7. FURTHER STRATEGY

For clarity?s sake, I will repeat the whole outline once again here, so that you do not have to go back to the last page to see it.
  1. Get registered with the ECFMG.
  2. Apply for Step 1.
  3. Apply for Step 2.
  4. Take the TOEFL.
  5. Get documents ready.
  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
  19. If you fail to match in the Scramble.
  20. Applying the next year
    21.
  1. TAKE THE TOEFL if you have not done so and when your score is reported, send the TOEFL Score Acceptance Fee and Form to the ECFMG. Without this, they will hold up your CSA application. An online sample test is available on the TOEFL website that you can use to judge your skills. Scheduling and payment over the phone is possible. A portion of the test is audio and needs concentrating because the audio cannot be repeated unlike viewing the comprehension passage as many number of times as you want to.
  2. APPLY FOR CSA so that you can schedule the test by October-November. If you can afford to make multiple trips to the US, you can schedule it earlier, too. Detailed booklet available on ECFMG website. Application processing takes 6 to 8 weeks. Eligibility period begins from the next month in which you get your scheduling permit. Schedule early, because your favorite dates may not be easy to get later. Choose dates so that they fall during a convenient period in between the interviews. This means that even at this early stage you need to be pretty clear about your schedule during the US visit. Have alternative plans ready for contingencies and interview calls popping up in between or at the last moment.
  3. GET DOCUMENTATION COMPLETED NOW.
    There are tutorials and books on the topics and a lot of money changes hands on the subject. Prepare separate PS for different fields you intend to train in. DO NOT SEND THE SAME PS TO DIFFERENT SPECIALTY PROGRAMS!
  4. RESEARCH THE PROGRAMS. With the help of FREIDA online, find all the hospitals and institutions in various states of the US that provide residency positions in the field (s) of your intended training. You may identify any number of institutions with a residency program in the field(s) of your interest. Some candidates will chose at least one field from an alternate allied specialty as a back up, e.g. also apply to family medicine programs with the main interest in internal medicine. Email all the programs of interest and ask about whatever information about the program requirements you need. It is wise to inform your situation and to pointedly ask about the visa, educational, research, and US clinical experience requirements.
    US Clinical Experience (USCE) is helpful in strengthening your applications. Programs ask for at least 4 weeks of such experience, some will ask for a 1-year experience. Many programs give preference to candidates having USCE, many others have a mandatory requirement for it. Most programs will not accept observerships which allow an FMG a spectator status. You can find about externships or active voluntary participation at a hospital near you or where your relatives live. Most useful USCE is a residency done at an accredited US hospital. These are usually people who have finished a 1-year preliminary or transitional residency from a US hospital. Yes! People do that to get USCE. It is difficult to volunteer and support yourself unless you have close family members in the US. You need to contact individual hospitals for opportunities for USCE.


    Programs have very diverse application requirements that may change every year or may be rigid as a rock forever. Mostly programs send out a stereotyped information sheet giving most details, some give out information in a personal manner as asked, some altogether ignore your specific queries and yet others will ask you to visit their web page. Some programs will chose not to respond at all. I must tell you here that I received a response from a program saying they only considered candidates who were related to their faculty. Never heard that one before in my life!

  5. ORGANIZE RECEIVED INFORMATION WELL. Be very clear about what specialties and programs you want to apply to. Read the requirements of all programs carefully before you shortlist them to apply. Take into account your qualifications and experience, graduation year, USMLE Scores, ECFMG Certification, current or proposed visa status, and your US clinical experience, and match them with requirements of each program. If not clear about any item, do not hesitate to mail the program back and clarify. I have heard that dermatology and radiology are virtually out of reach of the FMGs, but surgery and emergency medicine are now more available as AMGs are losing interest in them. As you would have guessed rightly, it has to do with the quality of life for physicians in those specialties.
    As you will soon learn, each ERAS application progressively costs more and more. Do not expect a program to be lenient on its eligibility criteria. If they say they are, good for you, but they are not bound to live up in the end to what they say. Some programs say they will also consider such and such candidates. That is most unpredictable and experiences are very variable on that. Usually, the programs which say they will consider something, e.g. a lower score, a different visa than what they routinely offer/accept, an earlier year of graduation, absence of USCE, etc., will in reality not seriously do so unless you have an exceptional record or abilities!
    Finally, all said and done, it will be very convenient to sort the very favorable, favorable, could-be-favorable and clearly unfavorable programs for application purposes. You will have the best chance of getting called for interviews from the very favorable programs.
  6. ERAS PROCEDURES.
  7. APPLYING THROUGH ERAS is indeed very quick, convenient, and exorbitantly expensive. The policy here may be to apply in one specialty only, or, if you feel like it (out of insecurity, interest, pragmatism, indecision, or any other reasons), to more than one. The price is scaled similarly for each specialty. (Applying to 50 programs in two fields cost me a thousand dollars!) You need to first 'select' these programs from the ERAS database and assign your transcripts, PS and LORs to each as you planned. Just click a few buttons and your application gets wings!!
  8. TRACK YOUR APPLICATIONS ON ADTS. You cannot physically see your applications, but the ADTS acknowledges them by showing within hours a list of hospitals applied to. The programs download the applications usually within 2 weeks. The earlier you apply, the earlier it may be downloaded by the programs and the better are your chances. Later on, they are flooded with applications far exceeding their expectations and they become disinterested. All my applications were downloaded, even if they reached late. Now you must wait for interview calls.
  9. PLAN FOR THE US VISA AND VISIT. US visas and airport immigration checks are very uncertain these days and not likely to ease in the near future. You need to argue your need for a long stay in the US very clearly and sincerely at the embassy and at the port of entry. If you are from some listed countries, you may have great difficulty in getting a visitor visa, especially if you are travelling alone. I know people in India who have passed the USMLE 1 & 2, but cannot get a US visa for CSA, interviews and Step 3. It may be curtains and a waste of all your time, effort and money pumped in this line. On the brighter side, as many as 7 out of 11 candidates for an interview with me at one program were from such countries. YOU MUST IN NO CONDITION VIOLATE YOUR VISA DEADLINE.
  10. KEEP STUDYING FOR CSA. Do not take this test lightly, because it costs $1200! The retake policy is also not kind to you if it is your 3rd or more attempt. CSA is very easy to pass. Just do not get rattled! Keep a discipline of time in all cases so that by the time 5 minutes are left in the case, you are already doing a physical examination. The CSA-Notes CD is an excellent guide, but at some places, a trifle too detailed for the 15-minute patient encounter time on the CSA.
  11. REGISTER WITH THE NRMP ($90) before the deadline passes. NRMP requirements should be fulfilled by the last week of February. See below.
  12. RESIDENCY INTERVIEWS begin in October and continue usually till end-January. You will have a choice of dates, and choose them with some wisdom allowing you to complete them in the same trip with CSA and, if needed, Step 3. Be in contact with the interviewing programs and tell them your travel and visa problems, if any. They will be often considerate and adjust you. If there is any confusion about program eligibility requirements, especially about the visa, clear them with the program on phone or by email before you travel to them. A phone call or email at this time may save you a lot of travel tiem and expense! Keep the travel program easy and straight so that you can be fit for your tests and interviews and also save yourself needless expenses repeatedly criss-crossing this vast country. Arrive at least 15 minutes before scheduled time and be dressed in a suit or the advised dress. It would be wise for girls and women to ask the program beforehand about how to dress. Some programs may have an evening get-together on the eve of the interview. NEVER BE LATE FOR AN INTERVIEW. If delayed, call the program and tell your situation.
  13. THE MATCH STRATEGY. The main job you have to accomplish is to prepare your preference list of the programs (called a Rank Order List or ROL) such that your interests are fully served. The simplest strategy should be an order of programs that you would really prefer to work at after considering your own position and the merits and demerits of the programs. DO NOT go by any assurances you receive at an interview, unless you are yourself very interested in that program. Make sure CERTIFIED ROL appears in green on the right top corner of your NRMP page before the ROL deadline. You can make changes to your preferences on the certified ROL before the ROL deadline, but not after that.
  14. POST MATCH SCRAMBLE. On the first day of the Match Week, you will know whether you matched or not. If you did not match, you must Scramble now. This is another short, sharp opportunity for you. On the second day, a list of all unfilled positions is released. The Scramble starts immediately. The match results for 2003 show that a lot of seats remained unfilled in many fields. This was when not all the seats from a program went through the match. The Scramble runs for 48 hours before the main match results. Preserve and study the list of unfilled positions in the specialty of your interest at various programs.
  15. IF YOU FAIL TO MATCH IN THE SCRAMBLE, you should register with the NRMP FindAResident facility. For those who are already registered with the NRMP for the match, the fee is $30 (2003). After registering, you can import some of the documents from the ERAS to FindAResident. This facility acts as a go-between for the programs with vacant positions and the unmatched candidates. Details are available at the NRMP site.
  16. APPLYING A SECOND TIME NEXT YEAR. Despite so many back up mechanisms, if you fail to get a residency position, it is indeed unfortunate. You need to reconsider your efforts and strategy. Next year, you have the advantage of not having to pass any more exams. You can straight away apply to programs, but you will need to redo the ERAS process. With your earned wisdom and rethought strategy, you should be able to get in this time. Be prepared to answer questions about what is novel about your renewed efforts, what went wrong last time and what have you done to remedy the problems. If you confidently answer all these, nothing will be taken against you. On the contrary, it will reflect positively on your ability to troubleshoot a problem!

USMLE TIPS

STRATEGY1