Faire son internat de médecine aux Etats-Unis, c'est possible!

The goal of these articles are to depict what's the hospital system and the life of an intern/resident like in the US (more precisely in Dallas, at UTSW). I'll start with the wards (internal medicine) rotation at the Veterans hospital since this is the rotation I just finished. Like all our rotations, it lasts 4 weeks. Each team is made of one intern (= first year resident, that's me), one resident (2nd or 3rd year), 2 medical students and 1 attending. Each person has a specific role in the team: - The med students follow between 2 and 4 patients. They are the ones who will have most time to spend with them and get to know them. They alert us about anything concerning (for example, one of my former med students realized my patient was being abused at home and thanks to her we were able to gather resources to help her). They see their patients in the morning before rounds and present them on rounds. They're expected to have a broad differential about their patient...

I think I gave you most of the information I had about all that, but if you have any other questions please don't hesitate to comment the articles or to contact me directly at elisa.pichlinski@gmail.com. I will answer as soon as possible :) On my to-do list for future articles - How to choose the programs in which to apply - The structure of medical studies in the US - The American residency rotations - The health system and the hospital Subscribe to be notified of updates by email! They shouldn't be too often. :-) Thank you! Elisa

Once you took the exams, applied for programs, interviewed, have been accepted ... It's not quite finished! There are still some specific steps on arrival for IMGs. The first thing you'll have to do is to report your arrival in the country. You will be contacted by your university's international affairs office to go see them as soon as possible. They will notify the ECFMG of your arrival. About ten days later, you can apply for a US social security number (the International Affairs Office will explain how). It takes another two weeks to receive it once you have filed your file. You will need it for many things. You can open a bank account quite easily with your employment contract. You can take a phone number but only prepaid (payment at the beginning of the month) before having a social security number. In terms of driving license, it is more likely that you will have to take retake a driving license test, unless you're from one of the four countries that has a ...

For everything included, count at least the following fees: - ECFMG application fee $125 - Step 1 $910 + $150 if you take the test outside the US / Canada - Step 2 CK $910 + $150 if you take the test outside the US / Canada - Step 2 CS $1565 + Airfare and Hotel Fee - The 5 existing test centers for now are located in Philadelphia, Chicago, Houston, Atlanta, LA - Translation fees for your transcripts and diploma. I used rushtranslate  on internet who offers fast translations (24-48h), that are accepted by the ECFMG, and cost $25 / page - ERAS token $120 - Application fee for each program (to send your file via ERAS): $100 for the first 10, then  $14 / program for the 11-20th, then $18 for the 21-30th, and $31/program after the 31st - Application fee for the J1 visa $325 - Cost of SEVIS $180 - Visa fees 136€ in France - Resources to study: First aid book $50, UWorld ~ $300 x2, Micro Sketchy $100, Pathoma $85 for 3 months of access to videos plus a book P...

To do your residency in the US as a foreign medical graduate, there are 2 different types of visa you can get: - The J1 visa, most common. This is a nonimmigrant visa that most programs offer (as it's sponsored by the ECFMG). It is quite easy to obtain at the US Embassy with some paperwork. - The H1b visa, which very few programs offer because they have to sponsor it themselves and it is extremely expensive. The advantage is that it's an immigrant visa so you can stay in the United States at the end of your training. Here's a little more information about the J1 visa. To obtain it, you will need: - DS160 form that you can to download online from the Embassy website - Photo with a specific size 5x5cm - you might want to ask if there's a photo booth at the embassy - Proof of payment of SEVIS fees ($ 180, specific fees for this type of exchange) - DS2019 form that the program you've been accepted to will send you - this is the time limiting factor to get an app...

Step 2 is composed of two parts, CK (Clinical Knowledge) and CS (Clinical Skills). Step 2 CK is very similar to Step 1, the main difference lies in the content that is much more focused on clinical, diagnostic and therapeutic questions. I thought it was easier than Step 1. Same format with this time 8 blocks of 40 questions and one hour break, 9 hours of exam in total. In terms of resources, I mostly used UWorld and took the exam 2 weeks after my French national board exam (very similar) so I did not need more than that. SketchyMicro videos are also very useful for this Step. There is a book "Step up 2 medicine" but it is not as complete as the one for Step 1. The Step 2 CS is a practical part and has to be taken in the United States. For now the 5 available centers are located in Houston, Philadelphia, Chicago, Atlanta, LA. This part lasts a whole day during which you will have to see 12 patient-actors. You have 25 minutes per patient. 15min maximum for the interview and...

As of this year, Step 1 has 7 blocks of 40 single-choice questions to do in 1 hour each. So it lasts a total of 8 hours with 1 hour break which you can divide as you want between each block. The scoring system depends on the others (it's a bit like a ranking exam but it's not officially said). Depending on the years and the schools you are aiming for, for IMGs it is recommended to get about 10 points or more above the American average (which my year was equivalent to 240 I think). I'm sure there's a lot of data online on how to prepare for this exam but here are my thoughts on how I did it. First of all you need a book called "First Aid for the USMLE Step One". There's pretty much everything you need to know for the exam. On average, Americans take 6 weeks to prepare specifically (they have already seen everything in class during the year), you should plan a little more. I took 6 weeks myself but I had already studied the 70% of clinical knowledge (ana...

The steps to apply take place on an annual basis: on September 15th , your application will be submitted to the programs you have selected. Between October and January, you will (hopefully) receive invitations for interviews (usually December-January for foreigners). The interviews last a whole day and usually include a general presentation of the program, a tour of the hospital, sometimes morning rounds or a lecture, and usually two 15-20mn interviews. You will also be invited to a dinner the night before with interns and residents in a more relaxed atmosphere. I recommend you to go and enjoy the opportunity to see the atmosphere between interns/residents, ask them about wellness, what they like/don't like about their program etc. This is the best time to try to learn important things that will not be said during the official program presentation. You will have until mid-February to rank your list of programs. The programs will also rank the candidates  and mid-March a computeri...

The first thing to do is to create an ECFMG account. The ECFMG (Educational Commission for Foreign Medical Graduates) is the commission that manages things related to foreign medical graduates: registration for exams, visas etc. To do this go to the ECFMG website and click on "Obtain a USMLE / ECFMG identification number". You will be redirected to the page to create your account, and once this is done you will have to wait a few days to receive your number. FYI they always respond to emails but it takes 3 to 5 business days. Once you have created your account, you will need to register to for Step 1 and 2. Two board exams that all American students and Foreign graduates must take. This process takes a little longer. You first have to pay the registration fee then print a form that you must sign and send in an envelope stamped by your school; inquire with the schooling department to find out who takes care of that. And be really nice to that person, you will most likely ha...

The most important thing is going to be your US experience: summer internships, observerships, exchange programs... Residency programs like people who have some experience, know how the system works and what they're getting into. 2/3 of the candidates are not retained because they have no US experience. And during those times, ask for letters of recommendation - they will be very useful for your application. What's included in your application? - Your resume/CV. Americans really like original experiences and volunteering. So try to get involved in college, in any field you like, if possible on a regular / long-term basis volunteering. If you have had unusual experiences that have nothing to do with medicine (for example I gave a hand for the accounting of my father's company who ran a French-Cambodian TV channel), do not forget to put it on your CV! - Your Step scores. Really important. Some programs have filters, and don't even read applications below a certain s...