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AmeriClerkships and the U.S. Residency Process – FAQs

The AmeriClerkships Medical Society was founded on the principle of helping international medical school graduates secure a US medical residency. Inspired by the experiences of Dr. Pedram Mizani, AmeriClerkships’ president, the company has helped over 700 students receive placement in residency programs based in over 150 U.S. cities, including Atlanta, New York City, and Baltimore.

Question: What are some of the obstacles international medical school students face as they apply for a U.S. medical residency?

Answer: Along with the expected challenges that national students face when applying for a residency, international students can expect a “dual learning curve” as they begin life as both hopeful residents and immigrants. Students often face language, cultural, technological, and financial barriers, among others.

Q: What are some ways that AmeriClerkships helps international medical school graduates overcome the obstacles they face in the U.S. residency application process?

A: AmeriClerkships provides assistance for international medical students throughout the entire residency application process. First, the company provides a free entry assessment for inquiring medical students. Once students choose to use AmeriClerkships’ services, the company offers insured U.S. clinical experiences that expose students to the culture of US health care, residency document reviews and revisions, mock one-on-one match interviews, and extra support for other “match” programs, such as SOAP (Supplemental Offer and Acceptance Program), that give medical students more opportunities to secure a residency. AmeriClerkships offers a secure payment plan and a lowest price guarantee in an effort to keep this an available resource for all students. It also offers office hours with the AmeriClerkships president, who offers years of personal experience, wisdom, and encouragement to students.

Q: What types of insured clinical placement services does AmeriClerkships offer?

A: AmeriClerkships offers clinical placement to medical professionals in one of the following five categories: medical student clerkships, medical graduate clinical experiences, medical graduate funded teaching hospital job placements and visa sponsorships, pre-health student clinical experiences, and medical assistant clinical externships.

Advice for the National Resident Matching Program (Part II: Tips)

In the previous post, we talked about the importance of the National Resident Matching Program (NRMP) and the algorithm that determines resident placements. In this post, we’ll discuss some of the best strategies to assist medical school graduates in succeeding in the Match.

Do your research: Although it goes without saying for many dedicated medical students, it is extremely important to learn as much as you can about potential residency programs in the United States. Each program has its own specialties, procedures, and personnel, which can have a profound impact on the medical residency experience. Similarly, you can maximize your efficiency and chances of success by identifying those programs to which you are most likely to earn admission.

Prepare for interviews: After you submit your applications, residency programs may decide to invite you in for an interview. The interview is your last chance to make a good impression on residency program directors, so it is important to be well prepared. Learn as much as you can about the history and operations of the program, as it will demonstrate a willingness to take initiative and go the extra mile. Emphasize the significance of your accomplishments without boasting and describe your resume in terms of its applicability to the position at hand.

Carefully consider your rank order list: The Match algorithm relies on rank order lists submitted by applicants and residency programs. Take into account all types of factors when deciding which programs to include. Although several applicants have attempted to “game” the system in the past, it is best to submit an accurate list with your true preferences represented. If you do not wish to attend a particular residency program, do not include it on your list. However, it is important to include all residency programs that you would attend if accepted. Keep in mind that the inclusion of additional residency programs has no bearing on the likelihood of gaining acceptance to programs higher on the list.

Be prepared for the Scramble: On Tuesday afternoon of Match week, unmatched applicants have the opportunity to contact residency programs with vacant spots and attempt to secure a position. Although the majority of students receive a match the first time around, it is nevertheless important to be prepared for the possibility of having to participate in the Scramble. Waste no time in contacting residency programs, as positions are likely to fill up quickly.

To learn more about the National Resident Matching Program, visit the website at nrmp.org.

Advice for the National Resident Matching Program (Part I: About the Match)

Every March, medical school seniors and graduates across the world eagerly await the results of the National Residency Matching Program (NRMP). Better known as the Match, the NRMP is a nonprofit organization that assigns candidates to open slots in American residency programs. Established in 1952 as a way to improve upon the decentralized matching process, the Match now receives full support from organizations such as the Council of Medical Specialty Societies (CMSS), the American Medical Association (AMA), the American Board of Medical Specialties (ABMS), and the American Hospital Association (AHA).

Because the Match is the only way for students to earn positions in graduate medical education (GME), competition among applicants is often fierce and requires months, if not years, of advance planning. Students begin the Match process by identifying the residency programs they would like to attend and completing applications for those hospitals. Although many schools require candidates to participate in the Electronic Residency Application Service (ERAS), a common medical residency application, a small number of programs maintain their own distinct application procedures. After candidates complete the application process, residency programs review the applications and select students to invite back for interviews. After interviews are complete, candidates are ready to enter the Match.

The Match uses an algorithm based on rank order lists, submitted by both residency programs and medical school graduates. The algorithm proceeds by analyzing each student’s list of preferences and attempting to place him or her with the highest-ranked residency program on the list. If a residency program also includes a candidate on its list of preferred candidates, the student will be tentatively matched with the program; otherwise, the algorithm will try the same thing for each of the other schools on the student’s list. The Match will continue to match students with their desired residency programs until they fill up, at which point a student who ranks higher on the program’s list than another student will take his or her spot, bumping the bottom candidate from the list and causing the algorithm to start over again for that student.

If students do not earn a match, they must participate in a process known as the Scramble, where candidates attempt to secure a spot at a residency program with an open position. Because there is a great deal at stake during the Match, it is extremely important to prepare well and utilize the most optimal strategies when composing rank-order lists. Check out the next post for some tips to chances of success in the Match.

AmeriClerkships: The Role of International Medical Graduates in American Primary Health Care

International medical graduates (IMGs) play a key role in the American primary health care system. While American medical graduates traveled to Europe in the late 19th and 20th centuries to learn new medical techniques, starting at around the time of World War II, IMGs began similarly seeking ongoing medical education and experience in the United States. While many IMGs return to their home countries with their new knowledge, a significant portion remain in America, where they fill many of gaps present in the American medical system. Approximately 25 percent of the U.S. physician population consists of IMGs, up from around 10 percent in 1963. Approximately 78 percent of those IMG physicians work in patient care, with around 75 percent of those doctors working in office-based practices.

IMGs have a greater likelihood of receiving training in internal medicine, family medicine, or other primary care fields than United States medical graduates (USMGs). A full 60 percent of first-year residents in family care are IMGs. Likewise, IMGs are more likely than USMGs to provide care in rural and underserved areas of the country. As physicians, they also tend to maintain a much stronger understanding of multiculturalism, which can help them serve their patients more effectively.

About AmeriClerkships: AmeriClerkships programs can help fill the growing need for IMGs in American primary care practices. The organization matches IMGs with physicians for pre-residency clinical training. This education serves as a valuable prerequisite for enrollment in American residency programs.

AmeriClerkships: Trials Faced by Foreign Medical Graduates in the United States

Historically, foreign medical graduates have faced significant challenges in obtaining residencies and entering the American medical workforce. These physicians continue to struggle with limited residency spots, visa restrictions, and widespread prejudice, despite the fact that they have proven an invaluable asset to many aspects of medicine in the United States. Studies have shown that medical graduates from schools outside of the United States are more likely to practice in medically underserved areas than physicians educated in America. Currently, foreign physicians comprise almost half of all doctors serving in inner-city or large metropolitan areas. In addition, foreign doctors constitute a disproportionately large percentage of general practitioners in the nation.

While many foreign medical graduates continue to fight for positions in American residency programs, those now practicing have demonstrated a high level of competence. Many of the nation’s largest medical organizations feature a high percentage of international physicians, and these professionals hold leadership positions increasingly often. In recent years, international medical graduates have also consistently performed better than those who graduated from American schools on standardized tests taken in coordination with residencies.

When considering coming to the United States for a residency, individuals from foreign institutions must obtain travel visas to come here and take an exam required for entry into residency programs. This alone proves difficult for many applicants, especially those from the Middle East and South Asia. After securing admission to a program, these individuals must then obtain a long-term visa. The popular J-1 visa requires that the individual return to his or her country of origin after completing the academic program. Many American residency programs cap the number of foreign medical professionals that they will accept, increasing the competition in an already fierce contest. Congress effectively capped the number of residency positions open in the United States more than a decade ago by limiting the funding that the federal government could offer programs. Until Congress reexamines this figure, programs will remain very competitive.

About AmeriClerkships

AmeriClerkships offers foreign medical students the opportunity to work with a variety of medical professionals in several different specialties in order to pursue pre-residency clinical training. These experiences enable international students to transition more easily into the American medical system and provide a serious advantage in the residency application process. For more information about AmeriClerkships, including participant requirements and program options, visit www.americlerkships.org.

AmeriClerkships: International Medical Graduates in American Residency Programs

In general, international medical graduates prove an invaluable asset to residency programs, strengthening them through diversity. These individuals offer a unique perspective, insight into a different system of values and beliefs, and an understanding of different forms of medicine. Unfortunately, Americans often associate “different” with “inferior.” As a result, many American medical graduates gravitate toward programs that do not accept many international graduates, believing them to be superior in some way. In reality, American medicine will remain forever indebted to the contributions of international medical graduates. In addition, these individuals often perform better than graduates of American institutions.

Unfortunately, international medical graduates still struggle to gain acceptance into American residency programs, largely due to prejudice, difficulties with visas, and a dearth of residency spaces. Once in a program, they often face discrimination from other residents, staff members, practicing physicians, and patients. Language often proves a significant barrier, especially when communicating with patients. While international medical graduates certainly possess excellent English writing and speaking skills, things such as regional differences, slang, and idioms prove difficult to understand. In addition, body language varies dramatically between cultures, requiring that the international students continue to learn American English expressions in addition to practicing their medical skills.

International medical graduates also struggle with differences in the medical education system, and Americans may mistake their deference for shyness or ignorance. Foreign graduates require time and guidance to grow accustomed to questioning their teachers and interacting with other students in a team-based learning environment, an educational system that remains largely American. For this reason, international medical graduates may want to research programs with instructors who have dealt with students from foreign countries extensively. These teachers generally understand how to encourage active participation from international students, and they have furthermore conquered their own biases against foreign education. International students may also want to make their intentions about education clear. While some come to the United States in order to stay and practice medicine, many plan to return to their respective countries and improve the medical systems there. Others may wish to do both.

About AmeriClerkships

International medical graduates can gain invaluable experience with the American medical system prior to enrolling in a residency program through AmeriClerkships. Clinical trainees work closely with attending physicians and other medical professionals, and later they receive an assessment and feedback about their performance. With AmeriClerkships, international medical graduates gain a strong competitive edge in the residency application process.

AmeriClerkships: American Residencies and Discrimination

Multiple studies have uncovered a considerable amount of discrimination toward those with medical degrees from institutions outside of the United States in the selection process for American residency positions. Two independent studies suggested that family practice programs sent applications in response to identical requests 80 percent more often when the candidate graduated from an American medical school. Many academics and medical professionals have pointed to graduates of foreign institutions as a solution for the current shortage of physicians, which will become sharper in coming years as health care reform comes into effect. By expanding coverage, the health care reform bill will result in a considerable increase in demand for general practitioners and other family doctors. Discrimination exists outside of family practice, as studies have seen similar results in psychiatry and surgery.

Many program directors seem to discriminate against graduates of medical schools outside of the United States despite the assertion that medical education should function as a meritocracy. Some programs enforce quotas on the number of these physicians accepted as residents, and some educators have actually expressed a degree of embarrassment about the presence of foreign graduates in their programs. Despite this discrimination, foreign graduates have consistently outperformed American graduates on the In-Training Examination since 1995. The presence of international graduates generally strengthens programs by providing diversity of culture and perspective.

Professionals inside and outside the medical community have called for a reexamination of residency selection processes, reducing the amount of non-academic prejudice exercised by committees. American medicine owes an enormous debt to the discoveries made by physicians educated in other countries and, while it outwardly renounces discrimination, evidence suggests that a large degree of prejudice remains. Instituting a monitoring system would perhaps reinforce this sentiment and demonstrate the unacceptability of caps and quotas in a self-proclaimed meritocracy.

Graduates of international medical schools face a number of challenges when they come to the United States to begin a residency. They do not need the added difficulty of securing a residency position due to discrimination, which ignores their demonstrated academic abilities.

About AmeriClerkships

AmeriClerkships grants graduates of foreign medical schools the ability to gain clinical experience in the United States before applying to residency programs. Qualified medical graduates pair with attending physicians and other hospital professionals, who offer training and evaluation. With AmeriClerkships, international students gain insight into the American medical system, easing the transition and accruing invaluable experience.

AmeriClerkships: Challenges for International Medical Graduates in the United States

Numerous physicians who graduate from foreign universities wish to practice medicine in the United States. Many countries do not have the resources necessary for the efficacious practice of medicine, mostly due to economic constraints. By choosing to complete residencies in the United States, medical graduates learn about the most cutting-edge medicines and techniques. Americans spend more money on medical development and research than any other country, making the United States an ideal place for physicians to further their careers. Unfortunately, these medical professionals often face a number of challenges, beginning with gaining acceptance into a residency program. Places in American residency programs are limited, and competition has become exceedingly fierce in recent years. Before applying, international medical graduates must obtain a travel visa to complete an exam and then secure an additional visa after finding a suitable program.

Once an international medical graduate arrives at his or her place of residency, the student faces a number of other hardships. In addition to dealing with possible prejudice, the individual must struggle with different customs, new cultural concerns, a foreign language, and an altered value system. In the end, however, the student must remember that diversity means strength and that these initial struggles will prove invaluable assets in the future. An average of one in four residents participating in a given program in the U.S. studied internationally, and facilities have grown accustomed to easing transitions. Still, the student must remain proactive, seeking help and guidance whenever necessary. Often, international medical graduates feel completely overwhelmed by the transition to the United States, but they must retain the confidence that got them through medical school. They experienced success in their respective countries and can do so again. Eventually, the feeling of foreignness fades as an individual becomes accustomed to a new culture and embraces new conventions.

The most important piece of advice that anyone can offer is to never fear asking for help and seeking out those organizations created to ease the transition, offer guidance, and address concerns before they become real problems. International medical graduates are not alone in facing the challenges of finding a residency, emigrating, and adapting to life in the United States.

About AmeriClerkships

In order to give international medical graduates an advantage in the residency application process, AmeriClerkships pairs qualified individuals with attending physicians for pre-residency clinical training. After each clinical block, supervisors evaluate program participants according to the 11 medical competencies that they use to assess residents. Many residency programs now expect international medical graduates to pursue such training, making AmeriClerkships an invaluable asset for these students.

AmeriClerkships: The Looming Physician Shortage and Foreign Medical Graduates

President Barack Obama’s recent health care reforms aim to increase overall access to health care while reducing the associated cost. Unfortunately, the United States already suffers from a shortage of primary care physicians, and the demand for more will grow sharply in the coming years as the government implements the reforms. The Association of American Medical Colleges expects a shortage of more than 91,000 doctors by 2020, a figure that has more than doubled from previous estimates due to expanded coverage. Part of the problem lies in the fact that graduates from American medical schools generally choose to pursue specialties, which earn more money than general practitioner positions. Many even feel forced to do this, anxious about the student loans that await them in the future.

Many people have suggested turning to foreign medical graduates in order to minimize the shortage of family doctors. Unfortunately, restrictive licensing rules and limited slots in American residency programs keep many foreign medical graduates from practicing in the United States. Those who wish to practice in American facilities must complete at least three years of residency here, but many applicants get turned away. In the European Union, partnerships exist between countries to import medical professionals to areas most in need. While the United States has a similar arrangement with Canada, graduates of institutions in other nations often face great difficulties in finding a residency program. Before these medical graduates can apply for the residency, they must travel to the United States and pass an exam. Many, especially those from the Middle East and South Asia, have trouble securing a travel visa in order to take the exam. If accepted into a program, students must then obtain another visa. The J-1 visa for education, however, requires that applicants leave the United States after training, defeating the purpose of completing a residency here.

The federal government’s Medicare program subsidizes hospital training programs, effectively giving Congress the power to control the number of available residency positions. Many foreign medical graduates are unable to gain entrance to residency programs due to a 1997 cap on Medicare-supported positions. Congress declared it would pay for only 98,000 residency slots. Since that time, the number of available residency slots has not grown at the same rate as the American population. Most of that expansion, furthermore, represents opportunities in advanced fields, not family medicine. Foreign medical graduates now fill about one in four residency positions, but that figure will decrease as more Americans choose to attend medical school. Many have proposed that Congress fund more residency slots, but that will detract from the funding that goes to health care subsidies. As the need for general practitioners increases, however, the United States will need to reach beyond its borders for new physicians.

About AmeriClerkships

AmeriClerkships matches pre-qualified foreign medical graduates with attending physicians and other medical professionals, allowing them to gain pre-residency clinical experience in a variety of specialties. This experience gives clinical trainees a serious competitive advantage when looking for a residency; in addition, several programs actually require foreign medical graduates to complete such training. After finishing clinical training through AmeriClerkships, international medical graduates receive an evaluation of their performance from their supervisor, who uses the same criteria applied to residents.

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