Rohayma Rateb
Educational Advisor/Coordinator
EducationUSA Center
AMIDEAST Egypt, Alexandria
Program objective
There are over 6000 medical school graduates in Egypt every year, contributing to a very high and competitive demand for jobs and positions in the medical field. Therefore, graduates seeking promising careers in medical fields are applying to take foreign medical equivalency exams, especially in the US. As an educational advisor, acquiring first hand experience and knowledge of the medical opportunities available in the US for foreign medical graduates is important to my role in assisting them to make realistic career plans. To learn more about specific areas in Medical Residency Programs, I needed to enhance my advising abilities.
Program Profile
The ECFMG certification and residency programs have always been vague in their opportunities, details, information and available options and is one field where specialized advising training is needed in. For years, all the information available has been only what the brochure contained. It was always frustrating and difficult to answer specific questions about specialized residency programs with the little information on hand, especially in such a competitive field. Applying to take the ECFMG and then to residency programs is a long, difficult and anxiety ridden process. The advisor must have all relevant information to answer questions and support this application process. I had no idea about all the options and details involved in the process. I was not aware of the criteria, logistics and steps involved once the application reaches its destination. I was finally enlightened about the ins and outs of the long and complex procedure of accepting an application and the routing it goes through. Advising takes on a whole new angle that is more informative, comprehensive and confident when the advising office is armed with such information.
Program Preparation
The first week in the PAL program was centered around leadership skills and the techniques used in identifying and resolving conflicts. This Leadership Program which used the Myers Briggs test helped me to identify my personality type and communication skills in dealing with others. This was very beneficial in a job where I am dealing with strangers on personal levels that involve future and life choices.
The program provided me with a multitude of skills in a crash/condensed content that included goal setting, presentation skills, type of questions, public speaking, communication skills (being clear, listening, prioritizing, adapting and staying focused.) It was especially helpful in learning flexibility to sudden changes to the scheduled appointments or sudden questions.
Institutions Visited:Research Results
The first and simplest piece of knowledge I gained was that in some schools in the US, the M.D. program is only 6 years as opposed to the universally understood duration of 8 years consisting of 4 years of college and 4 years of medical school. This was definitely new information.
International medical graduates (IMGs’) from an accredited 6 year program have to be ECFMG certified in order to apply to residency programs. The Accreditation Council for Graduate Medical Education (ACGME) is responsible for the Accreditation of post-MD medical training programs within the United States. There are about 8000 residency programs in the U.S. Applicants have to take USMLE Step 1 and USMLE Step 2 CK (Clinical Knowledge) and CS (Clinical Skills), the practical exam which must be taken in the U.S. ECFMG now has 5 CS testing centers in different regions such as Chicago, Huston, LA, and Atlanta in addition to their center in Philadelphia.
ECFMG has an On-line Applicant Status and Information System (OASIS); a web service to allow Applicants to check general information as well as the status of their items related to ECFMG Certification.
After being certified, foreign doctors can apply directly to program directors by using the ERAS (Electronic Residency Application Service). This service is developed by the Association of American Medical Colleges (AAMC) to transmit residency applications, letters of recommendation, dean's letters, transcripts, and other supporting documents to residency program directors via the Internet.After participating in the ERAS, all residency program coordinators
can access the system and check how many requests they have received. Programs
start categorizing the applicants according to their ECFMG test scores, previous
clinical experience, recommendation letters, community service (volunteer work)…..etc
One of the internal medicine programs received this year 1400 applications for
only 28 positions.
The applicants are then invited for interviews. Now applicants need to be qualified to meet the selection criteria. The ACGME endorsed general competencies for residents in the areas of:
Applicants have to be aware of the options of Inside the Match and Outside the Match positions. However, it’s up to the program director to allocate positions in and outside the match.
For the programs to be able to select the applicants as a preference, they need to register with the National Resident Matching Program (NRMP), "the Match" as the final step. It’s a computerized matching program for both applicants and programs, the NRMP matches eliminate the pressure that might otherwise fall upon applicants and programs to make decisions before all of their options are known. The "Ranking" Applicants and programs, then submit their rank order lists directly on the NRMP web site.
In February, after the interviews the applicants have submitted their program
preferences (Rank order list) applicants rank their preferences and programs
rank their preferred applicants. For example, the Match of March showed only
4,382 foreign trained doctors and over 15,000 US citizens were granted positions.
Post match scramble: On the Tuesday of the match week (third week of March)
a list of unfilled positions is posted on the website. It is very competitive
and all positions could literally be filled within an hour. This year’s
post match scramble had 1600 positions.
Applicants have more chances of being accepted in certain specialties such as Internal Medicine, Family Medicine and Pediatrics as they have many more positions to offer than other fields like Orthopedics or Ophthalmology. Such programs are very competitive because they receive hundreds applications for about 4 positions.
Regular residency programs (3-4 years) in areas such as Internal Medicine, Family Medicine and Pediatrics take only 3 years, Surgery is 5 years, Psychiatry is 4 years and Neurosurgery is 7 years. For subspecialties like Cardiology, applicants have to take a 3 year program of Internal Medicine and then Cardiology for another 3 years.
After the applicants get accepted, the medical school administration office sends a packet of information, contract and a temporary license (if required) by the state. The school must send its forms to be filled out by the applicant and they need to submit their credentials such as the diploma and transcript (which should be notarized). If it’s required, applicants have to submit their license to practice medicine in their home country. In the absence of a license, applicants can ask for waiver. The school then works with ECFMG on the DS2019 form, giving ECFMG 4 weeks to issue the form and send it to the school to be forwarded to the applicants.
J1 is always the visa for the residency programs although some programs assign H1 visa if the applicant asks for it but H1 visa requiring USMLE step 3.
Some programs help resident doctors to switch from J1 to H1 since a J1 visa holder (residency program) has a restriction that they need to come back to their home country for 2 years to be able to qualify for the H1 visa. There are other options besides coming back home; they can apply for a waiver program to work for 2 years in an underserved area in certain specialties.
Options in addition to residency programs include clerkships, observerships and research fellowships but most of the state schools don’t accept students for Clerkships or Observerships unless they have an affiliation with the home country institution.
Private schools like Johns Hopkins University School of Medicine offer a wide range of programs including clerkships, observerships and research fellowships for international students. There are no program fees for research fellowships as they consider the applicants to be interns and they receive a monthly salary funded by the National Institute of Health (NIH). Other options are available like clinical fellowships, for example. This is for one or two years and could be extended for a third year (but it requires ECFMG permit or students with previous residency programs).
Potential Follow-up
I have currently covered the ECFMG residency programs. I hope to enrich and expand my research in the future to include clerkships, observerships, clinical fellowships, and Research Assistantships. Once these other topics are covered, I can truly qualify to be an expert advisor on the ECFMG certification and all medical program facets.