So You Want to Become an MD in the US: Advice for IMGs from an IMG

If you're still in med school or already taking your step exams and feel free to write all of that in the chat. Also, at the end of the webinar, stay tuned because we're going to share a link for a free two-week trial of and we have some very exciting new project that I'm sure that you're going to want to check out. I know that when I was taking my step exams, I wish that we had that product available, but now you all have it. Okay, we have one brave person, Leslie from Mexico City. Welcome. I was in Mexico last week, Mexico City specifically for a wedding. I just love those so much I was there pretty much every single day. So welcome. Thank you so much for joining. Hi. Ahmed. We have some people from Canada exploring My options, it's amazing. Fifth year medical student from Kenya. That's amazing. Someone from Chicago welcome everyone. Thank you so much for joining. I hope that you enjoy our webinar today. Someone has an issue with audio. I hope it's just on their end and it's not me breaking off or anything. Colombia, I was in Columbia in February for another wedding. Very international friends. I'm a friend of Fabana, but she got married. She's the one that got married in Mexico City. Child, I got married in Rome. So many wedding stories. Okay, confirming our support team that your sound is working. Oh my gosh, a lot of people are joining. I'm still excited for this. And I think now that we've waited a few minutes, I think we can get started. I'm sure people are going to continue joining, but. I want to make sure that I have some time at the end to answer your questions. So, I'm going to First of all, welcome you to our webinar today. Feel free to ask any questions in the chat. Keep in mind that it can take some time to answer questions. I'm going to try, if possible, to answer as I go. In the presentation, but most of the questions I'm going to save for the end because maybe it's something that I'm going to already talk about at the end. It's at some point in my presentation, so I'm going to probably, leave most of the questions for the end. But thank you for your patience and thank you so much for joining. I'm going to share my screen now so that you guys can see my presentation. I hope. You can see my presentation now. So again, thank you so much for joining. I'm going to talk to you today about the US residency match. I'm going to give you some advice. Or I am GEEZ, from and I am G myself and I really hope this is useful. I'm going to try to include some tips and tricks, things that I found out along the way, things that I wish I had known earlier in my process, and I hope this is very helpful. So first I want to start with a little introduction. My name is Antonella. I graduated medical school in Milan, Italy. In Sarafale University and I actually finished my university graduated in 2018 to a long time ago and then did a year of like an internship to Rochini to get my medical license in Italy. Then I started also working for Osmosis when I was still in medical school part time as a script writer. And then in 2019 when I was done with my medical education things, they hired me full time and I'm currently the content manager. On 2021, I moved to Washington DC because of my husband's job. He got a really good, offer. And so, we moved and I started my process of finding out what I had to do, step exams, all that good stuff. And now I'm very happy to say that I applied last year. And match recently found out in March and I'm going to be a penetration I'm going to be in pediatric residency at Children's National here in Washington. And so first I want to talk about some very basic acronyms and entities. So, an IMG or international medical graduate is a doctor who graduated from medical school outside the United States and Canada. And there's 2 categories. There's US IMGs. These are US citizens or green card holders that went to medical school in another country. And then there are non-US IMGs like myself. These are foreign nationals. They did all of their studies. Everyone was born in another country and then decided that they wanted to pursue residency in the country. Then we have USM Elite. This stands for United States medical licensing examination. So basically, the infamous step exams. Now everyone must take them. This is not only for IMGs, but also for US medical graduates who need to take. These exams and so these are our requirement to be able to practice medicine in the US. On the other hand, there is this requirement only for AMGs, which is the ECFMG certification, stands for educational commission for foreign medical graduates. And this is going to be an entity that gives you a certification to be able to apply. And then practice in the US. This is only for IMGs. So now I would like to talk about the medical licensing examination. Really quickly. These include the US and least step exams and for MGC. So, the step exams are these 3 exams required to practice medicine in the United States. First, there's Step 1. It's an 8 h long exam with multiple choice questions that cover your basic sciences. This includes chemistry. Pharmacology, physiology, also some statistics, ethics and communication. And this is an exam that's pass or fail. Then you have Step 2 CK, which stands for clinical knowledge. This is a 9 h long exam. It's also multiple-choice questions and it has some throwback of Step 1 stuff but it's mostly clinical and especially very focused on diagnostics. So, there's a lot of questions that are like they present a case and then they're like what's your best next step and you have to pick for instance the best next imaging tool or the best management tool that or procedure that you would pursue in this patient. And the passing score is 214 out of 300. Finally, you have step 3. This is a 2-day long exam. Day one is about 7 h. Only multiple-choice questions. And it's very similar to Step 1 to yes, it's very like basic sciences oriented. Throws everyone off because you already forgot about that stuff. And then there's day 2, which is about 9 h. In the morning you will have multiple choice questions that resemble more Step 2 but it's not only diagnostic but also a lot of treatment-based questions, and then in the afternoon you're going to have a section of computer-based case stimulations. And so basically what they're trying to test is your medical application of basic sciences on day one and your clinical knowledge on day 2. And the passing score is 200 out of 300. Now in addition to these IMGs must also take this OET test stands for occupational English test and this is not just a basic English language test, it's mainly testing your medical terminology knowledge in English as well as your communication skills in English with patients, ethics, how you deliver information to a patient and how you communicate also with your peers. So, there's 4 sections. They're speaking, listening, reading and writing. Speaking is like a zoom call. And so, there's someone that's going to pretend to be a patient that you have a few cases, and you have to basically deal with them, try to convince them to get a specific procedure or answer any questions they may have here. Remember they're not testing your knowledge. So, you could actually be saying a bunch of things that are not totally correct. They don't care if you know the treatment for asthma for example, they just know that you're able to communicate with the patient. Where you're going to be listening to a conversation between a doctor and the patient and then you answer some multiple-choice questions. There's also a part where you are listening to like a lecture given by someone and then you also answer some multiple-choice questions. Then there's the reading portion where you have to read like an abstract and then answer again multiple-choice questions. And finally, there's a writing portion where you get information and history and everything about a patient and basically the writing is that you need to write like referral letter to whomever they need to be referred to and make sure to include anything that's pertinent and exclude anything that's not relevant and write it in this specific format and to pass the OET, you need to pass the 4 sections in one take. You cannot just pass 3 sections and then take it again and pass the following section. Then, for the ECFMG certification requirements, we have exams, and we have pathways. So, the exams we've been talking about to obtain your CFMD certification, you're going to need to take Step 1, Step 2 CK, and the OET. These exams can be taken in any sequence. You can take them in this order. You can take Step 2 first. I know people that need a little bit of a breather, so they take Step 1, then they take OT to breathe because IT is fairly easy and then they dive into Step 2. Personally, I took it in this order, Step 1, Step 2, and OET. Mainly because Step 1 and Step 2 are going to be valid for 7 years. While the OET is only valid for 2 years and it's going to expire. So, I wanted it to be the very last one that I took and make sure that if I didn't match last year when I applied, then it would still be valid to reapply for the following cycle and not have to take it because it's just money and time. That I just wanted to avoid if I could. Also Step 2 has some Step 1 questions in Step 1 really builds a good foundation. Also Step 1 is pass fail. So, there's that factor. Stress with Step 2 of really nailing in and getting a good score. So, I wanted to get all the psychological factors of knowing how the test center works. Computer work, everything out of the way with Step 1 and then be basically much more stress free first step too. I will tell you I cried so much while studying for Step 1 even though it was pass-fail, I did not cry once when studying for Step 2 or step 3 because I recently also took step 3. Now, these can be taken any sequence, however, they must be taken before residency. And when you take them, you're able to apply for a j 1 visa. And I'm going to talk about visas in a moment. Then step 3, it's the opposite. You don't need step 3 to obtain the ECF MG certification. You actually need the ACFMG certification to be able to apply to step 3. So, this means that obviously you need to take Step 1 and Step 2 first. Now step 3 can be taken before residency. Like in my case, I wanted to make sure that I didn't have it. Was starting residency. I just wanted to focus on residency, not getting in the way. But most people take it during residency and residency programs know this, so they are pretty accommodating, allowing you to like maybe taking a little time off or like at least a few days off. So don't worry about that. But if you can and you're an IMD, so this is the only point where you have an advantage, try to take it before. The main thing is that if you take it during presidency, it means that you fall under this other category. And so, you can apply for a j 1 visa. A j 1 visa is a student visa. That means that it's fairly easy to get for programs. That's not the issue. The problem is that when you're done with residency, you have to either go back to your country because it's a student visa. And so, once you're done with residency, you're done with your studies basically unless you apply for fellowship, but then after fellowship same thing. You have to either go to your country or the other thing you can do is go to these less desirable areas like more rural areas and you have to stay there for like 2 to 3 years until you are able to obtain a work visa. Now, on the other hand, the h 1 b visa, which you can apply to if you take step 3 before residency, now disclaimer, this is only in certain programs that sponsor that visa, not all of them do. But if your program does and you get the h 1 BV visa, it's a work visa. So that means you have no restrictions. Once you're done with residency, you can stay in the country. There's no limit for you. So that's why people, especially MDs, try to, if possible, take step 3 before residency. Now, the other thing for the CFMG certification is the pathways. And now IMGs applying for US residency need to follow one of these 6 pathways to meet the requirements for the certification. Pathway one, which is the one that I applied to, is when you already have a license to practice medicine in your own country. In my case, as I mentioned earlier, I had a license to practice in Italy. So, you can apply to pathway one and that's considered the best pathway because you just take the step exams. And that's it. For the other pathways, you need to take a few additional exams, and I have friends who have done that, and they said it's fairly easy exams. It's actually not an issue of how difficult they are to prepare. They're pretty easy. It's not like a whole new step that you have to take the issue is that again it's money and time that if you can save then pathway one is the easiest path to go to but otherwise it's don't worry it's like pretty simple according to my friends that did it and there they match then they're living happily ever after so pathway to if you passed a standardized clinical skill exam for medical relationship in your country. Like let's say your country has something similar to the steps. You have already taken Step 1. But you didn't take Step 2, so you didn't meet all the requirements for the license in your country. So that's where you fall in pathway to. Pathways 3, 4, and 5 are when your medical school is accredited by one of these agencies. Listed here. So that's something that you need to talk about with your university. To figure it out. And finally, pathway 6 is for all of the applicants that don't need any eligibility requirements for pathways one through 5. Now, once you're done with that, you can move on to the US residency application. So, I'm going to talk about the requirements. The errors and timeline and no errors are not Taylor Swift's tour it's something completely different because I'll tell you how many times I was googling ERAS for residency application, and I was only getting information about Taylor Swift's tour. So first of all, the application requirements. There are certain things that are must-have, so they are required to apply. And then there are certain things that are good to have. These are not required but might help you stand out. So, they must have, first of all, obviously your university diploma and your medical school transcripts. Then you need 3 to 4 letter software coming. The minimum is 3. I do believe certain programs accept too, but the minimum target 3. The maximum is 4. They don't allow you to put anything above 4. Letters of recommendation can be from any doctor. But ideally, you should try to get letters of recommendation from a doctor that practices in the US. If you can't, you can totally use letters from doctors in your country, but you can at least try to get one from a doctor in the US. Those are considered more trustworthy because it's someone that is also familiar with the system and all of that. It's already an insider, so they are considered more valid. Then you need your personal statement and your CV. So, the CV, pretty obvious. It just has all your medical background, medical education background as well as any professional background that you may have. On the other hand, the personal statement is this essay that you write about yourself. It should be one page long. Don't write a longer one because they get applications, they don't have the time to read anything longer than one page. Also don't recite your CV again. You want to make sure that in your personal statement you are translating who you are as a person, your personality. Any past experiences that make you unique. And that would make you stand out, that we make you memorable, and also that would make you a great resident in a great position in the long term. If you can also add a little bit about why that specific specialty that you're replying to is your passion, then that's obviously great. It's a lot of stuff that you have to condense in one tiny page. So, it feels like a lot and you, it takes a lot of, trial and error, but in the end it's totally doable and there's a ton of like YouTube videos or articles out there that are really, really helpful. In my case, for example, something that I felt would make me stand out or at least memorable is that I grew up moving. I went from country to country because of my dad's job. And so, I have lived in a total of different countries. I speak many different languages. I've also been able to do clinical rotations in many countries. And that means that I have also interacted with many countries. And that means that I have also interacted with many different patient populations in many countries. And that means that I have also interacted with many different patient populations. So, they're not going to remember your name and the name of every single applicant, but at least they're going to remember me, for example, as oh, that girl who's been in a bunch of countries. You know, you want to just add something that's going to make you very memorable and different from everyone else. And everyone has if you think everyone has something and makes them extremely unique. Then you're going to need Step 1, Step 2, and the CFMG certification. And now these come with a disclaimer. All of the programs are going to require that you have already taken Step 1. However, there are a few programs that are going to allow you to apply even if you haven't taken Step 2 yet and therefore you don't have the ECFMG certification yet. They might allow you to apply and they might even allow you to interview. However, they're going to require absolutely that you submit this information before they rank you and before you match. Otherwise, they're not going to rank you. So just make sure that you have all of that ready at least before February, if you couldn't have it ready before September, which is applications. I'm going to say though your application is going to be considered a week application. You're already an IMG and let's face it, that's seen received as a red flag in this country. So, you don't want to have any additional red flag in this country. So, you don't want to have any additional red flag in this country. So, you don't want to have any additional red flags or anything that makes your, so you don't want to have any additional red flags or anything that makes your application look weaker. So, in my case, for example, I took Step 1 in April, the twentieth 22. And I was going to take Step 2 in December. So, I could have technically applied to the 2022 2023 cycle without Step 2 however that would have made me a weaker applicant I didn't have a lot of rotations of the time. Maybe I wouldn't have gotten a lot of interviews, maybe I wouldn't have matched. And then that's a lot of stress added and also legend has it that for some reason if you don't match the second time you apply to the cycle for some reason, you're less likely to match. So, I just didn't want to ruin my chances, and I was not in a hurry. So does my advice try to have an application that is as strong as you can. But if you want to apply and you don't have it, then that's totally fine. Also, these final points have a plus minus because some programs might require it, and some don't. Every program has a website that lists their own requirements. So, some programs you'll see that they say we absolutely need this person to have US clinical experience. So, some in the country. And some will even specify maybe they want At least a month or 3 months, some crazy ones even want a whole year. So just Make sure that you know you meet that requirement if that program has that. And finally, the year of graduation, meaning the Gap year limit. This is something that some programs will list as well. I've seen 10 years, Kaplan, Gav, 7 years. 5 years, most programs will say 5 years and then there's also those that want 3 and one year. So, they want really fresh graduates. Now, I want to say this should, this is something that they post mainly as a deterrent. So that some people are discouraged from applying because they're like, oh, my gap is longer than what they need. So, I'm just not going to apply because they are getting thousands and thousands of applications. Don't consider it added a deterrent. Just make sure that you fill that gap with meaningful experiences. And something that they're going to think is interesting and that was worth your time. In my case, for example, I've been working for this medical education company, Osmosis. So, I've developed additional professional skills, and in fact in interviews they asked me a lot about that. They were really interested in that. So just make sure that you fill it with meaningful experiences. We also did a couple of rotations to make sure that I also had the clinical skills that were not super rusty. But don't consider it a deterrent. Just make sure you fill it with meaningful experiences. Some might just say we're very strict about this so no interview, but some might say you know what let's give this person a shot because it is a very interesting thing what they did, and I want to know more about that. Finally, there's some good to have. Things that are not required. But can help you stand out. As I mentioned earlier, step 3. This is not only going to be good for you in terms of Visa, but also programs really love it when an applicant already has steps 3. Because they know that you're going to be someone that doesn't need to have some take some time off to prepare or to take the exam that you're going to be 110% focused just on residency and so they love that. Full disclaimer, if you think you're not going to do well on step 3 or that you're even going to fail don't take step 3 before residency because that's actually going to make your application weaker. If you maybe got a really good score in Step 2, but then you got a really bad score or failed step 3, they might think that you got lucky in Step 2, or they might wonder. So just take step 3 if you really think you can commit to taking it and doing equally as well as Step 2 or even better. If not, there's no problem. No one's going to rule you out if you don't have step 3 and there's no issue and most people, the vast majority of people, take step 3 during residency. Then these are something I mean good to have mainly for you because it's less paperwork. On your end because matching takes a lot of paperwork so just less paperwork for you if not honestly programs don't really care because one visa is really easy to attain. So, it's not going to be a deterrent for them to give you an interview Re, it depends. So especially if you're going apply to the most competitive residencies, let's say. Dermatology, plastic surgery, ophthalmology, then you're definitely going to need a ton of research so that your application is extremely strong because these specialties are known to generally avoid IMGs. So, if you can have a ton of research and especially involving that field that you're that you're applying to. That's amazing. In my case for research, I didn't have much. I applied to pediatrics, so it was fine. I had my thesis obviously that you need to graduate in Italy. And then I had some publications with Osmosis, but they were not peer reviewed in journals, so they're considered weaker research but still good fillers for that section in your CB. Then observerships, these are like US clinical experience. However, with observerships, you are technically not allowed to be by yourself with patients, to touch patients, to take any notes or anything like that. In my experience, I did observerships. And it's a matter of gaining the trust of the doctors and the residents that you're shadowing. Once they gain your trust, once you gain their trust, I'm sorry, then they're going to really let you like it, I had no issues, they would let me take notes, they would let me go see the patients by myself. They, but it's a matter of gaining your trust, their trust and really showing that you care and that you're there to learn and to practice and do everything. These entrepreneurships are not only good for that, but, also for networking and I will tell you networking is the most important thing. So, when you do observerships, you are going to meet doctors. They're going to see your work ethic. They're going to see your abilities. They're going to see your interest and that you really want to learn and become better. So that's going to create a network and that can lead to letters of recommendation. In addition to that, they might know someone else in another hospital. Or anywhere else. So honestly, observerships work great for me for network. The other thing I did for network and honestly I did this to obtain those observer shapes as well is sending emails to any doctor that you find but not just a generic email like hello this is who I am please let me shadow you It has to be a really well thought email and well written email. You really have to first of all read about the person their background finds something that's meaningful to you. And that you resonate with. In their path, in their journey, send that email saying how you admire them because of whatever they did and how this resonated with you in your own pathway as well as your goals for the future. And then ask if they would be open to like meet like for a coffee if you happen to be in the same city or if they would be open to host you for an observership and honestly sending emails get take is going to be the most useful thing. I sent so many emails and probably like 5% of the people that you email are going to respond. So, it takes a lot of work, but those people that respond. It's because they saw something about you in your email and they're interested. So don't lose faith if not a lot of people respond very busy and just. Just do it. You have to do it and it's going to take you such a long way. Last but not least, speaking multiple languages. Remember that usually people in the US do speak English so they really value when someone speaks Spanish and that's something that in my observer ships because I happen to speak Spanish. That's something that made me shine because the residents that didn't speak Spanish would always like come ask me if I could help them translate because the translators are really horrible to use. So that's what made me gain their trust and I would try to on purpose bear myself up with those residents that didn't speak Spanish that way they would meet me, and I would be able to participate even more. So, it's just a matter of being strategic and using what you have to your advantage. There are also some areas like DC for example that really value if you speak rabbit because of their patient population. I don't speak Arabic, and they still matched so don't think that you now want that to go, download, Duolingo and learn. It's just a nice thing to have. Now, this is ERAS. This is what I was talking about. I don't have time to go through the whole website, but Erica stands for electronic residency application service. If you want to look at a really, really good tutorial, I have this QR code here that you can scan and you can watch this YouTube video tutorial by Malke Assad. He is a resident; he's an IMG and I believe he matched in plastic surgery, and I don't know him at all. This is not sponsored. He does not know who I am, but his tutorials were so helpful. Not only this one for ERAS, but also the ones that he has for interviews. For additional tips to take the step exams. So really if you want to go watch his YouTube page, that's amazing. This is the specific code that will lead you to the tutorial for very quickly looking at it here. This is my name, my picture. Make sure you take a professional picture. My ID, this is like your password. Is there a new passport that you're going to share with anyone? Well, any physician. Then, here you are going to apply to your programs. You can see I applied to 87. You have to apply to many programs as an IMG, then you're going to upload here. Documents, you're going to upload letters of recommendation, your personal statements, and all of that stuff. And you're going to create your CV as well here. And then you can view and print it. Okay, now I'm going to talk about the residency timeline. Now this is the timeline for 2320, 2020 2320 24. So, the one that I applied to last year and they had matched. Right now. Exact dates vary each year, but the months are the same. So maybe this year it's not going to be June, the 20 eighth, maybe it's going to be June 20 seventh. But it's pretty much the same. I believe they haven't released the exact date yet for 2024, 2025. So first you have June 28 is when the ERAS token is released. This is basically like an access code like a password for you to create your dashboard in ERAS and to subscribe to ERAS basically. That's when you can start writing your personal statements, start asking for any letters of recommendation, start, looking at programs, start doing all of that good stuff and you want to make sure that you have everything ready. Then September, the sixth to 27 that's 3 week window where you can start submitting your application that means in ERS you go right here and it makes it so easy to search for programs it even has the website of each program it has all the information you might need and then you decide if you apply or not and you save them. Right now, it's saying 0 saved because I already applied. But I had it up at some point probably like 200 programs saved. You start saving, then you decide which programs to apply to. And you pay for those programs. Only the ones you actually apply to. Make sure that you have everything ready by. September 27 or whatever is the deadline this year. Because September 20 eighth or the day again of this year's timeline. The ERS website is going to release every single application of every single applicant to every single program. And you want to make sure you're one of those first applicants in that first batch. It's not that you can't apply after that deadline. You definitely can. But there are programs that don't even look at applications that come later because They just get so many applications already that they don't even pay attention. You can also apply even if you don't have something ready like for instance, I received a letter of recommendation I think A few days after the deadline and I uploaded it. It doesn't matter. I had already applied. Then October through February is when interviews take place. Most interviews take place in November and December, some in January. Keep in mind that interviews take the entire day because there's a portion where they are presenting to you, presenting their program, talking about whatever they offer in their program. Then there's a few sessions where you're interviewed by different physicians one on one. So, you have separate interviews and separate people interviewing you that then are going to talk about you. And then there?s a session where you meet with some residents, or the chief residents and you get to ask questions to them as well. So, this is something that literally takes the whole day. I had to take the days off. At work for that. February first. Interviews and you can start submitting your rank list. February one to 20 ninth. So, the whole month. Now you have to rank the program that you liked the most. To the program that you liked the least. Don't try to be strategic about this and thinking, oh, I think this program liked me more. So, I'm going to put them first just because I think the algorithm is going to match me there. No, just follow your heart. And the algorithm is more. Favoring the applicant. So, make sure that you rank the order that you want and not the order that you think is going to be strategic. Also, the other thing to remember, remember that ranking is a legally binding track. If you match somewhere, you have to go. You cannot say no. It's not an offer. So, make sure that if there's a program that you really didn't like, or the program was in a city that you really don't like. You do not want to live there at all. Don't rank it because They say that anything from top one through 5 is fair game. I know a ton of people who matched in their number 4 position, number 2 position. So, if you didn't like that specific program for any reason, don't match it, don't rank it. March, the eleventh to March fifteenth is March week. So, it starts on a Monday when you get this email that is going to tell you if you matched or not. It's not going to tell you where. It's a surprise for Friday. But on Monday, this was the most nerve-racking day for me because I just wanted to match. I didn't really matter. Like really care all the programs that I ranked I really liked. So, I was just happy when I got that. Email on Monday saying you matched and then that week was very easy for me. If you don't match, you can go to the soap, which is the supplemental offer and acceptance program. Basically, you get an email saying you didn't match, then you get a list of programs that have empty spots. And so that week you can apply on Tuesday. I believe then you get interviews on like when Wednesday or something and then on Friday everyone knows if they matched. And on Friday, you also know where you matched. And so, everyone's happy. You know where you're going. Then you think April is going to be a chill month but not because there's a ton of paperwork. But you're just happy that you're doing that paperwork. And then June, July is when you begin residency, in my case, Children's begins June 12, which is pretty early. That's not common. Usually, programs begin later in June or even first week of July. And that's when you begin. Now, planning ahead, very important, timing and budget. First timing, I don't have the time today to go over every single detail. So, I have this QR code again that you can scan for a webinar that I hosted, about 2 years ago, I believe with 2 of my osmosis colleagues. And if you go to minute 21, my colleague Stefan is talking a little bit more in detail about all of this information. But just very quickly, the first thing you do is apply for a CFMG certification. This is not when you get the certification, you just apply, and they need to verify who you are. So, they verify with a notary, they verify with a bunch of documents that you need to upload and all that good stuff that takes about two weeks. Once they verify who you are and who you claim to be, then they say, okay, you're good to go. You can start taking the exams. So, then you schedule the exams, study time for each step exam, about 2 months to one year. It depends on you. No one knows you better than yourself. In my case, I studied for about board 5 months for Step 1 because I was so scared about Step 1. Then for Step 2, I was much more relaxed. I said for like, 2 3 months. And then the step results come after 2 to 3 weeks. And then you have to also take the OET. That you can study for like a week to a month. I studied for a month for the OET because I wanted to be really comfortable with the platform. I also have ADHD. So, I you have a very specific amount of time and also you have to listen to those conversations, and you can't listen again. And also, you have to listen to those conversations, and you can't listen again. You have to read those articles and You're going to run out of time if you don't practice or at least in my case. So, I wanted to make sure that I was very comfortable with the system and that I was not going to affect my score not because of my English capabilities but because of my time management. The OET results take forever. I feel like mine took like 2 months. I even reached out to, like, hey, did you miss place my results or what's happening? Because that was the very last thing that I needed for the certification. So just make sure that you're not taking the OET in September. Because they take their sweet time. Finally, after taking your exams, you can apply for approval. That's where you get the approval of the CFMG certification. You go ahead select your pathway, contact your country jurisdiction university, depending on your pathway, in my case because it was pathway one, I needed the jurisdiction of Pisa specifically, which is where I subscribed to get my license. Because that's where I'm from. And so, You have to contact them and they have to be the ones sending the proof that you have a license to practice and that you can apply the path we want or if you are applying to another pathway, then your university needs to reach out or whatever you need to do. Then you have to submit the proof of Step 1 step to that actually goes straight to the CFMG. You're not the one actually submitting that. Then your diploma, you need to pay the fee. There's always a hidden fee. I swear when I applied, I had nightmares. Waiting for the match thinking that I didn't apply because I was missing some hidden fee, and I would keep texting my friends. So anyway, there's a ton of fees. Make sure you pay for all of them. Finally, wait for the ECFMG to verify your status, verify everything you sent, and the way time is about one to 2 months for me. I don't think it took even a month, like maybe 3 weeks. That was fairly quick, but. Just in case it could take up to 2 months. Then you also need to plan ahead for the budget. I have here a list of the costs for my year for what I paid. Keep in mind that prices tend to increase a little bit every year for more information of like the current prices you can visit this website. So, these are some things that you need to pay, variable residency application fees. So, they recommend for IMGs that you apply to a hundred programs. I applied to 87. You don't feel like you need to reach 100, but you definitely need to apply to at least 80 I would say this is the price for a hundred. Other expenses if you do rotations or observerships when I did my observerships I had to travel for one of them I had to pay for accommodation. If you need a Visa, any study. Resources, etc. Now, I want to end my presentation by talking about some resources and tips, to hopefully help you nail your tests and then your residency application. First, some recommended test prep resources. Full disclaimer, what works for me might not work for you. This is what I used. If you scan this cure code, it's going to lead you to a Google Doc where I listed the resources that I used as well as the links. So that you can easily access them. So, the resources that I used, first of all, Uworld. Uworld is a must. You cannot escape your world. If you don't know what that is, it's a page that has question banks. And basically, that's going to help you not only study but also prepare for what you are going to face in terms of questions. The questions are not straightforward. They're written in this really weird way and they're skipping 3 steps and sometimes they give a bunch of useless information and then you have to learn. Find the specific information that you need. You need to learn how to use the system and find the labs, how to highlight the important stuff. So, Uworld is also going to help you actually use the platform on test day. That's really important. So, I would say that that's the most important thing that you definitely need to prioritize is doing questions every single day. Then, if you want to supplement with an additional resource in terms of books, I only used first aid. For books, this is this book that has condensed everything that's high yield and that's going to be tested on the exam. It's a great resource. The only issue with the first date is that it is so condensed that it's mainly bullet points, so it's missing a lot of context. It's missing explanations and sometimes you need to supplement with something else especially videos now for Step 1 the videos that I supplemented with were from USMLEY RX This is a website that has videos. Created by the same people that created the first 8 books. So, their videos were really great because I could follow along with the book while I was watching those Step 1 videos. They have a Step 2 product as well, but I did not use it, so I have no idea if it's good or bad. That's what I used, the Step 1, USM, LRX. For Step 2, Hi, I relied on online. This is a really great resource. That has lectures provided by a physician. He's like talking on a whiteboard and the only issue with online method that I would say is that well number one when I was taking Step 2, Now they are charging a subscription like all of their competitors. I mean as they should because they're charging for their work, but I would not use it now that I would have to pay. I mean, it's really good, but there's other sources. Also, the other thing is that because it's a guy with a black with a whiteboard, it's hard to update those videos. So sometimes they might be outdated with certain things here and there. They're still really great, but, and then the other thing is that some videos here and there, they're still really great. But then the other thing is that some videos are extremely great. But, and then the other thing is that some videos are extremely long, like especially OBGY and they were like, 45 min or maybe even longer and sometimes you don't have the time to watch 5 videos that are an hour long. You don't have 5 h to spend just on videos because you also have to read the book. You also have to answer your questions. There's a lot of stuff that they want to do. You also want to maybe eat and have a little bit of a life. So. Now, when I was studying Step 2, this was not available, but now it is Moses. We have this new product, and this is not for like to sell you our product this is honestly what I used for step 3. It was not available when I took Step 2, but it is available now that I took step 3. We have this new product clinical sciences and that's product. Targeting Step 2 or if you're doing a rotation in the US, it's basically videos that we try to keep at 10 to 12 min on average. With the most important clinical things that you might need to do as well as high yield things for the step exams and, another thing that we do with these videos is pair them with like an algorithm. That you can print. It's separate from the video and so you can follow along, or you can also just bring it and take it in your pocket when you're rotating. It has like the algorithm of the steps that you need to take and to follow. So that's especially useful for Step 2, a lot of questions in Step 2 are what's your best next step? So those questions sometimes are tricky, especially when you're starting to study. And so, these algorithms. Are extremely useful for that. Sketchy medical is another thing that I really used, especially for Step 1, I used micro, and I love it. I watched one pathology video, a pharmacology video. I did not like it. I felt like it was too much, and I did not use it ever again. I know that some people love it. In my case, I really loved Micro, so I highly recommend that. And then there's the divine intervention podcast by this, radiology resident called Divine. This podcast is so, so, amazing. I cannot recommend it enough. And again, this is not sponsored. He does not know who I am, but I'm telling you for months I did not listen to music whenever I was brushing my teeth because I wanted to take the steps fairly quickly. I did not want to waste any time. So, I was brushing my teeth. I was going to do groceries. I was walking my dog listening to Divine and his podcasts are so amazing. He has a lot of high yield information that he talks about, and he phrases like let's say a question asks about this patient and what are you thinking? I really hope you're thinking. Something else. He also has some podcasts helping you navigate the process in terms of like the psychology behind it and like how did not stress out. He has some podcasts about interviews, so it is, interviews, I mean, residency interviews. So, it is a really, really, really great podcast. Then Melman medical. This is this guy that has this website that you can find in my career code. This website has PDFs where he writes high yield bullet points or like what questions his PDFs are fairly long, but he has a lot of very valuable information. So, I did not have the time to go through all of them. Because they're a lot, but I did go through some of them, and they had some really great pearls that I still remember to this day, and I will never forget. And then finally obviously YouTube, there's videos about ethics. Just Takes Like Dirty Medicine is a YouTube channel that I really liked as well. And they also have tutorials for instance the one that I showed you earlier for the ERAS dashboard they had tutorials or like how to navigate interviews, they have mock interviews there that you can watch and learn how to answer questions and address certain things. So just YouTube has everything. Some additional resources that I did not use, but I know that some people really love, so I wanted to add Chris Kaplan, Pathoma, especially the first 3 chapters. Apparently, I don't even know what they talk about. Grids and beyond and key ambers and well so many more and I know that some people really love them. I'm just someone that thinks less is more and just wanted to focus on fewer resources. Now again, some study tips. Avoid using too many test prep resources because you want to take them these exams. Someday soon you don't want to take one to 2 years to take each account. I have friends that took a whole year for each exam. A long time, then you want to familiarize yourself with images. ECGs, especially for Step 2 and step 3. And I'm telling you that for Step 2, every single question block had at least one ECG image. So really familiar is yourself with ECG. Histology is mostly for Step 1. But it does come up in Step 2 and step 3 a little. So, you want to make sure at least for like the most high-yield things like certain. Lymphoma or leukemia findings like I don't know our rods for email just certain things that are really high yield. Imaging, radiology of course shows up a ton, actually divine intervention has a podcast. On radiology findings and he even has a slide deck where he shows some of those findings. It doesn't have every single high yield finding, but it has many high old findings, and it was a very good refresher. For me. And also, dermatology really important. There's a lot of questions that are really short. Don't give you a lot of clues but then give you a dermatology image like some rash or a lesion and basically, they want you to be able to recognize what they're showing in that image. Then study according to your schedule, have a life and take breaks to avoid burnout. Don't make these exams your whole life. In my case for example, I took Step 1. In April 2022, then I took a period because I wanted to get married and go on my honeymoon and then in September, I started studying for Step 2 and I took it in December. So, make sure that you're not postponing major life events, just for these exams. You're going to end up being a physician forever. That's you forever. So, make sure that you're also doing things that you are going to value. In your life. Take breaks, definitely take at least one day off per week. Don't study every single day because you're going to burn out. Don't neglect doing your Uworld questions. I was probably not good at this, especially in the beginning because you when you're starting to study, you're going to do poorly in those questions. And you Have to just keep going and you're going to think why am I doing this if I don't know anything? Well, at a certain point it starts making sense. It starts clicking in your mind. So don't neglect doing your world questions. Do them from the very beginning. Maybe in initially devote a little more time to books than Uworld questions but then start transitioning in time and then by the time you're closer to the exam you should take More, you should devote more time to questions than to books. Use self-assessment tools. These are like quizzes that you can take at home. Use them closer to the exam. I know that some people take them at for like at the very beginning to see where they're at. Guess where you're at? You're in a bad spot. So, you're going to pay for that exam except for 1 20, which is free. You're going to pay for that. You're going to take it. You're going to do poorly. It's going to discourage you. In my personal opinion, take it closer to the exam. If you want to take something earlier, just do some blocks of your old questions. And then after each question block of your world or each self-assessment, make sure that you review thoroughly every question, both the ones that you got right as well as the ones you got wrong and read the explanation really carefully. That's where you're going to get most of your learning from. And this is my very last slide. This secure code, I think you can again access the resources that I use. Just wanted to add it again, but IMG tips. Plan with enough time taking deadlines into account. Again, don't be taking the OBT in September because it's going to take one to 2 months to arrive. Just make sure that you're planning all of that observerships as well if you need to plan a trip, accommodation, all of that visa. So just make sure that you have a calendar. I bought a calendar and Amazon put it on my wall and I had every single day of my life, don?t rush better do everything well than fast for instance in my case. I could have applied in 2,022 but I had a raw half cooked application only had Step 1 honestly, I knew that it was better to wait the extra year, do more rotations, build more network. Have my ECFMD certification ready and then I'll maximize my chances to match, and I matched in my first option. Avoid comparing yourself to others. It was very hard for me seeing that my friends already matched while here I am basically 6 years later and I'm finally about to start but avoid comparing yourself to others. You're probably doing other great things, you know, I was exploring a different path, and he made me the professional that I am today. So, I don't regret honestly having those experiences under my belt. And avoid comparing yourself to others in terms of also scores and all of that stuff. You are in your own path. And sometimes we think the grass is greener on the other side, but everyone's going through their own stuff. Be optimistic, but also realistic. So, try to make sure that you are doing everything properly. Don't think that, oh, I'm just going to wait for the last minute or I'm just going to study for a week and hope to pass. Now be realistic and try to really plan accordingly. Research programs in cities that you're interested in really well. Again, the match is a legally binding contract. So, if you match somewhere, you have to go. So, make sure that you know where you're going. Keep a good support system in mind, in my case. I, I have my husband, so when I was applying to programs, I made sure to talk with him and like, rule out programs or cities where he would not be interested in moving because we are a partnership now and also make sure to prioritize and apply really strongly to DC so that I can stay in the area. Family or friends or whatever. It's really important to also keep a good support system in mind. Networking connections matter way more than scores. Believe me, when I was studying for Step 2 and when I got my score, I was really happy that I did really, really well on Step 2. But then I realized what is this score worth if I have 0 connections. So that's when I really started to, I had no letters of recommendation in March and in September I had 7. So, in I really started emailing, I really started making connections, rotating, doing what I had to do. So networking is really going to take you a long way in terms of meeting more people and also getting those letters of recommendation. Ask your professors or mentors if they have any contacts in the US. Sometimes that happens. But also, don't be shy and reach out to US physicians via email or LinkedIn. In my case, I had no one. I had no connections basically. I built them all from scratch so don't worry it is possible; you just have to persevere. Tried to do clinical rotations observer ships in the US. This is going to help your CD is going to look like, oh look, this person has experience in the US has been here. Understanding the system is going to understand the EMR, but also to obtain those letters of recommendation again. And finally, be proud of yourself. Starting this process is already an accomplishment. So again, don't compare yourself to others if someone took the exam much faster than you. You are in your own process. Be proud of yourself. Just the fact of being in this webinar and being interested in applying is a huge accomplishment. So, you know, give yourself grace and A lot of people do it so you can also do it. So, thank you for joining. I know. Well, hold on, Antonella. We have several questions in the chat. So, if you could take a look at those and we'll take 5 or 10 min to try to address as many of those as we can, that would be wonderful. Perfect. And I'll probably not going to be able to answer all of your questions because I had a lot to cover today. So, I apologize for that. That's my emails, my work emails, if you want to reach out with questions, I'm going to look at the chat now and. Let's see. Hosts and panelists. Answered. Where do I find them? Sorry? Oh, there is. So, if you go open the chat and then you go to the host and panelist version. Okay, I'm going to stop sharing my screen and look at those questions. Okay. Okay, so. Someone asked. My gap here has been as a profession in a medical school. Do I have an advantage? So that's definitely something that's really great and you need to highlight that something that was similar to my path in a medical education company like osmosis, I definitely highlighted that I kept my medical knowledge up to date and that's something that you should definitely take advantage of and highlight that especially when you write that in your CV and then in your interviews when they ask about that. So, do you have any tips on how to find clinical experiences that will take IMGs? Yes, so first of all, as I said, sending a bunch of emails and contacting doctors through email or LinkedIn, but then also there's some programs that offer them and you pay. So, one of the ones that I did was actually I paid for that and there's many programs that offer that definitely. How's the process of doing rotation in the US while one is a student? So that's actually a great advantage actually. When you have already graduated, what do you do is observerships? When you are still a student, you do what they call externship. And so that's more valid because in theory that's hands-on and they think in an observer shift theoretically if you don't gain the trust, you're not allowed to even touch the patient. With externship you can. And so that is something that you obtain through your professors in your university and the contacts that they may have. Let's see where I did my observerships. So, I did one in Mount Sinai in Miami, Florida. I did one in Phoenix, Arizona. And then since I live in DC, I've been constantly shadowing and rotating currently at children's. Here in DC those were the biggest network contacts that I made, and they will not get you in, but they definitely help you knock the door. So, someone says, do we have any restrictions? Is where I can apply for residency. No, you can apply everywhere. No residency is going to say we do not take IMGs because it would be illegal and discriminatory. They're not going to say it. Now there's many that are not IMG friendly. But you can apply. And if you want to apply to an IV League as this person does, you can. If you're an IMG, you're definitely seen as a Weaker candidate, that's the truth. But you can apply, and you might even get in like children's where I got in is the top 5 of the country and I still made it and I never thought I would make Okay, I had to look twice when I got that email. Do our grades in medical school or high school matter? Like high school? No, no one cares about high school. Medical school. Kind of like not a lot but unless you did like really poorly and barely past. In my case I graduated Suma Con Laude. So, they looked at it as, oh, wow, amazing. You're in IMG, but at least you graduated with really great score, so it was definitely a plus. But it's not our requirement as long as you didn't do like. For. Learning barely passed. Is there any benefit to having a degree in one of the healthcare areas and then do medicine course on apply to residency programs? I am not sure how to answer that question. I am so sorry. Is research important for family medicine? So, research is important. If you have research, it's going to be really great, for anything. Having said that family medicine is not one of the most competitive ones. So, I would say it's not. Absolutely necessary as long as you have something to fill that space in the CV. Otherwise in the CV, ERAS will say nothing or something like that. And it looks really horrible. So, in my case, I don't have any peer reviewed. Publications. So, I put my thesis, I put my online publications with this Moses, and you just want to fill that gap. If you're doing, however, a very competitive specialty, then definitely you need to have a ton of research and valid like peer reviewed journal published research. I find it painfully stressful creating flashcards. Everything I read how did you overcome this by not doing any Because as I said, I'm, less is more kind of go and that's also why I did not use, I have friends who used it. So again, this is not sponsored by anyone, not even Osmosis is sponsored by anyone, not even Osmosis is sponsoring this. So, this is not even Osmosis that is sponsoring this. So, this is not like against Anki or like sponsored by Divine Intervention, whatever. But I did not use Anki. I didn't think flashcards were worth my time as much as questions were worth my time. So, devote that time to questions, honestly. Because making flashcards is Takes a lot of time and it's stressful. Also, Uworld has a feature to create flash cards if you really find flashcards helpful. How can we be licensed in Italy to practice medicine? Okay, this is not like I am too related, but in my case, I did something called, that was like the seventh year and you did a couple of months rotating in as an intern and they were evaluating you and like your, skills whatever and then at the end of that, you would take an exam, which was like Step 1 and 2 combined and you got the license. I believe that was cancelled. That doesn't exist anymore. So, to avoid this extra year that you're actually spending doing this and not working. So, regarding the current practices, I am not too sure. I think you still have to do the, but you do it in the 6 years of medical school because medical school in Italy is 6 years. Did you do your clinical elective? Through an agency or by emailing doctors hospitals okay I almost used an agency I even had an interview with an agency and then I did not use it and I just did everything by myself because the agencies want to charge you at least ?2,000 some of them and some of them even more so honestly I did not do that I just because you're already spending a bunch of money. I just emailed I got everything through emails except one the Mount Sinai one and that I paid but directly to them. Not to an agency and it was actually much cheaper than that. It was like ?700 at the time. And it was a whole month, and it was an incredible rotation, and I learned so much. So, I would recommend that observership, 100% and I did not use agencies, but I've heard of people that have and that found them beneficial and some people that used to them and felt scammed because they had 15 other people that were also using that agency. The observers that I did have a maximum of literally I was the only observer. So, I had a lot of attention and time for myself and to learn and to ask questions. I would say that we have time for maybe one more question and then we can wrap it up. Okay, let's see. Final question. Most clinical experiences that I know are observations, I guess observerships. Are there any recommendations for acting internship or any hands-on activities? So, as I said as soon as you have graduated medicine. Like my case, you cannot call it hands-on even though my observerships were very hands-on, I was seeing patients by myself and all that on paper observerships cannot be called hands on because of legal issues because if you're not a student who are they going to sell the soup? Are they going to sue you? No, they have no entity. If you're still a medical student, they could see through your medical school or whatever they have convened like treaties or whatever they have. So after you graduate, you cannot call it hands on mainly for legal purposes, although probably if you gain their trust as I said it is going to be hands on or you're going to learn equally as much if not more because you're already a doctor that knows a lot and maybe has taken some exams. And that's an additional tip I want to give. Before taking the step exams, I was sending emails and no one was responding to Some people even responded, email me again once you get your scores. After I got my step to score and because fortunately it was a very good score is when people started responding to my email. So, first, as I did in 2022, The boat yourself to taking those exams and then I devoted 2023 to do all of those rotations have those letters of recommendation fresh have everything in place so that in I could apply and I'm telling you I went from having 0 letters in March to having 7 in September. So, there's a link. In the chat at the very bottom. And so that you can access a two-week trial first Moses and as you said, you can check out. New product, which is clinical sciences. I think that it's amazing. I think that it's amazing that we have this team. We have algorithms that you can just print and carry with you in your little pocket. So, make sure that you take advantage of this two-week trial and also thank you so much for joining. I'm sorry that I talked too much, but I hope it was helpful and please feel free to reach out and email me with any questions.