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Another Road to Residency

A second edition to Road to Residency


Compiled by: Class of 2000 Class of 2003 Updated by: Class of 2005
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PREFACE TO THE 2ND EDITION


The original Road to Residency was quite a masterpiece. I remember how blessed I felt to be part of the AKU family when I first came across the document. Although random information always descended upon us poor juniors, it was great to have one single reference guide available to answer our most important questions. I am sure that the founders of this compilation will be thanked for years to come. Another Road to Residency is merely a second edition an effort to account for the numerous changes which keep happening as time passes by. It is also an effort to increase the comprehensibility of the document, hopefully to an extent whereby few extra resources would be necessary. An effort to be the only thing that one would need to read. Of course, the word effort needs its punctuation marks as one would be quite foolish to imagine that no one will ever need to read anything else. For example, I would highly recommend that everyone purchases a copy of First Aid for the Match. It is an excellent reference. Read it cover to cover. However, that too would be insufficient alone as it cannot provide information which would apply specifically to AKU students. There are many other references offered at various points in the text. Do make use of them! Some chapters have been replaced with new versions (The Step 2 CS and Where to apply), others have just been updated (The Application Process, The Personal Statement, The Interview, The Step 3 and Travel and Places to Stay). The chapter Preparing for Interviews has been broken up into two components: Interview Attire and Interview Preparation. Furthermore, many new chapters have been contributed by various graduates of the class of 2003. The entire document was then reshuffled so that one does not become overwhelmed by the mass of information available. The rearrangement makes it possible to read only what you need to know for the time being and nothing else. Do read the chapter A Guide to Another Road to Residency. Another Road to Residency has been enclosed in a zip file so as to accommodate two other files: an excel file which contains information regarding a variety of Internal Medicine and Pediatrics residency programs, and, a map illustrating various cities in the USA where AKU graduates popularly apply to for their residencies. I hope that Another Road to Residency achieves the purpose that it was meant to achieve that is, not only to benefit those who read it, but, to help them comprehend how much their own juniors would appreciate them. Lets pray that AKUs tradition of seniors helping juniors continues forever, InshahAllah. The Editor Class of 2003
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PREFACE TO THE 1ST EDITION


The past 2 years have been lazy, stressful, uncertain, hopeful and despairing at the same time. Yet, they have come to pass. So shall they for you. My hope is that the following compilation proves useful for the class of 2001 and those in my own class who are matching this year. We have all tried to put in our two pence advice, tips, opinions and impressions. I have also added website addresses wherever possible since a lot of information is available on the net, and I thought Id save you the trouble of searching. I am very grateful to all those who have contributed to this text. I thank them for their time and consideration. I am thankful to Amin Lakhani for his immense support, co-operation and guidance in electives and the residency process. I am also thankful to my class mates, Farah, Kaashif and Sultana, who kept posting useful information on the e-groups. I hope this becomes a sustained and continuing process of support and help for classes to come. May Allah guide and help us all. Amen.

Zainab Samad (zainabsamad2000@yahoo.com) Alumnus, Class of 2000 The Aga Khan University

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CONTENTS
SECTION I INTRODUCTION A Guide to Another Road to Residency The Exam Timeline Money Matters SECTION II EXAMINATIONS The Step 2 CS The Step 3 SECTION III VISAS, ETC. B1 / B2 Visa H1B Visa J1 Visa Entering and Exiting the USA Status Change within the USA SECTION IV HOW TO APPLY IVa The Residency Application The Application Process When to Apply Where to Apply Researching Programs The Personal Statement Sample Personal Statement NRMP Registration IVb Residency Program Reviews Internal Medicine Pediatrics Radiology Psychiatry SECTION V ORGANISATION Scheduling Interviews Boosting Your Interview Count Rescheduling / Cancellation Interview Attire Class of 2003 Class of 2003 Class of 2003 Umbereen S. Nehal Zainab Samad (Updated) Class of 2003 Class of 2003 Class of 2005 Umbereen S. Nehal Umbereen S. Nehal Class of 2003 Class of 2003 Class of 2003 (Updated) Class of 2003 Class of 2003 Shaalan Beg Class of 2003 Shehzad Sami (Updated) Class of 2003 Class of 2005 Class of 2003 pg 06 pg 06 pg 07 pg 08 pg 13 pg 13 pg 18 pg 22 pg 22 pg 23 pg 28 pg 30 pg 31 pg 33 pg 33 pg 33 pg 36 pg 37 pg 41 pg 44 pg 45 pg 46 pg 47 pg 47 pg 61 pg 70 pg 71 pg 78 pg 78 pg 80 pg 81 pg 81

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Travel and Places to Stay Greyhound Tips SECTION VI INTERVIEWING Interview Preparation The Interview After the Interview Sample Thank You Note NRMP Rank List Submission Rank Order List SECTION VII APPENDIX VIIa Couple Matching

Zainab Samad (Updated) Class of 2003 (Updated)

pg 83 pg 84 pg 87

Umbereen S. Nehal Naasha Talati Class of 2003 Umbereen S. Nehal Class of 2003 Zainab Samad

pg 87 pg 88 pg 90 pg 92 pg 93 pg 94 pg 95 pg 95 pg 95 pg 96 pg 97 pg 99

Couple Matching Nabil Tariq Boosting Your Interview Count for couples Class of 2003 NRMP for couples Class of 2003 VIIb Specialty Information Surgery some thoughts Applying for General Surgery General Surgery Residency Friendly Surgery Programs Neurology Residency Neurology Residency Update Pediatric Issues Pediatrics OBGYN Psychiatry Match Radiology Ophthalmology Postdocs VIIc Other Visa Issues Visa Waiver United Kingdom Transits VIId Post-Match Scramble Post Match Scramble Post Match Scramble Residency Map of the U.S. Political Map of the U.S. Class of 2003 Muhammad Awais Class of 2003 Class of 2003 Class of 2003 Class of 2003 Nabil Tariq Ali Khalid Jawed Zarrish Saeed Khan Zarrish Saeed Khan Safdar Ansari/Irteza Hussain Mian Zain-ul- Sajadeen Urfy Class of 2003 Simeen Rais Pasha Zaraq Khan Filza Hussain Saad Shahid Ali Yureeda Qazi

pg 99 pg 101 pg 102 pg 105 pg 107 pg 114 pg 118 pg 119 pg 119 pg 123 pg 132 pg 134 pg 136 pg 136 pg 138 pg 139 pg 139 pg 141 pg 146 pg 148

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Each generation imagines itself to be more intelligent than the one that went before it, and wiser than the one that comes after it." - George Orwell (1903 - 1950)

SECTION I INTRODUCTION
A GUIDE TO ANOTHER ROAD TO RESIDENCY
Class of 2003 Another Road to Residency has been divided into six main sections in order to facilitate reading. Below, I have advised a simple guide to how one may opt to read the document. Of course, one can keep going over the text whenever one feels the need to revise information. I will refer to the points in time where one first needs to encounter the information: Introduction: Read as early as possible! [Money Matters will need to be referred to when planning your trip to the USA (to determine how much money you should take along with you)]. Read as early as possible to get a feel for the significance of these examinations and the necessary timelines. This will help you plan your own timeline for giving your Steps. Do not read every single detail at this point. Instead, skim over the section first and refer to these chapters when you are applying for these examinations and preparing for them. Read as early as possible to get a feel for the entire visa matter. Again, there is no need to read every detail at this point. Later, read the individual chapters in detail as required. Read after sitting for the Step 1, because, this deals with the residency application. After Step 1, you will have plenty of time to devote to understanding the process before starting Step 2 CK studies. Of course, you will need to refer to these chapters repeatedly while going about your application. After your Common Application Form has been submitted (September 1st), interview calls will start trickling in. This is when you need to begin the reading of this section. It will help you prepare for your USA trip, both mentally and physically. You will continue to refer to this chapter even when in the USA. 6

Examinations: -

Visas, etc.: -

How to apply: -

Organization: -

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Interviewing: -

Read just before you depart for your USA trip. Then read during your interview trail as required. This section contains information that does not need to be read by everybody. Information is divided into four parts: Couple Matching, Specialty Information, Other Visa Issues and Post Match Scramble Go over the chapter titles in the contents and read only if the chapter is applicable to you.

Appendix: -

If you have any further queries regarding anything at all (regardless of how silly it may seem), you can contact any of the following people. Theyd be more than happy to guide you in any way they can: Shaalan Beg Syed Shabbir Ijaz Bokhari Sani Haider Kizilbash Simeen Rais Pasha Safdar Abbas Ansari Class of 2003 Class of 2003 Class of 2003 Class of 2003 Class of 2003 shaalan@gmail.com shabbir.bokhari@gmail.com insanism@gmail.com simsv40@hotmail.com safdar.ansari@gmail.com

THE EXAM TIMELINE


Hussain Mahmud (Class of 2005) In the 2007 match even though almost everyone matched in the end, the number of total calls per person went down drastically. Till last year, with a scores in high nineties you could easily get at least a dozen calls. Besides bad luck, I guess the biggest shortcoming in our applications was that a lot of us took our Step 2 CS in October or later and got certified in mid-December; by then very few programs were sending out interview calls. Most of my other classmates had the same experience; all the people who got more than a dozen calls were certified way before. Apparently just Step 1 and Step 2 CK scores are not good enough for them anymore. The reason for this shift is not quite obvious. During the interview season, there was a rumor going around that the number of candidates has suddenly doubled due to the closure of UK/PLAB pathway. That has now proven to be false with the availability of NRMP statistics. There were a total of 14,965 IMG cadidates in the 2007 match; an increase of 7% when compared to last year. This increase is a part of the overall trend and has been observed for many years. So what changed this year? My conjecture is that the candidates are taking their exams early now and a majority is certified by the time the applications are considered for interview calls by the programs. So its imperative that in order to maintain the
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AKU edge and remain competitive, our candidates should be certified as early as possible too. The ideal way to do that is to get the CS out of the way when you go for US electives. Its an easy exam and youll end up saving a trip later. However, if you havent done that then its the advice you should be dishing out to your juniors and now the question of the whole exam timeline arises. If you want to be really safe your target should be to get certified by mid-October (the time when most programs will take up your application; if you arent certified most will put you in the to be reviewed later application pile. Your chances of getting a call from that place becomes slimmer then). For that you HAVE to take the Step 1 in May. Take a break for two three weeks after that and get down to study for Step 2 CK somewhere in mid-June. It wont take more than ten weeks at the most and you can easily take the exam by end August. Proceed to the US right after that and take your CS in early September (Schedule early so that you can get the last dates in that result reporting slot). Alternatively you can take the CS after Step 1, however there are more chances of getting your Step 2 CK delayed this way. Its ideal to get ECFMG certified as early as possible as detailed earlier. However if all else fails and unfortunately it is not possible to get certified by mid-October or so and you can take only one exam among Steps 2 CK and CS, my advice would be to go for the Step 2 CK. If the program is going to have two scores in hand when they consider your application, its better they have Step 1 and Step CK scores rather than Step 1 and Step 2 CS score. Its my feeling that they attach more importance to Step 1 and Step CK scores. Remember that all this is just a rough guideline. Of course each persons circumstances differ and it may not be possible to take the exams early or stay in the US for six months. Also remember that if you are getting certified in December then thats not the end of the world; most of us managed to match despite getting certified in December. But do start planning your exam timeline now with the aim of getting certified as early as possible.

MONEY MATTERS

Class of 2003

Lets face it. One of the most critical factors which alters ones course of life is the issue of finance. Admittedly, the entire process of getting into a US residency is on the expensive side. However, if you end up matching, the money spent becomes quite insignificant in the long run. Allow me to demonstrate. Before I do so, Ill tell you in advance that a lot of the terms used in this chapter will be unfamiliar. This chapter has been placed here only to give you a sense of proportion. Later, you may need to refer back to this chapter frequently when youre in the process of planning (e.g. your trip to the USA).
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Step 1:-

$805 This is a sum of the examination fee ($685) and the International Test Delivery Surcharge, that is, the fee for giving this exam in Asia ($120). $815 Likewise, $685 + $130 $1200 $290 (for 30 programs) $540 (for 40 programs) $790 (for 50 programs) $90 (for single applicants) $105 (for each participant of the couple match) $100

Step 2 CK: -

Step 2 CS: Applying at ERAS: -

Applying at NRMP: -

Applying for B1 visa: -

Air Ticket to Islamabad: - $120 (return ticket) Air Ticket to USA: $1400 (return ticket) This will vary with the city flown to and the airline used. $589 (for 60 days) $898 (for 75 days) (a combo of a 45 and a 30 day pass) $958 (for 90 days) (a combo of two 45 day passes) $300 I took a survey regarding public transport expenditure. Five people responded. The figures I received were: 100, 110, 200, 300, and 400. The width of the range is dependent on the total length of stay in the USA, the number of cities visited and the presence of relatives and friends in cities visited. I have advised a safe maximal amount to keep aside (for the careful spender, of course). $300 I took a survey regarding food expenditures. Five people responded. The figures I received were: 60, 100, 150, 200 and 1000! The width of the range is

Greyhound Ameripass: -

Public Transport: -

Food: -

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dependent on the total length of stay in the USA, the number of cities visited and the presence of relatives and friends in cities visited. If youll be staying with someone, not only will you be fed, youll frequently be given food to take along with you on your next trip. Hence, a cost cut. Of course, luxury can bump up the score manifold. So, there can never be an upper limit. I write $300 as a safe maximum amount to keep for a person who is careful with his / her pocket, yet does not compromise on his / her consumption. You may not spend all of it, but, its better to be safe than hungry. Hotel Stays: $300 Again, this is a maximal amount to keep aside. If you plan well, you should not have to spend a single cent on accommodation. AKU grads (and others too) are everywhere. However, if you ever have to, a single nights stay makes a serious dent in the budget ($100 approx). Again, better safe than homeless. $500 Of course, you must realize that you are not Hercules. You can fall ill. You can get hurt. You may need to get an urgent flight. Else, a number of things may happen which you cannot foresee. Although you will probably have some extra money on hand if you use the figures which I have quoted above (for food, hotel & transport), you should still maintain a further margin in case of emergencies. $6810 This is for a single applicant applying to 30 programs and getting a 60 day Ameripass.

Buffer: -

Approx. total (thus far): -

The remaining cost depends on the type of visa which you intend on applying for: H1B: Step 3: Health License: Attorney: USCIS: Premium Process: Total: $625 $170 $1000 $685 $1000 $3480

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This fee may be far less than the above quoted amount as some institutions offer to pay for some combination of the above fees (not including the Step 3, of course). Furthermore, the exact fees will also vary from state to state (again, not including the Step 3). J1: + Health License: - $170 PMDC Renewal: - $5 ESVP Application: - $200 SEVIS Fee: $100 Total (Max.): $475 Other expenses may occur while communicating with the residency program after the match. These are variable (usually negligible) and hence unaccounted for. Finally: Applying for H1B/J1: $100

Air Ticket to Islamabad: - $120 (return ticket) This is for the H1B / J1 visa interview. Air Ticket to USA: $800 (one way ticket) This will vary with the city flown to and the airline used.

Thus, the grand total cost of the entire process of getting into a US residency is: J1 applicants: H1B applicants: Now lets look at earnings! To take some rough averages, a resident earns about $40,000 per annum. After cutting taxes, the resident is left with about $2,500 per month. Now, one can EASILY save $500 a month if one is single. One can actually save much more if one is careful with how they spend. Even if one is a spendthrift, the income is still quite plentiful. Anyway, lets assume that one saves $500 a month. The full cost of a J1 resident will be covered in less than 18 months. The full cost of a H1B resident will be covered in less than 24 months. If the resident has a non-earning spouse to support, that resident is likely to save close to zero. However, if the spouse is also a resident, expect to be able to live on
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$8300 $11300

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one salary, that is, a saving of $2500 per month! In the latter case, even if both are H1B residents, the entire cost will be covered in 9 months! Although this article will serve to inform you of the involved costs and how much money you should take to the USA, it is meant to serve as a consolation. Many people see all their money trickling into the system and just wonder. They convert hundreds of thousands of rupees to mere thousands of dollars and just wonder. The point of the above text is to show that your money is being invested wisely. Eventually, you will pay for yourself (if all of the above was done on loan). And after paying for yourself, an extra $500 is an extra Rs. 30,000. Not bad for money sent back home to Pakistan. It feels good to move from supported status to supporting status. Of course, there is the gamble of the visa. There is no guarantee that youll get your visas, etc. when you need them. Admittedly, people have had their contracts cancelled due to prolonged FBI clearance, etc. However, only a small percentage of AKU graduates are held back due to visa issues. Indeed, the figure may vary from year to year, but the proportion is always very low. When gambling, one always weighs ones chances before one starts. Know this: your chances are very good do play them.

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SECTION II EXAMINATIONS
THE STEP 2 CS
Class of 2003

The Step 2 CS (Clinical Skills) is the examination that was formerly known as the CSA. To put it as simply as possible, it is just an OSCE with loads of frills. Nothing difficult, I assure you. AKU graduates rarely fail the exam. However, you have to pass it in order to secure ECFMG certification (and hence any chance of matching). So, I would strongly advise that you do not take it too lightly, regardless of what anyone says. Imagine how embarrassing it would be to get a pre-match at the place of your dreams and having to call them to tell them that you will not be able to join their program because you flunked the Step 2 CS Earlier, the TOEFL examination was also a requirement for ECFMG certification. However, since the transition from CSA to Step 2 CS, the TOEFL examination is no longer required. The Step 2 CS itself will be used to check your ability to communicate. The examination is available to be given throughout the entire year; however, it must be given before a certain deadline. In the Match of 2005, this deadline was December 31st 2004. In the Match of 2004, the deadline was January 31st 2003. So, it keeps changing. Youll have to check the ECFMG website (www.ecfmg.org) for the latest information. (Note that the deadline for the Match of 2006 is December 31st again). There are some recommended times that one should give this exam. The vast majority of applicants are going to visit the USA on a three month visit visa. In this period, it would be highly desirable to give the Step 2 CS, interview at a dozen programs, and perhaps even sit for the Step 3 examination, if you have time. The biggest constraint is the fact that the interview season lasts from November to January itself being a three month period. So, in order to maximize your chances of getting everything done before your visa expires, schedule the Step 2 CS somewhere in early November. Youll get it out of the way before you start interviewing. Also, since youll land in the USA in early November, you can continue to stay till early February, potentially enabling you to sit for the Step 3 examination. Of course, the earlier you give the Step 2 CS, the better. Itll speed up the process of ECFMG certification and enable you to get an earlier date for the Step 3. This, in turn, will allow an earlier processing of an H1B visa (if thats what youre going for). So, you see, everything is connected. Another fact is that program directors will be more keen on interviewing you and ranking you when you have passed more examinations. If you can secure a six month stay in the USA, sit for the Step 2 CS in, say, mid-October. Some people flew to the USA specifically for
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the purpose of giving the Step 2 CS early. However, to do this, youd have to have a long term visa to start off with (e.g. five year multiple) and plenty of funding. Being the fortunate ones you are, another opportunity has opened up for you lot one which was not available to us. Earlier, passing the USMLE Step 1 examination was a prerequisite for application for Step 2 CS. That rule has been abolished. All you need now are two years of medical school. Consequently, my advice would be that one should sit for the Step 2 CS during ones final year electives (if one is doing these in the USA). Any earlier would probably result in insufficient clinical and OSCE experience. There are five centers in the USA where the Step 2 CS examination can be given:

Philadelphia, Pennsylvania Atlanta, Georgia Los Angeles, California Chicago, Illinois Houston, Texas

Where you sit for the exam should not really make a difference. It did make a difference when the centers first sprung up in 2004 (earlier established centers dispatched results earlier). However, since they have been functioning for more than a year now, I dont think it will affect anybody anymore. As for the fine print regarding the examination, I have quoted an extract (slightly edited in order to update), written by Zainab Samad, from Road to Residency. Updates have been written in non-italicized bold text. A couple of comments before I attach her material: There is a new book in the market called First Aid for the USMLE Step 2 CS (Clinical Skills Exam), written by Vikas Bhushan and others. I would recommend this book for everyone. If one reads this and nothing else, it is more than sufficient. After familiarizing yourself with this book, if you feel you need more practice, then, go ahead and attempt the dozens of cases available in the Kaplan photocopy. More practice is always good. I spent a week of relaxed studying on this exam. However, one can get away with less. People pass the exam with a day or two of preparation (not that I would advise it!). The exam is all about being able to deal with the patient as a reflex. Therefore, grab a friend and practice, practice, practice. As far as Bates is concerned, one does not need to go over it if one is comfortable with physical examinations. The Step 2 CS has three components (on the basis of which youre marked):

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o Integrated Clinical Encounter (ICE) Subcomponent (Data gathering, Documentation) o Communication and Interpersonal Skills (CIS) Subcomponent (Questioning Skills, Information-sharing skills, Professional manner and rapport) o Spoken English Proficiency (SEP) Subcomponent (Extract commences here)

Preparation: Before going for the exam, watch the video and the Candidate Orientation manual that they provide (the candidate orientation manual is now available online - www.ecfmg.org/csa/com/index.html). If you are feeling very apprehensive, then read up the 47 cases given in the Kaplan CD photocopy. That gives a fair idea of what is tested in the exam. You can even go through the basic history and physical examination from Bates. The cases that generally come are very common complaints like chest pain, headache, backache, etc. These have been time and again tested in our OSCEs and therefore do not pose a problem. And when you take the history, youll find that there is a wide differential. The history usually does not point to one specific diagnosis because they want to check whether you know the right questions for those common complaints. During the physical exam, check the relevant systems e.g. in a patient with chest pain, you would want to check the pulse, JVP, listen for crepitations in the lungs, feel the cardiac impulse, percuss the heart borders (or pretend to), listen to heart sounds, check for sternocostal tenderness, palpate the abdomen for any epigastric tenderness, and check for pedal edema. Most patients do not have physical findings. But in some cases, the patient may have real signs - crepitations with a COPD lung, an inflamed joint, etc. The patient may even mimic signs - loss of sensation or paralysis. So bottom line - keep your eyes and ears open. During the patient encounter, you might get a mean and un-co-operative patient. Dont worry. They are being deliberately mean. The trick is to be firm. Remain polite and try not to lose your temper. Format: There are 10-11 patient encounters (the 11th is usually not graded but you will not know which one is the 11th patient). One gets 15 minutes with each patient and then 10 minutes to write the patient note. SO that makes 25 minutes for each patient encounter. The actual encounter is marked on a checklist by the patient. The checklist is for communication skills, the questions in the history that you asked and the maneuvers you performed in the physical exam. The patient fills this out once you leave the room. So what matters is not how you percussed the patient but whether you did it at all or not. This makes it much easier than our regular OSCEs. There
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are also points for knocking before entering, washing hands, draping the patient etc., so one needs to remember those. The Basic Format (that my friend Sultana came up with and that I found very useful), one should follow so that you dont forget anything: (Editors Note: Before you even knock at the door, pay attention to the case introduction written on the door. Read it carefully and jot down points on the clipboard. It is imperative to have your thoughts organized at this stage in order to avoid awkward pauses during the actual encounter. Write the name, age and any abnormal vital signs. You may even list your differential diagnoses. Write whatever mnemonic you use for history taking. Take your time at this stage and you will save time further on.) 1. Knock 2. Enter and address the patient by Mr. / Mrs. Surname 3. Introduce yourself as Dr. Surname 4. Walk to the sink, wash your hands and while you are at it, explain that you will be doing a brief history and physical exam and will be discussing your impression with the patient. 5. Walk back to the patient and drape the legs (they are usually uncovered) 6. Sit or stand; whatever you find comfortable. Spend 5 minutes taking the history. Avoid using medical jargon. Ask both open ended and close-ended questions. 7. While taking the personal history, if the person smokes or drinks, counsel there and then...or one tends to forget near the end. 8. Spend 5 minutes on doing a focused and relevant physical exam. 9. Spend 5 minutes summarizing/reconfirming the history that you got, explaining to the patient what you think, he or she has, what investigations you think he/she should get. Remember to ask if he/she has any questions. (Editors Note: - Also ask the patient if there is anything else that he/she would like you to know. This provides the patient to guide you if you have been misled. Remember, the simulated patient is not out to get you). 10. Tell the patient when you would like to see him or her next. Say that it was nice meeting them. Walk out. 11. If you are done before timethen walk out and start on the note. 12. The patient note has to be written in legible clear handwriting. Practice on the sample sheet that they provide in the information booklet. Since there is less space on the paper, put only relevant points and important negatives down. Warning: Avoid speaking to anyone inside or outside the exam center about the exam. You are not going to do any better by sharing your case histories or exams. But you might certainly end up paying for it if you do!! Only people with serious problems in communication fail the exam (those who dont know how to speak English) and since you are not in that category, you dont need to worry.
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Things to take with you to the exam center: 1) White Coat 2) Stethoscope 3) The CSA permit 4) Passport 5) They provide a pen 6) Dress professionally but comfortably (the way one dresses for a viva) 7) Panadol, lunch (if you think that the salad, fruit and chips that they provide will not whet your appetite. They have turkey sandwiches for those who are not too particular about halal food), and Chocolate if you want to. Coffee, soft drinks and water is provided. Travel and Places to stay: You can search yahoo for making a reservation at a hotel. Usually, the rates are lower if you book on the Internet .The website (www.usmle.org) provides a list of hotels near all the testing centers, some of which even offer special discounts for CS test takers! (you will have to show them a copy of your scheduling permit, of course). Regarding the Philadephia center, the Marriott and the Divine Tracy are right opposite each other and 3-minute walk from the center. There are plenty of other places to stay. You can find them on the net. Try and make it to the city at least a day prior. It is important to keep room for contingencies. Remember to put all the things that you are going to take to the exam center in a hand bag as one runs the risk of losing checked-in luggage. Website: For more detailed information, use the following link www.ecfmg.org/usmle/step2cs/index.html

(Extract ends here) Another thing which may prove useful After giving the Step 2 CS, one tends to wait impatiently for the result, because one can only apply for the Step 3 after passing it (along with all the other exams, of course). At that point in time, even the wait between the dispatch (as told by OASIS) and the actual receipt of the result (by mail) seems long. A simple way of finding out if you have passed is by trying to apply for the Step 2 CS again (dont worry, you will not be charged for trying!) After inputting your information, the website will tell you that you cannot apply for this examination because you have already cleared it. If this happens, you have passed! Apply away for your Step 3! If not, well, better luck next time!
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THE STEP 3
A few comments of update:

Shehzad Sami Updated by Class of 2003

The fee for Step 3 is now $625, not $570 as mentioned below. At the time of application, you will be asked which state board you would like to sit for. Do not be confused. Simply click on Connecticut and move on. Different states have different requirements for when one would be eligible to sit for Step 3. Some places require completion of postgraduate training. Others require an application for state licensure. The Connecticut board has no special requirements except ECFMG certification. Hence, the reason for applying for it. Furthermore, the state board which you sit for has no impact on anything. You can apply for the Connecticut Board of Step 3 and sit for the exam in any city in the USA (not just in the State of Connecticut). Furthermore, you dont even have to match in Connecticut. There will be no need to convert anything to anything just because you have matched at a different state. So, click on Connecticut and move on! Id like to differ (partially) with the mentioned timeline. I applied for my Step 3 on January 29th (the day I receive my Step 2 CS result) and I gave my Step 3 on 1st March. [I was officially ECFMG certified in early Feb.] I could have given it earlier, but I opted not to. Since I sat for my exam in the earlier half of the week, my result was dispatched in three weeks, that is, March 23rd. Admittedly, I received the score after the match, however, it did not interfere with the processing of my state license, and hence H1B visa. This is because it takes the program at least a few days to send out your information packet (containing state license documents). Thus, you can easily manage if you give Step 2 CS in November. However, as Shehzad mentions, the earlier the better. After all, the more exams youve passed, the more interview calls youll get. Another point of notice is that certain programs have been known to wait for up to six weeks after match day for Step 3 scores. So, one can actually get away with a highly delayed Step 3. However, visa delays in recent years have forced programs to be sterner regarding these timelines. Ask program directors regarding their current policies. The application form requires you to submit the date of issue of your ECFMG certificate. Hence, the natural assumption is that you cannot apply until your ECFMG certificate is issued. Fortunately, this is not the case. The time lag between the dispatch of the Step 2 CS result (if this was the last certifying exam you gave) and the issuance of the ECFMG certificate is quite short. About a week, perhaps. For some odd reason, if one just enters the date of dispatch of the last certifying exam that one gave (that is, usually, Step 2 CS) instead of the date of certificate issuance, the Step 3 application gets accepted. Why? I assume it is because there is also a time lag between your sending your application and FSMBs

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receipt. That covers for the earlier mentioned time lag. So, FSMB checks as to whether your certificate has actually been issued. When they see that is has, FSMB forgives you for your stupidity in making such a simplistic error, and processes your form anyway. The benefit of doing this will only be realized when you are counting days at the end of interview season because your three month visit visa is about to expire. However, dont be so over efficient that your form gets to them before your certificate is issued! TOEFL is no longer required for ECFMG certification. I cannot personally comment on the books mentioned as I used none of them, however, I have been told that Crush the Boards for Step 3 is indeed the single best resource for Step 3 preparation. I opted to read both the Kaplan Step 3 books and tried to solve as many Q Bank questions as I could. If, however, you have not given Step 2 CK recently, they will be insufficient as these books are not exhaustive. Perhaps, Step 2 books can be used then. In case your wondering how I fared in my Step 3, my score was a few points lower than Shehzads. So, have a look and see what suits you. Also, dont forget to go over the CD sent by USMLE. As Shehzad mentions, the Step 3 is a two day exam. The first day is exactly like Step 2, format wise. However, it is more difficult (naturally). Each block is an hour long. The second day is quite different. The first half consists of four blocks, each forty five minutes long. The second half are clinical cases which are based on a completely different computer program. This is the true challenge as you will be managing a patient in an undirected environment. All you are given is a brief history. Now, you decide what to do. You can choose to take further history. If so, further history is revealed. You can choose to examine certain systems. You can choose to start certain medications. Whatever you do, the simulated time keeps ticking. Take too long to manage a critical patient, and the patient dies. What you do affects what will happen next. It is like role playing a Choose your own adventure book. If you do unnecessary investigations, you lose points. If you manage efficiently, you gain points. It is loads of fun when you get the hang of it, even during the exam, as you always have more time than you need. So, the second day seems to go better than the first.

Why should you read this article? 99/98/94..need I say more!!!! Why give Step 3 before starting residency: If you want an H1B visa, it is essential that you give Step 3 before starting the residency. The other reason which many people thought in my class was valid enough to take Step 3 before residency was that you wont have to study other subjects ever again once you get on with your residency. So in a way, it never hurts to give
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Step 3 before the start of your residency, even if you dont want an H1B visa, especially when you are in the US for the interviews and all. Requirements: You need to be ECFMG certified before you can apply for Step 3. How to Apply: Go to www.fsmb.org and www.usmle.org and from there please print the Step 3 application. You need to send a copy of ECFMG certificate and AKU degree. Be sure to take all the original documents along with you to the US because you will need them for various reasons, including Step 3 application. Not to forget the money, $570. So if you plan to give Step 3, please include the fee in your total expenditure calculations which you need to take from here. The Strategy (The most important part of the whole discussion): Why does not everyone give Step 3 before the start of their residency? As mentioned earlier, you have to be ECFMG certified before you can apply for Step 3. This means, you have to take your CSA in time for you to be ECFMG certified, preferably well in advance of the end of interview season, which is by the end of February. That means you have to follow a fairly tight schedule from the beginning, right from starting your studies for Step 1 after graduation. Here is a rough calculation of the time periods and how to negotiate them: It is advisable to take Step 3 latest by mid March, preferably mid Feb to end of Feb. It takes 4 weeks for the Step 3 permit to reach you. So you have to be ECFMG certified by the end of Dec to mid January. It usually takes 6 weeks for the CSA result and approx 1-2 weeks for the ECFMG certificate to reach you. So you have to take CSA preferably in October. This will mean that you have to take Step 2 before October, which is always the advisable thing to do. Therefore, I will just summarize the timeline which needs to be followed if one is considering giving Step 3 in order to obtain an H1 visa. Step 1: Start of March-Mid April. Although in a perfect world, everyone would be done with their step 1 by the start of March. Step2: September. No later than 30th of September. This will make sure that you will be able to leave for the US in October. CSA: Apply soon after you receive your Step 1 score card. Give TOEFL soon after step 1. Schedule CSA in October, perhaps by 15th October. Step 3: In February.

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The whole timeline should be shifted to earlier dates if anyone thinks he/she can. Because the earlier, the better. The reason to give Step 3 as soon as possible is that most places like the candidates to have Step 3 result by the match date. Some even want you to have the Step 3 result in your hand at the time of the interview. You cannot do anything about that, but you can still go ahead and tell them about your plans and try to convince them that you are a winning horse and wont falter in Step 3 and will pass it without any trouble. All they are afraid of is lest you may fail after they have agreed to sponsor you for an H1B. Even then, it is not their headache that you have failed Step 3. They will just give you a J1. But they just dont want to get into the hassle of dealing with failures. You have to convince them that you will pass Step 3 without any problem in light of your Step 1 and Step 2 score. Study Material: Crush the Boards for Step 3 is the single best source for the preparation of Step 3. It is one book that every one should do before taking Step 3. Swanson is good too. Do it. But I dont think that it helps a great deal. But due to dearth of good material for Step 3 preparation, it is well worth the effort to go through this book. Better than Swanson are the Step 2 Medicine notes. I personally think that doing medicine notes should take precedence over Swanson. These 3 sources should prepare you enough to take on Step 3 in a very strong way. Also try to get your hands on the Kaplan Step 3 CD. It is available in the US through students and friends, though I am not sure whether it is available here in Pakistan or not. (Editors note: It is available in Urdu Bazaar) Format of the Exam: It is immaterial right now for me to tell you about the format of the entire exam. When you get around to taking the exam, I assure you, you will get to know about all the details. In short, it is a 2 day exam. First day is just like Step 2. But you just have to pass it instead of acing it. That helps boost the morale. Next day, half of the exam is like Step 2, other half is cases. When you get down to studying for the exam, send me an e-mail at shehzadsami76@yahoo.com and I will try to help you in this regard. But only if I like you. How long to study: 4 weeks is good enough. I studied for a little over 3 weeks. I got 94. For those of you who know me, I am no genius. Smart and intelligent hard work is the key. Without this, even 3 months is not enough. Summary: Step 3 is more of a hassle than a difficult exam. Nonetheless passing it requires a considerable amount of planning and hard work, which is very much doable and less stressful than many of the other things in life. Everyone should try and plan to give Step 3 while they are in the US for their interviews. Thanks: Special thanks to Zainab Samad for her noble efforts to compile this guide. May God bless her with lots of love and happiness in her future life. I hope that it proves to be helpful for many to come.
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SECTION III VISAS, ETC.


B1 / B2 VISA
Class of 2003

In order to go for residency interviews and the Step 2 CS, you need to apply for a US visit visa (B1/B2). Try and apply as early as possible. Ideally, you should have taken Step 1 and Step 2 CK before you go for the interview. However, the minimum is Step 1, i.e. you should have your Step 1 score with you when you apply. You can take the Orange permit for Step 2 CK and tell the consular that you are going to take it soon. You get the application materials from American Express offices in Karachi, Lahore and Islamabad. They are also available online at the web site of Islamabads US Embassy. Fill those up and put them in the application. Nowadays, they do not accept any extra documents to be attached with the application materials as every one is called for an interview. Once your application is processed, take the earliest date available. The American Express also gives out the interview dates. Do you mention Step 3 on the visa application and during the visa interview? The answer is NO. Step 3 is a big no-no. The reason is that people who have gone previously for residency interviews had to stay longer to do Step 3 and many of them took extensions. Visa consulars know that. So, on the application and during the interviews, mention your reasons for visit as Step 2 CS examination and residency interviewsthats all.

Documents to take with you for the interview: All original documents should be along with you for the interview. Needless to state, you will also take your passport and visa application. 1- Print out of Step 2 CS date and testing center 2- Print out of Scheduling Permit 3- Visa Letter from the ECFMG 4- Step 1 score 5- Step 2 CK score OR If not available, then Prometric center document that says that you appeared for Step 2 CK on a certain day OR If you have not yet appeared for the exam, then Orange permit for Step 2 CK and print out of Prometric date. 6- AKU documents (which include Medical School Diploma, Transcript, Dean's letter etc.)
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7- Job letter (if you are doing a job e.g. Teaching Assistant, Research Assistant, then ask your supervisor to write you a letter saying that you are working at this place and once you come back from the US, you will continue your job). + Pay slips. 8- Evidence of last trip to US: If you have gone to US before, what did you do there? Most of the students have gone for electives. It is worthwhile to keep US recommendation letters as proof of your visit. 9- Affidavits of support from your parents (saying that my son or daughter is going abroad for medical board examinations and I will be bearing his/her expenses). 10- Affidavit of Non-immigrant Intent (saying that you will return and giving reasons why you are going to do so). 11- Proof that you can afford the trip. This proof can be in the form of Bank Statement, Property Documents and/or credit Card summaries. 12- All educational documents from Matric/O levels to AKU. 13- Print out of your OASIS account. 14- Print out of your ERAS account (if applicable). Know which document is where otherwise you would not look good in front of the interviewer. Dress professionally but make sure that you are comfortable as well. Arrive at the Convention Center parking no later than six oclock in the morning. The system changes but at the time of writing, this is how they do it. You get to Convention center. Get rid of your mobiles and stand in the line where they give out bus tickets to the US embassy. Once you get the tickets, you make a run for the line where they are loading the buses for the US embassy. Please note that there are other buses for other embassies too so you need to check where to go. Once you sit in the bus, the bus takes you to Diplomatic Enclave and drops you in front of the US Consulate. There, you form two lines; one for immigrant visas and one for non-immigrant visas. You will stand in the non-immigrant visa line. Then, the security guards will call you and after a thorough security check, you go inside the Consulate where your fingerprints are taken and your passport and visa application is taken. Then, you wait for the interview. Good luck!!! After the interview, your passport is sent to USA for security clearance (if you are a guy). This takes a very variable amount of time. Officially, the consulars tell you that it would take anywhere from 2 weeks to three months.

H1B VISA

Class of 2003

The H1B is visa which is issued by the US government. It allows one to stay in the USA for a total of six years. The H1B is a dual intention visa, that is to say, one can apply for a green card while on this visa. The visa is the primary method used to bring professional level foreign employees into the USA. To be eligible
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for the H1B visa, one has to demonstrate a passing score in their Step 3 examination. Initially, the H1B is a three year visa which may be renewed for another three years. Hence, in the first three years, one can leave the USA and reenter with no problems. However, if one leaves the USA after three years have elapsed, one will have to revisit Islamabad for the purpose of renewal, and will have to undergo FBI clearance again. (Recently, there have been cases of USCIS nastiness whereby they have approved H1B visas for a single year only!) Since the H1B visa is issued by the US government, once it has been approved, Islamabad cannot deny you the visa (unless it finds some sort of forgery in your documents). However, they may defer your visa (in the light of insufficient availability of documentation) or hold you back on the basis of FBI clearance. Furthermore, I have been told that FBI clearance takes longer for H1B visas as opposed to J1 visas. Again, this is due to the fact that it is a dual intention visa. The number of H1B visas issued each year is determined by the US government. This H1B cap is currently set at 65,000. You will hear this term frequently as it often limits the number of H1B visas which an institution can offer. However, many hospitals are exempt from this cap as they are classified as non-profit organizations. Not all residency programs offer H1B visas. Some offer it freely, some may need convincing and others will not offer it at all. Another important point is that many fellowship programs will not offer you a spot on an H1B visa. So, if you are on an H1B visa, your chances of getting into a fellowship position drop quite a bit. However, there is the possibility of converting the H1B visa into a J1 visa. I am not exactly sure how this is done as I have heard mixed opinions on it. Some say that it cannot be done because one applies for the fellowship while one is doing their residency, and so your fellowship application will state your current visa (i.e. H1B) without indicating your intention to convert. This would lead to the immediate rejection of your application. On the other hand, I have also heard that it is an avoided possibility due to the mass of paperwork which one must undergo. Whoever writes the 3rd edition of Road to Residency may include the actual fact therein. Until then, youll have to find out for yourself. A safe method which one may use is to apply for a green card immediately after ones residency. Meanwhile, one may get a job with whatever qualification one has achieved thus far. After securing the green card, one may then apply for a fellowship, hence relieving visa issues. However, this process would prolong your training considerably. So consider it only if you intend on being in the USA for a few extra years.

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The dependent visa is called the H4 visa. This may be issued to the spouse and children of the H1B visa. This is a weaker visa than the respective J2 visa. This is because one cannot study, train, work or earn on the H4 visa. H1B visa holders have to pay more taxes than J1 visa holders. So, expect a good amount cut from your salary! The process of application for the H1B visa will generally end up taking more time than that of the J1. It is also more expensive (and this is probably why most programs dont offer it!) One should employ an attorney to file for the visa. Dont worry about looking for one! The program will tell you about the attorneys that they recommend. Depending on the program, they may offer to pay for the cost of filing of the visa along with the attorneys fee, however, this is not necessary. Another fee which you will have to pay for is that of premium processing. Usually, the processing of the H1B visa takes 90 to 120 calendar days, however, when premium processed, the time period is shrunk to only fifteen calendar days. The program may offer to pay for premium processing too (if youre lucky!) Another point is that one cannot file for the H1B visa before receiving the health license for the state. This is not the case for the J1 visa, where the two processes can occur simultaneously. Note that certain states (e.g. Georgia) waive the requirement of being licensed a fact that greatly expedites the H1B visa procedure. The process of application for the H1B visa is as follows: 1) Sit for the Step 3. 2) Make sure the program knows that you have given the Step 3, expect to pass it, and hence would like the H1B related documents to be sent to you with your information packet. Also request your program secretary to courier your documents to you (to speed things up) 3) Wait until you receive the information packet from the program at which you matched. 4) Apply for the (educational limited) health license of the state. (Forms will be given to you in the information packet. You may even download these from the internet, but this is sometimes discouraged as it interferes with the records of the residency program. There are three parts to the application. One is to be partially filled and sent by your medical school, the second is to be partially filled and sent by your program director and third by you yourself. Dont forget to ask Nasreen Sheikh to courier the AKU side of the story. Shell charge you a thousand rupees, but its worth it! The processing of your license will take a variable amount of time depending on the state. I think 4-6 weeks is a reasonable average estimate. They will let you know. 5) Submit documentation (and fee) to your attorney. Again, information should be made available to you in the information packet. The attorney
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will prepare your case for you, but cannot file for the visa until both your Step 3 has been passed and your health license has been issued. Although you may, it is best not to delay this. Deal with this immediately after dealing with the health license documents. 6) Make sure you update the residency program administration of your status. 7) Your health license will be sent to the residency program administration, and they will in turn fax it to the attorney. 8) Your attorney will file for your visa. With premium processing, the process will take fifteen days. 9) Once your visa is accepted, your documents will be sent to you and you can then prepare to go to Islamabad. Again, request them to be couriered. 10) On receipt of the documents, apply to Islamabad for your visa interview (the process is similar, but not identical, to that of the B1 application). 11) When your application is processed, fly to Islamabad. The H1B visa enables you to go for a walk in interview in Islamabad. So, no need to get an interview date as you did for the B1. The cost will also vary. I can only give my own example: Educational Limited Health License Attorney Fee USCIS (Immigration Service Filling Fee) Premium Processing Fee $170 $1000 $685 $1000

Note that the Educational Limited Health License fee will also be applicable for people who are applying for a J1 visa. Regarding the total time taken, you can do the math yourself. Remember that the transmission of documents takes time, even if couriered. A rough timeline is given below (applicable if Step 3 result is available at the time of receiving the information packet, or perhaps a little beyond): March April May June 3rd week 4th week 1st week 2nd week 2nd week 1st week 1st week 2nd week 2nd week 3rd week 2nd week Match result announced Information packet received (if secretary efficient!) Documents sent to program, state and attorney Processing of health license begins License received by program and faxed to attorney H1B visa premium processed H1B documents received in Pakistan Islamabad processes visa application Walk in interview at Islamabad FBI clearance completed (for girls) FBI clearance completed (for guys) (HOPEFULLY)

July

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So, unless you prematch, the H1B visa will probably cause you to be late. If you arrive late, the time has to be made up for in your vacations, elective time or perhaps even after your residency (that is, you will not graduate with the rest of your class and will consequently waste a year if you planned to do a fellowship). So, make sure you hurry everything maximally. H-1 Visa Update Class of 2005

The biggest change that has occurred over the last couple of years is that H-1 visa interview is not a walk-in affair any more. You have to submit the documents once you get them from the program to the American Express. Theyll take a fortnight and then give you the interview date once the passport comes back. Even though they prioritize H-1 interviews and usually give the date within a week or so but still this is a point where things can go wrong. So with the already constrained timeline, now it has become even more difficult to get the visa on time. Therefore it becomes even more imperative that you start the processing as quickly as possible. The first step, as explained earlier is getting the state Graduate Medical Training license. So start bugging your program coordinator right away, especially if its a program which doesnt offer H-1s routinely. Explain to them how long it takes to get the visa in our part of the world. Rather than waiting for the information packet, ask them to send you the state license form immediately and instead of getting it couriered, get it emailed or faxed to you. Different states have different licensing procedures. Some states are really nice and all they want is your part of the form and the hospitals part. Others want more paperwork e.g. Pennsylvania board requires one part to be filled by you, one by the hospital, another by AKU and USMLE transcripts by the ECFMG. You can either send copies of all your USMLE score reports plus the ECFMG certificate or you can get the transcript sent directly to the board by ECFMG through the Credential Verification Service (CVS). They charge $25, however remember this will set your application back by a couple of weeks. The whole process shouldnt take more than four weeks. Try to get the license made as quickly as possible because until its ready, your petition cannot be filed. Your program will direct you about the attorney hiring process once you reach that stage. Another thing that you can do to expedite the whole process is that get your approved I-797 scanned and emailed to you once your attorney recieves it from the USCIS. This will allow you to file your visa application with the US embassy in Islamabad immediately, saving four five days. While you are waiting for the couriered documents to arrive, your passport is being processed for the interview date.

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J1 VISA

Class of 2003

The J1 visa is a training visa. While on this visa, you can work only in training jobs like residencies and fellowships. It allows you to stay in the USA for a maximum period of 7 years. Thus, the visa allows adequate time for completion of training. Unlike the H1B which is stamped for 3 years, the J-1 is stamped for 1 year only. For the rest of the duration, you get your status changed from the USA. However, you do not get your passport stamped. This means that after the first year, if you leave the USA to go anywhere in the world, you will have to get the passport stamped again (from Islamabad) so as to re-enter the USA. In the good old days, when visa issues were not a major problem, one could travel freely on J-1. You usually get a three to four week vacation block. People used to come to Pakistan, re-apply for the J-1 and got it stamped before they returned. However times have changed now. Since visa processing requires FBI clearance, which could take weeks, it follows that you can only travel within the first year. The ECFMG also discourages traveling during the course of your training. With female doctors, its a complicated issue. If the passport does not go for clearance, then you can travel. But, if it does, then you can not return back to your program within the vacation period. The US visa policies keep on changing. Get an update before you make a decision. The principle of J-1 is that a doctor from a third world country is going to the USA for training. Thus it follows that you have to return to your home country to serve for at least two years. This also means that the visa consular at Islamabad gets to decide whether you should go or not. This is in sharp contrast with H-1 where the visa consular at the embassy cannot refuse.

Pros and Cons of J-1: J-1 visa is easier to get. It requires less processing, less money and therefore less hassle. No Step 3 result is required. Like residency programs, all fellowships sponsor J1 visas, however, a much lower proportion of fellowships (as compared to residencies) sponsor H1B visas. Thus, J1 visa applicants get an advantage over H1B visa applicants. The spouse of a J-1 may enter the USA on a J-2 visa, on which one can work or study in the US. You get to pay less tax (but you do pay it!!!). On the other hand, J-1 can get rejected at Islamabad. You cannot travel much except during the first year (the internship year). You cannot do moonlighting so J-1 is NOT a financially beneficial visa. It cannot be converted into a Green Card
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unless you return to your home country or do a J-1 waiver in the USA for two years. Processing for J-1: You need the DS-2019 (previously known as IAP 66) form from the ECFMG in order to apply for the visa at the Visa Consulate. In order to get the DS, you need a NOC (No Objection Certificate) from the Government of Pakistan. In order to get the NOC, you need a valid PMDC certificate. So here is how you do it. 1- First thing apply for PMDC renewal. For that you need your previous certificate. The form is available at records Office at AKU and online at PMDC website. Renewal fee is Rs. 300/= for one year. Urgent fee is Rs. 200/=. If you already have a valid PMDC certificate than you don't need to worry about it and you will save some time. Do this before you have matched. 2- Than you apply for NOC. The form is again available at Records Office AKU. The NOC form as well as the statement of the affidavit is also available online at www.ypprc.org in their download section. You need to attach attested photocopies of your a) NIC, b) Passport, (the form does not ask for it...but you still got to give it) c) PMDC certificate, d) AKU Degree e) And an affidavit saying that you are not a Government servant and stuff like that. f) You also need the OFFER LETTER from the program where you have matched. So you can apply for NOC only after you have matched and have the offer letter from the program. Once you have the NOC, than you apply for the DS 2019 from the ECFMG. You download the EVSP application form from the ECFMG website, fill it, attach all the documents and send it to your program. The EVSP application has a checklist included so you know which documents to send along with it. The program forwards it to the ECFMG. Pay the US$200/= fee on OASIS before you send in the form. The ECFMG takes a week or two to process your DS and sends it back to the program. When you get the DS form back, you will need to pay US$100/= as SEVIS fee. SEVIS stands for Student and Exchange Visitor Information System. ECFMG registers you with SEVIS and gives you a SEVIS ID number that starts with N. Once you have that number, you log on to www.fmjfee.com and make that payment. More info on that is available on the EVSP application
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form. Once you have done that, you are now eligible to go for J1 visa interview. So thats when you need all your luck!! The J-1 does not require state license or Step 3 result. So the processing of Residency permit or Temporary State license is independent of your visa application.

ENTERING AND EXITING THE USA

Class of 2003

All guys are going to have to undergo special registration when they enter the USA. After passing through immigration, you will be directed to another room where you will be asked to wait. You wont be alone! There will be many other similar people waiting for their turn. After a wait (which can sometimes be quite lengthy), you will be interviewed. The first time you visit the USA, the process may be on the lengthy side as your data will need to be inputted into their computers. Next time you enter, the process goes faster. What youll be asked really depends on the mood of the official who interviews you. They may sometimes burst with questions. On the other hand, they may not ask you anything at all (this will not be the case on your first visit!) Whatever happens, it is not a time to stress out. A big hype is usually created regarding this process, however, it is quite straightforward. Admittedly, there have been some nasty incidents, but, these are rare. You are entering the USA for a perfectly good and legal reason. Islamabad has had no issues with your entering. You should not have any problems in the USA either. Just make sure that you are well documented. They like documents and will compliment you if you have them. Have your exam permits, venue and date details available; have a list of the places that you have applied for interviews; have copies of emails which offer interviews; have print outs of the amount of money that you have spent in preparation for this trip; etc. You dont need to be as prepared as you were for your interview in Islamabad, but, the more confident and well documented you are, the easier youll make it for everybody. And since everything you say affects your permanent immigration record, a good start is likely to do you good later on. Again, IT IS NOT A BIG DEAL. It is here that you can even make requests to give you a six month stamp instead of a three month stamp provided, of course, you can give a good enough reason. I know a person who had already been stamped for three months, but, on request, the stamp was cancelled and exchanged for a six month stamp. Again, the officials there are not out to get you. They can actually be very nice. Another point regarding which there was some confusion. Just because you have entered the USA and undergone special registration at a certain airport, it DOES NOT mean that you have to leave via that same airport. When you initially
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undergo special registration, you will receive a list of airports from which you can exit the USA. Any of these will do. On your way out, if you have undergone special registration, you will have to register again. This time, registration is very short and sweet. However, you may have to look for the place. Once you have checked in and crossed security, find out where to go by using the courtesy phones available at the airport. You will get a stamp marking your exit on your passport, then, youll be free to go. NOTE: People who have not undergone special registration (women) will not receive a stamp on their passports when they are exiting the USA. The final proof of exiting the USA is the return of the I-94 / I-94W (the white or green card that you got at immigration). This card is to be returned to the airline people in the departure lounge when you are boarding the aeroplane. They will gather them all up and hand them in to the airport officials so that everyones departure is recorded. DO NOT FORGET TO GIVE IN THE CARD. If you forget, there will be no record of your departure, and it will be as if you never left the USA. This goes for both guys and girls.

STATUS CHANGE WITHIN THE USA

Shaalan Beg Class of 2003

Editors Note: The issue of status conversion while staying in the USA is a frequent concern. Many guys consider it because it eliminates the chances of being held back in Pakistan (due to either visa rejection or FBI clearance) to an extent such that their residency contract is often cancelled. However, the major disadvantage remains not being able to leave the USA. Another point of notice status changes cannot be done if one has entered the USA via a visa waiver. Q Is it possible to get my work visa stamped from the US? To answer this we need to understand some basic terms:

Status vs. visa Both your visa and your status may be H1 or J1 but they vary from one another in some fundamental ways. While the status is your legal permission to reside in the US, the visa is the actual stamp on the passport which allows you to (re)-enter the US. So, although you may legally have your status changed from the tourist B1 to the Working H1, this will not allow you to come back to the US if you ever have to leave and you are hence STUCK. To enter the country, you need a valid visa.

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Getting a visa involves going through the US consulate in Islamabad, and this means going through the infamous security clearance for guys. Currently, no one knows a hassle free method for Pakistanis to get a visa from any other country. Options may exist, however. So, if you ever find out, please ensure that this information is included in the next edition of Road to Residency. While the duration of the status can be extended from within the US for up to six (for H1) or seven (for J1) years, your visa will only be valid for the duration that it was initially stamped. To re-enter the US after that date, you shall have to get another visa stamped from the Consulate. Now here is where the H1 and the J1 can differ: It is possible to get an H1 stamped for up to three years while a J1 is only stamped for one, so a person on H1 can come and go from the US as he/she pleases for three years while the J1 only has one year. So the answer to the above question is that you may have your status changed from the Tourist B1 to H1/J1, and it will be 100% legal, but you will not have a visa on your passport.

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SECTION IV HOW TO APPLY IVa The Residency Application


THE APPLICATION PROCESS
Zainab Samad Updated by Class of 2003

I have attached the chapter of Road to Residency that was written by Zainab Samad. I have edited the chapter in order to update. Updates and comments are written in non-italicized bold text:

www.aamc.org/students/eras/steps/start.htm www.ecfmg.org/eras/index.html The above links have the answer to most of your questions. How to use the site? What are the steps in applyingetc? There is a wealth of information in the above two website links. I went over all of it and my application process went by very smoothly. I would advise that others do the same. Almost all programs require applications to come through ERAS (Electronic Residency Application System). This has made the process and applying a whole lot easier. Since the programs start downloading applications on September 1st, the ERAS tokens become available in July. Requesting the token has become an online process. www.ecfmg.org/eras/tokreq.html . The application fee is around $75. Your Token will be sent to the email address in your ECFMG record. You will have the opportunity to add or update your email address when you request your Token. To check your email address, access OASIS at https://oasis2.ecfmg.org/. On July 1st you will be able to log on to MyERAS at https://services.aamc.org/eras/myeras2005/ (Youll have to register before you are able to log in). As soon as you get the account, you can start working on the Common Application Form (on your account). This can even be printed out if you want to work on it in your spare time. The following link might help you in filling out the CAF - http://www.ecfmg.org/eras/comapp.html (I think this link is dead a worksheet which will help you fill the CAF is available at http://www.aamc.org/students/eras/support/worksheet2005.pdf ). Once the common application form is filled out, it is automatically converted to a CV. This form is sent to ALL programs. So submit it after checking everything a couple of times. Beware of typos and spelling errors since the ERAS program does not have spell check. The following link might help you in filling out My Profile http://www.ecfmg.org/eras/myprof.html (I think this link is dead too).
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. Before applying to programs you need to be registered with the NRMP at www.nrmp.org. Click on Match Site and then click on Register for NRMP matches. Besides, the CAF requires the AAMC ID, which can not be obtained without registering with the NRMP. Start early and work hard on your personal statement (PS). Show it to your seniors or juniors - anyone with a good head on his or her shoulders and anyone who can give you an honest opinion. You can make a number of personal statements. You can use different ones if you are applying in more than one specialty. In the mean time, the ERAS office will send you an information booklet about how to use their site, and stickers. Have the following ready. 1) A copy of the deans letter (Give your CV to Nasreen Sheikh, well in advance as the deans letter takes time to make.) 2) A copy of the medical school transcript (if you are in the top 15, get one which mentions rank) 3) Copies of recommendation letters. (You can have a max of eight letters on the sitebut only 4 can be sent to a particular program) Send as many as you can so that you have the option of choosing - 4 American letters and 4 AKU letters (including one from the dept head). Give your CV and PS to the letter writer so that he or she can add a personal touch to the letter. 5) A picture of you. The size should be 2.5 X 3.5 inches. These documents are labeled using the stickers [Stickers are no longer available. Read about it at www.ecfmg.org/eras/index.html under the heading How do I identify my documents). Also, now you need to send the ERAS Document Submission Form along with your documents. It is available at www.ecfmg.org/eras/docform.html ] and then sent to the address that ERAS provides. These are then scanned by the staff and put in your folder. After sending these documents, you can create them in My documents and then assign them to various programs once they are scanned. The Transcript, Deans letter, Common Application Form, CV, your picture and the USMLE transcripts are sent to all programs that you apply to automatically. The only thing that you have to decide while applying to a certain program is a) which LoRs to send b) which personal statement to send c) whether you want to release the USMLE transcript or not. Before selecting programs, SEARCH and SEARCH. Look up the Green book and the Internet for programs. You need to know, if the program is participating in the match, whether it is accepting applications through ERAS? What are its deadlines? Does it have specific requirements in terms of LoRs? Does it require a
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years US clinical experience? Does it accept only those with a green card or US citizenship status? What kind of a visa does it offer? Applying is really easy...just a click away. After you have applied, you can check the status of your application using ADTS (Applicants Documents Tracking System). This will allow you to see which programs have down loaded your application, how much of it, and when. With in a few days of applying you will start hearing from programs on the email address that you have provided in your Common Application Form. So provide a reliable email address, one that you can even access in the States. Factors that count in securing interview calls: 1) USMLE Step scores 2) U.S. Recommendation letters 3) Externships/Research Experience in the US 4) Medical School Performance 5) Calling up the Program Secretary repeatedly and sounding *really* enthusiastic about the program.(in fact this might be the single most important factor in a lot of programs, and I cant stress it more) Zainab Samad Class of 2000 (Extract ends here)

Another analysis of ones application has been added below: __________________________________________________________________ An important question that arises at this point is How is my application judged? and what makes an application stronger than others? Following factors play an important role and in that order: 1- USMLE scores (the higher the better...simple. This is the first and the foremost thing. Programs screen applications based on Step 1 scores. For example, a certain program decides that it will only call applicants whose Step 1 score is higher than 90. If your application has a lot of other strong points but your Step 1 score is 85, you will not be granted an interview call). 2- US Experience/electives (clinical experience in the USA; Observerships don't count. Some places equate UK or Canadian experience to US experience). 3- Strong Recommendation letters from Gora Saab (if you have done electives in US). 4- Strong Recommendation letters from your Medical School Faculty (or any
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other guy you have worked with). 5- Your performance in medical school (Class rank being an important indicator). 6- Reputation of your medical school in USA. (Yes, good reputation helps but lack of reputation does not prevent you from getting in). 7- Research experience is low on the list but is a definite advantage if you want to get into a University program. 8- Green card or American passport is an advantage because then there are no visa issues to solve for the program. However, I am not sure where to put it in the list. For some programs, it is an important advantage, for others it does not matter what your passport looks like as long as you prove to be competent.

_________________________________________________ WHEN TO APPLY


Class of 2003

Class of 2003

Applications for residency positions are sent via Electronic Residency Application Service (ERAS(r)). ERAS office starts transmitting your applications to the programs on September 2nd every year. Therefore, the earliest you can apply to any program is September 2nd. The timeline of important events can be found at relevant web sites. However, here is the pointer that I want to give you. - If you apply in September, you are applying early and you will get the advantage of early bird. - If you apply in the first two weeks of October, your application is "in time". You are OK. - If you apply in late October or worse yet, in November, your application will suffer. You will end up with less interview calls. Why is that? The programs analyze applications in order of the date of application. If you are a regular candidate but you have applied early, programs will look at your application first and decide there and then whether to give you an interview call. They are more likely to end up calling you because its early season and a regular candidate is acceptable. Now consider the same regular candidate applying in late October. Most of the programs have already called a lot of applicants. There are very few slots left so the programs tend to become more selective. A regular candidate may or may not be acceptable depending upon other options available to the program. Now the question arises "I will only have my Step 1 score in September Should
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I still apply? Will I suffer if I do not have my Step 2 score? The answer to both the questions is yes. Lets go through it step by step. - Ideally, you should have both Step 1 and Step 2 scores and passed the CS by the time you send in an application. That will give you the maximum advantage. However, that means studying hard and fast, going to US just for the sake of CS and getting it all done and over with before September. Thank God, we do not live in an ideal world so we can get away with less. - The minimum you need to apply for residency programs is a Step 1 score. That's the bare minimum and most international applicants do that. It is acceptable. In fact, if a program likes your application but requires your Step 2 scores before they grant you an interview, they will wait for you and put your application on hold till than. They will make their final decision whether to call you for an interview or not only after they have received your Step 2 scores. - The best approach which is both economical and fruitful at the same time is to have Step 1 and 2 scores before application (i.e. September). You take your CS when you go to US for residency interviews. Thus there is only one trip to US and you get the advantage of Step 2 scores as well. Conclusion: The advantage of early application outweighs the disadvantage of applying without Step 2 scores. Therefore apply early!!!!!!!!

WHERE TO APPLY

Class of 2003

If you know nothing about the various hospitals in the USA dont worry. Neither did I, until a month or two before I sent my application. Many people gather this information during medical school. If you did, Great! If not, join the club. How to find out? Ask your seniors! The reason for this is simple. They have already done their homework! Else, find out where your seniors have gotten into. This is very important. You see, the fact of the matter is, if a program has a history of taking students from your university, they will probably continue to do so, so long as their experience has been worthwhile. Hence, there is a gradual development of so called hubs. Some programs are AKU hubs. They love AKU students. Others are DMC hubs, etc. The university that you have studied at has a major impact on how much importance they give your application. I will illustrate this with a simple example. At one of the programs where I interviewed, an authoritative member of faculty informed us of the following: When that particular program interviews candidates, it gives them points for their various
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qualities. One of the things which gets points is the medical school. If a graduate from the home institution, they get 20 points. If from another US institution, they get 10 points. IMGs get 5 points. However, AKU students are the exception to the rule, and they get 10 points Think about it So, you see, if they are familiar with your school, your chances increase. Of course, even the fact that students are called for interviews is a positive sign, even if no one has matched there yet. After all, a program will only spend its resources on you if you have some chance (however remote) of matching there. So, keep in touch with your seniors. Of course, you do not always have to stick to the beaten path. Someone has to take the initiative in applying to previously uncharted territory. If you have done electives in a great university and you feel that you have been able to ensure that you have been well noticed, by all means, apply! If you have been looking at websites and have found a program which suits your interests, apply! After all, if you succeed in securing a spot, youll be pushing boundaries for your own juniors. However, keep in mind, applying is an expensive process. Furthermore, the more places you apply to, the more expensive it gets. The first ten places that you apply to will cost you $60. Programs 11-20 will cost $8 each, 21-30 will cost $15 each, and 31 onwards will cost $25 each! To put that in perspective, 10 programs cost $60, 20 programs cost $140 and 30 cost $290 It keeps doubling Keeping this in mind, decide upon the number of places which you should apply. The main factors that should determine this number are the strength of your application and the program specialty for which you are applying (and your bank balance, of course). If you have a decent application and are applying to a non-competitive specialty like internal medicine or pediatrics, 30 programs are more than enough, as long as the list of programs is primarily made up of the places which are AKU friendly. You could even get away with less, but, I dont think it is worth the risk. Of course, if you feel your application is weak, apply to more. If you are applying for something more competitive (like surgery, ophthalmology, radiology, etc.), apply to more. If you are couple matching, apply to more. I couple matched internal medicine with pediatrics, and we consequently sent out our application to fifty programs. Your aim should be to get yourself about ten interviews. If you achieve that, your chances of matching are quite good. Statistically speaking, applicants with at least six interview calls have almost always matched. Another tip would be to mark all the cities that you are considering on a map of the USA. Make sure you understand the distances which the map represents. I minimally understood USA geography prior to this exercise. Trust me, it made a huge difference both to my knowledge base and to my choice of application. The reason for this is THE USA IS ENORMOUS. And most of us travel by greyhound. I applied to places in Florida, but, I later realized that it was completely out of the way. I was even going to apply to Maine and Seattle but then I saw where they were on the map. Eventually, I restricted my program sites to central and eastern time zones. Even that was quite a ride The map will also be useful when you are planning your interview calls. See where you will be at a
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given date and where you have to go. This way you will be able to plan better. You don't want to spend time going back and forth, because it will exhaust you. Remember, although the residency trail is not that much of an intellectual challenge, it is physically exhausting as it requires a lot of traveling. Save your energy as mush as possible. Being a senior myself, my further two bits. Attached within this zip file is an excel file with all the information which I could muster. I also scanned the map which I made for myself. Help yourself! Do check out program websites. They will give you a feel of the program. Look at their requirements. They usually stick to what they state, however, they some programs overlook some of their requirements at times. Be wary of the language used (e.g. 6 months of US experience required is different from 6 months of US experience recommended etc.) If you feel that you need to know more, write to the program to ask them your questions. Ask them things like whether they take IMGs, visas offered, specific requirements like US experience, application deadlines, etc. Another thing to keep in mind is that some programs may suddenly become non-operational! So, make sure you check out the list of programs which are participating with ERAS. The website is www.aamc.org/students/eras/about/start.htm To repeat an above mentioned statement, make sure you apply to as many AKU friendly places as you can. Also, apply to an appropriate mix of programs. As in, some great places, some back ups, and lots of in betweens. Keep in mind though, at the end of the day, there is another thing that you will be told time and time again. Never rank a program which you would hate to go to It is better to go unmatched and go for the scramble than to be stuck in a place where you will be miserable. Since that is the case, why bother applying to a place where you have no intention of going? Another place where you can find out information about residency programs is FREIDA (Fellowship and Residency programs Electronic Interactive Database). (www.ama-assn.org/vapp/freida/srch/ ). This enables you to search for residency and fellowship programs in terms of specialty and location. Hence, a very useful tool. It will give you a good idea of what kind of program it is (university, community, etc.), size of the program, and, probably most importantly, the contact information for the program director and the program secretary. This is where you get the keys which open the door the ancient ritual of bugging the program administrative staff. There is a ton of information here. Keep in mind, the contents of this site have been written by the administration of the programs themselves. None of the information has actually been authenticated by anyone, and thus does not have to be all true. I came across program which claimed that the average amount of time that a resident works is 65 hours. If you come across something similar, make a mental note to hear the residents there laugh. During your interview trail, you will often notice that there is an interesting gap between
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how many hours the residents work and how many hours the program director thinks the residents work. So, dont believe everything you read. The only drawback of FRIEDA is that it does not have the information specific for IMGs. For example, it has no information on willingness to accept IMGs, IMG requirements for application, visa sponsorship availability and type, etc. All such information on FREIDA is pertinent only for US Medical Graduates (USMGs). Therefore, do not get excited if you find a certain program on FREIDA which states that applicants have to take USMLE Step 2 CS exam anytime before starting residency. That's only valid for USMGs, not IMGs. US News rankings are alright too. Itll give you a general idea of how great the place is. Most of the details are in the Premium bit. Admittedly, I bought it, but I dont think it taught me anything worthwhile. So, I dont advise it. I did some extensive work on US News. I read the rankings in many different ways. Looked at medical school rankings. Looked at rankings of internal medicine, pediatrics and family medicine programs: www.usnews.com/usnews/edu/grad/rankings/med/medindex_brief.php Looked at the rankings of the best hospitals for everything: www.usnews.com/usnews/health/hosptl/tophosp.htm In doing so, one can get a pretty good feel for how good the hospitals are. Keep in mind. Just because a hospital is good for something, it is not necessary that the corresponding residency program will be good. Sometimes you may wind up in a fellow run slump. So, look out! Another point to keep in mind is that US News Rankings are dependent on many factors, many of which do not concern the average resident. On the flip side, US News does not consider many factors which are of significant importance to the average resident. So, do not treat them like scriptures. Programs which are not ranked can be much better than those which are ranked. Better faculty contacts may lead to better fellowship placement. Board pass rates may be higher. Environments may be far more friendly (big shot programs are usually quite arrogant). The hospital may be excellent in the area which you want to sub-specialize in. Remember, your priorities will determine the ultimate list of program rankings. Another website is www.scutwork.com . Here, youll find a bunch of program reviews. Admittedly, I didnt use it, however, I mention it as it was recommended by Umbereen S. Nehal in Road to Residency. I have also added an extract from Road to Residency below: The things I was looking for in a Residency -Good program -Takes foreign medical grads (had at least one in their residents!!) although I did apply to a few programs which had really good names and no FMGs (did not get calls from those guys)
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-If there was an AKU grad there -Places that people in AKU apply to in general -Places which were not badly talked about or which did not get bad ratings from the previous classes. Because you spend a lot of money traveling to these places and time and effort, if you know in advance that a reasonable person really did not like it, then it is a waste of time and effort to go there I thought...unless, you are in the area and can interview there at the same time as your interview in another place nearby...... (Like I was in Houston so interviewing at UT as well as Baylor was something easy and convenient for me) -Places in clusters...if you are applying to one program in a city and serious about going there for an interview if you get a call then apply to a program close to that...if you get a call and want to interview there you can schedule the 2 together...even so dont apply to programs you will certainly not want to end up in and might not even interview at cause it is a lot of waste of money which happens every year to almost all of us cause we worry about not getting enough calls. Things to think about when going to an interview -What are your priorities in a place? Mine were location (I had family in Texas), the kind of program, residents, the sort of faculty, did I fit into that place, was it psychotherapeutic or pharm-oriented, was research necessary, did everyone seem happy or were really stressed out or even worse, bored...etc - Can you see yourself spending 4 or 5 years at this place and if you are thinking of a fellowship can you get one after this place? Or if you are thinking of an H1 or private practice, then what are the chances? -Do people moonlight and if so how does the program feel about it and do you want to. Shaheen Mithani

RESEARCHING PROGRAMS
Hussain Mahmud (Class of 2005) Which programs to apply to will be the biggest question youll be facing in September. There is no clear answer as you have to tailor your application list according to your own career plans and geographical preferences etc. The biggest help as detailed earlier, will be going through last years match list and the
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seniors advice. I found the Road to Residency immensely helpful even though some of the information is outdated; a few programs have stopped calling us while a few new places have opened up. But still itll serve as a good guide and you can build on the information it gives you by asking around. A few books are also available in the market which will definitely help you in polishing your application. These books will tell you how to apply and how to make your application look stronger; not where to apply. For that you have to rely on the word of mouth. The book which I used and found very good was First Aid for the Match (3rd edition). It gives you a very nice overview of the whole match process and how to go about applying, travelling, interviewing, visas etc. It has an excellent section on personal statements and comes in quite handy while you are writing your own statement as youll need as many samples as you can lay your hands upon at that time. Thanks to the pirates, you can get it from Urdu Bazaars for a hundred or so rupees. Another book that I recently came across was First Aid for the International Medical Graduate. I didnt get enough time to go through it it detail but it seemed nice. Other than the routine application and interviewing stuff, it had some really nice sections on travelling arrangements and how to organize things once you get the residency; practical stuff like finding apartments and getting the social security number etc. Its pirated version wasnt available in the market last year but if it is now, I would recommend it. Other books like The Successful IMG: Obtaining a U.S. Residency by Anagh Vora are also available but I didnt use them so dont know much about them. A wealth of information is available online. Ill go through a few of the sites I used while applying. 1. Programs own website: This will help give you a feel of the program, how academic or otherwise it is, what are the programs goals, how many IMGs are there, which visas do they sponsor etc. 2. FREIDA http://www.ama-assn.org/vapp/freida/srch/ As discussed earlier, this site has the most information about a program but you have to remember that this is coming directly from the residency program and not being verified by a third party, so there might be inaccuracies. Useful information includes the program contact info, size of the program, how many people do they call for interviews, vacations and other benefits. 3. Scutwork http://www.scutwork.com/ This is a helpful site if a review of the program in which youre applying to is available as a lot of programs havent been reviewed yet. The reviews give
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you an insiders peek into how life at the program is. A lot of reviews have been written by medical students but they are also very residency oriented and a good read. My impression was that most reviews are a bit dated, written in 2003 and 2004. Still this site must be a part of your pre-interview homework: will make you think of a lot of questions to ask during the dinner or interview. 4. Student Doctor Network Forums http://forums.studentdoctor.net/ This forum is used mainly by U.S. medical students to get across their queries about the residency application process and the programs and they are answered by residents. However there are IMG specific threads too. Tons of useful information is available on this forum, just keep digging. The discussions get really interesting at times. 5. FMGResidency http://www.fmgamerica.com/lists.html This site doesnt have much to offer except for a table . Again dont trust it too much as there are quite a few mistakes; just use it as a rough guide if you dont want to go down the beaten path and are into exploring new programs. 6. US News http://www.usnews.com/usnews/health/best-hospitals/tophosp.htm Most of the information about the residency programs is locked up and you have to pay for it. However a lot of information about the top hospitals, overall and speciality wise is available. You can get a good idea about the strengths and repute of a program, especially if you are interested in a particular subspeciality for fellowship. 7. Roadmap to Residency: From Application to the Match and Beyond
http://www.medschool.northwestern.edu/student-programs/residency/road_residency.pdf.

Another document with a name sounding suspiciously similar to our own R2R. Its a 38 page document released by AAMC giving an overview of the whole match process. There will be little stuff that you dont already know but still it provides a nice summary right from candidate eligibility requirements to the transition from medical school to residency. Some more helpful links can be found in the bibliography and webliography. 8. The Residency Interview: Making the Most of It http://www.ama-assn.org/ama/pub/category/6701.html This link has got some great tips for residency interview preparation. Make sure that its a part of your pre-interview homework during the initial interviews. Also roam around this site and youll find more useful stuff like tips on writing personal statements etc.

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THE PERSONAL STATEMENT

Umbereen S. Nehal

You should start working on this as early as possible. I revised my personal statement eight times before I sent it in. This should be what it says: personal. You want to describe specific experiences that inspired, motivated, shaped you. If you mention a patient, give that patient a name (make up a name if you dont remember). After reading your PS, a person should have a sense of who you are, what your goals are, what is important to you, why you chose the field you are applying to, and what you are looking for in a residency program (you may, but dont need to, explain why you chose medicine). You want to highlight all your strengths. You should ask lots of people to help you edit your statement. Even if you dont agree with that persons advice, you should take it into consideration. Who is to say that a residency director wont think the same thing after reading it? DO NOT LIE OR EXAGGERATE. If you write something really impressive in your personal statement, your interviewer might just ask you about it. You should remember that doctors are not literary people. You dont want to impress them with your vocabulary; you want to impress them with your clarity. You want the reader to remember the content, not your writing style. Americans like simple, straight-forward language so dont make your personal statement too flowery. And try to keep your sentences short. You definitely should not exceed a page (mine seems to, but with the proper formatting, it stays on one page). [Editors note: Although the website gives the provision for a three page personal statement, it is an unsaid rule to keep it limited to one printed page. This will keep it crisp and will prevent rambling.] Try to avoid the passive voice; use words that are energetic and expressive. Start and end paragraphs with strong statements. Ideally, the first sentence of every paragraph should grab the reader and make him/her want to read the rest of the paragraph. Remember, residency directors read hundreds of personal statements; they only have a few minutes to spend on yours. It might be helpful to make an outline before starting to write, of all the topics you want to cover. Website: The following link has some useful tips on this subject: http://www.ama-assn.org/ama/pub/category/6700.html

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SAMPLE PERSONAL STATEMENT

Umbereen S. Nehal

"Walk around feeling like a leaf. Know you could tumble any second. Then decide what to do with your time." -Naomi Shihab Nye My decision to leave Wellesley College and attend medical school in my parents' homeland turned out to be a deeply satisfying experience. I was motivated by a desire to learn about my cultural heritage and to be closer, both physically and emotionally, to my parents. I had been at the Emma Willard School, a boarding school in upstate New York, since the age of 14. My father's job required my parents to live half a world away and I felt that I was losing touch with my roots. While learning about my cultural heritage enhanced my personal growth, it was studying medicine in a developing country that was the most rewarding experience. I was fascinated by the spectrum of disease that existed in our patient population. The obese banker receiving streptokinase in the emergency room of the Aga Khan University Hospital presented a shocking contrast to the emaciated child with measles I saw in the community clinic. Visits to squatter settlements taught me how to prioritize care, making the best use of limited resources. I learned how to apply my textbook knowledge to the imperfection of real-life situations. Despite the frustration of seeing patients denied care because of financial constraints, I had a sense that I was making a difference. I felt I made a difference for Yasmeen, a 35-year old grand multipara, when I administered her first tetanus vaccine and offered contraception. Ultimately, my five years in Pakistan gave me far more than just a medical education. Some consider pediatrics depressing because it forces us to see children in pain or children who have debilitating illnesses. I find pediatrics uplifting because I see the resilience of a child's body and the triumph of the spirit. During my pediatric neurology elective rotation at Brown University, the child with cerebral palsy who proudly drew a picture with her foot inspired me. The most appealing aspect of pediatrics is the special relationship with the patient and the family that develops. It is a privilege to be part of the team that monitors and safeguards a child's physical, emotional, and social development. Continued growth, especially in my professional life, is a priority for me. After completing my ECFMG requirements, I began a research project with Dr. Julie Ingelfinger and Dr. Eric Grabowski at Massachusetts General Hospital. We are studying the pathogenesis of hemolytic uremic syndrome. It is exciting to be working on an NIH-sponsored project that may contribute to a cure for the most common cause of acute renal failure in children. My research background has helped to develop my inquisitive mind, critical thinking skills, and meticulous attention to detail. At the same time, I have maintained my clinical skills by attending rounds, participating in consults, and observing clinics. Diversity has been the cornerstone of my life. Born in Arizona, raised in Saudi Arabia, educated in the U.S. and Pakistan, I believe I have a unique perspective.
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As a teenager I worried that I would never "fit in" somewhere. As an adult I feel that, in fact, I can fit in anywhere. Because I am not defined by a single culture, I believe I can relate to almost anyone and easily build rapport with my patients and their families. During my elective rotations at Baylor University, Brown University, and at University of Texas at Houston, I recognized the importance of Spanish in the medical profession and subsequently enrolled in a language course. My recent courses in Spain and France, coupled with my fluency in Urdu, facilitate effective communication with patients. I hope to always have the opportunity to educate myself to better serve those around me. To that end, I am eager to take on the challenges and responsibilities of residency training. I seek a program that balances academics with community exposure, that has patients ranging from Kawasaki Disease to otitis media, and one that prepares its residents to assume real world responsibilities.

NRMP REGISTRATION

Class of 2003

(If you are a participant of the couple match, please ignore this chapter and read NRMP for couples) NRMP stands for National Residency Matching Program. This is the system which will determine where you go for your residency (and fellowships, perhaps). So, dont forget to register! (The website is www.nrmp.org ). NRMP registration commences on August 15th, and, the deadline for registration is December 1st. Since registration with NRMP costs money ($90 per applicant), I would advise registering after one has gotten past visit visa issues. However, as with all things, do not leave it till the last minute! Registration is quite straightforward. It should not give anyone any difficulties. Once you are registered, you can just forget all about NRMP for a while. Youll need it when you are making your rank list.

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SECTION IV HOW TO APPLY IVb Residency Program Reviews


INTERNAL MEDICINE
Zainab Samad (Program List Lessons to be learnt!)
1) University of Wisconsin, Madison, WI Internal Medicine Categorical: Rejection 2) University of Texas at Houston, Houston, TX Internal Medicine, Categorical: Invitation 3) Baylor College of Medicine, Houston, TX Internal Medicine, Categorical: Invitation 4) UT Southwestern School Program, Dallas, TX Internal Medicine, Categorical: Rejection 5) Vanderbilt University Program, Nashville, TN Internal Medicine, Categorical: Rejection 6) University of Tennessee Program, Memphis, TN Internal Medicine, TN: I was kept on the waiting list...but finally no call 7) Palmetto Health Alliance University of South Carolina School of Medicine Program, Columbia, SC Internal Medicine, Categorical: Couldnt review my application since I was not ECFMG certified 8) Brown University Program, Providence, RI Internal Medicine, Categorical: Rejection 9) Penn State University/Milton S Hershey Medical Center Program, Hershey, PA Internal Medicine, Categorical: No response 9) University Hospital/University of Cincinnati College of Medicine Program, Cincinnati, OH Internal Medicine, Categorical: No response; they called quite a few from our class. 10) Cleveland Clinic Foundation Program, Cleveland, OH Internal Medicine, Categorical: No response; they called quite a few from our class. The trick, I learnt later, was to keep calling their program secretary! 11) Duke University Program, Durham, NC Internal Medicine, Categorical: Invitation 12) University of North Carolina Hospitals Program, Chapel Hill, NC Internal Medicine, Categorical: Rejection 13) Mount Sinai School of Medicine (Bronx) Program, Bronx, NY Internal Medicine, Categorical: No response 14) Mount Sinai School of Medicine Program, New York, NY Internal Medicine, Categorical: No response 15) St. Lukes Roosevelt Hospital Center Categorical Program, New York, NY Internal Medicine, Categorical: No response

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16) New York Presbyterian Hospital/Weill Medical College of Cornell Medical Center Program, New York, NY Internal Medicine, Categorical: Rejection 17) Dartmouth-Hitchcock Medical Center Program, Lebanon, NH Internal Medicine, Categorical: Invitation 18) Washington University/B-JH/SLCH Consortium Program, St. Louis, MO Internal Medicine, Categorical: Invitation 19) Mayo Graduate School of Medicine (Rochester) Program, Rochester, MN Internal Medicine, Categorical: Invitation 20) University of Minnesota Program, Minneapolis, MN Internal Medicine, categorical: Said that it calls only those with a green card or a J1 visa 21) University of Michigan Program, Ann Arbor, MI Internal Medicine, Categorical: Rejection 22) University of Massachusetts Medical School University Campus Program, Worcester, MA Internal Medicine, Categorical: Said that it could not interview me this year since I was not fully ECFMG certified 23) Brigham and Womens Hospital Program, Boston, MA Internal Medicine, Categorical: Rejection 24) New England Medical Center Hospitals Program, Boston, MA Internal Medicine, Categorical: Said that it could not interview me this year since I was not fully ECFMG certified 25) Beth Israel Deaconess Medical Center Program, Boston, MA Internal Medicine: Rejection 26) Massachusetts General Hospital Program, Boston, MA Internal Medicine, Categorical: Rejection 27) University of Maryland Program, Boston, MA Internal Medicine, Categorical: Invitation 28) Johns Hopkins University/ Sinai Hospital Program, Baltimore, MD Internal Medicine, Categorical: Rejection 29) Johns Hopkins University Program, Baltimore, MD Internal Medicine, Categorical: An extremely polite rejection! 30) Johns Hopkins University Bayview Medical Center Program, Baltimore, MD Internal Medicine, Categorical: Rejection 31) Indiana University School of Medicine Program, Indianapolis, IN Internal Medicine, Categorical: Invitation 32) McGaw Medical Center of Northwestern University (Evanston) Program, Evanston, IL Internal Medicine, Categorical: Invitation 33) Southern Illinois University Program, Springfield, IL Internal Medicine, Categorical: Invitation 34) Loyola University Program, Maywood, IL Internal Medicine, Categorical: Said that their interview spots had been filled up by the time I applied 35) University of Illinois College of Medicine at Chicago Program, Chicago, IL Internal Medicine, Categorical: Rejection

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36) Rush-Presbyterian-St Lukes Medical Center Program, Chicago, IL Internal Medicine, Categorical: Said that their interview spots had been filled up by the time I applied 37) Emory University Program, Atlanta, GA Internal Medicine, Categorical: Invitation 38) University of Miami-Jackson Memorial Medical Center Program, Miami, Fl Internal Medicine, Categorical: Said that they could not interview me this year since I was not fully ECFMG certified 39) University of Florida Program, Gainesville, FL Internal Medicine, Categorical: Said that they interviewed only those with a green card or a J1 visa 40) Mount Sinai Medical Center of Greater Miami Program, Miami Beach, FL Internal Medicine, Categorical: Said that they interviewed only those with a green card or a J1visa 41) George Washington University Program, Washington, DC Internal Medicine, Categorical: A very rude rejection! 42) Georgetown University Program, Washington, DC Internal Medicine, Categorical: Rejection 43) University of Connecticut Program, Farmington, CT Internal Medicine, Categorical: Invitation 44) Yale New Haven Medical Center Primary Care Program, New Haven, CT Internal Medicine, Categorical: Rejection 45) Yale New Haven Medical Center Categorical and Preliminary Program, New Haven, CT Internal Medicine, Categorical: Rejection 46) Stamford Hospital/Columbia University College of Physicians & Surgeons Program, Stamford, CT Internal Medicine, Categorical: No response

Besides the places that people interviewed at, other programs that are known to call AKU graduates: (This list has been generated by looking through the emails of seniors that Amin forwarded) Little Rock, Arkansas University of Connecticut, Farmington Rush University University of Illinois-Chicago Loyola University Cook County Hospital, Chicago Brigham and Womens Hospital, Boston, MASS Mount Auburn, MASS Wayne State University/Detroit MC Kalamazoo Center for Medical Sciences William Beaumont Hospital, Royal Oak, Michigan St. Louis University University of Missouri-Columbia Northwestern University University of North Carolina (Pediatrics)
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St. Lukes Roosevelt Albert Einstein, Bronx Long Island Jewish NYMC at Westchester, Valhalla Case Western Reserve - Metropolitan University of Oklahoma Temple University Thomas Jefferson University Health Center of Pittsburgh Penn State University, Hershey, PA UT Galveston West Virginia University Morgan Town University of Wisconsin, Madison University of Illinois-Peoria Michael Reese Hospital, Chicago SUNY, Syracuse New York Metropolitan Center North Shore/Forest Hill, NY Brown University, RI SUNY, Buffalo Yale University West Virginia University Charleston SURGERY PROGRAMS Mayo Clinic, MN Yale University, CT University of Miami, Jackson Memorial Hospital, Miami, FL University of Arkansas, Little Rock, AK University of Iowa, Iowa City, IA University of Connecticut, Farmington, CT West Virginia University, Morgan Town, WV West Virginia University, Charleston, WV Mass General Hospital, Boston, MASS Cornell Medical Center, New York, NY University of Kentucky University of Tennessee, Memphis, TN Penn State University Temple University, PA Howard University, Washington DC Metropolitan Group of Hospitals, Chicago, IL Loyola University Mount Sinai Hospital, Miami, FL William Beaumont Hospital, MC Providence Hospital South Field, MI Western Pennsylvania Hospital, Pittsburgh, PA
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St. Agnes Hospital, Baltimore, MD Nassau County Hospital, East Meadow, NY Bronx Lebanon Hospital, Bronx, NY St. Joseph Mercy Hospital, Ann Arbor, MI

Zainab Samad (Class of 2000)


Matched in Internal Medicine - Duke University, Durham, NC. I applied in Internal Medicine to a total of 47 programs and got 12 calls. I interviewed at 9 places. The weak call to application ratio might have had to do with the fact that a) I gave my Step 2 very late in October (and the CSA even later in December) and was not ECFMG certified by the time I applied. b) Many of the programs that I applied to, either did not call FMGs, or called only those with a green card. c) I didnt apply to a lot of AKU favorites like WVU, Syracuse, Buffalo, UT Austin Etc. Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire The airport is not busy therefore direct flights can cost quite a bithence I flew to Boston. The Dartmouth coach operates from the Logan Intl airport and stops at the doorstep of the Hanover Inn. (A 2-hour bus ride) This program was very strong academically. The faculty was approachable and friendly. The program secretary was very helpful. She arranged my meeting with an AKU grad (97) who was a third year resident there. The hospital was relatively new and had excellent state-of-the-art facilities. They had a separate wing for call rooms!! The training involved rotating between 2 hospitals Hitchcock and the VA. It drew its patient population from the entire New England area. They saw very little AIDS and Lupus, I think. The only problem I had with this program was that it was in the middle of nowhereas if someone had built a world-class hospital in Nathyagali. Also I didnt see any desis. the population was pretty homogenous. University of Maryland, Baltimore, Maryland I drove from Washington to Baltimore. (A 45 min drive). This was another academically and clinically strong program. The interview call was a surprise since they havent called anyone from our seniors so far. I found the chairman and PD to be very enthusiastic about their house-staff and training. Residents rotated between two hospitals University of Maryland Medical Center and the VA. The interns worked very hard. There were plenty of opportunities for research and it was encouraged. Their residents (all American grads) landed great fellowships. Salima and I interviewed on the same day, and since the PD kept seeing us together all day, she remarked about it. Salima suggested that we should specifically mention in our TY note that we were not couple matching.;)
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Emory School of Medicine, Atlanta, Georgia I stayed at the University Inn at Emory. It is at walking distance from the University Hospital. They called quite a few people from our class. As opposed to last year, this year they were offering categorical positions. Training involved rotating between 4 hospitals the Emory University Hospital and Grady being the primary ones. It snowed on my interview day and the entire city was paralyzed. They had to cancel the tour and the second interview at the Grady. (It sounded like Karachi when it rains) The program has a big name and a great cardiology fellowship. They work their residents quite hard. Residents spend most of their time in the Grady Memorial. Its ER is famous. For those interested in Infectious Diseases, the CDC is next door. University of Texas at Houston, Houston, Texas I stayed at the Marriott, Texas Medical Center. Although, I was later to find out that the program provides free stay at the Residence Inn. Whether it is residency here or fellowship, youll find an AKU grad. The program is therefore familiar with AKU students and likes them. It offers an H1 visa. The program is on probation these days but the reasons cited were not particularly alarming. The program director and chairman were both very friendly and enthusiastic about recruiting me. The faculty is strong and renowned and research is encouraged. The workload was immense with hospitals as large as Baylor but half the number of residents. Baylor College of Medicine, Houston, Texas This is a very rich ($) and academically tough program. It provides a free stay at the Marriott (for interviews). It also offers an H1 visa. Training involves rotating through 4 hospitals (just like UT Houston). The patient population is diverse and one learns a lot. They are known for working their residents hard. They have some of the worlds most renowned cardiologists. ;) The faculty is approachable, and strongly encourages research. What discouraged me was that the resident who was conducting our last tour commented that he wouldnt do his residency there again if given the chance. He felt that the workload was way too much and that one tenth of his class had left at the end of first year. Washington University, St. Louis, Missouri The Barnes & Jewish Hospital hosts this program. I stayed at the Best Western Inn. (It provides a shuttle service to and from the hospital). This program is the tops. Their residents and faculty contribute to the Washington Manual. They used to take 2-3 residents every year through APNA. But since the September 11 attacks, they have discontinued the program. The PD was not friendly and sounded against the idea of taking foreign grads. He was predicting trouble with procurement of visas. It is a dream program as far as academics, research, and a humane attitude towards residents are concerned. This is one of the few places that boast of happy residents. Also, St. Louis is a nice and quiet city.

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Duke University, Durham, North Carolina A great program located in a small and quiet city. I stayed at the Brookwood Inn. It is located right across DUMC. The program takes a few foreign grads every year, primarily from AKU and AUB (American University of Beirut). Their Internal Medicine residency program is one of the best in the country. The residents are extremely busy and work hard. They have autonomy and gain lots of first hand experience (even if it comes from being alone on call as an intern in some of the rotations). This place is big on academics, evidence based medicine and research. The faculty is strong, dedicated and very dynamic. Mayo Clinic, Rochester, Minnesota This is another huge program located in a small city. The program provides free stay at any one of the hotels - Grand Kahler, Marriott or the Radisson. I had done electives there and that helps a lot in securing an interview call. They have a great reputation. Their fellowship programs are the best in the country. I had heard that it was fellow run. But I did not think so... both on my interview and electives. They usually call foreign grads for interviews but only take them on preliminary positions. Indiana University School of Medicine, Indianapolis, Indiana This is another favorite with AKU grads. A large, academically muscular and clinically malignant program. I stayed at the Radisson. The hotel provides a limousine service to and fro from the airport (10 $, and it is cheaper than a taxi ;) Their residents work very hard. Their ER is famous. They have great fellowships and some of the most renowned physicians in their faculty. I found them to be the friendliest. I dont know why they went unmatched this year.

Naasha J. Talati (Class of 2000)


Matched in Internal Medicine - Duke University, Durham, NC. The following is a list of the places that I got calls from. The first thirteen I interviewed at and have ranked them in the reverse order of my rank order list. I thought this may help when you make your ROL. 1. Univ. of West Virginia: Dr. Sarwari is now the Associate Program Director. Definitely apply; they call a lot of AKU grads for interviews. The downside: Morgantown is a small place, with not too much to do .if you are alone you may not want to end up there. Small/medium sized program 2. Univ. of Connecticut: two hours from Boston, two hours from New York City. A big program, multiple hospitals and AKU friendly. Not very strong in terms of teaching, but still a good program. Large program

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3. UT Houston: This is a good program, large in size. Was on probation this year. Multiple hospitals. You will get to see a lot of cases. The atmosphere is relaxed and the people are very friendly. They give H1s. 4. Dartmouth College: Very intelligent and friendly people. Excellent teaching. More teaching than the above three but maybe not as hectic or have as much patient exposure. I doubt that you get to see enough of a mix of diseases. Its a college town. Very very small. Very white, personally I think one would feel a little isolated there. Also it is a small program with about eight interns. 5. Univ. of Cincinnati: A very good program. Residents work very hard, also seemed pretty smart. They have a couple of AKU people. The city is also quite pretty. In my opinion academically a little stronger than the ones above. 6. Indiana Univ: Reasonably big city. An excellent program. Again you have to work very hard. The advantage is that they have a multiple hospital system with a county and private hospital. This means lots of diversity in the patients that you see. At the county hospital you see very sick patients and get to be the person in charge. I think residents do have to do some of the scutwork. Good people to ask will be Mubashir, Sadaf 2000 and Bilal 99. The residents' report was excellent. 7. Emory: Excellent program. Close to CDC. Very keen to take AKU grads. Definitely apply there. Strong academically. I felt Emory, Indiana and Baylor were all equally comparable and excellent places to do a residency. With a very hands on approach to medicine. 8. Mayo: Excellent reputation. Lots of opportunity for research. My opinion was that the residents do not get enough autonomy and do not get enough hands on experience lots of people will tell you it is a fellow run place. There is a lot of emphasis on sub specialized care. Lots of referred patients. I felt that you wouldn't see enough critically ill patients and also would not get to be as active in decision making as I wanted and so I did not rank it very high. 9. Baylor: Baylor and Indiana are similar in that they both have county hospitals. I personally liked Baylor more. I think that the residents are overworked but the ones I met seemed very happy with the program. Excellent morning report. 10. UT southwestern: Excellent program. Located in Dallas. Nali 98 is there. County hospital called Parkland hospital. Lots of autonomy to make decisions on patient care. Very nice Program director and chairman. Lots of emphasis on pathophysiology. Very friendly place. Other departments aside from medicine are not supposed to be as strong. Very stable program with a PD and chairman that have been there a long time. 11. Washington University, in St Louis: Has an excellent reputation but somehow I did not like it as much. The resident report was very dull. The program director was not very friendly or accessible and the residents were snooty. It is supposed to be an excellent program and I did rank it very high despite these flaws. Strong on research. No H1. You can get a fellowship anywhere you want after this residency. 50% patients are private which means that the private attending makes decisions on them. 12. Duke: This was my second choice. I really liked the people that I met; both the residents and the people who interviewed me were very friendly and smart. Also Duke has a reputation for strong academic medicine and clinical research.
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Interns have to do call alone on some rotations with a senior resident for back up. This means you learn very fast and get to do a whole lot. But may also be quite stressful. 13. Mass General Hospital. Again an excellent program. Again there are some services on which the intern does call alone with a resident as back up only. Lots of people told me that Duke and MGH are malignant. This is something you need to assess for your self. The interview is with a panel of five people. They read your file inside and out and ask specific questions about rotations and patients you saw. It was not as intimidating as I had expected. Do apply if you have a good record at AKU and good Step scores. They were a little snooty . But who knows if you impress them you may end up at MGH. Other programs that called me . Which you may want to apply to: SUNY Syracuse Westchester Valhalla University of Illinois at Springfield. Little Rock Arkansas UT Galveston Albert Einstein Jacobi medical center NY. Michael Reese, Chicago Pennsylvania hospital Cook County, Chicago The last four are not so great, if you do apply to them, then use them as back ups. Look at class of 2000's 99 and 98s match list and apply to the programs that people matched at. Hope this helps! If you have any questions email me at naashatalati@yahoo.com Good luck. I know it seems like a monumental task to get through all of this. But once it's over it doesn't seem so bad.

Salima Shafi (Class of 2000)


Matched in Internal Medicine Duke University, NC

University of Arkansas

+ve IMG dominant Friendly, have an excellent chairman Dr. Andreaoli Give H-1s Have taken AKU

-ve Academically weak, May be difficult to get competitive fellowships from here

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grads,

University of Texas

IMG friendly H-1

Baylor College of Medicine Program

Clinically very strong program Have a VA, a community hospital and a couple of private hospitals, very diverse in terms of patient population. Excellent opportunities for competitive fellowships H-1 Very strong academically Emphasis on EBM h-1/j-1 ranked among the top five medicine programs (USA news) Excellent program Comparatively thund with night floats etc Very strong cardiology program h-1,negotiable for strong candidates

No pre-matches I would rank it below UT Houston academically. Was on probation last year Weak academically (deduced from elective experience) Better then Arkansas Dont like people who want H-1s Some residents were unhappy with the work load Less EBM oriented than duke or Emory etc. Very competitive Considered the most malignant program by AMGs

Duke University Program

Washington University/BJH/SLCH Consortium Program

Program Director wasnt sure IMGs stood any chance this year though they called a lot of people, I thought that

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was kind of rude Huge class, 50% private attendings so teaching may not be as good as other programs Cleveland Clinic Foundation Program H-1 IMG friendly Give prematches Excellent fellowships Residency program doesnt have the same reputation as fellowships Heard people had problems getting into competitive fellowships PD made some biased remarks Small city/town/cold J-1 only? Has not been able attract good candidates despite the name J-1 only Morning report was not impressive at all J-1 only Mostly IMGs , Similar to Arkansas program academically ?J-1 only Private attendings Have to work with several attendings at a

Mayo Graduate School of Medicine (Rochester) Program

Excellent program Strong academics Amazing fellowships

Indiana University School of Medicine Program

Very AKU friendly Strong cardiology plus research opportunities

SUNY Health Science Center at Syracuse Program

Offers pre-match

Illinois Masonic Medical Center/Rush Medical College Program

Thund program Do take few IMGs

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University of Maryland Program

ST. FRANCIS EVANSTON

Strong program Medium sized Very enthusiastic pd and chairman Better than Indiana (academically) Community hospital h-1 prematches

time Not much teaching J-1 only not many IMGs

IMG dominant Most residents practice gen. med. after residency J-1 only had no IMGs till this year

University Health Center of Pittsburgh Program

Brook dale

Strong program medium size but have lots of money (for research Nice city) Free PDAs Better then Indiana(subjective ) offers pre-match and H-1,community hospital

bad area, IMGs only

HUSSAIN MAHMUD (Class of 2005)


Pre-matched in Internal Medicine University of Pittsburgh ISP, Pittsburgh, PA. I applied to 40 programs and got eight interview calls. One of the reasons for the low number of calls was that I got ECFMG certified in mid-December. I guess previously you could get away by doing that, but not anymore with the competition getting harder each passing year.

Rejections:
1. Emory University Program, Atlanta, GA 2. Southern Illinois University Program, Springfield, IL (Dont sponsor H-1 or J1 visas) 3. University of Illinois College of Medicine Program at Peoria, Peoria, IL 4. Indiana University School of Medicine Program, Indianapolis, IN 5. University of Kentucky Chandler Medical Center Program, Lexington, KY
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6. Henry Ford Hospital Program, Detroit, MI 7. Wayne State University/Sinai-Grace Hospital Program, Detroit, MI 8. Mayo School of Graduate Medical Education (Rochester) Program, Rochester, MN 9. Creighton University Program, Omaha, NE 10. Albert Einstein College of Medicine (Jacobi) Program, Bronx, NY 11. Mount Sinai School of Medicine Program, New York, NY 12. New York Medical College at Westchester Medical Center Program, Valhalla, NY 13. SUNY Upstate Medical University at Syracuse Program, Syracuse, NY 14. Cleveland Clinic Foundation Program, Cleveland, OH 15. Drexel University College of Medicine Program, Philadelphia, PA 16. Medical College of Wisconsin Program, Milwaukee, WI 17. University of Wisconsin Program, Madison, WI

Put on hold or never heard from them:


1. University of Iowa (Des Moines) Program, Des Moines, IA 2. St Francis Hospital of Evanston Program, Evanston, IL 3. University of Illinois College of Medicine at Chicago/Advocate Christ Med. Ctr. Program, Oak Lawn, IL 4. Louisiana State University (Shreveport) Program, Shreveport, LA 5. Kalamazoo Center for Medical Studies/Michigan State University Program, Kalamazoo, MI 6. Michigan State University Program, East Lansing, MI 7. St John Hospital and Medical Center Program, Detroit, MI 8. William Beaumont Hospital Program, Royal Oak, MI 9. Washington University/B-JH/SLCH Consortium Program, St Louis, MO 10. New York Methodist Hospital Program, Brooklyn, NY 11. SUNY Health Science Center at Brooklyn Program, Brooklyn, NY 12. SUNY at Buffalo Graduate Medical Dental Education Program, Buffalo, NY 13. Baylor College of Medicine Program, Houston, TX 14. University of Texas Health Science Center at San Antonio Program, San Antonio, TX 15. University of Texas Medical Branch Hospitals Program, Galveston, TX

Interview Calls:
1. University of Iowa Hospitals and Clinics Program, Iowa City, IA Medium sized program. They take a few IMGs every year. Academically very good and residents get nice fellowships later on. Offers H-1. Downside is the location; Iowa City being a small college town with not much to offer. 2. University of Minnesota Program, Minneapolis, MN Very AKU friendly. Academically sound. The P.D. changed this year but they still hold AKU grads in high esteem offering quite a few prematches. J-1 only.
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They usually take IMGs through prematches only so do not schedule your interview in mid or late January as by then most prematches have already been offered. I think from next year, they are merging the IM program with Abbot Northwestern that might increase the competition for fellowhips later on. Very nice city, though it can get atrociously cold. 3. University Hospital/University of Cincinnati College of Medicine Program, Cincinnati, OH Another AKU hub. Academically strong. Offers H-1. Take their own in fellowships. The atmosphere is relaxed and the people are very friendly. 4. UPMC International Scholars Program, Pittsburgh, PA The ISP is a special track meant for IMGs who are interested in pursuing clinical research later on in their careers. The program offers a two month clinical research training program at the start of second year and seminars continue throughout the second and third years of training. Otherwise exactly like the categorical program; theyve stopped taking IMGs in the UPMC Montefiore categorical program. Excellent research opportunities and very good fellowship placements. Offers prematches and H-1. 5. Pennsylvania Hospital Program, Philadelphia, PA This is the community hospital of Upenn. An interesting place as its the first US hospital, established somewhere in 1751. They still have the old fashioned circular operation theatre, with lots of room for spectators. The new part looks like any other hospital though. Almost all IM residents are IMGs, mainly Indians. Last year eight out of their ten residents matched with fellowships. The P.D. attributed this to the fact that the residents are really good; most of them come to the US after having done MRCP from UK. Academically good; Upenn people do their prelims there. They offer H-1s. The P.D. mentioned something about sponsoring the green card during the residency though Im not sure how that works. Location is awesome; right in the heart of downtown Philadelphia. 6. University of Connecticut Program, Farmington, CT AKU friendly place. Three different hospitals. Academically okay, slightly weaker than the first four places. People do get fellowships afterwards. Offers J-1 only. Expensive state. 7. University of Alabama Medical Center Program, Birmingham, AL Great program. Their Department of Medicine was chaired by Harrison and Cecil in the fifties. They are one of the best ranked programs in the South. People get great fellowships from here; their cardiology is awesome. AKU name works wonders here and they gave out lots of interview calls this year. The P.D. will give an indication if they are ranking you later on in the correspondence. Nice place to live; they take you out for a real estate tour through some really nice but expensive suburbs on the interview day.
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8. University of Oklahoma Health Sciences Centre Program, Oklahoma City, OK Average program. IMG friendly with lots of people from KE and India. People have to work really hard to get fellowships later on. Academically, perhaps they are at par with Uconn but the city is much worse to live in with few AKU grads around. They offer J-1s only.

PEDIATRICS
Umbereen S. Nehal (Class of 2000)
Pre-Matched in Pediatrics Baylor College of Medicine, Houston, Texas I focused my applications on the Northeast. I was doing full-time research and did not want to spend too much time traveling. Plus, I preferred to stay close to family for my residency (since I have sisters in Boston and NYC). I also applied to major cities like Chicago and DC. Since my parents were moving to Arizona, I did apply there as well. The following is a list of places I applied to according to the response categories: No Response: Phoenix Childrens Hospital/Maricopa Medical Center Program; Phoenix, AZ Yale-New Haven Medical Center Program; New Haven, CT New York Presbyterian Hospital-Weill Cornell Medical Center; New York, NY North Shore University/NYU School of Medicine Program; Manhasset, NY New York University School of Medicine Program; New York, NY University of Texas Southwestern Medical School Program; Dallas, TX Rejection: George Washington University/Childrens National Medical Center Program; Washington, DC McGraw Medical Center of Northwestern University Program; Chicago, IL Johns Hopkins University Program; Baltimore, MD Bay state Medical Center Program; Springfield, MA New England Medical Center Hospitals Program; Boston, MA (They used to take IMGs, but are trying to improve their reputation so are now only taking AMGs. People I know who interviewed there were not impressed.) St Christophers Hospital for Children Program; Philadelphia, PA Brown University Program; Providence RI (the secretary is very rude) University Health Center of Pittsburgh Program; Pittsburgh, PA Invitation:
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University of Connecticut Program; Hartford, CT: I heard from them extremely late. I found their attitude to be rude and unwelcoming. It was obvious that they had reviewed all the AMG applications first, found that they still had some interview spots available, and then contacted IMGs. Their email had the attitude that it was a great favor that they were inviting any of us in the first place, that we should be extremely grateful, yet we should be aware that it was highly unlikely that we would actually be accepted for residency training. Since the one date they offered me conflicted with an existing interview date, I declined their invitation (though I probably would have anyhow). Georgetown University Program; Washington, DC: I found out that this program was on probation after I had already scheduled an interview (I heard about it from fellow applicants, Georgetown did not notify me of their status). Most AMGs I spoke to were not impressed with the program and doubted they would rank it. I had scheduled an interview, but once I accepted the out-of-Match offer from Baylor, I cancelled all my remaining interviews (including this one). Cook County Hospital Program; Chicago, IL: Because this program was on probation, I decided not to interview. I also was interested in a university program. University of Illinois College of Medicine at Chicago Program; Chicago, IL: I had kept this as a safety, but once I heard from Baylor, I cancelled this interview. UMDNJ-New Jersey Medical School Program; Newark, NJ: I did not accept due to its location. New York Presbyterian Hospital (Columbia Campus) Program; New York, NY: I was very excited to get this invitation since I had heard many good things about it from faculty and from AMGs who had interviewed there. This was one of my last interviews that got cancelled after I accepted Baylor. It is supposed to be a very good hospital that is quite humane to its residents. And it is one of the top ten pediatric hospitals in the country. SUNY at Buffalo Graduate Medical-Dental Education Consortium Program; Buffalo, NY: This is a well-respected hospital that I initially planned to interview at. But, once I heard from other places, I cancelled this interview. The program itself is very good; it was the location that I objected to. Penn State University/Milton S Hershey Medical Center Program; Hershey, PA: I did not accept this interview due to its location. But they do pay for accommodation, so it is worth going to. Interviewed: Maine Medical Center; Portland, ME:
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This was my first interview. They put me up at a beautiful, historic bed and breakfast. The location is typical New England (which means a desi would feel quite out of place). It seemed to be a friendly, easy-going program. The hospital was beautiful with great facilities. But, I was put off by the very non-academic feel. Residents seemed more interested in how much free time they had than in what they were learning. There is a loose affiliation with the University of Vermont medical school. It would have been at the very bottom of my rank list, if at all. University of Massachusetts Program; Worcester, MA: I got a nice feel from this place. It is very well respected for pediatrics and is one of the best in the country for primary care. The hospital was beautiful with wonderful facilities. The faculty seemed friendly and dedicated. There was a good discussion generated during morning report. The location is a bit of a downer. Worcester is a has-been industrial town and there is not a lot to do. It has a growing ethnic population but few Muslims or desis. The hospital was having some financial troubles which led to instability in the administration. The workload seemed very reasonable and the residents seemed close-knit. This program does not routinely interview IMGs. I had called the secretary to check on the status of my application and had buttered her up. She promised to mark my file for special attention and a few weeks later I got the interview invitation. Massachusetts General Hospital Program; Boston, MA: This was one of my top choices through the Match. I had done research for a year and was very familiar with the program. The people (both faculty and residents) are wonderful- warm, friendly, welcoming, intelligent, hardworking, dedicated. It is a medium sized program with a very intimate feel. The morning reports are excellent and really contribute to resident education. There is a lot of commuting involved as residents go out to area hospitals in Cambridge, North Shore, and Newton-Wellesley. The advantage to that is that it provides a good balance to the highly specialized, tertiary care medicine at MGH. The disadvantages are that MGH is not a childrens hospital and it competes with both Childrens and NEMC for its patients. The hospital is historic, but not especially pretty or child-friendly. Residents work very hard and ancillary services at MGH are poor. There are few fellows so residents have direct contact with attendings. Of course, Boston is a great place to live, if you dont mind the high cost of living or the cold weather. And of course it is Harvard, yet it does not have Harvard attitude. Though they do take 1-2 IMGs every year, those IMGs usually have an inside connection. If you want to go to MGH, you should do a year of research or some elective time there. Even so, there is a lot of internal competition, so research is no guarantee of a residency spot. Dartmouth-Hitchcock Medical Center Program; Lebanon, NH: I loved this program. If it wasnt for the location in rural NH, this would have been my first choice. Most of their faculty is from Childrens (Boston) so it has very strong academics. It has competes with no other hospital in the area. I was
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very impressed by their commitment to primary care. Their hospital is breathtaking and had every imaginable facility. Even though it is not a separate childrens hospital, the pediatric areas are well demarcated and catered to childrens needs. Their call rooms looked like they belonged in a resort. The people were very friendly and welcoming. The workload seemed reasonable. Residents seem to have good job prospects in New England and get into good fellowship programs. Their residents have a 100% board pass rate. If I was married, I might have been very interested in the program. But, I really felt that I would be buried all alone in the middle of nowhere. University of North Carolina Hospitals Program; Chapel Hill, NC: This is a great program for anyone interested in preventive medicine or primary care. It is one of the best programs in the South and is well-respected throughout the country. It has academic merit, yet is very friendly and laid-back. There is a new childrens hospital that is set to open any day. It is absolutely gorgeous. The affiliated School of Public Health is one of the best in the country. And there is excellent balance between tertiary and community care. Residents go out primary care settings to experience pediatrics at community hospitals. Though the hospitals are at a distance (up to 50 minutes away), UNC provides transport and the actual work hours are shorter in the community hospitals. UNC has residents from all over the country and from reputed medical schools. The area is picturesque. It has a growing ethnic population and growing number of Muslims and desis in the area. Cost of living is very reasonable and the weather is good (hot and humid summers and mild winters). This program would have been #3 on my rank list. Duke University Program; Durham, NC: This reminded me a lot of MGH, but with more fellows. Residents work very hard. The faculty did not seem quite as accessible and residents seemed to communicate more with fellows. It was a medium sized program and residents seemed to have good rapport. Everyone was very intelligent and dedicated. It was a high energy place. The advantage is that it is the top dog in the area. It gets all the referrals for the rare and complicated cases. It certainly is a very well respected program and its graduates get top fellowships. It seemed like a great place for someone who wanted to end up in academic medicine. Baylor College of Medicine Program; Houston, TX: This was the highest ranked program to call me for an interview. I had done an elective there and really appreciated their modern, state-of-the-art facilities. I was a little wary of the size and the idea that it may be fellow-powered. Also, residents are only exposed to urban, tertiary care medicine and do not see true community medicine. But, I was impressed by the diversity of the patient population and the opportunity to see all sorts of exotic diseases. At the same time, there are straight-forward admissions for asthma or meningitis. But, there are also a lot of patients whose files are too thick to fit into a single folder. The interns work extremely hard but the workload tapers off by final year. The
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institution is very highly regarded and graduates can pretty much do anything they choose. And residents have a 95% board pass rate. The residents I met all seemed really intelligent and very good at what they do. Houston is an ugly, sprawling city, but it has a lot to do. Baylor pays a very generous salary and costof-living is minimal. And there is a huge Muslim/desi community. This program only calls those who are fully ECFMG certified. They have four out-of-Match positions that they often offer to IMGs. They usually decide by mid-January who they will offer those positions to and very aggressively pursue those people. The program director gave me one day to make my decision.

Simeen Rais Pasha (Class of 2003)


Matched in Pediatrics Wayne State University (Childrens Hospital of Michigan), MI Rejections: University of Washington Program, Seattle, WA University of Texas Southwestern Medical School Program, Dallas, TX Vanderbilt University Program, Nashville, TN Penn State University/Penn State Hershey Medical Center Program, Hershey, PA Rainbow Babies & Children's Hospital/Case Western Reserve University, Cleveland, OH University of Chicago Program, Chicago, IL University of Connecticut Program, Hartford, CT (Kept me on their waiting list for a while) No/Varied Response: Baylor College of Medicine Program, Houston, TX: Insisted on ECFMG certification before calling for an interview University of Tennessee Program, Memphis, TN: The secretary was very encouraging whenever I spoke to her but after a while I stopped pursuing the program as I had traveled away from the area. University of Iowa Hospitals and Clinics Program, Iowa City, IA: I called this program several times and till the end of December I was on the waiting listthey finally emailed to say that they had interviewed enough IMGs and they would probably not interview anymore, but I was still on waiting! Cleveland Clinic Foundation Program, Cleveland, OH: No response Duke University Program, Durham, NC: No response University of North Carolina Hospitals Program, Chapel Hill, NC: No response
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Dartmouth-Hitchcock Medical Center Program, Lebanon, NH: No Response St Louis University School of Medicine Program, St Louis, MO: No response University of Arkansas for Medical Sciences Program, Little Rock, AR: No response William Beaumont Hospital Program, Royal Oak, MI: No response Kalamazoo Center for Medical Studies/Michigan State University Program, Kalamazoo, MI: No response

Interview calls and Interviews: Case Western Reserve University (MetroHealth) Program, Cleveland, OH: This was the only interview I couldnt schedule. West Virginia University Program, Morgantown, WV : This is a relatively small program for Peds with 5 residents per year. Theyre very AKU friendly and this is considered a good place for a first interview as they make you feel extremely comfortable, though I was the only interviewee on my day. West Virginia is a small college town, lots of opportunities for outdoor activities and some lovely countryside. Not the place to be if you like city life though! The program offered a nights stay and breakfast at a charming hotel and the residents took me for a tour of the town and lunch at the Radisson as part of my day. I had 2 interviews, one with a neonatologist and the other with the Associate Program Director. (The PD was out of town but wrote me very nice email before the ranking.) Both the faculty and the residents were all praises for AKU particularly regarding their last Chief Resident, Salimah Dhanani (class of 98) The downs were the programs and Morgantowns small size and the fact that the Childrens Hospital was only a small part of the main hospital. The ups were a lot of hands on experience (no fellows), a lovely childrens wing and a friendly work environment. University of Texas at Houston Program, Houston, TX I secured this interview after I mailed the PD saying I was only in Houston for that time and I was very keen to interview. I had spoken to the secretary several times who had promised to put in a good word for me but always ended up telling me that I had to be ECFMG certified for an interviewapparently not! I actually love the Texas Medical Center in Houston (having spent two months there for electives so I was a little biased towards this program). This was the only place that asked for a list of original documents including my degree, transcript and a letter showing the breakdown of hours spent at AKU (make sure U get one made from the office if youre interviewing at any Texas Program), and kept verified copies after my interview. There was a casual social hour with the Peds and Med/Peds residents at the hotel they had put us up in the night before. Herman Childrens is again a wing which is part of the main hospital. Though not free standing, its a beautiful Childrens hospital and they were undergoing
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expansion at the time. This is a relatively large Peds program with over 20 interns and rotations at Hermanns and LBJ, a community hospital. The day consisted of an interesting morning lecture, overview with the PD, a tour and 2 interviews. The residents seemed happy with no complaints about the faculty but admitted there was a lot of hard work involved. One of the interns mentioned being on call Q4 the whole year around! With Texas Childrens and Baylor right next door there was a concern about the patient population but we were convinced that there were enough to go around! Downs: Considered the step sister to Texas Childrens, huge work load. Ups: (for me!) Houstons a great city with a large desi / AKU population, part of the largest Medical Center in the country, large/diverse patient population. University of Texas Medical Branch Hospitals Program, Galveston, TX This is a medium sized Peds program with about 12 residents per year. Galveston is an island about a half hour drive from Houston. The beach and weather is very Karachi-like. However, it is a small and quiet town, although Houston is of course not too far away. The Chief resident, Nadia Sarwar (AKU class of 99) was all praises for the program and the faculty. The morning report was well presented and discussed (again by an AKU grad actually). The day consisted of 3 interviews including one with the PD. I enjoyed my discussion with him and was impressed by the stress he laid on academics. The Childrens wing of the hospital was not too impressive however. The day included a drive around the island and lunch at a great sea food restaurant. Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine Program, Cincinnati, OH This was the most highly ranked program at which I interviewed being #7 for Peds according to US News. It was also the largest Peds program I went to with 35 residents per year. We had dinner the night before the interview with one of the interns who genuinely praised the program saying how great it was and how well the residents were taken care of. She also talked about how busy it could get. However, with the hospital being structured to handle a large patient load and with computerized patient records, she told us that is was quite manageable. The Childrens Hospital was absolutely beautiful and the interview day well organized with 3 interviews (with the PD, a chief resident and a specialist from a field that you were interested in). From the list of residents it was apparent that this was a rather white program with only 1 IMG per year who were all from European countries. The day started with a group interview with the Chairman (who had a bit of an attitude!) who went around the table asking us our interests and histories. The rest of the interviews were very casual and the PD was extremely nice having been an IMG himself once. SUNY Upstate Medical University Program, Syracuse, NY

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This was another incredibly AKU friendly program. Syracuse is an extremely cold place and we heard plenty of stories from the residents about coldest days that they had seen! One of the few places that didnt give a hotel stay, the residents had an informal dinner the night before at one of their homes which was a lot of fun. The residents were a happy group who enjoyed talking about the work they were doing and the different hospitals they were working at. Syracuse will have its own free standing Childrens Hospital from 2007 which everyone was very excited about. The day consisted of two interviews and a third surprise one at the end of the day so that the PD could talk to everyone on a one to one basis. The faculty and the residents were all very welcoming and again all praises for their AKU residents! We all received Thank you notes from the Chairman via email after the day was over and the PD himself wrote personal emails to all of us who interviewed and was incredibly encouraging. SUNY at Buffalo Graduate Medical-Dental Education Consortium Program, Buffalo, NY This was a medium sized Peds program with 15 residents per year. A big plus was the fact that it was based at the Childrens Hospital of Buffalo, a free standing Childrens Hospital with an established reputation. The building was undergoing some changes at the time and the newly renovated NICU and PICU were absolutely beautiful. There appeared to be a strong stress on academics and this was the only program in which it was compulsory to rotate through 9 subspecialties (in 2 week rotations) and where a research project was also compulsory. There were 2 formal interviews (with the PD and a faculty member) and 2 group interviews (with a Chief resident and the Chairman). My interview with the faculty member was a bit weird in that he spent most of the conversation sitting back lazily with his legs up on his desk, going on about the various flaws in Buffalo and how the program was probably as good as any other but he didnt really know much about the others so he couldnt say! (I was a bit put off by his attitude). The Chairman joined the candidates and the residents for lunch. There were several IMGs and again the residents seemed quite happy with the program. Long Island College Hospital Program, Brooklyn, NY I applied to this program as I had done electives at its campus in downtown Manhattan, The Beth Israel Medical Center (BIMC), and had thoroughly enjoyed the experience. This is a medium sized community program with campuses at the Long Island College Hospital (LICH) in Brooklyn and BIMC in Manhattan. Rotations are divided between the 2 locations and residents have a choice as to where they would like to live as subsidized housing is provided at both locations. The day consisted of one very informal interview with a junior faculty member and it was made clear that the purpose of the interview day was for us to find out about the program not really to be judged! All the IMGs were also told that if we were interested in a pre-match and an H1B visa, we should inform the office and our applications would be
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considered separately. After the tour of the LICH we were taken by the Chiefs to BIMC where we had lunch, another talk with the residents there and the tour. The interview day became rather long. The residents did not seem to be too happy with the cost of living in the area; the expensive housing being the main issue, in spite of being subsidized. I did not rank this program as not only was it community based, I was not impressed by the work environment and due to the very real fact that living in New York City IS rather expensive! Mayo Graduate School of Medicine (Rochester) Program, Rochester, MN Mayo is ranked #18 for its Peds services and at the time was the #2 Hospital in the US overall. Its Peds program is small with 10 residents per year and it doesnt have a free standing childrens hospital either. I went for this interview expecting a rather high and mighty attitude from the faculty and residents but was proven totally wrong! We met the residents for dinner the night before and I was pleased to find that they were quite laid back with an AKUite passion for free food! The day consisted of 3 interviews after the morning report and program overview and ended with a meeting with the Chairman. One of the interviews was with the PD and I was extremely impressed by the stress on resident learning and the complete absence of scut work. Learning is the residents top priority and their work load doesnt consist of any unnecessary work if they dont learn from it! The program also gives the option of electives at its campuses in Florida and Arizona where free housing and a car are also provided. Care is of course highly specialized (which may be a negative point) but I was assured that plenty of bread and butter Peds was also seen. A usual characteristic of the curriculum was the large number of elective months which allowed residents to structure their learning according to their own interests. Mariam Naeem AKU Class of 99 had finished her residency there at the time and received high praise from everyone I spoke to! Wayne State University/Detroit Medical Center /Children's Hospital of Michigan Program, Detroit, MI The Childrens Hospital of Michigan is ranked #27 by US news and has a large Peds program with 27 residents per year. I interviewed on the last day of their interview season and was incredibly impressed by the organization of the program, the patient and resident cultural diversity and the well balanced curriculum. The interview day consisted of 2 interviews, with a Chief resident and the associate PD. The Chair also met with the candidates as a group and once again there was much praise for AKU faculty and graduates. The residents met with us over lunch and seemed to be quite satisfied with their work environments and faculty support. There was also a lot of camaraderie and several of them were IMGs. The program has quite a few perks to take care of its residents, offers an H1B visa and also has an International Health track which gives the opportunity to do electives and research in China, Thailand and India. The free standing childrens hospital serves a huge
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patient population and theres plenty of opportunity for hands on experience and research. There was some concern regarding life in Detroit but like any large city in the US, it has its share of safe and shady areas! Indiana University School of Medicine Program, Indianapolis, IN Another large Peds program with 26 residents per year and an AKU grad for Chief resident (Zujajah Class of 99)! Residents train mainly at Riley Hospital for Children, a free standing Childrens Hospital which serves as a referral center for a large area as well. Dinner with the residents the night before answered a lot of questions about life in Indianapolis which may not be a large city but has plenty of indoor and outdoor entertainment opportunities. The interview day consisted of 2 rather casual interviews, one with the PD. Rileys is a beautiful hospital and the residents appeared to be a happy, hard working bunch. This program also gives opportunities to do electives in Kenya and lays great stress on its community / general Peds exposure. University of Illinois College of Medicine Program at Chicago, Chicago, IL This was my last interview which was almost in mid Feb. A medium sized program with 12 residents per year, the UIC hospital stands next to larger, better known hospitals like those of Rush University. The Peds residents were from all over the world and they appeared happy and supportive. The Program Director was also extremely nice and spoke well of his experience with AKU graduates. Sharmeen Feerasta (AKU Class of 99) was one of the Chief residents at this time and she has enjoyed her time at UIC and in Chicago. Rotations are both at the UIC hospital and at the Masonic Med Center at the community hospital. The resident participation in the morning conference was rather lazy though! Chicago is a great city to live in with again with a large desi/AKU population.

RADIOLOGY
Shaheen Mithani (Class of 2000)
Matched in Radiology - University of Arkansas, Little Rock, Arkansas

Radiology OK, the places I interviewed at for Radiology were (applied to 30 programs...didnt get calls...Very Important to find out about AKU graduates or anyone whom you could know in the program and tell them you are applying...very important)
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University of South Alabama, Mobile, Alabama Nice enough place. Nice residents Didnt like the town esp. the downtown and where I lived was not nice at all but it may just be an okay town There are lots of AKU people there in medicine and they all are happy enough. The program was a normal size 6 first years, a mix of good and bad faculty, which is something I found in all places. University of Arkansas, Little Rock, Arkansas Nice place. I really liked the town. It is a small and green place. Was my first choice! It has great faculty esp. for pediatric radiology and very good ones for adult too. It is supposed to be good for interventional as well. Both Mobile and Little Rock mostly accept their own grads which is true for a lot of radiology programs because it is becoming increasingly competitive and in the South inbreeding is very common. So that is something you have to overcome...once they call you for an interview you do have a good chance though. Psychiatry For Psych I interviewed at 7 places (applied to about 29 and got calls from about 12 or something...didnt follow up on the others cause I didnt want to interview at more than 10) Mayo Clinic, Rochester Good program director. I did not meet the chairman and did not like the assistant program director. As with all programs (and so I wont repeat it) half of the faculty was really nice and half was just okay. The place turned me off. If you really dont care about having people you know and having things you could do or greenery and a lot of that stuff, then it is ok to just look at the academic standing of a place which Mayo is good at. But I could not see myself living there for 4 years and being happy! I interviewed in Jan and it was cold and dreary and a lot of the residents had families of their own. More pharmacotherapy oriented than psychotherapeutic although the program director was most psychotherapeutic. It has small ward but a busy CL service. There is a lot of research. It was not high on my list of places UT Southwestern, Dallas Good program. Okay program director. I did not meet the chairman. They have some really good faculty. I enjoyed interviewing there. I liked the residents and the place. It was pretty high on my list. Pretty psychotherapeutic and I liked that...some research...chairman was basic science oriented and program director was into psychotherapy...liked the balance...liked Dallas. Separate Psych ER. They had a separate children's ward.

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Baylor College of Medicine, Houston Good program. I liked the program director. I did not meet the chairman. They had a good balance of pharmacotherapy and psychotherapy. Okay residents didnt like them too much. But I liked the faculty. And it was in Houston (which I dont like as a city at all, but my family is there) so it was also high up on my list. Nice assistant program director. I think they had a pretty busy service and with their new faculty from meninger have pretty good people to teach. Separate psych ER University of Texas at Houston, Houston Texas Okay program. I did not like the program director and I dont remember if I met the chairman. Some faculty was great but the others were less than impressive. Residents were ok. Felt the program's atmosphere was blah and everyone acted a little lazy. I didnt like that I guess. It was not very high on my list Washington University, St. Louis, Missouri A very nice program with a pretty good faculty. I enjoyed going there and had fun with the residents. Busy service. Good program director and very good chairman. Again, the chairman was a basic science guy. Very research oriented. Mostly pharmacotherapy but had a good base in psychotherapy. I liked the city a lot. It was relatively lower ranked because I wanted to be in Little rock or Dallas or Houston in that order and St. Louis is far from all of those place but otherwise a great place to interview at and would have been high on my list UTMB, Galveston The program was pretty okay. Not a great program but I really liked the place and really enjoyed meeting some of the faculty. I would probably enjoy being there. It was relaxed but not bordering on lazy and a little more pharm-oriented than I would like. Okay program director. I did not meet the chair. Not much research at all. Nice residents. Be ware that you have to interview a real patient. (You have to do that for University of Illinois too but they tell you that in the interview invitation and these guys dont!!!) It is not at all hard. I interviewed an adolescent with drug and sexual abuse and schizophrenia and I had not read anything to do with psych in at least 4 months but it was the best part of the interview and I really enjoyed myself a lot. Decent program I thought SUNY, Syracuse Good program director. They offered a pre match and an H1. Good chairman too. I did not like the residents who looked and acted lazy. Nice place. I didnt see it buried in snow, which is often the case in November, and so that may have something to do with my liking the place. I enjoyed going there and liked most of the faculty. Again, it was too far from home and family. They offer masters in public administration, which I was really interested in along with the residency. Location is why I didnt take it.........or give it serious thought
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Email me if there is anything I can help with!!! shaheenmithani@hotmail.com Shaheen Mithani P.S Best of luck!!!!

OMER ASLAM (Class of 2004)


Pre-matched in Psychiatry - Duke University, Durham, NC. 9 calls out of 30. Even though Psychiatry is not too competitive, most good programs need you to show commitment to the field (not just good scores), in terms of research, past psychiatry work experience in US or even in Pakistan. (I had done my AKUH internship in Urology and General Surgery). 1.SUNY at Buffalo, NY. First interview. Program was reasonable (but not world beating). Few Pakistani residents. Good faculty. Program director wasnt great. Cold dreary industrial city. 2.SUNY at Syracuse, NY. Average program. A very good program director, some good faculty. I liked the place, cold but nice and green. 3.UTSW, Dallas, TX. A better program than the first two. Large faculty. Good hospitals. Big program. Program director was okay, keen on taking graduates from AKU, as they had never had one. Residents were snobbish. 4.UVA, Charlottesville, VA. Nice quaint beautiful place. Ordinary program with a new high profile Chair. High on pharmacotherapy. One of the interviewers kept asking me abt 9/11 and if I had heard the term 'rednecked' and how proud they were of being rednecked! 5.University of Rochester, Rochester NY. Nice little town. Great place for someone who wants it real easy. Ordinary faculty. I didnt like it at all. 6.Duke, Durham, NC. Small town but green and warm. Really good program, good in psychotherapy, research. Brilliant program director, very helpful. Prematched!
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7.Mayo, Rochester, MN. COLD DREARY place in the back of beyond, great as it is! High on C-L psychiatry, not much psychotherapy. Brilliant program director (residents at both Duke and Mayo said that they had joined simply because of the brilliant program directors..) , but he has resigned since, I think! 8.Case Western Reserve university -Metrohealth, Cleveland OH. 9. Long Island Jewish medical centre , Glen oaks, NY. I didnt interview at the last 2 as I had accepted the prematch ... LIJMC is a very good program, Afroz 04 is there.. New York city programs are great for psychotherapy, difficult to get into... I didnt get calls for NYC programs!! Omer '04 .. omeraslam@gmail.com

Filza Hussain (Class of 2005)


Matched in Psychiatry Mayo Clinic, Rochester, MN Programs nice enough to write and say no: Massachusetts General Hospital/McLean Hospital Program, Boston, MA Johns Hopkins University Program, Baltimore, MD Albert Einstein Medical Center Program, Philadelphia, PA University Health Center of Pittsburgh Program, Pittsburgh, PA Programs that said no on the phone: University of Chicago Program, Chicago, IL Albert Einstein College of Medicine Program, Bronx, NY Albert Einstein College of Medicine at Beth Israel Medical Center Program, New York, NY New York Medical College at St Vincent's Hospital and Medical Center of New York Program, New York, NY Albert Einstein College of Medicine at Long Island Jewish Medical Center Program, Glen Oaks, NY Maimonides Medical Center Program, Brooklyn, NY Vague delaying tactics: University of Minnesota Program, Minneapolis, MN University of Michigan Program, Ann Arbor, MI
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Brown University Program, Providence, RI University of Kansas (Wichita) Program, Wichita, KS Baylor College of Medicine Program, Houston, TX No answer despite multiple messages on answering machines: New York Presbyterian (Columbia Campus) and NY State Psychiatric Institute Program, New York, NY New York University School of Medicine Program, New York, NY St Luke's-Roosevelt Hospital Center Program, New York, NY Cleveland Clinic Foundation Program, Cleveland, OH Temple University Program, Philadelphia, PA Thomas Jefferson University Program, Philadelphia, PA Medical College of Wisconsin Affiliated Hospitals Program, Milwaukee, WI Interview calls from: Yale-New Haven Medical Center Program, New Haven, CT Psychiatry: Yale is a large program in a charming city but somehow I found the faculty to be rather hostile, bordering on rude almost. It didnt feel like a conversation, it felt like the spanish inquisition. People on the East coast are generally cooler than I care for, so I was completely put off. Good program for go getters; a real boost for your psychiatry career. Anna Freud and Erick Erickson were at Yale. Investing in some Spanish lessons would be a plus, because the majority of the population is Hispanic. The program was facing some changes with the chairman leaving. Ask about the new chairman and always ask about if any residents have left and why. Mayo Clinic College of Medicine (Rochester) Program, Rochester, MN Psychiatry: I loved this program for many reasons and it was my first choice. I really like the people in the Midwest, they are simple and friendly. My family is really close by, an hour away. Thats important to me. The weather tends to be a bit of a minus but then again Rochester is equipped to deal with snow with the buildings being interconnected by underground subways and overground skyways. The PD was very friendly and he isnt the PD anymore, they are looking for a new one but even then the PD I met will remain on the faculty. The residents were really nice as well and the interview was more of a chat and getting to know each other better. I agree they make it look a little too good to be true and you have to take what they are saying with a pinch of salt but hey if they say short call means I go home at midnight whereas in reality they keep me till 2, Im cool with that. I also looked at the existing Pakistani community, a muslim community, mosque and ease of halal food availability. The hospital is beautiful. The wards are new and well lit.
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Duke University Program, Durham, NC Psychiatry: Kick ass program with some cool teaching tools like a one way mirror (very CIA) for psychotherapy training, the people were nice, very down to earth, infact it didnt feel like an ivy league at all. Was a little shabby for my liking. All psych docs wear lab coats and I despise that (no that wasnt on my criteria list, Im just saying!). The PD is this warm and gentle sweet lady, who likes giving awards for best personal statement and makes a cake for her interviewees. The city was a little rough, high crime rate, they were in the process of making some changes in conjunction with the state university and hospital so training sites get increased. EVERYONE goes to Duke for an ECT fellowship which is a week long. If Duke were in another city, like say Boston, this would've been my first choice. University of North Dakota Program, Fargo, ND Psychiatry: The only reason I applied here was because my uncle was here. Its a small program with only 4 residents a year, they do not offer an H1 and have an academic interview which sucked. I mean I did great at it but it just seemed so offputting. By the time I was done with the interview I knew I didnt want to match here, despite the PD calling me to tell me I was in his top 4. I didnt put it on my list. Creighton University/University of Nebraska Program, Omaha, NE Psychiatry: An interesting program, lots of training oppurtunities and nice people. A combined effort of Creighton and the state We have an alumnus there who is very friendly and very well liked so that was a plus. SUNY Health Science Center at Brooklyn Program, Brooklyn, NY Psychiatry: A 'B' program. They have the famous G unit, (historical significance in psych, check it out) large busy program, work work and more work. Brilliant oppurtunity to learn because of the sheer volume and diversity of psychopathology. Interesting Chairman who sat me down and gave me honest and solid advice about where I should place his school keeping in mind my other options. Pre-match offered.

University of Wisconsin Psychiatry Residency: Very nice program. Reputable university, ground breaking research, chilled out people, gorgeous city. This was the number 2 on my list (yup over Yale and Duke, I told you before you need to know what is important to you, it has to be more than just the name of the institute). Beautiful hospital. A slight predilection towards geriatrics and child psych (Peds was a compulsory part of the medicine rotation).
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Mount Sinai School of Medicine (Elmhurst) Program, Elmhurst, NY Psychiatry: Again interesting place due to the volume and diversity but not situated in a celubrious part of town. It houses the NYPD female inmates cell, so women law offenders with mental health issues are sent here and hence you get a taste of forensic psychiatry. Again work, work and more work. Very IMG friendly. H1 and prematch offered.

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SECTION V ORGANISATION
SCHEDULING INTERVIEWS
Class of 2003 Youll most probably start getting your interview calls while you are still in Pakistan. However, you will also most probably continue to get more interview calls while you are roaming around in the USA. There are many reasons for this, e.g. some programs will wait for your Step 2 result before they invite you, some wait till the end of their deadline for application, some are just plain lazy some will even call you as back ups in case their spots dont get filled by US graduates. Surprised? Some programs are willing to take someone they dont really want in order to diminish the risk of having unmatched positions. It makes them look bad statistically. Anyway, expect to be invited. So, keep checking your email at every possible opportunity. When a program invites you, they usually give you a list of dates on which you can interview. These will usually range between November and January. Now how do you choose your interview dates? Multiple factors come into play: Geographical location is a great way to arrange your interviews. Print out a map of the USA and chart out the distances. This way, travel time is shorter and hence less tiring. Nearing the end of interview season, this may turn out to be your primary criteria for deciding on whether you really want to interview somewhere. Ideally speaking, you should arrange all you interviews geographically so as to maximize the number of interviews which you can manage. Normally, if you interview on Tuesday and leave the city on Tuesday evening by Greyhound, chances are that you will reach the next city of interview on Wednesday morning or very late on Tuesday night. In both situations, one would not interview on Wednesday. So, the next possible interview day can be no earlier than Thursday. So for all practical purposes, one usually does about two interviews per week (or three if one is very efficient). On the other hand, if the spots in the same city, you can actually manage interviews on consecutive days. And of course, it will save you the hassle of actually having to return to a city. I even managed to schedule interviews in separate states on consecutive days (the interview was ending early and I would have been able to make it to the next city at a decent hour. In retrospect, I would not advise that. Greyhounds occasionally break down, or, get stuck in snowstorms. And AKU students love to interview in the places where there is a maximum chance of a snowstorm. (I know many who had problems, including myself). So, if you are crossing cities, leave a days gap. Another tip would be to cover longer distances over the weekends. That way you have plenty of time to recuperate. You do not want to exhaust yourself. Although, geographical planning is ideal, it does not always work very neatly. This is simply because you keep getting new interview calls, which have to be fitted in whatever slots are available to both you and the program. After a while, you will have no choice but to place an interview right in the middle of a perfect
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plan. Sometimes rescheduling works. Sometimes it doesnt. So, be prepared to face sudden changes of plan and long unexpected bus trips. As a general rule, schedule your interviews early. DO NOT schedule any of your first few interviews in January. Fit them in November and December as best as you can (again, geographically speaking). Save January up for the interview calls that you get while you are in the USA. When I was planning my bus route, I spread my interviews out, thinking that I would be able to manage a perfect route. I had also received a sudden influx of interviews before I left Pakistan. Imagining that my luck would continue, I left lots of week long and fortnight long gaps so that I could fit what was to come. Suddenly, I stopped getting interview calls. And I realized that I was in a messy situation. My travel plan had caused most of my interviews to be scheduled late. I would be left sitting idle for long periods of time in the early season, and, when the later interview calls would come in, I would not be able to place them, as November and December would probably be gone, leaving only January! Luckily, I was able to fix the problem by doing some quick rearrangements. So, fill up early spots. It is far easier to push interviews forward as opposed to pulling them back. Another point of notice. Although you will start the interview trail with immense enthusiasm, your excitement will dwindle with time. After the first seven or eight interviews, it will become extremely monotonous another greyhound station, another bus ride, another hotel stay, the same questions to be asked, the same question to be answered. All the hospitals will look the same. You will not even enjoy the free food (which was so dear in AKU). And it gets worse after Christmas break. After living outside the interview trail for a week or two, your feet feel like lead. A lot of US graduates cancel a lot of interviews in January (and that is another reason to keep January free for later interview calls). Again, the moral of the story is interview early. Last, but not even remotely least, try to schedule some really horrible programs as the first two or three interviews. Places where you would never want to go. Use these as an opportunity to get into the flow of interviewing. To learn the mechanics of what they expect from you and what you should expect from them. You will notice that all interviews follow similar formats. Following these rehearsal interviews, schedule the interviews which you would love to go to. This way, you can give them while you are still enthusiastic. And the faculty of the program goes out of its way to look for enthusiasm. Another perspective regarding interviewing has been given below: Interview late. I mean December and January. If you have applied early you will be able to cluster it well that way. Also you will see the worst of the weather at the place you may have to live in..... also at that point you will be judged fairly since some interviews have already happened and people have stopped expecting a super hero as an applicant...if you are one then it would be to your advantage! Shaheen Mithani
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BOOSTING YOUR INTERVIEW COUNT

Class of 2003

If you are a participant of the couple match, please skip this section and read Boosting your Interview Count for Couples In the month or two that follow the transmission of your application to the programs, you will get the majority of your interview calls. Theyll pour in fast, and then they will slow down. All the programs which were keen on interviewing you on the basis of your application have responded. The programs which are left may be waiting for further exam results. But, they may not notice when your scores come in. Or, they may have just cast a casual glance at your papers and moved on without realizing your credentials. Programs get thousands of applications. They cannot read every single thing which you have mentioned. You may be on their waiting list and they forgot to let you know. Ive even been in the situation where they wanted to interview me, but, conveniently forgot to inform me! Hence, it is absolutely essential to make an active effort to secure interview spots. If you sit passively, you will miss out. I know a person who had been rejected by a program, invited later on due to persistent enthusiasm and then offered a prematch by the same program on the day of the interview. So, do not expect everything to fall in your plate. Make a list of all the program secretarys names, phone numbers and email addresses. Then, contact them at every possible excuse. Continue to do so until you are definitely rejected. I would usually stop bothering a program when they rejected me, unless I had good reason to (e.g. my spouse had received an interview call from her corresponding program). Give them phone calls, write them emails! If you have not received a definite response, contact them weekly to find out about the status of your application. If you are on the waiting list, express your most sincere enthusiasm. Request that your application is reconsidered. When your Step 2 CK or CS result is dispatched, let them know. When you actually get your score, contact them enthusiastically to have them learn of the good news. Receipt of a score is a great reason to contact the program director, instead of going through the secretary. Tell the PD that you are happy to let him/her know that you have scored well in Step 2 CK, or, that you are now eligible for ECFMG certification. Then, offer a recap on your achievements (I would mention my medical school, my complete USMLE history and my ranking). Express your enthusiasm in the program. Request the consideration of your application now that you are the best thing since sliced bread. (By the way, all of this must sound extremely modest. Nobody likes an arrogant show off. Least of all program directors.) When you feel that the secretary of a program is not paying any attention to your application, write to the program director anyway. What have you to lose? As long as you dont sound too irritating, every email you send shows your interest. And it works. I did get invites this way. If a program tells you that you are on their waiting list, life becomes difficult. Waiting lists are very long, sometimes running in the hundreds. You may be
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anywhere on the list. Furthermore, only the person right at the top of that list will be called for an interview if someone cancels. Another thing. The people on the top of the list are usually not there due to merit alone. If someone had a perfect application with a missing Step 2 CK score, they may be placed at the top of the list when the result comes in (if equally perfect). However, usually this is not the case. The penthouse of the waiting list is usually given to people with a special reason to be there (for example, their spouse has already been invited for an interview call at that program). However, dont give up hope. Remember, persistent enthusiasm can bring about wonders!

RESCHEDULING / CANCELLATION

Class of 2003

Most programs allow you to reschedule your interviews. They also understand that you need to make travel plans convenient. And they are usually more than happy to comply. However, know that it does make things inconvenient for them. So, try not to wobble too much. In case you do, be apologetic and appreciate their patience. Due to whatever reason, you may eventually feel that you do not want to interview at a certain program. If this situation confronts you, then, do make sure that you cancel the interview as early as possible at least a few days in advance (preferably much earlier), so that the program can invite somebody else in your place. The place which you do not want to go to may be the best option for another candidate. Of course, you have the option of just not showing up. However, despite the fact that it may not affect you, it reflects very badly on your medical school. Your actions will determine the future of your juniors. Dont jeopardize their chances.

INTERVIEW ATTIRE

Umbereen S. Nehal

The suit: The most important thing is your suit. Some people toy with the idea of getting their suits made in Pakistan. That might be fine for men, but I think it is a total nono for women. This suit is your ticket to your residency. The most important thing about your suit is this: no one should notice it. As an IMG, you want to be in the perfect uniform to show your ability to blend in. And trying to find the right fabric, the right tailor, the right cut, the right fit while sitting in Karachi or Pindi is just going to drive you nuts dont bother. Bite the bullet and spend the big bucks on a ready-made suit in the States. Actually, if you are lucky, you can come across some nice sales and get a nice suit for a decent price.
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Color: Black is basic. You cant go wrong with it. Dark gray or navy are also good choices. I would suggest staying with solid colors. Cut/Style: This depends on you. If you are a woman, you probably prefer a longer jacket. But make sure that it fits properly. You dont want any bulges in front when you sit or in back when you walk. For women I suggest buying a pant suit. It is true that skirt suits are more typical, but most skirts come to the knee or have huge slits. Then there is the stocking issue. So, pants are just much more comfortable and convenient. Before you make the final decision on the suit, make sure you like it and are comfortable in it. You want to make sure it looks good when sitting, standing, or leaning over. Basically, you want a suit, which once bought; you never again have to think about. It should be the last thing on your mind on the interview day itself. Editors Note: For those (women) in Karachi, a lady called Alia does an excellent job with interview suits. Many AKU graduates in the past have been going to her. Her phone number and address are as follows: F73, Swiss Cottage No.10, Block4, Clifton, Karachi. Ph #5375265, 5870227. She is available between 10am to 6pm except on Sundays. Accessories (women): The shirt should be a solid color with a simple neckline. Either a blouse or a collared shirt is acceptable. Here you can be a little more adventurous. I wore a pale green (lime colored) silk blouse (not the shiny kind of silk, but the kind that looks like a knit shirt). But stay away from red, orange, or other bright colors. The shirt you wear should fit closely and not bulge out from under your jacket. Keep jewelry to a minimum. Pearl studs in the ears are appropriate. You dont want anything dangly or flashy. Again, you want to show how much you blend into American culture, and Americans wear very little jewelry. Socks: you can wear stocking or trouser socks. If you wear socks, make sure that when you sit, your pants do not ride up to show your leg.

Shoes: COMFORT, COMFORT, COMFORT. You will be taken on lengthy tours of hospitals, and you do not want to be hobbling about or be uncomfortably shifting from one foot to the other. My advice: spend the money and buy an expensive and comfortable pair of shoes. It is worth it. Be sure to break in your shoes before interview day. There is nothing worse than an hour-long tour in a new pair of shoes. If you are a woman, dont feel compelled to wear heels. Believe it or not, very comfortable shoes can look professional.

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TRAVEL AND PLACES TO STAY

Zainab Samad Updated by Class of 2003

Most people preferred to travel by Bus - Grey Hound. If you think you are used to Spartan traveling conditions, this is the most economical method of travel. A two month pass which costs around 500 $ can be bought at grey hound centers. www.greyhound.com This website provides information regarding tickets, bus schedules and deals on tickets. For those who know how to drive, getting an international license made before going to the States might be a good idea. I am not suggesting that you travel all over the place in a rented car, but it is a good option to keep open. Traveling by air isnt all that expensive as it is made out to be. And if you know your way around, you can get pretty good deals on tickets! If you have gotten most of your interview calls while in Pakistan, you can buy the Limited Coupons Confirmed Ticket. This ticket is sold by various airlines like United, Continental, etc and has to be bought before you leave Pakistan. You can issue a minimum of 3 and a maximum of 8 to 10 coupons. You have to tell the travel agent the origin and destination for each coupon, but you dont have to specify the date and time except for the first coupon. You need to check with your travel agent regarding the coupons since the rules keep changing with each season. Following are useful websites for buying cheap tickets in the United States: www.cheaptickets.com, http://travel.yahoo.com, www.orbitz.com, www.travelocity.com, www.expedia.com, www.southwest.com, www.hotwire.com Most airline ticket websites require payment by credit card. The tickets are mailed to the billing address of the credit card, so one needs a credit card with a US billing address. Return tickets are cheaper than one-way. Make it look like you are spending at least a week at your destination. Also, the tickets need 5 business days to be processed and sent. On the other hand, you can purchase e-tickets at the airport, but those might not always be cheap. The best thing to do is to use a combination of air and ground travel. You should also try and schedule the interviews at places in geographical proximity in such a way that you can do them in one go. The programs usually provide a list of hotels which have subsidized rates for interview candidates. It is always good to check the rates for a particular hotel on the internet. Sometimes, the rates on the internet are lower than the advertised subsidized rates. You should stay at a hotel that is close to the interview place or one which provides a shuttle service. Also, if you know any AKU graduates in the area, you should definitely get in touch with them well ahead of time. They might invite you over. And that will save you bucks.
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How much money to take? Estimates vary but 3000$ is a safe figure. Carrying a lot of cash is not recommended - carry cash in the form of traveler cheques. Get a credit card if you can. A few comments of update: Do not hesitate to contact your seniors. More often that not, they will be more than happy to help in any way they can. They may provide you with a place to stay, with transport, with food and (perhaps most importantly) a sense of belonging. Furthermore, dont restrict yourself to AKU graduates. I stayed with graduates from other medical colleges as well, and they were happy to help. You see, all your seniors realize how trying a time the interview trail is. They have all been through it. They know how difficult it was. They are able to appreciate all the help which they received when they were roaming. And they know how much you, in turn, will need it. Interacting with your seniors will cut down your expenditure immensely. Hotel stays cost about $80-100 a night. If you do your homework, you will not have to spend a single dollar on accommodation. I interviewed at fifteen places. Not once did I have to get a hotel room. Make good use of www.mapquest.com a website which provides information regarding how to get from one place to another. Itll give you an idea of how far the greyhound station is from the hotel which you are staying at, how far the hospital is, etc.

GREYHOUND TIPS
Class of 2003 (UPDATED by 2005) You will soon realize that the Greyhound bus will be your second home in the USA. It would therefore be useful to know how to best handle your trips: If you intend to do most of your traveling by Greyhound, buy a Domestic Ameripass (description may be found at www.discoverypass.com). All the travel you can manage for 30 or 60 days at $522 and $645 respectively. A 40,000 Rupee bus ticket does seem too steeply priced but if your interview calls are in double digits then this will be the most economical way to travel. However if you think youll get lesser number of calls and all of them are not in a particular geographical region, then do consider other options like Amtrak or flying. Greyhound offers you a lot of convenience. It allows you to change bus schedules with utmost ease, whenever you like. Very useful for sudden changes in plan. However, since most of the people who give the tickets dont know what to do with it, it sometimes causes problems and confusion. You may travel on any bus service. However, if it is non-Greyhound, make sure you show your pass at the ticket counter and get a proper ticket (for free).

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Domestic Ameripasses may be purchased at the greyhound station immediately before you begin your journey. They may even be bought in advance, but then dont forget to tell them to label it with the correct starting date, i.e. the date of your first trip. I would advise buying it in advance because, again, not all the people at the ticket counter are very familiar with Domestic Ameripasses. If your trips will be infrequent, buy individual tickets, well in advance. This way, they are cheaper. Stand in line as early as you can. You would hate to miss an interview because you missed the bus. Although you may have a ticket, there is no reservation. If there are fifty people in front of you in line, you will not get on the bus. Thus, get in line early. A bus may already be carrying passengers, and may only take a dozen more. Again, get in line early. NEVER leave baggage unattended. NEVER let documents out of sight, even when you are sleeping! People have lost important documents. Keep them next to you always. My baggage has been slit open with a knife. If baggage is being unloaded at a stop, be vigilant. Once, a person accidentally started to walk off with my luggage. Here is a time tested granny tip stitch a pocket to your vest and keep your passport, money and greyhound bus pass in that. That way even if you lose your entire luggage you will have your ID, $ and bus pass to get back to home base. Make sure it is stitched properly and yet comfortable enough when you wear it with everything in it. Leave all important documents (including your return ticket to Pakistan) at your home base. Interviewers almost NEVER asked for proof of anything; some places ask for ECFMG certificate or degree at the most. Again unless they specifically ask you to bring along a document dont take anything. You are allowed four bags in total: two may be loaded under the bus, 50 lb each; two may be taken on board with you, 45 lb each. If your bags weigh any more than 52 lb, they will not allow you to take it with you, even if you just have one bag. Best is to distribute the weight. If you remove the extra weight and put it in a plastic bag to take it on board that will make them happy. Travel Light! The greyhound will let you carry quite a bit but you will have to carry it everywhere. It is no fun dragging it in snow and up and down subway stairs. So if you pack wisely all you will need is one bag on wheels and one hand carry. All I used to carry was interview suit, a leather folder, dinner night clothes, shoes and socks (I wore the same shoes on dinner and interview-nobody is that bothered to notice), three shirts, one pair of pants, one sweater, alarm clock, phone book (even if your mobile phone has one), something to keep you busy on the bus (iPod, novel, step 3 book), some dry snacks, a water bottle. You would already be in your most comfortable jeans/ warm sweater and coat (buy a woolen coat so it works even on interview day). Anything else that you might need in particular Makeup? Shalwar Kameez? Before starting your journey ensure that you have your interview itinerary, address and phone numbers (and yahoo/google maps) of your hosts and the program where you would be interviewing at.

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All bags which are loaded under the bus must be tagged at the ticket counter. Tag all baggage, even the hand carried ones. If you lose a tagged bag they take it to the baggage claim of the destination city and give you a call as well as send a notice on the address you put on the bag. Make sure the conductor tears the right tickets! When you get on the bus (and if you are early) do a quick survey of the bus. There are some places which are better places to sit than others: o The best place is only due to good fortune about midway along the right side of the bus is a door which allows wheelchair bound people to get on the bus. There, the seats are mobile and can be pushed in front to make room for the wheelchair bound person. Sometimes the conductor forgets to push it back, and there is all the leg room in the world. o Next would be the seats immediately behind the front most seats, the latter being reserved for the handicapped. Since a handicapped person is not always there, and the bus is not always full, there is a minimal chance of someone leaning back on you and cramping your sitting. o If neither of these are available, stay as close to the front as possible. The further back you go, the louder and nastier the crowd gets (because they are further from the bus driver). Furthermore, the seats are arranged two by two. People tend to look for empty seats. If they see you occupying one, there is a good chance that they will move towards the back. When they realize that there are no more empty seats, they will be at the back of the bus, and will just occupy one there. o Know that the seats are not regularly placed. There are slight differences in the amount of leg room available. Sometime you may strike quite lucky! o Buy neck rests. You can sleep anywhere without getting a cramp with them on. If not take a window seat; use your sweater as a pillow against the window. You can silently tell people that you do not want company by placing your bag next to you. However, if the bus starts to look full, then, be nice and move your bag. There are some stops where you can get off at, but you cannot get on (limited service bus stops are suffixed with a (B) on the website for greyhound). Although rare but if ever you get stranded in a greyhound terminal (it happened to me due to a blizzard) call up your friends to let them know where you are and how long you are expected to be there/ call up anyone you know in the city to get rescued from the terminal/ call up a cab and go to a well known hotel (no cheap motels). If all else fails and you have to spend a very long time in the terminal you can go the help desk and ask them to keep your luggage at a safe place (bigger bus terminals might charge you a bit for it). With no luggage to take care of stretch your legs and maybe even sleep a bit. Regardless of what impression you may be getting, it is not all that bad! I still recommend the Ameripass as the most economical way to travel. I used it throughout.

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SECTION VI INTERVIEWING
INTERVIEW PREPARATION
Umbereen S. Nehal

Researching programs: Once you get called for the interview, is when the real research begins. You want to be knowledgeable about the program so you can ask intelligent questions from your interviewer. You want to be able to say I noticed blah, blah on your website, could you elaborate on that? Know what the program is known for. Try to find out where the residents are from and where they go. At interviews you are selling yourself. A good sales(wo)man knows to tailor a sales pitch to the customer. The only way to do that is to know the customer. Plus, once you start interviewing, you will start getting very confused with all the details. So, it is better to be familiar with the basics before you arrive. Interview packet: (to be prepared for each program) -Info on programs (see above) -Contact info for programs (in case your travel is delayed or you get lost) -Questions to ask during interview -Notepad to take notes -Envelope to keep business cards of your interviews/the chief residents Packing: Make a list of everything you need to take. That list should include everything from your passport to your toothbrush (forgetting a toothbrush is actually extremely stressful when on the interview circuit). If you take that list with you, you can also tick off everything when you repack to leave the hotel so that you dont accidentally leave something behind. I think it is a good idea to buy a travel alarm and a lint brush. Cell phone: I would advise everyone to get a cell phone if possible. I think that they are invaluable when traveling. For women, having a cell phone is important from a safety point of view; if something happens, you can call for help immediately. Final Tips: Courtesy is the most important thing to remember. -You want to gush over the secretary. (S)he might remember to put in a good word for you with the residency director. On the other hand, (s)he could just, oops, lose your application. -Be sure to send thank you letters/notes/emails to the program directors. Some people like to send letters to every interviewer, but that is not necessary. Just a few lines are enough. If you are really motivated, you can send a few lines
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immediately afterwards and send a longer letter closer to the match. That way you will be fresh in the program directors mind when (s)he is making the match list. You can use my sample thank you letter to compose your own. You could also just send mine off with your name on it. But since the rest of your class may also do so, it might be embarrassing to have the exact same letter arrive from all AKU grads. In which case, instead of impressing the program director with your eloquence, you will impress him/her with you lack of integrity. You make the choice. -Every bit of correspondence should be run through the spell-checker. You dont want to ruin a good impression with incorrect spelling or poor grammar. Warning: CANCEL INTERVIEWS IF YOU DO NOT PLAN TO ATTEND. There is nothing more despicable, ungrateful, selfish, and morally defunct than the AKU student who deprives his/her classmates and slanders the name of AKU by failing to show up for interviews (or who cancels only 24 hours before you should cancel as early as possible but no later than 72 hours before). You may be thinking, Well, so long as I get into a residency, I really dont care about the rest. Well, I have some important news for you: You will probably be applying for fellowship, and if you make a bad impression, that impression might still linger when you send your application out again. And, it is entirely possible that you might not match or that you might hate the residency you match at. In which case, you will be sending out your applications to the very same programs you treated so shabbily. And, as many AKU students probably know from the experience with Brown University, the actions of a few do ruin the chances of everyone to come. (I mean, of course you are entitled to bad behavior if you choose. But if you do exercise that right, just know that you are lower than pond scum.) But, basically, what goes around, comes around. Be a decent human being and nice things will happen to you.

THE INTERVIEW

Naasha Talati

The interview is basically an informal chat usually between 15-40 minutes, and is usually with two people in the faculty. Occasionally you get interviewed by the program director. The thing that they are looking for in a candidate is that the person should have clearly defined goals and reasons for their choices, be very motivated and enthusiastic and know what they want from residency and from life. Its a tall order to have all these answers figured out . But they appreciate it if you do! If you are apprehensive about the interview itself you can try and do a mock interview with a faculty person at AKU.
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So the main questions typically asked during the interview are. Why do you want to do internal medicine? Why do you want to come to the US for residency? What are your long term goals/ how do you see yourself ten years from now? They want to know whether you want to do private practice, general med, research, subspecialty fellowship. Do you plan to go back or stay here? What are your interests outside of medicine? If you know what subspecialty you want to go into they will ask you why etc. They may ask you what are your strengths and weaknesses. Its good to be prepared with an answer! Editors note: giving an example of what to say for a weakness so that it can actually sound positive: I tend to work too hard and not leave enough time for my personal life, I care a lot about my patients and sometimes spend a lot of time counseling them which can make me less efficient, I tend be a hands-on type of person and wish I spent more time reading journals and texts, etc. DO NOT say, I have a bad temper, I have a hard time getting along with others, I have problems staying motivated, etc They may also just start the interview with a phrase like Tell me about yourself. Its a good idea to say something specific about yourselves your strengths your interests Describe an interesting case. Compare your experience at electives versus at AKU. They will ask you a lot about your electives. What were you doing since you graduated. Have something to say that is specific and constructive. You don't all want to say you did clinics in a katchi abadi. They have probably heard that too often already! Another favorite question that I got asked almost every time was, why did you apply to our program? If there is something interesting written in your personal statement, the Interviewer may have a question about that.

Editors Note: Other questions that I would like to add are the following: Questions on US clinical experience Questions on previous research experience RARELY (in community hospitals) you may be asked clinical academic questions (e.g. what is the management of heart failure?). This shows that they are more keen on using you for labor rather than educating you. You may not want to go to such a program. Probably the most frequently asked question is, What do you want to know about our program? Always be ready for this. Research the program well so that you have plenty of intelligent questions to ask. Questions which relate to the program

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specifically (e.g. I remember reading that you send students to Brazil for international electives. Would you please elaborate on that?) are going to show far more interest than general questions (e.g. Do you intend on making any changes in the current structure of the curriculum?) Also, do not forget that the faculty hears the same questions again and again. Remember to ask questions that will make you stand out (favorably!) in their memories. "FIRST AID for the match" has a list of questions and most questions are similar to those. "Getting into a residency" by Iserson also has interview questions but I never got questions like the ones in that book and think that chapter is useless. Apart from the interview being a process by which they can see what you are like as a person, it is as much a process by which they expect you to assess the program. Therefore in all interviews you will be asked what do you want to know about the program, what questions do you have, do you have any concerns about our program? You must be ready to ask them a lot of questions about the program. This will show them that you are really interested in them and that you need to know the details to make your choice. You need to come across as very enthusiastic about the program. If there are AKU grads at the program make sure you get in touch with them find out about the program. They will ask you why you applied to their program. You must have concrete reasons for applying to a program. That will show them that you didn't just apply to them at random (even though you may have). You can say stuff like the AKU grads at your program speak highly of it and told me to apply. You can say that you are looking at programs in big cities/small towns.as the case may be, you can say that you know that the program is strong in a particular field you are interested in. You must read up about the program on the web site before the interview so that you know some special or unique features about the program. For e.g. Indiana offers international electives to Kenya if your interest is in ID you can easily tie all of this together. Washington University has a CSTAR program in which you can do research if your interest is research you can say that is why you applied specifically to them. The interview process does take some getting used to so it is a good idea to schedule about two of your less competitive programs first to get the feel for the interview process. I did thirteen interviews and personally think that by ten you are quite exhausted.Ten places are enough to interview at. If you do not interview with the program director and if he/she is around you must go up to them introduce yourself, thank them for the invitation, and tell them you like the program. You don't need to have anything important or impressive to say to them its just a good idea to go say hi!
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Its a good idea to think about what your priorities are for where you match and you realize this as you go to different places. In my opinion the important things were: I wanted to be in a relatively big place and not in too small a town. Also I wanted to have a big mix of patients. I also thought its good to have multiple hospitals preferably with a county hospital. Also, a program whose main goal is to let the residents run the show and make decisions and do procedures. (Baylor, Indiana and Emory, UT Southwestern are excellent in these features.)Think about what you want . You may want an H1, you may want to be close to relatives, you may want to be in a city with a lot of desis, lots of AKU grads. Or you may simply want to be in the best program you can get into. Everyone has their own priorities and its a good idea to think about where you want to be the next three years Just being in a good program is not necessarily the most important thing. It is useful if you know what you want to do after residency . For example, if you want to do Cardio . It would definitely impress them if you have taken concrete steps in that direction like if your elective was in cardio if you worked in cardio after graduation, if you did some research in the subject. It all shows that you are focused to one goal and know what you want. They like that. (Editors Note: Interviewers do not, however, expect all of their candidates to have decided on the courses of their lives so soon. So, do not hesitate to say, I want to enter my residency with an open mind and will decide therein. The key is to avoid lies and exaggerations. Websites: The following are some useful links with Interview questions and tips: http://www.ama-assn.org/ama/pub/category/6701.html http://www.ama-assn.org/ama/pub/category/7811.html http://www.applyresidency.com/interview.cfm http://www.imgi.org/interview.html

AFTER THE INTERVIEW

Class of 2003

After the interview, make sure that you maintain some sort of contact with the program. Write them a thank you note telling them how much you liked their program. Also, give every note a personal touch by, perhaps, referring to something that the program director discussed with you during the interview. Or, perhaps, some unique facet of the program. It is not advisable to write a standard email and send it to every program since the programs, with their years of experience, will recognize it as a standard email. And that may actually have a negative impact. After all, it represents lack of bother. Although, emails are highly convenient, it is best to send your appreciation to the program via snail mail, like a thank you or a Christmas card. Although it takes an extra effort, the program director will see this extra effort and hence
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The programs that like you would also like to see that you are interested in them. Thus, they are more likely to rank you high if you can convincingly convey your interest in their program. Hence, the importance of continuing to write to them at every possible excuse, even after you are done with the interview. Probably the one thing that would get the message across loudest is a second visit to their program. Some programs may ask you to visit them again. Even if a program does not and it happens to be very high on your rank order list, write to them regarding the possibility of a second visit and go ahead with it (if your schedule allows). It will give you another opportunity to impress the program, plus it will convince the program faculty that you are genuinely interested in what they have to offer. Class of 2005 adds: In order to leave a good impression, use good quality stationery for example Linen Papers with matching envelopes. Choose a decent colour like ivory. You can buy them from any Staples stores however youll have buy a whole box of 100 sheets or so. Use a laser printer to print the letter unless you are very confident about your handwriting; and sign the letter at the end. Remember these twenty bucks will be well spent; I got some very nice emails from the interviewers after they received the thank you note. Afterwards, you can conduct the correspondence by email.

SAMPLE THANK YOU NOTE


January 14, 2002 Your address Your phone number Your email address Harvey J. Hamrick, MD Department of Pediatrics Education Office Campus Box 7593 The University of North Carolina at Chapel Hill Chapel Hill, NC 27599-7593 Dear Dr. Hamrick,

Umbereen S. Nehal

It was a pleasure visiting you, the faculty, and the residents at the University of North Carolina at Chapel Hill on January 10, 2002. I am near the end of my interviews and have given considerable thought to the programs; I can say with confidence that this program is my top choice. Downloaded from the AKU Alumni Discussion Board <http://board.akualumni.net>

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During my visit, I was impressed by the balance between academic medicine and community care, the breadth of pathology in the patient population, and the state-of-theart facilities. The interview day revealed a very supportive relationship between faculty and residents. It was obvious that resident education through open dialogue is a top priority. Everyone I met was warm, hospitable, and very accommodating. I was struck by the camaraderie between residents, the confidence level of residents, and the excellence of ancillary staff at UNC. The School of Public Health also offers exciting possibilities. The solid clinical experience offered by the program is by far the most attractive element. I appreciate the opportunity to experience both specialized care in a tertiary hospital setting and ambulatory care in community hospitals. I felt that UNCs program provides excellent exposure to both academic and practical aspects of pediatric care. I would be delighted to have the opportunity to train at UNC. I believe it would match my requirements and would allow me to contribute to its accomplished reputation. Sincerely, Umbereen S. Nehal

NRMP RANK LIST SUBMISSION

Class of 2003

(If you a participant of the couple match, please ignore this chapter and read NRMP for couples) Rank lists may be submitted starting January 15th and ending February 23rd. Again, the worst thing for you to do is to wait for the last moment. Last moment impulse changes will also lead to regrets. So, meditate on your rank list well in advance and submit it early. This way, you will have plenty of time to consider. For the submitted fee, applicants are permitted to make a rank list of 15 programs. If one desires to rank more than their allotted number, each extra program ranked costs $30. Youll have to certify the rank list when it is ready. Although the process of certification looks really official and final, you can always change it and certify it again (as long as you do so before February 23rd). If you fail to certify your rank list, it will not be accepted. If you change and do not certify, your last certified rank list will be accepted. If you prematch, do not forget to withdraw from the main match (that is, NRMP) before the rank order list deadline. If you have submitted a rank list and you do not withdraw, you are legally obligated to accept the appointment made to you by the main match, even if you have accepted a prior prematch.

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It is here, on the NRMP website that you will find out where you matched. Relevant days have been described below: Monday of Match Week (say, March 14th): You find out if you matched (by email) Tuesday of Match Week (say, March 15th): List of unfilled programs available to unmatched candidates (for scramble) Thursday of Match Week (say, March 17th): Match results available!

RANK ORDER LIST

Zainab Samad

Once you are done with the interviews, you will have a fairly good idea of how you liked each place, city and program. You can then sit down and make the ROL. This is in fact your wish list. The good news is that the matching process works in favor of the candidate. The following link will explain how the matching process actually works - http://www.nrmp.org/res_match/algorithms.html But to put it simply, it will try to match you at your first choice and if the residency program has ranked you at all, you will match there. If your first choice does not work out, the computer moves down to the second choice and so on. It keeps moving down till you have matched. Hence, your ROL should not be governed by the I will definitely take you impression that most program directors give, but by whether you want to go there at all or not. You can go about making the ROL in two ways: 1) Make a table with the things that matter to you in a residency... (program standing in academics and research, attitude towards residents, city, presence of friends or relatives, visa offered, weather, social life etc.) And then grade various programs according to that. Then, rank them according to the scores you have come up with. 2) The second way is really simple. Sit, meditate, and go according to your gut feeling. Generally people put all the programs that they interviewed at, on the ROL (max of fifteen) since they fear going unmatched. In specialties like Surgery, ENT, Ophthalmology, and with couple matching this might be a very prudent thing to do. However, I feel, considering the fact that most AKU graduates match at their first few choices in Internal Medicine and Pediatrics, you can even put only those programs that you *really* want to go to. Eight to ten places is a reasonable number. Do so, ONLY if you feel comfortable with the idea. Website: https://services.nrmp.org/R3/Home/Login/Login.cfm

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SECTION VII APPENDIX VIIa Couple Matching


COUPLE MATCHING
Nabil Tariq In a couples match, there isnt much you do as a couple initially. You apply separately to ERAS as well as the programs. You of course apply to the same programs, or at least in the same locations. Depending on the competitiveness of the fields one or both of the couples are applying to, you should apply to as many programs as possible without becoming a pauper. At least 50 is a good number, more is better. You then wait for the interview calls. It is then that you start. How much one can influence a partners interview calls depends on a number of factors. If both of you have been called, then the problem is solved. If one of you has been called, then whether the other can get the program to call the other candidate depends on the following: 1) How good the candidate (that has been called) is relative to the program? A stellar candidate applying to a small community program has more say. 2) Is it the same dept.? If both have applied to the same dept., then it is a lot easier. Even if they are different depts., if they are at a similar level of competitiveness, for example Medicine and Peds, they can communicate with each other relatively well. But if one of them is Surgery for example, a more competitive field, then it is easy for Surgery to influence Medicine but difficult for Medicine to influence Surgery. 3) The timing: Can you try to tell the program to call your spouse even before you have interviewed there? One can try, especially if it is the same dept., and tell them to review your spouses application before you come to interview so you can come together. But you can obviously wield more influence once you have interviewed there and especially if it went well. 4) Reputation of AKU at program 5) One should bring up the topic of couple matching with every single of the interviewers. If you are a good candidate and your interviews went well, you can really push your case. Couples have to enter their match lists and indicate that they are couple matching by entering their partners NRMP no. on their own page on the NRMP site. The intricacies of how to make up a list, as a couple, can be read on the NRMP site. Does entering a couples match jeopardize your chances of a good match? The answer is complicated. It depends on a lot of factors. Whether they are applying to the same dept. or not, how good the candidates are, are they of similar caliber etc. The bottom line is though that just like in any relationship, compromises might have to be made. It might not affect your chances at all; in fact it might even help your chances, but be prepared that you might drop down a few places on your rank listheybut thats OKyou cant have everything
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BOOSTING YOUR INTERVIEW COUNT FOR Class of 2003 COUPLES


In the month or two that follow the transmission of your application to the programs, you will get the majority of your interview calls. Theyll pour in fast, and then they will slow down. All the programs which were keen on interviewing you on the basis of your application have responded. The programs which are left may be waiting for further exam results. But, they may not notice when your scores come in. Or, they may have just cast a casual glance at your papers and moved on without realizing your credentials. Programs get thousands of applications. They cannot read every single thing which you have mentioned. You may be on their waiting list and they forgot to let you know. Ive even been in the situation where they wanted to interview me, but, conveniently forgot to inform me! Hence, it is absolutely essential to make an active effort to secure interview spots. If you sit passively, you will miss out. I know a person who had been rejected by a program, invited later on due to persistent enthusiasm and then offered a prematch by the same program on the day of the interview. So, do not expect everything to fall in your plate. Make a list of all the program secretarys names, phone numbers and email addresses. Then, contact them at every possible excuse. Continue to do so until you are definitely rejected. I would usually stop bothering a program when they rejected me, unless I had good reason to (e.g. my spouse had received an interview call from her corresponding program). Give them phone calls, write them emails! If you have not received a definite response, contact them weekly to find out about the status of your application. If you are on the waiting list, express your most sincere enthusiasm. Request that your application is reconsidered. When your Step 2 CK or CS result is dispatched, let them know. When you actually get your score, contact them enthusiastically to have them learn of the good news. Receipt of a score is a great reason to contact the program director, instead of going through the secretary. Tell the PD that you are happy to let him/her know that you have scored well in Step 2 CK, or, that you are now eligible for ECFMG certification. Then, offer a recap on your achievements (I would mention my medical school, my complete USMLE history and my ranking). Express your enthusiasm in the program. Request the consideration of your application now that you are the best thing since sliced bread. (By the way, all of this must sound extremely modest. Nobody likes an arrogant show off. Least of all program directors.) When you feel that the secretary of a program is not paying any attention to your application, write to the program director anyway. What have you to lose? As long as you dont sound too irritating, every email you send shows your interest. And it works. I did get invites this way. If a program tells you that you are on their waiting list, life becomes difficult. Waiting lists are very long, sometimes running in the hundreds. You may be anywhere on the list. Furthermore, only the person right at the top of that list will be called for an interview if someone cancels. Another thing. The people on the
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top of the list are usually not there due to merit alone. If someone had a perfect application with a missing Step 2 CK score, they may be placed at the top of the list when the result comes in (if equally perfect). In my experience, however, being a part of a couple makes this happen more times than anything else. If your spouse gets an interview call from their department, your department is manifold more likely to invite you too (especially if your spouses program is comparable or better than yours). It becomes a diplomacy issue, I suppose, because your spouse can request her program secretary to talk to your program secretary. Consequently, you get the penthouse of the waiting list. Once, my spouse was rejected by a program, and I was invited at a later date. I contacted my program secretary, I contacted her program secretary, and I asked my program secretary to contact hers. Within hours, she moved from a rejection to a We would be happy to have you come for an interview (by the way, the bold letters have not been added by me the program did that). When we interviewed there, my spouse got extremely positive vibes. So, a rejection is not always a rejection, especially if you are part of a couple. Most programs are couple friendly. The tone of the secretary changes completely from a nasty you are scum to a pleasant Ill make sure I give it another look and pass your file on to the program director. If your spouse gets an interview call, have him/her do what I did above. They pay more attention to an interviewee rather than any random applicant. Have the spouse emphasize that they would love to be at this program, but, alas, cannot because you have not been invited. It works. Another tip regarding couple matching. If you are to interview at a hospital that will not invite your spouse, however, your spouse has an interview call from some other hospital in the vicinity, make sure you inform the program of this. Otherwise, thinking that your spouse has not interviewed at their program, they will just not rank you, even if they like you.

NRMP FOR COUPLES

Class of 2003

NRMP stands for National Residency Matching Program. This is the system which will determine where you go for your residency (and fellowships, perhaps). So, dont forget to register! (The website is www.nrmp.org ). NRMP registration commences on August 15th, and, the deadline for registration is December 1st. Since registration with NRMP costs money ($105 for each applicant when taking part in the couple match), I would advise registering after one has gotten past visit visa issues. However, as with all things, do not leave it till the last minute! Registration is quite straightforward. It should not give anyone any difficulties. If you register as a participant of the couple match, youll have to make sure that you get your name linked up with your partner. Each of you will have to cross
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verify each others requests before your status as a couple is accepted by NRMP. Coupling, however, is not a permanent process. You can always opt to uncouple as you please. Once you are registered, you can just forget all about NRMP for a while. Youll need it when you are making your rank list. Rank lists may be submitted starting January 15th and ending February 23rd. Again, the worst thing for you to do is to wait for the last moment. Last moment impulse changes will also lead to regrets. So, meditate on your rank list well in advance and submit it early. This way, you will have plenty of time to consider. For the submitted fee, participants of the couple match are permitted to make a rank list of 20 programs (each). If one desires to rank more than their allotted number, each extra program ranked costs $30. Youll have to certify the rank list when it is ready. Although the process of certification looks really official and final, you can always change it and certify it again (as long as you do so before February 23rd). If you fail to certify your rank list, it will not be accepted. If you change and do not certify, your last certified rank list will be accepted. For couples, rank lists have to be made separately, but in concordance. That is, for example, if one has MGH as #1 on their list the other should have a corresponding program, e.g. MGH or something in Boston (if city matching) or something even further (if the couple so desires!) You can even opt to have one person not match (for which the NRMP Program Code is 999999999). You can always view your partners rank list at a click of the mouse, however, do not expect to see both your rank lists side by side on the same page at any point in time! If you prematch, do not forget to withdraw from the main match (that is, NRMP) before the rank order list deadline. If you have submitted a rank list and you do not withdraw, you are legally obligated to accept the appointment made to you by the main match, even if you have accepted a prior prematch. For a coupled applicant to withdraw, you have to uncouple before withdrawing. It is here, on the NRMP website that you will find out where you matched. Relevant days have been described below: Monday of Match Week (say, March 14th): You find out if you matched (by email) th Tuesday of Match Week (say, March 15 ): List of unfilled programs available to unmatched candidates (for scramble) th Thursday of Match Week (say, March 17 ): Match results available!

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SECTION VII APPENDIX VIIb Specialty Information


SURGERY some thoughts
Nabil Tariq

Surgery was once considered off limits for foreign medical graduates (FMG), it is not so anymore. It still is more competitive than Internal Medicine or Pediatrics, but a categorical position is now attainable with a good application. There are a lot of issues to consider when choosing a surgery program or rather in them choosing you. The first step is usually cluster bombing. I cannot emphasize enough why it is so important to apply to as many programs as one can reasonably afford. At least 45-50 programs but, preferably close to 60 to 70. Now the type of programs you want to apply to depends on your goals, and of course the strength of your application. But even if you are a stellar candidate, remember this is Surgery and do not get over confident. Do apply to at least 15 to 20 low tier programs. Let me talk about your future goals. This, more than anything else, will guide your program choices and in the end, your rank list. You have to be clear on what you want. There are a lot factors to consider. The bottom line in Surgery at the moment is that if one is really keen on wanting to go to a big name university program i.e. the big famous ones like Mayo, Yale, Cornell, etc.; you most likely will have to go through a preliminary year, even if you have a year of research. There you will have to prove yourself and also hope that they like you. Generally speaking, AKU graduates have not had much trouble impressing the program directors and they eventually go on to become categoricals in big programs. But some have had quite a bit of trouble. There are many important issues such as visa status. If you are a green card holder or a citizen, then you are fairly comfortable. If you are not, then you have to think about the potential problems. There is a new rule by the ECFMG that you cannot repeat PGY (Post Graduate Year)-1 again even if it was a prelim. Previously people used to repeat the prelim year and do so two or three times to wait for a categorical spot to open. That has changed since then. You will have to move to another institution if there is no PGY-2 opening at your place. ECFMG does not allow repeating for J1 visa holders. This does not apply to green card holders or citizens or even H1 visa holders. They can repeat if they want. It is important to see what other options one has. If one has a decent (a relative term) categorical option, one can go for that or be more daring and go for the preliminary year at a big name place. The latter is usually more difficult if you have visa issues (see above) or if you are couple matching. It is risky to do a prelim if your partner is also there. She or he might have to move as well next year if you do. That will be a major problem. Will going to a big name place make you a better surgeon? Not necessarily, as there are other things you have to think about. The number and variety of surgeries you perform is very important, as is the amount of autonomy
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you are given in performing those surgeries. There are well known examples of people who come out of a place like Harvard and are excellent academicians, but there surgical skills leave a lot to be desired. Having said that, it also does not mean that performing hundreds of extra operations will make you an excellent surgeon, as an important saying in Surgery is You can teach a monkey HOW to operate, but you cant teach him/her WHEN to operate. There is another fact that we have to accept. As FMGs applying for surgery, we usually dont have much choice in deciding which program to go to and a lot of the time it is whoever will take us. But it is fairly easy for AKU grads with good scores in the USMLE (average above 90) to land a preliminary position at a good place. For categoricals, the program will probably be less reputable, but it is now possible to get one provided you have done reasonably well on the USMLEs. There are a few general things that apply to all specialties, but especially the more competitive ones. Apply early, by the beginning of October, even if your Step 2 score has not yet arrived. It will be posted directly to ERAS. Give your Step 2 by the end of September and be ECFMG certified by end of November or early December. The other important point I want to make is about research. People have become very fond of it lately. I have talked to a lot of program directors about this. If you want a spot at a competitive place, you are much better off doing well on the USMLEs and doing a year of prelim than one or even 2 years of research. The amount of exposure time you get as an intern to the faculty far outweighs any research position. You have a lot more opportunity to prove yourself. I must emphasize, do well on the USMLEs and dont let research compromise your score. Unless you discover the cure for Breast Cancer, you are better off with the prelim year. These were some of the major issues to think about when applying for Surgery. In conclusion, it is very possible to get into a surgery program at the moment, provided you plan right. I am sure there will be a lot of other questions that people have. You can e-mail me at nabiltariq@hotmail.com and I will be happy to answer your questions.

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APPLYING FOR GENERAL SURGERY

Ali Khalid Jawed Class of 2003

A lot of the stuff that has been written is still accurate. To get into surgery you need to apply to a lot of programs. I think that 60-70 programs are a good number. And yes your USMLE scores are very important. But there is one very important and new variable which is starting to affect things now and will continue to do so even more in the coming years. All General Surgery programs in the USA are now required to have the 80 hour work week for their residents. This has made General Surgery very attractive for American Graduates. As a result most programs will offer you a preliminary position. You can and will get calls for categorical positions but remember that there are a lot more American Graduates applying for Surgery so even if you interview for a categorical position, you may not match in a categorical position. There is another important factor to remember about prelim positions. You only have three months to impress your consultants. Its not a year. Thats because you start your prelim position around end June/beginning July and you have to reapply for a PGY2 Slot in September. So it is very important to remember that when you rank a prelim program, it should be one which does not have too many prelims and which has a history of taking prelims into categorical positions. For example, The Mayo Clinic in Rochester will now be taking 18 prelims. It will require you to have extremely unique talents to distinguish yourself among 18 prelims in 3 months. You have to remember that at the good universities a lot of the prelims are FMGs who may be as good as you or even better. Another thing was research. Well, its true research cant beat clinical experience in the USA but research always counts. It will always help your application although the degree to which it will do so will vary from place to place. A lot of programs will ask what you have been doing since graduation. Its always a good idea to get some clinical work done after Step 2 and before you go to the USA. Thats a lot more impressive than saying that you sat at home and studied. But remember that your steps take priority. It wont help you to have a house job as part of your CV and have mediocre USMLE scores. People applying for surgery usually have good scores, even the American Grads so you have to score especially well. Try and contact all your seniors who are doing surgical residencies or who are consultants and fellows and get them to help you. If nothing else they can ask the program secretary to send your application to the Program Director. Most FMG applications dont go beyond the secretary level and getting them past the secretaries is a major hurdle. Contact your alumni as soon as you have applied. DO NOT WAIT TILL YOU GET TO THE USA. Get their emails and start sending mails. A lot of surgery programs are just looking for people to fill out surgery positions and they will not get you a PGY 2 position after you are done. You do not want to go into such a program. The most valuable commodity for you is
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information. Get as much information as you can about all the programs that you are applying to. I would also recommend that you stay in the United States until the Match. It will help you in the Post Match/ Scramble and even if you match you can ask the program to send you your contract, which you can take back to Pakistan. This helps a lot with the J1 application, which is the type of visa that most surgery programs are offering now. And for the unaware, please get your PMDC certification. You need a valid PMDC certificate to get an NOC from the Health Ministry. This NOC is required for your J1 visa. A lot of this might seem discouraging and it is. I have been there and its quite upsetting to see the kind of response that one gets from the surgery programs especially if you have good scores on your Steps. But you have to hang in there and hope for the best. You cannot direct the wind but you can adjust the sails. And always remember that you are as good as any American Graduate and never let anyone tell you otherwise. The playing field will never be truly level for you as an FMG but hard work and faith in yourself and God will always get you where you want to go.

GENERAL SURGERY RESIDENCY


Zarrish Saeed Khan (Class of 2005) I applied to 74 programs. I got 8 calls in General Surgery (UT Southwestern in Dallas TX, West Virginia in Morgantown WV, North Shore Long Island Jewish in New York, Bronx Lebanon in New York, New York Hospital of Queens in Flushing New York, University of Pennsylvania, Mayo Clinic Rochester MN, Yale in Newhaven CT). The last three are preliminary programs. For university hospitals I was advised to apply to both prelim and categorical programs. Also apply to University of New Mexico, University of Maryland, University of Kentucky (there are two - apply to Louisville for sure), Huron in Ohio, New York Presbyterian Cornell, Creighton Nebraska, Harlem in New York, Maimonides in New York, Providence Mercy in Michigan (I am not sure exactly of this name), Valhalla in New York....these are the other programs which called some other people who were interviewing with me. People put a lot of emphasis on contacts - I think you should try to contact people who are already there not so much because they can get you calls (usually they CANT) but more so because you will be able to benefit from their experience and moral support and believe me that's very important. I will just pass on some useful advice that I received on the way and combine it with my experience: 1) Take this as an investment and apply to AT LEAST 70-80 programs. I tried to apply to places that had called Pakistani students before. I now think those programs are a MUST apply but also apply to other programs. Dont waste too much time reading every website but check their basic requirements e.g. an
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important one will be US clinical experience requirement (some e.g. Our Lady of Mercy, NY and University of South Carolina require a year of US experience). Also check if they need you to have a J1 or H1 visa/green card (e.g. University of Virginia and Nassau, NY) have this requirement because they had trouble with IMGs who couldnt make it on time. Never count your rejections; in fact expect a lot of them. The 'I am showing interest' phone calls that you have to make to the programs were BAD! It was a quick way of getting rejections. In some programs you only get the answering machine (if you get an answering machine dont leave a message unless its the fifteenth time that you called the answering machine; better call later and talk to a real person); some coordinators were amazingly rude, if you are like me you will also get nervous and sound very lame in the initial 30 calls you make. But it helped almost everybody get at least one extra interview - worthwhile I would say. Also take a printout of all your programs with their phone numbers and record what you said to the coordinator in every call. Unless the coordinator asks for your last name/AAMC number dont consider that a ''useful'' call. Dont beat about the bush; its okay to ask directly (politely) that you are calling to inquire about the status of your application. End your calls with a cheerful I appreciate your help and have a nice day. 2) Do not 'Not Apply' to programs thinking you wont get a call from there. (Some great places like Mayo, Yale, UPenn will call you for a prelim only) and dont take it for granted that the 'bad places' will call you for sure. Apply to a good mix of good, bad and middle tier programs. 3) Do your level best at every single thing. Everything should be perfect: your step scores (most importantly), your application, personal statement, letters of recommendation and once you go there you should be on your best behavior. A small leak can sink a ship so dont overlook anything. The competition is immense; so many would have 99s, past research and clinical experience (with the change of laws in UK, the flux of IMGs has further increased the competition in some service oriented community programs). Some programs that I know had called AKU seniors, didnt call anyone in our year (but some other programs warmed up to IMGs so it's not all bad). 4) Having said the above, do not stress out if everything isnt perfect. You need to have the satisfaction that you did everything to the best of your ability but well let's say you got: a) One bad score. Remember that people with less than 99/99 have matched. b) No US experience. At least five of us applying this year had no US elective experience in final year; all of us matched either in a prelim or categorical program. c) Dont think if your application lacks in some way it would be the end of the road. There is no guaranteed success formula. See if you can make up in another way.

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5) I committed the mistake of making my application too long. Try to keep it as concise as possible, emphasize your selling points for example instead of making 10 entries describing similar experiences (e.g. KAP research studies) just make one or two and list your projects there. Nobody has the time to read lengthy applications. The same goes for personal statement; I would say it should not exceed 500 words. 6) The situation this year had been relatively bad with quite a few people going unmatched. The time when you apply is not the time to predict if you will have a good or a bad year. Therefore, apply to 15-20 programs in a less competitive field as back-ups. Depending on your situation a) if you get enough surgery calls you can politely cancel your other interviews later. b) you may discover that you were not that passionate about surgery after all and cancel your surgery interviews. c) you may think that you would rather go to a great medicine program rather than going to bad surgery programs. You may come up with a rank list that looks like... good surgery - good medicine - bad surgery - bad medicine programs d) you may go through the match ranking surgery on top and ''others'' at the bottom. However, I personally think that you should NOT apply to "pure backups" i.e. joining a program with the intention to drop out the next year to reapply for surgery the next year. It is bad for your own impression, as well as the impression of other graduates from your school/country. You hope that people before you havent messed up your chances so be sure that you dont mess up things for anybody either. 7) Each year, one or two people match in categorical right away while most will find a prelim. Prelims are tricky; they can land you in an incredible place or they might jeopardize your chances especially if you are on a J1. From what I heard, I think you should continue hunting for a PGY2 spot but it's better to go through the match again next year. The ECFMG rule is that on a J1 you cant repeat a year but if the program can show that your rotations are a little different from what you did in the prelim year and hence your training is ''advancing'' then you can go through the match. This doesnt apply to green cards and H1 so its even better if you find a prelim on H1 (in addition the advantage that you dont have the 'visa time will run out before I finish my residency' stress). While ranking prelims, look if they have a history of taking their prelims in categorical programs, what do the "insiders'' (residents) say. Also when you visit the programs you might find one or two prelims who are now categoricals (and obviously they will tell you doing prelim there is wonderful) but try to find out what happened with the rest of prelims, did they find a spot elsewhere and did the program help them in that. I think I have talked to/heard about some 10 prelims; I think amongst them 3 changed to something else but others were able to find a surgery categorical after 1-2 yrs of prelim. YOU MUST RANK YOUR CATEGORICALS ABOVE YOUR PRELIMS, which was the unanimous advice I received. If you get a prematch offer for a prelim I would suggest you dont take it even if you think that your chances of landing in categorical through the match are very small.
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8) Finding research post docs is difficult but it gives your application a significant boost especially for good university programs. I met this K.E. grad who went unmatched one year, then did two years of research that got him a categorical with H1. The programs look for results; you may have done research in med school only and have got several good publications that might be a good enough proof of your commitment to research. Research however didnt seem to count to a lot in some community programs that I visited but even they will be impressed that you have done some work in ''MGH, Columbia or whatever great place/person'' you have worked at/with. 9) Thank you notes: write an email both to PD and the coordinator within 1-2 days. In this mention the names of people you met (interviewers and residents who gave you tour etc). In end January, write a letter to the PD in which you mention that you have decided that they will be amongst your top choices. 10) Remember as an IMG it will be difficult, always has been. You feel "branded" at times but stay upbeat. After all, so many people have found surgery residencies (we even have IMGs doing neurosurgery!!). InshaAllah you will too. Keep praying and do your level best along the way. You will have days when things look really bad and then days when everything looks great; just hope the eventual result is good :)

FRIENDLY SURGERY PROGRAMS


Zarrish Saeed Khan (Class of 2005) DISCLAIMER: Here is a list of programs that have interviewed/matched (at least at some time) AKU graduates/IMGs. Such lists can sometimes be misleading 1) You spot an AKU grad in a programs resident list and assume they will call you too, not realizing what that grad had to offer that made the program take him/her in the first place. 2) The program requirements might have changed over time (e.g. of visa sponsorship/US experience). It would be best to do your homework before you apply (i.e. dont blame me). SOURCES: These are places I and my class fellows(2005) interviewed at, lists that some friends from 2002,2003 and 2004 sent me and YPPRC. Upto serial number 27 are the programs that either appear repeatedly in lists or are found in recent lists. Below that I dont personally know anyone who interviewed there recentlybut I would mention them anyways.

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

University of New Mexico, NM University of Pennsylvania, PA Yale University, CT Mayo Clinic, Rochester MN West Virginia University, Morgantown, WV University of Texas SouthWestern, Dallas TX North Shore Long Island Jewish, NY Bronx Lebanon, New York Providence Southfield, MI New York Hospital of Queens, Flushing, NY University of Maryland, MD Maimonides Medical Centre, NY Washington Hospital Center, DC University of Tennessee, Memphis, TN Metropolitan Group of Hospitals, Chicago, IL Brooklyn Hospital Center, NY West Virginia University, Charleston, WV New York Presbyterian Hospital, Cornell Medical Center, New York, NY University of Kentucky, Kentucky ST. Joseph Mercy Oakland, MI ST. Joseph Mercy Pontiac, MI Creighton University, Nebraska, NE Graduate Hospital G Surgery Training Program, PA Westchester County Valhalla, NY Harlem Hospital, NY. Huron Hospital Program UDMNJ, Newark University of Arkansas University of Miami, Jackson Memorial Hospital, Miami, FL William Beaumont Hospital, MI Brown University, RI Saint John ,MI SUNY Syracuse, NY SUNY Buffalo, NY

J1 Prelim H1 Prelim J1 Prelim J1 Prelim J1 J1 H1 J1 Prelim H1? Prelim Taken AKU grad

J1,Prelim only

Taken 1 aku grad Prelim

J1, prelim only H1 if step 3 by dec

Apparently the program has closed down H1

Taken AKU grad after prelim

Taken IMGs

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35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51

Hospital of St Raphael, CT Rush University, Chicago IL Dartmouth, New Hampshire Temple University Hospital Program, PA University of South Carolina, charleston University of Connecticut, CT

Took an AKU grad after prelim 2000,2002, prefer IMGs for prelim

Need 1 year US exp Interview people with research or Uconn electives Need 1 year of US exp, taken AKU grad Need 1 year of US exp, taken AKU grad Need 1 year of US exp You need to have a J1/H1 to apply No response to me No response to me-called AKU grads in past No response to me You need to have a J1/H1 to apply

University of Tennessee, Knoxville University Of Utah, Salt-lake city

University of Alabama

Our Lady of Mercy,Bronx,NY University of Virginia Cleveland Clinic, OH Loyola University, IL Indiana University

Howard University, Washington DC Baylor Medical Center Nassau County, NY

NEUROLOGY RESIDENCY

Safdar Ansari (2003) & Syed Irteza Hussain (2000)

If youre reading this youve probably decided to make a career out of clinical neurology or are considering doing so in the near future. In the following pages we wont go into the reasons why we chose this is as a career or what you may find appealing as this is a to the point guide you have to read once youve made that decision and want to find a Neurology residency position in the United States. Neurology is basically a three year program with a preliminary year of internal
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medicine before it, making it a total of four years before you qualify to sit for the boards. All Neurology training programs take part in the Neurology Matching Program, (NEMP) which is in turn sponsored by some guys in sunny California under the banner of the San Francisco Matching Program. However and this is the sucky part, you also have to register with the National Residency Matching Program (NRMP) and use the Electronic Residency Application System (ERAS) separately as you will have to apply under a separate cover for the prelim year in medicine. So you will be spending twice the amount as it is a two tier match for you. The website for the San Fran Matching Program is www.sfmatch.org. All of you should thoroughly go over this website. It contains all details that you need to know. Pay specific attention to the Timetable in the Neurology section. This provides a rough guideline on when you should be doing what and gives you an idea of what to expect in the near future on your road to a Neurology residency. I suggest that you thoroughly browse the website and either download and print/save the following specific documents: - Common Application System (CAS) Instruction Manual; - 6-page CAS Application Form; - CAS Initial Distribution List; - CAS Supplemental Distribution List; - Rank List; - Post Match Distribution Form; - Return Original CAS Documents Form (To be used after the Match ONLY). You will NOT need to send all of these documents in with your application package but common sense dictates that you should be familiar with all of them and their purposes. Since the San Fran Match is an early match (it is announced about 3 weeks earlier than the regular Match, the NRMP) you have to get all your paperwork in order and sent off earlier than other people. I sent off my application packet to the San Fran Central Application Service (CAS) sometime in the first week of August (Safdar). For the coming year of 2005-2006 the CAS Target Date is August 31. So it is imperative that you have all your documents with CAS by that date if you want to meet all your program deadlines. First of all you have to register at the SFMatch website. The Registration fee is 100$ payable by credit card. I faxed in my registration form and they emailed me a confirmation and then mailed me a registration packet, which included the following; 1) Registration Certificate; 2) Username and password to view the online directory;
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3) CAS bar-coded labels for you CAS documents. The online directory of programs at the website contains the complete contact information of all programs listed with the NEMP. The barcode labels are attached to the application pages to allow their sorters to properly sort and scan the application. The application forms (unlike ERAS) are not filled in online. They are downloaded in Adobe Acrobat Format and then filled in. I strongly advise that you purchase a copy of Adobe Acrobat Professional Version 6.0 or higher. Most Software vendors have this piece of programming, and it is sometimes referred to as Adobe Acrobat Writer. This software allows you to fill in the form fields on the PDF file and then save it. Ordinary versions of the Reader software do not allow you to save. CAS requests that you send in original Letters of Support. Although that is not possible for any letters that you might have from the US (from your electives), it is possible with letters from AKU faculty. You do not need to go and bother the faculty member who wrote you that letter. All you have to do is submit photocopies of AKU LoRs to the Student Affairs Office, and they will provide you letters printed on the AKU Letterhead which are just as original as the originals themselves! It is a smart idea to do this in any case, so that you can get copies of your letters in case you lose or damage the originals that you have. Your target to apply (or send in all your documents to CAS) should be mid August. You want to beat the rush of all other applicants and have your application scanned and ready for forwarding to your selected programs by the end of August or first week September. By the time you apply it is ideal if you already have your Step 2 score, and it is brilliant if you also have your Step 2 Clinical Skills score; and it is perfect if you are already ECFMG Certified! Seeing as how you can now take any exam first and in any order I strongly advise all of you to take your Step 2 Clinical Skills exam while you are in the US for your electives. Find out how to apply for the CS from www.ecfmg.org or www.usmle.com. I myself had only my Step 1 Score with me when I applied (Safdar). I received about 16-17 interview calls out of 38 programs applied to, and I dare say that I would have received significantly more if I had been ECFMG certified. ECFMG Certification makes all the difference!!! In reality it is quite difficult to be certified when you apply. What makes it doubly difficult is the early timeline of the San Fran Match. Your target Step 1 date should be sometime in late Feb or early March, and you should sit Step 2 in July so that you have both results by August. The CS should be taken as early as possible, and no later than November; it takes about 4-6 weeks to report (although it should be significantly faster now for you guys) and you need to be ECFMG certified when you submit your Rank Order List on January 17 (according to the website, www.sfmatch.org). Having said all that, I (Safdar) took my Step 1 on 17 June, applied in August in the middle of my Step 2 preparation, and then took
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Step 2 on October 26 and CS on November 4. I was not ECFMG Certified by January 17, the Rank Order List Deadline. Because the San Fran Match is not run on the Internet like ERAS, they have no way of knowing about your ECFMG status unless you tell them. I told my top three ranked programs that I am not certified as yet, but will be in about two weeks and they were OK with it. They generally know that youre not going to pass Step 1 and Step 2 and then flunk the CS, which is not that difficult an exam. The point of all this is that you should try your level best to beat the timeline and stay ahead, but in case you do lag behind your schedule, all is not lost. Once you have registered with SFMatch and you have received their application packet, you can access the online directory of Neurology Programs. Then you can start preparing you program list. This is a complicated and stressful process as the number of programs you apply to is directly proportional to your credit card bill! It is also important to gauge how IMG friendly the programs are, and the way to do that is to email them directly, ask around with people you know who are already in Neurology residencies and looking over their websites. The best way to is to write to the program directors sending a copy of your Resume, telling them about your interests in Neurology and how you like there program and that you would be interested in going there. This way you will find out from their response if they are ready to entertain you as an applicant. You shouldn't be surprised if they're not willing to entertain you as Neurology is a primarily university based residency and most of the good places will only entertain their own graduates --- however you will be surprised that a lot are also willing to entertain you as well, so this is a sort of trial and error method. But this way you get some idea about their stance on IMG's. Secondly review their faculty, along with their respective research interests and see if your interests are compatible with what's gong on in the program and if you have prior experience in these areas be that as a research fellow or clinical electives these are huge plus points! I will break away from the discussion for a moment now to delve into the importance of research. Neuroscience has undergone an explosion in the field of research, coming up with new and innovative ways to treat some and diagnose others. Like all other residencies research will help improve your CV, so if you have the time and dont have any other constraints I advise doing a research fellowship in the states and will most definitely help you get into a program of your choosing. Secondly it will help you decide your interests within this vast field. However its is not an essential to do this in the US and if for some reason you cant then I would strongly advise you to take up a project at AUK and try to get something or the other published. Our university is quite active in the Pakistan Academy of Neurological Sciences and you can also present at their meetings and conferences. The latter helped me in my CV (Irteza).

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Applying to about 30 programs is a pretty safe bet. You also have to remember the cost factor and the fact that you will also be applying through ERAS to the NRMP and that will inevitably double your cost. In retrospect I feel that I applied to too many places (38) and too safely. I should have applied to more highly ranked programs, and I urge you to do the same. Neurology is not that competitive and with decent USMLE scores and some good research behind you, I am sure you can all Match high! (Safdar) The following table is an excerpt from the Neurology Match Report of January 2005. Do pay attention to the highlighted values and

Total SF Match Registration IMG Registration Matched Total # Seniors Matched # US Grads Matched # IMGs matched Avg. USMLE Matched Avg. USMLE Not Matched Applicant Rank Lists US Senior Rank Lists US Grad Rank Lists IMG Rank Lists Avg. Applications Avg. Interviews Avg. Offers % Matching Total % Seniors Matched % US Grad Matched % IMGs Matched

January 04 1079 657 512 314 18 180 220 202 705 326 25 354 21 6.2 4.6 73% 96% 72% 51%

This Match 1111 646 501 323 21 157 217 211 684 336 27 321 23 6.5 4.3 73% 96% 78% 49%

Now comes the question of your PGY-1 prelim. The trend nowadays is that the Neurology programs will have an arrangement with their respective departments of Medicine and there is an integrated program with them - you may or may not have to apply separately to their department of Medicine. This info will be available from each program. However to be on the safe side if you really like a program in one city it is prudent to apply separately to one or more prelims that are close to your Neurology program. The US grads usually apply to community based programs near there Neurology programs. However there is a down side to this, in that the teaching for your one year in medicine may not be good enough. Anyway, the basic requirement for a prelim is that it should be ACGME
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accredited and if you are selected by a Neurology program they will accept any ACGME accredited prelim training. From my experience, there were only two programs out of 11 that I interviewed and ranked that did not offer the preliminary year of Internal Medicine along with the Neurology residency. One of them was Baylor which was my Number One choice and the other was UTMB-Galveston which was my last choice! Its safe to assume that most places will offer you the PGY 1 position and so you should register with ERAS and fill in the Common Application Form and upload all your documents to ERAS, but should not APPLY to a prelim spot unless you have contacted the Neurology department and confirmed with them what is advised. A smart and cost effective way would be to apply to only those PGY 1 Internal Medicine programs whose associated Neurology departments have invited you for interview but do not guarantee a prelim spot, as well as about 3-5 safe community programs which are likely to offer you a prelim spot. Obviously, you are more than welcome to contact us when finalizing your program list for last minute advice and input. The interviews are a lot of fun. Most of the Neurology and Neuroscience programs in the States are now grossly over funded, due to the recent attention being paid to this field. Therefore the departments really treat you nice! Most of them cover your hotel stay, and some even cover your entire hotel expense, not just the room rent and tax! That means you (and your friends in some cases) can order room service and watch free movies all at the programs expense! Needless to say, your expenses will show up on the bill that is sent to the program secretary, so dont go overboard, if you know what I mean!!! Most of the interviews are very relaxed. They usually start with an informal dinner with the residents the evening before. This is a good time to get to know the residents and get your questions answered. But do not ask questions just for the sake of asking them, and trying to appear intelligent and interested. Trust me, those residents are smart people (obviously) and they DO form opinions about you, and the Program Director usually does ask them about their opinions before making the Programs Rank Order List. In some cases, the Chief or senior residents are even part of the interviewing and selection committee. So the point is, that during the dinner you should be relaxed and friendly, the residents want to know whether you will be a good colleague. Do not ask meaningless questions, try to avoid pointless and political conversations, and last but not the least, TRY VERY, VERY HARD NOT TO FORGET THE RESIDENTS NAMES!!! It can be extremely embarrassing when the resident addresses you by name and you have no idea what his or her name was! Just remember what my mentor told me. The fact that youre there already means your academics are good enoughbe yourself, be polite and be well mannered and you must come across as a friendly person to work withoh and yes dont order noodles and dont eat rice with your fingers! (Irteza)
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On the interview day, you will mostly have about 4-7 interviews, each lasting about 20-40 minutes. That is a LOT of interview time and you will have ample time to form an opinion about the program and its staff, and vice versa. You will mostly get an opportunity to talk to the PD, but if you are not scheduled to meet him then you can try to bump into him sometime after lunch or at windup time. It is imperative that you thank him for inviting you and ask any questions that you have in mind that are important in making your rank order list. The question of Visa sponsorship is a very sensitive one, and should be addressed to the PD only if it hasnt been answered definitively by other reliable sources (e.g. AKU Alumni at the program). It can get to be very frustrating when your few questions about the program have already been answered and then each and every faculty member you meet asks you if you have any more questions! Try to think up a few more meaningful questions, but if you cant then simply state that all your questions have been answered and then shift the conversation to some other subject. Basic points that you should consider or look at in a program: 1) Are the residents there happy or are they disheveled, lousy and in a bad mood (believe me you will see a couple of those programs). 2) Financial solvency of the place, research grants etc--- wherever the money is pouring in your interest both academic and financial will be looked after. 3) The stability of the program rests on the Program Director (as well as the Chairman)---note if he's been around for long or intends to do so and his attitude towards teaching. 4) Research prospects for residents and options for fellowships. 5) What does the city have to offer and would you like living there? One last piece of advice for the interview season is to remember to pack your swim trunks! Most hotels you are put up at have swimming pools or Jacuzzis that should be put to good use! The faculty at AKU in the Neurology Department is extremely helpful and its best that you schedule an appointment with Dr. Nadir Ali Syed, Dr. Saad Shafqat or Dr. Mohamed Wasay and you will find them extremely helpful. This has been a brief guide and overview and you will obviously have some unanswered questions which can be addressed if you contact us. For more help you can contact: Safdar Abbas Ansari, Baylor College of Medicine (safdar.ansari@gmail.com) Syed Irteza Abbas Hussain, University of Wisconsin at Madison (irteza_shah@hotmail.com) Asma Zakaria, Baylor College of Medicine (asmazakaria@hotmail.com) Ali Aamer Habib, Cornell University (aliaamerhabib@yahoo.com)

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NEUROLOGY RESIDENCY UPDATE


Mian Zain-ul- Sajadeen Urfy (Class of 2005) CONTENTS: 1. Neurology as a career 2. When and What to do 3. Places to apply and Prelim Year 4. Interview 5. People in Neurology NEUROLOGY AS A CAREER: If youre reading this youve probably decided to make a career out of clinical neurology or are considering doing so in the near future. In the following guidelines, I wont go into the reasons why I chose this as a career or what you may find appealing as this is a to the point guide for steps you have to take once youve made that decision and want to find a residency in the States. I must say that this field has undergone tremendous growth and development in recent years, which is evident from the fact that 50% of NIH funding is now contributed towards basic or clinical neurosciences. Furthermore, the need for clinical neurologists would continue to grow in the foreseeable future. Neurology residency is a four year program in United States, including one year of preliminary medicine or internship. Some programs are categorical, meaning that internship position is guaranteed in those programs while others are not, and you have to search for preliminary year yourself. I will talk about prelim year later on in my discussion. Neurology used to be a part of the San Francisco match till 2006, when the consortium of neurology program directors decided to move neurology to ERAS (electronic residency application service). The most obvious advantage of this move is that now applicants can use only one application to apply to neurology programs and as well as preliminary year spots. Apart from that, it opens now on 1st September (in 2006) unlike SF match which opens usually two or three weeks early. This would mean that now interview calls would come late and the match would be announced of course with ERAS/NRMP in the 2nd week of March. WHEN AND WHAT TO DO: Well, as any other residency there are several important parameters which should be taken into account that would not only boost your interview count and will also definitely help you in getting into a program of your choice. The first and foremost thing that makes a difference is your USMLE scores and timing of your exams. I would say the higher you score, the more interview calls you will get, but scores in both steps above 90 and preferably above 95 would be really helpful for top ranked programs in US. However that does not mean that low scores are not entertained, so do keep your hopes high and try to make other factors stronger in your application. Another thing which could be of benefit is your early CS
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result, because nowadays, the results are being announced a little late which means getting ECFMG certified late. I encourage you to therefore; take your CS early, so that you are ECFMG certified early, lets say October. US clinical experience is another important point that would boost your interview count definitely. Even if you do not have US experience, I encourage you to do observerships in US before the interview season that would show your motivation and enthusiasm for the field. Neuroscience has undergone an explosion in the field of research, coming up with new and innovative ways to treat some and diagnose others. Like all other residencies research will help improve your CV, so if you have the time and dont have any other constraints I advise doing a research fellowship in the States and will definitely help you get into a program of your choice. Secondly it will help you decide your interests within this vast field. However its is not essential to do this in the US and if for some reason you cant then I would strongly advise you to take up a project at AKUH and try to get something or the other published. Our university is quite active in the Pakistan Academy of Neurological Sciences and you can also present at their meetings and conferences. PLACES TO APPLY AND PRELIM YEAR: Now comes the issue of how to go about applying; there usually are two constraints 1) money, as the size of your credit card bill is directly proportional to the number of institutions you apply to, 2) IMG Friendly vs. Non friendly programs. I would say looking at the trends and current situation, to apply to at least 50 programs of your choice. Fortunately, and a proud fact is that AKU graduates have been to the best of places all over the US, so keep your hopes high, but select the programs of your choice intelligently, considering your future goals; e.g. academics or private practice, US clinical experience, geographic preference and so on and so forth. Below is the list of programs that I hope would help you in your selection of programs. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. University of Alabama Medical Center Program University of Arkansas for Medical Sciences Program University of Colorado University of Connecticut Yale-New Haven Medical Center Georgetown University Emory University University of Cincinnati University of Illinois College of Medicine at Chicago Southern Illinois University Indiana University School of Medicine University of Iowa Hospitals and Clinics Program University of Kansas University of Kentucky University of Louisville

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16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40.

Tulane University Johns Hopkins University Boston University Henry Ford Hospital Wayne State University Mayo Clinic (Rochester) St. Louis University Washington University/B-JH/SLCH Consortium Program University of Nebraska UMDNJ- New Jersey Medical School University at Buffalo Mount Sinai School of Medicine New York Presbyterian (Cornell Campus) Columbia University Case Western Reserve University Cleveland Clinic Foundation University of Toledo Drexel University Temple University University of Pittsburgh University of Tennessee University of Texas South Western at Dallas Baylor College of Medicine University of Texas at Houston University of Wisconsin

I have generated this list on the basis of past experiences of AKU graduates applying in neurology, and it does not in any way suggest that you should get discouraged from applying to other places, or you may not get calls from other places. As I mentioned earlier, one year of internal medicine is mandatory by American Academy of Neurology for neurology residency which is known as Preliminary Year or Intern Year. Some of the neurology programs are categorical meaning that internship year is guaranteed in those programs, while some are advanced programs and require the candidates to complete the internship year on their own. Therefore, apply separately through ERAS for preliminary year. One of the ways to target preliminary programs is through last years unmatched list. Apply to at least ten of those programs, and you may select 5-6 more programs by your own intuition. INTERVIEW: The interview season begins early as everything else and extends from Nov 15 to about the first week of Jan. Youll probably get a lot of info on how to go about these interviews and I shall not go into that. Just remember what my mentor told me. The fact that youre there already means your academics are good
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enoughbe yourself, be polite and be well mannered and you must come across as a friendly person to work withoh and yes dont order noodles and dont eat chawwal with your fingers! Besides that it is wise to review the interests of your interviewers and what is going on in the program so that youre aware of what theyre working on. Basic points to look at in a program: 1) Are the residents there happy or are they disheveled, lousy and in a bad mood (believe me you will see a couple of those programs). 2) Financial solvency of the place, research grants etc--- wherever the money is pouring in, your interests both academic and financial will be looked after. 3) The stability of the program rests on the program director---note if hes been around for long or intends to do so and his attitude towards teaching. 4) Research prospects for residents and options for fellowships. 5) What does the city have to offer and would you like living there? Once youre done interviewing, submit your rank list (in time!) solely on how you would rank them and according to your preferences and then go and have some fun until the results are announced. LIST OF CONTACTS: Here are some of the Past graduates of AKU who have done their residencies in USA. I contaced few of them and found them very cooperative and helpful. 1. Dr. Saad Shafqat (residency from MGH; now faculty at AKU) 2. Dr. Nadir Ali Syed (residency from UMDNJ; faculty at AKU) 3. Dr. Tahseen Mozaffar (Washington University at St.Louis; faculty at UC at Irvine) 4. Dr. Imran Ali (faculty at University of Toledo) 5. Dr. Ayeesha Kamal ( residency from Cornell University; faculty at AKU; former faculty at Temple University) 6. Dr. Jawad Kirmani (residency from Ohio State University; fellowship from UMDNJ) 7. Dr. Irfan Lalani (residency from Baylor College of Medicine; fellow at MD Anderson) 8. Dr. Asma Zakaria (residency from Baylor; fellow at Cleveland Clinic) 9. Dr. Irteza Shah (residency from University of Wisconsin; fellow at University of Illinois at Chicago) 10. Dr. Safdar Abbass Ansari (resident at Baylor) 11. Dr. Ali Aamir (resident at Cornell University) 12. Dr. Sara Khan ( resident at Cleveland Clinic) 13. Dr. Amber Khan (resident at University of Cincinnati) 14. Dr. Osman Mir (resident at Emory University) 15. Dr. Zain ul Sajadeen (starting neurology residency at Baylor from 2008 onwards)
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This has been a very brief overview; but I hope would help you in some ways in terms of your approach towards neurology residency. In case of any help, please do not hesitate to contact me at zainulsajadeen@yahoo.com. You can also contact faculty at AKU which includes; Dr. Nadir Ali Syed, Dr Saad Shafqat, Dr. Ayeesha Kamal, Dr. Mohammad Wasay, Dr. Mughis Sheerani. They were always willing to help me at any time.

PEDIATRIC ISSUES

Class of 2003

Applying for a Pediatrics residency does not require a special technique, as is the case with General Surgery, Neurology, etc. However, it is slightly more difficult to secure a position in a good university hospital with a big name. In contrast to Internal Medicine, only a small number of AKU graduates apply for a residency in Pediatrics. An unfortunate consequence of this is that a lot of the AKU hubs (for internal medicine) are not familiar with AKU standards. Big university names are relatively more reluctant to offer interviews for Pediatrics. However, as always, the trend is moving upwards. As the critical mass of AKU Pediatric residents is increasing, the interview trails are becoming more and more fruitful. Another issue is that the established so-called AKU hubs are (again) a consequence of internal medicine applicants. The corresponding Pediatric program is usually much smaller and less reputable. Usually, the corresponding program is merely a minor department of the general hospital. On the other hand, if the corresponding program comprises of a separate childrens hospital, chances are that it interacts less frequently with the internal medicine department. Hence, again, less information regarding AKU graduates. Although some applicants may want to work in a smaller program as it allows them more one on one interaction with faculty and their fellow colleagues, I personally preferred larger programs with separate childrens hospitals as they offered more clinical experience. You will have to decide for yourself as to what kind of environment suits you better. However, if you do look for larger programs, your options will be restricted. I interviewed at fifteen programs. Seven had separate childrens hospitals: Childrens Hospital of Pittsburgh, Cincinnati Childrens Hospital, Childrens Hospital of Michigan, University of Texas in Houston, Oklahoma University Health Sciences Center, SUNY Buffalo and UTMB Galveston. (Loyola also states that it has a childrens hospital, but, it is more of a department than a hospital as such.) The first three are considered to be excellent residency programs, however, CHP and Cincinnati have never taken an AKU graduate.
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Since AKU is yet to establish its reputation amongst Pediatric programs, I think that it is more important to have US experience for Pediatric applicants (as compared to Internal Medicine). Again, this is relative. One can still secure a good number of interview calls without US experience. For the record, I had none.

PEDIATRICS

Simeen Rais Pasha Class of 2003

I applied to 30 programs and got calls from 12. Most programs call for interviews based on the Step One score and on how early they receive the application. Seniors will tell you time and time again and theyre absolutely right.APPLY EARLY! And that means have your Common Application Form etc all ready to send to your list of programs on the very first day if possible! The Peds interview is usually very casual and youre asked at every opportunity if you have any questions. Its a good idea to check out the program website before going for the interview so you can have a list of questions generally and about specific aspects of the program as well. It helps you with remembering points about the program too at the end of the interview season when all places start to look and sound the same. Due to the strict regulations, most programs do have pretty much the same rotations and characteristics and at the end of the day your decisions may boil down to the feeling U get about a place and the people during the day. Other points which may influence your choices and which vary from person to person are program size, work load and patient diversity, location (city versus town), weather, proximity to family, program reputation/ranking. For Paeds, a free standing Childrens Hospital is a definite plus as everything then is geared towards Children in your work environment.

OBGYN RESIDENCY
Zaraq Khan (Class of 2005) Matched at Mayo Clinic (OBGYN Categorical) I will try and put down a few points regarding the OBGYN residency application process and quote my personal experience of the application and interview season for this field. If you are reading this section then you must be considering a career in OBGYN. So first of all, I want to congratulate you on choosing the best specialty in medicine (of course a lot of people will disagree) but trust me this might be the best decision you would have made in your life.
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When I was planning on applying I hadnt heard of anyone going into this field from AKU before. When I checked with the alumni office, there were a couple of people but none of them ever responded to my mails. I was discouraged by a lot of people who thought getting into a specialty that has not been explored by AKU grads would be virtually impossible without research. I think otherwise. Its hard but not impossible.

Preparation in Medical School:


My advice would be that if you have decided earlier in medical school, direct all your research towards OBGYN or at least do research in other subjects whose topics are related to OBGYN (for example I was involved in a study with the Dept. of Peds Surgery but the topic was Imperforate Hymen and its presentation in kids). I know for a fact that OBGYN has gotten a lot easier to get into (and you can get in without research as well) but this varies from year to year (our year was exceptionally good). Do remember that OBGYN is a surgical sub specialty and it will always be more difficult to get into than Int Med, Peds, Neuro etc. So a little research would not do you any harm. It can be very straight forward stuff from case reports to simple file reviews but do get published. I would suggest one publication at least, while two or three would be great and obviously the more the better. Be extremely nice to the gynae ppl at AKU. Make sure they know you personally and work hard during the rotation. These are the people who are going to be writing LORs for you. If you get an honor call or honors in gynae it would further strengthen your application. During the summer break in first, second and third year itll be great if you can do lab research in some field related to womens health (breast cancer research is an excellent option) but that time is basically to chill so you can do whatever you want. I am just mentioning it here for the driven ones (that btw is found in abundance at AKU ). I did my first year electives in Dermatology and second year in Eye. Also in my second year I worked for a breast cancer lab (which was much appreciated during the interviews). These are the little things that count.

U.S Work Experience:


I cant emphasize enough on this. From my experience US clinical experience (for OBGYN at least) is equally important to having good USMLE scores if not more. Every where I went for my interviews, the first thing that was asked was about my electives in OBGYN in the US and how I liked then and how they were in comparison to the OBGYN back at home. Now I know that with the PBL, the whole schedule for the Med School has changed but we used to have a 3 month elective slot in our final year. If you know for sure you want to do OBGYN, arrange all three in OBGYN. I did my first at Thomas Jefferson in Gen. OBGYN, my 2nd and 3rd were at Baylor in Gyn Surgery and MFM (Maternal Fetal Medicine) respectively. Had I not done any clinical work in the US, I know for a fact that my interview call number would be much smaller. Its better if the US
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experience is in OBGYN, but any form of clinical work is better than having none at all.

USMLE And ERAS Application:


Road to residency has beautifully covered these topics so I wont get into the details. One thing is for sure; be ECFMG certified by Mid October and apply EARLY.

Applying to Programs:
This was the hardest part for me in this whole ordeal. I had no advice as of where to apply and I didnt know which place was better than the other. So I blindly applied to all the BIG names, AKU favorites and to the IMG friendly places (which I found out by visiting the website of each program state by state and seeing whether they had any IMGs among their current residents or not). I also checked whether I could apply to the place or not. For example some places like Yale required an LOR from an ICU person (which I didnt have) etc etc. I ended up applying to A LOT OF PROGRAMS. The lesson you can learn from me is dont go crazy applying all over the place. Only apply to IMG friendly programs, a few good places and AKU friendly places. I would also advise you not to apply to the places that I got rejections from because none of us (me and the other two girls who were applying with me in OBGYN in the same year [both matched as well] were called from those places) or at least thats what I know . I applied to a total of 60 programs. Got 24 calls and interviewed at 15.All places were for categorical. I didnt apply for Prelim. Following are the places I got called from: 1. University of Maryland (Baltimore MD) interviewed 2. Sinai Hospital/John Hopkins (combined program) (Baltimore MD) Interviewed (prematch offered -----declined) 3. Baylor College Of Medicine ( Houston TX) Interviewed 4. Staten Island University Hospital ( Staten Island NY) Interviewed 5. Wayne State/ Detroit Med Center (Detroit, MI) Interviewed 6. University Of South Alabama ( Mobile, AL) Interviewed 7. Moore house School of Medicine ( Baltimore MD) Did not interview 8. Hurley Med Cntr/Michigan State University. (Flint, MI) Interviewed 9. Emory University. (Atlanta GA) Interviewed 10. Mayo Clinic (Rochester MN) Interviewed 11. University of Chicago (Chicago IL) Interviewed 12. Drexel University/ St. Peters Hospital. (New Brunswick NJ) Interviewed(prematch offered----declined) 13. Dartmouth Hitchcock Hospital (Lebanon NH) Interviewed 14. University Of Mississippi ( Jackson , MS) Did not interview (wanted to but dates not suitable) 15. Howard University ( Washington DC) Did not interview 16. University of Virginia (Virginia) Did not interview (wanted to but dates not available)
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17. University Of Miami/Jackson Memorial Med Cntr (Miami FL) Interviewed 18. Mammonides Hospital (Brooklyn, NY) Did not Interview 19. Rush University (Chicago, IL) interviewed 20. Franklin Square Hospital (Baltimore, MD) Did not interview 21. East Tennessee State University (Mountain Home, TN) Did not interview 22. St.Francis Hospital. (Connecticut) Did not interview 23. University Of West Virginia (Charleston, WV) Did not interview 24. Henry Ford Hospital. (Detroit, MI) Interviewed Places Where I got rejected from: 1. Louisiana State (they said they would not support any visa) 2. Brigham and Women Hospital 3. Mount Sinai Chicago 4. Vanderbilt University 5. UT Southwestern 6. UT Houston 7. John Hopkins 8. Washington University (St.Louis) 9. Beth Israel (Boston) 10. Medical College Of Wisconsin 11. VCU Med Cntr/ Med College of Virginia 12. George Town 13. University of Iowa 14. North Western University 15. Cleveland clinic 16. NYU 17. Duke

Ranking the programs:


As far as ranking the programs is concerned, its a very personal decision. I wanted to rank programs in an order of whether I would be able to get in or not and whether Id be able to have opportunities for fellowships. Visa was also a big concern for me; I wanted an H1 rather than a J1 and thats how I ranked my programs. I ranked a total of 14 out of the 15 places that I interviewed at. My ROL:
1 2 3 4 5 6 Supp List 1328220C0 1716220C0 1160220C0 1113220C0 1295220C0 1104220C0 Obstetrics-Gynecology Mayo School of Grad Med Educ-MN Obstetrics-Gynecology Baylor Coll Med-Houston-TX Obstetrics-Gynecology Univ of Chicago Med Ctr-IL Obstetrics-Gynecology Emory Univ SOM-GA Obstetrics-Gynecology WSU/Detroit Med Ctr-MI Obstetrics-Gynecology Jackson Memorial Hosp-FL

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7 8 9 10 11 12 13 14

1377220C0 1252220C0 1147220C0 1300220C0 1515220C0 1852220C0 1249220C0 1307220C0

Obstetrics-Gynecology Dartmouth-Hitchcock Med Ctr-NH Obstetrics-Gynecology U Maryland Med Ctr Obstetrics-Gynecology Rush University Med Ctr-IL Obstetrics-Gynecology Henry Ford HSC-MI Obstetrics-Gynecology Staten Island U Hosp-NY Obstetrics-Gynecology U South Alabama Hospitals Obstetrics-Gynecology Sinai Hosp-Baltimore-MD Obstetrics-Gynecology Hurley Medical Ctr-MI

I luckily ended up at my first choice with an H1.

In Summary:
All I have to say is believe in yourself. Now you can say that youre not the first one to be getting into this mess of OBGYN. If the three of us could do it so can you. I sincerely hope this small article was of use and hope that you get the residency of your dreams. If you need my help for any further help do not hesitate to contact me on zaraq1@hotmail.com. Best of luck and God speed. PS: Props also go to Erum Azhar from the class of 2004 who matched in OBGYN at Maimonides Hospital in New York and Hafsa Memon from the class of 2005 who matched in OBGYN at University of West Virginia at Charleston. Both of them, like me matched without doing a year of research.

THE ROAD LESS TRAVELLED PSYCHIATRY MATCH


Filza Hussain (Class of 2005) 1. Decide what kind of psychiatry do you like, more therapy based or more biological (pharma based)? I wanted the best of both worlds. Once you decide that, and let me assure you there is nothing wrong with either, youre well on your way to figure out what programs you should be looking at. A rule of thumb, West coast -- Biological, East coast -- Therapy based (by and large) 2. What kind of city do you want to live in?
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Some people take the weather into consideration as well. This may seem unimportant but do think about 6 months of knee high snow and low sunlight! 3. Do you have friends and family close by? Trust me this is very important in the whole process. 4. Are you still in the dazzle em with the name frame of mind? If you are, thats not a bad thing, but dont just apply to top universities. Have a balanced approach; A programs, B programs and a few in betweens. 5. Do you just wanna chill or does the adrenaline rush of a crisis situation and more workload that your entire family tree can handle does it for you, or are you the in between kinda person? Usually it is chill in smaller towns, more research based, more education than work oriented programs. On the other hand there is killer workload in all govt hospitals and in big cities but an amazing opportunity to train. 6. Do you know what you might wanna do after your residency (child psych, adult, geriatrics)? Some programs have predilections (e.g. University of Wisconsin at Madison has an amazing program geared towards child psychiatry.) How do you know all these answers? Well some by talking to seniors, topica zindabad, others you will ask in interviews. You will not have the neatest package in the beginning; some things will unfold as you go along. A few things to look out for. Check ACGME certification status of a program. My first interview call was from a place that was on probation. You wouldnt wanna go there. Also check how large a program is; this hints at work load, calls, individual attention during training. In my opinion about 6-9 residents per year is a good enough number, but larger universities like Yale and Upitt have massive programs with loads of faculty. I think those are the most important questions. In deciding where to apply, find the lists below. They enumerate H1/J1 programs as well as IMG friendly places. The Personal Statement: Make it your own. KNOW why you want to do psychiatry. Even if your reasons are an easy lifestyle or using psych as a backup, dont let that come through since they are weary of such people. Be passionate about what youre doing. Quote examples from your career as a student that helped you decide on psych. They like knowing about a comparison between cultures. Cross cultural psych, whats it like in Pakistan. Dont just talk about elective experiences. Tell them about the stuff you did on the wards in Pakistan and again not just psych wards. http://www.psych.org/edu/med_students/psychmatch.cfm?pf=y (I found this site useful in preparing for the interview) For the interview, be yourself. If you know why youre doing this then there is nothing to be afraid of. They can ask you anything they like and you can still answer it because youre not fibbing or concocting and just in case you are, make
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it believable!!!! Let the passion come through and ALWAYS go prepared with questions to ask them. Shows that you are interested. An interesting thing about the interview process is that most psych programs review their applications a little later than say a medicine program would. So if you dont have many calls by end November, beginning December, dont freak out. List of Psychiatry programs sponsoring H1B visas: AR University of Arkansas for Medical Sciences Program Little Rock, AR 400-04-22-014 DC St Elizabeth's Hospital-DC Dept of Mental Health Services Program Washington, District of Columbia 400-10-21-239 FL Jackson Memorial Hospital/Jackson Health System Program Miami, FL 400-11-21-051 IA University of Iowa Hospitals and Clinics Program Iowa City, Iowa 400-18-21-069 IL University of Chicago Program Chicago, IL 400-16-31-062 MA Massachusetts General Hospital/McLean Hospital Program Boston, MA 400-24-21-288 Harvard Medical School (South Shore) Program Brockton, Massachusetts 400-24-21-279 MI Kalamazoo Center for Medical Studies/Michigan State University Program Kalamazoo, Michigan 400-25-31-284 MO University of Missouri-Columbia Program Columbia, Missouri 400-28-21-109 University of Missouri at Kansas City Program Kansas City, MO 400-28-21-110 NE Creighton University/University of Nebraska Program Omaha, NE 400-30-21-116
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NY Albert Einstein College of Medicine Program Bronx, NY 400-35-11-131 Maimonides Medical Center Program Brooklyn, New York 400-35-21-143 SUNY Health Science Center at Brooklyn Program Brooklyn, New York 400-35-21-154 Brookdale University Hospital and Medical Center Program Brooklyn, NY 400-35-11-136 SUNY at Buffalo Graduate Medical-Dental Education Consortium Program Buffalo, NY 400-35-21-126 Mount Sinai School of Medicine (Elmhurst) Program Elmhurst, NY 400-35-11-242 North Shore University Hospital/NYU School of Medicine Program Manhasset, New York 400-35-11-129 New York Presbyterian Hospital (Columbia Campus)/New York State Psychiatric Institute Program New York, NY 400-35-21-138 Albert Einstein College of Medicine at Long Island Jewish Medical Center Program Glen Oaks, NY 400-35-21-142 Harlem Hospital Center Program New York, New York 400-35-11-140 Albert Einstein College of Medicine at Beth Israel Medical Center Program New York, New York 400-35-11-134 St Luke's-Roosevelt Hospital Center Program New York, NY 400-35-21-270 New York Presbyterian Hospital (Cornell Campus) Program New York, NY 400-35-11-147 SUNY Upstate Medical University Program Syracuse, New York 400-35-21-160 OH Cleveland Clinic Foundation Program Cleveland, OH 400-38-22-175 PA Albert Einstein Medical Center Program Philadelphia, PA 400-41-31-189 Drexel University College of Medicine Program (formerly MCP Hahnemann School of Medicine Program) Philadelphia, Pennsylvania 400-41-21-192 Temple University Program Philadelphia, PA 400-41-21-195 University of Pennsylvania Program Philadelphia, PA 400-41-21-197
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TX University of Texas Medical Branch Hospitals Program Galveston, TX 400-48-11-212 Baylor College of Medicine Program Houston, TX 400-48-21-213 VA Carilion Health System/University of Virginia (Roanoke-Salem) Program Salem, VA 400-51-21-267 WI Medical College of Wisconsin Program Milwaukee, WI 400-56-21-229 List of Psychiatry programs sponsoring J1 visas only: AL University of South Alabama Program Mobile, AL 400-01-22-232 CA University of California (San Francisco)/Fresno Program Fresno, CA 400-05-21-018 University of California (San Diego) Program La Jolla, CA 400-05-21-026 UCLA Medical Center Program Los Angeles, CA 400-05-21-025 Cedars-Sinai Medical Center Program Los Angeles, CA 400-05-11-022 University of Southern California/LAC+USC Medical Center Program Los Angeles, CA 400-05-11-023 California Pacific Medical Center Program San Francisco, CA 400-05-22-028 University of California (San Francisco) Program San Francisco, CA 400-05-21-030 VA Greater Los Angeles/UCLA-San Fernando Valley Program Sepulveda, CA 400-05-31-032 Stanford University Program Stanford, CA 400-05-31-033 CO University of Colorado Program Denver, CO 400-07-21-038 CT
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University of Connecticut Program Farmington, CT 400-08-21-266 Institute of Living/Hartford Hospital Program Hartford, CT 400-08-21-295 DC Howard University Program Washington, DC 400-10-21-049 George Washington University Program Washington, DC 400-10-21-048 Georgetown University Program Washington, DC 400-10-21-047 FL University of Florida Program Gainesville, FL 400-11-21-050 GA Morehouse School of Medicine Program Atlanta, GA 400-12-21-262 IL Loyola University Program Maywood, Illinois 400-16-21-064 McGaw Medical Center of Northwestern University Program Chicago, IL 400-16-21-060 Rush-Presbyterian-St Luke's Medical Center Program Chicago, IL 400-16-11-061 Advocate Lutheran General Hospital Program Park Ridge, IL 400-16-21-257 Southern Illinois University Program Springfield, IL 400-16-21-065 KS University of Kansas (Wichita) Program Wichita, KS 400-19-21-254 KY University of Kentucky Medical Center Program Lexington, KY 400-20-21-074 University of Louisville Program Louisville, KY 400-20-21-075 LA Louisiana State University/Alton Ochsner Medical Foundation Program New Orleans, LA 400-21-21-291
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MA New England Medical Center Hospitals/Tufts University Program Boston, MA 400-24-21-093 Boston University Medical Center Program Boston, MA 400-24-21-089 Cambridge Hospital/Cambridge Health Alliance Program Cambridge, MA 400-24-11-094 MD University of Maryland/Sheppard and Enoch Pratt Hospital Program Baltimore, MD 400-23-21-289 Johns Hopkins University Program Baltimore, MD 400-23-21-081 ME Maine Medical Center Program Portland, ME 400-22-11-080 MI Henry Ford Hospital Program Detroit, MI 400-25-21-235 MN Hennepin County Medical Center/Regions Hospital Program Minneapolis, MN 400-26-21-285 Mayo Graduate School of Medicine (Rochester) Program Rochester, MN 400-26-21-107 MO Washington University/B-JH/SLCH Consortium Program St Louis, MO 400-28-21-114 St Louis University School of Medicine Program St Louis, MO 400-28-21-113 MS University of Mississippi Medical Center Program Jackson, MS 400-27-11-108 NC Duke University Program Durham, NC 400-36-21-167 ND University of North Dakota Program Fargo, ND 400-37-21-251
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NJ UMDNJ-Robert Wood Johnson Medical School (Camden) Program Camden, NJ 400-33-21-255 UMDNJ-Robert Wood Johnson Medical School Program Piscataway, NJ 400-33-21-121 NM University of New Mexico Program Albuquerque, NM 400-34-21-123 NV University of Nevada Program Reno, NV 400-31-21-263 NY Albany Medical Center Program Albany, NY 400-35-22-124 Nassau University Medical Center Program East Meadow, NY 400-35-11-128 New York Medical College at St Vincent's Hospital and Medical Center of New York Program New York, NY 400-35-12-152 Mount Sinai School of Medicine Program New York, NY 400-35-11-146 New York Medical College (Metropolitan) Program New York, NY 400-35-11-148 University of Rochester Program Rochester, NY 400-35-11-158 New York Medical College at Westchester Medical Center Program Valhalla, NY 400-35-21-162 OH Case Western Reserve University (Metro Health) Program Cleveland, OH 400-38-21-240 Ohio State University Hospital Program Columbus, OH 400-38-21-281 Wright State University Program Dayton, OH 400-38-21-178 Medical College of Ohio Program Toledo, OH 400-38-21-181

OK University of Oklahoma Health Sciences Center Program Oklahoma City, OK 400-39-21-184


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University of Oklahoma College of Medicine-Tulsa Program Tulsa, OK 400-39-21-246 PA Thomas Jefferson University Program Philadelphia, PA 400-41-21-196 Allegheny General Hospital Program Pittsburgh, PA 400-41-21-272 RI Brown University Program Providence, RI 400-43-21-203 TN Vanderbilt University Program Nashville, TN 400-47-11-208 TX University of Texas at Houston Program Houston, TX 400-48-31-215 University of Texas Health Science Center at San Antonio Program San Antonio, TX 400-48-31-218 Texas A&M College of Medicine-Scott and White Program Temple, TX 400-48-21-276 VA University of Virginia Program Charlottesville, VA 400-51-21-220 Virginia Commonwealth University Health System Program Richmond, VA 400-51-21-223 VT University of Vermont Program Burlington, VT 400-50-11-241 WI University of Wisconsin Program

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RADIOLOGY
Saad Shahid Ali Class of 2005
As much of the application process is common to all specialties, I will be brief and include only the things pertinent to radiology and getting a radiology residency position. Diagnostic Radiology is a 4 year residency preceded by a transitional/prelim medicine/prelim surgery year. These 5 years can be followed by a fellowhip (interventional, neuro, abdominal, musculoskeletal, cardiac, nuclear med, etc.) which is 1-2 years in length. For various reasons, radiology has become very competitive to get into over the past several years even for the U.S. medical graduates. Through various routes (which I will mention), however, it is still very possible for us to get a spot. There is no IMG friendly place and therefore I recommend applying broadly to as many places as you can afford. I applied to around 130 radiology programs from a total of 190. programs. I did not apply to the West Coast because it is generally more competitive, requires California letter, etc. In addition, you would apply/interview for a prelim medicine or transitional year at the same time. As with other more competitive specialties, I think the best way to get in is by doing research for 1 or 2 years. Other routes AKU grads have successfully taken to get in are matching into a medicine residency and applying after their first or second year or matching into a nuclear medicine residency program and then applying after a year or two into radiology. You should know that by doing full time research for 1-2 years, you are an attractive candidate (and a better fit) for the bigger academic programs but they consider themselves too big to consider an IMG. Lesser known community programs often feel you will not be a good fit because of your research interests and with the current trend they can still attract many decent US grads. Recent AKU grads going for radiology have applied to over a 100 places and have received interview calls from different places (no one program consistently). Therefore, I think its best to apply very broadly and to all types of programs. I think the most important factors for an IMG applying are USMLE scores and strong LORs from well-known US radiologists. Unlike other fields, I think its very difficult to impress your attending while doing a month-long clinical rotation in radiology as you are only passively observing in the reading rooms. The purpose of research for 1-2 years is not only to get abstracts/papers/research experience on your CV, but more so to be able to get strong letters of recommendation/develop contacts with faculty that have gotten to know you well over the course of a year or two.
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Places I received interview calls from : Univ. of Iowa Washington Universisty in St.Louis Brigham and Womens Yale William Beaumont Baystate (MA) Cook County (IL) Univ. of Florida Univ of TN - Memphis Univ of Louisville Med College of GA Providence (MI) St. Joseph Mercy Oakland (MI) Wayne State Dartmouth. I ultimately matched at Iowa (which was fourth on my rank list). I should add that I received the interviews from the Tennessee and Louisville programs because of the help of AKU alumni in the radiology programs there. Contacts (current radiology residents in the US): Muzammil Shafi from 2002, Univ. of Louisville Absaar Ahmed from 2002, Washington University in St.Louis Adeel Sabir from 2002, Yale, New Haven Hussain Thaver from 2001, Baylor, Houston Saleem Farooqui from 2001, Univ. of Tennessee-Memphis/Methodist Saquib Khawar from 2001, Northwestern, Chicago Muneeb Ahmed from 2000, BIDMC, Boston Of the above seven residents, 3 did 2 years of research, one did 2 years of nuclear medicine residency, one finished internal medicine residency, one did one year of internal medicine, and one matched directly. I did one year of research before matching. If you have any questions, please feel free to email me at saadali82@hotmail.com. I am sure youll find the above residents helpful as well. I would also recommend looking at a website www.auntminnie.com It has a forums section for medical students and residents/fellows/faculty in or interested in radiology.

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Ophthalmology Postdoctoral Fellowships: How Bad Do You Want It?


Yureeda Qazi Class of 2005 Ophthalmology residency positions are among some of the toughest to secure for international medical graduates. Aspiring ophthalmologists go to every length to prove their passion for the medicine and science alike, and a research fellowship is one such path taken. Surely being an American/Canadian citizen or possessing a permanent resident status can be your golden ticket, but for the majority of us who dont have that privilege, getting a postdoctoral research fellowship in ophthalmology is a curry of timely luck and much perseverance. In my opinion, there is unnecessary hype associated with ophthalmology postdocs, and it is not as unattainable as many consider it to be. With a plan at hand and some previous knowledge of the postdoc season, it can simply be a matter of a few e-mails, a telephone interview and some paper work. If there is one pearl of wisdom I would like to give to all our budding ophthalmologists, it would be: persevere, and you are gold. I can not emphasize enough the importance of trying and seeking options regardless of the number of rejections you may receive. Postdoctoral research fellowships 101 Know why you want the research fellowship. Know which lab parameters would suit you best, such as small vs big, location, extent of funding support etc. Build your CV, but please, DO NOT ever lie about your laboratory skills or accolades. Your supervisor will be able to tell when he/she asks you to design an experiment during your telephone interview. Explore laboratories, look out for projects which genuinely interest you since your enthusiasm will show in your cover letter to the director of the laboratory, and you do not want to be stuck working on something mundane for the next 1-2 years. It is not necessarily true that only the renowned institutes have great research laboratories. Invest time looking for laboratories which are publishing regularly in your area of interest, and this may well be a laboratory in not a very popular place. Do not forget some of the aims of your fellowship - to publish and develop long-term contacts. For ophthalmology, it is wise to register with ARVO (www.arvo.org), they will send you e-mail notifications about available postdoctoral positions as advertised on ARVOJobs. Previous laboratory research experience in needed for most postdoctoral positions, unless it is an entry-level position. Make it very clear in your initial correspondence that you would need an H1B visa (if you do), explaining your reasons for the request; it is much better to
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find this out earlier on rather than wasting time until they bring up the issue and express their inability to sponsor an H1B. Value your time and theirs. Your cover letter will win half your battle. Put in the time and effort to write a formal, enthusiastic and personalized cover letter. Identify what you like about their research and how you could be useful to them (lab skills, past research experience, time commitment). Structure your cover letter, make it succinct and effective. Have a friend read your cover letter and comment on it. It is useful to make good contacts during your electives; they will serve as your mentors and prospective sources of recommendations for postdocs/residency. Having American referees is certainly a plus since they have been through the system and are a local phone call away for your supervisor. Once you have an offer, ask to speak with your supervisor/director of lab, and make sure you have questions prepared. Read up on their research work and know your laboratory techniques well in case you are asked to apply them during your talk. Be courteous, polite and gracious- priceless tools. If an H1B is difficult for your supervisor to sponsor, offer to cover as much cost as possible. You may be asked to support yourself with grants in order to supplement your salary. For ophthalmology, Fight For Sight (FFS) is an excellent organization, it is prestigious, elite and very welcoming to young investigators. Applications are usually submitted by March, for a start date in July. (www.fightforsight.com) In the end, your efforts and patience will be well rewarded. Contact alumni who hold residency or fellowship positions for advice and useful contacts. Here is a humble list of some places that have accepted AKU graduates for research fellowships (ophthalmology): Schepens Eye Research Institute, Boston, USA (Harvard affiliate) Mass Eye and Ear Infirmary (prefers American citizens/permanent residents) New York Eye and Ear Infirmary (requires a 3 month unpaid observership without guarantee of a position later on) Medical College of Georgia Case Western Reserve University- School of Medicine Boston University He who perseveres wins this race, so keep your hopes high and keep trying. I wish you all best of luck. yureeda.qazi@gmail.com

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SECTION VII APPENDIX VIIc Other Visa Issues


VISA WAIVER
Class of 2003

Citizens of certain countries (e.g. United Kingdom, etc.) may enter the USA at will for the purpose of visit. That is to say, there is no need to apply for a B1 visa from Islamabad for the purpose of sitting for Step 2 CS and Step 3, or for interviewing. The visa is issued right at the airport. This exception is known as the visa waiver. For all practical purposes, a visa waiver is RARELY rejected. However, cases have occurred with disastrous consequences. This is because if a visa waiver is ever rejected, one can never enter the USA on this waiver again. This waiver being a major boon, one would not like to lose this liberty. So, know its conditions: 1) One must be a citizen of a Visa Waiver Program country. 2) One must possess a machine readable passport. If you have not had your passport renewed in the last few years, you may not have one. Starting this year, you will actually have to get a biometric passport made. I dont think this facility is available in Pakistan yet. 3) One must have a valid passport that is valid for six months beyond ones intended visit. 4) One must be seeking entry for 90 days or less, as a temporary visitor for business or pleasure. 5) One must have a round trip transportation ticket to any foreign destination other than a territory bordering the USA or an adjacent island. 6) One must arrive via a carrier which has signed an agreement with the USA to deport you if you are found to be inadmissible. This applies if you are entering by land or by sea. Note that one can also enter at a land-border crossing point from Canada or Mexico. 7) One must have filled the Form I-94W (you will either get this on the aeroplane or at the airport). It is green in color, as opposed to the regular white one. 8) Absence of visa ineligibilities (previous rejection, criminal record, etc.) Note that Canada is not part of the visa waiver program. They travel visa-free due to other immigration laws. If youre Canadian, youll have to look these up yourself. Now, in the event of the following, you will not be able to use the visa waiver (that is, you will have to go to Islamabad to get a B1 visa): 1) You intend to stay for more than 90 days. 2) You have previously been rejected.
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This is where the problem usually arises. A period of 90 days is usually insufficient to sit for ones Step 2 CS, interview, get ECFMG certified and sit for ones Step 3. So, your options are as follows: 1) Go to Islamabad and get a B1 visa. You can tell the official that you need it because you intend on staying for more than 90 days. How advisable this is, I dont know. Although this is the most proper thing for one to do, I dont know anyone who has done this. Everyone fears visa rejection and FBI clearance stalling. On the other hand, it may accelerate your visa processing when you eventually apply for the J1 / H1. Remember, if you have been traveling on a visa waiver, you have never underwent FBI clearance. Hence, FBI clearance takes a longer period of time. When you will be applying for the J1 / H1 you will be in a time crunch. Perhaps it would be better to take the plunge earlier when you have more time on hand. However, again, if your visa gets rejected, the visa waiver no longer applies. So, I would not advise this. 2) Leave the USA within 90 days and reenter at a later date. This is what everyone does. There is no specific time period which you have to wait before coming back to the USA. You should just have a good reason. (Even this does not always apply as the immigration officials sometimes become quite casual when you they see the visa waiver.) If you are coming for the purpose of the Step 3, make sure that you have evidence (i.e. the permit along with details of the date and venue of the examination). Another question which arises is which country should one hop to? The ideal cheap alternative would be Canada, however, this is not advisable due to condition (5) mentioned above. People have done it, but they received major problems at the airport. The second thing which people think about is the United Kingdom (if they are British). However, people have problems here too. I suppose the reason for this is it indicates that one intended to visit the USA for more than 90 days. After all, you did not return to your home country. The ideal situation is to return to Pakistan. Although this is more expensive, I dont know anyone who has had problems when they did this. I did this myself, and I think that the extra funding is well worth it. Note that if one is on a visa waiver, one can legally leave the USA to enter Canada, Mexico or an adjacent island and reenter the USA. However, the trip must take place during the original authorized period of admission. The most important point, however, is Whatever you do, make sure you leave the USA within 90 days. Under NO circumstances should you overstay. None whatsoever. An AKU graduate was refused entry to the USA simply because she overstayed by a single day, and that too due to bad weather conditions preventing her from leaving. You do not want to permanently damage your immigration record. So, make sure you leave the USA with plenty of breathing room.
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UNITED KINGDOM TRANSITS

Class of 2003

People sometimes have problems when they transit the United Kingdom, en route from the USA back to Pakistan. They have had problems at the airport, sometimes to the extent that they were asked to return to the USA and get a transit visa for the UK. So, know the rules: You need a Direct Airside Transit Visa if you transit the UK and are not going to go through immigration, unless you come under the following exemptions (relevant ones mentioned only): 1) You are traveling FROM the US with a valid US visa and a valid airline ticket for travel via the United Kingdom to another country 2) You are traveling TO the US from another country and hold a valid airline ticket for travel via the United Kingdom and a valid US visa 3) You last entered the US with a valid US visa which has now expired but you hold a valid airline ticket for travel via the United Kingdom to another country and you are intending to transit the United Kingdom within 6 months of your last date of entry to the US. These three points have been quoted directly off the website www.britainusa.com A few points of clarification. Just because you are leaving the USA during the allowed three month or six month stay, it does not mean that your US visa is still valid. You will notice that the visa (which you received from Islamabad) has an expiry date mentioned on it. That date marks the last possible date at which you may enter the USA, (e.g. March 6th) It does not mean that you have to leave the USA by this date. Hence, this date is the expiry date of your visa. Now, when you reach the USA (say November 10th), you get a stamp on your passport which tells how long you can remain in the USA (three months, six months) (say, May 10th). This period can go far beyond the expiry date of the visa. So, in accordance to the above examples, if you leave the USA between March 6th and May 10th, point (1) will not apply to you. Note that point (3), however, still applies. But, for some reason, the airport people in the UK dont seem to recognize this rule. They create a huge fuss and detain you for hours on end. So, be prepared. Take a print out of their site. A chap I know requested them to call the British Embassy in the USA. The latter then clarified the point, so, the UK airport people let him go. Another point. If you are not changing aircraft in the United Kingdom, they dont have any problems with letting you transit, even if your visa has expired. To summarize, point (3) is confusing. If you are to fly via UK with an expired visa, make sure you leave the UK on the same plane that you entered. Else, you can always invest in the Direct Airside Transit Visa itself. Details can be found on the above mentioned website!
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SECTION VII APPENDIX VIId Post-Match Scramble


POST MATCH SCRAMBLE
Class of 2003

The following is an extract from www.ecfmg.org/eras/index.html#88 , that is, the ECMFG website. It provides all the information that you will need to know if, God forbid, you do not match and have to take part in the Post-Match Scramble. Although the exact dates apply to the Match of 2005, they approximate those of the match week of later years. A point to note although the scramble does indeed apply to IMGs, the chances that an IMG will post match is very very low. Indeed, preference is given to US medical graduates.

This General Information about the post-Match Scramble may answer your questions. Please be aware that the Scramble involves three different organizations:

MyERAS, operated by the Association of American Medical Colleges www.myeras.aamc.org The National Resident Matching Program (NRMP, or "the Match") www.nrmp.org Your ERAS Crew at ECFMG, your designated Dean's Office www.ecfmg.org/eras

Who may apply? All applicants who have not matched. IMGs must have their passing results for all required exams reported to the NRMP in time to participate in the Match (refer to the NRMP website for complete information), but they do not have to be certified prior to the Match in order to participate. When do I apply? You may apply as soon as the list of unfilled positions has been posted at www.nrmp.org at 12:00 noon, Eastern Time in the United States, on Tuesday, March 15, 2005. This is also the site where the final Match results will be posted 2 days later. To which programs can I apply? You may apply to any program that has an unfilled position.

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What if I have applied to a program earlier? Let them know that they already have your application, and ask them to take another look at it. You cannot re-transmit your application. How do I gain access to the list of unfilled positions if I did not register with the Match? You need an NRMP / AAMC ID and a password. How do I apply, via fax or ERAS? Ideally, you will have contacted a few programs in advance to find out whether you should apply, and how each program wants to receive your application. Since it will be difficult to reach the program directors and receive the answers you need during the Scramble, we suggest the following method: Add up to 30 programs to the list of programs to which you have applied and try to follow up with these programs by phone, if you can. If a program prefers to receive your application by fax, you can still fax your application to them. How much will it cost? You may apply to a maximum of 30 programs during the two-day scramble. There is no charge for applying to programs during the scramble. However, to release your application, you must complete the payment process, even if the amount due is zero. Any programs to which you apply after 12:00 noon, Eastern Time in the United States, on Thursday, March 17, 2005 will be charged at the regular rate. For more information, see ERAS 2005 Application Fees on the AAMC ERAS website. How long will the Scramble last? Two days, from 12:00 noon, Eastern Time in the United States, Tuesday, March 15, 2005 to 12:00 noon, Eastern Time in the United States, Thursday, March 17, 2005. On Thursday, March 17, 2005, at 1:00 PM, the results of the Match will be announced. Are there programs that participate in ERAS, but not in the Match? Yes. Are there programs that participate in the Match, but not in ERAS? Yes. Which programs are they? We do not have this information. Do I have to appear for interviews? We do not know. The program directors will tell you.

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Can I make any changes or updates to my application? You may change any information that the software will allow you to change. You may change the information in MyProfile and you may reassign personal statements and Letters of Recommendation. What will my ERAS Crew at ECFMG do for me during this period? Throughout the season we check your files, on a daily basis, for any new information that would require an updated ECFMG Status Report to be transmitted to the programs. That new information could be a USMLE score or issuance of an ECFMG Certificate. Once a new Status Report has been created, based on any of these conditions, it will be transmitted automatically at the end of the day. There is nothing you need to do. During the two Scramble days, we will login to the ERAS Post Office several times each day to retrieve your document assignments and program lists. We will process those lists and transmit your documents shortly thereafter. What is the best strategy? During the 48 hours of the Scramble, there is no time for manual processing. Your file must be ready for automatic processing by our system before the Scramble begins. That means: At least one week before the Scramble, you must apply to at least one program. If you are planning to apply during the post-Match Scramble only, you must still apply to at least one program about one week before the Scramble. You must also make sure that all of your documents have been received and assigned, so that we can attach and transmit them before the Scramble. If you are sending us new or replacement LoRs, we must have them one week prior to the Scramble, so that we have time to attach them. If you have a new, additional LoR, assign it to one of your original programs. This gives us time to attach it before the Scramble. During the Scramble we will not have time to do it. If you are sending us a replacement LoR from the same writer, attach a note to it that reads, "This replaces the previous LoR." Otherwise, we might mistake it for another copy of the one we have already scanned and discard it without scanning. After that, your file is ready for the Scramble.

POST MATCH SCRAMBLE


Muhammad Awais (Class of 2005) This is the part of R2R which we are least interested in the beginning but with the passage of time it becomes more important. I would suggest reading this portion soon after the interviews or during interviews. Keeping in view the current situation we need to be prepared for the scramble and for that we need all the info. Ill try to put in as much as I can.
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What is the Scramble?? It refers to the two day period after the match, in which all those who failed to match try their luck and capabilities to get in to the programs. I must say that this is the most hectic, tense and frustrating period and unless its well managed/organized the chances of success are meager. When do I need the Info?? You need it when you receive any of the three messages: 1) You didnt match in any program, 2) You didnt match in a preliminary program 3) You didnt match in an advance program Important Things to Remember The most important thing is proper attitude with endless desperation. If you are not pumped up that day you might lose a position. You need to be very attentive, proactive, and well supported by your well wishers. Infact you should have 2-3 friends/well wishers working for you that day. You also need to prepare a soft copy of your documents including CV, mark sheet/transcripts (medical college and USMLE), ECFMG certificate, Medical School diploma, photograph, cover letter, Dean's letter, and LORs. You will require these for faxing and emailing your application to the respective programs. This brings forward 2 more things, a computer with a very good internet connection (which is not a big deal in US) and fax machine. Youll also need 2-3 phones either cell phones, pc phones or landlines. Before Match Day During the whole residency period youll get to know what are your chances to get matched in the residency programs, even if you have ~10 calls there is some chance that you might go unmatched, so almost everyone prepares for post match (at least we all did). One week before the match day, APPNA contacts you regarding this issue; you should give them your info so that they can refer you to respective people who are in contact with PDs and other people. I believe this is an important step because one of my friends got his residency through this channel. So the crux of the matter is to use each and every resource you have, give it a last blow, give it your best effort, as after this day your might not be able to use your skills till the next year. Find A Resident and Electronic Residency Find a resident is a sister website to ERAS, its good to register with them as programs advertise on this website and they can contact you through Find A resident, but I seriously doubt their usefulness. For the two days of scramble I didnt see any internal medicine position being advertised on this site, only family medicine positions were there and that too were very few in number. It takes around $ 30 to register at their site; you can import all your application material from ERAS and make an updated application, so it takes less time then others.
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Although I am skeptical about its usefulness but at that time you never know what works out so go for it. Electronic Residency.com is a private website which advertises during the residency period regarding the scramble and other services, although they have an impressive system of fax and email application but they are way too expensive, according to my friend they asked for $ 1200. I dont think you need to register on this site but still we dont have stats about it. Post Match Day As I said earlier, you need to be very well prepared. An ideal plan would be like the one given at the end of this note. On the post match day get up early, call your team (friends and well wishers) and get them ready for the game. Divide your work among your team. What we did was got ourselves on a conference call, as we were sitting at distances. Whatever the case may be, you need to divide your work. At 12 noon the list gets published at NRMP, take that list and start calling programs, lines would be busy but keep calling them. You can also ask your friends to talk to the Program Coordinators as you, this might be risky but it can help, as many people are calling at the same time. The list contains program contacts, so get the contacts and start calling, email them, fax them, call them, if you are close by meet them, do whatever you can to contact them, tell them how interested you are in the program. This is the time when the PDs are as desperate as you are, so use this opportunity. We were 4 people connected through msn and conference call, A (brother) was copying the list and sending to others, faxing the documents to programs, B (Unmatched guy) was talking to PDs and program coordinators on phone, C (brother) was seeing the list, choosing programs to contact, coordinating everyone and encouraging B, D (friend) was emailing the programs, checking find a resident and applying via ERAS. E (Bs mom) was praying a lot. So everyone was working on same mission, equally desperate, equally responsible for getting B into the program. ERAS A very important and valuable source on the post match day. You just have 30 places to apply, and almost all the programs ask you to apply through ERAS, so what we did was to apply blindly to 15 programs right away, i.e. Within 15 minutes of NRMP list, but after that, application was based on the programs being contacted and the response given by them. The server gets overloaded and thus very slow, so you need to be extra patient for that. Importance of Contacts This is another very important source, if someone goes to the program director and puts in a good word for you, it increases your chances a lot, an example of this is a person from APPNA contacted my friend on post match day and asked him why he didnt match with such good scores (90s in both steps), and then that person contacted a PD and told him about my friend, the PD himself contacted
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my friend, took an interview on phone and offered him a position, which of course was accepted. If you find a program in your city that has unmatched positions, go to them and meet the PD. This can be your jackpot, as PDs always prefer meeting and seeing people rather than talking to applicants on phone. Same is the case with residents, if you know of someone in the program, call him and request him to go to the PD and put in some good words for you. Majority of people are helpful, and putting in good word is no big deal. In the end I would repeat what I said earlier on, this is the time when nothing seems to be working for you. You need to make things work for you. Pray, be positive and work hard. The more desperate you are, the more are your chances to get a position. Remember most positions are given away within a few hours of the post match scramble period, so if you waste a single second you might be wasting a position. Good luck for the residency process! May Allah bless us all with what we want.

B Post Match Scramble Game Plan


Version: 0.5(Draft). Please always refer to the version number when referring to this document.
A = brother ; B = Unmatched guy ; C = brother ; D = friend Time (EDT) Eastern Daylight Time 6:30 AM 7:00AM
Responsible Person

Action

Details

Finalize Application Package for Faxing

B 1. Send out application package for Faxing Time: 7:00 AM EDT: Responsible: B B to send out PDF and Word version of the finalized application package to be used in faxing to C @gmail.com. Should also include E-Mail / Fax cover letter. C / A, confirm the receipt and validate the application package. Communicate sign-off or any changes. Package signed-off, no further changes. Preferred version PDF.

7:30AM

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8:00AM

Call Dr. X 2. Call Dr. X Time: 8:00 AM EDT (Eastern Day Light Time). Responsible: B Call Dr. X Ph: ( ). Explain him your situation. Request for help. Have a pen and paper handy. Ask him how he can be reached quickly and directly. Ask for position at Y hospital If Dr. X cannot be reached, contact your friend at X hospital. Scream for help. Repeat action until successful contact. Failure is not an option.

8:30AM

Communicate Game Plan

A/C 3. Communicate game plan to everyone. Time: 8:30 AM EDT: Responsible: A/C A / C: Communication the game plan to everyone. Ensure everyone is on the same page. Fill in the required email address / phone numbers. Get agreement on Roles and Responsibilities. Everyone gets refreshed and ready for post match scramble battle. 5. Everyone logs into the messenger War-Room Time: 9:15 AM EDT: Responsible: B / A / C / D Login to the preferred messenger service. Ensure 100% availability for the next 6-8 hours. Failure to do is HIGH TREASON. Only acceptable breaks are for 5-10 minutes for rest-rooms. 6. Login to NRMP and ERAS and Findaresident. Keep the session alive. Time: 9:30AM-12:30PM EDT: Responsible: B / D Login to NRMP. Ask for help from A / C on messenger if there are problems. Keep working until you have the valid session. Try using reload button instead of logging in again. Site would be slow. Download the list of unmatched programs at the earliest possible time at 12:00 PM EDT. B/D: Simultaneously logs into ERAS. Be ready for applying. Call B friend with last year's unmatched positions. Request for follow up. Follow up with Dr. X to see if will be getting an offer. War room meeting to communicate how B's friends will call the programs. B to give them all the required Bio information. Messenger will be used when friends talks to a program to coordinate, for e.g, if offer is being made, should it be accepted etc. Everyone B Get NRMP list ASAP. C: Sort the list, compile a list of 15 programs which you need to apply to in ERAS. Keep 15 programs for later on. C communicates the list of 15 preferred programs to others D applies to 15 preferred programs in ERAS B/C/D Everyone

9:00AM 9:15AM

Chai Pani Login to War Room

9:30AM

Login to NRMP / ERAS and Findaresident

B/D

10:00AM 10:30AM 11:00AM

Call B friend (last year unmatched positions) Follow up with Dr. X, if required War Room Meeting

B B

11:30AM 12:00PM 12:15PM

Everyone stands by Get NRMP list Short-list

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12:15PM

A starts faxing

12:15PM 12:15PM 12:15PM

C starts emailing Find a resident Friend starts phone calls: ACTION ON HOLD

A: Gets the phone numbers, emails and fax numbers of all the open positions, not the 15 positions only. Faxes and emails can be sent to unlimited number of programs. Prepare an excel document with Phone #, emails and faxes. Email excel document to C for emailing A sends faxes to all the programs. C emails the package to all the programs. D uses findaresident.com to apply to open positions. B / D start calling 15 preferred programs with the communication earlier agreed on in the war room meeting.

C D B/D

Communication Plan
War Room Contacts MSN messenger to be used for war room Email address and Phone nos.

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Figure 1 Residency Map of the U.S.

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Figure 2 Political Map of the U.S.

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