Recently, I interviewed an IMG for a university-based IM residency program. I asked her, why are you interested in this program?
Her answer was ” because this program gives strong clinical teaching with exposure to varied pathologies in addition to excellent research opportunities and fellowships after graduation”
It was a decent answer. But it gets interesting from here.
Since she had done a rotation in another university program before, my follow up question to her was:
Why are you interested in this program over the other program you did your observership at?
She thought for a second, said she liked the city this program is in and after a pause, said she did not get an interview at the other program.
She is being very honest here. She is excited about this university program because it is a university program and she does not have an interview at the other university program close to this one.
But that is not what the PD wants to hear. He is looking for genuine interest in his program. He wants to know what makes his program special. He has worked very hard to get the program the reputation it has and he wants candidates who are going to respect and maintain that reputation. This is what school spirit is about in the US.
So how do we show that same spirit for the program if we did not do undergraduate there, don’t have siblings or family in the city or have not done a bunch of rotations/research in the program?
You do it by researching the program.
Not just, how many residents it has, what rotations you do in the first year, where did the PD do his residency etc. But go deeper than that. Program’s website has all the hidden information you need to ace the interview. It’s your job to find this information and use the words that they use on their website in your answers.
5 tips to quickly and thoroughly reviewing the program’s website
Look at the following sections in the program’s website:
1. Director’s message page– Take a note of what the program’s core values are, what are they proud of, what are the unique features of the program per the PD
2. Rotations– Look up how long and frequent the rotations are for your field of interest (eg. primary care- at least 3 months of outpatient clinic per year with an option to do a few more away outpatient rotations each year)
3. Alumni– Where have the previous residents gone after their graduation. If this is not listed on their website, ask other residents during pre-interview dinner.
4. Faculty and staff– Quickly glance at faculty bios to see if they specialize in something (ID, geriatrics, HIV etc) or are they all IM docs. If they specialize, you can say you would learn so much from all these attendings who are specialists in their fields. If they are all internists, you can say you are excited to learn from experienced internists or pediatricians who have probably seen all kinds of patients by now by working in such a busy institution.
5. Location– Say something about the city the hospital is located in (beautiful outdoors, bustling big city, a quaint small town with a familial community environment etc.), the type of population the hospital services (indigent population, immigrants, a wide variety of patient types due to multiple satellite clinics residents go to etc)
If you want to see a video of me researching a pediatric residency program quickly and use the information to prepare for an interview, sign up here.
I use to carry a Residency Program Research Template (RPRT) during my interviews. At the hotel the night before, I would quickly research the program using this template. It was super quick and very thorough. Get my free RPRT that you can use to research a program systematically before your interview. This will save time, keep you organized and give you all the unique valuable information about the program that no other IMGs will have
I meet an applicant or two like this every year. There are red flags in their profile. But, I can almost guarantee they are going to match. These IMGs have a drive to match like no one else. They will go to great lengths to achieve that. There is a lot to learn about success in residency match and life and in general from these IMGs.
Here is an example of one such IMG:
His name is PK. He found my website AlphaIMG and sent me an email asking for help. His profile is as follows
Step 1: attempt
Step 1: 220s
Step 2CK: 210s, CS: pass
Step 3: pass
Research: poster presentations, 1 published paper
USCE: 1 externship in local clinic, 4 observerships in inpatient/outpatient setting.
As you can see, PK has a decent profile but with some major RED FLAGS. And because of these red flags, he failed to match for past 2 years.
He gave himself one more year to go all in as far as effort, time and money spent on pursuing his dream of residency in the US. If he does not match this year (2018), he is going to apply for PhD in some research related field.
PK has managed to receive one interview this year. He wants to make sure he impresses the hell out of them in the interviews. So he reached out to me to help him train for the interviews. He skipped the Skype interview training and decided to meet me in person for interview coaching and an observership with me.
PK started his observership with me on the day we had decided. I can instantly see that his work ethics and dedication was unlike anyone else. He was on time, impeccably dressed and ready to work. He did great in his observershp. I not only gave him a great LOR and trained him for his interview, I called up my buddy who was a former resident of the program he was interviewing at in 2 weeks and asked him to let PK rotate with him for 2 weeks and call up the program director before PK’s interview.
That is why I can guarantee PK is going to match with an attempt, old YOG, unable to match for past 2 years and only 1 interview. He was ready to do whatever it took to achieve his dream.
If you are feeling down about your chances of matching and are serious about being a physician in the US, don’t let go just yet. Give it one more shot and let this be your best shot ever.
I have been getting many emails after the match results. A lot of students who visit my website are going through an extremely difficult time. Be it frustration because you have tried everything and still did not match or anger at an unfair system who prefers people with super high scores or contacts and leaving out genuinely hard working people or pure helplessness because the mistakes you made in the past with your application cannot be undone.
In this emotionally overwhelming time of your life, you open facebook or any social media and see your friends and people who you know celebrating their match success and sharing stories. And here, you are planning to go underground or disappear for an indefinite period of time.
I have been there many times. I felt something similar when I saw my low scores on my usmle results. I was able to turn it around in my favor when I eventually applied, but I have lived this painful experience through some close friends and family members who did not match. Now I stand together with students who have reached out to me before and were not able to match.
People deal with severe degrees of stress differently. Some take a downward spiral route with alcohol, drugs, persistent self-pity and inaction.
For those who know me and my principles, that is not the AlphaIMG way.
I prefer another way to deal with extreme personal or professional stress and failure. I came across this years ago in a book “Extreme Ownership” by Jocko Willink.
It is called Prioritize and Execute.
You can sit here in a puddle of misery for next 6 months and go through the same emotions at next match or you can prioritize the areas of your application that are going to create the most impact and start to execute each of those areas. Then you can celebrate and post pictures on facebook next match when you get that residency you deserve.
If you are clueless on how to prioritize and execute your application for the upcoming match, read on.
Step 1: Identify your target market
Every IMG who I coach for the match, the first thing I am looking for when I speak with them is what kind of programs I will target for them. Is she a university program (UP) candidate or a community program (CP) candidate. Applicants who have research and teaching experiences, who have rotations in specialty fields and who are aspiring to do fellowships are some markers of university program candidate. Community experiences, interest in primary care fields, strong volunteer focus display qualities for a community program resident. Identify if you are a UP candidate or a CP candidate.
Step 2: Look at your application from PD point of view.
Now that you know what category you are in, look at your application form the program director (university or community program) point of view.
Most PDs and interviewers are looking for a candidate who is going to provide the most value to their program. Not the candidate who has the highest scores or the one with most published papers. Candidate with a stellar resume may not be a good fit for a small community program focusing on serving a minority population. In this regard, every program is somewhat different.
If you are a UP candidate, is your application entirely consistent with what a university program is looking for?
If you did not match with 4 or more interviews and decent interview skills, I guess not. What is missing? Do you not have enough university clinical experience? Or are you lagging in research papers/posters? Same with if you are a CP candidate but your application is not true of a community physician. Be honest with yourself and list things that make you a wholesome UP or CP candidate.
Step 3: Prioritize. Make a list of your modifiable deficiencies.
Don’t worry about how you are going to get those research publications or clinical experiences yet, just make a list of things that make you a wholesome UP or CP candidate.
Don’t list low USMLE scores or old Year of Graduation on there. Those cannot be changed. But a lot can be. Prioritize based on what is deficient the most.
Step 4. Plan and Execute on those deficiencies.
Now that you have a list of things you need to make yourself be a perfect university or community program candidate, think about the ‘how’. How are you going to get that research papers or that rotation in a university program? If you are a CP candidate, how are you going to get strong LORs from community practitioners? Here are some articles to get you started on this process.
Step 5: Make 3-month plan.
Write down a plan for next 3 months. Not longer than that as things most likely change in 3 month period. Pick one thing on your list and target that for next 3 months. Explore every possibility you can to get that goal achieved in 3 months. Email every program that you know of. Reach out to every contact you have, even if you have not spoken to them in years. Plan on attending every conference in that field and meet as many attendings as you can.
I picked up side jobs and a loan to get the money I needed for the application. The interest rates on that loan were ridiculous. I paid it off very quickly once I got the residency. Never regretted it.
We all have a savage in us to get us what we want, it just needs to be unleashed. I know this because I saw it in myself and now I see it every year in some students.
Step 6. If you have less than 4 interviews.
It is very difficult to match for an IMG with less than 4 interviews. Your #1 goal this year is to get more than 4 interviews. Start reading this guide to make sure you get more than 4 interviews this year. All of the above still applies to you but you have to redo your entire application to get those interviews.
To summarize, start following these six steps to get over the misery of not matching as soon as possible and move on a positive spiral towards matching.
Step 1. Identify your target market- university or community programs
Step 2. Look at your application from a PD point of view- are you a UP or a CP candidate?
Step 3. Prioritize- make a list of your modifiable deficiencies in your target category.
Step 4. Execute- Start at the top of that list and make a plan to clear the first deficiency.
Step 5. Make a 3 month plan to execute on the first deficiency.
Step 6- Revamp your application if you have less than 4 interviews. Follow this guide.
There it is. 6 powerful steps to deal with the pain of not matching and ensuring that next year is a big success for you.
Do more observerships and externships, get more USCE… BUT HOW??
USCE is one of the most important pillars of your residency application. But it is becoming just as hard to get it as is residency itself. I get at least one email every day asking about how to get more USCE. A lot of IMGs have emailed many faculty members but have not received a single reply back.
If that is your problem, read this article. It will give you six ways to get observerships, externships, and research positions. I have yet to meet an IMG who was unsuccessful in getting USCE after using these 6 steps.
1. Local physician groups of your country of origin (AAPI, APPNA etc.) :
Don’t just show up at their events and ask each and every physician if they can let you shadow them in the clinic or hospital. Attend their meetings a few times. Be a friendly person in the crowd. See if you can volunteer for their events by asking the chairperson if he/she needs help. Then, when they starting knowing you a little bit since you have been going to the meetings regularly, ask them if they can let you rotate with them for a couple of weeks.
Knowing a faculty member/PD in a residency program is the highest level of contact. But most of us do not have that. Friends/neighbors in the US who know doctors, previous mates from medical college who are now residents, neighbors from back home who know someone in the US who is a doctor are contacts too. Use them. Don’t be shy now. You are going through the most decisive time of your career. Once you get into residency, you can pay them back or send them a thank you gift card.
If there is a medical conference in your city or close to where you live, try to attend that. I recently met a family medicine resident who met the program director of his residency program at once such conference, got to know him and got matched at his program. Even if you don’t meet the PD, you will meet a lot of faculty members. You don’t have to befriend everyone, but just by being present there for 2-3 days, being friendly and chatty, people will start to recognize you after a couple of days. Take contact information of those who you connect with the most and stay in touch. Registration for these conferences is not very expensive if you select a student rate.
Pro tip: Email them before you register and ask them if they will let you volunteer at the conference which provides free entry and tons of exposure to faculty members.
4. Previous rotations:
This was my go-to method to get more USCE than I can handle when I was applying. Once your current rotation comes to end, ask the attending you are working with if he has a colleague, friend or someone he knows in cardiology, GI or any other field you are interested in who you can go talk to and ask for a rotation. Repeat the process after each rotation.
5. Masters, Ph.D. programs:
I do not advocate joining one of these programs just to match but if you are in one already or have graduated, email your mentors, faculty, friends from these programs and ask them if they know someone who would let your rotate with them. This is how a lot of people get job opportunities in the US. Through their alumni circle. Again, this is no time to be shy and think “I don’t’ want to bother them, they probably don’t even remember me now”.
Pro tip: If you don’t try, you will never know. And there is nothing to lose.
These are very effective six steps that will get you into a rotation or research position. Most IMGs sent out ineffective emails for a few days and give up. That is using only one of the six methods to get USCE and that too not doing it right. No wonder they are unsuccessful. Be more aggressive in pursuing your dreams.
Decide right now what kind of doctor you want to become in the future. You can change it later.
It is also called polarization. And it works.
If you try to be liked by everyone then no one will like you.
And this social concept works for your residency application too.
With this article, I want to give you the secret sauce that will help you write a strong personal statement, CV and do well on your interviews.
It sounds too good to be true. But it is hundred percent true.
You decide exactly what kind of doctor you want to be and you make your personal statement, CV, interview answers point to that. You decide this based on your life, skills, experiences, and interests.
When I started applying, I was thinking of becoming a primary care physician (PCP) in a small town in the US. Of course, I didn’t do it (I am an assistant professor in a University now). But I made sure the story I told on my resume, personal statement and interviews matched my aspirations to become a damn good small town internist. In my personal statement, I talked about an incident in my medical college when I was working in ER and saw a patient I knew from my clinic rotation. The patient had a history of a medical condition that contraindicated the medicine infusion that the ER attending had started. Because I knew the patient well, I was able to stop that treatment before it caused harm. Experiences like these are very rewarding because I know my patients and they know me well. That makes me interested in becoming a PCP.
Yes, I still listed all the USCE, research and volunteer work I did. But, I paid more attention to the clinical experience and ability to work hard and connect with my patients (qualities of a PCP) in my personal statement and interview answers.
The program directors who trained residents mainly to go into primary care loved it. They talked about their residents who went on to start private practices and what not. They shared their stories of how good they feel when they connected with their patients and took care of them for years.
Big universities who train residents to become researchers and academicians didn’t consider me a good match. But most of them didn’t consider me at all because of my low scores.
Had I prepared my application with a little bit of research, a bit of clinical work, for both big universities and community programs, I would have appeared a weak candidate to all of them.
It is no secret that my scores were very low. In spite of that, I was able to get 11 interviews, 1 pre-match which I refused and matched at my top choice university affiliated program.
This is the secret sauce that worked for me. And it will work for you too.
Look at the big picture with your application right now. What are your strengths? All the work you have done so far. USCE you were able to get, research you worked on or got published, extra stuff you did back in medical school. Does it make you look like a person who is into primary care or a primary care/hospitalist who likes to do research or a specialist who enjoys clinical practice or a specialist who wants to research some novel treatment options and become well renowned for that? One time, I worked with an applicant who ended up matching at a University program with low scores because she focused her entire application on wanting to become a travel medicine physician (she had done some missionary work in Nicaragua). Another applicant had a successful match based on his interest in taking care of immigrant population in the US.
There are a number of different areas you can explore. The one you chose depends on your life experiences. Think about your life even before you joined medical college. Influences you had from your parents, friends, events in your life, experiences in medical college and later when you moved to the US.
Choose one specific thing you are thinking of doing in the future. Let that one thing be the flavor of your application. Let that one thing be the distinctive factor that separates you from thousand other IMGs. Talk about that in your personal statement and during your residency interviews.
Writing personal statement is difficult, time consuming and often boring.
When your applications fits the program’s criteria for an interview, the PD looks at the personal statement and letters of recommendations to decide if you are worth the time and money to be offered an interview.
Also, once you get the interview, personal statement form the grounds for interview questions.
So, personal statement or SOP is incredibly important for your success of matching. Especially, if you have red flags in your application.
Recently, I took a class in health care quality and safety (link). This is an emerging new field in medicine focusing on improving the quality of health care in the USA and worldwide. For anyone who is interested in pursuing a masters or a graduate level course before residency, this is a great area to improve your chances of matching.
To be accepted in the course, the university required that we submit a personal statement. It has been more than three years since I wrote a personal statement for myself and I got stuck at the first line. I had three days before the application deadline.
I did what I learnt when writing my residency personal statement. I used the steps below to get it done.
With this article, I will show you how to start writing your personal statement for residency, what to do when you are stuck (writer’s block) and how to review the personal statement at the end to make sure there is no spelling of grammar error.
1. The beginning (The first words):
Set aside two to three 30-minute blocks.
Imagine a busy program director reading your application for the first time.
Make a list of things you want to tell him or her. Don’t filter or judge anything at this stage. Just start listing everything that comes to mind.
Think of your goals and achievements, life events that shaped you, failure and lessons you learnt, things you want to do in life and how residency in that field is going to help you achieve that.
Is there something that you did in your medical school, after moving to US, while raising a family that no one else around you was doing? (Real life examples: worked part time in a suicide hotline center, started a free drug sample clinic in med school, tutored high school or medical students, took long walks in the park).
Is there something your friends tell that you are good at?
List everything. Don’t stop yourself. Nothing is wrong at this stage.
My list looked for my graduate course personal statement looked like this:
Practicing physician in a high turnover university setting for three years
Trained at internal medicine residency program of UNC Chapel Hill. Another high workload program
During residency, no exposure to healthcare quality except daily signal out to the next resident
Gradually learning concepts of HQS while working as an assistant professor
Experienced areas of healthcare in the US that did not provide the level of care compared to the money spent
Physician burnout due to complexity electronic medical record
Medical errors from flaws in system
Personal story of medical errors committed because EMR was setup in a way to easily miss things
Like to be in job where there is new to learn everyday.
Play tennis in free time. First recreationally, now developing skills to play professional
Try to make at least 10 points. The more, the better. But don’t worry if you cannot come up with 10 points. You will find more things to say as you move on. Once you hit 30 minutes, stop, come back tomorrow and do the same for another 30 minutes.
Once again, don’t think how stupid it sounds or this is something you should not mention in a PS. Let your creativity flow. Just put down anything and everything that comes to your mind about your past life, experiences, achievements, failures, lessons learnt, skills that you have.
2. The middle (Connecting the dots):
Start writing sentences using the points above. These sentences don’t need to have the perfect grammar, spellings or flow of words. They serve only one purpose at this stage- connecting the points you listed.
So for examples, if I try to connect the points I made above for my personal statement.
I would write down something like this : “ Having completed my residency in internal medicine program at University of North Carolina, I was no stranger to the high workload and high stress medical environment. But, what I was not aware of was the extent of quality improvement projects ongoing at this institution. In residency, my experience of healthcare quality and safety was limited to an efficient and thorough checkout to the next resident coming on service.
You keep doing this until you go through most of the points on your list. Some points can be omitted if you realize they have already been covered in other sentences, not as important as you thought they were initially or you don’t want the PD to know about it.
Again, don’t judge the quality of your sentences at this time. Continue to write sentences to the best of your ability using the framework of the points you listed.
Stage 3: Just before the end (Personality formation):
By this stage, you should have about 1000 words or more in your personal statement. If you have less than 700 words, go back to stage 2.
This is a little tricky to explain.
But read over your 1000+ words you have written so far. Do you see an image of yourself being portrayed in the writing? (E.g. 1: hard working, dedicated student who always scored high in medical college but failed in USMLE step 1, learnt some lessons, came back and did very well the next time. Then started tutoring other students to avoid the mistakes she made. Now ready to move on with next step in becoming a primary care doctor that you always wanted to be. E.g. 2: high achieving and research focused doctor who is driven by researching new ways to treat heart disease, likes to be surrounded by people in off time).
It does not have to be one of these two examples. It can be anything that you feel represents you. If the sentences you have written so far don’t form a personality that matches your own, go back to step 1 and think of more points focused on your personality.
Personal statement has to be around 800-900 words to be able to fit legibly in one page. So cut down excess words now if they don’t represent you, have already been covered elsewhere and fluffy without adding meaningful content.
4. The end (Check grammar, spelling and flow of words):
Use MS Word, online grammar checker to check spelling and grammar. Make corrections suggested by these programs. Then have your computer read it out loud to you (ttsreader.com). Does the sentences flow from one line to next? Does it make sense to a first time reader? Make fine corrections based on this. Come back a week later and read your personal statement again. Do you like it? Does it need more tuning? What does your closest friend or family member think about it?
Do this every week till you are satisfied that you got a personal statement that is error free, rich in content that highlights your strengths and represents who you are perfectly.
Step 1. The beginning (The first words): Make a list of you life events, strengths, failures that you overcame, skills that you learnt, jobs that you took, projects that you started, hobbies that you are passionate about in two thirty minute blocks. Be creative. Don’t judge anything.
Step 2. The middle (Connecting the dots): Start writing sentences using the points above. Again, don’t judge the quality of sentences. Try to reach 1000+ words.
Step 3. Just before the end (Personality formation): read you personal statement and try to give it a personality that matches you perfectly. Add more points to step 1 if it lacks a personality. Remove words that don’t represent who you are. Try to cut down to 700 words.
Step 4. The end (Check grammar, spelling and flow of words): Fine tuning to ensure there are no grammatical or spelling errors, sentences flow from one to next without sounding chopping and it is an overall easy and pleasant read for the PD.
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