Applicant’s Perspective

Warren Go, MD

Patricia Baile, MD

Michael Mendoza, MD

Agenda

Why prepare well for the Match2009 NRMP Match Outcome

The Journey AheadUSMLE and ECFMG CertificationERASInterview TrailNRMP (Match)

The YADP Program

“Time is against you. If you want to train here get everything done now. The only asset you have is being recent grads. Do not waste time with activities that won’t attract program director’s attention”

Aldo Dumlao, MD. Class 2002Utica, New York

The 2009 NRMP MatchThe 2009 NRMP Match There were 22, 427 PGY-1 positions in 2009 There were 36, 972 applications received by

NRMP in 2009- an increase of more than 1,016 compared to 2008

Why prepare well for Why prepare well for the Match?the Match?

Fill rate of 2009 is 95.4 Increase of US medical seniors applicants US IMGs and Non US IMGs registered the

largest increase among all applicant groups

Specialties with highest Specialties with highest matched rate among US matched rate among US medical Seniorsmedical Seniors

Internal MedicinePediatricsPreliminary MedicineEmergency MedicineAnesthesiologyFamily MedicineDiagnostic RadiologyOB-GynecologyTransitional YearSurgery (Categorical)

Specialties with highest Specialties with highest matched rate among US matched rate among US IMGsIMGs

Internal MedicineFamily MedicinePediatricsPsychiatryOB GyneEmergency MedicinePreliminary Medicine Preliminary Surgery

Specialties with highest Specialties with highest matched rate among Non-matched rate among Non-US IMGsUS IMGs

Internal MedicineFamily MedicinePediatricsSurgery PreliminaryPsychiatryNeurologyPreliminary Medicine

Competitive SpecialtiesCompetitive SpecialtiesDermatologyNeurological SurgeryOrthopaedic SurgeryOtolaryngologyRadiation Oncology

Successful applicants in the matchRank more programs within their preferred

specialtyMostly US seniorHave higher USMLE step 1 and Step 2 Scores

The Journey Ahead

Educational Commission for Educational Commission for Foreign Medical Graduates Foreign Medical Graduates (ECFMG)(ECFMG) The “Dean’s Office” of International

Medical Graduates (IMG) IMG

MD or equivalent degree from medical school outside the US or Canada

US citizens graduating from medical school outside US or Canada

Non-US citizen who graduated in any US medical school is not considered IMG

Standard ECFMG Certificate Required before starting ACGME accredited

Residency Program Not required for:

Applying for residency programs Participating for the NRMP (provided you passed Step1,

Step 2 CK and Step 2 CS)

ECFMG certification by September 1 (Advantage)

Requirements for ECFMG Certification Medical school and Graduation year listed in International

Medical Education Directory (IMED) Examination requirements:

Pass Step 1 Pass Step 2 Clinical Knowledge (CK) Step 2 Clinical Skills (CS)

Verified Medical Education Credential Requirements Final Medical Diploma Final Medical School Transcript

Standard ECFMG Certificate are sent approximately 2-6 weeks after all of the requirements have been met

I took USMLE step 1 after 2nd year. Step 2 ck during 3rd year. Step 2cs after 3rd year. Step 3 shortly after graduation. I recommend doing observership or clinical rotations in US. Getting US doctors to write letters of recommendation....... The key to getting a good residency is proper planning and formulating a timeline which you can follow.

Francis Ryan Tan Class of 2004Pittsburgh, Pennsylvania

The United States Medical Licensure Examination (USMLE)

USMLE Step 1 USMLE Step 2

Step 2 Clinical Knowledge (CK)Step 2 Clinical Skills (CS)

USMLE Step 3

USMLE TOPICS ITEMS BlocksMatched US

Applicant Score

STEP 1 Basic Sciences 336 Multiple Choice test items

7 blocks (60 mins/block)

225

STEP 2 Clinical Knowledge

Clinical Sciences

352 Multiple Choice Test items

8 blocks (60 mins./block)

231

STEP 2 Clinical Skills

ICE, CIS and SEP

12 Patient Encounters

15 mins. Patient encounter and 10 mins. Clinical note

Pass

STEP 3

Emergency Dept. Inpatient, Outpatient, Office

480 Multiple Choice test items, 9 Computer based Case Simulations

DAY 1: 7 blocksDAY 2: 4 blocks and 9 CCS case

Pass

Eligibility for Examination for Step 1, Step 2 CK and Step 2 CS

For Current Medical StudentsEnrolled in a medical school outside the United

States and Canada that is listed in IMEDCertification from Medical school indicating

current enrolment status. Completed at least 2 years of medical school.

For Medical School Graduates Graduate of medical school located outside US and

Canada listed in the IMED.Medical School must certify your status as a graduate

of the school.Medical credential verification Consider the postal/processing time lag for receipt of

application in ECFMG (least 3 weeks processing)

IMG Applicant ECFMG NBME Prometrics

CSEC

Decides to Take Step 1 and Step 2 CK Registration

Information

Issues Scheduling

Permit

Test Delivery Entity

Score Report for Step 1 and 2CK

Decides to take Step 2 CS US regional

CSEC Centers

Score Report for Step 2 CS

Program Entities for Registering and scheduling for USMLE step 1, Step 2 CK and CS

Eligibility Period for Step 1 and Step 2 CK Eligibility period

Three month period of your choiceLimited Seat availability in Prometrics Test

Center during peak seasons.Busiest testing times in the US/ Canada

○ May – July○ November - December

Eligibility and Scheduling for

Step 2 CS 12 Month Eligibility ONLY administered in the United States

Atlanta, Georgia Chicago, Illinois Houston, Texas Los Angeles, California Philadelphia, Pennsylvania

dates are available on a “first-come, first served basis. Availability is not guaranteed Peak time (Step 2 Calendar schedule)

May to July

Travel Status for CS IMGs are responsible for:

Travel and accommodation arrangementsTourist VISA

Upon request ECFMG provides Step 2 CS applicants with a letter that may assist for getting Visa

(NOT A GUARANTEE) If unable to get a US VISA- a full refund can be

requested.

Reporting of Scores

Step 1 and Step 2 CK3-4 weeks after your test date6-8 weeks if taken during “Peak time”

Step 2 CS Found on Schedule for reporting resultsTypically 6 weeks. Dependent on the volume of test takers

“peak time”

Sequence and Retaking Exams Steps can be taken in any order except Step 3 Are you prepared? Step 1 and Step 2 CK

You may retake more than four times in any 12 month period

Step 2 CSYou may retake more than three times in any 12

month period

Tips in Scheduling for Exams Application, registration and verification all online. FEDEX or other courier services for sending

documents . Scores = extent of preparation Don’t think one exam at a time when scheduling. Schedule with a goal of being ECFMG certified before

September 1 ONLY take exams when you are confident enough that

you will get a HIGH score.

Tips when studying Set a HIGH GOAL (99 why not?) Commit Choose one reviewer and master it. Practice, Practice, Practice – MCQs Take scheduled breaks Review Materials:

Step 1: First AID, Goljan Notes, Kaplan Materials, Crash the boards, USMLE World

Step 2 CK: Kaplan notes, Crash the boards and USMLE World Step 2 CS: First AID and Best friend to practice Step 3: Step 2 CK study materials and USMLE World

Self study vs. Review centers – Discipline? Pray hard

THE ERAS-INTERVIEW-NRMP CYCLE

US Graduate Medical Education for IMGs

Standard ECFMG Certificate. Certain specialties and programs vary in

their competitiveness. The directors of residency programs

decides on:Selection of applicants for interviewRanking the applicantWhether a contract is actually offered.

Research your specialty and Programs early on. Select a specialty

Selecting Programs within your specialty○ Location of individual programs○ Hospital affiliations○ Accreditation○ Performance of their graduates○ INSIDER (Connections!!!!)

FRIEDA Online ERAS Website Contact Programs via Email

Programs for Applying to Graduate Medical Education programs ECFMG (Secured Online program)

IMG’s designated Dean’s office Provides access to ERAS Website (Token) Applicant’s supporting documents (USMLE Transcript, ECFMG

Status report, LORs, etc.) and transmits them to ERAS

Electronic Residency Application Service, ERAS (Secured Online program) Applicant’s personalized website to contact, apply and transmit

“credentials” to program directors. Program Director’s website to screen, select, “filter” and

communicate with applicants. Generally, US programs accepts application through ERAS.

ERAS Documents Common Application Form (CAF)- “the resume” Personal Statement Medical Student Performance Evaluation (MSPE) Letter(s) of Recommendation (LoR) Medical School Transcript USMLE Transcript ECFMG Status Report Postgraduate Training Authorization Letter – “California

Letter) 2x2 Colored Photo

“Apply to many programs but concentrate on a few and make contact with them showing special interest. Research the programs prior to the interview. As I interview applicants especially IMGs they are too willing to admit that they apply to as many programs.....its a numbers game. That may be so but please never admit it.”

Todd M. Reiter, MD Class of 2004Richmond, Virginia

Getting interview invitationUSMLE scoresNumber of programs you applied in ERAS.Insider-NetworkOnce called for an interview- the playing field is

equal for all applicants

“Many Filipino applicants that I have encountered are very quiet and modest when they come in for their interviews...This does not help at all and can actually be a point against you...Do not be modest about your accomplishments”

Josefina Paderes, MD

The Interview Experience“TIPPING POINT” Could be the most stressful, frustrating, challenging

but enriching part of the cycle Realizations:

Resourcefulness How to travel and pack light Forced to “shed” the Filipino “humble/mahiyain” culture. Meet fellow applicants “Eye opener” how TRULY competitive

the match.

How you feel spending 3-4 years of life in the hospital.

National Resident Matching Program (NRMP)

An online program that runs the “match algorithm” process

Applicants submit online a list of residency programs he/she has interviewed with in order of preference.

Program directors also submit a list of applicants “they prefer” for their programs –rank order lists

Program directors usually rank only applicants they have Interviewed.

There is no guarantee that the programs to which you have applied will interview you or include you on their rank order lists.

If you are ranked by programs, there is no guarantee that you will be matched to any of these programs.

TIP: rank only the programs you like and willing to attend.

FINANCIAL ASPECT of ENTERING

A US RESIDENCY PROGRAM

EXAM PREPARATION COST

Step 1 3 months $ 710 (+130)

Step 2 CK 2 months $ 710 (+145)

Step 2 CS 1 month $ 1,200

*Step 3 2 months $ 690

FIXED EXPENSES USMLE Steps 1-3: $ 3,585 ERAS Registration: $40 Application for Programs :

1st 10 programs: $6011 – 20: $8 each21 – 30: $15 each31 onwards: $ 25 each

NRMP Registration: $40

VARIABLE EXPENSES

• Travel: $ 1,200 (MLA-USA-MLA)

• Interview: variable• *Rent: $ 1,000 / month• Living expenses: $600/mo

• Estimated Total Cost: 6000-10,000 USD– Estimate based on 6 month stay in US

The road to your residency begins now! STUDY VERY VERY HARD and get HIGH SCORES in

USMLE Steps Start building your CVs-Document it. Start writing down “memorable” clinical encounters. Involve yourself in Clinical research, publication

opportunities. Moonlighting vs Concentrating on USMLEs Start networking Research your specialty and Programs Get Medical volunteer experiences local or US Pray and Work hard

Young Alumni Development Program (YADP)

Goals and Objectives

Facilitate Transition to US health Care system Mentor to UERMMMC Medical School graduates

pursuing careers in Medicine in the US. Provide Career advancement in Medicine in the

US Provide network of mentors in medicine Establish a committee involving mentors, Dean

and other faculty members of UERMMMC College of medicine, members of UERMMMC-MAAAA, Inc. And the UERMMARVADC Chapter

Eligibility Criteria for YADP

Graduate of UERMMMC who are seeking residency or fellowship training in the US.

Must have passed USMLE Step 1 or Step 2. Must be responsible for obtaining appropriate

VISA, living expenses, accommodation and health needs.

“So in closing, make good use of your time - even if you do not get in this cycle. Look for ways to enhance not only your experience but most importantly your academic track record - that is well documented and verifiable. A few abstracts or one peer reviewed publication (does not need to be 1st author) will surely beat one dozen observerships in some obscure clinic that carry no or very little academic impact or pedigree”Don't lose hope, continue to aim high but remain realistic - and best of luck!!

Romergryko G. Geocadin, MD, Class 91Director, Neurosciences Critical Care Division

Johns Hopkins Medical Institutions

Get more Information ECFMG (www.ecfmg.org) Fellowship and Residency Electronic Interactive Database

(FRIEDA) – www.ama-assn.org/ama/pub/category/9306.html ERAS (www.aamc.org/eras) NRMP (www.nrmp.org) USMLE (www.usmle.org) Prometrics (www.prometrics. Com) YADP yahoo groups SDN USMLEtoMD Prep for USMLE Iserson, KV. Iserson’s Getting into a residency: A guide for

Medical Students, 6th Edition www.uermmarvadc.org