First Aid for the International Medical Graduate.pdf

Contents

Preface to the Second Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv

Preface to the First Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvi

1. Evaluating Yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Four categories of IMGs: where do you belong? . . . . . . . . . . . . . . . . 2

Out of touch with medicine for a while? . . . . . . . . . . . . . . . . . . . . . . 5

Why do you want to go to the US? . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Goal setting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

-Time table for the examination preparation . . . . . . . . . . . . . . . 8

-Professional goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

2. Getting to the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

“Achieving” the visa—strategic moves . . . . . . . . . . . . . . . . . . . . . . 13

Refusal of visa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Types of visa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

About Form DF-156 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

3. Preparing for the Exams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Who needs to take the exams? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Obstacles facing IMG Examinees . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Computer based testing (CBT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

-Why CBT? USMLE’s perspective . . . . . . . . . . . . . . . . . . . . . . 37

-The Sylvan center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

-Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

-Rescheduling the exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

-Reexamination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

-Where to take the test? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

-Dressing for the exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

-Time management during the exams . . . . . . . . . . . . . . . . . . . . 41

Long vignettes: A method to the madness . . . . . . . . . . . . . . . . . . . 43

A Few Last Things to Remember. . . . . . . . . . . . . . . . . . . . . . . . . . . 44

4. USMLE Step 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Eligibility criteria for step 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

What is WHO World Directory of Medical Schools? . . . . . . . . . . 45

Medical education credentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

x Contents

Application process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

-Completing the application form . . . . . . . . . . . . . . . . . . . . . . . 47

-Paying the USMLE fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Step 1, the exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Pass/fail statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Course outlines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Topics likely to be overlooked by IMGs . . . . . . . . . . . . . . . . . . . . . 50

What if I fail? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

5. USMLE Step 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Eligibility criteria for USMLE 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Application process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Step 2, the exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Pass/fail statistics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Course outlines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

-Compensating for different teaching styles . . . . . . . . . . . . . . . 60

-Topics likely to be overlooked by IMGs . . . . . . . . . . . . . . . . . . 62

What if I fail? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

6. English Exam (TOEFL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Importance of having a good grasp of English . . . . . . . . . . . . . . . . 69

Pros and cons of computerized TOEFL . . . . . . . . . . . . . . . . . . . . . . 71

Application process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Scheduling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

TOEFL, the test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Preparing for TOEFL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

7. Clinical Skills Assessment Exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Stated purpose of CSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Issues surrounding the CSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Who needs to take CSA? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Eligibility criteria for CSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Application process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Scheduling the test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Scheduling strategy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Timing the application for a visa . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Making your travel arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . 87

CSA, the exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

What is a SP? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Things not to do while working on each case . . . . . . . . . . . . . . . . . 93

Scoring components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

Step-by-step approach to doing well on the CSA . . . . . . . . . . . . . 96

Use of abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Not sure of your command of English? . . . . . . . . . . . . . . . . . . . . . 104

Contents xi

8. USMLE Step 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Scheduling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

Computer based testing (CBT) . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

Computerese . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110

Pass/fail statistics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

Step 3: The exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

CCS, an introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

Preparing for the exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

9. Getting into a Residency Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131

The problem of low scores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132

Application process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

-What is ERAS? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

-How does ERAS work? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135

-Computerese . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136

-Getting the application material . . . . . . . . . . . . . . . . . . . . . . 137

-Eligibility criteria for applying through ERAS . . . . . . . . . . . 137

-Fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137

-Installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138

-Key issues raised by the introduction of ERAS . . . . . . . . . . . 149

Choosing among the programs . . . . . . . . . . . . . . . . . . . . . . . . . . . 149

-Deciding where to apply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

-National residency matching program (NRMP) . . . . . . . . . . 152

Interview process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

-To the Program Directors . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166

10. Building Your Nest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171

-Getting a Social Security number . . . . . . . . . . . . . . . . . . . . . 171

-A thing called credit history . . . . . . . . . . . . . . . . . . . . . . . . . . 173

-Finding a place to live . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

-Obtaining a driver’s license . . . . . . . . . . . . . . . . . . . . . . . . . . 174

-Arranging for telephone service . . . . . . . . . . . . . . . . . . . . . . . 175

-Getting your wheels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176

-Lining up car insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176

-Opening a bank account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177

-Enrolling in a health insurance plan . . . . . . . . . . . . . . . . . . . 177

-Finding your compatriots . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178

-Getting to know your town or city . . . . . . . . . . . . . . . . . . . . . 178

11. Survival Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

Your first month in residency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

Frequently asked questions on an on-call day (or night) . . . . . . . 190

Learning to function as a public relations (PR) person . . . . . . . . 201

xii Contents

Dealing with the members of your team . . . . . . . . . . . . . . . . . . . . 201

Surviving the ICU rotation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204

12. Getting Through the Residency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209

History taking, American style . . . . . . . . . . . . . . . . . . . . . . . . . . . 209

Physical examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215

H&P and daily progress notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228

Electrocardiography (EKG) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230

The Mentor Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243

How to get the maximum out of a rotation? . . . . . . . . . . . . . . . . . 244

Clinical examination test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246

Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247

13. Some Distinctive Features of the Practice of Medicine

in the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251

Ethics, patient rights and legal issues. . . . . . . . . . . . . . . . . . . . . . . 251

Evidence based medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256

Computers in medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266

14. The Second Year of Residency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273

Fellowship hunting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273

-The IMG Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273

-Timeline. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274

-Factors influencing acceptance into a fellowship program . . . 275

Becoming a senior resident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277

Resident as teacher . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278

15. The Final Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281

-Getting ready to go back home. . . . . . . . . . . . . . . . . . . . . . . . 281

-Continuing with a fellowship . . . . . . . . . . . . . . . . . . . . . . . . . 282

-Job hunt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282

-Your visa type. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283

-Your job options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283

-An IMG’s job hunt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284

-CPT tangles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285

-Your Contract—the fine print . . . . . . . . . . . . . . . . . . . . . . . . 286

-Buying a house. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287

-Moving. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288

-Board certification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288

-Licensing boards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289

-Polishing the rough edges . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291

Important Organizations and Agencies . . . . . . . . . . . . . . . . . . . . . . . . 291

Web Addresses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297

CHAPTER 1

Evaluating Yourself

During my stay in the United States, I have seen hundreds of interna-

tional medical graduates (IMGs) coming here from different countries.

Most of these people come to the United States believing that they will

have access to all the modern technology for treating their patients.

Some of them are motivated by stories of doctors living in million-

dollar mansions, but nearly all of them have neglected to step back and

evaluate themselves before coming. It is extremely important to be

aware of your characteristics so that you can exploit your strong points

and work on your weaknesses.

By the time a person reaches the United States, he or she falls into

one of the following groups:

1. Fresh graduates who are driven by their peers in medical

school. There are medical schools in some countries where

almost the whole class takes the U.S. Medical Licensing

Examination Step 1 (USMLE 1) en mass in the third year of

medical school. Later the same batch takes the U.S. Medical

Licensing Examination Step 2 (USMLE 2) after the final

year. Some in this group catch the next plane to the United

States after graduation day. These people either have a close

acquaintance in the American medical profession or have

resourceful parents or relatives. On average, most people

have spent a few postgraduation years in their own countries

before coming to the United States.

2. People who have achieved a high level of training in their own

country.

3. People who have gained recognition in their own country,

some of whom may be internationally known. Interviews with

some of these people reveal a common denominator: While

they were successful according to the standard definition in

Plik z chomika:

Inne pliki z tego folderu:

Inne foldery tego chomika: