Studying for USMLE in Australia

[trippasnippa11]

Hi all!

I'm an Australian undergraduate student studying at the University of Western Australia, in the Assured Pathway to the MD. I'll be starting the MD next year; however, after having spent a relatively long period of time in the USA on exchange, I'm really interested in practicing medicine in the USA (or at the very least, keeping the option open!).

I decided this relatively late, and as such, I didn't have time to think about applying to medical school in the USA (also tbh I'm really keen to get my medical degree started next year). I did some research, and my current understanding is that I will need to sit the USMLE exams (and get a very high score), as well as organise some sort of elective in the USA to increase my chances of matching into a US residency program.

My questions are:

1. Is there anyone out there who has had the experience of studying for the boards as an Australian medical student? I'm interested in knowing what your experiences were(ESPECIALLY Step 1, as I know the basic sciences required isn't really covered in as much depth in Aus medical schools)

2. Is there anyone out there who can give me a rough idea of the timeline involved in applying to a US residency program as an Australian medical student (i.e. when they did all the boards, when they tried to match) in particular, did most of this occur DURING medical school or AFTER medical school?

3. Is there anyone out there who has managed to organise a really good medical elective in the USA? How much did it cost, and what were the steps involved in organising it?

Thanks in advance

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[bashwell]

Hi all!

I'm an Australian undergraduate student studying at the University of Western Australia, in the Assured Pathway to the MD. I'll be starting the MD next year; however, after having spent a relatively long period of time in the USA on exchange, I'm really interested in practicing medicine in the USA (or at the very least, keeping the option open!).

I decided this relatively late, and as such, I didn't have time to think about applying to medical school in the USA (also tbh I'm really keen to get my medical degree started next year). I did some research, and my current understanding is that I will need to sit the USMLE exams (and get a very high score), as well as organise some sort of elective in the USA to increase my chances of matching into a US residency program.

My questions are:

1. Is there anyone out there who has had the experience of studying for the boards as an Australian medical student? I'm interested in knowing what your experiences were(ESPECIALLY Step 1, as I know the basic sciences required isn't really covered in as much depth in Aus medical schools)

2. Is there anyone out there who can give me a rough idea of the timeline involved in applying to a US residency program as an Australian medical student (i.e. when they did all the boards, when they tried to match) in particular, did most of this occur DURING medical school or AFTER medical school?

3. Is there anyone out there who has managed to organise a really good medical elective in the USA? How much did it cost, and what were the steps involved in organising it?

Thanks in advance

I did and did very well on Step 1 but @Phloston is the guy to ask when it comes to all things USMLE.

I'll try to write more later about your other questions if I have time as I'm pretty busy at the moment.

 

[Phloston]

Hi all!

I'm an Australian undergraduate student studying at the University of Western Australia, in the Assured Pathway to the MD. I'll be starting the MD next year; however, after having spent a relatively long period of time in the USA on exchange, I'm really interested in practicing medicine in the USA (or at the very least, keeping the option open!).

I decided this relatively late, and as such, I didn't have time to think about applying to medical school in the USA (also tbh I'm really keen to get my medical degree started next year). I did some research, and my current understanding is that I will need to sit the USMLE exams (and get a very high score), as well as organise some sort of elective in the USA to increase my chances of matching into a US residency program.

My questions are:

1. Is there anyone out there who has had the experience of studying for the boards as an Australian medical student? I'm interested in knowing what your experiences were(ESPECIALLY Step 1, as I know the basic sciences required isn't really covered in as much depth in Aus medical schools)

2. Is there anyone out there who can give me a rough idea of the timeline involved in applying to a US residency program as an Australian medical student (i.e. when they did all the boards, when they tried to match) in particular, did most of this occur DURING medical school or AFTER medical school?

3. Is there anyone out there who has managed to organise a really good medical elective in the USA? How much did it cost, and what were the steps involved in organising it?

Thanks in advance

My advice would be to follow the UQ-Oschner thread for advice (yes, I know it's not your program but there's a lot of info floating around there as it's the biggest American-driven Aussie program). Yes you will need to do a US elective. Yes you will need high usmles. You will have to also apply during your final year in Aussie med and take a six month ish break after you finish before starting US residency.

 

[trippasnippa11]

I did and did very well on Step 1 but @Phloston is the guy to ask when it comes to all things USMLE.

My advice would be to follow the UQ-Oschner thread for advice (yes, I know it's not your program but there's a lot of info floating around there as it's the biggest American-driven Aussie program). Yes you will need to do a US elective. Yes you will need high usmles. You will have to also apply during your final year in Aussie med and take a six month ish break after you finish before starting US residency.

Thank you for the very quick replies! I will take a look at the UQ-Oschner thread
When you find the time to answer a few more questions, I was wondering:

1. How difficult was it to organise an elective in the US, and how early in advance did you start organising them?
2. Do you have any recommendations for US electives?
3. When did you start studying for Step 1?
4. How difficult did you find balancing studying for Step 1 and your regular medical school assessments?

 

[trippasnippa11]

bump

 

[Domperidone]

#1. Are you nuts? I'm half in jest about this statement.

You have a guaranteed job after you graduate as an Australian citizen. Your training is optimized for the Australian residency pathway. You understand that if you travel overseas and do residency outside of Australia, without completing the intern year, should you wish to return to practice med in Australia - whatever residency you do abroad *may not even count. You'll still have to return to *either return to do residency in Australia or go through a heap of hoops, and you may not even have a guarantee given the hiatus and high demand for internships nowadays.

Like every other Western country, it's very tough to gain entry into a medical system & practice if you have either a) a foreign medical degree or b) ya did residency in a foreign country. There are many, many reasons for this, which go beyond the scope of this thread.

If you're dead set about the states, I would suggest you think about for fellowship (so after you finish residency & registrar training at home) OR look into it after you finish the intern year, so you haven't cut yourself off with your home country. Or you're essentially shutting the door and throwing away the key to coming back. (not impossible, but massive challenge)

How much have you thought this through? Or you're ready to permanently migrate to the US? Exchange in the US is completely different from working as a resident. Even students do 30 hour shifts over there. The work-life balance concept is completely different.


#2. you haven't started med school yet (or you're now starting first year). correct? that's not really late into consideration. It's early.

Step 1 is taken at the end of 2nd year, Literally. you cannot sign up for the Step 1 until your school confirms this. It tests the first two years of basic medical science. e.g. microbiology, physiology, pathology etc. Aussie schools are variable on how in depth they are. You are better off contacting international students or grads at your respective medical school for advice.

Generally speaking, the very keen start studying in first year.
As in, as they study for medical school courses, they also use the USMLE materials, they practice Qbank questions accordingly. If you're studying cardiac physiology, do USMLE practice qs on the topic.

#3. US electives - freaking difficult to organize. Not impossible however.
It's to do with insurance. it's also $$$, and some places charge upwards of $1000 for insurance alone in addition to other costs you pay the hospital directly or medical school involved. Versus, elective are much easier to organize in every other country of the world (i.e. commonwealth countries).

You have to look into organizing these things early, they're also highly competitive and sought after. Same goes with canada. can some times take upwards of a year in advance to arrange. as in, deadlines for applications could be anywhere from 6-12 months in advance of proposed elective dates. You also have to hope it lines up with dates your med school allows you to take for the elective. 1-2 months minimum is required to put together applications (because they involve things like getting drug testing, TB testing etc etc.). It's no joke.

In terms of where to go, it's a massive country with thousands of places you could try to apply to. It's not like Australia, where it's a relatively much more finite number. think about what state you want to practice in in the future and take it from there. factor in also that not all states recognize particular medical school degrees from Australia.

#4. Compared to American counterparts, it's easier to study for the Step 1 as an Aussie med student. The hours are much nicer. This is very generally speaking. Or so I've been told Many people (whether or not they take the Steps, whether Aussie or international) often use the Step 1 materials to study for their own medical school assessments. Given how $$ the step 1 industry is with their learning materials, they're often higher quality than some of the lectures at med school (it's logical - not like doctors are formally taught how to lecture to students, at some schools, lectures are optional. learning is self-directed). There's also far more questions to practice with from the USMLE Qbanks and books, schools can struggle to come up with enough practice (or examinable) questions for student.

#5. Have you researched much about time and $$ investment into the steps?
there's 4 steps total-ish. Your step 1. then your step 2CS. then your step 2CK (after med school - your step 3)
Each costs thousands of US $$. Step 2CS - live exams shall we say, requiring you to fly to the USA.
the written portion of the steps are 8 hours long. roughly.
Applications for residency is also $$ and so are the interviews. As an IMG, you'll have to apply to like 50-60 programs..or more. (if i'm wrong, the number is way more). You really have to think about whether it's worth so much of your time and resources or $$ to just keep an option open.

Note: I did not take the Steps (nor do i have any plans to)
So, take what I say with a grain of salt.

 

[trippasnippa11]

#1. Are you nuts? I'm half in jest about this statement.

You have a guaranteed job after you graduate as an Australian citizen. Your training is optimized for the Australian residency pathway. You understand that if you travel overseas and do residency outside of Australia, without completing the intern year, should you wish to return to practice med in Australia - whatever residency you do abroad *may not even count. You'll still have to return to *either return to do residency in Australia or go through a heap of hoops, and you may not even have a guarantee given the hiatus and high demand for internships nowadays.

Like every other Western country, it's very tough to gain entry into a medical system & practice if you have either a) a foreign medical degree or b) ya did residency in a foreign country. There are many, many reasons for this, which go beyond the scope of this thread.

If you're dead set about the states, I would suggest you think about for fellowship (so after you finish residency & registrar training at home) OR look into it after you finish the intern year, so you haven't cut yourself off with your home country. Or you're essentially shutting the door and throwing away the key to coming back. (not impossible, but massive challenge)

How much have you thought this through? Or you're ready to permanently migrate to the US? Exchange in the US is completely different from working as a resident. Even students do 30 hour shifts over there. The work-life balance concept is completely different.


#2. you haven't started med school yet (or you're now starting first year). correct? that's not really late into consideration. It's early.

Step 1 is taken at the end of 2nd year, Literally. you cannot sign up for the Step 1 until your school confirms this. It tests the first two years of basic medical science. e.g. microbiology, physiology, pathology etc. Aussie schools are variable on how in depth they are. You are better off contacting international students or grads at your respective medical school for advice.

Generally speaking, the very keen start studying in first year.
As in, as they study for medical school courses, they also use the USMLE materials, they practice Qbank questions accordingly. If you're studying cardiac physiology, do USMLE practice qs on the topic.

#3. US electives - freaking difficult to organize. Not impossible however.
It's to do with insurance. it's also $$$, and some places charge upwards of $1000 for insurance alone in addition to other costs you pay the hospital directly or medical school involved. Versus, elective are much easier to organize in every other country of the world (i.e. commonwealth countries).

You have to look into organizing these things early, they're also highly competitive and sought after. Same goes with canada. can some times take upwards of a year in advance to arrange. as in, deadlines for applications could be anywhere from 6-12 months in advance of proposed elective dates. You also have to hope it lines up with dates your med school allows you to take for the elective. 1-2 months minimum is required to put together applications (because they involve things like getting drug testing, TB testing etc etc.). It's no joke.

In terms of where to go, it's a massive country with thousands of places you could try to apply to. It's not like Australia, where it's a relatively much more finite number. think about what state you want to practice in in the future and take it from there. factor in also that not all states recognize particular medical school degrees from Australia.

#4. Compared to American counterparts, it's easier to study for the Step 1 as an Aussie med student. The hours are much nicer. This is very generally speaking. Or so I've been told Many people (whether or not they take the Steps, whether Aussie or international) often use the Step 1 materials to study for their own medical school assessments. Given how $$ the step 1 industry is with their learning materials, they're often higher quality than some of the lectures at med school (it's logical - not like doctors are formally taught how to lecture to students, at some schools, lectures are optional. learning is self-directed). There's also far more questions to practice with from the USMLE Qbanks and books, schools can struggle to come up with enough practice (or examinable) questions for student.

#5. Have you researched much about time and $$ investment into the steps?
there's 4 steps total-ish. Your step 1. then your step 2CS. then your step 2CK (after med school - your step 3)
Each costs thousands of US $$. Step 2CS - live exams shall we say, requiring you to fly to the USA.
the written portion of the steps are 8 hours long. roughly.
Applications for residency is also $$ and so are the interviews. As an IMG, you'll have to apply to like 50-60 programs..or more. (if i'm wrong, the number is way more). You really have to think about whether it's worth so much of your time and resources or $$ to just keep an option open.

Note: I did not take the Steps (nor do i have any plans to)
So, take what I say with a grain of salt.

Thank you for your detailed and helpful reply

1. In terms of having a guaranteed "job" after graduating, it really depends on what your definition of job is. Yes, you are guaranteed to be a doctor, but if you're an Aus medical student I'm sure you're aware of the current issues many doctors are having with getting a training spot in their chosen specialty and the disillusionment/disappointment that's been associated with that. Many of my friends who are currently in Med school are considering other countries since this issue doesn't look like it'll be fixed anytime soon (in fact, they're still opening NEW medical schools and potentially worsening the bottleneck!) In fact I'm sure if I did the Steps and applied to a General Surgery residency program in the US (with LORs, good scores, etc) , I'd be more likely to complete my surgical training faster than someone who stayed in Aus and spent numerous years trying to get accepted into SET training

Regarding how much I've thought it through - I definitely spent a lot of time doing so! Many factors contributed to it - my amazing experience living there, family ties and the general feeling that I enjoyed the atmosphere there better than Aus. Basically I want to keep my options open and expand my horizons HOWEVER I am planning on completing my intern year in Aus to keep my options even MORE open were I to decide I wanted to relocate back to Aus.

2. I'm starting early because I would really like to weigh up my options as soon as possible and figure out how well my 1st/2nd year studies would prepare me for Step 1 - I've heard that there is sometimes a lack of basic sciences taught in most Aus med schools compared to what is required for Step 1, so I thought it would be good to know how much supplementation/extra study I would need to perform as highly as possible (especially important as I'm a non-US applicant)

3. Yep I've heard similar from older students at my school! I have some family in the US who are physicians so I will be asking them for help/advice as well regarding how best to approach organising the elective

4. That's a relief!

5. I definitely do still think it's worth giving it a shot despite the cost! Despite the monetary and logistical hurdles that I would need to jump over, it's been a long-term dream of mine to live in the US (for at least some of my life) and I would still like to try.

 

[Domperidone]

1. Sure, remember I don't know you from any other random that comes out of the woodwork. I just go by what information you offer in initial posts (or don't offer). Most pre-meds and even first and 2nd year medical students have no idea how the training system works. Good for you that you're thinking about this now. However, you haven't even gone through any clinical year rotations yet (second hand experience is not quite the same thing).

I am perfectly aware of the training situation. I'm currently a resident medical officer, PGY2.
The training system is different, hence why it seems longer in Australia. the balance is in the lifestyle and hours.

Also, while it takes a number of years to apply and be considered for registrar training - this position is the equivalent to a senior resident in countries like the USA and Canada. You don't go straight into their equivalent of "registrar" training in the USA. the years leading up to it include house officer years (depending your state) which could mean that as early as PGY2 you can have only surgical rotations, in which they start teaching you techniques and allow you to assist. You will be expected to work independently in the wards and manage post-op (or pre-op) patients, run clinics etc. Prior to getting on the program, you are also expected to undertake unaccredited surgical registrar positions (where you do surgery, you lead rounds, you do admissions). Regardless, it's all surgical training, you're still doing surgery. While it's relatively condensed in the USA (longer hours - long shifts are 30 hrs) it's stretched out in Australia to allow for lifestyle balance (long shifts are 15 hours). To say that you're in a hurry to finish before you've even started..

Even consultant positions in hospital based specialties and fields are becoming more competitive to obtain. Unless you're willing to go private or go rural. Surgery in particular is all about who you know ~ if they've trained you and worked with you, they're more assured of your skills and reliability. It's rare for people to even move interstate. It's also hard to give up networks (other residents and consultants you've worked with for months to years). Residency while shorter in the USA, is still not an insignificant number of years. You'll be away for a while and trained in an entirely different system and approach.

2. Again, it depends on medical schools. I know nothing about UWA. but yes. there is a "lack" of basic sciences in pre-clinical years relatively & generally speaking. Again, different training system. For instance, anatomy is less extensively taught nowadays at Australian schools, because you are expected to take further surgical anatomy courses as a resident prior to applying for the SET. The idea is that surgical level of anatomy is not particularly useful unless you're going into surgery. Basic sciences and physiology are also covered more in depth as you go through post-graduate training dependent on what stream you choose. Medical school only sets up the foundation.

5. No one says you can't try.
Your life to live if you want to be miserable
That said, fellowship training also requires the Steps (for which travel is strongly encouraged for surgical trainees), but you only need passing scores.

Bear in mind also that your American (and sometimes Canadian) counterparts in medical school in Australia have limited options. either they would like to return home or that is virtually their only option. i.e. the Ochsner kids in the Australian-American program (upwards of 200 of them each year) are Priority 8 or lower if they want an internship in Australia. *very generally, they're treated same as any australian grad with regards to applying back to their home countries *as in they are seen as IMGs. with some exceptions. Their debts are up to 60k USD *edit - 60 k USD per year that's 80k AUD each year or 240k USD for 4 years.

Try to appreciate the privilege you have, despite the bottlenecks, as a citizen you are still a protected species. Great if you wish to go overseas, but remember some of your international classmates will take whatever they can get (because in some cases, they don't really have a safety net)

 

[pre med 2014]

i.e. the Ochsner kids in the Australian-American program (upwards of 200 of them each year) are Priority 8 or lower if they want an internship in Australia. generally, they're treated same as any australian grad with regards to applying back to their home countries - IMGs. Their debts are up to 60k USD. Try to appreciate the privilege you have, despite the bottlenecks, as a citizen you are still a protected species. Great if you wish to go overseas, but remember some of your international classmates will take whatever they can get (because in some cases, they don't really have a safety net)

LOL do Aussies think 60K is a lot of debt to be in for med school? Or did you just forget to type in that it's 60K per year for tuition?

 

[bashwell]

LOL do Aussies think 60K is a lot of debt to be in for med school? Or did you just forget to type in that it's 60K per year for tuition?

That's about how much my total debt is after graduating from an Aussie med school. I think it's a lot, but when I compare it to friends from US med schools then it's not too bad.

 

[pre med 2014]

That's about how much my total debt is after graduating from an Aussie med school. I think it's a lot, but when I compare it to friends from US med schools then it's not too bad.

Yea but your tuition is subsidized by the Aus government since you are a citizen but I guarantee that your Med schools actual tuition is around 60k per year. Ochsner students pay that 60K per year because we do not get subsidized. So IMGs debt is not up to 60k it is up to 240-350K depending on if you take out a cost of living loan for all 4 years and how much you can self finance.

Also we are not really treated the same as an Aus student applying to US, this is because we do all our clinical rotations (except for 1 during 4th year) in the US and are US citizens. We can do away rotations pretty much anywhere and get letters from recommendations from those places where we may later apply. This puts us at a huge advantage from a technical standpoint in comparison to our Aus counterparts


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[Domperidone]

Lol, I forgot to type it in.
Omg. Massive oversight as 60k per year is 240k over 4 years. Not to mention embarrassing as i was trying to prove a point.
Have just edited it.

I'm not an Aussie by the way.
So, lol also thanks reminding me how f****** I am without my job or if this goes in the pooper. (meant that in a non-douchey way. I try to think about this for as little as I possibly can)

 

[bashwell]

Yea but your tuition is subsidized by the Aus government since you are a citizen but I guarantee that your Med schools actual tuition is around 60k per year. Ochsner students pay that 60K per year because we do not get subsidized. So IMGs debt is not up to 60k it is up to 240-350K depending on if you take out a cost of living loan for all 4 years and how much you can self finance.

Also we are not really treated the same as an Aus student applying to US, this is because we do all our clinical rotations (except for 1 during 4th year) in the US and are US citizens. We can do away rotations pretty much anywhere and get letters from recommendations from those places where we may later apply. This puts us at a huge advantage from a technical standpoint in comparison to our Aus counterparts


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Mate $240-350K, I have no words, I hear similar stories from others but still shake my head.

However having a huge advantage is good news. Hopefully that means you shouldn't have too much difficulty matching in a good (lucrative) specialty you enjoy in the States! Good luck to you (and others in the same position).

 

[pitman]

For many former int'l students, medicine is a second career. The first one pays for the second.

 

[Domperidone]

Not in my year or the years below mine.
Most were recent grads from bachelors that were on student loans. Or recent masters or the (occasional PhD) grads, also on student loans to get through. Most were of science backgrounds, occasional engineer. Even the business grad I knew had a loan. Average age of internationals going through was 24-26, not really an age where you have a lot saved up (definitely not the 100k to 200k range, let alone 300k). Students starting in their early 30s were a minority group. For others, their parents paid if they could afford it or took a mortgage on the family home.

Maybe the proportion of students who could drop 100-300 k out of their personal savings from their former careers was higher 10 years ago when you were going through. I wouldn't know that, but currently that's not the case with most going through now and I graduated recently. Tuition just keeps going up 10-12% every couple of yrs. Whatever it used to be, is not what it is now.

Anyway,
again, kudos OP (if you're still lurking) at least you thought about length of training or any post-graduate training as a pre-med/new med student. Most don't. There's another thread with a premed who believes that becoming a doctor in Australia is a relatively shorter process (compared, where I have no idea).

Whether it takes too long in Australia, has long been debated.
it is relatively shorter in the USA. but there's trade offs.

You can start working towards both paths. no one is saying you can't, just that it's hard. If you want to do the USMLEs, do the USMLEs. Do rotations in both countries, and decide what suits you from there. Keep an open mind.

 

[pre med 2014]

For many former int'l students, medicine is a second career. The first one pays for the second.

Your parents money doesn't count as a career!!


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[Domperidone]

Trust fund babies need some lovin' too. Even the ones that have never held a job before med.

I'm just bitter I wasn't one.
:C

One attending tried comforting me. He was like at least you don't have kids and a mortgage. I.e. sure you have debts but at least you have relative "freedom". By freedom i translated it to less guilt with work...taking extra shifts and locumming.

 

[pitman]

Note that *many* is like few -- it's relative to what one might expect. There will be some each year on their 2nd (or for me, 3rd) career, which IMO is many.

I was being a bit facetious saying the first pays for the second. I had a rather large savings, which should have covered all expenses for four years, but the Oz dollar soared (from ~.6 to 0.9), and even I ended up with $50k in debt.

 

[sean80439]

Yeah, this was definitely my third.