FAQ#7 : Question from a final year student thinking of the USMLE

I'm in my final year and am only a month away from my finals. I only learnt about the USMLE and it's various perks a couple of months back and am interested in pursuing it. However, housemanship starts a mere 2-3 months after graduation and from what I've read, that would be insufficient time to fully prepare myself for Step 1. Also, preparing during housemanship seems impossible what with the grueling working hours. What would your opinion and advice be in terms of preparing for the USMLE for someone who's in this situation?

There are many who have been in your situation, where they only decide to take the USMLE in their final year.

There are two options right now. And deciding on which option is dependent on how much you are willing to sacrifice to get into the U.S.

If getting into the U.S. is only your backup plan, then I would advice that you try to study for the USMLE as much as you can prior to housemanship, and then aim to treat the USMLE as a part time study as you go through housemanship. With it being the shift system, it is still possible to commit 1-2 hours everyday to prepare for the USMLE.

If getting into the U.S. is your primary plan, and you want to get in as soon as you can and are willing to sacrifice housemanship income, then you should consider postponing housemanship. Complete all the USMLE steps prior to starting housemanship. This should take you about 6-10 months, depending on the speed of which you can study for the USMLE.

FAQ #6 : About electives, CS, and visa

1) Would there be a problem if I apply for the match late? Perhaps one year after my graduation?
It won't make much difference. The difference will be significant if you apply more than 5 years after graduation.

2) If I go for my electives and do my CS at the same time, would it affect my visa application?
No. Just be clear and honest about the reason you are heading to the U.S. during your visa interview.

3) How long before my electives do I need to apply for my visa? Do I really need to wait for the elective approval letters before applying for the Visa?
Generally, you should apply for a U.S. electives at least 6-8 months before your elective period. Complete the application as soon as you can. Visa application and processing may take from one week to one month.

4) What kind of questions do they ask you during the Visa interview? Are Malaysians generally approved for Visas without much difficulties?
It's easy to get a visa as long as you are honest. Just clearly state the reason you are heading to the U.S.

FAQ #5 - about ERAS, Certification, Electies, and Housemanship

I'm now a second year medical student. I'm going to take USMLE Step 1 soon and although it's a little early for me to ask, do we have to complete Step 2 CK & CS in order to participate in ERAS?
There is no absolute rule that you need to have Step 2 CK and CS for ERAS. However, MOST of the international graduates will be ECFMG certified when they apply for the match. Hence, in order to be competitive, you need to get the ECFMG certification. To get ECFMG certification, you need the Step 1, Step 2 CK and Step 2 CS.

How do I plan which hospital to go for my electives?
You need to do extensive research online, and make a list of all the hospitals which provide elective opportunities for international students. List down the pros/cons, including pricing, requirements, location and so on. It should take you a few days to do this, but it will be worth it. I would recommend that you google “Freida”, where you can find a list of all the residency programs in the U.S.

Also, if you do residency without completing internship in Malaysia, will you still be allowed to work in Malaysia? From what I've heard, if we don't complete internship in Malaysia, we will have to start from being a houseman even after we've specialise elsewhere. Is that true?
Not true. When you return to Malaysia, you can choose to apply to universities or to the government. Most foreign trained specialist will apply to work directly into universities, be it local university, or private. Hence, most work in UM medical center, UKM medical center and so on. These are under the Ministry of Higher Education, not the Ministry of Health. There are also those who work directly with government universities without medical centers like UNIMAS, and even local private universities . If you want to “berkhidmat kepada Negara”, you can apply to work with the government. However, the downside is : there is a chance you will be posted to some rural area where there is not enough support staff and equipment for you to fully utilize and contribute your overseas training. There is also a chance that you need to do “housemanship” training in Malaysia. I know of one story a few years ago where an Anesthesiologist trained in the U.K. who returned to serve Malaysia’s Ministry of Health, only to be asked to complete housemanship. He immediately packed his bags and left to work in Singapore. However, there are also many who were not required to do housemanship again. I think it all depends on your luck, and who you know. My suggestion is that if when you return and the government wants you to do housemanship again, just reject their offer and work in UM Medical Center or UKM Medical Center. If you spend more than 10 years overseas, you can also immediately work in private hospitals.

FAQ #4 - About timing, electives, and the match

From KY :

Are the chances of getting a match is higher if I sit for the steps as an undergraduate or after I graduate?
It doesn’t matter whether you sit for your Steps during medical school or after graduation. The end point, the USMLE score, is the most important, regardless of whether you obtained it during medical school or after.

Is it true that the most important thing to do is to get an elective done in the States as an undergraduate while I'm still a medical student?
If you want to get an elective position in the U.S., best is to do it while you are still a medical student. This way, electives are more easily available. After graduation, you can only get observerships or externships as your “U.S. Clinical Experience”.

Are 2 months enough for electives?
Generally, yes. But of course, if you can afford to go for more, I would recommend you to do so.

Can you please tell me something about the match? My friend told me that there is only one match which happens in September every year. Thus, it is important to complete the elective, Step 1, Step 2 CK and the Step 2 CS by August in order to apply for the match in September
Yes, every year, U.S. med students and foreign graduates apply to the match in September.

I am a third year medical student. My plan is to do an elective as a third year medical student in Malaysia, finish my fourth year, do an elective for 2 months in the States in 2014, finish my final year, graduate in May 2015, sit for the Step 1 by the end of 2015, sit for the Step 2 CK by April 2016, complete the Step 2 CS by August 2016, apply for the match in September 2016. What do you think about this?
Your plan is good. However, if I would recommend that you sit for the Step 2 CS when you do your electives in the States in 2014. At the same time, I would also recommend that you start preparing for the Step 2 CK now, and take it BEFORE you graduate – perhaps 6-8 months before graduation. This is definitely doable as ALL U.S. medical students also take the Step 2 CK before they graduate, some even in the third year itself. Don’t worry on not being able to answer its questions because the Step 2 CK focuses more on diagnosis and investigations, as compared to the Step 3 which focuses more on management. You do not need the Step 3 to apply for the match. Then I would recommend that you study for the Step 1 immediately after you sit for Step 2 CK. This way, you can take the Step 1 by July-August 2015, and have your results ready before the Match. You can then apply for the 2015 match. This is the ideal plan, if it don’t work out, you can always postpone the exam and go back to your original plan.

Welcome to USMLE Malaysia

2006 - 978 house officers per year.
2009 - 3,150 house officers per year. Number of medical schools increased to 28.

In 2013, it is estimated that more than 6,000 graduate doctors will be joining as house officers. The number of medical schools has increased to 36. This is the biggest problem facing Malaysian healthcare now, the overflow of houseman. It's effects on training is also becoming more evident. There are also limited positions for one to train to become a specialist.
 
Many do not realize the postgraduate training opportunities that one can obtain in the U.S. Common myths include:
1) US postgraduate training is unpaid (false)
2) It is hard to get a spot if you are not a citizen or PR (false)
3) Its impossible for a Malaysian graduate to get to the U.S. for training (false)
4) Specialist training in US is not recognized in Malaysia (false)
5) I need to go to the U.S. to sit for the USMLE (false)

The purpose of this blog is to help you discover that the pathway to residency to the U.S. is 100% possible as long as you put in the hard work, effort and have the right study strategy. The few Malaysians who attempted the USMLEs are already doing their subspecialist training in the U.S., and some have even returned to Malaysia and are currently practicing as consultants in Malaysia.

A good way begin your journey to understand the USMLE is to go through the list of topics available on the right side of this blog.

I wish you all the best in your journey of discovery. If my posts have helped you in any way, I hope that you will click the "like" button available on this blog, and hopefully help more med students and doctors discover this blog.

- Jamie -