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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
  oldgrad2000 - 05/18/20 23:17
  thank you so much for your encouraging post, exact same situation as you were in, still trying get a foot in some how, was trying to work on that neurology fellowship thing you suggested but no luck yet, will keep trying.  
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* Re:My match experience and my advice to all IMGs
  braveheart_2020 - 05/19/20 05:34
  You are welcome
If you could afford an unpaid research fellowship training as a start, I would suggest you contacting the following two places:

1- Research fellowship , Epilepsy, UH Cleveland Medical Center (previously named : Case Medical Center). They are known to appoint research fellows and sponsor J visas for that if needed, they would train you very well in epilepsy. If you have great USMLEs and you are fresh graduate, they will take you afterward for residency at their own place, otherwise they can provide you with LORs only. Most of researchers that I know have matched elsewhere (only 2 matched at UH). Even though I was not considered for residency there, I am very grateful for being trained there, since that is where I have really learned all my skills.

2- Research fellowship, Epilepsy, University of Texas at Houston. The former epilepsy director at Cleveland medical center has moved to Houston and became vice chairman of Neurology there two years ago. He replicated the same research fellowship in epilepsy at his program.
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* Re:My match experience and my advice to all IMGs
  c137 - 05/19/20 08:50
  Hi braveheart, first of all thank you for sharing your experience. I wanted to ask you about the fellowship: when I go onto the site it says one of the requirements is to have completed a neurology residency. Am I looking at the wrong web page, or did you actually do the fellowship before getting into residency?

Thank you for your time
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* Re:My match experience and my advice to all IMGs
  braveheart_2020 - 05/19/20 13:11
I did fellowships before residency.
You would need to look for non-ACGME accredited clinical fellowships . Look up the AAN website and search for fellowships in epilepsy/Neurophysiology/Neuroimmunuology/Headache/ Autonomic.
Open them one by one, and check which one is not accredited by ACGME and contact the program.

The epilepsy fellowships in general they expect you to have some prior knowledge in EEG reading. They want to hire you to help clearing the load of work, and seeing patients with them in epilepsy clinic.
If you have previous experience in epilepsy and EEG, then would be extra plus.

In Cleveland there are 2-3 months courses of intensive lectures in EEG. One in Cleveland clinic and one in UH Cleveland medical center, both are free to register at. If you chose to stay as research fellow afterward at those two places in Cleveland then would be good (will be unpaid).
Similar EEG course has started in UT Houston, I believe also free of charges.
Other places like George Washington Epilepsy center in D.C, which is also directed by one of the previous directors of the epilepsy center at UH Cleveland medical center have similar course.

Fellowships like NYU -Autonomic disorders would be good opportunity too if you want something less complicated, they offer 1-2 years of fellowship, and its mainly an outpatient clinic fellowship. Residency at NYU afterward is almost impossible given that it is competitive for the american graduates, therefore this fellowship would be great add to the resume and then relocate to different place.

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* Re:My match experience and my advice to all IMGs
  maanas - 05/22/20 00:28
congratulations on your success, and thanks for the detailed input, i have talked to you once earlier MPH vs non ACGME fellowship,
i have got admission in MPH in a very average university and have got good scores in first few cources, ofcourse my aim is also towards residency in neurology, plz suggest should i continue for mph thing? is it really going to worth it or i switch to non ACGME fellow ship?? yes nothing is in our hands but by discussion i might get a correct direction to pursue?
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* Re:My match experience and my advice to all IMGs
  braveheart_2020 - 05/22/20 04:19
  Thanks maanas for your message.
Looking retrospectively, If I personally had the chance to do MPH then I would rather have done it instead of my fellowships. MPH is a degree program, that would offer you the possibility of different carrier track too if God forbidden you did not find residency position for the upcoming years.
I am assuming the MPH program you are doing is in USA or Canada. If it is somewhere else, then I would say fellowships would be better.
Fellowship can serve as an evidence of commitment towards the specialty of your interest. If you do any of the neurology sub-specialties fellowships in neurology, it can help your resume towards residency in Neurology and Child Neurology.
The clinical fellowships in epilepsy that I have done over the last 3 years did not help me matching with the program where I have done my fellowships though. They were not that supportive, and they went blindly with the same selection criteria (fresh graduate, high USMLE scroes). I was able to match somewhere else using my credentials.
The research fellowship that I have done first in epilepsy back in Cleveland is what helped me to learn EEGs. Not the clinical fellowships that I have done afterward where the amount of teaching was near zero honestly.

Also I am not sure if I said that before in previous comments, but I will say it again here. Doing epilepsy fellowship would qualify you to do the ABCN board (American Board of Clinical Neurophysiology). You can do it after 10 months of EEG rotation in any clinical fellowship (epilepsy/neurophysiology). You don't have to have primary board to take that exam. It is decent board and well respected. In USA there are two boards for EEG. ABPN ( epilepsy and neurophysiology) which pre-requires ACGME residency and fellowship. And ABCN (which you can take if you have or don't have ACGME accredited training). I did take this exam, and helped me compensating for my USMLEs

The other fellowships in Neurology does not qualify you for any board without prior residency training . For example doing Autonomic /Neuroimmunology/Headache /Neuroimaging (all of which are non ACGME accredited, but they are UCNS accredited) requires you to have prior residency training and to have unrestricted medical license as per UCNS website.

Hope this is helpful
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* Re:My match experience and my advice to all IMGs
  luckylady - 05/22/20 15:45
  Hi @braveheart_2020

Thank you for sharing about your journey. May I ask what your YOG was? And what your USMLE scores were e.g. 200's, 210's, 220's, etc? Thank you and congrats on matching.
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* Re:My match experience and my advice to all IMGs
  braveheart_2020 - 05/22/20 16:43
  Thanks luckylady
My YOG is 2009 (no gaps though), had plenty of observerships and externship rotations , then 7 years of epilepsy research and clinical fellowships
My scores are in 200's
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* Re:My match experience and my advice to all IMGs
  luckylady - 05/22/20 21:16
  Great! Thanks for sharing braveheart_2020, your story inspires me to keep going!  
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* Re:My match experience and my advice to all IMGs
  braveheart_2020 - 05/23/20 03:24
  Glad to hear so.
Don't get deceived with the usual comments that you must have scores in 250s and be fresh graduate to match ! Yes, those kind of applicants have better chances and less complicated struggling with match. However, if you don't have good scores and you are an old graduate then just keep going and improve yourself until you reach your goal. The biggest negativity in my life in my previous years was many of my coworkers and friends from my medical field who have advised me to leave the country and do residency somewhere else or repeat my medical school in USA to be "fresh graduate" and reapply......gladly, I did not listen to any of them! :)
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