Question to aPD and anyone in a general surgery program

[scalpelboy]

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I am a US citizen IMG, graduated 2003 from Cairo University School of Medicine. My medical school graduation required a 1 year rotational internship that I successfully completed in Cairo, Egypt. After graduation I had a 2 year surgical training in general and plastic surgery in Cairo University in what's equivalent to a preliminary surgical residency in the US. I relocated to the US in 2005 and has been working as a Surgical First Assist in multiple surgical specialities including general, plastic,orthopedic,OB/Gyn, ENT,vascular, Cardiothoracic and minimally invasive surgeries. I passed my CS test on first attempt and passed both Step 1 and step 2 CK on the 2nd attempt each after obtaining special accommodation on my second attempt due to difficulty spending long time on computer monitors. My special accommodation is documented in my USMLE transcript but not in my personal statement. My passing scores on Step 1 and step 2CK are 201/ 82 and 202/83 respectively but I have not yet taken part 3. I have excellent LORs; 2 from OB/Gyn attendings, 1 from ENT attending and 1 from General Surgery professor that I worked with, all in the US. I applied to 206 general surgery programs(both categorical and preliminary spots) on 9/10/2010 and have an excellent Dean's letter that was released on 11/1 .My LORs and medical school transcript were not completely uploaded to ERAS until 9/25 and I did change my LOR assignment to all programs once my strong LORs were successfully uploaded. My clerkship surgery evaluation during medical school rated me as very good on a scale of Excellent-->poor performance and I graduated on top 25% of my class. I have a total of 4 plus years of surgical assistant experience in the US in multiple community hospitals that are not linked to any surgery programs and I have no connections to any surgical residency programs. I don't have any research experience other than minor studies I have been involved in during medical school but I have some oral presentations and preceptor roles that I have been involved in during general surgery conferences in the US.
Up to this moment(11/1/2010) I received 35 rejections out of the 206 programs I applied to and haven't heard from the rest of the programs.

Is there any hope in matching to general surgery this year? Is there anything I can do to boost my chances? Should I email the PDs and inform them about my exam situation that required special accommodation before I could pass?

 

[Way2Swanky]

Don't think it's going to happen for you.
-IMG
-7 years out of med school
-failed Step 1 AND Step 2 CK
-obtained very low Step scores on a retake, with special accommodation
-minimal research
-no connections

There's essentially nothing on your application to mitigate any of those problems. Gen surg is a pretty competitive field and I doubt that even an American senior would be able to match with those USMLE issues.

If you don't match this year, I would suggest maybe considering Ob-Gyn. Much less competitive than GS, but even still I think it may be a long shot.

I am a US citizen IMG, graduated 2003 from Cairo University School of Medicine. My medical school graduation required a 1 year rotational internship that I successfully completed in Cairo, Egypt. After graduation I had a 2 year surgical training in general and plastic surgery in Cairo University in what's equivalent to a preliminary surgical residency in the US. I relocated to the US in 2005 and has been working as a Surgical First Assist in multiple surgical specialities including general, plastic,orthopedic,OB/Gyn, ENT,vascular, Cardiothoracic and minimally invasive surgeries. I passed my CS test on first attempt and passed both Step 1 and step 2 CK on the 2nd attempt each after obtaining special accommodation on my second attempt due to difficulty spending long time on computer monitors. My special accommodation is documented in my USMLE transcript but not in my personal statement. My passing scores on Step 1 and step 2CK are 201/ 82 and 202/83 respectively but I have not yet taken part 3. I have excellent LORs; 2 from OB/Gyn attendings, 1 from ENT attending and 1 from General Surgery professor that I worked with, all in the US. I applied to 206 general surgery programs(both categorical and preliminary spots) on 9/10/2010 and have an excellent Dean's letter that was released on 11/1 .My LORs and medical school transcript were not completely uploaded to ERAS until 9/25 and I did change my LOR assignment to all programs once my strong LORs were successfully uploaded. My clerkship surgery evaluation during medical school rated me as very good on a scale of Excellent-->poor performance and I graduated on top 25% of my class. I have a total of 4 plus years of surgical assistant experience in the US in multiple community hospitals that are not linked to any surgery programs and I have no connections to any surgical residency programs. I don't have any research experience other than minor studies I have been involved in during medical school but I have some oral presentations and preceptor roles that I have been involved in during general surgery conferences in the US.
Up to this moment(11/1/2010) I received 35 rejections out of the 206 programs I applied to and haven't heard from the rest of the programs.

Is there any hope in matching to general surgery this year? Is there anything I can do to boost my chances? Should I email the PDs and inform them about my exam situation that required special accommodation before I could pass?

 

[Buzz Me]

Agreed that it will be a very difficult match. You need to have LORs from surgical attendings (not OB/GYN), and you need research or something else to bolster your app - the Step 1/2 CK failures and 7 years since med school graduation are really hurting your chances.

 

[NotAProgDirector]

We'll see if you get any interviews, but I worry that the advice above may be correct. I doubt that telling PD's that you had problems with "computer monitors" that required special accommodations is going to help -- most programs have EMR's that require facile use of computers. You have some chance of getting a prelim surgery spot, although there is no guarantee that will lead to anything. If you get no interviews, there really isn't much you can do to improve your application short of getting some good connections to a GS training program, which is unlikely. You need to decide whether you want to continue working in the OR as an FA, or you could consider applying to FM.

 

[Winged Scapula]

There's not much to add to the insight offered above. I also fear that your time away from residency training (the training outside of the US is generally not considered) is a substantial factor. Many programs will not accept applications from those more than 5 years out of training.

In addition, as has been noted, subpar scores on the USMLE *with* special accomodations is hardly going to endear you to surgical faculty. Let's also not forget the increasing use of endoscopy/laparoscopy/thorascopy in surgery as well as the requirement to demonstrate skill in such techniques during your training. If you need special accomodations to read text on a computer screen, how are you going to function with OR monitors?

A preliminary position (there will be many available in the scramble) is probably your best chance.

 

[scalpelboy]

Hello everyone, thanks for the reply.

I think the special accommodation thing got kind of overblown a little bit. Obviously I am not blind nor can't I handle the basic computer load that everyone deals with (chatting on this blog, EMRs, CMEs...etc).
Also I have no problem performing laparoscopic surgeries or utilizing equipment that we currently use in the ORs ( this is what I currently do for living for more than 70hrs/week).
My main problem comes up with glare reflected from the monitors,car lights ...and I have a certain threshold than once reached my eyes just shut down. This is basically caused by ocular rosacea and long term doxycycline treatment(photosensitivity). The major influencing factors are the duration,proximity of exposure and the background contrast.
Anyways the special accommodation that I received was basically the permission to use eye drops and polarized glasses during my test( no extended time, more breaks or anything of that kind) so I didn't realy get any real extra advantage than anyone else. It was still hard for me to finish the tests (8 hours)with my dry glary vision but bearable with the use of the glasses.
So I wouldn't really call it "low scores *with* special accommodation "

From what I see, everyone almost agrees on that the chances are pretty slim matching to a categorical program.. How about matching to a preliminary spot? Do programs actually care to fill their preliminary spots in the match if they could? I see programs that fail to fill any preliminary spots EVERY year..Does that mean they don't even interview for these spots in the first place and drop it for the scramble?
Also all the rejections I received so far were from programs that did not identify whether I was rejected from their categorical or preliminary spots eventhough I applied to the categorical and prelim of each program. 😕

 

[Brunette1981]

Doubtless someone who knows more about surgery prelims could help you more but I would wonder/worry about what the POINT of doing a surgery prelim is.

Most programs that would hire a surgery prelim who is a bit of a dark horse as regards to matching at all are probably the sort who take a lot of prelims to do scut and don't offer any (or at most 1-2) of them advanced spots.

So if you complete a surgery prelim, what have you gained? You still can't practice as a surgeon (or as anything really). You aren't necessarily any closer to getting an advanced spot.

Maybe it would be better to apply in a field where you can match into a categorical program (like FM - they do some procedures). Or, if life circumstances allow and you are dead set on being a surgeon, work as a surgeon in Egypt where you would have better connections/opportunities.

 

[JackADeli]

...I think the special accommodation thing got kind of overblown a little bit. Obviously I am not blind...

I don't think so... nor do I think it "obvious".

...My main problem comes up with glare reflected from the monitors,car lights ...and I have a certain threshold than once reached my eyes just shut down. This is basically caused by ocular rosacea ...The major influencing factors are the duration,proximity of exposure and the background contrast...

I think this will be a big problem. General surgery, residency especially, is filled with long, long, long hours staring at screens, bright lights, headlights, etc.... It would be a big problem for you to suddenly have your "eyes just shut down" after an attending stares at you during a case with a bright headlight beam to your eyes or maybe someone shines you with the HD, ultrabright light cable from a lap scope. Putting aside your FMG status, putting aside your USMLE failures x2 steps, I think the reality of this is significant based on how you have described it. I don't foresee your eyes/condition improving with age or more intense OR time.

...So I wouldn't really call it "low scores *with* special accommodation "...

I would as noted above... and USMLE did! You can not have it both ways. You failed. Then, once your requirements were met, above what others require, you passed. Then somehow, arrangements were not made for your second exam, even though you knew you required them....

Long and short, here is my two cents. I think others have already hit it too. First, I don't see you categorical into any competitive or pseudocompetitive specialty without outside influence. Your basic aopplication, eyeballs aside, is subpar. So, IMHO, OB/Gyn categoriacl is out as is GSurgery. Second, I am not sure you will get a categorical spot in non-competive field with your current application.

My recommendations... You should do two years of prelim in something or two diferent somethings. i.e. prelim general surgery and prelim OB/Gyn or something like that. Then I suggest you apply to a non-competive field. At that point, whatever programs will know that you will have two years USA accredited postgraduate training by the time you start. You should also plan to complete you step 3 ASAP so you don't run out of time. After all that, you could still surgery first assist but will at least have now completed a residency. i.e. if you do primary care residency, you could still first assist.

 

[dragonfly99]

I don't think you can realistically get into general surgery or any surgical field. Even a US grad with your stats would have a very hard time, and you are a foreign grad who is years out of training. I think you got some bad advice (or didn't get any) to try to push this hard for a surgical residency. I just don't see how it can happen. At best, you might scramble into a prelim spot, but I'm 95% sure they'd just use you for scut and you probably would not have a decent change to even go on up to a categorical spot from there.

In your shoes, I would go for something like family practice or pathology. Go for something where you might have a shot at a categorical residency, if you want to practice independently in the US. If you don't have debt and you love the OR above all, then could keep doing what you are doing, or try to scramble for a prelim spot, but realizing it's unlikely to lead to a full surgical residency...

 

[braluk]

As an aside, and I'm not sure how applicable this is anymore but I have a good family friend who went into FM, and mostly does inpatient stuff in a rural area- this includes what old FP's did- deliver babies, some minor surgical stuff. You might be able to find a niche this way- but it seems that there is a general consensus here- and it's supported by Charting Outcomes Data by NRMP.

http://www.nrmp.org/data/chartingoutcomes2009v3.pdf