No hand-on USCE IMG. Where should I aim for?

[rhomboid]

Hello. I'm an IMG from Asia. I graduated 8 years ago, and had completed my internal medicine as well as sub-specialty training in my home country. I have strong clinical experiences, and had > 20 original publications. I decided to continue my career in US, and is currently a MPH student. I aim to apply for the 2017-2018 cycle.

My strength:
1. Strong clinical experience in IM and in sub-specialty
2. Strong publication lists
3. Step 1 > 250 (others not taken yet)
4. A MPH degree
5. High GPA, some awards...etc

My weakness:
1. Graduated many years ago
2. No hand-on clerkship or sub-internship. Even I can do some observership or externship, that would not be counted toward hand-on experience.
3. I am not very confident with interview and social activities with current residents.

My aim is still to be an academic physician, and I hope to be in university-affiliated IM program.
However, I know may programs specifically asked for hand-on USCE, and that is not possible for IMG who already graduated. I also thought that I am too ambitious wanting to matched to high-ranking IM programs.

My questions are:
1. Should I aim lower, aiming to get a IM spot first, and get into a good fellowship later?
2. Is there anything I can keep doing to increase my profile?
3. Would It help if I still apply to those programs, followed by a letter to program director or coordinators?

Thanks a lot!!

---

Members don't see this ad.

 

[NotAProgDirector]

You should check minimum requirements for programs, many have them posted on their websites. If you don't meet their minimums, you won't get an interview no matter how much you impress in other areas. Writing to the PD would be unlikely to change this. All that said, it's only money -- you can apply to as many programs as you want and hence can aim as high as you want (unless they change the process next year).

 

[Medstart108]

Hello. I'm an IMG from Asia. I graduated 8 years ago, and had completed my internal medicine as well as sub-specialty training in my home country. I have strong clinical experiences, and had > 20 original publications. I decided to continue my career in US, and is currently a MPH student. I aim to apply for the 2017-2018 cycle.

My strength:
1. Strong clinical experience in IM and in sub-specialty
2. Strong publication lists
3. Step 1 > 250 (others not taken yet)
4. A MPH degree
5. High GPA, some awards...etc

My weakness:
1. Graduated many years ago
2. No hand-on clerkship or sub-internship. Even I can do some observership or externship, that would not be counted toward hand-on experience.
3. I am not very confident with interview and social activities with current residents.

My aim is still to be an academic physician, and I hope to be in university-affiliated IM program.
However, I know may programs specifically asked for hand-on USCE, and that is not possible for IMG who already graduated. I also thought that I am too ambitious wanting to matched to high-ranking IM programs.

My questions are:
1. Should I aim lower, aiming to get a IM spot first, and get into a good fellowship later?
2. Is there anything I can keep doing to increase my profile?
3. Would It help if I still apply to those programs, followed by a letter to program director or coordinators?

Thanks a lot!!

Lots of IMGs will match to a "lower tier" IM program later matching to a good fellowship. I think you should apply broadly, to some reaches but mainly aim for programs will consider you. You might be surprised and get an interview at a highly ranked program, but if a program explicitly states that you need USCE to apply, then you are probably out of luck.

You will notice a lot of IMG attendings in the US did their IM training at an average program but managed to secure well known fellowships and staff positions. I think that speaks to the fact that they had what it took, but just not the USCE to match to a good IM program, but once they matched their "star" power was recognized.

I am confident you will match if you apply broadly. Your only disadvantage is being a foreigner with some language/cultural barriers, needing a visa, but you have done a degree in the US, which means you will have a somewhat better understanding of US culture than other IMGs. Otherwise, your application is stellar. Good luck.

You will be surprised some top US academic programs specifically only take those IMGs who were stellar in their own country and just need an opportunity to succeed. Many top IM programs in the country will take 1 or 2 IMGs a year who have a similar application to yours.

 

[rhomboid]

@Medstart108 : Really thanks for your kind words! It sounds much better now!

@aProgDirector : I noticed that there are observership and externships. Some companies specifically offered externships in states such as NY, claiming to offer "hand-on" USCE after graduation. Although I am suspicious, but do these externships help?
If not considering externships, are several months of observership in clinical rotation better, or it it better to attend clinical meeting and out patient clinic better in terms of matching for residency?

Thanks a lot for both of you!!

 

[NotAProgDirector]

Your question isn't easy to answer. There is no standardized definition of what an "externship" or an "observership" is, and what individual programs might consider acceptable will vary.

Ideally, what you'd like is an inpatient experience in a "teaching environment" (i.e. there are other students/learners involved) with hands-on responsibility -- you're the one writing orders, writing notes, examining patients, talking to consultants, etc. Everyone will agree that this "counts".

Externships may not meet these goals. You may be placed in an outpatient environment, or be placed with a private doc in their office who doesn't otherwise have any teaching responsibilities. Presumably externships include patient history/exams, order writing, note writing, etc but there's no guarantee of such.

Observerships usually involve no patient exams, no notes, no orders. As an observer you're only allowed to watch. We can talk about cases. But it may be possible to get an observership at a teaching program.

Again, I can't tell you which is better. Each program may consider these differently. The one thing that probably everyone will agree upon is that more is better.

 

[rhomboid]

Thanks for your suggestion. I know it is hard, and I will try!

 

[rhomboid]

After 2 years I should report back my progress so that other people may see it. I applied to everywhere in the country, both reaches and safeties. I got interviews at about 6 of the top 50 IM programs with some other smaller university programs. Last week I learned that I've matched into my #1.

Sorry I cannot provide more details about programs or interviews for anonymity, but I would like to especially thank @Medstart108. Your encouraging words are very important to me and is one of the main reasons that I can continue this long process. And indeed I think top IM programs are willing to take a "bet" on non-traditional IMG applicants like me or other older AMGs. Thanks for all who had helped me before. Even a simple word means a lot. To other old IMGs or AMGs alike, please keep faith and work hard!

Lots of IMGs will match to a "lower tier" IM program later matching to a good fellowship. I think you should apply broadly, to some reaches but mainly aim for programs will consider you. You might be surprised and get an interview at a highly ranked program, but if a program explicitly states that you need USCE to apply, then you are probably out of luck.

You will notice a lot of IMG attendings in the US did their IM training at an average program but managed to secure well known fellowships and staff positions. I think that speaks to the fact that they had what it took, but just not the USCE to match to a good IM program, but once they matched their "star" power was recognized.

I am confident you will match if you apply broadly. Your only disadvantage is being a foreigner with some language/cultural barriers, needing a visa, but you have done a degree in the US, which means you will have a somewhat better understanding of US culture than other IMGs. Otherwise, your application is stellar. Good luck.

You will be surprised some top US academic programs specifically only take those IMGs who were stellar in their own country and just need an opportunity to succeed. Many top IM programs in the country will take 1 or 2 IMGs a year who have a similar application to yours.

 

[Medstart108]

After 2 years I should report back my progress so that other people may see it. I applied to everywhere in the country, both reaches and safeties. I got interviews at about 6 of the top 50 IM programs with some other smaller university programs. Last week I learned that I've matched into my #1.

Sorry I cannot provide more details about programs or interviews for anonymity, but I would like to especially thank @Medstart108. Your encouraging words are very important to me and is one of the main reasons that I can continue this long process. And indeed I think top IM programs are willing to take a "bet" on non-traditional IMG applicants like me or other older AMGs. Thanks for all who had helped me before. Even a simple word means a lot. To other old IMGs or AMGs alike, please keep faith and work hard!

I'm very happy for you, so glad to see that it worked out and happy for the update!