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Yeah, sure, perfect. So, welcome to our last session of medicine in the US. We're joined by um who's a doctor who has um already done the ma step three, has great experience with the application um and is gonna be talking about the match process as well tonight. And so if you have any questions through it, just find them in the chart. And I will hand over to Doctor Patel to introduce himself and, and to share with you guys. Thank you. Hello, everyone. My name is Doctor Patel. I'm an international medical graduate from India. So I have been pursuing this uh path for residency in United States and I have uh completed all the examinations. I'm a CFM G certified and I applied internal medicine residency last year. Uh Unfortunately, I didn't mat but I'm uh right now working towards improving my CV and will be applying again this year. So, yeah, James, you want me to start with the presentation? Yes, please. Yeah, perfect. OK. So uh we'll go ahead with your step three. Basically, it's the last exam in the whole series of yours and it's not that uh difficult uh per se. It's basically uh an exam which focuses, which is mainly the residents in the US given their PGY one year. That is the first year of residency also called as intern year. So it's just helps them to revise all the clinical and basic sciences. They have been, they have studied in the past and all that stuff. Uh from the img perspective. The thing is that if you are done with, you are semi step three, you have no worries and you can uh gain some confidence in the program director's mind that OK, you are done with your semi and you can, you won't have uh you won't have that hanging sword over your head in your first year of residency. So that's it. And you can only take us family in uh United Sta States, only the prometri centers in the United States. So uh that's the one thing that you have to keep in mind and we'll, we'll start by looking at the eligibility. So to take you some step three, you'll have to first clear, step one, step two and via the pathway which is whichever is applicable to you. And the ot examination, you will have to get a CFM G certified. And also you'll have to uh gain a medical degree uh from whichever country you are from. If you are from us or Canada, you gain MD or DU degree uh from a country like India, you gain MB BS. So you have to be a graduate to sit for your family. Step three. And after that, you can create an account on FS MB. That is a different account. Uh that is a different website from the USM. You mainly for the step one and step two, you uh create an account on CF MG and apply via CF MG. But for you, step three, you have to create account on FSB. There is a federation of State Medical Boards and you have to apply there. And when you start applying, you pay the fees and you uh there's a form that is generated and you have to notarize it in the US itself or you can either use the local library or local lawyer or there are a few online notary services like Notary C. So that are also feasible. They'd like charge you about 20 to $25. And yeah, so like step three costs uh about 900 something dollars. Uh I just forgot to uh add the exact price. But yeah, it's around the same uh price range. Regarding the exam style. The step three has, is a two day exam and both days you have to schedule in a span of less than two weeks. So like you can take day one and then after seven days you can take day two. So it, it depends on your schedule and your flexibility. You can schedule it, however you like day one is about, it's seven hours and it has six blocks of MCQ S and each block has about 38 to 40 questions. Uh The question uh number is variable because there are a few questions which are very lengthy. So to cover for that, the few blocks may have 38 questions and day one mainly focuses on basic sciences and all the stuff that you might have studied in step one and step two CK. So uh that is the you, if you are giving step three just after taking step two, that's the best time to give step three. Because like you have everything fresh in your mind and you can easily uh a appear for the exam. I'll go through the what the resources you can use and what I did. And uh by that way, you can get more idea about it. And for regarding the exam particulars, there are 45 minutes of breaks and five minutes of tutorial, you can use tutorial uh as a break time if you just skip it. So basically every uh examinee does that. So you get 15 minutes of break and six blocks and day two mainly has two components. First one is similar to day one that is MCQ, but the type of M CQ here is a little different. It mainly is more clinical based like prognosis and management. What's the best next step screening type questions? And it has six blocks again, but each block is only 30 M CQ per block. And the time limit is 45 minute for each on day one, it was one hour per block. Here, it is 45 minutes per block. So six blocks afterwards you uh the exam moves on to s cases. So basically CCS cases is uh I would like to put it in a way that it is a computerized version of a case where you just deal with her electronic medical record. It's a software that comes in front of you. They'll describe that this the information about the patient that this year old patient come to the hospital. There are key settings, the patient might come to the emergency department or a clinic or general inpatient ward or in ICU like that. And based on the setting, you'll as a physician, you'll assess the patient, you'll first decide. OK, I want to do a physical examination. So you'll just click the boxes that OK, I want to examine CVS, I want to examine uh respiratory system based on the uh so you, you just tick the boxes and once you submit the system will give you findings like OK. CVS examination showed this and all that stuff based on that findings, you move on to ordering uh test results, lab results or imaging, all the tests, you would order in a proper medical setting and those test results have a timeline which would uh and there's a virtual time which which is ongoing and uh if you just virtually move the time forward, like let's say forward 24 hours. So like if some CBC results were pending in six hours, so you'll see the six hours results on your screen. So it's a very uh nuanced version. So like it's very difficult to understand it uh upfront from just my explanation verbally. But for that, you have to practice on S cases.com. So that is the best resource you can use for S cases because they have their own software and you can practice all that stuff in it. Uh There are 7, 10 minute cases in the exam and 6 20 minute cases. And the time limit is uh sort of arbitrary because like if uh if you do everything right and you resolve the patient's complaint and patient starts feeling better, the case might end in less than 10 minutes, let's say six minutes. Uh And if you do everything wrong and patient starts feeling worse and um uh something uh bad happens. If the patient dies or something, then the, then also the case will uh end earlier. So it's just the arbitrary time limit. But in general, the consensus is that CS cases is a scoring part of uh step three because it weighs heavily on the scoring, the three digi score, it's like about 25 to 30% of the score. So if you do it properly, and if you practice this cases, there is a high chance that you'll be able to uh easily pass and even score better for the break section. You'll have 45 minutes of breaks and 12 minutes of tutorials and you can skip tutorials. Tutorials would be S one for M CQ and one for CS cases. And uh here, II would say like the break may seem less in comparison to the nine hours of the exam that is written. But as I said, like the cases will end early. So whatever time that was left will be automatically added to the your break time. So you won't have to worry about the time on day two. It won't be a problem regarding the content that is tested on day one. There are lots of biostatistics question. There are drug ads. So drug ad is basically an ad of uh a drug which describes everything uh side effects and but it is uh made it, it's not like something written in a pharmacology textbook. It's like some pharmacological company has put on a ad in a magazine. It's like that. So you just have to um read it and go through it. And based on that there are questions that you have to answer in abstracts. Also, it's like an abstract of uh uh some research article and based on that you have to answer a few by statistics questions that are there and sequential diagnostic questions are there. So in that, based on the previous question, the follow up questions would be uh decided. Like first of all, they are asking pathology, then based, then the next question they would be asking uh what's the next best step? Uh what's the next best step or what's the next uh diagnostic uh order that you would like to order some uh like uh in that zone. And if you are given step one step, it is step three, consider sometimes tests micro and pharmac more than other subjects. So it is advised like you go through uh your step one micro from first aid or sketchy, whatever you have went through. And on day two, there are more clinical questions, more step to type questions like screening best prognosis. Next, best step, heart sounds related ECG and all that stuff for CS cases. As I said, like if you have uh done about 100 plus cases, if you have practiced 100 100 plus cases from CS cases.com, you'll be easily able to go through the uh that section of the exam. And um I'm not exaggerating but like almost every person who sits for you and step three practices the C CS portion on that website. And it's like a, it's just like counterpart of you will, but you will also offer C CS cases, but it's not that uh uh interactive and it's not uh similar to what the real exam offers. So the software of real exam is very much close to S cases.com and like if you are practicing your case on that website, they'll also say that you missed this test that you had to put in to get better marks or score better on that particular case. So uh mainly for resources. Uh so it depends on how much you want to score. Basically, your step three, everyone focuses on passing the exam and that's what is necessary. But like lately, the perception has been since step one has become pass fail. And for img scores have always been uh one sort of filter. So people are trying to score better on step three as well. And it is believed it is like perceived like step three scores are important when you apply for fellowship and uh in your future career. So it's not important for residency, residency program don't uh don't focus much on step three scores. But yeah, so you have to decide what range you want to be in based on that, how fast you can prepare for the exam. So once again, in terms of resources, uh you'll only focus on your world. There are about 1700 questions. So like you can go through your world once and you can clear the exam easily. Uh II had lots of stuff on my plate when I went through when I gave step three. So like I was only able to give 65%. Uh I was only able to complete that much portion 65 only and even then II had a great time. Uh I score about 223 on step three and one of the you before exam you want, you might want to predict your score. So, Uw, there are UW ss and again, Uw's are the easiest and best way to predict like uh to know your that if you are ready or not. Uh CC again, CCS cases.com and to supplement this uh two gold standard resources you can use first a step one and refer to your original study resources for, for micro Biostat pharmac from wherever you might have studied during your step one or step two examination. So that would be the best way to revise the those subjects. And yeah, you should also uh go ahead and at least attempt once the free 120 that is on the USM website because that would give you the best idea of how the questions would be framed and how the CCS would look in the real exam. So uh in terms of benefits for IMG SI would say it improves your application. Uh It shows that you have uh completed all the requirements for a residency, it increases the confidence of a program director because few programs who are very busy, let's say in New York City, they are very busy, they have lots of patients. So sometimes they might, they might feel confident. OK, my resident has already cleared step three and so he don't, he won't need to take time off for step three and there's no hanging sword that he uh he or she might have to pass or uh they might fail the exam. So that's one thing for your own self. There's no worry during PGY one year that OK, I, you still have a one year family exam left. Um, in terms of H one B Visa, sponsoring all the, all the US hospital that sponsors your H one B Visa. Uh They require you to take your step three before joining residency. So if you are planning for H one B Visa, you'll have to plan to take your se step three before in such a way that you have completed the step three before December of the ear before the match year, right? So if the match is in 2025 you have to complete your step three by December of 2024. And as I said, like higher scores, it's believed that it might help with fellowship match. But that's, that's in the future. Usually programs require passing scores and the passing currently the passing score is 200 almost there is a 98% guarantee of pass like the passing rate is 98%. Yeah. So that was uh everything that I had to say about step three. If anyone has any questions, you can put it in the chat or James if you would like to guide them. Yeah, perfect. If anybody has any questions at all, uh follow them in the chat and thank you doctor for sharing there, I guess. Uh I'll kick it off. I just have one question. Um So because step three points for getting like fellowships and things like that, can you reset it if you got a low score or is it just you can reset it if you don't pass? Yeah. So it's just like every other year exam you, if you pass and score above the passing um range, you can't re reset your scores. Ok. Ok. Yeah. And the E uh validity criteria applies like all the U assembly are valid for seven years. So validity criteria applies. But if, if in the short term you can't reset your scores. Yeah. Ok. Thank you. Yeah, I don't see any other questions there. OK. So should I move on to e application? Yeah, good. OK. So there's a high likelihood that whenever you as an img if you are trying to apply for residency uh and you are taking step three, you'll be doing both at the same time. So for the upcoming med cycle, the things are as on your screen. So the the new cycle will start from June 5th ECF MG will start giving tokens from June 26th. So I'll explain what the tokens is. Yeah, the application formally starts from September 4th and you have to complete all the stuff, all the information you uh that isn't required for your application before September 25th. And you have to apply and pay for your application before that date. And afterwards, the programs will able to review your application wherever you have applied. So basically what era's application is, is basically a standardized application. The scenario here is uh let's say, consider me as a applicant. I am a job seeker. And if I apply to a hospital that uh that hospital is providing me a job. And before everyone used to apply randomly to hospitals. And based on that finding based on that whole process, hospital will assess all the applicants and it was very randomized and not standardized process. So Iras application was brought in. So now every medical student either be it US or international medical graduates who want to do residency in us, everyone applies through I A and it's not only for the residency but also for the fellowship applications also go through a. So the full form of era is electronic residency application system and I have, I have a few screenshots of how the uh the the platform looks like and uh starting with F MG tokens. So if you are an I MG applying for er uh for the residency, what you'll have to do is you have to create an account on er and to create an account, you have to get by a token. So obviously, if you have reached the stage of applying residency, you must have uh an CF MG account and your uh overseas account there. So you have to go on the oasis and you'll have to uh buy Token there. So there's a simple process, you just say that I have to buy Era Token. You pay 1 $65 there and a token is issued. That token would be a number which afterwards you go to the, er, website. So Era website is that my ac website, you can easily Google it and you go there, register and there during registration, they will ask you for a token number. That's how your CF MG and my application, they both are linked. That's one way they are trying to link your ECF MG data and plus application. So yeah, to get your token, if you are us medical Canadian medical schools, they have their own system for international medical graduates. You go through ECF MG, then you register on my portal. This whole portal is for used for this application. And afterwards, once you have registered for my portal, uh there are only a few details based on uh your profile. It's a self-explanatory form and you land on this page. So this page is a dashboard of your my portal. And as you can see from left side, the left side is your application in the middle is the number of documents that are required. And on the right, there are programs that you might uh search for, save them and apply to. So on from starting from the left, you have to fill all the personal information, biographic information. Uh So the personal information would be all your phone numbers and emails and addresses and all that stuff. Some would be filled already. Uh other stuff you'll have to fill some biographic information may include your geographic preferences and other uh like if you, you have setting preference, you want to uh apply in urban setting, all that stuff. Education is your, if you have uh after medical school, you have completed other degrees, you want to add the education and there's an experience section. Uh The experience section has one thing. You all should know that you can only add 10 experiences. So out of 10 experiences, it can be any, it can be work experience, it can be voluntary experiences or it can even if you want to exper uh add your hobbies or interests, you have to use one of the experiences, it can be research experience. So in total, you can only add 10 experiences. And if you hold a license in some other uh it's the license basically regards to if you hold some license in practice in us. But I don't think so. It applies mostly to IM GS and in publication, if you have research publications, you can uh upload them. There's a whole format how you can do that. So I'm not going in detail of each one of this portion. Because that would uh that requires a whole session for itself because it's a huge, not huge but very large application. There are lots of things you have to consider. So I'm just trying to give an overview of how things are uh with this Aras application and then come coming to the document section. Uh That's first thing you have to upload a personal statement. OK? So this one's the uh one screenshot that I put for the type, how it will come. You have to fill all these details, all the work authorization match information. And based on that you can uh one from starting from registering on IR portal to the whole month before you apply, you can daily work on this. Save your information, come back again like that. So yeah, uh you have to put a personal statement for every program that you apply to. So what you'll do is like you write your own personal statement somewhere on your computer and then you click on create new, you add all the text and they'll create a standardized personal statement format for you. So all the things that you have written would be the same. And this personal statement goes to each and every program that you apply to then comes a letter of recommendations. So to apply to the residency program in the US. Sorry, uh you'll have to uh upload minimum three letters of recommendation and you can even upload four recommendations So how this recommendation thing works is you have to generate a request. So if you can see the new section there, you uh start with adding information about your receptor. Any doctor either be in the US or uh if you are joining from UK or India, wherever the doctor is located, they have to have their own ac account. And you can start by adding that information on this uh by clicking on a new and based on those information, a letter id will be created that is unique to that particular uh doctor. And afterwards there is this, you can see the confirm for uploading. So what you can do is it generates a request letter for you. So you can download that request letter and send it to your preceptor who is willing to write you a letter of recommendation. So once you send that letter of recommendation, it would have a letter ID on it. And whenever your receptor uploads your letter, the the preceptors have their own portal for a letter of recommendation. So they upload the letter of recommendation on that particular portal. But while uploading, they have to put this specific letter so that it reflects on your my portal. So that's how this whole letter of recommendation thing works. And you have to uh get at least three and based on specialty that you are applying to. If you are applying to family medicine, you have to get family medicine letters Um If you are applying for internal medicine, you have internal medicine s surgical specialty, you will have to focus on getting surgical letter of recommendations. And yeah, and other additional documents I come to that later. There's a screenshot that I have put in later in the slide. Um Yeah, so after that, now you start your search for all the residency programs that you want to apply to. So basically you go on to search, you search for particular states and particular uh residency that is either internal medicine, emergency medicine. And based on that you select a particular program, a particular program is a particular hospital in any part of the United States. And um it offers a residency program. There are students uh there is a graduate medical education course that goes on and uh you can apply beforehand, you have to research. So for research, you will have to either use uh Freda that is the residency uh tool for. Um it, it is by AC and also you can use residency explorer. So both these tools will provide you more information about the residency program. And you'll also have to individually visit each residency programs website to make sure all the information and all the requirements of each programs are met by your application. Sorry, Doctor Patel and some people are saying that this screen is frozen for them. I'll try and present it from my side. Um See if that works for Google. I think it was just recently. Ok. Sorry about that. Can you tell me from which slide it was frozen so that I can? Yeah, I think it was, did you, were you guys able to see um the personal statements section, this one or what part did you miss from the er application? So I thank you from here. Ok. Yeah, so from the dashboard. Yeah, so basically application information, documents, information and programs, information. So from, yeah, if you can just move on to the next slide. Yeah, so that's how you'll see all the uh sections, you'll have to fill out everything, personal information. Then biographic information, as I said, there are geographic preferences, all that stuff and there's a whole lot of other details. Uh like I said for 10 experiences, that's, that's all, there's also other drop down menus where you have to select what kind, what things you learned from, what qualities you learn from that particular experience, all that stuff. Um I'm not covering out everything in detail here because it would have been a one particular one particular lecture for application itself. I'm just trying to give the overview here. And so basically you add licenses your publications and at the end of everything you certify the application. So once you certify, you can't change anything in the application except for your personal details. OK. Yeah. So and just move on to the next slide. Yeah. So like this slide is for personal statements. You, you can just uh upload your personal statement here beforehand. You'll have to start about 1 to 2 months before you are planning to upload your personal statement here. You have to start writing your own story, how you are connected with internal medicine and uh or whatever branch you are applying to and you upload that whole person statement here and it will produce a standardized copy for you. Um Later moving on to a letter of recommendations here, you have um the section where you generate a letter request for each receptors that you are trying to get a letter from. So once you click on add new, you'll have the option to add all the information. As you can see, uh all this stuff has been put in by an applicant and you select the specialty you and the once you click on generate, there's a unique letter ID that is generated, you download that letter request and you can either send it via email or you can send it uh as a PDF and your letter writer would then use that letter id to upload the upload the letter of recommendation for you. Uh One thing that I would like to add is that the letter I it either it can be waived or unwed so waived means that you have waived your rights to see that letter, what your preceptor has written for you. And unwed means that you have seen the letter and you know what your preceptor thinks about you. So, uh it's uh a general consensus, most of everyone does is like they wave their right because it's what's the best thing that you can do because program directors want you to be confident that, ok, um, you have waved your right and you know that the letter that your letter writer has written would be good at because like you are confident in your own skills that uh your letter writer has written good things about you. Uh That's one perspective of it. So basically when the letter writer uploads that letter, it turns into yellow and then it's processed by CF MG and and it turns green. So that's, it's true for every document, it, it plays between yellow and green. Once it's green, everything's great. You just have to select that document while applying. Yeah. So uh in terms of additional documents, I'll come to that later for this. This is the page where you start selecting your programs that you want to apply to. So you once you start saving the programs, basically, you add programs, you know, uh you search by city or state or you know that this particular program is I MG friendly or um or meets your specific criteria is what you want, you might want to stay in one particular state or one particular city based on that, you add that program. So this whole process of adding which programs you want to apply is very personal. You have to fulfill your own criteria. You have to research on residency explorer or Freda. Uh Those two are the platforms where you can research or know more about the programs uh for any residency programs and you have to decide if uh it aligns with you. You even have to check their, the program's own website. Uh Each program has their own GME page where the intermedic or any other particular residency program, there's a page for it and you go through it, you check all the requirements and some programs have three years of year of graduation requirements, some have five years of graduation requirements. So all that stuff you have to look at and based on that you select the programs that you are going to apply here. Yeah. So OK, so this is the application fee structure. So each program that you apply, you costs you money and based on this uh algorithm up to 10 programs, it's $99.11 to 20 is 19 each. 21 to 30 is, it's 23 each. And after 30 programs for every program you have to pay $27 each. So it's um like you can, if you can see the example, II guess the phones are small but uh if you can just look at the examples, you'll get a very good idea about it that how the fees are calculated. So like uh as I MGS people apply to about hun 100 and 50 to 180 programs. Uh And even if you want to apply broadly, you go to 202 100 plus programs. I myself applied to 230 programs and it costs me around $6000 or something. So, uh that was just the cost of uh application fee. And uh that's regarding that and erato, I mentioned 1 $65. And before this stage you have completed all the US family exams. So every exam has generated a transcript and that you have to pay $80 to uh this era portal so that the US family can send each transcripts copy to each and every program that you are applied to. OK. Yeah. So you can move on to the next one. So in terms of documents, I covered personal statement, letter of recommendations, uem transcripts, then there's medical student performance evaluation MSP that you get from your home, medical school and you have to upload it beforehand. It is processed by um uh the portal and it gets it, it takes few, few days, but it gets approved after a few days. Same applies for medical school transcript. Um If uh you are, if you want to look at the format for MSP, you can go to the website uh uh sorry, the AC website where they have a standardized format which they use for us medical schools. Um In terms of photo, you have to get a professional photoshoot done. Uh just so that you look like someone, some doctor, you are as a doctor, you look like a doctor. You are applying to residency program and ACF MG status report is not a, a document per se, but it uh shows the programs that either you are ECF MG certified or not. So like let's say you started your application when you are not CFG certified. And in the meanwhile, you completed all the requirements and you became ECF MG certified. So ECF MG and er portal communicate regularly. And if there are any changes in ECF MG uh certification or updates on their end, they'll transmit that information to my portal and it will reflect on your ECF MG status report. Yeah. So afterwards you, you have selected all the programs you cert you are certified, your application, you select and pay for each and every program. So your application has been sent to each and every program. So this happens uh on, as you, as we saw the timeline for the match uh era application on 25th September from this year, the program will start and start looking at your application. So what happen generally is like in the starting October and uh first half of November, most of the people start receiving interviews and uh based on that, uh most of the people start receiving interview, they also received some in December, January. Uh So you even look at uh that you can go to the previous dashboard section. There's a sec uh there's one uh interview section on the upper right. So if uh someone sends you an interview, some program sends you an interview, you can see your interview there and sometimes program also communicate via email. So you can should schedule your interview via email. There are few, it, it might be via Zoom webex, all that stuff. And so that's the application part. This is this portal is the NRMP Match portal. So this is the whole new different portal. Uh There's not a lot of stuff that you need to do on this portal. You just have to register on this portal, you have to pay $70 for it and you just have to put the ACI D that has been generated on your name when you register for my portal. So basically what you are doing is you are trying to link your my portal and your NRMP Match portal. So what happens is when via my portal, you applied to the hospitals and they received your application. They decided uh how can uh uh what kind of candidate you are if they want to select you or not? And then they on their end, they also have to uh create an account on this NR NP Match. And they also do a rank order list on this portal and you as a candidate based on the number of interviews that you have received you uh once you register it, you have option to add uh the programs that you have interviewed at. And yeah, so the uh ma match algorithm works its magic. And in March, you get to know if you have matched that a particular program or not. So that was the whole uh brief overview about this uh uh process how things go. There's a lot more nuances and details in this. Um but it would take a longer time to explain. I just wanted to give some overview of how things uh go at this end. Great. Thank you so much, doctor. That was really, really good. Very um if any, any questions and please the chat for us. Um in terms of the guidebook, I will get that out to you guys and by tomorrow afternoon, I just have one quick question. You see whenever you're trying to decide on what programs to apply to, do you read that on, er, or do you read that on the hospital's website? Yeah. So uh as you saw there was a, a name of the program written there, so you don't have a lot of information on you. Just have the name of the program and brief detail about the program director, their address and all that stuff. So if you want to find more detail of your eligibility requirements, the application requirements, if the sponsor visa or not, you have to go to the, the best source is their own website because it's the most updated one. And you can also check on residency explorer. That is the website that is the sister website of my portal and either you can check on Freda. Freda is also a residency uh so sort of database for residency programs. Ok. Thank you. Um I don't see any other questions. So thank you very much, Doctor. I will let you go now and thank you so much for sharing. I really appreciate it. Thank you so much for having me. Thank you so much for perfect. Thank you and thank you everybody for joining.
