Why usual residency interview preparation fails IMGs? An unconventional interview preparation for IMGs .

family medicine residency for img


In my senior year of internal medicine residency, one of my friends asked me to get her an interview at the program. I knew she was hard working, smart and a great team member. So I sent an email to my program director who invited her for the interview (do contacts help?). Before her interview, she called me a few times and we prepared for the interview. We talked about all the common interview questions and how she was going to answer them. On her interview day, she was well prepared. After her interview, she mentioned that everything went great. But when it came to ranking her, she was not ranked high. The reason I later came to know was the attendings and other residents she met during the pre-interview dinner thought she was "too shy" or "she may not be able to work in a close-knit team like ours"

With this article, I will show you what is the conventional way of preparing for the interview that most IMGs (including my friend here), why this does not work for IMGs and an unconventional way of preparing for the interview suited for IMGs.


Step 1: memorize your personal statement and CV.
Step 2: google most common residency interview questions, memorize the answers.
Step 3: Have your best friend or family member ask you those questions and you answer it like you would in an interview. Or speak in front of the bathroom mirror.
Step 4: Buy a suit. Book your flights.
Step 5: Show up on time at the pre-interview dinner and the interview.

As you can tell, this does not sound very good. Especially for something as important as residency interviews. We work so hard to get these interviews, we want to go an extra step and make sure we nail them. Pretty much every IMG I know (including myself) spends a reasonable amount of time preparing for the interviews. Generally, their preparation is enough to get them a shot at being ranked high by the program; if their scores are high, they have good letters of recommendation and they do not need a visa. But that is not the majority of IMGs. No matter how hard we try, chances are most IMGs have some red flags on their application. So we need a little more than just a cookie cutter interview preparation.


You see, my friend had decent scores, contacts in the programs, good interview but was not ranked high by the program because she did not appear socially fluent during the interview and the resident dinner.

That is the problem with our conventional interview preparation; it does not help with social fluency, which is what most people perceive when they meet you for the first time. Not how well you answer the questions like "tell me about yourself".


This is a supplement to your convention interview preparation mentioned above. But this is far more effective than the previous. You still read your personal statement and CV a few times before your interview. You still buy a nice suit (and get it tailored), you still show up at the interview on time. But you take it one step further. You work on your social fluency. Social skills like any other skill can be learned.

I know what you are thinking: I have so much to do, how am I going to learn a new skill in such a short time?

That's where the unconventional interview preparation comes into play. Nothing worth having comes easy or fast. But if you take some simple steps starting now, you will appear much more socially fluent and less awkward.You will not face the problems that my friend mentioned above faced.

Before we dive into these simple steps let's look at five reasons why IMGs need social fluency for interviews:

1. English is not our first language, so it is harder for us to express our views in English
2. We are in a different country with different mannerisms and culture.
3. We are not very savvy with sporting/political/musical/TV events of this country. So if someone starts talking about these things, we wouldn't have much to say.
4. We are always busy with USMLE, observerships, research, jobs to be able to go out and be social
5. We hang out mostly with people from our home country after moving to the US.

We know why my friend mentioned above was not ranked high for the match. In spite of good scores, contacts and apparently doing well at the interview, her lack of social skills came off as poor communication, shyness and not being a team member to the staff in the residency program.

The good news is, within a few weeks you can improve your English fluency, body language, vocal tone and communication in general. This will help you appear more confident, fun and attractive to the attendings and other residents during your interview. I know this because I was very socially awkward when I first came to the US and even today if I don't use these steps regularly, I go back to being that shy unconfident guy.

# Step 1: Talk to people. (Groundbreaking, I know!)

When I say talk to people, I don't mean your mom. Or your best friend from medical school. I mean people you barely know or don't know. Because, when you go for interviews, you are going to spend a whole day with people you've never met.

Here is what I do. You can be creative and find ways suitable for you.

1. Talk to people during your day-to-day errands. At the grocery store, on the subway commuting for your rotation, waiter/waitress at the restaurant etc., make a habit of talking to 5 people a day. Just say hi, how is your day? Give them a compliment about their shoes or something. Don’t feel bad if they are not friendly, most people are not social anymore (cell phone culture). Try this for 3 days. On the 4th day, you will feel more open to communication and it will come naturally to you.

2. Friends - not the ones you talk to every week. Someone off your facebook friend list who you’ve never talked with. Talk to them in English.
3. Speakeasy, bars, festivals- talk to everyone there.

4. On your way to the interview, flights, hotel where you are staying, elevators. Make it a point to chat up people. You don’t have to say much, just say hi, how are you today? I like your dress, what do you think of this hotel etc. You get the point.

# Step 2: Understand small talk.

A lot of IMG candidates I see have no concept of small talk. Back in the day, I hated small talk. I wanted to get straight to the point of conversation. But that is not how interviews go.

You meet the residents during the dinner or the attending in their office; they are not going to launch off into typical interview questions. They will start some small talk. Some of my interviews were only small talk. We all know how to small talk. Remember the last time you had a small get together with your closest friends or family members. The small talk lasted for hours. You weren't discussing you resume that time. Have the same mindset when you first meet the residents and attendings. You are just getting to know each other. They are asking some questions about you and you can ask questions about them. You are not trying to prove yourself or show off how much you learned during your observership. Keep it light and playful.

# Step 3: Stop judging yourself when talking to people

If you do above steps right, this will happen automatically. Us IMGs are always focused on how our accent is, is our English okay, are we impressing the other person etc. This makes IMGs sound stifled and not very confident during interviews. You English is fine and you are confident. Accept it.


In addition to the common interview preparation that we all do, these three steps will help you tremendously to enjoy the interview process and be successful.

My first interview did not go that well because I was not in the practice of talking to random people. I knew the most common questions, I had also memorized my personal statement and cv. I was able to answer questions in a factual manner but I was not able to have a conversation with the other interview candidates, residents in the program and the attendings who interviewed me. I knew I had to do something, I still had ten more interviews to change that. I followed the steps above ( and I still do). My interview performance got much better. I was able to talk about myself in a very effective way so that people remembered me. In fact, I was offered an out of match position after one of my interviews because the program director enjoyed a conversation we had about my perspective of medicine in the US as an IMG.

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Assistant Professor of Medicine practicing in US

Get ready for the Match: 5 steps to stop procrastinating and get stuff done.


Assistant Professor of Medicine practicing in US

Back in 2009, this time of the year was one of the most stressful time of my life.

I was preparing for the upcoming NRMP match.

I had to get documents from my medical school, research and list the programs to apply to, work on my personal statement along with school and a part-time job.  I was losing motivation and thinking of applying a year later.  There was just too much to do and not enough time.  But I had come too far to let it go at this stage.

Maybe like me,  you too are feeling overwhelmed with work, family, studying for exams, and working on your application. Maybe you are thinking you might not have all documents ready by September and will have to submit a halfhearted application or be late on your application.

Keep reading on because I was in the same place as you are. I will show you a few simple techniques I used to get my application ready and achieve the kind of success in the match that I didn’t think was possible.

I started using these five steps to boost my productivity. It took some time to get into the habit. But within a few days, I was making tremendous progress. I got my application ready well in time for the match. I was also able to complete my USMLE Step 3 soon after the match. I never thought I would be able to do so much in so little time.  

1. Baby Steps

Focus on series of small wins rather that worrying about the final goal to keep your motivation going.

Make a list of all the things you need to do to complete your application.  Divide the workload into big and baby steps. You don’t have to do too much in a day, just a little. It will add up fast. For example:

Each baby step you take motivates you to take the next step. Before you know it, you will be a lot closer to the big step and eventually your final goal.

2. Productive hours

We are not at your best performance all the time.There are some periods in the day when our brain taps into limitless potential. For most people including me, this is 1-2 hours after waking up. Make a list of things that you find the hardest and do it during one of these productive hours.  I reserved working on my personal statement for 15 minutes after I wake up. Figure out when you are at your best and hit the toughest baby steps during those times.

3. Prioritize

This is the one advice we have heard a million times but are never able to stick to .

The advice comes in many different forms, but it is essentially the same.

“Don’t get distracted” or  “stop watching TV” etc. I have heard many versions of this. I could never follow it.  Until I found the missing piece of the puzzle. It becomes much easier to follow and stick to once you know the whole story.

You don’t stop watching tv or socializing forever. You just stop it for the most productive hours of your day. In my case, I stopped checking my email for the two hours after I wake up and worked on my application. I was getting a lot more work done and not feeling guilty for doing things I like.

4. Power of momentum

This is one of the most powerful tools to accomplish major goals. But you have to follow the steps above to be able to use this tool.

You have identified your baby steps. You know when you are the most productive. Now you start working towards those baby steps. You keep the hardest steps for the productive hours of your day. You are avoiding distractions during the productive hours of your day.

To get the power of momentum at this stage, you continue to work on your baby steps every day. If you are having a bad day or something else that prevents you from working on your application, don’t skip the day. Just spare 15 minutes to work on your application. So when your pick it up next day or the day after, you are mentally ready to get back to work.

5. Visualize your success

This is the hardest of all and the most beneficial.

When I first heard about this, I was skeptical. I never believed in airy-fairy things like this. But I was ready to try anything to succeed in the match. So I gave it a shot. The results were amazing. Now I am a firm believer. I have used this to match at my top program, succeed during residency, get my first job and even win a tennis tournament when the odds were against me. Seasoned athletes like Muhammad Ali, Michael Jordan, Tiger Woods use detailed visualization before their sporting events.

I know it will help you achieve success beyond what you thought possible.

Before you go to sleep when you are lying in your bed, visualize yourself getting your dream residency spot. Don’t just think about getting it. See yourself accomplishing the baby steps and submitting your application. Visualize yourself when you open your email and read the match result. You are feeling happy, excited or anxious. Feel everything. Live the moment.

It will be difficult at first. Our brains are wired to focus on the lack of things. Reframing your thoughts to having what you want is immensely powerful. If you feel the emotions when you are visualizing your success, you are doing it right. The stronger the emotion you feel, the better it works.


I know what you are going through right now. I have been there. Even now, I feel overwhelmed with work and worry about failure. At times, I want to achieve a lot in a day and don’t have enough time.

When I am in that situation, I use these 5 steps to boost my productivity and get some work done.

1.Figure out the baby steps to get to the big win.

2.Work on the hardest/most boring/most time-consuming steps during your most productive hours.

3.Avoid distractions during the productive hours.

4.Keep the momentum going. Even if that means working for 15 minutes a day on your baby steps.

5.Visualize your success and how you would get there. Feel the emotions you would feel when you get there.


Do contacts help in getting residency?

Do contacts help in getting residency?

applicant multiple red flags

Short answer- YES

But very few IMGs who come to the US have strong enough contacts to get them into residency program. I did not have any contacts in the US when I came here. I know many of my friends who matched in top university programs had no contacts in the US. But on our USMLE to residency journey, there are plenty of opportunities to find contacts that will help you in getting externships, residency and even jobs/fellowship after your residency.

With this article, I will show you:

  •      What does having contacts actually mean.

  •      What to do if like me, you have no contacts


What does having contacts actually mean?


Examples of contacts helping IMGs in getting residency:

Example 1. When I was applying for my residency, I had a roommate who was always out having fun while I was looking for observerships, working on step 3 and doing everything I could to make my application stronger. Like him, I wanted to drive to the beach every weekend or go to a cool city and take a bunch of photographs to post on facebook. And the worst part was, he had scored less than I did on my USMLE step 1 and 2. You have probably guessed it by now, he had connections in the US that he was counting on to get him into residency when we both apply in just a few months. My friend mentioned above obviously matched.  

Example 2. Let’s look at some other examples of people I know who matched with contacts- someone whose best friend from college was a 2nd year resident in a program or someone whose spouse was a resident.

These are examples of personal connections. As we now know, they obviously help in getting a residency. You either have a personal connection or you don’t. So if you do, you are lucky. Ask them to get you a residency spot in the program that they are affiliated with.


But if you are like me with no personal connections in the US, then keep reading on.


Example 3: This is another example of someone else I met along my journey of USMLE to residency who matched with help of connection. This applicant did an observership in a private clinic. She enjoyed going to that clinic and the clinic staff liked having her too. The observership attending was friends with the PD at a nearby residency program. He not only wrote a strong letter of recommendation for the applicant, hedid something else that not many attendings do and not many IMGs ask for. He sent an email to his PD friend about the applicant.

Now this is HUGE. I can’t tell what happened in the back end but my guess is, the PD read the email and pulled up the person’s application on his computer. The applicant stood out in the pile of thousand other IMG applications. Just one email (or sometimes a phone call) from the attending.  Of course the applicant was invited for an interview at the program. This is an example of professional connection.

This is also called networking. I am not a big fan of the word networking because it makes the process sound very formal and structured. You go to a big conference, say hi to as many people as you can, if someone looks like they are important and seems interested in you, you take their contact information and hound them after the conference to let you do an observership with them. Aaagh! I tried that once and hated myself for doing that. Meeting new people, getting to know them and building a professional relationship should feel natural and fulfilling. If it is not fun for you, it is not fun for the person you are meeting.

So how does an IMG who has not been in the US for too long, not have much experience in the clinical field and always busy with USMLEs and application go out and meet attendings and built a professional relationship with them?


I am glad you asked.


What to do if you have no contacts in the US? 

There are number of ways of doing that. The list below shows some but it is not all-inclusive. Making professional connections is a very natural process and there are a million ways of doing it. But these will help you get started. Look for these opportunities to connect with people while you are working on everything else for you residency.

1.     Clinical rotations/masters program/volunteer work:

Like the applicant above, when you are doing your observership, don’t keep your eyes just on the LOR at the end of your rotation. Enjoy the process. Chat with the clinic staff, get to know them, tell them about yourself. If the attending you are working with mentions about residency programs in town, ask them how do they feel about the programs. Do they offer good education? Are the attendings easy to work with? Does he know any of the attendings? If he does, and you feel he is going to write you a strong letter, it’s okay to ask him to let the program know that you will be applying. IF YOU DON’T ASK, YOU DON’T GET

The same principal applies if you are working on research with someone or volunteering in a clinic. Think beyond LOR. Working on meeting more people, knowing them and building a relationship.

If you are in MPH or other master’s programs, you faculty advisor, internship supervisor, friends you make during masters research projects can become your connections.


2.     Medical conferences:

After being to many conferences and trying out many different things, I have finally figured out a way to be more productive at conferences. I learnt most of these techniques from the the book Never Eat Alone.  It has a lot of good information on networking for your career in general but for an IMG who is fresh off the boat and trying to get residency, these are a few things to keep in mind.

powerful ways to get USCE

      Try to be a presenter at the conference instead of the audience. Email the conference contact person and ask them if there is any scope of poster or podium presentation. Most of these conferences are looking for presenters. We all have some work we have done back in our home country or something we have know more about than others that we can present (for example: medical tourism in India, evolving health care in third world countries, case report on a rare diagnoses etc). Based on the type of conference, pick something you can present and email the conference contact person asking for an opportunity to present.  

      Don’t be a wallflower. This was a problem I was facing when I first came to this country. I thought why would anyone want to meet me? What do I have to offer them? If I talk to anyone, I would come off as needy or desperate. I was so wrong. People come to conference to meet people. Sometimes, they are just as anxious as you are and by you breaking the ice and introducing yourself, you are helping them open up. Don’t just stand at the corner, sit on the last chair during a lecture or eat alone during the breaks.  Put yourself in front of people.

      Don’t latch on too the first person you meet for the entire conference. Keep finding more people to talk to. On the flip side, don’t be that person who is constantly darting around the room hunting for a prey.

      When you meet someone, instead of figuring out what they can do for you, think more about what you can do for them. You can listen to them about their problems, see if you or someone you know have solutions for them.

      Be a little vulnerable about yourself. Tell people who you are, what your passions are or some stories about you. Now don’t just go on and on and bore people to death but sharing a little personal information gives others permission to open up about their life.

      When you feel like you have connected with someone on a deeper level than just talking about the weather or how great the last lecture was, take their contact information to stay in touch later.

      Stay in touch later. This is where you will be better than 99% of other conference attendees. People don’t take this extra step of reconnecting with those they met at a conference. That’s just a waste of time and money going to the conference. Send a quick ‘nice to meet you’ email. Remind them about something you guys talked about and how much you enjoyed that.

      If you feel like you almost became friends with someone during the conference, don’t wait for the conference to get over to reach out to them again. They got to eat later that night. Suggest a great place to eat or drink and invite them to come along.

      If you meet the same people is elsewhere or in other conferences, re-introduce yourself.  This will help solidify your network.

3.     Physician organizations:

Join physician organizations from doctors of your home country like AAPI, NAAMA. These organizations have frequent networking events. Showing up at these events is good but volunteering to be on staff (guest list manager, venue preparation etc) is better. Email the organizer before the event and ask them if they need volunteers.


4.  Others:

Every person you meet during your journey to get into residency is a part of your network. Only if you keep up with them.  Also, try to remember two things about everyone you meet; their name and one thing about either their family or hobby.



If you are an IMG with no contacts in the US to get you a residency interview, you are not alone. Very few people have contacts strong enough to get them into residency.

You will have ample opportunity to built your network and use it before match to boost your application.

If you follow the tips above, you will expose yourself to a lot more people who can help you get USCE, research, interviews and even spot at residency programs you never thought you could get.

I learnt a lot of these skills during my USMLE preparation and internal medicine residency. It definitely helped me get interviews and a job after my residency.


How to score 240+ on all USMLE: Tips from 3 IMGs who cracked the USMLE code.

IMG Guide to Finding USCE

Let me first tell you, this article will not teach you the material you should read or the qbanks you should subscribe to or the workshops you need to attend to score high. There is a lot of information on the Internet about that.  What it will show you is:

  • Exact system you should have to ensure 240+ score on all steps.

If you are preparing for step 1 , step 2 or step 3, if you are in US or outside US, medical student or an IMG, this system will help you be a better test taker and a high USMLE score is almost guaranteed.  No matter which USMLE step you are working on right now, you get this system down; you are on your way to a stellar score.

This is a story of three IMGs who were from different academic achievements in medical school. They studied together and scored 240+ on all USMLE steps.

They came to the US with the same dream as all. To complete USMLE, apply for residency and match at a good program. Like you, they were confused by all the noise out there. Read all kinds of books, solve many q-banks, look for USCE, do some research, work part time. On top of that, the whole MCQ type question was new to them. They felt that there is too much to do in a very short time. They had spend a lot of money already buying the question banks and books but they were not sure how to make the best use of them, They got discouraged when they read on the forums about people failing USMLE step 1 or 2 after reading the same material as they were planning to read.

What did they do differently?
What made them read the same material as everyone else, but score much higher?
Did they follow a specific study schedule? Did they have a study partner? Did they pay for a USMLE preparation course?


They had a system that they followed and now they are sharing it with you all. The trick is to stick to these steps and trust the system.


System step # 1:

Timing for USMLE steps:

Planning in advance about how long you are going to spend in preparing for each step is crucial. If you plan to just start reading now and see how it goes, you have planned to fail. Give yourself 6-9 months for each step. General rule is if you have nothing else to do right now, no job, no kids, just focusing on USMLE, try to complete each USMLE step in 6 months. If you have one other responsibility, give yourself 7 months. If you have more than 1 responsibility, give 8-9 months per USMLE. Too little or too much time can be detrimental. Everyone is different and have different studying speed, but make a rough plan and stick to it. I have seen a lot of students preparing for USMLE step 1 or 2 for more than a year and not scoring as well.

System step # 2:

Distributing your time between theory and question banks:


Once you have figured out how many months you are going to give before you schedule your test, pace yourself in reading the theory part. Try to read each subject twice. Have a slow first read and a quick second read. Do not spend too much time memorizing the theory; you will not be able to retain everything anyway. Understand the concepts, make some notes if that is what you generally do and move on.

The three IMGs above devoted 30% of their total time period to theory and 70% to questions. For example, if you have no job, kids/family commitments or school (masters, PhD), give yourself 6 months to complete each USMLE and give about 2 months for theory and 4 months for question banks. The fun part begins when you start solving questions. This is when your test taking skills rise exponentially. You will retain a lot from your theory when you are actually solving questions. No matter where you completed your medical school from, how old your year of graduation is, do not feel pressured to remember the entire theory before you start q-banks. That will just waste a lot of your time.

System step # 3

Getting the most out of q-banks:

When starting with questions banks, solve 50% questions subject wise and 50% mixed. Start with subject wise first, that would include third read of the theory while doing the subject questions. The rest 50% would be mixed questions. This should take significantly less time than the previous 50%. Goal is to improve as you go forward. Don’t expect to score 80% correct from the get go. Goal should be 3-4 test blocks a day. You will start at 1-2 block per day but keep pushing yourself.

Before you start the block, imagine you are sitting in USMLE exam room.  The doors of the room you are sitting in should be closed and cellphone should be turned off. During the 10-minute break, train your brain to totally unwind from USMLE (this will help you during your breaks in the actual USMLE exams).  Eat a small snack or take few sips of coffee or any other drink you prefer. Read all the answer explanations for the blocks you have completed. You should ideally be spending more time reviewing answers and writing down or making notes all the new things. Now you can take a longer break. Repeat the process for next block. Do this up to 4 times a day if schedule allows. You breaks will get shorter as you progress further. Try to stick to this schedule. Most students who end up taking too long or not scoring too well on USMLE start off strong but then slack off. The winners stick to their plan.

System step # 4

Last week preparation before the exams:

Last week before the exam­ should be spent reading the marked questions that you generally get wrong and reviewing concise portions of texts (highlighted parts in your study material or a quick study guide). On your last day before the exam- ­relax, watch a movie, go out with friends and have fun. This will help you sleep better the night before and be ready for the test. Trust your preparation.  If you have followed the system above, you have trained your brain to endure the stress of USMLE.

We have covered a lot of things here.

  • How to decide how much time you should give for each USMLE?
  • How to distribute this time between theory and q-banks?
  • How to get the most out of q-banks?
  • Overall, how to train your brain to perform at its optimum capacity during the day of exam?

Now, if you are just starting out your USMLE journey, or you have been preparing for USMLE step for some time now but not sure if you are chances to score high are or if you have already given one USMLE step but not happy with the results, sign up below to get a INSIDER’S KIT to know exactly how these three IMGs scored 240+ on all their USMLEs. Get the details about the books and q-banks they read, scores on q-banks and self-evaluation tests to predict if you they were ready to take the test and a template study schedule to get you started.


Test names are the registered trademark of their respective owners.



Advise from an IMG who matched in dermatology at a prestigious university program

getting perfect personal statement

You know when you see them.

From the first day they start working on their application to the day of the match, you see them being methodical and inspired. They have good and bad days like everyone else, they have successes and failures like everyone else but they persists in their upward spiral of being the best.

Welcome to the world of top performer IMGs. These are the IMGs who persisted in their efforts to match at their dream residency spots despite their limitations.

You may have seen some of these applicants, may be you have read about them on the forums or heard stories. The real question is :

CAN YOU BE THE TOP PERFORMER IMG?   Can you match at your dream residency spot ?

The answer is YES.
Even if you don’t have amazing scores.
Even if you are an old graduate.
Even if you need a visa.

And one way to this is to learn from these top performer IMGs. I want to talk about studying the best. Too many people seek advise from not so successful people and walk away with vague inaccurate information that dont help them in any way.

I’d rather introduce you to amazing, successful IMGs who can show you what you all are capable of doing but never thought you could do. Being the best is never an accident. If you’re aiming to be amazing at what you do – whether it’s residency match or your career after residency– one of the best things you can do is elevate who you study from.

To do that, I have created this section for interviewing some amazing IMGs and asking them how exactly they did it.

Our first top performer IMG is someone who matched in dermatology residency at a big university program this year. She outlines exact steps she took, how long she worked for it and her credentials/scores to land a residency spot in on of the most competitive programs in the country.

Here are the questions I asked her and her replies.

1. Dermatology is PGY2 through PGY4, with pgy1 being a prelim position in medicine or surgery. Is that correct? Is there a PGY1 in dermatology?
Yes that is correct. Like some other specialties such as Ophthalmology and Anesthesia, Dermatology needs a PGY1 in medicine or surgery. Another option is to do a Transitional Year (kind of an internship where you rotate in every department for a few weeks/months). Transitional year is very competitive as they have limited spots and mostly American graduate applicants. In general, I found matching in to prelim equally taxing as derm because you are competing with candidates who are applying for derm/ophtho/radio etc.

2. What were your scores or is it necessary to have super high score 230+ for derm?
Most dermatology programs have a Step 1 cut off of around 225. The mean score for selected candidates is over 230. While a high score is vital, a high score alone is not enough to secure an interview in dermatology.

3. Did you have an advanced degree; MPH, PhD etc in US? Do you think that helps?
I did not have any advanced degree in the US. But I had completed a dermatology residency in my home country, which probably helped me secure research fellowships in the US.

4. Did you work in any capacity in dermatology in US? Volunteer, observership, externship, paid research etc. Also for how long?
I did two research fellowships in US for a total of around three years. I was on a paid research position in the last two years.

5. What other tips do you have for a dermatology IMG applicant?
I think it is not an easy path to get into derm. It is more of a marathon than a sprint race. My journey was long and stressful but persistence ultimately paid-off.Having 2-3 years of quality research experience is a must for everyone whether it is an AMG or IMG. I know many AMG’s who have done 2-3 years of research before matching in derm. Last but not the least- having a good network is indispensable. I had 4 great LOR’s from key opinion leaders in derm and reached out to all possible sources for help during the whole application process.

Tips and tricks for getting US clinical experience

Once I completed my USMLE step 1, I started thinking about  applying for observerships/externships, The first thought in my mind was me standing in scrubs and white coat with bunch of other residents and the attending in a hospital wards. I soon realized that this is not always the case because I was getting no replies back for my emails from the attendings.

How to write a personal statement img

Attendings in university hospital and community physicians get many emails from IMGs every month asking for clinical rotation. Only a few of these applicants get positive replies from the physicians.

What do these selected few applicants do that hundreds of others IMGs don’t. What made them get an observership or externship over many other IMGs with much higher scores?

I was one of those IMGs. I emailed hundreds of attendings for clinical experience and did not get even one reply back. At first, I thought it was because of my low scores. Then I made a few changes to the emails I was sending and I started noticing that attendings were replying back. Not all had USCE opportunities for me but some did. It was still better than no response at all.

In this post, I will show you exactly what I did to go from zero replies to ending up scheduling 5 observerships, 1 externship and 1 research volunteer experience (which later turned into a published paper and part time job)  in just a few weeks

These are the same techniques I later used to secure away rotations during my residency. 


Let’s look at two promising IMG candidates who sent me emails for USCE:

Candidate 1 tells me about their stellar scores, dedication to pursue internal medicine residency, strong work ethics and accomplishments in home country.  Later, in the last paragraph she tells me that she wants to come over for 3 month externship.

Candidate 2 tells me that they want to shadow me for a week during my rounds and understand the work day of an internist.  She is applying for internal medicine residency. She has checked with the coordinator of my program and her credentials and visa are in order as long as she finds a faculty member to agree to her rotations.

Who do you think I will feel more comfortable to come in for a rotation?

If I have one spot in my practice to accommodate a student, candidate 2 is by far the most likely to be selected.


Once again, think about what goes in the attending’s mind when he opens his mailbox in the morning. He has a few emails with subject “elective sponsorship request’ or “observership inquiry” or something similar. He knows what it is about. If he is even a little bit inclined to offer the observership, he wants to know when and how long the student in planning to come. But he has to read about 3 paragraphs before he finds this information, he has lost interest already.


This is the hard part but incredibly rewarding. When I first joined my workplace, I had no idea what were the rules of the institution for observership or externships. So I ignored most of these emails. Then one day, I got an email from an IMG which blew my mind. He had already asked the program coordinator of the department about rules before he emailed me.  In his email, he told me exactly what the policies were so I did not have to figure them out. All I had to do was say YES!


If you do the things mentioned above, you will most likely get an observership. After about a week of observing, you will get a feel of what his work is like, when he is busy and when he has some down time. By now, the attending will also be a little more comfortable with you being around.  He would have realized that it’s not that bad (maybe even helpful) to have a student shadow him around. At this point, you can tell him that that as an IMG, ‘hands on’ experience is a sought after feature by program directors. Tell them you would love to stick around a little longer and take histories and perform brief exams on the patients. Tell them, you have checked with the department and you can get the institution HIPAA certificate. Most likely, the attending will be fine with that.

If you get an externship using above tools, great job!  You can buy me a coffee later. But if you don’t’, no worries.  IMGs get hung up on externship vs. observership debate. I had a month of hands on externship in a community clinic. The interviewers were more impressed with my LORs from observerships because the attendings genuinely enjoyed having me around and mentioned it in the LOR

There you go guys. If you have not had success getting USCE after hundreds of emails then there might be something wrong in your emails. I wasted many valuable months spamming inboxes of attendings in local university with long unfocused emails. Then, I made these changes and I had more obersverships available (for free) then I could attend.