Medicine in the US



In this insightful on-demand teaching session, participants will be able to gain invaluable insight from the personal journey of Dr. Marriam Savior, an international medical graduate now serving her third year Neurology Residency at the University of Maryland Medical Center. This engaging, free-flowing session covers a wealth of topics including how Dr. Savior chose her career path, why she decided to study in the US and tips for securing a residency abroad. Attendees will not only get an inside look at the residency program and its demands but they will also learn about navigating the complexities of being an International Medical Graduate in the United States. Whether you're considering a career in Neurology or interested in studying overseas, this session provides invaluable advice and experiences from a medical professional who has been through the journey.
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Dr Mariyam Saviour, a Neurology Resident at the University of Maryland Medical Center, will be talking about:

1. Residency vs UK training


3. How to gain clinical experience in the US

4. What it's like to live & work in America

Learning objectives

1. Understand the structure of medical residency programs in the United States as compared to England. 2. Identify benefits and downsides of taking additional clinical rotations in medical school and how they assist in choosing a subspecialty. 3. Learn about the importance of deciding early about committing to a residency program in the U.S. and the need for planning ahead for USMLE exams and clinical clerkships. 4. Gain insights into the lifestyle and demands of different subspecialty roles within neurology, such as Neurocritical care. 5. Understand the functioning of patient management software like Epic and its role in maintaining efficient physician-patient communication.
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Computer generated transcript

The following transcript was generated automatically from the content and has not been checked or corrected manually.

Pool is associated with the Walton Center. I don't know if you're familiar with it. It's a dedicated neuroscientist trust in Liverpool. Um They see some really cool exotic cases. Um I would say it's like the Queen square of the north of England, kind of, is that the way I'd put it? Um And I had like, really, I had a fantastic rotation there. I had phenomenal consultant, just really smart, really um uh kind of oriented, like they prioritized education and teaching goddess involved. And so even though it was really complex and kind of vague what we were learning, it was just really exciting and there was just so much enthusiasm and passion from these consultants. And so I was like, this is really neat. Um And I loved reading about it like II there was one specialty that I really enjoyed reading. Mhm And so from that, I was kind of like, OK, I think this is what I wanna do, but I'll keep my mind open, tried everything else out and nothing, it, nothing was as fun as neurology for me at least. Um And then I did a couple of rotations and I realized OK. This is definitely what I wanna do and that's just kind of how I ended up doing this. Um I think doing those extraclinical rotations definitely helped because being a medical student, I don't know that you fully understand what a neurologist does. Um, like with a lot of subspecialties, but the clinical rotations is what solidified it for me. OK. Um And do you know what you wanna specialize in like or subspecialized in? I guess once you're done? Yeah. Um, so here, uh, neurology is a four-year program but in your third year, which is what I'm in currently, I have to apply for my fellowship, which would be like your subspecialty. So I'm gonna be applying for Neurocritical care. Um, which um, the, the applications open in January. So I'll know by summer if I got in or not. And where? So, yeah, that sounds really, really cool. Well, the hours must not be um, great if you're, if you're going for an emergency kind of care. Yeah. Yeah, I think that's what puts people off of, um, neurocritical care. Um, in my year, I'm the only one applying for it in general when people are looking at subspecialties. One of the big things that they try to figure out is like, whether you wanna be primarily, at least in neurology, whether you wanna be a, primarily an outpatient doc or an inpatient doc cause your lifestyle is gonna be pretty different. Um, most of my we're seven residents per year, everyone in my cohort except for one person is going, applying for predominantly outpatient based subspecialty. Um It's just me and another one of my colleagues who's gonna be applying for stroke, which is um more of an inpatient um subspecialty. But yeah, the hours are hard but you, when you become an attending or consultant, um you do have a lot of um kind of leeway in terms of how you negotiate your contract. And so some of my attendings or consultants here, they're doing like a week on a week off service, they're doing like education in between. Um So you can, you can kind of tailor it as you want and decide how, how heavy or load you wanna take on. Obviously, that might have some financial implications because obviously the more time you're on service, the more you're gonna get paid. Um but you kinda have to just decide that for yourself, but you do have flexibility in figuring out how you wanna manage your schedule. Mm. And I would say being an outpatient neurologist here to me looks harder because we, you know, we use like um online uh a patient system called Epic. Is that like, do you guys use that Cerner Epic? Um I personally haven't, I it's pretty common here that the uh the kind of app or whatever you wanna call it that we use in the hospital to write notes, put in orders everything is electro um um electronic here. Um And your patients can actually message you through a portal. Oh, someone just put something in the chat. Yeah, someone's used Epic. Yeah. Hi. Hi, Di Di. Um it's very common here. Um It's really easy to use. It's very intuitive which I love but your patients can actually message you through the portal on there. And my outpatient like um my attendings they're like getting messaged all the time. Um by clinic patients, they're getting stuff sent through to them. Patients are calling in clinic asking you to speak with them. So you're kinda like on all the time. Whereas if you're an inpatient neurologist, you're like, OK, I'm here doing these hours, then I'm out, I've signed out to the next person. Um It's kind of a cleaner break in my mind. Ok? That's kind of cool. Yeah. Um we have about 25 people. So um what I will do is I'll just give you a quick introduction. So, hi everyone. This is Doctor Marriam Savior. She is APG Y three at the Maryland Center. Um University of Maryland Medical Center. Yeah. Um in neurology, this session is gonna be a lot more interactive. So if you guys can mm put messages in the chart, there's no slides, it will be recorded so you can come back to it. Uh I'll just hand it over to you and yeah, sounds good. Um Hi everyone. Uh firstly I wanna say thanks to um Dill and the British Medical Association for um inviting me to speak about my experience as a, a resident here in the United States. Um I wanted to keep this pretty informal. Um I don't have slides. I feel like a lot of um there's a lot of information already out there in terms of like blogs and forums that you guys have probably already seen that has a ton of like resources that you can use. So I wanted to speak more about my personal experience here and some of my colleagues who are also um transplant or what they call IM GS International Medical graduates here in the US. Um And I was telling um Bill that at any point, if you guys while I'm talking have specific questions, just feel free to interrupt me. II don't mind at all or if you wanna pop it in the chat, that's totally fine too. Um But yeah, so that's what I was thinking for. Now. They did send over some questions, some kind of generic questions that I can work through just to get started, but I can start with a brief introduction about myself. Um My name uh So I'm Marriam. I'm a third year resident here at the University of Maryland Medical Center. I'm doing my neurology residency, which is a four-year program. So I'm in my penultimate year. I'm based, I'm living in Baltimore for those of you who may not be familiar with the US. Baltimore is um a city in the state of Maryland. I'm on the east coast. I'm about, we Baltimore is about 45 minutes from Washington DC. Um, but yeah, so I um went to, I'm, I'm, I went to medical school at the University of Liverpool. Uh, now quite a few years ago, I was in your five-year program and in between my 4th and 5th year, I did an intercalated BSC in Neuroscience and Mental Health at Imperial College London. Um Just because at that point, I knew that this is what I wanted to do. And then after I graduated, um back in, I wanna say 2016 or 2017, I uh stayed on to do the foundation program. So I did my fy one at Charing Cross Hospital in London and Fy two at Watford General Hospital just outside of London before moving to the US and kind of starting that whole journey. Um In terms of one of the questions I do ask is like, you know, when did I decide how was that helpful process for me? I would say compared to some other people that I've met, I decided fairly late that I wanted to move and do residency here. Um I, I like it was between my Fy one and fy two year that I started to be, get more serious about wanting to move to the US for residency. I just the, the path in, in the UK in terms of becoming a neurology registrar just seemed very convoluted to me. I'd have to do CMT at that point, they were talking about changing it from like 2 to 3 or four years and then I had to apply and there's no guarantee I'd get in. People are telling me, well, a lot of people are not having to do P hds. The whole thing just seemed really convoluted to me and very time consuming. So I wanted a more streamlined path. Um And the US was uh seemed like a viable option. I decided to stay on and finish Fy two. And then I took a year to does that. I'm just gonna pause here. There's a question in the chat. Does that mean you sat step one and two over F one F two. I didn't. Um I it II would had really busy rotations. So it was just, I was just exhausted. There was no way I could have done at least step one doing F one or F two. If I could actually do things over again, I would have done step one as a medical student. Um And that's what I would say. It's like one of the big points I would say today is that if you are serious about moving to the US at least do step one early on in medical school because all that basic science stuff is gonna be fresh in your mind and two when you're applying to do clerkships in the US, which are a pivotal part of trying to get letters or recommendations for your application. A lot of schoolss here before they, um when they're considering whether you'd be eligible to do a clerkship, which is basically like clinical experience here will ask for step one. So do your step one early for that reason. Um And can you skip Fy one and two in the UK and start practicing in the US right after medical school? 100%? You can. Um And I would, if again, if I could do things over again, that is what I would have done. I would have done if uh step one and step two as a medical student, um maybe a year out after medical school to do it if you're finding it too much with all your other clinical duties and then um do your also take that time to do your clinical clerkships here and just apply for residency and do it straight out of medical school. So you do not need F one and F two to start residency here. They don't particularly even care if you've done it or not. On that note, when is the best time to sit the U Assembly? In your opinion, medical school, at least step one, do it early on in medical school. When you, when you're doing all your basic science and stuff, you can do it as a third or fourth year that's totally fine when you're doing your clinical rotations. But I just think in terms of timing, maybe that at the end of your first year or in your second year might be better. Having said that I, you have to, it's very personal and I've met people who've done it early on in medical school, who did it at the end of medical school. And people like me who did it the way after medical school, doing it after medical school is really, really hard step one. It's like very painful. So do it during medical school. Um If you know you wanna move to the US, is it worth skipping F two and just doing F one to get registration? Yeah, that's a good question. So someone also recently asked me that one, my kind of rationale for staying uh completing F one is I thought, OK, let me get my GMC registration so that I at least have that as a backup. Um I don't know that that was a, a very, that's a very personal choice and I don't know that it made a whole lot of sense for me. I think I should, I could have just cut out, saved myself a couple of years by just going straight from medical school there to doing residency here rather than doing F one. I don't know that it added any value um to my career path. Um Unless you are thinking that hey, in the future I definitely do wanna come back to the UK then that has Utility II was fairly certain that I didn't really wanna go move back to the UK. Is it difficult to get matched in surgery in the US? It's difficult to get matched in most um specialties in the US as an I MGI MG. For those of you are not familiar with, stands for international medical graduates. So anyone who did not go to medical school in the US is considered an I MG regardless of whether you did med school in Australia or India or the UK. Um A as an I MG, it is gonna be harder because they're not familiar with your system where you're coming from. So when residency program directors are looking at your application, when they see you're a US medical student, they know what that means because there's a uh there in terms of curriculum and experience, there is more uh it's more cohesive here. Um Whereas in the UK, they, they don't know what our medical school system is like. They don't know what our clinical rotations are like. So there's a little bit more kind of hesitancy, you know, they're wondering, you know, will you fit in and gel with the program? Will you be able to keep up with like the workload and expectations? So one is an I MG, it is more competitive and the other thing is the exact subspecialty you're applying for Derm and Opto are probably the most competitive and then your surgical um residencies and radiology. I would say those are like broadly speaking, the the hardest specialties to get into here having said that I know IM GS who've matched into all of those specialties over the years. So, um Arian is asking, does being a UK grad have any benefit over other IM GS in the match process. So I don't have data to back it up. But based on my personal experience, I would say yes. Um because there's, you know, culturally we are, the two countries are fairly similar and I've met medical students here. They uh we have medical students on all of our rotations. So I interact with them quite often and there is a lot of similarity between how their system is run here and how the UK system is run. So the transition from the UK to here is um I would say easier than uh maybe coming from another country. Um So I II wanna say that when they see that you're from the UK, they do view it a little bit differently, but I don't have like data to back it up. I haven't talked to a program. I can ask them specifically that question. That would be my personal opinion. Do you need work experience in the US? You do um 100% you need clinical experience in the US as part of your application. And there are a variety of different clinical experiences you can do here. They call them either clerkships, clerkships or observers. Um, clerkships are hands-on, you will be seeing patients be presenting them during rounds. You're making recommendations. Observers are essentially what, what it, what it says you are an observer, it's not a hands-on rotation. You're always just, you're following an attending or another resident. Um So you don't have as much autonomy. And so when you're applying, it's better to have clerkships on your CV than observer ships. But if you can't get clerkships, at least do observer ships in order to do clerkships, you can just go on each um medical school website. So that's what I did. I went like multiple different medical school websites and II checked, do they offer a clerkship for international medical graduates? And there are a ton of places that do a lot of the good, but a lot of the top institutions will require that you've done your step one. When you apply for a clerkship, I had not done my step one at that point. So um immediately there were a lot of places that I just couldn't even apply to. And so that's why I was saying that it's better to do your step one early. So by the time you're in your 3rd and 4th year trying to look for clerkships in the US, you at least have your step one done and dusted. Um And your step one is valid at least when, when I was doing it valid for like seven or eight years. So it it you'll, you'll be fine. Um But yeah, the reason you need work experience in the US is two fold. One, the program directors are looking at your application um will feel more confident because then they can see, ok, this individual has um been in the US, has kind of worked in the healthcare system here. Um and is not gonna be in shock when they move for residency. And two, this is how you get letters of recommendation, you can get letters of recommendation from the um consultants you're working with in the UK, but it doesn't carry nearly as much weight as getting a letter from a US um consultant IE attending is what we call them here. And do you want to get letters from people who from faculty who have clout um who um are in academia who and hopefully people who have, you know, kind of established a name for themselves in that field because then when you submit your application, a program doctor looking at it and they see the name on it. They're like, oh, this guy has done a lot of work in TBI, for example, because I'm in urology. Um and he's recommending this individual that carries more weight than just a, you know, uh someone who maybe doesn't have as much academic clout, writing, writing you a letter. Um I, so that's one of the reasons why I did at the end of my uh fifth year of medical school, I actually applied to do a clerkship in, at Beth Israel deaconess, uh which is a hospital in um in Boston. It's one of Harvard's uh um Harvard's affiliated hospitals and I did a neurology clerkship there for one month and I got a letter from a faculty member there. And what was interesting is I use that letter as part of my residency application. And when my um when my program director later uh was talking about my application, she was like, oh yeah, I saw, I saw you got a letter from this attending. I actually went uh I did fellowship with her and now she's, you know, head of this here and there. So people know each other in the academic circle here. So that's why getting a letter from someone who has that kind of UD uh is gonna be really beneficial. Evangelina Evangelia is asking if you skip F one and F two, is it hard to adjust the US system? Since learning has been centered around the NHS system? Um I don't, that's hard for me to speak to because I did do F one and F two and maybe the transition for me was easier because of that. I will say that clinically, I was uh probably a little ahead of my co residence uh in my 1st and 2nd year because I had F one and F to experience to kind of bring forward. Um But I don't, I don't think the benefit of that outweighed the time I lost doing F one and F two. I would still just have finished medical school and come straight here to do residency. I wouldn't have stuck around to do F one and F two if I could do things over again because I think the UK and the US system are not super different in terms of the kind of clinical care. Next question. Do you know any UK I MG S that got into radiology? Um I don't know a, a UK I MGI do know someone from um the who went to medical school, I believe in the UAE who's now doing radiology. Um Is there a specific reason why you're asking or I think that one might be more of a um I think they might be interested in radiology themselves and is one of those ones where you're not, a lot of people aren't quite sure how competitive radiology is as a specialty in the US. Got it. Yeah, I mean, it is, it is a competitive specialty because um the lifestyle is really good and the pay is really good. Um So a if you wanted to know more about it, I can try to uh get the contact details of this. Um It's a friend of a friend who is doing radiology residency here. I could try to get their details and put you guys in touch if that helps. Um Yuki is asking, are you on an E One B Visa? I'm worried that J one would affect future career. I don't actually know what an E One B Visa is. Um So if you, you know, feel free to speak up. But uh in terms of AJ one for those of you who are not familiar, it's kind of like um AJ one is, um, a, a fairly straightforward visa in the sense that your institution does not have to sponsor you. That's why a lot of residency programs like it, it's a lot less paperwork for them than coming through like an H ONE B which is sponsored by your employee. The thing with the J one is that after you've completed your training, it's, um, you have to do either two. it's either two or three years in an underserved area in the US or you go back to your home country and do a couple of years there before you can come back. Um, I met, I've met a lot of people on AJ one and it is less straightforward than if you were a resident here, but I haven't, II think it's still doable because if you didn't want to go back to your home country, working in an underserved area here for 2 to 3 years isn't, um, isn't too bad and an underserved area, you know, I had this misconception that an underserved area meant like middle of nowhere Alabama. Um, which it can be, but you can also be in the inner city of like, uh, uh, parts of New York City are considered underserved. Parts of Baltimore are considered underserved. Parts of Chicago are considered underserved. Right. So, it doesn't necessarily mean that you're relegated to like the, somewhere in the midwest with nothing to do or, you know, um, it just, it can be very variable. Mm but um no, I'm not on, I'm not on a visa. So that's it makes it harder for me to kinda speak to what that path would be like. But I have um lots of colleagues and friends who did come here on AJ one or H one. So again, if you wanted to know more about that, happy to put you in touch with them, um how can we make ourselves stand out as IM GS um your scores, your step one score particularly and strong letters of recommendation? I think even if your scores were mediocre, but you had excellent letters of recommendation that would definitely boost you up. So those are two things. Good exam scores, get great letters and the way you're gonna get great letters is by doing lots of rotations in the US. Demetrius is asking, hi, just out of interest is a format AQ and a session or are there some topics that will be covered? There were some questions that dill sent through um that I had prepared to kind of talk through. But these questions that you guys are asking are actually addressing most of those questions anyway. So happy to kind of keep going with this flow. But I can also revert to kind of a more formal chat if people find that more helpful. Um Dylan is asking with the harder specialties is step two, what determines what you can do in the US or do we need to build a portfolio like the UK? Um So you have to do your step two before you even apply for residency here. Um I'm I'm not sure. I completely understand that question. You have to have step one and step two before you can even get into residency here. That sorry to interrupt, I think that's more um about the step two score. Like how much weight does, how well you score in step two um matter when you're applying to specialties. What I've, what I've been told is step one is the kind of the score that they really look at. But you also wanna do well in step two, particularly as an I MG because overall, you know, if you can show that your exam scores in general are great, then it gives you a competitive advantage over kind of um US graduates. So between the two exams, step one definitely scores count a lot more and step two. you, you wanna score well, but it doesn't carry as much weight as your step one. So again, sorry to sorry to just interrupt. Um step one is, is now pass or fail? So does this score still matter? Oh yeah, you're right. Sorry that happened while I was here. It it's hard to say but I would say as an I MG it probably will help you stand out if your step two score is high, particularly given that step one has become a pass fail. Aan is asking does having experience and research have any benefit when applying to non-academic residency programs? I don't know that there. So firstly, I don't think there are any like non-academic residency programs because all programs have to be affiliated to a, a university like a medical school here. Um You don't get stand alone programs that are not attached to an institution. So by, by the nature of that, they're all gonna be academic to some degree or another, obviously, the degree of that is gonna be different, you know, like Harvard is gonna be different from the University of Maryland where I'm at in terms of academic clout. Um but research experience is definitely beneficial and program um love seeing research publications. So if you say your scores aren't great, but you have really great research experience and great publications that will carry a lot of weight. Um And I have colleagues who particularly IM GS who after their medical school came to the US and did kind of like a research fellowship for a year or two at an institution they built um and they use that time to kind of build their network, um go to conferences, get publications and a lot of those people end up actually matching into programs at that institution itself. Um because people then have worked with you, they, you know, they're like, ok, this person was good to work with, they had great work ethic, they'll fit in culturally here, that kind of barrier to accepting you as an applicant has come down because now they've had facetime with you because of the research fellowship you've done with them. Um So I know at least two people. Um I actually met them at a conference in Germany. They're from Greece. They, after medical school in Greece, they came here and they did research fellowship in uh in cardiology for about a year or two years at Yale. And they both ended up matching into internal medicine at Yale. Um So that was pretty impressive and I think that's also a one route that you can, you can use. He is asking, did you do a clerkship as a medical student? Once she had graduated, I did a clerkship. So a at Liverpool, how it worked was that we finished our uh final year exams in May and I had a month between my graduation and my exams where I could kinda do whatever I wanted. So I used that month, it was June to come to Boston and do my clerkship. Mm The thing with like some of these medical schools here is that they wanna see that you're still a medical student when they accept you for a clerkship. If you're graduated, they, they tend to be more hesitant to accept you as a clerkship student. They wanna see that you're still affiliated with your medical school. So I chose to do it just before my graduation. If you move to us right after uni when can you find time for clerkships? Uh If you move to the US right after university, when can you find time it, you, they offer clerkships like throughout the year except for like the holiday season, like December or January. So you have a lot of flexibility as to when you wanna do your clerkships. Um It just depends on what's going on. I in kind of in terms of your life and your schedule, but I had II was fairly flexible. I could do clerkships in the summer. I did um one in spring. So that wasn't really an issue. How long do you recommend doing a clerkship or observer? You need at least when I was applying until, correct me if I'm wrong, but I believe you still need at least three letters of recommendation for most residency programs. Um And so I try to do at least three months of uh clerkship slash observers here in the US. So I could have three different letters of recommendation. I wanted all my letters to be from us attendings ie consultants. Um I didn't ask anyone in the UK to write me one because II was just told it it doesn't carry weight. Um So I did three months. Um A lot of IM GS that I've worked with, they do like 56 months of it just really to make sure that they have like really strong letters. Um got a ton of experience, research, et cetera. But I would recommend, I would recommend at least two months if you can do three and get three different letters from us attendings. Um You're gonna be in a good spot. How do clocks differ from electives? It, it's essentially the same thing. They just use a ton of terms. The ones that you wanna be aware of is um ships versus observers because those are two very different things. Ships are hands on experience. The letters you get from that are gonna carry f far more weight than being an observer at e observer ships. The program directors give importance to intercalated degrees. So I that's a tough question to answer. Um I don't think it's a degree in itself that carries weight more. So what you, what you came out of with, in, in, from that degree. So when I did my intercalated degree, I got um two publications out of it. I mean, I wasn't like I was first author on one of them and like fourth or fifth author on the second one. And as a result of my degree, I also actually ended up presenting my work at a conference in the UK and in Germany, um and won a prize for one of those posters. So I could put all of that on my CV, which is a direct result of the degree. But I don't know that if just doing the degree and not having gotten all of that out of it would have carried weight. When in medical school, would you recommend starting to apply for clerkships? Did you pay for these? Yeah. So that's a good question. Um I would recommend start applying, start trying to do your clerkships um be um uh after your second year. So you will have cause your summers are longer right? Earlier on in medical school, you get bigger like longer summer breaks. By the time you hit 3rd and 4th year, at least for me at Liverpool, my summer breaks are becoming shorter. So do your step one early in medical school and then start doing clerkships um towards the end of your second year if you can, right. So that by the time you're in your fifth year, you might have done at least two or three months and then you don't have to um spend time after medical school trying to get that experience in terms of money. Yeah, I did have to pay for them. Unfortunately, some of these are not cheap. I did, um, the ship I did in Boston. Um, this is a couple of years ago, I ended up paying $4000 to do it. Um, at a month, uh, a month at the hospital. I think part of the reason it was so expensive is also because it's a Harvard Hospital. Um, but it was just something I have to do because I really wanted to come here. Um I did Observer Ships in Texas and um those were cheaper, I think I paid like 1500 to $2000 for the Observer ships. But yeah, you need to also kind of keep in mind the uh financial cost of kind of the transition, the exams getting these experiences, they all cost money. How long do we have after doing step one or two to finish all three exam series, you have a, a lot of time. So at least when I was doing step one, my step one was valid for seven years. Um So I had plenty of time to get all my other exams done. Um And I did uh step two, I think is even longer validity period and step three you don't have to worry about because it's not a prerequisite prior to applying for residency. You do step three while you're a resident. So you can kind of forget about step three for all intents and purposes right now. Just focus on step one and step two and they are valid for years. So you have plenty of time to do it. That's why I was saying do step one early on a medical school because that's your biggest and most important exam. And then you can do step two even after medical school just prior to applying to residency. Is there a proper online form for the recommendation letter? Can it be signed by a GP or just consultant? There is no um preformatted letter and I would avoid using a preformatted letter because then when a program director reads through it, it is just gonna sound like someone just, you know, automated and then just filled in some answer. It needs to be really personal, it needs to sound like that attending or uh IE consultant worked with you and can really vouch for your um skills, work, ethic, professionalism, et cetera. It is also helpful if you can, if they can drop specific examples of encounters that they saw you undertake or like, you know, so and so so dealt with a really difficult patient who had advanced dementia and was able to formulate a a very thorough differential diagnosis including XX LS. So that when the program director reads a letter, they can be like, oh, ok, this this person really worked with this uh student can really vouch for them rather than just a generic preformatted letter. And you were asking, can it be signed by a GP or just consultant. Um, it can be signed by a, anyone technically who is a consultant. Um, but if you want your letter to carry weight, you want it. Like I was saying earlier, you want it to be from one A US physician. And um it would be helpful if it's someone who has academic clout. There's, um, there's no point in getting, I uh there's no point in getting a letter of recommendation that's signed by a trainee like a registrar or a fellow. It has to be, it has to be a consultant. What main things would you recommend? Medical students should now focus on for, for example, things like research and steps to take. Um, that's a hard question to answer because it depends on where you are in your journey to applying for residency in the US. I'm happy, um, a lot to kinda chat with you privately and kind of work, talk through that, but I don't have a generic answer for that. Um, good afternoon. Is it possible for an IMG to get residency in general surgery in the USA? Yes, it's definitely possible. There is no um, residency program that, um says no to img's from the get go. It's open to anyone if yes. What kind of hands on experience is required? Can you suggest a medical school in which I can apply for surgery hardship? What kind of hands on experience again you wanna do? Um, uh uh, sorry clerkships. Tho those are the hands on experiences that you wanna get. Um, it clerkships. When I use that term, it applies for any specialty you're gonna apply in the US. Um, so clerkships are definitely needed. Can you suggest a medical school in which I can apply for surgery clerkship? I'm sorry. I, unfortunately, I'm not very familiar with general surgery in the US. So I don't have like medical schools that I can, um, kind of name drop right now. But I would assume that any reputable medical school would have a good surgery clerkship. You can apply to. Um, the way I went about looking for clerkships is that I just went to the medical school website. Um, and there's most of them have, uh, kind of a, a tab or page for, um, students who wanna apply to do clerkships because even in the USA, lot of students will go to other medical stu schools to do clerkships because that's how they can also then, um, get their foot in their door to apply for residency in another program. So a lot of you can just search it and you'll find it, would it be bad if there is a long gap between clerkship and residency? Um, that's a good question. I'm gonna reframe that. Um, it, it kind of, there's a twofold answer to that. So time if they see gaps in your CV, um, it, it can be kind of a semi red. Um, So there are two gaps that they're gonna look at is like time for medical school graduation to when you're applying for residency. 1 to 2 years is generally what I've heard is ok when you're hitting like four or five years, it kind of stands out to program directors, they'll be like, oh, well, what, what were they doing all that time? Um, are they gonna be out of touch with, um, the system and kind of find it hard to transition back? Those are the things they're gonna be thinking about and uh you want to do your clerkships as close to your application as possible, right? Because you're gonna be the reason you're doing clerkship is really to get letters of recommendation. So if I get a letter of recommendation, um say from two years ago and I'm applying for residency now, it's not, it's not gonna carry as much weight as a letter that I got from six months ago. Um So you want, you wanna really plan out your timeline early on, figure out when you're gonna do your step, figure out when you're gonna do your clerkships and when you're gonna apply for residency. And one of the things someone told me that I thought was helpful is plan backwards. So think about when you wanna um match when you wanna start residency program. And so then go back and think, ok, I have to apply this time the year prior to be able to start work in T 2025. That means I would have had to have these clocks done by this time. So I have my letters of recommendation. That means I would have had it done step one by this time. So work backwards. Think of where you, when you wanna start work and then go back. How are you managing the work-life balance? It was definitely um a, a little bit of a shock initially when I was in my P gy one year um because I started on an inpatient floor and they, you get like one day off every seven days approximately and then on the weekend, if you're not on call, you can technically sign out at 12 if you can get all your work done. So on average, I was getting about four to five days off a month as APG Y one when I was on uh inpatient block. You're not always on an inpatient block. You do outpatient blocks too. So it's not like that was my whole schedule, but that was definitely very different from the UK system for me. And the first couple of months I would just come home and I just couldn't do anything else but you get used to it very quickly. What I do like about the uh schedule here is that when you're scheduled to leave, you do you do leave the hospital? Like if my sign out when I'm on call will be 8:30 p.m. The A the oncall team will come, I actually can leave at 8:30 p.m. Whereas when I was in F one and F two, I was never leaving on time. Right? Like I would just, the nurses will be like, oh, we need another cannula, we need this. And those are things that you just couldn't really sign up to the on call team because they were already getting slammed. Whereas here you have really great ancillary staff. So I didn't have to worry about that stuff. I just have to worry about my patient and you have the everything is very team oriented. So there are multiple people with you that are helping you out with your uh tasks and they also do format the schedule so that if your sign out, for example, is at 830 I'm on call, my, the last new patient I'm required to see will be at 730. So they, they buffer it so that you have an hour to kind of finish up your task and get ready for Xanax so that you do actually leave on time. So I really like that here. I know that if 830 is the end of my call, I will walk out of the hospital at 830. Um But otherwise, I mean, it, it is an adjustment initially like residency is very busy. Um They are condensing a lot of stuff into a shorter time period than what you would be doing in the UK. I personally prefer that cause then I can just do it and I'll be done with it um in a couple of years. So I'm Yeah. Um How come you're not on a visa? Um So I actually um my husband is, was in the US at the time. Um So I'm here with him. Any advice for studying your assembly and the visa needed for clerkships, studying for the US family. There, there are a couple of ways you can go about it. I use kind of the generic resources that um everyone is recommending at that time, which is first aid. I think everyone should have a copy of first aid if you're gonna be doing the U assembly. And then there are a couple of core textbooks like uh Golden's Pathology. Uh For example that I used um and I have links to websites that made specific recommendations that I'm happy to share. Um So that's what I used. Um I also relied um on like youtube videos for complex uh for complex concepts. I didn't have any specific person that I turned to. It's just whatever was available. Um If you're a visual learner, I would recommend that a lot of my friends. Um oh, what colleagues said that they use like tutors um you assembly tutors to help them through that process and help them formulate a study plan. I personally didn't, I just made my own study plan and I had like, you know, in day one, I wanna get through this topic. Day two, day three. If that works for you, you can do that. If not, there are tutoring groups that will help you with that. Um, there is one that I haven't used, but I've heard really great things about before. I forget I can just put it in the chat. I mean, all you have to pay for all of these, but if you find it helpful, I can send it through so I can put it in the chat deal. I'm just gonna send it to you after and you can disseminate it. Sure thing. Um Alternatively, you might be able to put it in announcements. Where can I find announcements? Um So you see where the chat is, messages, feedback, polls and announcements? Oh, it doesn't actually, it just says messages, feedback and polls for me. Ok? Uh No worries. Yeah, just send it to me and I'll, I'll get it out to everyone. Ok? Um Sorry, I lost track of the chat. I might have to work. I might have skipped a few people here. So, ok, can you tell us a bit more about the differences in training between the UK and the US? Is there a portfolio of things you need to do for complete during residency? Is the training standardized IE does it make sense to take the least desired residency? There's only one offered to you. OK. So difference with the training between the UK and the USI would say what I love about being a resident in the US is that um my education is a priority when I was an F one and F two. I just felt like I was there to as service provision, right? Like uh II just didn't feel like all the stuff that I gone through to medical school was being utilized or my education just didn't feel like a priority. Sure, I met with, met with my mentor, you know, once or twice a year, but it was just kind of take things off on my logbook, not really to enhance my learning in the US. Um And this is why I came here and II find it very fulfilling is that my education is a priority, right? Like patient care definitely matters and patient care is prioritized, but they, they schedule things so that you are getting learning. I have for example, and it's pretty ubiquitous programs in the US, regardless of which specialty you go into, you have didactics, which is conference every day. So one hour, 1130 to 1230 for me, I am expected to break off from my work duties and go attend Didactics. They provide lunch for you, which is also pretty standardized. Um And this is throughout the year, except for like the holiday season, we also twice a week have morning report where we talk about specific patient cases that were interesting. It's about 30 mi, 30 minutes. So from 745 to 815, I have that twice a week um on Wednesday morning. So Wednesday is our grand rounds day, which is two hours in the afternoon where uh a speaker from in another institution will come and talk about their area of um interest. So in neurology, some subspecialty of neurology and um that's two hours on a Wednesday afternoon that we are also expected to attend unless there is an emergency. And II have to say that I, you know, like I've always pretty much 80% of the time I am able to go. The only times I can't go for the didactics is when I'm on the ICU and that's because we're expected to stay on the unit obviously and not um leave it for um leave it for a prolonged period of time. So that's just a kind of a flavor of how things are here. Um I mean, there's, there are a lot of tiny, tiny d like change differences between here and, and the UK. But that's the biggest thing for me is that I feel like my education is a priority and I feel like I'm spending my time here critically thinking about my patients and managing them and not worrying about not being paged, about putting in a cannula, not being paged about putting in another IV or drawing blood like the nurses and the ancillary staff do all of that. I'm actually just thinking and managing my patient. Um So that's very fulfilling and um uh uh I think that's the biggest difference between the US and the UK. The other difference is that the path here is more streamlined, like getting into residency is um it, it is very difficult, but once you're in, you're kind of, your training path is very streamlined. Like I'm not, you know, II, I'm not having to do any kind of core medical training. If you're a surgeon, you don't have to do core surgical training. You're literally like in your specialty of interest and then you can subspecialise further. Um So it's very, it's kind of a one shot, you know, you know, exactly the path the trajectory. You're not having to do other things in between to fill it up before you can do your area of interest. And you do have to um I have like a logbook, an online logbook that with certain um milestones and um things that I do have to meet during my time residency. So for example, I have to, in my first year, I have to have done at least five lumbar punctures and to be signed off so that I can do them on my own. Um I have to have certain patient encounters that I need to be documenting every year, but it's nowhere near as um burdensome as I would say, the portfolio that I had to keep as an F one F two. the, the requirements are not, they're more straightforward and they're, I just find that they're generally easier to meet. Um, in terms of numbers is a training, standardized. I, it doesn't make sense to take the least desired residency. If it is only one offered to you, I personally would say no. Um, if, if you are, I, if you, if that's not your area of interest, then I'm not sure that's what you should go for just because there was only one offered to you. But again, I think that's a very personal decision. II can't speak for you. Um because there are a lot of personal and financial implications of applying for residency and sometimes people just go for what is offered. So, um did you apply for a clerkship via V SL O? If so, it seems like they require specific specialties and modules to be covered during places in med school to be eligible. I'm gonna have to II don't know what V SL O is. So I didn't use that for ships. I just applied directly through the medical schools and they didn't have um they had some paperwork that University of Liverpool had to complete to verify that I ei am who I say I am that I've, you know, passed each year and done specific like certain modules, but it was fairly straightforward. It wasn't anything kind of unique, the directors like audits and applications. I don't know if they like it. I had, I had done some audits, I put it in there but it doesn't carry as much cloud. Uh I mean, you can, I mean, audits count as quality improvement projects so it does carry weight. Um I would definitely include it if you've done it, but also see if you've been able to present those audits at um conferences. If you've been able to get any publications out of it that carries more weight, can the recommendation be from someone in the US who has academic clock? But isn't espe especially different to the one you're applying to? Yeah, that's a good question. Um It can be, there are no rules about who you can and cannot get a letter from. Um, they're not not gonna uh read your letter of recommendation because it was written by a certain someone, but it's not, ii personally would not include a letter of recommendation from someone who's not in the specialty that you're applying to. It. It doesn't, it's not meaningful um in the sense when you know, from a program director's perspective. But if it's the only thing that you have, then it's better than not having a letter. If that makes sense. You want your letters to be from people who are in the specialty you're applying to. Um Someone says that they have a problem with connection and can't hear is anyone else having that problem? I think it might be more on their end. Um The session is recorded though so people can come back to this when their connection is better. Got it. Ok. I'm sorry. I hope I didn't get the recorded session. Um Can that recommendation letter be signed by someone you observed during clinical placement as a medical student or does it have to be someone you organize independently? It can be from uh it can be from someone that observed you during your clinical placement. Yeah, definitely. Would it be more difficult to shift to the US after working in the UK for 5 to 4 to 5 year in the UK? For 4 to 5 years? Yes, it, it would be more difficult um because they're looking at the, when you're, when you're applying for residency program directors are gonna look at how far out you are from the date of your medical school graduation. Having said that II don't think that's a hard stop, right? Like they're not gonna throw out your application because it's been five years since you came out of medical school and you were working somewhere else. That that's not a hard stop. The preference would be that you've applied soon after medical school. It would also depend on what you were doing in those 4 to 5 years, right? Like if you, um so for example, um next year we have matched an applicant from, I believe it, it's um somewhere in the Middle East who actually did subspecialty training in the Middle East and um completed four years of, I think, a radiology, um uh uh residency in, in their home country and is now applying for neurology. Um So, you know, my program director didn't reject his application because he'd been doing something else. But they would consider the timeline or the, the gap between graduation when you're applying. The other thing I would say is that the further you're out from your medical school graduation and you've been doing other stuff, the adjustment to residency might be harder for you. I think that's also a personal thing, but something to keep in mind because you're also gonna be, you know, moving to another country. You're not just getting a new job, it's a whole lifestyle change that you have to consider. If you're applying for surgery, would they only consider surgical correction for application or does any correction count it? It should be a clerkship in the specialty you're applying to, for it to carry weight. So, yeah, if you're applying for a surgery, a surgical residency, get surgical clerkships. Can the UK unions offer secure clerkships in the US? No, you have to organize it yourself, at least uh from what I've heard and my own experience, my university um wasn't organizing it for me or uh helping me reach out to people. I had to do all of that. And then I went to Liverpool. I'm like, hey, I need this paperwork so that I can do this. And they were willing to sign the paperwork to verify that, you know, I was a medical student and I've done these many years, but they were not part of the process. They were not involved in the process of me securing that clerkship. If that makes sense, I think some universities, I think Imperial, for example, did have affiliations with certain universities in the US. Um, if that is the case, then you can um try to use that to your advantage and speak to people who um have organized that and see if they can help you secure clerkships. But the University of Liverpool, as far as I know, didn't have any affiliations with us. Medical schools does in medical school, you do your hardship at matter. I don't think so. Um II think, well, actually I take that back. It, it helps if you've done the clerkship at a school that is, you know, renowned and has a name. And one of the reasons I went to Harvard is because it's a well recognized name and most of the faculty, there are kind of leaders in their field. So I knew that regardless of who I got my letter from that name would probably stand out in my application if I had gotten it from uh my Harvard affiliated hospital. So II do, it probably helps your application. Um But the bigger thing is the kind of experience you get there. Um I probably would not have uh for an um it's kind of nuance but you wanna weigh the name uh against the type of experience you're getting there. So, doing an observer at an elite institution may not count as much as doing a clerkship at a lesser known institution, right? Because clerkship is hands on and that's what program directors prefer. So you kind of have to weigh that up a little bit. Are clerkships specialty specific. And if they are, is it better to do clerkship and specialty you're applying for? Yes, they are specialty specific and do it in the specialty you're applying for is the age of applicant a consideration for program directives. I'll be four days from them applying for residency. You know, I II don't think so. Um I don't think, I think it's more so like when they're looking at your CV, they're gonna be looking at when you graduated, what you were doing the years between graduation and applying for residency more so than your actual age, you know, in my cohort itself there, I, there are people who are in their thirties to late twenties. Um I'm probably kind of older in my cohort than compared to my colleagues. Um I, you know, recently met a fellow who's gonna be doing um neurocritical care, which is a subspecialty of neurology. Um And he is like way more advanced in age than most of the other fellows in that subspecialty So uh yeah, could you give an overview of the training pathway in the USI here is F one and F two, then ST one, how does it work in the US? Could you use neurology as an example? Sure. Um In the US, you have four years of medical school and then in your fourth year, you apply for residency and you start residency um straight out of medical school. So if I graduate in June um of 2024 I would you get like, you know, a couple of months off and then in July 2024 you start residency. Um So for neurology, for example, most programs here are three or four years. If surgical residency programs tend to be 5 to 7 years, neurosurgery, for example, is seven years, neurology is four years medicine, internal medicine is three years. Um And then once you're done with the residency, um in your final year of residency, if you wanna subspecialized II EA super um specialist in your area, you can apply for that in your final year of residency. So I was telling Bill before you guys um came in on the meeting, my plan is to do neurocritical care. Um And that's a two-year fellowship and I'm currently in the process of applying for it. If I get in when I graduate residency, which will be in about a year and a half, I'll start fellowship right after that. Um I'll have maybe like a week off and then I'll start fellowship and I'll be done in two years. So it's a very streamlined, very straightforward path here in terms of um specialty training. You don't, uh you don't do any kind of core medical stuff, core surgical stuff. It's just, this is a specialty I'm gonna apply for. You do that residency and you can be done and be a consultant which some of my colleagues are doing or you can be like, oh, actually, I wanna um be uh a stroke physician or I wanna be a neuro intensivist. Then you do your fellowship in that would it be possible for us to set meetings up with you separately in case we have more questions later? Yeah, definitely. I'm um more than happy um for dill to send out my email, I had a lot of people who help me in my PAP here. Um And I'm uh more than happy to kind of um do what I can for you guys cause it's really hard and there's a lot of information out there. But for me, it was really helpful to hear from individual people and individual experiences. So, yeah, so um just on that night, we do have the beamer pigeonhole. If your questions weren't answered today, please drop them in there and then if it's ok with you, Marriam, um I might try and type up AFA Q because we've had a, we've had a lot of the questions be repeated in the chat. Um So I was thinking if we make a quick cheat sheet and then if people still wanna get in contact with you, I can then give you an email out if you're happy with that. Yeah, definitely you can share my email. Um and then happy to answer kind of more individual questions and I can um I'll send you some of the links that I use and some of the resources that I people have passed along if anyone wants Jesus. Perfect. Ok. Um You said you had to leave at two pm ish, right? II can um just give me a second, let me just check something and I'll come back on. Sure thing. Ok. So yeah, like I was saying, if Doctor Marriam can't answer any of your questions, please do use the beamer pigeonhole. Um What I will try and do in the next week or so is right up a lot of her answers to the questions we had commonly, it seemed like you guys were specifically interested in clerkships. Um And some of the more specifics, if anyone does want her email, she said we can share it. So I'm more than happy to send that out as well. Um But yeah, maybe she did say she had to leave around now. So I do II can I can hang on for a little bit longer? Um Yeah, I'm gonna, I'm just going to the chat now. I'm gonna skip through some of the questions because they're very like clerkship oriented and I think we've gone through some of those already. And I can also, you know, if you want me to type up some of the answers, I'm happy to do that for you as well. Um, let's see, I'm gonna try to pick out ones that are different here. The English language proficiency is a good question. Um, I did have to show, even though I went to a uh went to medical school in England, I did have to show English language proficiency by doing one of the extra stuff. Um The I did the L TF I don't know if that's because um my, so my passport is Indian. I don't know if it was because of that. Um I was telling dill before you guys came on that I only came to England for medical school prior to that I was living in Tanzania. So my path was like, really convoluted and I don't know if it was because of that or just because I was in the UK, no clue. But I did have to do the I LT S. Um It's like the easiest exam in the world. Uh If you've already done medical school in the UK, it's just kind of inconvenient because you have to find time, you have to pay for it. But the exam itself is really, really easy to do. Um And I had to do it uh prior to submitting my application for residency, I didn't have to do it for the US families. Can we only apply for residency in the US? After F one and F two? No. The only prerequisite to apply for residency here is that you have to have graduated from medical school. Um Getting into fellowship programs after residency is nowhere near as competitive as getting into residency itself. There are usually more fellowship positions and there are applicants and it's kind of, it's kind of nice based on what I've, what I've like, I've been talking to some fellows now and it, it sounds like the programs are, they really want you, they'll kind of like really wanna engage you, they'll reach out to you um because they wanna fill their spots and they know there aren't that many applicants there. Um So the kind of the, the roles reverse a little bit between residency and fellowship, which is nice. So, yeah, nowhere near as competitive as getting into residency. Once you're, once you're in residency in the US, you do like a lot of opportunities open up. Um Yeah, do um merits distinctions at medical school. Give plus points for residency programs. Yeah, it does. I don't know exactly how much weight it, it'll give your application. But if they see things in your CV um that point towards you being an out outstanding student program directors are definitely gonna like that. How was it adjusting to life in the US in general alongside adjusting to the medical system. Yeah. So this was a question dill had also forwarded me just kind of the whole um transition to the US and living um living here. So just so you guys have some context. I had um lived in New York as a kid. I mean, I was really young. I was like in the fourth or fifth grade at that point for a couple of years. Um And then when I was in the UK, my brother was in grad school here, so I would come and visit him for like Christmas and Easter. So the US was um it felt fairly familiar. Um Before even moving here, what I didn't realize is that um is that there's AAA big difference in a kind of culture and your day to day life depending on where in the US you end up and that's something you might wanna keep in mind. So there is a East coast culture, there is a West coast culture and then like in the middle, it's kind of like the, it's kind of just like a vague kind of area like the Midwest is what we call it. Um the east coast. The, the best way for me to describe it is kind of, it reminds me of London, it's, you know, fast, uh a fast pace, everyone is busy. Um People are a little bit more kind of um rash. Um maybe a little bit more kind of in your face. You know, everyone's just really busy and um kind of rushing to do things. So you, I felt like I was kind of in London when I was here. Um And it'll vary a little bit. I mean, New York is probably an extreme example of that at Baltimore. I would say it is probably lower down on the scale there. Um But the east coast reminds me of London. Um the west coast. Uh So California Washington, it's like definitely a chiller culture, life is slower paced. Um It people are generally just more laid back. Um And probably a little bit nicer depending on how you wanna look at it. Um And then the Midwest, so that's like Michigan, Ohio, um Indiana, Illinois, they're really Minnesota, they're really known for, uh probably being some of the nicest people in the country. Um I would say the pace is probably slower. Um uh it's probably in between the west coast and east coast and people in general are just very friendly, very polite, really easy to get along with. Um So that's kind of your flavor of America up and down the coast. Um For me personally, I there was some cultural adjustment. Um oh, like being in the east coast, like I, even though I've been in London, I felt like people were just a little bit kind of more in your face here a little bit more. Um abrupt. Um They, you know, to me, I just felt like sometimes some of my patients were being rude and then I just realized that's actually just how they interact with each other. Um So that took a little bit to get used to. I think it also part of it is um you know, I do see a difference in between how my male, my caucasian male colleagues are treated versus how I as an Asian female. Um It, it is being treated. Um And some of my female colleagues have also said that. So I think that is part of it. Um And for other, I mean, I think those are the big things. There are like other things, right? Like, so one of the things that people have asked me, um are, you know, you hear a lot about gun violence in the US and that is a, it is a real problem. It's something that I've had to think about for the first time in my life. I've never thought about that before. Um I've not had any personal experiences um or any negative experiences here in the US so far. Um touch wood, but that's something that I've had to start thinking about um when I'm going out in public spaces and so on which I've never had to think about before. Um And that it, it is a real problem here. So something to consider and it really depends also where in the US you are, um, you know, Baltimore is, um, it's so socioeconomically, um, kind of deprived city, so to speak. There are parts of it that are very affluent but a lot of it is a kind of an underserved population which reflects in the patients that I'm treating it. It's interesting because, because of that I see really cool pathology that I probably wouldn't see elsewhere. Right. Like we have a patient on our service right now who has neurosyphilis. Um I probably wouldn't see that if I was in um you know, um upper West side of Manhattan, for example. So it, you know, it has pros and cons um but there, depending on where you end up in the US, your experience could be very different. Um Was it difficult getting a visa for a clerkship? No, because you can um come here on a visit, visa for your clerkship. It's not considered a job. So you don't have to apply for a specific visa getting a visit. Um Visa is really easy. Um Particularly if you're um living and working in the UK. I'm a bit confused as to how to apply. Are there any resources or guidelines, are you referring to how to apply for residency or how to apply for clerkship? And you can, you can also, I guess, message dill and we can, uh I can email you privately too clerkship. Ok. Um I can send dill uh let me just write this down I can send you kind of a lift deal about how to apply for clerkship. It's really, you just have to go to the university website and apply directly through them. Yeah. Sure. Um, I'll get that out to everyone after the talk. Yeah. Um, roughly how many hours a week do you work in residency? And how does it compare to after residency? Oh, it really depends on what rotation you're on. So, currently I was telling Bill earlier that I'm on my neurocritical care block. Um It's a two week block. Your ICU blocks, whether it's a medical ICU or neurocritical care ICU are um probably the longest hours you're gonna be working. So I am currently doing 12 hour shi shifts 630 to 630. Um And then on Friday, I do a 24. So I go in at 6:30 a.m. and I finish at 630 the next morning on Saturday morning. So I end up um clocking in at around 70 to 80 hours currently. Um And I'll be doing that for two weeks. We do have work hour restrictions. So if I go over 80 hours a week, my program does get dinged actually. Um So they have to format your schedule so that you're not breaking those work hours. Um When I'm on my outpatient blocks and neurology, it has both outpatient and inpatient blocks. So, you know, epilepsy clinic, for example, or um Parkinson's Disease Clinic. II maybe do 30 hours a week. So there's a huge contrast and so it really depends on what blocks are on there after residency. Um I don't have personal experience yet, but from what I've heard from, uh friends who graduated in the prior years, it's completely different. Um Being an attending. Um Sounds fantastic. Uh You can really schedule, you can really format when you're signing a contract with the hospital. You can, you have a lot of weight and saying, you know, this is how much I wanna work. This is how, what are the services I wanna do? So you can really tailor that contract to um your preferences. So if you wanna work a ton, sure, if you're like, I wanna work a week on and then have a week off, you can do that and I have friends who are currently doing that. Um So there's some visa questions here. Um I am kind of worried about going into the details of that because I didn't go down that path and I don't know if the rules have changed, given that there's been a turnover in administration here um from like Trump to Biden. So some things have changed in the past couple of years, but generally speaking, your Visa options are gonna be your J one or H ONE B and there are not many programs that offer an H one B because they have to, they have to sponsor you and it's AAA very arduous process for the program. The J one does not require sponsorship. It's kind of like an exchange visa, so to speak, which is why a lot of programs will go for that. Um I am happy to send links with more information about those visas. Um But there are also other visa options out there. There is um like a what they call, they call like an Einstein Visa if you're like exceptional in your field, um You can come through that visa so I can send information on that. Ok. I I've had heard this term being dropped a couple of times in the chat V SL O and a non vs application. I have not heard about a V what this V SL O system is. I'd never used it. It didn't come up when I was applying for clerkships. So, yeah, I'm sorry, I don't know the answer to that. How do you apply to residency if your specialty requires an intern year? Do you apply twice or programs offer them combined? There are um that's a great question and you have programs uh that have them combined. For example, the University of Maryland is combined and you have programs where you do the intern year at that, at their hospital and then you go to another hospital to complete the rest of it. Um It is when you guys are applying for residency, you will see a couple of terms being thrown around categorical programs versus advanced programs versus in transitional year. And what I'll do is I'll type out what those mean exactly. Um, in terms of when you're applying. But if I, uh in terms of my own experience, I applied when I applied to the University of Maryland, it's what's called a categorical program, which meant that the program here has combined the intern year, which is my first year with the, the neurology residency, which is my last two years as one program. So I only had to apply once and here for the whole time, I have co residences who did the intern year at another hospital. So one of my co residences currently did her intern year at in New York and then came here for the rest of her residency. It's still one application that you're using, but the way you have to rank it and the way you submit it is a little bit different. Um And again, I can send you information on that. Is it a US medical school website that you need to contact and organize your clerkship of your own? I did, I went to the US medical school websites and I contacted them individually. If your medical school in the UK has affiliations with schools in the US, you can try to use that to your advantage and go to your medical school and be like, hey, do you help organize experiences at, at that institution? I know that Imperial had some affiliations but I um I never used that. Um Liverpool did not. So it depends on where you're at, but most medical stu im GS that I have come across just went to the US medical school website and applied directly through there. Is it good to do the U Assembly during UNI and then complete foundation years first before moving? So I would um so first part of your question, is it good to do the U Assembly during university? Yes, I would say it's a good idea to get at least that one done while you're in university in terms of the foundation years before moving again. I think that's a personal question. It depends on whether you intend to um come back to the UK or whether you're like, I wanna get some experience here and see what it's like before I move to the US, right? Like you have to decide that for yourself. Um But II, you know, if you were like, no, II don't wanna come back to the UK. I know I wanna stay in the US and do all my training there. I don't think there's any point in doing your foundation years. You're just kind of wasting time if you secure a position as an intern and don't get your choice, especially for after the engineer, what are the options? You can actually reapply. Um There's AAA process called the soap, which is a kind of like a scramble if you don't match. Um where program you can recheck programs individually through the same portal to try to match. Um So you do have options if you don't match. Um In the get go from the get go. How long does it take to be masked to a residency of your preference? I'm not sure what you mean by that. Um Like from, from what point to what point are you referring to? They might still be typing. Um But yeah, I think we've gone through most of the questions uh between applying and starting the residency. So you would um so I can talk about the current cycle. So medical students have a um applied in October now uh in September, October now is interview season. So we are actually um interviewing applicants. Um And the interview season is typically from November to about early February and then your match date ie when you find out if you've matched, your note is in, in March and then you start residency in July. Ok. So I think that's most of the questions done. Um Firstly, thank you everyone for coming. If you have more questions that weren't answered, please use the Beamer pigeon hole. Also. Um Marriam, if it's ok with you, would it be better for people to get you on linkedin rather than potentially having a a spam email? Yeah, I II thought I'm, yeah, linkedin is fine. You guys can message me on linkedin. Um And yeah, and then we'll try and get AFA Q form out uh an F AQ sheet and the resources out as well within the next week or so. So keep an eye out for that, please fill out the feedback. Thank you very much for coming. Thank you, Maram. So yeah, of course. Um I'm happy to kind of, I think there were a lot of questions about clerkships and visas. Um in terms of the visas, like II just wanted to clarify, like I'm not the best person to answer those questions about visas. I can point you guys to like li like resources. I can walk you through that, but I just don't have personal experience with it and a lot of the rules have changed in the past couple of years. Um And so that is something you, I forgot to mention this earlier, but something you guys should look into early on. Um You know, what your visa options are uh before you even get started on this process because that has been tricky for a few people that I know of. Um But there are a lot of the other questions about clerkships, which I can definitely um help with. Awesome. Thank you very much. Um The feedback form will come to you once the stream ends. Uh I'll just paste the pigeonhole in the chat one more time. Thank you everyone for joining. Thank you so much, Marriam. I think this is super useful. Thanks for organizing this. Good luck to everyone. I, I'll end it here.