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Medicine in the USA Series

  1. Overview of the process, pros and cons of healthcare in the USA and ECFMG Registration
  2. USMLE Step 1 and 2
  3. Electives in the USA, Letters of Recommendation and Visas
  4. USMLE Step 3, Applying for Residency and the Match
  • Access to 4 online sessions and recordings
  • Access to guidebook
  • Option to be added to a Whatsapp group with other medical students/doctors planning to move to the USA
  • Discount codes

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Computer generated transcript

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

Perfect. So we will give it another minute or so before we just start. Mhm. Ok, great. So welcome along everyone and thank you for tuning in. Er So tonight we have Sandra Hammer, who's joining us, who's a family medical student at Queens in Belfast. And uh I just wanted to update you. So we're gonna have uh the first part of the guidebook emailed out to you um by tomorrow and it'll have um some of the discount codes. So we got um a discount for a rotations um of $250 and whenever you sign up, um you have to sign up before the end of March. Um Then I'll also send out a link for a whatsapp group if you want to join and just where you just can discuss um your application for the um any questions you might have in there. Um I will pass over to. Oh, thank you very much, doctor. Cool, thanks James. So as you said, uh my name is Sandra and I'm a final year medical student at Qu. So uh today I'm gonna be doing a talk on basically um what the U assembly is um the different parts of the U Assembly um steps to becoming a US physician. Um what the E CFM G is and the eligibility requirements to write these exams, how to register for the exams, pros and cons for the U Assembly exams. Um And then I also added the slide on uh practicing in the US and the UK, but I forgot to add it to the slide. Um and then uh resources that I thought would be helpful and then a little bit of AQ and A at the end, um if you have any questions, just put them in the chat and then I will get back to you at the end. So just to start off. Um sorry, I think my slides are a bit out of order but OK, this, this was the first slide. That's my bad. So um before I kinda talk about like what everything is, I just want to give everyone like a brief outline of how you can become a doctor in the US. So the first thing to do would be to take your step exam. So these are the U assembly step exams, there's step one, step two CK and then there's an occupational English test afterwards or even like alongside, like you can kind of bo do both at the same time. You do electives in the US, you then apply for E CFM G Certification Pathway. Um And I'll, I'll talk more about that. A bit later on. Um there are different pathways but most people would be going through pathway four, which is what like us us as international students would be doing. Um And then you apply for residency and you get invited for some interviews, you go through the match process where you get um assigned basically a job at a certain hospital that you would have applied to. And then during residency, um you complete your step three exam. So what is the USM? So the United States missing exam is a three step exam. You stopped saying a license to practice me medicine in the US. It's owned by the F Ss MB and the N BM E which is not important for you to know at all. But um these are kind of terms that you'll be seeing if you're going through this process. So I just wanted to mention them. The U Assembly is an all in one exam that allows both American and international students to practice medicine in the US. Um As I said, it's composed of step one, step two CK and the step three part, there used to be a steps, a step two CS which is clinical skills exam, but then that was canceled because of COVID and it was replaced with the occupational English test. And um you have to like also provide a letter which is an attestation of your uh clinical skills from the Dean of Medicine. And then this is kind of just the overview of when you would take them. So um the next talk that John is gonna be doing, it's gonna go more in depth about all of these exams, but I just want to kind of mention the order of them. So um you go through step one which is seven hour exam that has all like the basic principles and science and modes of therapy and pathology and biochemistry and all that kind of stuff. And then pending um your pass on that exam, you then do set two CK which is an eight hour exam and that one is more like clinical uh knowledge and skills and just like your clinical um decision making and management and things like that. And then you would go on to do the O ET and which is just like an English speaking exam. Um and you have to do it no matter what country you're kind of applying from, even if it's like the UK, which is an English speaking country you still have to do the O ET. And then step three is an exam that you do in your first year of residency, which is kind of similar to step two, but it's just like that final step that you need to do in order to get EC F MG certification and then just a little bit more on that. So what is the E CFM G? So the E CFM G is the governing body that's responsible for the entry of IM GS into the US for medical practice. Basically, the EC FFM G, the only purpose of it is they wanna verify that you are somebody that has completed all of the requirements that they have and then you are able to use their services in order to apply for residency. So the first time to come off uh come across the A CFM G is when you're applying for an A CFM G number and you're submitting an application to them in order to verify your identity and then to receive a scheduling with the scheduling permit, you can then schedule um step one or step two and then you take the exam and your results are kind of uploaded to A CFM G and then using their um services, you then can like transfer those results on to A A which is what you'll be using to apply for residency and then in terms of eligibility. Um So the um most important one, I guess for people attending this talk would be number three. So you have to be a medical student or a graduate of a medical school outside of North America, listed under the world directory of medical schools. Um So the first two just kind of apply to us and Canadian students. But the third one is the one that um kind of we would fall under. Um But you have to double check that your university is actually listed on this list and it's just like you look it up on Google, like world directory of medical schools and it's the first link or the second link or something, you find your school and then if you qualify, you are now eligible to write both of these exams. Oh. And, um, the, just a little note like you need to actually be officially enrolled or you need to have a diploma from the medical school and that's how you will be eligible and then how to register for the exam. So, um all three exams, but kind of we'll focus on the first two because step three is kind of after you start residency. So the first two, they're computer based exams that you write at Prometri Centers for step one and step two, you apply via the E CFN G application website. Um I do wanna say though just recently like last week or something, they have just switched this portal to something called my inte. Um and when I was making this presentation, that portal wasn't actually up yet. So I don't know if the steps are gonna be exactly what I'm saying that they are. Um but it's meant to be like an easier portal to use. So it, it should be fine. Um But then uh just the second thing. So for step three, you just apply through a different one. It's not a CFM G, it's just F FSM D. Um So once you've registered through the E CFM G portal, um it's you for every exam, you just apply the exact same way. So it's always through the E CFM G portal. So let's say you're applying for a step one, you go through the E CFM G portal or I guess my health. Now, um you submit your application and then you get a number and you also get a scheduling permit in order for you to get that scheduling permit, you need to select a specific eligibility period that you prefer to write the test in. Um, for every eligibility period. It's usually three months, I think. Um, so let's say it's gonna be like May to July, June, July. Yeah, I don't know, July, um, 2024. If that's your eligibility period, then, um, that's when your scheduling permit will, like, that's what it will say on the permit. And then you have to go on a pro metric website and you have to schedule that exam with your scheduling permit number. Um, and you can book up to six months in advance. And then if let's say you picked an eligibility period of like May to July and then you realize, like I'm not ready, like, I can't write it, you can apply for like an extension period or it's a one time extension period. But, um, there is a cost to pay for that as well. So just in terms of, uh, pros of doing the assembly. So um obviously doing both of these um is sorry. Um but doing both of these exams is kind of necessary in order to be able to apply for residency in the states. Residency is like the postgraduate program right after uh American students finish um medical school. So that's what they go directly into after and it's post graduate training. So in order to get into postgraduate training, you need to complete those exams. Um In addition, um the U Assembly is kind of recognized all over the world. It's the us that recognize it is it, you can get countries like Singapore, um the UAE Qatar, Canada and Australia, some places do recognize the U Assembly as well. So doing the exams would be nice, like even if you're not going to the States, because again, a lot of countries recognize them and actually like value them a lot. So it kind of provides you with that extra edge. Um and then just with that extra edge that I was talking about, um you can also have a competitive edge. So if you do really well on these exams, when you're applying for residency, it can kind of separate you from other international students who are also applying, especially for um specialties that are really, really competitive, things like surgery, um and dermatology and like uh specialties like that. Um And then obviously doing these exams allow you to start the pathway of getting CFM G certified and becoming an attending or a consultant in the US. And that opens up like a whole of opportunities afterwards, um which I'll talk about a bit later on and then in terms of the cons of doing the assembly. Um so doing all, I guess both exams like step one and step two before you start working, it can be extremely expensive. Like there's not only like the paying just to get like the EC F MG number, but you have to pay for each exam and then you have to pay for resources for each exam and then you have to pay if you're pushing the exam or if you're like postponing it for any reason or if you're switching the testing center, it can really, really, really like rock up. Um And just to give you an idea, every exam is around $1000. And then um if you ever wanna like postpone an exam that depends on like how early you're postponing it. So that can range from $50 to 100 and $50 or even more if you're canceling it the day before. Um And then there's like the USM OE fees. But then there's also like thinking about if you're gonna be doing electives in there, if you're hoping to do residency in the States, you need to do electives and that can just really, really build up over time. So thinking about it early is always a good idea because then you can either kind of have like a savings fund for it or if you can try to see if there are available funding, um and go from there. Um And then the second thing is that it is extremely time consuming on top of um like existing clinical responsibilities or just responsibilities as a student. So studying for these exa exams, um, each one, if you're studying for it kind of properly and have like a dedicated time for it, each one should take you 4 to 6 months. And obviously most med students don't just have 4 to 6 months off of like just doing nothing. So you're gonna have to be studying for it after placement or after lectures. So it can kind of be like a significant responsibility on top of everything that you have. Um The third thing is that it can be really stressful just because there's, oh, it's obviously like a very high stakes thing. So if you're spending that much money to write like such long exams and then these exams, your performance on them kind of dictates whether or not you're gonna match your residency. So if you're constantly like thinking about just high stakes, it is like, it can cause an incredible amount of stress and pressure. Um and that can also just have like negative impacts on your performance on the exam as well. And the last thing is that there's actually no guarantee that you will match for residency if you do these exams. Um, although that they, like, they can kind of give you that competitive edge that I was talking about. If you do really well on them, you're not guaranteed a match slot. So it might end up being that you'll do the exams and even if you do well on them, there's still a chance that you might not match just because of how many people are applying every year and how competitive it is. So I know that all sounds like extremely miserable and like, why would anybody do them based on everything I just said. Um, but again, the, the pros are really important because it's globally recognized and it can open a lot of opportunities for you that you wouldn't necessarily have in the States. Um And then ultimately the decision to take the exam just depends on what your priorities at are as a future doctor. So it depends like what kind of healthcare system you wanna work in, how much money you wanna be making, where you wanna be living, what like climate you wanna be living in. Um So that is all things that you need to take into consideration. And then, um this is just a slide on practicing in the US versus in the UK. So I know it looks like a lot, but I will kind of talk through it one by one. So, um I just wanted to start off with like the medical education and how it's different in the US versus the UK. So in the US, they have to do a four-year uh bachelor's degree and then four years of med school. Whereas in the UK, it's 5 to 6 undergraduate um medical degree and then afterwards, um they move on to post graduate training and they start residency. So residency is kind of specialized training right from the get go, you pick what you wanna apply to whether that be surgery, internal medicine, specific surgery like urology or any, anything like that. You, you pick what you wanna do like right away. Um And then if you do things like an internal medicine residency, you can then do a fellowship after and things like gastroenterology, cardiology, any like the medicine specialties. Whereas in the UK, obviously, most of you probably know you do foundation training for 2 to 3 years and then you apply for a specialty or GP training. So all in all um training to become a specialist in the UK can take a significantly longer period of time. Um But do bear in mind that most students in the UK would have already done like a four years bachelor's degree before you. So when they're starting residency, they're already a bit older than your average student would be here. And in terms of licensing and certification, so as I mentioned, you have to do the USM exams. Um and just as a little side note, um the content of the exams and how to study for them and all of that will be in the next talk that we do. Um And then in the UK, you just have to do the M RCP or the MR CGP. Um And then in terms of specialization. So obviously, in the US, there's a diverse array of specialties. Um and they're quite competitive residency matches because again, by then most students would have done eight years of schooling. So they, for the most part know what they wanna do, especially because their medical school um curriculum usually has them a lot more involved than students in the UK where we would just kind of be doing a lot of observing there, they have their own patients, they do their own like consultations and it's, it's kind of like being an F one but during med school, um so by then, like, they're pretty much ready to pick the specialty that they would like to right away. And there's a very like huge range of specialties that you can apply to. Whereas in the UK, there's a big emphasis on GP, but obviously there are specialties here as well. Um And then the healthcare system in the US, it's pretty complex and it's often private based. Um and the big overlying thing is insurance. So insurance plays a huge, huge, huge role and it will also play a huge role if you decide that you're wanting to apply for residency. Um because what you'll be doing as a resident a lot of times is just be on the phone with insurance companies try to figure out like, can we authorize this treatment for my patient or does this patient have treatment? Uh sorry, does this patient have this kind of insurance that they said that they had? So it just is a lot of stuff and it can be quite annoying but um that's how their system works there. Um And then obviously in the UK, the NHS provides health care um based uh through taxes. Um And then in terms of the work environment in the US, so most of their um settings are either like private practice, academic institutions or hospital based settings. And even in hospital based settings, there are different types of hospitals. So there are academic hospitals and there are community hospitals or tertiary hospitals. So all of that is kind of important to look into when you're applying for residency because you'll be applying to specific institutions and you'll have to know like what kind of institution this is and if this is the kind of institution that you want to work at. So for example, if you are really into research and you want to be involved in that, then you would want to be working in academic hospital because that's your best chance of getting that research. Um And in the UK, uh we have obviously NHS hospitals uh general practices and there are some private healthcare institutions as well depending on where you live that can be like really prevalent or not that prevalent um and salary and compensation. So I think most of you would know that like the compensation in the US is quite high. The main reason for that is because by then, um most students have again eight years of schooling, so they are in quite a significant amount of debt. So the average salary is a lot higher than you would expect it to be in the UK. And obviously, the medical education cost is lower in the UK. So the salaries don't need to be as high as they would be in the States. Um In the guide that we're gonna send out, there's gonna be like an average um salaries uh heading. So you can kind of take a look at that based on the specialty that you're looking to apply to and then in terms of professional opportunities. So, uh in the US, there are opportunities for research, leadership and a diverse patient population. Um Whereas in the UK, there's like a huge emphasis on patient care, community medicine and public health. And obviously, a lot of these things are interchangeable, like, of course, you'll have opportunities for research, leadership and all of that in the UK as well. Um It just depends on you and like the opportunities that you seek out and I guess how much time you're willing to dedicate to finding these opportunities versus in the US where they're kind of almost like offered to you depending on where you are, but you have to be present for them. Um And in terms of frequently asked questions. Um So do I have to write, although you assembly during meds, although you assembly exams during med school? Um So no, you can write them whenever you would like to write them. Most students choose to write them during their med school years just because the information is still fresh in their mind. And obviously there's gonna be a lot of new stuff that you're learning when you're studying for these exams. But, um, you're still like in the student mindset and, um, it's easier almost to study when you're still a student. Um, because then afterwards, whether you'll be working or you'll have other kind of more important responsibilities. It might find, it might be hard to find time to study for it. Um, but just bear in mind that you need to do all three exams within seven years of your first step pass. So if you do step one and you pass it, then you need to have done step three by the seven-year mark. Um, also I made a mistake earlier when I said that you like pending your step one pass, you can then write step two. That's actually not correct. You can write both of them whenever you like, you can start with step two if that's easier for you and then do step one after they're interchangeable in that way. Um And then how many times can I write the step one? Uh You can write it up to a maximum of six times and how do I study for the step exam? So, studying varies depending on who you are and we're gonna go way more in depth on that again, on the next talk. Um But just be aware that there are so many ways to study for it and you'll always see people like on Instagram or youtube and telling you like, oh, like this is the only way that you will study for this or sorry, that you'll pass these exams. Um But just be aware that like there are so many ways and there's not a single right way and you just have to kind of find what works best for you. And then resources I thought I just like list them out here. So you'd uh be aware of them. But again, they're on the guide. Um The most important one is probably the You assembly bulletin because that's the one that they update really regularly and add um like just everything you need to know about booking that exam. Like for example, the switch from EC F MG to my health that I found on the USM bulletin just when I was literally adding the slide. Um So always check that and they have like, I think it's like a 60 page document or something uh like really, really in depth and in detail. Um And then there is the Medic portal. So this is a UK student specific um little blog about applying to the USM LE. So this, it's pretty helpful for UK students. And then in the application portals like the, the link that I put at the bottom, you'll find the link for E CFM, G as well as FSM B for step three. And then uh there's the prometri website which is just this test center where, where you will be writing all of your exams. And I also found a youtube video that I thought was like really updated and really, really good for international students. And I just thought I'd like it there. And again, it will be on the guide. So that is all for me, for me, not for me. Um So if any of you have any questions, I'm happy to answer them. Perfect. Thank you so much. So, yeah, there's a few questions in the chart. OK? And if you're able to help out with them, yeah. Um would will we share the slides later? So all of the information that I had on these slides is actually gonna be in the guide. So you should have everything there and that will be sent to you. Um How much do electives cost on average? See? OK. That's a really hard question to answer. Just because finding electives in the States, there are so many opportunities and some of them, you can kind of like create on your own by reaching out to specific doctors and seeing if they can take you for an elective. Um And that might be free depending on if you have connections. And then there are um organizations like you assembly sy or uh am O opportunities like James was mentioning, which have kind of um more expensive electives, but they take away like the stress of trying to plan it on your own. I think the average on those when I was looking um for a four week elective, I think it was between 2000 to $3000. Um And obviously that doesn't include like flights or accommodation or anything like that. So it, it can really like accumulate over time. Um If after passing step one and step two, how long does it take before I start residency training? Um So every year, the residency um portal like the residency program applications are due in September. So if you are wanting to apply for September 2024 you just need to make sure that your exams are done by like like a, a month and a half before and then you can apply that year. Um So you don't really have to like wait, but you just have to wait for your like mark to come out kind of thing, which takes like I think four weeks if I'm not mistaken, are there some specialties that are easier to get matching? Um, yeah, there are some specialties that are known to be a bit, uh, easier just because there are more positions for them. So, the common ones that you'll hear about are, uh, family medicine which is GP and internal medicine. Um, I think there's like a list of like the five, um, not ii don't wanna say easy because it's still really hard to match, but just like the five specialties that the most in GS uh uh match too. And they change every year, I think last year it was family medicine, internal medicine, neurology, pediatrics. And I can't remember the fifth one. but they update that information every year. So you can kind of just Google it and see if completing step one, step two. Do I need to apply residency right away or are the results valid for a period of time? Yeah. No, the results are like valid. II don't wanna say forever but like there's no rush to apply like you can kind of keep them in your back pocket and apply later on. How could we access the guidebook or whatsapp group? I don't know that for you. So uh I'll send it out in an email. You'll get the guidebook, you'll get the link to the whatsapp group and you'll also get the A rotations and I'll send it out by tomorrow. Ok. Um, does it look less favor favorable on your application for residency if you took the step exams after med school? I heard that American hospitals bef prefer graduate straight out of med school. Um, it, I don't think it matters when you took, uh, you take your step exams, like, so long as you do, like, well on them, it, I don't think it matters when you do it. Um, although it is true that they do kind of like fresh graduates, like straight out of med school. It's not, it doesn't hinder your application in any way, especially if you do something with that time that you have like after you graduate. So if you graduate med school and then do F one and then apply during F one that also can look really valuable on your application. So I think it would only look a little suspicious if you just like took like three years off and like kind of did nothing because then they would want like an explanation for the gout. Um But in terms of when you do the stress exams do them whenever it works for your schedule, I wouldn't worry too much about that. Is it true that if step one is failed, at least once the institutions were applying for residency out will downgrade our applications and prefer students that pass it on the first go. So um II II think, OK, it is true that after they changed step one to pass fail cause it used to be um like um like Mark. So like you used to kind of get like a mark on it. Um But then last year earlier before they changed it to pass fail. And there's been a lot of like discourse about like what that means because uh now if you fail after they've already made it pass fail, it just looks a little suspicious again for lack of a better term. Um But again, I don't think that it is the end of the world if you fail it because if you kind of make up for it in the rest of your application um or in like just like your step two mark is like so incredibly high or you have like a ton of research, like if you have something that will kind of make them overlook that step one fail, then I don't think it's a huge deal, but it is true that some institutions will kind of like filter you based on preset criteria and they do kind of exclude people that have failed at once. How did you find the step one exam? Was it harder than your world and ambos? Um So I, yeah, I don't think I mentioned what I've done. So I will probably mention that now. So yeah, I have done step one. and I passed it and I'm doing step two in May. Um Step one was an extremely difficult exam. I think it's because I had to learn everything, like, just kind of like basic principles all from the beginning. And I felt like it was really testing a lot of the really insignificant things that I didn't think mattered. Um So it was hard, but I wouldn't say that it was significantly harder than the U World Bank. I felt like the U World Bank really prepared me well for it. Um And even like the U World forms like the UW SA form one and form two, I actually thought that like I don't remember if it was the first one or the second one. I thought that that one was harder than the actual exam. Um but the exam is really mentally taxing like it is like seven hour exam and you can't leave and like you have to time your bathroom breaks and it just can be like really heavy on the mind. Um But in terms of content like so long as you're using your world and kind of like the main um resources that we'll be talking about at the next talk, you should be ok. Is your world and first aid enough to study? Um I would add two more things to that. So again, John won't talk about it in the next talk, but just like a brief description. So the main four resources that you should be using are you World First Aid on and poma um you world or sorry, you uh Yeah, on, you can kind of use in conjunction with your world. So it's like a flashcard um type of uh so uh software. Um And there's like a specific deck called the on deck and using, uh and that deck was created by uh previous us students who wrote these exams. Um So you would kind of just like unspent the flash cards um that are relevant to like the quiz that you just did on your world. And that's how you do like repetitive um Like what's it called? Space repetition. Yeah. Um And then Phoma is just like a pathology textbook. Um There's a, I think there's a subscription for it. Um But for the most part, it's just a textbook and you just read the first three chapters and if you do all of that and you're like, kind of doing well, then you should be OK with just those four. I don't know if emboss would have been super necessary because it is like another um like bank. Um But some people find it helpful that they eliminate step three. You uh No, so step three still exist. It's just you don't typically do it. Um Typically you just do it in residency. Um But for people who have, who aren't students anymore and have already graduated and are working as like working professionals and uh consultants or anything like that, sometimes they prefer to do step three earlier because then you become e CFM G Certified. And then the residency program doesn't have to sponsor you. Um, if you're certified, so it's kind of easier for them. A actually, no, they'll still have to sponsor you, but it's just a different visa that it's really like, there's like a lot of detail to this kind of stuff. Um, but just know like the you assembly or step three still exists and you can write it whenever you want, But most people usually write it in residency. How much time is it past step one B for? I don't, I honestly don't know if there is like, I could be completely wrong. I don't think that there is a specific time. I think you just need to do all three exams by the seven year mark. So I assume if you only do step one and then wait and don't do any of the other ones, then you'd have to kind of redo it, is it easier to match in the US directly from med school or after foundation years? That just depends on how much you did during med school. Um And how much experience you have with research. And um if you've done any electives in the US and just like everything that would fluff up your application. Like if you don't have a lot of that from med school, then it would be harder for you to apply for med school. Um And it does look good on your application if you have like at least like one foundation year because they do really value um UK training. So it wouldn't hinder your application. But if you like worked your ass off in med school and have everything that you possibly need, then um you can apply after med school and your chances would be good in a five-year M BBS program. When would you say is the best time to write? Step one and step 20 That actually reminds me I had that on the powerpoint and I didn't say that out loud. Um Two seconds, right? So in this slide, um I kind of put the boxes in red when I would recommend for you to kind of do them if you would like to match after graduation. So step one can be done in the summer of year three and then you can do step two CK end of year four because then by the end of year four, you should have most of your rotations or sorry, your placements completed already. So that like background knowledge would be there. Um And then o et it, it's not like a super hectic exam, like you can write that whenever you'd like, but I also recommend you do that in uh year four, any type four. Um You mentioned that the U Assembly can help with an application to Canada. Can it replace the MCC QE N exams for Canada? OK. So for this one, I am not entirely. Sure because I've heard that there are some programs that will kind of take you with the U assembly without the need to do the MCC QE or not. But just be aware that like, it's maybe like one or two programs, like, it's not a super common thing. Um And I don't know which ones have done that because I remember trying to look for it and then I just found like I fell down the rabbit hole. So I think maybe like some BC programs and more of like the rural places, even like the Northwest territories and things like that, they're way more likely. But places like Ontario, um or Manitoba, Quebec, you have to do the MCC QE and uh exams. Is it true that most people have to do a research project in the USA to have a residency chance? I mean, after graduation from medicine, II don't know if you need to have a re like a research project per S EI do know that a lot of people kind of go and do a research here there. Um I think from my own experience, I've heard of people doing that usually when they're going for super competitive residencies. Um But I don't think it's like absolutely necessary for you to do a research project to have a chance at residency. I know a lot of people who haven't done that who just did like normal, like case studies and things like that. During med school or even during F one and they've been accepted. Do I need my medical school diploma before applying for residency or could I apply at the beginning of my fifth year? No. So you can apply at the beginning of your fifth year. So long as your program will end by June. Yeah, cause residency usually begins in the first week of July. So you just need to have a diploma in your hands by the first week of July because um this is actually an issue like at Queens. Um So Queens usually does graduation like the first week of July. And I remember one of my friends who had applied and had gotten into residency, he thought that he'd have the diploma before his um start date. But then Queens didn't wanna give him the diploma earlier because our like uh graduation was like the or something and his work was the first. So he could not work until the fifth, which obviously caused him a little bit of an issue with his um preceptors, but it was fine at the end. Um But just kind of make sure that your school is aware that you would be applying and would be willing to give you the diploma earlier. Um If will you be providing advice on how to get electives? Yes, we went on the third talk and yeah, I think it was like the third talk. That'll be Yeah. 19th March. Um does it help to have a green card. Yes, it does help to have a green card, which is so unfortunate cause it obviously restricts you significantly if you don't have one. but most programs will be willing to sponsor you. Um, sponsor. You just means like the uh, like kind of issue you like a work visa. Um But sometimes you'll find that like programs who don't typically take a lot of international students, they will continue to not take not international students because they don't wanna go through the path of um, sponsoring people. But for the most part, that's not like a huge issue, but it, it looks better to them if you're already like a US citizen because then they won't have to go through that, like battle with you. Um, high up to how many gap years, post graduation is acceptable for a match there. It's, there's no like specific set amount of gap years. Um, you, you'll find people who kind of have like 10 years after their graduation and then that's when they're applying for residency and some people you can match like it is possible to match, but they really do prefer, um, fresh graduates because then they can kind of train them the way that they would have liked to, to from the get go. Um, but I would say that if you're kind of within that three year range after graduation, then you still have a pretty good chance how much UK, the school grades matter. Um, they don't matter at all. And I've seen a lot of like, program directors on, on Twitter say that they don't matter at all because each school will grade you differently. Um, so a lot of these programs don't even, like, look at the marks because they know that, like, it just depends on where you go. And some schools are known to be harder than others and um their scoring scales and systems are just different. So it's, it's not um heavily looked upon how important is being involved in a research project or having publications for a match. So it is really, really, really important to have both of those things. Um As I was kind of saying on um that last slide in the like the table um a lot of the doctors that work in the US are really heavily focused on like academic um work. So they like, they really, really look highly upon students that have research under their belt. Um So I would say having publications is almost necessary unless you have like some other kind of experience that is like so, so spectacular on its own that they would be willing to overlook that. But um I would recommend you have a couple under your belt before applying is teaching and, or organizing in international or national events relevant applications like it is in the UK. Um Like, do you mean like, oh OK. Um So it's relevant. Yeah, you can kind of definitely add it to your application. Um on each application, there's like a cos um section and you can just add it there. Like if it's something that you were heavily involved in and it's a really good experience then yeah, you can add it. There does board and beyond have all of the information you need for the step one exam. So I, when I was studying for mine, somebody had told me to do boards and bons and I started watching the videos and I was so incredibly bored throughout all of them. They are so content heavy and it's a lot of information and although like he does a really good job of explaining everything, just be aware that you have to have the time to be sitting watching videos like for three hours a day. Um I don't think it has all of the information that you need for step one exam. I think you definitely need to supplement with other resources like your world and Phoma and um AKI. But the nice thing about a and that on deck that I was talking about is that um the students who made this deck over the years have compiled information from boards and beyond and from Patho a and from your world and everything and just put it into one. So you will find like boards and beyond information on, on King, sorry. Where are the UW sa one and two forms you mentioned, please. Thank you. So these forms are on your world um When you log into your world, um there's like a, it says your World Bank and then there are two forms underneath. I think it depends on the package that you kind of applied for. Um But uh they're, they're on your world. Are you applying for residency in fifth year or are you going to apply during your foundation year? Um So I'm actually staying for F one. and I'm gonna be applying for a residency in Canada. Um I'm only doing the US exams just kind of like as a backup in case I don't mention Canada that they offer. So during F two, I will apply for the US and at least I would have done the exams during med school. So it's not something that I have to worry about. Is there any difference in the process for American citizens studying in the UK? Yes. So as I, as I was telling you, like, so long as you have like, like you're then like if you have a green card or if you have a passport, you become a USI MG. Um And then if you're a USI MG International Medical graduate, then they don't need to sponsor your visa. So some hospitals might like want that because then they won't have to go through the process of like sponsoring visas and things like that. So the process is the exact same. But the way that they look at you would be a little bit different is the O, et exam compulsory to take. Even if you attended an English speaking University. Yes. So stupid. But yes, you have to do it regardless. Um, it doesn't matter what university you went to or what country you live in. Um, I don't know if that changed recently but, like, as of my knowledge, as of this year, you still have to do the O et because it's, it's not like the um I don't remember what the other English exam is called, but it's not like that one. Like this is an occupational English test specifically on health care. So can you communicate with somebody in a health care setting? And it is a written exam? But there's like a listening, reading and speaking component are the residency programs more favorable to us graduates compared to Im GS. Yes, they are. Yeah, they want their own, they because they had already trained them during med school and um they know their systems, they know everything about being in the US. So they, they take more US graduates than they do in GS. What's the difference between King and Zany? So, so Zany is actually a part of so is just like an overlord deck that has all of the like um cheesy Dorian Zany, like all of those like mini decks. Is it true that the residency period is hell. What are the most competitive residencies is that depends on the state hospital or the type. Yeah. So residency period, I have not gone through it myself, but I have seen people who have, and it is torture. Um You kind of have to rush to apply for everything by September and then you wait a couple of months. Um and then you start getting interview invites and that can be as early as like November to, as late as February. And you're constantly like kind of just like waiting for an interview and sometimes you can miss an interview if you like, aren't awake at 5 a.m. and they sent the email at 5 a.m. So it's, it's really like growing process. But, um, you find out if you match in March and the health is over, what are the most competitive residencies? Um, uh, obviously, like just your typical ones, like nerve surgery, surgery in general is really competitive. Dermatology, plastics, um, interventional radiology. Um I don't have them off the top of my head to be honest and they do change every year. It, it, they don't depend on the state or the hospital. It just depends on what year you're applying and how many other people are applying. Um, but it's typically those ones that are usually, um, more competitive. How do you go about getting published as a medical student? Like how do you get someone to accept you on to their research? Ok. That is quite a heavy question that I would need like an hour and a half to talk about. Um, and I don't think I have an hour and a half. So I'll just give you like the cliff notes. The best thing that I would do if I were you is reach out to professors in your program or doctors that you're working with, depending on what stage you're in. Just express your interest in research and tell them like, if they're involved in anything, you would like to help because a lot of times these people would be doing um research projects and they'll have their med students do a lot of like data collection and then if they like you, they'll add you to their paper. So you'll, you'll get like an authorship and a publication that way. Um And you can also always like do your own thing, like if you're on a rotation and you see like a cool or interesting patient and you decide you want to write like a case study on it, you're within your right to do that and write it up and submit it to any journals. Does the area of research that you do matter? Like, will they overlook you if you have research in a bunch of different specialties rather than a specific one? No, it, they won't overlook you, but it definitely looks better if you have a lot of surgery research. If you're applying to a surgery. So it's not something that they would kind of be like, oh, like, how can this person have this, this, this like? No, they, they, they would like, look highly on you if you have a lot of publications, but it would look better if you have specific ones to the specialty that you're applying to. Is it harder to march into Canada or America? Uh, Canada? Um, it is significantly harder to match into Canada because they just have way less hospitals. And obviously the States is significantly bigger and the states kind of just takes more in GS. Um but it's not impossible to match into Canada either it's just harder and it's also not possible to apply to Canada if you don't have a citizenship or APR. So that's like a, an obstacle as well cause you need to apply for that first and then apply to Canada. Where can we find the on king flash card deck? And how much does it cost? So, uh it's free, which is the best part about it. Um And you can find it by looking up on REDDIT and it should be like on the U Assembly subreddit. Um Is it harder to match in Canada as a UK resident as opposed to a Canadian passport holder? Yeah. So as I was saying, you need to be a Canadian citizen or a Canadian pr holder in order to apply for residency or? Yeah, to apply for residency in Canada, you can't apply as a UK resident if you want to one day be a doctor in Canada. Would us residency make any sense? Yeah, absolutely. So, um, what a lot of people do is they end up applying to us residency first and then after they finish residency or graduate from residency, they've been applied for an attending position, which is a consultant in Canada. And that switch is a lot easier than going from Canada to or sorry, going from whatever country you're in directly to Canadian Residency just because of how competitive it is to or difficult it is to get to uh residency in Canada. How did you allocate time to setting for the assembly during normal medical school exams? Um So it was really hard. Um II just basically kind of had to be really strict with myself. And um most of the time I was kind of prioritizing the USM over my med school exams here simply because I knew that I was kind of never gonna say for um I wasn't gonna like practice medicine here long term. Um So I was just kind of hoping that like all of the medical knowledge that I was gaining from sitting for the steps was gonna help me with my exams here and I ended up working out so far. So, um but I would recommend like, if you're somebody that like can't do both at the same time because it is really difficult to do both at the same time. And it took me a while to figure out, um, spend more time on it during your summers and during your breaks, um, use that as a dedicated step one time and just study for the step exams. Are there in g unfriendly hospitals? Is there a place where we can access this type of information? Yes. So there are in g unfriendly hospitals. I don't know the exact website for it. Um, sorry. Um, but you can, if you look up, like, I don't even know what you can look up. But I think if you look up like I MG unfriendly hospitals usa like there should be a website that comes up and you'll get like a list of um hospitals and how many IM GS they've taken in the past? And I think there's also one website where you can see what previous Im GS have said about this institution. What do you mean you can lose an interview if you don't see the email right away? Yeah. So this like this blew my mind. Ok. Sometimes they'll send you like, you know, ok, when you book a flight, for example, sometimes the flight can get overbooked and then you can lose your seat if you're not there in time, it's that same idea. So they'll send out interview invites to like 10 people, but there will be eight spots. So if you don't book the interview right away you can lose the spot. Um, obviously they don't all do that, but some of them do that. And so you have to be like strapped with your Apple watch or whatever it is and just constantly be on your phone checking to see if you've gotten it through an invite in. What years of the five year M BBS? Should I organize an elective in the US? How many electives should I organize? Um, It depends what your program is like. Um So for my school, for example, there was like a dedicated time for it. Was your four summer. Um II guess that would be a good time to do it. Um If you have like 4 to 8 weeks off, you should book like 2 to 3 electives and sorry, two electives with eight weeks off. And if you have even more time, you should try to do three electives. I know that sounds like a ridiculous amount of time and money and energy and effort, but it can be really difficult to match without us experience. So if you can at least get eight weeks like that, that would be good. Um And you should definitely do it after you've done your placement in that specialty here. So if you want to do a pediatrics elective, make sure that you've done your pediatrics placement in the UK or whatever country you're study in and then go do your elective in the States. Is there any specific state that is more favorable to Im GS or less Im GS. Yeah. So the most popular ones that are, like, favorable to Im GS are, um, New York, Florida. Um, Pennsylvania. Uh, again, I don't have them off the top of my head. Like this is just like one of those niche things that you kind of need to research. Um, but the m, the most popular ones would be, or, sorry, I forgot. Chicago too. So, New York, Chicago, Florida and Pennsylvania. And I think there might be a couple. But, uh, you, those are easily looked up. What are the pros of working in Canada versus the USA? Oh, that, ok. Um, so working in Canada is kind of similar to working in the UK because again, it is a, uh, public healthcare system, there's no private, uh, health care at all. It's just public. Um, II can't, I would, I would need an hour and a half to like, discuss this one a bit more. But, um, it's not as academic as the States. You can still do academic work if you want it academic as the States. Um, and sometimes like, you'll find that working as a resident in Canada is a bit more enjoyable than working in the States. Simply because sometimes in the states, like, you can get like programs that aren't as well regulated as they should be. Whereas in Canada there's like widespread regulation. So most residency programs will kind of have the same systems as each other and you won't be like overworked or drowning or anything or you might be, but it won't be as bad as if you were in like a tertiary hospital in the U in uh the US is the four weeks that we get for like this for fourth year, enough for you as clinical experience. So, um I would recommend if it's possible to reach out to your school and try to see if they'll allow you to do um a couple extra weeks. Um One US clinical experience is good, but is it excellent? No, because the main thing that you're wanting out of these electives is to get a letter of recommendation so that you can add that to your application for the States. Because um in the residency application, you can add three or four letters of recommendation and um it's really highly favorable if those letters are coming from um a US physician and even better if it's coming from like a recognized hospital. So you wanna maximize your chances of getting those things. So, II would really recommend you try to do at least like 6 to 8 weeks. Great. Thank you so much. That was all my questions. Thank you. I feel like you answered it really well and your talk was so comprehensive. Thank you. No problem. So, thank you everyone for showing up. We will send you out the guidebook, um the whatsapp link and the discount code by tomorrow. Um Yeah, thank you very much for joining. The next session is um on the 20th of February at 7 p.m. which is Tuesday as well. And so we'll see you then. So there's one more question that I'll answer super quickly. Um If you work in the US and change your mind to go back to the UK is the training transferable from my knowledge so far, James, I don't know if you know anything about this, but I don't think that it is like, I think you would actually need to kind of start from the beginning. I thought you needed to do F one F two. Yeah. Come back. But yeah, I think if you haven't done here but that's, they ignore lunch. Yeah, I don't know. And again, like those, these things like change all the time too. So it's just one of those where you just have to constantly like keep an eye out. Ok. Fine. I'll answer one more question. Um Should you do like this in one specialty or multiple or does it not matter? So it depends what you are wanting to apply to residency for? So if you know, you wanna do internal medicine, there's nothing else that you're gonna be applying for, do all of your electives and internal medicine. And whether that be like you do like one general internal medicine, then one cardiology, they're still both like internal medicine. So that would be fine. Um, but then if you're thinking like, oh, like, I don't know, like, I don't want internal medicine but I kinda want peds as well. It would be fine to do electives, kind of one in each, but it would be better for you to kind of figure out which one you like more so that you can kind of build your application towards that one specialty. Ok.