Introduction of the new work permit laws in the United Kingdom
may mean that training opportunities have become tougher for
international medical graduates. These sudden changes have left
many doctors feeling anxious and uncertain about their medical
careers. For this reason, further training in the United States,
via a residency programme, is being considered a more favourable
and secure option. The exam and selection process for a residency
programme may seem long and arduous and discourage candidates.
We aim to highlight how to make the process as smooth as possible,
enhancing your chances of getting the residency programme of
choice.
Why USMLE All doctors wishing to practise in the United States have to
take the United States Medical Licensing Exam (USMLE), irrespective
of whether they are US graduates or international medical graduates.
International medical graduates may take the USMLE to apply
for a residency programme, research programme, or work in a
superspecialised area. Once you have passed the USMLE and have
been certified with the Educational Commission for Foreign Medical
Graduates (ECFMG), there is no distinction between international
medical graduates and US graduates when applying for programmes.
Whats is residency? Residency is a period of training (equivalent to senior house
officer level) an individual has to do after graduating from
(US) medical school. It lasts three to eight years, depending
on the specialty. For licensure in the United States you have
to complete residency training and step 3 and have ECFMG certification.
After this you can apply for a fellowship (equivalent to specialist
training).
What is USMLE? The USMLE has several steps: step 1, step 2 clinical knowledge
and clinical skills, and step 3.
Step 1 is an eight hour multiple choice exam and tests basic medical sciences such as anatomy, physiology, biochemistry, and microbiology and their clinical applications. It is a computed exam and it can be taken in several parts of the world, including the United Kingdom.
Step 2 clinical knowledge is a nine hour exam and tests the clinical specialties such as internal medicine, surgery, obstetrics and gynaecology, and psychiatry. This is also a multiple choice computed exam, and it can be taken in several parts of the world including the United Kingdom.
Step 2 clinical skills tests an individual's clinical skills and ability to communicate with patients and can be taken only in the United States. Participants must register for the exam before 1 July and take the exam by 31 December to qualify for a residency starting the next year.
Step 3 tests the clinical management of patients and is administered only in the United States. The programme will normally specify if step 3 should be taken before or during residency.
The step 1 and step 2 exams may be taken in any order. To register
for the exams go to
www.ecfmg.org for steps 1 and 2 and
www.fsmb.org for step 3. All associated costs are listed on the application
form.
USMLE Scores Scoring highly in the USMLE step 1 and step 2 clinical knowledge
exams makes the difference between getting a cutting edge residency
programme and an average one. In general, scoring 75 percentile
(60% to 70%) is enough to pass step 1 and step 2 clinical knowledge,
but may not be enough to get into a residency programme. Exams
cannot be retaken to improve a score once an individual has
passed. You should aim for percentiles in the late 80s and early
90s for an internal medicine residency and late 90s for a surgical
residency.
USMLE PreparationPreparation times range from three to six months for step 1
and step 2 clinical knowledge and one to two months for step
2 clinical skills. It is worth starting study by January 2007
for a residency starting in July 2008. Generally residency programmes
like candidates to have less than five years' experience after
graduation, so starting the USMLE process soon after graduation
is advantageous. However, this varies from programme to programme
and scores on the USMLE are particularly important, as are further
degrees such as membership of the Royal College of Physicians
and strength of the application.
How to apply for residency programme Before applying for a residency programme you have to be ECFMG
certified. This requires your medical degree, medical school
transcripts, and step 1 and step 2 clinical knowledge and clinical
skills scores.Then you need to enrol in the National Resident
Matching Program and apply for a residency programme using the
Electronic Residency Application Service. There is no limit
to the number of programmes you can apply for, but each application
has to be paid for. Programmes rank candidates and in turn candidates
rank programmes through the matching programme, essentially
leading to a "match." The matching programme main match is defined
as "an impartial venue for matching applicants' preferences
for residency positions with program directors' preferences
for applicants." Matching takes place in March, and both the
candidate and the programme are legally bound to the outcome
of the match. Residency programmes prefer candidates who have
some US hospital experience, so enrolling for an elective in
the United States may be something worth thinking about. A letter
of recommendation from a US consultant is high on the list for
a residency match, but letters from UK consultants may be the
next best thing. A detailed personal statement is also required.
Timeline Ideally a candidate should spend about two years preparing for
residency. However, this depends on the individual and in some
cases preparation can be achieved in a year. The following guide
is for candidates wishing to start a residency in July 2008
2:
- Begin study for step 1 and step 2 clinical knowledge in January 2007 (January 2006 at the earliest and March 2007 at the latest)
- Step 2 clinical skills should be applied for before 1 July and taken before 31 December 2007
- Complete step 1 and step 2 clinical knowledge exams by August 2007
- Consider attending observerships in the United States before submitting an application for residency as this is a bonus point on your curriculum vitae
- Submit residency application by October 2007 as interviews are generally held in November or December
- Scores for step 1 and both steps 2 should be submitted by December 2007 at the latest
- Rank programmes in February 2008
- Match in March 2008
- Residency starts in July 2008.
You should allow enough time for getting letters of recommendation
from referees. You may also need to get advice on writing a
personal statement and interview preparation. If you are not
called for interview it is highly unlikely that you will be
offered a residency position.
Matching
There are three opportunities to match. The main event is the
match in March. After this there is a post-match scramble,
where a list of unfilled vacancies from the match is posted
on the Electronic Residency Application Service and unmatched
candidates have an opportunity to obtain a position. Lastly,
www.findaresident.com also posts unfilled positions.
Preparing in UK
You can obtain USMLE videos and notes from this site:
http://www.usmlestep.com/
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