theprince911

2+ Year Member
Oct 21, 2014
43
15
Status
Medical Student
Hey all,
I've been a long time lurker on this forum, and have seen that many of you are very helpful. It's nice to see such a close community. This will be a long post, but if you could bear with me, I would really appreciate it.
I need some guidance about my path. I'm a US citizen in my final year of medical school in Asia. I didn't come here because I couldn't get into medical school in america - I was in a well reputed Biomedical Engineering program with plans to attend medical school. Financial issues and a desire to attain my goal drove my decision to attend this program and end up as a doctor.
I had difficulty adjusting to the system here and my gpa was quite low.. I pulled myself together in the last two years, but my gpa is still not ideal. I have, however, scored very well on most of my rotations. I feel like my basic sciences (except anatomy and pathology) are weak, but I can somehow work around all of my weaknesses on the wards. I never studied as hard as a few of my classmates have, as I've found that I learn better with hands on experience. That shows with my low basic sciences gpa and my relatively higher clinical grades. I want to start at square one. I want to understand all of medicine (I learn by understanding, not by memorizing.. everything I have learned I have done so by understanding. I haven't memorized a word throughout my 5 years here, and it's worked for me so far)..
my goal is to end up as a general surgeon initially and later to pursue a fellowship in colorectal or cardiothoracic since integrated programs are near impossible for IMGs. I can't see myself doing anything else. I don't care where I end up or if it's a community program, but that is what I want to do.
I feel like surgery is the right fit to me because it all just makes sense. I read our entire textbook once for surgery, and did amazingly on my exams. Everything just clicked. And I loved it. I love surgical patients, the whole thought process that goes into treating them, and of course I love operating. I've scrubbed in many times with the head of surgery as a first assistant (which is generally prohibited here for students). I have walked residents through procedures under his supervision. I have presented for many surgical conferences at his request.. it's my passion, to say the least.
So now that you know a bit about my background, the following are the issues I need help with:
-I'm studying for my internal medicine and pediatrics finals at the moment.. I've scraped by in my internal medicine rotations with high grades but I feel like I never understood the material.. I never felt comfortable with it, and honestly I feel like I've been cheating myself because I've gotten through it with little effort whereas others have had a harder time and not scored so well but know so much more than me. As such, studying for this final is difficult. Where reading the surgery textbook was a pleasure, I can't understand internal medicine at all. I can't visualize medicine mentally like I could surgery. I don't know how to study for it and feel satisfied with my knowledge.
-I need to take a year off after I graduate to do my steps.. I want to minimize the chances of this hurting my chances of matching into general surgery. I'm going to try to knock out step 3 as well so that I have even more of a fighting chance in the match.
-I have 2 electives lined up in general surgery, and may be doing a third. One of them may be with an osteopathic attending. Would a letter from a DO hurt my application for an allopathic residency?
-last but not least.. how do I start at square one? I want to study for the steps in such a way that I cover everything and understand it. I want to be more than proficient in anything that I study. I'm not asking for a schedule, more an approach. I don't take notes, for example, as I find that reading the text or listening to the lecturer is better for me and I remember these things longer. The problem is that whereas with surgical topics (including gynae/obs, ent, ophtho, etc) I still remember things I learned 3 years ago that I only learned once, I forget medical topics in about a month or so.. the interest is there, but since I can't visualize anything for those topics I don't remember. 90% of my learning depends on me making these mental images and I just can't do that with medicine because I don't understand it.

I don't know how to overcome these hurdles.. but I will do anything I have to to end up doing what I love for the next 50 years.

Thank you very much for your time. I hope that you can help me out with these issues. I look forward to being a contributing member of the SD community.
 
Mar 29, 2013
812
947
hey man, when we interview people for residency, we don't like to see that they took a bunch of time off for steps. if you are going to take a year off for steps make sure you do SOMETHING in the hospital, keep those clinical skills up.

I haven't studied for steps in a few years so im not sure what the "new" best way is. You should go over to the step 1 forum and post this there as well. My only advice is make sure you get some clinical experience in that year. Hope all goes well for you.
 

ThoracicGuy

5+ Year Member
Jun 11, 2013
9,596
23,459
Status
Attending Physician
Don't worry about Step 3. That won't enhance your app by passing and can only hurt by failing it.
 
OP
T

theprince911

2+ Year Member
Oct 21, 2014
43
15
Status
Medical Student
Thank you for the replies, I appreciate the advice..
as far as the gap goes, I guess I meant I want to apply for the 2016 match seeing as we graduate at around March 2015.. hopefully I can get all of the steps done by the match.
It's a relief to know that step 3 won't raise my chances..
I'll post this in the usmle forum too, but do you have any advice about how to study internal medicine or peds?
 
Sep 26, 2014
31
9
Status
Medical Student
I think that it's not highly recommended to take Step 3 before matching, since really few programs consider it as a main factor when choosing a candidate for an interview, according to some statistics only around 30-40% programs mentioned it as a factor and as mentioned above, not passing it might hurt your application.
 
Sep 26, 2014
31
9
Status
Medical Student
Thank you for the replies, I appreciate the advice..
as far as the gap goes, I guess I meant I want to apply for the 2016 match seeing as we graduate at around March 2015.. hopefully I can get all of the steps done by the match.
It's a relief to know that step 3 won't raise my chances..
I'll post this in the usmle forum too, but do you have any advice about how to study internal medicine or peds?
I have a doubt about something you didn't mention or maybe I was distracted and haven't noticed it. Have you already had any clinical experience in the United States? I mean, a clerkship? Those experiences can only be done when you're a student and they are usually very important for an IMG and hospitals usually only accept you if you're in your last year of medical school. So, if you graduate without having any of those experiences, you'll be able only to get observerships and other kinds of experiences that are usually not "hands on" and thus less valued.

Awesome grades are essential but USCE and good LoRs are also important, keep that in mind :)
 
OP
T

theprince911

2+ Year Member
Oct 21, 2014
43
15
Status
Medical Student
I have a doubt about something you didn't mention or maybe I was distracted and haven't noticed it. Have you already had any clinical experience in the United States? I mean, a clerkship? Those experiences can only be done when you're a student and they are usually very important for an IMG and hospitals usually only accept you if you're in your last year of medical school. So, if you graduate without having any of those experiences, you'll be able only to get observerships and other kinds of experiences that are usually not "hands on" and thus less valued.

Awesome grades are essential but USCE and good LoRs are also important, keep that in mind :)
I haven't done any electives yet, but I have a clerkship lined up for December of this year in general surgery as well as a subinternship for April or may if I get into it..
my clinical grades are pretty decent but the problem is that at my university, everything is gpa based.. they grade us based on big papers we take at the end of every semester and our actual clinical rotation grades don't even show up on the transcript. I was thinking about asking the administration to put those grades on the transcripts for me if they'll help my chances (not sure if the school will comply, however)
 
  • Like
Reactions: Lattes

MalibuPreMD

10+ Year Member
Oct 30, 2006
268
90
Status
Resident [Any Field]
Our department of trauma / acute care surgery has 4-5 research associates that are FMGs. They typically work for two years and study for the USMLEs during that time as well. If all goes well, after two years they'll have good scores, work experience in a well known US academic hospital, a few publications, presentations at conferences, and a letter from a well known surgery department. Maybe something like this would work out well for you.
 
  • Like
Reactions: 235009
OP
T

theprince911

2+ Year Member
Oct 21, 2014
43
15
Status
Medical Student
Our department of trauma / acute care surgery has 4-5 research associates that are FMGs. They typically work for two years and study for the USMLEs during that time as well. If all goes well, after two years they'll have good scores, work experience in a well known US academic hospital, a few publications, presentations at conferences, and a letter from a well known surgery department. Maybe something like this would work out well for you.
Thank you for the suggestion, that actually sounds like a very good idea. I wouldn't mind doing research for a couple of years, but would you recommend going for this approach, or should I try to take my steps as soon as possible?
 

MalibuPreMD

10+ Year Member
Oct 30, 2006
268
90
Status
Resident [Any Field]
I wouldn't mind doing research for a couple of years, but would you recommend going for this approach, or should I try to take my steps as soon as possible?
My advice would be to line up a research gig (note that these are typically unpaid, so you'll likely need to take that into account) and start sometime early next fall (like september) that way you can explain the gap between graduating and starting the research job as a vacation/time needed to move back to US during residency interviews. I imagine that gives you 8-12 weeks to study. For your goals, you'll need to dominate step 1 (>245), and it sounds like Step 1 material is not your strong point (since it is in no way conceptual/"surgical") so you better expect to study 80-100 hours a week and burnout isn't an option - if you would truly "do anything" for a career in surgery then this shouldn't be an issue. You can study for step 2 while working in a research lab.

You have difficult goals but they're not impossible. Good luck!
 
Last edited:
OP
T

theprince911

2+ Year Member
Oct 21, 2014
43
15
Status
Medical Student
My advice would be to line up a research gig (note that these are typically unpaid, so you'll likely need to take that into account) and start sometime early next fall (like september) that way you can explain the gap between graduating and starting the research job as a vacation/time needed to move back to US during residency interviews. I imagine that gives you 8-12 weeks to study. For your goals, you'll need to dominate step 1 (>245), and it sounds like Step 1 material is not your strong point (since it is in no way conceptual/"surgical") so you better expect to be work 80-100 hours a week and burnout isn't an option - if you would truly "do anything" for a career in surgery then this shouldn't be an issue. You can study for step 2 while working in a research lab.

You have difficult goals but they're not impossible. Good luck!
Thank you for the advice. You've been very helpful. I think I'll go for research.. is it difficult to line up some clinical research as opposed to basic science research?
I don't mind if it's unpaid.. I'll handle it. I'll handle the steps too, because I don't see any other option.
 
OP
T

theprince911

2+ Year Member
Oct 21, 2014
43
15
Status
Medical Student
That wall of text doesn't scream "surgical personality"
It's sad to see people like you pursuing a career in medicine, where we are supposed to help and heal others. Frankly, your arrogant statement doesn't exactly scream "doctor."
I came here to ask for advice and help, not to be dismissed with a single, rude sentence. If you don't want to contribute, please do not post in my thread.

Regardless, I wish you the best.
 

repititionition

Sure!
7+ Year Member
Feb 29, 2012
622
525
Status
It's sad to see people like you pursuing a career in medicine, where we are supposed to help and heal others. Frankly, your arrogant statement doesn't exactly scream "doctor."
I came here to ask for advice and help, not to be dismissed with a single, rude sentence. If you don't want to contribute, please do not post in my thread.

Regardless, I wish you the best.
Except that it was said in jest.

I feel for you. I have no doubt that there are countless people around the world (I really meant that: more than I could count) smarter and more talented than me in any given realm of medicine, and I'm conscious of the fact that I hit the jackpot just by being a U.S. citizen.

Good luck. It sounds like your determination will bear fruit.
 
Apr 24, 2012
121
71
Status
Medical Student
Except that it was said in jest.

I feel for you. I have no doubt that there are countless people around the world (I really meant that: more than I could count) smarter and more talented than me in any given realm of medicine, and I'm conscious of the fact that I hit the jackpot just by being a U.S. citizen.

Good luck. It sounds like your determination will bear fruit.
OP is a U.S. citizen.
 
OP
T

theprince911

2+ Year Member
Oct 21, 2014
43
15
Status
Medical Student
Except that it was said in jest.

I feel for you. I have no doubt that there are countless people around the world (I really meant that: more than I could count) smarter and more talented than me in any given realm of medicine, and I'm conscious of the fact that I hit the jackpot just by being a U.S. citizen.

Good luck. It sounds like your determination will bear fruit.
I apologize for my outburst then. Thank you for your kind words, it means a lot. I will pursue my goal and stop at nothing to achieve it.
 

MalibuPreMD

10+ Year Member
Oct 30, 2006
268
90
Status
Resident [Any Field]
my goal is to end up as a general surgeon initially and later to pursue a fellowship in colorectal or cardiothoracic since integrated programs are near impossible for IMGs. I can't see myself doing anything else... but I will do anything I have to to end up doing what I love for the next 50 years.
…would I have a real shot at neurosurgery?
Huh, OP? Before you commit to anything you better think long and hard what your goals are.

In response to your question, I have no idea if you will have a shot at neurosurgery.
 
  • Like
Reactions: spik
OP
T

theprince911

2+ Year Member
Oct 21, 2014
43
15
Status
Medical Student
Huh, OP? Before you commit to anything you better think long and hard what your goals are.

In response to your question, I have no idea if you will have a shot at neurosurgery.
My goal is to be a surgeon period.. of course I'd love to be a neurosurgeon, much more than I want to be a general surgeon. I was keeping it real though, honestly I do know it is very difficult to match into neuro. It was always in the back of my mind but I never thought about it because of that. An opportunity may have opened up for me though, to do some research with a pretty well known neurosurgeon at a well known place. So I think I might have a glimmer of a chance at this and now I'm seriously considering it. If there's even the slightest chance I want to go for it
 
OP
T

theprince911

2+ Year Member
Oct 21, 2014
43
15
Status
Medical Student
Why didn't you attend an American medical school?
My plan initially was to do just that. Then I found out I could just skip undergrad and do what I really wanted to do, which was to be a doctor, if I went to medical school here in Asia.
 

W19

Membership Revoked
Removed
Removed
Account on Hold
Gold Donor
2+ Year Member
Sep 24, 2014
6,096
4,210
Status
Resident [Any Field]
That did help a lot. It motivated me even more, which is what I really needed.
Do you think that if I could spend a year or two researching with a renowned neurosurgeon, and if I scored really high on my steps, that I would have a real shot at neurosurgery?
Neurosurgery is EXTREMELY competitive even for US grad based on what my MS4 mentor told me... You might have a shot--no one knows. 255 independent applicants matched in GS in 2014 as opposed to only about 17 in Neurosurgery.

http://www.nrmp.org/wp-content/uploads/2014/09/Charting-Outcomes-2014-Final.pdf
 
Last edited:
Apr 24, 2012
121
71
Status
Medical Student
Why would I do that? Sounds very counterproductive.
Because I am skeptical regarding you chances. You went to a medical school in Asia, which likely recruits people with average intelligence, and still didn't perform well unless foreign language was your issue. You have also struggled with internal medicine, which is the key to doing well on Step 1 and Step 2. Subpar performance on Step 1 will be the last nail in your coffin, and there is no way back unless you want to practice in Asia.
 
OP
T

theprince911

2+ Year Member
Oct 21, 2014
43
15
Status
Medical Student
Because I am skeptical regarding you chances. You went to a medical school in Asia, which likely recruits people with average intelligence, and still didn't perform well unless foreign language was your issue. You have also struggled with internal medicine, which is the key to doing well on Step 1 and Step 2. Subpar performance on Step 1 will be the last nail in your coffin, and there is no way back unless you want to practice in Asia.
Average intelligence? Lol this university is one of the best in the country. Many many doctors from here are successful practitioners not just in the US but also in the UK, Canada, all over the world. I dont regret coming here at all. It's known for its rigor. Acceptance rate is like 1 to 2 percent too. So it's not like I went to some random school, I did my research. I'm not worried about getting a residency. I'm worried about getting one in surgery. Because I know that no matter how good the school is, the fact that I'd be an img is going to make it difficult. If I knew I wanted to go into surgery before, I would have gone the American route.
As far as internal medicine goes, just because I'm struggling and it's difficult for me does not mean that I will perform badly. I am determined to overcome my struggle with it and perform as well as I need to no matter what.
Just in the past couple of days everything started clicking for me and I actually like it now, albeit not as much as surgery.
Not so stressed anymore.. may be a tough road ahead, but I'm determined to get there, so I will.
Thank you all for your help.
 
Apr 24, 2012
121
71
Status
Medical Student
Average intelligence? Lol this university is one of the best in the country. Many many doctors from here are successful practitioners not just in the US but also in the UK, Canada, all over the world. I dont regret coming here at all. It's known for its rigor. Acceptance rate is like 1 to 2 percent too. So it's not like I went to some random school, I did my research. I'm not worried about getting a residency. I'm worried about getting one in surgery. Because I know that no matter how good the school is, the fact that I'd be an img is going to make it difficult. If I knew I wanted to go into surgery before, I would have gone the American route.
As far as internal medicine goes, just because I'm struggling and it's difficult for me does not mean that I will perform badly. I am determined to overcome my struggle with it and perform as well as I need to no matter what.
Just in the past couple of days everything started clicking for me and I actually like it now, albeit not as much as surgery.
Not so stressed anymore.. may be a tough road ahead, but I'm determined to get there, so I will.
Thank you all for your help.
LOL Good luck!