Intern year abroad or steps ? -USFMG

[eire md]

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Hi guys

I am a US Citizen who finished medical school from Ireland in Nov 2012. I am studying for USMLE step 1 at the moment and plan on taking the steps as soon as possible (within next 4-5 months). However, I have not done any internship after medical school and I've heard a lot of program directors want to see some sort of clinical training after graduation.

I have an offer of internship from National university hospital in singapore which is an ACGME-I accredited program (the first one outside united states) and im thinking of taking that up. However that would delay my study for the USMLE. I will then do one year of internship ( JUNE 2013- JUNE 2014). and then study for steps which will take another 6 months and end up applying for residency in OCT 2015.

If i dont do intern year i can study for steps now and apply for match in OCT 2014. Once im done with the steps i was thinking of doing some clinical research to show the programs that i was not sitting idle during this time but was actually doing something.

So far, I have 3 publications in high impact factor journals , 1 US clinical elective at UCLA in emergency medicine, reseach at Cleveland Clinic in pediatrics and my MD degree. However, since Ireland was following the british system I was unable to complete my steps during medical school and have to take some time to do them now.

I am aiming for a gen surg residency. Do you think i am being foolish by setting aside intern year and studying for steps ? Or should i get my internship at singapore out of the way and then study for steps ?

Please advice ! thanks

 

[shan564]

PDs want to see clinical training after you graduate if you've been out of med school for a few years. If you just took a few months to study for the Steps, it won't be a big hindrance.

But that's assuming that it's just a few months. You don't want to be away from clinical medicine for an entire year when you apply. What have you been doing since November?

 

[gutonc]

Hi guys

I am a US Citizen who finished medical school from Ireland in Nov 2012. I am studying for USMLE step 1 at the moment and plan on taking the steps as soon as possible (within next 4-5 months). However, I have not done any internship after medical school and I've heard a lot of program directors want to see some sort of clinical training after graduation.

I have an offer of internship from National university hospital in singapore which is an ACGME-I accredited program (the first one outside united states) and im thinking of taking that up. However that would delay my study for the USMLE. I will then do one year of internship ( JUNE 2013- JUNE 2014). and then study for steps which will take another 6 months and end up applying for residency in OCT 2015.

If i dont do intern year i can study for steps now and apply for match in OCT 2014. Once im done with the steps i was thinking of doing some clinical research to show the programs that i was not sitting idle during this time but was actually doing something.

So far, I have 3 publications in high impact factor journals , 1 US clinical elective at UCLA in emergency medicine, reseach at Cleveland Clinic in pediatrics and my MD degree. However, since Ireland was following the british system I was unable to complete my steps during medical school and have to take some time to do them now.

I am aiming for a gen surg residency. Do you think i am being foolish by setting aside intern year and studying for steps ? Or should i get my internship at singapore out of the way and then study for steps ?

Please advice ! thanks

I think the biggest issue that will limit your chances is going to be your minimal USCE (1 month...most places require between 6 months and 2 years...but not all). If you can study for, take and do well (like 240+) on the Steps (1, CK and CS if not 3) in the next year then you'll be in OK shape. I too question what you've been doing for the past 6 months as that's more than enough time to study for and take at least one or two of those tests. Clinical experience outside the US is irrelevant to most PDs. So decide now whether you want to practice in the US or elsewhere.

 

[Winged Scapula]

Agree with the others above:

1) lack of US Clinical Experience may be a factor; doing an internship, even at an ACGME-I (which many programs will have no experience with), is not a replacement. But it is what it is.

I'm not sure who has been advising you to this point, but you should have done more US Clinical electives.

2) what have you been doing since November? I can tell that if it occurs to me that you have had over 6 months to study for and take the USMLEs, it will occur to other faculty.

It sounds as if you're planning on taking a year to study for them. Time away from clinical medicine to do that will not go unnoticed and not in a positive way.

I will also take issue with your claim that because you trained in a program which followed the British system, you couldn't take the examinations during medical school. Most US faculty will know that is not the case, as many students before you have done it (including myself and shan654, the user who responded to you above).

3) the more time you take off, the lower your chances will be to match. General Surgery is a moderately competitive specialty, especially for a categorical position. Honestly, if you wait until October 2014 to apply (assuming you don't take the internship position), you will be over 2 years out from clinical training. That's a problem.

You haven't told us why you cannot take Step 1 within the next few months and be ready to apply *this* fall. Obviously you've got to do well on the exams otherwise your application will likely be round filed but do you really need 1 year+ to study?

 

[eire md]

Hi guys thanks for your replies... here are the answers to the questions you asked me:

1. I have been doing research in Ireland since I graduated out of which I have managed a publication in a high IF journal. I have been trying my best to study and get the steps over with but multiple distractions (including my mothers health) have gotten in the way. I know its not a valid excuse but I'm not sitting idle (if that's the impression i gave).

2. Yes I only have one US clinical elective and I know i require more, but i was hoping that instead of taking up the internship position at Singapore , i'll do more US clinical externships/observerships and try and muster some LOR's through that route during the next few months. Clinical research in the US was another option i was thinking off, to show them that my time outside school was well utilized.

3. I dont plan on taking more than 6 months to finish up the steps. In all honesty, i am in 2 minds about applying this year because everyone told me that for IMGs its important to have all 3 steps done by september end (the day you submit your nrmp). If i give step 2 ck and cs by december, I will have less chances of getting interviews. So i thought I should aim for OCT 2014 when i will have all 3 done in time for the match.

So i guess the question remains , that can i fill time untill then by clinical research, externships and observerships ? Or should i join my internship now itself and then give the steps after im done with intern year ? Time will be taken off then as well ... only i'll have internship to show for it.

There is a third option , i am in process of asking singapore to maybe delay my start date by a few months so i can get steps done by then and then join the internship ?

 

[eire md]

Could someone please guide me here ? I'm very confused !

 

[shan564]

I think your best bet is the option that involves externships and Step studying. If you have some American LORs and you have decent Step scores, the gap in experience won't be a huge deal, especially if you've been doing clinical research in that time. Plus, your externships count as experience.

You're right about having your Step scores in by Sept (early-mid Oct at the latest). If you're planning to wait until Dec, then that would significantly limit your choices.

The problem with taking an internship in Singapore is that you wouldn't be able to do externships in the US. And interns work hard in Singapore, which would leave little time for USMLE studying.