FAQ#12: After housemanship

I received an email from a house officer who is about to complete his housemanship:

"I am a houseman now who is about to finish  housemanship in 4 months time, so I m thinking all this while about my future, where and who I want to be.

Mrcpch and usmle are my choice of option now.

In your opinion, how many years do I need before I pass all the exam and start my residency in the US?

And which pathway could be faster to become a specialist?

Do I need to complete all 3steps before I start applying for residency?"


1) How many years do I need before I pass my exams?
I would estimate about 1 year of part time studying.

2) Do I need to complete all 3 steps before I start applying for residency?
You will need to complete Step 1, Step 2 CK, and Step 2 CS.

3) Which is the fastest pathway to become a specialist?
I am assuming you would like to be a pediatrician, given your interest in MRCPCH.  Following the Malaysian path, I assume that you may take about 2 years to complete your MRCPCH.  You will then proceed to gazette for 1.5 years, and you will be a General Pediatrician.  So as a final year HO, you are looking into about 4 years before becoming a General Pediatrician. 

If you were to take the U.S. path, you will take about 1 year plus to complete USMLE, and about 6 months in the whole application process.  That would be about 1.5 years before starting Pediatric Residency.  You will then enter into a 3 year Pediatric Residency program, where you will rotate through all the core specialties in Pediatric from neonatology to pediatric outpatient clinic.  After that, you will become a General Pediatrician.  This means about 4.5 years if you take the U.S. path.

Now, the question you need to ask yourself is, do I want to go beyond General Pediatrics?  In Malaysia, how fast do you think you can be a Pediatric Gastroenterologist?  These are questions you may want to ponder.  Perhaps two to three years after working as a General Pediatrician, you apply for a subspecialty training program in University Malaya? You can self sponsor for your MRCPCH, but you cannot do that for a subspecialty training program, which means you most likely need to receive scholarship from the Ministry of Education or the Ministry of Health, for which you will be bonded for another 2-3 years after your subspecialty training.

If you choose the U.S. path, in your second year of residency, which is about 3-4 years from now (for you), you will be given the option to apply for a subspecialty training program, otherwise known as a Fellowship.  Fellowships generally ranges from 2-3 years.  The first day of fellowship training (July 1st) starts on the day after your last day in residency (June 30th), and there is no time gap between residency and fellowship training.  Immediately after fellowship training, there is no bond or contract, and you can choose to work in whichever academic or private facility as you would like.

I would recommend that you think of what is your end goal.  Do not limit yourself to your surroundings and know that, everything is possible if you have the determination.