Congrats, you have matched! At this point, the euphoria of matching might be wearing off as you begin to receive zillions of emails and packets from your respective programs. You have probably already discovered that you are going to need to gather a ton of paperwork before you head across the pond to your U.S. residency. I would like to discuss one of the documents you will need – the ECFMG (Educational Commission for Foreign Medical Graduates) certificate.
By Sarah Wesley
Recently, a number of sources have raised the concern that match statistics were worse for IMGs this year, including particular alarmism about the few Family Med and Pediatric spots that went to IMGs and DOs. In particular, these sources have caused a great deal of angst as people have conjectured that this year’s primary care stats may reflect a general trend for the future involving all types of residency programs. I wish to address the error of reading into isolated statistics, with the hope that my viewpoint will ease the minds of international medical school graduates minds and encourage them to continue applying to residencies in the US.
Once you have endured the hassle of arranging a sub-internship, buying plane tickets, and obtaining housing, traveler’s insurance, the works, you may find yourself having a moment of panic as you realize that the only thing you know about the workings of American hospitals is what you garnered from watching Greys Anatomy, ER, and Scrubs.
Before you begin to hyperventilate and perhaps even syncopize, take a deep breath and be assured that this is the plight of the majority of international medical students who find themselves attempting to navigate a foreign medical system. This article is meant to preempt some of your questions, the same questions I had, and to provide tips to ease the transition.
Among English-speaking graduates, the Step 2 Clinical Skills exam generally produces the least amount of study angst. As long as you can take a decent history, communicate effectively, exhibit empathy, and come up with a reasonable differential diagnosis and plan, you will pass. There is no numerical score, and the exam consists of only twelve patient stations with actors. The tasks of communication and note writing under pressure can be more daunting when you are dealing with a language barrier or/and an unfamiliar system of notation for writing your assessment.
You’ve made it….you have passed your med school classes, aced your USMLEs and sub-internships, received amazing recommendations, bought expensive plane tickets, and now you are sitting in front of the program director and are being asked a question that is very simple in nature but that is also really simple to mess up. Here are two common IMG-specific questions and some short tips on approaches to your thinking when answering these and others.
The sub-internship (sub-I) is a 3-4 week period during which final-year medical students work as unpaid interns, often with a much lighter patient load but with all the responsibilities and tasks of an intern. Many competitive residency institutions require that IMG applicant have completed a minimum of 1-2 sub-Is in the U.S. in order to be considered for a spot. Some applicants will have the finances and time to complete many more than the required number of sub-Is, and you should specifically research the requirements on the websites of the programs and specialties you are interested in.
Of the three USMLEs, the Step 1 is perhaps the most intimidating. The Step 1 exam requires a revisiting of basic anatomy, physiology, embryology, pharmacology, and biochemistry. For a medical student attending an institution where the majority of others are not taking the Steps, it can be difficult to juggle your home institution’s exams with the USMLE tests. Moreover, for an IMG who is already out of medical school and working, it can be difficult to find the time to relearn everything. Here are a few tips for success: