Medical IMG from the UK hoping to apply for Internal Medicine - what steps should I take?

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TheBoneDoctah

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Hello lovely people. Apologies in advance if this is completely the wrong place to post this, but I was looking for some advice. Please feel free to point me in a different direction if these questions would be better suited elsewhere.

I am currently working as a Junior Doctor in the UK. I graduated in July 2019, and being a professional procrastinator, was very middle of the road during medical school. However I did not have any issues coasting through, and managed to get an oral presentation at an international conference, and a poster presentation along the way. I only really considered the possibility of moving to the US in the last couple of months of medical school, pretty much right in the middle of finals. I started to get a little more serious after graduation, but Alas, I was then forced into taking up a job as a professional Covidologist. Due to a combination of my lack of long term planning and the circumstances I mentioned, I have only just started building my application.

I am currently in the midst of revising for the STEP 1, which is proving extremely difficult (but manageable), alongside working full time as a Doctor. I appreciate this is going to be a long, difficult, lonely and expensive road for me, and am under no illusions that this will be easy. However I have decided to go for it, as I feel I would likely regret not at least attempting this in 10 years time.

I just had a couple of questions that I thought may be suited to this thread as I would like to apply for internal medicine, hopefully followed by Cardiology. That is far into the future, and I appreciate it will be extremely extremely difficult for an IMG.
I aim aiming to have finished STEP 1 and STEP 2 CK, by December 2021. My only priority at the moment is to ensure I score highly. My questions pertain to the STEP 1 and also USCE and CV gaps.

Firstly, do you guys feel it is sensible to attempt the Step 1 prior to it becoming pass fail, in a bid to get a high score and potentially stand out from other IMGs at the time of application who only have a Pass, or do you feel that the selection committees may not even have access to a 3 dight score if some applicants are being scored as pass fail? I do appreciate that the Step 2 CK will likely take up an increased role of importance.

My second question pertains to USCE, of which I currently have none. I appreciate that as I have already graduated, I will only be able to do observerships. I am hoping to do 2-3 months worth with an aim of getting some US letters of recommendation. Again this will be difficult as the Attendings will not be able to see me actually practice medicine. However the hope is that I can impress them with my knowledge, professionalism, communication skills and enthusiasm. In addition I would of course try to have a letter of recommendation from the head of Medicine at my current hospital. I appreciate this is not ideal, but would it at least fulfil a minimum requirement and give me a shot if I had excellent STEP scores, considering I am applying for internal medicine which is traditionally one of the lesser competitive specialties ( I have no idea why, as I absolutely love it)?

In the UK we do 2 postgraduate years rotating through different specialties as Junior Doctors every 4 months prior to beginning a specialty training programme. I am due to finish at the end of July next year, after which I have a choice of either going into training in the UK, or taking a year out to either do a research masters in cardiovascular science, while working 1-2 days a week clinical, or getting a non training job/moonlighting in order to save up some money and undertake some (very expensive) observerships in the US. Would this period be classed as a CV gap if I were still working a couple of days a week as a doctor? Not doing a research degree would grant me more flexibility in terms of getting more USCE. Is the potential research exposure worth having only 1 month of USCE prior to application, or is it preferable to have more USCE and work on my CV in other ways?

I am so sorry for the essay, but I would really appreciate your opinions regarding this. I would also like to wish good luck to all my colleagues who are applying for the match this year, I really hope you are rewarded for all your hard work. Thank you so much in advance!!
I will comment on the board questions. At this time, there seems to be no real consensus of what PDs will use to stratify applicants. Some say they will just use Step2CK, others say they will just use research, letters, and your school pedigree. It really is going to depend on the program.

My advice would be to take it before the P/F starts (but ONLY if you are 150% ready and are hitting your practice score marks). Do not rush your exam because if you do and don't do well, your chances will be nil. I am a firm believer that students coming from lower-tier MD, IMG, and DO schools need to Step 1 to be scored so that they can show they have what it takes to compete for these higher caliber residency programs.
 

TheBoneDoctah

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The uncertainty aspect is exactly what is making me want to take the step 1 prior to it becoming pass/faIl. The hope is that having a documented objective score that has been used for years to determine the suitability of applicants to certain programs will be somewhat of an advantage. Thank you very much for your input, it is very much appreciated!
absolutely
 
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