Email from a reader

I got this email from a reader some time ago:

Thank you so much for sharing your experience in your blog. I came across your blog regarding training in US, just like how many others did.

My plan is to apply for the coming match in 2013 September. However, as I made this decision of pursuing post graduate training in US rather late, I did not do my elective in the states when I was a medical student. Thus, I think it puts me at slight disadvantage compared to others candidate in terms of letter of recommendation and also the part on US clinical experience, even though we may have the same scores. I am actually looking at internal medicine programs, which may be considered the least competitive compared to other programs. But I am interested in university affiliated hospitals so that I can have more research opportunities in the future, which is rather tough for international medical graduate. But either way, I am happy if I can secure a spot in any hospital.

I have tried sending emails to a few university affiliated hospitals for externship experience, but most of them only offers clinical elective to medical students, which I am not already. Some offers observership, but I think it would not be considered as part of USCE in the residency application. I also came across a few websites eg FMG portal which offers help to seek for externship spots at a sky high price - but from the list they gave me, there are only categorised to specialty and areas, but not the name of the hospitals, so I am not sure how reliable it is.

1) Should I apply to the FMG portal?

2) Should I wait for the observership from the universities hospital, which I can only apply after I am ECFMG certified, after passing my Step one in April? ( then I may not be on time for this year's application in september, since it takes time to process the certificate , then the letter of recommendation.)

3) Or should I go ahead with the application in September without any USCE and letter of recommendation from US?

4) Do you know any hospital in particular which offer such elective spot to IMG?

5) What are your experience with other students/IMG ? ( I mean how many actually manage to secure a spot, in particular the internal medicine?)

 

The truth is, I'm feeling more and more rusty with the application process since I did this 12 (gulp) years ago. And so things undoubtedly have changed much.

However, if any of you readers find yourself in a similar situation, I have this to say. And I humbly acknowledge that I am not directly involved in any residency selection processes (so I can't speak from firsthand experience) though am on faculty in 3 residency programs and a medical school here.

It might be 'ideal' to do a US elective. Especially in the specialty you seek, and in the hospital to which you hope to apply. And to get a letter of reference from a US physician.

However, just because you don't have the above, is not the end of the world. Ideal is one thing, but there are many things to consider too.

I know of quite a few IMGs who got into residency programs here without the above. I for one didn't do any US electives when I was a student (though granted, Canadian hospitals are probably seen in a similar light). And I am of the opinion that almost everyone can potentially secure a spot. The question will always be, how flexible are you?

If you are worried that your credentials might not be strong, to consider less-competitive specialties. And to apply to less popular programs/locations. At the very least, have a few of these backups.

Also, I know of some foreign-trainees whose US-elective plans backfired- I met numerous students who wanted to apply to work at the 2nd-ranked top hospital in the country (ahem)- but their performance in that month was less than satisfactory which gave them not-too-good letters. And firsthand feedback to the program director that they were not suitable candidates. So, a US elective isn't always a plus.

While it might be true that letters from overseas physicians might not carry as much weight, I'm sure these do account for something. And I'm not sure the letters I've written for students here, would be seen much more differently from letters coming from elsewhere, since the program directors probably know as much about me, as they do about some Dr. X in Malaysia. Hence I doubt I have any more credibility than anyone else.

I do feel strongly though, that a clinical observership carries very little weight. Do it if you're curious about how things are done in a different country. But don't do it to try to get your application any stronger. As an observer, for medicolegal reasons, the hospitals cannot allow you to directly involved in patient care. So your mentor would not be able to make an assessment and write you a good letter with this.

So, whoever you might be, and wherever you are, getting a spot certainly is possible. Don't lose faith!