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C A R I B B E A N
M E D I C A L S C H O O L S
C A R I B B E A N
M E D I C A L S C H O O L S
A J o u r n e y a n d G u i d e
A J o u r n e y a n d G u i d e
C A R I B B E A N
M E D I C A L S C H O O L S
C A R I B B E A N
M E D I C A L S C H O O L S
A J o u r n e y a n d G u i d e
A J o u r n e y a n d G u i d e
A s a d R a z a , M . D .
A s a d R a z a , M . D .
By the author of one of the leading websites for Caribbean Medical Schools for the past 12 years – CaribbeanMedicine.com!
All Rights Reserved
This book is available for purchase at the following online bookstores: www.Amazon.com www.BookSurge.com www.Abebooks.com www.Alibris.com www.BooksinPrint.com www.GlobalBooksinPrint.com
Printed in the United States of America International Standard Book Numbers ISBN-10: 061555251X
ISBN-13: 978-0-615-55251-4
To order multiple copies at discount rates, please contact: Create Space customer service department: www.createspace.com Edited by Carla McDonald | [email protected]
Cover and Interior Design by Leigh Anne Ference-Kaemmer | www.laferencekaemmer.com Cover Photograph by R. Gino Santa Maria | Dreamstime.com
This book is dedicated to the people of Baghdad, Mosul, Basra, Fallujah, Karbala, Najaf, Kabul and Kandahar.
With my love and admiration.
“Two roads diverged in a yellow wood,
and sorry I could not travel both . . .
and I took the one less traveled by and
that has made all the difference”
_____________________
Robert Frost, 1920
ACKNoWLEDGEMENTS xix Chapter 1
INTRoDUCTIoN
1
Preface 1 Basic Path 2 Exams 2 Residency 4Some Basic Pros and Cons 8 Medical Schools in the Caribbean 10
Admission 14 Tuition 15 Financial Aid 17 Basic Advice 18 About 20 Chapter 2
MY FIRST TWo YEARS
oF MEDICAL SCHooL
21
The Journey 21
The Basic Science Classes 22 Anatomy, Histology, Embryology 22 Biochemistry, Physiology, Psychology, Ethics 24 Microbiology, Neuroscience, Genetics , Epidemiology 25 Pathology I, Pharmacology, Physical Diagnosis 27 Clinical Medicine, Pathology, USMLE Board Review 28
Island Life 29
Chapter 3
MY THIRD AND FoURTH
YEARS oF MEDICAL SCHooL
33
Third Year Clinical Rotations 33
Pediatrics 34
Psychiatry 35
Internal Medicine 35
obstetrics and Gynecology 36 Surgery 37
Fourth Year 38
Summary of Events 39
Chapter 4
USMLE
41
USMLE Step 2 CK (Clinical Knowledge) 41 USMLE Step 2 CS (Clinical Skills) 42 Clinical Skills Assessment 42
USMLE Step 3 45
Chapter 5
MY RESIDENCY APPLICATIoN
47
Choosing a Specialty 47
Make Your Visa List 48
Call the State Licensing Boards 48
Apply with ERAS! 49
Attend Interviews 50
Chapter 6
WoRK VISAS
51
J-1 Visa 51 J-1 Waiver 52 H-1B Visa 53 My H-1B Visa Story 55 Green Card 58 Chapter 7BooKS USED IN
MEDICAL SCHooL
61
Chapter 8HoW I CHoSE A CARIBBEAN
MEDICAL SCHooL
67
Evaluating, Researching and Comparing all the Schools 67
Saba Websites 70
Student Websites 70
Business Website For Saba Island 70 Chapter 9
MY PERSoNAL SToRY
71
Chapter 10
SUMMARIZED TIME LINE
75
A Quick Look at All the Key Steps 75 Chapter 11
DETAILED TIME LINE
77
A Complete Summary of
All the Events During Your Four Years 77
Basic Sciences 77
Clinical Sciences 78
Chapter 12
CARIBBEAN MEDICAL
STUDENT CoMMENTS
81
What Students from other Schools
Have to Say About Their Experiences 81
AUC 81 Ross 85 Saba 87 Spartan 91 St. Eustatius 91 St. George 93 Unibe 94 Windsor 95
Chapter 13
FINANCIAL AID
97
How to Pay for Medical School 97
Financial Aid Sources 98 Chapter 14
HELPFUL URLS
99
Essential Websites for Your Research 99 Caribbean Medical Schools 99 Medical organizations of the United States 100 Chapter 15
MY RANKINGS
101
My Ranking of the Medical
Schools in the Caribbean 101 Chapter 16
MCAT AND
USMLE ADVICE
105
Chapter 17
RESIDENCY PRoGRAMS
111
Descriptions of the Residency Programs
Completed After Medical School 111 Chapter 18
oPPoRTUNITIES FoR
INTERNATIoNAL MEDICAL
GRADUATES IN CANADA
121
Chapter 19HIGH CoST oF AN
INFERIoR EDUCATIoN
125
Chapter 20FACTS FoR INTERNATIoNAL
MEDICAL STUDENTS
129
Chapter 21
Chapter 22
FREQUENTLY ASKED
QUESTIoNS
139
Admission 139 Financial Aid 159 Medical School 161 Clinical Rotations 164 USMLE 169Immigration and Visas 170
Residency Training 176
Licensure 183
Chapter 23
ABoUT THE AUTHoR
191
Chapter 24
TESTIMoNIALS
ACKNoWLEDGEMENTS
To my grandfathers, Hashmath Raza and Jawad Ali Baig, both of whose biological fathers died when they were young boys, but with the help of their mothers, studied hard, earned University degrees and became great men . . . still remembered by many to this day.
To my father Rashid Raza and my mother Zainab Raza, both of Hyderabad, India, for raising me with a tremendous emphasis on education.
To my sister Mariam Mirza in Dubai, UAE and my brother Ali Raza in ontario, Canada for being great siblings. We are a great team. I love you.
To my teachers, professors and coaches at the schools I graduated from: Brampton Centennial Secondary School, York University and Saba University School of Medicine.
Finally, to the United States of America for providing me with all the opportunity I could ever desire in life.
Chapter 1
INTRoDUCTIoN
PREFACE
Caribbean medical schools have become a very popular option for undergraduates wishing to pursue a career in medicine.
In Canada, a country of 34 million people, there are 14 English language medical schools (3 French). Nationwide, those 14 medi-cal schools offer only 2,043 spots annually. In ontario, where I grew up, only one out of every six applicants gets accepted and matriculates (in 2010 there were 5,412 applicants for 954 spots in that province). As a result, many qualified students are being rejected year after year.
A typical path for Canadian students has been to apply to medical schools in the United States, but this has proven to be a difficult and extremely expensive route.
In the United States there are 125 medical schools offering a total of 18,655 spots; and, one out of every 2.3 applicants gets accepted. In 2010 there were 42,742 applicants for those 18,655 spots. But, if you are a Canadian applying to the U.S., you are considered a foreign applicant.
the first year class at a U.S. medical school. So, 99% of students that are accepted and matriculate at a U.S. medical school are U.S. citizens or permanent residents of the United States (Green Card holders).
Therefore, instead of giving up on what, for most, is a very deeply-felt goal of attending medical school, many students have chosen to enter medical schools in the Caribbean with the goal of obtaining a residency and eventually practicing in the United States or Canada.
I want to provide much-needed information to students, like you, who are considering this option, as there must be many un-certainties you are facing.
BASIC PATH
1. Graduate from a Caribbean Medical School (M.D. degree)
2. obtain ECFMG certification
3. obtain a residency in the United States
EXAMS
ECFMG
ECFMG (Educational Commission for Foreign Medical Gradu-ates) is an organization that issues a certificate that you will need to obtain to become eligible to enter a residency (post-graduate training) position in the United States. To obtain the certificate you must pass:
USMLE Step 1
(taken after the first two years of med school) USMLE Step 2 CK
(taken after the third year of med school) USMLE Step 2 CS
(taken after the third year of med school)
USMLE
The United States Medical Licensing Exam Steps I, II and III are standardized tests that U.S. medical students have to take and pass as well.
1. USMLE Step I is based on the first two years of medical school - the basic sciences.
2. USMLE Step II is based on the third year core clinical rotations.
3. USMLE Step III is all clinical, with an emphasis on the management and treatment of a patient. Most take it after their first year of residency.
Also, twelve states will allow candidates to register for the Step 3 examination before they have started a residency program.
USMLE STEP 2 CS
The USMLE Step 2 CS (Clinical Skills), which was formerly known as the CSA (Clinical Skills Assessment), is a one-day (pass/fail) exam in which you interview and diagnose patients.
You can take it at one of the five ECFMG centers that offer it: Pennsylvania, Georgia, California, Illinois, Texas.
RESIDENCY
This is by far the most important aspect. Remember, the M.D. degree can be earned anywhere. It is a residency that will be your ultimate goal.
There were 16,893 U.S. medical graduates in 2011, and there were 26,158 total residency positions available in the United States NRMP residency match. This means that the difference of 9,265 spots were available to the “Independent Applicant pool.”
This pool includes U.S. D.o. (Doctor of osteopathic Medi-cine) graduates, Canadian medical school graduates, and all International Medical Graduates (IMGs) from all over the world, regardless if they are a U.S. citizen, Canadian citizen or a citizen of any other country.
In 2011 a total of 20,842 Independent Applicants were com-peting for those remaining 9,265 spots.
Caribbean medical schools place their students in clinical rotations in affiliated hospitals in the United States during the third and fourth year of medical school. Therefore, Caribbean medical students are at a far greater advantage when competing with other IMGs for U.S. residency (post-graduate training) positions.
Residency programs tend to feel more comfortable with students that have been trained in a U.S. hospital and are fa-miliar with basic procedures and technology. This also gives Caribbean medical students the benefit of establishing contacts and friendships with the doctors and supervisors during the clinical years. Those people will not only write your letters of reference, but can aid you in obtaining a position in a U.S. residency program.
U.S. RESIDENCY PRoGRAMS
Residencies for recognized specialties are diagrammed below. The length of each bar represents the years of training required for certification.
1 2 3 4 5 6-7
FAMILY PRACTICE
EMERGENCY MEDICINE
PEDIATRICS SUBSPECIALTIES INTERNAL MEDICINE SUBSPECIALTIES oBSTETRICS/GYNECoLoGY
PATHoLoGY G EN ERA L
SURGERY SUBSPECIALTIESNEURoLoGICAL SURGERY oRTHoPAEDIC SURGERY oToLARYNGoLoGY URoLoGY TRANSI-TIoNAL or PRELIM MEDICINE or PRELIM SURGERY ANESTHESIoLoGY DERMAToLoGY NEURoLoGY NUCLEAR MEDICINE oPHTHALMoLoGY PHYSICAL MEDICINE PSYCHIATRY RADIoLoGY - DIAGNoSTIC RADIATIoN oNCoLoGY
CoMPARISoN oF RESIDENCY PoSITIoNS AvAILABLE IN CANADA AND THE U.S.
FREIDA (www.ama-assn.org/go/freida) lists all ACGME-accred-ited residency programs. The U.S. column in this table is the NRMP (www.nrmp.org) list, which only has those programs that participate in their Match, which is a lower number. In the U.S. a certain number of residency positions are available outside of the NRMP match (non-NRMP residencies).
The Canadian column is complete (stats taken from www.carms.ca). Keep in mind that the U.S. Match is much better for Caribbean grads as it has around a 50% IMG match rate; whereas the Canadian match rate for IMGs averages around 10%.
Residency
Program Spots in Canada in 2011 Spots in the U.S. in 2011
Anatomic Pathology 24 1081 Anesthesiology 118 841 Dermatology 26 362 Diagnostic Radiology 88 1124 Emergency Medicine 65 1626 Family Medicine 1089 2708 General Surgery 114 1108 Internal Medicine 402 5121 Neurology 40 594 Neurosurgery 16 195 obstetrics/Gynecology 100 1205 ophthalmology 38 Non-NRMP orthopaedic Surgery 81 670 otolaryngology 29 283 Pediatrics 157 2482
Physical Med and Rehab 23 373 Plastic Surgery 28 108
Psychiatry 131 1097
Radiation oncology 21 171
Residency
Program % IMGs in the U.S.
in 2011
Avg hrs/week
(PGY-1) Avg Salary(U.S. $) (PGY-1)
in 2011 Anesthesiology 14.4 61.6 48,343 Anatomic Pathology 37.1 50.9 47,505 Dermatology 3.5 45.2 49,142 Diagnostic Radiology 10.3 51.7 49,973 Emergency Medicine 8.7 56.3 47,912 Family Medicine 41.6 63.3 47,394 General Surgery 20.5 75.5 48,023 Internal Medicine 53.7 64.2 47,699 Neurology 40.9 64.4 48,786 Neurosurgery 11.8 76.6 47,580 obstetrics/ Gynecology 20.2 71.1 47,793 ophthalmology 6.9 51.6 49,062 orthopaedic Surgery 2.9 70.5 47,577 otolaryngology 2.4 67.6 47,556 Pediatrics 32.1 65.6 48,090 Physical Med/ Rehab 19.7 54.6 48,959 Plastic Surgery 10.6 64.9 55,151 Psychiatry 38.7 56.2 48,448 Radiation oncology 3.6 50.0 49,120 Urology 4.9 66.4 49,771
SoME BASIC PRoS AND CoNS
THESE ARE THE PRoS:
1) Split camp U.S. program: first two years (sciences) completed in the Caribbean, last two years (clinicals) completed at affiliated hospitals in the U.S.
2) U.S. curriculum: hence, better preparation for the USMLE than other foreign schools.
3) Much easier to get accepted than U.S. or Canadian schools. 4) Three entering dates: September, January and May.
BUT THESE ARE THE CoNS:
1) Having to go from state to state to do your clinicals. However, if you enjoy traveling and going to different places
and meeting new people, and want to take advantage of establishing contacts, this could be a PRo! Also, it is pos-sible to get most of your rotations in the same place with certain schools.
2) The Visa problem for non-U.S. citizens when trying to get a residency in the U.S.
There are two types of visas available to do residency in the United States. The first one is the J-1 visa, which you can get through the ECFMG. You will need to have an offer from a U.S. residency program and a “Statement of Need” from the Ministry of Health in your home country. However, after completion of your residency in the U.S., you must return to your home country for two years, unless you get a J-1 waiver.
The second visa is H-1B. This requires that you take an additional exam (USMLE Step 3) before applying for the visa. This may take several months to get before starting residency, so it’s good to plan ahead with a timeline. Twelve states (Arkansas, California, Connecticut, Florida, Louisi-ana, Maryland, Nebraska, New York, South Dakota, Texas, Utah, West Virginia) will allow candidates to register for the Step 3 examination before they have started a residency program. So getting a visa is very possible, but will require some additional time.
NoTE: you are not limited to those states for a residency. You are free to do a residency in other states. Those states listed are the ones that allow students to register for Step 3 before starting a residency.
3) May have to do better than the average U.S. grad on USMLE Step 1 and USMLE Step 2 CK to get a residency, and also have to pass the USMLE Step 2 CS!
Examinations are given in a format compatible with that of the USMLE at some schools. But success on the boards will depend on the student’s work ethic and determination. Be prepared to work hard.
4) If you are from Canada, obtaining a residency in Canada as a foreign medical graduate is very difficult.
MEDICAL SCHooLS IN THE CARIBBEAN
All these schools are listed with the WHo (World Health organization) and the IMED here: https://imed.faimer.org
Readers are reminded that WHo has no authority to grant any form of recognition or accreditation to schools of medicine or other training institutions. Such a procedure remains the ex-clusive prerogative of the national government concerned.
WHo limits itself to publishing information on medical schools that have been provided or confirmed by the govern-ments of its member states.
ENGLISH LANGUAGE CARIBBEAN MEDICAL SCHooLS RECoGNIzED BY THE MEDICAL
BoARD oF CALIFoRNIA
Source: www.mbc.ca.gov/applicant/schools_recognized.html
M.D. Programs
DoMINICA
Ross University School of Medicine
www.rossu.edu
GRENADA
St. George’s University School of Medicine
www.sgu.edu
NETHERLANDS ANTILLES Saba University School of Medicine
www.saba.edu
ST MAARTEN
American University of the Caribbean School of Medicine
M.B.B.S. Programs
JAMAICA
University of the West Indies Faculty of Medical Sciences
www.mona.uwi.edu/fms
BARBADoS
University of the West Indies School of Clinical Medicine
www.cavehill.uwi.edu
TRINIDAD AND ToBAGo
University of the West Indies Faculty of Medicine St. Augustine
www.sta.uwi.edu/fms
The above listed seven medical schools are the only English language medical schools located in the Caribbean that are ap-proved by the Medical Board of California.
THE IMPoRTANCE oF CALIFoRNIA LICENSURE:
States in the U.S. are becoming increasingly strict with regard to recognizing foreign medical diplomas, in particular from gradu-ates of new offshore Caribbean medical schools. Most stgradu-ates are slowly, but surely, approaching the high standards of California, which is the strictest state.
Therefore, it is best to only consider schools that are licensed in California, as the other states in the U.S. will soon adopt the same guidelines as to which foreign medical diplomas they rec-ognize and approve for licensure.
FULL LIST oF ENGLISH LANGUAGE MEDICAL SCHooLS IN THE CARIBBEAN
ANGUILLA
Saint James School of Medicine Anguilla
anguilla.sjsm.org
ANTIGUA AND BARBUDA
American University of Antigua College of Medicine
www.auamed.org
University of Health Sciences Antigua School of Medicine
www.uhsa.ag
ARUBA
Aureus University School of Medicine
www.aureusuniversity.com/aruba
Xavier University School of Medicine
www.xusom.nl
BARBADoS
University of the West Indies,
Barbados Faculty of Medical Sciences
cavehill.uwi.edu
BoNAIRE
Saint James School of Medicine Bonaire
bonaire.sjsm.org
CAYMAN ISLANDS St. Matthew’s University
School of Medicine (Grand Cayman)
CURACAo
Avalon University School of Medicine
www.avalonu.org
Caribbean Medical University School of Medicine
cmumed.org
St. Martinus University Faculty of Medicine
www.martinus.edu
DoMINICA
All Saints University School of Medicine, Dominica
www.allsaintsuniversity.org
Ross University School of Medicine
www.rossu.edu
GRENADA
St. George’s University School of Medicine
www.sgu.edu
JAMAICA
All American Institute of Medical Sciences
aaimsedu.com
University of the West Indies Faculty of Medical Sciences
www.mona.uwi.edu/fms
MoNTSERRAT
Seoul Central College of Medicine
www.seoulmed.org
University of Science,
Arts & Technology (USAT) Faculty of Medicine
SABA ISLAND
Saba University School of Medicine
www.saba.edu
ST. KITTS AND NEVIS
International University of the Health Sciences (IUHS)
www.iuhs.edu
Medical University of the Americas (Nevis)
www.mua.edu
University of Medicine and Health Sciences, St. Kitts
www.umhs-sk.org
Windsor University School of Medicine
www.windsor.edu
ST. LUCIA
American International Medical University School of Medicine
aimu-edu.us
Atlantic University School of Medicine
ausom.org
ADMISSIoN
The mean GPA (Grade Point Average) and MCAT (Medi-cal College Admission Test) for accepted students at Caribbean medical schools varies greatly. A competitive applicant usually has a GPA of around 3.2 and MCAT scores of 7 or 8. Most of these schools require at least three years of undergrad, but some will accept students after only two years.
Chances for admission are better if you apply well before the date you would like to enter, as most of the spots are open then. But buyer beware! Some of these schools are so desperate for students that they will accept anyone that applies.
Two big problems arise with this:
First, several of these newer schools are really bad, so get-ting admission into them means nothing. Second, many of the students that are offered these ‘easy’ admissions are totally not academically suitable for medical school and therefore will never pass the USMLEs. In the process they and their parents will lose tens of thousands of dollars.
The MCAT is optional at most schools, but it is highly recom-mended that you write it. It is excellent preparation for medical school studies.
TUITIoN
Here is a table comparing the tuition (in U.S. $) at the Caribbean medical schools. one semester is four months in duration. These tuition rates were valid as of January 2012. But may have changed since then. Please verify these values with each school. Medical School Caribbean Island School is Located on Tuition for Basic Sciences per semester Tuition for Clinical Rotations per semester
All American Institute
of Medical Sciences Jamaica $6,000 $7,200
All Saints University Dominica $4,995 $6,995
American International
Medical University St. Lucia $9,500 $9,850
St. James School of Medicine Anguilla $6,500 $7,500 American University of Antigua Antigua $12,282 $13,970 University of Health Sciences Antigua $11,500 $11,300 Atlantic University
School of Medicine St. Lucia $3,800 $6,800
Medical School Caribbean Island School is Located on Tuition for Basic Sciences per semester Tuition for Clinical Rotations per semester Aureus University
School of Medicine Aruba $6,495 $7,995
Avalon University Curacao $6,500 $7,700
CAHSU Belize $8,000 $9,500
Caribbean Medical
University Curacao $4,900 $6,900
Destiny University St. Lucia $7,000 $8,000
International
American University St. Lucia $6,000 $9,500
MUA Nevis $9,500 $10,450
Ross Dominica $16,575 $18,200
Saba Netherlands Antilles $10,150 $10,950
Seoul Central
College of Medicine Montserrat $4,999/trimester $6,000
Spartan St. Lucia $4,950 $9,750
St. Eustatius St. Eustatius $7,800 $8,400
St. George Grenada 1&2: $22,414Terms
3&4: $30,660 $22,625
St. James School of
Medicine Bonaire $5,000 $7,500
St. Martinus University Curacao $7,400 $10,500
St. Matthews Cayman Islands $9,400 $10,950
Trinity School of
Medicine St. Vincent $10,800 $12,500
University of Medical
and Health Sciences St. Kitts $7,925 $11,000
University of Science,
Arts and Technology Montserrat $4,100 $4,500
UWI - Faculty of
Medical Sciences Jamaica $18,126 Per year
UWI – School of
Clinical Medicine Barbados $16,618 Per year
UWI – Faculty of
Medicine St. Augustine Trinidad and Tobago $21,500 $25,000
Windsor St. Kitts and Nevis $4,990 $4,990
Xavier University
FINANCIAL AID
UNITED STATES Federal: www.fafsa.ed.gov Sallie Mae: www.salliemae.com Stafford: www.staffordloan.com CANADA Bank of Montreal: www.bmo.com Canada Trust: www.tdcanadatrust.com/student/pro.jsp CIBC: www.cibc.com oSAP: osap.gov.on.ca Royal Bank: www.royalbank.ca Scotia Bank: www.scotiabank.com INTERNATIoNAL IEFA: www.iefa.orgFinancial Aid Guide:
BASIC ADvICE
Keep in mind that a school listed with the World Health organization (WHo) or the International Medical Education Directory (IMED) still may not qualify for licensure in the United States.
What really matters is state approval. Currently only five Eng-lish language medical schools located in the Caribbean islands are approved by all fifty states in the United States.
Those Caribbean medical schools are American University of the Caribbean, Ross University, Saba University, St. George’s University and the University of the West Indies.
Be prepared. Know what you are getting yourself into:
1. Please contact several people in your search for info, pref-erably “the source” (school administration, medical orga-nization, etc.). Research, research, research!
2. Be VERY aware of the RISKS involved with attending a foreign medical school and becoming an international medical graduate (IMG). Contact the AAMC, AMA, NRMP, CaRMS and find out the facts regarding this issue. only go to an established California-approved medical school. Stay away from schools that just opened up in the last few years and are promising basic sciences on their island with USMLE preparation and guaranteed clinical rotations.
3. The most important thing I can tell you about attending medical school is to make sure you are academically suit-able. In other words, be certain that you will be able to handle the intense medical curriculum. I found, for me, the biology section of the MCAT prepared me quite well for my studies in medical school. If you feel your background is weak, and that you may have problems, then before
you attend, I strongly recommend taking some college/ university courses, in biology, physiology, biochemistry, etc. Just take a look at the medical school curriculum to get an idea of what types of courses you need to prepare for, and make certain that you do!
4. ...and lastly, follow your heart. Don’t attend medical school because it will make your parents happy, or because you think it will make you prestigious or rich. All this is ac-tually not true about a career in medicine. Attend only if you have a genuine interest in the study of medicine and the subjects involved, and you love to study. This way you will be happy. otherwise you will be miserable and will drop out.
Find out the FACTS. Get them directly from the source - the “horse’s mouth,” as they say - whether that is the medical schools, the ECFMG, FSMB or other governing bodies. It is important to know the truth and the risks involved with Caribbean medical schools, and the realities. That is the only way you can make the most informed decision for yourself.
Some basic questions one should ask the Caribbean school are: 1) What is your USMLE Step 1 and Step 2 first-time pass rate? 2) What is your clinical placement rate (at affiliated hospitals
in the U.S.)?
3) What percentage of your graduates obtain a residency in the U.S.?
Ask away! Don’t be satisfied until you know everything. Then, and only then, can you decide whether or not to attend a Carib-bean medical school. Read this great book, post on the forums and share your information. I sincerely wish the best of luck to you all. I know the pain you are going through.
ABoUT
This guide was originally started in 1999 by me for a few friends who were interested in attending a foreign medical school. It was soon realized that this information was very much needed by many others as well.
Since then, in the past 13 years now, my guide, book, website and forum have been widely read, with tens of thousands of stu-dents from all over the world taking advantage of the valuable information they provide. I honestly never thought the response would be so profound.
The goal of the guide remains the same: to provide step-by-step information to anyone who is interested in studying medicine at a Caribbean medical school and then going to the United States to obtain a residency and later a license to practice medicine.
I have gone through the entire process: I have attended and graduated from a Caribbean medical school, completed the two years on the island, completed the two years of clinical rotations in the United States. I have passed the MCAT, USMLE Step 1, USMLE Step 2 CK, USMLE Step 2 CS, ToEFL, MCCEE, MCCQE Part 1 and USMLE Step 3.
I received my ECFMG certificate and the H-1B Visa and I did my post-graduate (residency) training in the United States. I obtained my full state medical license and am now practicing as a physician in the U.S.
If you wish my success to be yours, I can show you how: it’s all outlined and explained in detail in this book. Simply read the book and be on your way. I wish you the very best in achieving your goals!
Chapter 2
MY FIRST TWo YEARS
oF MEDICAL SCHooL
THE JoURNEY
After a lack of success in gaining admission at a Canadian or U.S. medical school, I decided to pursue an M.D. degree in the Caribbean.
With over 1600 medical schools worldwide, why the Carib-bean? Well, as a Canadian, I knew that once I left Canada to go to a foreign medical school, getting back into Canada would be very difficult, so my goal was to go to the U.S. and work there.
Now, getting into the U.S. for a residency depends largely on your USMLE board scores. Since the USMLE is based entirely on the U.S. medical curriculum, many foreign medical graduates have a tough time doing well on this exam because they learned medicine in another country, at a school that has a different cur-riculum than the U.S. schools.
So, in choosing a foreign school, with the goal of eventually working in the U.S., I chose a Caribbean school because these schools have a U.S. curriculum and you can do your third and
fourth years of medical school (the clinical rotations) in the U.S. This maximizes your chance of obtaining a residency position in the U.S..
After looking through all the schools, I chose Saba University School of Medicine. So let me tell you all about how my years went on this “rock.”
Hence begins the story of an International Medical Graduate (IMG).
THE BASIC SCIENCE CLASSES
I started FIRST SEMESTER (of five on the island) on September 6, 1999. What a historic day in my life!
our classes were 1) Anatomy, 2) Histology and 3) Embryology.
1) ANAToMY
The professors structured this course in an excellent way. At the start of each block they gave you a handout, which had everything you needed to know. During the lectures they supplemented the handout. Plan on wasting your time reading that big Moore book? Well, that is a no-no. Just know those handouts cold for the tests.
I recommend the Board Review Series for Anatomy. The
Netter Atlas is a must, always have it open while studying. Now,
for the lab, you need to go after hours to the lab (with other med students) and quiz each other on all the cadavers: don’t just know your cadaver, you must know all of them. This course will teach you where all the organs, vessels and nerves are so that later you can learn about their diseases with a better understanding.
2) HISToLoGY
This course was easily the worst experience I had at Saba. The professor was this incredibly conceited and rude person, who
quite honestly did not care about you or what you learned. He just walked into class every day and recited (by memory) the day’s lecture, at a New York taxi cab’s speed and then left. The students who came to Saba with a really good histology background were able to do well, but otherwise you were screwed.
on at least three times during this course, the Scranton in-correctly marked questions wrong on our tests. All these times this professor said that he would give us these points at the end of the course. These are points that we had EARNED (not a curve!). Well, at the end of the course he didn’t give them to us. He was a liar on a big power trip. I complained about him to the President of the school, the school did nothing.
This is one thing you will notice very early on when you at-tend a Caribbean medical school: there is no real professionalism among the teaching staff.
A great book is the Wheaters w/CD ROM. Now for the lab component, like anatomy, you need to go after hours to the lab and learn the slides. This is largely a course that deals with the way something looks under a microscope, normally and abnormally, and to learn how to differentiate between the two.
3) EMBRYoLoGY
Basically, if you just read your textbook, you were fine. Lectures were like a story. I preferred reading the text (even though I hate reading big books). But this book is very readable and interesting. Read the book! There is no shortcut. You may think that there is, but it won’t work.
The High Yield book for embryology is terrible, way too point form. A lot of people dismiss this class, but it IS important be-cause many of the diseases you learn in Pathology are embryo-logical. This course will teach you about the ‘nine month’ period that a baby goes through from conception to birth.
SECoND SEMESTER we had Biochemistry, Physiology, Psychology and Ethics.
4) BIoCHEMISTRY
A lot of stuff to learn, but Dr. S. was excellent. He made bio-chemistry seem easy. Dr. L. taught us the harder blocks, so it was tough. Pathways, pathways ... and more. Enzymes, rate-limiting steps and all that ‘short term’ memory stuff. Make yourself some nice charts and keep them for when you get to pharmacology, where you learn about drugs that block these pathways.
Class notes and Lippincott is all you need. Lippincott text rules. There is a lot of stuff on this course, but that book, with your time commitment, will help you really get a handle on this course. Dr. S. based his final exam on the 30 Biochemistry pages in the famous First Aid for the USMLE Step 1 book: a great idea, I think.
5) PHYSIoLoGY
This is a very important course because physiology is the study of the normal functioning of the human body. You need to get a good handle on it before you get to pathology, which is the study of the abnormal. So learn as much as you can. I had a good experience in this course.
I recommend the Saunders Physiology book by Costanza. Great subject. Saunders Physiology by Costanza is the #1 book for physiology. There is a lot of controversy about whether to use
Guyton. My opinion? You have got to be kidding me ... waaay too
much info in that book for a one-semester course. That Guyton book is awful.
6) PSYCHoLoGY
Dr. K (a fellow York University grad!) makes your life a lot easier in this course. Believe me, this course could be really hard, but Dr. K teaches it in a fun way. I recommend the High Yield book. Psych is a good read. You can relax (at least I did) and read the Kaplan and Saddock Pocket Handbook and learn a lot.
7) ETHICS
The J.D. who taught this brought his 17 years of law practice experience to this course. It is quite interesting. So sit back, relax (everyone got an A) and just listen and talk about medical ethics, and learn some cool things.
THIRD SEMESTER we had Microbiology, Neuroscience, Genetics and Epidemiology.
8) MICRoBIoLoGY
The first month of this course was - God - such a struggle. I mean, the prof was just awful. our class notes were basically a bunch of random words with no correlation ... a word salad. So every student was reading a different source to TRY to under-stand what the hell was going on. Just look at the books people in my class were reading a Immunology required text, Lange’s,
High Yield, BRS, USMLE Review Book, Medical Micro Book, etc.
With the students who took their course before, their schema once again compensated, but me, the math major, got killed. Just when I thought I had to throw in the towel, Dr. T. came in and taught us. She was like our “MESSIAH” saving us from the falling depths of hell. She was wonderful.
In five semesters on the island, my favorite textbook was the
Clinical Microbiology Made Ridiculously Simple - get it! For
organized. Microbiology is very important. Get a good handle on all the bugs: bacteria, parasites, fungi and viruses. Make charts with a list of all the bugs and some classic ‘buzzwords’ about each. It will help you later on.
9) NEURoSCIENCE
“Please rescue me!” Could things get any worse? The lectures for this class are the biggest joke. You sit in class for two hours every day and learn nothing. So I would go home after class and read that God-awful Snell book. I read the entire book (540 pages) and recall, I HATE reading big textbooks. But I had no choice. I typed up chapter summaries for the entire book. Neuro can be very hard, so don’t get bogged down with details, just learn the big picture.
10) GENETICS
The prof plagiarized this course straight from the Thompson and
Thompson Genetics books. He put all his copied lectures in one
notebook. During class he explained them as if he wrote them. In addition, unfortunately he demonstrated terribly unprofessional behavior: from verbally abusing students to physically abusing teachers (yes, this is true), to failing students he did not like. Welcome to the Caribbean, folks.
He desperately needed professional help in controlling his tem-per. I think he had a very sad and troubled life. I have no idea why the school kept him on staff. Genetics was easy so don’t worry.
11) EPIDEMIoLoGY
Just print out her PowerPoint® lectures and read them and the book. Don’t sweat this course … the amount of Epidemiology you need to know for the USMLE Step 1 would probably take about two weeks to learn. This course is about statistics related to health care.
FoURTH SEMESTER (second year begins!). We had Pa-thology I, Pharmacology and Physical Diagnosis.
12) PATHoLoGY I
This course was largely a review of stuff you already know (the first half of the Robbins book). The profs were terrible and you basically realize what a waste of time it is after a few weeks. Just read the pocket Robbins and read their PowerPoint® lectures (which were basically pocket Robbins typed word-for-word into PowerPoint®).
Pathology is arguably the most important course. It is held over two semesters. Robbins text is used here, it’s a horrible book. Personal opinion? The Golgan book is way better. Can you read and understand all that is Robbins? If yes, then that’s great! If not, get the pocket Robbins. Pathology I is mostly all cellular ‘ga-ga’ - really boring. Learn it all because, unfortunately, they will be on the boards.
13) PHARMACoLoGY
Dr. N. and Dr. I. did a great job at teaching this course of 700 drugs. The orange Katzung review book is excellent. The green
Katzung book is far too detailed for a one-semester course. Also,
the board simulator series pharmacology questions are very good to do for preparation.
Read their PowerPoint® lectures first, then read the corre-sponding chapter in that review book and do the MCQs. For the final exam, I did all 570 pharmacology questions from the
Board Simulator CD Rom; it helped a lot!
You have to know this course well; it is extremely important. For each drug learn the generic names, drug class, mechanism of action, usage, side effects and drug interactions. Study this course hard.
14) PHYSICAL DIAGNoSIS
I did the absolute bare minimum in this course, because it was so badly taught and disorganized, and I learned next to nothing. So I can’t tell you anything about it, sorry.
FIFTH SEMESTER (almost out of here!), we had Introduc-tion to Clinical Medicine, Pathology II and at the end of the semester, USMLE Review.
15) INTRoDUCTIoN To CLINICAL MEDICINE
This was by far the most useless course of the entire five semes-ters. I mean, they could have made this course very helpful, and really solidify what we had learned so far. But they didn’t. It was mostly student presentations, which are snooze city, and irrelevant lectures by useless profs. Geez, what can I say, presentations! So learn how to use Microsoft PowerPoint® and get a head start on writing History and Physicals if you have time.
16) PATHoLoGY II
Arguably the most important course for the boards, but we had the most horrible profs this side of the Atlantic ocean. Sometimes I could not believe how bad they were. They were mostly heavy-accent losers from foreign countries. I mean, this course had the worst professors. Man, oh man. The only reason I would even attend class is because we had this bogus attendance policy. But people still skipped! Just read Robbins, Golgan or the
Kaplan books and teach yourself.
You have to know your pathology of organs systems. otherwise you will never pass the boards. Learn patient presentations, even for Step 1. Be able to link pathology to pharmacology and mi-crobiology, as these types of questions appear in large numbers. Get the First Aid book and the Vignettes and a good ‘digestible’ pathology book and study, study, study!
17) USMLE BoARD REvIEw
They put this at the very end. Four weeks of professors coming in and trying to review two years worth of basic sciences. I just sat in the back of the class and read my Kaplan books.
Well, on April 18, 2001, a day I never thought would come, I finally finished my time on that boring island (yeah!).
I started my third year clinical rotations in August of 2001 in the United States.
IMPoRTANT NoTE:
My dear friends, please remember that finishing five semesters of basic sciences at a Caribbean medical school does not mean much. In fact, it means absolutely zero!
EVERYTHING you have to do in order to get a residency in the United States happens AFTER you leave the island.
ISLAND LIFE
EXERCISE
I continued to run, but not nearly as often as I used to. I did some weights at the gym in Windwardside (which is where I lived). But man, did I miss my track club back home - all the training and the races I used to run.
SABA BAY To BAY RoAD RACE
When I first came to Saba Island I saw how hilly the place was and, I must admit, I was pretty disappointed. I knew it would be very hard for me to continue running on Saba the way I used to back home in ontario, Canada.
I started anyhow, but it was pathetic. I mean, a 25-minute run was exhausting me on those monster hills … and back home I used to run for an hour everyday!
In July, 2000 the wonderful people of Saba, including Suzanne Nielsen, held the Bay-to-Bay (Island Wide) run/walk on Saba. From the airport all the way to the other end of the island – Fort Bay. Approximately 12km (7.5 miles).
I thought it would be impossible to run it. I mean the climb from the airport to the first three villages is crazy. You go from zero to 2000 feet above sea level within the first part. I walked half of it and still won the event in 1 hour and 16 minutes. Later they told me that the Saba record was 1 hour and 7 minutes.
In December 2000 they held the event again and I ran the entire way! The first part, from the airport to the church at Up-per Hell’s Gate was entirely uphill! But I ran it in 19 minutes. I knew I would break the record when I saw this time on my watch. Anyhow, I had not been training, to be honest, just going for 25 minute runs here and there. But I still put in a very strong effort and reached the bottom in 39 minutes and made it to the finish in 43:33. New Saba record!
It was pretty cool. I am sure someone can break this record, but I don’t think someone can lower it below 41 minutes. However, you never know! It’s all really in the mind because when Profes-sor David Aarons and I set the pace that day, we led a total of six people under the old record.
SoCIAL
Well, for me, life on the island was not as great as it could be. The island is very small with only around 1400 people.
I chose to live as inexpensively as possible. I had no cable, phone or vehicle.
In a way it’s good, because I got a lot of studying done, but yes, I have to admit, things got very boring and lonely. It was a sad time in my life.
Sometimes I would go out to a party at the house of some of the students; or go to Guido’s, Lollipop’s or Queen’s Garden for a dance or whatever.
other students, however, were living with all the luxuries you can have on Saba: phone, internet, vehicle, cable, nice houses, warm water for a shower, air conditioning, etc.
I figured I could do without these things for 20 months, because I could barely afford to go to this school … I had an excellent ability for sacrifice.
As far as finances go, I just paid tuition/fees and $470/month for rent (I lived in Windwardside, which is the heart of Saba). If you lived in some crappy place in St. John’s or Hell’s Gate you could probably get a place for $300 or less. I spent money on food, photocopies and not much else.
BREAKS
During the break after first semester I went to St. Vincent (a nearby island). I was there for three weeks. It was a really memo-rable time, and I had a lot of fun.
In second semester, I went to St. Barts for a day trip. It is a nice little French island with some neat places to shop, dine and beach. During the break after second semester I went to St. Martin with a friend of mine. St. Martin is nice, man. That is a really beautiful place for a vacation and to meet women.
The break after third I HAD to go home, otherwise my mother would have killed me. It was nice to see my family after a year. They made fun of how much weight I had gained.
INTERNET
The internet was, as always, my source of info and communi-cation to the outside world. Internet access is difficult as there is only one free place – the library. You can get internet in your room to your PC, but that requires getting a phone line and
internet access, which is costly.
But I continued to post on my website forums to help incoming students or to learn a little myself from what others had posted.
PoST ISLAND
USMLE STEP 1
After I completed the first two years of medical school (the basic sciences) on the island, I went back home to Toronto, on-tario, Canada to study for USMLE Step 1.
I took the Kaplan center access med pass for USMLE Step 1 which consisted of:
1) Preview (Step 1 books) 2) Lesson (videotaped lectures) 3) Review (question banks)
The first 30 days (which included the books) were $600 Canadian dollars.
I studied for 14 weeks for USMLE Step 1. The first seven weeks I read the Kaplan USMLE Step 1 books and I went to the Kaplan center and watched the videotaped lectures with a 30-day Kaplan Med Pass.
Info at: www.kaplanmedical.com
Then the second seven weeks I completed questions online with
Kaplan QBank and several other CD roms I had.
I also read the High Yield section of the First Aid for USMLE
Step 1, and a few other books I had. I studied very hard for this
exam. I wrote the test on July 28, 2001. I got my results four weeks later and I passed.
Chapter 3
MY THIRD AND
FoURTH YEARS oF
MEDICAL SCHooL
THIRD YEAR/CLINICAL RoTATIoNS
My third year schedule was as follows:
Pediatrics (6 wks) Aug 13, 2001 – Sept 21, 2001 Psychiatry (6 wks) Nov 5, 2001 – Dec 14, 2001 Internal Medicine (12 wks) Dec 17, 2001 – March 8, 2002 OBGYN (6 wks) March 11, 2002 – April 19, 2002 Surgery (12 wks) April 22, 2002 – July 12, 2002
I started my third year clinical rotations on August 13, 2001. I completed my first rotation at Leonard J. Chabert Medical Center in Houma, Louisiana, USA.
PEDIATRICS (6 wKS)
• AUG 13, 2001 - SEPT 21, 2001
This is a six-week rotation that I did to start off my third year. There were four physicians that we rounded with, one physician per day in the morning. There were five students in this rotation. It was an 8 a.m. – 4 p.m. type shift, not that stressful. Because it was my very first rotation, there was a lot to be learned, including simple things like common hospital abbreviations that I did not know.
In the morning we were in the hospital. When we arrived we had about an hour or so to go see the patients that had been admitted to the hospital (the ‘In-Patients’). When we went to see the patient, we would write a daily report in standard S.o.A.P. (Subject, objective, Assessment, Plan) format - basically the patients’ complaints, their current vital signs, the current assessment and possible treatments. When the doctor arrived we would then do rounds. At this time we would have to present the patient to the doctor; in other words, tell the doctor about the patient. The doc would then agree or disagree with what we had written and further advise on the plan for the patient and discuss the patient’s condition.
In the afternoon we were in the clinic. These were the ‘out-Patients.’ When a patient came in, we (the students) would first go in and perform a physical exam, just the basics, looking at their ears, listening to their heart, lungs, bowel sounds, and then writing down what we found - normal or abnormal. Then the doctor would come in and take a look at what we had written and proceed with the treatment of the patient. Bread and butter of pediatrics is asthma, ADHD and otitis media. We had a test at the end of this rotation.
After this rotation, I wrote and passed the ToEFL to get that requirement out of the way. (Note that this test is no longer re-quired for IMGs).
I did my next three rotations in Elgin, Illinois, USA at Provena Saint Joseph Hospital.
PSYCHIATRY (6 wKS) • Nov 5, 2001 – DEC 14, 2001
This was a laid-back rotation. Basically, I spent time up on the Psych floor and with a psychiatrist. I saw the doc a couple of times a week and he would go over some patients with me and look over History and Physical reports I had done. There was a psych lecture series given at a nearby mental health clinic that I attended. In the afternoons all the in-patients had group sessions which were quite interesting and amusing at times. There were also out-patient programs on weekends that I went to. Bread and butter of psych is depression, depression, depression, bipolar and some schizophrenia.
INTERNAL MEDICINE (12 wKS) • DEC 17, 2001 – MARCH 8, 2002
This was an extensive rotation that covered far more than you could grasp in three months. The first four weeks I was with an internist/geriatric specialist in his office. I saw all the patients with him. I drew blood, gave shots, wrote prescriptions, etc. I spent time with him at lunch and did rounds with him at two hospitals and nursing homes. Bread and butter of this practice is hypertension, diabetes, hyperlipidemia, thyroid disorders and urinary incontinence.
The next three weeks I spent in the Emergency Room. I learned how to put in IVs, foleys, do EKGs and suture. The ER is not like what most people think; it’s not the excitement that you see on TV. It’s more like a walk-in clinic.
The last five weeks I rotated one week at a time through five specialties (oncology, Nephrology, Gastroenterology, Cardiol-ogy, Neurology). Whew! Too much to soak in, but I would just go home at the end of the day and read about the stuff that I saw during the day. I read the Blueprints books mostly. These are great books.
The most enjoyable part of this rotation, for me, was helping out at the free clinic. The Chief of Staff at Saint Joseph Hospital ran this clinic and he would let med students come and just hop right in, as if we were the docs! of course, he would have the final say on any treatment. It was great experience to be given the responsibility of handling patients. I would go in, do a SoAP note, talk to the patient and then come out and present it to the doctor, and he would approve or disapprove of what I wanted to do. He would then explain what should be the proper manage-ment of the patient.
At the end of this rotation I had an oral exam and a written exam. The doctor that had supervised me the longest completed my student evaluation that my university required for each rota-tion.
This hospital had a lecture series given by the Chief of Staff mixed in with student presentations. We went to lecture three times a week, time permitting. Even though Provena St. Joe’s was not an ACGME (Green Book) hospital, it was a great place to do rotations.
oBSTETRICS AND GYNECoLoGY (6 wKS) • MARCH 11, 2002 - APRIL 19, 2002
This was one of those rotations that pleasantly surprised me. I had heard from other students that an oB/GYN rotation is hard and really a pain; but, for me, it turned out pretty memorable.
I was with a very successful physician/business man. He had three practices and a lab business.
I was with him in his offices and assisted him with deliveries (vaginal and cesarean). He was a rather interesting character, always cracking jokes. He took me out three times (twice to ladies night in the Chicago area) and we had great discussions on medicine and other world issues. He really motivated me to work hard and made me realize how competitive the private practice setting is.
He learned Spanish (from scratch) so he could better serve the large Hispanic community in Elgin, Illinois. Also, he mas-tered doing laparoscopic hysterectomies. See, 85% of the large hysterectomies in the United States are done abdominally, but he has done 95% of his laparoscopically. It takes more time to learn this procedure, but it results in a shorter recovery time for the patient. I assisted him in these lap hysterectomies as well as other procedures like Dilation and Curettage and Loop Electro-surgical Excision procedures and Cesarean and vaginal deliveries. Bread and butter of oB/GYN is routine pregnancy exams, pap smears, uterine fibroids, endometriosis, pelvic pain, cervical dys-plasia, hysterectomies, ultrasounds and – unfortunately - cancer.
SURGERY (12 wKS)
• APRIL 22, 2002 – JULY 12, 2002
I did this rotation at Peninsula Hospital Center in Far Rocka-way, New York, USA. I was living in Jamaica, Queens, New York (home of rapper 50 Cent!) Down the street was a KFC with cashiers taking orders behind bullet-proof glass.
Twelve weeks in the operating room you get to see and assist in a wide variety of surgeries, for example: cholecystectomies, appendectomies, amputations, pericardial window, bowel resec-tions, arterial grafts, and many other procedures. The operating room can be a grueling place.
There was a lecture series at the hospital, with grand rounds, and also tumor board. We also had an opportunity to gain valu-able experience at three clinics (vascular, surgical and breast).
I took the USMLE Step 2 CS (it was called the ‘CSA’ back then) in December of 2002 and the USMLE Step 2 CK in Janu-ary of 2003.
My third year was 42 weeks of core rotations, my fourth year was 30 weeks of electives that I completed in Toledo, ohio, USA from July 15, 2002 to February 21, 2003.
FoURTH YEAR
I completed my fourth year in Toledo, ohio, USA. I set up all my rotation there myself. It went as follows:
Family Practice (inpatient)
(4 wks) July 15, 2002 – Aug 9, 2002
Family Practice (outpatient)
(4 wks) Aug 12, 2002 – Sept 6, 2002
Internal Medicine (outpatient)
(4 wks) Sept 16, 2002 – oct 11, 2002 Gastroenterology (6 wks) oct 21, 2002 – Nov 29, 2002 Infectious Disease (6 wks) Dec 2, 2002 – Jan 10, 2003 Nephrology (6 wks) Jan 13, 2003 – Feb 21, 2003
Basically, fourth year is a time for you to choose certain areas that you feel will be beneficial to you and your future plans. I think Gastroenterology is very high yield. Also inpatient Internal Medicine is an area where you can learn a lot. Since I wanted to be in primary care I chose my electives in those fields (Family Practice, Internal Medicine, etc.).
You don’t really have to set up your rotations. You can stay at the same hospitals where you did your third year and that is the easiest way. I guess I wanted to make my life difficult, so I tried to set up all of my fourth year by myself. I just emailed several Family Practice residency programs, and a few said yes, I could come for an elective or two. Then, once I was there, I just started talking to doctors and asked them if I could “hang out” with them for six weeks or so. That’s pretty much the way it went.
My advice for clinical rotations is to try to do them at AC-GME hospitals that have residency programs. Also, make sure that the rotations offer didactic sessions (lectures or meetings). Some clinical rotations I did were just completely worthless. I learned absolutely nothing in them. The attending was never there and I just sat around. There is also an enormous amount of self-teaching. You basically have to be a self-starter and just get some good books and teach yourself.
If you can teach yourself, you will do well. But if you require spoon feeding, you will never survive and will never pass the USMLEs.
My friends, do NoT underestimate the amount of time you will need to complete everything (rotations, tests). You need a lot of time and hard work! Do NoT take time off during your clinical rotations. This has been proven to be the kiss of death. Guaranteed. The thing is that once you get into rotations, you are on your own. The school does not care if you take two years or four years to complete your rotations.
The problem with this is that if you give a slacker an inch, he will take a mile. So people take time off and never get things done on time, miss the Match, miss two matches, etc.
SUMMARY oF EvENTS
My dates for all my important events were as follows:
1 September 1999 Started Medical School in Caribbean 2 April 2001 Finished Second Year on the Island 3 July 2001 Passed USMLE Step 1
4 August 2001 Started Third Year in the U.S. 5 october 2001 Passed ToEFL
7 December 2002 Passed USMLE Step 2 CS 8 January 2003 Passed USMLE Step 2 CK 9 Feb 21, 2003 Finished Fourth Year 10 April 11, 2003 Received M.D. Diploma 11 April 17, 2003 Received ECFMG Certificate 12 May 29, 2003 Received Step 3 Permit
13 July 1, 2003 Took USMLE Step 3 14 August 15, 2003 Got Step 3 Result
15 Sept 1, 2003 Sent out Residency Application 16 oct, 2003-Jan, 2004 Attended Interviews
17 March 2004 Residency Program Match
18 April 2004 State Training License Application 19 April 2004 H-1B Visa Application
20 June 2004 obtain Social Security Number 21 July 1, 2004 Start Residency
It is my firm belief that it is chronologically impossible to complete all this in four years. Guaranteed. Canadians and other non-U.S. citizens who want the H-1B Visa will need an extra year (or two!) to complete all this.
I have never heard of any non-U.S. citizen who started in Sep-tember to successfully be able to start residency on July 1 four years later. Even the lucky ones, who match on time, need several months extension from the residency program to complete Step 3, get a training license, get a social security number, etc.
Chapter 4
USMLE
USMLE STEP 2 CK (CLINICAL KNowLEDGE)
I started studying for this test about two months into third year and studied straight into my fourth year. A lot of studying! I initially read the:
1) Blueprints Series
(five books – Psyh, Peds, Surgery, Int Med, oBGYN) 2) Blueprints Q&A books (five books)
The Blueprints series is a good start. They are easy to read,
you can read each book in just a few days (or weeks). The books are concise and have some good questions in the back. The matching Q&A books are good, but they only have approximately one hundred questions per book. once I read the Blueprints, I was ready to get into more details. So I started with the:
3) Kaplan USMLE Step 2 CK books
These books are very detailed and have a ton of info. I think they are the very best books on the market for USMLE Step 2 CK. They should be read repeatedly.
After I finished with them I started practicing questions with: 4) Kaplan Step 2 QBook (850 questions)
5) Kaplan Step 2 QBank (1000 questions) 6) Kaplan CD Rom (400 questions) 7) NMS Step 2 QBook (900 questions)
once I finished I reviewed with this great little book by Adam Brochert called:
8) USMLE Step 2 Secrets
Great book! Best review book out there for Step 2 CK! The author also has written a matching question book called Mock
Exam.
www.usmle.org also has 150 questions that you can get from
them for free.
USMLE STEP 2 CS (CLINICAL SKILLS)
CLINICAL SKILLS ASSESSMENT
(formerly known as the CSA - CLINICAL SKILLS ASSESSMENT)
This exam consists of 11 patients (not real patients, they are actors). You basically go into each room with a clipboard in your hand. You have 15 minutes to take a history, do a physical exam and discuss tests and possible diagnosis. Then you come out of the room and you have 10 minutes to write a patient note.
There are certain things you must do with every patient (or you will fail). Those things are:
1) Always examine directly on skin. Never through a gown. 2) Always auscultate directly on skin. Never through a gown. 3) Always wash your hands before touching a patient. Basically, before you go into the room, there will be a note on the door. It contains the introduction info about the patient, like the chief complaint and vitals.
You then knock and enter. Introduce yourself. “Hi, I’m Asad Raza. I am a medical student, and your name is?”
You then start asking questions. 1) Chief complaint
2) HPI (History of Present Illness) – onset, Duration, Pro-gression, Frequency, Location, Radiation, Quality, Inten-sity, Alleviating factors, Aggravating factors, Associated symptoms. The mnemonic is oDP FLR QI All Agg Ass 3) PMH (Past Medical History)
4) PSH (Past Surgical History) 5) FH (Family History)
6) SH (Social History) – Alcohol, Tobacco, Drugs, occupa-tion, Marital status, Diet, Sleep, Sexual activity, Exercise. Mnemonic is ATD oMD SSE
7) Medications 8) Allergies
9) Review of Systems
Just go through this standard list. Write down the answers the patient gives you on the paper and clipboard you are provided.
It’s actually very easy. Some cases have a few other things you need to ask (of course). And, for some cases, you don’t need to ask as much. This part of asking questions should only take about five minutes. Now, at this point, you are ready to do the physi-cal exam. Remember to wash your hands. Palpate, percuss and auscultate directly on skin – not through a gown. The standard things to check on a physical exam are: Heart, Lungs, Abdomen.
There is one very important and interesting thing I want to point out. This test is not really a test of your physical diagnosis skills. For example, as long as you put your stethoscope on the patient’s heart, you will earn the point for that part of the exam. Remember the patients are not doctors! They are just normal people who are there to act. If you spend a lot of time with your cardiovascular exam, you will still only earn that one point. So stick the stethoscope on the patient and then move on to the next thing.
The physical exam should take about five minutes. Now, for the final five minutes of the 15 minutes you are in the room, you discuss the tests you are going to order and what possible things you think the patient might have. Basically, you tell the patient the work-up plan and the differential diagnosis.
Then you thank the patient, shake hands, walk out of the room and sit down and write your patient note. You have ten minutes for this. You are given a standard form to fill out. You write down basically exactly what happened in the room.
I took the exam on December 13, 2002 in Atlanta, Georgia. I took the Greyhound Bus from Toledo, ohio to get there.
The only thing I used to prepare for this exam was those 40 cases that are floating around the internet. It’s a PDF file that has 40 cases that are written exactly the way they appear on test day! The file, when printed out, is 190 pages. Each case goes through:
oPENING SCENARIo:
This is exactly what is hanging on the patient’s room door. PATIENT PRoToCoL:
CHECKLIST:
The exact questions you need to ask for this case to score the points you need to pass.
WRITE-UP:
Sample answers of what you should write on test day!
These cases are exactly what the actual test is like. They are the best. Just memorize them cold and you will be set. Don’t waste your money on that worthless oSCE book. Those 40 cases are all you need.
The cases that I used to study for the USMLE Step 2 CS are available here: www.CanadaQBank.com
USMLE STEP 3
After I finished all my fourth year electives on February 21, 2003, I contacted my school to request my M.D. Diploma. They sent it to me on April 11, 2003. I immediately sent a copy to ECFMG and I got my ECFMG certificate on April 17, 2003. I then sent out my application for Step 3 to FSMB with a copy of my M.D. diploma and ECFMG certificate. I got the permit to take the exam on May 29, 2003. I registered for the state of Connecticut. After I got the permit I called my nearest Prometric center (in Michigan) and scheduled a date for July 1 and July 2 (it is a two-day test). I got my results six weeks later in the middle of August. Then I was ready to apply for a residency with ERAS. The ERAS cycle opens up on September 1. Perfect timing.
I started studying for USMLE Step 3 as soon as I was done with Step 2. I read:
1) Kaplan USMLE Step 3 books (Internal Med, Neuro, Peds, Psych, oBGYN, Surgery, Epi/Ethics)
These are really good. I read them twice and then started on questions with:
