Tag: Preliminary

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Spotlight interview: from the Caribbean to a categorical surgery residency

Today I had the good fortune to interview a close friend who matched into one of the toughest specialties in the medical field. Not only did she match into general surgery but she also earned a categorical position. Here’s her advice on how she did it.

 

 

Tell us a little bit about yourself. Who are you professionally? Who are you outside of the hospital?

 

I go by Laura Edwards, or just Laura. I am a native South Floridian but I was raised by a strong mid-western mother. I come from an extremely diverse place, which was paired with values that cherish a nonjudgmental attitude and service for others.

I carry those values with me into practice. I use these with patients and colleagues just the same. I am a team player, whatever that means today or tomorrow. I feel comfortable to take the lead or to coordinate behind the scenes.

Outside of the hospital, I am a laid back lady. I binge-watch amazing TV shows, I meet friends for a brewsky, I read fiction, and I have dog. And yes, I study too.

 

 

What specialties did you apply to? How did you come to choose it/them?

I applied to general surgery positions (categorical and preliminary) only. Not applying for other specialties was a serious decision that was made with much thought and care. Many people encouraged me to have a back-up plan. I had to ask myself all the ‘What if’s?’; “what if I get a preliminary spot the first year, and then AGAIN the second year?’, “How will I significantly improve my application before the next cycle?”, “What will I do if I don’t become a surgeon?”, “How will I cope with that?” etc. I calculated the risks as best I could. Yet, in the end I listened to my gut, which told me that I was going to be a surgeon.

 

  

For those who don’t know, what is the difference between a categorical and a preliminary surgical residency?

In the world of general surgery, a preliminary position is a 1-year contract whereas a categorical position is a 5-year contract (or the amount of years required to finish the program). A preliminary position is for a Post Graduate Year (PGY) -1, -2 or even -3 resident. Going into a preliminary position will require the resident to apply for another position the following year, which means entering ERAS again, i.e. residency starts in July and you start your new application in September, only 2 months later. And as many of us know, the more times one enters ERAS the poorer the outcomes can become with each cycle.

When preliminary positions are offered to general surgery candidates it likely means there is something about your application isn’t absolutely perfect. This can be a variety of things: your medical school, your evaluations, your grades or scores, something said on your interview day, etc. It is my understanding that preliminary positions are usually given as a trial year. The program is confident enough to train you for one year but not enough to commit to 5 years.

Therefore, categorical positions i.e. full-contract positions are the goal. When a categorical position is offered, the program director is saying “We see you as a real potential surgeon. We believe with our training and your foundation you could complete our residency program successfully.”

 

 

How many programs did you end up applying to? 

I applied to approximately 230 categorical positions and 150 preliminary positions. As a international medical graduate, I was very unsure of how my application would fare. Fortunately, my family supported my efforts during this time. We all believed the more applications sent the more opportunities I would find. Every penny is worth it.

 

 

How many interviews did you go on for each?

I went on 6-7 categorical interviews and 5 preliminary interviews.

 

 

Any crazy stories from the interview trail?

No crazy stories really. But always be friendly with the other applicants; they might become your co-resident or you will see them again at another interview.

 

 

What did you find to be the most frustrating part of the interview process?

 

There were two things that left me frustrated again and again. The first was waiting.

Waiting for interview invitation emails to come in is the most gut-wrenching part. I found myself going through highs of triumph and hope and lows of defeat and fear. It is an extremely unpredictable and emotionally taxing time. I highly suggest taking up some activity that will strongly distract your mind.

Once on the interviews, the second thing I found most frustrating was that many interviewers were unaware of how the Caribbean schools are structured. I found that my interviewers assumed that I completed all my rotations on the island. I found myself explaining the general flow of my medical education. Once I was able to explain that I had done 2 years of clinical rotations at various hospitals in the US, they were much more open to me as a candidate.

I guess, you would think that all interviewers at least glance through your transcript or would see that your letters were from American institutions, but unfortunately this was not always my experience. My advice concerning this is just to assume your interviewer has no idea where you completed the 3rd and 4th years. Use this as an opportunity to talk up your experience.

 

 

Do you feel that coming from a Caribbean medical school hindered your chances to match in one of the most competitive residency specialties?

Yes, without a doubt. The US applicants I interviewed alongside were overall more relaxed with the whole process. They spoke of turning down interviews and gave off the vibe of “It will all be okay; I’ll end up somewhere [as a categorical surgical resident].”

But let’s step back a bit.

I decided to go for surgery very early on in medical school. Therefore, everything I did was geared towards this goal. I joined the surgery interest group, attended knot-tying sessions and studied as hard as I could without going crazy for Step 1. I spent my entire third year lining up sub-internships (aka audition rotations) at hospitals outside of my medical school’s network. I pursued research within the surgical department from the 2nd week of my third year. I nurtured and maintained a MEANINGFUL relationship with my research mentor (and still do to this day). Everyday I woke up; I made sure I did something to become closer to my goal. I thought about it multiple times a day. I made a phone call to a surgery department while walking in between patients, sent a quick email to a coordinator. My efforts were relentless.

I’m sure some US graduates work this hard to attain their goal but I did not get the feeling from fellow applicants that they had the same level of intensity. I truly believe that my edge/aggressive attitude was what got me to where I am today.

In my mind, there is only one chance to gain that cherished categorical surgery spot, so hold nothing back and have no regrets.

 

 

What do you think were your greatest strengths about your application? What set you apart from the other applicants?

 

My step scores got my application through the filters. Then, my letters of recommendation only confirmed what others saw in me. And lastly, probably what set me apart was the friendly and confident-yet-humble manor I held during interviews.

I also have a MA degree in Marriage and Family Therapy. This was the unique twist I had in my application. This gave my application depth and made my reasons for applying to surgery even more sincere and pragmatic. In reality, I use counseling skills in every relationship I have and more importantly at work and with my patients.

For my program in particular, what set me apart in their eyes was my work and patient care they saw during my sub-internship. I went out of my way to make sure the program director knew my name. I always asked my attendings how I could be better. I made sure my chiefs knew I was reading and following up on previous concepts I was unsure of. I was so intent on being impressive that it actually worked and they vouched for me following my interview.

 

 

In contrast, what were your greatest weaknesses about your application?

Of course, the fact that I was an international graduate and had average step scores were things that I had to compensate for, but at the same time, these are things you cannot change.

The one weakness I could have prevented was a particularly bad evaluation from a particularly important person. The clerkship director for my 3rd year surgery rotation knew my interest in surgery and therefore held me to those standards. Instead of striving for excellence, I became overwhelmed and eventually gave up on trying to impress her. That led to poor decisions that only worsened the situation. I knew her evaluation of me would not be stellar but I did not think she would be so damming either.

The lesson to learn from this is to never let anyone get so down on you that you start to believe them. You are your best advocate and champion. Never let that go.

 

 

How did you do on the USMLE’s? 

I studied hard for Step 1 and received a 233.

I took a risk and scheduled my first sub-internship during the month I was also studying for Step 2 CK. I ended up splitting my time 90% rotation and 10% on CK. So inevitably, I got a 233, the same score as Step 1. This was devastating because all institutions look for an increase in score. A stagnant or decrease in score is can be seen as a red flag. Interviewers asked about my CK score on two occasions. Once I explained that I was also doing my first sub-internship rotation they all understood and did not ask any further questions.

However, the risk I took was worth it because that first sub-internship is where I matched that following March. Hennepin County Medical Center saw me as a person, as a blooming surgeon and not as a number. I hope you all find this too when searching for your residency spot.

 

 

What advice would you give to other international medical graduates who want to pursue a categorical residency position?

 

First of all, thank you Marc for interviewing me. The process of getting this all down on paper has been a good exercise. It has helped me to realize new foundational truths that will help others and me along the way. My main pieces of advice for those pursuing a categorical surgical position are as follows:

  • Be your own champion, always
  • Be relentless in your efforts to stand out
  • Do away rotations at non-affiliated hospitals
  • If you don’t have the scores (~230 or above), be realistic about your chances

 

 

Thank you Laura for taking the time to let me interview you. Your tenacity is inspiring.

Be sure to subscribe below and like me on Facebook so you don’t miss you next week’s interview!

 

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What happens when you don’t match

What happens to medical students who don’t match? Here’s what one unmatched psychiatry applicant had to say.

 

Thanks for letting me interview you Steven. You have a pretty unique story that my readers would love to hear about but before we delve in can you tell us a little bit about yourself? Who are you professionally? Did you go straight from undergrad to Ross? Who are you outside of the hospital?

My pleasure, Marc. I appreciate the opportunity to share my story as I feel people can learn from any experience in this process, both good and bad. I graduated from NYU in 2010 with a Bachelor of Arts in Mathematics. After graduation, I had about six months before starting with Ross University’s MERP (Medical Education Review Program) and I knew I needed to make money. So I took a job that any medical school bound person takes – working in the jewelry and diamond industry. I did mostly bookkeeping but I also prepared orders for a wholesale company that dealt with Macy’s, JcPenney, Sears, HSN, QVC, etc. It taught me a lot about dealing with large staffs and it was a nice break away from the science and math world I had spent so much time with in undergrad.

Professionally, I’m the one making jokes in the office but I focus on the patient when I’m in the room. I like to be a reason people enjoy coming to work, because they know it’ll be fun and productive. On the same token, I’m also someone who isn’t afraid to call someone out for their BS because I expect someone to do the same to me if I ever act out of line. I also am one of the first people to teach someone how things run in the office, how to order labs, do procedures, etc. Not only do people feel comfortable if it’s a peer teaching them but it helps me better my skills as well.

 

 

What specialties did you apply for? How many programs in each specialty? What was your reasoning for that number of programs?

I applied to psychiatry, internal medicine, and internal medicine-psychiatry combined. For psychiatry, I applied to 76 programs. For internal medicine, I applied to 10. And for IM-psych, I applied to all 9 programs in the country. My step scores weren’t that competitive and there are only 196 psychiatry programs in the country. I went through each program on FREIDA and checked to see if I matched their step requirements. If I did, I tried to see who the residents were. If there were zero or one Caribbean grad in all the PGY positions, then I didn’t apply as I felt that that one particular Caribbean grad may have had a connection there or had stellar scores. Plus, why would I spend money on programs that were going to outright reject me?

For IM, I applied to where I had rotated and since I could apply up to 10 for one fee, I applied to some hospitals in the NY/NJ area (which is where I’m from). And for IM-psych programs, there were only 9 so it made the most sense to apply to all of them.

 

 

How many interviews did you end up receiving? How did you feel your chances were at matching?

Formally, I received three interviews, but in total, I ranked four positions. I received 2 for psychiatry and I was taken off the waitlist for 1 IM-psych program. All of them were university-based programs. At the IM-psych program, I had mentioned that I had also applied for a psychiatry categorical position at the same place and I wanted to know if I had to come back for another interview, which I was totally willing to do. Ten minutes after that mini-interview, I had an impromptu meeting with the program director of psychiatry and she told me that she will see what the other four interviewers had to say about me from that day and she would let me know if I needed to come back or not. Two weeks later, I’m notified that she had enough to consider me for a position. Throughout the next two months prior to match day, I had received several emails about how the psychiatry program is expanding and there’s new facilities and all these wonderful things. I didn’t think I was a shoo-in but I felt that maybe I had a great shot.

 

 

So, it’s Monday, March 14th. The day applicants find out if they matched. You open the e-mail and find out that you did not obtain a residency. What’s going through your head?

Before that day, I told myself whatever happens, happens. I actually slept well the night before! I was driving in Fort Lauderdale and taking care of some errands and I happened to look at my phone. For five seconds, I was completely numb. And then it hit me. My biggest fear came true. All that work, all that money, all the stress, and for what? Nothing.

*cue Kim Kardashian ugly crying*

I can honestly say that it is one of the most devastating experiences and I would not even wish it upon an enemy. The e-mail just says “you did not match”. Not even a “good morning” or “hey girl!” Just one line that says you’re not good enough to continue in your career. After quickly doing my errands and a few snot-filled tissues later, I sped home passing several cops on the way and began on SOAP.

Most of us aren’t familiar with the SOAP, or the Supplemental Offer & Acceptance Program. Can you walk us through your experience with it? (Here’s a link to the SOAP schedule for my readers)

SOAP is a chance for unmatched applicants to apply to unfilled spots in all fields of medicine. However, this means that you will have to come up with new personal statements in the matter of hours, which is exactly what I had to do for family medicine. As Markus said in a previous posting, the website was down and no one could send in applications (because like LOL, heaven forbid the ERAS website works when it needs to).

I spoke with a friend who match into IM the year before through SOAP and she guided me through the process while she was at work. She told me to apply to the IM prelim, IM categorical, and family med programs that had the MOST open spots. I had only 45 spots to pick from and I used 5 of them on psychiatry programs that were unfilled. Then I went through family medicine and internal medicine. In retrospect, I could’ve used those 5 on family medicine or IM spots but what’s done is done.

 

 

So on Monday you found out that you didn’t match. Then during the week you went through the SOAP.  Friday comes along and you find out that you didn’t SOAP into a residency. How did that feel?

By that point, I had already gone through the five stages of grief. Denial set in when I was in the car. Then anger when I was cursing at anyone on the road that was slowing me down from getting home (which is what I do on a regular basis and I’ve been trying to work on but YOU try driving on I-95 in Fort Lauderdale and Miami and tell me you don’t have road rage, but I digress…). Bargaining was SOAP. Depression set in when the 5th round of SOAP happened and I hadn’t received any offers. It continued for a week when all I saw on Facebook were my friends posting that they matched at their number one or number two choices. It wasn’t that I wasn’t happy for them. Every single one of us had a unique journey and even the people I didn’t like, I respected them enough in a professional sense to be proud that they get to continue their journey. It was more about the fact that I didn’t get to continue my journey with them.

Several months had passed and I hadn’t reached the acceptance stage of grief. It wasn’t until I went to the AAFP National Conference in Kansas City at the end of July that I had realized that I had been in the wrong field all this time. I realized within the first hour of the conference that I had such a wrong idea as to what family medicine and primary care entailed. There are so many opportunities for me as a family medicine doctor, whether it be to provide medical care for a whole family, work as a hospitalist, deal with mental health issues, or even perform procedures. After I didn’t match, I had told myself that something big was in store for me, and I finally believed it. Networking at the expo hall with the residency programs made me realize that I was a perfect fit for family medicine and that there are programs out there that WANT me. As I’m writing this, I can definitely say that I wasn’t supposed to match into psychiatry because I realized that I was meant to match into family medicine (I’m hoping). It feels good to be in that acceptance part of grief!

 

 

Why do you think you didn’t match? What were your step scores? Was your application particularly weak in any one specific area?

I had thought about not giving exact numbers here, but in all honesty, who cares? Step 1 was a 208, and step 2 CK was a 209 (yes, the EXACT passing score). Step 2 CS was a pass and everything was on the first try. I expected my Step 1 score but my CK was an absolute miracle. I had worked harder for CK than I did for step 1 and yet, I was not getting anywhere with my studying. I took a UWorld assessment two days before just to get more questions in and I had about 179. So in two days, my score JUMPED 30 points. (This is NOT a plan I recommend to ANYONE, by the way.) I know I’m a terrible test taker and that in rotations, I shined and my letters of recommendation reflected that.

In addition, I had failed one course in basic sciences, and THAT was a reason why a program didn’t take me. They were too worried that I may not pass step 3 (which I’ll go into below) and therefore, not be able to be licensed. However, my scores were good enough to get some interviews at university programs so I must have done SOMETHING right.

 

 

Do you think the fact that you attended a Caribbean medical school played a factor?

Not at all. The places I had interviewed at were very IMG friendly, as were the residencies I spoke with at the AAFP National Conference.

 

 

What do you plan to do while you wait to apply for the 2017 match?

I am currently a Clinical Teaching Fellow for Ross University. Some of my colleagues know it as “junior faculty” but teaching fellow is the formal title and you better believe I am using that on my CV. For those who don’t know what that is, my role is to act as a standardized patient for the incoming 3rd year medical students and assist other junior faculty in teaching how to handle difficult patients and certain common primary care cases, as well as how to begin to formulate an efficient style of medical interviewing. I also assist in Ross’s Ambulatory Care Competencies elective, where we prep the 4th year students for Step 2 CS by presenting cases and critiquing their notes.

Outside of Ross University, I tutor for Huntington Learning Center (which I have been doing since 4th year of med school), where I mostly do SAT/ACT math and high school subject tutoring in math as well. In addition, I’m getting my MBA in Health Services Management through Keller Graduate School of Management, which is one of the sister schools of Ross University. What’s great about that is that they have an “MD to MBA” program where I was able to get credit for 5 out of the 16 courses, so now I only need to complete 11 of them. In addition to working, I plan on taking Step 3 by the end of October. Needless to say, I only know one speed and it is full speed ahead.

 

 

How are you handling your loan debt?

Some of my loan debt could not be deferred or put into forbearance, so I have been paying that off. However, since starting grad school, I’ve been able to defer most of my loans while taking out more. Thanks, Uncle Sam!

 

 

What words of wisdom would you give to someone knowing what you know now?

Have plans A through Z ready to go from the jump. You don’t want to rely on them, but you want them ready if you have to execute them.

Go to as many networking conferences as you can. I know those things can cost money, but at the very least, go to the big ones run by the specialties to which you are applying.

But most importantly, it’s not a matter of “if” you become a resident, but rather it’s a matter of WHEN. 2016 was not my time and I realize that now. However, come 2017, I will be a better applicant and in a better frame of mind to continue on in the next chapter.

 

 

Thank you Steven for an informative and entertaining interview. I look forward to finding out where you match in 2017.

 

Next week I interview a Ross University graduate who matched into a categorical general surgery position. Be sure to subscribe to my blog, like me on Facebook, and follow me on Twitter so you don’t miss it!

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Spotlight interview: Joey from Brooklyn lands a PM&R residency

I know him as Joey from Brooklyn and had the pleasure to rotate with him before he was Dr. Seldin. Here’s what he had to say about his journey to landing a Physical Management & Rehabilitation (PM&R) residency.

 

 

Tell us a little bit about yourself. Who are you professionally? Who are you outside of the hospital? What was your path to medicine?

The best way to tell about myself is to start from where my family is from. My father is from Brooklyn and my Mother is from Queens. I grew up on Long Island and my wife is from the Bronx. And its not hard to tell when you talk to me, my accent says it all.

I went to college to the University of Buffalo and received a BS in Psychology. During this time I became very interested in Fitness and Nutrition, performed in Body Building Shows, and learned from one of the greatest Trainers in Buffalo John Schweikhard. This love for fitness and nutrition pushed me in the direction of perusing a masters degree in nutrition from Columbia University. While earning my Master’s I lived in Washington Heights and would spend my free time on the Upper West Side (UWS). One Friday in June of 2008 I was in a Bar on the UWS of Manhattan at a place called Burbon St. I was there early and she walked in, I looked at her and said “yo legs come over here” and we hit it off. At the end of the Summer, July 28, 2008 I was in a bad accident and lost my right eye. This was hard time for me. I finished my masters thesis a few months later. 90% of the people I studied with at Columbia went right into medical school all over the country.

I lost my flow, this was the first time in my life that I wasn’t in school anymore and didn’t have a job and didn’t know what to do. After a year and a half, when I had more confidence after loosing my sight and multiple surgeries, I fell back on my fitness and nutrition knowledge and decided to professionally train people. At the same time my little brother starting to box and I put a lot of effort into helping him train. I would make his meals and slept on his couch in return. Then I came to a point when I realized I needed to really go for what I wanted my whole life which was a to become a doctor. At this time I was professionally training several doctors and one of them who was a cardiologist said, ‘if you want it then go for it’. I took the MCAT and honestly very did poorly. So I took it again, and again and again. Finally I was at a party and this kid who was shadowing at one of my client’s offices was like, ‘I’m going to Ross’. I didn’t know anything about this school and said to myself it is worth a try.

Outside the hospital I am a family man, I had my son two weeks before the start of my 3rd year of medical school. It was hard to give time from my family and study but I pushed through. I had my 2nd child 6 weeks ago. She was due the day before we started residency but she arrived early. It was perfect timing because it gave me a chance to get to know her.

 

 

What specialties did you apply to? How did you come to choose them?

Before I started medical school, I came to know this field called PM&R, Physical Medicine and Rehabilitation. While I was training clients I came to build a lot of great relationships. One of them worked at North Shore LIJ hospital system and he helped me volunteer at their hospital in the PM&R division. I didn’t know it at the time but this small step may have gotten me the career I have today.

So I knew in my head before I started medical school that this may be the field for me. What most people don’t know is, I kept an open mind during my 3rd year of medical school and really enjoyed all of my rotations. The closest thing to PM&R for me was emergency medicine. I also met the best attending physician there who really inspired me and peaked my interested in that field too.

So I applied to both PM&R and EM.

 

 

So going into PM&R means you have to do a transition year. Did different programs have different requirements for that transition year?

Most programs require you to complete a preliminary year in either internal medicine, family medicine, surgery, or a transitional year (this is like 5th year medical school- you rotate in surgery, OB/GYN, medicine, the ICU, EM, and some electives). Some programs have a categorical position, meaning you do your first year in that program as a medicine resident. Medicine is the most relevant in my opinion. The thing I didn’t know was that internal medicine preliminary spots are very hard to get. See, the ophthalmology, dermatology, radiology, and anesthesia guys and gals are going for IM prelim spots as well. So they’ve got the top step scores and they are US students. Where I am just in the top of the scores applying as an international medical graduate.

 

 

What was it like applying and interviewing for both of them?

I truly enjoyed the interview process and anyone who knows me also knows I am a talker. And when it comes to interviews, I thought to myself this is probably the only time I can get away with talking about myself all day. Another thing about applying to specialty fields is you don’t get interviews until October and until late December. It was mid October and I had like 4 interviews. My buddy applying to IM had like 20 by the end of September. Then all of a sudden I was bombarded with them.

 

 

How many programs did you end up applying to? What was your reasoning for that number of programs? How many interviews did you receive for each respectively?

I applied to 129 programs but I didn’t break the bank like other people I know. It ended up costing about $1,600. I applied to 10 transitional, 39 PM&R, 55 EM, and 25 IM programs. I got 10 PM&R, 10 IM Prelim, 6 EM, 1 TY interview for a total of 27 interviews. Of these interviews, 6 of these interviews I got by bugging programs to interview me and one of them is where I matched.

 

 

How did you end of ranking your programs?

My ranking was not an easy task. I went on a lot of interviews and honestly there a few things to consider for you rank. Some people rank based on location, academics, specialty, and other things. For me the most important was location. Staying in NY and being close to both my wife’s family and my family meant a lot.

 

 

What was the most challenging aspect of applying to PM&R?

There are not a lot of programs and in many programs are only 2-4 spots per year. I think there is only like 116 spots in the whole northeast.
For EM the IMG is non-existant these days. The programs are big into US students. There was lots of spots, lots of programs but I got only a few interviews.

 

 

Any crazy stories from the interview trail?

So SUNY Downstate PM&R pre-interview social, was at a bar in the village. It was open bar with top-notch drinks. The kicker was that we had to drink a certain amount to get a discount. So the residents had us downing beers and shots. I drank 6 Chimays and Duvels and downed a glass of Jonny Walker Blue. Then I had the interview the next day…good thing it wasn’t until 12pm.

 

 

What do you think were your greatest strengths about your application?

I applied locally. There are by far the most programs in NYC and having ties to an area can boost your ranking. I also scored very well. It is a special feeling when you go on an interview and pretty much know you probably have better scores then most of the people sitting next to you. If you go to Ross you know how hard it is to make it off that island and you know how hard you can work. I know I can work harder than anyone out there. I had a child right before my 3rd year of school and still was able to go up 17 points on step 2.

 

 

In contrast, what were your greatest weaknesses about your application?

The medical school I attended I would say was the greatest weakness. But is only the limiting factor for getting interviews. 80% for sure if you get an interview, they really want you otherwise they wouldn’t interview you.

My first interview was at Stony Brook PM&R, the director said, hey you go to Ross, great school. I laughed hard in my mind. Turns out that a resident many years ago at Stony Brook was a super star. On the flip side, there are hurdles with advanced match. See you can score a PM&R place on match day but that is only years 2-4 for your residency. You still need to also match in prelim as well. Now I matched in both of course otherwise I wouldn’t be talking to you about it. But sometimes a programs ranks someone in PM&R and the person doesn’t secure a prelim spot, and can’t soap into a spot either. Pretty much just fucked.

 

 

How did you do on the USMLE’s? What were your step scores? Do you think your step scores negatively/positively affected the number of interviews your received?

Step 1 242 and Step 2 257. They definitely helped me and I looked up the average scores on the ERAS stats list. No one scored as high as I did in 2014 in PM&R on Step 2. I know if my scores weren’t as good I would not have gotten close to the number of interviews I had.

 

 

What advice would you give to other Caribbean and/or American medical graduates who want to apply to PM&R?

Take every interview you can get. Also make sure you can rotate at a place that will let you go on your interviews during your rotation. On one of my electives I went on 4 interviews in one week and they didn’t give me any shit about it, which was great.

If you have shit scores, plan for back ups. Don’t be foolish. And if your scores suck, make sure you can relate to the field you are going for and kill it on the interview. I know one guy (and if he reads this will know who he is) has bad step one scores, but improved on step 2 but still under the average and landed a great residency. The reason is he related to the field and in the end of the day you only need one place to rank you (or two places if you’re going into PM&R…one prelim and one advanced spot). Even if it was your last rank, it’s better than nothing.

Take your test seriously. In June during my last 3rd year rotation I took a practice NBME and got a 220. I took another NBME one month later and got a 225. I finished 3rd year and had 4 uninterupted weeks to study. I took my 3rd NBME and got a 235. Took another 1 week later and got a 236. I wasn’t too happy at this point. But had got a lot down in the last 2 weeks of studying. 1 week before my exam, I took the USMLE World self-assessment got a 256 and was happy. 1 week later and got a 257. Holy shit was I happy.

Don’t worry about how many hours you will work as a resident in one field or anther. Before I started I didn’t know if I could really do this. But I did know I can push myself hard. Honestly I am up at 5 am every day, get to hospital 6-6:15am and finish about 5-6pm on a regular day. Not to mention short call and weekends. But I never feel like I can’t do it. You will do it. You’re so busy that the day flies by. You know your job is awesome when I go in on a Saturday at 6:30am and look at my clock and its 5pm and I need to get these last few notes done before sign-out. You can do it too I promise. I really can say that I love my job.

 

 

Thank you Joey for giving us a candid look at your application process. Be sure to subscribe so you don’t miss my second interview with an unmatched psych applicant.

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Spotlight interview: from California to the Carribbean, an emergency medicine resident shares his advice

Tell us a little bit about yourself. Who are you professionally? Who are you outside of the hospital?

Well hello there everyone! My name is Ami, pronounced Ah-mee.

I’m an easy going but sometimes intense guy from Los Angeles, California (cough cough the best city in the world). I grew up in the suburbs or “the valley.” I went to UC-Irvine for my undergrad and double majored in International Studies and Biology, but mostly spent my time surfing… hence my atrocious bio GPA, average MCAT that eventually led me to Ross like many other people. As I answer these questions I’ll give a line of advice from my experience thus far.

There is a small caveat before Ross University where I decided to get serious towards the end of senior year of college (too late to take the “correct” path to med school). I graduated, then took some bio classes at UCLA, did some research in the ER at Children’s Hospital in LA (CHLA) and got EMT certified to boost the résumé. This still wasn’t enough.

Now bear with me because the story below has a lot to do with the next 5 years of my life.

The story: I had been surfing the same spot in North LA for around 5 years at the time and there was always this guy in the water, who was there so often, I just figured he was some surf bum with no job. So I start talking to this guy and I ask him “well what do you do?” and he causally answers, “Well, I’m a doctor…” I actually laughed out loud and said, “No, really what do you do?” He’s like “no, seriously.”

So at this point I’m intrigued and ask “well, what type of doctor are you and where do you work?” And to my surprise, he says “I’m an Emergency Medicine doctor and I work at UCLA for the past 15 years” So we talk more in depth about how I’m trying to go to med school and he tells me how he just started this Med-tech company and because I’m used to taking tests, “why don’t you come over to the office and do some quality assurance/beta testing on the ultrasound simulator…”

Thus begins my mini, 1 year career working for SonoSim, Inc. Being in that start-up environment where 9-5 is unheard of and 1 position equals 5, was the best experience of my life. It taught me how to actually work hard and made me responsible for the progression of a company where others depend on you and if you fail, the entire team/business fails. All this combined with a lot of ultrasound scanning made for the best med school prep I could’ve hoped for. It also gave me a close look into the world of emergency medicine, which is likely why I went for EM over Surgery in the end.

***Advice #1: Always say yes to new opportunities, the smallest door can change your life.

 

 

What specialties did you apply to? What attracted you to emergency medicine and surgery?

I double applied to Emergency Medicine and General Surgery, no back ups in Internal Medicine/Family Med etc. I’m an ADD, instant gratification, need challenges type of guy and I know that I would never find happiness in other specialties. I also love using my hands so I needed a specialty that was heavy on procedures. As many of my friends and wonderful girlfriend can attest to, I struggled immensely deciding between Surgery and EM. I applied to both realizing that I would love both for different reasons: EM would provide enough procedures and diagnostic challenge with great lifestyle. Surgery would be all procedures and the fulfillment of definitive care. Also, I still personally believe Surgery is slightly more intellectually stimulating/challenging than EM (says the EM resident lol).

***Advice #2: Introspection, knowing yourself, is the key to every life decision.

 

 

How many programs did you end up applying to? How many EM? Categorical? Prelim? What was your reasoning for that number of programs?

I applied to every single Emergency Medicine program in the country, some 180+ programs. I applied to about 100 general surgery programs and every prelim position at those programs as well. It cost upwards of $6,000 JUST. TO. APPLY.

Was it worth it? YES. For most, you are already in debt; the only thing that matters is that you give yourself the best chance possible to get a residency. Obviously, be realistic about your résumé, scores, personality, etc.

***Advice #3: You end up in the place your supposed to be. Trust the process.

 

 

How many interviews did you go on for each specialty?

EM: 8, Gen Surg: 3, Pre-lim: 2. I went to every interview I got, it was logistically difficult and expensive. I flew across the country about 5 times. Again, you’re a “foreign” graduate; you have to take every opportunity possible. The statistics and amount of people applying for certain specialties are in flux every year, so advice doesn’t hold true year-to-year. My interview excel sheet is below.

***Advice #4: You are never too good for a certain place or program. Be humble.

 

 

How did you end up ranking the programs? (Surgery higher than EM? Better the program the higher it went regardless of surgery or EM?)

It’s a combination of things. I really wanted to be close to home in California so I ranked those programs first, it was just a bonus that those programs had everything I wanted as well. UConn had everything the California programs had and I absolutely loved the leadership and residents, more than any other place I went.

Jackson Memorial was a gamble because the program is brand new, but you can’t beat the patient pathology/experience. The Detroit programs are amazing, well established programs, also with great patient pathology. I was really impressed with Detroit and would have been grateful to go there as well. I only ranked one Surgery program higher than some EM because I would’ve been happier with those people doing surgery than the others doing EM. Like everyone says, it’s a feeling during the interview that really sets your decision.

Below is the excel sheet of my interviews/dates/ranks

I ranked them:

1) Stanford Univ: EM

2) UCSF-Fresno: EM

3) UConn: EM

4) Jackson Memorial: EM

5) St. John: EM

6) DMC-Sinai Grace: EM

7) Cleveland Clinic – Florida: Gen Surg

8) Crozer Chester: EM

9) Lehigh Valley: EM

– The rest of Gen Surg

– Prelims

***Advice #5: Trust your gut.

 

 

Any crazy stories from the interview trail?

Noone I interviewed with ever passed out or threw up, but I heard one good story.

Apparently the year before at one of the hospitals an applicant for Emergency Medicine got so drunk at the meet-n-greet the night before, he blacked out, got alcohol poisoning and ended up in the hospital. The kicker is that the next morning when the applicants were getting the tour of the Emergency Department, he was passed out in one of the ED beds with an IV, recovering…

Needless to say, don’t be that guy.

***Advice #6: Don’t let your insecurities steer you into bad decisions.

 

 

What did you find to be the most frustrating part of the interview process?

Simply the cost. It’s hard to justify applying to so many places. A lot of people hedge their bets and apply only to places with a history of taking foreign grads, but you just never know. I pulled every string I could, called acquaintances, went to conferences to network, and tried everything I could. Now I’m at a program that usually never took Ross grads and I had interviews in places I would’ve never expected.

It’s a numbers game in the end; you want your face and résumé in as many hands as possible.

***Advice#7: Never give up because the feeling of comfort can be dangerous.

 

 

Do you feel that coming from a Caribbean medical school hindered your chances to match in one of the more competitive specialties?

Absolutely, 100% yes. It’s just the reality of the situation and you have to make the best of it. Interviewing in California as an IMG, likely means I would have easily been accepted as a US-grad. Everyone will ask on interviews “Why Ross/Caribbean and how was your experience?” The answer is always “It made me more resilient, hardworking and appreciative.”

I was very bitter about this fact for a long time, if you’re like me, my advice is to just let it go. You have to make peace with this because people will feel your animosity and energy during the interview, which will never end well. If you’ve made it into the match, then by definition you have worked your butt off and don’t let anyone make you feel any different.

***Advice #8: Be a politician. Being able to spin your story might make or break you. Practice.

 

 

What do you think were your greatest strengths about your application? What set you apart from the other applicants?

I think my work experience and ultrasound research were really the 2 things that set me apart. I had really great letters of rec for Emergency med. I even had my old boss before med school write me a letter, remember he’s an ER doc at UCLA so his input was relevant. Besides the other 2 SLOEs (specific EM letters you need to apply in EM) I had the Ob/Gyn Program Director who I did ultrasound research with during my 3rd year write me a letter as well.

Letters of Rec are extremely important; on almost every interview people mentioned the letters. Its one of the only ways for programs to get an idea of who you really are, your work ethic, your personality, etc. For surgery, I had few interviews and I think this is a direct correlation to weaker more generic letters of rec in surgery. I was also only able to do 1 real surgery sub-I before applications, which hurt as well.

***Advice #9: Tell your story, figure out what part of your story is interesting, and let others give you feedback.

 

 

In contrast, what were your greatest weaknesses about your application?

I think my greatest weakness was the places I did Sub-I’s and away rotations. All my EM rotations were within the Ross network: 2 in Chicago at Mt. Sinai, and 1 in LA at California hospital. I would have had more interviews if I had set up better away rotations. It’s important to do Non-affiliate rotations. I have friends from other foreign med schools with similar scores and resumes that had 15+ interviews because they did a lot of away rotations and set them up early. Most places will give you a curtsy interview, but if you do well there, they will definitely consider you for a real spot. Again, you have to spin your story: I had great experiences from my rotations, inner city ED’s are very similar and an important exposure to have.

***Advice #10: Be informed about the process and plan ahead.

 

 

How did you do on the USMLE’s? What were your step scores? Do you think your step scores negatively/positively affected the number of interviews your received?

Step 1: 237, Step 2: 252, CS: Pass

Clearly these scores are critically important. For EM, 220 range might keep your application from going in the trash. But remember, the program coordinators are just clicking check boxes for criteria. If you call a program with any legitimate reason that you want to go there (i.e. spouse, family, I like snow, you guys look cool, my grandma’s brother’s daughter’s dog can’t live without me, whatever) they will pull your application out of the trash and look, hopefully. Have people make calls for you and never be afraid to call yourself and ask.

***Advice #11: Nothing beats a personal touch to create an empathetic connection. People will work harder for you if they feel connected.

 

 

What advice would you give to other international medical graduates who want to pursue residency in emergency medicine?

Work and study hard. Do many non-affiliate away rotations. Get your SLOEs in early. Go to ACEP and SAEM and get at least 3 program directors emails. Follow up! This is not the time to be shy but of course there is a balance and “business etiquette.” Be direct and if possible a little playful and funny. In the end, and maybe most importantly, these people have to like you and want to work with you.

***Advice #12: Regardless of what happens (match, no match, prelim or dream job) it’s a life long journey in medicine and you will end up in the right place.

 

 

Wow Ami (Ah-mee), thanks for a great interview and some amazing advice.

 

Subscribe and check back next week for an entertaining interview with another Caribbean graduate who matched into Physical Management & Rehabilitation!

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Categorical vs Preliminary

After med school comes residency where young doctors learn how to actually be doctors. But not all residencies are the same. In general, there are two types of residencies that students can apply for, ‘categorical’ and ‘preliminary’ positions. Categorical spots offer full residency training for their specific field of choice in order to become board certified. Preliminary positions only offer one or two years of training.

Categorical positions are a guaranteed job and it’s what every applicant shoots for. Earning a categorical position means that your application process is over until you apply for jobs or fellowships in order to further specialize after you complete your residency. Each residency training program has different lengths. Internal medicine, family medicine, and pediatrics are three years a piece. General surgery, and otolaryngology are five years. Psychiatry, pathology, and obstetrics and gynecology are all four years.  Technically dermatology, anesthesia, neurology, opthalmology, diagnostic radiology, and radiation oncology are also four years. However, these residencies are actually three years long in their respective specialty after completing a one year preliminary year.

One might apply for a preliminary position for a few reasons. The biggest being that some advanced residencies require a preliminary year, such as those mentioned earlier. For instance, most anesthesia residencies require one preliminary year before a young doctor finishes their final three years of residency specifically training in anesthesia. The other big reason students apply for preliminary positions is as a backup. Prelim positions secure you one year’s worth of paid experience. For instance, a student might apply for both categorical and preliminary positions in their respective specialty depending on the strength of their application. Surgery is a notoriously competitive field so even a strong applicant might go unmatched. Thus, many students apply to both categorical and prelim positions in the hopes that if they don’t match into a categorical position that they will at least have one year to figure out their next move.

But a prelim spot at a program doesn’t secure you a categorical spot next year. Most residencies and programs don’t have second or third year prelim positions and you need a categorical position to finish residency. So if I apply to internal medicine only and receive a prelim spot I would be happy because I have a definite job for one more year but I would still be anxious because my future would not be certain. I would have to go through the match one more time to earn a categorical position somewhere.

If you’re looking for more information on this subject Wash U explains the basics pretty well. So do Doctors in Training (DIT). But my favorite post on this subject is from RK MD- a tech savvy anesthesia resident.