IMG and Surgery

[donysious]

I am a foreign medical graduate. I graduate in October and won't get my certificate till march. I plan on doing a general surgery residency. I am going to apply next September. So I have about a year to do anything I want. I have to give my steps 1 & 2. I also planned on doing the step 3. I have a few months of US clinical experience and a few letters. I have waived my right and so don't know if they are good. I eventually want to specialize in some surgery that interests me and do a fellowship and practice clinical surgery. I would like to know how I could improve my chances at a residency categorical spot. Should I do any research in this time or just spend the time improving my score. How adversely does time off affect an application or how positively does research affect it. What I am asking is how do I improve my chances at a categorical spot. Thank you for reading.

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[Winged Scapula]

There is no doubt that a lapse in clinical education/patient contact adversely affects your application.If you are graduating in October 2012, why are you waiting until September 2013 to apply for a US surgical residency? That will mean you won't start residency until July 2014, or more than 18 months after graduation.

Are you waiting until you have taken Steps 1 and 2 and have your ECFMG certificate? While many programs prefer/require ECFMG certification to even apply, that is not true for all surgical programs. FYI: Step 3 won't strengthen your application and isn't' necessary for ECFMG, so you might as well focus on the other steps at this point.

IMHO, its a toss up as to whether research helps you enough to balance out the time away from school. It is unlikely to do so, but sitting around on your parent's couch is absolutely not going to be helpful. You are expected to be doing something from the time of graduation until you start residency.

What you are expected to do is to have really high Step 1 scores. Almost all FMGs do, generally assumed to be due to the increased length of time they have to study for the exam over AMGs. So your decision about when to apply may be based on how much time you have to study for the exams.

You'll also need a back up plan. Categorical surgery is a difficult match for FMGs/IMGs and you may end up doing 1, 2 or more years as a prelim resident without a categorical position. Make sure you decide UP FRONT how much work you are wiling to put in to get the position.

 

[maverick_pkg]

Would advise you not to graduate in October. If possible delay your graduation till after Jan next year. That way, your graduation year becomes more recent at time of application.

Further, you should come here and do more USCE which you can only do prior to graduation. After graduation, you can only observe but not do clinical electives. Make sure they are under well known people or hospital so that the LOR carries more weight.

Also make sure that your scores are around 99 double digit. Have some research in your application if possible. Shows an academic bent of mind. Hope this helps.

 

[donysious]

Thank you for the replies. I already have 6 months of US clinical experience with a few letters. I think I have done enough of that. I am returning home now to finish up medical school and graduate. The thing is I cannot apply this year since I will not receive my degree certificate before the match. That is why I have this time. I also wanted to know if research matters if I want to go into a community program. Would a community program affect my chances at a good fellowship cause I definitely want to do one after residency.

 

[Winged Scapula]

Thank you for the replies. I already have 6 months of US clinical experience with a few letters. I think I have done enough of that. I am returning home now to finish up medical school and graduate. The thing is I cannot apply this year since I will not receive my degree certificate before the match. That is why I have this time. I also wanted to know if research matters if I want to go into a community program. Would a community program affect my chances at a good fellowship cause I definitely want to do one after residency.

I'm still a bit confused. Are you stating that although you graduate in October you won't actually get the diploma ("degree certificate") until March? I wasn't aware that ECFMG or the NRMP required the actual diploma just verification that you had graduated and finished all requirements toward the degree. Please check on that. No US schools provide diplomas before the Match either (since graduation typically happens after the Match). Speaking from experience, I did not have my diploma in hand either when I went through the Match, only before I started residency.

As for research, it is generally not required for a community program or even expected, although it can't hurt. Fellowship matches are more traditionally more common from academic programs but most community programs have also been successful in sending people to fellowships. It all depends on what you are planning training in - Trauma, Transplant, etc? Sure you can match from a community program. Pediatrics? Not as likely. But I would be careful about stating "I definitely..." because many, if not most medical students change their minds during residency about what they wish to do in the future.

 

[jasb66]

First hand experience here, IMG doing surgery, starting PGY-2 now as a categorical. Try, by all means, to have your ECFMG certificate ready by application time. In addition to clearing up step 1 and both steps 2, you must present a certified copy of your original, final, official, government-issued medical school diploma. This is non-negotiable to obtain ECFMG certification, there is no way around it.

Another to-dos: do not extend your year of graduation to year of application too long, get +250s in the steps, do not dare to fail step 2 CS, step 3 is not important, research is overrated but better than staying at home country enjoying total lack of responsibilities, improve your English and interviewing skills. Optimally, find a mid-tier place to do surgery-focused research and mingle with the surgery department. You will have a higher chance of getting a spot there, at least as a prelim, rather than going to Hopkins or Duke, where you chances are slimmer.

If you don't get a categorical spot (which are incredibly hard for us despite having it all in application) read here -> http://forums.studentdoctor.net/showthread.php?t=807981

Also, destroy the ABSITE. Anything lower than 99th percentile puts you below the level of many IMGs, prelims included. I have met many who broke the test with a 99th, not just as interns, but as PGY-2s and so on. Especially important if you end doing a PGY-2 prelim year, getting a 99th it's a big ****ing deal.

Cheers.

 

[Winged Scapula]

FIRST HAND EXPERIENCE *HERE* AS WELL, IMG who completed surgery in the US and matched to a categorical position.

While it is, of course, desirable to have the ECFMG certificate in hand to apply (and some programs require it), I think it debatable that given this means the OP will be over a year out of school when he applies (and more than 18 months out when he starts internship) whether it is wise.

So the question is: apply once he has the ECFMG certificate even though that means sitting out a year or apply to programs that don't require it before the start of residency?

I don't think anyone is suggesting to the OP that he doesn't need to rock Steps 1 and 2, or that he doesn't need the diploma to get the ECFMG certificate. His medical school only needs to verify that he has completed the requirements for graduation. Except for programs that require the certificate to apply, you only need to complete all the requirements for the certificate by the time of the ROL for the match.

Frankly, the suggestion above to delay graduation is not a bad one if he can convince his school to allow it. Its what I did - while I used it to do more US electives, it also allowed me to not have as much down time between school and residency (which almost never looks good).

 

[jasb66]

FIRST HAND EXPERIENCE *HERE* AS WELL, IMG who completed surgery in the US and matched to a categorical position.

While it is, of course, desirable to have the ECFMG certificate in hand to apply (and some programs require it), I think it debatable that given this means the OP will be over a year out of school when he applies (and more than 18 months out when he starts internship) whether it is wise.

So the question is: apply once he has the ECFMG certificate even though that means sitting out a year or apply to programs that don't require it before the start of residency?

I don't think anyone is suggesting to the OP that he doesn't need to rock Steps 1 and 2, or that he doesn't need the diploma to get the ECFMG certificate. His medical school only needs to verify that he has completed the requirements for graduation. Except for programs that require the certificate to apply, you only need to complete all the requirements for the certificate by the time of the ROL for the match.

Frankly, the suggestion above to delay graduation is not a bad one if he can convince his school to allow it. Its what I did - while I used it to do more US electives, it also allowed me to not have as much down time between school and residency (which almost never looks good).

WS, I do not doubt from your experience, but I think that as a former 11' and 12' IMG Match participant for surgery, I can share my two cents. I did extensive research about ECFMG requirement timelines, since I didn't get mine until January 11'. IMHO, programs, at the very least, require it at the time of ROL - not having the requirements for its expenditure only, but the certificate itself. The risk that underlies with the former is that they can match a certificate-less IMG who by many reasons (especially with an institution as ECFMG) can have his/her certificate delayed, precluding him/her of starting residency on July 1st, as certification is a must for GME at any ACGME program. This is very bad for programs and has happened in the past. ECFMG issuance is a cumbersome process with extremely strict requirements and it takes around 4-6 weeks to have it mailed to you once all documents are submitted and approved. At the moment one document has a flaw, the process is delayed 4-6+ weeks. The vast majority of programs require it at time of application or somewhere in November, when submission deadlines are reached.

My statement from previous post, regarding ECFMG as a must by the time of applications, comes from my (and many other IMGs) experience that 90% or more of programs paper-trash IMG applications without the certificate, reason being too that there are just too many solid applicants who have it. They may have paper-trash my application for many other reasons (mainly by the fact that I am an IMG), but on 11' I was certificate-less and got a prelim spot by miracle. On 12' I had a certificate and had to cancel interviews. Even though, if you get invited to a program that does not require it, being certificate-less during interviews and being questioned about it on Nov-Dec-Jan, gives the program a reason to not rank you. This is what I felt when I was questioned about it. It is not enough to tell them 'hey, I will be getting it on Feb, or May when I get my diploma or clear step 2 CS or wathever'. If there is such a flexible program with these issues out there, I would like to know.

Hence, my advice stands. Your chances, which a priori are small, become dramatically reduced if you apply without a certificate.

 

[donysious]

Thank you for all the great replies. Even though I complete the requirements for a med school diploma in October I will not receive it until sometime next year. I am not sure when I will receive it. And also i couldn't apply this year since I would have no time to rock the steps. So if I started research somewhere in October or November I would be able to do about a year and half of it before I start a residency assuming a get one ( which is a huge assumption ). Would that research help me during my application even though I may not have any publications from it when I apply ?

 

[Winged Scapula]

WS, I do not doubt from your experience, but I think that as a former 11' and 12' IMG Match participant for surgery, I can share my two cents. I did extensive research about ECFMG requirement timelines, since I didn't get mine until January 11'. IMHO, programs, at the very least, require it at the time of ROL - not having the requirements for its expenditure only, but the certificate itself. The risk that underlies with the former is that they can match a certificate-less IMG who by many reasons (especially with an institution as ECFMG) can have his/her certificate delayed, precluding him/her of starting residency on July 1st, as certification is a must for GME at any ACGME program. This is very bad for programs and has happened in the past. ECFMG issuance is a cumbersome process with extremely strict requirements and it takes around 4-6 weeks to have it mailed to you once all documents are submitted and approved. At the moment one document has a flaw, the process is delayed 4-6+ weeks. The vast majority of programs require it at time of application or somewhere in November, when submission deadlines are reached.

My statement from previous post, regarding ECFMG as a must by the time of applications, comes from my (and many other IMGs) experience that 90% or more of programs paper-trash IMG applications without the certificate, reason being too that there are just too many solid applicants who have it. They may have paper-trash my application for many other reasons (mainly by the fact that I am an IMG), but on 11' I was certificate-less and got a prelim spot by miracle. On 12' I had a certificate and had to cancel interviews. Even though, if you get invited to a program that does not require it, being certificate-less during interviews and being questioned about it on Nov-Dec-Jan, gives the program a reason to not rank you. This is what I felt when I was questioned about it. It is not enough to tell them 'hey, I will be getting it on Feb, or May when I get my diploma or clear step 2 CS or wathever'. If there is such a flexible program with these issues out there, I would like to know.

Hence, my advice stands. Your chances, which a priori are small, become dramatically reduced if you apply without a certificate.

I am well aware of all the above issues and actually address them (more than once) in my posts above. Your experience is just as valid as is mine, however, there is a big difference between having all the exams and medical school done at the time of application (which is what i suggested to the OP) and telling programs, 'hey, I will be getting it on Feb, or May when I get my diploma or clear step 2 CS or whatever'. I never suggested that the OP wait until the spring to take the USMLEs or in any way delay his testing. The diploma is a piece of paper; the school will document, as they must for ECFMG, that he has completed all the requirements in OCTOBER. There are no schools that I am aware of, US or otherwise, that hand you the diploma the very same day you finish the requirements.

That is not to say that some won't programs will require the certificate. Again, I have mentioned this being a fact more than once.

My position is that the OP has very little to lose except money to apply to programs which do not require the certificate rather than sitting out for 18 months.

We are dealing with an applicant who has no real plans for a job after graduation. But given his most recent post, which states he doesn't have enough time to take the Steps before application season, then it appears he has to wait to apply until next year.

IMHO, research is fine but without publications don't expect it to significantly improve your application.

 

[thinker]

Are IMGs that match fresh graduates or did they usually complete a GS residency in their home country?

Also does the research have to be in general surgery? I have a M.Sc. in neuro from Canada with two publications and one month research experience at McGill in ENT (no publications).. just wondering that other than getting really good Step 1 scores.. what does it take to get a spot? I'm not in the Caribbean btw.

 

[ajimd]

I matched out of medical school, did not complete GS residency overseas, did not have a ton of GS research (minimal really), but had good step I and II scores, good GPA and spent a year in the U.S. as a 5th year med student (basically), to better help integrate into the system - Having sat in on several "match meetings" at our program, I think it is on an individual basis (as with everything). The Step scores get you in the door, how you interview and what you do from that point forward determines whether you rank high or low. Good luck

 

[rigid]

Hey i was wondering how competitive CT and vascular fellowships are for IMGs with general surgery training.

 

[Winged Scapula]

Hey i was wondering how competitive CT and vascular fellowships are for IMGs with general surgery training.

Do you have a pulse?

These are not considered competitive fellowships. What will matter will be your ABSITE scores, visa needs, LORs (as usual) but for CT in particular, there are loads more positions available than applicants. IMGs are well represented at all but the top tier.

 

[rigid]

Do you have a pulse?

These are not considered competitive fellowships. What will matter will be your ABSITE scores, visa needs, LORs (as usual) but for CT in particular, there are loads more positions available than applicants. IMGs are well represented at all but the top tier.

Thanks for the reply WS. Quick question about ABSITE, I'm not familiar with that exam being done by residents in Australia. Does it need to be done online or is it based on a 1 off done after completing residency?

 

[Winged Scapula]

Thanks for the reply WS. Quick question about ABSITE, I'm not familiar with that exam being done by residents in Australia. Does it need to be done online or is it based on a 1 off done after completing residency?

Ah, I didn't realize you were doing your GS training outside of the US.

The ABSITE is the American Board of Surgery In-Training Examination; it is done yearly by US general surgery residents.

Bear in mind that some US fellowships require that you are Board Eligible by the American Board of Surgery; that may mean if you do your GS training outside the US or Canada you may not be eligible for fellowships. However, traditionally many of the CT fellowships are open to IMGs who train outside of the US; they may be unaccredited. Make sure you research this before application. Some will accept you if you are FRACS.

 

[residentx]

i m IMG with both step scores 250 plus, CS passed 1st attempt, interested in surgery , but with no US clinical experience , what are my chances and what do you advice, is it worth applying for surgery, any scope of interviews ? or shud i just go for medicine

 

[ajimd]

Not sure how to answer this really - If you are interested in surgery, then apply for a surgical position. If you want to do medicine, then apply for a medicine position. I have never really discouraged anyone from not pursuing what they really want to do in life because of their USMLE scores, or research, or clinical rotations...etc. Now, are there some hard and fast facts about who gets into those positions? sure. But to NOT apply to surgery because it's "too competitive" or you are an IMG is selling yourself short. I also think its a bit presumptuous to assume that if you don't get into surgery, you always have medicine to fall back on... PD's really look at what you are wanting to do - If they see you have medicine and surgical programs in the mix, then your commitment to surgery certainly comes to the forefront, and despite yours scores, research....etc. you may be less competitive than others simply because it sounds like you don't really know what you want to do in life.
When I applied for surgery, I was willing to do a prelim anywhere just to get my foot in the door in a surgical program and work my way up from there. I never really thought about IM as an alternative career choice unless I turned out to be "all thumbs" in surgery. Will a US rotation help you - definitely. Will the lack thereof disqualify you from consideration - I don't think so.