Overview of Residency Matching Program Applicant’s Perspective Warren Go, MD Patricia Baile, MD Michael Mendoza, MD

Agenda Why prepare well for the Match The Journey Ahead 2009 NRMP Match Outcome The Journey Ahead USMLE and ECFMG Certification ERAS Interview Trail NRMP (Match) The YADP Program

“Time is against you. If you want to train here get everything done now. The only asset you have is being recent grads. Do not waste time with activities that won’t attract program director’s attention” Aldo Dumlao, MD. Class 2002 Utica, New York

The 2009 NRMP Match There were 22, 427 PGY-1 positions in 2009 There were 36, 972 applications received by NRMP in 2009- an increase of more than 1,016 compared to 2008

Why prepare well for the Match?

Fill rate of 2009 is 95.4 Increase of US medical seniors applicants US IMGs and Non US IMGs registered the largest increase among all applicant groups

Specialties with highest matched rate among US medical Seniors Internal Medicine Pediatrics Preliminary Medicine Emergency Medicine Anesthesiology Family Medicine Diagnostic Radiology OB-Gynecology Transitional Year Surgery (Categorical)

Specialties with highest matched rate among US IMGs Internal Medicine Family Medicine Pediatrics Psychiatry OB Gyne Emergency Medicine Preliminary Medicine Preliminary Surgery

Specialties with highest matched rate among Non-US IMGs Internal Medicine Family Medicine Pediatrics Surgery Preliminary Psychiatry Neurology Preliminary Medicine

Competitive Specialties Dermatology Neurological Surgery Orthopaedic Surgery Otolaryngology Radiation Oncology

Successful applicants in the match Rank more programs within their preferred specialty Mostly US senior Have higher USMLE step 1 and Step 2 Scores

The Journey Ahead

Educational Commission for Foreign Medical Graduates (ECFMG) The “Dean’s Office” of International Medical Graduates (IMG) IMG MD or equivalent degree from medical school outside the US or Canada US citizens graduating from medical school outside US or Canada Non-US citizen who graduated in any US medical school is not considered IMG

Standard ECFMG Certificate Required before starting ACGME accredited Residency Program Not required for: Applying for residency programs Participating for the NRMP (provided you passed Step1, Step 2 CK and Step 2 CS) ECFMG certification by September 1 (Advantage)

Requirements for ECFMG Certification Medical school and Graduation year listed in International Medical Education Directory (IMED) Examination requirements: Pass Step 1 Pass Step 2 Clinical Knowledge (CK) Step 2 Clinical Skills (CS) Verified Medical Education Credential Requirements Final Medical Diploma Final Medical School Transcript Standard ECFMG Certificate are sent approximately 2-6 weeks after all of the requirements have been met

I took USMLE step 1 after 2nd year. Step 2 ck during 3rd year I took USMLE step 1 after 2nd year. Step 2 ck during 3rd year. Step 2cs after 3rd year. Step 3 shortly after graduation. I recommend doing observership or clinical rotations in US. Getting US doctors to write letters of recommendation....... The key to getting a good residency is proper planning and formulating a timeline which you can follow. Francis Ryan Tan Class of 2004 Pittsburgh, Pennsylvania

The United States Medical Licensure Examination (USMLE) USMLE Step 1 USMLE Step 2 Step 2 Clinical Knowledge (CK) Step 2 Clinical Skills (CS) USMLE Step 3

Matched US Applicant Score USMLE TOPICS ITEMS Blocks Matched US Applicant Score STEP 1 Basic Sciences 336 Multiple Choice test items 7 blocks (60 mins/block) 225 STEP 2 Clinical Knowledge Clinical Sciences 352 Multiple Choice Test items 8 blocks (60 mins./block) 231 STEP 2 Clinical Skills ICE, CIS and SEP 12 Patient Encounters 15 mins. Patient encounter and 10 mins. Clinical note Pass STEP 3 Emergency Dept. Inpatient, Outpatient, Office 480 Multiple Choice test items, 9 Computer based Case Simulations DAY 1: 7 blocks DAY 2: 4 blocks and 9 CCS case

Eligibility for Examination for Step 1, Step 2 CK and Step 2 CS For Current Medical Students Enrolled in a medical school outside the United States and Canada that is listed in IMED Certification from Medical school indicating current enrolment status. Completed at least 2 years of medical school.

For Medical School Graduates Graduate of medical school located outside US and Canada listed in the IMED. Medical School must certify your status as a graduate of the school. Medical credential verification Consider the postal/processing time lag for receipt of application in ECFMG (least 3 weeks processing)

Issues Scheduling Permit Decides to Take Step 1 and Step 2 CK Registration Information Test Delivery Entity IMG Applicant ECFMG NBME Prometrics Score Report for Step 1 and 2CK Decides to take Step 2 CS CSEC US regional CSEC Centers Score Report for Step 2 CS Program Entities for Registering and scheduling for USMLE step 1, Step 2 CK and CS

Eligibility Period for Step 1 and Step 2 CK Three month period of your choice Limited Seat availability in Prometrics Test Center during peak seasons. Busiest testing times in the US/ Canada May – July November - December

Eligibility and Scheduling for Step 2 CS 12 Month Eligibility ONLY administered in the United States Atlanta, Georgia Chicago, Illinois Houston, Texas Los Angeles, California Philadelphia, Pennsylvania dates are available on a “first-come, first served basis. Availability is not guaranteed Peak time (Step 2 Calendar schedule) May to July

Travel Status for CS IMGs are responsible for: Travel and accommodation arrangements Tourist VISA Upon request ECFMG provides Step 2 CS applicants with a letter that may assist for getting Visa (NOT A GUARANTEE) If unable to get a US VISA- a full refund can be requested.

Reporting of Scores Step 1 and Step 2 CK Step 2 CS 3-4 weeks after your test date 6-8 weeks if taken during “Peak time” Step 2 CS Found on Schedule for reporting results Typically 6 weeks. Dependent on the volume of test takers “peak time”

Sequence and Retaking Exams Steps can be taken in any order except Step 3 Are you prepared? Step 1 and Step 2 CK You may retake more than four times in any 12 month period Step 2 CS You may retake more than three times in any 12 month period

Tips in Scheduling for Exams Application, registration and verification all online. FEDEX or other courier services for sending documents . Scores = extent of preparation Don’t think one exam at a time when scheduling. Schedule with a goal of being ECFMG certified before September 1 ONLY take exams when you are confident enough that you will get a HIGH score.

Tips when studying Set a HIGH GOAL (99 why not?) Commit Choose one reviewer and master it. Practice, Practice, Practice – MCQs Take scheduled breaks Review Materials: Step 1: First AID, Goljan Notes, Kaplan Materials, Crash the boards, USMLE World Step 2 CK: Kaplan notes, Crash the boards and USMLE World Step 2 CS: First AID and Best friend to practice Step 3: Step 2 CK study materials and USMLE World Self study vs. Review centers – Discipline? Pray hard

THE ERAS-INTERVIEW-NRMP CYCLE

US Graduate Medical Education for IMGs Standard ECFMG Certificate. Certain specialties and programs vary in their competitiveness. The directors of residency programs decides on: Selection of applicants for interview Ranking the applicant Whether a contract is actually offered.

Research your specialty and Programs early on. Select a specialty Selecting Programs within your specialty Location of individual programs Hospital affiliations Accreditation Performance of their graduates INSIDER (Connections!!!!) FRIEDA Online ERAS Website Contact Programs via Email

Programs for Applying to Graduate Medical Education programs ECFMG (Secured Online program) IMG’s designated Dean’s office Provides access to ERAS Website (Token) Applicant’s supporting documents (USMLE Transcript, ECFMG Status report, LORs, etc.) and transmits them to ERAS Electronic Residency Application Service, ERAS (Secured Online program) Applicant’s personalized website to contact, apply and transmit “credentials” to program directors. Program Director’s website to screen, select, “filter” and communicate with applicants. Generally, US programs accepts application through ERAS.

ERAS Documents Common Application Form (CAF)- “the resume” Personal Statement Medical Student Performance Evaluation (MSPE) Letter(s) of Recommendation (LoR) Medical School Transcript USMLE Transcript ECFMG Status Report Postgraduate Training Authorization Letter – “California Letter) 2x2 Colored Photo

“Apply to many programs but concentrate on a few and make contact with them showing special interest. Research the programs prior to the interview. As I interview applicants especially IMGs they are too willing to admit that they apply to as many programs.....its a numbers game. That may be so but please never admit it.” Todd M. Reiter, MD Class of 2004 Richmond, Virginia

Getting interview invitation USMLE scores Number of programs you applied in ERAS. Insider-Network Once called for an interview- the playing field is equal for all applicants

“Many Filipino applicants that I have encountered are very quiet and modest when they come in for their interviews...This does not help at all and can actually be a point against you...Do not be modest about your accomplishments” Josefina Paderes, MD

The Interview Experience “TIPPING POINT” Could be the most stressful, frustrating, challenging but enriching part of the cycle Realizations: Resourcefulness How to travel and pack light Forced to “shed” the Filipino “humble/mahiyain” culture. Meet fellow applicants “Eye opener” how TRULY competitive the match. How you feel spending 3-4 years of life in the hospital.

National Resident Matching Program (NRMP) An online program that runs the “match algorithm” process Applicants submit online a list of residency programs he/she has interviewed with in order of preference. Program directors also submit a list of applicants “they prefer” for their programs –rank order lists

Program directors usually rank only applicants they have Interviewed. There is no guarantee that the programs to which you have applied will interview you or include you on their rank order lists. If you are ranked by programs, there is no guarantee that you will be matched to any of these programs. TIP: rank only the programs you like and willing to attend.

FINANCIAL ASPECT of ENTERING A US RESIDENCY PROGRAM EXAM PREPARATION COST Step 1 3 months $ 710 (+130) Step 2 CK 2 months $ 710 (+145) Step 2 CS 1 month $ 1,200 *Step 3 $ 690

FIXED EXPENSES Estimated Total Cost: 6000-10,000 USD VARIABLE EXPENSES USMLE Steps 1-3: $ 3,585 ERAS Registration: $40 Application for Programs : 1st 10 programs: $60 11 – 20: $8 each 21 – 30: $15 each 31 onwards: $ 25 each NRMP Registration: $40 Travel: $ 1,200 (MLA-USA-MLA) Interview: variable *Rent: $ 1,000 / month Living expenses: $600/mo Estimated Total Cost: 6000-10,000 USD Estimate based on 6 month stay in US

The road to your residency begins now! STUDY VERY VERY HARD and get HIGH SCORES in USMLE Steps Start building your CVs-Document it. Start writing down “memorable” clinical encounters. Involve yourself in Clinical research, publication opportunities. Moonlighting vs Concentrating on USMLEs Start networking Research your specialty and Programs Get Medical volunteer experiences local or US Pray and Work hard

Young Alumni Development Program (YADP)

Goals and Objectives Facilitate Transition to US health Care system Mentor to UERMMMC Medical School graduates pursuing careers in Medicine in the US. Provide Career advancement in Medicine in the US Provide network of mentors in medicine Establish a committee involving mentors, Dean and other faculty members of UERMMMC College of medicine, members of UERMMMC-MAAAA, Inc. And the UERMMARVADC Chapter

Eligibility Criteria for YADP Graduate of UERMMMC who are seeking residency or fellowship training in the US. Must have passed USMLE Step 1 or Step 2. Must be responsible for obtaining appropriate VISA, living expenses, accommodation and health needs.

“So in closing, make good use of your time - even if you do not get in this cycle. Look for ways to enhance not only your experience but most importantly your academic track record - that is well documented and verifiable. A few abstracts or one peer reviewed publication (does not need to be 1st author) will surely beat one dozen observerships in some obscure clinic that carry no or very little academic impact or pedigree” Don't lose hope, continue to aim high but remain realistic - and best of luck!! Romergryko G. Geocadin, MD, Class 91 Director, Neurosciences Critical Care Division Johns Hopkins Medical Institutions

Get more Information ECFMG (www.ecfmg.org) Fellowship and Residency Electronic Interactive Database (FRIEDA) – www.ama-assn.org/ama/pub/category/9306.html ERAS (www.aamc.org/eras) NRMP (www.nrmp.org) USMLE (www.usmle.org) Prometrics (www.prometrics. Com) YADP yahoo groups SDN USMLEtoMD Prep for USMLE Iserson, KV. Iserson’s Getting into a residency: A guide for Medical Students, 6th Edition www.uermmarvadc.org