Preparing for a U.S. Medical Residency Interview

Although many U.S. allopathic seniors have a chance to complete mock interviews at their medical schools, some foreign medical graduates may not be fully prepared for the interview process. Completing all the required medical exams and meeting the basic requirements for acceptance is an important first step. However, it does not guarantee admission. Candidates must also impress the interviewer. In this article, we’ll outline how foreign medical graduates can prepare themselves for a successful interview.

Review your own background

Interviewers often ask questions about a graduate’s past experiences. While many graduates can talk confidently about past experiences, reviewing them prior to the interview can be helpful. Perhaps you had forgotten about that volunteer experience you completed three years ago. Reviewing your background can bring more memories to the surface. Then you will be prepared when the interviewer asks a question about your experience.

Research your chosen specialty

At a U.S. medical residency, you will be interviewing for a particular specialty. Having extensive knowledge of this specialty is likely to impress the interviewer. To prepare, keep up to date on the latest developments in your selected specialty. You can subscribe to journals on the specialty or even just set up a Google Alert to send you notifications of new developments. Interviewers may ask your opinion on major issues facing the specialty and this research will help you provide a valuable response.

Research your chosen program

Interviewers will likely ask why you chose the specific school program. Knowledge about the program will help you develop a good answer. For example, the program may be ranked highly. This is a somewhat generic answer, however, and greater specificity will reveal how much you researched the program. A more specific answer would be because you want to work with a specific doctor who is an expert in a procedure that you would like to learn. The second answer, which demonstrates how much research you did, is more likely to impress an interviewer.

Matching with a U.S. medical residency requires more than a stellar resume and high scores on the ECFMG examinations. While the resume and exam scores will get you in the door, you will also have to impress the interviewers. Being knowledgeable about your own experience, your chosen specialty and the interviewing program itself is likely to impress interviewers. When it comes time for the medical residency to rank possible candidates for the match, you want them to rank you toward the top.

An Introduction to the ECFMG Certification Examination

Before foreign medical graduates can match with a U.S. residency program, they must receive certification from The Educational Commission for Foreign Medical Graduates (ECFMG). Receiving a certification demonstrates that a foreign medical graduate is ready to enter an ACGME (Accreditation Council for Graduate Medical Education) accredited residency program. To receive a certificate, foreign medical graduates must demonstrate that they completed their schooling and take Steps 1 and 2 of the United States Medical Licensing Examination (USMLE). Passing the exam is one of the most time-consuming parts of ECFMG certification because graduates must prepare, study and visit the U.S. for the clinical skills demonstration. The basic components of the exam are outlined below:

Step 1

This one day examination consists of multiple choice questions. Seven hours of testing are broken into 60 minute blocks. Graduates can expect to see up to 240 questions throughout the course of the day. This test focuses on systems and processes. Examples of commonly covered systems include the immune system, the renal and urinary system, the endocrine system and the respiratory system. 55-65% of the exam tests medical and scientific concepts. The processes section covers normal and abnormal processes, testing a graduate’s knowledge of patient care, diagnosis and management. The USMLE posts examples of the question formats to give graduates an idea of what to expect.

A USMLE Bulletin states:

Test items commonly require you to perform one or more of the following tasks: interpret graphic and tabular material, identify gross and microscopic pathologic and normal specimens, and apply basic science knowledge to clinical problems.

Step 2: Clinical Knowledge (CK)

This one day examination also consists of multiple choice questions, but it has 8 hours of testing broken into 60 minute blocks. Graduates can expect to see up to 318 questions through the course of the day. The testing focuses on similar topics as Step 1, but has a different focus. A USMLE bulletin explains how test items differ from Step 1.

Most Step 2 CK test items describe clinical situations and require that you provide one or more of the following: diagnosis, a prognosis, an indication of underlying mechanisms of disease, the next step in medical care, including preventive measures.

Although similar information is covered, Step 2 focuses on the disease categories and physician tasks, as opposed to the systems and processes covered in Step 1.

Step 2: Clinical Skills (CS)

This part of the examination consists of 12 patient encounters of 15 minutes each. Each patient encounter is conducted with an actor trained to portray real patient symptoms. Telephone patient encounters may also be included as part of the examination. Sub-components that are analyzed in this portion of the test include:

  • Integrated Clinical Encounter (ICE)
    • Includes data gathering and documentation skills assessment
  • Communication and Interpersonal Skills (CIS)
    • Includes an assessment of the graduate’s ability to create a supportive relationship with the patient
  • Spoken English Proficiency (SEP)

This is the portion of the test that typically requires foreign medical graduates to visit the United States.

Foreign medical graduates that intend to pursue ECFMG certification will have to pass all three portions of the exam listed. However, with the proper support, like clinical externships,  foreign medical graduates can pass the exams, interview with U.S. medical residencies and match with a residency.