High School students considering a career in Medicine.

Medicine is a way of life (so are most other demanding professions). You need to figure out if that life is for you.

Your training will be 1/4 or 1/3rd of your career, the rest of it will be spent “being” a doctor. People find the idea of being a doctor enticing (money, respect, expert status, living up to other’s expectations) but find that few years in, they can’t wait to do anything other than medicine. Anecdotally, about half of the practicing doctors would choose another profession if they could go back (supported by the data on Medscape about Physician satisfaction). This differs by specialty and or location. Most of the dissatisfaction stems from unrealistic or misplaced expectations. Most of us like to think that if we work hard for a few years, we should be able to enjoy life in the later years. That’s not true for most doctors. Training is undoubtedly harder with longer hours, but as a attending, you have much more responsibility. You can also never get away from working long or odd hours in most specialties.

The doctors who are happy with their decision to pursue medicine are usually the ones that understood the life of a physician, the hours they work and the sacrifices they would have to make. They still choose to practice medicine in spite of these obstacles because they are driven by whatever it is that makes them tick (this is very much subjective). You have to first understand what your life is going to be like and figure out if you have the drive/ motivation to live that life. You are still quite young to figure these things out. More life experience will definitely help with making this decision. I agree with others in that you need to talk to doctors, shadow a few, work in a doctor’s office etc. Also, don’t restrict yourself to any one profession. College might be a good time to diversify. As long as you take the required courses for pre-med, try different things. Talk to lawyers, bankers, engineers, artists, etc. Its not just about whether medicine is right for you. It’s also about whether you like something else more than medicine.

Don’t pick a profession for anyone else but yourself. It only matters what you think about it. Anyone who is disappointed with your choices will eventually come around when they see how happy you are doing what you choose. to do. Also, don’t just listen to people that are unhappy with their career. These generally tend to be younger professionals who are under a lot of pressures apart from their professions and may likely project their discontent as being solely based on their job. Talk to folks who are in their field of expertise for atleast 10–15 years. They can give you a more objective opinion about their field.

If and when you decide to become a physician, I’m sure there are a lot of resources out there to help you get into a medical school. Pick one with good training and student satisfaction. These are not always the top institutes. At the “top” or expensive universities, you often pay for the name and nothing else. The name matters if you want to be a researcher (to get grants) or if you want to lead organizations (improves your market value). For all other reasons, pick a school where the students are happy with their professors or have great class camaraderie. Those are way more important than the big name.

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Are there books that I can use to learn medicine through problem or complaint- based approach?

Are there books that I can use to learn medicine through problem or complaint- based approach?

Answer by Ninad Salastekar:

First Aid Q&A for the USMLE Step 1, Third Edition (First Aid Usmle): 9780071744027: Medicine & Health Science Books @ Amazon.com

First Aid Cases for the USMLE Step 1, Third Edition (First Aid USMLE): 9780071743976: Medicine & Health Science Books @ Amazon.com

First Aid Q&A for the USMLE Step 2 CK, Second Edition (First Aid USMLE): Tao Le, Kristen Vierregger: 9780071625715: Amazon.com: Books

UCSF Hospitalist Handbook | AgileMD (highly recommended)

Rotation Prep | NEJM Resident 360 (highly recommended)

Are there books that I can use to learn medicine through problem or complaint- based approach?

What are some tips for writing a strong medical personal statement for a US residency in neurology as a foreign medical graduate?

What are some tips for writing a strong medical personal statement for a US residency?

Answer by Ninad Salastekar:

While I agree with Pnauman, PS is a required part of your application. So here are some guidelines I use when writing these (incredibly painful) statements.

  • Don’t try to be fancy. Regardless of what you’ve heard, you do not need to write a statement that makes you stand out from everyone else. Don’t get me wrong, it’s great if you volunteered to cure blindness in orphans on the top of the Himalayas, but if you didn’t, no one is going to hold that against you. It’s OK to be average (YES, I said it). But it is unacceptable to be an a%%.
  • The personal statement is about trying to convey the “why” behind your career choices, thus giving the reader a taste of what you are as a person. It is not a chance for you to reiterate your resume. This sounds harder than it seems. I should know. I’ve discarded atleast 20 versions of my PS before finally coming up with an acceptable one.
  • The PS does not have to be about only the medical stuff you’ve done. It does not have to be cliched (Illness in a family member inspired me to become a doctor), although if that is true, then by all means write that.
  • The structure (general, not just for neurology):
    • 1st paragraph: Who you are, why did you choose to be a doctor and why are you interested in this specialty. Include your unique experiences here.
    • 2nd paragraph: Summarize your academic journey giving some insights into your decisions (I accepted a research position after graduating because I am interested in pursuing a career in academia/ I enjoy problem solving and diving into the details of the molecular basis of disease, resulting in a incredible 2 year research position at ABC labs, etc.).
    • 3rd paragraph: Sell yourself. Tell the program why you are a good candidate. Be subtle, but direct (wtf?).
      • Don’t: I’m the best student in my class, have always topped every subject and am the most dedicated and hard-working person you’ll come across.
      • Do: I’m motivated, hard-working, and eager to learn. I believe in a meticulous approach to my work, thrive under pressure and enjoy working and collaborating with people from various disciplines/ specialties. (tailor this to your personality).
    • 4th paragraph: Tell the PD why you love their program (FYI: read about the program, talk to friends in the program. This may not be possible for all programs, but do this for your top 5 programs).
      • Don’t: Your program is the best in the world. You have world-class education, cutting edge research and everyone ends up getting a fellowship.
      • Do: My mentors and seniors who are graduates of the program, speak highly of the quality education offered by your program. I’m particularly interested in ______________ (enter unique aspect of program).
    • End with a summary of whatever you’ve said in the statement, highlighting the main points: You’re excited to be a neurologist and hoping to contribute to research in degenerative neuro disorders. You’re very much looking forward to an opportunity to talk more about your application and the fact that you’re a great “fit” for the program (hinting at an interview). You feel that this program would be a great next step in your career and you would be grateful for an opportunity to work with them (being humble helps).

Finally, do not be discouraged if you don’t have exceptional achievements to talk about, or have little to no research. Remember, this is about giving the reader a chance to know the person you are (hence, personal statement) and not a list of your achievements (you have your resume for that).

After you write the PS, have several people proofread it for grammar and content (preferably native English speakers). Also ask for feedback from people who do not know you well. Ask them if after reading the statement, they felt that you are a likable person. Trust me, if a stranger feels that your statement conveys a friendly and likable picture of you, you’ve written a great PS.

Hope this helps.


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What are some tips for writing a strong medical personal statement for a US residency in neurology as a foreign medical graduate?

How can a first-year medicine student apply as a volunteer at hospitals in the US (to begin with the USMLE)?

How can a first-year medicine student apply as a volunteer at hospitals in the US?

Answer by Ninad Salastekar:

I agree with Christopher.

Volunteering at US hospitals will not help you get into a residency program.

Good scores will. Your time may be most effectively spent preparing for Step 1.

Once you advance to the 3rd or 4th year of medical school, apply to electives in US hospitals. This will help tremendously. You’ll have hands on clinical experience (the only type that matters) and you may end up with great letters of recommendations from the physicians who supervise you during these electives. Other advantages are opportunities to get involved in research to strengthen your resume and the opportunity to network (very important).

Hope this helps.

Good luck!


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How can a first-year medicine student apply as a volunteer at hospitals in the US (to begin with the USMLE)?

Is it really that difficult for an IMG to get residency even after he/she gets good scores in the USMLE?

Is it really that difficult for an IMG to get residency even after he/she gets good scores?

Answer by Ninad Salastekar:

It is. For a number of reasons.

  1. Foreign grads competing for the limited residency spots far outnumber the available positions.
    • 28,849 positions were offered in this year’s match.
    • A total of 35,969 applicants applied to these positions in the 2017 Match.
    • US allopathic seniors (4th year MD medical students) accounted for 18,539 of the total applicants. Their match rate was 94%.
    • DO students accounted for 3590 of the total participants. Their match rate was 81%.
    • Of the 10,127 non-U.S. IMGs who registered for the Match, 7,284 submitted rank order lists of programs, and their match rate was 52.4%.
    • So assuming the match rates of US grads, they filled 20,333 of the positions leaving 10,127 Non US IMGs and 7149 US IMGs, a total of 17,276 applicants, to compete for the remaining 8516 positions. So thats really a 50% chance of matching. Its essentially a coin toss.
    • Luckily, greencard/ citizenship and high scores tilt the probabilities in your favor as IMGs. The rest of it is just networking.

2. What IMGs think matters vs. what really matters in terms of a successful match.

  • So many of us spend a ton of money and time doing things that never actually help. Some of it is the lack of reliable sources of information and mentorship. Some of it is the diverse criteria that programs look for (except high scores and visa) which makes it equivalent to shooting a moving target blindfolded. Some of it is the companies that take advantage of this uncertainty and offer services of questionable important/ value at a steep price, further misleading IMGs.

So yes, it is difficult to match even with great scores. Think of scores as the base minimum requirement to match. Like an eligibility criteria really. Matching successfully takes much more (as so many applicants with great scores will tell you). This generalization of course has its limits as you cross the 260 milestone on your steps. Then the laws of physics breakdown and your personality, emotional intelligence your passion and those other pesky things that everyone tells you are important, don’t matter. There are a lot of programs out there that simply look for who’s got the biggest d***. Oh my bad, I meant scores.

I digress. (I’m on nights. Give me a break)

Yes, it is difficult to match. No it is not always fair. And yes, none of this is important once you match and can finally live out your dream.

Data source: NRMP Match Data 2017


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Is it really that difficult for an IMG to get residency even after he/she gets good scores in the USMLE?

If you have done all the steps of USMLE and don’t get residency, what alternatives do you have as an IMG?

If you do not get into a residency (and want to practice medicine), here are your alternatives:

  • Try again next year
  • Go back to your own country and try to get into a residency program there
  • Go to a different country and try to get into a residency program there (australia, NZ, Canada)

If you’re ok with not practicing medicine, you could do almost anything else.

  • Masters in Public Health: become an epidemiologist etc.
  • Master of Science in Clinical Research: work in academia or industry (pharma)
  • Master of Healthcare Administration: Hospital administration or administrative roles in other medical related institutes
  • MBA: Hospital administration or administrative roles in other medical related institutes, consultancy jobs, etc.
  • PhD: hardcore research in academia or industry (pharma), eventually become a consultant or “expert” in your field of research if you publish successfully, teach, etc.

If you do not want to practice medicine, then you can literally switch careers into a completely unrelated field by doing a Masters (in addition to those mentioned above). People in the US switch careers all the time. Related careers offer higher chances of success.

Passing the USMLE and or having the ECFMG certificate is not good for anythign except to get into a residency training program. The ECFMG certification does not allow you to practice in any other capacity in the US or elsewhere. You might be able to use your USMLE steps to get certified for a residency position in New Zealand (their equivalent of ECFMG certification).

Hope that helps.


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If you have done all the steps of USMLE and don’t get residency, what alternatives do you have as an IMG?

What are the top 10 research topics for undergrad medical students?

This is a difficult question to answer for a number of reasons:

  • what region/ country are you asking about?
  • what is the purpose of the research? Are you looking for a career in research (PhD) or a career in medicine with some research experience?
  • how would you define “top” research topics? Do you mean which ones are the best funded, which ones have the most impact etc.? These are not always the same.

In general, clinical trials testing newer drugs have a lot of hype surrounding them and tend to have the highest chance of changing medical management. Basic science research is another hot field. Discovering new receptors or molecules to target, investigating the physiology/pathology of cancer, research in immunology are some of the “glamorous” research topics in the US.

However, there is research in almost every field you can think of and one can argue that most of it equally important. You never know which breakthrough in which field is going to help us make gigantic leaps in terms of progress. Medical breakthrough is very much dependent on research in other field of engineering, IT, social sciences, psychology etc.

Hope that answers your question.


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What are the top 10 research topics for undergrad medical students?

What can I do to get authorship in a research study in which I spent a lot of time and effort, before being abandoned by the team leader?

Unfortunately, most research assistants do not qualify for an authorship according to the guidelines of most journals. To be included as a co-author, you need to have contributed intellectually to atleast one aspect of the study/research. So if you (as an example) collected data, cleaned the data, conducted study visits, created figures/charts, did some basic analysis, you still wouldn’t qualify to be a co-author. Unless the work you did involved you coming up with an original idea (and not just did what you were asked to do by the PI), you have no legal claim over the authorship.

Having said that, most PIs are very considerate when it comes to encouraging junior researchers to contribute intellectually and will often suggest ways in which such researchers could earn their authorship ( writing a big chunk of the manuscript or coming up with your own research question, analyzing it and writing about it).

But realize that all of this is at the discretion of your PI. If he/she does not want you on the paper, there is very little you can do about it. There definitely are mechanisms in place for you to take such grievances to a committee, anonymously, and have them negotiate a fair agreement, but I don’t fancy your chances when it comes you your word against the PI’s about how much you contributed to the project. Also, you would instantly lose any chance of a recommendation (but you already know that).

So here’s what I suggest:

  • Review literature on the topic of the study you worked on.
  • Pick a reasonable research question that you can answer using the collected data and write about using your data analysis and writing skills.
  • Pick a conference that is likely to accept an abstract based on your research question.
  • Be nice to the PI. Catch him/her in a good mood, be prepared to pitch your abstract idea to him/her.
  • If you insist on doing all the work yourself (analysis, writing and submitting), chances are good that your PI will agree to it.
  • Now analyse the data using excel and write an abstract. Have your PI review it and sign off on it before you submit.

This course of action prevents you from being completely shut out from enjoying the fruits of your labor. Getting an abstract out of it (you’ll be the first author as opposed to some middle author on a manuscript) is better than not getting anything. You also get to keep a civil relationship with the PI. You have the potential of converting your abstract into a manuscript as an added bonus.

I made a lot of assumptions about your role in the study/research. I apologize if this solution doesn’t make sense for you.


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What can I do to get authorship in a research study in which I spent a lot of time and effort, before being abandoned by the team leader?

What should we expect after we do our MBBS and PG in India?

Q. What should we expect after we do our MBBS and PG in India? 

Answer by Alien,MD

Well, I’m going to start with the basics.

Choosing a specialty:

Only two rules:

  1. Pick something you are reasonably confident that you can do (physically and mentally) for the next 20–30 years.
  2. Don’t pick something you hate.

*If you’re lucky, you might end up practicing a specialty which you have a natural aptitude for. You’ll find it easier than others, you’ll do better than others and you’ll love what you do.

*If you’re not so lucky, you’ll pick a field that requires you to stretch your limits, endure a steeper learning curve (frustrating period), but eventually you’ll get good at what you do and more often than not, you’ll begin to love what you do.

Notice that I did not mention money or prestige as a criterion. You get to decide how much you can live with. In any case, give priority to lifestyle over money if you have to.

Also note that I did not say pick something you love. If you start there, (knowing the ridiculous system by which Indian medical students get to select there PG), you’re in for a heartbreak (more likely than not). I would suggest reading the two * scenarios above. Note that in both cases you will eventually end up loving what you do (within reason). So stressing out about picking what you love is a moot point (in my opinion).

Choosing between employee status and starting your own practice:

imgmbbs

This chart only covers the popular options. Other (equally or more important) options include working for the Government (Medical Officers, Advisers or Administrative), academia (of immense value) or research.


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What should we expect after we do our MBBS and PG in India?

Low Step 1 score? Read this first!

black-and-white-woman-girl-sitting

I scored 210 (or insert a score here) on my Step 1, what are my chances?

I screwed up my Step 1 score, should I quit now?

Sounds familiar? This is one of the most common question asked in any of the USMLE forums. My heart goes out to anyone who has poured their heart and soul into studying for Step 1 but ended up with a low score. Step 1 is the hardest test you will ever take in your life. It tests basic science topics that give most students nightmares, it is the first time that most IMGs have to take such a test, and you have to answer stressful questions for 7-8 hours with your life literally hanging in the balance (what if I screw this up!). I think they should have an award for those of us that walk away without a duodenal ulcer by the end of it. If you find yourself in the group of people with unfortunate scores on Step 1, I’m here to tell you that it is not the end of the world.

Is Step 1 score one of the most important factors that determines your success in the match? Probably. But is it the only one? Most definitely not. Would life have been much easier if you had score 20 points higher? Certainly. But does it mean that applicants with low scores do not match? Not at all.

If you look at the NRMP website, almost 272 applicants with Step 1 scores less than 220 matched into IM (Charting Outcomes for IMGs 2016, page 113). Almost 30% of all IMG applicants, with Step 1 scores less than 220, and that applied to IM, matched into an IM residency position. So if you have a low Step 1 score (<220), your job is to be in the top 30% of all candidates with similar scores in order to match. How do you do that?

  • Score well on Step 2 CK and Step 3
  • For the love of God, do not pay for USCE. It is a scam. More on this later.
  • Network, Network, Network! Reach out to seniors, friends, family friends, your uncle’s third cousin’s niece (you get the point), and let them know that you will be applying to their program. Your email/message should say something along these lines:

Hi,

My name is ABC and I’m a friend of QRT. He/she recommended I get in touch with you for advice about applying to IM residency. I’m keen on applying to your program. Do you have any advice for me in terms of what I can do to stand out as an applicant at your program?

I would really appreciate your help.

Thank you.

 

Most people will respond to such an email. The worst case scenario is either they don’t reply or say that they cannot help you. Repeat this process as many times as you can. Eventually you’ll find atleast 5 people who will be willing to ask their program co-ordinators to take a look at your application.

That’s how you get your foot in the door. For more on things you can do to boost your application (besides scores), read my post here.


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