Wednesday, 7 February 2018

Updates 2016-2018 - From internal medicine to subspecialty training

I have not posted in quite a while. Things have been busy, but going really well.

I have completed my internal medicine residency. It was an amazing experience. I will definitely miss my friends that I met during residency.

Even before graduation, I have received a lot of job offers to work as an Internist. The pay was quite good, averaging around USD$180,000 to 220,000 annually.

Below is an example of the emails I received.













The pay around the U.S. for internist is not too bad. As you can see below, it also depends on geographical location.













Anyways, I had actually already decided to pursue a fellowship position in a nephrology. I am currently undergoing an additional 2 years of training in nephrology, to graduate as a nephrologist (this year!). I remember my classmates in medical school in Malaysia mentioning that it is quite rare to see someone finish training to be a subspecialist in nephrology, without any bonds, within just 6 years of graduating from medical school.

I guess if I were to head back to Malaysia to work in private hospitals in the future, I may be one of the younger nephrologist. Anyways, I probably will be working for at least a few years in the U.S. after graduation, just to have enough money to travel the world while I am still young; while at the same time, have fun practicing nephrology!

Jamie

Wednesday, 21 December 2016

FAQ#17: USMLE Agency

I received an email from a student asking about how to obtain study materials.

Hi, Dr.Jay, good day for you!

I'm *** here. I would like to ask few questions (starter questions) regarding the exam.
First of all, do we need any agency to settle the middle works to go for the USMLE? or we can buy the materials and  just prepare for it on oueselves? 


I did not use an agency when I started my preparation for USMLE. I bought the Kaplan study materials online, just like what my sister is currently offering. I then prepared for the exam myself.

I have met 2 of the agencies that offering help with USMLE, and off course the costly one. I'm not sure what else is counted in except the materials as they charge each step about rm12000-14000.

This is the main reason for me on why I did not go through any agency. It is too expensive for me.

Do you think its worth to work with the agency to get the USMLE done successfully? 

What these agencies offer are probably the official Kaplan USMLE course. You can go with the official course if you can afford the RM 14,000 course fee. I would not recommend any other materials other than Kaplan materials complimented by some other books which I detailed in my other blog post (http://usmle-for-malaysia.blogspot.co.id/2013/02/how-to-study-for-usmle-step-1.html and http://usmle-for-malaysia.blogspot.co.id/2013/02/how-to-study-for-usmle-step-2-ck.html)

Are those videos and books enough for us to prepare for the exam? Do we need any extra tutorials/classes?  

If you go through the videos, it is like going through a live class.


Do we really need to use the latest version of materials or all of them contain the same? 

Medicine does not change a lot from year to year. I would say that as long as your material is within the last 5 years, you will be okay.
The materials I used were 4-5 years old when I studied for my exam. I still did pretty well. Study materials don't really get updated, but how questions are phrased do. You will learn new styles of questions by doing the question banks.


How to register for the exam? Do we need to pay? Manual or online?

You will need to apply online. Please refer to this blog post: http://usmle-for-malaysia.blogspot.co.id/2016/05/applying-for-usmle-exam.html.


Saturday, 14 May 2016

Applying for the USMLE Exam

A lot of students/graduates give up on applying for the USMLE because they do not have the patience to learn and understand the application process. It can be complicated, but you will have to spend a few hours researching on the steps to apply.

I have outlined the basic steps below.

Terminology:

ECFMG: This is the official group which takes care of us foreign medical graduate.
IWA: this is a website which allows you to register for the USMLE
Prometric center: test taking center
EMSWP: this is a new program launched recently by ECFMG to improve speed of communication between ECFMG and foreign medical schools. Not all medical schools have EMSWP. If your medical school is enrolled with EMSWP, communication between them and ECFMG will be mostly online (instead of paper mail).
OASIS: website to check your status on USMLE exam registration


1. Check IMED

Check if your medical school is listed under IMED: https://imed.faimer.org/. If your medical school is not listed, you need to contact your medical school and have them register with IMED.

2. Get the USMLE ID
You need to visit this website: https://secure2.ecfmg.org/usmleidrequest/usmleidrequestnavigator.aspx.

Enter your information as directed. They will then send you an email within one week with your “ECFMG ID”, which is an 8-digit ID number. This will be your ID number which you will use in the future to apply for USMLE exams or get your exam results.

If in one week, you do not receive your ID number, check your email thoroughly. If you still do not have it, call ECFMG at +1 (215) 386 5900.

3. IWA application
Ensure that you have a good internet access, and a computer linked to a printer.
Enter the IWA website: https://secure2.ecfmg.org/emain.asp?app=iwa
Enter your USMLE ID and password and log into the website.
If you do not have a password, look at the bottom of the page and follow the link: “If you have a USMLE/ECFMG Identification Number, but you are a first-time user of ECFMG On-line Services, click here to establish an account.”
Fill up the forms on the website as directed.

Following that, you will be required to send ECFMG some paperwork. The most important is : Form 186.

Form 186 are forms that let ECFMG make sure that you (your name and a your photo) are in fact existent and that this is your signature and this is your ECFMG ID. These forms may have to be signed by your medical school official.

4. Certifying that what you said is true
During the IWA process, you will be required to have your medical school send documentations to ECFMG to ensure that you do exist and studied or are studying in the said medical school.


This step can be pretty confusing, and I would recommend that you give ECFMG a call at 1 (215) 386 5900 to clarify anything and everything. You probably need to get a calling card that allows you to call ECFMG at a cheap rate.

If you are already graduated: please read through: http://www.ecfmg.org/2016ib/credentials-for-certification.html. The basic idea is that if you already graduate, ECFMG wants to make sure that you in fact did graduate from whichever medical school you said you graduated from even before they approve you for a USMLE exam. You will need to have your medical school complete FORM 186.

If you are still a medical student: you will need to have your medical school complete Form 186 and Form 183. Also take time and read through Appendix 1. Basically, there is someone in your medical school that has been assigned to be the point person that is authorized to certify Form 186 and Form 183. You need to ask your medical school. If your medical school does not know, you need to get your medical school to contact ECFMG (this will be challenging because of time difference, so you really need to harass/bribe/sweet talk your academic affairs department of student affairs department.

Read Appendix 1 below for more information.

5- Wait for confirmation

ECFMG will contact you by email and by mail. If you do not hear back, do not hesitate to call them at 1 (215) 386 5900. You really need to be proactive in this step.

6. Communication between ECFMG and Medical School

At this stage, ECFMG will be communicating with your medical school. Your role at this stage is to make sure your medical school receives and responds to ECFMG’s communication.

7. OASIS
The final step is ECFMG receives your medical education credentials/certification directly from your medical school.
When you log into OASIS, you will get to see: "Medical education credentials received and verified".
Congratulations!

8. Apply
Congratulations. Now you will be able to apply for the exam. After paying for the exam, you will receive a scheduling permit. You can use this scheduling permit to schedule your exam in your local prometric center.

APPENDIX 1

Certification Form

Medical School Graduates: To be registered for USMLE, an international medical graduate must provide copies of his/her final medical diploma with the exam application, if the diploma has not been submitted to ECFMG previously. ECFMG also requires that, before an international medical graduate can be registered for USMLE, the applicant's status as a medical graduate must be verified directly by his/her medical school. As a result, the process of applying for examination as a medical school graduate will vary depending on whether your medical education credentials have been verified by ECFMG and whether you are a graduate of a medical school that participates in the ECFMG Medical School Web Portal (EMSWP) Status Verification program.

For complete information on the medical education credentials that may be required at the time of exam application, see Credentials for ECFMG Certification in the ECFMG Information Booklet. You can check the status of your medical education credentials using ECFMG's OASIS. The certification form you will be required to complete as part of your exam application will vary depending on whether or not your medical education credentials have been primary-source verified by ECFMG.

You will be required to complete a Certification of Identification Form (Form 186) if you do not have a valid Certification of Identification Form (Form 186) on file with ECFMG. The Certification of Identification Form (Form 186) must be completed by you and an authorized official of your medical school and/or a Consular Official, First Class Magistrate, Notary Public, or Commissioner of Oaths. Each medical school has been requested to provide ECFMG with a list of medical school officials authorized by the school to certify Form 186. Your form must be certified by an official on this list. Contact your medical school to determine the officials authorized by your medical school for this purpose; ECFMG will not provide this information to applicants.

The on-line part of your application will be transmitted to ECFMG only when you click on one of the links to proceed to the Certification of Identification Form (Form 186).

There are three Certification of Identification Form (Form 186) options for medical school graduates:

  • "Certification of Identification Form (Form 186) - Certification by Medical School Official," for all medical school graduates
  • "Certification of Identification Form (Form 186) - Certification by Notary Public," for graduates of medical schools that participate in EMSWP Status Verification and for graduates whose medical education credentials have been primary-source verified by ECFMG
  • "Certification of Identification Form (Form 186) - Certification by Notary Public and Medical School Official," for graduates of medical schools that do not participate in EMSWP Status Verification and whose medical education credentials have not been primary-source verified by ECFMG


When you have completed the on-line part of the application, you will be able to view the Certification of Identification Form (Form 186) options available to you.

If you complete a "Certification of Identification Form (Form 186) - Certification by Medical School Official" or a "Certification of Identification Form (Form 186) - Certification by Notary Public and Medical School Official," your Form 186 must be sent to ECFMG directly from the office of the medical school official who signed the form. If the form is not sent to ECFMG from the office of the medical school official, it will not be accepted.

If you complete a "Certification of Identification Form (Form 186) - Certification by Notary Public," the form can be sent to ECFMG by you.

In either case, the signature(s) of the official(s) must be current; the official(s) must have signed the Certification of Identification Form (Form 186) within four months of the date that it is received at ECFMG.

Additionally, ECFMG must receive the Certification of Identification Form (Form 186) and any additional documents and photographs as soon as possible but no later than 12 months from the date you submit the on-line part of your application. ECFMG must receive the on-line part of your application, the Certification of Identification Form (Form 186), and all required documents to process your application.

Your application will not be considered complete until the completed Form 186 (if you do not have a valid Form 186 on file with ECFMG) and any other required documents are received at ECFMG.

Once accepted by ECFMG, Form 186 remains valid for five years for exam applications and requests to extend Step 1 and Step 2 CK eligibility periods. Applications and requests submitted during this five-year period can be completed entirely on-line.

If you are a graduate of a medical school that participates in EMSWP Status Verification and your medical education credentials have not been primary-source verified by ECFMG, ECFMG cannot complete the processing of your application until your medical school verifies your status through EMSWP. ECFMG will make your record available to your medical school and request verification typically within three weeks of receipt of a complete application. The time needed to complete the processing of your application is contingent upon your medical school’s response to the EMSWP verification request. You will not be registered for examination until your medical school verifies your status.

Medical School Students: The certification form that you are required to complete will vary depending on whether your medical school participates in the ECFMG Medical School Web Portal (EMSWP) Status Verification program. Medical school students enrolled in medical schools that participate in EMSWP Status Verification will be required to complete a Certification of Identification Form (Form 186), if they do not have a valid Form 186 on file with ECFMG. Students enrolled in medical schools that do not participate in EMSWP Status Verification will be required to complete a Certification Statement (Form 183).

Once accepted by ECFMG, Form 186 remains valid for five years for exam applications and requests to extend Step 1 and Step 2 CK eligibility periods. Applications and requests submitted during this five-year period can be completed entirely on-line. A completed Form 183 must be submitted for each exam application.

Both the Certification of Identification Form (Form 186) and Certification Statement (Form 183) must be completed by you and an authorized official of your medical school. The on-line part of your application will be transmitted to ECFMG only when you click on the link to proceed to the Certification of Identification Form (Form 186) or Certification Statement (Form 183).

Each medical school has been requested to provide ECFMG with a list of medical school officials authorized by the school to certify Form 186 and Form 183. Your form must be certified by an official on this list. Contact you medical school to determine the officials authorized by your medical school for this purpose; ECFMG will not provide this information to applicants. The signature of the medical school official who signs your Certification of Identification Form (Form 186) or Certification Statement (Form 183) must be current; the official must have signed the form within four months of the date that it is received at ECFMG. The form must be sent to ECFMG directly from the office of this official. If the form is not sent to ECFMG from the office of the medical school official, it will not be accepted.

If you are required to complete a Certification of Identification Form (Form 186), ECFMG must receive the Certification of Identification Form (Form 186) and any additional documents as soon as possible but no later than 12 months from the date you submit the on-line part of your application. ECFMG must receive the on-line part of your application, the Certification of Identification Form (Form 186), and all required documents to process your application. To complete the processing of your application, your medical school must verify your status through EMSWP. ECFMG will make your record available to your medical school and request verification typically within three weeks of receipt of a complete application. The time needed to complete the processing of your application is contingent upon your medical school's response to the EMSWP verification request. You will not be registered for examination until your medical school verifies your status.

All forms and documents required to complete your application must be sent to ECFMG in one envelope. If you are required to complete a Form 186 or a Form 183, this envelope must be sent to ECFMG from the office of the medical school official who certifies your form. If you are not required to complete a Form 186 or a Form 183, this envelope can be sent to ECFMG by you.

If you are required to complete a Certification Statement (Form 183), ECFMG must receive the Certification Statement (Form 183) and any additional documents as soon as possible but no later than four months from the date you submit the on-line part of your application. ECFMG must receive the on-line part of your application, the Certification Statement (Form 183), and all required documents to process your application.













Friday, 13 May 2016

FAQ#16: Question from a JPA scholar


I received an email from a second year Malaysian medical student who is a JPA scholar. 

Hi Dr Jay,
I am a 2nd year Medical Student in Malaysia and am very interested in pursuing a residency in USA. I am currently preparing for my STEP 1.

 
1. Is residency equivalent to Masters?
Yes. In Malaysia, after housemanship and 1-2 years of MO-ship, you may apply and enter into a Masters training program, which is basically a specialization program such as internal medicine, surgery, orthopedics or pediatrics. In the U.S., after the USMLE, you immediately enter into a residency program such as "internal medicine, surgery, orthopedics or pediatrics".

2. I am a Jpa scholar and thus bonded by the government. Is there any way to pursue a residency in USA by a Malaysia government scholarship like MYBRAIN15?

 
I am not familiar with scholarships. However, if you question is if you need a scholarship to pursue residency, the answer is no. You get PAID to train in the U.S. In Malaysia, you will have to be sponsored by KKM to undergo Masters training. The result of KKM sponsorship is that you will have to be bonded by KKM after graduating from Masters training.

3. I would like to come back to Malaysia after pursuing a residency. What status would I be in? A specialist, fellow or a master student?

Specialist or Consultant. Essentially you will have COMPLETED your training.

4. Is there any expiry for USMLE step 1 score?
 
When applying for residency, most States will have a law that you will be expected to complete Step 1, 2 CK, and 2 CS within 7 years. Means the date which you take your first paper to your last paper must be within 7 years. You will then be "ECFMG certified". The ECFMG certification does not have an expiry date.

5. I am intersted in Neurology/Neurosurgery. I realise that an IMG prospects to get a match in the field is impossible. But still are they are img in neurology/neurosurgery?
 
Neurosurgery would be impossible unless you are willing to spend a few years doing research in the U.S. Neurology is easy to get into in the U.S. About 30% of neurology residents in the U.S. are foreign medical graduates based on my rough estimation.

6. What are the advantages of me doing a residency in neurology/neurosurgery compared to a master programme in Malaysia?
 
I think your question is about pros/cons of each pathway. Right now you are thinking: should I just stay in Malaysia for Masters, or should I head to the U.S. for residency?
 
Malaysian Masters
Pros
- get to stay back in Malaysia, be with your family
- familiar with the local hospital system
- familiar with lecturers/educators from same background
- comfortable

Cons
- will be bonded with KKM after completion of training
- will be posted to underserved areas after completion. It will be unlikely for you to be able to stay ina big city. KKM will definitely need to post you to small towns to serve as a specialist
- will only start many years after graduating from Medical school as you will have to do housemanship and even some years of MO-ship first
- not recognized in any other country except Malaysia 
- there will be a time gap between completion of Masters training and the start of subspecialty training

U.S. Residency
Pros
- recognized globally
- structured training program. Has been in existence since the 1900s. The first residency program was started by Sir William Osler himself
- no bond after graduation
- earn USD while training with estimated take home salary of USD$3500 every month
- you will get to apply for fellowship (subspecialty) training even before completing residency. No time gap between residency and fellowship. Fellowship for example will be: general surgery going into vascular surgery, general surgery going into plastic surgery, internal medicine going into gastroenterology, pediatrics going into pediatric cardiology, anesthesiology going into pain medicine, radiology going into interventional radiology. There also won't be any time gap if you decide to continue on to be a sub-sub specialist: eg: internal medicine into cardiology followed by electrophysiology, or internal medicine into nephrology followed by transplant nephrology.
 
Cons:
- requires completion of the USMLE
- stepping out of one's comfort bubble
- some specialties will be very difficult for a foreign medical graduate to get into. You will need to look at the statistics to find out the % of foreign medical graduates in each specialty to estimate your chance.

 

Friday, 4 March 2016

FAQ#15: Exam dates, recent graduate from medical school


I received this email from a medical student who just graduated and is currently waiting for housemanship posting, He is thinking about the USMLE given that he has some time at hand.

Before i start i would like to intro myself here... I just graduated from Medical school and currently waiting for my housemanship posting. I have always been interested in taking the Usmle
Here i would like to ask 3 simple questions which i hope ul can guide me thru it.

1. When are the examination dates? Is it only once a year?

The exams for USMLE Step 1 and Step 2 CK will be taken in a test center. There is one in Kuala Lumpur. It is a computerized test. Just think of it as taking an 8-hour driving license. Like driving license test, you can take it any day of the year. You will have many people in the center taking other tests as well, such as TOEFL. There may also be those who will happen to be taking USMLE on the same day as you. Just like driving license computer test, the questions will be entirely different even if you take them on the same day.

2. Can i know how and where i could get myself registered for this exam?

You can apply for the exam via USMLE.org.

3. Do u think it is possible to study for Usmle during housemanship because i might be getting my posting in XXX and i think it my distrupt the entire studying process. Do u think it is worth to delay my housemanship a year later just to focus on this exam? I really hope you can give me a good advice on this.

I think it really depends on what are your goals. Most fresh medical graduates who express interest in the USMLE belong to one of the following groups:

The “All-in” group : I am sure that I really want to go to the U.S. My family is supportive of me putting away housemanship and focusing in the USMLE exams. I don’t care if my friends start posting their housemanship photos on Facebook. I won’t be envious because I have a much bigger goal now.

The “50-50” group: I really want to go to the U.S. However, I am not sure if I can really make it. Can I really do well in the USMLE? I don’t think my family will approve of me taking time off to study. All my friends are already working, how can I just keep studying and spending parent’s money? Okay, perhaps I will not delay my housemanship. In the meantime, I will spend my current free time studying for the USMLE. I will also try to work hard and take some hours out to study for USMLE when my housemanship starts. Perhaps I will do well in the Step 2 CK that I will be taking, which gives me the sign that I should continue to study and ace the Step 1, and then pass the Step 2 CS. Once I have those papers done, perhaps I will apply to the U.S. before I start MO-ship and have a chance to train in the U.S. Anyways, studying for the USMLE now will keep my clinical knowledge active, rather than lazing around before housemanship.

The “maybe” group : I just graduated,and have some time. What should I do? Maybe try to study for the USMLE? I am not too sure if I want to do that. This is my last vacation before slaving off with KKM. Wouldn’t it be good if my medical school degree is recognized all over the world? Anyways, will see. Perhaps I will try searching around about this USMLE thing, and see how hard the exam really is.

Therefore, I think in the end, it really depends on the amount of "pain" you are willing to go through. You probably just completed your major final medical school exam. You may decide that you want to take the time off to enjoy. Or you may decide to continue the momentum you had from studying for your finals, and pour your energy into studying for the USMLE.