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The Myers Hurt Method Podcast

Countdown to the MATCH - the official podcast of the Dr Myers Hurt AKA the Match Gurus is the only podcast dedicated to helping residency applicants shine on interview day. Dr. Myers Hurt discusses specifics involving the NRMP and ERAS, and dissects common (and uncommon) residency interview questions for The Match.
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Now displaying: August, 2016
Aug 30, 2016

Questions on today’s podcast come to us from Dr. Sagar Shah via twitter - you can follow him @thisissagarshah In a short exchange he asked questions a lot of our IMG clients ask, and I thought the answers would be valuable to a wider audience, so I’ll answer them here. There is a lot of good information available online from different sources like the ECFMG, ERAS, etc.  so I won’t regurgitate a lot of that stuff and will instead give more personal advice.

Any US student who wants to get a bit of understanding may also gain some insight from today’s topics. As you may remember from earlier episodes, only about 50% of any given match year over the last 10 years has been US allopathic MDs, IMGs made up about 40% of the pool or may not know, IMGs currently make up about 25% of the physician workforce. Most of those in Internal medicine, psych, pedi - more primary specialties. Regionally, New Jersey, New York, Florida, and Illinois had the highest concentration of IMGs when last polled in 2009 - could have shifted a bit since. The country supplying the most IMGs is India, the Caribbean schools collectively make up a huge chunk - Dominica, Grenada, Netherlands Antilles, then Pakistan, China, Philippines, Mexico - overall 127 different countries granting ECFMG certificates in this 2009 paper. So, a bit of perspective - as a US student you will absolutely work with an FMG in the near future, and as an FMG, you will not be alone when you match into a US residency program. Let's get into the questions:

Dr. Shah asks: Can you give a good strategy for IMGs?

This is a very loaded question with about 50 questions encapsulated into this one - so I think I know what you are asking and I’ll try and outline a “good strategy” for any IMG.  When we work with clients, each individual candidate is unique - geography, speciality, graduation year, family concerns, US experience, visa status, etc - so it is hard to point a whole group of people in one direction with advice, but there are some highlights:

  • Do as well as you possibly can on the USMLE. I can not emphasize this enough.  Some foreign schools already have credibility in certain states or in certain programs so that PDs and state licensing boards are familiar with the caliber of graduates that come out of them. Lots don’t - so doing well on a standardized test makes you look good comparing apples to apples. Be prepared to do whatever it takes - multiple review courses, thousands of dollars, multiple months off for individual study.  SImply put, the higher your score, the better your chances.
  • Know your priorities - as an FMG, getting a US residency spot is already a hard process, for you and your family, and it is a hard choice both personally and professionally when deciding what you are going to prioritize. Ultimately you may find yourself needing to choose between practicing any type of medicine in the US vs practicing a specific specialty anywhere on earth. You will often see IM or FM residents in US programs who were Orthopedic Surgeons or Ophthalmologists in their home countries, but they choose to change specialty to practice medicine in the US. On the flip side you see US citizens who go out of the country for medical education, fall in love with Dermatology or Otolaryngology to the point that they remain in their training country to practice that passion instead of trying to get into the hyper competitive US options. Think about these options when deciding what would benefit you and your loved ones the most.  
  • Be flexible - the saying “beggars can't be choosers” absolutely applies here - apply to a huge number of programs, and absolutely apply to multiple specialties. Consider multiple geographic regions.  If finances are a strain, you can focus your efforts, but the reality is that extra 12/16/26 dollar fee to tack on one more program is a drop in a bucket and can get your foot in the door to a six figure salary for the rest of your career - now is not the time to pinch pennies.
  • Be realistic - short term - knowing where to apply and how to go about it, and long term as well. Some IMGs end up compromise too much and get stuck in patterns of multiple prelim years, malignant programs, grad school, and other endeavors to try and become more competitive for the match and can paradoxically become less competitive, and really mount up debt. Some test prep courses can be these endless loops of multiple time test takers, who can ace qbanks but not get residencies - end up a tutors, advisors, lab assistants, phlebotomists, foreign MDs are definately not guaranteed anything in the US. Know how competitive you are and focus your efforts accordingly.
  • Use your connections - anyone you know - and I mean anyone, previous alumni, any friends or relatives, anyone you rotated with on AI or observership.
  • Play to your strengths - whenever the opportunity arises - PS, LORs, interview, make sure you let them know you speak multiple languages, talk about your hands-on experience, paint a picture of IMGs as a group that is hungrier, harder working, more resilient, more flexible - willing and able to move countries to train.  As any US students listening may not realize that different countries have regulatory bodies and medical training outside of the US can be drastically different - US students have curriculum that can be evidence based, problem based, well researched, validated tools, etc. learn from an online module, and get excited when an attending lets them throw a few simple interrupted sutures during closing - when students in Mexico for example don’t have the luxury of having a note taking service, or even professors who know what is covered on Step 1, but they were first assist in transplant cases with a resident in charge  - no fellow, resident, other students fighting for the case.
  • Be optimistic - don’t believe everything you read on SDN or valueMD or other forums. Plenty of IMGs have jobs. In fact, IMGs make up about 25% of the current physician workforce.  This is a subject that hits close to home as personally, I am an IMG, and it is the reason I wrote my book and the reason I started this business was to help IMGs - I think they are a vital portion of the medical workforce and bring elements to US medicine that will continue to drive it forward. “Millennial” generation with note taking services, angry when a professor didn’t tell them what question was going to be on a test, upset over anything less than perfect on an evaluation form - nauseating and not indicative of patient care. IMGs traditionally flying blind, fighting tooth and nail for any position available often taking USMLE on their own, with bootleg study review materials, fighting for any leg up, fighting to find material relevant to the USMLE vs deciding between 4-5 books to see which is best. A handful of common US student complaints are about not getting enough away rotations, or the lack of financial support or housing, or getting an evaluation from a resident that an attending signs, or even an attending you didn’t really spend time with. Meanwhile IMGs may have clinical rotations in 7 different cities with a loose word-of mouth network of where to live, and shared subway cards, IM in Chicago, then OB in NYC, Psych in LA - and they are grateful for a LRO in English from ANYONE, much less the person who will give them the best letter.  Long list of intangibles that IMGs deal with often that departments may or may not know - you have been through a lot, you will get through this too.

Dr. Shah asks: What is more important for IMGs - research work, or electives and observerships?

  • Clinical, clinical, clinical. Research is important, but to frankly answer this question, I have to emphasize clinical patient care. You are looking to get into a program to take care of patients, so show them you can take care of patients - the more involved the better. Get an LOR out of the experience, and if possible get it at a hospital you want to train at.

Dr. Shah asks: What are the common mistakes made by IMGs when applying to residency programs?

  • Prior to applying - Not doing your homework - not using connections, not looking at the specifics of visa paperwork, how to get one, which ones you need, if a program will sponsor it. State specific in some cases, program specific.
  • Commonly overestimate their value - look at your scores, look at your application, you will not get ortho - there is a difference in being optimistic and being delusional - miracles may happen elsewhere, but don’t bank on it in the Match.
  • Commonly underestimate their value - in the current landscape, there are still not enough US grads to fill all of the available spots - your life, happiness and career are not worth too much compromise. Bad program, on probation, abusing residents, poor education, poor employment opportunities - that will be a bigger stain on your record than your foreign school - at the next level you are always judged by the most recent level - you are no longer a *** grad, you are a *** resident.
  • Common mistakes during the interview I have seen - focusing too much on justifying academic performance - many foreign schools work on strictly objective, merit-based rewards - highest score gets the highest spot. I encourage all of our IMG clients to remember the social component - telling families they lost a loved one, discussing cancer diagnoses, end of life care, navigating health system beliefs.
  • Nuances of the english language lost in translation - miscarriage vs abortion, obesity vs fat, spanish culture.    
  • Forgetting that this is a job to learn - when coaching US clients we usually work on US lifelong student changing a mindset from student to employee - need to work on projecting leadership / confidence / reliability / autonomy that go with patient care, and dampen the submissive, passive traits. IMGs I see a lot of the opposite - well established physicians that may carry respect / klout to a degree that need to change mindset to a more traditional learner. Programs don’t want to but heads with someone for multiple years who is coming in and telling them how to do things or how they used to do things back home - you are there to learn from these people, learning pt care, learning communication, learning procedures - even if you have performed 200 knee replacements back home, you are interviewing to be an intern  next year - wound vac changes, bowel disimpaction, perhaps someone half your age being your superior, etc - show THAT aspect of your personality.

For our last question today, Dr. Shah asks: Looking at the current scenario can an IMG with a green card get into Radiology residency?

Yes - do your homework, be flexible, be realistic, know yourself - all of the above apply. Know that they are not going to hand it to you, and you are going to have to work for it, but be optimistic. FIrst I would make sure I was a competitive applicant - are my scores well above average? Would my application as a US student be competitive? Look at “Charting outcomes in the Match” - diagnostic radiology - step 1 235, step 2 240 - Data shows while most applicants matched at 240 and above, 14 of these “independent applicants” matched with 200 or less.

If you were a client, I would polish your application - make sure your strengths come across as strengths, and any red / yellow flags are addressed. CV polished, appropriate experiences highlighted, perfect multiple PS, LORs appropriately uploaded. Etc.

Create a spreadsheet, look at every website to determine if they are “IMG friendly”, or call them all - or even outsource that.  When I was applying freelancing was taking off, I hired a virtual assistant call every program coordinator I was interested in and ask bluntly about cutoffs and multiple attempts, IMGs - whatever your specific situation. If you were my client, that is something we can arrange for you.

Once you have your list, polish your application - would tweaks in your PS add to your application? - geography specific or school specific - are you familiar with a professor’s works, research,etc. Mention these specifics so they stand out once you clear the initial hurdles.

Then, apply to every single one you can afford.

That would then generate a handful of interview invitations, I would walk you through how to communicate with programs, how to best schedule, and we would practice radiology-specific mock interviews with explicit feedback on body language, diction and word choice, confidence, how to tell your story given different interviewer styles or different question types to make sure you are your best self to these handful of people in a handful of hours. We would help you create your rank list, and sit back and wait patiently. There are some other pre and post communication nuances we could coach you through if they arise.

As a backup plan, take that same list of programs, and apply across the board to preliminary medicine (or surgery) programs with radiology departments you want to train at - if you don’t match in radiology, you will at least have a US residency spot as a foothold. I would show you how to structure your rank list to set you up to rank at any radiology program first, then fall to your top choice IM program. During that year, spend every free moment with the radiologists and let them know your interest. Radiology reading rooms - trauma call in the ED - hang out with the residents, and talk with faculty if available - let them know your interest bluntly and that you will be applying next year. To a US residency program, a year spent in US clinical medicine is better than 5 years at the best hospital in any other country, research, perfect step scores, etc. You would now be Dr. Shah, intern at *** IM program. Keep up with radiology CME websites / trending news - be able to discuss specifics of scans - really impress these people.  They will be doing the interviews, can pass the word up the ladder, and the more senior resident will be the chief residents.

In addition, there are rare opportunities to jump into available spots mid-year - so we would be looking for any available spot that opens mid-year - funding is attached to resident slots, so if people leave secondary to illness or family crisis, or disciplinary action,etc. , there are opportunities to move laterally into programs.

Not foolproof, and no guarantees, but a solid plan to set you up to be that approximately 30% of the entering PGY 2 class that comes from outside of US allopathic seniors.

To join the Myers Hurt Method Course, visit https://www.drmyershurt.com/themyershurtmethodcourse

Aug 21, 2016

Hey everybody this is Myers Hurt with another edition of “Countdown to Match Day,” the official podcast of the Match Gurus, and the only podcast aimed at helping applicants shine on interview day. Remember to follow us on twitter @theMatchGurus and send any questions you want answered on the show. If you like the content please take some time to leave a review on iTunes, or review the book on Amazon.

In true countdown style, this season we’ll release one podcast each week for the 40 weeks leading up to Match Day.  This is season 1 episode 9 - now 32 weeks to go until #MatchDay2017. Let’s get started:

What to expect - usually the resident dinner is a collection of applicants and residents, set up as an informal environment to get some questions answered from the resident point of view. There is no set question time / eating time, it just flows naturally.

Who will be there: residents and their significant others - specifically to answer the most amount of questions for the most amount of people. Consider the scheduling from the other side. Residents already feel overworked and underpaid - even with free food as an incentive - it says a lot to volunteer time to go out after a 12-16 hr day only to talk about how much you love that 12 or 16 hour day. Consider the timeline as well - as chief I could always get people fighting over the first few free steaks, then late in the season it could be pulling teeth.

Who to bring: spouses are ok, children, parents, friends - even girlfriends/boyfriends are not. No need to bring anything to take notes, anything to try and impress people - just an opportunity to be yourself.

What to wear: not a suit, not jeans and a t-shirt - something in between - a business lunch or business dinner. Collared shirt with or without blazer, good rule of thumb is it is always easier to dress down instead of dressing up.

What to order: If you have any preferences as far as vegetarianism, vegan, kosher, food allergies, etc - feel free to mention to the program coordinator - feel free to communicate without being judged.

Alcohol - borderline issue - never be the first to order alcohol, tea, water, soda are safe bets - if the most senior person at the table orders a beer or some wine, feel like the ice is broken, and go for it. Always ok to abstain without fear of being judged, just don’t order bottle service, not Jersey Shore. Remember that you are always being interviewed. I understand both arguments - in a stressful environment, one glass of wine takes the edge off, however, if alcohol makes you anything less than your best self, best to abstain.

Nothing new - allergies, don’t like the taste.  Nothing sloppy or saucy - think first date - want to enjoy a civilized meal in a nice setting, no need to wear most of your dinner, or embarrass yourself.

What questions to ask: “front line” questions - parking, housing, child care, - things that are important to you.  As well as how they feel - do they get along with faculty, do they get along with each other, do they feel like they are learning, good balance of learning and autonomy to learn by doing

Pearls: remember the resident’s names - it always comes up the next day - who did you go out with? Multiple people ask, and simply by remembering the names of your future colleagues shows an incredible amount of interest. Forgetting people or forgetting what you talked about is a red flag.

You are being watched - how you interact with the waitstaff, hostess, etc all reflects on how you will work in a team. In the hospital, you have nurses, students, PT, OT, maintenance, dietary, mid levels, attendings, etc - I’m Texan, so yes ma’am, no ma’am and holding doors open for people is second nature, but anyone rude to the waiter or waitress is absolutely going to hear about it. Would always be suspect of a candidate who was rude.

To join the Myers Hurt Method Course, visit https://www.drmyershurt.com/themyershurtmethodcourse

Thank you to everyone for listening, remember to send you questions to us through our website at www.thematchgurus.com, twitter @theMatchGurus, or snapchat.  Our book is now available on Amazon - please leave a review there as well. Take care.

Aug 21, 2016

Hey everybody this is Myers Hurt with another edition of “Countdown to Match Day,” the official podcast of the Match Gurus, and the only podcast aimed at helping applicants shine on interview day. Remember to follow us on twitter @theMatchGurus and send any questions you want answered on the show. If you like the content please take some time to leave a review on iTunes, or review the book on Amazon.

In true countdown style, this season we’ll release one podcast each week for the 40 weeks leading up to Match Day.  This is season 1 episode 8- now 33 weeks to go until #MatchDay2017. Let’s get started:

In this episode, I talk with Dr. Mike McInnis - we talk about Internal Medicine, how to identify a good Internal Medicine program, introverted personalities, and social medic during the interview season.

To join the Myers Hurt Method Course, visit https://www.drmyershurt.com/themyershurtmethodcourse

Thank you to everyone for listening, remember to send you questions to us through our website at www.thematchgurus.com, twitter @theMatchGurus, or snapchat.  Our book is now available on Amazon - please leave a review there as well. Take care.

Aug 4, 2016

I want to break format today and talk exclusively about the personal statement this episode. I know a lot of you already have one, or have at least a draft of one, but with enough time between now and September 15th (and even after that) I will help you make it better.  

I think there is a sort of comfort level and confidence that med students approach the PS with and that is fair - because all of your previous personal statements up until now worked. Lots of positive reinforcement - positive thing - however those were personal statements for you to convince people you are good at reading, studying, and taking tests.

Residency is a job. Literally the first “real” job you will have as a physician. This is a personal statement to convince programs you deserve a job.  Lean away from telling them you have objective skills, and towards subjective skills. Demonstrate professionalism, communication skills, teamwork, goal setting, and understand the challenges and demands of the road ahead, and still want to make a living at it.

Almost breeds an inherent difficulty as the typical med student had curriculum focused on math and science, or at least prioritize them over language and arts, now asked to produce a written piece that we are not necessarily that comfortable with. To add to the discomfort this a rare moment that you are both the salesperson and the product.

NRMP data from the 2014 program director’s survey ranks it as the fifth factor used when deciding who to extend interview invitations to (Step 1, LORs in the speciality, MSE (Deans letter), step 2 CK, then personal statement) and about halfway down when deciding who to rank - so it is up there to get your foot in the door.

I would consider it one of the only subjective methods to tell your story before the interview - CVs and transcripts, USMLE scores all fit into boxes well, LORs and dean’s letter are what others say about you - PS is the only chance you have to tell you story - talk about yourself.

 

  • More important to a program that does not know you - no rotations, no sub-Is, no away rotations - how are they going to get to know you and your work ethic?

 

  • Opportunity to briefly explain any gaps in your record - if done carefully and cast in a positive light

 

  • Proficiency in english language - for IMGs from unknown schools

 

  • Behavior patterns: Writing styles that can identify positive or negative behavior traits - I,I,I,I - narcissism, whereas too much self-depreciation or responsibility sloughing may shine through

 

If you haven’t looked at MyERAS yet - there is no specific prompt - extremely open ended - what should you write about?

 

Personal statements need to be:

 

Written by you

 

A study performed by the Brigham and Women's Hospital In Boston, Massachusetts published in MedScape article ''Level of Plagiarism in Residency Application Essays Worrisome'' revealed that 13.7% of Personal Statements submitted by IMGs to IM, Anesthesiology, and Surgery programs at the hospital were plagiarized.

 

Plagerism http://www.ncbi.nlm.nih.gov/pubmed/26462161 - plagerism scanning software in anesthesiology applications 4% of US grads, 13% of IMGS 8 words or more of unoriginal content - as much as 58% percent of the statemetn unoriginal.

 

Polished of all spelling errors - spell check, multiple edits, multiple proofreaders.

 

Friends and family are ok, but they already like you - i recommend involving a third party for an unbiased approach

 

Reddit / SDN “PS swaps” are a decent choice - although the opinion of other 4th years is not necessarily the best

 

Does benefit you to get it read by someone who has done it before - even last year’s MS4s / current interns.

 

Read it out loud - clear / concise wording

 

Polished of all grammatical errors

 

I love Grammarly /

 

Consider using a professional service / scribindi / fivver / odesk / Match Gurus

 

Formatted appropriately for MyERAS - one page, 600-700 words - ASCI formatting - so no bolds, italics, or underlining shows up - no emojis - you need to make your points pop with actual english words.

 

The MyERAS application can be viewed as a PDF version of the information entered in MyERAS by selecting View/Print MyERAS Application located on the Application section on the Dashboard and top-right area of every page under the Application section. This allows you to see how the contents of the MyERAS application will be displayed to programs.



Steps to take:

Start now - sometimes attendings ask for PS and CV for writing your LORs

 

Brainstorm - entertaining stories, even and maybe especially even inappropriate ones - what elements of your personality can you draw out of those moments?

 

Structure - opening, closing, know what you want to say and how you want to say it

 

Aim for a balance of past, present, and future in the speciality

 

Familiarize yourself with the ERAS requirements - length and formatting

 

Don’t be afraid to start over - if you hit on something that really resonates with you - start again

 

Answer the obvious questions - why this speciality, why do you think you will excel?

http://www.ncbi.nlm.nih.gov/pubmed/25342950 - 2012 resident class of UC Davis Derm residents matched vs unmatched - surprisingly those that specifically why they liked derm were higher in the matched, much higher trait were those who mentioned their desire to contribute to the medical literature.

 

Know your audience - all interviewers, not just PD, will look at to ask questions.

 

Know that if you are applying to different specialties, can use different statements, you can upload specific versions to specific programs if they have specifics in geography and school name - just make sure to send the correct one.

 

Things to avoid:

Lies / exaggeration

 

Plagiarism

 

Dashes / slashes, short abbreviations

 

“I knew i wanted to be a doctor when”

 

The opening impact statement / the opening quote “webster's defines” - overdone, may come back like fashion waves. I am personally guilty of this in a previous personal statement

 

Anything too outrageous - no ZDogg raps here - works well for him now, but don’t forget that he is still an internist from Stanford. I would actually love to have him on the show and find out his advice - I’ll reach out to him.

 

Too long = too boring

 

Don't talk shop - avoid medical jargon - these people already know more than you

 

Do not restate your CV in narrative or prose form

 

Don't rehash your medical school PS - you are already “in medicine” this is a statement of why this specialty - why specifically pathology or why specifically dermatology

 

Dont talk about personal illness - boring and an illegal question if they ask it another way - may even add some unconscious bias - just avoid it

 

No mention of religion, politics, or any other controversial issue. NOt a soapbox

 

Pearls and resources:

Knowing what I know now, if i were reapplying to family medicine, I would talk about my newfound passion for growing food, how I arrived at that passion through personal weight loss journey, then see health benefits in individual patients in published medical literature in Mediterranean diet, anti-inflammatory diet on cardiovascular risk, community health as far as community gardens, how these real live social networks help educate and promote health, simple upstream interventions that benefit pubic health. That can demonstrate an understanding of preventative health, community outreach, knowledge of health literature, goal setting and achievement, it is relevant to the specialty, personal reflection, long term involvement.

 

Medfools

 

AMA has good resources

 

UNC

 

ECFMG

 

MCW sample personal statements

 

Really knock it out of the park, talks about various sentence structure, diction and word choice, crisp and elegant writing, “The Elements of Style” by Strunk

To join the Myers Hurt Method Course, visit https://www.drmyershurt.com/themyershurtmethodcourse

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