feeling like a blacksheep

[harmnot]

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I am US-IMG med student who just started a rotation in a hospital where there are US med students. Well, I have done other rotations at the hospital that was challenging but good overall with good evaluations. However, on this particular rotation, I am having a really hard time. The attending along with the US med students are from a local US med school teaching/rotating at this community hospital. I understand the stigma that US-IMG students have to face in spite of hard work and board scores...etc. But this attending goes out of his/her way to ask only the "US" students questions, gives me the cold shoulder, basically, I don't exist. Patients that I interview gets ignored or has to wait a really long time. I am doing everything that I did in my past rotations, I work hard, try to help, try to prepare, try to stay out of the way....when I should...My biggest fear is this attending will give me a terrible eval. simply because I am a US-IMG....I am going on the way I am being treated. My question is, is there anything I can do or should do that I am not already doing?

 

[Tigerz_Fan]

Well, if you are prepared every day, are reading about the medical problems your patients, are busting your butt with scutwork, and developing a good professional relationship with the other US students, then you are doing everything you can.

If you have developed a good working relationship with the other students, ask them if they have noticed the problem.

I assume you have advisors at your school. I would start discussing the problem with them now, so the bad eval would not be a shock.

I'm also going to PM you in a minute to get more info....

 

[doc20]

in medicine never take anything personal
and just dont ever be over senstitive, or life would become overly miserable!

 

[BlondeDocteur]

I am going to say something that might strike you as kind of mean. It will definitely strike you as unfair. It's meant to be a "this is the way the world is, NOT how it should be" kind of thing. But perhaps it could help you understand and address the problem. It's a sort of sociological analysis.

My medical school is a famous one, and a snobbish one. We have students rotate in the summer from less famous institutions, be they state allopathic schools, osteopathic schools, Caribbean, or foreign-foreign.

The students who go to my medical school and its "peer institutions" in general have gone to famous colleges and were expensively privately educated before that. They are very polished, very bright, and present themselves to the world in a particular way. They speak fluently, present very well, and can discuss all matter of topics in an informed, educated way.

Medical students from the less famous schools come on service and immediately seem different. It has nothing to do with their medical knowledge or boards scores, which in many cases are equal or superior to the home students'. In general, it's an issue of opinion and speech. For example, in the paragraph of your original post you made several syntax errors (using the singular conjugation of a verb when you needed the plural, for example). If you were to do that when presenting a patient or even simply discussing the news headlines of the day with the attending that would not be well received.

You might say "that's bull****, what on earth does that have to do with taking care of patients?! I'm here to be evaluated on the basis of my performance as a medical student!" and you would be absolutely correct. It's not fair, at all. But it is often the case that attendings, residents and home students extrapolate from speaking skills and casual chitchat a notion of a person's intelligence and capability.

"Working hard" and "staying out of the way" wouldn't remedy the perception, and the latter especially wouldn't go very far towards correcting things. My advice would be to work very hard on polishing your oral presentation skills and to learn to voice opinions (on a case) succinctly and fluently.

Of course, I could be nuts, so feel free to take this with a grain of salt.

 

[novastorm]

.

 

[Elfy]

Patients that I interview gets ignored or has to wait a really long time.

Blonde Docteur,

I taught college in NYC and I had many American-born, "expensively privately educated" students whose syntax and spelling looked exactly like this. I also had many immigrant students, facing constant financial and visa status hardships, whose written English was flawless.

My point is that language skills have nothing to do with being "expensively privately educated". They have everything to do with a love of learning and hard work stemming from the parents that the child picks up or not.

Moderators: Would you agree that this thread belongs in the Clinical Rotations section rather than in the General Residency sub-forum?

 

[BlondeDocteur]

Fair enough. I wasn't arguing that only the "expensively privately educated" could speak their own language well (else, if you look at my signature, I'd be hanging myself by my own rope). The two are often correlated, though.

 

[DarthNeurology]

. . . The attending along with the US med students are from a local US med school teaching/rotating at this community hospital. I understand the stigma that US-IMG students have to face in spite of hard work and board scores...etc. But this attending goes out of his/her way to ask only the "US" students questions, gives me the cold shoulder, basically, I don't exist. Patients that I interview gets ignored or has to wait a really long time. I am doing everything that I did in my past rotations, I work hard, try to help, try to prepare, try to stay out of the way....when I should...My biggest fear is this attending will give me a terrible eval. simply because I am a US-IMG....I am going on the way I am being treated. My question is, is there anything I can do or should do that I am not already doing?

The reason why the attending is more friendly with the U.S. students is because they are from the same school, and perhaps even this attending has worked with these same students before and maybe designs curriculum for this school.

If you are worrying about an eval and trying to "stay out of the way" this actually is counter productive. Focus on taking care of the patients and studying. If you *don't* have a higher than average step 1 score, then you may have a knowledge deficit compared to the U.S. students. Most IMGs/FMGs have lower board scores than U.S. students, although there is some overlap. You have to be proactive in any rotation to get a good grade.

If the attending is asking the U.S. students questions, then ask the attending good questions about the patient care, this will make you more involved and part of the team.

 

[DarthNeurology]

My medical school is a famous one, and a snobbish one. We have students rotate in the summer from less famous institutions, be they state allopathic schools, osteopathic schools, Caribbean, or foreign-foreign.

The students who go to my medical school and its "peer institutions" in general have gone to famous colleges and were expensively privately educated before that. They are very polished, very bright, and present themselves to the world in a particular way. They speak fluently, present very well, and can discuss all matter of topics in an informed, educated way.

"Working hard" and "staying out of the way" wouldn't remedy the perception, and the latter especially wouldn't go very far towards correcting things. My advice would be to work very hard on polishing your oral presentation skills and to learn to voice opinions (on a case) succinctly and fluently.

Of course, I could be nuts, so feel free to take this with a grain of salt.

Well, Columbia is not on the level of Harvard, or on the level of John Hopkins, it is near the 10th position of medical schools and perhaps this is because of research which many medical students don't participate in. There are at least 40 to 50 medical schools just as good as Columbia in terms of clinical education/basic sciences which is more uniform than you think from medical school to medical school.

If you do very well at a state school, i.e. good board scores and clinical evaluations, then you would have a better shot at plastic surgery than someone who went to medical school at Columbia and got average board scores or clinical grades.

In the real world the name of your medical school doesn't mean that much among U.S. medical schools if you don't have the grades and board scores to go along with your residency application.

In terms of having to go to a fancy private college to go to Columbia's school of medicine, I doubt if this is true. Place that I consider truly top pedigree, like Harvard, John Hopkins, etc . . . take students from state universities, small liberal arts colleges, and private places, they don't care about a name, they want the top students!

I really don't know where Blond Docteur comes up with using proper grammar is the way to go on rotations . . . There is a slang that is used on all the wards I have been on, and it isn't proper english! From my experience the residents/students who get the best grades or are the best liked use slang and make grammatical errors BUT are nice and concise when describing things. In medicine it matters more what you are saying than how you say it (perhaps the opposite of how law works!).

There is a "fluency" that is rewarded on services, but it is a fluency with medical knowledge and terminology. I knew a US student with a heavy accent, made english grammatical errors as this was not his first language, but got great grades and matched in ENT surgery because he knew his stuff. Nobody looked down on his english skills!

While BD does have a lot of good insight, this is one of her worst posts, in that if you know your stuff on the floors you can go far no matter how many times you use a double negative.

BD has pointed out my grammatical or maybe spelling errors a couple times on this board, but I don't think this correlates with clinical grades as I made 99 on a step (250+), got excellent evals clinically, and was remarked upon during wards about how "educated" my speach was . . . by residents, in front of everybody. So, even if my grammar is off, I sound very educated as I read a lot of medicine and non-medicine stuff.

I applied for residency and Columbia and matched at a rank *above* it, and even got an email as to why I didn't rank the Columbia program higher . . . Please BD, Columbia isn't that great of a medical school. If you want to do plastic surgery I would rely more on getting an average score for plastics folks, i.e. around 240 and doing well in clinical rotations.

If BD has very polished english skills I would like to know if she honor surgery and all of her rotations . . . It seems right now she might be doing research between her third and fourth year, hard to tell as her "bio" is out of chronological order . . .

 

[mgdsh]

Have you tried speaking with the attending in private and asking him/her how your performance has been thus far, what you can do to improve and what you can do to really excel at the rotation?

Did they give you a list of objectives for students that enter the rotation?

 

[Elfy]

Fair enough. I wasn't arguing that only the "expensively privately educated" could speak their own language well (else, if you look at my signature, I'd be hanging myself by my own rope). The two are often correlated, though.

They are correlated because of reasons that have to do with socioeconomic status, race, and ethnicity.

 

[anesth02]

- Harmnot,
It's your choice if you want to take advise from someone named "blondedocteur". Enough said about that.
Well...
Sometimes it takes someone who has been in your shoes to understand were you're coming from.
All I can say is to pray that this rotation is over soon and that he/ or she does not give you a real terrible score. It is the nature of the environment of medicine at times to have attendnings that are partial to other med students or to have med students that are overly arrogant.
I recommend that you try not to alienate yourself though (no pun intended). Trust me that might worsen the situation. I'm sure you've heard keep your enemies closer, well this is true.
Still be a part of the team even though you might not be able to stand the people around you. pretend to care even when you don't. I know it may seem phony but your goal is just to survive the rotation. Telling someone about wht's going on may be a good way for damage control but it may also make you appear as a trouble maker. Frankly, it really depends on who you tell and how you say it, so that is kinda ify . So long as nothing major happens, you will still grauate and become Dr. X and tht's really all that matters. Believe it or not, not even that attending will matter years from now, who knows you may even end up beign his/her Dr. in the future.
Hang in there 🙂

 

[tracheatoedoc]

There is bias against IMGs.
It usually involves an egotistical attending, e.g. I'm a carib grad and the first month of my TY I'm with the attending who thinks he's the smartest MD in the world. Well I was his match and he remarked to me a number of times "wow I've never had anyone answer that" i.e. I was answering his tough questions. Having trained in england I was very good at physical exams and diagnosis and he sometimes would be surprised at my correct conclusions based on physical signs, etc. He basically gave me the lowest passing evaluation. I'm sure I was one of the best interns he ever saw clinically, but he could not get over me being from the Carib.
Fortunately it had no adverse impact on my career.
Incidentally the attending was the most brilliant physician I've ever worked with.

 

[SLUser11]

I am going to say something that might strike you as kind of mean. It will definitely strike you as unfair. It's meant to be a "this is the way the world is, NOT how it should be" kind of thing. But perhaps it could help you understand and address the problem. It's a sort of sociological analysis.

Well, Columbia is not on the level of Harvard, or on the level of John Hopkins, it is near the 10th position of medical schools and perhaps this is because of research which many medical students don't participate in.

To come to Blonde Docteur's defense, there is an unspoken bias that exists....I'm unsure if it's based entirely on semantics.....probably more of an overwhelming feeling of general superiority (usually misplaced). Still, she's not necessarily subscribing to this reasoning, just unsuccessfully trying to be a 3rd party reporter.

Darth, I find it ironic that you're trying to prove that med school names don't matter, and do so by trouncing the name of BD's specific med school as "not being top 10," which to me shows that you absolutely care about school status.

You guys can start a private chat room to discuss who's #7 versus #8 on the "bestest med schools" list....it would probably generate a lot of attention in the pre-med forums....however, it doesn't really answer the OP's question. Instead, it just shows that there is a worthless pissing match going on between our nation's "brightest" medical minds.

To the OP: Life isn't fair. You knew you'd be facing obstacles when you agreed to train at an offshore med school. Many will view yourself and your education as inferior to that of State U's allopathic school. This snobbery exists on all levels.....Harvard vs. State U vs. DO school, surgery vs. Int Med, etc.....the hard part is that you are near the absolute bottom of this status totem pole, regardless of your step 1 score......most people won't disregard what they think is a poor medical education because you scored well on a single test.

My advice would be to work hard and develop a thick skin, because this bias will follow you through the match, and likely deep into residency, despite other SDNers' cry that it won't. It is not an even playing field, and it never will be during your medical training.

 

[Elfy]

To the OP: Life isn't fair. You knew you'd be facing obstacles when you agreed to train at an offshore med school.

Maybe yes, maybe not. Maybe s/he is born abroad and given visa restrictions didn't really have a choice where to train until now, and came here to improve.

regardless of your step 1 score......most people won't disregard what they think is a poor medical education because you scored well on a single test.

Belittling someone's solid accomplishments in standardized tests (which after all as BD said are as objective a yardstick as it gets) just to reinforce ethnic prejudice does not make a good judge of character or skills in a rotation. As for shining in the match, that's what the other steps are for.

OP, e-mail the attending, cc his/her supervisor (dept chair, whatever) and make an appointment to ask her how you can improve your performance. Not why the attending doesn't seem to like or include you. That's putting the pressure on him/her. How you can improve your performance.

Ask her what s/he thinks your strengths and weaknesses are and how s/he suggests you address them.

No matter what s/he says and how, don't reply immediately or get into an argument. S/he'll only tell you "then why do you ask for my honest opinion and waste my time?" Listen to what s/he says, try not to look upset, nod, pay attention, and take notes. Go home and think calmly about what s/he said and if any of it makes sense.

Two weeks later, also via e-mail, contact the attending again, cc their supervisor, detail in your message what was originally advised, what points you have addressed, and ask for guidance on what remains to be done. Chances are, if anyone was targeting you unfairly, they'll back off.

 

[BlondeDocteur]

Darth, you have made the point over and over again that you think my medical school isn't "#1." Which is fine. All I said is that it is both famous and snobbish, and I don't think the annual shuffle dance of the USNews rankings speaks to that. Columbia, quite unlike Harvard or Hopkins, tends to accept people from a very narrow range of undergrads (Hopkins in particular is much more democratic) so I think the sociological analysis of the student body was quite correct.

I have no idea what sort of US medical school the OP is rotating through. It might be one like mine, or it might not. But if it's one like mine... 'bias' is far too weak a word to describe the utter prejudice that exists against the unpedigreed.

But all this is neither here nor there-- I just wanted to help a brotha out, and maybe shed some light on his treatment. Thanks, SLUser, for understanding my intentions.

Lastly, Darth, I don't plan on applying to plastics on the merits of my grammatical savoir-faire alone. 🙂

 

[SLUser11]

Maybe yes, maybe not. Maybe s/he is born abroad and given visa restrictions didn't really have a choice where to train until now, and came here to improve.

Well, the OP describes himself as a "US-IMG," so.....also, I didn't say the OP chose to go to an offshore med school. I said the OP agreed to go to one, knowing that prejudice existed. most people in that situation have very few actual choices. Anyway, now you've got me arguing semantics....

My point is: It doesn't matter. The bias will be there regardless.

Belittling someone's solid accomplishments in standardized tests (which after all as BD said are as objective a yardstick as it gets) just to reinforce ethnic prejudice does not make a good judge of character or skills in a rotation. As for shining in the match, that's what the other steps are for.

Slow down...don't start waving your "ethnic prejudice" flag around. The OP is self-admittedly a US-IMG, for one, and i agree it doesn't make a good judge of character.....but once again, IT DOESN'T MATTER. Not to sound like a broken record, but the whole situation is admittedly unfair.

 

[Bill_Brasky]

There is bias against IMGs.
It usually involves an egotistical attending, e.g. I'm a carib grad and the first month of my TY I'm with the attending who thinks he's the smartest MD in the world. Well I was his match and he remarked to me a number of times "wow I've never had anyone answer that" i.e. I was answering his tough questions. Having trained in england I was very good at physical exams and diagnosis and he sometimes would be surprised at my correct conclusions based on physical signs, etc. He basically gave me the lowest passing evaluation. I'm sure I was one of the best interns he ever saw clinically, but he could not get over me being from the Carib.
Fortunately it had no adverse impact on my career.
Incidentally the attending was the most brilliant physician I've ever worked with.

I want to applaud this post as one of the best and most mature I've ever seen on SDN. He notes the attending was egotistical and that his treatment of him was unfair, but is able to still accept the attending as a brilliant physician despite the flaws. Probably being a clinical bad ass from England helps, but I wish more people on this message board were this grown-up.

 

[Elfy]

Well, the OP describes himself as a "US-IMG," so.....also, I didn't say the OP chose to go to an offshore med school. I said the OP agreed to go to one, knowing that prejudice existed. most people in that situation have very few actual choices. Anyway, now you've got me arguing semantics....

My point is: It doesn't matter. The bias will be there regardless.

Slow down...don't start waving your "ethnic prejudice" flag around. The OP is self-admittedly a US-IMG, for one, and i agree it doesn't make a good judge of character.....but once again, IT DOESN'T MATTER. Not to sound like a broken record, but the whole situation is admittedly unfair.

Well, it's never been clear to me whether this is a born-abroad educated-abroad person who then managed to become a US citizen or a natural citizen who elected to attend medical school abroad.

Yes, this is semantics, which does not seem to be the OP's strong suit, at least not these days (no offense OP, you probably have a lot on your mind). Anyway, US-born IMG or US citizen FMG, I hope my advice about setting up a meeting with the attending does help clarify whatever is going on.

 

[BobA]

Isn't it possible that the attending is taking it easier on you because he/she doesn't know what to expect from you?

If they are used to having students from their own American school, they might feel more comfortable challenging them. While they might not know what to expect from you and so they don't challenge you.

Also, some of us who worked really hard to get into US medical schools resent the fact that there are people who just pay to go to a carib school and end up with similar jobs. The resentment is real and you should probably get used to it whether or not it's valid.

 

[SoCuteMD]

It's also possible that the attending is a gradute of the medical school or the local school's residency program. This always created a little bit of kinship between med students and attendings at my school. In addition, I would echo the above poster's comments on the attending having certain expectations of students from the local school, as s/he probably sees a number of them in any given year. It's also possible that the attending is more invested in those students. S/he may be evaluated by them at the end of the course, and their evaluations may play an important role in possible academic appointment or promotion.

 

[Logitech]

Whether this attending is biased or not against IMGs, you need to take action to prevent a disaster from occurring. An attending treating some medical students badly is not unique to just IMGs. Do not let this bias make you think that all is futile. What has worked in the past for many students is to go over the attendings' expectations of you and your progress throughout the rotation. If you have not already done so, charismatically ask your attending if you could meet with him at the beginning, middle, and end of the rotation to go over his expectations of you and your progress. Also, be sure to meet with your senior resident for feedback/advice and interns as well. Therefore, when you have your meeting with your attending, you can say, "I am really enjoying this rotation, and given your greater experience in this field, I was hoping you can tell me what you feel I am doing well in and what I need to improve upon." That way, the attending is forced to acknowledge the good things you have done, and when you have your meeting at the end of the rotation, or even along the way, you can say that I took your advice and improved upon these skills, and I feel I have made tremendous improvements. Thank you for your help. At the same time, you can use these meetings to let the attending know that your senior resident has been very helpful in helping you develop these skills (input skills here) and that the senior resident said these things about me (input good comments here). It's good to get feedback from senior residents and other interns because attendings will often ask them about your performance after you leave the rotation. Always have meetings on your rotations to establish what people expect from you, what you are doing well in, and what you can improve upon. It's important to have people acknowledge in words what you are doing well in, because at the end, this is what they will remember instead of letting one bad outcome define your rotation. Good luck. Hope this helps.

 

[lowbudget]

My question is, is there anything I can do or should do that I am not already doing?

Squeaky wheel gets the grease.

Don't fret over not getting enough attention as the other kids on your service. If you're doing well, you're doing well. You won't get a terrible eval if you're doing your job.

For some reason, bad students & bad residents get all the attention. Attendings don't worry about the good ones and therefore don't pay much attention to them... not by choice, but because of constraints.

Maybe the reason people think you don't matter... is... because you don't think you matter. Listen, you chose to go the school you went to for whatever reason. So be proud of it. And be proud of yourself.

As far as being "expensively privately educated", I couldn't stop from laughing, probably because I'm one of them. It's all smoke and mirrors and sorry-excuses-for-doctors put up a great act. But that's all it is... theater. Which is why I find it entertaining to watch. There are just some people out there who're better at marketing than you... welcome to the real world.

If I were you, I'd keep my eye on the big picture: If you need constant attention and feedback from an attending, you've got problems. At the end of the day, it's not your attending who'll judge your abilities as a doctor... it's your patients.

And when you get out, what will build your reputation will be your patients' outcomes and how you connect with them. Not someone who buys the most expensive advertisement...

So stop worrying about other people. Smile more, laugh more. Enjoy your rotation. Learn your stuff. Do your work. Go home. You have plenty of friends & family who think you're awesome. There's more to life than getting a good eval.

 

[harmnot]

And to think I was an English major! LOL Granted my native language is not English but I can express what I need to get across alright. Although I may not agree with everything that was written, I do appreciate everyone's thoughtful opinion and advice and will definitely take them into consideration. First of all I have trained under a number of attendings who were US grads and they were excellent and attentive teachers irregardless of where the med students came from. I think their objective was which student worked the hardest, learned the most, was the most helpful, the least arrogant, had the most appropriate bedside manners, you get the picture. Its the level of integrity and security that these "US" attendings have that makes them stand out from the few that feels the need to "baby their own." In the end, who they send out into the medical world are going to be physicians that will have to treat patients from different socioeconomic levels, race, religion, and hopefully their standard of care will not be prejudice. And that is a lesson that med students can learn from their attendings, residents...their superior. Poor students come from all walks of life. My three colleagues ( can I call them that ) who are all US med students leave early, lie about their attendance to conferences, and show up late don't reap the smug attitude that I seem to be generously given. I am not being sensitive but it does get frustrating when you want to be taught too. For a number of reasons I had to go to a caribbean med school ( grades were not stellar/3.5, no family members who were US school alumini, were not a particular religion etc. )so I was cognitive of the fact that I will have to work twice as hard and was going to have odds stacked up against me. I am cool with that for the most part, but I have faced prejudice in different forms and this is just another facet of it. And frankly it sucks! I do want to say that I have met plenty of US- IMG students that make it difficult for future US-IMG students to find an elective rotations or residency spots because of their flaws. I love medicine and I am humble and grateful and feel privileged to be in a position to possibly make a difference while getting to work in such an exciting vocation.
Ok, BlondDocteur bring out your RED pen!

 

[McGillGrad]

'irregardless' is not a word

 

[dragonfly99]

Whether this attending is biased or not against IMGs, you need to take action to prevent a disaster from occurring. An attending treating some medical students badly is not unique to just IMGs. Do not let this bias make you think that all is futile. What has worked in the past for many students is to go over the attendings' expectations of you and your progress throughout the rotation. If you have not already done so, charismatically ask your attending if you could meet with him at the beginning, middle, and end of the rotation to go over his expectations of you and your progress. Also, be sure to meet with your senior resident for feedback/advice and interns as well. Therefore, when you have your meeting with your attending, you can say, "I am really enjoying this rotation, and given your greater experience in this field, I was hoping you can tell me what you feel I am doing well in and what I need to improve upon." That way, the attending is forced to acknowledge the good things you have done, and when you have your meeting at the end of the rotation, or even along the way, you can say that I took your advice and improved upon these skills, and I feel I have made tremendous improvements. Thank you for your help. At the same time, you can use these meetings to let the attending know that your senior resident has been very helpful in helping you develop these skills (input skills here) and that the senior resident said these things about me (input good comments here). It's good to get feedback from senior residents and other interns because attendings will often ask them about your performance after you leave the rotation. Always have meetings on your rotations to establish what people expect from you, what you are doing well in, and what you can improve upon. It's important to have people acknowledge in words what you are doing well in, because at the end, this is what they will remember instead of letting one bad outcome define your rotation. Good luck. Hope this helps.

I agree with this 100%. Actually 1000%. Having been through med school and IM residency, I can say that this is how the students who got great evals got great evals. It isn't necessarily a matter of working hard, trying hard, etc. When you approach things as described above, it is hard for people not to be in your corner. I think it's important that you don't panic, because I don't see evidence of major badness going on here.

I don't know whether this is anti-IMG bias or not. It might be. It might not be. Perhaps the attending is just distracted, or he already knows the other med students from prior rotations, or he/she just isn't used to having 3 students on service at once and has trouble giving enough attention to all (that is a LOT of med students for one attending/one team, I have to say). Perhaps the attending isn't asking you a lot of questions because he/she want to slam you, knowing you are new to this institution, or perhaps avoids asking too many questions because a previous students(s) complained about being pimped. You just don't know.

You don't know what is going on, just know that you feel left out of the rotation. The best thing is to be proactive...just go to the attending and ask for a short meeting to get feedback. Repeat at midrotation and/or weekly. This makes it harder (though not impossible) to get a low evaluation. Just go for it. You can do it!

 

[BabyPsychDoc]

If I remember correctly,

alumnus (not aluminus) - singular masculine
alumni - plural masculine
alumna - singular feminine
alumnae - plural feminine

Regardless, my understanding is that unless one is aiming for one of the private, endowed colleges, one does not have to have a parent - alumnus/alumna of that school.

Go easy on BD - she just gave you an example of what she thinks might be a part of your difficulty. Good luck.

 

[harmnot]

Merriam-Webster





irregardless

One entry found.



Main Entry:ir·re·gard·less Pronunciation: \ˌir-i-ˈgärd-ləs\ Function:adverb Etymology😛robably blend of irrespective and regardlessDate:circa 1912 nonstandard : regardless
usage Irregardless originated in dialectal American speech in the early 20th century. Its fairly widespread use in speech called it to the attention of usage commentators as early as 1927. The most frequently repeated remark about it is that “there is no such word.” There is such a word, however.

 

[harmnot]

If I remember correctly,

alumnus (not aluminus) - singular masculine
alumni - plural masculine
alumna - singular feminine
alumnae - plural feminine

Regardless, my understanding is that unless one is aiming for one of the private, endowed colleges, one does not have to have a parent - alumnus/alumna of that school.

Go easy on BD - she just gave you an example of what she thinks might be a part of your difficulty. Good luck.

I stand corrected with the plural/singular thing, I have always been corrected for this error. With regards to the family being an alumni, that was just an example of how some students facilitate their acceptance into medical school. And my comment to BD, its a friendly joke.

 

[Impromptu]

I tend to speak English, not Latin:

appendixes, not appendices
pneumothoraxes, not pneumothoraces

There is a reason why Latin is a dead language. Let's keep it that way.

 

[McGillGrad]

If anything, it is slang. It is not a proper English word (regardless of its use by the uneducated.)

You can use it, but you will be judged on it.

Merriam-Webster





irregardless

One entry found.



Main Entry:ir·re·gard·less Pronunciation: \ˌir-i-ˈgärd-ləs\ Function:adverb Etymology😛robably blend of irrespective and regardlessDate:circa 1912 nonstandard : regardless
usage Irregardless originated in dialectal American speech in the early 20th century. Its fairly widespread use in speech called it to the attention of usage commentators as early as 1927. The most frequently repeated remark about it is that “there is no such word.” There is such a word, however.

 

[dragonfly99]

Geez, guys!
Since we are piling on.
"All right" is two words, and I don't think "alright" is a word, even though lots of people use it.
I bet "geez!" is not a word either

Anyway, OP, I don't know any med schools that takes much stock in someone having a parent who is an alum...that helps for undergrad at some private schools, though. I'm sure there is some nepotism that is around (like taking folks who did research at a particular school, or went to the associated undergraduate college, etc.) but that is just life. It helps to have parents who are docs...I don't but had many classmates who did in med school and I'm sure it helped them in the admissions process, and probably in med school and residency as well. Again, life is not fair.

Anyway, there are rotations in med school where you are going to get treated crappy, a lot of times through no fault of your own. This can happen to US allopathic students too. You can get stuck with house staff who are depressed, or just hostile. Same for attendings, etc. You can get people who are just low graders, etc. while your buddy down the hall gets the attending who gives everyone "honors".

As far as what the other med students are doing, don't concern yourself with that. If they don't learn what they need to learn, they'll get theirs when they are interns and don't know what the f-ck they are doing. I also saw students who really didn't do much in the way of work on the wards getting "honors", etc. while sometimes I didn't. Again, that's just life. This particular place where you are rotating may value other things besides working hard and taking care of your patients - perhaps they want you bringing in research articles Qdaily, or making scientific presentaitons to your team, etc. I still say you'll improve your chances by trying to get a meeting with the attending - ask him/her how you are doing, and what you can do to improve. At least then you'll know you have done whatever you could.

 

[BlondeDocteur]

"Irregardless" is rather like "normalcy." It's a word most people think is a word and has therefore passed into semi-regular usage. Which is where most of our words come from in the first place-- a neologism that catches on.

I think the bottom line, OP, is that strong biases exist. People are looking out for any small discrete thing that can confirm those biases. Saying "rotations was" and "patients has" just once would be enough.

Of course it could have nothing to do with you being an IMG whatsoever. I found as a third year that my personality (which is pretty firmly fixed at this stage in life) meshed quite well with about half of the specialties and not so well with others 🙂cough: pediatrics :cough: ), and there was just nothing I could do to get on well with my peds residents and attendings. They simply never saw me as "one of them," because in truth I wasn't.

 

[BlondeDocteur]

I bet "geez!" is not a word either

To pile it on: I'm donning my Super Pedantic Superhero costume right now. Buckle up.

"Jeez," the popular faux-swear meant to evoke taking the name of Our Lord and Savior in vain, is spelt with a 'j'. It is in the family of "gosh," "darn," and "shoot."

"Geez" is, in fact, a word, though there should be a glottal stop in the middle (Ge'ez). It is the sacred language of the Ethiopian/Abyssinian Orthodox Church and has been dead lo these many centuries.

And... I'm out.

 

[nancysinatra]

If anything, it is slang. It is not a proper English word (regardless of its use by the uneducated.)

You can use it, but you will be judged on it.

Exactly. As demonstrated here, the correct word is "regardless."

 

[dragonfly99]

I agree that "irregardless" is not really correct English. It's more of a slang word that has become kind of acceptable because of the number of people who use it. I would say "regardless", not "irregardless".

And I now know how to spell "jeez!". Thanks bdoc!

Regardless (or irregardless!) of all this, I still think if the OP wants to go to the mat for a good grade in 3rd year, and feels things are somehow not right on the rotation, the #1 best way to improve his/her chances is to go to the attending and have a chat. The senior resident as well, unless he/she seems like a total ogre. It's harder for people to dis you later once you've tried to get them "in your corner" so to speak. Sometimes working hard is not enough to get noticed, or get a positive evaluation. Sometimes a little brown nosing and grade grubbing is really necessary.

 

[nancysinatra]

My medical school is a famous one, and a snobbish one. We have students rotate in the summer from less famous institutions, be they state allopathic schools, osteopathic schools, Caribbean, or foreign-foreign.

The students who go to my medical school and its "peer institutions" in general have gone to famous colleges and were expensively privately educated before that. They are very polished, very bright, and present themselves to the world in a particular way. They speak fluently, present very well, and can discuss all matter of topics in an informed, educated way.

Medical students from the less famous schools come on service and immediately seem different. It has nothing to do with their medical knowledge or boards scores, which in many cases are equal or superior to the home students'. In general, it's an issue of opinion and speech. For example, in the paragraph of your original post you made several syntax errors (using the singular conjugation of a verb when you needed the plural, for example). If you were to do that when presenting a patient or even simply discussing the news headlines of the day with the attending that would not be well received.

You might say "that's bull****, what on earth does that have to do with taking care of patients?! I'm here to be evaluated on the basis of my performance as a medical student!" and you would be absolutely correct. It's not fair, at all. But it is often the case that attendings, residents and home students extrapolate from speaking skills and casual chitchat a notion of a person's intelligence and capability.

Oh please. I go to a snooty eastern medical school as well. The grammar, well roundedness, and fluency in current affairs (or any other "topic" you might consider) of most people is appalling. For proof of at least the grammar part of this I am happy to submit endless Power Points that we were shown that prove the utter inability of some very expensively privately educated faculty to even put together a sentence, let alone consider the visual impact of their presentation. Medical school is not the UN or some fancy corporation where image matters and where sophisticated dealings take place. Nor is it a deep thinking liberal arts style intellectual utopia. People are more often than not operating on a level of brute bias and stereotype. They're also often tired and irritable. If not hungry as well.

Pedigree is something that as often as not simply happens to people, and half the time those who have it don't present themselves terribly well. Being expensively privately educated hardly correlates 1:1 with poise and presentability.

EDIT: "cache" rather than "pedigree" may be what's tripping this student up if in fact he/she is rotating somewhere prestigious. School names and pedigrees carry cache. People respond to that. It's hardly deep though.

 

[DarthNeurology]

Darth, you have made the point over and over again that you think my medical school isn't "#1." Which is fine. All I said is that it is both famous and snobbish, and I don't think the annual shuffle dance of the USNews rankings speaks to that. Columbia, quite unlike Harvard or Hopkins, tends to accept people from a very narrow range of undergrads (Hopkins in particular is much more democratic) so I think the sociological analysis of the student body was quite correct.

I have no idea what sort of US medical school the OP is rotating through. It might be one like mine, or it might not. But if it's one like mine... 'bias' is far too weak a word to describe the utter prejudice that exists against the unpedigreed.

But all this is neither here nor there-- I just wanted to help a brotha out, and maybe shed some light on his treatment. Thanks, SLUser, for understanding my intentions.

Lastly, Darth, I don't plan on applying to plastics on the merits of my grammatical savoir-faire alone. 🙂

1. I haven't made the point that Columbia isn't "#1", we all know that, but rather that Columbia is not in the same cohort of medical schools like Harvard, Hopkins, etc . . . and that I can name 30 or so U.S. medical schools that have an equal or greater reputation than Columbia, the U.S. News and World Report takes into account research more than the clinical reputation of schools. Columbia doesn't have the same name recognition as Harvard, Hopkins, Mayo, Standford, etc . . . really, it is just another medical school. On the west coast everybody raves about Harvard, U. Penn, Mayo, but believe me, nobody really knows or cares that much about Columbia, . . . medical schools in New York don't have the same pedigree/name recognition for some reason, probably because there are so many medical schools in NYC people assume the education is limited.

2. It appears that you don't understand the difference between a democracy and meritocracy. While all medical school admissions committees may vote on applicants (making them democracies), some may not be a strict meritocracy, i.e. favoring applicants who went to "blue blood" schools over just as good state schools for no other reason than the name recognition.

3. The name of undergrad/business school you go to means a lot in terms of connections in some professions, . . . not medicine, all the time there are medical school students from less well known medical schools who go on to plastics or ENT, because they did very well clinically. That Columbia may have some name recognition in the Northeast means little to individual medical school student when applying for residency. If you don't know how to play the game at your school in getting LORs and honoring surgery then you don't get the competitive residency. By and large U.S. medical schools have almost identical curriculum in basic sciences and clinical education is very variable, even between sites at the same school.

I know plenty of *excellent* med students who gave up going to high powered places like Harvard to go to a state medical school because of lower tuition and got into plastics, dermatology etc . . . It really is silly to go to a place like Columbia that is ultraexpensive, and may not at all provide the same level of education as state schools which are generally more uniform in consistency clinically than private schools. If you did apply to Columbia for perceived benefits by going to a big name place, then sorry, but you really wasted your money! There are probably around 20+ state medical schools where you can get a better education for a more reasonable price.

4. Have you actually rotated with IMGs while at Columbia? I have been on rotations with both U.S. and IMG students, and there wasn't a discrimination one way or another, everybody knows getting into medical schools is a crapshot, even with excellent college grades, and some U.S. med students sure don't live up to their reputation at all. . .

 

[BlondeDocteur]

Well, this thread has degenerated into another pissing match.

USNews is silly-- they change their "rankings" annually in order to sell more magazines. To say that Columbia P&S is "just another medical school" that that is has "no reputation outside of New York" and that people haven't heard of it on the West Coast is equally silly. There is something about my "this is how the world is" posts that really irritate you, but calling white black isn't going to prove your point.

If you want a yardstick and if you believe in the wisdom of crowds, read the pre-allo section of this site. See which schools people are most eager to get into, which they turn down for which others, etc. Harvard certainly comes out #1, with Hopkins close on its heels. Next would be UCSF, then Columbia, then UCLA and Penn and Stanford. Then WashU and Duke and Cornell.

I don't mind speaking openly on sdn about what I perceive to be the major shortcoming of training here-- the snobbishness and emphasis on pedigree. But the bottom line is, the medical school is old (first to grant an MD in the colonies), Ivy, in New York, and wealthy. The clinical training is fantastic-- being a quarternary hospital in NYC means we see *everything* and have every sub-subspecialty service under the sun. That, coupled with the fact that it attracts a cadre of very bright, motivated, interesting people as its students (people who want to be in New York for a reason), is why I came here. I even-- gasp-- turned down "#1" and "#2" because I was seeking fit, not chasing names.

I think there is great utility in calling a spade a spade. I don't for a second pretend that the oligarchic self-reinforcing network of prestige thing is a good thing. But it exists, as the classic elephant in the room in posts such as the OP's, and I think it's worth airing out.

Finally, Darth, PLEASE don't respond debating the little "rankings" from pre-allo. Neither I nor anyone else wants to go there.

 

[nancysinatra]

I think there is great utility in calling a spade a spade. I don't for a second pretend that the oligarchic self-reinforcing network of prestige thing is a good thing. But it exists, as the classic elephant in the room in posts such as the OP's, and I think it's worth airing out.

I wouldn't count on that network being so reinforcing. First, wait for your own class's match day. At my snooty school plenty of people matched respectably, but not spectacularly. Those who did match most impressively were the workhorses, not the aristocracy of the class. Second, years out from med school and residency, what's to say that oligarchy still reinforces itself? Some of the best pedigreed people meet with failure, especially if they let their guard down or rest on their laurels.

I don't think there is enough information in the OP's posts to assume that the classic elephant in the room is the elephant in this room. The OP may have atrocious grammar and not know how to hold his teacup at a faculty club luncheon, but we know nothing about the pedigree of the place he's rotating at or the attending in question, or the favored students for that matter. Plenty of US med students are equally inarticulate. Plenty of hospital rotation sites are not prestigious at all. Plenty of attendings just have chips on their shoulders.

In any case, if this is truly about classism, and if this attending is truly a person of the most impressive educational breeding, wouldn't they find a more insidious way to display their prejudices? Blatantly ignoring a medical student seems rather declasse.

 

[DarthNeurology]

USNews is silly--

I think there is great utility in calling a spade a spade. I don't for a second pretend that the oligarchic self-reinforcing network of prestige thing is a good thing. But it exists, as the classic elephant in the room in posts such as the OP's, and I think it's worth airing out.

Finally, Darth, PLEASE don't respond debating the little "rankings" from pre-allo. Neither I nor anyone else wants to go there.

I would consider Washington U and Duke more respectable than Columbia, . . . maybe why you don't want to go there when discussing rankings is that according to US News, Columbia is 11 in research and 58th in Primary Care, ouch. However, University of Michigan Ann Arbor, with whom it is tied, is 11th in research and 17th in Primary Care. Personally, I would want a good balance as medical students rotate through a lot of primary care experiences as students, such as in internal medicine clinics.

Presuming that you have had *only* your third year clerkships and are doing research, what clinical situations have you seen foreign trained medical students being made the pariah on a rotation? You haven't even said that you have rotated with foreign students at Columbia!

Columbia does a lot of research which leads to its research rank being high, but clinically it may be lacking with a primary care score of 58 . . . unless all Columbia produces is plastic surgeons and dermatologists, oh wait, you have to have a good foundation in internal medicine to do well in those specialties.

While Columbia may be an ivy in name, there are a lot of "new ivies" in terms of undergraduate education. Again you equate undergraduate reputation with medical school training, two different institutions run by different staff.

Consider that you truly "learn" medicine as a resident and the majority of your "contacts" and your reputation will come from where you did residency training. Medical school is practically a non-factor when applying for fellowships as well. If you go to Podunk Medical School and do an internal medicine residency at John Hopkins, bingo, you will get a great fellowship if you do well in residency. If you go to John Hopkins Medical School and then go to Podunk Internal Medicine program, and don't do that well, then you won't get a great fellowship regardless of where you went to medical school.

I am not personally offended by your comments about how the world is BD, but my clinical eperience tells me the opposite, . . . maybe when/if you go to somewhere else outside of Columbia you will see how know one really cares where you went to medical school when in residency. It is great that you have "school spirit", but saying that Columbia is somehow "famous" is silly. I had a positive impression of Albert Einstein and Cornell, and knew little about the Columbia when applying.

But your right, US News is silly, I would give a higher respectability ranking to Emory and Mayo, in terms of great medical student education OVER Columbia, i.e. I think Columbia doesn't deserve to be a #11 medical school.

 

[SLUser11]

The world revolves around me.

No it doesn't. The world revolves around me!

Just a few quick points, then you can get back to your pissing match.

1. This thread now absolutely belongs in the pre-med forum.

2. Blonde Docteur: I think NancySinatra might be your doppleganger.

3. Maybe it's just my feeble Nebraska roots, or my overpriced and obviously lower-class Jesuit education, but I feel like Darth is the type that in high school frequently referenced how all of his tormentors would eventually be pumping his gas for him, and then retreated back to his room and played with 20-sided dice........

 

[Black Surgeon]

I am going to say something that might strike you as kind of mean. It will definitely strike you as unfair. It's meant to be a "this is the way the world is, NOT how it should be" kind of thing. But perhaps it could help you understand and address the problem. It's a sort of sociological analysis.

Socialogical analysis? or narcissistic brouhaha.

My medical school is a famous one, and a snobbish one. We have students rotate in the summer from less famous institutions, be they state allopathic schools, osteopathic schools, Caribbean, or foreign-foreign.

The students who go to my medical school and its "peer institutions" in general have gone to famous colleges and were expensively privately educated before that. They are very polished, very bright, and present themselves to the world in a particular way. They speak fluently, present very well, and can discuss all matter of topics in an informed, educated way.

Medical students from the less famous schools come on service and immediately seem different. It has nothing to do with their medical knowledge or boards scores, which in many cases are equal or superior to the home students'. In general, it's an issue of opinion and speech. For example, in the paragraph of your original post you made several syntax errors (using the singular conjugation of a verb when you needed the plural, for example). If you were to do that when presenting a patient or even simply discussing the news headlines of the day with the attending that would not be well received.

This is what we—public school educated and inarticulate scholars—classify as a manifestation of the subconscious psyche. BD's perception of what may be the root cause of the OP's trouble is inadvertently influenced by her own condescending, uppity, and entitled attitude towards anyone who has anything less than an Ivy league private school education or has been anything but silver spoon fed. Her school's name has given her a false perception of self, thus she roams around without realizing (or admitting to herself) that the "snobbishness" is within her.

 

[lowbudget]

But the bottom line is, the medical school is old (first to grant an MD in the colonies), Ivy, in New York, and wealthy. The clinical training is fantastic-- being a quarternary hospital in NYC means we see *everything* and have every sub-subspecialty service under the sun. That, coupled with the fact that it attracts a cadre of very bright, motivated, interesting people as its students (people who want to be in New York for a reason), is why I came here. I even-- gasp-- turned down "#1" and "#2" because I was seeking fit, not chasing names.

1. University of Pennsylvania established the first medical school (then known as the College of Philadelphia)... not Columbia (then known as King's College).
http://elane.stanford.edu/wilson/html/chap3/chap3-sect6.html

2. Who is "we"? I won't argue with the speculation that your medical school class has seen "everything". But I will venture to guess that no one student or resident has seen "everything". The availability of sub-subspecialists means that patient care gets consulted away, chopped up and divided, such that no one truly "see" or "does" everything... (or anything, for that matter). If not done the right way, your education can be reduced to who should be doing what and when... an annoying turf mentality rather than learning actually how to manage a patient. All you end up learning is how to write an order for someone else to do your job.

I'm not terribly impressed. "Everything" doesn't just happen in NYC. "Everything" happens "everywhere". I highly doubt "everything" flies into Columbia from, say, California or Texas just because Columbia has seen it all. I'm quite sure there're other hospitals in the United States that've seen "everything" as well. Columbia's truly not all that unique from that standpoint.

3. Same goes for the cadre of bright, very motivated, and interesting people. Columbia doesn't have a monopoly on these people. These people are everywhere. And if you simply take the time to meet other people from outside of your institutional front porch and spend less time looking in the mirror, you'll agree with me that such is the case.

I will applaud you for your school spirit though. Go Lions!

We can only ride the coat tails of our universities for so long. At the end of the day, it's your achievements, your patient outcomes that truly matter.

 

[soulofmpatel]

Sigh...I'm going to have to give the real deal to the OP once again.

OP: You are a FOB. Fresh Off the Boat. Your language skills are sub-par, you're socially awkward, you're not familiar with subtleties of American culture, and you're not familiar with the American style of medicine.

You probably look nervous and helpless to your attending, she s/he is trying to help you save face by not pimping you. If you want to participate, you need to look comfortable and confident. You need to be the kind of girl/guy who chats up the other students/residents/attendings during down time. You need to make people laugh. You have to speak with an accent that people can understand.

You can't be that weird quiet foreign kid that no one can understand. You might be a genius, but it doesn't matter. It's not good enough.

Assimilating into American language and culture takes years. You might try making American friends to accelerate the process.

 

[BabyPsychDoc]

I tend to speak English, not Latin:

appendixes, not appendices
pneumothoraxes, not pneumothoraces

There is a reason why Latin is a dead language. Let's keep it that way.

Cool! Does it mean we can start using "axises" instead of "axes" and "testises" instead of "testes"? After all, belonging to human "specieses" we can dictate rules for our languages...

 

[BabyPsychDoc]

Sigh...I'm going to have to give the real deal to the OP once again.

OP: You are a FOB. Fresh Off the Boat. Your language skills are sub-par, you're socially awkward, you're not familiar with subtleties of American culture, and you're not familiar with the American style of medicine.

You probably look nervous and helpless to your attending, she s/he is trying to help you save face by not pimping you. If you want to participate, you need to look comfortable and confident. You need to be the kind of girl/guy who chats up the other students/residents/attendings during down time. You need to make people laugh. You have to speak with an accent that people can understand.

You can't be that weird quiet foreign kid that no one can understand. You might be a genius, but it doesn't matter. It's not good enough.

Assimilating into American language and culture takes years. You might try making American friends to accelerate the process.

I have to say, I tend to agree with soulofmpatel. People would not respect you, regardless of your knowledge, if they do not like you as a pal - or, if you have not been able to demonstrate your knowledge to them because of your social presentation/language skills. Your main goal right now should be integration - so spending more time with your American buddies (or try to make some) might be more beneficial for you than investing it into more and more reading/studying. OTOH, if you only have a problem with this particular rotation, why do you care so much? Maybe, the best thing for you to do would be to kick back and relax, and wait for the next rotation - with a different attending - to show yourself off.
Good luck.

 

[pillowhead]

Darth, you have made the point over and over again that you think my medical school isn't "#1." Which is fine. All I said is that it is both famous and snobbish, and I don't think the annual shuffle dance of the USNews rankings speaks to that. Columbia, quite unlike Harvard or Hopkins, tends to accept people from a very narrow range of undergrads (Hopkins in particular is much more democratic) so I think the sociological analysis of the student body was quite correct.

I went to undergrad at a large state school and interviewed at Columbia for med school. I have never been to such a snobby, stuck-up, ridiculous place in my life. I swear everyone's jaw dropped when they found out what undergrad I went to as if they expected all state school attendees to have horns or a a tail or something. I withdrew my application from consideration after going there. What a ridiculously insufferable place. I did end up a private school for both med school and residency and have worked with folks from the entire range of eliteness with regards to schools and have never encountered attitude or haughtiness like from Columbia.

 

[nancysinatra]

Just a few quick points, then you can get back to your pissing match.

1. This thread now absolutely belongs in the pre-med forum.

2. Blonde Docteur: I think NancySinatra might be your doppleganger.

3. Maybe it's just my feeble Nebraska roots, or my overpriced and obviously lower-class Jesuit education, but I feel like Darth is the type that in high school frequently referenced how all of his tormentors would eventually be pumping his gas for him, and then retreated back to his room and played with 20-sided dice........

No, I'm myself. I just think this "sociological analysis" is very likely incorrect, and here's why. Caribbean med schools have contracts allowing their students to rotate at very specific hospitals in cities like New York. Yes, sometimes they will rotate alongside US students, but it's unlikely that the OP is actually at a high status hospital like Columbia, because why would Columbia allow offshore students to rotate for months at a time at its hospital (and the OP said he's been there for awhile)? I could be wrong, but that makes no sense. At the kinds of hospitals where you do see US and offshore students together, you cannot predict who the attendings will be. Period. You cannot assume they will be Columbia-minted snobs. Medicine in America is huge and doctors come from all walks of life. Especially in the public hospitals of big cities like New York. And that is where US students and offshore students are most likely to mix. At these places, especially in a multicultural city, having a foreign background can be a definite plus. Of course, we have NO IDEA where the OP is actually rotating.

I have been on rotations in community hospitals where we were working alongside Caribbean students. The political aspects to these contracts and the fact that the Caribbean students don't get much support from their schools (and can be taken advantage of as a result) actually can create situations where the attendings and residents prefer to work with them, rather than with the US students. It can go either way. There was a New York Times article on the subject not that long ago as well.

Anyway this idea that attendings are all so highbrow that they are monitoring the grammar and general intellect of the foreign students on their service just seems like it's out of a dream world to me. Yes, I think the OP probably could benefit from trying to fit in better, and he can work on that, but who knows what's up at this place?

 

[Winged Scapula]

Sigh...I'm going to have to give the real deal to the OP once again.

OP: You are a FOB. Fresh Off the Boat. Your language skills are sub-par, you're socially awkward, you're not familiar with subtleties of American culture, and you're not familiar with the American style of medicine.

Trouble is the OP identifies himself as a US-IMG which is a US citizen trained abroad (most likely the Caribbean). Thus, not FOB although he does state that English is not his first language.