FAQ#13: Questions from a Paediatric Medical Officer with MRCPCH

I apologize for the long hiatus, being caught up in residency training program. I will be completing my residency program in a few months, and have also been accepted into a subspecialty fellowship program. Life has been great here in the States to the point that I am second guessing my decision to move back to Malaysia at the end of my training. Perhaps I may decide to just stay on and work here in an academic institution, and only go back to Malaysia once a while to help conduct training courses for my fellow Malaysians.

I have received tons of questions via email, but was not able to respond to all of them. I will try to respond to some from now onwards. I received this email from a medical officer who is really dedicated towards his/her own training.

Hi. I m medical officer working in XXX.  I had previously email you as a houseman at the final year. I chose to stay in Malaysia and came to sarawak after completion of my housemanship.  I sat for mrcpch and passed the first 2 parts within 1 year. During that time, I was not ready to leave Malaysia. However, only after I started as a medical officer, I does not seem to be satisfied with the training here. It does not make me to be confident to work as a paediatrician in the future. And, there are a lot of issues of medical officer overloaded, followed by the previous issue of houseman overload.
It made me to rethink whether decision of staying back is correct.

I had few questions. 
1) After I completed my housemanship, I will be exempted from licensing exam in Ireland. I realised that work overload issues at Ireland are obvious and economic state in Ireland are unstable. 
My aim is to be trained better. Going Ireland is within my choices. Mrcpch Is not recognised in Ireland. I need to take mrcp paed Ireland beginning from part 1.

Second choices that I has is stay back at Malaysia and finish my last part.
The mrcpch will be clinical.


Thirdly,
I start to wonder whether I shall consider US residency as one of my other options. Can you interpretate the pros and cons of choosing this option? I start to consider migrate to oversea as I really disappointed with Malaysia health system.

I am not familiar with the training program in Ireland, and how does the Irish training program work. In general, the questions you would have to ask are (1) Will they accept you immediately into a pediatric training program and guaranteed to complete it as a consultant pediatrician? (2) Will they accept you into a pediatric subspecialty training program? (3) Will they discriminate against your nationality when it comes to competing against locals?

I think you should not thinking of going to the U.S. for training having to be a permanent endeavor. You can always return to Malaysia as a subspecialist, or head to Singapore. I also feel that you should think beyond general pediatrics. You would want to be able to contribute more, beyond general pediatrics to the community. Think about this: (1) if you were to stay in Malaysia, will you pursue pediatric subspecialty training? (2) will you be satisfied with the pediatric subspecialty training and become a confident subspecialist? (3) will you be okay with staying in the KKM system for an additional 8+ years? This is because you have to complete your MRCPCH, undergo gazettement, apply for Masters for subspecialty training, undergo Masters training, get bonded.

The best part about training in the U.S. is that you get trained as a pediatric subspecialist really quickly with no bonds. I am now a third year medical resident, and will start as a subspecialty fellow in a fellowship training program soon. When I complete my fellowship program, I will be a subspecialist and am free to choose to either work in an academic institution in the U.S., work in a private hospital in the U.S., return to Malaysia, head to Singapore, head to Australia, and many other choices.

Another thing about the application is that U.S. is not like some other countries where perhaps those with citizenship will be accepted first, with foreigners taking the leftover spots. I have been accepted into a pretty competitive fellowship program. Four, including myself, in my class, applied for this specific fellowship. Based on merit, myself and another classmate got the fellowship. The other two did were not as good, did not get the fellowship, although they were Americans. Here in the U.S., as long as you work hard, you will be judged almost equally.

2) second question, am I too old to start as a resident at us? Going to  be 28 this year

When I started my residency (1st year), the average age of the class is around 29-30. The oldest in my residency class was 35. This is because the American medical school is a graduate entry program. Furthermore, many Americans usually do some other work before deciding that medicine is for them.

3) do Ielts a must to proof my English proficiency? I sat once. But writing component was too poor despite of overall mark of 7.5

IELTS is not required. Passing the USMLE Step 2 clinical skills exam gives the programs the assurance that you can communicate well with patients.

4) let say, If I decide to go for usmle, which part you would suggest me to start first? Any link on application process that you could share with me?

I would suggest you go with USMLE Step 1 first. It has been awhile since you were exposed to surgery, psychiatric etc. Therefore, just take it step by step. Furthermore, completing part 1 MRCPCH would probably give you some good basic science knowledge to tackle Step 1. Looking into USMLE Forums would be a good start.