Overview of Residency Matching Program

1. Applicant’s Perspective Warren Go, MD Patricia Baile, MD Michael Mendoza, MD Overview of Residency Matching Program

2. Agenda • Why prepare well for the Match • 2009 NRMP Match Outcome • The Journey Ahead • USMLE and ECFMG Certification • ERAS • Interview Trail • NRMP (Match) • The YADP Program

3. “Time is against you. If you want to train here get everything done now. The only asset you have is being recent grads. Do not waste time with activities that won’t attract program director’s attention” Aldo Dumlao, MD. Class 2002 Utica, New York

5. The 2009 NRMP Match • There were 22, 427 PGY-1 positions in 2009 • There were 36, 972 applications received by NRMP in 2009- an increase of more than 1,016 compared to 2008

6. Why prepare well for the Match?

9. Fill rate of 2009 is 95.4 • Increase of US medical seniors applicants • US IMGs and Non US IMGs registered the largest increase among all applicant groups

10. Specialties with highest matched rate among US medical Seniors • Internal Medicine • Pediatrics • Preliminary Medicine • Emergency Medicine • Anesthesiology • Family Medicine • Diagnostic Radiology • OB-Gynecology • Transitional Year • Surgery (Categorical)

11. Specialties with highest matched rate among US IMGs • Internal Medicine • Family Medicine • Pediatrics • Psychiatry • OB Gyne • Emergency Medicine • Preliminary Medicine • Preliminary Surgery

12. Specialties with highest matched rate among Non-US IMGs • Internal Medicine • Family Medicine • Pediatrics • Surgery Preliminary • Psychiatry • Neurology • Preliminary Medicine

13. Competitive Specialties • Dermatology • Neurological Surgery • Orthopaedic Surgery • Otolaryngology • Radiation Oncology

15. Successful applicants in the match • Rank more programs within their preferred specialty • Mostly US senior • Have higher USMLE step 1 and Step 2 Scores

16. The Journey Ahead

17. Educational Commission for Foreign Medical Graduates (ECFMG) • The “Dean’s Office” of International Medical Graduates (IMG) • IMG • MD or equivalent degree from medical school outside the US or Canada • US citizens graduating from medical school outside US or Canada • Non-US citizen who graduated in any US medical school is not considered IMG

18. Standard ECFMG Certificate • Required before starting ACGME accredited Residency Program • Not required for: • Applying for residency programs • Participating for the NRMP (provided you passed Step1, Step 2 CK and Step 2 CS) • ECFMG certification by September 1 (Advantage)

19. Requirements for ECFMG Certification • Medical school and Graduation year listed in International Medical Education Directory (IMED) • Examination requirements: • Pass Step 1 • Pass Step 2 Clinical Knowledge (CK) • Step 2 Clinical Skills (CS) • Verified Medical Education Credential Requirements • Final Medical Diploma • Final Medical School Transcript • Standard ECFMG Certificate are sent approximately 2-6 weeks after all of the requirements have been met

20. I took USMLE step 1 after 2nd year. Step 2 ck during 3rd year. Step 2cs after 3rd year. Step 3 shortly after graduation. I recommend doing observership or clinical rotations in US. Getting US doctors to write letters of recommendation....... The key to getting a good residency is proper planning and formulating a timeline which you can follow. Francis Ryan Tan Class of 2004 Pittsburgh, Pennsylvania

21. The United States Medical Licensure Examination (USMLE) • USMLE Step 1 • USMLE Step 2 • Step 2 Clinical Knowledge (CK) • Step 2 Clinical Skills (CS) • USMLE Step 3

23. Eligibility for Examination for Step 1, Step 2 CK and Step 2 CS • For Current Medical Students • Enrolled in a medical school outside the United States and Canada that is listed in IMED • Certification from Medical school indicating current enrolment status. • Completed at least 2 years of medical school.

24. For Medical School Graduates • Graduate of medical school located outside US and Canada listed in the IMED. • Medical School must certify your status as a graduate of the school. • Medical credential verification • Consider the postal/processing time lag for receipt of application in ECFMG (least 3 weeks processing)

25. Issues Scheduling Permit Decides to Take Step 1 and Step 2 CK Registration Information Test Delivery Entity IMG Applicant ECFMG NBME Prometrics Score Report for Step 1 and 2CK Decides to take Step 2 CS CSEC US regional CSEC Centers Score Report for Step 2 CS Program Entities for Registering and scheduling for USMLE step 1, Step 2 CK and CS

26. Eligibility Period for Step 1 and Step 2 CK • Eligibility period • Three month period of your choice • Limited Seat availability in Prometrics Test Center during peak seasons. • Busiest testing times in the US/ Canada • May – July • November - December

27. Eligibility and Scheduling for Step 2 CS • 12 Month Eligibility • ONLY administered in the United States • Atlanta, Georgia • Chicago, Illinois • Houston, Texas • Los Angeles, California • Philadelphia, Pennsylvania • dates are available on a “first-come, first served basis. • Availability is not guaranteed • Peak time (Step 2 Calendar schedule) • May to July

28. Travel Status for CS • IMGs are responsible for: • Travel and accommodation arrangements • Tourist VISA • Upon request ECFMG provides Step 2 CS applicants with a letter that may assist for getting Visa • (NOT A GUARANTEE) • If unable to get a US VISA- a full refund can be requested.

29. Reporting of Scores • Step 1 and Step 2 CK • 3-4 weeks after your test date • 6-8 weeks if taken during “Peak time” • Step 2 CS • Found on Schedule for reporting results • Typically 6 weeks. • Dependent on the volume of test takers “peak time”

30. Sequence and Retaking Exams • Steps can be taken in any order except Step 3 • Are you prepared? • Step 1 and Step 2 CK • You may retake more than four times in any 12 month period • Step 2 CS • You may retake more than three times in any 12 month period

31. Tips in Scheduling for Exams • Application, registration and verification all online. • FEDEX or other courier services for sending documents . • Scores = extent of preparation • Don’t think one exam at a time when scheduling. • Schedule with a goal of being ECFMG certified before September 1 • ONLY take exams when you are confident enough that you will get a HIGH score.

32. Tips when studying • Set a HIGH GOAL (99 why not?) • Commit • Choose one reviewer and master it. • Practice, Practice, Practice – MCQs • Take scheduled breaks • Review Materials: • Step 1: First AID, Goljan Notes, Kaplan Materials, Crash the boards, USMLE World • Step 2 CK: Kaplan notes, Crash the boards and USMLE World • Step 2 CS: First AID and Best friend to practice • Step 3: Step 2 CK study materials and USMLE World • Self study vs. Review centers – Discipline? • Pray hard

33. THE ERAS-INTERVIEW-NRMP CYCLE

35. US Graduate Medical Education for IMGs • Standard ECFMG Certificate. • Certain specialties and programs vary in their competitiveness. • The directors of residency programs decides on: • Selection of applicants for interview • Ranking the applicant • Whether a contract is actually offered.

36. Research your specialty and Programs early on. • Select a specialty • Selecting Programs within your specialty • Location of individual programs • Hospital affiliations • Accreditation • Performance of their graduates • INSIDER (Connections!!!!) • FRIEDA Online • ERAS Website • Contact Programs via Email

37. Programs for Applying to Graduate Medical Education programs • ECFMG (Secured Online program) • IMG’s designated Dean’s office • Provides access to ERAS Website (Token) • Applicant’s supporting documents (USMLE Transcript, ECFMG Status report, LORs, etc.) and transmits them to ERAS • Electronic Residency Application Service, ERAS (Secured Online program) • Applicant’s personalized website to contact, apply and transmit “credentials” to program directors. • Program Director’s website to screen, select, “filter” and communicate with applicants. • Generally, US programs accepts application through ERAS.

38. ERAS Documents • Common Application Form (CAF)- “the resume” • Personal Statement • Medical Student Performance Evaluation (MSPE) • Letter(s) of Recommendation (LoR) • Medical School Transcript • USMLE Transcript • ECFMG Status Report • Postgraduate Training Authorization Letter – “California Letter) • 2x2 Colored Photo

40. “Apply to many programs but concentrate on a few and make contact with them showing special interest. Research the programs prior to the interview. As I interview applicants especially IMGs they are too willing to admit that they apply to as many programs.....its a numbers game. That may be so but please never admit it.” Todd M. Reiter, MD Class of 2004 Richmond, Virginia

41. Getting interview invitation • USMLE scores • Number of programs you applied in ERAS. • Insider-Network • Once called for an interview- the playing field is equal for all applicants

42. “Many Filipino applicants that I have encountered are very quiet and modest when they come in for their interviews...This does not help at all and can actually be a point against you...Do not be modest about your accomplishments” Josefina Paderes, MD

43. The Interview Experience“TIPPING POINT” • Could be the most stressful, frustrating, challenging but enriching part of the cycle • Realizations: • Resourcefulness • How to travel and pack light • Forced to “shed” the Filipino “humble/mahiyain” culture. • Meet fellow applicants “Eye opener” how TRULY competitive the match. • How you feel spending 3-4 years of life in the hospital.

44. National Resident Matching Program (NRMP) • An online program that runs the “match algorithm” process • Applicants submit online a list of residency programs he/she has interviewed with in order of preference. • Program directors also submit a list of applicants “they prefer” for their programs –rank order lists

45. Program directors usually rank only applicants they have Interviewed. • There is no guarantee that the programs to which you have applied will interview you or include you on their rank order lists. • If you are ranked by programs, there is no guarantee that you will be matched to any of these programs. • TIP: rank only the programs you like and willing to attend.

46. FINANCIAL ASPECT of ENTERING A US RESIDENCY PROGRAM

47. VARIABLE EXPENSES FIXED EXPENSES • Travel: $ 1,200 (MLA-USA-MLA) • Interview: variable • *Rent: $ 1,000 / month • Living expenses: $600/mo • USMLE Steps 1-3: $ 3,585 • ERAS Registration: $40 • Application for Programs : • 1st 10 programs: $60 • 11 – 20: $8 each • 21– 30: $15 each • 31 onwards: $ 25 each • NRMP Registration: $40 • Estimated Total Cost: 6000-10,000 USD • Estimate based on 6 month stay in US

48. The road to your residency begins now! • STUDY VERY VERY HARD and get HIGH SCORES in USMLE Steps • Start building your CVs-Document it. • Start writing down “memorable” clinical encounters. • Involve yourself in Clinical research, publication opportunities. • Moonlighting vs Concentrating on USMLEs • Start networking • Research your specialty and Programs • Get Medical volunteer experiences local or US • Pray and Work hard

49. Young Alumni Development Program (YADP)

50. Goals and Objectives • Facilitate Transition to US health Care system • Mentor to UERMMMC Medical School graduates pursuing careers in Medicine in the US. • Provide Career advancement in Medicine in the US • Provide network of mentors in medicine • Establish a committee involving mentors, Dean and other faculty members of UERMMMC College of medicine, members of UERMMMC-MAAAA, Inc. And the UERMMARVADC Chapter