Help - Planning for Residency

[drcuma]

Hi-
I have a dilemma that i'm trying to figure out. I am currently an IMG from one of the big 4 in the carib. I got a 256/99 on Step 1 and I'm in the beginning of my first rotation. I was in the september class, so calendar-wise, it is tight to match for 2012. At any rate, my school requires 4 cores + Fam Med or all 5 cores to be done before being elegible for Step 2 CK/CS. With that said, I've worked it out to get those requirements done by mid June 2011, which will leave me end of June & July for Step 2CK/CS. My goal was to have these scores back for Sep 1 for applications for internal med. Some of the programs that i was interested in are in New England, and many of them require both Step scores. Additionally, some of these pre-match on a rolling basis, so i figure, having a complete app for Sep 1 will maximize these chances. However, the hospitals that I am rotating in (for cores) are not well known and the letters I would get from here are not from anybody "well-known in the field". So here are my options:

1. Maintain current schedule to have Step 2 scores and apply Sep 1 with LOR from not well known hospital MD's
2. Shift the schedule to do elective rotations at more well-known hospitals and get possibly LOR from "stronger" MD's....and not have my scores for Sep 1.

Any insight?

Thanks

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[Winged Scapula]

1) IM is not a very competitive residency except at the top notch places;

2) The places that are competitive for IM are not likely to take kindly to your Caribbean education;

3) IM is a huge field with few widely well known practitioners. Thus, who's to say that the attendings in the hospitals where you are planning on doing electives are any more "well known" than the Joe Blow MDs at your core hospitals?

5) LORs tend to fall lower on the list of important factors than USMLE scores;

6) you might not want to do a residency or pre-match at any of the places you'll rotate at;

7) if the pre-matches are offered on a "rolling basis" (which is a med student term, I suspect you mean they offer them periodically throughout the year, if there are acceptable candidates), then your chances are no greater if you apply earlier;

8) This is not medical school with the great rush to get everything in on "Day X" - you can still apply after 9/1 and get interviews.

In the end, IMHO, it probably doesn't make any significant difference in matching.

 

[NotAProgDirector]

Totally agree with WS, as usual.

Would add that you could plan an elective in August. Ask for a letter 1/2 way through. The biggest problem will be ECFMG's slow turnaround on loadling LOR's, but chances is it would be in by mid to late Oct which is not too late for some / many of the more competitive programs.

 

[dragonfly99]

Does anyone think that he should plan to take Step 2's later in the year? What's the rush to take Step 2 early since the Step 1 score is so high? I think this particularly regarding the Step 2 knowledge test. I can see where the clinical skills Step 2 might be important for a Carib grad (to prove that your clinical rotations were OK, your patient H and P skills are adequate, etc.).

I agree in general about LOR's from famous people not being that important in IM, but I'm not sure I totally agree about them being THAT unimportant. OP is a Caribbean grad so needs any advantage he can get. Does nobody think that a LOR from an associate or full professor at some well known place would help his application? It may not help much, b/c as you say, those type places are not likely to take him anyway. I still think it might help.

However, my advice is see what your school (and maybe recent alumni of your school) say about when to take Step 2. You don't want to screw yourself over, and you already have a great Step 1 score, which will be hard to "beat" on Step 2.

I also think your main focus right now should be doing the absolute best you can in year 3, and worry only secondarily about doing away rotations, etc. Worry more about setting up a good sub-I in medicine for next summer or fall, and about doing well in year 3, and worry less about who your LOR's will come from, or when exactly to take Step 2 tests.

 

[NotAProgDirector]

Going to disagree with DF here. Having step 2 completed early is important. I essentially don't even consider IMG's without Step 2 CK completed. For IMG's, getting Step 2 completed as early as possible is important, although doing well is more important than taking it early.

 

[Winged Scapula]

Agree with aPD.

For AMGs, I can understand the wisdom of delaying Step 2 with a fantastic Step 1 score.

However, for IMGs/FMGs there are programs that won't accept applications without Step 2 or even without the ECFMG certificate already in hand. As aPD notes, without that extra bit of assurance that they will get a certificate, many programs will not consider an IMG/FMG without Step 2 done by the time of appilcation.

 

[dragonfly99]

Oh, OK, guess my Step 2 advice was bad. But what about the clinical skills test? Wouldn't a program worry more about a FMG or IMG failing that part?

 

[NotAProgDirector]

IMG's are best served by having all of their steps (1/2CK/2CS) done as early in the application cycle as possible.