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Residency in the USA. Um My name is Anna and I am a member of the Preclinical education team um of the U A MS, which you might know that is a nonprofit organization that connects all of the Medical faculties of the Czech Republic. And uh I will be hosting today's lecture. Uh Today, we will tell you everything you need to know about the USM L exam and the uh residency application for the USA. Um And it is my pleasure to introduce you to our speaker today. Doctor Bas Baruto, who is a graduate of the Charles University of the Y one, the first five, you'd be in Prague and is now a pediatric residence in the uh US. So without further ado, I'll hand the torch over to Doctor Bark to share her knowledge on the, on the matter. Thank you. Hi, everyone. Um You pronounce my name so well, thank you. People can pronounce it. So that's really nice. I'm glad to hear that. So uh can you see my screen? I'm gonna go into slideshow to somebody. Let me know if it looks like in presentation mode doesn't work. Yeah. Yeah. Yeah, it works. Perfect. All right guys. So um like I, you were told I'm doctor uh I'm a first year pediatric resident. I work at China Hospital Baltimore in Maryland in the United States. Um I graduated from 1st, 2nd year of medicine uh last year in 2023 in June. Um So I know that a lot of you guys might uh be at different stages of, of like, be like, you know, continuing your uh your application and wanting to pursue residency in the US. So I will touch on like different parts like us and the application, but just please please feel free to ask questions. Um If you, if it's something that's more relevant to you. Um I wrote like a more general outline and then just tell me what applies to you guys more if you know, you have more specific questions about us, certainly, or outpatient process based on where you are in the process. Um So generally, what do I need to apply for residency in the US? So before you apply for residency, which before I start, you even residency is basically just further training in the United States. We don't do foundation here like the UK Foundation. If one F two, we don't have that. So um in almost most specialties, you will directly go into the specialty that you're interested in. Um So what do you need is step one and step two to apply, then obviously, you need to pass those um preferably you need clinical experience in the United States um before applying in your preferred field of interest. So, um this can be really hard to get from like these, the experience I had. Um there are organizations that help you like. Can you guys see my cursor if I like c Yeah. OK. So there are organizations like us and start the AM O opportunities. I'm sure you've heard of AM O I think they do a lot of like advertisement through our um university personally from my own experience. Uh It can be a little bit more pricey AMMO. Um us and Leery was one of those that I personally like found myself. Um one of those organizations that helps um organize a clinical experience for you. Um you still have to pay um but it's cheaper. Um Sometimes you can get um clinical experiences through like if you have a connection or, you know, someone who can get you, you know, for you to shadow somewhere. But in those cases, it's usually more a shadowing experience and less hands-on. And what I mean by that is like, you'll shadow the work of another doctor, but you won't be like super involved in the care of like, you know, rounding on your own patients and writing notes and things like that. But if you were to like do pay for experiences, a lot of times you can be involved in the care of the patient um which you know, that is the ideal experience you wanna have when flying because they do differentiate between those things. But whether it's an observer shift where you observed or shadowed where or you were like hands on involved and it was like a full on rotation. So it is a difference. So I think it's worth paying for that so that you get the full experience. Um uh Before I go into volunteering experiences, um when you do these clinical experiences in the US, um you can get recommendation letters. Uh you need four recommendation letters, 3 to 4 recommendation letters when you're applying. Um I recommend getting recommendation letters from the places you rotate at. Um especially if you give a good impression, you can rotate um that at a place that you rotate at, so you can get a recommendation letter from them. I've heard it's also a good idea to get a recommendation letter from our own university. Um It is what I did as well, but if I were to go back and do something differently is if there was a doctor I worked with for a long time, whether it was like on a research project or for example, if some of your anatomy dissectors or assistants or something like that, if there's a doctor you worked with very closely, they can write you a better letter because they know you. So the quality of your letter, the quality of anyone recommending you really matters in the US. These type of things really matter when you're applying um in terms of clinical experiences other than paying for these like it was always RCA more opportunities if you are organized and smart with your timing because it can be, it can be overwhelming. Um you can organize to do a clinical experience through um a lot of like some of the universities in the US provide those. If you apply for them, you can do it through a university or like through a medical school, something like that, but it can be harder to get, it can be more competitive. And um there's like specific times you have to apply for them. So obviously, if you pay for these organizations that are curated for international graduates for international students like us, then this is easier and but you know, it, you have to pay for it and there's all of that things and generally they recommend they, when you're applying, you will see, they will say it's not required to have clinical experience, but it is definitely recommended. Um And it is definitely something that makes you a more competitive applicant. Um if you have 2 to 3 months of clinical experience in the United States, um on top of that, um having the majority of your letters from them and having like one letter from our university or doctor you work with closely that's outside of the US is a good idea as Well, so in terms of um volunteering experiences and activities around, again, extracurricular activities around or revolving around your field of interest. Um Again, I think they really like to see that you're committed to the field you're applying to. So any volunteering security activities that you have that revolve around, like, for example, I always talk about myself if I did, I did pediatrics. So I would like when I was back in, when I was still a med student, I would uh teach in like a, I would teach English at an orphanage online. Um So, you know, it's like things towards Children or things towards like curating your um application around your specialty. So it looks like, you know, you really wanna do this. Um personal statement is just when you're applying, you have to write like a letter of motivation of why I wanna do the specialty. And obviously, while you're applying, you also have to um submit your results. Um I don't know how much weight this carries. Um I know like when I was a med as a med student, I really was like, worried about that like, oh, will they look at like a specific grade or will they, does it matter? I mean, I think that for example, I was applying to pediatrics. So I think my grade in pediatrics mattered. But I don't know um generally the weight that it carries, but it is part of the pro like the procedure that you have to submit your results. Um I do know that you do have to report it. There is a specific question they ask if you have been in I on ISP. So if you have taken an extra year, you do have to report it. That is there um in terms of research. So medical students in the US are very well rounded in that sense that a lot of them have research. And I feel like coming from someone from our background at our medical schools, it can be hard to get that type of exposure sometimes. Um if you're aiming for more competitive specialties like surgery, uh radiology, something like that, 100% recommend you to do some sort of research, whether it is. Um I know some of my friends and medical students that were doing research with specific departments at our university. Um And in that case, I would definitely recommend if you can like if you're in third year. And like, obviously, if you're in sixth year right now, this is not something you can really now. Um But if you are more early in your process, then you can for sure, reach out to um doctors and try to uh get involved in research, you know, reach out to many doctors in our university and try to see if there's any opportunities for you to get involved in research projects. And I think that really strengthens your application. Um There are you can always, like, again through the U SMS and all there are ways that you can, like, be involved in publications and like literature review papers and things like that. And in my honestly on a grand scheme of things, it's kind of just like a check box, something you just have to do. Um, just so that you have it on your application that you published some paper. Um, uh, yeah, I know some of my friends and some of my uh seniors as well that um wanted to do sort of more competitive specialties and you can apply before, if, before this is not a requirement. Like I don't wanna scare you because that's not what I did. That's not my friends who went into internal medicine did either. But I have friends who wanted to either get into a very, very good program or get into like a more competitive specialty and they applied for like a, a research um position in the United States. A lot of universities will take um us like graduates as a research fellow and that is unpaid. But it's like, basically you do research at a really big university. Um I know a lot of our graduates who went into Yale um Mass uh Magen, which is a hard word to do a research year because it's unpaid so we can get placements there and it really strengthen your application, but it is a year of your life. So at least a year of your life. So you really have to like weigh your costs and like, what are your priorities? Um I don't know if I overwhelmed with you guys with those information, please. If you have any specific questions, I will touch more into like step, step exams and specifics of the application process in my next slide. But if you have any specific questions about clinical experiences, research, volunteering, please ask me. Now, I have a question actually. Um does it matter if the research is like um like an original one or it can be a review? Like what do you consider as like a strong like research opportunity? Yeah. So obviously a strong research opportunity, a strong research opportunity is an original um project and that you work with like a senior doctor and things like that. But I do wanna say like uh having, I think you said literature reviews and things like that, that's what I have personally myself. Um I think having that is better than nothing. And like I said, it's like a checkbox for a lot. Like it just kind of like looks like you did some research, you are familiar with how to do research or um review research to write further, like, you know, to write a research paper type of thing. So um any research is better than no research um again, you can still match without research. But um I would definitely say original research projects that you did over like a year or 200% better, especially if you're aiming for competitive specialties. If you're aiming for more um classic specialties like internal medicine or pediatrics or family medicine, um I would say literature reviews, those type of research paper, things are accepted. OK, thank you. No guys. Any other questions about experiences, volunteering? Hello. Uh I have a question. Uh I wanted to ask like if I wanna latch into a specialty and if I'm going to go to the US to do an internship, should I focus on doing an internship in that specialty or does it not matter? OK. What specialty are you thinking? I'm thinking feeds as well. OK. So um I think the majority of your internships should be curated towards the specialty you wanna apply to. So if you wanna do uh peds, um definitely, I would think of like doing a Peds rotation, whether outpatient or inpatient, out inpatient can be a bit harder to get. Um outpatient rotations can be a little bit easier to find. Um I do wanna add an internal medicine rotation is like a foundation type of thing. So having an internal medicine rotation, regardless of the specialty, you will end up applying to can be good for your, like it can strengthen your application. So I think generally it's a good idea but having specific internships, like if you wanna do Peds, having Peds rotate internships makes it look like you know, you really like this field. So definitely prioritizing rotations for your own specialty. I do wanna add on top of about the rotations is I've seen people who like apply and do a rotation in like cardiology. Um Not that it's bad, you know, obviously, like if that's the field you're interested in. Sure, but cardiology is not a residency you will directly match into. Um that is a fellowship. So first you have to do three years of internal medicine and then apply to cardiology. So, so as a medical student, you should be doing a rotation in internal medicine. If you're, you, you know that's adult medicine that you're interested in. That way, it strengthens your foundation. And then if you were to do a cardiology rotation on top of it, that's OK. But if that's all you have is like a specialized um rotation. It's not, I would say it's not the best. So that is something I've seen. So I just wanted to um because I know a couple of people who were doing that. So I just wanted to add on that. Any other specific questions you guys have about rotation before I move on? OK. Um OK. Us advanced. So step one step one is now has become pass and fail. When I did it, it was not pass and fail, it was graded. Um It being pass and fail, I feel like takes a lot of pressure off because you just need to pass it now. Um And the passing grade is 196 which is uh low. So it's so I think it's, it's pretty doable to pass. Step one now. Um I do wanna say that in the past when step one was um grade it and not just pass and fail, I feel like it would prepare you more in the sense that you had a really strong foundation and then doing step two made it so like you start at a higher baseline, but now it's more like a pass and fail. So, you know, your foundation might not be as strong because you were just aiming to pass. Um I still think that step one is an exam now that it's just pass and fail. It's great to just get it out of the way if you, this is what you wanna do. And um I do recommend generally doing your step one before you end up doing a rotation in the US. Obviously, again, it's your preference. But I just think like, um you know, us, residency pathway is an expensive pathway if you were to compare it to like UK, so it's something like getting that out of the way so that you're not, I passed the initial exam. Now, I can like focus on like getting one or two rotations in and then doing my step too when to do your step one. Step one has pharmacology. So I did it after my fourth year. Um, so the summer after my fourth year, I think that's what we do for it. Yeah. Um, I know some people who are doing it and after third year, but they were doing, studying farm on their own if that works for you. Sure, personally II want to do for him and then do it, take my time. Um, step two is graded. Um, the grade on your step two matters. Um, passing grade is 214. The average grade for step two in 2023 is when I did it myself was 248. Um Now talking about like average great being 248. It's pretty, um, some of you might think, ok, that's a pretty high average grade. Uh Step two, generally people tend to score better on step two compared to back when we had a grade for step one. like, ok, your grade matters to an extent, like obviously if you have a not a good grade at all, like, you know, it's very far from an average, obviously it matters. But for you to feel like there is like a threshold you need to reach and then if you don't make that great, then like you're not gonna match the or you're not gonna get a job, that's not how it works. Um, when I was a med student, I thought the grade carried a lot of weight. I thought, um, the grade mattered more than it actually did once I realized once I applied. Um, so your application as a whole matters a lot in the US rather than just your grade. So there are people who have lower grades, for example, than, than you or whatever, like, than they do than me. And, um, ended up having more interviews. That's just because it's like a overall look at your application rather than just looking at your grade. Um looking at like if your whole application is well rounded rather than just you having a good grade. Um or I know people who had really, really high grades like 95th percentile, 99 percentile or something like that. And you know, when you have a grade like that, you would think like, well, every university program is gonna want me, but as an international student again, you having a crazy good grade is not everything, unfortunately. Um and a lot of other things like your recommendation letters, your volunteering experience, your clinical experience play a huge role. So I think, you know, don't um obsess over your grade but understand that um especially for more competitive a um specializations, having an above average grade is an important factor in your application. Um I do wanna show, do I have it? Yeah, before I a ask like you guys if you have any specific questions about step exams, um I couldn't find the most recent one. So this can this might not be like super accurate. Like I don't think this is from this, this is not from this year. So like the most recent year, but it just sounds like a um pattern, like a general pattern. Um So depending on the specialty, you're going for the average grade of the applicant that gets a job. So matches is different. So for example, family medicine um has a lower um average uh average step two grade. So the the dark blue is people who match so they, you know, got a job and then the green one is people who did not. So clearly you see it overlaps. So that tells you your grade is not everything but um as you can see, it's like much, much lower the average like the range of grades, for example, compared to general surgeries. So, you know, there were people who did not match with in general surgery with a 245 and this is keep in mind this is for American graduates. Um we'll get into that later like the differentiation of being an American graduate uh versus a foreign graduate. Um So yeah, or like for example, here, pediatrics. Yeah, so pediatrics again, huge range, but um pediatrics is also not a very competitive specialty. It's relatively easier to get into a more um approachable um specialization especially for a foreign graduate. Um So it's a, you know, a lower grade that you can aim for. Um same whereas internal medicine, internal medicine, internal medicine is the same. But like, for example, if you were to look at radiology, you know, there were people who did not match with a 255. So it's like generally, and this is the pattern that you see like some specialties are very competitive and generally people who match have a higher grade. And then there are specialties that people have uh matched with lower grades. Um Any specific questions about step exams? No. All right guys now studying for the step you back. Um So first step one, first aid book, the US only step one book, first aid book is really important um in terms of learning your foundation knowledge, you know, you basically just have to sit and read the book. Um It's a big book but um your world on top of that, your world is a really important resource. Um You world is basically like a question bank. So there's a bunch of questions and um you like, you know, you can learn through their explanation. So when you get a question right or wrong, there's a lot of explanation you can learn through that. Um And it's important like to use your world like uh learning tool, not like a testing tool because um you can learn a lot through your world rather than just test yourself. So that's why I say it's important to start your world early for both step one and in step two. and not just read a book because test taking skills are super important for you as an and your world teaches you those test taking skills. Um There is a first aid book for step two. Personally, I did not use it. Maybe I literally opened it maybe like one time, two times. Uh because your world is so useful. And literally, if you do your world question bank two times, I feel like that's more than enough. So I didn't use the first aid book for step two. First step one, the first aid book is very important and it has a lot of information for you on top of that. Obviously, first step one, I did sketches. Um you guys know sketchy, we use sketches um you know, for micro farm path or some of us use this for pathology. So sketchy, sketchy were great. Um There's an an is like a flash guards system really, really good for remembering key details, stupid information about like genetic things that they test you on. Um And it's like flashcards that basically if you know things, um it will show you the flashcard later and if you don't know it, it will show you the flashcard earlier. So the system makes it so like you don't see a flashcard that you know, well, um often and then it's something you don't know. Well, you'll see it more often. So it's a really well made system. Um I think he personally is a lot of commitment. I used it but I would say I didn't use it, um, religiously, like, strictly. But, um, if you can't commit to an kids are great, they boost your grades. Um, I really recommend any case if you can commit to it. Um, and boss and you guys know, I don't know if our university still, I know for a faculty would like, sponsor us to have an AMBOS membership to an extent. Um I used for step one and step two just because I had um the membership from university and it was a great second question back on top of your world. And uh the questions were a little different than usual. So I liked it. Um There is also AM BME. So am BME is like an organization that um organizes the step exams. American organization, you can pay to do mock exams. So basically, they're like long, they're like four hours I think like, so then it like simulates a real exam to an extent and gives you like a grade or tells you like areas you need to improve on. Um And I think I really recommend doing a couple of them before going for your exam because um you like doing one like a month or two months before your exam and then doing another one as you get closer, it tells you like, what is your baseline grade? How much you need to improve based on what you're aiming for, especially for step two. Yeah, but, you know, you have to pay for those separately. There is, I think like offline versions, but I do not endorse that you can find them if you want. Um Other than that, um I wanna say, yeah. So those are the main resources guys. Um If you, I do wanna say that step one exam is, gosh, I don't know, was it seven hours or I think it was seven or eight hours and step two exams longer. So I think eight hours or nine. So, you know, this is, these are really long exam and you study for them for months. So it's a, it's a big commitment. I think it pays off in the end. But um for those of you are just considering us now, I think it's important to consider all of that on top of the cost, any specific questions about step exams you are studying? Um Hi. Yes, I have one question. So I was wondering when would you start studying for step one and when we start something? Yeah. So, so like I said, you, there's farm in step one. So I would say doing it after you finish uh fourth year. So I did it in that summer. So basically I studied, I think I studied from June to like October but like, or like July, I think realistically I studied, like I, if I studied seriously from July to October, I do wanna say there was a grade back then. Um So I was aiming for a certain grade. So I had to study for longer to reach that grade. If I was aiming to pass, I could have done my exam a month earlier. So I think now that there is pass and fail, I think it's something you should just do mock exams and once you're consistently passing to just do your exam, so not to put an ex a lot of pressure on yourself. But I would say like 232 months. So July to October is what I studied. But keep in mind I had to have a grade. So I was studying for a longer time. Um as well as you probably also have to uh register at some examination center. So is it usually like 2 to 3 months in advance as well? Yeah, you can register, you can register like I think up to six months in advance, but you can even register a week at before. Like it's a huge range that you can register, but there is something like a scheduling permit that you have to get. Um and that can take like a like two weeks to come sometimes. So do not leave it for last minute in case your scheduling permit doesn't reach in time. But this is like very um there's a process if you google it, like uh how to apply, how to register, how to set it up. It is there. Um But yeah, give yourself, I would say at least like a month and a half to like register it. Also, back when I did step one, we had a center in Prague. Um I think they closed the center because I couldn't do my stuff too in Prague and I had to do it in Germany. So I don't know if they restart the center in Prague or you guys also have to like go to it in Germany. So that's also things to keep in mind like timing wise for yourself and making sure the dates are available for you. Oh, because sometimes this can get full. So yes, at least I would say a month in advance. OK, thank you. No problem. Also, I had one question uh which Anx did you use? First step one? Oh my God. An Yeah, I'm trying to remember the names like um gosh, I don't remember. Maybe I can help you out. Was it Jan? Yeah, I use Janki and there was another one I think like maybe that's, yeah, Zany, I use Zany and then I think like your like here was one of them, but I did use Zany. Yeah, I think that Zany had a lot of the sketchy stuff. So I think you use Zia and or you could, if you're motivated, you can make your own card from um like mistakes you get on your world making card uh cards from like mistakes that you have. That's also a really good idea. All right, thank you. No worries. Any other questions. So, hm. So I do wanna just roughly go over how the process works. Um Again, I don't know if uh if all of you guys are still doing your steps or if some of you have like are in a different step in the process. So this may be more relevant for you. Um Generally applications um get submitted in September every year. So now it's November. So the next batch would be next September. And that's like when you already have your letters, letters of recommendation and your personal statement, you can apply for more than one specialty if you want. They won't know they like people you apply to, they don't know that you applied for like, I don't know, internal medicine and family medicine. They won't know that, but it is something you can do. Keep in mind, it means you have double the work and it's double the cost in that sense because you're applying to two separate specialties and you have to like do two separate personal statements, two separate everything. Um You like submit your application on Era in September for the next year. Residency starts in June to July. Um So I'll tell you my own timeline. So I graduated last, we're in 2024 right? Yeah. So I graduated last year in June and then I did step two in July, end of July. And then I applied in end of September and then I started residency in June of this year. So automatically the system makes it. So you take like a 10 month, 11 month gap. Um Unless you can do step two and apply. No, sorry guys, you can apply and do your E two after fifth year. But then it's, it can be really stressful because then if you finish medical school in June, you have to, you know, go and start residency. So uh it's, I would not recommend that personally, but because that is so stressful, I have like medical school is already a six year process I would wanna break. So that's what I did. I took a 10 month to like, you know, interview and then stop working. So that's the process. Um in terms of um interviews, you get interviews from like October to February. Um I think what is different about the American system is there's something like a, so let's say if you got 10 interviews, you have to rank your interviews like your first choice, second choice, third choice and then you basically end up getting one. So the hospitals that you also interview rank you based on like their preference of like the applicants they interviewed and then the system matches you and then you get one job like you don't, it's not like you get three job offers and you get to choose at the end. Um Basically you just interview and you send the rank list. So you don't know which place in your rank list you got until when you match, which is Match Day of March. So um yeah, it's a, it's an interesting process. It's different then for example, if you were to be in the UK. Um but um yeah, different, I do wanna a little graph in terms of. So P gy one is like a first year resident um maturates by applicants. So orange is the MD senior. So this is, this is basically American graduates who went to medical school in the US. Um blue you can ignore blue, blue is like in the US, they have like an alternative medical school. They're called D not relevant to us. Um Then non USI M GS are international medical graduates are who are not American and require visas. As you can see since 1992 until now the mass have increased and around. I think it was like 55% about 50% of non usi M DS are matching um which is, which is good stat it's not bad. And um USI M GS are international medical graduates who are American. So their mad is obviously higher. They do not require visa sponsorship. So just keeping in mind that there is like a 50% something chance of matching on your first try. Good. So yeah, um I feel like uh I, you know, this is a lot of information and it can be overwhelming. You might be thinking why even do residency in the US? I think uh there's a lot of pluses to doing presidency in the US. Residency in the US is a faster route to specialization compared to UK. There's no F one F two he residency three-year program. After three years, you're a pediatrician, you can either work as a general pediatrician in the hospital or you can work as an outpatient um clinic, pediatrician. Internal medicine is the same. It's a three-year program. After three years, you can work as an internist in the hospital, general internist, or you can work as an outpatient internist again like a clinic, clinic, clinician or with ps in internal medicine, you can do further fellowship. So if you like a specific subspecialty, you can do a self specialty fellowships which um differ in length around 2 to 3 years, extra training. If you wanna be a cardiologist, whether it's a Peds cardiologist or an adult cardiologist. If you want, I don't know IC doctor, it's like a three year program. Things like that. If you wanna do surgery, surgery is generally a longer program everywhere. So that's a five year per year generally for a general surgery. Um I do wanna say doctors in us are well compensated. What I mean by that is that they're well paid. So now, obviously as a resident when you're in residency, no, like it's decent but it's, I mean, ii think it's better than people who are a junior doctor in the US. Uh, in UK. I mean, we all know how it was with NHS and Brexit and all of that and the strikes. But, um, definitely were well decently paid, um, as a resident. But, um, once you finish residency as a senior doctor, as an attending doctor, doctors are well paid here, there's a lot of opportunity for growth. And I think that is a very big attraction um living in the US. Um It's a very large country, there's a lot of opportunities. Um a lot of different lifestyles, a lot of different like options of places to live in and it's like its own world. I feel living in different parts of us is very different. So there is a place for everything. Um I do wanna talk about the cost um coming to the US. Um residency is, is not, it's, it's a cost to consider. I mean, I know we all pay for medical school in, in Charles University or in Prague anyways, but this is like an additional cause I think if you apply to the UK, you don't have to do all a lot of things, a lot of these extra costs and you know, buying new world paying for step exam, doing clerkships. But I think it's like a investment that you make early on to get the results of being a senior doctor in the US. So those are all things I would consider and I did consider when I was applying work hours and workload are also important things to think about. I had friends who are um F one F twos in um UK. And I know that at least from what I've heard that they don't have to work on the weekend, on the weekend, on a lot of rotations or majority of rotations, you can choose to work on a weekend and you get paid extra for that. But in the US, it does not work to work in the, we can um work schedules are quite tough. Um So those are things to consider. Um workload is probably heavier here compared to if you were to do medicine in the UK. So those are so many things, any other specific questions that you guys? Hi. I have a question like it's a little off topic, but I just, I'm just interested in. What is your plan after residency? Like, are you gonna specialize? Yeah. So I'm still deciding I am thinking of specializing. Um and I like ICI like um NICU, so neonatal ICU. So that's what I'm thinking about right now. But it's three years of, you know, resident salary again and three years of heavier workload compared to a senior doctor. So it is something I'm thinking about still. That's how I feel right now, but maybe after three years I'm gonna be tired and I'm just gonna wanna work as a senior like uh hospitalist. So we'll see, but right now I'm leaning towards, I see you. Self specialty. Ok, thank you. And good luck. Thank you. I have another question um about like scheduling your uh clinical experience in the US. Um, like, like for me, I have this problem um like my exams that I'm probably not gonna be able to fit at all, like through my studies in LF one. So I heard that like if you take your clinical experience as like a graduate, then it's not gonna be like hands on. Um do you know anything about it? Like how it will affect my application or I think? Really? Are you in sixth year? Yes. OK. Um Yes. Um there is less opportunities for hands on as a graduate, especially if you were to apply directly to like um universities that want to give rotations. Um You can't do that as a graduate but these private companies like if you work through us company or am opportunities, they usually allow it, especially in a clinic setting. Some of them might be a little more strict, but you still have opportunities to us and those, those organizations to get an experience that's more hands on, but it can be a little bit harder um to organize. It is still possible to get hands on experience as a graduate. It's just harder to find and you have to go through these organization. But to say it's it, it is possible, right? It's not like uh when you finish school, then you cannot lie to it anymore. I know what you mean because I remember hearing this as well. It's just that um the official like if you were to do a rotation as a medical student in like a um university or in like a teaching hospital, yes. In that case, you need to be a student. But going through these organizations of a Mr you as these organizations that you know, take a charge to arrange your rotation in those cases and majority of them, you can still do some hands on. Thank you. Thank you so much. I do wanna say because I remember this was like something that I think some people struggled with like timing irritations. I did. So I did step one after fourth year and then I did step two after sixth year like in that window before applying summer of fifth year. I didn't have an exam. So I used the summer of fifth year to do rotations and we did have to do like a four week rotation for internal medicine. So it was like two birds, one stone to do that rotation and then do that in the US. And it counts as the rotation you have to do for microscope. So it was like, I was trying to get my US uh oh you know, clinical experience and then count that as my internal medicine uh elective rotation for that was required for our university as well just to save time. And I did the same with the Peds because there was like a two week peds, elective rotation requirement, I think in fifth year again. So again, I did my PTH rotation in the US and I wrote it off. I was allowed to write it off as my required peds um rotation for university as well. So that saves you time. Um I do wanna show um before I get into it, obviously, choosing a specialty or choo choosing word of practice should not be a financial decision. But um I think it's an important driving factor for a lot of us. Um Personally, I pick peas. I do wanna raise awareness that pea is not well comps compared to other um medical specialties in the US. Um compa in comparison to other specialties. So this was not really a financial choice that I made. But um I do wanna show generally that us doctors are paid well and I think it's an important thing because we spend a lot of money applying. Um It's a hard process, the exams are hard. So I do wanna say it does pay off. Um you know, internists on average, earn $282,000 a year. Um This is pretax, obviously, there's a, a lot of tax in the US. Um But I do wanna say like it's well compensated. And if you were to do a three-year fellowship like cardiology or gi gastroenterology, you pay well and it is um you know, there's a lot of opportunity for growth. So I think that is a huge plus of the US which makes this process worth it. So, any other um sorry, I just wanted to know is it possible maybe to give a, like a general estimate of the total cost of the whole admission procedure or like this whole path? Mhm. Um Her rotation, I think every rotation I did was around 1000 something dollars. Um There were rotations, there are options that are much more expensive than that. I was trying to pick the cheaper ones. Um I think A ML tends to charge a little more. Also look into that. Sometimes there's no difference but sometimes it is more um other than that. Um So, so if every rotation is like 1000 you have to do like 2 to 3, 1000 something. So do the math and then you know the cost of if you fly there, if you don't have family, you have to stay there in a Airbnb or something. If you have other friends, that's what I did. If you have other friends who are applying to the US, plan it together in that, that way you can get an apartment together, live in the same city to do your rotations. Um you know, be money smart because it's an expensive process. Um So that, that is the exper clinical experience. The new world is usually around $400 300 dollars. And then you have to get it for step one and then you have to get it again for step two. And I do wanna say you do step three once you start training, so you have to get it again. Now, I, now I have it for step three. So that is another thing. But um that is a cost and then step one is the right thing. Around $900. Step two is the same around 900 to $1000. Um ok, application process depends on the specialty you apply to. Um there's more options, more programs you can apply to like internal medicine has like, I don't know, 405 100 programs in the country that you can apply for residency. You don't have to apply to every single one because the application system charges you per program, something like that. So it's a, it's a complicated thing. But after like the 1st 30 programs, you apply to a chart. So then obviously if you apply to more programs, you pay more. But then as an international, you wanna be applying to like over 100 to 200 programs to cover yourself. Um So obviously that's a cost per program. So those are all things to consider. And sometimes if you have to pay for a research project to get involved. If, you know, if that's what you want, that is another cost. Um, yeah, I think it's an expensive process that maybe, you know, it's not um realistic for some people. But if it is something that you can do, I think that the outcome is worth it. That's what I think. Does that answer your question? I can't give you a specific number but this is like the breakdown of things I generally spend money on. That's great. Thank you. Uh Hi. I have a question um for our chosen specialty. Um How many programs do you recommend that we like kind of apply to, to have a good chance of matching? Is there a specific number of programs that we apply for or what specialty? Uh for example, pediatrics? OK. Um pediatrics I had so like I said internal medicine was like 400 programs. So my friends who applied to internal medicine, you know, they applied for more program, two more programs than I did um PS had like, I think it was like 200 programs. And so there's a website. Um I don't remember the name. I think it's called Residency Explorer and put it in the chat that you can see how like what percentage of people in that program in that hospital are international students like international graduates. That way you don't waste your money applying to a program that does not take grad internationals at all because you pay for program. So I think I had like 200 options that were like sponsoring visas. And then I removed like, I don't know, like 40 programs that basically took zero international students. So then I applied to like 120 or 130. Ok. So my application was much cheaper, that my was not much cheaper, but like, I think it was like 1000 $2000 cheaper than $1000 cheaper than my friends who applied to internal medicine. Um because there were less options and so I applied to other places. But um yeah, depends on how many options there are. So then, you know, peds, I basically applied to everywhere that allowed me just because the number was ok. But with internal medicine, if you wanna apply to every program that you can, it's 400 programs. So then you have to filter things out. All right. Thank you. Hi. Uh I have a question. What type of visa did they sponsor you? Like H one B or J one? Mhm. So I'm on J one. I do wanna touch on that. That's a good point. I forgot. Um So H one B you could only be sponsored on H one B if you did step three. Um step three is another exam that technically you have to do. Um once you start residency, so you do it in the first year of residency. Like I'm studying for step three right now. But, um, you can do it early, like it's not, it's allowed and that way you can, um, qualify for H ONE B. Um, then like when you're picking programs, you can see which program sponsors J one and which program sponsors H one B more programs to sponsor J one compared to H one B. So again, it's easier to match into AJ One program or a program that has J one mainly than to get an H one B and pay. Like if you were to put a program that gives H one B first on your like rank list, more people will wanna go there because H one B is a better visa. So, you know, it's a bit, it's more competitive to get into that program then, but I'm on one. All right. So after you do step three, you're pretty much qualified for an H one B and you can, you can transfer the visa. You, you cannot transfer your visa. Um It's only when you're applying that. If you already have your step three, you qualify for H one B if that hospital offers H one B. Um Oh, ok. Yeah, my hospital doesn't offer H one B so I have to stay on J one and J one. you cannot leave J One Visa um until you finish your program and you ha you're expected to like either go back to your country or do 2 to 3 years. Of, um, work here in like a more underserved area which is still in the city but like a little bit more like an area with like, um, uh, more like a below poverty line or a minority groups type of thing. Um, you're expected to, like, do that type of work for like, two or three years before you can transfer your visa. So there is, um, certain expectations that come with going on day one visa. Um, but it's easier to get on. It's easier to match. And if, if your goal is to match faster and start residency faster, it's easier. All right. Thank you. Um I have a question. Mhm. Uh So you said that you're studying for the step three right now? Uh How do you manage your time between residency and step three studying? And do you think it's advisable to start before you start residency? Like you said, you had a 10 month gap. So do you advise starting then or during residency? So I could have done a step three during my 10 month gap, correct. It wouldn't have affected my application. That was one of the reasons I did not do it because I already applied. And so it wouldn't have affected like, unless I did it right away, it wouldn't have affected interviews I got or how I would have racked places because they would not have been aware that I passed. Um, unless I did it really early to like announce it to programs. So that was one reason I didn't really feel like doing it and I wanted like a break. That was one thing. Um also doing step three, step three can only be done in the United States. So then I had to basically get another tourist visa to come to United States and do my step three and then leave and then apply for my work visa again. So it was like a lot of steps to do my step three to be able to, you know, before residency. I know people who did their rotations in the US and then did step three at the same time. If you take a gap here, you can do that and time everything that way. Um But I technically did not get it, take a gap here because I applied um two months after, even though the system makes it. So you take 10 months off. I was interviewing. So it doesn't count as a gap here. Um Now balancing it during residency, it's hard. Um There is less pressure to do well in step three, there's less expectations because you already matched. And if you wanna do a fellowship later, um they look at a lot more things other than your step 33. because they look at like your recommendation letters and your um performance in residency. So and step three is an exam you do first year in residency. So, so much changes throughout your residency. That its relevance when applying for fellowship is much, much lower. So it doesn't carry as much weight as step two, for example. So there's less pressure to perform well, perform really well. But it is hard to um time. Um You just have to like, uh right now, you know, I have some holiday before this, I was on a pretty nice rotation that I had time to study um in the afternoons. Um You have to just kind of learn to balance it and it's really hard. Um But it works, there are rotations that are lighter. If you're clinic or if your work is light, then you can study in the afternoon, whether if you're in the hospital or at home and if you have weekends off, then you can study on the weekend. Yeah. Thank you for sure. I'm not sure if you touched on this. But can you just talk again like about when you recommend someone should do their like us rotations? I can share. Exactly. So I think summer after fifth year cause I did step one after fourth year and then I did step two after I just finished sixth year. So summer after fifth year was I didn't do it. Exactly. So that's when I did like two or three rotations. And I was saying it earlier that if you wanted, like we, I don't know if every faculty is the same. I know in first faculty we had to do an elective rotations like four weeks for internal medicine, two weeks for pediatrics. So I covered those by my electives in the US. So when I did rotations in us, it counted as my elective for medical school. That way I didn't have to like go to another rotation for a month just to sign things off for medical school. So I was able to do things like two birds, one stone That way I was saving time. All right, I got you. Thank you. No worries. Um I do wanna one last thing is regardless of all these nice numbers that you see here. Uh I was looking at this um report of doctors if in the US, if they feel fairly paid, given their work demands and 51% which is half said no. So even if you see these um salaries, keep in mind they're pretax. Keep in mind that uh healthcare in us is a very demanding field to work in um healthcare here is private. So a lot of things come with that work. And um I feel like dynamics of like healthcare here are very different than what we see in medical school in Europe. So that is like a it's a challenge adapting to that. So I think there's a lot of challenges that come with it and even with a good salary, majority of people feel that they're still not fairly paid. I just wanted to say that I thought it was interesting. Um But yeah, uh any burning last questions. Um Yeah, I just wanted to ask you mentioned that some students uh do their rotations uh within a gap here. Uh Just want to know how does this affect the application? Um One gap year is usually OK. Um There are programs that filter graduates out when they're like reviewing applications if you had a gap year for like if your graduate year was like more than four years ago or more than three years ago. But um if it was like less than three years ago, it doesn't matter as long as you are productive in your gap year. If you have research, if you have um rotations done, then it's OK. If you're like sitting at home and not doing anything in your gap here, then that gap is a problem. But if you're like productive, it's OK. Thank you. Any other questions guys. Before we end, I would like to ask a more personal question. Um And if I would like to ask about how you personally felt about the work-life balance as uh in the US now as compared to maybe when you first came to Prague and you studied medical school. Yeah. Mhm. Um I think we are very lucky as medical students in Prague. I think you guys should appreciate that yours you have in Prague. Um I compare it to med students in um I'm sorry, he, he my boy. Uh, yeah. Uh, in terms of the med students in us are very overworked. Hi guys, this is ash. Maybe many of, you know, him in case he wants to come in include it. I apologize. Anyway, um, uh, the med students in Prague are, you know, we, we have a very nice schedule. That's not typical. I think a lot of times, you know, it's very rare for us to be in the hospital at 5:06 p.m. still with in the clinic. A lot of times that doesn't happen. Uh We don't do night shifts as we as students and we don't do any of that. I think a lot of medical students here do a lot of heavy rotations. They work a lot. And so I think what we do in Prague is not a huge well representation of medical students. So obviously, if you compare it with work-life balance that we have in Prague, no, like you're not gonna, it's not similar but you know, if you are someone who likes to go out, do a lot in your life with like your free time for sure, you can still do that in residency, but we do work a lot and you have to be very good at time managing and prioritizing what you wanna do in your free time. And it, it's, it's, it's a, it's a learning slope like it is a hard, but that's ok and it's gonna be hard everywhere. So but like, I think um it's a lot better than, than we expected. Um Like we still do have time to go out, we still do have time to have fun. Um It's just not the same as Prague. It's just, yeah, Prague is too good guys. So II Yeah, I didn't expect to, to say that we had an easy life. Yeah, but um so, so integration in the US was also quite easy. Yeah, I think integration in US is much easier than integration in Prague. I would think the it's very multicultural here. Everybody is very welcoming in that sense. It's much easier. The integration here is much easier. Everything is in English and that's a big plus. And I personally that was a big, I know a lot of people go to Germany for residency for me. I could not see myself like again, like this is my life of living somewhere where I don't understand the language um not feeling comfortable. So, you know, wanting to interact comfortably with my patients was a big thing and um we have that here and the integration is much better there is, I mean, I'm sure a lot of, you know, like there is a community of every culture in, in the US and you can for sure, find your community. Thank you so much friendlier than they are. Yeah, in general, like the average person like in your group, if you, if you're interviewing, you will see like, yeah, the, the main thing that we're looking at in your interview really is going to be how friend you are. Yeah, when you're interacting with everyone. And so they really try to pick out just people who can be friendly at any situation. And so that's all you're gonna be interacting with honestly. So OK, good to know. Thank you both. No worries, guys. Any other questions? Uh uh Have you? Uh Yeah, sorry. Do you wanna go fast? Uh Ego versa. That's fine. Um I just wanted to ask if you don't mind sharing. Um How many research publications you did to like get matched with? PS? OK. I did 38. I did 22 or 32, I did two, I think. Um Again, I think for peas um there isn't a huge emphasis on research. Uh So I did too because that's physically what I was able to do before flying. Um If you can do more kudos to you for sure. Um I do wanna say, yeah, it's not, it's not a huge driving factor in. It's a nice thing to have, but all right. Thank you. Uh So my question is kinda related to the previous question like what would count as a publication? Mhm um Case studies, literature reviews, case series. If, if you're involved in like a proper research, if you go through like us and, and all those organizations, you can pay to be part of like a um meta analysis. It's like a more extensive research or if again, I have friends who did research projects with our university for years and then eventually they published. So um you know, they publish like a proper paper with like actual like to collect the data from patients and stuff. So then anything that gets published in a journal does not matter if it's not like a huge journal. They, they mm Thank you. II think uh as long as you, you try to get, try to get it published, all they wanna see, I think was something that's underemphasized. But um volunteering, if you guys have volunteering experience, they really like that. Like if, if you're, if you're not going for a big academic program, they're not gonna want that much research honestly. They, if you have like uh other things that show your interest in here with like elderly, if you uh like disabled people um um that you asked, I think you said an abstract at university. Do you mean like at our university at Charles University? Uh It's not Charles but different university, but it's the same idea. We did a project uh with a presentation and abstract. OK. So when you're applying, there is a place to separately put, if you presented a project, like there is a place for that. And I urge you, if you did do an abstract and a project, you can always publish it on um on journals that are easier to publish. There are a lot of them if you Google and it's just like a big plus for you guys, Max, you'll pay like $20 each if there's like three of you or four of you. And then you can have a publication under your name and you can do that in a, in a low impact journal as a medical student. You don't have to be a doctor to do that. Oh OK. Thank you. Someone else had of questions. Yes, I have a question. So for me, I'm doing basic research, but it's way more difficult to publish because of the nature of the research. So in this case, is it still like, um is it viewed like on the same level even if I don't publish? I think I know that a lot of people were doing like research and anatomy or pathology type of thing. Um I think any sort of, if you were actively involved in a research project that is a great like talking point and it's something that makes you stand out and in your like when you apply it in your interviews, they will for sure ask you about it. Even if it's not something you published as being involved in an active research project looks really nice even then. And if eventually I would always like urge you to um talk with your um senior doctor that you work with on a project. If you, it is possible to it in any way and try to make it sound like it's relevant to whichever specialty that you're. Yeah, like, make it so, like, maybe you can emphasize a part that's like, relevant. I don't know if it's like an anatomy project or you're interested in we, um, in, like surgery or if it's like, I don't know if it's specific to specific, like, um, system of like cardiology and wanna do internal medicine and you're telling them I'm more interested in cardiology right now, then it's like relevant, you know, that type of thing. Ok. Thank you. No, anyone else? Um Yeah, I had a bit of a broad question. Do you think it would be easier if you just mm if you're in your first year, if you moved to the US and just did eight years of medicine there and then started like residency in the US or do you think it's the same if you're an international student in Charles and you're an international student in the US? Do you think it makes a difference? Are you a first year student? Yeah, I am. Ok. Um So he, I mean, I ii considered like following the US path because I have my sister here. Um couple factors made it unattractive to me. One was cost me doing a bachelor's college degree in US and then doing four years of medical school is very expensive, very expensive. It's way more expensive than it is in Prague to do six years, then you save two years by doing a medical school in Prague. Um I think we're both like the youngest people in our residency. It's really nice to be really young and already starting your residency. And that, that's a big plus and it feels, you know, like it's faster, it's a faster route. It is harder to go from a European medical school to residency. You are less competitive compared to an American applicant uh American graduate. But I think if you just push and do all of that, I think it eventually is a faster route. II think it's like a easier route in that sense. And medical school in Prague is a much chiller experience compared to medical school in the US. And from my experience that I see the medical students here, whatever they do and um it's very competitive to get into medical school in the US, even if you do four years of college and now you have to apply to get into medical school. You might not get it in the first round. It's a whole like, yeah, so for me that's what I um yeah. So is it, is it easier for us medical students to do what they want? Yes, 100% like it, there is no comparison. It's a lot easier. But do I regret going through the drug system? Not at all? Not, not for a minute. But then again, like we are lucky we want the specialties that are more img friendly if you want like a, more surgical, like, if you want subspecialty, if you're thinking like plastics, I mean, actually we'll say. Sure, sure. It's po, it's possible. Yeah. Sure. But, but would, would I have risked my six years for it? No. No. Yeah. Um, yeah, but II definitely don't regret it. Like, if you do want surgical specialty, II don't advise to stay in front. Um, so I'm sorry, you said if you wanna do something surgical, you shouldn't stay in Prague or you, it doesn't matter if you wanna do a general surgery, you can. Sure. It's, it's a, you have a decent chance if, uh, if it's something else, it's, uh, your, your, your chance is like less than 10% less than 5%. Whereas for like, um, im, it's like 40 for like people, it's like 50. Um, yeah. So what's, what's, if you do, like, you go to the US, you do internal med medicine? Can you then switch over? Is it easier than to switch into surgical? If you're already in the US? It doesn't matter. We, we wouldn't do that because of how hard it causes us to reapply again. I would, I, I think if you were dead set on like, orthopedic surgery. Yeah. As an IMG, that's not gonna be realistic. I was telling him just now we had someone who was two years or one year. Our senior I don't remember. He did, I think one year of plastic surgery, like a research in the US and then applied. And he had so many other, he has many connections. He had a lot of connections. He had to do research for, I think, two years before matching into plastic surgery. Keep in mind, like, even then he's not gonna match into LA, you know, like it. Like you have to, like, it's a huge lengthy process to get into a very, very competitive specialty, like plastic surgery or dermatology or orthopedic surgery because, you know, so it's not impossible but you have to put years of research after graduating. And, you know, that for me that was, I mean, anyways, I was not interested in those things. So it didn't matter. Like, it's, it's already really difficult to get into one of the I MG friendly specialties. It's not, it's like, it's difficult but it's definitely doable 100%. Um, but, yeah, for a non I MG friendly one, it's, you have to do everything. Yeah. Like, does it make a difference if, like, in all of your summers and whatever, before you apply to the US? You do, um, like a, a lot of internships in the US? Does that make any difference? Yes. Yes. If you have been basically involved in the American health care system from the start of your medical career. Yes. It makes a difference if you have someone, if you have an attending over there, a program director who's gonna be like, I like this. I like this person. I want this person on my team. That's it. If you have a connection much, if you have a really good connection that will drive your application regardless of the specialty. If, if you just, if you have one big shop guy here, that's it. You're done. No, honestly. OK. Thank you. Oh, guys, my boyfriend is in internal medicine. By the way, if you guys don't know him, he's in DC. But um yeah, before we sign off any last questions, I know like a lot of you guys might have questions. That's why I've given you last time. OK, I got you. II have a question um More about the interviews like what are they like? And what type of questions do they ask during the interviews and stuff? Interviews are mainly for them to see that you're a friendly and nice person to work with? Um They ask a little bit about like your work experiences, rotations, volunteer experiences. What do you do in your free time? How do you manage? Stress those type of things um that you can like find a bunch of questions online and prepare. Um They'll ask a lot like about like your background of where you grew up. How was your medical school experience? You know, a lot, there's not a huge number of applicants from Prague or Europe. So they a lot of times for me they had questions about that. Like, oh, I was like, oh, how was that for you? Because it was, like, different. They weren't used to seeing applicants from Prague. So, yeah, I think it's not like they don't ask you like, medical questions because your grades speak for itself. If they ask you medical questions don't go to that. That's a red flag. Yeah. It, it's a red flag if they ask you something. I don't know if they set up like a clinical scenario and then they ask you if, if they ask you. Yeah, like um um like an ethical scenario. That's a different thing. But if they ask you like um a patient comes in with whatever, what's, what would you do next? Yeah. Or like if they say like, how do you present this patient? Like on rounds? That's not OK. But if they're asking you like, how do you handle a difficult patient or ho how, what was an experience you had? Like um a patient who, I don't know was like suicidal or something and how you handled it. That's OK because they wanna see your like social skills and your management skills. If they're asking you like your knowledge or how do you present a patient clinically? That's not OK. Yeah, because like, like they can see you great. Like, even if you don't know that one doesn't matter one situation, they can see you great. They know you're overall, like if that's not enough for them. Yeah, it's a bad program. Uh And also just one last question to get internships and things like that in the US. Do you think it's always better to go through those? Um How do you say again, those organized programs? Yeah. Um No, if you have connections to go through it is better. There are, if you Google, like, I know like suny, suny downstate and upstate are like universities in um hospitals in New York that you could apply as a medical student to do rotations there. Those are really good ri know University of, I know Illinois and Chicago would have the same program. You just have to Cleveland Clinic if you have to time it, you can do that. Those are the ideal ones personally, neither of us timed it well. And we wanted to match really fast. That was our priority. So we did not get to do that. But um usually when you don't pay and you go through a connection because I did one of those. Um It was more like an observer. I didn't get as much hands on experience and hands on experience. Gives the doctor more opportunities to write you a good letter and more opportunities for you to learn things and learn the healthcare system. So that's the truth. I learned a lot, you know, honestly, genuinely learned a lot. Yeah. But uh yeah, so I think the paid one gives you an opportunity to get more hands on a lot of times. Ok, thank you. Like basically, yeah, get what you can like whatever you can do do. Yeah, thank you very much. No worries. Any last questions around around what time in your like six years of med school? Did you know that you wanna go for the US? And until what time would you say is a good like time to know for sure and like start preparing. Um I, OK, if you have family in us, then obviously, that's something you're thinking about anyways. Um I had some family. So from the start, it was something that was on my radar. Um After I did my step, like I said, I said it earlier that if you do step, I think I always recommend doing step one before going on a rotation because rotations are expensive. They're time consuming, going on a rotation and then not passing step one is not motivating. Um I would always say do your step one first and generally that's after fourth year. So uh and then like, you know, for me that was like uh OK, I passed my step one so then I can go, you know, like if it was like a reassuring thing for me that I can do it. And then um yeah, so for me that was that and then there's never, but it's, it's and then, but it's never like a late like, ii know people who graduated and then started the process and that's ok. But there's never a late time. If, if, if, if you decide later it's ok, but the sooner you do it, the sooner you make attending Saturday. So, ok. Yeah. So, yeah, I mean, if, if you wanna like get a really competitive specialty and you go to internships for first year, yes. Go do that. But um yeah, just a really quick question. Oh, sorry, sorry, go. Thank you. Like for me, I'm in fourth year and I'm thinking of cardiology mainly. So like I'm thinking of giving you a simile like in the fall of fifth year. Is that like a good start? Um I would recommend doing step one after fourth year, not after fifth year using the summer of fifth year for you to do rotation. Um and then doing your step two after six, like during sixth year or after sixth year. Um um So I would recommend doing step on after fourth year, especially now that it's pass and fail. Also, I do wanna remind because I was talking about this earlier, that cardiology is a fellowship. You cannot directly go into cardiology. You will go into internal medicine for three years. You can emphasize in like your motivation letter that you're interested in cardiology, but uh still you will be matching into internal medicine. So you should focus on having rotations generally in internal medicine. Um You can have research in cardiology and emphasize. Hey, this is the field I'm leaning towards. But you wanna show that you understand internal medicine and also for if you wanna do cardiology or gastroenterology, you wanna try to get into the best internal medicine program you can get into because they are pretty competitive fellowships. Um So yeah, II think what said is right? You, you should do step one as soon as, as soon as possible so that you can get working on your actual application after that. All right guys. Ok. Thank you. I'm gonna do one last question if you have. Um it's just a really quick one and um I don't know, I'm sorry if this is weird. But um how old are you and your boyfriend? Because you said that you guys are way younger than the people in your program. Like how old are you when compared to the others? I'm, I'm 6 ft, I'm 25 and you're 24. Ok. He's 24. I'm 25. Ok. Thank you. No worries. All right guys. Uh Yeah, the majority of people are like first years are 27. Seven is a pretty common. Yeah, so 28 you'll see older. Hi guys. It was really nice talking to all of you. I hope that we got to answer your questions and I think you guys found it helpful um useful. So all the best uh I wanted to thank you for my part from the US team doctor. Really for this really informative presentation. We truly appreciate you taking the time to inform us on the topic really. And, uh, guys, I hope you enjoyed it and we are, uh, really looking forward to see you on our next education event. Ok? Ok. Bye guys. Thank you again very much. All right. Bye.