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FAQs of young physician seminar Chicago October 20

Find answers to the most commonly asked questions.

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FAQs

Q – Is there a more stringent standard of USMLE for a Pakistani or Indian physicians?
A – No

Q – What is that one thing which makes your application too good to be denied?
A – There isn’t any one particular thing. The parameters for screening are as follows:

  1. The USMLE scores and medical school transcripts
  2.  Being a recent graduate, as there is a better chance of molding him/her as compared with someone who is already working in a senior position in his/her country.
  3. The letters of recommendation are very important as well, and it has to be a personalized letter about the candidate by the recommender.
  4. The applicant is a “well-rounded” individual, in that he/she is not just interested in studying course books but also has other interests and some constructive hobbies.
  5. The candidate must be presentable at the interview, and must know how to interact well with the interviewer.
  6. The follow-up after interview is extremely important as well. Sending a thank you letter or card, but not to the point of harassment and no over enthusiasm.

In a nutshell, the interviewers are looking for a “complete package”, and there isn’t any one thing that can make the application too good to be denied.

Q - Sending emails to program directors and showing interest in their program, would it help a candidate’s chances of securing a residency slot?
A – Generally, it does not help, as October to January is one of the busiest times for the program directors. They are screening applications and interviewing candidates. It is very unlikely that a director addresses all of the emails individually.

Q – Is it too late to apply in October/November, even though it is still before the application deadline?
A – In 2012, screening and interviewing process started a little earlier than it normally does, so generally it is better to apply as early as possible because if a program director likes a particular application as soon as its read, he/she might call the applicant for an early interview. As time goes on, more and more people start applying and the general screening process begins. Sometimes even before the deadline, slots get filled up. Hence, the earlier you apply the better chance you have of getting an interview call.

Q – In the interview, one of the more popular questions is “why do you want to be a physician in our program?” Aside from the passion about medicine and job security, there are various other common replies. What answer would make a candidate stand apart from others and who really is eager to secure a future in medicine?
A – The candidate must have done some kind of research about the program and the university he/she is applying to. The interviewer wants to know about the interviewee and his/her areas of interest and specialty. The interviewer can ask just one question to assess the candidate’s credentials for the slot, whether the candidate has done his/her homework. He/she may not be asked directly the reason for joining the program, so that is something that the candidate needs to communicate during the interview. The interviewer wants honest answers, for example, one of the reasons for joining a program could be that the candidate has family in that particular city, or that he/she grew up in that city. It could also be something unique about the program, like it sends a lot of its residents on mission work. Therefore, the candidate should just give an honest answer as to why he/she selected that program from a list of 800 programs.

Q – What role does STEP 3 play in getting an interview call and in the selection process?
A – This is a very common question amongst applicants. In general, STEP 3 does not count in the screening process or as a factor in the interview. Getting good scores in STEPS 1 and 2 is important. STEP 3 is not a requirement for training in the US, but is only for licensure, and most programs require the candidate to complete STEP 3 within a certain time period during training, but not for the selection process. STEP 3 is only required if the applicant wants to apply for H1 visa for your residency program.

Q – Does a house job or internship back in the home country help a candidate’s chances of securing a spot for residency in the US?
A – It adds to the experience of the candidate if he/she is a recent graduate and did a year of house job or rotating internship in medicine or surgery, provided it was done at a credible institution and is known to the program being applied to. However, it can be a plus point for the applicant if he/she was doing house job or internship in home country while studying for USMLE STEPS than just studying.

Q – According to the new guidelines by the NRMP, programs are either participating in the match or they are offering all their slots to pre-match. In which spectrum do most programs lie?
A – It is a difficult decision for most programs. This is the first year when NRMP has adopted the “all-in” or “all-out” position. For the last couple of years, more than 7,000 IMGs began Post-Graduate Year 1 (PGY1), out of which 4,500 or so have gotten a position through the traditional matching process, and about 2,500 got positions from outside the match (for the most part pre-match). No one knows what the statistics will be for this year. NRMP Executive Director claims that most of the programs are going into the match, but it remains to be seen.

Q – Is it better to interview early because hospitals have more pre-match slots on offer, or is it better to interview late?
A – Some programs start interviews a month earlier, i.e. in October, than it generally starts so as to wrap up the whole matching process as soon as possible.

Q – Do programs look at the 2-digit score or the 3-digit score?
A – This is a highly controversial area in the decision making process. Traditionally programs looked at the 2-digit scores, whereas in recent years programs have started looking at the 3-digit scores. It is a bit problematic for programs to translate the 3-digit score into a 2-digit score. Some hospitals do still try and convert the 3-digit score, which is reported on the USMLE website to students, into the 2-digit score. One particular program uses some sort of an informal table that, for example, would translate a score of 225 into a 90, and the table is based on the most recent exam scores.
The 2-digit score is not a percentage score, but a percentile score based on the candidate’s performance related to everyone else, i.e. a score of 99 does not mean 99 percent. In recent years, about 40% of the examinees have received a score of 99. Then what is the 2-digit score now? The USMLE is going to finish the 2-digit score completely because it is subject to so much confusion. The reason for the 2-digit score is that most states’ licensing boards have a requirement in their regulations that one must get a score of 75 or better to be considered for a residency program. But a score of 75 relates to a different 3-digit score over time. The 3-digit score has a cutoff score as well and every 3-4 years is revised by the USMLE. For example, lets say in STEP 1 the cutoff or pass score is 181, which equates to a 75 (the cutoff score in the 2-digit system). Three years from now, after the house of medicine looks at the results and everything else, they determine the new cutoff score should be 184. At that point, the 184 would equate to a 75 in the 2-digit system. Therefore, the candidates should focus on the 3-digit scores now, and this is the reason that the USMLE is moving away from the 2-digit scores system as it is subject to a lot of confusion and misinterpretation.

Q – What if a candidate applied in September but the result of the clinical part came out in October? Is it too late to send in the clinical scores to the program for consideration?
A – For those programs that are still looking to fill positions in September it’s not late to send in the scores, but for those that have already filled the positions, it is late. Preferably programs would want everything complete at the time they are calling applicants for interviews.

Q – The cutoff value is 90 for a particular program, and a candidate’s score in STEP 1 is above 90 however the 3-digit score for STEP 2 is better than STEP 1 but it is still not in the 90s because of some changes that ECFMG made after June 2012. How is the decision made now? Is it based on the 2-digit or the 3-digit score?
A – STEP 1 and STEP 2 CK have a score whereas STEP 2 CS has just a pass or fail and no 2- or 3-digit score. With respect to the scores, the cutoff point of the 3-digit score will be different for each of the STEPs so one cannot compare the correlation to the 2-digit scores. For example, the cutoff point for STEP 1 may be 180, which may equate to a 75 in the 2-digit system, but the cutoff point for STEP 2 CK may be 184, which again may equate to a 75.

Q – Do programs in general give preference to candidates with a green card over those who require visa support?
A – A candidate with a green card is not necessarily given preference over the ones who require visas but it makes it easier for the program to get them in. Some programs have gone to the extent of waiting for a year for some applicants who have been matched with the residency program but have not been able to get a visa. So the candidate had good credentials but because of some technicality (the visa), he/she has been unable to join the position. It is easier for the programs to get people in when they don't have to go through the rescheduling and other issues; therefore, all things being equal, preference might be given to the person with a green card in some programs. Otherwise, the candidate with better credentials would always be chosen.
Some of the programs don't even consider the visa status. These programs select people purely on their academic merits. But there are some other programs that filter out all IMGs  when screening, but when offering the applicants interviews, the visa status of that candidate is ignored. The other extreme is also there. Programs that don't even offer interviews without a green card or US citizenship. Overall, a vast majority of programs select candidates based wholly on merit.

Q – Residents on J1 visa, do they require a specific DS form if they want to travel abroad? Do they need to contact ECFMG beforehand?
A – If a resident is on J1 visa and its not expired, it is recommended that he/she contacts ECFMG just to make sure that he/she has the most current DS2019 authorized for travel. On the ECFMG website, there are a few unfortunate cases listed when a resident has returned to his/her home country for a short stay and has been unable to get back into the US. It is unfortunate for the resident as well as the residency program. Therefore, candidates must take a conservative approach in this matter and avoid international travel because of the slim possibility of a draconian consequence.

Q – Some foreign medical schools have a very strict transcript as compared with other medical schools in the same country. Are the program directors and selection committee aware of this?
A – In general, the medical school of the applicant also plays a major role in the individual being selected for a residency interview. The ranking of the medical school is also taken into consideration. But most US trained program directors don't pay much attention to foreign school rankings and base their selection purely on the basis of transcripts and scores for the initial screening. It is best to explain something like this to the director if called for an interview.

Q – Lots of transcripts have no mention of honors but only have a pass/fail written. How are those transcripts read during the screening process?
A – A candidate with such a transcript must have a very good reference letter, which should mention the honors earned by the candidate.

Q – Shouldn't candidates be given a chance of an interview even if he/she has an average USMLE score but an exceptional college transcript? Isn't it unfair to rely too much on the USMLE scores while ignoring the other aspects of the candidate’s credentials?
A – It is not possible for programs to interview every single one of the 4000 candidates so some kind of screening process has to come in, and USMLE is used for that. Given the limited resources at the disposal of program directors, it is not possible to interview all applicants.
On the other hand, there are modestly priced tools on the National Board of Medical Examinations website for STEP 1 and STEP 2 CK and CS. Applicants must make use of such tools and evaluate themselves before the real test. This will help them get a pretty good sense based on their performance as to how they would do if they performed the same way on the real STEP 1 and STEP 2 CS and CK. At least the candidates should be familiar with the tools available to them to enable them to score better on the tests.

Q – Would doing residency in Pakistan help make the application a more appealing one for programs?
A – It is on a case-by-case basis. Occasionally programs do look at it in the case where there are 2 very equal candidates, but one has some sort of training in the field he/she has applied to and the other does not. In this circumstance the program director would tilt more towards the applicant with some training in the field, provided the training was taken within the past 10 years. If the training was completed 12 or 15 years, it does not count.

Q – What is a recent graduate? Is this cutoff of “within 10 years” training an arbitrary program-by-program determination?
A – For one program it could be the 10 year limit, and for another it could be 5 years. The main thing the programs look at is what the candidate has been doing during the time between graduation from medical school and applying for residency in the US. Hence, there is no specific cutoff for each program. The candidate must be able to prove that he/she has been productive in those years when he/she was not in clinical work or residency. For example, an applicant graduated in 2008 and then did 2 or 3 post-doc research fellowships and has publications to show for it. In this case the application would be a strong one. However, if the candidate graduated in 2008 and spent the next 4 years studying just for the STEPs, then that is unacceptable.

Q – Hospitals in general do not allow formal externships, which is beneficial for the students as those students are then exposed to medicine as practiced in the US. Hospitals and physicians informally charge the students for such opportunities. Is there a way to really look into the potential of these young physicians and make this externship into something formal, as it will be really helpful for the prospective trainees?
A – All of the hospitals get inundated with such requests, but there is a limit to how many applicants can be accommodated. Externships are good, and some are paid as well, but what the programs look at is whether it was actually beneficial and meaningful for the applicant or not. This is actually a very difficult area. The problem that the hospitals have is that the candidates do not have proper licensure, and it is against the law as well. Also, there are a few problems associated with externships and observerships, which are: 1. The cost issue: it involves a lot of time but no compensation for the administrators; 2. It is a lot of extra approvals in terms of the regulatory approvals required. The hospitals need to get the candidates immunizations and ready to be in a hospital environment; and 3. The physician has to take personal responsibility of that trainee. The trainees are not allowed to touch the patients, but there still have been instances when the observers, through no fault of theirs, have been involved with some issues with patients. Hence, the whole idea of externships and observerships is only there, even though at a high personal cost to the physician, for altruistic reasons on the physician’s part. It is also known to be the “wild west”, in that there is no proper definition or distinction between externships and observerships. People can’t agree on what these 2 concepts mean. There are people out there who are promising the moon and taking advantage and exploiting the needy and, in some cases, desperate people, but there still are some legitimate externships and observerships. An example is at the University of Pittsburgh Medical Center, which has a well established and respected program.
One of the things that the ECFMG’s ECHO program is trying to work on is to try and make some sense of the whole observership/externship world. Another thing that ECHO is working on is the “Plan B” for an applicant. The reality is very difficult these days; the scores that may have worked 15 years ago may not work now. What should candidates do if they find themselves in such a situation? What could be the other options for candidates who fail to get into a program for residency in the US? Whether it be research, or it be in technology, or in the healthcare industry, ECHO is trying to bring out all such “Plan B” situations for the candidates who fail to get into a residency program. Alternate careers is something that is completely overlooked by most physicians, but some of the best and most respected people are outside clinical practice. These careers range from public health to research and healthcare management careers.
The whole idea of externships is that it enables the candidate to be familiar with and adapt to the systems based practice. Nowadays, numerous programs and hospitals outside the US electronic record systems, and managing to get some clinical experience in the US can only help the candidate’s case.

Q – How should a candidate handle a clinical question asked in the interview?
A – There are some programs that still do ask such questions, but some don't too. The reason for not asking a clinical question is that it seems to be a waste of time as the candidate is assumed to be well-versed in his/her particular field, including the clinical side. It also depends on the question asked; the candidate might be given a clinical scenario and asked to explain how he/she would handle that situation. Another possibility is that the candidate is asked a question about a particular scenario and asked for his/her expertise on the topic. These are basic questions that the candidates generally prepare for and are expected to know as well.

Q – A candidate with a fair amount of research applies to a community program that doesn't have a lot of research involved. Should he/she mention the research in the application?
A – Anything that increases the “market value” of the applicant certainly should be mentioned. The research topic and field is secondary. What’s important is that it shows the candidate’s hunger and drive to get things done and be involved in the medical field. The true benefit of research is to account for the years before the residency interview. The candidate need not have to bring it up during the interview, but it certainly carries some value in the interviewer’s decision.

Q – What if an applicant does not have enough resources to get a letter of recommendation from a US clinical physician, as a letter from a US physician would carry more importance than one from a physician in the home country of the applicant? Also, would it be taken into consideration if the applicant has already submitted the application?
A – It varies from program to program, so the best thing is to email the program coordinator and ask them directly. When seeking a credible advisor, it is recommended to search in the advisory network of ECFMG. Candidates can sort out advisors in terms of their specialty and country of origin. It has proven to be very fruitful for many advisees.
Getting a good letter of reference from your mentor or advisor involves a lot of hard work. It has to be planned early by the candidate. Speaking to the mentor before starting rotations about a possible letter of reference is much better than asking for a letter in a casual fashion after the rotation. During rotations, remind the mentor once or twice about the letter and ask them to correct your deficiencies. The advisor or referee would then be able to write an honest letter about you. Also, make sure it is a blinded letter in that you have waived your right to see the letter of recommendation. Ask the advisor to send the letter directly to the program coordinator if it’s after the application process.

Q – After a candidate is offered an interview, which is a stronger candidate for selection: one who is a better candidate on paper or one who seemed better during the interview? What is a bigger factor for program directors when deciding on a particular candidate?
A – After the interviews, when the rank list is being made, the committee gets together to discuss each applicant. At that point, the committee has stopped looking at the scores and go by how the candidate is overall. Hence, the interview process is key as it leaves a lasting impression of the candidate on the interviewers and decision makers. Having some sort of unsaid chemistry can increase the candidate’s chances.
There are some programs that have a scoring system, with points assigned to each factor. For example, if a candidate manages a score of 27 out of a possible 30 points, generally 18 of those 27 points are for the interview and the remainder is for scores and other aspects.

Q – What “buzz” words do program directors look for in a letter of recommendation?
A – Some examples are: “this is the best applicant or candidate I’ve had in the last 5-10 years”, or “in all my 15 years in this position, this candidate would rank in the top 1% of all my trainees”, and “we would be delighted if this resident matched with your program”. Something that would harm a candidate’s chances is: “please call me for additional details”. This means that the recommender wants to discuss something with the program, information that cannot be disclosed in a letter, and hence, it leaves a bad impression on the program director.

Q – During the post-match or aftermath times, what happens in the SOAP process or the scramble process?
A – Usually programs do not have any problems during the match, so they don't go through the scramble process.

Q – This year (2012) programs have the option to be either all-in or all-out. Is this good for the applicants or bad for them?
A – There isn’t a definitive answer to this question, as no one can know for sure whether it is good or bad for the applicant. If on the NRMP website, a program is listed as all-in, then it is all-in. If the program is not listed at all, it doesn't necessarily mean that it is all-out because the deadline for being all-in hasn't come yet. Although if a program is listed as all-out, then the applicant might want to contact the program and ask them directly and appropriately whether it is all-in or all-out. If a candidate has been offered a pre-match, then it’s an all-out program.

Q – What is the role of networking and contacts in an application?
A – At the end of the day, a candidate must have a reasonable application; he/she must have good scores and a CV to be considered for the program at least. If that is not the case, no matter who the candidate knows or how well he/she knows them, it is unlikely that the contact or reference will play a role in the final decision. The program director might conduct a courtesy interview but the candidate cannot be granted a courtesy job. The applicant must achieve something first on his/her own through the application or interview, and then the role of contacts comes in. Making contacts involves building relationships, hence it is absolutely essential that the candidate identifies his/her mentor in time and then try and build a positive relationship with the mentor so as to ask them to put in a good work for the candidate.

Q – What is the role of research funding in conducting effective and noteworthy research in Pakistan?
A – Research funding is a very critical factor that enables a candidate to conduct research, but it is not the most important factor. What is important is the question of the research, the methodology used in conducting research, a relevant and appropriate design to interpret the data generated, and finally drawing appropriate conclusions from the research. All this can be done with minimal funding, or sometimes even no funding at all.