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Imgdocco said:
Hi guys,
I want to apply for next years match and need your help determining the significance of a single failed exam (pre-clinical 1 failed attempt, successful remediation, but delay of 6-8 months in total academic time). A short run through of the profile:
Non-US IMG (visa required)
YOG 2020
Step 1: 250+
Step 2: 255+
3 PUBMED indexed research publications (co-author)
2 months of electives, 3 months of observerships. (specialty specific)
I know this probably doesn't matter as much, but following the failure (again, 1 subject, failed by 1.5%, successfully remediated on second attempt. Subject was Pre-Clinical) there were no more failures in ANY subject, with an immediate rise of over 15% over-all raw percentage evidenced on transcripts. Its bothering me that this delay will come up on the MSPE, and I want to figure out, through your opinions, just how screwed I really am. Not that screwed? Dead in the water as a non-US IMG hoping for anesthesiology? Please help me out!
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what have you been doing in the off-year? Aside from mediation of 1 subject
 
I speak based on my experiences as a foreign student who went to an American medical school. I think your stats and scores are competitive, but understand that it is much more difficult as a foreign graduate applying than American grads. Anesthesiology overall is not super competitive, I don't know why you have been unable to match. Did you do rotations in thr USA and have good LORs? Did you apply broadly enough? Are you geographically limited in your application? Are you going for the easier to obtain J1 visa (vs H1b)? Are there any other aspects of your application that might raise red flags?
 
Imgdocco said:
Oh, I'm sorry for not clarifying. I haven't as yet sat for a match because I was hoping to accumulate more USCE (I only have 2 months of it, and 1 US LOR) and hopefully give and pass step 3 as well to show that I'm not a liability that'll fail boards when the time comes because of that one pre-clinical failure on my record. When I do apply, I have a list of 127 or so programs (basically anyone who would offer a J1, H1, or either/both) that I will be applying to and I have no geographical preference, but do have H1 preference. I don't think there are any other components of my profile to raise a red flag because I made sure to change my study habits and got into the top 10% of my class consistently thereafter. I guess I'm more so just worried that as a non-US IMG, the journey is already hard enough as it is, especially for something like Anesthesiology, so I'm trying to strategize both my approach to the failure in my application and interview, and also plan out how much back-up I need to be applying to in-case that one failure has somehow sunk me. Sorry if this sounds overly neurotic.
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I think you have a good chance for success here by applying broadly. I would concentrate on middle of pack programs, have a few lower tier ones, and a few higher tier "reach" ones. Programs will almost certainly ask about reason for remediation and taking an extra year so be prepared for those questions on the interview. There will be scrutiny... Its not difficult to score highly on board exams when you have lots of extra time to study for them. Programs in less desirable places may also ask why you are applying there. If you are not white, I urge you to review the geographic area of the program and take that into consideration. Violent crime is pervasive in certain inner city areas. Also racism is deeply rooted in American culture and certain states might not be a good fit. J1 is definitely much easier to get, the H1b visa is expensive and not many programs sponsor them.
 
Imgdocco said:
Thank you for your response, I appreciate you addressing the issues I didn't even think of yet. I will probably be placing IMG heavy locations highly after a couple of reach programs, but I'm pretty willing to go anywhere. Do you think stating the H1 preference would be a bad idea even if I follow up with saying I'll be willing to take the J1 too if it came to that? My reasons for the remediation are pretty much too much workload and a death in the family just prior to the first examination, and I'm hoping the PD's would be able to see that I dont intend to use it as an excuse or a crutch by looking at my performance after the failure. I'll be applying about 2.25-2.40 years after graduation, depending on if they count till application or till joining the program. Would that be seen as a red flag as well? Even if I did volunteering+research+some clinical work at the time?
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Explain why you are out and what you did during that time. Just don't make it seem you wasted your time. Keep up with your medical school knowledge base.

Many middle tier IMG heavy programs only sponsor J1. Think about it from their perspective. If they have loads of IMGs applying to their program happy to take J1, what incentive do they have to pay thousands of dollars, extra resources and time to sponsor an H1b for you? Applying for an H1b especially when the program hasn't sponsored many before and not familiar with the process, can be fraught with hiccups and delays. In my opinion, you will have a better chance getting H1b with top tier programs that want the best applicants, have done it plenty of times before, and are willing to pay for it.

Do more research and figure out the best strategy for you. Not bad to think about H1b but know it is tough for a foreign national IMG. Be OK with J1 with a waiver after. Waiver doesn't mean going to middle of nowhere. Lots of places are undeserved including some bigger cities.
 
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