1. Guide to 4 th Year Electives Hosted by ASG 21 February 2007

2. Why “Away” Electives? Witness medicine, U.S-style. PRACTICE medicine as it is in the U.S Understand WHAT will be expected of you during residency. Understand WHERE you want to complete your residency training. Solidify your choice of specialty. Get LOR’s from U.S. physicians

3. Getting started Setting up electives can be an easy 3 step process. If…you put in the effort early: 1 – Research 1 – Research 2 – Doing the paperwork 2 – Doing the paperwork 3 – Sending out the material 3 – Sending out the material

4. Why are you doing this?? Or how to choose where/what electives. 1.By the summer between 3 rd and 4 th years you should be decided upon your choice of specialty. 2.Further, you should have a geographic area chosen for your residency. This will inform your choice of electives.

5. STEP 1 – Research Visit a medical school near your home Visit FREIDA at www.ama-assn.org. This is probably the best way of choosing. This is probably the best way of choosing. Consult the ASG provided list of past electives

6. STEP 1 Things to consider: 1. DO THEY TAKE FOREIGN STUDENTS? 2. Location -where you are going to live? - Cost of housing. Can be substantial. -how will you get there? 3. Cost -how much does the elective cost -Expenses : transportation, housing, food, gas, utilities, etc. 4. Time/Schedule -What is the limit of time spent at institution -will you have enough time to get from one rotation to the next (if schedule available)

7. STEP 1 Don’t do ALL your electives at Big Name Schools Look for programs that have taken IMG’s in the past and that you are planning to apply to that particular program Make a good impression, will most likely get an interview offer Make a good impression, will most likely get an interview offer

8. STEP 1 Narrow down your possibilities to 4 or 5 different institutions Last part …EMAIL and ASK for the material You might have to have it sent to your house…US/Canadian address. You might have to have it sent to your house…US/Canadian address. Some schools offer all the applications online Some schools offer all the applications online

9. STEP 2 - Paperwork It will involve: getting material from Dean’s office getting material from Dean’s office getting your medical records getting your medical records getting medical tests getting medical tests asking for a number of letters asking for a number of letters Watch out for application deadlines! (Some places have them, others do not)

10. STEP 2 What you will need: 1.Transcript from Dean’s Office 2.Letter of “Good Standing” from Dean or Vice Dean 3.Vaccination proof and/or Titers 4.Malpractice Proof 5.Proof of Personal Health Insurance in the US 6.USMLE Step 1 7.Letter of Recommendation (s)

11. STEP 2 - Transcripts Official transcripts with all completed Basic Sciences and Core Clinical Rotations. PROBLEM ! You are in the middle of your rotations PROBLEM ! You are in the middle of your rotations Solution – make sure Dean’s office puts down “pending” for clinics which you are in or still have to do. Solution – make sure Dean’s office puts down “pending” for clinics which you are in or still have to do. Internal Medicine SurgeryPsychiatry Family Medicine  Might have resubmit to the Elective institution a full completed transcript before starting Make sure that you have all grades and credits from Basic Sciences!

12. STEP 2 – Letter Obtain letter of “Good Standing” What is it? What is it? Nothing more than a letter that you have not killed anyone here, that you are up to date with all your work, and you are mentally stable Who writes it? Who writes it? Dean or Vice Dean should write it What if they don’t have it? What if they don’t have it? You write one, have them read it, and they will sign it. How many? How many? Get enough copies with original signatures as you have applications

13. STEP 2 – Medical Proof You will be asked to provide proof of the following vaccination or exposures to: Polio Polio MMR MMR DPT and last Tetanus booster DPT and last Tetanus booster Hepatitis B Hepatitis B Hepatitis C Hepatitis C Varicella Varicella TB TB Pneumococcal Vaccination Pneumococcal Vaccination You might have to provide Titers for some

14. STEP 2 – Medical Records Do I need titers: YES…it is a definitive way of showing proof that you have been immunized and that you are not infectious now YES…it is a definitive way of showing proof that you have been immunized and that you are not infectious now Where to get it? ASG website has the map posted with directions how to get there ASG website has the map posted with directions how to get there How much is it? It will cost you about 300 zloty to get the following: It will cost you about 300 zloty to get the following: Rubella Ig, Varicella Ig, HBV Ig, HBV Ag, HCV Ig

15. STEP 2 – Medical Records TB – you will have to be tested Where? You can do it at Pulmonology and the cost is 25 zloty You can do it at Pulmonology and the cost is 25 zlotyWhen? What about BCG? They do not care…you still need to be tested. They do not care…you still need to be tested. You will also need to have CXR and if you are lucky they will even write the results in English You will also need to have CXR and if you are lucky they will even write the results in English PPD given Result read MondayThursday TuesdayFriday FridayMonday

16. STEP 2 - Malpractice Available at the Dean’s office at your request. If not there, email the New York Office and have them Fax over a copy with your name on it either to Dean’s office Dean’s office ASG office ASG office

17. STEP 2 – other material Other things they can request: STEP 1 results – if you haven’t taken it, but you are planning on it, then hold off with application until you can deliver the scores, but REMEMBER ABOUT DATES STEP 1 results – if you haven’t taken it, but you are planning on it, then hold off with application until you can deliver the scores, but REMEMBER ABOUT DATES Letters of Recommendation Letters of Recommendation You should be also collecting them for your ERAS/MATCH Consider getting them from Department Heads – some Residency programs also require them

18. STEP 3 – Sending application Check and recheck your application Attach application fee US currency (check/money order) or Canadian currency depending where you are doing your elective US currency (check/money order) or Canadian currency depending where you are doing your elective Money orders can be obtained on Fredry near the Okronglak (round building) at Western Union Money orders can be obtained on Fredry near the Okronglak (round building) at Western Union Send applications home and have your parents attach checks Send applications home and have your parents attach checks

19. STEP 3 – Sending application Before sending application Inquire if rotation is still open Inquire if rotation is still open Get in touch with institution and ask if they can reserve the particular rotation that you are interested in Get in touch with institution and ask if they can reserve the particular rotation that you are interested in Check deadlines to see when you can send it in. Check deadlines to see when you can send it in. If everything is OK…SEND IT! FedEx an expensive but reliable option – tracking option

20. After sending Application Remember it takes a good week for mail to arrive to the US/Canada Ideally, you should get a written response within a month… if you don’t, email or call! If they did not receive your application, ask if you can fax it to them and deliver official version at a later date.

21. Arrival of Letter IF you are approved…You are done. You now only have to worry about getting there. IF you are NOT approved…Call them Ask why Ask why If rotation booked…your alternatives are: If rotation booked…your alternatives are: Change date (if possible) Change to a different rotation Try to pick up a rotation at the other institution that you have applied to

22. Time Line JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptember STEP 1 STEP 2 STEP 3 You should be in electives !

23. What electives should you do? Start out with an “easier” rotation: Outpatient clinic Outpatient clinic Consult Service Consult Service If you are feeling ambitious: Sub-Internship All MS4’s are required to do one All MS4’s are required to do one Extremely demanding, huge responsibility Extremely demanding, huge responsibility Sub-I’s in Internal Med difficult to get, as MS4’s are all required to do one by their medical schools, spots usually full Sub-I’s in Internal Med difficult to get, as MS4’s are all required to do one by their medical schools, spots usually full Save it for the end: Save it for the end: Familiar with the hospital Comfort with writing notes/physical examination Get specialty-specific letter of rec.

24. Conclusion Start early and you should have no problems! If you are planning on doing electives in the Spring the same deadlines may apply to you (check with the medical school) If you are the ‘last minute’ type, you too can get an elective.

25. Essentials:

26. Essentials: Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine – by Marc S. Sabatine

27. Prep for your Electives Practice presenting patients like you would during rounds and writing SOAP notes Pre-read!!!! Learn Lab Values shorthand: Familiarize yourself with medical shorthand terminology: rrr, mmm, ntnd, ttp, no m/r/g….. rrr, mmm, ntnd, ttp, no m/r/g….. WBC Hb Htc Plt Na K Cl HCO3 BUN Cr Gluc

28. Most Importantly: Practice presenting patients like you would during rounds and writing SOAP notes Familiarize yourself with medical shorthand terminology: rrr, mmm, ntnd, ttp, no m/r/g….. rrr, mmm, ntnd, ttp, no m/r/g….. Know EVERYTHING about your pts Follow up on all lab results, imaging studies, line placements, etc Communicate with the nurses – don’t assume that they check their orders regularly If something’s changed, let the nurse know

29. Tips Geriatric pt? - GDS/MSSE -Make sure that they’re seen by PT -Make sure that they’re seen by PT Inquire about pt’s activity level, who do they live with, etc Inquire about pt’s activity level, who do they live with, etc Lines? PICC, central line - note placement and date - ie PICC line in left arm (9/06/06 -) Pt on antibiotics? – Note start of tx ie Zosyn (11/17/06 -) ie Zosyn (11/17/06 -)