USMLE

Hello everyone, a few years back I dreamt of US residency but I had no idea what I was going into. The journey was hard for me but I was fortunate enough to have some wonderful people who guided me through it. I had faith in myself and that’s what kept me going in some of the darkest hours.

I was the only student from my school who completed this journey this far, thus it was hard for me as I had no guide, to begin with. Looking back it made me stronger because I did everything from scratch- starting from understanding the whole process by myself and at the same time educating others- my parents, boyfriend, his parents, my professors, and a lot of other people. I am sure there are hundreds of aspirants who are in the same situation as mine, that is the reason I am writing this blog. This is a small effort to give back to the community. So, to start with, there are many phases in this journey:

Deciding what you want to do

For me, the biggest hurdle was to decide whether I am ready to take this journey. I spent 2 years deciding that. I did 1 year of service at a community rural center, then spent another year preparing for my home country residency. 

Before you start this journey, you need to know yourself, your family, your spouse and have an idea about the future. You need to know what the process is like, how long does it take, what are the stakes and what is your backup plan? Let me start answering a few of the above questions:

THE PROCESS:

Exams

If you are a graduate, you will need to take 4 exams – Step 1, Step 2 CK, Step 2 CS, Step 3(optional: can be deferred until your intern year). Each exam takes minimum 6-9 months of preparation depending on your ability to grasp, study time and years of graduation. 2CS, 3 you will have to come to the US to take it. Again, there are people who have done these exams in 2-4 months time, but that is not the usual case.

US Clinical Experience (USCE)

It is a mandatory (almost) component. This means you have to do a rotation in one of the hospitals in the US to gain an understanding of how things work here. Trust me, it is really helpful both for interviews and exams(especially for CS).

Letter of recommendation

Another vital component- you will have to EARN a minimum of 3 letters of recommendations from physicians, at least 1 from US physician- preferably all 3 from US physicians. The sweeter the letter is, the better your chances of getting brownie points.

Documentation

Trust me, this is the hardest and the most tiring thing of the whole process. I would have never applied for residency if I would have had any idea what a tedious task it is. The US is very specific about the documents, if you mess up one signature with another or a stamp in a different place then allowed, you are screwed. You will have to redo it again. Mind it, international shipping costs a lot and in addition, you have to go to your medical school again and again for the same thing which pisses off both you and your academic office staff. So be prepared to visit your medical school multiple times or have a friend out there who can help you with the documents.

Timing

If you are planning to start residency by July 2021, you will have to have all 3 LORS, Medical school performance evaluation (MSPE) with all other documents sent to ECFMG, US Rotation, Exam results, ECFMG certification all done by September 5th, 2020.  So basically 1 year before you start residency you should be ready. Proper timing is a very crucial component. 

Money

If you are an IMG you will have to come to the US to gain US experience and earn LORs, take Step 2 CS and Step 3 and for that probably will have to travel to the US more than once. So in an average one will be spending around USD 10,000-15,000 (which vary depending on a lot of other factors). 

Chances

Chances of getting matched is variable- you can have 240s in both steps but still get unmatched, on the other hand, someone with 210s- 240s can get matched. It depends on various factors like visa, contacts, interview day, scores, LORs, US experience. Always remember it is a gamble, you can never be confident enough about your chances until the day of Match- March 15th 20XX. There are statistics available on the NRMP website which gives a good overview of the chances of matching depending on the scores, year of graduation, publications, etc. but these are just numbers. I am a deviant of that statistics but I matched!

Conclusion

So in a nutshell, it is a big gamble of time, effort, money and family. But is it worth taking it? Yes, it is. 

The first step is to know what I mentioned above and more. Of course, there are great resources which have answers to thousands of FAQs- Usmle-forum and usmleforum are two great resources which everyone should join. So after gathering sufficient information, ask yourself:-

• Why do you want to do a residency in the US?
• Are you willing to invest 2-3 years of your life preparing and will you be able to handle failure?
• Do you have enough family support, does your spouse or loved one support you?
• Are you financially stable enough to spend this huge amount?

If the answers to the above questions are positive, and you are sure, just dive into it and do not look back. Golden Advice: Do not prepare for both home country residency and USMLE at the same time. You might think you can do it and it will be a safety net if you fail USMLE, but in reality, you will end up with nothing. USMLE preparation needs 100% dedication- to take the Steps, earn rotations by searching available opportunities, earn good LORS, do research and also if possible continuing clinical practice. 

Have faith in yourself and keep going! Goodluck! Feel free to post any queries.