How is it fair that the step 1 scores of medical students go down because medical students are being graded against medical GRADUATES, to me that is insane.
As an FMG myself, I will have to disagree. Being an FMG already puts you at a great disadvantage from the beginning (which tbh is understandable from any PD's perspective). Many US students might not realize the extent of the disadvantage we are during the match : it's not only that you just graduated from a med school outside of the states :
1)Your clerkships mean nothing because the clerkships here are done in a different way. You can't even match them.
2) You have no Dean's letter because guess what, the title of the Dean here means nothing and most students don't even know his name - and of course he doesn't know you, so if he writes you a letter out of pity because you told him about your dreams of doing your residency in the States, that's a two-line generic impersonal letter at best.
3) Your grades don't mean ****. You might get a 9 in IM during your 6th year which you literally worked your ass for but the PD doesn't know (and isn't obligated really) what scale are we talking about, the relative difficulty of getting x vs y grade, since exams are not standardized and non comparable between different schools or even what is that 6th year you 're talking about, as med school here is 6 years and there is no pre-med.
4) Your LOR's don't mean ****, even if you tried really hard to get them.
5) Doing your rotations here is VERY expensive for the average IMG. I'm not talking about the few millionaires from India who can easily afford them, I'm a European myself coming from a middle class family and just doing the steps, coming to the US for step 2cs and coming again for interviews is almost a year's worth of money of what BOTH my parents earn. Adding to this the cost of a 2 or 3 month stay in the States and the total cost goes overboard.
6) Prepping for the USMLE as a med student, at least in my country, almost certainly means that you get to be behind in your studies and graduating later and that might not be an option for many. And with no step scores while a student, good luck finding an elective - which can ONLY be done while in med school, and as we already mentioned, they 're expensive.
Therefore, as an FMG, going to the match with just great step scores, a publication if you 're really lucky and maybe an observership, with no US LOR's and no actual US clinical experience, the step scores are the only strong card in my hand. And I consider it fair, that I get the chance to put in the effort to make absolutely sure I gain this only advantage I can get, and that is of course taking the steps as a graduate. That of course while earning zero money (as my then-fellow med students are now working) and at the expense of my own personal life.
And for those who 'll ask "Then why come here?", the answer is because I want to get the best training I can get worldwide and reach my full potential as a medical doctor, while earning a decent amount of money while busting my ass off during residency - residents here might be working the same hours but earn around 1/4 of the average US salary.
I didn't come here to whine about being FMG. I actually think the US matching system is actually pretty good at filtering the average from the good and the good from the best. In comparison, we don't even have interviews for the residency spots, it's just a waiting list. Rather I posted this to make things clear about why having the chance to take the steps as a graduate is fair game.
