Bad News for IMGs, 5000 extra AMGs this year!

[Dirt]

I have a dream that IMGs will one day live in a nation where they will not be judged by the school they went to, but by the content of their stats (both hard and soft)...oh yeah, and their character.

Unfortunately your dream is just that.

The truth is there is less control over a Caribbean education and that makes Caribbean grads more of a risk. You can have whatever stats you want, IMGs as a whole are riskier than US grads and that is all PDs need to know.

Even among US grads there is prejudice against those who didn't go to Harvard, regardless of scores, character, and all the rest.

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[handwriting]

Unfortunately your dream is just that.

The truth is there is less control over a Caribbean education and that makes Caribbean grads more of a risk. You can have whatever stats you want, IMGs as a whole are riskier than US grads and that is all PDs need to know.

Even among US grads there is prejudice against those who didn't go to Harvard, regardless of scores, character, and all the rest.

I hear ya. All you can do is do what you gotta do...and hope for the best.

 

[Law2Doc]

Okay, so I'm an IMG, and I'll be participating in the 2013 match.

...and I've been thinking. Consider the US-born/raised IMG. He goes offshore to learn his basic sciences. He comes back to the states and does his rotations in American hospitals. So then I ask...is it really important where someone learned his basic sciences? Are textbooks better on the mainland or something?

What if that student does really well (great Step scores, great average, good ECs) and gets respectable recommendations from doctors at US hospitals? Is that person really all that different from an AMG?

I guess IMGs will always have cooties. However, when a program director looks over that IMG's app, the only aspect of that person's app that will differ from an AMG's will be the school itself.

I know that not all IMGs share the same route (i.e. not all IMGs are US citizens who went abroad), but for those who did their basic sciences out of the US (and there are thousands of these folks)...they're not that different from their AMG brethren.

These students just might stand a "decent" chance at matching into their desired specialties/places.

Having seen some of the rotations offshore applicants complete at some of the local community hospital, I have to say that it's really not the equivalent experience to what most US based programs provide. A lot of community hospitals are happy to take money from offshore applicants and put on some semblance of a rotation, but they really don't have much invested in these folks like a hospital affiliated with a local academic center would, so it's almost up to the med student to force the attendings and residents to hold them to the same kind of expectations, which few do. The attendings pawn off these offshore students on the residents, who pawn them off on the interns, who have too much to do to worry about someone else's educational experience. As a result I have no doubt that a lot of offshore folks are simply less clinically prepared for intern year than their US counterparts. and it's this lack of the equivalent experience that forces PDs to give the nod to anyone coming from a US program where rotations are a known commodity. So not, it's not the same experience just because it's in the US. Often it's an extremely watered down version of what US students endure.

 

[handwriting]

Having seen some of the rotations offshore applicants complete at some of the local community hospital, I have to say that it's really not the equivalent experience to what most US based programs provide. A lot of community hospitals are happy to take money from offshore applicants and put on some semblance of a rotation, but they really don't have much invested in these folks like a hospital affiliated with a local academic center would, so it's almost up to the med student to force the attendings and residents to hold them to the same kind of expectations, which few do. The attendings pawn off these offshore students on the residents, who pawn them off on the interns, who have too much to do to worry about someone else's educational experience. As a result I have no doubt that a lot of offshore folks are simply less clinically prepared for intern year than their US counterparts. and it's this lack of the equivalent experience that forces PDs to give the nod to anyone coming from a US program where rotations are a known commodity. So not, it's not the same experience just because it's in the US. Often it's an extremely watered down version of what US students endure.

Yes, some rotations are watered down. Residents don't "teach" much. There's not much "guidance." However, this is hospital dependent, rotation dependent, and house staff and attending dependent. My long-time girlfriend is an AMG, and some of the hospitals in which she rotated (ones that IMGs are barred from doing rotations at) have also been a bit lacking in the "holding-students-up-to-a-certain-level-of-expectations" department.

The students who are less clinically prepared...or let's say...dangerously unprepared for intern year...by all means, let the NRMP weed them out.

Here's the thing: many offshore schools accept a crapload of students per year compared to the number of accepted individuals who make up the entering classes of US schools. Possibly, >50% of those accepted at offshore schools are markedly subpar compared to their US counterparts. However, the top students at those schools are really A-OK, and then some. It's just a pity that IMGs are "guilty until proven innocent," so to speak, as opposed to vice versa. It's a tough uphill battle for us because of that. My advice to anyone: don't go offshore if you can avoid it.

[For the record, I'm cool with IMGs, AMGs, DOs...you name 'em. I just get kinda nauseated by knee-jerk prejudice against anyone.]

 

[leviathan]

Yes, some rotations are watered down. Residents don't "teach" much. There's not much "guidance." However, this is hospital dependent, rotation dependent, and house staff and attending dependent.

That may be true, but US med schools ensure that the hospital, rotation, and house staff involved with US rotations are of proper quality. Caribbean schools are often just happy to get ANY hospital to take their students, regardless of quality, as long as they did a 'rotation' on paper. There are definitely also a lot of good hospital rotations as well, but I can understand a PD will have no way to know what kind of training they really got.

 

[Law2Doc]

That may be true, but US med schools ensure that the hospital, rotation, and house staff involved with US rotations are of proper quality. Caribbean schools are often just happy to get ANY hospital to take their students, regardless of quality, as long as they did a 'rotation' on paper. There are definitely also a lot of good hospital rotations as well, but I can understand a PD will have no way to know what kind of training they really got.

Exactly. At the place I saw (a popular rotation site for one of the big three), the rotation had no resemblance to the kind of structure and teaching the US counterparts taking a core rotation would get. All the residents were from different US programs and the consensus was that this kind of rotation simply wouldn't fly at any of our alma maters. It was possible for the students to be proactive and make the rotation a better clinical learning experience, but 99% were content to just slide through. So yeah, because the hospital and staff have so little invested in these rotations and students, and because there really isn't all that much oversight to ensure that folks get a true rotation experience, and because, I suspect, a rotations popularity directly stems from how little work they are going to expect from the students, the result is substandard schooling as compared to the LCME governed rotations US students do. Given this discrepancy, at least for some rotations, it is totally reasonable for PDs to stick with the US applicants where there is better assurance that they completed a "real" set of rotations.

 

[handwriting]

What you guys say is true.
But you guys make it sound so goshdarn black and white.
If I were an outsider, I'd think that offshore students' rotations are a total farce all the time, every time.
I keep in touch with friends who are doing rotations at a bunch of different hospitals where offshore students rotate, and not every rotation is a joke. There are rotations on par with university affiliated rotations. Some of the offshore students' rotations might be even better. And even though it might be getting rarer, sometimes offshore students rotate with mainland students.
As for the less than desirable rotations...I pity the fool who doesn't make the most of them.

Also, I know some chairpersons and attendings who'd take offense to the idea that their departments' rotations are parodies of a real rotation. Offshore schools also make sure the hospitals put students up to a certain standard--this isn't just an American university thing. They make sure the students excel on a number of different levels. One small example is oral exams. My school mandates oral exams for each rotation to make sure students know how to present cases and manage patients. I know some American schools which don't even have orals. It's a small difference, because that skill can be tested day in and day out on the wards, but I'm just putting that out there.

In additon, the lack of semblance to a "real" rotation is sometimes a strong point. In rotations where there aren't many or any residents, for example, students get to work directly with attendings. You can bet your bottom dollar that the learning experience is really potent in these situations. Offshore students also often find themselves rotating at hospitals where immigrants make up much of the patient base. The patients often don't have adequate insurance. They're also more amenable to working with students. Nobody's slapping your hand. Nobody's telling you that you're not good enough to try a procedure. There's so much hands on learning that students who go on to graduate have seen it all and done it all by the time they're interns.

 

[physicsnerd42]

But you guys make it sound so goshdarn black and white.

Everyone knows it's not black and white. But think about it from the PD's perspective. With an LCME-accredited school, at least you know there is a certain standard that must be met by that school and its educational experience to maintain accreditation. When we're talking about foreign schools (like in the Caribbean) , it is too much effort for the PD to figure out whether the LCME standards have been met. So a US student is a much safer bet.

 

[angleoflouise]

I am a Carrbean Medical student applying for General and Vascular Surgery this year. Having done two away rotations at very prestigious universities in General Surgery, I quickly realized that my clinical education was far better than a US clinical education. My medical school allowed me to rotate at a hospital where there were no residents and the medical students were first assistants on everything. We received one on one education from the attendings and didn't have to share anything with residents. While on my away rotations and second look interviews, I saw med students standing around, watching, sometimes opening doors for residents and attendings, sometimes fetching crap for pissed off interns. Once in a while, a very basic pimp question would be thrown out at the end of each case, and the med student gave a very basic answer. I wasn't impressed at all.

Are there rotations where students are just pretty much given an A for doing whatever, yes, and I know of them, but they are very few, and you have the choice not to sign up for those rotations. All in all, it balances out and I don't appreciate AMGs slamming Carribean medical schools and won't stand for it.
This is exactly what I would tell each PD I met with during this season's interviews and they were visibly impressed and surprised even. So to all the future Carib grads, you have to explain it to the PD in this manner and dissolve the myth about crappy carib school rotations.

 

[DoctwoB]

What you guys say is true.
But you guys make it sound so goshdarn black and white.
If I were an outsider, I'd think that offshore students' rotations are a total farce all the time, every time.
I keep in touch with friends who are doing rotations at a bunch of different hospitals where offshore students rotate, and not every rotation is a joke. There are rotations on par with university affiliated rotations. Some of the offshore students' rotations might be even better. And even though it might be getting rarer, sometimes offshore students rotate with mainland students.
As for the less than desirable rotations...I pity the fool who doesn't make the most of them.

Also, I know some chairpersons and attendings who'd take offense to the idea that their departments' rotations are parodies of a real rotation. Offshore schools also make sure the hospitals put students up to a certain standard--this isn't just an American university thing. They make sure the students excel on a number of different levels. One small example is oral exams. My school mandates oral exams for each rotation to make sure students know how to present cases and manage patients. I know some American schools which don't even have orals. It's a small difference, because that skill can be tested day in and day out on the wards, but I'm just putting that out there.

In additon, the lack of semblance to a "real" rotation is sometimes a strong point. In rotations where there aren't many or any residents, for example, students get to work directly with attendings. You can bet your bottom dollar that the learning experience is really potent in these situations. Offshore students also often find themselves rotating at hospitals where immigrants make up much of the patient base. The patients often don't have adequate insurance. They're also more amenable to working with students. Nobody's slapping your hand. Nobody's telling you that you're not good enough to try a procedure. There's so much hands on learning that students who go on to graduate have seen it all and done it all by the time they're interns.

It's like the difference between buying a car from a certified dealer or a private seller. Sure you could buy a great car from a guy on craigslist, but you'd rather get a car (student) from an dealer that you trust and has a reliable track record and where you've bought cars before.. Even if that car might have a few more miles on it (worse stats), the assurance of quality is worth it.

 

[leviathan]

So to all the future Carib grads, you have to explain it to the PD in this manner and dissolve the myth about crappy carib school rotations.

It's not a myth, it's a well-known fact that the quality of Carib rotations are often far below those of US schools. I don't know if you other Carib students aren't reading properly, but once again, nobody said all rotations are of low quality. The only thing you can do is try to find a way to convince them that the quality of your clerkship training was good.

As a student of a Caribbean med school I was fortunate to do almost all my rotations alongside med students at a good midwestern university program, so I feel that will be helpful at application time. I also had the misfortune of doing one of my rotations in a hospital that is crammed full of Caribbean students (from the big 3). It was, as others have said, a parody of a real medical school rotation and I'm just glad I don't want to go into that specialty, as I feel they short-changed my learning experience. Yes, I had plenty of downtime to master the knowledge on this rotation, but obviously there is lots from direct patient exposure that textbook learning cannot replace. This is why I understand when PDs are leery of our training.

 

[Buzz Me]

PDs are worried about the inconsistency of an applicant's medical education and experience coming from an offshore school. I'm not even sure there's that big a difference, in their minds, between a Caribbean school and a European/South American/Indian/Middle Eastern one, for example.

Is this the inherent assumption that there was something wrong with that student's app when they were a pre-med applying to med school? Or because of the for-profit stance of some of these offshore schools? Or the perceived lack of prestige of these schools (because, believe it or not, residency programs care what schools their interns come from)?

It's a tough perception to crack. When we've had visiting med students from Caribbean schools, those that do as well as the local med students here are just seen as doing a good job. But those that perform at a subpar level feed the paradigm that "Caribbean students should be avoided."

 

[fishsnack]

I am a Carrbean Medical student applying for General and Vascular Surgery this year. Having done two away rotations at very prestigious universities in General Surgery, I quickly realized that my clinical education was far better than a US clinical education. My medical school allowed me to rotate at a hospital where there were no residents and the medical students were first assistants on everything. We received one on one education from the attendings and didn't have to share anything with residents. While on my away rotations and second look interviews, I saw med students standing around, watching, sometimes opening doors for residents and attendings, sometimes fetching crap for pissed off interns. Once in a while, a very basic pimp question would be thrown out at the end of each case, and the med student gave a very basic answer. I wasn't impressed at all.

Are there rotations where students are just pretty much given an A for doing whatever, yes, and I know of them, but they are very few, and you have the choice not to sign up for those rotations. All in all, it balances out and I don't appreciate AMGs slamming Carribean medical schools and won't stand for it.
This is exactly what I would tell each PD I met with during this season's interviews and they were visibly impressed and surprised even. So to all the future Carib grads, you have to explain it to the PD in this manner and dissolve the myth about crappy carib school rotations.

So you're basing your judgement on n=1 of your own education and a perception of something you observe as an outsider. When a PD chooses an IMG, they have no idea what kind of clinical training they have. Maybe awesome (as you claim yours was), or borderline non-existent.

Like said above, I would tread carefully throwing generalizations around.

 

[Domenech]

Non-US citizen IMG match rate is 40.9% anyway. With more people off from the islands, it's only gonna get lower. It's been getting lower every year anyway. And with medical schools in US increasing their enrollment and the total number of residency slots being stagnant, it's only going to get even tougher in future.

 

[Socrates25]

The newer MD and DO programs that have crawled out of the wood like cockroaches arent going to be any better for clinical training than the carib programs are.

I always laugh when I hear about a new MD program opening up in bumble**** alaska and the dean of the school who couldnt get an academic job anywhere else says something like "we will provide our medical students with excellent clinical training in our solo doc FP office and our 20 bed state of the art hospital"

 

[fishsnack]

The newer MD and DO programs that have crawled out of the wood like cockroaches arent going to be any better for clinical training than the carib programs are.

I always laugh when I hear about a new MD program opening up in bumble**** alaska and the dean of the school who couldnt get an academic job anywhere else says something like "we will provide our medical students with excellent clinical training in our solo doc FP office and our 20 bed state of the art hospital"

Lets take a look at some of the most recent MD schools:

Copper in NJ: has its own 500 bed teaching hospital
Hofstra Med School in NY: LIJ is a 900 bed teaching hospital with every residency and fellowship

You can pretty much do this for every new MD school. Aside from the fact that LCME evaluates every clinical position offered by these schools. Can't say the same for DO schools, but they'll get squeezed right after the IMGs

 

[Dirt]

The newer MD and DO programs that have crawled out of the wood like cockroaches arent going to be any better for clinical training than the carib programs are.

I always laugh when I hear about a new MD program opening up in bumble**** alaska and the dean of the school who couldnt get an academic job anywhere else says something like "we will provide our medical students with excellent clinical training in our solo doc FP office and our 20 bed state of the art hospital"

Lets take a look at some of the most recent MD schools:

Copper in NJ: has its own 500 bed teaching hospital
Hofstra Med School in NY: LIJ is a 900 bed teaching hospital with every residency and fellowship

You can pretty much do this for every new MD school. Aside from the fact that LCME evaluates every clinical position offered by these schools.

burn.

 

[b-real]

I am a Carrbean Medical student applying for General and Vascular Surgery this year. Having done two away rotations at very prestigious universities in General Surgery, I quickly realized that my clinical education was far better than a US clinical education. My medical school allowed me to rotate at a hospital where there were no residents and the medical students were first assistants on everything. We received one on one education from the attendings and didn't have to share anything with residents. While on my away rotations and second look interviews, I saw med students standing around, watching, sometimes opening doors for residents and attendings, sometimes fetching crap for pissed off interns. Once in a while, a very basic pimp question would be thrown out at the end of each case, and the med student gave a very basic answer. I wasn't impressed at all.

Are there rotations where students are just pretty much given an A for doing whatever, yes, and I know of them, but they are very few, and you have the choice not to sign up for those rotations. All in all, it balances out and I don't appreciate AMGs slamming Carribean medical schools and won't stand for it.
This is exactly what I would tell each PD I met with during this season's interviews and they were visibly impressed and surprised even. So to all the future Carib grads, you have to explain it to the PD in this manner and dissolve the myth about crappy carib school rotations.

Let us know if/where you match. Probably won't be at "very prestigious universities."

 

[nycitygas]

Let us know if/where you match. Probably won't be at "very prestigious universities."

I really don't think telling the PD of "prestigious university programs" that your carribean medical school education surpassed any US MD education is going to help you. You probably would have been much better off being humble while highlighting the benefits of your education (more 1 on 1 training, less scutwork, living on a beach, ect")