Medical Education

Admission to medical education in the United States is competitive. So competitive, in fact, that many undergraduate

institutions in the U.S. appoint a pre-med adviser whose job it is to help guide American students through the process of applying to medical school.

Medical school competition is even steeper for international students. According to the American Association of Medical Colleges, of the 1,371 international students who applied to medical school in 2007, only 164 matriculated. The picture is a bit more encouraging for international students interested in enrolling in medical residency programs – in the 2008 National Resident Matching Program (NRMP), 45 percent, or 4,650 of the 10,300 graduates of non-U.S. medical schools who applied, matched to a first year position. Still, the application process is arduous, and includes a series of written and practical exams in addition to the complicated NRMP.

FIVE STEPS FOR APPLYING TO MEDICAL RESIDENCY PORGRAMS IN THE U.S.
By: Rohayma Rateb

U.S. residency programs offer an excellent opportunity for aspiring doctors from around the world to further their education and gain excellent experience. There are roughly 8,000 residency programs in the United States. While this process might seem quite daunting, a basic understanding of the different testing, evaluation and matching processes will help you advise students on how best to navigate the path to a successful residency. What follows is a step-by-step explanation of the basic process.

Step 1. Complete the ECFMG Application
The first step in the process is for students to apply to the Educational Commission for Foreign Medical Graduates (ECFMG, www.ecfmg.org) for a USMLE/ECFMG Identification Number. Because of the variety of educational standards, curricula, and evaluation methods across the world, the Accreditation Council for Graduate Medical Education (ACGME) requires a standardized testing procedure for all international applicants. Be sure to familiarize yourself with the information available on the ECFMG website. The website provides the eligibility requirements for starting the certification process and walks you through the process of applying for the required exams online through an Interactive Web Application. The exams are offered a number of times throughout the year and are described in more detail on the chart to the right.

Step 2. Take the United States Medical Licensing Examination (USMLE) Medical Sciences, Clinical Knowledge and Clinical Skills Exams
Students must have completed at least three years of medical school to apply for any of the required USMLE exams, which include the Step 1 Medical Sciences exam and the Step 2 Clinical Knowledge (CK) and Clinical Skills (CS) Exams. These same tests are also administered to graduates of U.S. and Canadian medical schools. The Step 1 exam is aimed at testing general scientific knowledge, whereas Step 2 assesses a student’s ability to put this knowledge into practice with a patient. Students should also refer to the ECFMG Information Booklet to see whether these exams can be substituted with any of the medical science exams they have taken previously. All three tests must be passed within a seven-year period; if all three are passed, results do not expire. The Step 1 and Step 2 CK Exams are administered worldwide at Thomson Prometric test centers. The Clinical Skills exam must be taken in the United States. Students must obtain a scheduling permit from ECFMG to register and schedule the test date with Prometric.

Step 3. Apply to Residency Programs
After passing the required exams and achieving ECFMG certification, students can apply to the residency programs of their choice through the Electronic Residency Application Service (ERAS).

Applications are submitted during September and October. ERAS is a service developed by the Association of American Medical Colleges (AAMC) to transmit residency applications, letters of recommendation, dean’s letters, transcripts and other supporting documents to residency program directors.

After reviewing the applications, admissions officers invite select applicants for interviews, which typically take place during November, December and January. Here, admissions officers further evaluate applicants based on the general competencies required of residents: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.

Because these programs are highly selective, it is wise for students to spend time researching all the potential residencies that would be a good fit given their academic background and professional goals. The Graduate Medical Education Directory (Green Book) and the Accreditation Council for Graduate Medical Education (ACGME) are good resources for this research.

Step 4. Match with a Program
In February, following the interview process, both applicants and programs rank each other through the National Resident Matching Program (NRMP), a service which provides an impartial venue for matching the preferences of applicants and programs. In March of 2008, 15,242 graduates of American medical schools and 4,650 graduates of non-U.S. medical schools were matched to a first year residency position. The positions that are not filled in the initial match process are then listed on the NRMP website. These positions can be filled in as quickly as an hour.

Step 5. Obtain a Visa
Following acceptance, medical schools send accepted students an information packet, contract, and temporary license. The J1 visa is the typical visa for residents although some applicants are able to acquire an H-1B visa if they have taken Step 3 of the USMLE tests or apply for a waiver program to work for two years in an underserved area. Once the final certifications have passed between the student, the interlocutor agencies and the medical program, students should contact their U.S. Embassy or Consulate to set up a visa interview and inquire about all of the documents required for their visa (www.unitedstatesvisas.gov).

Ten Tips for Applying to Medical School in the U.S.

By Margaret Anyigbo
Getting into medical school in the United States is highly competitive for any student, but even more so for international students. Of the 129 medical schools in the United States, only 50 enroll international students. Any international student who is determined to apply should keep the following tips in mind:

1. Doctors are not all science majors.
Medical school admissions officers are interested in diverse educational backgrounds and appreciate students with a variety of talents and interests. Regardless of your major, be sure to take the biology, general and organic chemistry, physics, math and English requirements and have a good GPA.

2. Take the process seriously.
The process is expensive and should not be taken casually. It requires total commitment, maturity and intellectual ability. You will be under a lot of pressure.

3. Consider where you have the best chance of enrolling.
Research and apply to schools that will be the best fit; however, be sure to investigate how many international students have been enrolled in the past. You will have a better chance getting into private medical schools. State schools favor U.S. citizens and state residents.

4. Take the MCAT once.
Some medical school admissions negatively view taking the MCAT multiple times. Students should aim for a minimum score of 10 in each of the three sections.

5. Perfect the personal statement.
Prove you pay attention to detail by submitting a polished piece. Do not be shy. This is your opportunity to market yourself; be sure to highlight your achievements, strengths and leadership qualities.

6. Prepare for the interview.The interview is an elimination process. Interviewers are not looking for standard answers but rather responses that distinguish the applicant. They want to find out how well students can think on their feet.

7. Choose references carefully.
The evaluation should be written by someone who can attest to your ability, someone like a pre-med adviser, science department professor or member of the university pre-medical committee. Submit a profile to the recommendation-writer, providing information he or she might not already know, such as your involvement in extracurricular activities.

8. Find an internship.
Admissions officers highly regard students who have volunteered or interned in a healthcare-related setting. From observing the medical profession first hand, you will learn whether it is the right fit for you and what specialty you might want to pursue.

9. Have a financial plan.
Financing medical school may be your biggest challenge. If scholarship money is not available, students must prove they have the ability to pay $200,000 or get a co-signer.

10. Seek advice from others in the field.
Students should take advantage of their environment and discuss medical school plans with professors and classmates. Professors might have suggestions that guide students down the right path. Classmates and other pre-medical students going through the same admission process can share insight about the experience.

Margaret Anyigbo is a EducationUSA Adviser in Lagos, Nigeria.