Sunday, December 17, 2006
This is another popular and competitive IM subspecialty. It also is considered one of the three most procedural subspecialties in IM (sharing the honor with GI and Pulmonary/critical care). Cardiology is a 3 year fellowship, with at least 2 years of required clinical training time. The rest of the fellowship can be spent in research or additional clinical time. The clinical practice of cardiology is highly varied, and it allows for a large number of areas of subspecialization. Cardiologists can do angiograms, angioplasties (with interventional training), right heart catheterization, echocardiograms, manage heart failure, coronary artery disease, hypertension, treat arrhythmias, treat pre- and post- heart transplant patients, and manage adult patients with congenital heart disease, just to name a few. Some cardiologists will choose to do further subspecialty training. After cardiology fellowship, graduates can do a 1-year fellowship in interventional cardiology, where they get trained in such things as angioplasties, coronary artery stenting, valvuloplasty, and even things like pulmonary artery stenting. Another certified fellowship that cardiology grads can do is a 1-year fellowship in cardiac electrophysiology, where fellows are trained in pacemaker placement and interrogation, intracardiac defibrillator placements, cardiac resynchronization therapy, and VT/VF and afib/flutter ablation techniques, among other procedures.
What is "fast-tracking?"
Fast tracking, or short tracking, is an option that some residents do who are interested in pursuing academic medicine in a certain subspecialty. People who fast track complete their IM residency in 2 years, instead of 3 years, and then start their fellowship after their second year. The catch to it is that they have an extra year of research added on to their fellowship, so it does not save them any overall time. Advantages of fast tracking include: the ability to pursue a more in-depth research project as a fellow in order to jump-start one's academic career; and less overall clinical training time (some may view this as a disadvantage). A major disadvantage is that in order to fast track, the resident must pretty much know which subspecialty they want to pursue before they even start residency, because they will have to apply for fellowships early in their intern year, and they will not have enough time to adequately explore most subspecialties. Most people who fast-track have MD/PhD's or have already done extensive research in their intended subspecialty. In order to short track, you must get permission from your residency program, then apply and get accepted to a fellowship program as a short-tracker. You do not have to stay at the same institution as your residency in order to short track, although that is the most common way to do it.
Which IM subspecialties are more competitive to get into then others?
Right now, most people agree with the following order of competitiveness:
Allergy and Immunology
Wednesday, December 13, 2006
September 29, 2006
The USMLE program recommends a minimum passing level for each Step. Medical licensing authorities may accept the recommended pass/fail result, or they may establish their own minimum passing requirements. The recommended requirements to pass USMLE Step 1, Step 2 Clinical Knowledge, and Step 3 were originally identified in the early 1990’s and the Step 2 Clinical Skills standards were first identified in November 2004.
The USMLE Step Committees are responsible for the design and development of the Step examinations, as well as establishing and monitoring standards. These committees are made up of physicians and scientists who bring educational, licensing, and practice perspectives to this process. Every three to four years a Step Committee is asked to complete an in-depth review of standards. This process is about to begin for USMLE Step 1. The current recommended minimum passing score of 182 was most recently reviewed in 2003.
The Step 1 Committee is scheduled to assess the minimum passing score at its meeting on December 12-13, 2006. In its review of the minimum passing score, the Step 1 Committee will consider information from multiple sources including: 1) results of surveys of various groups (e.g., state licensing representatives, medical school faculty, samples of examinees) concerning the appropriateness of current pass/fail standards for Step examinations; 2) recommendations from independent groups of physicians and scientists who will participate in content-based standard-setting activities late in 2006, 3) trends in examinee performance; and 4) score precision and its effect on the pass/fail decision. The decision of the Step 1 Committee will be posted at the USMLE website. If the Committee determines that a change is appropriate, the new recommended minimum passing score will become effective for all examinees who begin their Step 1 examination on or after January 1, 2007.