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Obtaining a US Residency
IMG Tips for Obtaining a U.S. Residency
As a Foreign Medical Graduate (FMG or IMG) applying for a residency in the U.S., you face tough competition. But that doesn’t mean it’s impossible. There are some key differences in the approach that should be taken by an FMG vs. a U.S.-trained physician, and being aware of those differences will put you ahead of the game. Here are the four primary things that Residency Directors focus on when evaluating the application of an FMG.
1) USMLE scores
2) Letters of Recommendation
3) Research/clinical experience in the U.S.
4) Personal Statement
Obviously, when it comes to the USMLE your goal is to achieve the highest possible score. Oddly enough, it is sometimes recommended that you try to fail the USMLE on purpose if you do not believe you are doing well, since you won’t be able to retake it if you just barely pass.
Beyond test scores, there are several other things you can do to increase your chances of obtaining a residency position. Below are some tips for setting yourself apart from your peers:
Gain U.S. experience.
Prior to applying for a residency program, you should try to obtain as much experience in the U.S. as possible. Even though you may have trained extensively in your home country, it is difficult for Residency Directors to determine the level of your experience in a U.S. context, which is why they focus so heavily on your U.S. experience.
Experience can come in the form of paid positions, electives with medical schools or hospitals, internships, observerships, or volunteer positions. Any U.S. experience should be listed clearly on your application, and your overseas experience should be described whenever applicable. Keep in mind that a job title can sometimes indicate completely different levels of responsibilities in different countries. Therefore, be clear in describing the responsibilities you’ve held throughout your career thus far.
Show commitment to your chosen specialty.
It’s possible that you chose your desired specialty based on what is least competitive in the U.S. Often physicians who were ER doctors in their native countries decide to pursue family practice or internal medicine positions in the U.S. because there are more opportunities available in those areas. That’s perfectly OK and sometimes a smart thing to do…but you do not want to convey this when applying for a residency.
It is important that you convince the Residency Director that you are dedicated to the specialty you’ve chosen. And simply saying that you are dedicated is not enough. You need to show it through the experience you have gained, the electives you have chosen, and the research you have done.
Participating in research projects is one way to show commitment to your specialty. It also shows faculty members that you will not need additional training in research basics. Be careful, however, of the type of research you do. Ideally, you want to participate in research projects as part of an internship or observership as opposed to in lieu of those positions.
Making presentations is another way to 1) show commitment to your specialty, and 2) get face time with your supervising physicians, which will translate into stronger letters of reference (see below). If the opportunity arises, offer to update your department on a certain topic or to present a lecture to residents and medical students.
Finally, while some of your experience in a foreign country may be helpful to your specialty in the U.S., you do not want to dwell on prior experience in your application if it is not relevant. In the case of obtaining a residency, well-roundedness is not a virtue.
Letters of Reference
Letters of reference from physicians you have worked with in the U.S. are a very important part of your residency application. It is not enough to simply have several “nice” letters. Your letters need to be laudatory and specific in terms of your skills and strengths.
But how do I have any control over what is written?
Beyond simply asking someone to write a letter for you, there are several things you can do to affect the quality of the letter that is produced on your behalf.
1) Work hard and get noticed.
Saying that you really want to practice in the U.S. is one thing…demonstrating it is another. It is important that you do everything in your power to gain U.S. experience and to make the most of every position, whether it’s a volunteer position or a paid position. Work on weekends, take extra calls, establish yourself as someone who can be counted on by your colleagues. This will not only enable you to learn as much as possible in a short period of time, but it will translate into strong letters of recommendation.
Keep in mind that working hard is only valued if your hard work is noticed by others. The more valuable you are to a program, the more your supervising physicians will be aware of your skills and strengths. It is not enough to just show up every day and do what is asked of you. You need to ask questions, offer to make presentations, and help out wherever you see a need. You want your efforts to be remembered by your colleagues when it comes time for them to recommend you to a residency director.
2) Don’t procrastinate.
Don’t wait until you are leaving or have already left a position to request a letter of recommendation. If you do, the person writing the letter might put it off, forget completely, or be unable to recall your work at the time of writing the letter. You want the person writing the letter to see you on a regular basis while he/she is completing the task. This will not only ensure that you receive the letter in a timely manner, but it will ensure that your skills and strengths are fresh in the writer’s mind.
3) Be prepared.
A strong letter of reference is one that is as specific and detailed as possible. A letter saying, “John is hardworking and polite” is not nearly as effective as one that states, “John has worked harder than any of his peers and contributed greatly to the office by streamlining billing procedures, working directly with patients when I am understaffed, and offering to work nights and weekends when needed.”
One way to help ensure that you get an outstanding letter is to type a list of attributes that you would like to highlight. Now, you don’t want to hand this to the person writing the letter without being asked to do so, or he/she might take offense. But a lot of times the person writing the letter will ask you for assistance. Some might even ask you to write a draft of the letter for them to review. While this can be a tricky situation, make sure you take advantage of it. Don’t be afraid to really sell your best qualities.
3) Make sure you review the draft.
Don’t ever allow a letter written on your behalf to be submitted without reading it first. It is your right to read the letter and to choose whether or not to use it based on its content.
The Personal Statement
The personal statement is an extremely valuable tool for the FMG. Not only does it give you an opportunity to demonstrate your proficiency in English, but it is your one chance to tell the admissions committee exactly what makes you great. Take advantage of this!
In order to determine what belongs in your personal statement, spend some time doing brainstorming exercises. Write down everything that comes into your head about why you feel you would make a great resident and a great physician. Are you a strong leader? Do you have good interpersonal skills? Think about all the compliments you have received over the course of your medical training. What areas do you excel in? What makes you stand apart from others?
There are three major components to the successful FMG’s personal statement:
1) Clinical experience
It is critical that you convince the residency director that you are able to handle the rigors of a U.S. residency program. The challenge you face as an FMG is that residency directors will be looking to discredit your education & experience outside of the U.S. as being below U.S. standards.
If you have had any experience in the U.S., you need to explain this in explicit detail in your personal statement. This includes not only post-graduate positions, but any rotations you might have completed at U.S. hospitals during medical school. Describe the toughest cases you had to handle; explain your interaction with hospital staff; and give details about your typical workload, the type of patient population you worked with, and the level of responsibility you held.
If you have not had experience in the U.S., but you feel you have had comparable experience in another country, you need to explain why you feel this way. Do not assume that residency directors are familiar with the nuances of medical training in your country. It is up to you to convey the level of your training and to explain how your experience relates to that of your peers in the U.S.
2) Reasons for choosing a specialty
During the brainstorming phase, write down very specific reasons why you are interested in a particular specialty. Simply saying “I have always admired surgeons” isn’t enough to convince a surgical residency director that you will succeed. You need to show him/her that you are truly passionate about your chosen specialty, and that you have the skills necessary to succeed in that specialty.
For example, if you are targeting family medicine or internal medicine, you might discuss your interpersonal skills, ability to multi-task, and desire to work with a very diverse patient population. Make sure that you give examples to support each statement you make. Rather than simply saying, “I have always had a good rapport with my patients,” give specific examples. Did anyone ever compliment you on your interpersonal skills? Have patients specifically requested you because of the relationship you’d built?
If you already have had experience or training in the specialty you are applying to, then make sure to describe that training in detail. Perhaps you haven’t had direct experience in your specialty of choice, but you have had experience that relates to that specialty. That should also be emphasized in your personal statement.
3) Personal information
Since this is, after all, a personal statement, you should infuse a bit of your background and personality into your writing. This can include some details about your life and your upbringing, interests and hobbies you have outside of medicine, and/or a specific event that was meaningful to you.
You do not want to devote too much of your personal statement to these topics since your main objective is to convey your experience and skills. However, this can help to make the reader feel that he/she is getting to know you, and it can also be used to highlight some important personal qualities. For instance, if you have participated in volunteer work, excelled in sports, or maintained a long-term hobby, this will say something about your commitment level and work ethic.
After you have determined what will be in your personal statement, the actual writing and editing process begins. This is extremely important! What you say will only be as strong as how you say it. For this reason, make sure you get input from a professional writer or from someone you know who is a native English speaker and is very confident in his/her writing ability.
The Interview
You scored an interview? Fantastic! That’s a huge step on your way to success. But don’t allow yourself to get too comfortable. While getting an interview means you “passed on paper,” it is equally important that you impress the Residency Director in person. Here are some tips for doing so.
1) Spend a lot of time brainstorming answers to potential questions.
Do research to find as many typical interview questions as you can, and spend a lot of time thinking of what your answers would be. Of course, you won’t be able to guess every single question that might be asked, but you can get pretty close. Take advantage of the time you have now to clearly assess your skills and strengths. Write out your “ideal” answers on paper. The more time you spend doing this, the more easily the answers will flow during an interview. They will already be on the tip of your tongue and you won’t find yourself caught off guard and later thinking: “If only I’d said that.”
2) Listen closely to the interviewer.
Sometimes in an interview situation, you can get so caught up in how you are coming across and what you are going to say that you lose sight of what is being said to you. Make sure that you are fully present in the interview and that you listen closely to the questions that are being asked and the information that is being told to you. First of all, this will help you to ask intelligent questions at the conclusion of the interview. Secondly, you want to answer each question thoroughly. If an interviewer asks you a two part question and you only answered the second part, he/she will think you weren’t paying attention.
3) Avoid excuses.
An interview is sometimes an opportunity for you to explain those things about your application that might be less than stellar. Poor test scores, poor grades, or lack of experience may be brought up by the interviewer. If so, you should focus on how you have compensated for those lesser aspects of your application rather than giving excuses. If your low scores, etc. were a result of a specific incident in your life, such as illness or the illness of a family member, you may want to mention this very briefly. But don’t dwell on a lengthy explanation. Merely state the cause of the problem and then focus on how you overcame that issue.
4) Relax!
If you’ve spent sufficient time prepping for your interview, there is no reason why you should be tense during the interview itself. Take a deep breath and feel confident in the fact that you are a strong candidate who is well prepared. Don’t be afraid to show a little bit of personality. While you don’t want to be too casual, you also don’t want to come across like a robot programmed to spit out answers.
Conclusion
Securing a position in a U.S. residency program is a difficult thing to do. But those things that are most difficult are usually the most rewarding. If you approach the process with diligence, patience, and a positive attitude, you will surely meet with success. And once you’ve overcome this hurdle, you will have made a great stride toward a fulfilling career.
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Finding a J-1 Waiver Position
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Medical Students' Guide to the CV
Writing a Personal Statement
The most important step to getting the residency or fellowship you want.
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