(This post was written by Dr. Faris Baig to guide USMLE aspirants for their Match in the USA. Dr. Baig was kind enough to allow me to share this post on my blog, for which I am very thankful).
My name is Mirza Faris Ali Baig. I graduated from Sindh Medical College, Karachi, Pakistan in the year 2014. After graduating I completed the 1-year internship from Jinnah Postgraduate Medical Center, Karachi, and only after that I decided to pursue the USMLE journey. It took me around 10 months to complete Step 1, Step 2 CK and Step 2 CS. I applied for 124 Internal Medicine Residency programs in 2016 and successfully matched in 2017. The purpose of this document is to briefly discuss the mistakes I made and highlight a few pertinent steps to consider before and during the match season which can help you plan everything in advance.
Below are a few of my salient credentials:
Mirza Faris Ali Baig
Step 1: 257
Step 2 CK: 259
Step 2 CS: First attempt
Year of Graduation: 2014
USCE: 3 months, all observerships
1- Presence Saint Francis Hospital, Chicago, IL
2- University of Alabama, Montgomery, AL
3- UPMC McKeesport, Pittsburgh, PA
4- Cook County Hospital, Chicago, IL
5- Oak Hill Hospital, FL
6- MacNeal Hospital, Chicago, IL
7- Rochester Unity Hospital, NY
8- Bronx Lebanon Hospital, NY (Pre-match)
Matched at UPMC McKeesport, Pittsburgh, PA
I graduated in 2014 and opted for a complete one-year internship. Reason: Didn’t have US Visa at that time and therefore wanted to have some backup if things didn’t go as I planned. Since the year of graduation is an important factor when you apply for the residency match, I would highly recommend all applicants from Pakistan and India to apply for the visa before graduation because it is difficult to get one once you graduate and don’t have anything solid to show your ties with your home country. I thought I can manage step study with internship and therefore took less busy rotations thinking I can make time for step 1 preparation but I could only give one complete read to Kaplan. Therefore, I wouldn’t recommend the internship to Pakistani applicants unless you’re looking for a backup like I did.
Now there are a lot of things one needs to know before planning out the match strategy. My biggest mistake was that I wasn’t in contact with the people who went through the whole process recently. That’s why a lot of things were new to me. For example, Step 2 CS score report comes out after around two months, there’s a score delay for CK from mid-June each year. You have to take these things into consideration and plan accordingly.
Like I said before, plan way ahead and gather all the necessary information about the match cycle. Like when are the ERAS applications submitted? How many letters of recommendation can we upload to the ERAS? What documents do you need from your medical school? How to write the personal statement? What are most residency programs looking for in an applicant? There are a lot of misconceptions regarding each one of them and I will briefly discuss them below.
Step scores and visa status are the two most important factors in getting you an interview call. Ideally, Step 1 prep should take 6-10 months max, Step 2 CK right after Step 1 and shouldn’t take more than 3 months. For CS you just need a good practice partner and 3 weeks. For applicants from Pakistan, it is best to give CS in Chicago or Houston and stay at or near the APPNA house. You will find a good number of seniors who can help you with the preparation. The average Step 1 and 2 CK scores are getting higher each year, 250s and 260s are very common now. Therefore, I strongly advise everyone to give ample time to your step preparation. If you still get something in 220/230 it’s not the end of the world. Work on your CV by gaining more US clinical experience, step 3, volunteer work, research projects and trying to get them published in a well-known journal.
Letter of Recommendations:
You can upload up to 4 letters of recommendations (LORs) in your ERAS application. Ideally, three should be from US physicians in the field of your interest. Letters from University hospital’s faculty member weights more than community/private clinic LOR. How to get them? You will have to work for it. It is better to apply after step 1. Email widely and use your resources well. I got 2 rotations through my contacts. Once you get it, ask the physician to waive the LOR, meaning you are waiving the right to see the LOR and the physician uploads it him/herself to your ERAS application. A waived LOR has more weight than an unwaived LOR. Start requesting your waived letters from mid-June since most physicians have a very busy schedule and they might give you a little hard time uploading it before the deadline.
Everyone has a story behind why they chose this field. Start writing your story early and show it to your seniors/ colleagues for feedbacks. There is no need to make it an emotional story; it doesn’t work well. Write about real life experiences and what you learned from them. Keep it simple, professional and something that makes you look like an enthusiastic professional (not a student) who is ready to be a part of US healthcare system. Personal statement and US clinical rotations are discussed at each interview so be prepared to answer anything you write in your personal statement.
Medical School Performance Evaluation (MSPE):
Medical School Performance Evaluation, you need to get this document from your medical school. MSPE is a summary of all of your ranking and achievements as a student. Although it’s more important for students graduating from US med schools, it’s a necessary document required by almost every program and therefore should be made according to the standard format given online. MSPE is released by the ECFMG 2 weeks after we submit the ERAS application, i.e. on October 1st.
Each year ERAS application token is available from mid-July, meaning you can start working on your application to apply to programs for residency. Eras is very user-friendly and the best part is you don’t have to upload a personal CV, you just need to briefly describe all your volunteer, professional work and training experiences along with the start and end dates and that’s it. Apart from the CV, you will be asked to upload LORs, MSPE, medical school transcript, ECFMG status report (uploaded and updated automatically once you get ECFMG certified), ECFMG transcript (have to pay some fee through OASIS before it is available to the programs), personal statement and a photograph to complete your application. Most programs ask for ECFMG certification, once you are done with Step 1, Step 2 CK and CS you are electronically ECFMG certified and that’s all you need. These requirements are given on each program’s website and they are more or less the same. CV, MSPE, and personal statement are uploaded instantly but LOR takes time, around 2-5 days in early August, and 7-10 days late August. Deadline for uploading LORs is September 1st, any letter uploaded after September 1st will be most likely available after Sept 15 (the day ERAS applications are submitted).
Apply on September 15:
Applying to programs is much easier now; you can start applying to programs from Sept 6, although all applications will be available to programs on Sept 15, at 9:00 AM EST. No matter what, you must submit a complete application on Sept 15. Most programs download the applications on Sept 15 and each program (even a small community program) now receives around 4000-6000 applications, which is a huge number and most of them don’t even need to download any further applications. So it’s best to apply on time.
IMG Friendly Program Lists:
Another mistakeInternationall applicants make is poor research on programs before applying. Each year a lot of applicants apply to programs who are either not sponsoring the visa, have different score requirements than posted on their website, or different year of graduation cut off. You can download a number of IMG friendly program lists online. Search each program on Frieda, check their websites for score cut off and supporting documents. But it is equally important that you email/call each one of them and ask for an updated eligibility criteria. You pay 100$ for first 10 programs and then 26$ for each, so apply wisely after thorough research. Ideally, work in a group and make a personal list of programs most suited to your overall profile. An average number of programs to which IMGs apply range from 120-200.
Step 3 is becoming increasing important now. Pre-match programs strongly recommend having step 3 on board. It also helps in getting H-1 visa once you match, so get done with step 3 before last week of December of the year you apply since there’s a score delay of a couple of months each year around this time.
During Match Season:
Stay proactive right from day 1. It has been said numerous times and I can’t stress on how important it is. Start emailing programs early. Most programs wait till October 1st when the MSPE is released before they start reviewing the applications and it is important that you email/call them during the entire period. 1 email/2 week and calls to follow up during Oct-Nov, 1 call/week for the rest of the season was my plan. Update about any publication, step result, LOR as soon as they are available. Is visiting programs a good idea? I don’t think it helps in major cities like NY or Chicago where each program entertains a good number of such visitors every day. It might work in small cities and remote areas; they do appreciate your effort and might be able to give an interview call.
Keep Yourself Busy:
Research, step 3, volunteer work, observerships etc. Do something you can talk about during the interview. I was asked what I am doing during the season at almost every interview.
After reviewing all the applications submitted through ERAS, programs start sending out interview invitations to the shortlisted applicants, starting from mid-October onwards for IMGs. Most interview calls are sent through email. They send the interview day schedule and available dates and ask the applicants to reply with the three most convenient dates as soon as possible. Some programs use online interview scheduler like IV broker etc. Select the dates as soon as possible and write back a decent reply thanking the program for the interview opportunity. All communication with the program should be highly professional. The average number of applicants interviewed by most programs ranges from 200-300, depending on the number of positions offered.
Before going into the interview read each and everything about the program, ABIM passing rate, in-house fellowships, visa sponsorship etc. Then write a few program specific questions to ask, they all will ask you for questions and they appreciate program specific questions, it makes you look interested in their program and leaves a very good impression. Never ask about the salary, benefits, and vacations, they are mentioned on their website and Frieda.
Routine Interview day is 6-8 hours long. In most programs, the chief fellow receives the applicants in the lobby. He/she will take them for the breakfast to have a small introductory chat. This is followed by the orientation about the program; it’s history etc by the program director. Generally, there are 2-3 separate interviews with the program director and the faculty. Most commonly they ask about US clinical rotations and any interesting case you saw while rotating. One might ask about the personal statement, your time in med school etc. I was asked about an incident where I made a mistake and had to inform my senior about it, anytime I had an argument with a colleague/senior etc. Ethical questions are now a lot more common where they present you with a scenario and ask how you would handle the given situation. Interviews are followed by hospital tour, noon conference, and lunch.
You should be dressed professionally, be confident and extremely friendly, warm and humble. Indulge into the conversations but don’t try to act as you’re the smartest guy in the room. The residents talking to you are looking for a teammate. Scores don’t matter once you get an interview call. Personality, confidence, communication and interpersonal skills score more here. Speak only when you’re asked to speak, stay normal and answer confidently. The interviewer are very smart people, they have been doing it for years so don’t ever try to lie about anything.
Send a thank you email to each faculty who interviewed you, best to do it immediately after the interview. Some programs do not appreciate thank you cards, they will tell you straightaway so send them only if you think it’s a good idea. Programs, where I interviewed were happy with the emails.
Rank Order List:
You can start working on ROL from mid-January; the deadline is mostly the third week of February. I wrote brief notes after each interview about the program in general, working environment, my views about the residents and the hospital. They helped me a lot during ROL submission. There are a number factors to consider while ranking, a few of them are program’s general structure, University vs community vs university-affiliated community hospital, fellowship opportunities, visa sponsorship, program director’s personality, collegiality among the residents and location etc.
Be Nice to Everyone You Meet:
Last but not the least, be nice to everyone you meet during match season, practice interview with everyone and help your fellow applicants. Stay away from negative people (you will find a lot of them around you). Remember match season each year is a very unpredictable. I have seen applicants with more than 20 interviews going unmatched, and some with just 1 interview matching so a lot depends on your luck here as well. No one can predict your chances of matching no matter how weak/strong your credentials are. Help each other and spread positivity. Since I have been through this extremely long, tiring and nerve-wracking process, I will be more than happy to help/guide. Hope this helps and good luck to all future applicants.