Anesthesia Observership Opportunities and Alternatives

A question recently asked by an applicant whose primary interest was anesthesia residency was how to obtain additional experiences and possibly observership in anesthesia?


1. Try for publicly announced observership opportunities
a. MD Anderson Cancer Research Center/University of Texas Houston, Texas, (link)
b. Cleveland Clinic, Cleveland, OH (link)
c. Drexel University, Philadelphia PA (link)
d. Massachusetts General Hospital, Boston MA (link)
e. University of Florida, Gainesville (link)

These are publicly announced programs and thus have a high visibility. This translates into a higher competition for the few spots that are offered. The programs that offer such positions have a well-established curriculum and defined guidelines. Most of them require fees (example 500$ a week at MD Anderson) but will have a structure to the learning experience. Didactic and practical training may be both covered.

2. Try for unannounced observership opportunities – cold calling physicians in anesthesia. This is the underbelly of the observership beast. A large segment of potential opportunities exist but since they are not officially announced information is usually word of mouth. For what these positions give up in sheer competition, they make up for it in the amount of leg-work and effort that applicant needs to make to initiate the process. Often, you may have to write to several faculty in the practice, in multiple practices, in more than one hospital and all over the state. There are programs and doctors who do wish to teach and are willing to take on observers – its just a matter of reaching out to them

3. Pre-op clinics (internal medicine): This is not to say that observerships in medicine are any easier than those in anesthesia, observerships are difficult to come by for international physicians period. There are many more general internists and possibly family physicians who may spend a portion of their work week doing pre-op clinics. Many places run these clinics in conjunction with Anesthesia team but the experience is similar. Patients with complex medical history going in for elective surgery are assessed for preoperative risk analysis and perioperative complication reduction

4. Emergency medicine rotation: This may benefit those interested in anesthesia (or EM or IM or even FM) by being exposed to common procedural techniques. As an observer due to strict hands off policy – you wont be able to do any procedures but the observer experience would still count. Intubations, central venous access catheter placements, cut-downs, arterial cannulation, pressor protocols etc are some common areas that may be worthwhile.

5. Simulation laboratories (Sim-lab): most major institutions have a simulation lab where life size human dummies can be practiced. These are not just blocks of wood or latex but highly sophisticated pieces of engineering. Fees may be required and access may be limited. 

6. Anesthesia grand rounds and Anesthesia meetings: This is another avenue to tap if you are looking to enhance you CV with anesthesia related material. Also an opportunity to make connections with faculty and have brief informal discussions and exchange contact information.

What Makes A Training Program Good: Factor To Consider When Ranking Programs For The Match – Congruence

Part 2 of series titled: what makes a residency training program an excellent choice.

Few days ago, I wrote an article about the educational aspects of what makes a program attractive. Today, I will touch upon another important facet: how well you think you will fit in. Once you match into a program, you will be a part of the machinery in the institution. You will learn how things work, execute actions and yourself become an indispensable widget in the big scheme of things. Hence, it is imperative that you match to a place that you recognize provides an excellent fit as far as work is concerned.

Some problems that may come up as a result of poor adjustment (resident adjustment disorder) can be friction with colleagues, lack of support from faculty, joyless work environment, tedium of daily chores, hardship during training and most of all attrition of resident morale, compromise with educational training and ultimately, effect on patient care. Thus, the consequence of that one small part that does not fit in, is wide and far reaching. There are many areas where incongruence can occur and if not recognized and ameliorated can lead to many of the effects mentioned above.

Emotional in-congruence:

Training in internship and residency is tough. You have to have a certain level of emotional maturity to deal with the long hours, difficult personal and professional decisions, and place above self the welfare of the patient under your care. If there is an attitude and expectation, that you are above the rest, this will very quickly degenerate into a unpleasant situation. One must recognize that you are part of the team and if that sense of team work is lacking then that program is one to steer clear of. See if your personality traits match those of current residents. What drives them? Is it the same for you?

Professional in-congruence:

In almost all programs you will find a multitude of resident personalities. The perennial slackers, those that do just enough to stay in the black and those that go above and beyond the required level to make it better for everyone. Get a good feel for the approximate breakdown for the three types in the program. You can bluntly ask the chief resident “what percent of your current residents do not go that extra mile to get things done? Or like to slack off?” If there is an alarmingly high number [30-40%] of these personality types, then it may become a burden to work there.

Physical in-congruence:

If you are the only foreign medical graduate in a program that has only American graduates this can create a situation of misunderstanding. This physical incongruence should not prevent you from considering ranking the program but should remind you to work at improving communications. What may considered as a norm for most of graduates back home may be in fact a contentious issue for your colleagues. Do not hesitate to explain yourself should you find yourself in a situation where there may be doubt regarding what you mean.

Lock has to fit the key as well, Does the applicant provide a good ‘fit’ for the program?. The programs also keeps an eye out for applicants that will fit in. Remember, match is a two way process and the programs are looking for applicants who will embrace the work ethic, the values of the institution and be almost ‘zero’ maintenance. In fact, an applicant who has awesome scores but has had issues with faculty, insubordination or interpersonal problems may be considered lower than someone who scored lower on exams but is easy going, great to get along with and hard working.

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Competitiveness Of Fellowships After Internal Medicine Residency

AIM: To ascertain which fellowships are most competitive for internal medicine residents after training. 

DATA: Meta-analysis of data from NRMP fellowship match data 

SOURCE/CITATION: 

National Resident Matching Program, Results and Data: Specialties Matching Service 2012. Appointment Year. National Resident Matching Program, Washington, DC. 2012. pdf here

METHOD:  

Data from fellowship match summary was selected pertaining to internal medicine fellowships and tabulated. The competitiveness of a particular field was calculated using ratio of [Number of applicants/Number of position]. 

RESULTS:  

Fig 1. Competitiveness score for fellowship application for all applicants

When arranged and charted on the graph (figure 1), you can see that in 2012 the fellowship with the most applicants to positions offered was gastroenterology. The easiest fellowships at the current time to get into are Infectious diseases, followed by nephrology and then rheumatology. GI has always been a favorite amongst medicine residents. Whether this is because it is a procedure-based field has anything to do with the order of the result is a matter of open discussion. However, another procedure-based field like cardiology was lower on the list so that may not be the only reason. It may be that GI is more appealing because of better understanding of core concepts during training, more exposure during training and comfort of familiarity. It appears that ID may not be appealing to a lot of applicants (for whatever reasons) and so is nephrology. 

Fig 2. Proportion of applicants applying to fellowships for 2012

There is another aspect to this result. One thing that is not evident immediately is the number of positions that are offered for fellowships. The total number of fellowship positions accounted for in the above specialties is 3059. In 2009, there were 4922 PGY1 positions that were offered (The assumption here is that applicants who entered a graduate medical program in 2009 were ones applying for the 2012 fellowship position. There may be other factors and the assumption may be slightly incorrect but it’s the easiest one to consider). Thus one could say that approximately 2000 applicants chose to not sub-specialize after finishing their training. The proportion of applicants wanting to get into a sub-specialty is shown in figure 2. Thus in the coming years, as the number of applicants that apply to fellowship training increases and the number of positions remains unaltered, it is going to affect those specialties that have very few positions to being with. For example, allergy and rheumatology which have the fewest positions may end up becoming extremely difficult to get into. 

Bear in mind the results of the 2012 match discussed in above paragraphs are for all applicants. The story is very different if you do a selective subset analysis of international medical graduates applying to fellowships. Figure 3 shows the number of non-US grads who matched into fellowship programs (No. of matches, all apps minus US grads). As seen in figure 3, Allergy/Immunology is the most difficult for international graduates to get into followed by GI and then ID. Towards the other other end of the spectrum Nephrology is the easiest for IMGs to get after medicine residency followed by rheumatology and endocrine. 

CONCLUSIONS: 

1. GI is the most competitive amongst all applicants for fellowship, while ID was least competitive.
2. Highest proportion of applicants to fellowship sub-specialties were to cardiology and least were to allergy.
3. As number of applicants increases, the specialties with fewest positions (allergy and rheumatology) may see an increase in the competitiveness score.
4. For international medical graduates allergy is most competitive while nephrology is the least competitive to get. 

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Importance of USMLE Step 2 CS score attempts in Program Interviews

Step 2 CS is an important exam for residency applicants. While American medical graduates do not have any issues passing this exam, many international and foreign medical applicants fail this exam for multiple reasons. Similar articles in the past have dealt with issues like which are the best programs for applicants with attempts in Step 1 and how Step 1 and Step 2 CK score affect interview invitations.

Reasons for failing and importance of Step 2 CS: 

Difficulty with accent, spoken English, customs, problems with comprehension of the standardized patient and unfamiliarity with the medical conduct and bedside manners in US, all contribute to high failure rate in IMGs. Step 2 CS is a pass/fail exam so it is important to clear this exam prior to applying for residency. It is one of the required examinations to get ECFMG certified which in turn is mandatory for residency application, matching and eventually state licensing to practice medicine in US. 

Using data analyzed from the program directors survey an NRMP publication (2012), program specialties were arranged in the order of importance they place on passing step 2 CS when considering applicants for interviews. The results, shown in figure 1, were indeed surprising. 

Fig 1: % of programs that consider step 2 CS result in inviting applicants for  residency interview, Source: NRMP

Results:

1. Highly competitive programs like dermatology, ENT (OTO), ortho, plastic etc did not place much importance on step 2 CS results 

2. Radiology which is competitive and a favorite for foreign trained radiologists was also at the bottom. 

3. Pathology, pediatrics and psychiatry programs (79, 82 and 83% respectively) used step 2 CS scores when considering applicants for interview 

4. Resounding majority of family medicine programs(91%) considered step 2 CS scores when inviting applicants for interviews. 

Discussion: 

The fact that highly competitive programs like Derm, Ortho, ENT etc do not stress much importance in USMLE step 2 CS pass/fail score may be as a result of a combination of factors. They are inherently very difficult residencies to get into with the bar for selection placed very high in other areas (AOA, research, contacts?, networking). All applicants are American graduates with almost 100% pass rates for USMLE step 2CS, which makes considering this exam a criterion less important.     

Radiology may not place much importance on this exam for the simple reason, this is a clinical skills exam and radiology is not a clinical skills field. The irrelevance of step 2 CS for radiology may reflect in its low importance as a factor to grant interviews. 

Looking at FM, IM, pediatrics and psychiatry, FM tends to place the most importance on step 2 CS scores. Thus if you have failed in this exam, it may not be a good idea to apply to FM as vast majority (91%) of programs are going to take your 2CS score into account. There may be other things in your resume, which may help you gain an interview mitigating the effect of a failed step 2 CS but a lot of FM programs seem to place importance on this result. 

Implication: 

Though the difference between IM, FM, Peds, psych, path and neuro are small, they may still be important enough to consider which programs you are going apply to if you have an attempt on your USMLE step 2 CS. 

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Reference:

National Resident Matching Program, Data Release and Research Committee: Results of the 2012 NRMP Program Director Survey. National Resident Matching Program, Washington, DC. 2012.

Age Limit To Begin Your Residency?

Discrimination by age is not permitted by the US laws. One cannot be simply refused a residency position because they are ‘too old’.  Another subset of applicants with special situations are those who have a disability and has been dealt before. Laws preventing age discrimination in residency selection are a good and a bad thing. 

Old graduates do match: It is good because it provides hope and chance for many old graduates that are thinking of pursuing residency graduate medical training in US. Many applicants are medical graduates in other fields like surgery or psychiatry who are now wanting to pursue training in US. They may not get into the field of their choice but are willing to make adjustments with other fields like Family medicine or pediatrics. I know personally of one 45 year old applicant who was a surgeon in his home country who matched into a family medicine residency.  Another example is a close colleague who was in her 40s matched in to an internal medicine residency program. Examples like these are plenty and offer hope to those who are thinking of changing their career plans at a later stage in life.

Though legally there is a law in effect preventing ‘ageism’ in work place and residency recruitment, the reality of the situation includes some level of discrimination against those who are old. Program directors or admission committees can make any number of excuses to not take an older candidate and since there is no requirement to provide a reason to the applicant who does not match, most of the time, it is left to speculation as to what may have happened. 

Reasons for 'ageism' in workplace: Part of the reason why the PDs and programs may not prefer to take older graduates is because, residency is in itself an extremely stressful situation. Successful completion of internship and residency demands sharp mental acuity, good physical condition and ability to deal with ever increasing stress of patient care. Each incumbent resident is a valuable member of the hospital workforce that cannot be easily replaced. It is because of this reason, that the programs want to hire a candidate they can see finish the residency without issues and complications. The general thought being that those who are older – like in their 40s and 50s are too set in their ways and will not be easy to train. There is also consideration that health issues may be relevant when older graduates are taking increasingly difficult responsibilities of patient care. Thus, in the real world, there may be a situation where, for two applicants A and B who are evenly matched except for age, the younger applicant may have a slight edge than compared to older one. This is however not a rule set in stone, as there are some FM programs or community peds/IM programs that may actually prefer to have more senior house staff due to their maturity in dealing with all circumstances.

If you are an older graduate (30+, 40+ or even 50+), have decided to pursue your dream of medical practice in US, then by all means go for it. There are good reasons to fulfill your ambition but temper it with a good measure of reality knowing that this will be a hard task, but which can be won with fair amount of knowledge of the match process, hard work and effort. If you wish to be in touch and get the latest posts and updates, join me on Facebook or follow me on Twitter. Also Scroll below ↓ for the most popular articles this week!

Interview To Ranking To Match: The Critical Choke Point For Residency Applicants.

Looking at all the IMG pertinent subjects as a follow up of the small series of articles called proportion of applicants interviewed, ranked and matched, I was not surprised to see the below funnel shape emerge. Look at the number of applicants interviewed on the left hand side of the figure. For sake of clarity the subjects have been stacked such that the scale represents the total number of applicants interviewed with each slice representing the respective specialty. 

Figure 1: attrition in number of interview, ranked and matched residency applicants. | source NRMP

The numbers of applicants ranked by the programs has been included as a way point in the center and finally the mean number of applicants matched to the specialty is shown on the right under ‘matched’ category. 

There are several important observations gleaned from the data 

1. Maximal overall attrition of applicant pool is seen in subjects like Internal medicine, pediatrics, emergency medicine (this was a surprising finding) followed by anesthesia 
2. Other specialties like psychiatry and family medicine along with neurology had less dramatic of attrition of applicant pool. 
3. The step down from interviewed to ranked applicant category was the most in subjects that demonstrated the least proportional fall in applicant numbers vix pathology, neurology, surgery and even FM and psych 
4. The step down from mean interviewed number to mean ranked number of applicants was gradual in IM, pediatrics and emergency medicine.

Implications 

1. Across the board for most part, all applicants that are interviewed for residency position are placed on the program rank order list. Which means that you must have to perform extremely poorly to be not considered for program ROL after the interview. This should help those folks who are afraid or concerned about their performance in interview. 
2. While most of the applicants that are interviewed are ranked, the above figure does not and cannot distinguish, where on the rank order list the applicants are spread. Program ROL
3. Programs like IM and pediatrics interview far more number of applicants than positions available while on the other hand, pathology, neurology etc are more discerning as to whom to invite for interviews. Their interview invitation list is tighter and the ranked applicant and matched applicant list is proportionally smaller. 

Conclusions

The data represented in this way should alert the prospective residency applicant of the attrition in numbers of applying (not shown), interviewed, ranked and matched applicants. 

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Proportion Of Interviews, Ranked And Matched Applicants For Primary IMG Friendly Specialties

Using data from the NRMP program results, we find an interesting trend between number of applying candidates, applicants interviews, ranked to a program and matched numbers. The figure below shows the mean number of interviews, ranked and matched applicants in Primary IMG friendly specialties. A similar analysis of secondary IMG friendly specialties has been done and can be read at the link provided.

Figure Key:

• “Interviewed” refers to the average number of applicants a program has interviewed.
• “Ranked” refers to the average number of applicants the program places on their rank order list
• “Matched” refer to the average number of applicants that match into a program. This is generally the number of positions that program has.
• “Primary IMG friendly” program refers to specialties which IMGs apply and are the core group of IM, FM, Peds, Psych. 

  

Fig. 1: Proportion of interviewed, ranked and matched applicants primary IMG (Source NRMP)

As can be seen in the figure, Programs in internal medicine had the highest average number of applicants interviewed. IM also has the highest number of applicants ranked to programs and a high number of applicants that matched. Pediatrics was pretty close to medicine when it came to mean number of applicants interviewed and ranked. Pathology typically is not IMG friendly but was included here to keep the balance of specialties from secondary IMG friendly programs. Family medicine had the least number of applicants interviewed per program amongst the BIG four, ranked per program and matched per program. The numbers in the bars denote the mean number of applicants for respective category. 

What is the implication of this information?

16 applicants are interviewed for one position in Internal Medicine

12 applicants are interviewed for one position in Pediatrics

11 applicants are interviewed for one position in Psychiatry

11 applicants are interviewed for one position in Family Medicine

12 applicants are interviewed for one position in Pathology

Thus to maximize chances in matching in say, FM you likely need 11 interviews and so forth. This is the mean and numbers can be different for individual programs. This is slightly different for IM because by that comparison, one would say, 'you need 16 interviews to secure a match to at least one program'. There are 2 off shoots of this statement, one, you do not need 16 and any number between 10 and 15 should do the job. This explained by the fact that residency match is not a straight mathematical probability problem, the human element plays a big role. Second, there is a strange trend of having 15+ interviews and the rate of matching going down this has a few possible reasons as well which are discussed in article link provided.

If some one has the above number of interviews, then the chance of matching is exceptionally strong. However, you only need one interview to match because, if you ace that one interview, you can still be ranked at the top of a program ROL and match into that program. Therefore if you do not get as many interviews, do not be disheartened instead focus on the few you have! If you wish to be in touch and get the latest posts and updates, join me on Facebook or follow me on Twitter. Also Scroll below ↓ for the most popular articles this week!

Proportion Of Interviews, Ranked And Matched Applicants For Secondary IMG Friendly Specialties

Using data from the NRMP program results, we find an interesting trend between number of applying candidates, applicants interviews, ranked to a program and matched numbers. The figure below shows the mean number of interviews, ranked and matched applicants in secondary IMG friendly specialties. A similar analysis of primary IMG friendly specialties has been done and can be viewed at the link provided.

• “Interviewed” refers to the average number of applicants a program has interviewed.
• “Ranked” refers to the average number of applicants the program places on their rank order list
• “Matched” refer to the average number of applicants that match into a program. This is generally the number of positions that program has.
• “Secondary IMG friendly” program refers to specialties which IMGs apply to but are not the core group of IM, FM, Peds, Psych.

Fig. 1: Proportion of interviewed, ranked and matched applicants (Source NRMP)

As can be seen in the figure, Programs in anesthesia had the highest average number of applicants interviewed. Anesthesia also has the highest number of applicants ranked to programs and highest applicants that matched. Compared to radiology, Ob gyn and surgery, which occupied a central position, Neurology had the least number of applicants interviewed per program, ranked per program and matched per program. The numbers in the bars denote the mean number of applicants for respective category. 

What is the implication of this information?

16 applicants are interviewed for one position in Radiology

13 applicants are interviewed for one position in Anesthesia

12 applicants are interviewed for one position in Ob-Gyn

12 applicants are interviewed for one position in Surgery

12 applicants are interviewed for one position in Neurology

Thus to maximize chances in matching in radiology you likely need 16 interviews, anesthesia 13 interviews, Obgyn, surgery and neurology are at 12 interviews each. This is the mean and numbers can be different for individual programs.

If some one has the above number of interviews, then the chance of matching is exceptionally strong. However, you only need one interview to match because, if you ace that one interview, you can still be ranked at the top of a program ROL and match into that program. Therefore if you do not get as many interviews, do not be disheartened instead focus on the few you have! If you wish to be in touch and get the latest posts and updates, join me on Facebook or follow me on Twitter. Also Scroll below ↓ for the most popular articles this week!

The Do's of a Personal Statement Infographic

ECFMG is not only involved in the processing, dispersion of documents and certification of international medical graduates, they also do have a pretty helpful section that deals with other aspects of residency application. At their ECHO (ECFMG certificate holders office) resource section I found some Do’s pertaining to personal statement. Instead of list after list of pointers that are available on other sites, I decided to make a infographic highlighting the key DO’s of your personal statement. The Infographic is shown below

The DO's of a personal statement

Key things to consider are

1. Keep your personal statement honest – don’t hide failures, or disciplimary actions etc. instead use it to explain why you had issues in the first place.
2. Your passion for medicine, life long learning and service to alleviate the suffering of humanity must be explicit in your personal statement
3. Always make a mention of personal anecdote or experience that shaped your life.
4. Keep the personal statement length to one page. No need to crank out a Tolstoy or Dostoyevsky here.
5. Make sure you have a clear explanation of why you want to come to US for training, leaving things behind in home country
6. must make a clear and succinct description of what makes you tick, what makes you unique and what are your special skills
7. Discuss your future plans in your statement, let the reader know what your career goal is and how you see yourself in the future.
8. Have friends and family read your piece and give comments, don’t take comments too personally, if their opinion matters, make appropriate changes.
9. Must read your personal statement at least 50 times (okay.. many times) for errors in spelling, grammar, sentence construction and content.

No matter what specialty you apply to, be it family medicine or psychiatry, pediatrics or any other, you MUST focus on your personal statement and make it the best literary masterpiece that you can create in your life! For the DONT's of a personal statement read on...

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Influence Of A Gap In Medical Education - Cv On Residency Application

Introduction:

Very often, there is a question of how much does a gap in your medical education affect your residency chances?  Though there are no predetermined definitions or rules to describe what constitutes a gap in medical education, common understanding dictates that any period of your life where you are not involved in medical training or carrying out your duties as a physician are called ‘gaps’

Gaps can be small from few days to weeks time, moderate (few months at a stretch) or long gaps (years). Some common examples of small gaps in CV are taking time out to prepare for exam after graduation for medical school or even few weeks spent for personal reasons. The most common cause of moderate sized gap in your CV is actually related to the effort of applying for USMLE itself! Many applicants are done with medical school and are then preparing for steps 1 or 2 CS/CK and take a few months off to make sure everything that needs to be done is done. These moderate gaps have some influence on match chances but the most damaging of all are long gaps where the applicant has been out of medicine for years at a time. On common theme in this scenario is an applicant who has failed multiple times and takes years to get ECFMG certified or an applicant who decides to focus on other career or personal life (kids, spouse etc).

It is important to distinguish an old graduate (applicant with old year of graduation) from someone who has a gap in CV. Not all old grads will be considered as having gaps especially if they have been productive in other medically related fields (residency applicants doing PhD, masters etc). Thus old year of graduation in itself is not a bad thing but having breaks in education or profession is. 

Motivation: 

For an international medical graduate, minimizing the amount of gaps in CV is ideal. However, there are extenuating circumstances where there will be gaps nonetheless. In view of this inevitability, I have analyzed data from NRMP to see which specialties are lenient when it comes to gaps in your CV and which ones are more strict.

Methods: 

The line graph demonstrates two parameters, importance of gap in CV for obtaining interview (INTERVIEW) and importance of gap in CV as regards ranking the applicant (RANK). The individual specialties are depicted on the X-axis with increasing order of importance that the programs place on gap in CV. Since interview precedes the process of ranking, the subjects were ranked according to influence on interview invitations and then the influence on ranking was overlaid.  The ‘interview’ and ‘rank’ factors were different metrics and were normalized using min-max algorithm to allow for appropriate comparison.

Fig 1: Importance of gap in medical education (CV) per program specialty, source NRMP

Result: 

As can be seen in the figure, the subjects of pediatrics, surgery and Ob-gyn placed the least importance on having a gap in your CV when it came to offering an interview. On the other end of the spectrum, emergency medicine, pathology and psychiatry placed the most importance.  Radiology, internal medicine and neurology were in the middle. Most subjects except for emergency medicine had narrow range of fluctuation regarding the importance of gap in CV when it came to ranking applicants for match.

Implications: 

1. Applicants with multiple or long gaps in CV may be better off applying to pediatrics, surgery, Ob-gyn or anesthesia residencies. However, since only pediatrics is IMG friendly, it would be a better choice amongst others.
2. Those interested in pathology and psychiatry have to make sure that there are no big or multiple gaps in their education to increase the chances of matching to their favorite specialty
3. Family medicine was surprising result where in it seemed that programs in FM placed a fair amount of weight on your continued medical education/profession. 
4. When it came to ranking applicants, there was not much inter-subject variation on the importance of gap in CV except for emergency medicine.

Conclusion: 

Having a break in your medical training or profession as a physician can have an important effect on your chances of interview and matching to a residency program. There are significant inter-subject differences, which warrant careful selection of subjects if an applicant has gaps in CV. However, there may be other things in your resume which could make a positive impact in your application and compensate for the negative influence of having a gap in your CV. If you wish to be in touch and get the latest posts and updates, join me on Facebook or follow me on Twitter.

Step 2 CK Score and Chances of Interview - Residency

USMLE Step 1 score has been analyzed in a previous article and while step 1 is a huge factor is deciding the interviews and match chances, step 2 CK scores are often just as important. In fact, the two scores together can decide for most part if you will be called for an interview. Analysis of the program directors survey by NRMP yields very interesting results for how step 2 CK scores affect your chances of interview and subsequently residency.

Fig 1: Step 2 CK score and chances of interview| source @ NRMP

The graph in figure 1 shows a ‘stock chart’ indicating the high, low and the mean scores. The subjects are arranged in the order of increasing average scores. Scores that lie along the red line are the ‘lows’, which reflect the scores below which the programs DO NOT offer interviews to residency applicants. On the other hand, the scores along the blue line reflect the ‘highs’, which are scores above which the programs usually offer interviews for applicants.

One must be careful to interpret this data because this is a composite of all applicants. The values are lower than those required of by the international medical graduates because they also include scores and data of graduates of American medical schools. An important facet of this result is, if you have scores lower than 195 in step 2 CK, then the chances of getting interviews in ANY specialty is very poor. However, there are inter-subject differences that are also apparent on this graph. Psychiatry, family medicine and pediatrics do not per say place that much importance on step 2 scores in comparison to internal medicine, pathology or radiology.

For applicants that lie in between the blue and red lines, the success of their application may depend on other factors.  These other issues are dealt in depth in respective segments of the website.

Conclusions: 

1. Scores below 195 are very unfavorable for any specialty
2. If you score poorly on step 2 CK, then there may be a better chance in family medicine, psychiatry or pediatrics
3. Conversely, if you are interested in radiology or pathology then getting high scores on Step 2 CK is must
4. Applicants who score 245+ can safely expect a few interviews irrespective of the subject they have applied. This is more so in case of pediatrics, family medicine and psychiatry.

One must realize that scores are but one factor in the whole match process and should not affect your choice of applying for match. There are other things in your resume which can make a positive impact in your application process like research, USCE, observerships, volunteer work and other achievement can often help you just as much as scores.
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Letter Of Recommendation For Residency Applicants Made Simple

Process of letter of recommendation made simple

For the applicant

1. Select your referee well – don’t just select anybody who is willing to write a letter. Select someone who knows you and is willing to work with you to draft the letter
2. Discuss your goals with the letter writer – both professional goals and the goal of getting into a residency. Many a times the referees do not have a clue as to what they need to write for residency applications – guide them in this matter.
3. Discuss if you want to have a letter unique to a specialty or you want a relatively not specialized letter OR you can ask for both!
4. Provide clear cut instructions on how to write the letter, how long, what to write, what to include and how to sign etc (blue ink versus black ink)
5. Provide detailed instructions on what they need to do with the letter after they are done writing. Be explicit in letting them know NOT to mail it back to you but to send it to ERAS

For the referee (letter writer)

1. They must be reputable and be heavy hitters (medical director, Dean, higher up administrators etc)
2. Preferably in the US medical system – but if not possible to get US LOR then its still is OK
3. Can back up your recommendation letter with personal phone call if needed
4. Believe in you
5. Knows you personally
6. Can comment on who you are as a person and who you can do

For the letter of recommendation itself

1. Must be on a professional or institutional letterhead – just looks official!
2. Must include contact information should the PD or program decide to call and verify – they can do that and they definitely do (not all cases but those they have selected to match into the program)
3. Must be meaningful in content – hence discuss with the writer how you want to proceed with the letter
4. must make a note of personality, professionalism, leadership quality, interpersonal behavior, clinical and personal skills that make you unique.
5. May waive or chose to not waive the letter – I recommend to waive if possible.
6. The importance of letter depends on where it is issued from, check out the order of importance of LoR to make sure you have one which makes the highest impact.

This is it, as simple as it can get. Start working on the process of getting a super stellar LOR and it will help you secure interviews for residency. Remember Deans letter (MSPE) is not considered as a letter of recommendation. Hopefully these pointers will help you secure a wonderful letter of recommendation and help match into a good program. If you wish to be in touch and get the latest posts and updates, join me on Facebook or follow me on Twitter.

Using The Right Language To Convey The Accurate Message: Shaping Your Research CV For A Residency

Using the correct context is extremely important in expressing your accomplishments when it comes to residency application. Demands are high for an international medical graduate to have a very well rounded CV to stand out from the competition. The need to have research experience may be important in some cases where applicant has a lot of USCE but still feels that having research experience on his CV may make his case more appealing for a residency program.

Goal of portraying your CV as geared towards residency application

Any applicant who is applying for residency is a physician in training. Remember the adage that everything you must do or have done should be some related to your profession as a physician. This is important because, they are looking for physicians to train not researchers to do basic science or artists to perform (Contrary to the popular saying that medicine is both a science and art). Remember, all your endeavors should be goal directed. There are times, however when the opportunity you get may not be the ideal prospect when it comes to residency application. A good example is if you get accepted to do a research rotation in basic science in a lab of a famous professor. How do you make most of the experience in your favor? This article will touch on the topic of portraying your work as being relevant to medicine.

Research experience is broadly divided into three broad categories – Data acquisition (which could be bench related work or patient data), data analysis (statistical work and analysis) and then finally publishing (writing manuscripts). As a research volunteer or trainee you will be intimately involved in at least one of the three steps of research. As a temporary person you may be involved more in the first two steps but if you are lucky then even the third step may not be off limits. 

There are a few rules when it comes to your research experience as it pertains to residency application

• RULE #1: Prefer to chose to work in a lab which does research on medical condition which IS or HAS a HUMAN counterpart. Thus if you are doing DNA sampling  is it for mice for research in Diabetes, cardiovascular disease etc or is it in Arabidopsis thaliana for plant fungal disease. It is easy to justify the former for physician experience but not the latter.

• RULE #2: Familiarize yourself with the scientific jargon, understand the goal of the research. Ask your PI for the proposal for you to go over so that you can understand why is it that you are doing all of this in the first place

• RULE #3: The devil is in the details! Understand and then explain what is it that your project deals with (it may not be your project- but you are working on it!!) For example, If you are working with mice with Parkinson’s disease. Understand and then explain what is it in Parkinson’s disease that you are researching – it is a way to reduce the degeneration of Substantia nigra or is it looking at effect of oxidant stresses on neuron function.  Just saying that you are working on Parkinsons’ disease is not good enough. 

• RULE #4:  Think big. Even if your sole job is do maintain a mouse strain in a lab don’t just think your are doing just that. Say why the strain is being used and why your job is so vital! For example, if you are taking care of the Ob/ob mice – say on your CV that the project that you are intimately involved with is related to studying the effects of leptin signaling in obesity (or what ever your PI is doing).

• RULE #5: Do not embellish or garnish your CV just to make it look good. There is a difference between putting things the right way so as to make an impact and creating non existent thing to make an impact. Former is a tact you need to develop, the latter is a tragedy waiting to happen. 

Hopefully these rules will help you guide your research experience towards the goal of residency. Remember, it is not opportunities that decide what happens to us but what we chose to do with them that decides our fate. If you wish to be in touch and get the latest posts and updates, join me on Facebook or follow me on Twitter.