Is Step 1 really the most important variable, as an IMG?

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Jonari

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I'm starting to get really stressed and worried about my upcoming Step 1. Taking the latest nbme 13 exam, with nbme 15 left - I'm averaging between 224 - 228. Most are ******ed silly mistakes, by not reading the questions properly. I want to break a 245 on my exam to be considered a competitive applicant. I hope that this could land me into an ortho residency.

For all intensive purposes, lets say I get a high 220s, I'm basically looking at the next 40-50 years in only primary care, right? I just want to make myself proud, my family proud, and friends for scoring high and getting into an awesome residency field.

**Insert "undoing" defense mechanism - even though they're done unconsciously, lol this is how I feel**
 
Unfortunately, even a 245 wont get you ortho as an IMG.
 
Sure, if you don't know the right people...

If you know the right people there is no difference between a 228 and a 245. If those points make a difference then you don't know the right people. I was in your same position wanted Ortho, thought I knew the right people etc. Ortho is close to impossible to get, around 1% every year go to IMG's and you don't know how long it took them, research years, phd's,etc.
 
in 2012 3 spots went to US-IMGs and 6 spots went to IMG's. I know for a fact that one of those IMG spots went to an already established total joints orthopedic surgeon from a different country with 260+ on !/II, and multiple publications. This is the real competition you're up against as an IMG, not the average US allopathic numbers.
 
US allo students need a 245 on Step 1 to be considered competitive for ortho.
 
IMGs and Ortho are a bad mix to begin with. It's rare, but possible. You need to score higher than the AMG peers or else they would throw your app in the trash.
 
The proper phrase is "For all intents and purposes".

guess you haven't heard the phrase "panflips" or "minus whale"...


thanks for all the informative posts in this thread. going to just need to keep moving forward, and try to minimize my silly mistakes on my exam.
 
I'm starting to get really stressed and worried about my upcoming Step 1. Taking the latest nbme 13 exam, with nbme 15 left - I'm averaging between 224 - 228. Most are ******ed silly mistakes, by not reading the questions properly. I want to break a 245 on my exam to be considered a competitive applicant. I hope that this could land me into an ortho residency.

For all intensive purposes, lets say I get a high 220s, I'm basically looking at the next 40-50 years in only primary care, right? I just want to make myself proud, my family proud, and friends for scoring high and getting into an awesome residency field.

**Insert "undoing" defense mechanism - even though they're done unconsciously, lol this is how I feel**

So is this why you're always flipping a ****? Because it seems like you're way too stressed about this bud. I think you need to accept the fact that most IMGs end up in primary care and just do the best on Step 1 that you can. Hopefully your family will be proud that you're a doctor, not that you're a orthopod vs an internist.
 
I'm starting to get really stressed and worried about my upcoming Step 1. Taking the latest nbme 13 exam, with nbme 15 left - I'm averaging between 224 - 228. Most are ******ed silly mistakes, by not reading the questions properly. I want to break a 245 on my exam to be considered a competitive applicant. I hope that this could land me into an ortho residency.

For all intensive purposes, lets say I get a high 220s, I'm basically looking at the next 40-50 years in only primary care, right? I just want to make myself proud, my family proud, and friends for scoring high and getting into an awesome residency field.

**Insert "undoing" defense mechanism - even though they're done unconsciously, lol this is how I feel**

Where are you coming from? Carribean?

If carribean, even getting in the 220s, IM at a solid program is still going to be an uphill battle.

How long have you been studying? If it is more than a few weeks, it is unlikely you will break that 240 barrier.
 
Where are you coming from? Carribean?

If carribean, even getting in the 220s, IM at a solid program is still going to be an uphill battle.

How long have you been studying? If it is more than a few weeks, it is unlikely you will break that 240 barrier.

do foreign IMGs have a better chance than caribbeans? I would think yes, but not completely sure now that I think about it
 
I'm starting to get really stressed and worried about my upcoming Step 1. Taking the latest nbme 13 exam, with nbme 15 left - I'm averaging between 224 - 228. Most are ******ed silly mistakes, by not reading the questions properly. I want to break a 245 on my exam to be considered a competitive applicant. I hope that this could land me into an ortho residency.

For all intensive purposes, lets say I get a high 220s, I'm basically looking at the next 40-50 years in only primary care, right? I just want to make myself proud, my family proud, and friends for scoring high and getting into an awesome residency field.

**Insert "undoing" defense mechanism - even though they're done unconsciously, lol this is how I feel**

Ortho?!? I didn't realize this was your goal. It's simply not realistic, even with a 260+ for an IMG. I'm not even lying, I know a girl from my school who got a 250+ and 260+ and didn't match her top 10 ranks for IM. (Note: She needs a Visa)

Dude, I have a friend at a Top 5 school in the US. He didn't even get his top 2 choices in ortho with a ~260 and a first author publication or two in the field. The simple fact that you went the IMG route limits you heavily. That's honestly all there is to it.

Step 1 isn't really the biggest factor here, its the fact that you're an IMG. The sooner you accept that the quicker you'll move on and be happier with whatever lies ahead.

Even "only primary care" is a priviledge and a blessing for all IMGs these days, especially those of us with average scores.
 
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do foreign IMGs have a better chance than caribbeans? I would think yes, but not completely sure now that I think about it

Carribbean students rotate in US hospitals. Huge advantage with that alone, assuming they are US Citizens.

Foreign IMGs with US Citizenship have a significant advantage as well. Since having a US Citizenship is one less thing for programs to worry about. Also, often times these foreign IMGs will have actual intern year experience as is mandatory for their programs, which are fairly rigorous (~60% pass rates).

Foreign IMGs requiring Visa - They need significantly higher scores and the competition is much steeper for them as a result. (240+ or bust)
 
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I'm starting to get really stressed and worried about my upcoming Step 1. Taking the latest nbme 13 exam, with nbme 15 left - I'm averaging between 224 - 228. Most are ******ed silly mistakes, by not reading the questions properly. I want to break a 245 on my exam to be considered a competitive applicant. I hope that this could land me into an ortho residency.

For all intensive purposes, lets say I get a high 220s,I'm basically looking at the next 40-50 years in only primary care, right? I just want to make myself proud, my family proud, and friends for scoring high and getting into an awesome residency field.

**Insert "undoing" defense mechanism - even though they're done unconsciously, lol this is how I feel**

You should have gone to a USMD school if you wanted to do that. You should consider yourself lucky that you can even exploit the Caribbean backdoor to practice medicine in the US. Were we any other country, you'd be flat-out of luck.

Deal with it. You aren't ortho material.
 
You should have gone to a USMD school if you wanted to do that. You should consider yourself lucky that you can even exploit the Caribbean backdoor to practice medicine in the US. Were we any other country, you'd be flat-out of luck.

Deal with it. You aren't ortho material.

Lol "you aren't ortho material". This is why I read sdn. Stupid comments like these make my day

Sent from my Nexus S using Tapatalk
 
Matching ortho as an IMG appears to be insanely hard, but it has been done. Your step score will matter a ton. Less than a 250 could be a deal breaker. Make sure your entire app is perfect. Good luck.
 
I'm starting to get really stressed and worried about my upcoming Step 1. Taking the latest nbme 13 exam, with nbme 15 left - I'm averaging between 224 - 228. Most are ******ed silly mistakes, by not reading the questions properly. I want to break a 245 on my exam to be considered a competitive applicant. I hope that this could land me into an ortho residency.

For all intensive purposes, lets say I get a high 220s, I'm basically looking at the next 40-50 years in only primary care, right? I just want to make myself proud, my family proud, and friends for scoring high and getting into an awesome residency field.

**Insert "undoing" defense mechanism - even though they're done unconsciously, lol this is how I feel**

Unlike others I think you have a shot at Ortho as an IMG but you're going to have to score a lot higher than a 245. I would say 255-260 should be the bare minimum.
 
My buddy's sister went from carribean to internal med residency to cardio intervention and is making like half a mil a year right now. If you want the prestige and all that, something like that is your best bet. I would forget about any surgical subspecialty. General surgery is a maybe, but a longshot either way. IM is awesome though... has a lot of cool subspecialties.
 
You should have gone to a USMD school if you wanted to do that. You should consider yourself lucky that you can even exploit the Caribbean backdoor to practice medicine in the US. Were we any other country, you'd be flat-out of luck.

Deal with it. You aren't ortho material.

To an extent, I agree (though wouldn't have used the same harsh words). This is purely anecdotal, but of the 10-20 or so people I know who went to the islands for med school they all have a very similar and distorted mentality about their career. They believe that if you want something badly enough you can get it, regardless of your aptitude. If you really really want to go to undergrad but have a bad high school record you can find a decent school that'll accept you. If you really really want to go to med school but have a bad undergrad record there's always Caribbean MD schools. Residency is a different ball game; there's no "backdoor" entrance into becoming an orthopedic surgeon in the U.S. if you come from a lowly ranked foreign med school with poor stats. At some point people have to realize that you can't get everything you want just because you want it badly.
 
At some point people have to realize that you can't get everything you want just because you want it badly.

👍 The truth is a harsh mistress. The reality is that there are plenty of grads with good board scores from US schools that don't match to ortho every year. It's considered competitive for a reason.
 
Carribbean students rotate in US hospitals. Huge advantage with that alone, assuming they are US Citizens.

Foreign IMGs with US Citizenship have a significant advantage as well. Since having a US Citizenship is one less thing for programs to worry about. Also, often times these foreign IMGs will have actual intern year experience as is mandatory for their programs, which are fairly rigorous (~60% pass rates).

Foreign IMGs requiring Visa - They need significantly higher scores and the competition is much steeper for them as a result. (240+ or bust)

Its not as bad as you say it is for Visa requirers. If you are willing to go for a J1 visa (meaning you get kicked out for 2 years after residency/fellowship) its only slightly more difficult because the J1 doesn't cost the hospital much money and its less paperwork.

If you want an H1B it is much more difficult and a lot of unis say no to H1Bs but yes to J1s. H1B puts you on track for a green card but costs the hospital more money and is a lot of paperwork
 
Its not as bad as you say it is for Visa requirers. If you are willing to go for a J1 visa (meaning you get kicked out for 2 years after residency/fellowship) its only slightly more difficult because the J1 doesn't cost the hospital much money and its less paperwork.

If you want an H1B it is much more difficult and a lot of unis say no to H1Bs but yes to J1s. H1B puts you on track for a green card but costs the hospital more money and is a lot of paperwork

Eh I don't think residencies make that distinction. I think they group all FMGs the same. The hospital itsel doesn't choose residents. The doctors in each program choose and I doubt are responsible for different expenses for visas. That's more of the hospital's job.
 
For all intensive purposes, lets say I get a high 220s, I'm basically looking at the next 40-50 years in only primary care, right? I just want to make myself proud, my family proud, and friends for scoring high and getting into an awesome residency field.

We don't need to waste medicare dollars on training IMGs with this mentality. We need physicians who go into medicine for the love of it, not to make mommy and daddy proud. An awesome residency program is one that you are passionate about - you clearly lack that inner passion and are looking for the approval of others. I think this just might not be for you. Please find a nice program in your home country.
 
I'm starting to get really stressed and worried about my upcoming Step 1. Taking the latest nbme 13 exam, with nbme 15 left - I'm averaging between 224 - 228. Most are ******ed silly mistakes, by not reading the questions properly. I want to break a 245 on my exam to be considered a competitive applicant. I hope that this could land me into an ortho residency.

For all intensive purposes, lets say I get a high 220s, I'm basically looking at the next 40-50 years in only primary care, right? I just want to make myself proud, my family proud, and friends for scoring high and getting into an awesome residency field.

**Insert "undoing" defense mechanism - even though they're done unconsciously, lol this is how I feel**

"Intents and purposes"

for future reference. 🙂
 
We don't need to waste medicare dollars on training IMGs with this mentality. We need physicians who go into medicine for the love of it, not to make mommy and daddy proud. An awesome residency program is one that you are passionate about - you clearly lack that inner passion and are looking for the approval of others. I think this just might not be for you. Please find a nice program in your home country.

Don't worry nobody is taking your jerbs. Im pretty sure he IS a US-IMG anyways. Also, everyone has different motivators. Half the ppl in med school are only there for the "money" and job security. Plenty of others (read: Asians) have similar motivators as OP. End of the day, he's still helping people one way or another.
 
Its not as bad as you say it is for Visa requirers. If you are willing to go for a J1 visa (meaning you get kicked out for 2 years after residency/fellowship) its only slightly more difficult because the J1 doesn't cost the hospital much money and its less paperwork.

If you want an H1B it is much more difficult and a lot of unis say no to H1Bs but yes to J1s. H1B puts you on track for a green card but costs the hospital more money and is a lot of paperwork

It is very bad/worse for those requiring a Visa. Reason being there are a LOT of IMGs (requiring Visa) and scores for these candidates are definitely higher (highest) across the board for the same specialty. Take into account these IMGs study for 1-2 years PER exam. US-IMGs have a clear cut advantage as determined by previous match statistics.

IMG friendly hospital (community):
AMG could get in with a passing score+
US-IMG 210+
IMG (Visa) 230+
This obviously is the lower tier IM program I'm talking about. (The lowest being the scutwork ones which offer pre-matches to every vulnerable IMG who has a 230+, and many bite.)
 
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None of this talk about US MD vs IMG, "what do I need to get into X field" is really that useful at this point or should change how you approach step 1. Study your ass off, do as well as you can, and then figure out what is a reasonable residency goal based on the score you get. There are lots of great specialties within medicine, even with a 220+ I'm sure you can find something that you would find intellectually stimulating and personally satisfying; if you happen to do well enough that your dream specialty is on the table, even better, but right now worrying about that shouldn't affect your studying.
 
None of this talk about US MD vs IMG, "what do I need to get into X field" is really that useful at this point or should change how you approach step 1. Study your ass off, do as well as you can, and then figure out what is a reasonable residency goal based on the score you get. There are lots of great specialties within medicine, even with a 220+ I'm sure you can find something that you would find intellectually stimulating and personally satisfying; if you happen to do well enough that your dream specialty is on the table, even better, but right now worrying about that shouldn't affect your studying.

For IMGs it does in fact matter. Many put their life on hold for this exam and lose years as a result while aiming for a high score. They think they have a genuine shot at a top residency if they achieve that score no matter how long it takes. (Anywhere from 1-3 years just for Step 1 alone, and rarely even longer.)

In their home countries, people regularly study for several years to get to the next level. Its because the score is all they look at in their home countries. Its how they get into med school and its how they get into residencies. There are no interviews or "complete" applications (resumes).
 
For IMGs it does in fact matter. Many put their life on hold for this exam and lose years as a result while aiming for a high score. They think they have a genuine shot at a top residency if they achieve that score no matter how long it takes. (Anywhere from 1-3 years just for Step 1 alone, and rarely even longer.)

In their home countries, people regularly study for several years to get to the next level. Its because the score is all they look at in their home countries. Its how they get into med school and its how they get into residencies. There are no interviews or "complete" applications (resumes).

I'm not saying the exam doesn't matter; OBVIOUSLY it does, and to directly answer the title question of the thread, it is the most important factor. I'm just saying it shouldn't affect the actual studying process that much. To match well in any field as an IMG he's going to need a good step 1 score, so he should just study his butt off for as long as he has and do as well as possible regardless.
 
I'm not saying the exam doesn't matter; OBVIOUSLY it does, and to directly answer the title question of the thread, it is the most important factor. I'm just saying it shouldn't affect the actual studying process that much. To match well in any field as an IMG he's going to need a good step 1 score, so he should just study his butt off for as long as he has and do as well as possible regardless.

Agreed.
 
We don't need to waste medicare dollars on training IMGs with this mentality. We need physicians who go into medicine for the love of it, not to make mommy and daddy proud. An awesome residency program is one that you are passionate about - you clearly lack that inner passion and are looking for the approval of others. I think this just might not be for you. Please find a nice program in your home country.

Stop with the inner passion BS. Then why are the most competitive residencies to obtain also happen to be the ones that are the best paying. Why are Cards and GI the most competitive IM sub-specialties, they are because they are the best paying.

Complete shocker the lower paying fields are the easiest to get into. I'm sure everyone is following their "inner passion".

*****.
 
Stop with the inner passion BS. Then why are the most competitive residencies to obtain also happen to be the ones that are the best paying. Why are Cards and GI the most competitive IM sub-specialties, they are because they are the best paying.

Complete shocker the lower paying fields are the easiest to get into. I'm sure everyone is following their "inner passion".

*****.

No man it's obviously because there's so many people who found their true passion in the GI system.
 
And every AMG going into ortho is passionate about knees and shoulders? They just want to dedicate their lives to rehabilitating weekend warriors who went a little too hard on their mountain bikes? Please, spare us the nonsense. Ortho is a competitve speciality because the surgeries are fun, the compensation is great and the lifestyle is pretty good for a surgical specialty. Lets see what kind of song you sing when you finish 3rd year. Hopefully your "inner passion" that you wrote about on your amcas application won't have fizzled out or you won't be "worthy" to practice rural med in north dakota.

1. AMGs pay taxes into medicare that goes to fund their residency programs, and don't jump ship once we are done funding their training to go practice back in their home country.
2. I am totally fine with people going into ortho because they think the surgeries are fun, etc. , just not because they want to brag to their friends and show of their diploma to their parents. THAT is nonsense.
3. I have no desire to practice rural medicine, but if I did, I would absolutely do it.
4. I spent multiple years working in a hospital, I at least have a pretty decent idea of what goes on there and the issues that various specialties deal with. I can still message you if you want me to follow up after 3rd year though and let you know that I will still plan on doing what I enjoy.
 
1. AMGs pay taxes into medicare that goes to fund their residency programs, and don't jump ship once we are done funding their training to go practice back in their home country.

US-IMGs, who's "home country" is the US pay taxes as well. So, what is your point?
 
My whole point is that nobody needs to be going into medicine to please mom and dad and brag to their friends, wherever the hell they are from. I didn't know this person was in the US...this person said IMG, sorry I didn't do sufficient stalking to not get flamed by a bunch of internet police. Its pretty sad that so many people are laughing at the idea of actually going into medicine because you are passionate about it.

By the way, I shadowed a GI doc as an undergrad and he absolutely loved that ****...no pun intended.
 
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US-IMGs, who's "home country" is the US pay taxes as well. So, what is your point?

They exploit a backdoor specifically designed to do an end-around USMD admissions. This backdoor exists because the US is the most lenient country in the world for foreign-trained MDs to practice in but was never intended to allow off-shore medical schools to admit failed US candidates and allow them to obtain practice rights. In any other country, if you can't get into the country's medical school, tough ****, go find another career.

The fact that IMGs can practice at all here should be seen as a blessing.
 
My whole point is that nobody needs to be going into medicine to please mom and dad and brag to their friends, wherever the hell they are from. I didn't know this person was in the US...this person said IMG, sorry I didn't do sufficient stalking to not get flamed by a bunch of internet police. Its pretty sad that so many people are laughing at the idea of actually going into medicine because you are passionate about it.

By the way, I shadowed a GI doc as an undergrad and he absolutely loved that ****...no pun intended.

(I'm AMG). It's awesome to go into medicine for "the passion" and "the fire." I'm one of those people myself. But to criticize an IMG for wanting to go into a highly competitive field for the prestige and probably the money is kinda lame considering most AMGs do the same. You can talk **** about them backdooring the system and all that, but don't generalize IMGs for the same things that AMGs do lol. I like GI a lot too.
 
Its pretty sad that so many people are laughing at the idea of actually going into medicine because you are passionate about it.

By the way, I shadowed a GI doc as an undergrad and he absolutely loved that ****...no pun intended.

No one is laughing at people going into medicine out of passion; what rubs people the wrong way is your idea that one is somehow a terrible person if they AREN'T going into it for that reason. Some people just see medicine as an intellectually stimulating career with pretty good pay. There's nothing wrong with either approach.
 
all those measly IMGs slogging it in primary care trying to make their families proud for 1/2 the pay.

BS. The hospital I worked at was absolutely packed with IMG/FMG fellows in subspecialties - many of the fellowships had more FMGs than AMGs. Don't act like we just shove all of our FMG applicants into primary care - they apply to these programs because it is a privilege to come and practice here, and may not have been competitive enough for another program or may be part of the few who want to practice primary care.
 
They exploit a backdoor specifically designed to do an end-around USMD admissions. This backdoor exists because the US is the most lenient country in the world for foreign-trained MDs to practice in but was never intended to allow off-shore medical schools to admit failed US candidates and allow them to obtain practice rights. In any other country, if you can't get into the country's medical school, tough ****, go find another career.

The fact that IMGs can practice at all here should be seen as a blessing.

So...do something about it? The US system clearly doesn't care if one is from a diploma mill or not.

The US has been using foreign-IMGs to support nearly 25% of its healthcare system (physicians) for decades now. If the US had the ability (money) to open more schools and fill the residency slots, no one is stopping them from doing so. US-IMGs are a way to keep citizens ahead and take all that tax-payer entitlement into consideration.

Also, not every US-IMG is from the Caribbean. Some choose to go to rigorous overseas med schools. Generalizing is pointless. (Myself for example, I never took all the pre-reqs to apply here, I never took the MCATs, and I'm not a Caribbean grad. I saw an opportunity, and I took it. My goal has always been primary care though, so I knew what I was getting into.)

Also, you're wrong (probably just have no idea and are making stuff up) about other countries and their admissions standards. Some countries have a quota in place for which students can pay full tuition while the other 75-95% of the spots are nearly free of cost to the students (government and the full-tuition quota cover them). Their lifetime earnings are lower though. The US just screws its own med students on the front end instead.
 
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No one is laughing at people going into medicine out of passion; what rubs people the wrong way is your idea that one is somehow a terrible person if they AREN'T going into it for that reason. Some people just see medicine as an intellectually stimulating career with pretty good pay. There's nothing wrong with either approach.

Please quote where I mentioned people being terrible for going into medicine for an intellectually stimulating career with good pay. I agree, there is nothing wrong with that. You missed what I said:

What I think is pathetic is people going into medicine to brag about it, like the OP.
 
They exploit a backdoor specifically designed to do an end-around USMD admissions. This backdoor exists because the US is the most lenient country in the world for foreign-trained MDs to practice in but was never intended to allow off-shore medical schools to admit failed US candidates and allow them to obtain practice rights. In any other country, if you can't get into the country's medical school, tough ****, go find another career.

The fact that IMGs can practice at all here should be seen as a blessing.

You clearly don't know what you are talking about.

1. The US is NOT "the most lenient country in the world for foreign-trained MD's..."
a. In ALL European countries, a foreign specialty recognition can be converted to a European specialty recognition provided most European requirements for the specific specialty are met
b. To have your medical degree recognized, you just need to graduate from a med school listen in IMED
c. To be certified to work as a doc, often (depending on country) you need to pass some measly exam (like nothing close to the USMLE), to prove you have a minimum of medical knowledge
d. In Scandinavia (and in most European countries, I presume), language proficiency is not a requirement - as such, I have seen a ton of Arabs/Central asians with kindergarten level language proficiency and communication skills.

2. I'm a foreign medical grad, on a J1 visa, in a good neurology program
a. I pay taxes
b. My salary may be funded by your tax money, but I do honest work for my pay
c. I come with an education worth $300.000, step scores >265
d. I plan to contribute to healthcare in the US for the next 30-40 years
e. My salary as a resident is half of what it is in Europe

So... I get the training, the US gets a free doc.

By the by, lots of Western European people go to countries like Poland to earn a medical degree... because they couldn't get into medical school in their respective home countries.

By the by the by, I had an American citizen in my med school class: He moved to Denmark to receive 1) free medical education and 2) All expenses paid (up to $1.000/month.
 
Please quote where I mentioned people being terrible for going into medicine for an intellectually stimulating career with good pay. I agree, there is nothing wrong with that. You missed what I said:

What I think is pathetic is people going into medicine to brag about it, like the OP.

OP is at the tail-end of his Step 1 prep. Understandably so, his social skills, and brain are probably fried :laugh:.

On any other day, I would put money down, that OP has other more genuine/altruistic factors, but letting himself and his family down is something which is an emotional factor at this time. I know I've felt similarly at times and lost sight of the "big picture" occasionally myself. I'm sure this isn't isolated.
 
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