Carib with Double 99's - No Guaranteed Spot

[relaxedMD]

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I want to recount a recent experience and spark some discussion. I will reveal my motive within the body of the story:

I recently rotated with students from a little known medical university in the blue-green waters of the Carib. I did a double take of their white coats because I didnt recognize their school insignia on their arms during rounds. I dont recall ever hearing their university's name mentioned on these forums, which I visited often during my med school years. And to their dismay, I said to them one morning " I dont know anyone training at this medical center from your med school". And that was the truth. Six months in to my residency I am pretty certain, no one from this little known med school in the carib matched at this university program last year.
In fact, I told them both that I was very surprised that they were able to acquire an away rotation there. Briefly, both of them had high aspirations for general surgery residency. Both of them were eager fourth year gen surg sub-I students. Neither one of them were enrolled in ERAS this cycle. They were "off cycle" according to one of them.
During our weeks together, I observed them on the floors. In private I was open and honest about the carib reality. The same way that I speak of it on this forum. For weeks I observed them and compared them to their US counterparts. 3rd year US students were outshining them every day,in effort and skill set.
I hadnt offered unsolicited advice to them, until one day I overheard them at lunch talking about applying to 100 programs in gen surg, only gen surg for them, and "cool" fellowships in plastics, etc. They spoke about friends of theirs in ENT, and Ortho, etc., generally remarking on the glamour of it all in surgery.
I interrupted them, "Realistically you are at a disadvantage for gaining a gen surg residency these days. There are carib grads from better known schools competing for the same spots that you are."
One of the guys interjects by saying " this guy will be fine" pointing to his peer "because he got double 99 on his boards already".
It was at this moment when a rare negative thought slipped into my mind.
It was DOUBT. Very simple doubt. So I said with a somber tone " I am not so sure its that easy". I felt instantly terrible for burdening him with discouraging words. I believed his scores were true, however I couldnt bring myself to see this guy "easily matching" in cat gen surg.

Since I had gotten to know their personalities, skill sets, aptitudes, reputation on the wards, I felt compelled to present them a dose of reality.
My advice was for them to get awesome letters, and outshine their peers in their current rotation. After that apply to cat IM, cat FM, and cat Gen Surg.

In my opinion: Double 99's do not guarantee you a fair shot at a university categorical spot in General Surgery coming from a little known carib school.

rlxdmd
(6 months and still chillin')

 

[howelljolly]

I can PROMISE you that double 99s and a Carib degree will not "guarantee" a spot in GS, or IM or anything else for that matter.

 

[DRJJ1]

I want to recount a recent experience and spark some discussion. I will reveal my motive within the body of the story:

I recently rotated with students from a little known medical university in the blue-green waters of the Carib. I did a double take of their white coats because I didnt recognize their school insignia on their arms during rounds. I dont recall ever hearing their university's name mentioned on these forums, which I visited often during my med school years. And to their dismay, I said to them one morning " I dont know anyone training at this medical center from your med school". And that was the truth. Six months in to my residency I am pretty certain, no one from this little known med school in the carib matched at this university program last year.
In fact, I told them both that I was very surprised that they were able to acquire an away rotation there. Briefly, both of them had high aspirations for general surgery residency. Both of them were eager fourth year gen surg sub-I students. Neither one of them were enrolled in ERAS this cycle. They were "off cycle" according to one of them.
During our weeks together, I observed them on the floors. In private I was open and honest about the carib reality. The same way that I speak of it on this forum. For weeks I observed them and compared them to their US counterparts. 3rd year US students were outshining them every day,in effort and skill set.
I hadnt offered unsolicited advice to them, until one day I overheard them at lunch talking about applying to 100 programs in gen surg, only gen surg for them, and "cool" fellowships in plastics, etc. They spoke about friends of theirs in ENT, and Ortho, etc., generally remarking on the glamour of it all in surgery.
I interrupted them, "Realistically you are at a disadvantage for gaining a gen surg residency these days. There are carib grads from better known schools competing for the same spots that you are."
One of the guys interjects by saying " this guy will be fine" pointing to his peer "because he got double 99 on his boards already".
It was at this moment when a rare negative thought slipped into my mind.
It was DOUBT. Very simple doubt. So I said with a somber tone " I am not so sure its that easy". I felt instantly terrible for burdening him with discouraging words. I believed his scores were true, however I couldnt bring myself to see this guy "easily matching" in cat gen surg.

Since I had gotten to know their personalities, skill sets, aptitudes, reputation on the wards, I felt compelled to present them a dose of reality.
My advice was for them to get awesome letters, and outshine their peers in their current rotation. After that apply to cat IM, cat FM, and cat Gen Surg.

In my opinion: Double 99's do not guarantee you a fair shot at a university categorical spot in General Surgery coming from a little known carib school.

rlxdmd
(6 months and still chillin')

you must be a fortune teller maybe you should just concern yourself about you unless you can give solid advice for the future if you told me that I personally would have been insulted and put you in your place fast,,,you don t control the future and don t know who knows who to get you into places so don t be so cocky and try to appear as somebodies hero because you re not,,,i hope i never meet someone like you for various reasons

 

[howelljolly]

you must be a fortune teller maybe you should just concern yourself about you unless you can give solid advice for the future if you told me that I personally would have been insulted and put you in your place fast,,,you don t control the future and don t know who knows who to get you into places so don t be so cocky and try to appear as somebodies hero because you re not,,,i hope i never meet someone like you for various reasons

chill out. use punctuation. you shouldnt be so cocky in thinking that your contacts can get you a residency. He was being nice, and I wouldn't mind meeting him. You, on the other hand... Go to a residency program and wave your 99s in the PDs face. See how fast he puts you in your place.

This thread offers useful advice for premeds thinking of going to the Carib, with the goal to get double 99s and land a residency. The truth is that getting double 99s will not guarantee you a residency. That is solid advice. Maybe if you still want to try the Carib route, you might want to have something else up your sleeve - like knowing someone.

Heres some more solid advice. If you do get an interview invitation, dont assume that your scores will get you ranked. Even if your double 99 lands you an interview invitation... once you get to the interview, the faculty may be blinded to your scores. Meaning, the faculty who are interviewing you, and have seen your PS and CV may NOT have seen your scores. So don't put too much faith in scores.

 

[Tigerz_Fan]

chill out. use punctuation. you shouldnt be so cocky in thinking that your contacts can get you a residency. He was being nice, and I wouldn't mind meeting him. You, on the other hand... Go to a residency program and wave your 99s in the PDs face. See how fast he puts you in your place.

This thread offers useful advice for premeds thinking of going to the Carib, with the goal to get double 99s and land a residency. The truth is that getting double 99s will not guarantee you a residency. That is solid advice. Maybe if you still want to try the Carib route, you might want to have something else up your sleeve - like knowing someone.

Heres some more solid advice. If you do get an interview invitation, dont assume that your scores will get you ranked. Even if your double 99 lands you an interview invitation... once you get to the interview, the faculty may be blinded to your scores. Meaning, the faculty who are interviewing you, and have seen your PS and CV may NOT have seen your scores. So don't put too much faith in scores.

Totally agree. And rlxdmd is absolutely correct with what he is saying.

Lately, we have had a couple of students from small schools rotate through. Each one of them really did not have any clue what they were up against. IMHO, it's important for all Carib students to understand the reality of the situation with the extremely competitive match years ahead.

 

[RussianJoo]

Thanks for the great post Rlxdmd. I am actually kind of surprised that those guys acted the way they did. The carib students I've rotated with including myself have all been very humble and showed a ton of respect. I have only seen arogance or lazyness from US med students. Sure there are days when you're run down or tired and want to slack off but for the most part the carib students i've rotated with have been go getters. it's a dog eat dog out there and I presonally would feel very emberased if a 3rd year out shined me, just because 4th years have more experience and should always out preform 3rd years. Especially if those guys were trying to match at that hospital. All I can really say is WOW they're up for a very rude awakening next year when they go through the match.

and to DRJJ1, you should be thankful there are people like Rlxdmd out there that will be honest and tell you that you're acting like a jerk or not doing what you're suposed to because not too many actually care to give productive criticism and will just let you be and then simply not write you a strong LOR or not even bother ranking you for the match. As a carib student/grad if anything I would think he's being nice to them and offering them good advice.

 

[relaxedMD]

I want to start by saying, that DrJJI's comment is acceptable. He doesnt know me and my history with this forum, specifically the carib forums. If he takes the time to reread all 119 of my SDN comments/replies I dont think he would make such a statement.

For the rest of us in this discussion I am glad that you see where I was going with this story/discussion. Very glad. With that I want to advance the plot further. I was in on the student evaluation meeting for these students. Without saying much I will say that the attendings and senior residents were not impressed. Since I spent the MOST amount of time with them, they wanted my opinion on the matter.

My opinion is this: in general if you are a fourth year sub-Intern, you should be able to do everything that an intern does minus the added responsibility of carrying a code pager and consult pager.
While they were both hard workers before rounds, (at times ready to give up), they lacked a strong base of knowledge, organization skills, patient examination skills, knowledge of ICU machinery, note writing ability, and their round presentations were often incomplete.
The team worked hard to steer them the right way. So did the other students. I spent my personal time after hours to work with them, in the ICU, and regarding notes, and presentations. But its hard to pick up all of this when you dont already have a solid base from 3rd year.
Unfortunately while they improved in the second half of the rotation one of them received a satisfactory while the second of the two was failed. This attending never fails students, but she felt after the teams discussion that it would be disservice to let him think he was prepared for the intern year, especially since he was interested in GEN SURG.

In my opinion: His little known carib school, I am afraid, is not training their students at the same level as a US University program.

rlxdmd

 

[futureboy]

What is the little-known Carib school? Inquiring minds want to know.

 

[howelljolly]

Hmm.. I didnt really know where you were going with that.

I wouldn't say that his little known Carib school wasn't training their students...

I'd put a majority of the responsibility on the quality of the 3rd year core rotations.

Yes, the quality of the core rotations may have something to do with the school itself (in that a better school can contract for better rotations). But the student can usually go outside the available contracts, find out where most Carib students are getting (good) cores, and get a contract negotiated. Perhaps the students weren't aware of what they were missing out on.

Secondarily, I might say that the school is at fault for not providing clinically oriented basic science lectures.

But really, knowing how to function on the wards, especially as a Sub-I, has more to do with your 3rd year cores, which are totally separate from the school on the island.

Even if the student Honored the rotation, they still aren't guaranteed a residency.

Thats kinda where I thought you were going with this. If you look at the Charting Outcomes data from the NRMP from last year. General Surgery independent applicants (that includes Carib US-IMGs) with a scores of 240 (thats a 99) had about a 35% success rate of matching, which only increased to a success rate of 45% with a score of about 270.

So thinking you're guranteed General Surgery with a 99 is so far from reality its unreal.

While Im at it, it should be noted that a "99" encompasses anything from a score of 240 to 300 (or whatever the max is). Thats a big spread. And any fool can get a 99. 😉

 

[relaxedMD]

Hmm.. I didnt really know where you were going with that.

I wouldn't say that his little known Carib school wasn't training their students...

I'd put a majority of the responsibility on the quality of the 3rd year core rotations.

HJ: It was inappropriate for me to make that last statement about "little know schools". Let me explain. My point is what you have stated HowellJOlly.

Recently established medical schools in the caribbean ("my little known schools") are not equipped to train the strongest residency candidates.
Which is why I would like to think people should shy away from the "NEWER" schools and pick an established carib institution.
Atleast the BIG 4 have a statistically PROVEN product, as shown by their residency/match success statistics. I feel that established schools are providing ALOT MORE than just 4 years of USMLE board prep to their strongest students.
As I see it, in the future, carib students are going to need alot more than SICK board scores to impress US university level attendings and PDs. For one thing, they are going to need atleast two solid clinical years of training at a strong training hospital with exceptional core rotations; some place with an emphasis on student training by the residents, lectures for students by the residents, teaching rounds for the students by the attending/residents, and SHELF-type examination to demonstrate your aptitude.

It was obvious to me and my team of residents and attendings that the two candidates described in this story had none of these at their surgery core.

A final note: One time, the attending asked this student for his shelf results in surgery and the student replied "we didnt have to give that test." That attending happened to be the Chair of General Surgery at my University.

rlxdmd

 

[dragonfly99]

I think that relaxedMD is right. There is a lot more to med school than the first two years. Even at US schools, the teaching during 3rd year can be sporadic and substandard...it actually takes a LOT of organization and a LOT of good attendings to make up a decent 3rd year core rotation. I'm sure most students applying (including those applying to just US schools and those applying Carib or Carib plus US) don't think as much about that as they do the 1st/2nd year classes. After all, when students apply and take a tour, etc. they're usually mostly talking with 1st/2nd year students and faculty, and their frame of reference is college, so they mostly think about classes, etc. However, the quality of 3rd year rotations is important, and students shouldn't have to do all the work, or most of the work, to try to set those up or worry if there will be competent teaching when they get there. So some of the "bargain" Caribbean schools may not be much of a bargain.

 

[howelljolly]

Fair enough.

The Big-4 schools offer a number of advantages over the others. Including, but not limited to strong clinical rotations, and shelf exam requirements. That said, not all of the Big-4 require the shelf. But all have a proven track record in residency placement. Im sure name recognition itself has a lot to do with that.

However, one can certainly get sub-par clinical education from a Big-4 school (especially the ones which struggle to place students in clinicals). Conversely, one can get a decent clinical education from a small new school by actively setting up their own clinicals at good teaching hospitals.

Rather than turn this into a "go to a big4" thread, lets just leave it at the point that stellar board scores do not entail a residency placement.

 

[howelljolly]

I think that relaxedMD is right. There is a lot more to med school than the first two years. Even at US schools, the teaching during 3rd year can be sporadic and substandard...it actually takes a LOT of organization and a LOT of good attendings to make up a decent 3rd year core rotation. I'm sure most students applying (including those applying to just US schools and those applying Carib or Carib plus US) don't think as much about that as they do the 1st/2nd year classes. After all, when students apply and take a tour, etc. they're usually mostly talking with 1st/2nd year students and faculty, and their frame of reference is college, so they mostly think about classes, etc. However, the quality of 3rd year rotations is important, and students shouldn't have to do all the work, or most of the work, to try to set those up or worry if there will be competent teaching when they get there. So some of the "bargain" Caribbean schools may not be much of a bargain.

Thats a good reason to avoid the smaller newer schools.

And even if you think its worth the effort to set up your own clinicals...The sheer volume of students that you'll be competing with for the dwindling number of extra residency seats makes it a battle not worth fighting.

 

[relaxedMD]

No matter how you look at it, a strong clinical core experience and their teaching value can only be quantified with a "final examination". It doesnt have to be the "Shelf exam" but it needs to be a comprehensive exam similar to the SHELF. In my opinion, the schools that do not have it as a requirement may be afraid to give it because they know that the statistics will reflect how poor their teaching actually is at their core rotation sites.

How does it benefit a student to forego a final exam? From my experience, finals keep you on your toes during the rotation and force you to be prepared. It motivates you to keep reading on a nightly basis. One difference I noticed between the US third years and the carib 4th years was that the 3rd years were always reading on their down time. Their knowledge was fresh until the final week of the core. Without core final exams, the information is lost/forgotten when the rotation ends. There is no consolidation, and no quantifiable assessment of the amount of information absorbed by the student.
Back to the story:
When that student said he didnt have to take a shelf exam to the attending, I saw the senior resident gasp. Clearly that was a bad sign. That attending will report this information to the PD and students from this newer school will rarely, if ever, be considered excellent carib candidates. Bad for that program, and bad for lesser known schools outside the US.

Also, this issue of where you do your core rotations highlights a good point made earlier by Dragonfly99, that students scramble for the best clinicals sites offered to them. Sometimes students can wait months to have a solid core scheduled. While some may not want to wait for a great core site, they are sacrificing the end goal of the clinical years: becoming proficient enough in the practice of medicine to act as a strong competent intern. The ones that do wait may delay their graduation time. [As an aside, I believe that these 4th years trained at a good hospital in the local area that has a surgery residency.]

I am not in this discussion to promote the Big 4, but I dont want my brothers, sisters, cousins, and friends to get duped into attending newer CHEAPER carib schools that dont have their best interest at heart; schools which are ill-equipped to adequately train large numbers of medical students and ensure that they match into residency with minimal speedbumps.

rlxdmd

 

[relaxedMD]

Double 99s dont guarantee anything.

I spoke to the same carib student today who I spoke of in the original post. I am sad to report that he did not match into categorical general surgery. He matched into a preliminary spot in general surgery at a NY area hospital.

He seemed disappointed that he did not get a categorical spot in gen surg. He repeatedly restated his excellent board scores and letters of rec during our conversation. Clearly he was distraught. He didnt know what he could have done to improve his chances any further. I tried to console him. I was unable to.

His is a very common scenario this time of the year. The Match is very cruel to IMGs. Please do not set your expectations too high. Or else you will get burned.

rlxdmd

 

[sandyjay]

I want to start by saying, that DrJJI's comment is acceptable. He doesnt know me and my history with this forum, specifically the carib forums. If he takes the time to reread all 119 of my SDN comments/replies I dont think he would make such a statement.

For the rest of us in this discussion I am glad that you see where I was going with this story/discussion. Very glad. With that I want to advance the plot further. I was in on the student evaluation meeting for these students. Without saying much I will say that the attendings and senior residents were not impressed. Since I spent the MOST amount of time with them, they wanted my opinion on the matter.

My opinion is this: in general if you are a fourth year sub-Intern, you should be able to do everything that an intern does minus the added responsibility of carrying a code pager and consult pager.
While they were both hard workers before rounds, (at times ready to give up), they lacked a strong base of knowledge, organization skills, patient examination skills, knowledge of ICU machinery, note writing ability, and their round presentations were often incomplete.
The team worked hard to steer them the right way. So did the other students. I spent my personal time after hours to work with them, in the ICU, and regarding notes, and presentations. But its hard to pick up all of this when you dont already have a solid base from 3rd year.
Unfortunately while they improved in the second half of the rotation one of them received a satisfactory while the second of the two was failed. This attending never fails students, but she felt after the teams discussion that it would be disservice to let him think he was prepared for the intern year, especially since he was interested in GEN SURG.

In my opinion: His little known carib school, I am afraid, is not training their students at the same level as a US University program.

rlxdmd

was the student who failed, the one who had double 99s in the steps ? Does a double 99 mean that the student had taken both Step 1 and Step 2
and if so why were they so poor in presentations etc. Doesn't the step 2 test people in these skills?

 

[Phur]

Very interesting story. In your opinion what do you think kept the person from matching? Was it just being from the Carib? the specific school s/he went to? Was it more of a personality problem? Or just the nature of the beast of the Match as a whole? I know only the PD's of the programs the person interviewed at knows for sure, but from your experience working with them. What do you think?

 

[relaxedMD]

I will answer both the posts here in response to my update.

He took step 1 and scored very very high. He took step 2 CK and scored very very high. That is because he obviously practiced and studied. He was prepared to take the test. The other side of practicing medicine is recalling information at the bedside when you need it. And ofcourse having physical exam skills training. Some schools are better than others at this, some schools dont care how good your exam skills are. He was not so sharp on rounds. That is a reflection on the way his school prepared him.

I think personalities also need to match when interviewing for a position. You need to be likable and agreeable. I am speculating but maybe he rubbed someone the wrong way. I dont know what the PD thought. The student did have an ego, but nothing outrageous.

One big mistake is that he thought he would match neurosurgery coming from a small carib school.
That led him to over shoot on his rank order list of programs. He may have set his hopes too high. If he thought he would match neurosurgery than maybe he put very competitive programs ahead of less competitive community programs. The MATCH is a computer program, you need to understand the algorithm and play the game with realistic expectations. He did not.

The second key point in his inability to match was that he only had 6 categorical interviews for surgery. The carib grad statistics would give him a low probability of a successful match. Six interviews is low for a carib grad trying to match something semi-competitive like General Surg.
That number is very low for someone with such high scores. This means that there is a clear carib bias in the PD's minds in GENERAL SURGERY.

If he was DO he would have had twice as many interviews. If he was a US grad he would have interviewed at Harvard, Stanford, Hopkins, Duke, etc.

The carib reality needs to be faced. You are not equal to the US grads, DO or MD, even if you rock the boards TWICE before you put your application in.

Maybe one year of surgery research would have improved his chances of matching. He may impress his program next year and they might offer him an actual categorical spot, but the chances of that are slim. For now he is cheap labor for them.

I sincerely wished him the best of luck. I am confident he will become a surgeon someday, he will simply have to take the long windy road.

rlxdmd

 

[badasshairday]

Wow. Crazy story. People need to know this info. I know a guy from college who is at a small carib school too, (St. E somthing), and I don't think he understands what he is up against either. He talks about how he is going to match into radiology like it is no big deal (hasn't even taken boards yet). 🙄

 

[NotAProgDirector]

One big mistake is that he thought he would match neurosurgery coming from a small carib school.
That led him to over shoot on his rank order list of programs. He may have set his hopes too high. If he thought he would match neurosurgery than maybe he put very competitive programs ahead of less competitive community programs. The MATCH is a computer program, you need to understand the algorithm and play the game with realistic expectations. He did not.

I fully agree with almost all you have said, but the above is confusing. The way the match alg works, you cannot hurt yourself by ranking very competitive programs highly. It will try to fit you into them, and if it fails it will move down your list. Each time you get bumped out of a program on your rank list, the next prog on your list becomes your "new #1". So, you cannot hurt your chances of matching by ranking "reach" programs highly -- in fact, this is exactly what you should do.

The second key point in his inability to match was that he only had 6 categorical interviews for surgery. The carib grad statistics would give him a low probability of a successful match. Six interviews is low for a carib grad trying to match something semi-competitive like General Surg.

If above you were trying to say that perhaps because of his double 99's etc he only applied to competitive programs and "set his hopes too high" on competitive NS and GS programs (note: no such thing as a noncompetitive NS program) and then only got 6 IV's, that's certainly possible and I totally agree.

 

[Knicks]

What the heck?!

So a student gets double 99's and that still won't be enough to get into a program of his choice? (carib school or not, and assuming the rest of his application is decent). I mean, ok that is a possibility, but it shouldn't be simply due to the fact that he's from the carib. What ELSE must one do? I mean, double 99's, a "very very high" step 2 score should help with SOMETHING; it's GOTTA have SOME impact SOMEWHERE.


In that case, double 99s also shouldn't (and probably DON'T) guarantee anything for AMGs either then.



ex: If someone knows high school algebra and can teach it to my kid, I don't care where he learned the algebra; US, Mars, Jupiter.,,,,, just teach my kid. But if you're gonna say that someone who learned algebra on Mars isn't guaranteed to teach it (just cuz he's from Mars), then the person who learned algebra in the US should also not be guaranteed to teach it.

 

[dragonfly99]

knicks, it is not just bias on the part of program directors.

The Step 1 and Step 2 only test your medical knowledge base - that's it. They don't test whether you know how to take care of patients, write notes, do lateral thinking/integrating of the information that you know. And Step 1 and step 2 don't show anything about how hard your school has worked you during 3rd/4th year. How many patients per night on call did you admit? How much responsibility did you assume in taking care of them?

In US schools, the 3rd year grades often count as much as 1st/2nd year combined, because the clinical clerkships are considered so super important. In part, when residency directors take a student, they are buying a product of the particular school that graduated that student; and what program directors are saying when they don't want to take these Caribbean students is that they don't think the product they are putting out is very good. Maybe some of that is bias, but a lot of the bias is based on their experiences, or the experiences of other physicians/PD's they know. Besides, if you read the original post, you saw that the students described in the post were not up to snuff clinically. They clearly were not ready to function as interns. It certainly can happen that the people with the super high test scores are not necessarily the best clinically. There is LOT more to med school and being a physician than taking and passing tests. Don't get me wrong - those tests are important. We have to have some objective measuring stick by which we can evaluate someone's medical knowledge. There is so much more to residency selection than that. If the USMLE were the only thing that was important, we wouldn't need to do 3rd/4th year clinical rotations at all, or go on interviews...we could all just submit our board scores and programs would rank us based on that.

 

[Knicks]

knicks, it is not just bias on the part of program directors.

The Step 1 and Step 2 only test your medical knowledge base - that's it. They don't test whether you know how to take care of patients, write notes, do lateral thinking/integrating of the information that you know. And Step 1 and step 2 don't show anything about how hard your school has worked you during 3rd/4th year. How many patients per night on call did you admit? How much responsibility did you assume in taking care of them?

In US schools, the 3rd year grades often count as much as 1st/2nd year combined, because the clinical clerkships are considered so super important. In part, when residency directors take a student, they are buying a product of the particular school that graduated that student; and what program directors are saying when they don't want to take these Caribbean students is that they don't think the product they are putting out is very good. Maybe some of that is bias, but a lot of the bias is based on their experiences, or the experiences of other physicians/PD's they know. Besides, if you read the original post, you saw that the students described in the post were not up to snuff clinically. They clearly were not ready to function as interns. It certainly can happen that the people with the super high test scores are not necessarily the best clinically. There is LOT more to med school and being a physician than taking and passing tests. Don't get me wrong - those tests are important. We have to have some objective measuring stick by which we can evaluate someone's medical knowledge. There is so much more to residency selection than that. If the USMLE were the only thing that was important, we wouldn't need to do 3rd/4th year clinical rotations at all, or go on interviews...we could all just submit our board scores and programs would rank us based on that.

Great post. Thanks.

So on one hand, Step scores can be considered to "determine our future", yet they are not indicators of how we'll function in real patient care.

In that case, shouldn't the step scores be replaced with some standard of measure that actually has some definitive meaning to it?

 

[Raigon]

Great post. Thanks.

So on one hand, Step scores can be considered to "determine our future", yet they are not indicators of how we'll function in real patient care.

In that case, shouldn't the step scores be replaced with some standard of measure that actually has some definitive meaning to it?

Not sure, but I believe Step 2 and Step 3 covers doctor-patient interaction.

 

[Phur]

A couple more things came to mind as I was thinking about this some more.

First, since 99 is generally a little below 240 and up, 15-20% of med students are running around saying they got a 99 (assuming a gaussian distribution). The guy with 260, however, is going to look more impressive than the gut with 237. Not all 99's are created equal.

Secondly, I was trying to figure where a PD could potentially see through the facade of someone who just tests well, but really isn't that good. I'm assuming clinical grades were less than impressive, especially if they're getting to 4th year, but not knowing basic clinical aspects. A 'Satisfactory' is really going to hold someone back compared to those with similar stats and honors in rotations. And I'm also guessing MSPE comments were probably less than perfect.

As someone entering clinicals in the next few months, definitely some thinking to be done. Try and learn from others' mistakes.

On the subject of the Steps, Step 1 (maybe the others, too) was originally designed as a P/F exam. It wasn't intended to become what it is today. It's purpose was to test whether you had enough knowledge to enter the hospital setting. But since numbers are attached to it, it's become a measuring tool for which it wasn't meant to be. I've heard they want to change the Steps in the somewhat near future too, but I don't know enough about it to really comment.

 

[relaxedMD]

I will respond below to aprogdirector.

I fully agree with almost all you have said, but the above is confusing. The way the match alg works, you cannot hurt yourself by ranking very competitive programs highly. It will try to fit you into them, and if it fails it will move down your list. Each time you get bumped out of a program on your rank list, the next prog on your list becomes your "new #1". So, you cannot hurt your chances of matching by ranking "reach" programs highly -- in fact, this is exactly what you should do.



If above you were trying to say that perhaps because of his double 99's etc he only applied to competitive programs and "set his hopes too high" on competitive NS and GS programs (note: no such thing as a noncompetitive NS program) and then only got 6 IV's, that's certainly possible and I totally agree.

When I spoke to him, I got the sense that he spent a majority of his time wooing the one NS program here. He was counting on a match in Neurosurgery at this institution. To his credit, he did an away month (audition rotation) and received an LOR from the PD. That was his only NS interview. The other 5 IVs were cat general surgery. He felt that Categorical General Surgery was his back up. I remember thinking that was too cocky. This is what set him back perhaps, a big ego coming from an average caribbean school.

I agree with you, he did nothing wrong by ranking NS first. That is what you are supposed to do. But before the ROL was submitted, I wonder how much time he spent communicating with the general surgery PDs and coordinators trying to get second looks, personal sitdown conversations, send notes of interest, etc. Maybe he did everything possible, I just dont know. I am only relaying what I gathered in conversations with him and his close peers.

As for the places he interviewed at, I am not sure of those details. What I know is that he didnt get any top tier university programs, what he got was a couple of mid tier univ and the rest low tier community hospital programs.

I hope that clarifies the details that I have at this time.

rlxdmd

 

[relaxedMD]

A couple more things came to mind as I was thinking about this some more.

First, since 99 is generally a little below 240 and up, 15-20% of med students are running around saying they got a 99 (assuming a gaussian distribution). The guy with 260, however, is going to look more impressive than the gut with 237. Not all 99's are created equal.

Secondly, I was trying to figure where a PD could potentially see through the facade of someone who just tests well, but really isn't that good. I'm assuming clinical grades were less than impressive, especially if they're getting to 4th year, but not knowing basic clinical aspects. A 'Satisfactory' is really going to hold someone back compared to those with similar stats and honors in rotations. And I'm also guessing MSPE comments were probably less than perfect.

As someone entering clinicals in the next few months, definitely some thinking to be done. Try and learn from others' mistakes.

When PDs look at scores they do a double take if they see stellar scores such as double 99's. IMO 230 and above means you spent a lot of time preparing in school. And that is why PDs have cut offs for most semi- and competitive programs.

Where this student went wrong, the purpose of the original post, is that he chose to go to a second rate carib school because it was cheap and easy to get into. HIS school did not even hold a SHELF exam after the core rotations. The Students had never had their knowledge examined after rigorous core training. That is a major red flag.

Replay:
Assoc PD "How did you do on your surgery SHELF?"
Student from said school "We didn't have to take the SHELF when we finished surgery?"
Assoc PD "Why not?"
Student... "Our school does not require it for our grades."
Assoc PD to 3rd Year Surgery Resident " What kind of school doesn't require a quantitative evaluation of their student's progress?!!?!"
Surgery Resident "A caribbean school, I guess?"

Actually happened in front of my face. I quickly interjected and disagreed that not all Caribbean schools behave this way. I said, "SGU has qualitative and quantitative evaluation methods"....blah, blah and etc.

What message do you think this sends to the actual PD? For that matter what do you think the Gen Surg PD said to the NS PD when he/she heard this.
That school did not even have a standard evaluation form for all of their cores. They had the most generic form, where half of it was left blank for comments. As far as MSPE comments, I dont even know if that school cared enough to hire a good team of advisors and counselors to guide the students during the ERAS/NRMP process. I speculate when I say it was probably written poorly as well.

In all SERIOUSNESS, the caribbean world needs a governing body to standardize their clinical curriculum, including dedicated time to clinical skills practice. Additionally they need to ensure that every student logs an average amount of training during clinical years in the US; training that is certified with a formal oral and written examination. Too many of these students go to community hospitals that dont care to train students and over work their own residents so they cant take the time to teach. How well will they learn in that environment?

This particular caribbean school hurt one of it's best students by not preparing him well enough to compete for his dream residency.

rlxdmd

 

[Knicks]

^^ wow, that's rough.

By any chance, do you know the name of the school in question? Well, you probably DO know it, so the question would be, would you be willing to mention it?

 

[NotAProgDirector]

When I spoke to him, I got the sense that he spent a majority of his time wooing the one NS program here. He was counting on a match in Neurosurgery at this institution. To his credit, he did an away month (audition rotation) and received an LOR from the PD. That was his only NS interview. The other 5 IVs were cat general surgery. He felt that Categorical General Surgery was his back up. I remember thinking that was too cocky. This is what set him back perhaps, a big ego coming from an average caribbean school.

Totally agree that if he spent the majority of his time / energy trying to win an NS spot, it perhaps cost him a GS spot. Of course, if he had not spent the time / energy on NS and then not gotten the spot, he'd never know if trying harder would have made a difference.

What the heck?!

So a student gets double 99's and that still won't be enough to get into a program of his choice? (carib school or not, and assuming the rest of his application is decent). I mean, ok that is a possibility, but it shouldn't be simply due to the fact that he's from the carib. What ELSE must one do? I mean, double 99's, a "very very high" step 2 score should help with SOMETHING; it's GOTTA have SOME impact SOMEWHERE.

I agree with everything that's come before. High scores on the USMLE are definitely useful -- they demonstrate that you have a baseline level of book knowledge. But there are many other things students need. In surgery especially, PD's want to know if the student has the manual dexterity, crisis management, self assurance, drive, etc to succeed. The only way to really measure those is by references. If PD's don't know your school, don't know what your rotations were like, don't know how much you actually did in the OR, etc, it will put you at a large disadvantage.

By any chance, do you know the name of the school in question? Well, you probably DO know it, so the question would be, would you be willing to mention it?

It really doesn't matter. At all. The less well known the school is, the less experience the PD has with it, the more of a problem this will be.

For example, I interviewed a student from a less well known carib school a few years ago. They had excellent steps, and did a bunch of great US rotations with great LOR's. He was a nice guy. At the end of the day, my chair said "I've never heard of that school. He's not on our list, and please don't invite anyone from it again". And that's that.

This problem exists at all non US schools. The less well known it is, the bigger the problem.

 

[Knicks]

It really doesn't matter. At all. The less well known the school is, the less experience the PD has with it, the more of a problem this will be.

For example, I interviewed a student from a less well known carib school a few years ago. They had excellent steps, and did a bunch of great US rotations with great LOR's. He was a nice guy. At the end of the day, my chair said "I've never heard of that school. He's not on our list, and please don't invite anyone from it again". And that's that.......

F*ck.

What more can a carib. student do? "Excellent steps",,,, "great US rotations",,,, "great LORs",,,, "nice guy".....

is the stigma of coming from a non-US school THAT bad????!

 

[relaxedMD]

^^ wow, that's rough.

By any chance, do you know the name of the school in question? Well, you probably DO know it, so the question would be, would you be willing to mention it?

I hope it doesnt offend you but I would like to keep this anonymous. My purpose is not to bad mouth one particular school. I am interested in stirring debate so that there can be some changes across the caribbean system.

My hope is that administrators from these schools are reading these forums as well. Key word there is HOPE.

I will be more exact by saying the school does not rest in the "Big 4" category.

rlxdmd

 

[relaxedMD]

F*ck.

What more can a carib. student do? "Excellent steps",,,, "great US rotations",,,, "great LORs",,,, "nice guy".....

is the stigma of coming from a non-US school THAT bad????!

I understand your frustration with this scenario and the one that aprogdirector just highlighted in his comments.

The key to my survival was being realistic in what I could achieve. For example, suppose I absolutely loved and wanted integrated plastic surgery, there is no chance that I would have matched, no matter how hard I worked in my FOUR YEARS OF CARIBBEAN MEDICAL TRAINING. I know this because they post the match statistics on the NRMP website each year. According to those statistics my chances of matching Integrated Plastic Surgery was smaller than my chances of winning the mega jackpot twice in a lifetime (BY THE WAY: does anyone want to calculate these odds for real...i am just "guestimating".) MY point is, the chances are virtually NONE. Knowing that, would I choose to waste my time pursuing something that unrealistic?
The answer should be a logical one.

When deciding where they would like to be in their career ten years down the line, most US med students go with their heart, their passion. IMO Caribbean grads dont have that luxury with competitive specialties and we need to go with our heads. The statistics are posted every year; every year someone is "shocked they didnt match rads, ortho, ophtho, neurosurgery" from the caribbean.

aprogdirector: Thank you for your insight on the matter. It reinforces what I have been trying to highlight.

rlxdmd

 

[Raigon]

I understand your frustration with this scenario and the one that aprogdirector just highlighted in his comments.

The key to my survival was being realistic in what I could achieve. For example, suppose I absolutely loved and wanted integrated plastic surgery, there is no chance that I would have matched, no matter how hard I worked in my FOUR YEARS OF CARIBBEAN MEDICAL TRAINING. I know this because they post the match statistics on the NRMP website each year. According to those statistics my chances of matching Integrated Plastic Surgery was smaller than my chances of winning the mega jackpot twice in a lifetime (BY THE WAY: does anyone want to calculate these odds for real...i am just "guestimating".) MY point is, the chances are virtually NONE. Knowing that, would I choose to waste my time pursuing something that unrealistic?
The answer should be a logical one.

When deciding where they would like to be in their career ten years down the line, most US med students go with their heart, their passion. IMO Caribbean grads dont have that luxury with competitive specialties and we need to go with our heads. The statistics are posted every year; every year someone is "shocked they didnt match rads, ortho, ophtho, neurosurgery" from the caribbean.

aprogdirector: Thank you for your insight on the matter. It reinforces what I have been trying to highlight.

rlxdmd

My god that's scary... does the same thing happen with the Big 4, (i.e. SGU, SABA, ROSS, AMA) - as in, will they discriminate against them just because they are from the Caribbean, even if they are the best 4?

For example, say someone has high USMLE scores (270/99+), good LORs, outstanding clinical performance, an excellent interview and he comes from St. George University School of Medicine. Will he be turned down just because he's from a Caribbean medical school, even if it's from a reputable Caribbean? Or will the big 4 actually help in the process and add points?

 

[Knicks]

I hope it doesnt offend you but I would like to keep this anonymous.

Nah, not offended at all, and I completely understand.

 

[NotAProgDirector]

My god that's scary... does the same thing happen with the Big 4, (i.e. SGU, SABA, ROSS, AMA) - as in, will they discriminate against them just because they are from the Caribbean, even if they are the best 4?

For example, say someone has high USMLE scores (270/99+), good LORs, outstanding clinical performance, an excellent interview and he comes from St. George University School of Medicine. Will he be turned down just because he's from a Caribbean medical school, even if it's from a reputable Caribbean? Or will the big 4 actually help in the process and add points?

The answer to your question is "yes". Being an IMG is a negative as far as matching. If you go to a Big 4 school and do well as you describe, you'll be one of the most competitive candidates coming from the Carib. You'd be very likely to get a spot in IM, Anesthesia, etc. But you would be very unlikely to get a spot in the most competitive fields, nor the most competitive programs in less competitive fields.

 

[Raigon]

The answer to your question is "yes". Being an IMG is a negative as far as matching. If you go to a Big 4 school and do well as you describe, you'll be one of the most competitive candidates coming from the Carib. You'd be very likely to get a spot in IM, Anesthesia, etc. But you would be very unlikely to get a spot in the most competitive fields, nor the most competitive programs in less competitive fields.

Hmm... suppose there two people as claimed above (both outstanding stats and everything). One is from St. George. The other is from a very prestigious and well known medical school outside the United States: i.e. Cambridge, University of Sydney, Flinders University, Tokyo University, top universities in Ireland etc. Would the person from St. George or prestigious international medical school have more of an advantage or are their status equal and will equally be looked down on by program directors?

That's what I don't understand, will reputation of your school make a difference or as long as you are an IMG you will be treated like a piece of **** no matter how much you shine (even if you are a US citizen and top student from say... Cambridge or Oxford, I think most PDs SHOULD have heard of those)? If that's the case, then America SUCKS. I'm sorry for saying that, being an American and all, too.

 

[Shoushu]

What the heck?!

So a student gets double 99's and that still won't be enough to get into a program of his choice? (carib school or not, and assuming the rest of his application is decent). I mean, ok that is a possibility, but it shouldn't be simply due to the fact that he's from the carib. What ELSE must one do? I mean, double 99's, a "very very high" step 2 score should help with SOMETHING; it's GOTTA have SOME impact SOMEWHERE.

In that case, double 99s also shouldn't (and probably DON'T) guarantee anything for AMGs either then.

ex: If someone knows high school algebra and can teach it to my kid, I don't care where he learned the algebra; US, Mars, Jupiter.,,,,, just teach my kid. But if you're gonna say that someone who learned algebra on Mars isn't guaranteed to teach it (just cuz he's from Mars), then the person who learned algebra in the US should also not be guaranteed to teach it.

Do Double 99's mean 99-Percentiles on Step 1 and Step 2? If they outscore 99% OF homeland students and 99% OF Carib/other foreign students, how can one say they don't have enough medical knowledge?

The student from low-tier carib might say, "Look, I scored higher than 99% of US-based students, and I'm American Citizen with all other things like LORs, ECs, equal. Still not having a spot in gen surg?"

 

[NotAProgDirector]

Hmm... suppose there two people as claimed above (both outstanding stats and everything). One is from St. George. The other is from a very prestigious and well known medical school outside the United States: i.e. Cambridge, University of Sydney, Flinders University, Tokyo University, top universities in Ireland etc. Would the person from St. George or prestigious international medical school have more of an advantage or are their status equal and will equally be looked down on by program directors?

That's what I don't understand, will reputation of your school make a difference or as long as you are an IMG you will be treated like a piece of **** no matter how much you shine (even if you are a US citizen and top student from say... Cambridge or Oxford, I think most PDs SHOULD have heard of those)? If that's the case, then America SUCKS. I'm sorry for saying that, being an American and all, too.

Depends on the PD. I agree that all things being equal (which is impossible, but assuming) the student from a "famous" european school would probably have a big advantage. But it really comes down to each PD's decision about where someone belongs on the match list.

 

[Raigon]

Depends on the PD. I agree that all things being equal (which is impossible, but assuming) the student from a "famous" european school would probably have a big advantage. But it really comes down to each PD's decision about where someone belongs on the match list.

Ah okay. I thought all IMGs were treated bad. Guess where you go to school does make a small difference, even if only by a little. But that would also depend on the program director and existing that factor would be a hindrance, as it limits what programs you can apply to that will give you that advantage.

Sorry for being a bit emotional on this. I know a few international US citizens like me who were forced by their family during middle school or high school to move to another country and it's not our fault we were forced to study college and medical school in another country. It's not that we couldn't make it to a US medical school, it's just that we don't want to have to take a post-bacc in order to fulfill US prerequisite. It seems a bit unfair to judge all foreign schools inferior or unequal to US schools. But we do want to return to the United States to practice medicine and don't want to be looked down upon simply because we studied outside the United States. But some program directors won't even consider that; they just think, "Oh look he/she's not from a US medical school"... CLICK. This applicant has just been rejected. Guess that was what I was angry about.

Well, I guess it's down to this: I'm applying for medical school in Australia first. If I can't get in, then I'll go for the Caribbean route, but only the big four. Ugh... a lot of material to cover on the USMLE and we'll have to start from year 1 because Aussie curriculum won't cover it. Scores will make a difference, but it shouldn't determine everything. But you can't just reject an applicant because your medical school isn't from the United States.

I do however, agree and understand that two applicants with equal standing, if one is from a foreign medical school and one is from a US medical school, they give priority to that US medical student. That's obvious, a country should definitely pick a US student first because they're from the US and US wants to train their own doctors as of all other countries. However, if one really bad AMG with horrible stats and horrible clinical skills gets picked over an IMG (with US citizenship) with outstanding stats and excellent clinical skills, I would definitely want to file for discrimination. Because that's just ridiculous and I hope that really doesn't happen.

Hrm... one last question though - how much will a difference of 2 years clinical rotation by the Caribbean vs the two 4~6-week blocks overseas electives make? Some say that the 2 year difference will make a more powerful impact, but some people say the US clinical rotations is just to fulfill some minimal requirements and get letters of recommendations. One of the attending physicians on SDN from Flinders University, Australia, (perhaps you've heard of her, she's one of the administrators here; I won't mention who as to respect your privacy, but you should know who) is an attending surgeon and she says that the 2 months is definitely enough to get the hospitals to know you and write you a good letter of recommendation?

But perhaps that was because she matched about 5~10 years ago, things may have changed over the past decade. I'm not sure. But now, all I know is that for now, for IMGs, the NRMP will be an uphill battle against a torrent of bullets and cannons raining down on you with the enemy screaming, "Go back to your own country!" =D And with the health care bill just recently passed (yes it passed damn it), who knows how it will affect IMGs now???

 

[dragonfly99]

a "99" score on one of the USMLE steps does NOT equal 99th %ile. I scores in that range on one of the steps and I definitely did not outscore 99% of applicants...perhaps 90% or so.

Regarding the person who posted above...very, very few Caribbean students make 270 on the USMLE. Very, very few US students make that score. Remember, most student who are in the Caribbean are there because they didn't have the grades and/or MCAT scores to get into a US school. A lot of them aren't good standardized test takers, particularly for the US-born students (as opposed to Canadians and others).

People on here STILL don't seem to get that the USMLE is just a written test of basic knowledge. Even that standardized patient exam that is part of Step 2 is pretty basic and only shows if you have very basic knowledge and know how to do (or at least fake doing) an exam on a patient (who is fake anyway). A lot of US schools spend tremendous resources setting up clinical clerkships for their students to learn skills of basic patient care they will need to know as an intern. There are still quite a few lectures during 3rd/4th year, there is hopefully a lot of informal teaching that goes on during rounding on patients, in the operating room, etc. at a good teaching hospital. A lot of these Caribbean schools just shunt their students off to random hospitals, where there might only be a handful of fellow students at a time (if that) and NOBODY accountable for teaching the students, pretty much. This isn't necessarily true of all the schools, but it is true of some of them. So even if these students have high USMLE scores, the program directors are likely to look askance at their applications, since their clinical training is likely not to be up to snuff.

Another thing about the Caribbean schools is that people know that some people are down there because they had problems in their background (trouble with the law, thrown out of a US school, etc.) and this makes some people worry about these students. Realistically, I know that this %age of Caribbean students is likely to be very low, and I personally wouldn't worry that much about it, but I think that some faculty members do.

 

[Shoushu]

\

a "99" score on one of the USMLE steps does NOT equal 99th %ile. I scores in that range on one of the steps and I definitely did not outscore 99% of applicants...perhaps 90% or so.

Regarding the person who posted above...very, very few Caribbean students make 270 on the USMLE. Very, very few US students make that score.

So what does scoring 99 on the USMLE even mean? What does Double 99 mean? Esp if the average score is 200 something?

Of course scoring 270 is hard. I heard that though perfect score's supposedly 300 for USMLE I , no one ever scores perfect as someone might score perfect 1600 SAT or perfect 36 ACT.

 

[Raigon]

a "99" score on one of the USMLE steps does NOT equal 99th %ile. I scores in that range on one of the steps and I definitely did not outscore 99% of applicants...perhaps 90% or so.

Regarding the person who posted above...very, very few Caribbean students make 270 on the USMLE. Very, very few US students make that score. Remember, most student who are in the Caribbean are there because they didn't have the grades and/or MCAT scores to get into a US school. A lot of them aren't good standardized test takers, particularly for the US-born students (as opposed to Canadians and others).

People on here STILL don't seem to get that the USMLE is just a written test of basic knowledge. Even that standardized patient exam that is part of Step 2 is pretty basic and only shows if you have very basic knowledge and know how to do (or at least fake doing) an exam on a patient (who is fake anyway). A lot of US schools spend tremendous resources setting up clinical clerkships for their students to learn skills of basic patient care they will need to know as an intern. There are still quite a few lectures during 3rd/4th year, there is hopefully a lot of informal teaching that goes on during rounding on patients, in the operating room, etc. at a good teaching hospital. A lot of these Caribbean schools just shunt their students off to random hospitals, where there might only be a handful of fellow students at a time (if that) and NOBODY accountable for teaching the students, pretty much. This isn't necessarily true of all the schools, but it is true of some of them. So even if these students have high USMLE scores, the program directors are likely to look askance at their applications, since their clinical training is likely not to be up to snuff.

Another thing about the Caribbean schools is that people know that some people are down there because they had problems in their background (trouble with the law, thrown out of a US school, etc.) and this makes some people worry about these students. Realistically, I know that this %age of Caribbean students is likely to be very low, and I personally wouldn't worry that much about it, but I think that some faculty members do.

I understand that they have bad impressions of Carribbean medical schools, but why of IMGs in general? What if the American studied outside the United States like I wrote in my post above and received strong grades and entered a strong medical school? Why discriminate against those people as well?

That's what I don't feel right about. There are a lot of PDs who seem to dislike all IMGs whether they're from a good school or not and whether they're actually strong applicants or not simply because they didn't go to a US medical school.

And with the health care bill recently just passed, it will be even more of an uphill struggle for IMGs like us.

Gee, thanks a lot Obama.

\


So what does scoring 99 on the USMLE even mean? What does Double 99 mean? Esp if the average score is 200 something?

Of course scoring 270 is hard. I heard that though perfect score's supposedly 300 for USMLE I , no one ever scores perfect as someone might score perfect 1600 SAT or perfect 36 ACT.

No, 99 is a double digit score you receive in which after you pass a certain score in the 3 digit score (230~240, I don't know the exact numbers). Before that, it's just interpolation I assume.

Yeah, scoring 270 is hard, but I personally know a friend (look in the Australian forums for his post on his experience) from my country that scored a 276/99 on his step 1. He says it depends on how much you study, but then again he was always a nerd =D (38 on his MCAT, woohoo).

Of course no one's scored a 300 for the USMLE! You're not supposed to! I mean, has anyone scored a 45T on the MCAT? I should think not (although there was a rumor somewhere in the forums that there was someone who did, but I forgot where).

Comparing the MCAT/USMLE to SAT/ACT is like comparing hard university material and elementary school material.

 

[NotAProgDirector]

I know a few international US citizens like me who were forced by their family during middle school or high school to move to another country and it's not our fault we were forced to study college and medical school in another country.

Not to make a big deal of it, but if you knew you wanted to come back to the US to practice medicine, you could have come to college in the US after graduating from an international school, so I don't really see this as your parent's fault.

It's not that we couldn't make it to a US medical school, it's just that we don't want to have to take a post-bacc in order to fulfill US prerequisite.

It would be much safer to do whatever prereq's are necessary and then go to a US medical school than to go to Aus or the Carib. You may not want to do this, but that's what you should do.

But you can't just reject an applicant because your medical school isn't from the United States.

I do however, agree and understand that two applicants with equal standing, if one is from a foreign medical school and one is from a US medical school, they give priority to that US medical student. That's obvious, a country should definitely pick a US student first because they're from the US and US wants to train their own doctors as of all other countries. However, if one really bad AMG with horrible stats and horrible clinical skills gets picked over an IMG (with US citizenship) with outstanding stats and excellent clinical skills, I would definitely want to file for discrimination. Because that's just ridiculous and I hope that really doesn't happen.

Actually, I can simply reject an applicant because of their medical school, and it's not discrimination. I'm not allowed to discriminate based on sex, age, religion, etc. But I certainly can choose people based upon medical school quality. And "quality" is in the eye of the beholder, not based on any lists or other nonsense. As mentioned above, there are plenty of people who do well on the USMLE but then have trouble in clinical medicine. medical school is more than exams. If there is a medical school which I do not feel has high enough quality, or simply one I am not familiar with and hence really don't know, I can decide not to interview people from that school. And you have no basis to sue.

Hrm... one last question though - how much will a difference of 2 years clinical rotation by the Caribbean vs the two 4~6-week blocks overseas electives make? Some say that the 2 year difference will make a more powerful impact, but some people say the US clinical rotations is just to fulfill some minimal requirements and get letters of recommendations. One of the attending physicians on SDN from Flinders University, Australia, (perhaps you've heard of her, she's one of the administrators here; I won't mention who as to respect your privacy, but you should know who) is an attending surgeon and she says that the 2 months is definitely enough to get the hospitals to know you and write you a good letter of recommendation?

But perhaps that was because she matched about 5~10 years ago, things may have changed over the past decade. I'm not sure. But now, all I know is that for now, for IMGs, the NRMP will be an uphill battle against a torrent of bullets and cannons raining down on you with the enemy screaming, "Go back to your own country!" =D And with the health care bill just recently passed (yes it passed damn it), who knows how it will affect IMGs now???

Although quantity of rotations is important, it's quality of rotations that's more important. 4 weeks in a high quality location with good LOR's is probably sufficient to match in the less competitive fields, although I would target 8-12 weeks. The two years of clinicals offered by Carib schools are of mixed quality -- if you want to succeed, it's best to arrange your own 4th year rotations at more academic institutions.

 

[Raigon]

Not to make a big deal of it, but if you knew you wanted to come back to the US to practice medicine, you could have come to college in the US after graduating from an international school, so I don't really see this as your parent's fault.

Not really, as my parents basically said, "Go to a college in Taiwan or we'll cut you off financially." It's not impossible, but it was near impossible. And I was still in high school then. I was like... 17 or 18. I didn't know that much at that time yet geez, give me a break.

It would be much safer to do whatever prereq's are necessary and then go to a US medical school than to go to Aus or the Carib. You may not want to do this, but that's what you should do.

It may be out of pride, but it's also because I want to leave another option open in case I don't get matched. I suppose I want to go to Australia because I like Australia, too and if I don't match into a US residency, then I can stay in Aussie because it's not a bad country either.

Actually, I can simply reject an applicant because of their medical school, and it's not discrimination. I'm not allowed to discriminate based on sex, age, religion, etc. But I certainly can choose people based upon medical school quality. And "quality" is in the eye of the beholder, not based on any lists or other nonsense. As mentioned above, there are plenty of people who do well on the USMLE but then have trouble in clinical medicine. medical school is more than exams. If there is a medical school which I do not feel has high enough quality, or simply one I am not familiar with and hence really don't know, I can decide not to interview people from that school. And you have no basis to sue.

Perhaps I was going a bit too far saying it was discrimination. Perhaps I didn't make myself clear and I wasn't thinking straight at that time and now I've calmed down. I guess I just wanted to say that just because it's not a school from the united States doesn't mean it's worse than a US medical school. That's all I wanted to say.

Although quantity of rotations is important, it's quality of rotations that's more important. 4 weeks in a high quality location with good LOR's is probably sufficient to match in the less competitive fields, although I would target 8-12 weeks. The two years of clinicals offered by Carib schools are of mixed quality -- if you want to succeed, it's best to arrange your own 4th year rotations at more academic institutions.

Yeah, I understand that. I know a few people who've matched back telling me quality over quantity. 8~12 weeks is a magic number. Thanks!

Again, I apologize for going out of hand on my last post. I've calmed down a little now. Thanks.

 

[NotAProgDirector]

Again, I apologize for going out of hand on my last post. I've calmed down a little now. Thanks.

I think it's fair to say that I got a bit out of hand also. My apologies if my post came across as harsh.

I agree that if an Aus medical school leaves you the option of training/living in Aus permanently, that is a better choice than the Carib which (obviously) doesn't have that option.

Good luck!

 

[ButImLETired]

Not really, as my parents basically said, "Go to a college in Taiwan or we'll cut you off financially." It's not impossible, but it was near impossible. And I was still in high school then. I was like... 17 or 18. I didn't know that much at that time yet geez, give me a break.



It may be out of pride, but it's also because I want to leave another option open in case I don't get matched. I suppose I want to go to Australia because I like Australia, too and if I don't match into a US residency, then I can stay in Aussie because it's not a bad country either.



Perhaps I was going a bit too far saying it was discrimination. Perhaps I didn't make myself clear and I wasn't thinking straight at that time and now I've calmed down. I guess I just wanted to say that just because it's not a school from the united States doesn't mean it's worse than a US medical school. That's all I wanted to say.



Yeah, I understand that. I know a few people who've matched back telling me quality over quantity. 8~12 weeks is a magic number. Thanks!

Again, I apologize for going out of hand on my last post. I've calmed down a little now. Thanks.

I think another important factor is that program directors aren't necessarily just stigmatizing IMG's on principle. The US medical school system is extremely standardized, and in order to be a part of the system (ACGME, I think) you must follow extremely strict rules. This is why very legitimate, long-standing med schools are put into probation occasionally. They are very strict as far as what each med student should be taught, quality of clinical training, etc. This is why you can get a residency just about anywhere from anywhere in the US. The residency directors know how you've been trained, and know that it was fairly standardized. There's way less of a chance of getting a wild card who learned nothing. Plain and simple.
People get very stuck on the name of a school, but they forget that residency directors just don't want to get a dud. A student with good grades and a decent Step 1 score is still a safer bet than a student from a school whose clinicals are all over the US and largely community-based, regardless of his/her step 1 score. Step 1 tests, as someone in another thread pointed out, what foramen the greater petrosal nerve enters, etc. Is it useful? Maybe. But not nearly as useful long-term as extremely solid clinical training.