle

If you have already completed a U.S. medical residency program and want to specialize your training through a fellowship program, there are 18 specialty options available for the December cycle. Five of them are new this year, including several that might be of interest to foreign medical graduates who have completed residency programs in the popular specialty areas of pediatrics and internal medicine.

Advanced Heart Failure and Transplant Cardiology
Clinical Cardiac Electrophysiology
Gynecologic Oncology (Obstetrics and Gynecology)
Maternal – Fetal Medicine
Reproductive Endocrinology and Infertility

MD Fellowship – July Cycle

Most aspiring medical fellows submit their applications to the ERAS during the July cycle, in which 46 specialty areas are offered. Although the July deadline has already passed, it can still be helpful to be aware of the newly added specialty areas, in case you plan to apply in the future. Most of this year’s additions are in the increasingly relevant field of clinical informatics. Several are ideally suited to foreign medical graduates who have completed residencies in one of the three most popular residency specialty areas:

Clinical Informatics (Family Medicine)
Clinical Informatics (Internal Medicine)
Clinical Informatics (Pediatrics)
Clinical Informatics (Pathology)
Clinical Informatics (Emergency Medicine)
Clinical Informatics (Anesthesiology)
Adult Congenital Heart Disease

Preparing for a Residency or Fellowship in a New Specialty Area

For aspiring medical residents, it can be a challenge to prepare for a residency in a newly created specialty area. But remember — all of the other applicants are in the same boat! If your academic interests lie in one of the new fields, make sure to provide a full explanation in your personal statement, which is the part of your application where you get to tell the application reader about your career goals. In addition, the physicians who write your letters of reference may also be able to speak to your interest in the subject.

Before you apply for a residency, you might also consider completing a graduate externship program that is related to the new specialty area that you are interested in. For instance, if you are considering applying for a residency in Family Medicine / Osteopathic Neuromusculoskeletal Medicine in the future, an externship in Family Medicine or Neurology could look great on your CV. Similarly, if you one day hope to do a fellowship in Advanced Heart Failure and Transplant Cardiology, a clinical externship in Cardiology, Interventional Cardiology, or Metabolic Cardiology could be a great experience.

Need more help with the residency application process? FMG Portal offers clinical externships and other resources that can help foreign medical graduates get matched. Contact us today for more information!

Finding a Place to Live in the United States: Information About Accommodations

If you are considering a student elective, clinical externship, or medical residency program in the United States, one of the most important things that you have to think about is living accommodations — that is, where you will live for the duration of the program. If you are entering a U.S. medical residency program, you will need long-term housing, since medical residencies in the United States can last anywhere from three to seven years. Alternatively, if you are completing a graduate externship program or a student elective, there are more short-term living accommodations available.

It is important to note that housing is different in the United States than it is in some of the other places around the world, so it can be helpful to get an idea of your options before you start looking for accommodations. Read on to learn more about long-term housing options for aspiring medical residents and short-term accommodations for medical students and graduates who are visiting the United States for a clinical externship or a student elective.

Long-Term Housing Options for Medical Residents

As a medical resident in the United States, there are a wide range of factors that can contribute to the type of housing you choose — including your financial circumstances, your family situation, the region of the country in which your residency is located, and whether or not your program is in a rural or an urban setting. Here are some of the types of housing that you might want to think about.

Apartment. An apartment is one of the most common housing choices for medical students and residents in the United States, especially in urban and suburban areas. If you want to live alone, you can often find a studio or one-bedroom apartment. Alternatively, many medical residents share a two- or three-bedroom apartment with roommates. This can be a great way to cut down on the cost of living during your residency, and it can also help you make social connections with other residents. In many cities in the United States, renting an apartment is the most common (and affordable) option. However, there are also some places where investing in your own apartment is a feasible option, so it is important to find out about housing prices in the area of your residency before you decide.

Shared house. In some locations in the United States, it is easier for prospective renters to find a shared house than a traditional apartment. In a shared house, you might rent one bedroom for yourself and share a kitchen, bathroom, and living room with other roommates. You might also be able to find a situation in which a house is split between floors, with one renter on the first floor and one renter on the second floor.

Single-family house. If you are bringing a family to the United States and you need more space, you could consider buying or renting a single-family house. Again, availability and affordability depend on the location of your residency and your criteria for living accommodations, but in some places, it might make sense to invest because medical residency programs last for so long. Still, it is important to note that, if you choose to buy instead of rent, you are responsible for the care and upkeep of your house, and you will need to balance find a balance between the time you spend caring for your house and your responsibilities as a medical resident.

Accommodation Options during Clinical Externships and Student Electives

Before applying for a medical residency program, many foreign medical students and graduates complete a clinical externship or a student elective in the United States. These programs typically last for either three months or six months, and they can be a great way to learn more about a specialty area of interest, bulk up your CV, and establish connections with physicians in the United States who might be able to write letters of recommendation when you apply for a U.S. medical residency program. Because clinical externships and student electives are shorter than residency programs, the options for living accommodations are different:

Subletting an Apartment. Many foreign medical students and graduates choose to sublet an apartment for three or six months. In the United States, it is typically easiest to find sublets available between June and August, when many university students are away from their apartments for the summer.

Short-term Apartment Rental. In some apartment buildings, landlords offer six-month leases, so if your clinical externship lasts for a full six months, this can be an affordable option. Alternatively, if you are completing a three-month student elective or clinical externship, you might find an apartment where you can choose month-to-month rental for three months.

House Sharing. House sharing options, like AirBnb, are becoming increasingly popular in the United States. Depending on the location of your student elective or clinical externship, you might be able to find a short-term rental in a fully-furnished home for an affordable price.

For foreign medical students and graduates who are interested in applying for U.S. medical residency programs, FMG Portal provides a wide range of resources. We offer three-month student electives for foreign medical students, as well as three- and six-month clinical externships for graduates. We can also help you with accommodations when you decide to participate in these programs. Contact us today for more information!

Choosing a Medical Residency: Regions of the United States

The United States is one of the largest and most diverse countries in the world. A few weeks ago, we talked about the differences between medical residency programs in urban and rural areas. However, it is important to note that even within the category of “urban” or “rural,” there are significant differences between different parts of the country. Within the geographic borders of the United States, you can find an example of almost every climate zone, and there are distinctive cultural differences between regions as well.

During your residency, the characteristics of the region in which you live can affect both your lifestyle and your work as a physician. This is especially true if you are pursuing a residency in one of the more general medical residency subjects — such as family medicine or pediatrics — since the types of cases you encounter can depend largely on the cultural circumstances of the region. Therefore, if you are a foreign medical graduate looking to get matched to a residency in the United States, it can be helpful to learn more about the different regions of the country so that you can apply to programs in places where you will feel comfortable living and where you will have the chance to work on cases that fit in with your medical interests and career goals.

The East Coast

The East Coast is one of the most densely populated areas of the country. As a result, you can find more medical residency programs in this region than any other, and you will find most of them in urban and suburban areas. The East Coast is home to some of the largest cities in the country, including New York City, Boston, Philadelphia, and Washington, DC — each of which has its own unique culture. However, they do share some general characteristics, such as highly diverse populations, good public transportation, and easy access to restaurants and grocery stores.

If you live on the East Coast, you can expect to experience four distinct seasons. Summers are hot, and winters can be very cold. In the northern areas, you might get a lot of snow in the winter, but further south, heavy rain is more common. Both spring and fall on the east coast are considered to be beautiful. In general, the culture on the East Coast tends to be more formal than in other areas of the country.

The Midwest

The Midwest, also known as the Great Plains, refers to the inland states between the east coast and the Rocky Mountains. Some of these states include Ohio, Iowa, Illinois, Michigan, and Minnesota. Although large portions of these states are rural, there are also a few major cities, such as Chicago and Detroit. Like the states on the east coast, you can expect cold winters and hot summers in the Midwest states. People in the Midwest are especially well-known for being friendly.

One of the most significant health issues that you will face if you work as a physician in the Midwest is the opioid abuse epidemic. The misuse of opioid medications (such as morphine, oxycodone and hydromorphone) is a growing problem in all parts of the United States, but it is especially concentrated in the Midwest. As a medical resident in the Midwest, you may treat overdose cases or individuals who are seeking treatment for addiction, so if you are interested in pharmacology, psychiatry, or any other drug-related area of medicine, a residency program in the Midwest may be of interest to you.

The South and Southwest

As in the Midwest, the South and Southwest regions are mostly rural, but with a few major cities, such as Atlanta (in the South) and Houston (in the Southwest). The climate in these states is much warmer and more humid in the summer, but Southerners also enjoy milder winters. The South is famous for its hospitality and its delicious comfort food.

Two medical issues that are more prominent in the South than in any other part of the country are obesity and smoking. Southern states like Mississippi, Louisiana, Alabama, Kentucky, and West Virginia have some of the highest numbers of people who meet the criteria for obesity and who say they smoke regularly. As a result, physicians are challenged to treat patients with many obesity-related medical conditions (such as type II diabetes and heart disease), as well as health problems caused by smoking (such as lung cancer).

The Mountain West and the West Coast

The Mountain West region includes the states that are between the Midwest and the West Coast. Some of the states in this region include Colorado, Utah, Idaho, and Montana. Because of the Rocky Mountains, much of this region is rural, although there are a few large cities, such as Denver. The Mountain West is known for its dry climate. In the winter, there is often snow, especially in the high country. In the summer, you can expect a daily temperature swing, with warm days and cool nights.

Outside of the East Coast, the West Coast is the most populous area of the country. Most people on the West Coast live in California, where the climate varies considerably. Southern California is warm and sunny, while Northern California is overcast and cool for most of the year.

The Mountain West and West Coast states are well-known for being among the healthiest in the United States, with low rates of smoking and obesity, and high rates of activity and exercise. However, the outdoor adventure opportunities in the states — like hiking, rock climbing, and skiing — can cause traumatic injuries. If you are interested in treating sports- and outdoors-related injuries — in either an emergency room or a rehabilitation setting — this region could be a great place to work. California is also particularly well-known for cutting-edge technological advances, so a residency in this area could be of interest if you are interested in medical technology research and development.

Choosing Between Regions of the United States

As an aspiring medical resident, it can be a challenge to figure out which region(s) of the country you would be comfortable living in. One way to experience life in the United States first hand is to complete a student elective or graduate externship before you apply. Not only can this give you a better idea of what it is like to live in a particular region of the United States, but it can also give your CV a boost and connect you with physicians who could possibly write letters of reference for your application.
FMG Portal offers student electives and graduate externships in a wide range of fields. Contact us today for more information!

Medical Subspecialty Spotlight: Bariatric Medicine

If you want to dedicate your career to the prevention and treatment of obesity, you may want to consider an educational track that leads you to subspecialize in bariatric medicine. Physicians who choose this subspecialty work with adults and/or children who are overweight or obese. As a bariatric medicine specialist, you would help your patients manage their weight and the associated complications, and you would devise prevention strategies for at-risk patients who want to avoid becoming obese.

Understanding Obesity

According to the World Health Organization (WHO), “Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health.” More formally, overweight is defined as having a Body Mass Index (BMI) of 25 or above, while obesity is defined as having a Body Mass Index (BMI) of 30 or above. Being overweight or obese puts patients at a higher risk for a wide range of other health problems, including:

Heart disease
Stroke
Type II diabetes
Cancer
High blood pressure
Osteoarthritis
Gallbladder disease
Sleep apnea
Asthma

Obesity is a growing problem around the world. The WHO estimates that the population of obese individuals has doubled since the 1980’s. In 2014, an estimated 1.9 billion adults were overweight, with 600 million of them meeting the criteria for obesity. In the same year, the WHO estimated that 41 million children under the age of 5 were either overweight or obese. Obesity is a particular problem in the United States. According to 2011-2014 data from the Centers for Disease Control and Prevention (CDC), 36.5% of adults in the United States were obese, and 17% of children between the ages of 2 and 19 were obese.

The Bariatric Medicine Subspecialty

Given the increasing severity of the obesity epidemic in the United States and around the world, many American medical schools have started offering fellowships in bariatric medicine. To get a bariatric medicine fellowship, you need to have previously completed an ACGME-accredited U.S. medical residency program in a relevant specialty area. Some of the residency specialty areas that schools accept include:

Internal Medicine
Family Medicine
Pediatrics

These three residency focus areas provide the general medical education that you need in order to succeed in a career as a bariatric medicine specialist. In each one of these programs, you learn about diagnosing and treating patients with a wide range of conditions, which is important bariatric medicine specialists work with overweight and obese patients who have highly diverse physical and mental health histories. Importantly, these three residency specialties were also the top three specialty areas in which foreign medical graduates got matched in 2015, according to data from National Resident Matching Program (NRMP).

What to Expect from a Fellowship Program in Bariatric Medicine

After completing your residency, you can apply to a one-year fellowship program that focuses on bariatric medicine. It is important to note that most fellowship programs that focus on bariatric medicine are officially titled Obesity Medicine and Nutrition Fellowship programs.

Because obesity is such a complex health condition, bariatric medicine fellowships tend to be highly interdisciplinary. You will likely study prevention and treatment strategies that involve nutritional programs, behavioral changes, pharmacological interventions, and bariatric surgery. Upon completion, you will be prepared for the board certification exam offered by the American Board of Obesity Medicine (ABOM).

Getting Into a Fellowship Program

So far, there are only a few Obesity Medicine and Nutrition Fellowship programs in the United States, so entrance is competitive. However, you can boost your chances by demonstrating your commitment to a career in the field. Here are a few things you can do as a medical graduate and as a medical resident:

Complete a graduate externship program in bariatric medicine before you apply for a U.S. medical residency. Not only can this boost your odds of getting matched to a residency program in the United States, but it can also indicate to future fellowship application readers that you know what you are getting into and and are ready to take on the challenge of a career in bariatric medicine.
Do bariatric-medicine related research while you are a resident. Many U.S. medical residency programs in internal medicine, family medicine, and pediatrics allow you to do conduct scientific research as part of the program. Whether you do lab research on pharmaceutical treatments for obesity, or population studies on obesity risks in certain demographic groups, having already done research on bariatric medicine may give you an edge over the other fellowship applicants.
Complete a fellowship in a related field. At some schools, in order to enter the Obesity Medicine and Nutrition Fellowship program, you need to have already completed another one-year fellowship in a related subspecialty area, such as endocrinology, gastroenterology, critical care medicine, or nutrition. Be sure to look into the requirements of the programs you are interested in before you apply.

If you want to pursue a career in bariatric medicine, FMG Portal is here to help. We offer graduate externships in the field and other services that can improve your chances of getting into a U.S. medical residency program. Contact us today for more information!

Choosing a Medical Residency Setting: Urban or Rural?

As a foreign medical graduate, there are many factors that you must consider when applying to medical residency programs in the United States. With so many different residency programs available at universities and medical centers, it can be hard to narrow down the list, even after you have identified your specialty area of interest. One of the factors that you should take into account is the setting of the residency program — that is, whether your choose a program in an urban area, a rural location, or a small city / suburban area. The setting that you choose can make a big difference for your residency experience, in terms of both your medical work and your life outside of the program. Read on to learn more about what you might expect from U.S. medical residency programs in urban and rural areas.

Choosing a Medical Residency in an Urban Area

U.S. medical residency programs in urban areas offer distinctive opportunities for foreign medical graduates. In cities, you can find lots of hospitals, outpatient care centers, and community health centers, so your clinical rotations may take place at many different sites around the city. This can give you a broader range of experiences than you might get from a residency program in a rural area or a suburban setting.

Many of the cities in the United States are also characterized by significant racial and socioeconomic diversity. Indeed, a 2015 study by the Brookings Institution found that the 50 largest cities in the United States had a significantly larger gap between the rich and the poor than smaller cities and rural areas. Therefore, if your residency is in an urban area, you might have the chance to work with patients from a wider range of cultural and economic backgrounds. Depending on your country of origin and the city in which you choose to work, you may have foreign language skills that can come in handy when working with the diverse populations of American cities.

Choosing a residency program in an American city will also significantly impact your lifestyle outside of the program. One of the benefits of living in a large city is that you will never need to worry about being bored — from restaurants to museums to concerts, there is no limit to the cultural experiences you can find in American cities! However, one of the drawbacks is that living accommodations are more expensive in American cities, so you may need to live with roommates. At the same time, public transportation systems are better in cities than in rural areas, so you may not need to own a car.

It is important to note that there is no “typical” American city, so if you are looking for a residency program in an urban area, you should do additional research about the cities you are considering. As of 2015, the 10 most populous metropolitan areas in the United States were:

New York City, New York
Los Angeles, California
Chicago, Illinois
Dallas – Forth Worth, Texas
Houston, Texas
Washington, DC
Philadelphia, Pennsylvania
Miami, Florida
Atlanta, Georgia
Boston, Massachusetts

Choosing a Medical Residency in a Rural Area

The opportunities that you would get as a medical resident in a program in a rural area are different from those that you would get in an urban area, but they can be just as educational and fulfilling. According to the Centers for Disease Control and Prevention (CDC), health risks for Americans in rural areas are significantly greater than for those living in rural areas, so as a medical resident, you may have the opportunity to gain experience with more serious cases. Here are a few statistics from the CDC about health disparities in rural areas that can provide insight into some of the challenges that medical residents in rural areas face:

Compared to Americans in urban areas, rural residents are more likely to die from heart disease, cancer, chronic lower respiratory disease, and stroke.
Death from unintentional injury is 50% higher in rural areas than in urban areas — primarily due to motor vehicle crashes and opioid overdoses.
Children living in rural areas are more likely to have mental, behavioral, and developmental disorders than those living in urban areas.

Because there are fewer physicians in rural areas, residency programs in rural areas are more commonly available in the broader specialty areas of family medicine, pediatrics, and internal medicine. That’s good news for foreign medical graduates, since the NRMP reports that these were the top three areas in which foreign medical graduates got matched in 2015.

The rural areas in the United States are located primarily in the Midwest, the South, and the West, each of which offers different cultural opportunities and lifestyle options. For example, in many rural areas in the West, there is easy access to outdoor activities like hiking, rock climbing, and rafting. On the other hand, the South is famous for comfort foods like fried chicken and pecan pie. Rural Midwesterners are known for being particularly friendly. On a more practical note, if you are living in a rural area, your housing will probably be less expensive, but you may also need to own a car in order to get around.

Clinical Externships in Rural and Urban Areas

Researching rural and urban areas in the United States can be helpful as you decide where to apply for a U.S. medical residency program, but there is no substitute for real-world experience. A great way to learn what life is really like in one of these settings is to complete a clinical externship. FMG offers clinical externships in many areas around the country, including rural and urban settings, as well as small cities and suburban areas. Contact us today to learn more about all of the resources we offer for foreign medical students and graduates!

Medical Specialty Spotlight: Adolescent Medicine

As you look ahead to your medical career, one specialty area that you might want to consider is adolescent medicine. As an adolescent medicine specialist, you would provide care for pre-teens, teenagers, and young adults. The period of adolescence starts when the patient reaches puberty and ends when the patient is in their early twenties, so you would have the opportunity to work with patients during a crucial period of development. Read on to learn more about starting a career in this rewarding field.

The Educational Steps for Aspiring Adolescent Medicine Specialists

After earning your medical degree, you can expect to spend another six years in residency and fellowship programs before you can become a Board-certified adolescent medicine specialist. Specifically, you need to complete a three-year medical residency program and a three-year Adolescent Medicine Fellowship.

The first step is to complete a three-year residency program in one of the more general medical specialty areas. According to the National Resident Matching Program (NRMP), applicants for an Adolescent Medicine Fellowship must have previously completed a three-year medical residency in one of the following specialty areas:

Pediatrics
Medicine – Pediatrics
Internal Medicine
Family Medicine

That’ good news for foreign medical graduates, since internal medicine, family medicine, and pediatrics were the top three specialty areas in which foreign-trained physicians got matched in 2015, according the the NRMP.

After completing a three-year residency in one of those specialty areas, you can apply for a three-year fellowship in Adolescent Medicine. Unlike some other fellowship programs, the matching process for Adolescent Medicine Fellowship programs is facilitated by the NRMP. Therefore, after you have completed your first residency program, you would go through the ERAS process to get matched to an Adolescent Medicine Fellowship program, just like you would for any other residency program.

What to Expect From an Adolescent Medicine Fellowship Program

All Adolescent Medicine Fellowship programs last for three years. The time that you spend in the program is typically divided between clinical experience, research training, and didactic coursework. In general, the first year is spent mostly on clinical training and coursework, while the second and third years involve more academic research.

However, it is important to note that the proportion of time spent in each of these areas can vary depending on the program. Some programs are primarily intended for aspiring adolescent medicine clinicians, while others focus on training adolescent medicine specialists who spend more time on academic research that supports their practice. As you look at the different programs that are available in the United States, make sure to find out about the emphasis of each one of the programs that you are considering.

Clinical Training in an Adolescent Medicine Fellowship Program

During your clinical training, you will probably have the opportunity to gain experience in multiple settings. You may complete rotations in hospitals, outpatient care centers, behavioral health clinics, substance abuse clinics, gynecology departments, school-based health clinics, and even homeless shelters. If you are interested in public health, adolescent medicine can be a great choice, because many programs offer opportunities to work with teens and young adults from a wide variety of socioeconomic backgrounds.

Because adolescent medicine is such a broad discipline, your clinical training will equip you to treat young people with many different physical and mental health conditions. Some common topics of study include:

Eating disorders
Gynecology
Substance abuse
Nutrition
Sports medicine
Chronic diseases

Research Training in an Adolescent Medicine Fellowship Program

In addition to your clinical training, an Adolescent Medicine Fellowship involves academic research. In most programs, the research opportunities have implications for public health. For instance, you may conduct epidemiological research to try to understand disease frequency in certain adolescent populations, or you may conduct lab-based molecular biology research to develop sexually transmitted disease therapies that are safe for young adults. At some universities, your research can serve as the basis for a Master of Public Health (MPH) degree, which you can earn as part of the Adolescent Medicine Fellowship Program.

Starting Your Career as an Adolescent Medicine Specialist

Once you finish your fellowship program, you will be ready to take the Adolescent Medicine Certification Exam. This exam is developed jointly by the American Board of Internal Medicine (ABIM), the American Board of Family Medicine (ABFM) and the American Board of Pediatrics (ABP). The ABP administers the exam once a year to candidates who have completed an Adolescent Medicine Fellowship program. Passing this exam means that you are Board-certified in the subspecialty area of Adolescent Medicine.

Advice for Aspiring Adolescent Medicine Specialists

Even if you are still in medical school, there are steps you can take that can help you prepare for an Adolescent Medicine Fellowship program in the United States. Completing a student elective or a graduate externship in the field is a great way to learn more about the subspecialty area and increase your chances of getting matched. FMG Portal offers clinical externships for foreign medical graduates in Adolescent Medicine, as well as the three other relevant specialty areas: Internal Medicine, Family Medicine, and Pediatrics. Contact us today for more information about what we offer!

Year: 2017