A lot of questions!

[IsisI]

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Please help me decide the best plan out of these two and also help me correct them (timeline, time period scheduled, etc.)

I'm an IMG who passed out with a very average score and I'm planning to start reading for USMLE properly in a couple of days.

Plan 1:
Nov 11 - May 15 : Step 1 Prep (6 months)
May 16 : Step 1 Exam
May 17 - Oct 16 : Step 2 CK Prep (5 months)
Oct 17 : Step 2 CK Exam & Visa Application
Oct End : Apply for ECFMG Certification
Dec - Feb : USCE (Externship) for LOR
Mar - May : Step 2 CS & Step 3 Prep + Exams
Jun - Aug : USCE (Externship) for LOR
Sep - Jan : Interviews
Mar '14 : Match

Plan 2:
Nov 9 - May 15 : Step 1 Prep (6 months)
May 16 : Step 1 Exam
May 17 - Oct 16 : Step 2 CK Prep (5 months)
Oct 17 : Step 2 CK Exam & Visa Application
Nov End : Step 2 CS
Dec - Feb : USCE (Externship) for LOR
Mar - May : Step 3 Prep + Exams
Jun - Aug : USCE (Externship) for LOR
Sep - Jan : Interviews
Mar '14 : Match

Basically, my main question is: Is it better to take Step 2 CS one month after CK when the theory knowledge is fresh in your memory OR is it better to take it after a few months of externship/observership even though it would be 4-5 months after you have read for CK? (Question 1)

Secondly, is the time period I have scheduled for each step enough given that I was a pretty average student in college and hardly remember any of my pre-clinical basics now? (Question 2)

Thirdly, is my schedule good enough for backups in case of mishaps like a Visa rejection or a CS failure (God forbid) and also for the normal time it takes time for things to happen, like results, ecfmg certification, etc.? (Question 3)

Fourthly, once I have scheduled the 1, CK and CS, what is the maximum time can I postpone the dates for each? I mean, how many months can I postpone the step 1, ck and cs dates MAXIMUM and how many TIMES can I postpone each of them? (Question 4)

Fifthly(!), I started my undergrad in 2004 and completed my final year exam in 2009, and intern year in 2010. Which of the two is my actual graduation year? (Question 5)

And, finally, is it ok to get ACLS & PALS certification done in my home country or online OR is it better to do it in US in between one of the externships? (Question 6)

Thanks!

 

[Prop]

I'm not going to answer all of your question, but with regards to Plan 1 that is NOT doable. You need to pass Step 2CS in order to get ECFMG certification, and you need ECFMG certification in order to apply for step 3.

I would recommend taking step 2CS soon after step 2CK, with all the knowledge fresh in your brain (I took step 2CS 10 days after step 2CK, and it worked out great).

I hope someone else will answer your other questions

 

[kingkenny]

Your Year of graduation(YOG) will be the year you finished your internship. One thing about your plan is that there is a huge gap between your YOG and the year you want to match. This in itself is a red flag in your application.

 

[IsisI]

I would recommend taking step 2CS soon after step 2CK, with all the knowledge fresh in your brain (I took step 2CS 10 days after step 2CK, and it worked out great).

Thanks mate. Plan 2 it is then. Question 1 solved.

Your Year of graduation(YOG) will be the year you finished your internship. One thing about your plan is that there is a huge gap between your YOG and the year you want to match. This in itself is a red flag in your application.

Question 5 solved. Thanks for that! Well, I can explain. My intern year finished in September 2010 and from October 2010 to September 2012, I will have to work (mandatory two years) at a rural center here. Since I'm completing this obligation only by September 2012, I cannot complete my exams and get all paperwork done by the time application needs to be submitted for 2013 match.

I have the appointment letter for Oct '10 to Sep '12 which I plan to attach to my personal statement. Wouldn't the PDs empathize? Especially since I would not have lost touch with medical work (between my two years rural service and the two externships) even though I had graduated 3 years back.

 

[Winged Scapula]

As a medical school grad, you are ineligible for true USCE. Only observerships are available to you.

 

[NotAProgDirector]

Basically, my main question is: Is it better to take Step 2 CS one month after CK when the theory knowledge is fresh in your memory OR is it better to take it after a few months of externship/observership even though it would be 4-5 months after you have read for CK? (Question 1)

Since CS tests more "practical" skills (like how to take a history) it would seem much better to gain some US experience first. Many IMG's that fail CS do so because they don't know our system. CS doesn't only test your ability to make a diagnosis, it really focuses on how you act, interact with patients, etc.

Secondly, is the time period I have scheduled for each step enough given that I was a pretty average student in college and hardly remember any of my pre-clinical basics now? (Question 2)

3-6 months seems resonable, although this depends on what else you're doing at the time. If you're also trying to work 2 jobs, perhaps not so good.

Thirdly, is my schedule good enough for backups in case of mishaps like a Visa rejection or a CS failure (God forbid) and also for the normal time it takes time for things to happen, like results, ecfmg certification, etc.? (Question 3)

This is a somewhat pointless question. A "Visa problem" will screw up your timeline for months to years, so no timeline will work. Getting yourself off of the terrorist watch list or some other visa problem will not be easy to fix. Equally, failing a step is likely to bring your whole dream of working in the US to a halt. You will find it much more difficult, and perhaps impossible, to get a spot. So, I would not worry about these issues, since if they happen, you'll need to reconsider this whole plan.

Fourthly, once I have scheduled the 1, CK and CS, what is the maximum time can I postpone the dates for each? I mean, how many months can I postpone the step 1, ck and cs dates MAXIMUM and how many TIMES can I postpone each of them? (Question 4)

In the US, when you sign up for Step 1/2CK/2CS you get a three month eligibility period. You can rebook / reschedule the exam as many times within that three month period as you want, limited by what slots are open. I bvelieve you can request a 3 month extension for a fee. If you don't take it within those 6 months, you lose your fees and you have to start over. Note that the rules for taking the exam outside the US might be different.

Fifthly(!), I started my undergrad in 2004 and completed my final year exam in 2009, and intern year in 2010. Which of the two is my actual graduation year? (Question 5)

I'd say that your year of graduation is whatever is on your transcript / diploma.

And, finally, is it ok to get ACLS & PALS certification done in my home country or online OR is it better to do it in US in between one of the externships? (Question 6)

It's not clear that certifications outside the US would be recognized. If you have the choice, I'd do them here to be safe.

 

[IsisI]

As a medical school grad, you are ineligible for true USCE. Only observerships are available to you.

What do you mean? Externships aren't allowed for IMGs anymore?

Since CS tests more "practical" skills (like how to take a history) it would seem much better to gain some US experience first. Many IMG's that fail CS do so because they don't know our system. CS doesn't only test your ability to make a diagnosis, it really focuses on how you act, interact with patients, etc.

Ok, so there is one vote for CS right after CK and one vote for CS after 1 USCE. 🙂 Anyway, maybe this information would help! My externship would be in Psychiatry. Would it still be better to do CK -> USCE -> CS?

It's not clear that certifications outside the US would be recognized. If you have the choice, I'd do them here to be safe.

They have AHA accredited training program and certification right here in my country. But, does the ERAS application ask "Have you completed AHA's ACLS/PALS" or does it ask "Have you completed ACLS/PALS in US"?

 

[Prop]

Your Year of graduation(YOG) will be the year you finished your internship. One thing about your plan is that there is a huge gap between your YOG and the year you want to match. This in itself is a red flag in your application.

This is not completely true - it depends on which country you graduated from. Some countries require you to finish internship in order to receive your final medical diploma, while other countries deliver the diploma at the end of medical school.

You need to figure out which category your country belongs to (I had to fulfill a mandatory 1-year internship, but I received my medical diploma prior to this, and my date of graduation was the date of my last exam at medical school).

And as aPD said, your diploma should state the date of graduation.

 

[Winged Scapula]

What do you mean? Externships aren't allowed for IMGs anymore?

What I mean is that you cannot do a clinical elective once you have graduated from medical school, mostly due to licensing and medical liability reasons.

Be aware that many places and services which advertise placing FMGs into externships cannot circumvent rules about a physician (which you are) requiring a medical license or training license and malpractice insurance to practice medicine or to have real "hands on" clinical experience. This is why observerships are what everyone does.

I an unaware of any externship that allows medical school grads to have clinical experience which does not require the above (i.e. ECFMG certification, medical or training license and malpractice insurance). I suppose you could find someone in private practice who doesn't heed to such requirements and is willing to take a risk with offering such externships but I'd surmise your LOR from your research would carry more weight.

This has not changed (i.e., this is not a new rule).

 

[gutonc]

What do you mean? Externships aren't allowed for IMGs anymore?

Externships are allowed but not for graduates, only for students. This has always been the case as WS points out. You can get an observership but those are mostly meaningless.

They have AHA accredited training program and certification right here in my country. But, does the ERAS application ask "Have you completed AHA's ACLS/PALS" or does it ask "Have you completed ACLS/PALS in US"?

ERAS asks only if you've completed ACLS or PALS. But frankly it makes no difference. Every single program will make you take it as part of orientation anyway, and nobody cares whether you've already taken it. It's kind of a dumb question on ERAS...kind of like, "have you had a TB test?" No matter what the answer is, you're getting another one before you start.

PS...please stop with the crazy font...it's really annoying.

 

[IsisI]

What I mean is that you cannot do a clinical elective once you have graduated from medical school, mostly due to licensing and medical liability reasons.

Externships are allowed but not for graduates, only for students. This has always been the case as WS points out. You can get an observership but those are mostly meaningless.

Thank you. I did not know this. But still, I guess an observership or two would be better than nothing. And, it would be the only way for me to get US LORs while also serving to fill up the one year break from clinical work.

About research jobs, my gut feeling is that I will enjoy clinical experiences more than working in pharmaceutical company sponsored trials. It would also help me understand the standard of practice and patient interactions in US, both of which would be quite useful while appearing for the interviews.

Almost forgot - a huge thanks to aProgDirector for answering all my other questions.

.

 

[urg2beSURG]

About research jobs, my gut feeling is that I will enjoy clinical experiences more than working in pharmaceutical company sponsored trials.

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I think you should look for a research job in a university, or university-affiliated hospital. Those are the ones that may get you good LORs! It's not only about sponsored trials..