USMLE and residency

[M3dhop3ful]

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Hi everyone

I did a search but didn't find anything on this, likely because my question is so basic.

In any case, I am currently an M2 at a canadian university. I've received several recommendations to write my USMLEs since I am interested in a competitive specialty (ENT) and it would be great to have several options available. The issue we are facing in canada is that the gov't has increased the number of seats in med school over the years I matriculated, while maintaining the same number of residency spots, It will be to my benefit to expand the pool of schools I can apply to.

My questions

1) I know the USMLE is important, but to what extent? Everything is pass/fail in canada, with no class ranking (not even in clerkship). Residency evaluation is based on research, elective performance, and reference letters.

So the only two parameters that would be used to measure me are 1) research, 2) electives, and 3) the Step 1 score. Will a lot of research and a solid step 1 score help make it likely to get my residency of choice?


2) Apparently USMLE scores and residency by discipline correlations are top secret?? Is there any unofficial info that can help you estimate what score you need for what specialty?

3) If you have a high step 1 score, will it make you competitive for all residencies even if your application shows a demonstrated interest in only one specialty? For example, can you be gunning for plastics, have a lot of research in the area and a high step 1 score, and be considered competitive for some other specialty like Urology just by virtue of having a high step 1 score?

I'm asking this because I will likely back up with family. I think it's a specialty I can do as a career, albeit definitely would never be my top choice. I'm not going to do any electives in it, or do any research. So I would only be competitive for it by achieving a high usmle score.

If I do this, can I effectively "secure" a family medicine position, even if I have no electives in it or any significant demonstrated interest? How do FM programs in the US view the whole idea of students backing up with them?

 

[squareknot]

Hi everyone

I did a search but didn't find anything on this, likely because my question is so basic.

In any case, I am currently an M2 at a canadian university. I've received several recommendations to write my USMLEs since I am interested in a competitive specialty (ENT) and it would be great to have several options available. The issue we are facing in canada is that the gov't has increased the number of seats in med school over the years I matriculated, while maintaining the same number of residency spots, It will be to my benefit to expand the pool of schools I can apply to.

Unfortunately, this is true for current US medschools as well. And as a result, will make it tougher for you come match time (as well as IMG, FMG applicants) compared to now.

1) I know the USMLE is important, but to what extent? Everything is pass/fail in canada, with no class ranking (not even in clerkship). Residency evaluation is based on research, elective performance, and reference letters.

So the only two parameters that would be used to measure me are 1) research, 2) electives, and 3) the Step 1 score. Will a lot of research and a solid step 1 score help make it likely to get my residency of choice?

It will be crucial for you to score very high on your step 1. You will have to score higher than what is acceptable for AMGs (ie 220's might be okay for AMG going into IM, but IMG/FMGs will need higher #'s). Research will be very important for research-heavy fields (some surgical subspecialties). Elective time is mainly used to gather letter of recs, which will be another important part of your application. Since you say that your school is purely pass/fail, it may help to do some aways at programs of your choice to not only "strut your stuff" but also to see what they are really about. There are some aspects of programs that might not be readily apparent on interview day.

2) Apparently USMLE scores and residency by discipline correlations are top secret?? Is there any unofficial info that can help you estimate what score you need for what specialty?

Short answer is no, there is no magical database with step 1 numbers. A lot of "how competitive am I?" is realized early in the interview season. You apply to a bunch of places of interest, and if you make it through the initial filters, there's something in your app that is of interest to the programs.

3) If you have a high step 1 score, will it make you competitive for all residencies even if your application shows a demonstrated interest in only one specialty? For example, can you be gunning for plastics, have a lot of research in the area and a high step 1 score, and be considered competitive for some other specialty like Urology just by virtue of having a high step 1 score?

I'm asking this because I will likely back up with family. I think it's a specialty I can do as a career, albeit definitely would never be my top choice. I'm not going to do any electives in it, or do any research. So I would only be competitive for it by achieving a high usmle score.

If I do this, can I effectively "secure" a family medicine position, even if I have no electives in it or any significant demonstrated interest? How do FM programs in the US view the whole idea of students backing up with them?

Let's just say it will be very difficult to juggle 2 competitive specialties, like plastics AND uro, during the interview season. Come september, if it's pretty obvious your application is tailored to a certain field, say plastics, you may not be taken seriously by other (also competitive) fields. You need something more than just a high step 1 score to be competitive for both interviews AND getting highly ranked. If you're on the fence, it will show, not just in your CV but during the interview as well. Pick 1 field that you're competitive for, and run with it. However, if it's a super competitive field, it's okay to have a backup -- just don't make it obvious to the backup program, but don't lie either. On the other hand, if you're doing plastics, it might make more sense to choose a backup that is similar, like surgery (a lot of plastics applicants do this for this reason). But plastics and FM? I guess both do involve different degree of procedures but they are very different (lifestyle, personalities, etc). Check out the specialty forums here and compare yourself with successful canadian applicants to see where you stand. It's tricky process and seems daunting at times but very doable.

 

[alwaysaangel]

2) Apparently USMLE scores and residency by discipline correlations are top secret?? Is there any unofficial info that can help you estimate what score you need for what specialty?

Its not top secret in the US. Every year NRMP releases the averages for those who successfully matched into a given specialty.

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

 

[monkeygirl09]

Hi everyone

2) Apparently USMLE scores and residency by discipline correlations are top secret?? Is there any unofficial info that can help you estimate what score you need for what specialty?

USMLE scores and residency by discipline correlation is far from top secret. The NRMP has a lot of data available on their website:
http://www.nrmp.org/

I think you want to check out Charting Outcomes in the Match
http://www.nrmp.org/data/chartingoutcomes2009v3.pdf

There is info both for US MD grads and for independent applicants which includes IMGs.

I think that document will help answer lots of your questions.

 

[gravitywave]

everyone replying to this thread seems to be regarding Canadian schools as international.

how can this be true when all the Canadian schools are accredited by LCME at the same standards as US schools are? i would think that OP has a far better chance than someone from the Caribbean.

 

[mmmcdowe]

everyone replying to this thread seems to be regarding Canadian schools as international.

how can this be true when all the Canadian schools are accredited by LCME at the same standards as US schools are? i would think that OP has a far better chance than someone from the Caribbean.

I was also under the impression that canadians had it easier than other IMGs.

 

[WellWornLad]

I did a search but didn't find anything on this, likely because my question is so basic...Apparently USMLE scores and residency by discipline correlations are top secret?? Is there any unofficial info that can help you estimate what score you need for what specialty?

Well you must be new to this whole internet search thing, because this question must come up about 5 times a week on this forum. Honestly, people should probably be required to read the NRMP website and pass a short quiz before posting here.

I'm not going to do any electives in [family medicine], or do any research. So I would only be competitive for it by achieving a high usmle score.

Oh, laughter. I bet you could get a middling USMLE score, do no research or ECs, and slap at least one person on each of your FM interviews and still match somewhere.

 

[M3dhop3ful]

hmm thanks for the replies everyone, that gives me a pretty good picture of what to expect. It seems that a good step 1 score won't win the war for you, but you cannot win without it.

Are canadians regarded in the same boat as IMGs? I hope not..I know for us, US grads, while they don't match as well as canadian grads, they certainly do much, much better than IMGs.

@squareknot: traditionally, here in Canada at least, people who gunned for surgical specialties, backed up with gen surg. Unfortunately, it's practically impossible to back up with gen surg because it's gotten to be increasingly more competitive, as much as ENT, Ortho, plastics. Your options when going to a competitive specialty here are now 1) back up with family if you can see yourself doing it, or 2) rank only your top choice specialty and hope for your sake there are some decent openings in the second round. ENT and family medicine are different and not really related, but I can see myself practicing family for the rest of my life. I'd much, much rather practice ENT.

@wellwornlad: I guess matching into family is really easy in the US? are some FM programs regionally competitive? I'm assuming that programs in large metropolitan cities are going to be more competitive than programs in the middle of nowhere,
and so backing up with those might be more difficult..

 

[ArcGurren]

hmm thanks for the replies everyone, that gives me a pretty good picture of what to expect. It seems that a good step 1 score won't win the war for you, but you cannot win without it.

Are canadians regarded in the same boat as IMGs? I hope not..I know for us, US grads, while they don't match as well as canadian grads, they certainly do much, much better than IMGs.

@squareknot: traditionally, here in Canada at least, people who gunned for surgical specialties, backed up with gen surg. Unfortunately, it's practically impossible to back up with gen surg because it's gotten to be increasingly more competitive, as much as ENT, Ortho, plastics. Your options when going to a competitive specialty here are now 1) back up with family if you can see yourself doing it, or 2) rank only your top choice specialty and hope for your sake there are some decent openings in the second round. ENT and family medicine are different and not really related, but I can see myself practicing family for the rest of my life. I'd much, much rather practice ENT.

@wellwornlad: I guess matching into family is really easy in the US? are some FM programs regionally competitive? I'm assuming that programs in large metropolitan cities are going to be more competitive than programs in the middle of nowhere,
and so backing up with those might be more difficult..

Traditionally FM is considered one of the easiest specialties to match into in the US and no I've never heard of a "competitive" FM residency here. This is not to say there aren't any, I just don't know of any personally.

As a Canadian IMG you will in all likelihood match SOMEWHERE in the US if you're going for IM, FM, etc.

 

[JokerMD]

sdf

 

[alwaysaangel]

based on lots of sources USLME is one of the most important part of your application. I'm also interested in ENT, and I've been told by several 4th years who are matching into ENT from my school that you should aim for 250 to be comfortable for ENT.

i think the average is around 240's 😕 but you should aim high

You also need multiple honors in clerkships and research.

A friend of mine had a Step 1 in the high 260s. That alone was not enough for ENT.

 

[Gheorgia]

You also need multiple honors in clerkships and research.

A friend of mine had a Step 1 in the high 260s. That alone was not enough for ENT.

I also wanted to point out to the OP that he/she should consider setting some visiting rotations at ENT programs in the US that he wants to match into. Most ENT folks who matched did so at their home program or at the places where they rotated. And as the others have said, in the absence of clerkship grades, that may be the only thing besides the USMLE score that the programs can rate you on.

 

[Gheorgia]

hmm thanks for the replies everyone, that gives me a pretty good picture of what to expect. It seems that a good step 1 score won't win the war for you, but you cannot win without it.

Are canadians regarded in the same boat as IMGs? I hope not..I know for us, US grads, while they don't match as well as canadian grads, they certainly do much, much better than IMGs.

@squareknot: traditionally, here in Canada at least, people who gunned for surgical specialties, backed up with gen surg. Unfortunately, it's practically impossible to back up with gen surg because it's gotten to be increasingly more competitive, as much as ENT, Ortho, plastics. Your options when going to a competitive specialty here are now 1) back up with family if you can see yourself doing it, or 2) rank only your top choice specialty and hope for your sake there are some decent openings in the second round. ENT and family medicine are different and not really related, but I can see myself practicing family for the rest of my life. I'd much, much rather practice ENT.

@wellwornlad: I guess matching into family is really easy in the US? are some FM programs regionally competitive? I'm assuming that programs in large metropolitan cities are going to be more competitive than programs in the middle of nowhere,
and so backing up with those might be more difficult..

I'm not a Canadian but I'm fairly certain that most Canadian medical schooll are LCME accredited and are evaluated on the same level as US medical school.

Also surgery here is somewhat competitive but not supercompetitive on the same level as ENT or ortho.

As for FM. Most FM medicine programs here are super easy to match into. There are a lot of programs (in rural places) that simply can't attract US medical school graduates and so help sponsor and train FMG from Asia and South America, etc. to fill their ranks

 

[ZagDoc]

Matched into ENT this year, so some of my thoughts may be more ENT-specific.

ENT is a notoriously tough, tough specialty to match as an IMG. Which is not to say it isn't possible, but of the 3 IMG ENT residents I know, all 3 did research years at big-name ENT institutions (Mass Eye and Ear, Vandy, and Ohio State) prior to applying. To give you a sense of how competitive it is, in this years match only ~15% of IMG applicants matched. Last year it was ~30%. The year before, ~20%. As stated, as a canadian med school grad you're in a better position than carribbean and over-the-pond(s) students, but I imagine you are still at a bit of a disadvantage. I don't know if the NRMP lumps canadian grads into it's IMG statistics or not.

If you're shooting for ENT, you need to kill the USMLE. It's almost a requirement for US students to have >240 to have a shot these days, so as an IMG you need to add 10-15 points on top of that at least. This is especially important for you as you will not be able to distinguish yourself with clinical grades since you're P/F.

Research is also pretty much a requirement in applying to the field now... and not summer benchwork stuff where you dont know what you're doing. ENT programs want to see publications, they want to see you have an active role in the study, they want to see you presenting your research at grand rounds, at conferences, on posters, etc. As an IMG, you want to get involved in research projects, preferably at a first author level. You need to milk those projects for as many lines on your CV as possible.

ENT is also a very small field where connections go a long way. I personally netted another interview solely based on a phone call from one of my letter writers. The chairs of different departments talk to each other quite a bit. There's a fair number of well-respected and notable ENT surgeons from Canada, so I'd ask around your department, see how you could maximize your chances. Good letters go a long way in the field.

ENT residencies in the US are all about a.) Step 1 score b.) clinical grades/AOA status c.) research d.) LORs. You're allowed to be deficient in one of those 4 areas if your other 3 make up for it, as it was explained to me. But the line is thinner as an IMG.

Not trying to scare you, ENT is an awesome field (there's a reason I chose it!) I'm just trying to give you a realistic sense of how ridiculously competitive the field is these days. I met some applicants on the interview trail with some truly monstrous applications who were very personable people, and not a single person I met felt like they have a match spot in the bag. We were all sweating bullets until the end.

If you're interested in more ENT-specific info, otomatch.com is a better place for it. A lot of current residents post over there as well.

 

[nothingman]

Some quick summary points:

As a graduate of an LCME-accredited Canadian med school, you should academically have equal standing to an American student with respect to licensing and the match. You will not be treated as an IMG/FMG in the US.

You will, like all students applying for US residencies, need at least USMLE Step 1 taken and scored prior to applying. Given the grading system you describe, and depending on how well you do on Step 1, you may want to also take Step 2 CK prior to applying or around late August of the application year so that you have the option of releasing your score for interviews if you did well.

If you want to match in the US, especially in a competitive specialty like ENT, it would help you hugely to do electives in well-known hospitals in Canada (with international standing) as well as hopefully, in the US, and get letters from known attendings there. This will help more than anything else if you do well.

You can only ultimately participate in one match though you can register for both CaRMS and NRMP. I believe CaRMS is earlier (correct me if I'm wrong) so if you've matched in Canada you withdraw from the NRMP.

The biggest issue for you in going to the US, unless you're a dual Canadian and US citizen/green card holder (I may have missed this), is going to be getting the appropriate kind of visa (ideally, H1-B) from the US institution sponsoring your training. Far from all places offer this, and it's worth asking about prior to applying. I don't know a lot about the J-1 alternative, other than it's easier to get, inferior to H1-B and can possibly interrupt your training or force you to return to Canada for some amount of time afterwards. Others can supply better info here. Good luck and feel free to PM!