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American International Integrated Observership Programs

It is a difficult road for any international medical graduate (IMG) trying to practice medicine in a country different from the one where they graduated from medical school. Each country’s requirements for medical school are different, and pre-requisites for those medical schools vary greatly. As a result, other countries do not know what they are getting when they take on a foreign medical graduate. Although their education may be superior, there is no way of telling whether it was superior or greatly inferior.

Whether inferior or superior, education abroad combines many strengths and challenges. Being multi-lingual and multi-cultural is a definite advantage when it comes to bedside manner and diversity in care. However, language barriers, standards of care, and the overall practice of medicine may differ greatly from one country to another. There are also different exposure rates to the treatment of various regional illnesses. For example, experience in the care of dengue fever patients varies across different countries. While one country may have a large incidence of the illness, another country may have little to none. It is difficult to determine what medical graduates have had adequate training in all illnesses.

There are no “apples-to-apples” comparisons of international medical school programs, but this does not mean foreign medical graduates are inferior. Instead, it means that they have to prove their academic and clinical know-how in an effort to provide a comparison to those who need it.  The EFMG does a good job of serving as a Dean’s Office for foreign medical graduates, but residency applicants still need to have experience in the United States in order to confirm that their clinical skills and training fit the practice of medicine in this country.

The American Medical Association (AMA) registers American International Integrated Observership Programs (MedicalObs) to help foreign medical graduates become accustomed to medical practice in the United States. These observerships last for one to three months, and they allow FMGs to get a taste of American medicine and do a little networking along the way.

Program Elements

Observation: The first thing the program does for FMGs is gives them the opportunity to observe doctors in a hospital setting. This gives FMGs a greater understanding about the workflows of American hospitals, the types of patients they may encounter, and the relationships between physicians and other staff. Nurses are critical to the care of patients, and the doctor-nurse relationship is a huge facilitator of care. FMGs must understand this in order to perform successfully during residency training.

Evaluation: FMGs who are enrolled in observerships will also get reviews from the program director. This is critical feedback by professionals in the medical field, and it can be instrumental in helping guide an FMG into a successful residency Match.

Letter of Recommendation: The evaluating director will also provide a letter of recommendation. Letters from American medical leaders are critical for residency applications, as they prove that you have worked successfully in American healthcare settings.

Certification: The certification from an observership is a great credential because it shows that you are focused on integrating your culture with the American culture of healthcare rather than letting it be a barrier.

Mock Interviews: The interview process can be very intense for FMGs who have all the same struggles of American residency applicants and the added difficulty of language and cultural differences. Mock interviews are the best way to hone answers to interview questions, and they help to build confidence.

Review of Application: Acting alone in the residency application process is a mistake for FMGs, and personal statements made with the review from a qualified and experienced healthcare professional can ensure that personal statements contain the elements needed for program directors to see the candidate as a success.

Speech: For FMGs with strong accents, it can be difficult to practice medicine. Not only will staff and patients have difficulty understanding thick accents, but some patients may not be able to trust a physician whom they cannot understand. Accent reduction courses are available through observerships to combat this problem.

There are many other benefits to American International Integrated Observership Programs. Membership to the alumni network can be a good tool to help find connections with other physicians. Local community groups and events where FMGs participate in events helps to integrate future residents with community members.

In many cases, the challenges FMGs have in finding a good residency Match are unfair, as there are many good and in some cases better medical schools outside of the United States than within. However, residency program directors have no way of knowing what an FMG’s specific circumstance was, and they must be presented with evidence not only that training was sufficient but also that the applicant is ready to transition into the culture of the American healthcare industry. Observerships make it easier for residency program directors to see the quality of FMG applicants.

Difficult Residency Interview Questions

The purpose of residency interviews during the Match is to pair a medical graduate with an environment that will enhance learning and develop the skills of the physician. However, interviewers are not equipped with the time to get to know every medical student, so they must use challenging interview questions to really get to know what type of candidate a medical graduate is. For the foreign medical graduate, difficult interview questions can be particularly challenging.

The Easy Questions

Don’t worry. There will be easy questions, and medical graduates will have plenty of general questions in which they can rehearse answers. Typical “easy” questions are:

  • Why do you want to be a physician?
  • Why are you interested in this residency?
  • What are your strengths when it comes to practicing medicine?
  • What is your biggest weakness when it comes to practicing medicine?
  • What are your goals for the future?
  • Why did you choose your specialty?
  • Describe your medical school training.
  • Who has been your greatest mentor?
  • What will you do if you are not selected for this program?

These questions are easy because they can be predicted and rehearsed. Especially for foreign medical graduates who may struggle with cultural or language barriers, the easy questions are a stress reducer because they can be practiced.

These questions are also very important because they confirm your education experience and the quality of education received abroad. They also give the candidate a chance to insert some personal details that will allow him or her to stand out amongst other candidates.

Although rehearsing the easy questions is advisable, answers should not be memorized. This can make replies come out robotically and make answers seem disingenuous. When practicing the easy interview questions, it is better to use bullet points to rehearse rather than full replies in complete sentences. This will give the candidate a chance to practice delivering natural and semi-spontaneous responses. The interviewer is not seeking a prepared speech but rather a natural conversation.

The Difficult Questions

While the content and delivery of the easy questions is important to assessing your ability to communicate your skills, difficult questions are designed to see how a residency candidate handles stress. They may be bizarre questions that have nothing to do with the residency program, and how you react to them tells interviewers a lot about your ability to handle stress.

For the foreign medical graduate, the difficult questions can be extra stressful because the interviewee must understand first that it is an intentionally difficult question. This can be difficult if the contextual elements of the question are misunderstood. This may force the interviewer to ask the question in a different manner to try to get the FMG to understand the question, and if this does not work, the interview may take an awkward negative turn. Examples of difficult questions are:

  • What is your favorite color and why?
  • Have you heard any negative comments about our residency program?
  • If you were stranded on a desert island and could bring one item from home, what would it be?
  • Tell me a joke.

It is obvious that these questions have nothing to do with your skills or qualifications, but they can show a lot about what a person is able to handle.

Preparing for the Difficult Questions

It is impossible to predict what the difficult questions will be, but your response to them should be candid. Some questions are meant to evoke hard emotional responses, and how you handle your emotions matters. Remain calm, and answer the questions with as many facts as possible. Leave any feelings or emotions out of your replies whenever possible. This is a test of emotional fortitude, which is a requirement in medicine, and the only way your interviewers can judge your strength is by throwing out some unexpected lines of questioning.

When you are practicing with mock interviews, throw in some crazy lines of questioning, and practice responding in an intelligent and calm manner. If it is a funny question, don’t be afraid to give a clever or witty response. The difficult questions are a chance to show personality and uniqueness. Everyone has practiced, canned responses for the easy questions, and the difficult questions are an extra way to stand out.

Lastly, start thinking about the difficult questions as an advantage. They are really an opportunity more than an obstacle, as long as the candidate is prepared. They are an opportunity because they give the interviewee a stab at capturing the interviewers’ attention and showing how the candidate can think on his or her feet. If a candidate feels like this is where their weaknesses are, then they should practice more because the difficult questions are going to happen.

The Match is a lengthy process, and after all the exams, certifications, and residency hurdles, there is still one part of the residency application process that must be conquered to be matched, and that is the interview. Like everything else, it requires preparation, and practicing the easy and the hard questions will give the foreign medical graduate a big advantage in the interview.

The difficult questions during an interview are not necessarily graded by the quality of your answer but rather how you react to being asked such a question and then if you are able to shift your thoughts in order to answer thoughtfully. The interviewers are not expecting your answer to be as amazing as they expect from the easy questions, but they want to see that you are not easily thrown off by a little uneasiness in a situation.

ECFMG: The Starting Point for Residency Applications

In order for a foreign medical graduate (FMG) to apply for residency, they must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). This certification assures residency programs that a candidate is qualified to enter a program based on United States medical education requirements. This is an essential part of the residency application process, and it is important because medical education requirements vary around the world.

The quality and relevance of medical education around the world has been called into question by U.S. residency programs, as program directors are unable to compare standardized U.S. medical school education with that of education in other countries. While medical knowledge is easy to determine based on standardized testing, clinical experience is not as easy to compare. That is why FMGs must attend a U.S. residency program, but programs want assurance that their educational background is sufficient to begin practicing medicine.

U.S. medical graduates are labelled ready for residency by their Dean’s Office, but those offices are not available for international students. As a result, the ECFMG has aimed to create a Dean’s –like office that standardizes the process for FMGs through certification.

In order to get certified by the ECFMG, an applicant must apply through an interactive web application (IWA). This application allows the ECFMG to confirm an applicant’s identity, contact information, and education background. This act alone is indicative of how difficult it is to confirm FMGs’ education, as the simple identification process is extensive. Simply providing current identification is not enough.

The medical school attended by the FMG must be listed in the World Directory as meeting requirements for the ECFMG examination, which is the United States Medical Licensing Examination (USMLE). Applicants who do not have a resident status in the United States must also apply for a Visa. This is only part of the process leading up to the Match, but each step must be taken in order to meet the requirements for a residency application.

USMLE

The USMLE is separated into parts, and applicants must pass Step 1 and Step 2 of the USMLE in order to be certified. The third step can be passed during residency.  Parts 1 and 2 of the exam test medical science knowledge and clinical skills. 2006 statistics show that US medical graduates scored higher on these tests than international medical graduates, but non-US international medical students scored higher than US international medical graduates except in clinical skills. Preparation is key to passing these tests, and English proficiency has been blamed for poor performance among FMGs. These tests are administered throughout the year, but you must be certified by the ECFMG before the start of your residency program.

Visa

FMGs are typically not residents of the US, but they may have established some form of legal resident status prior to applying to be certified by the ECFMG. If not, the ECFMG is able to sponsor applicants for a J-1 Visa.

ECFMG services

While the ECFMG is responsible for certifying that candidates are qualified for American residency programs, they also provide many services to FMGs. For example, they will help an FMG apply for residency programs through the Electronic Residency Application Service. They will also help applicants create verified career portfolios. They are basically the go-to organization for FMGs who need to get ready for the Match.

The ECFMG was established in 1956, and its goal was to improve the U.S. education system by standardizing the evaluation process of FMGs. In other words, it recognized the need for diversity in the medical community and welcomed the opportunity to help FMGs advance their career in the U.S. healthcare system. It is important to remember that the differences in education received abroad versus in the U.S. are not labelled as inadequate. Instead, it is simply different, and it cannot be accurately compared without some sort of a mediating process. The ECFMG provides that mediation.

That is not to say that there is not extensive preparation involved in getting certified by the ECFMG. Applicants are advised to pay attention to the timeline of deadlines and opportunities for FMGs to get certified and further their journey on the path to the Match. It is a complicated process that can quickly fail if an FMG does not complete certain tasks at certain times. Test scores are also important, and study plans should be set up and carried out months prior to the testing.

Navigating the pathway to the Match can be very confusing, and although the ECMG helps applicants get to the Match through certification, it can be helpful to employ other agencies to navigate the system and make sure steps are taken at the right time. The key to success is preparation and the utilization of resources such as FMGPortal. Obtaining a U.S. residency is an attainable goal as long as an FMG is motivated and obtains the help needed to get from the beginning of the process with the ECFMG to the end of the process with the Match.

Coping Strategies for Foreign Medical Students

Some may argue that the journey to residency for Foreign Medical Students is equally challenging to that of American medical students, but this opinion lacks acknowledgement of the challenges Foreign Medical Students face when transitioning to a residency along with a new country.

While certain struggles, such as communication and culture are similar throughout time, foreign medical students also face hurdles such as constant political change. For instance, executive orders introducing travel bans can complicate visa processes. Many hurdles are well-beyond the control of the student, which is why it is important to develop coping strategies to maintain focus while navigating a medical system that can hold biases against foreign students.

Potential Struggles for FMGs

  1. 1. Communication: The most obvious struggle for Foreign Medical Graduates is communication barriers. While FMGs are required to pass a language proficiency test such as the TOEFL (Test of English as a Foreign Language) in order to obtain ECFMG Certification, passing this test does not eliminate all language struggles. In fact, an acceptable score on the TOEFL means a student is fluent and capable of conversation professionally in their profession, but they still may struggle with the language nuances developed among native speakers. This can be frustrating for students, professionals and patients. If the student is not careful to clarify any misunderstandings, this can lead to medical errors and unacceptable mistakes. As a result, communication can be a big struggle for FMGs.
  2. 2. Culture: A foreign country may have very different cultural norms than the cultural norms of America, which is not bad but can present challenges during interviews and professional processes. For instance, one country may find assertiveness to be a rude attribute, while it may be considered a strength in an American interview. Handshakes may be perceived differently in other areas of the world. The details of these differences are not as important as the fact that they cause added stress for FMGs in uncertainty and newness.
  3. 3. Team Work: Team work is essential in the healthcare field, and it can be difficult to insert oneself into a team when presented with communication and cultural differences. Additionally, once in a team setting, it is easy to fade into the background and not be a quality participant in the team. Not only must Foreign Medical Students have the courage to join teams, but they must conquer their fears of making communication and cultural mistakes in order to become a valued team member.
  4. 4. Logistics: On top of communication and culture, which can greatly impact one’s ability to engage in team work, FMGs must ensure that they are handling all the details of their transition to another country. As mentioned previously, things like visas can become complicated by political agendas. In addition, it can be difficult to develop a strategy for applying to residencies because it often involves a careful balance of applying to residencies that are known to accept FMGs without neglecting the residencies a FMG is truly passionate about. Organization, strategy, and perseverance is integral during this time, but it adds stress that the traditional medical student from America does not face.

Coping Strategies

There are many other struggles FMGs face, and many of them are unique to the student and their home country, but inherent in all of these struggles is increased stress that can negatively impact the outcomes of residency placement. That is why FMGs must develop coping strategies to handle stress and keep their minds focused on the goal.

  1. 1. Personal Resources: One of the most important strengths that a FMG can develop is personal resources. These are skills and actions that one takes in order to avoid fatigue and burnout, which can create an abrupt end to residency pursuits. For example, a FMG may practice breathing techniques, yoga or meditation in order to center himself or herself on his goals. FMGs may need to take personal time to reconnect with their own lives, which may seem displaced in a different country. Music can be a valuable reminder of home. There are endless possibilities when it comes to personal resources, and it is important that FMGs identify these resources prior to the time when they are needed. In this way, they will be emotionally prepared for stressful transitions.
  2. 2. Social Support: Alternatively, social support can be as essential as personal resources. It is very easy to hide from social interactions when faced with communication and cultural differences, but this actually increases stress for the inevitable social interactions that will need to take place for successful residency placement. Orientation and acculturation programs are available to assist FMGs in mixing American culture with that of their own, so they can achieve residency placement success without discarding their own traditions completely.

It is essential to FMGs that they remember their own cultural identities while blending that with American culture in order to provide effective care that is in line with American Medical School standards. It is a stressful challenge to maintain both the past identity of a home country while integrating that with American culture. This is why FMGs must focus on coping strategies, which will become easy to implement when needed if they are developed in preparation to stressors instead of on an as-needed basis.

U.S. Clinical Electives/Clerkships Increase Confidence and Confirm Education

Foreign medical graduates make up 25 percent of the working physicians in the United States, yet the U.S. does not have standardized accreditations for these medical schools. As a result, the quality of the education received abroad has been questioned by policymakers and voters. That is not to say that foreign medical schools are not of high quality, but foreign medical students seeking U.S. residencies have difficulties with successful placements if they cannot prove U.S. clinical experience. This is why U.S. clinical electives/clerkships are integral to the education process.

The outlook for foreign medical graduate’s placement in U.S. residency programs is good. In 2010, 2,881 non-U.S. citizen foreign medical graduates were placed into residency programs, but that number increased to 3,641 in 2015. That is 760 more filled positions by non-U.S. citizens. This is not what was originally predicted, and the outlook was predicted to be negative for non-U.S. citizens. However, the National Residents Matching Program (NRMP) has determined the cause of the increase in non-citizen medical graduate placements to be the shortage of U.S. medical graduates to fill the positions. There are simply not enough graduates to fill the available positions. This is good for foreign medical students, but they still have to be able to prove quality education.

Residency directors have acknowledged difficulty placing non-U.S. graduates do to non-standardized education measures, but there may also be biases present among some who simply don’t know if foreign medical schools are producing the quality of residents desired. This is why clinical electives/clerkships work so well: they give non-U.S trained medical students clinical experience under well-reputed Attending Physicians. This results in multiple benefits when it comes to applying for residency programs and interviewing during the Match process.

In order to be placed into a residency of choice, a foreign medical graduate must prove that their educational experience was exceptional and that they are ready to work hands-on as a medical provider. Without clear clinical experience during medical school, a challenging process becomes nearly impossible. Especially for the foreign medical student who is dealing with the cultural changes of an American society, the lack of U.S. clinical experience can cripple an interview for a residency. In contrast, clinical experience within the U.S. assures directors that a foreign medical student has had the chance to apply his or her knowledge and skills in the U.S. medical system, and it makes abilities confirmable. Not only are interviewers assured of a candidate’s ability, but the candidate is able to communicate in a more confident manner. Clinical electives/clerkships pave the way for residency placement.

Not only is U.S. clinical experience a way to influence residency program directors to choosing foreign medical students, but so is the word of U.S. physicians. In an effective clinical elective/clerkship setting, a medical student should be able to gain multiple letters of recommendation (LORs). Letters of recommendation can be the tipping point for directors who need a bit more assurance that medical training has been sufficient. Glowing letters of recommendation from Attending Physicians at teaching hospitals are like a giant stamp of approval for interviewers who need sound confirmation of a candidate’s experience.

Finding a clinical elective/clerkship can be done through FMG Portal. Through FMG Portal, a foreign medical student seeking clinical electives in the U.S. has access to many tools to aid him or her through the process. These services include USMLE preparation assistance, experience with Attending Physicians who are ACGME-affiliated, Visa Embassy Interview Assistance, help with accommodations and a simple, monthly payment program. Students are able to experience outpatient and inpatient situations, and core specialties along with sub-specialties are offered. Most-importantly, the Attending Physicians that students will work with are seasoned professionals, and their recommendations will be influential.

The benefits of clinical electives/clerkships are undeniable, and they give confidence to foreign medical students who need experience in the U.S. to prepare themselves for the Match and residency interviews. They also serve the needed purpose of confirming the quality of education received abroad. Again, there is no denying the fact that there is quality education abroad, but residency directors must be able to confirm that education has been fulfilled in a way that meets or exceeds the quality of U.S. medical schools. That is why getting some clinical experience in the U.S. prior to graduation is a good way to guarantee success.

While it is worth noting the potential biases and discrimination that foreign medical graduates may receive when applying to residencies, it is also worth noting their advantages. Foreign medical graduates have a different perspective when it comes to applying medical knowledge, which may include more education along the lines of infectious disease or among cultures that exist in the U.S. but are not specifically targeted in the U.S. medical school system. There are definite advantages to foreign medical schools, but it must be coupled with U.S. experience in order to make a U.S. residency match a probability.

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Ranking and Marketing: Getting a Residency Match as a Foreign Medical Graduate

Registering for The Match through the NRMP begins September 15, 2018. International Medical Graduates (IMGs) should have ECFMG certification in progress, as it is due by the rank order list deadline of February 20, 2019. The ECFMG provides the NRMP with confirmation that USMLE exams have been passed and that applicants are eligible for The Match. It serves as a Dean’s office for all foreign students to ensure that they meet the standards to qualify for a residency program.

The Match

The NRMP facilitates the ranking and placement of medical students into residency programs, but they are not in charge of program requirements or supported visa types. Applicants to each program must pay careful attention to whether or not the program accepts IMGs and the deadlines for sponsoring visas if applicable. The majority of residencies participate in the NRMP, but it is not a requirement.

Do IMGs have less opportunity for a match?

Foreign medical graduates have a history of obtaining less first-year residency matches than U.S. medical graduates, but the numbers are improving. First-year residency matches went from a 53.3% match rate in 2017 to a 56.5% match rate in 2018. This rate has been steadily increasing over the past decade.

The reasons for the lower number of first-year residency matches may not be warranted, but they still exist. Some program directors may have unfounded judgements about the quality of training abroad, but this is a stigma based on archaic thinking rather than facts. A more reasonable explanation may be that international programs differ from U.S. programs, so they are difficult to compare. Transcripts and academic achievements from different countries with different curricula are challenging to fully understand because they differ from the standard U.S. curriculum. While this creates a challenge to obtaining a match, it also opens a window of opportunity to market oneself during the application and interview process.

Market your Abilities and Stand Out Above the Rest

Applications are a starting point to combat any biases that may emerge during the application process. Program directors need to know that an applicant has proper training, skill and experience. A high score on the USMLE may be the first thing evaluated on an application from an IMG, but there are additional ways to stand out. Another way to stand out is by submitting letters of recommendation by U.S. doctors with whom an applicant has worked closely. Letters that clearly explain clinical abilities and provide examples of it will have a big impact on program directors. Supporting documents such as letters of recommendation and transcripts will be transmitted to ERAS applications through ECFMG.

A second way to improve the odds of a match is aggressive marketing. Applying to many schools is one tactic to increase odds, but 5 to 10 top picks deserve extra attention. Contact program directors and coordinators of these programs for introductions and tips prior to the interview. Those who wrote letters of recommendations may also contact program directors and give verbal recommendations. Ultimately, when applicants make themselves present in the lives of the people in the program, their applications become more meaningful, which increases the odds of a match.


Ranking Strategies

There are many strategies for ranking residencies for The Match. The ECFMG instructs applicants to rank them in the order in which they most want to attend them, which exercises the full purpose of the Match but may not yield a match. A quick internet search will provide lists of IMG-friendly specialties. Applying based on this may not be the best option for long-term career choices. There is not one clear-cut method that will guarantee a match, but some recommend a mix of high-competition residencies and low-competition residencies to improve the odds. Others recommend applying to as many residencies as possible. While one ranking strategy may work for some and not others, the application process combined with smart ranking choices will yield more positive results for Foreign Medical Graduates.

Rank Order Lists

Twenty programs are allowed to be listed on the rank order list (ROL), and 20 more can be listed on the supplemental ROL. Extra fees can be applied to place more programs on the ROL, but there can be no more than 700 listed for one applicant. The deadline for certification is 9 p.m. February 20, 2019. No changes can be made after this time, and matches are binding.

The Foreign Medical Graduate Prospective

As mentioned previously, the matches among foreign medical graduates are growing in number. Physician shortages and increased knowledge sharing from organizations such as the ECFMG are facilitating matches by matching the need for more providers with the surety that applicants are trained and skilled in their profession. It is a difficult process for all medical students and graduates, but it is a process that can be a success if a person provides proper evidence of their education and skill through documents and interviews.

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Understanding the Differences between the ERAS and the NRMP

For foreign medical graduates, there’s no denying the complexity of the process of landing a position in a US medical residency program. From the day you start brainstorming your personal statement to the final hours of Match Week, it is essential to make sure that you stay on top of all the requirements and check all of the necessary boxes so that you can end up in the program of your dreams. One of the things that can initially be confusing is the fact that there are two separate organizations that are heavily involved in the overall process of landing a US medical residency: the ERAS and the NRMP. Read on to learn about the role that each of these organizations plays in the process as you go from a foreign medical graduate to a US medical resident.

The Key Distinction between the ERAS and the NRMP: A Question of Purpose

As you try to land a US medical residency, you will work with both the Electronic Residency Application Service (ERAS) and the National Resident Matching Program (NRMP). Perhaps the most significant distinction between these two organizations is that they differ in their fundamental purpose. Specifically, the ERAS is the system through which you will submit all of your residency application materials, while the NRMP is the organization that facilitates the actual matching process, once all of your documents have been submitted to your programs of interest.

From a practical perspective, this means that you’ll be focusing primarily on ERAS requirements during the first part of the process, while the NRMP takes over during the second half. With the ERAS, your goal is to make sure you get all of your application materials into the system so that they are sent out to the programs of choice–complete and on time. Once the programs have evaluated these materials and you have had the chance to interview with interested programs, the NRMP facilitates the creation and submission of ROLs, and it generates the results that you end up receiving at the start of Match Week, and it coordinates the SOAP process until the final results are announced on Match Day.

Comparing the 2018-2019 ERAS and NRMP Timelines

Because the ERAS and the NRMP are two different organizations, they operate on two separate  timelines. They have different registration start and end deadlines, and they separately set other key dates as well. If you are looking to participate in the 2018-2019 application and matching process–that is, if you want to start your US medical residency program in July 2019–it is important to be familiar with the schedules of both the ERAS and the NRMP for the 2018-2019 season.

The ERAS 2018-2018 timeline is already underway. It started on June 7, 2018, when it first became possible for applicants to register on MyERAS and start preparing their US medical residency applications. If you haven’t started the registration process, now is the time. In less than a month–on September 5, 2018–applicants can start sending their applications to ACGME-accredited residency programs through the ERAS system. These programs start receiving the application materials ten days later, on September 15, 2018

Conveniently, that date coincides with the start of the 2018-2019 NRMP timeline. At 12:00 p.m. Eastern time on September 15, 2018, applicants for 2019 US medical residency programs can register with the NRMP. Registration remains open for the next two and a half months, until 11:59 p.m. Eastern time on November 30, 2018. After that date, candidates are required to pay a late fee alongside their main registration fee.

The last important date for the ERAS is October 1, 2018–the day that Medical Student Performance Evaluations (MSPEs) are released to residency programs. That means you have to be absolutely sure that your medical school has submitted your MSPE by that date. Alternatively, as a foreign medical graduate, you may need to submit the MSPE yourself, so you should make sure that you are ready to meet that deadline.

After that, no more documents will be submitted through the ERAS. However, the MyERAS 2019 season technically continues alongside the matching process facilitated by the NRMP. As a result, MyERAS will remain open until May 31, 2019, so you’ll always have easy access to your documents if you need them.

As the role of the ERAS essentially ends in the fall, the NRMP basically takes over in the winter and early spring, which means there are a series of important dates you need to be aware of in the lead-up to Match Day. First, on January 15, 2019, Rank Order List (ROL) entry opens at 12:00 p.m. Eastern time, and candidates have until 9:00 p.m. on February 20, 2019, to certify their ROLs. Match Week begins on March 11, 2019, when candidates find out if they got matched and the Supplemental Offer and Acceptance Program (SOAP) opens for those who did not. It all ends on Match Day–March 15, 2019–which marks the end of the NRMP timeline.

The Bottom Line: ERAS vs NRMP

The bottom line for foreign medical graduates is that the ERAS and the NRMP differ in both their purpose and their timelines, but understanding and working effectively with both organizations is essential for landing the residency position of your dreams. FMG Portal is here to help you with all of your needs when it comes to the residency application and matching processes. Contact us today to learn more about all of our services for foreign medical graduates!

Residency Specialty Spotlight: Oncology

Cancer is one of the greatest medical challenges of our time. According to the World Health Organization (WHO), it is the second-leading cause of death worldwide, accounting for about 1 in 6 of all deaths–a total of over 8.8 million people in 2015. It’s also been the subject of considerable biomedical research in recent decades, leading to significant advances in treatment and prevention options, so if you’re a foreign medical graduate, now is one of the most exciting times to train for a career in oncology in the United States. Not only will you be making a positive difference in the lives of patients struggling with the disease, but you will also have the chance to learn about the most cutting-edge techniques, technologies, and therapies used for treating the disease. Read on to learn more about the road to a career in oncology and what you need to do to pursue this specialty area of medicine.

 

Oncology Residency and Fellowship Training Options for Foreign Medical Graduates

 

As an aspiring oncology specialist looking for residency and fellowship training in the United States, there are two training paths for you to choose from. Both offer excellent training for foreign medical graduates, so you can’t go wrong either way!

 

 

  • Option 1: Internal Medicine Residency (3 years) + Oncology Fellowship (2-3 years)

 

The traditional route to becoming an oncology specialist is to start by completing a three-year US medical residency program in internal medicine before completing a three-year fellowship in Hematology and Oncology or (less commonly) a two-year fellowship program in Oncology. For foreign medical graduates, this can be a great option, especially since the latest data from the National Resident Matching Program (NRMP) indicates that internal medicine is the most common residency specialty area for foreign medical graduates, accounting for about 43.9 percent of all successful matches in 2015. Spending three years studying internal medicine can also be helpful if you’re not yet sure which area of oncology you want to focus on for your career, because an internal medicine residency will give you in-depth insight into all of the different body systems that may be affected by cancer.

 

Although the most common fellowship option for aspiring oncology specialists in the United States is Hematology and Oncology, many institutions have also been adding more specialized programs, including some that last only a single year and are designed for physicians who have already completed both an internal medicine residency and a general oncology fellowship. Here are a few of the more specialized topics that you might pursue in a fellowship:

  • Breast Surgical Oncology
  • Cancer Anesthesia
  • Cancer Rehabilitation
  • Gynecologic Oncology
  • Head and Neck Surgical Oncology
  • Leukemia
  • Lymphoma / Myeloma
  • Musculoskeletal Oncology
  • Neuro-Oncology
  • Oncologic Emergency Medicine
  • Onco-Nephrology
  • Urologic Oncology

 

  • Option 2: Partial Internal Medicine Residency (1 year) + Full Radiation Oncology Fellowship (4 years)

 

An increasingly popular option, which has become available more recently, is to spend your first year in a medical residency in a generalist subject–such as internal medicine, surgery, or a related field–before advancing to a four-year residency program in radiation oncology. One of the advantages of this option is that the total training time is only five years, and you can start practicing as an oncology specialist as soon as you finish, without completing a fellowship program beforehand. However, it is important to note that you’ll have to go through the NRMP residency matching process again after the first year of your residency, which can be challenging and time-consuming, especially considering the obligations you’ll have as a first-year resident in your generalist program.

 

What to Expect from Oncology Residency and Fellowship Programs

 

Although oncology residency and fellowship programs differ in their scheduling and organization, there are certain things you generally expect from the training. After having gained a foundation of knowledge in your full or partial internal medicine residency program, you’ll have the chance to focus more specifically on oncology care, including cancer mechanisms, diagnostic imaging, treatment planning, side effect management, recurrence prevention, and even healthcare policy, among other topics. In some programs, you may have the opportunity (or be required) to conduct either basic, translational, or clinical research. With most programs, by the time you finish, you’ll be ready to achieve subspecialty certification in Medical Oncology and/or Hematology through the American Board of Internal Medicine (ABIM).

 

Pre-Residency Planning for a Career in Oncology

 

Oncology residency and fellowship programs can be highly competitive, so as a foreign medical graduate, you need to be able to show residency programs that you are a strong candidate. One way to strengthen your candidacy is to complete a graduate externship in oncology before you try to get matched. Completing a program like this can help you show an application reviewer that you are truly committed to the specialty area, and it can give you something to talk about during your residency interviews. It will also allow you to make connections with attending physicians in the United States, who may be able to write letters of recommendation to support your application.

FMG Portal offers graduate externships for foreign medical graduates in a wide range of specialty areas, including oncology. Contact us today to learn more about our programs!

Foregoing an Observership in Favor of a Clinical Externship

As a foreign medical student, an observership in the United States might sound like a great idea. After all, an observational experience in a clinical setting might have been one of the things that initially inspired you to pursue a career in medicine. When you were in secondary school or completing your undergraduate studies, just spending a short period shadowing a physician may have really made a difference when determining your decision to pursue a medical course of study. However, the situation is much different after you’ve completed medical school. As a foreign medical graduate, you have dedicated years of your life to the study of medicine in the classroom and the clinic, so it is far less likely that you will truly gain from standing by and watching other physicians work. Therefore, if you’re looking for a US experience before applying to a US medical residency program, the best approach is to forego an observership in favor of a clinical externship. Read on for more information about why.

 

The Differences between an Observership and a Clinical Externship

 

The fundamental problem with observerships is that they are just what they sound like: the chance to observe another physician go about their daily routine. But as a foreign medical graduate, you’ve probably already spent a lot of time doing just that over the course of your education—and a few more months of doing so before you apply for a US medical residency program probably won’t make a big difference. Plus, if you try to write about an observership on your personal statement when you apply, it will be harder for you to argue that the familiar experience was truly meaningful–and the program official who is evaluating your application will be able to tell.

 

Moreover, the observership itself can be both frustrating and disappointing for a well-trained physician like yourself. Once you’ve been classified as an observer in a clinical setting–not as a true participant–it’s easy to get sidelined by other healthcare professionals. If observership is in a high-pressure specialty area like surgery or cardiology, it’s easy to get pushed aside by an attending physician who is (rightly) more concerned about the patient’s health than about making sure you have a good view of the procedure they are performing. As a result, there’s a high risk that you’ll end up missing out on any truly meaningful learning experience you might have had, since you’ll just feel obliged to get out of the way and let the attending physician and the other healthcare professionals do their jobs.

 

In contrast, if you enroll in a clinical externship program, you’ll always be in on the action. A clinical externship is a truly hands-on experience, which means that you’ll have real responsibilities from Day 1. Depending on the specialty area in which you are working, some of the tasks your attending physician may assign you include:

  • Presenting patients
  • Analyzing patient histories
  • Performing physical examinations
  • Assisting with complex procedures

Put simply, a clinical externship will truly give you a taste for what you would be doing if you chose to pursue a residency in the specialty area of the attending physician with whom you are working. Later in the medical residency application process, you will be able to draw on the experience when you write your personal statement, talk about your career goals during your interviews, and decide which programs from which specialty areas you want to include on your ROL.

 

Establishing a Strong Relationship with the Attending Physician

 

Over the course of your clinical externship, your attending physician will come to rely on you to complete the tasks discussed in the previous section. Not only can this increase your knowledge of the specialty and help you cement your decision to pursue a US medical residency program in the area, but it can also enable you to develop a strong professional relationship with your attending physician. They may be able to act as a mentor as you go through the US medical residency application and matching process, and they may agree to write you a strong letter of recommendation when you decide to apply. Since many US medical residency programs require or prefer foreign medical graduates to submit at least one letter of recommendation from a US physician, this relationship can play a major role in whether or not you get matched to the program of your choice.

 

When you’re just doing an observership–not a clinical externship–you won’t be working quite as closely with the attending physician, so there will be less of an opportunity for true mentorship. Also, because you were only observing clinical procedures (rather than directly participating in them), the attending physician won’t be able to speak to your technical abilities when they write you a letter of recommendation. That will make for a weaker reference that will be less convincing for the program officials who read it.

 

A Clinical Externship Through FMG Portal

FMG Portal recognizes the value of hands-on experience for aspiring US medical residents, so we don’t offer observerships–only hands-on clinical externships for foreign medical graduates and student electives for foreign medical students. Contact us today to learn more about our high-quality programs!

Making a Good Impression Online: Tips for Foreign Medical Graduates

As a foreign medical graduate applying for US medical residency programs, there are lots of factors that play into the determination of whether or not you end up matched. Obviously, your primary application materials–like your personal statement and letters of recommendation–play a huge role, as do your scores on the USMLE tests, especially Step 1 and Step 2. However, there are also less formal aspects of your candidacy that can play into the matching process, including your online presence.

 

These days, it’s simply standard practice for admissions officials at US medical residency programs to google a candidate before seeking a match. With so much information available online, most admissions admissions officials consider it wasteful–or even irresponsible–not to take a quick look at a candidate’s online presence. Therefore, as you prepare to apply for US medical residency programs, you should start thinking about how you appear on your social media and professional networking accounts. Read on for some tips that can help you make a good impression when admissions officials take a look at the available online information about you.

 

Embracing a Professional Social Media Presence

 

Deciding to apply for a US medical residency program doesn’t mean you have to delete all of your social media profiles and try to disappear completely from the internet. In fact, depending on your age and the country where you earned your medical degree, it might be surprising to program officials if they see that you don’t have an account on Facebook, Instagram, or another popular platform. Applying for a US medical residency just gives you the chance to review your accounts and make sure that you are presenting a professional social media presence. Here are the main things you should do:

 

  • Make your social media profiles private. One of the easiest ways to maintain the professionalism of your online presence is to set all of your social media accounts to “private.” For most social media platforms, it’s easy access your profile settings and make sure that only your friends can see your personal information and posts. Medical residency program officials will recognize this as a sign that you–like so many people around the world–enjoy the opportunity to connect with others on social media, but you’re responsible enough to limit your interactions to those with people you know.
  • Choose an appropriate public profile picture. On many social media websites, anyone can see your profile picture, even before you have approved them to view your full profile. Therefore, you may want to choose a profile picture that you would not mind a program official looking at. You do not need to go out and have a professional photo taken, but it is ideal to choose a photo that generally reflects well upon you–portraying you as the serious, thoughtful, motivated, passionate, hardworking person you are. Whether it’s a photo of you from in full robes at your medical school graduation or a candid shot of you hiking with your family in a scenic area, you want to choose profile photos that you think would be perceived positively by almost anyone.
  • Beef up your LinkedIn account. If you have an account on LinkedIn (or another popular professional networking website), make sure that the information on the account is accurate and up-to-date. If you don’t regularly use the account, there’s no need to spend hours trying to improve it. You just want to make sure that the information the account is consistent with the things you list on your CV and talk about in your personal statement. If you are an active user with an extensive amount of content on your account, you may want to set aside time to go through your whole profile and in order to check for discrepancies.  

 

Erasing Potential Red Flags

 

Even if your social media accounts are set to private, it’s still a good idea to get rid of any posts or photos that could raise red flags for program officials, since you never know when they might fall into the wrong hands. Take the time to untag yourself in photos from the craziest parties you attended, or get rid of the albums altogether. You may also want to delete any potentially offensive or inflammatory statements you might have made on Twitter or other platforms. There’s nothing wrong with putting up posts in support of political or social causes–in fact, truly passionate advocacy may be viewed favorably by program officials–but it’s usually best to get rid of anything that is downright rude, mean-spirited, or include any profanity. Also, if you have out-of-date accounts on platforms that you don’t use anymore, now is a great time to get rid of them.

The bottom line is, it’s not likely that your online profile will make or break your US medical residency application, but it’s never a bad idea to take every opportunity you can to make a good impression. For more tips on how you can present yourself as an excellent foreign medical residency candidate, contact FMG Portal today!