US Electives available for International Medical Students

[JC Denton]

Wow. Congrats! I'd kill to be able to spend over half a semester at a place like Johns Hopkins. It's cool that they even allowed you to do an observership, because I thought only research electives were possible there.

However, what I'm dying to know is whether it would be possible during the third year to complete some required rotations in the US, while earning some school credit in the process.

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[Hzzof]

please till me

- How much money i am expected to spend in a period of 3 months in the states?(I mean all expensis other than the ticket).

- Does this differ widely from a state to an other (Chicago, Florida, Arizona, Lousiana, Pennsylvania, Verginia, Texas, Ohio)?

- I am trying to find a place to do clinical externship for 3 months. Programs I found ask about 5000 USD for this period. Is this number high or normal.

 

[WindyCity7]

You can also find and submit schools to the following URL:

Free Clinical Rotation Finder Application

The AAMC site tends to have quite a few bad links. The links here are checked once a month to validate that nothing has changed and also includes non-institution locations (i.e. private hospitals).

Good Luck

 

[rox]

$5000 is definitely expensive. The above mentioned link in very helpful if you are still a student.

 

[dafodils]

i have got clerkship at 3 colleges...Harvard, Northwestern and Beth Israel Medical center..... it would very helpful if anyone could help me choose between them... thank you!!!

 

[WindyCity7]

i have got clerkship at 3 colleges...Harvard, Northwestern and Beth Israel Medical center..... it would very helpful if anyone could help me choose between them... thank you!!!

Dafodils,

I can answer your question from a cost perspective and from tenant experience at Northwestern:

If I ranked the (3) clerkships by cost of living from MOST EXPENSIVE to LEAST, they would stack up like this:

Beth Israel New York City
Harvard Cambridge/Boston
Northwestern Chicago

I have had quite a few tenants in doing rotations at Northwestern and all-in-all, they've all said good things about it. I haven't had many tenants in New York do a Beth Israel rotation (so I don't know much about it) and Harvard is just a good school. Maybe a medical student can chime in on the nuts and bolts of actual rotations.

Good luck!

 

[rox]

Harvard charges a lot for electives.

 

[dafodils]

Thank you so much.... it sure helps a lot...

 

[Med2014]

I'm a 2nd year student (out of 6 year program) in Budapest-Hungary.
After the 3rd year we are required to participate in internal practice for one or two months.
I was wondering if it's possible to do so in the US (specifically in NY or CA) considering I have not done the USMLE step 1 yet.

Thank everyone

 

[donaldtang]

I find that most famous schools (e.g. Harvard, Cornell...) charge a high tuition fee, then any one know what are the advantages of these famous schools, compared with those institutions that do not charge any tuition fee?
Thanks in advance!

 

[travelbug5341]

I'm a 2nd year student (out of 6 year program) in Budapest-Hungary.
After the 3rd year we are required to participate in internal practice for one or two months.
I was wondering if it's possible to do so in the US (specifically in NY or CA) considering I have not done the USMLE step 1 yet.

Thank everyone

Hi! I'm a US citizen studying at the University of Szeged. I'm going into my second year and just finished my nursing practice here in California. So it is definitely possible to do your internal medicine practice here . The problem is that medical schools and hospitals here really don't have an equivalent to these summer practices, so it is a bit difficult to find a place would be willing to organize something like that for you. You may also get less hands-on stuff here due to liability problems. I would recommend looking into it early and sending emails to the heads of internal medicine departments. It may help to look at smaller hospitals rather than large city or teaching hospitals, because they may be less busy and more willing to accommodate you. I don't think you will need to have taken the USMLE, although if you are planning to practice in the US you should take it during/after 3rd year anyway. I'm not positive about the USMLE though so try asking around. One more thing, make sure you have your visa set up early, it usually takes some time to get a visa to the US. Hope that helps, good luck!!

 

[Jon Alves]

Hi everyone!
My name is Jon, and I'm a student at "Faculdade de Medicina de Lisboa" a 3rd grader.... Ever since I got into this college my main objective was to go study in America.... Ever since I know myself, but that's something not related to the topic....
The thing is that I feel that my "hands are tight".... I don't seem to find any exit to go to the US to study.... And I'm wasting my time in this damn country studying wrongly.... The methods they use here are totally surreal....this guys know absolutely nothing about teaching Medicine.... I've been researching Medical colleges in America.... And for what I've seen, that's some real Medical teaching.....
I was wondering if any of you guys know something about this topic, how to go study Medicine in America.... Maybe you know about scholarships, or ways that I've never heard....
I was hopping you guys could give me hand on this....
Thanks

Best regards,
Jon

 

[Winged Scapula]

Dear Jon,

Most US medical schools require that you have an undegraduate degree from a US college. I would assume this is not the case for you. In addition, non-citizens are not eligible generally for US loans (medical school in the US is not free and can cost you upwards of $200K USD) so many schools require you have evidence that you can pay all 4 years of medical school tuition and living expenses.

Therefore, your best approach is to finish medical school in Portugal, although you could certainly apply to some US schools and see what your options are. There is a book called the MSAR (Medical School Admission Requirements) available from the AAMC (American Assoc of Medical Colleges) which will give you specific details about how many non-US citizens schools take, and what the requirements are. It can be purchased on-line.

If you cannot get into a US school, consider schools in the UK or other EU countries, or finally coming to the US for residency training. Of course, it depends on where you want to work. Check the Portugal requirements to work as a physician - you don't want to train in the US, if you can never come home to work. Medical degrees are not necessarily transferrable across countries.

Finally, the English phrase is "my hands are TIED" (not tight).

 

[rox]

Jon, this sticky thread discusses electives in the US. Electives are clinical rotations that you might do in the US and get exposure to the system. It might be one thing to consider, otherwise you should probably post in a different place. Good luck!

 

[Jon Alves]

Dear Jon,

Most US medical schools require that you have an undegraduate degree from a US college. I would assume this is not the case for you. In addition, non-citizens are not eligible generally for US loans (medical school in the US is not free and can cost you upwards of $200K USD) so many schools require you have evidence that you can pay all 4 years of medical school tuition and living expenses.

Therefore, your best approach is to finish medical school in Portugal, although you could certainly apply to some US schools and see what your options are. There is a book called the MSAR (Medical School Admission Requirements) available from the AAMC (American Assoc of Medical Colleges) which will give you specific details about how many non-US citizens schools take, and what the requirements are. It can be purchased on-line.

If you cannot get into a US school, consider schools in the UK or other EU countries, or finally coming to the US for residency training. Of course, it depends on where you want to work. Check the Portugal requirements to work as a physician - you don't want to train in the US, if you can never come home to work. Medical degrees are not necessarily transferrable across countries.

Finally, the English phrase is "my hands are TIED" (not tight).

Thank you very much for your answer....
I don't care about coming back to portugal to work, what I really want is to study in America and work there.... And never come back to this place.... Study Medicine and being a doctor in this country is a nightmare.... really hateful.... I was hopping to finish my medical student "career" in America and stay there
Did I just open "some more options" or closed a couple of them?

 

[Jon Alves]

Dear Jon,
Finally, the English phrase is "my hands are TIED" (not tight).

GOD! I'm sorry! My bad What an idiot! pff! Sorry again....

 

[rox]

well, you got quite good answers here Good luck!

 

[Jon Alves]

well, you got quite good answers here Good luck!

Yes I do, thank you very much you all....
I'll do some research and try to find some way out....
Thanks for all the help, I'll keep you posted if I find something helpful
Wish me luck

 

[KRS]

I am a final-year, international medical student from India, and I'm in the process of short listing schools/hospitals for my electives. I would like to do two internal medicine clinical electives next spring, in March and April, in the US.

Is it preferable to apply to universities like Harvard, UT San Antonio, Cornell or to hospitals like Kaiser Permanente, San Diego. Or do the LORs carry the same weight, as long as they are written by a high ranking (Director of/Head of/Chief of) clinician there who has observed your work?

Where is it easier to get malpractice insurance at?

 

[rox]

Places that offer malpractice: BCM, UT-Houston, UTMB, Vermont, Mount Sinani(NY) and Harvard.

 

[KRS]

Thank you Rox.

 

[KRS]

Starting academic year 2009-10, UT-Houston requires international candidates to have passed USMLE Step 1 in order to be eligible for an elective.

Baylor has exhausted all authorization numbers allotted for students from India, halfway into the academic year.

It would be nice if someone could compare clinical electives taken at med schools vs. non-affiliated hospitals. The former often charge tuition fees, have early deadlines, but are more reputed, while hospitals could be easier to get into. Do LORs received from both places carry the same value if they're written by high ranking officials (Director/Dean/Dept. Head/Chair etc.)?

 

[NotAProgDirector]

Starting academic year 2009-10, UT-Houston requires international candidates to have passed USMLE Step 1 in order to be eligible for an elective.

Baylor has exhausted all authorization numbers allotted for students from India, halfway into the academic year.

It would be nice if someone could compare clinical electives taken at med schools vs. non-affiliated hospitals. The former often charge tuition fees, have early deadlines, but are more reputed, while hospitals could be easier to get into. Do LORs received from both places carry the same value if they're written by high ranking officials (Director/Dean/Dept. Head/Chair etc.)?

Academic programs are likely to be much more impressed by academic LOR's.

 

[Surgical FMG]

i have a similar question. as aProgDirector alludes to, academic programs are more likely to be impressed by letters from academic places... but what about from within academic place, e.g. tossing up between mt sinai, northwestern, texas san antonio, upenn, thomas jefferson, UC san diego, NYU, UCLA.

would it be wiser to go to someplace where there have been IMG's who manage to match, which is less famous, rather than somewhere reaaaally famous (e.g. harvard) but no IMG has ever matched there before.

im interested in General Surgery, intend to match 2012.

some friends from Australia are thinking of doing it at Harvard, which charges, as of 2009, a hefty tuition fee of 3200 USD per month. u get a certificate which contains a clerkship grade, and a statement that you "performed and fulfilled the responsibilities equivalent to a final year Harvard medical student".

is that worth it for a 3.2k tuition fee? wil that certificate really carry you far? in terms of applying for a residency program, or just job prospects back in Australia, for example.

 

[Winged Scapula]

IMHO, the Harvard "certificate" is not worth the paper its written on and is a waste of $3200 USD.

Look, there's no doubt that its a great school and I'm sure the certificate is "suitable for framing". But every rotation will give you a grade and if you request, a statement that you performed at the level expected/above expectations etc. If you want a formal LOR, you ask. If that's what you get for the $3200 USD, you're paying for the Hahvud name, if you ask me (and I realize you didn't).

As aPD notes, its best to do your rotations at an academic medical center with residencies. As a matter of fact, the state of Pennsylvania refused to accept a rotation of one of my classmates because it was not at an ACGME institution - moral of the story is not to do community hospital or private practice rotations unless they are affiliated with a medical school or residency, at least not in Pennsylvania. Fortunately, she had enough rotations to meet the requirements for licensure.

All of the places you've listed jeffreyleow are good institutions; Penn is a very well regarded medical school and within the US, I can't see a certificate from Harvard being any more well regarded than a good LOR from faculty at Penn.

As I've said before, you guys are nickel and diming this. WHERE your letter is from isn't that significant of a factor. I highly doubt aPD is going to be kowtowed by a letter from Harvard anymore than he would be from a letter from say Mt Sinai. I'm sure he's past being impressed by Ivy League.

What matters is that you get a good elective experience which ends up with a US faculty member writing you a damn good LOR. And IMHO you help yourself more by rotating at a place that you might stand a little chance of doing residency at. But if you've got an extra $3200 USD lying about (and you might, given the current exchange rate), then by all means go to Harvard. I'm sure its an excellent program, but probably not that much better than any of the other places you've listed or the hundreds of others that will accept FMGs for final year electives.

My two and a half cents...

 

[Surgical FMG]

IMHO, the Harvard "certificate" is not worth the paper its written on and is a waste of $3200 USD.

Look, there's no doubt that its a great school and I'm sure the certificate is "suitable for framing". But every rotation will give you a grade and if you request, a statement that you performed at the level expected/above expectations etc. If you want a formal LOR, you ask. If that's what you get for the $3200 USD, you're paying for the Hahvud name, if you ask me (and I realize you didn't).

thanks. this really does help confirm and validate my previous suspicions. my previous opinion was that 3.2k was really not worth it. i opined vehemently that a US experience, harvard or not, is a US experience and probably will be something cool to talk about back at work in Australia. i did tease my friend who was so dead keen on the harvard thing - i told him he might get a [email protected] email which he should certainly post on facebook and email everyone with, just for the sakes of making the money worth.

As aPD notes, its best to do your rotations at an academic medical center with residencies.

duly noted. im trying to go for places which has at least 99% IMG based on the facs.org residency search facility. that way, at least i know an IMG has been accepted before, ever.

What matters is that you get a good elective experience which ends up with a US faculty member writing you a damn good LOR. And IMHO you help yourself more by rotating at a place that you might stand a little chance of doing residency at. But if you've got an extra $3200 USD lying about (and you might, given the current exchange rate), then by all means go to Harvard. I'm sure its an excellent program, but probably not that much better than any of the other places you've listed or the hundreds of others that will accept FMGs for final year electives.

My two and a half cents...

once again, thanks for the opinion. really helps put things in perspective... "damn good LOR" is what i'll be aiming for!

WS, will keep u up to date abt my US electives next yr!

 

[Surgical FMG]

IMHO, the Harvard "certificate" is not worth the paper its written on and is a waste of $3200 USD.

Look, there's no doubt that its a great school and I'm sure the certificate is "suitable for framing". But every rotation will give you a grade and if you request, a statement that you performed at the level expected/above expectations etc. If you want a formal LOR, you ask. If that's what you get for the $3200 USD, you're paying for the Hahvud name, if you ask me (and I realize you didn't).

thanks. this really does help confirm and validate my previous suspicions. my previous opinion was that 3.2k was really not worth it. i opined vehemently that a US experience, harvard or not, is a US experience and probably will be something cool to talk about back at work in Australia. i did tease my friend who was so dead keen on the harvard thing - i told him he might get a [email protected] email which he should certainly post on facebook and email everyone with, just for the sakes of making the money worth.

As aPD notes, its best to do your rotations at an academic medical center with residencies.

duly noted. im trying to go for places which has at least 99% IMG based on the facs.org residency search facility. that way, at least i know an IMG has been accepted before, ever.

What matters is that you get a good elective experience which ends up with a US faculty member writing you a damn good LOR. And IMHO you help yourself more by rotating at a place that you might stand a little chance of doing residency at. But if you've got an extra $3200 USD lying about (and you might, given the current exchange rate), then by all means go to Harvard. I'm sure its an excellent program, but probably not that much better than any of the other places you've listed or the hundreds of others that will accept FMGs for final year electives.

My two and a half cents...

once again, thanks for the opinion. really helps put things in perspective... "damn good LOR" is what i'll be aiming for!

WS, will keep u up to date abt my US electives next yr!

 

[prince8585]

Hey guys,
This is a great piece of information, hope it helps a lot of people. Thanks for helping out.

Cheers.

 

[genius19]

Many programs require passing USMLE Step 1; most do not require more than that



No. Most US programs have a policy that any elective positions are made available after their own home students have enrolled. You get the leftovers. In addition, not all rotations are available. You are generally limited to 4th year electives (ie, final year electives) which require basic prerequisite courses.



As long as you are still a student (I am not sure about the "internship"), these are clinical electives with patient interaction. If you are coming to the US after you graduate, then you are no eligible for student electives and are limited to observerships. Therefore it behooves you to do the electives while a student.



If you choose to do them after you complete medical school, you are not eligible for these electives. You are only then eligible for observerships.

Is there any requirement of passing toefl prior to applying for electives ?

 

[rox]

Is there any requirement of passing toefl prior to applying for electives ?

Some schools do require TOEFL. You have to check every school individually.

 

[genius19]

Some schools do require TOEFL. You have to check every school individually.

do most schools have a requirement of only a step 1 score ?

 

[Winged Scapula]

do most schools have a requirement of only a step 1 score ?

Usually.

 

[genius19]

This has been addressed several times here including in the thread above. You are not eligible for electives during your internship year or anytime after you have graduated. Only observerships or research positions are available and as noted above, observerships are practically worthless.

actually in india students are not awarded the medical degree prior to the completion of one year of internship after 4.5 yrs of study ( it's a 4.5 +1 = 5.5 yrs course). As US universities require med students to be in their final year while applying for an electives, are the students in the final yr ( i.e, internship year ) not eligible for electives ?

 

[rox]

actually in india students are not awarded the medical degree prior to the completion of one year of internship after 4.5 yrs of study ( it's a 4.5 +1 = 5.5 yrs course). As US universities require med students to be in their final year while applying for an electives, are the students in the final yr ( i.e, internship year ) not eligible for electives ?

Once you graduate from medical school you are not eligible for electives, even if you are doing an internship.

 

[schandan13]

actually in india students are not awarded the medical degree prior to the completion of one year of internship after 4.5 yrs of study ( it's a 4.5 +1 = 5.5 yrs course). As US universities require med students to be in their final year while applying for an electives, are the students in the final yr ( i.e, internship year ) not eligible for electives ?

Clerkships, done DURING internship AFTER passing final prof MBBS only.

 

[donaldtang]

Hi, Winged Scapula
You said “what matters is that you get a good elective experience which ends up with a US faculty member writing you a damn good LOR”
Yes, good LOR is what most international students need,
My question is：is it more difficult to get good LORs from faculties of famous university hospital(e.g. Harvard) or from faculties of those less famous hospitals?
Thanks in advance!

 

[Winged Scapula]

Hi, Winged Scapula
You said “what matters is that you get a good elective experience which ends up with a US faculty member writing you a damn good LOR”
Yes, good LOR is what most international students need,
My question is：is it more difficult to get good LORs from faculties of famous university hospital(e.g. Harvard) or from faculties of those less famous hospitals?
Thanks in advance!

Donald,

I don't know if its anymore difficult per se.

It *may* be more difficult to shine, as such programs will be used to seeing the cream of the crop. In addition, you may not spend as much time with faculty at these places, due to the programs being "top heavy" - ie, lots of layers of fellows and residents between you and the attending. Smaller programs tend to get you more face time with faculty. Bear in mind that US faculty will want to see that the person writing you the letter actually knows you - therefore, don't assume a letter from the Department Chair is better than from an Assistant Professor, assuming the former didn't spend much time with you. The best letter comes from the faculty member who spent the most time with you and knows you the best.

However, if you do well, there is no reason that you wouldn't be able to get a good letter from a Top Tier place.

 

[Winged Scapula]

actually in india students are not awarded the medical degree prior to the completion of one year of internship after 4.5 yrs of study ( it's a 4.5 +1 = 5.5 yrs course). As US universities require med students to be in their final year while applying for an electives, are the students in the final yr ( i.e, internship year ) not eligible for electives ?

Clerkships, done DURING internship AFTER passing final prof MBBS only.

The key genius is 2 fold:

1) does your school still classify you as a student during your internship
2) the wording of your application

American program administrative staff are not very sophisticated about how medical education is structured outside of the US. Therefore, if they see any mention at all of you being an INTERN, they will deny your application.

Thus, technically as long as you have not been awarded the final medical diploma and are still considered a student, you should be able to clerkships in the US during your internship IF your school, when asked to verify your status, notes that you are in your final year of medical school training and does not state that you are an intern. If they use the latter term, US programs will assume you have already graduated.

Semantics, but you do have to be careful.

 

[bigtymer]

For us IMGs from schools where our 3rd year rotations are more shadowing and busy work than actual intern work, what is the best way to prepare for electives in the US so we are not caught off guard or overwhlemed by the work required from us?

 

[leorl]

Be yourself and learn quickly. There's nothing you can really do to prepare except study your theoretical knowledge. When you get there, just be the first to admit that you have not done the procedure before, but you would love to learn. When I did my first ER rotation as a student, myself and one of the interns had never done a pelvic examination before as we were not permitted to during our OBGYN rotations . We got laughed at, but once they showed me, I did every single one that walked through the door. That earned me respect. Don't worry about the discrepancies in education that you will find, just be willing to learn.

 

[leorl]

One thing that may help is to become familiar with the SOAP format of note writing (just google SOAP) as most US residents use that as their template. Also make note of the way they abbreviate lab results (ie. by using the diagrams), and knowing the US units will be good too - they use different units from most other places. If you get the small book Maxwell's clinical reference (literally 10 pages in small print), it will help you immensely.

 

[bigtymer]

does anyone know where a final year IMG can do a 2 week elective in september in medicine or any subspecialties (or EM as well)? I have 2 weeks off in september and I'd like to do an elective but I've been only seeing 4 week elective rotations minimum. Thanks

 

[donaldtang]

does anyone know where a final year IMG can do a 2 week elective in september in medicine or any subspecialties (or EM as well)? I have 2 weeks off in september and I'd like to do an elective but I've been only seeing 4 week elective rotations minimum. Thanks

As far as I know, Cornell medical college offer some 2 weeks electives, you can browse their course catalog and see if they fit your schedule.
Good Luck

 

[ramelteon]

Guys its very expensive universities

 

[austin12345]

really need help wid dese questions-
1. am i supposed to attach my insurance certificates and OSHA training wid the application..r i can complete it anytime efore joining the rotation
2. wat doucments othe than deans letter are required on behalf of our medical school
3. what o they mean that an IMG should have completed all core rotations vefore applying
4. as an IMG wat time is perfect to apply
5. can i apply in advance and complete the insurance, OSHA formalities later but before joining the programme...i mean how didi ou guys proceeded with the thing...tanks ...

 

[austin12345]

really need help wid dese questions-
1. am i supposed to attach my insurance certificates and OSHA training wid the application..r i can complete it anytime efore joining the rotation
2. wat doucments othe than deans letter are required on behalf of our medical school
3. what o they mean that an IMG should have completed all core rotations vefore applying
4. as an IMG wat time is perfect to apply
5. can i apply in advance and complete the insurance, OSHA formalities later but before joining the programme...i mean how didi ou guys proceeded with the thing...tanks ...

 

[211498]

Has anyone current info on the NYU visiting student program?

1.) What is the maximum number of rotations? 12 wks possible?

2.) There is a field "Referred by..." on the application form, will I need a faculty sponsor?

3.) Do I have to fill out one form for each requested 4wk elective?

4.) Which visa is required? B1?

Thanks!!!

 

[211498]

Anybody?

 

[confused doc]

Well, this type of experience is not so common, but they do exist, it has worked for me, at least. I am a foreign medical student, currently attending
the 2nd year of a MD pathway with six years of duration. I must be something like an American 1st year student. I will be doing a Research Elective + Clinical Observership at Johns Hopkins for 2 months and a half (nine weeks), officially, though the medical school. The only advice I'd give you is simple (but rarely effective): Send e-mails to the chairs and directors of the speciality you'd like to work with. Maybe they'll answer and, well, maybe you'll get your position, if you insist a lot and be lucky....Unfortunately that's how it works, at least at Hopkins (I'm not so sure about the other schools, anyway it must be something similar). There's an application process (JHU), but the truth is: If you do not have a previous agreement with your potential preceptor, there will be no donut for you, probably (I had an agreement)...They don't make it clear at the Hopkins web site, but that's how it works for us (IMGs) in the real world........Good Luck

HI EVERYONE!
I am a final year medical student who is totally confused about everything.I am extremely ambitious but confused I am interested in doing my residency in USA but have a couple of concerns which I request somebody on this forum to help me with................



USA :

1.i got an elective in plastic surgery in yale this june,but as the chances of getting in a surgry residency are slim,would this elective help me get a residency in internal med?

2. does an ivy league elective have more weightage?

3.if I take my final year exams in January 2011 and do an elective in internal med in usa while waiting fro my final year results,will that count as elective too because technically I will be still in final year until the results are announced?

4 If I start my usmle prep in Jan 2011 wil i be able to take my steps and aply fro a match for 2012?

5 How will be the job market in 2013 when is most probably that il match

please help me out

 

[NotAProgDirector]

1.i got an elective in plastic surgery in yale this june,but as the chances of getting in a surgry residency are slim,would this elective help me get a residency in internal med?

2. does an ivy league elective have more weightage?

3.if I take my final year exams in January 2011 and do an elective in internal med in usa while waiting fro my final year results,will that count as elective too because technically I will be still in final year until the results are announced?

4 If I start my usmle prep in Jan 2011 wil i be able to take my steps and aply fro a match for 2012?

5 How will be the job market in 2013 when is most probably that il match

1. It's less than ideal. If you're interested in Internal Medicine, it's better to do an IM rotation. Also, if you show up at Yale and say "I'm interested in IM, not surgery" you might find that no one is interested in you anymore -- surgeons tend to be that way. It's infinitely better than nothing.

2. Maybe. If you get a good letter, then probably yes. If you end up being yet another student on an overloaded team who doesn't get much experience or face time, then no.

3. It's totally up to the US medical school to determine if you're still in your "final year" while awaiting exam results.

4. Depends on how long you plan to study. To maximize your competitiveness, you should have all three step scores as early as possible. Best is September 1. Latest is Nov 1. If you start studying in Jan and take the exams by July, you'll be fine.

5. Who knows? There are those that predict that the increase in US grads will squeeze out IMG's from the match. There are those that think the new health care bill will insure more people, driving up the need for primary care, which will in turn lead to congress increasing GME spots.