Importance of the MSPE as an IMG ??

[Phloston]

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Hi, there aren't any recent threads on this topic, so I just want to get some answers from anyone reading this, if possible.

I am at an Australian medical school and will be an IMG applying into the match.

Obviously a dean's letter / MSPE would need to be submitted with the match application regardless, but does anyone have any knowledge as far as the actual significance or importance of the MSPE as an international applicant?

Do competitive residency programs still rely heavily on it, or would they mostly look at good USMLE scores, research, etc.?

Any information would very helpful!

Thanks,

 

[splik]

It is as useful as it is. By which I mean the more information it has that they can use, the more it will be used. So if it has your class ranking on it, then that would be useful. If it says nothing of consequence, it is useless. I usually tell IMGs that they should put whatever makes them look good in it. So for example, if you were in the top 10% that should be on there. If you were a poor student, then nothing should be mentioned.

Your step 1 score is the most important part of your application as an IMG followed by US letters of recommendation. Research is not particularly helpful except to show commitment to that specialty (but if its in a different specialty not helpful). Publications are more helpful than research, as research without publications mean very little. Again, you are being evaluated for your clinical ability (unless going for research track), whether you can run PCRs or cut up mice is not all that useful. For top programs, they are looking for people they think will become leaders in the field, and that is why publications are a measure. But if you're not interested in research, it doesn't matter - you can discern yourself with teaching, community organizing, advocacy, writing, administration, leadership - and evidence of these will be helpful. But they all are dwarfed in importance compared to your USMLE step 1 score (which the only thing than can be used to compare all applicants), and your US LoRs (which are all the same I guess, but you need someone to vouch for your ability, preferably someone well known or from an institution known to where you apply).

 

[splik]

I answer this question and many others in this thread: http://forums.studentdoctor.net/showthread.php?t=897562

Although some of the info is specific to psychiatry, most of it is relevant to any specialty.

 

[Phloston]

It is as useful as it is. By which I mean the more information it has that they can use, the more it will be used. So if it has your class ranking on it, then that would be useful. If it says nothing of consequence, it is useless. I usually tell IMGs that they should put whatever makes them look good in it. So for example, if you were in the top 10% that should be on there. If you were a poor student, then nothing should be mentioned.

Your step 1 score is the most important part of your application as an IMG followed by US letters of recommendation. Research is not particularly helpful except to show commitment to that specialty (but if its in a different specialty not helpful). Publications are more helpful than research, as research without publications mean very little. Again, you are being evaluated for your clinical ability (unless going for research track), whether you can run PCRs or cut up mice is not all that useful. For top programs, they are looking for people they think will become leaders in the field, and that is why publications are a measure. But if you're not interested in research, it doesn't matter - you can discern yourself with teaching, community organizing, advocacy, writing, administration, leadership - and evidence of these will be helpful. But they all are dwarfed in importance compared to your USMLE step 1 score (which the only thing than can be used to compare all applicants), and your US LoRs (which are all the same I guess, but you need someone to vouch for your ability, preferably someone well known or from an institution known to where you apply).

Does that mean an MSPE that doesn't say much won't hurt an applicant as long as his or her USMLEs are strong?

In terms of research, good advice there. I'm hoping the PhD and publications will make an impact (I want gen surg at MGH, BWH or BID).

I answer this question and many others in this thread: http://forums.studentdoctor.net/showthread.php?t=897562

Although some of the info is specific to psychiatry, most of it is relevant to any specialty.

Great thread, thanks!

 

[splik]

Yes it means if your MSPE is uninformative it won't hurt you (unless it would have helped if you are a stellar student). Even for US students it is often regarded as useless as many med schools are pass/fail and they never say anything bad. It's only useful if it tells them whether you honored your rotations.

Am not sure what your publications are in but they will help more if related to surgery. A PhD is helpful because it shows you can work hard which is probably the most important characteristic for surgery. Other evidence of masochistic tendencies will also help (only half joking). If you want to go somewhere like MGH you have to do an elective there and get a LoR from them otherwise you don't likely don't have a chance. You usually have to have done some research there for a year or more to get a look in (for other specialties, I don't know about gen surg). A short 4-8 week visit is not going to do much unless you are amazing. If you don't have any Harvard connection you are wasting your time.

 

[Andreji]

I can imagine my MSPE served close to nothing but still tried to arrange for it to adjust as far possible as it could to AAMC standards. That is, my dean agreed to scale numbers into some common used terms in the US (superior, outstanding, this sort of thing); mention of my track record for leadership activities upfront; and at the end, in spite of not having a class percentile distribution, they included my placement on national exams, with charts and stuff that could be appealing.

Far as I know, nothing was lost with that document; probably it had little value anyways, but moreso depending on its release date (and to add to what Splik said, the release date was after 80% of my interview invites, so, yeah).

And to further add to Splik's words, no matter how thick the MSPE, and high the step scores....you should land rotations and superstrong LORs and research (and then some) in your field and places of interest. And also be down to earth-ish....I don't mean not applying to MGH, etc., but certainly also applying to other places. Coming from a country with a lot of focus on going for the US, I can tell you I've seen people do 4 wks at yale and landing surgery the match after that, and people doing rotations, 1-2yrs research at NYP-CUMC and MGH and still no luck.

Be amazing. 👍

 

[Phloston]

Now that you look back on things, do you guys have any unique perspective as far as how to rip super-great LoRs? Would you have done anything differently / acted differently?

Clerkships = 8 weeks. Now I mean, that's just not a lot of time.

In other words, aside from knowing your stuff and being as obsequious as possible (would you even recommend that?), is there anything else that comes to mind?

I've already looked at the link you've posted, splik (great link), but I'm asking about with respect to you guys uniquely.

 

[Andreji]

Well I'll give you some insight on my experience. I landed 2 very solid (as per my interviewers, never got to see them) LoRs from a month's experience at NYP-Cornell (actually did 2mos, but the people on the other month were in another speciality and were late with the letters).

Now more than half of the following will be obvious and known to you, albeit very useful:

Before the rotation:
0) Now I know you're going for gen surg, which greatly differs from my choice, but when choosing the specific rotation (eg, floors, ICU, outpt) think two things:
-Where am I stronger? if you do better at one than the other, choose it. you're not there to learn as much as you are to stand out!
-Where am I bound to get more one on one time w/attendings? I chose outpt because I enjoy it, but it also provided me with tonnes of time to speak and do things in a laid back fashion. I wasl also in L&D in obgyn and this was much more intense, but unproductive due to the high turnover of on-call attendings, the heaps of work and, to my opinion, the use of masks, caps (I think visual memory is very valuable!)

During the rotation:
1)be seriously proactive from day one. Stand out, behave like an intern and not a student. we pretty much do much of the patient management down here so we're used to being hands on, opinionated, etc... There's a patient to be seen? step up before you're asked to see him/her.

2)That is, of course, to an extent. don't controvert unless the point is solid and well laid out- no one wants someone to come and impose views. Learn from them, but be sure you also have stuff to teach them. we conferred 90% of the patients with staff and residents and it was always a good time to give some input, even if it isn't the final decision.

3) Ask, ask, ask. not dumb questions (yes there are dumb questions) but remember there are no dumb questions (wtf?). Don't let silence take over while with your sponsors...even relatively obvious questions (eg., "would x be better than y in this patient?...") so long as you can word out some reasoning and start a small discussion ("...because he/she has z comorbidity and it is possible that x...."). I did this so often I thought it was dumb, and yet more than half the times fellows and other attendings would chime in.

4) you don't have to know everything but much as in point 3, a guess with a solid reasoning will spark conversation rather than a blank stare. communication always earns points!

5) if you master another language and you plan to go to a major hospital such as MGH, use this to your advantage. I'm fluent in spanish and french (and fairly good in dutch and german) which for a major hospital (ie, hub for foreign visitors or underserved populations) was quite useful. I took on patients as a translator more than as the in-charge guy half the times, and this made me fairly well-liked with the residents and fellows when they needed any translation (an on-the-phone translator will never equal the flow of communication).

6) play your foreign cards. Bring new stuff to the table. I am doing peds and am a big fan of the IMCI initiative in place in developing countries, but rather unknown in the US. so this was a healthy set of ideas that was also good for discussion. Whenever some random disease or treatment comes up, if (again) you have the reasoning to back your point, comment on how they'd do things in your country. beware, though- don't do it as though they're doing it wrong- it's a tricky card to play, and you want discussion, not controversy.

7) a big, final DURING- I never once mentioned I wanted LoRs. now this is very personal, some people say upfront, but in my opinion, that'll only make them more critical of your performance and not in a good way. Let your overall performance be the judge of thingsI was offered one at the end of the rotation and even left the subject there for the moment (read below).

After the rotation
8) Stay in touch. if you had a good rapport, you'll get their emails. Email in a few days to say thank you; ever so often, let them know what you're up to- I told my LoR writers about my studying for the steps, then the scores, then the next step etc etc. Even told them when I was going back to NYC so I could drop by and say hi- got invited to lunch by them. I dropped the LoR request then and there, one full year after being with them.

9) be polite if you're in town....spare a minute to drop by and say hi.

10) also keep in touch with residents and fellows if you can- sometimes they interview, or get a word in for ya.

11) and be polite even if things are hopeless. I was basically told they wouldn't interview me at the hospital months before but that didn't refrain them from wishing me the best of luck. And by the description I got on my LoRs (I didn't see them, and didn't bother asking to do so either) from interviewers, they were themselves sincerely hoping to see me there. Then again, they're two of the sweetest people I've met, so I'm glad to have kept a long term friendship going, without the pressure of being on their residency program. In the end, I landed one of the best programs so one door closed and a bigger one opened!

Hope it all helps

 

[Phloston]

Thanks so much for the reply. That helps a ridiculous amount.

2)That is, of course, to an extent. don't controvert unless the point is solid and well laid out- no one wants someone to come and impose views. Learn from them, but be sure you also have stuff to teach them. we conferred 90% of the patients with staff and residents and it was always a good time to give some input, even if it isn't the final decision.

I tend to be "that guy" who's always quizzing my friends (in a pedantic way; I just like talking a lot about medicine). Are you saying that I should "quiz" the attending or residents from time to time on random knowledge, or must the information brought to the table be strictly relevant to a particular clinical situation, for the sake of appropriateness?

5) if you master another language and you plan to go to a major hospital such as MGH, use this to your advantage. I'm fluent in spanish and french (and fairly good in dutch and german) which for a major hospital (ie, hub for foreign visitors or underserved populations) was quite useful. I took on patients as a translator more than as the in-charge guy half the times, and this made me fairly well-liked with the residents and fellows when they needed any translation (an on-the-phone translator will never equal the flow of communication).

I only have English and Hebrew (the latter of which would probably have no actual importance). That's pretty awesome that you were able to take on that role though.

 

[Cali2]

Best of luck in your application. However, would strongly recommend against quizzing the attendings/residents, especially on topics unrelated to the clinical situation. It would be taken as pimping, which I think would be inappropriate from a medical student. Better to just ask well-informed questions regarding the current patient!

 

[Andreji]

Best of luck in your application. However, would strongly recommend against quizzing the attendings/residents, especially on topics unrelated to the clinical situation. It would be taken as pimping, which I think would be inappropriate from a medical student. Better to just ask well-informed questions regarding the current patient!

Oh yeah, don't go quizzing anyone. especially if you are prone to sounding pedantic or something. And really be aware of circumstances. if everyone's handling a crisis in the ICU or something, don't go pulling off any remark that's irrelevant to the situation. And if you don't get too well along with an attending, well, don't go asking too much to him either.

I only have English and Hebrew (the latter of which would probably have no actual importance). That's pretty awesome that you were able to take on that role though.

Mmm don't underestimate the power of speaking Hebrew in certain places like NY.

 

[Ronin786]

As far as knowing a foreign language, I've heard that knowing Spanish can help boost your application quite a bit.

Is it worth it to learn a new language? I know it sounds ludicrous, but I should have a bit of free time after my steps, and I think it won't take more than a couple months to learn Spanish.

 

[Andreji]

Is it worth it to learn a new language? I know it sounds ludicrous, but I should have a bit of free time after my steps, and I think it won't take more than a couple months to learn Spanish.

Pardon my cynicism, but unless you have a solid background in spanish somehow, it will definitely take more than a couple months to learn Spanish (or any language, for that matter). For the mere reason that this is a latin language with quite a different structure from english.

As a spanish speaker who's piled on years of travel through the US, I can tell you many people whom I assume learnt spanish in a couple months come up to you and attempt to pull it off. Effort appreciated, but suffice it to say unless you actually master the language (or at least pull it off very decently) and can fluently communicate with patients in distress (or simply in a rush), two months of 'por favorrr' and 'uno coca-colo' won't cut it.

Again, sorry for the cynicism.

As far as boosting an application, spanish for the most part will obviously be the language of choice (much in a reciprocal fashion, as english is the de facto second language of latin america). But as far as for example looking to pursue a global health track (my case)-or a residency in a globally outreaching program- any and many other languages may well help

 

[Ronin786]

2 Months may be oversimplifying it, but what I meant was I should have enough free time to learn Spanish.

I probably won't be a whiz at it, but as far as honestly being able to put it on the ERAS application and not looking look a total fool while speaking.

I was just wondering whether the return is worth it or not?

 

[splik]

Now that you look back on things, do you guys have any unique perspective as far as how to rip super-great LoRs? Would you have done anything differently / acted differently?

I've already given my experience. I have not seen my US LoRs so Im not sure but I imagine they are good - remember you must ask for a strong LoR. I did not ask at the time as I did not plan on coming here, it was 3 years later but I stayed in touch and they remembered me! Staying in touch is very important, more than the LoRs is the connections and someone who will go out of their way to help you get interviews etc. As for my letters from my home country - I wrote them myself and am a very good writer and they were very well received! You may find a letter from the Chair of Surgery at your medical school is required so go and say hello and make sure they will write you a letter or at least sign what you have to write! You might also be surprised, perhaps some of the surgeons down under have rubbed shoulders with bigwigs in the States and will put a good word in for you.

 

[Andreji]

You might also be surprised, perhaps some of the surgeons down under have rubbed shoulders with bigwigs in the States and will put a good word in for you.

Yup, this is especially true. It didn't particularly help me, but I know for friends in more competitive specialities, the fact that any of our local attendings knew someone across the pond helped land research positions, residency interviews, etc.

 

[Andreji]

I probably won't be a whiz at it, but as far as honestly being able to put it on the ERAS application and not looking look a total fool while speaking.

I don't know much about the recruiting process but frankly I doubt bilingualism is a game-changer nowadays, especially given the layout of the ERAS application itself (hardly highlights language skills I guess), and the fact that program committees will go through so many applications boasting so many great feats, I doubt it will come down to what a marvelous surprise one candidate speaks spanish- especially if it is so just on paper.

I assume this wasn't a major fact to get an interview invitation myself. But when actually interviewing, I did touch on the subject at some point (with much finesse somehow to include it into the conversation) and maybe at that point it did help somewhat. But then you're face to face and have to be able to put your money where your mouth is, I guess.

 

[NotAProgDirector]

I probably won't be a whiz at it, but as far as honestly being able to put it on the ERAS application and not looking look a total fool while speaking.

If you put that you are fluent in Spanish on your application, you should be prepared to be interviewed in Spanish.

 

[Phloston]

If you put that you are fluent in Spanish on your application, you should be prepared to be interviewed in Spanish.

Subtle tangent:

I had a medical-related job interview once in college and had always written "Languages: English, Hebrew, Spanish" on my resume (I had taken Spanish in high school and college). Anyway, I did my undergrad in Boston, and when I went to the interview, it was in Spanish. That being said, it didn't go over well, because after about one minute it had become very evident that I couldn't hold a true conversation in it. I remember it actually having made me extremely frustrated because it reinforced the fact that Spanish is so important in medicine nowadays, and if I had only had a more definitive sense of my future career path earlier on, I absolutely would have learned it more seriously in the past.

 

[Sarcoidosis]

Great Advice!

 

[Sarcoidosis]

Well I'll give you some insight on my experience. I landed 2 very solid (as per my interviewers, never got to see them) LoRs from a month's experience at NYP-Cornell (actually did 2mos, but the people on the other month were in another speciality and were late with the letters).

Now more than half of the following will be obvious and known to you, albeit very useful:

Before the rotation:
0) Now I know you're going for gen surg, which greatly differs from my choice, but when choosing the specific rotation (eg, floors, ICU, outpt) think two things:
-Where am I stronger? if you do better at one than the other, choose it. you're not there to learn as much as you are to stand out!
-Where am I bound to get more one on one time w/attendings? I chose outpt because I enjoy it, but it also provided me with tonnes of time to speak and do things in a laid back fashion. I wasl also in L&D in obgyn and this was much more intense, but unproductive due to the high turnover of on-call attendings, the heaps of work and, to my opinion, the use of masks, caps (I think visual memory is very valuable!)

During the rotation:
1)be seriously proactive from day one. Stand out, behave like an intern and not a student. we pretty much do much of the patient management down here so we're used to being hands on, opinionated, etc... There's a patient to be seen? step up before you're asked to see him/her.

2)That is, of course, to an extent. don't controvert unless the point is solid and well laid out- no one wants someone to come and impose views. Learn from them, but be sure you also have stuff to teach them. we conferred 90% of the patients with staff and residents and it was always a good time to give some input, even if it isn't the final decision.

3) Ask, ask, ask. not dumb questions (yes there are dumb questions) but remember there are no dumb questions (wtf?). Don't let silence take over while with your sponsors...even relatively obvious questions (eg., "would x be better than y in this patient?...") so long as you can word out some reasoning and start a small discussion ("...because he/she has z comorbidity and it is possible that x...."). I did this so often I thought it was dumb, and yet more than half the times fellows and other attendings would chime in.

4) you don't have to know everything but much as in point 3, a guess with a solid reasoning will spark conversation rather than a blank stare. communication always earns points!

5) if you master another language and you plan to go to a major hospital such as MGH, use this to your advantage. I'm fluent in spanish and french (and fairly good in dutch and german) which for a major hospital (ie, hub for foreign visitors or underserved populations) was quite useful. I took on patients as a translator more than as the in-charge guy half the times, and this made me fairly well-liked with the residents and fellows when they needed any translation (an on-the-phone translator will never equal the flow of communication).

6) play your foreign cards. Bring new stuff to the table. I am doing peds and am a big fan of the IMCI initiative in place in developing countries, but rather unknown in the US. so this was a healthy set of ideas that was also good for discussion. Whenever some random disease or treatment comes up, if (again) you have the reasoning to back your point, comment on how they'd do things in your country. beware, though- don't do it as though they're doing it wrong- it's a tricky card to play, and you want discussion, not controversy.

7) a big, final DURING- I never once mentioned I wanted LoRs. now this is very personal, some people say upfront, but in my opinion, that'll only make them more critical of your performance and not in a good way. Let your overall performance be the judge of thingsI was offered one at the end of the rotation and even left the subject there for the moment (read below).

After the rotation
8) Stay in touch. if you had a good rapport, you'll get their emails. Email in a few days to say thank you; ever so often, let them know what you're up to- I told my LoR writers about my studying for the steps, then the scores, then the next step etc etc. Even told them when I was going back to NYC so I could drop by and say hi- got invited to lunch by them. I dropped the LoR request then and there, one full year after being with them.

9) be polite if you're in town....spare a minute to drop by and say hi.

10) also keep in touch with residents and fellows if you can- sometimes they interview, or get a word in for ya.

11) and be polite even if things are hopeless. I was basically told they wouldn't interview me at the hospital months before but that didn't refrain them from wishing me the best of luck. And by the description I got on my LoRs (I didn't see them, and didn't bother asking to do so either) from interviewers, they were themselves sincerely hoping to see me there. Then again, they're two of the sweetest people I've met, so I'm glad to have kept a long term friendship going, without the pressure of being on their residency program. In the end, I landed one of the best programs so one door closed and a bigger one opened!

Hope it all helps

Great Advice!