What is the thing you worry most about in your future residency application? Is it a low USMLE score; a bad clerkship evaluation; or even the school you go to? Whatever it is, we all have something to overcome. But how exactly do you overcome your biggest deficit?
Caribbean medical students, and IMGs (International Medical Graduates) generally, have a lot to overcome. Fewer than 1/3 of residency program directors say they “often” offer interviews to US IMGs. In other words, more than 2/3 of residency programs say they “seldom” or “never” interview Caribbean grads. The ones that succeed rarely tell their secrets. It’s like someone telling you they scored high on Step 1 by, “just using UW and FA.”
At Stanford, we called med students “ducks.” On the surface, they were placid, projecting the most outward calm. But underneath the water, they were paddling like crazy. Many pretended like we didn’t work hard, and acted surprised if we did well on a test. (Humble-brag, anyone?). It was hard to know just how hard everyone was working.
In this guest post, a Caribbean grad pulls back the curtain on her intense routine. She made sacrifices. Her dad called her crazy. But she was scoring 240s on her Step 1 practice exams 8 months before her actual test. She went from scarlet-lettered IMG to hot ticket item in a competitive residency.
No matter your background, there are important lessons. We can all overcome our biggest weaknesses to achieve our residency dreams.
Here is her guest post:
How I Ended Up In a Caribbean Medical School
To anyone in a Caribbean medical school, or considering one, my story will sound familiar. Most who end up here is otherwise qualified to attend medical school in the US. However, we have one large knock against us, often grades or MCAT.
I went to a very challenging undergrad. I chose one of the more difficult majors despite being a D1 athlete. As such, my grades weren’t up to snuff for an American medical school.
I considered sitting out a year and retaking courses to bring up my GPA. My dad suggested (demanded) I apply to a Caribbean school. I was accepted and enrolled after I completed college.
Are Competitive Specialties Out of Reach of Caribbean Med Students?
I learned that the stigma is real. The beaches are pretty, and students study on boats. What you don’t hear is that most students either don’t match or are primary care physicians. But I wasn’t the typical student. I wanted something different than primary care.
Caribbean Medical Schools: Beautiful Beaches, Residency Stigma
I had my eyes set on anesthesiology. My problem was most Caribbean med grads don’t become anesthesiologists. I needed to work smarter and harder to set myself up for success. My undergraduate scores and the IMG scarlet letter made this all the most important.
Working Harder, Not Quite Smarter
I worked hard. My problem was I wasn’t very efficient.
I arrived at the library by 6 am, every day, without exception. Like many students, I didn’t attend class. Instead, I’d review the previous day’s material up to three times. I’d watch the day’s lectures on double speed and make powerpoint slides as I worked.
In the time students covered the material once in class, I’d have reviewed the same material twice. I’d leave the library around 7 pm to go to the gym, with breaks for tea and lunch every few hours.
I studied 12 hours a day. I stared at a white wall, and had no idea whether there was sunshine or a hurricane outside.
When I’d call home at night, my dad would say I’m crazy.
Turning My Hard Work Into Results
Despite having no life, I wasn’t happy with my results. My goal of anesthesiology still felt far. So I went looking for help.
Towards the end of second year, I found a USMLE Step 1 tutor. Alec Palmerton of Yousmle emphasized mastery of material, rather than memorizing it. He also introduced me to space-based repetition. I began making Anki cards rather than powerpoints. This exponentially increased my productivity and retention.
It was a steep learning curve. Initially, my cards were terrible. With the aid of Alec’s instruction, I was able to understand pathogenesis to presentation. In this concept, you create flashcards that connect things together to build mastery. We critiqued many of my cards so I could make efficient, effective cards on my own.
I took an NBME self assessment eight months before Step 1 and scored a 244. I was upset. I wanted to compete with the American grads who were scoring 260s who would go on to practice at the Ivy’s.
Three months before Step 1, I took another practice exam. 258. Still wasn’t good enough. I used NBMEs, Qbanks, and additional textbooks to generate nearly 10,000 Anki cards. Despite the large number, I breezed through these reviews using the fundamentals that Alec had taught me. One week before my Step 1 exam, my last practice exam was 269.
Mastery and Spaced Repetition Led to Impressive Clerkship Performance
I used the same techniques once I began clerkships in New Jersey. On each rotation, I’d read a textbook or two, and generate more Anki cards. Again, I’d be reading in the library at 5 am before the start of the rotation, or even 4 am if it were a surgical rotation. I’d come home and read for an hour or two, or do my Anki cards on the stationary bike if I was short on time.
Once I became comfortable with the content, I began working on the UWorld Step 2 Qbank. I converted the more challenging questions and concepts into cards. By the end of clerkships, I had another 5,000 cards, in a separate “Step 2” deck. Again, my schedule seemed crazy to friends and family, but I knew this was what I had to do to succeed.
Fast forward to interview season. As an IMG from California, I couldn’t fall back on my home state programs. My school told us to apply to 100 programs. Instead, I applied to only 34 programs. I received 23 interviews. The rejections came from reach programs. They told me that I looked great on paper, but they were not accepting foreign graduates.
I matched my first choice. I owe much of my success to my work ethic. But, as my father says, it’s better to work smarter than hard. Alec taught me how to work smarter, which made me far more efficient. I wouldn’t have had nearly the success without his support and guidance for the Step series. And I will use the same principles for the ITE (in-service training exams) in residency.
Photo by Xan Griffin.
