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* My match experience and my advice to all IMGs
  braveheart_2020 - 05/18/20 06:12
  I would like to share my match experience with the applicants, especially those that thinks they have red flags, or they are not fit to compete with their current credentials.

My advice is that you should first believe in yourself, and believe that you can achieve your goals eventually. You are an MD, and you shall get residency at the end.

Myself I am an IMG/US citizen, my USMLEs were all below average and didn't do well in them. I tried multiple times to match but didn't get it. I was able to get interviews initially through contacts, and the response I was getting from the program directors (that are IMGs themselves) was like (leave the country, you don't have a chance). Of course I did not listen to them !!!. First, I recognized my gaps in my resume, and have set a plan to compensate for them in order to compete with other applicants.

I ended up doing 3 years of unpaid research fellowship initially and had good number of publications and presented them at national conferences, then did 3 years of clinical fellowships at different hospitals in epilepsy and Neurophysiology at other hospitals, and acquired EEG board certifications eventually over the last 2 years. I was able to establish great exceptional qualification that none of my peers at a resident or applicant level had, and was able to read EEGs and manage epilepsy patients at a very high level.
And finally I was able to match in Pediatric Neurology afterward despite being old graduate with bad USMLEs. The program where I have matched offered me the position after serving as a research fellow for a year in epilepsy. And they were truly supportive to me.

I have done my three years of clinical fellowships at places that have not supported me for residency. However, I was able to get clinical experience doing those fellowships. I saw the quality of care that was provided by the same physicians that were involved in choosing candidates and were labeling them with what so called (red flags).

The epilepsy director of one place was giving the inservice exam questions to the fellows to have them get high scores and get recognized nationally ! Other physician from the same place did not read an EEG for a neonate that had seizures overnight without any intervention. The priority of that program was how to cover up for that mistake !! Our reports were manipulated to cover up mistakes done by the attending at multiple occasions. Other attendings at other hospital where I have done another clinical fellowship had similar problems, and did not review the continuous video EEGs overnight for ICU patients at multiple occasions. Infact during the entire what so called "clinical fellowship" the attendings gave up a total of 8 lectures only during the entire year, and the neurology residents were complaining that they are not being taught by the faculty. No one listened, and no one cares about their complains.
The Neurology chairman at one academic place was supposed to cover IOM procedures during surgeries. IOM is a way to monitor the functions on nerves and spinal cord during critical surgeries. You should alert the surgeon right away if you see any change to get the required intervention. Thus, those studies need to be reviewed live during the surgery, and not afterward. The chairman was relying on the IOM techs to read the study during the procedure which is a big violation and against the standards of care. The techs told me that this chairman has never logged in remotely to access the study during the operation. Infact, I have seen that too during a month of elective that I have done in IOM during my fellowship. You will be able to see if someone has logged in remotely to the study while monitoring. Apparently the tech said that it is ok, we can not say anything to him. Guess who is getting paid for this study? it is the chairman apparently .

When I was a fellow, I was asked to review the long term video EEG studies every 3-4 hours, and after I left, they did not have fellow the year after, and the studies ended up being unreveiwed for more than 12-20 hours at times. This indeed would affects the quality of care provided to patients, especially the ICU patients with risk to develop seizures. The standards of care at that place will be enforced only if there is a trainee to use.

What I am trying to say, some of those that are involved in choosing candidates are truly an embarrassment for the field of medicine. So don't listen to discouraging comments. You will fail to match when you get depressed, and you chose to give up.

My message is, focus on one field of medicine, and do a sincere efforts in it, believe in yourself, and don't listen to the discouraging comments. You should find the right place to put your hard work at. Build your contacts with the attendings and the residents. Everytime you move to another hospital, you are starting from scratch again, you should only consider this step If you feel that your current place is not supportive for residency. If they are not supportive, then leave it and go somewhere else, and do whatever you were doing at your former place. You will be able to impress the new place further with your experience.

I hope this is helpful
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* Re:My match experience and my advice to all IMGs
  braveheart_2020 - 05/23/20 04:16
  Also I am aware about three other persons with similar stories who were able to match at the end:

1- An old graduate (2006) with low USMLE scores. Neurology training at his home country. He did 3 years of unpaid research fellowship in epilepsy, then worked one year in medical billing where he was treated harshly by the staff physician at that office, then he found a spot for clinical fellowship in epilepsy for a year, then did another year at another program. He was able to get a medical license in Illinois and found a private practice place where he could practice with fine salary but lower than the usual physician salary He worked few months under supervision, and then happened to be able to match at the end during the same year in neurology.

2- An old graduate (2005), with good USMLE scores. Pediatric training at her home country. She did one year of research in neuroradiology then two years of clinical fellowships in pediatric epilepsy, then matched at different program in pediatric neurology.

3- An old graduate (2008) with low USMLE scores and no training back home. She did observerships, worked as a lecturer for medical terminology at some college, then did clinical fellowship in pediatric epilepsy, and another fellowship in neuroimmunology. She eventually matched in Neurology last year at different place, however the program where she has matched last year has bankrupted and all residency positions were terminated, and the residents ended up being transferred to different places. She was able to move to an internal medicine program at different state.

Passing USMLE step 3 is mandatory thing if any of you happened to be on the same boat like us. Actually, step 3 became one of the usual things that any residency applicant might have done before applying. So, not doing step 3 make your application not looking good nowadays.
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* Re:My match experience and my advice to all IMGs
  maanas - 05/26/20 13:17
  hi @braveheart_2020,
thanks for the encouraging and supportive massages, yes i am doing MPH in US, neuro fellowship and ABCN boards is a good idea, but i think you cant do it along with a graduate course but afterwards.
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* Re:My match experience and my advice to all IMGs
  huse12 - 06/22/20 21:04
  congrats. your match is highly deserved. I am old graduate 2002. very difficult journey. I was in last year of my pediatric residency when I moved to US, then passed steps became ECFMG certified. Score were not great. Tried two times. signal interview each year but not matched. Then I did MPH in 2015. Got a job as Research coordinator at teaching hospital. Tries step 3 two times but I didn't pass. Now I am in deep pain and feeling of failure is overwhelming. I heard from so many people that you will never matched. It looks like I am wasting my life. I really dont know what to do now.  
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* Re:My match experience and my advice to all IMGs
  braveheart_2020 - 06/22/20 21:44
  Thanks Huse12,
Yes, you might be in difficult position but it is not impossible to match.
Now given that you have attempted step 3 and you didn't pass it, would make you under mandatory obligation to do it again and pass it (hopefully with good score) before your next match cycle. Prepare well for step 3 and do USMLEWORLD Q bank three times or so entirely for step 3.

Next step is to take extra measures to build extra qualifications in your CV that would make you distinguished in your field. The reason I have advocated for epilepsy fellowships here "pre residency fellowship" is to get qualified for the ABCN board (American board of clinical Neurophysiology), which would add extra certifications to your resume. For most programs, they did not care really about my ABCN boards, however, certain neurology/child neurology programs would be interested to know how did you take those exams and if you are truly fit to read EEGs and manage epilepsy patients. I got hired in my residency position because of my extra skills, not because of my USMLEs which I have bad performance in them.
I am aware about two other applicants who also did ABCN before residency and matched in neurology.
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* Re:My match experience and my advice to all IMGs
  huse12 - 06/22/20 22:41
  Thank you brave heart. I worked very hard but now I am dishearted. My job is very clinical and I interact with consenting patients and then follow up through out the study. My boss is helpful. but the university hospital where I work they will not give me residency, very strict rule. I really dont know I will be able to pass my exam  
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* Re:My match experience and my advice to all IMGs
  braveheart_2020 - 06/23/20 03:53
  HUSE12. Then this is not the right place to continue your work at. If the place is not welling to get you residency, then why would other places would take you without knowing you. In your case, the hospital that will give you residency must know you in person, must know you are hard worker, and must see your qualifications. And USMLE step 3 is a must for you, given you have took it twice and failed. You don't want your USMLE score report that get mailed to the programs to show you have failures with no passing attempt.

Look for a programs where you can do research or fellowship, preferably, with the chairman, program director or associate program director. You don't want to work with a lab, and the person that is involved has nothing to do with the selection committee.
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