U.S. Medical Residency

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!

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!

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!

Polishing Your Personal Statement: The Editing Process

If you’re participating in the ERAS process, you’re probably spending part of your summer working on your personal statement, which is a key component of your application for a U.S. medical residency program. Over the course of the last few posts, we’ve been going over the major steps of the process: from the early stages of brainstorming, to the first draft, to the later revisions of your personal statement, there are lots of important things to keep in mind so that you can create a personal statement that will impress the application readers at your desired residency program. Once you are happy with the general content and overall organization of your personal statement, it is finally time to move on to the last step of the writing process — editing and polishing.

Steps within the Editing Process

When you submit your personal statement to a medical residency program, it is essential for the document to be free from errors in spelling, grammar, and punctuation. Even if you are telling a great story that shows your application reader exactly why you are an excellent candidate for their residency program, your reader can be easily turned off by a minor mistake. Mistakes can suggest sloppiness or a lack of true interest in the program — and you don’t want your reader to think either of those things! In order to ensure that the personal statement you submit is error-free, here are some key steps to take:

Run the spelling and grammar check in your word processing program. These tools are NOT comprehensive, so you should NOT rely solely on them to edit your paper…but they are still valuable tools that are readily available. You might as well use them.

Read the paper out loud. You might recognize this tip from the post about the revision process, but it can also help you as you edit your paper. When you read your personal statement out loud, it’s easier to catch minor wording errors, such as using “a” instead of “an,” because they just don’t sound right when you hear them. Reading your paper out loud can also help with the identification of grammatically incorrect sentence structures.

Print your paper out. Again, this tip applies to both the revision process and the editing process. Often, when you see the words directly on paper, errors in spelling and grammar are more likely to jump out at you.

Ask multiple friends to read your personal statement. At this point, you’ve been staring at your personal statement for days, weeks, or even months. People who have never read it before are much less likely to overlook spelling mistakes and grammatical errors. Also, it’s a good idea to get multiple perspectives on your personal statement. Sometimes, a sentence structure that makes sense to one person is confusing for another, so it can be helpful to have more than one person weigh in.

Ask an expert in American English to help you edit. If English is not your first language, it may be a good idea to have a native speaker look over your personal statement. Ideally, this person should be most familiar with American English, since you’re applying for a U.S. medical residency program. An American English expert might be able to detect subtle in grammar or diction that detract from the overall message of your paper, and they can help you tweak it so that it reads smoothly for an American application reader.

What To Watch Out For When Editing Your Personal Statement

When you edit your personal statement, or when you have a friend edit the document, it can be helpful to think about exactly what you are looking for before you start. That way, you’re more likely to notice the errors that exist in your personal statement. Here are a few of the things you should keep in mind:

Spelling. Misspelled words look bad in your personal statement. If you come across a word and you’re not sure of the correct spelling, consult a dictionary.

Punctuation. Does every sentence end with a period? Are the commas in the right places? If you used quotes or parentheses, did you make sure to close them? Are colons and semicolons used appropriately?

Grammar. Look for common mistakes, like errors in subject-verb agreement and the use of singular and plural nouns.

Capitalization. Make sure that names and other proper nouns are capitalized. All other nouns should not be capitalized.

Presentation. Although you may not be able to control the font size and style of your personal statement when you enter it into the ERAS system, make sure that the overall layout of the personal statement is visually appealing. Rather than having one long block of text, it should be divided into cohesive paragraphs that look good on the page.

By carefully editing your personal statement for problems in each of these areas, you can be sure to make the best possible impression on your residency application reader. As a result, you will maximize your odds of being accepted into your desired program!

For foreign medical graduates, landing a U.S. medical residency can be a challenge, but FMG Portal is here to help. Contact us today to find out more about the resources we offer!

Revising Your Personal Statement for a U.S. Medical Residency

If you are planning to apply for a U.S. medical residency in 2018, you’re probably already in the process of working on your personal statement. After successfully brainstorming and planning out your personal statement, you may have written your first, second, or even third draft by now. Once you feel like you have a solid draft in hand, you can move on to the next phase of the writing process: revising your personal statement.

Revising Your Personal Statement

Revising your personal statement means going back and reconsidering its overall content, organization, and flow. When you’re ready to revise your personal statement, take a look at our previous posts on what to do and what not to do when writing your personal statement. After ensuring that your personal statement meets those general guidelines, here are a few more things you can do to make the revision process as productive as possible.

Give it a day to rest. After you finish a draft of your personal statement, it can help to step away from the paper for a little while. Many writers get so wrapped up in writing that they start to miss obvious problems with organization and sentence fluency. Often, when you come back to your paper, the problems will immediately jump out at you, so they are far easier to fix. Plus, with so much of the summer remaining to work on your personal statement, you can afford to take your time!

Have a close friend or family member read it over. When you’re revising your personal statement, your main focus is on the overall content (not the grammar or punctuation — editing comes later), so it is best to have someone who knows you well read it over for the first time. Even your best friend isn’t a grammar whiz, they can tell you whether your voice and your story truly shine through, because those are the things that will stand out to your residency application reader!

Print it out. Many students no longer write anything by hand, but when you print out your personal statement, it can be easier to see how the changes you make fit into the paper as a whole. Also, when you cross things out on paper, they don’t get deleted on your computer — so you can add them back in later. If you do decide to revise your paper only on your computer, make sure that you save separate versions of each draft so that you can always recover the parts that you took out if you need to.

Read it out loud. Reading your personal statement out loud can help you quickly identify problems with flow. Your eyes might skim over a confusing sentence as you silently read over the document, but when you read it out loud, you have to consider every word and how they fit together. Also, reading your statement out loud can make you realize if you are starting every sentence the same way, which is a sign that you need to vary your sentence structure.

Imagine you are the application reader. Read over your personal statement as if you had never met yourself before. What questions would you have? Is there anything that does not make sense? Again, before performing this exercise, it can be helpful to step away from your personal statement for at least a few hours.

Have someone who is familiar with the U.S. medical residency application process read it. Whether it is an adviser at your medical school, an attending physician who was trained in the United States, or a friend who has already been matched to a U.S. medical residency program, it often helps to get advice from someone who has a general understanding of what application readers are looking for.

Seek advice from your letter writers. When you ask for letters of reference, some attending physicians ask for a draft of your personal statement. You should make sure that you hand them a copy that has already gone through multiple revisions (and has undergone enough editing that it is free of major errors in spelling and grammar) — but you can also ask them for any advice that they have on it. They may be able to help you tweak the content so that it does a better job of highlighting your character or emphasizing the quality of your clinical experience in your desired specialty area.

Keep revising. Even if you feel like the first draft of your statement is well done, remember that revision is more than a one-hour, one-day, or even one-week process. Leave ample time to create multiple drafts, try out different organizational structures, and add or remove content. That way, the content of your personal statement will be well-established when it comes time to move on to the next step in the writing process — editing. Stay tuned to the blog for advice on editing in a future post!

If you’re a foreign medical graduate and you’re thinking about applying for a U.S. medical residency, FMG offers lots of resources that can help you get matched. Contact us today for more information!

Residency Specialty Spotlight: Occupational and Environmental Medicine

If you want to focus your career on preventive medicine, a residency program in occupational and environmental medicine (OEM) could be right for you. This specialty area is unique because it is highly interdisciplinary. As a physician specializing in OEM, you will be trained to diagnose and treat work-related injuries and illnesses, so your education will include experience in both traditional medical care and public health.

Occupational and Environmental Medicine Residency Programs

Residency programs that train specialists in occupational and environmental medicine typically last for two years. They are designed specifically to train physicians in the competencies laid out by the ACGME for Residency Training in Preventive Medicine (Occupational Medicine specialty), as well as those defined by the American College of Occupational and Environmental Medicine. Specifically, OEM residency programs typically involve studies in:

Clinical practice of OEM
OEM-related laws and regulations
Environmental health
Disability management
Toxicology
Hazard identification, assessment, and management
Disaster management
Public health and disease prevention
Management and administration

Many programs also provide opportunities for academic research in OEM, and some programs even give residents the chance to earn a Master of Public Health (MPH) or Master of Occupational Health (MOH) degree in the first year. As a result, when you finish, you will not only have the skills needed to work in a clinic or hospital, but you will also be prepared to get a job in a corporate setting, work for a government agency, or serve as part of a legal or regulatory body.

Applying for an OEM Program as a Foreign Medical School Graduate

Because OEM combines studies in medicine and U.S. law, it is one of the less common choices for foreign medical graduates. However, if you are passionate about making a difference in the field of OEM, don’t hesitate to apply!

The most important thing to do on your residency application is to show that you are committed to a career in OEM. For instance, you can discuss previous work experiences or research that you have conducted in the field. It can be especially helpful to have completed a clinical externship in the occupational medicine, because it can demonstrate to your application reader that you have the knowledge and skills that are required for a U.S. residency in OEM. A clinical externship is also a great way to boost the quality of your CV, and you may be able to get a letter of reference from an attending physician in the United States, which is required for some programs.

FMG Portal offers clinical externships in many different specialty areas, including occupational medicine. Contact us today to get help with residency placement!

Drafting a Personal Statement for a Medical Residency Program

Earlier on the blog, we discussed the importance of brainstorming and planning out your personal statement. If you’re going to apply to a U.S. medical residency program in the fall, now is a great time to start writing your statement. From the first draft to the final copy, your personal statement will likely go through lots of revisions, so it is best to get started as soon as you can.

To recap the personal statement planning post, the content of your personal statement should highlight key aspects of your CV, explain why you have chosen your particular medical specialty area, outline your career goals, and demonstrate the personal qualities that make you a great candidate for a U.S. medical residency program. However, putting that down on paper in a convincing way can be a major challenge. Here are some tips to consider as you work on your draft:

Tell a story. Often, you can capture your reader’s attention by opening with a personal story or detailing a particularly meaningful experience that shaped your medical interests and career goals. Your personal statement can discuss experiences as recent as medical school courses and graduate externships, or it can reach as far back as your childhood — as long as your story is genuine and relevant to your decision to pursue a medical residency.

Think about your audience. The person reading your personal statement will also be reading hundreds of other applications, so you want to let your own voice shine through. That way, you can stand out from the rest. At the same time, you have to remember that the reader might not be familiar with some of the things you take for granted. Especially as a foreign medical graduate, you should make sure to explain anything that might be confusing — like differences in school systems — in order to clarify for your reader.

Pay attention to flow. On a similar note, you should make sure to organize your paper in a way that makes it easy for your reader to follow. You might organize it chronologically, or you could choose a cause-and-effect structure in which you show how various experiences directed you toward your goal of a U.S. medical residency. It all depends on the story you are trying to tell, but no matter what, your writing should flow easily from one idea to the next.

Keep it succinct. Many U.S. medical residency programs do not set out a word limit for your personal statement, but it’s usually best to keep it to 700 words or less. Remember that all of your academic and work experiences are already on your CV, so you only need to pick out the most important ones to talk about in your personal statement. That way, you can emphasize the most powerful information and avoid boring your reader.

Even if your first draft doesn’t come out perfectly, don’t worry! You still have lots of time to re-draft, revise, and edit until you have a personal statement that can truly impress the U.S. medical residency program of your dreams!

If you need help with the residency placement process, FMG Portal is here to help. Contact us today for more information!

Category: U.S. Medical Residency