STEP UP TO US PRACTICE

By


FLORINA GRIGORE
OANA GRIGORAS
ALEXANDRU COSTESCHI
?IMG?
What about US?
An international medical
graduate (IMG), earlier known as
a foreign medical graduate
(FMG), is a physician who has
graduated from a medical school
outside of the country where he
or she intends to practice.
NIH
MASS GEN
Johns Hopkins BIRD EYE VIEW
NYC

Path to United States Practice Is Long Slog
to Foreign Doctors



Karsten Moran for
Published: August 11, 2013
Table. The 10 Most Prevalent Non-U.S. Nationalities among
International Medical Graduates (IMGs) Working in the United States.
McMahon GT. N Engl J Med 2004;350:2435-2437.
PRESENT TESNSE
1. 1. Traverso G, & McMahon GT (2012). Residency
training and international medical graduates: coming to
America no more. JAMA : the journal of the American
Medical Association, 308 (21), 2193-4 PMID: 23212494


2.
http://scepticemia.com/2013/01/08/the
-usa-dream-for-imgs-coming-to-an-end-
analysing-the-2012-match/
http://razvandadu.wordpress.com
http://www.usmleforum.com
http://www.prep4usmle.com
http://www.myusmle.com/forum/index


......how much is too much???

TESTIMONIALS
?
?
?
?
Q: WHERE / WHEN DO I START
NOW 05/23/14

? STEP 0

2 weeks for research and decision( forums ,
websites , friends , friends of friends ,
teachers, facebook, insta..pint


Q : WHAT SHOULD I CONSIDER FIRST?

ECFMG - http://www.ecfmg.org USMLE-http://www.usmle.org
UP-TO-DATE







DECISION ?
NOT YET!!!
1.PARENTS 2. SIGNIFICANT OTHER
3. FRIENDS 4mentor TEACHER
THE MIRROR TEST
Now that we've covered the soft topics

Q: WHAT DO I NEED?
A

1. INFO
2. A PLAN
3. MONEY

Q: WHAT DO I NEED?
B#

AND THE MOST IMPORTANT
1. EXTEND AND IMPROVE YOUR RESEARCH , START CONTACTING
PEOPLE , YOUR FACULTY SITUATION , MAKE FRIENDS
NEVER NEGLECT YOUR ONGOING STUDIES in order to be an IMG you
have to graduate!!!!

2. YOU HAVE TO WIRE YOURSELF to the BIG WORLD ( # medical
literature , state of the art therapy , medical news , controversies ,
meetings)

3. CV !!!! you need a solid back-up


DISCIPLINE
You need a timetable
DISCIPLINE
https://www.youtube.com/watch?v=4R_I2G_mWsc&fe
ature=kp

youre not just a graduate
youre a IMG



MONEY
1.Go back to your parents and
have a serioous talk
2. Dont push it to hard
3. Alternative
COST
FEES
STEP 1 850$
STEP 2 CK - 850$
STEP 2 CS 1480$
APPLICATION FORM - 65$
USMLE TRANSCRIPT 65$
STEP 3 f(x) center 850$- 950 $
VISA AROUND 500 $
TRAVEL EXPENSES + HOUSING up to 10.000 $
interview APPLICATION up to 2000$
+ what you cant predict.




BANKRUPTCY?
DAMAGE CONTROL


LOANS(1)
LOANS(2)
LOANS, LOANS , LOANS


https://www.cec.ro/home/persoane-
fizice/credite/credite-de-consum/credite-pentru-
studii-postuniversitare.aspx
http://www.piraeusbank.ro/Persoane-
Fizice/Credite/Creditul-pentru-Studii.html
https://www.bcr.ro/ro/presa/informatii-de-
presa/arhiva/2012/trimestrul_2/bcr-a-lansat-
creditu-oentru-studii-academic-bcr



JACKPOT
NOW THAT YOU HAVE THE MONEY
I . ECFMG - APPLICATION
STEPWISE IB- your guideline

1. ID identification number
2. ECFMG financial account
3. ELIGIBILITY
()
No 1: PAY ATTENTION TO DETAILS
No 2: as time flies neurons die
No 3: follow the steps
VISA

H1B *
J1
GREEN
CARD

VISA (2)
-http://romania.usembassy
.gov

-https://www.facebook.
com/bucharest.usembassy
STEPS
3AS IN4
STEP 1

STEP 2 - CLINICAL KNOWLEDGE

STEP 2 - CLINICAL SKILLS

STEP 3 - # delayed emergency
WHERE?
STEP 1

STEP 2 CK

EUROPE / USA

STEP 2 CS
STEP 3

USA

STEP 1 AND STEP 2 CK -location
EUROPE

Armenia, Croatia, Finland, France, Germany, Greece,
Ireland, Israel, Italy, Lithuania, Netherlands, Portugal,
Spain, Switzerland, Turkey, and the United Kingdom
PROMETERIC CENTER
https://www.p
rometric.com/
en-
us/Pages/hom
e.aspx
STEP1- CONTENT
!!!! USMLE INFORMATION
BOOKLET
MCQ -322 multiple-choice items with only one
best answer DIVIDED in 7 blocks / 46 items
pauses between blocks

The test is designed to measure basic science
knowledge

PRE-CLINICAL CURRICULA.





STEP 1 CONTENT(2)
System / process focused

CLINICAL CASE SCENARIO!!!!! ( for step 1??? Are
they out of their mind??)

from patient to enzyme

STEP 1 CONTENT(3)


General Principles , Hematopoietic and
Lymphoreticular Systems, Central and Peripheral
Nervous Systems , Skin and Related Connective
Tissue, Musculoskeletal System,Respiratory
System,Cardiovascular System,Gastrointestinal
System,Renal/Urinary System,Reproductive
System,Endocrine System,Immune System
???
STEP 1 CONTENT (4)

...IN TERMS OF UMF CAROL DAVILA.
STEP 1 CONTENTS(5)
ANATOMY , BIOCHEMISTRY ,
PHYSIOLOGY , GENETICS , MOLECULAR CELL
BIOLOGY ( BIOCEL) , MICROBIOLOGY ,
IMMUNOLOGY, PHARMACOLOGY

#INTERDISCIPLINARY AREAS: AGING , NUTRITION ,
EPIDEMIOLOGY , MEDICAL ETHICS,

# PATHOLOGY FIZIOPAT + MORFOPAT


QUIZZ
THE CORRECT ANSWER
A

The correct answer is A. The brachial artery is
immediately medial to the tendon of the biceps
brachii at the elbow. As the artery enters the
forearm, it is covered by the bicipital aponeurosis, a
broadening of the biceps tendon.
Q
THE CORRECT ANSWER
B
The correct answer is B. In utero differentiation of the
Wolffian ducts into the normal male phenotypic internal
reproductive tract requires testosterone, but not
dihydrotestosterone. On the other hand, differentiation of the
indifferent external genital slit into the penis, prostate, and
scrotum does require dihydrotestosterone. A congenital
absence of 5a-reductase in these tissues will result in
feminization. If left untreated, the affected individuals are
generally phenotypic females until puberty, at which time
increased amounts of testosterone result in virilization ("penis-
at-twelve" syndrome)
Q
3. A 24-year-old AIDS patient develops chronic
abdominal pain, low-grade fever, diarrhea, and
malabsorption. Oocysts are demonstrated in the stool.
Which of the following organisms is most likely to be
the cause of the patients diarrhea?
(A) Diphyllobothrium latum
(B) Entamoeba histolytica
(C) Giardia lamblia
(D) Isospora belli
(E) Microsporidia

THE CORRECT ANSWER
D
The correct answer is D. All the organisms listed are
protozoa. There are two intestinal protozoa specifically
associated with AIDS that can cause transient diarrhea
in immunocompetent individuals but can cause
debilitating, and potentially life-threatening, chronic
diarrhea in AIDS patients. These organisms are
Isospora belli, treated with trimethoprim-
sulfamethoxazole or other folate antagonists) and
Cryptosporidium parvum (no treatment currently
available).
Q
4. A 28-year-old man decides to donate a kidney to his
brother, who is in chronic renal failure, after HLA typing
suggests that he would be a suitable donor. He is admitted
to the hospital, and his right kidney is removed and
transplanted into his brother. Which of the following
indices would be expected to be decreased in the donor
after full recovery from the operation?
(A) Creatinine clearance
(B) Creatinine production
(C) Daily excretion of sodium
(D) Plasma creatinine concentration
(E) Renal excretion of creatinine


THE CORRECT ANSWER
A


The correct answer is A. Because creatinine is freely
filtered by the glomerulus, but not secreted or
reabsorbed to a significant extent, the renal
clearance of creatinine is approximately equal to
the glomerular filtration rate (GFR).
SCORES
I DO
WHAT I
DO BEST
, I TAKE
SCORES
STEP 1 SCORES


The number of test items you answer correctly is
converted into a three-digit score.

Most Step 1, Step 2 CK, or Step 3 scores fall
between 140 and 260

RANGE 220-240


YOUR SCORE ON THE OTHER HAND

260++
STEP 2 CK



()
PROMETRIC , SCORES ( REMEMBER 260+++).ETC



STEP 2 CK
Integrated content

apply your system - process based knowledge
from STEP 1


DISORDER
STEP 2 CK
CONTENT:

internal medicine, obstetrics and
gynecology, pediatrics, preventive
medicine, psychiatry, surgery, other areas
relevant to provision of care under
supervision.
QUIZZ
A 6-year-old girl is brought to the physician
because of a 1-month history of a recurrent
pruritic rash on her arms. She was born at
term and has been healthy except for an
episode of bronchiolitis 6 months ago treated
with albuterol. A photograph of the rash is
shown. Which of the following is the most
appropriate next step in management?
(A) Coal tar therapy
(B) Oral antibiotic therapy
(C) Topical antibiotic therapy
(D) Topical corticosteroid therapy
(E) Vitamin supplementation

THE CORRECT ANSWER
D
?
STEP 2 CLINICAL SKILLS

HANDS ON , PATIENT
FOCUSED
FICTIONAL PATIENT (?)

STEP 2 CLINICAL SKILLS
WHERE?? HOLLYWOOD???

- ATLANTA
- HOUSTON
- CHICAGO
- LA
- PHILADELPHIA

STEP 2 CLINICAL SKILLS
HANDS ON!!!

PASS/FAILED

LANGUAGE SKILLS
STEP 3

Step 3 is a two-day examination

assessing the knowledge and skills of physicians

http://www.usmle.org/pdfs step-3



STEP 3
IMG- FRIENDLY STATES
# RESOURCES?????
KAPLAN





QMAX
GOLJAN , ROBBINS , CMMRS .
AN OVERVIEW
# IMPORTANT TOPICS
Interview

match/prematch
fellowship

USCE / OBSERVERSHIPS!!!!
PhD!!!!!


I TOOK A TRIP DOWN TO LAMERICA
?
$ 30,1 BILLIONS