Showing posts with label medical school. Show all posts

Wednesday, February 8, 2012

FAQ’s (A pooled list of good questions I’ve been asked by medical students):

1. Question:

I have taken all my USMLE steps and have a few interviews for internal medicine in US. Do i need to apply through the CaRMS match in order to get a J1 visa or just taking the MCCEE would get me the statement of need?

Answer:

For a J1 Visa, you must:

1.Hold a valid ECFMG certificate (which you will receive once you have completed USMLE 1, 2CS, 2CK and graduated).

2. Hold a contract or official offer for a position in an accredited residency program

3. Provide a statement of need (issued by your home country - this serves to confirm your commitment to return to Canada upon completion of training in the US). To obtain one, you can visit the Health Canada website.

You must pass the MCCEE to get one.

2. Question:

What are the commonly asked residency interview questions for which to prepare?

Answer:

See my list here:

http://canadianimgmatch.blogspot.com/p/interview-questions.html

3. Question:

Is it really important to have the MCCQE1 as well as the MCCEE?

Do residency programs in your experience prefer students that have also completed the MCCQE1? I had to complete the USMLE's first due to school requirements for graduation, so I was unable to schedule the exam before this upcoming May session. My classmates previously informed me that the USMLE's are considered equivalent to the MCCQE's.

Answer:

They don't consider the QE exams for the match. USMLEs at this time are only equivalent in Ontario for those who entered residency in 2010 and prior. You will have to take your MCCQE's after starting residency.

4. Question:

“I am at [a great Carribbean med school] and about to take the Step 1 USMLE. As soon as I complete the Step 1, I plan to do some shadowing & get some additional accreditations that might enhance my CV. A big concern I have right now is how my USMLE score will affect my chances of matching in Ontario. Did your scores weigh heavily, if at all?”

Answer:

USMLE scores typically do not matter when applying to Canada. You will submit your scores to the CaRMS application site, but they are not typically considered. I do, however, recommend that you study hard for it to keep options open in the US and obtain as many US interviews as possible (for the interview experience and to have more choices for a residency).

The MCCEE is what you will need to take for applying to Canada. This score does matter for IMG's, mainly as a screening/cut-off tool for interview invitations. Once you get the interview, the score no longer matters.

I talk about scheduling the MCCEE in my first blog post. You should take the MCCEE in September 2012, not too long after you take the USMLE step 2 CK. The content is essentially the same. Be sure to study for each USMLE using USMLEWorld online q bank for practice and getting used to the format/timing.

The MCCEE exam is a shorter exam (4 hours) with shorter question stems. To get an idea, do a few sets of questions on "Canada QBank" a couple of weeks before you take the MCCEE.

5. Question:

What is the scope if one apply for residency in a specialty after completing master in that field? For example, if one is interested in doing residency training in pediatrics, what's the scope of getting a residency in peds after completing master in pediatrics? Will it be a boost on Residency application or will it have a negative impact b/c one is out of clinical practice for long time?

Answer:

From my experience, having a Master's degree definitely boosts your application in applying for residency, especially if it is in the same field. It will provide you with reasons and points of discussion for choosing that particular specialty.

Keep in mind that in Canada when applying for your license before commencing residency (i.e. in Ontario through the CPSO, http://www.cpso.on.ca/), you will need to provide information as to any pause taken during medical practice. This should not be an issue however, since your reason would be to complete a Master's degree immediately after completing medical school.

That being said, in certain fields of general practice, i.e. Internal Medicine, Family medicine, pediatrics, a Master's degree is not expected or required, since many in these fields end up working in the community setting after completing residency, not necessarily as academics (but there are certainly many academic careers that can come from completing one of these residencies).

If you have applied in your final year of medical school and have not matched to a residency program, then doing either a master's or a research year is better than taking the year off, but committing yourself to a Master's may require a minimum of two years. You may even be able to do some clinical observerships if you find the time in a place where you'd like to match.

6. Question:

Were there a fair number of individuals in the mid 30's age range at SGU or will I be “geriatric”?

Answer:

We definitely had a mixed crowd. Most in their 20's, but we had several in their 30's and even a few in their 40's and 50's, believe it or not. It really is "never too late". We had some students who had careers in completely unrelated fields, some who went to grad school, and some who worked as Chiropractors, Physician Assistants and nurses before applying. You will not be a "Geriatric".

7a. Question:

I am an SGU student, about to start my third year clinical rotations and am starting off with medicine core as my first rotation. I will be new to the wards and the added pressure of performing well on an important rotation is making me nervous.

Answer:

Medicine is actually a good one to start with. You'll cover the most important (high-yield) areas needed for boards, so you'll be motivated right off the bat and have an early head start on your studying. You will also see the general approach in clinical scenarios you will apply to other rotations (i.e. you'll be able to look at the big picture when you're on Surgery and be a lot more thorough). Don't worry; they don't expect you to know everything. They know you are just starting your clinicals!

7b. Question:

I was wondering if I could please ask for your advice on how to prepare for these rotations, what to keep in mind during medicine and if there is anything important that I should be doing during clinicals?

Answer:

You will be studying along the way. The SGU affiliated hospitals typically have great didactic lectures scheduled for the students. These are all important topics for boards. Pay attention during those and it helps to study the topic beforehand if you know the schedule in advance. Don't over-study...enjoy your clinical experience and enjoy your time in the US! You will likely review again before the end-of-rotation exams.

In terms of textbooks, please check out this page I made on my blog

http://canadianimgmatch.blogspot.com/p/highly-recommended-textbooks.html

click the link on the left for "Wards". Those are the books I bought.

These will obviously depend on your rotations (i.e. you may not need the Neurosurgery text!).

Did you read my blog on "How to study for the Boards and Wards"?

http://canadianimgmatch.blogspot.com/2010/04/how-to-study-for-boards-and-wards.html

This described how I studied during my rotations.

8. Question:

I have completed all of my USMLE with scores from 86-99, and MCCEE and MCCQE1 with scores in the 95+ percentile.

What programs you think I stand a good chance in? Neurology and Internal Medicine is my preference but I am open to other good specialties like Radiology, OB GYN, etc.
I understand some are thought o get in but what is your suggestion and what should I do to make this happen?
Any other suggestion you want to give me?

Answer:

Your qualifications look solid. If you have a Canadian citizenship, you are ok with the current exams you have completed. If you do not, you will likely need to complete the MCCQE2.

Having a reference from a Canadian physician will definitely help, especially if they are in the field to which you are applying, and they are relatively well known in their field or a program director (but this is not always necessary).

You will need to put forward a very good reason in your personal statement as to why you want to switch from your current program to one in Canada and in a new particular specialty.

Also, you must convey to the program that you really want to practice in that specialty. I know it's difficult to get what you absolutely want, and that sometimes you may feel you have to settle for almost anything in order to match, but programs will see that and may question you on why you have selected certain rotations and why their specialty. It may be better to apply to maybe one or two specialties in which you will be 100% satisfied if you match. Do not apply to multiple, unless you have a solid reason and personal statement tailored to each specialty with an amazingly solid and convincing argument as to why you deserve to be in THAT specialty, and have the rotations and letters to back it up (i.e. Radiology and OB/GYN - very competitive, and very niche specialties). Applying to IM, peds and/or family would be easier given your match in the US.

Also note that there are way fewer IMG spots in Canada (Family and IM are growing in number, but they also have many more applicants). You should check the CaRMS website to see the statistics of applicants last year.

Be sure to consider location and lifestyle. Programs in Ontario are all great and there is a major focus on teaching with really strict rules on allowing residents to have their dedicated teaching time uninterrupted by clinical practice.

They are all major university programs, so the training should be great no matter where you end-up.

Some info on Neurology in Canada:

There are few IMG-friendly programs. Most are in Ontario (Western, Toronto, McMaster, Ottawa). These are major centers with a large catchment area, so you will have a good amount of exposure to all of those rare diseases you read about in textbooks, but never thought you'd see.

If you take all of your MCC exams prior to applying, you have more chances outside of Ontario. For Quebec, you will need to take a French equivalency exam as well, even for McGill (which is an English program).

The Neurology program is 5 years long. (In the US, it is 4 years with your first year being entirely in Internal Medicine).

In Canada, much of your rotations in your first 2 years will be medicine subspecialties (this also includes ER and ICU).

At Western (UWO), you would have 2 months of neurology in PGY-1 and 4 months of neurology in PGY-2.

You will also have 2 months of neuro-radiology and 1 or 2 months (your choice) of neurosurgery.

Upper years: urgent neuro clinic, subspecialty rotations (epilepsy, neuromuscular, neuropathology, pediatric neurology, etc.), electives, longitudinal clinics where you manage followup of your own patients.

Some advantages of a 5-year neurology program:

1. More exposure to subspecialties of neuro (Neuromuscular/EMG, Neuropath, Epilepsy/EEG, Movement disorders, Stroke, Neurorads, NeuroICU, etc., with more elective time). This will make you feel very comfortable/competent should you choose to go into general neurology/community practice. Having 5 years of training is also appealing if applying to practice or do a fellowship in the US later on.

2. If you decide to switch early on to a different specialty, it will be easier, because most specialty programs in Canada are 5 years, including Surgical specialties, OB/GYN, EM, etc. and the 5-year funding can be transferred over. (for example, I have a colleague who switched from Urology to EM early in his 3rd year and had no problem doing so). That being said, I don't recommend switching. I hope you get what you truly want right from the start.

9a. Question:

You mentioned in your first blog post that med students need to write the MCCEE in order to get the J1 to do residency - is this a hard and fast rule?

Answer:

Yes, you need to write the MCCEE if you plan to get into a residency in Canada or the US right out of med school, without taking a year off. This will help getting a J1. The J1 basically requires two things...matching to a US program and filing the right papers through the Canadian government (see the link I provided on my blog).

9b. Question:

What if I want to get a US residency where the hospital sponsors me on a H1B? Would I still need to write the MCCEE if I don't want the J1?

Answer:

The likelihood of getting an H1B is next to impossible before finishing med school in time to start your residency (this should answer your next questions as well!) Also, they offer these less and less.

9c. Question:

You wrote that I would need time off after I graduate to apply for the H1B visa - why? Is there a long processing time?
What if I begin my residency on the J1 (so that I can start residency right after graduating and so that I'm not taking time off after I graduate to wait for the H1B visa application to go through) and then start looking for hospitals that could sponsor my H1B and issue the J1 waiver to exempt me from having to come back to Canada? Should I ask the hospital I apply to for residency to just start me on a J1 but then later switch to a H1B?

Answer:

The hospital will have their requirements for non-US citizen IMG's defined as accepting of J1 or H1B. Most accept the J1 because this doesn't cost the hospital anything, whereas sponsoring you for an H1B costs them several thousand $$. You may apply for a waiver down the road. This is based on need by the hospital and if they're willing to support you. Hope this answers your next few questions.

P.s. there are plenty of opportunities to work in Canada after residency in the US...so don't worry about the J1 and having to come back. The J1 is good for up to 7 years, so it should be enough to do a fellowship after residency, unless you plan on going into neurosurgery (which in itself is 7 years long)!

10. Question:

Do teaching hospitals in the US treat Canadians from Caribbean med schools or Canadians from US med schools better?

Answer:

No difference in most places from what I've seen. Most of the affiliated US hospitals have been used to training IMG's for years. A lot of the attendings in many US schools/hospitals were IMG's!

For those who dread the MCAT (My spiel to the wannabe medical student):

What prompted me to write the following is a US News article I just read on their website, titled “Top 3 Reasons Medical School Applications Are Rejected”.

top-3-reasons-medical-school-applications-are-rejected

Have faith people! Yes, I agree, grades do matter, and I also agree that an obvious progressive upward trend or a small blip on the radar shouldn't hold you back. Your grades show how much effort you put into your chosen coursework.

I do feel however that your MCAT performance only matters because it is the only “standardized” tool available. I am sorry to those who enjoyed a music degree in undergrad; the MCAT is looking to punish you. I don't believe the MCAT provides a strong correlate with how you will perform in medical school. Unfortunately, it is still being used.

To give a personal example, I took my MCAT while in grad school (far removed from the basic chemistry and physics courses I took in my first year of undergrad) and had very little time to study for it, given my demands in the lab amongst other important aspects of extra-curricular involvement. My MCAT score was let's just say in the "20's". The writing sample was my best section (Scored an “S”, scoring is from J-T). I still had several research publications, presentations, leadership roles in extra-curricular activities and teaching experience in the life science fields, with a 3.7 undergrad GPA and a 4.0 grad GPA. Unfortunately, I did not even get an interview at a Canadian/US medical school (I didn’t bother applying to most, considering I knew the MCAT score would keep me from entering the door). I decided to apply to SGU as I was encouraged by the consistently successful residency matches to great programs in the US. I was accepted to SGU and certainly put the work in! I maintained one of the top GPA’s in my class; did well during my clinical rotations in the US alongside Cornell students, and scored 240+/99 on my USMLE. I eventually obtained many residency interviews in the US and Canada, and matched to a great Canadian residency program and had pre-match offers from US programs.

My medical school experience will be missed. I studied basic sciences in amazing weather with students from all over the US, Canada, the UK, etc., and was taught by American and Canadian professors. I loved living in New York during my clinical years – not many med students outside of those at NY med schools can say that.

I must say though, I am glad to be home and training in one of the top programs in my specialty. So far, residency is going great; I’ve kept up the momentum, and my rotation evaluations/feedback from attending physicians and staff have all been extremely positive. I am now involved in conducting interviews and enjoy providing constructive feedback for successful matching.

There are some students who score in the high “30’s” on their MCAT and have a personality that would not necessarily fit with most in the setting of clinical/academic medicine (and no, I am not referring to those that apply to pathology – my pathologist colleagues are fantastic people).

Point of the story: Clearly, the MCAT score is not reflective of your competence and professionalism as a future physician. Schools need to “ease-up” on the weight they put on this exam as a screening tool for medical school candidacy. Some school have, but unfortunately not enough.

-------------------------------

Additional advice for med student hopefuls:

Do your best, study hard, and enjoy the undergraduate/graduate life. Take it all in. Always be respectful of colleagues, keep the drama at home, be open to criticism and, in the words of Jay-Z, “Wipe the dirt off your shoulder”. All of these will be reflected in your letters of recommendation when it comes time to apply to med school.

When you decide to take the MCAT, try taking it shortly after you’ve completed your core basic sciences. Take a review course only if you have the time for it and willing to spend the money or if you need the strict defined scheduled lectures and practice sessions. If you’re involved in research, many research supervisors do not accept “studying for your MCAT” as a good reason to take time off. I understand from my own personal experience that taking this much time off is not always feasible.

Mature applicants looking to switch careers may not be able to take any time off without losing their job in the “hopes” of getting into med school.

Do not re-take the exam if you don’t feel any more prepared the second time around. Don’t sweat the small things. Remember, we are not applying to be rocket scientists; maybe brain surgeons, but trust me, rocket science in my opinion is way more complex than neurosurgery.

If you truly wish to be a physician, but do not wish to prolong the torture of trying to get into a US or Canadian school, apply overseas. The training in most places will prepare you well and the programs teach all of the same evidence-based practices (or should). The one caveat I have is this. If you plan on applying to a Canadian residency program (as a Canadian citizen), going to the UK, Australia, etc. is just as appealing to the programs, if not more so, than going to a Caribbean school. If you plan to apply to a US residency program, Caribbean medical schools (SGU, Ross, AUC, SABA) may be a better option given the opportunity to do all of your clinical rotations in the US. I do not recommend completing too many clinical rotations in the UK coming from a Caribbean school, as some residencies may not accept those rotations as transferrable.

Wednesday, April 14, 2010

How to Study for the Boards and Wards

I've been getting a lot of questions from third-year students regarding study materials. I will go over what books I believe were most helpful for the rotations (the wards) and what books are best for the intense review for the USMLE Step 2 CS, Step 2 CK and MCCEE.

For the Wards, it depends on the rotation. I shuffled through quite a few textbooks before I recognized which were the most effective for end-of-rotation exams (shelf exams). Some of my colleagues liked to use the Kaplan books along the way. I found them a little too dense. If you feel you can cover the entire texts during each rotation, then go for it. For OB/GYN, a subject we learn little about during the first 2 years of medicine, I used the Blueprints Obstetrics and Gynecology , as it was well laid out, covering enough for the wards and the boards. For Surgery, I highly recommend Surgical Recall (and I urge you to listen to the audio files that come with it – you’ll get through the material quicker). For Internal Medicine, Step Up to Medicine is in enough depth to cover you for your rotation and at least 70% of the material on the boards (which is Internal Medicine). In addition, you should have First Aid for the Wards and Boards and Wards, which are concise reference/review books that really help consolidate the important material for your end-of-rotation oral and written exams. These two should also cover you for Pediatrics, Psychiatry and Surgery. For practice questions, I liked the Kaplan Qbook for Step 2 CK. Hang on to Boards and Wards for fourth-year and residency as a handy pocket reference.

For USMLE Step 2 CS, you should take this exam either after Internal Medicine, Family Medicine or Emergency Medicine in your third year. Don’t forget to register early for this exam, i.e. January of your third year for a March-June test date. I recommend studying for two weeks for this exam during your core rotation (Just don’t sign up for a date too close to a shelf exam date). The only book I recommend for this is First Aid for Step 2 CS. Make sure you go over the logistics of the exam itself discussed in the first few chapters and the mock cases in the back of the book and role-play with a friend. Practice doing your History and Physical (H&P) within 15 minutes, and typing up your H&P afterwards within 10 minutes.

For USMLE Step 2 CK, depending on how much time you dedicate to some hardcore studying between your third and fourth year, I recommend choosing between either Step Up to Step 2 CK or First Aid for Step 2 CK if you only have a few weeks to study and want to limit the number of textbooks. In addition, you should definitely pick up Step 2 Secrets, which is a very effective review book in question/answer format with high-yield tables. I only bought this book two weeks before my exam and wish I had started reading it sooner. The most important thing is to make sure you register for a USMLE World question bank. Make sure you do all the questions (2000+). Pace yourself by doing them in timed blocks with randomized questions. If you have extra time to study, you can start by doing questions untimed and your weakest subjects first. Dedicate one day per week in your last two-three weeks to do a full length timed practice test (8 Blocks of questions) – either from the NBME website and/or a USMLE World full-length practice test. Read the explanations to questions carefully on USMLE World, and write down some of the key points in your First Aid or Step Up review book (Writing down notes helps consolidate the information). First Aid for Step 2 CK is not as complete as I would have liked, however, it did provide structure as an outline to my review and was a good last minute review tool, especially with the material I added while doing USMLE World questions. I dedicated four solid weeks to study for Step 2 CK. You may decide you need anywhere between three-six weeks to study for this, depending on how well-prepared you feel after your core clerkship rotations and/or how you performed on Step 1. Do not postpone taking it! You don't want to worry about this exam while applying for residency in early fourth year.

For the MCCEE, as I stated in my previous blog post, you should take this soon after Step 2 CK. The only additional studying I recommend involves doing practice questions on Canada QBank. At least try to cover the ethics/population health-type questions.

- Phil

Tuesday, April 6, 2010

Canadian Students training abroad on the road to residency back home...

Going through the residency application process is stressful, and often times confusing – I should know, I have been there. As a Canadian IMG from St. George's University (SGU) who sincerely wanted to return to Canada for residency, I truly understand how daunting and discouraging the process can seem. In an effort to aid future applicants, I have detailed below some important areas of the application, which should help ease the process, remove some of the guess work – and most importantly help you acquire a Canadian residency!

First steps…exams and credentials!

Whether you plan on applying for residency training in Canada or the US, as a Canadian citizen, you must register with the Physician’s Credentials Registry of Canada (PCRC) in January of your third year (that is if you began in August). Getting a response from them takes a couple of weeks. This is essential to take the Medical Council of Canada’s Evaluating Exam (MCCEE), which is required to apply to the Canadian Resident Matching Service (CaRMS) or to get J1 Visa approval from Canada to train in the US. You may have heard about the H1B Visa as “ideal” and almost unconditional, however, you will need time off after you graduate to apply. US programs must provide sponsored funding for this; some programs will deny you an interview if you only choose to apply with the intent of getting an H1B Visa (but without actually having it yet). The J1 is accepted by more US programs, obtained through the Educational Commission for Foreign Medical Graduates (ECFMG), supported in part by your home country, and valid for up to seven years of training. It requires that you to return to your home country after you have successfully completed residency. You will only begin applying for the J1 Visa once you have matched to a residency program in the US. You can find out more about the J1 Visa on the ECFMG website.

You should take your MCCEE exam shortly after completing USMLE Step 2 CK (The MCCEE September dates in 2009 opened on September 8). So, if you plan on taking the USMLE Step 2 CK in August between your third and fourth year, take the MCCEE as soon as you can in September. Do not fear this exam! It is half the length of the Step 2 CK exam and the content is comparable. If you want some MCCEE oriented practice questions after completing your USMLEWorld Qbank for Step 2, you should try Canada QBank.

Padding that CV…

There are many books and online guides to help with formatting your CV for residency applications. I will only briefly cover what I feel are the most important aspects of the CV and what you should/should not include, what you may forget to include, and what will increase your appeal. Remember, no matter how you decide to organize your CV, keep the date formatting consistent and in chronological order (preferably most recent to least recent).

Research, Presentations – It never hurts to have at least one publication or presentation. It does not need to be in the same field to which you will eventually apply, but if possible, it should. If you have research experience, this should be at the top of your CV just after "Education" (list of degrees/post-secondary education). Even if your presentation and your publication pertained to the same topic, place the presentations under one section and the publication under another. If you have several publications and abstracts, list them under separate sections. Aside from scientific manuscripts, your graduate degree thesis (if applicable) can be placed under publications. Other things you may wish to include are newsletter/journal editorials you have published.

It is never too late to get involved in research. I went to grad school before medical school and had a lot of exposure to basic science research. Those of you that did not can get involved in basic science research during your basic science years of medicine. Approach a professor with whom you’re interested in working, and see how you can contribute to their current research efforts. If there is no lab available, some schools, such as SGU, for example offer surgical anatomy research opportunities using human cadavers through the Student Clinical Research Society (SCRS). In addition, there are also summer opportunities to pursue surgical courses at the University of Alabama at Birmingham. Surgeon-wannabes will benefit a lot from this, having previous surgical exposure when they enter their third year general surgery clerkship. I was fortunate and managed to get three publications out of my experience with the SCRS. During your clinical years, if you come across an interesting case in clerkship, express an interest in writing it up as a case report for your attending. These can be done fairly quickly and published in time for your residency application. Other options could be to approach an attending early-on in a field of interest and ask if there are research opportunities available. Sometimes, an eager student will encourage the attending to complete a paper they have already been working on, and get involved to help expedite the process. Don’t worry where your name goes on a paper - just get it on the paper! Some of these may lead to a presentation at a national conference or at the hospital’s resident research day. Be sure to let the attending know that you are willing to submit and present a poster at a pertinent conference. I am speaking from experience as I have completed two case reports and two presentations during my third core clerkship at NY Methodist Hospital in Brooklyn, NY.

Awards…

Keep these pertinent to Academics. Leave your black belt in karate for the skills section of your resume!

Awards could include any scholarships from undergrad, graduate or medical school; honour society, Chancellor’s/Dean’s List, teaching awards, research studentship awards, etc.

Membership in Professional Organizations…

Take a look at any attending physician’s CV (and not for its overwhelming length). I assure you this section will be on there. It’s never too early to join. The American Academy of Emergency Medicine (AAEM) offers free student memberships. The Canadian Society for Life Science Research (CSLSR) is for students of all levels interested in pursuing life science research (basic and clinical in both academia and industry). The CSLSR has very low membership fees, and provides members the opportunity to meet with potential mentoring physicians/scientists and the chance to present at an annual national conference. The American Medical Students Association (AMSA) is open to all medical students from WHO-approved medical schools. I would recommend joining any one or several of these to gain valuable exposure to your field of interest!

Extra courses complement your “skills”…

All those selectives you took during your basic science years of medical school you thought may be useless, are not useless at all. They may be great content for your personal statement or a topic of discussion during your residency interview, i.e. selective in radiology, head and neck, or that surgical anatomy course you took. If research was involved, put it under your research experience. BCLS, ACLS, PALS, and any other certificates pertinent to health-related courses should be placed under skills.

Complete this section by including any languages spoken (i.e. Fluent in English and French, some conversational Spanish).

Extra-curricular

As with all sections of your CV, your extra curricular activity should be limited to experiences you had as an undergraduate, graduate and medical school student. Since your entire CV should be no longer in length than 2-3 pages single-spaced, only include what you deem to be your most important extra-curricular involvements. Examples include, teaching assistant/tutor; executive/member of health-related organization; clinic or health fair volunteer; student council; journal editor, etc.

Hobbies and interests

List four things, which you love doing in your spare time. You will be asked about these in your interviews, so be prepared to speak about them in detail.

Choosing electives - especially the ones in Canada!

The CaRMS application will ask you to list your fourth year electives. Some like them broad, but you should do at least 1-2 in the field to which you intend on applying. Try and do them as early as possible, and at the place you would like to end-up for residency.

Visiting electives need to be pre-planned and you must apply early for these (6-9 months before the intended start date). This is one of the most important steps in your planning process, having Canadian experience will certainly add weight to your application, and will significantly increase your chances of getting interviews in Canada. Some schools, such as McMaster have quotas on the number of visiting elective students they take from each school. Others, such as the University of Toronto, only allow visiting electives between January-June. This isn’t helpful for those who began third year rotations in August, and have a full year of core rotations to complete by July 31 the following year. So make sure you invest the time to carefully plan, and select electives at Canadian universities, believe me this will pay off!

I would advise taking August between your third and fourth year off to study (for at least three to four weeks) for your USMLE Step 2, and to prepare your ERAS applications for September 1. You should submit your ERAS application for US programs, whether or not your goal is to return to Canada or stay in the US for residency.

McGill is one of the most accommodating places to get an elective. The catch-22 here is that, if you intend on applying to Quebec for residency, you must obtain a certificate of equivalence from the College des Medecins du Quebec (CMQ), which requires completing the MCCEE, MCCQE1, MCCQE2 and a French Exam (in addition to the USMLE steps). Realistically, this would take a full year or more to complete, and most medical students are not willing to wait that long. Why they require so much to allow IMG’s to train in their province is beyond me, but bear in mind that they also end up with more unfilled residency spots than any other province. Completing an elective in a specialty program at McGill is still very valuable; it allows you the opportunity to obtain a letter of recommendation from some of the most recognized Canadian names in the specialty. I did a neurosurgery elective at the famous Montreal Neurological Institute (McGill) with a world-renowned neurosurgeon/neuro-oncologist and he graciously provided me with a letter of recommendation. This ended up being a positive topic of discussion at some of my Canadian interviews for both Neurosurgery and Neurology.

While it’s important to acquire letters of recommendation from Canadian attendings for your CaRMS application, they may not be ready in time for your ERAS application. Do not stress too much about this unless you intend to use the letter of recommendation from an elective in Canada for your US residency applications. You will have until mid-late November of your fourth year to get these letters into CaRMS. Unlike ERAS for the US, the deadlines for CaRMS are not on rolling basis. Your ERAS letters should be ready by September 1 – so make sure you obtain letters from US attendings throughout your third year clerkship.

The best thing to do is research the dates of available visiting electives at each Canadian University on their medical education website (do a Google search for “visiting electives at McMaster or UWO” for example). Contact the school to see if they can accommodate more visiting students, or contact your prospective supervisor and if they approve, submit your application (some require an additional fee, which is well worth it). You should get a response within several weeks. In the grand scheme of things, the Canadian specialists will likely know others within their specialty, and you should not worry about where you do your elective in Canada, but rather with whom you do it. Any experience will be beneficial, even more so if you obtain a great letter of recommendation.

Why should we submit an application to ERAS and make sure it is submitted on opening day?

Because there are hundreds of programs in the US you can apply to for each specialty, and you have equal opportunity for all spots. In Canada through CaRMS, this is not the case. In the first iteration, you are competing against other IMG’s for a few designated spots (i.e. in 2010 there were ten IMG spots for Orthopedic surgery, five spots for neurology, one spot for Urology, one spot for Dermatology, and one spot for Neurosurgery). Although not a frequent occurence, some of those IMG spots remain unfilled (i.e. this year, many specialty programs at The University of Ottawa did not fill their IMG spots for unknown reasons).

It is unspoken, but, being Canadian (requiring a US VISA) and an IMG will put you at a double disadvantage when applying to competitive specialties in the US, i.e. Dermatology, Otolaryngology, Neurosurgery, Ophthalmology, Urology, etc. You may not get interviews at most of the programs to which you apply, but if you apply early, you will increase your chances because interview invitations are sent on a rolling basis. I found this out a little too late. It also helps to call the schools, sometimes an interview you may have intitally been denied opens up. I have a colleague who managed to get twelve Neurosurgery interviews by doing the above, and matched to a neurosurgery program in the US. The advantage of applying to US programs is that their interviews are held a few months earlier than Canadian interviews. Consider this “practice” for the CaRMS interviews and an opportunity to rank US programs, leaving more options open in case you don’t match to a Canadian program. This year, the CaRMS match results came out one week before the NRMP results. It will be expensive, but well worth it, I have colleagues who did get several interviews for IMG spots at Canadian programs this year, but did not match. They waited a week for the US results and matched to a great program. You may also be lucky (or unlucky?) enough to get a pre-match offer requiring you sign a contract with a residency program before the match results. In the US, this is done for IMG’s who impress program directors during their interviews (Canada does not offer pre-matches). This is great if you’re content with staying in the US and really like the program. I received a pre-match offer from an excellent university neurology program, but declined it, hoping to match in Canada. Some IMG’s may feel it is safer to take the offer, however, you are required by legal agreement, to withdraw from all matches if you choose to sign a contract for a pre-match offer.

Do USMLE scores matter in Canada?

This is truly unknown. One program director from the University of Toronto told me “they know what a good score is”. That being said, to some it may matter, especially if the score is high, i.e. 95-99 on a two-digit scale. You will be studying hard for the USMLE regardless and hoping that will translate into a good MCCEE score.

Personal statements

One of the things I truly believe helps the most in obtaining an interview in Canada, is strong evidence in your personal statement demonstrating your commitment to training in that particular specialty and in that particular program. The personal statement requirements are different for every program; you will need to check the CaRMS website to verify the necessary content (some have specific questions that must be answered in the body of your personal statement). Since there are limited programs for each specialty to which IMG’s can apply, you should take your time in putting your personal statements together. They should not be as generic as what you complete for the ERAS application (which does not need to be tailored for each individual program).

I got an Interview!

Once you receive an invitation for an interview, be confident and happy. In Canada, you are up against other IMG’s for the spot (with the exception of a few universities). There are so few spots and you should be proud you’ve gotten this far. The number of applicants vary every year and by program. These numbers are never as high as the US numbers (which makes perfect sense, since neither are the available spots, programs or population). You can search the CaRMS website for Reports and Statistics by year and they will list the number of IMG applicants for each specialty and the percentage of those that matched at all. Aside from primary care, the number of candidates invited for an interview is very small. This year, for one otolaryngology spot at the University of Ottawa, they interviewed three IMG’s out of forty applicants in the first iteration. For Neurosurgery, they interviewed six out of thirty-five applicants for one IMG spot. For neurology, it varied per school. Last year, they had over one hundred and forty applicants for only five IMG spots. To give you an idea of how variable the selection process can be from program to program, this year, for neurology, they interviewed six IMG’s at the University of Ottawa for one spot, ten IMG’s at the University of Toronto for two spots, and about twenty-six IMG’s at the University of Western Ontario for one spot. As previously stated, some spots do not fill at all, but most do. When it comes time to rank the programs, be sure to rank the programs as you want them, not how you may perceive they want you. The match is designed to work in the applicant’s favour (visit the CaRMS and NRMP websites to see how the match algorithm works).

I recommend reading "The Successful Match" by Katta and Desai (2009) for tips on how to prepare your applications and plan for interviews. Although this book seems to apply mainly to US programs, there are great tips that can definitely help when applying to Canada.

Why Canada vs. the US? It only matters if it matters to you. If you want to train closer to home and increase your chances at obtaining an attending position at a Canadian hospital down the road, then apply to CaRMS. No matter where you apply in Canada, you can be sure the training will be excellent. They are all major university programs (unlike many in the US, which are community hospitals), most of them being research intensive with consistent track-records of graduates obtaining competitive fellowships at top universities in Canada and the US.

There are a few setbacks, but since the recent opening of more IMG spots in the last few years, IMG’s, especially those at SGU, are well prepared for residency - giving them a lot to talk about, and the ability to convince the program directors that they deserve the spot. Those applying to Ontario should recognize that they must sign a Return of Service contract agreement, which indicates they must practice in an underserviced community of Ontario (as of 2010, this means anywhere outside of Ottawa or the Greater Toronto Area) upon completing their residency training in Ontario for up to five years. The good news about this is that those who wish to pursue community medicine will have a job available after they complete residency. If you wish to practice in the city, i.e. Ottawa or the Greater Toronto Area of Ontario, you can pay back $50,000 for each year of residency training to get out of fulfilling the return of service. Those who wish to pursue a career in academia do not have to serve in a rural/underserviced environment if they obtain an academic appointment at a university program, where 40% of their time is spent teaching. This is feasible, as most attendings at the University of Toronto, for example, are involved in training/lecturing medical and graduate students, as well as residents and fellows daily. Those wishing to verify this should contact the Ministry of Health and Long-Term Care. Also, unlike other provinces, those who complete residency training in Ontario are eligible to sit for the Royal College of Physicians and Surgeons exams without taking the MCCQE1 or MCCQE2 during residency, provided that they passed all three steps of the USMLE. The buck doesn’t stop there! Should you obtain a residency in Canada as an IMG, prior to commencing your residency program, you will be required to complete one month of pre-residency training with the Centre for the Evaluation of Health Professionals Educated Abroad (CEHPEA), which provides services to internationally educated health professionals including standardized evaluation and orientation programs and assessments for direct entry training in Family Medicine and other specialties.

If you ask me, it’s all worth it in the end. It is important to remember, you must be happy where you train for residency – ideally, with both the program and the location. You may be there for a long time!

This may all seem overwhelming, but, if you truly wish to return “home”, it can be done! I can only imagine as more of us compete for and successfully obtain residency positions in Canada, more doors will open for other Canadians who have temporarily expatriated to attend medical school abroad. This year, aside from me obtaining neurology at the University of Western Ontario, fellow SGU grads obtained Canadian residency positions in Pediatrics, Ophthalmology, Internal Medicine, Family medicine, and Dermatology. Last year, we also had a student match to Orthopedic surgery.

If you put in the time, effort and commitment, it can be done! Although there are few resources out there for IMG’s who want to pursue residency training in Canada, I hope this piece helped to clarify the process. I am committed to helping medical students fulfill their goals, and hope to welcome many more Canadian IMG’s “home” in the future. Good-luck!

- Phil

Abbreviations