scramble vs intern?

[VommoV]

hi guys,

i'm an american and also IMG. i'm graduating from my med school this june. i have applied for general surgery this upcoming match, but unfortunately haven't had any interviews yet.

so i'm planning to work here in ireland for a year as an intern, and enter for match 2009.

however, i've been hearing that staying in ireland will weaken my candidacy and i should enter scramble instead, reason being it's better to get my foot in the door doing a year of prelim surgery. my reason for wanting to stay is:

1 - higher pay, slightly better hours
2 - take step 3 to strengthen my application for 2009 match

will delaying my return to the states really hurt my chances? does anyone have any factual information regarding this? opinions and suggestions also welcomed. thank you guys in advance, and happy 2008.

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[NotAProgDirector]

hi guys,

i'm an american and also IMG. i'm graduating from my med school this june. i have applied for general surgery this upcoming match, but unfortunately haven't had any interviews yet.

so i'm planning to work here in ireland for a year as an intern, and enter for match 2009.

however, i've been hearing that staying in ireland will weaken my candidacy and i should enter scramble instead, reason being it's better to get my foot in the door doing a year of prelim surgery. my reason for wanting to stay is:

1 - higher pay, slightly better hours
2 - take step 3 to strengthen my application for 2009 match

will delaying my return to the states really hurt my chances? does anyone have any factual information regarding this? opinions and suggestions also welcomed. thank you guys in advance, and happy 2008.

Taking Step 3 is not likely to improve your application much. If you did poorly on Step 1 and/or 2, perhaps a stellar score on Step 3 would help, but not likely. If you need a visa and want an H, then Step 3 is a must but you mentioned already that you're an american.

An internship in Ireland is going to be of mixed value. First of all, you'll only have completed 4 months before you need to apply for the match again, which isn't very long to get a good letter. If your internship in Ireland is surgical, that might help -- if it's a mixed rotating internship it's unlikely to help at all. You'll need to arrange for interview tim during your internship, which can be tricky.

On the other hand, a prelim surgical year is no guarantee of anything. Some prelims get categorical spots, but some/many do not. If you shine in a good US program, that would be the best way to get a surgical spot. You'll be working VERY hard, and I'd consider trying to get some research done with your "free time" if possible.

There is no easy answer. If you got no interviews at all and applied broadly and on time, then it's also time to consider what you will do if surgery is not in your future. if you applied late then it's hard to know what your chances are.

No easy choices. Good luck!

 

[VommoV]

Taking Step 3 is not likely to improve your application much. If you did poorly on Step 1 and/or 2, perhaps a stellar score on Step 3 would help, but not likely. If you need a visa and want an H, then Step 3 is a must but you mentioned already that you're an american.

An internship in Ireland is going to be of mixed value. First of all, you'll only have completed 4 months before you need to apply for the match again, which isn't very long to get a good letter. If your internship in Ireland is surgical, that might help -- if it's a mixed rotating internship it's unlikely to help at all. You'll need to arrange for interview tim during your internship, which can be tricky.

On the other hand, a prelim surgical year is no guarantee of anything. Some prelims get categorical spots, but some/many do not. If you shine in a good US program, that would be the best way to get a surgical spot. You'll be working VERY hard, and I'd consider trying to get some research done with your "free time" if possible.

There is no easy answer. If you got no interviews at all and applied broadly and on time, then it's also time to consider what you will do if surgery is not in your future. if you applied late then it's hard to know what your chances are.

No easy choices. Good luck!

thanks for your reply,

i guess i've forgotten to add few details in my previous thread. my step 1 score is 227/92, which in my opinion isn't too great, but isn't poor either. i also have two good letters of recommendations from surgeons and one from cardiologist (from electives at cleveland clinic this past summer 2007).

however, i haven't taken step 2 ck and cs yet, which is probably the reason why i have not received any interview offer. i just wasn't ready. my step 2 ck is in 2 weeks, and cs is 10 days after that. i'm taking my exams this time, and my scores should be available in march. not that this will make any difference with my current situation, but at least i will be eligible to enter scramble i guess.

with these new parameters, will it change my situation?

one more thing, if i do go into scramble and find a prelim gen surg spot, isn't it basically a same thing (working for 4 months before applying again)? i don't know how the transition from prelim to categorical works. please let me know.

thank you again

 

[NotAProgDirector]

thanks for your reply,

i guess i've forgotten to add few details in my previous thread. my step 1 score is 227/92, which in my opinion isn't too great, but isn't poor either. i also have two good letters of recommendations from surgeons and one from cardiologist (from electives at cleveland clinic this past summer 2007).

however, i haven't taken step 2 ck and cs yet, which is probably the reason why i have not received any interview offer. i just wasn't ready. my step 2 ck is in 2 weeks, and cs is 10 days after that. i'm taking my exams this time, and my scores should be available in march. not that this will make any difference with my current situation, but at least i will be eligible to enter scramble i guess.

with these new parameters, will it change my situation?

one more thing, if i do go into scramble and find a prelim gen surg spot, isn't it basically a same thing (working for 4 months before applying again)? i don't know how the transition from prelim to categorical works. please let me know.

thank you again

This does change things. As an IMG without Step 2, it's no surprise that you got no interviews. You wouldn't be eligible for the match either, as you're not ECFMG certified. Next year, with a complete application and assuming a good STep 2 score, you'll be in a much better situation.

So, assuming a decent Step 2 score, the question is whether you'd be better off in a prelim US surgical spot vs an internship in Ireland. You already have some US experience which is a big plus.

The honest answer is that I don't know. Hopefully Kimberli will note this thread and put her two cents in. My guess is that the US prelim surgical year will help you the most at that program. You will certainly need to interview widely for a spot, so whichever path you take make sure you have free time in Dec/Jan.

 

[Winged Scapula]

aProgDirector is correct. Programs want to know that their candidates will be ECFMG certified, especially when its a relatively competitive field like General Surgery. You are required to have completed all the steps toward certification by date of submission of your Rank Order List, with the exception of your final diploma.

I agree, it is *highly* likely that the reason you didn't get any interviews is that programs are increasingly looking for applicants who have completed all the steps toward ECFMG certification, with some even requiring certification to interview. They are unlikely to interview someone who has quite of bit of work left toward certification with the attendant risks of matching someone who cannot get certified and therefore, cannot start residency. Unfortunately, it appears you didn't know realize this or underestimated its importance.

Like aProgDirector, I'm afraid I cannot offer a definitive answer as to whether its better to take a Prelim position in the scramble or to stay in Ireland for another year. But as he notes, there will be some logistical issues...will you be able to get time off to come to the states to interview? Depending on how successful your application, you could need two months available to interview. In addition, a Irish intern year usually follows the British system of medical education in which you will have very little surgical training (ie, it will be akin to a rotating internship), so the experience it offers to PDs evaluating your application would be minimal. The major advantage would be if you were interested in ever returning to the island to work.

Thus, I really see little value in staying in Ireland except for the last reason above. Step 3 is not likely to give much added value to your application. MY recommendations would be:

1) be in the US for the scramble. The scramble is very difficult, psychologically and technically. Trying to do it from abroad is even harder. Programs may wish to meet you in person. You'll need access to a FAX and a good phone and internet connection.

2) do some research into programs, trying to find ones that have a history of taking a prelim into their categorical track. I know ECSU and Penn State both have such a history; others surely exist.

3) if you find a program which has a Prelim position available in the scramble which interests you, take the position with the knowledge that it will be a nearly year long audition rotation. Expect to work MUCH harder than you ever have. Start working early with your PD regarding potential positions for the following year - either in your program or another one. Bear in mind that academic programs tend to have more flexibility in regards to offering a position because of the lab/research years.

4) if you don't find something in the scramble, I would still probably recommend you try and find some research here in the US unless your internship year in Ireland really will afford you time to come back to the states for interviews (and you can afford to travel back and forth or stay here for a couple of months). As noted, since applications are accepted in September and the deadline for Surgery programs is October 15-November 1, there isn't a lot of time to impress faculty, so you have to start running on July 1.

Next year you will be applying with ECFMG certification and some US experience which will strengthen your application greatly.

I wish I could give you definitive answers, but there are no hard and fast rules or universal truths about this issue. Finally, please be aware of the IMG/FMG surgical "trap" - the American Board of Surgery no longer accepts applications for Board Certification from residents who have trained in more than 3 programs. Therefore, you do not want to be the resident who jumps from program to program, continuing as a Prelim rather than being offered a Categorical resident. I have no doubt that some programs take advantage of IMG/FMGs this way, especially as surgery has gotten more competitive and applicants are more desparate. Thus, you need to consider a Plan B as well.

 

[VommoV]

thank you both aProgDirector and Winged Scapula,

u guys are great. thank you both for your insightful advices. i knew i was digging myself into a deep rut when i delayed my step 2s, but i figured postponing was better than doing poorly. o well...i just hope that i do well enough next thurs to make it worthwhile.

i think i'm going to enter the scramble and hope for the best, and if that doesn't work, find a job here. finding a research position seems attractive, but i don't know how effective that will be unless i find a research spot in the institution where i want to work as a resident. there are supposedly 5 weeks of break for an intern here in ireland, so perhaps i can bust my butt until dec and use my vacation time then.

anyhow, thank you both for your interest and advices. i welcome more suggestions & informations!

 

[Winged Scapula]

thank you both aProgDirector and Winged Scapula,

u guys are great. thank you both for your insightful advices.

You're welcome.

i knew i was digging myself into a deep rut when i delayed my step 2s, but i figured postponing was better than doing poorly. o well...i just hope that i do well enough next thurs to make it worthwhile.

I understand your logic, but delaying an exam to do better when the exam is required for application doesn't make much sense. Oh well, as you say, now you know better.

i think i'm going to enter the scramble and hope for the best, and if that doesn't work, find a job here. finding a research position seems attractive, but i don't know how effective that will be unless i find a research spot in the institution where i want to work as a resident.

The point of doing research if staying here in the US isn't necessarily to help get you a residency position next year but rather:

1) keeps you doing something sort of medical; if you take the year off and don't do anything medical or wildly interesting, it will look bad on your application;

2) keeps you in the US, geographically desirable for interviews

3) does put you in contact with people who may know faculty at other departments; that is, you want to do something in clinical research

there are supposedly 5 weeks of break for an intern here in ireland, so perhaps i can bust my butt until dec and use my vacation time then.

Bear in mind that many programs may interview before December or January. It will be wasted time if you use your vacation during December because most US programs will not interview during the last two weeks of the month. You'll also need to see if you are able to take your 5 weeks off whenever you want and if you can take them in a block before commiting to the idea of staying in Ireland.

anyhow, thank you both for your interest and advices. i welcome more suggestions & informations!

I suspect that English is not your native language. Please make sure that your PS has been read by a native English speaker so as to weed out some of the grammatical errors and phrasing which sound awkward to the American ear.

Best of luck to you...

 

[loud]

I don't want to spoil any hopes as you never know what could happen, but as far as this year scramble, it is unlikely that he will make it. He is taking his CS in Feb 25th and based on the USMLE Cs reporting results will come out on April 23, 2008. Scramble will be on the 18th of March.

http://www.usmle.org/Examinations/step2/step2cs_reporting.html

Like others have said already, best is to try and finish the exams get the ECFMG cert., and apply by Sept 1st.....I am sure you will get plenty of IVs with good Step 2 scores. BTW your Step 1 score was good, don't get carry away by all the 99 nonsense....Try to get another 90s on your CK get all your letters ready, your ECFMG and most imp do a good IV. GL

 

[VommoV]

thanks loud and others,

i appreciate your inputs. yes, you are quite right, i read about the time range which i will receive my step 2 cs result. unfortunately it's well past scramble date...and i wonder if programs will accept it when i say "i'm quite certain that i have passed step 2 cs"...they probably will not, but i'm still going to try anyhow.

on the brighter side, i just received my step 2ck score today. 227/94, which isn't bad at all. so with 92 in step 1 and 94 in step 2, i'm hoping that i should have a better chance next year if this year doesn't work out. question still remains as far as what i'm going to do this year...

 

[buckley]

I will have to agree that ECFMG certification is really important in securing those interviews. In fact, I tell everyone who asks me that it really is almost a "myth" that an IMG can apply with just Step 1 scores. It's very, very, very hard to do so. Remember that you are also competing with other IMGs, many of whom are not only ecfmg certified but step 3 passers as well. And the number of IMG applicants are really increasing. Since you don't need a visa, that's a big edge, but you still need to pump your application up.

Surgery is a tough field to break into for IMGs. The people I know who were able to get in are those who did electives as students in the hospital where they ended up in or those who worked as research assistants.

As for the scramble, sure you can try as it will not cost you anything to apply to 30 programs. But as mentioned, it will be tough without that ecfmg certificate. Prelim surg is a year-long audition with no guarantees.

But then again, isn't this USMLE path the same? 🙂 It's a looooong limbo!

Good luck to us

 

[surgiwho]

I think you have gotten some great advice above.
This is what I think (IMHO): As far as the scramble vs. Internship:

I honestly don't think that you are going to be able to do a prelim this year. You have to be ECFMG certified ( I imagine for all programs, but I could be wrong ). The ECFMG certification will still take some time AFTER you graduate and get your diploma in. It could get delayed even if you do everything right (unfortunately talking from experience). This is also the reason that programs usually (if not always) need the ECFMG cert. prior to you starting residency. So, if you get your diploma in June, granted all your scores are in, then it takes about 8 weeks (sometimes 5 months, I kid you not!!!).

My advice:
If you can get another rotation here in surgery, take it. It is important to be known by a program and to have US LOR's from SURGEONS. If you can't I would start your internship. I think it is good experience for you. Also, know that 5 weeks might not be enough. I think you will get a few interviews, but they might be spread out and as an IMG, you need to keep your dates open. Again that is my opinion. Another school of thought, and I don't know you or your application, is that you might have to do a prelim year anyway (if you don't match, which is a definite possibility), so why not do one now and save the year of pain. Just be careful and do a lot of research into where you would do that prelim.

I am sure you know that as aPD said prelim might be a road to
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Best of luck!