6. STRATEGY AND PLANNING

The foremost goal of every candidate should be to finish the whole process in the shortest possible time, with minimum possible expense and maximum possible outcome!

Strategy and planning depend on the status of the candidate, availability of diploma, readiness of other documents, ability to spare time and money, and various other factors to which your fancy points. I will just tell you what is a good strategy for all and what should be good for an FMG who is already a graduate or more, punctuated by my own story in between. It is not necessary that one should follow in my footsteps, and my case is not the usual one anyway, but events may take a similar course and a candidate may need to follow the same steps as I did. I would recommend that you try to do your best under your circumstances and not commit the same mistakes that I did. A failure at any stage is very expensive in terms of loss of time, confidence and money. Prevention of these three tragedies is the whole idea behind this elaborate website.

The following steps are common to all FMGs. The only difference in the medical student scheme is in the timing of the initial tests.

  1. Get registered with the ECFMG.
  2. Apply for Step 1.
  3. Apply for Step 2.
  4. Take the TOEFL.
  5. Get documents.
  6. Research residency programs.
  7. Organize received information.
  8. Get ERAS token & start your ERAS account.
  9. Apply through ERAS.
  10. Track your applications on ADTS
  11. Plan US visa and visit.
  12. Take the CSA
  13. Register with the NRMP
  14. Residency interviews
  15. Apply for Step 3 if needed.
  16. The Match strategy
  17. Post Match Scramble.
  18. FindAResident facility
1. For the best outcome, it is important for all candidates to finish their ECFMG Certification requirements before their interviews. Although not always, the residency programs tend to place candidates with ECFMG Certification higher than those who are still to get it.

2. There will be NO PREMATCH residency placements from 2004!! All residency seats must necessarily go through the Match.

CASE 1. THE MEDICAL STUDENT

Boy! You are sharp and wise if you have already decided at this early stage to go ahead and try for a US residency.

If you have entered a medical school outside the US and are reading this, you have the best opportunity of all others. This is because you have a spread out schedule which is easy on your time and pocket. Also, you will not need to strain unduly over academics. Although policies in the US may take a more favorable or unfavorable turn by the time you complete the process, you have the luxury of time on your side, which most FMGs do not have.

This is how best you can carry out the initial steps in your campaign:

  1. Apply for and take Step 1. Get registered with the ECFMG and apply for USMLE Step 1 on the same form when you are completing studying anatomy, physiology, pathology, pharmacology, and social medicine. This should be at least 2 years after joining the medical school. Your medical school Dean will need to verify your medical school status. Give the registration 4-8 weeks. When this is complete, you receive your ECFMG ID which you should learn clearly by heart. This will not change lifelong. Plus, you should have received an orange permit for taking the Step 1 exam. You will also receive a letter with these telling you your eligibility period for taking Step 1, which usually begins the following month and lasts 3 months. This period may be extended by paying a fee if you cannot take the test in the specified 3 months. Rules are available in a booklet that ECFMG sends you or from their website.
  2. Apply for and take Step 2. For this you should apply to the ECFMG while undergoing your rotating internship preferably before January of the year in which you wish to begin your residency in the US. You are required to complete at least 4 years of medical school. Orange permit and other things will be as for Step 1.
  3. Apply for and take TOEFL.
  4. Proceed with the rest of the steps as listed above. Plan your CSA during the interview season.
CASE 2. THE EXPERIENCED MEDICAL GRADUATE

You, with some working experience, have a few advantages over medical student applicants. You need not wait between the USMLE Steps 1 and 2 (I took them one week apart), in fact, some prefer to pass Step 2 before Step 1. You may have a residency or hospital work experience which will be looked favorably upon. (You will have to repeat the residency anyway!). You are more confident in handling patients. You will not need to study too hard in your specialty for the exams. Someone from internal medicine, like me, will decidedly have it easier than graduates from other fields. Research experience and publications give you good credit.

There are some disadvantages, too. The pressure is on you to finish the whole process in the shortest possible time. Studying for Step 1 is not easy, especially if you have been away from academics for a long time. You will have to study current physiology, anatomy, pathology, social medicine and other subjects all over again. Your studies may be compromised by your attention to some other factors mentioned below. You may tend to become worn off and detached earlier in the face of setbacks than a student candidate. You may have families to support, a job at stake, pressure of existing work, and so on. Moreover, as is my experience, despite good scores, you will not be considered by many programs on the basis of your graduation year and your age; not even by those programs that profess not to have a graduation year limitation. On the other hand, my example again, there are some programs that will appreciate your experience, efforts and achievements.

For everyone, there is a huge lot to gain. I can tell you, the chances of your success are directly proportional to your determination and motivation. You should hold your head high, have confidence, and show them what you are!

The following should be a good strategy for you:

  1. Register with the ECFMG and apply in the same form for Step 1 and, if you like to take it within a short time, for Step 2. It will cost you double the money in one go, but half the time, and that is very important. The best time to take these tests is before the May of the year before you wish to start your residency in the US. You should have your score reported by June and you will be ready to start your ERAS account in mid-July.
  2. Take TOEFL.
  3. Get the LoRs, Dean?s Letter, and your personal statement (PS) completed before July.
  4. Proceed as for the general scheme outlined above. Plan your CSA during the interview season.

STRATEGY 2

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