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. 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. 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. 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. 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. 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. 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!

The Value of Mentorship for Foreign Medical Graduates

Once you have earned your medical degree, you might not be sure if you really need another mentor in your life. After all, throughout your academic career and early professional experiences, you’ve probably already had countless mentors–from your kindergarten teacher to your high school sports coach to your favorite college professor to the dean of your medical school. However, as a foreign medical graduate looking to get matched to a US medical residency program, you can still benefit from the mentorship of an attending physician in a graduate externship experience. Here are a few of the top reasons why:

A mentor can familiarize you with their particular specialty area.

When you apply for a US medical residency program, you need to be ready to show the program that you are truly committed to the specialty area that you have selected. A mentor can offer insight on specialty (and subspecialty) areas that goes far deeper than what you experienced during your rotations in medical school. As a result, when it comes time for you to apply, you’ll have a better sense of what you do (and don’t) want from your medical career. For instance, a mentor may have done a residency in internal medicine before choosing a more specific subspecialty for their fellowship, like infectious disease, and they can help you learn about both–and decide which one is right for you, or whether you want to pursue something else altogether.

A mentor can help you with professional networking.

If you decide you want to pursue the same specialty or subspecialty as your mentor, they can help connect you with top clinicians and researchers in the field. Alternatively, if you want to go in a different direction, a mentor may already have a broad network that can help you access the resources you need.

A mentor can help you get “back in the game” if you have taken time off after medical school.

More than ever, foreign medical graduates are choosing to take time off to work or start a family before shooting for a US medical residency. As a result, it can sometimes be challenging to jump straight back into a clinical setting. The guidance of a mentor in a graduate externship program can help smooth the transition, so you’ll be well-prepared and ready to go when you finally get matched to a US medical residency program.

A mentor can help you understand what it means to be a true medical professional.

You might not realize it, but when it comes to professionalism, there are important differences between being a medical student and being a practicing physician. Once you’re a medical resident, you’ll have more responsibilities, which means you’ll be held to higher standards of conduct. Before you start your US medical residency program, you need to be ready for the change, and a mentor can help you rise to the challenge by modeling professional behavior and offering their honest perspective on what it means to be a professional physician. This guidance can help you smoothly make the professional transition from medical student to medical resident.

A mentor can help you get a better idea of what your life outside of work would be like as a physician in their specialty area.

Your relationship with a mentor during your graduate externship is fundamentally a professional one, but that doesn’t mean you won’t have conversations about everyday life. In fact, a mentor can be a great source of information about what day-to-day life looks like for a professional in their specialty area. For instance, they may be able to help you understand how they make time in their schedule for family and/or recreational activities. A mentor may also be able to offer insight on lifestyle opportunities in particular regions of the United States, which can be helpful if you’re not familiar with the different parts of the country.

A mentor can be a valuable asset in the residency application and matching process.

Today’s US medical residency application process is increasingly competitive, so you need to be ready to capitalize on your strengths and compensate for your weaknesses. After spending months working with you during a graduate externship, a mentor can often offer you frank advice on the strengths you should highlight in your application and the areas you should try to improve on in the future. Depending on your relationship, a mentor may also be able to advise you on program selection, help edit your personal statement, and/or write you a letter of recommendation, all of which can be invaluable as you try to land the residency of your dreams!

FMG Portal offers graduate externships around the country for foreign medical graduates who want to get matched to a US medical residency program. We also provide assistance throughout the application and matching process. Contact us today for more information about all of the services we offer!

Questions to Expect in Your US Medical Residency Interview: A Guide for Foreign Medical Graduates

When it comes to your interview for a US medical residency program, it’s important to be prepared. Not only do you want to have a good idea of what to expect in terms of the interview day schedule–as we discussed in the previous post–but it can also be helpful to know what might be coming when you go into the formal interviews themselves. Although the specific interview questions can vary between programs (and between individual interviewers within a single program), there are certain questions that you’re probably going to be asked. Read on for a list of the most common questions and some ideas on how you might approach them in your US medical residency interview.

Common Interview Questions for Foreign Medical Graduates

As a foreign medical graduate, here are a few of the US medical residency interview questions that you are most likely to be asked:

Can you tell me a little bit about yourself?

This is the standard opening question for a US medical residency interview, and it can help set the stage for your whole conversation. When you’re responding, your goal is to be informative, but succinct. You should provide a brief personal and educational background (where you grew up and went to medical school), as well as a short description of how you got interested in medicine, but you don’t need to go into too much detail. After, all, you don’t want to start giving answers to questions that might be asked later in the interview and end up repeating yourself.

Why do you want to do your medical residency in the United States?

This is a question that only foreign medical graduates get asked, and your answer can help you stand out from the other candidates. Your interviewer will probably be genuinely interested in what brought you to this decision, so you should be ready for it.When faced with this question, it is important to be honest because there is no “right” answer. The most important thing is to offer a thoughtful, well-reasoned response that tells the interviewer a little more about you and your goals. If possible, try to tell an illustrative story that highlights the factors that played into your decision. .

What do you envision yourself doing after completing your residency?

As you answer this question, it is especially important to remember to avoid a “canned” response: make sure you aren’t just listing the professional goals from your personal statement. The interview gives you the opportunity to expand on what you wrote and offer a more personal perspective. Whether you dream of advancing your career in the United States or hope to eventually return to the country where you completed medical school (or another country altogether), you want to show your interviewer that you have clear goals and a high level of motivation to achieve them.

Why are you interested in this particular specialty area?

With this question, you have two objectives: to show that you are well-informed about your chosen specialty area and to demonstrate your genuine passion for the field. It offers an excellent opportunity to expand on some of the specialty-related experiences that you listed on your CV, such as student electives and graduate externships. In the interview, you have the chance to explain to your interviewer how meaningful these experiences were to you personally and how they shaped your professional goals for the future.

What is your favorite book/movie/TV show?

When you get a question like this, you might feel pressured to reference an American show that you think your interviewer has heard of–and if that’s the truth, no problem. However, if you love an obscure TV show that only airs in your home country, don’t be afraid to talk about it! With these types of questions, interviewers are looking to hear about your interests outside of your academic and professional life, so your sincerity is more important than the specific book/movie/TV show you choose. Plus, your interest in foreign media could help demonstrate a way in which you could contribute diversity to the program!

Getting Ready for Your Interview

As you prepare for your interview, you may want to do a trial-run with a friend or colleague, and they can ask you some of the questions listed above. However, as you practice, you want to make sure that your answers don’t sound scripted. Even if you’re expecting one of these common questions, you still want your real interview to be a conversation, not a performance. This is especially important for foreign medical graduates from non-English-speaking countries, since interviewers may be evaluating your language skills, and you don’t want your interviewer to think you simply memorized a well-written speech. Therefore, remember to engage with your interviewer and be genuine with your responses–don’t just recite what you planned out in advance.

FMG Portal is here to help foreign medical graduates at every step of the US medical residency application and preparation process. Contact us today for more information!

The Residency Interview Days: Making the Most of Each Event

The interview process for a US medical residency program offers a variety of valuable opportunities for foreign medical graduates who are hoping to match in the spring. Not only do interviews allow you to show why you are a good fit for the program, but they also give you the chance to learn more about different programs and decide how you might rank your options on your ROL in the winter. Usually, the interview process lasts for one or two days, and every event on the itinerary counts. In order to make the most of these these events, it can be helpful to know what to expect. Read on to learn more about the structure of the interview days and how you can make the most of each event.

Interview Day Events to Expect

Every residency program has a unique itinerary for its interview day(s), but there are some general similarities that you can count on. As a candidate, knowing what to expect from each event–and how you can get the most out of it–can help you successfully navigate the interview day(s):

Orientation / welcome presentation. The official start to most interview days is a welcome presentation by an administrative leader, during which you and the other hopeful candidates are given an overview of the program. You’ll typically hear about the daily expectations for residents, the educational structure of the program, and any research opportunities that may be offered. The presentation also usually covers logistical details related to salary, benefits, services, and lifestyle (like housing and transportation). It can be helpful to take notes during this session, but most of the information will probably be available in information packets provided by the program. Instead of frantically trying to copy every word, keep a pen handy to jot down the side notes and anecdotes that you won’t be able to find in the official paperwork.

Formal interviews. Of course, the formal interviews are at the heart of the interview days. Depending on the program, you might find yourself interviewing with faculty members, current residents, or both. The number of interviews also varies between programs, but you can typically expect anywhere from two to six formal interviews. As we discussed in an earlier post, there are key do’s and don’ts that can help you through the interview. As you prepare, you may also want to set up a practice run with friends, colleagues, mentors, or other candidates from your medical school.

Tour of the facility. The extent and scope of the tour can vary significantly depending on the size of the facility, but it always gives you the chance to get a feel for the general atmosphere of the institution and the surrounding area. It can be challenging to take notes as you walk during the tour, and you probably won’t notice as much if you’re focused on your notebook. Instead, focus on observing observing your surroundings and write down what you remember later.

Informal meals and social events. Often, aspiring residents will have the chance to sit down to an informal meal with current residents and/or staff. It could be a breakfast in the hospital cafeteria, dinner at a nearby restaurant, or even drinks after all the interviews are complete. These events can be fun, but you should also remember that they are still part of the interview process, so you don’t want to make a poor impression. Instead, try to get to know the residents and staff, find out what it’s like to live in the area, and take the chance to ask about informal topics like apartment options and nearby recreational opportunities.

Opportunities for resident shadowing. Although not included on the itinerary for all US medical residency programs, there are some programs that give you the chance to shadow residents during rounds or resident reports. This can help you get an idea of the workplace atmosphere and the daily life of residents in the facility. However, if you’re considering several different specialty areas when you are constructing your ROLs later in the winter, it’s important to remember that a few hours of shadowing may not provide enough information for you to develop a comprehensive understanding of the differences between specialites. For that, you may want to consider a longer graduate externship program. On the interview days, you should focus on the atmosphere in the facility and the general experiences of the residents so you can decide if it is the kind of place where you would enjoy working.

Exit interviews or closing presentation. Formal exit interviews are less common, but there are some programs where you will briefly meet with an administrative official before the conclusion of the interview days. There are also programs where a one-on-one exit interview is replaced by a general closing presentation from a hospital administrator. Either way, this closing event isn’t the time to try to cram in details about your previous experiences or plans for the future. Rather, an exit interview or closing event gives you the chance to make one final, positive impression–so remember to be friendly, indicate your sincere interest in the program, and smile!

If you’re a foreign medical graduate looking to get matched to a US medical residency program, FMG Portal is here to help you at every step of the process. Contact us today to learn more about everything we offer!

Preparing Your Rank Order List: Do’s and Don’ts for Foreign Medical Graduates

Now that you’ve finished your initial application, completed your interviews, and finalized your registration for the 2018 Match, there is only one thing left to do: prepare your Rank Order List (ROL). Earlier on the blog, we talked about the basics of ROLs — what they are, how they work, and what foreign medical graduates need to know from the start. Today, we were going to go further in-depth and talk about some of the Do’s and Don’ts for creating an ROL. That way, when the Rank Order List Entry opens on January 15, 2018 (mark your calendar!), you will have the tools you need for success.

DO’s for Creating Your Rank Order List (ROL)

When it comes to creating your rank order list, there are key things that you should make sure to do.

DO rank programs in the order of your true preference. The ROL is the place where you get to tell the NRMP where you want to train. After spending months or even years scoping out programs and trying to get a feel for the different training options, this is your opportunity to let the NRMP know which programs you think will best support both your personal and professional goals. Even if you worry that a particular program might be a “reach” for you, you should rank it at the top if it is the place where you would most like to complete your training!

DO include a both competitive and less-competitive schools on your ROL. While you should definitely rank your preferred programs at the top — even if they are highly competitive — you should also try to include programs with less competitive profiles on your list. That way, if you don’t end up getting matched to some of the more competitive programs, you won’t run the risk of not getting matched at all.

DO remember to certify your ROL before the deadline. In order for the match algorithm to process your ROL, it needs to be certified within the R3 system by 9:00 pm Eastern Standard time on February 21, 2018. Also, you should note that the R3 system is notorious for running slowly in the last few days before the deadline, so if you have your ROL ready in advance, DO upload it early.

DO remember that you can change ROLs that have already been certified. If you decide to upload your ROL early, you still have the chance to change your mind before the February 21 deadline — as long as you remember to recertify your ROL. The Match algorithm will only process the last certified ROL.

DON’Ts for Creating Your Rank Order List (ROL)

Preparing your rank order list might seem simple enough, but don’t be fooled! There are a variety of pitfalls that you can easily fall into if you’re not careful. Here are a few major DON’Ts for foreign medical graduates who are preparing their ROLs:

DON’T rank programs where you aren’t interested in training. When creating your ROL, you may be tempted to rank all the programs where you interviewed, and that’s a great plan if you feel comfortable training in any of the programs. However, if you have misgivings about a program and are only including it because you feel desperate to get matched, you might want to think twice about adding it to your ROL. When you certify your ROL, you make a binding commitment to train at any program where you get matched, so you should only rank programs where you would feel satisfied about (and celebrate!) a match.

DON’T include programs where you did not interview. As you already know, the Match is a computer algorithm. It won’t recognize any programs where you did not interview as options for a match. Therefore, it’s not worth the time to include any of these programs on your ROL.

DON’T wait until the deadline to enter your ROL into the system. Creating an ROL requires more than just writing down a list of programs — the R3 system can initially be confusing, so you should give yourself enough time to figure it out. Also, the NRMP warns that its servers tend to get overloaded in the last few days before the deadline, so it’s a good idea to give yourself extra time to make sure that you won’t have to worry about unexpected technological glitches.

DON’T forget to save your ROL after making changes. When you add a new program to your list or change the order in the R3 system, you have to click the “save” button before you leave the system if you want to return to your ROL the way you left it. It is important to note that saving an ROL is different from certifying it. Saving your ROL allows you to develop and change your ROL as the deadline approaches, but it is only finalized and ready for processing by the match algorithm when you certify it.

DON’T try to import an ROL on a mobile device. These days, you can use your smartphone or tablet for just about everything. Unfortunately, that doesn’t include every part of the residency matching process. In order to import an ROL in the R3 system, you need to be using a traditional laptop or desktop computer.

Whether you’re anticipating the last few months of the 2018 NRMP Match, gearing up for the 2019 Match, or looking ahead to future years, FMG Portal is here to help you every step of the way. Contact us today for more information!

Considering Advanced Studies in Interventional or Metabolic Cardiology

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

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

Introduction to Interventional Cardiology

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

Introduction to Metabolic Cardiology

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

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

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

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

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

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

Reasons to Pursue Graduate Externships in Interventional and Metabolic Cardiology

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

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

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

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