Medical Career in USA…the Steps to Success..

1. The Exams

The USMLEs (United States Medical Licensing Examinations) are a set of medical exams designed to evaluate your readiness to safely enter the American medical system. The organisation that watches over the application of foreign nationals to the American Medical system is the ECFMG (Educational Commission for Foreign Medical Graduates) and they administer the USMLEs outside of the USA. USMLE are multiple choice exams that are now only held on computer. There are three steps to completing the USMLE exams. Your nearest testing center can be found on www.prometric.com

The first part, USMLE step 1, is a multiple choice exam consisting of about 300 questions taken over eight hours in one day at the test center. The step 1 covers all of the basic sciences - Anatomy, Biochemistry, Physiology, statistics, Behavioural science, microbiology, pharmacology, pathology and ethics. 66% of international medical graduates pass this exam with each sitting, while 91% of US medical students do.

The second part was recently divided into two parts, USMLE step 2ck (clinical knowledge) and USMLE step 2cs (clinical skills). USMLE step 2ck consists of a similar one day computer based examination, and covers all of the clinical sciences including medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry, forensics, emergency care, ENT, ophthalmology, tropical health, ethics. 75% of international medical graduates/students pass this on first sitting, while 95% of US medical students do.

The USMLE Step 2cs examination is a newer requirement for ECFMG certification. The USMLE step 2cs is an expensive ($1200) examination is held in only a few American cities throughout the year. It brings examinees face-to-face with ten simulated ('standardized') patients - ie actors pretending to have specific complaints. You are tested on your ability to rapidly assess a patient, communicate your thoughts to them, and to write a note about your assessment and plans.

2. The ECFMG Certificate

The ECFMG (Educational Commission for Foreign Medical Graduates) certificate is a document proving that you have fulfilled the education requirements needed to practice medicine in the USA. The Necessary components are to have
1. - your medical degree and transcript verified by ECFMG (can take a long time)
2. - passed USMLE 1 and 2ck
3. - passed the clinical skills assessment (or step 2cs)
4. - passed a TOEFL english examination (or step 2cs)
5. - paid ECFMG in full
All of these components must be valid at the time when you apply for final certification. This certificate testifies to the fact that you have fulfilled the requirements for entry into clinical training in the USA.

3. ERAS

The electronic residency application system (ERAS) is a method of centralised, computerised application for residency. After you have paid the required application fee and requested a 'Token' via the On-line Applicant Status and Information System (OASIS), ECFMG will send a unique identification number ('a Token') by e-mail. This Token will permit the applicant to access the AAMC's ERAS website to complete his/her ERAS application on-line. Simultaneously, you'll have to mail photocopies of your supporting documents to ECFMG. On this online site you have to
a. enter your personal details in a standarised curriculum vitae
b. enter a personal statement (click here for advice about creating your personal statement) and...
c. designate the residency programs you wish to have your application sent to.

The supporting documents that you have send in the mail include
1. your photograph
2. your examination transcript and
3. your letters of reference
4. your dean's letter /medical student performance evaluation

Foreign medical graduates send these paper items to the ECFMG who act as your "dean's office". They scan your paper documents and photo, match it to your online application items and e-mail the lot to the residency programs you selected. You should complete all of the ERAS application procedures as soon as possible, but by December 1st in your year of application at the latest.

4. Interviews

The most difficult part in your application will be securing an interview.
There are no guaranteed methods to getting an interview at any of the top hospitals. However you can increase your chances by

- doing an elective
- getting good USMLE scores
- doing well in your own medical school
- having a research publication
- having very strong letters of reference from your dean and referees

5. The Match
What happens in the Match is .....
(1) You apply to the programmes in the hospitals that interest you
(2) those programmes that are interested in you will invite you for an interview
(3) after the interview, the hospital ranks you among all those they've interviewed
(4) After all your interviews, you rank the programmes that you want and
(5) on a certain date in March, all of these preferences are chewed on by a computer and the hospitals are matched with the applicants.

You will optimise your chances of matching by...
(1) Being organised and ready
(2) having good grades, USMLE scores and references
(3) performing well at interview
(4) having done an elective at the hospital you're applying to
(5) knowing about your visa plans

You can obtain a position before the match too. This happens when programs are sufficiently impressed with you (or sufficiently desperate for applicants) that in the days or weeks after the interview, they offer you a position directly, providing you agree to withdraw from the match right there and then, and sign the paperwork. This works well for less competitive candidates who are very unsure about their potential to match through the ranking process, and are happy with the offer.