The Palestinian American Medical Association (PAMA) is a humanitarian, nonprofit, nonpolitical, and charitable organization aiming to promote educational achievements and expertise of Palestinian health care professionals with goal of promoting health care in West Bank and Gaza.
This is a roadmap for Palestinian medical students who are planning to continue their post graduate medical education in the USA. Without enough preparation, research, and knowledge, this lengthy process can be both exhausting and frustrating. Much of the information presented in this page is obtained from several sources including; PARCEED, AAFP. AMA, ECFMG, ERAS, and USMLE.
By no means this page has all the information about the topic, we tried our best to put together concise and useful document for you. Please refer to the resources provided at the end of this page for further guidance. You can also contact us through this website for questions you might have.
Specializing in the US is worth every penny and minute spent. Getting American board in your future specialty is the best you can achieve worldwide. Your potentials will be unlocked in the US where you can pursue your dreams without limitations. This is in addition to admirable life style and financial security.
It will also take you at least 16 months from starting the process to Match day, and additional three months to start your training. The process of getting ECFMG certified and getting matched in a US residency will cost you about $15000. Add another $5000 to your first resident paycheck.
USMLE exams are expensive, please review ECFMG fees for details. It includes $895 for step 1, $895 for step 2, in addition to $150-200 for international test delivery fees for tests taken outside the US and Canada, and $1550 for CS. The process also entails travel and stay to and in the US. You will need $3000 round trip from Palestine to US, assuming you will do your CS, interviews, and US clinical experience rotation during the same US stay. At least you will stay for a month in the US to do your exams and interviews, which will cost you at least $5000 for stay and pocket money. The average number of interviews you will need to match is 10, and each interview will cost you about $300-500.
Be also be prepared to be an expert in time management and multitasking. At average, you will need at least 3-6 months preparation for each USMLE exam. You will also need time for interview, lucky if you can get it done in a month. You should plan to be done with step 1 and step 2 CK by June, and preferably have passed your CS by Sept. You might plan to do the CS in the summer and time it with your US elective clinical rotation “need to be a student though to get your elective at most places”. Having that said, you can still plan to do your CS later to time it with your travel for interviews.
Getting your specialty in the US is worth all the time and money you will invest. You need to be equipped with perseverance and determination, have trust in your abilities, and don’t be discouraged by disappointments that are part of the success package. Others did it and you can.
Get ECFMG certified
It is highly recommended to be ECFMG certified by June of the year you are planning to apply for US residencies. Test scores are released on Wednesdays after three to four weeks of your exam date. Additionally, you need to allow time to become ECFMG certified after completing your exams. Historically, delays in score reporting had been announced about one month ahead. This is a short notice for such an important phase and therefore, always plan for bumps in the road. You might start with Step 1 or Step 2 as you wish, but it is better for you to do both before the CS exam. Once you pass the three exams, you are automatically ECFMG certified and will get the certificate which is valid for 7 years. Once you pass an exam, you cannot re do it to improve your scores, 7 years have to pass before you can do it again. If you fail an exam, you will have 3 more attempts within 12 months, for IMG as yourself, failing an exam is a BIG problem and will minimize your chances in even getting an interview.
Apply and prepare for USMLE exams
You need to register for ECFMG online as a first step. First, you will create an ECFMG On-line Services account. Second, obtain a USMLE/ECFMG Identification Number (ID). Third, get your ID and password in the email, and finally obtain your scheduling permit. Once you have your permit you can start scheduling your Step 1&2 at Prometric test centers in nearby countries “Jordan, Tel Aviv center in the 48/Occupied lands, Egypt” and CS in the US. VIDEO1, VIDEO2
- Make sure your name in the ECFMG account matches your name on your medical diploma, medical school transcript, and passport. These documents go hand in hand when it comes to document verification and visa application.
- Read ECFMG Policies and Procedures Regarding Irregular Behavior that might bar an individual from future examinations.
- Choose the dates of your exam carefully, rescheduling is not without fees and you will not guarantee finding other dates that suites you.
- Travel couple of days before your exam, get yourself a break from studying and have fun. In addition, you want to make sure you have enough time to travel and cross borders.
- If you live in Gaza, you might want to consider moving to another country and stay there as a transitional period. You can do clinical attachment/observership in Jordan/Egypt and during this time you can study and do the USMLE steps.
USMLE Step 2CS “might do it at time of interviews “Sept-Dec”
This is the exam that you need to prepare for the most. Studying medicine abroad equip with vast medical knowledge and enable you to score high on Step 1&2. Step 2 CS is more about communication skills and time management. Mock patient interviews that help prepare you for this test are highly encouraged. Find a practice partner or two and simulate the encounter with them with a timer. You might do this test any time after your step 1 or step 2, your application will be stronger if you are ECFMG certified at time of submission “Early Sept”. If you plan to do your exam in the summer during your medical school years or after graduation, make sure to apply for this test at least 6 months in advance. This will help you schedule it on the date you wish and gives you time to issue your B visa. Having the scheduling permit and the date of the exam will increase your chances of getting your VISA timely. First Aid for Step 2 CS should be the primary resource, Kaplan series are also very useful guide for this test. You can might choose any of the five test centers for CS exam. VIDEO
- It’s preferable to book your test at least 3-6 months in advance. You can use the e-mail notification services to get the latest updates about the available testing days. Alternatively, you can use Check4Change extension to your browser.
- Having at least 1-2 months of US Clinical Experience (e.g. elective/observership, etc) before the test is clever idea to prepare yourself to the US clinical practice especially communication skills.
- It doesn’t matter which center will you take your test at, but most IMGs choose Houston or Chicago as they have more international SPs who have a relatively clear and understandable accent.
- If you don’t have a study partner, the best thing to do is to come to one of the nearby hotels e.g. Park Inn where you can find a lot of students/graduate who prepare for the test very well. Another important spot is Kaplan center where they conduct the step 2 CS preparation course. Many students practice there, and it is very likely that you find a study partner. You can also post on the various USMLE forums found online.
- In addition to First Aid book, YouTube videos are extremely helpful.
- It’s very important to train yourself on fast typing and use the official patient note online entry form.
- Time management is also very important; my best advice is to use this wonderful application which exactly simulates the exam timing.
Time management tips for USMLE exams
Before the exam:
1- do a simulation of the exam . Do 7 or 8 uworld blocks- with breaks in between – or 2 consecutive NBMEs or UWSAs. This way, you ll be familiar when you start to lose your concentration or feel hungry and when you will need a longer break between the blocks.
2- This is optional, but doing the practice test in the prometric helps to reduce the tension of the exam.
This is also considered a test drive and by doing this, you ll know exactly where the prometric is.
The night before the exam :
1- Sleep well . Your memory and logic will be tested tomorrow. Your brain should be ready for that.
2- Sleep without taking any meds but if u have to, make sure that this time is not the first time you try them.
1- Arrive early to the prometric. You’ll sign some papers and pass a simple security check.
2- Wear comfortable clothes with less pockets and shorter sleeves.
Blocks and breaks:
1- Skip the tutorial
By doing this, you ll have a complete one hour break instead of a 45 minutes one.
2- Pre-schedule breaks according to the previous simulation Enter the exam with a plan in mind about using your breaks. Choose what best suits you based on what you felt during the simulation that you did.
3- Eating, drinking and using the restroom
Use your breaks wisely. Eat small things/snacks in breaks to avoid hypoglycemia during the exam and eat a small sandwich/breakfast before the exam to have some energy to start. Don’t forget to visit” the restroom in your breaks.
4- Staying in the exam hall
You don’t have to leave the hall during your break. If you wanna take a fast 5 minutes break, you can simply stay where you are, close your eyes, relax your mind and continue your exam when you feel ready
While solving blocks:
1- Reading the question/the last line first
Always read the last line first in all USMLE exams, some questions are answered only by reading this last line! This is useful especially in pharmacology questions. This will help you to save some valuable seconds. As a rule, read last line first then go back and read the question normally.
2- Highlight any abnormal findings
When you read a question, highlight the age,sex and where the patient was admitted; ER, outpatient. Also highlight any abnormality like hemodynamic instability.chest pain…etc. Your eyes will focus on these findings and will try to associate them to reach a diagnosis.
3- Omit distractors
Many sentences are just fillers to distract you. For example, a myocardial infarction in a 70-year old male, a person who smokes only occasionally or who drinks on weekends.
4- Resist the urge to re-re-read, simply mark and go on
Read the question and apply the hints mentioned above. If you don’t know the answer yet, read the highlighted parts again, if you still don’t know the answer or you are not 100% sure of it, pick the one you feel it is the right one, mark the question and move to the next question. You may get back to this question only when you finish answering all other questions.
5- Leave abstracts and drug ads till the end
This applies for Step 2 CK and Step 3 exams. Abstracts and drug ads are very lengthy and they may take a lot of time in addition to the fact that many statistically insignificant data is thrown here and there. When you see an abstract or a drug ad, choose any answer then move on and go back only when you finish all other questions.
6- Don’t leave unanswered questions
Even if you don’t have any clue about a question when you read it, choose an answer, mark it and go on. Having a 20% possibility to answer the question right (supposing a question has 5 choices) is better than having nothing. In general, don’t change your first answer, your first hunch is most probably the right one. Change your answer only if you are sure that the one that you chose is wrong.
Get your scores and ECFMG certificate
You will receive an email four week after your test date. The test report will be available on your ECFMG account for 120 days. The report will include your name and score, in addition to detailed graphical performance. VIDEO
Now that you have successfully passed all the examination requirements for ECFMG certificate “USMLE Step1, Step 2CK and CS” you will need to pass the Medical Education Credential Requirements. ECFMG verifies every applicant’s medical school diploma with the appropriate officials of the medical school that issued the diploma and requests that the medical school provide the final and original medical school transcript. Once the above verification process is complete, you will receive your ECFMG certificate. Should you finish all the required exams before your graduation from medical school, you will still need to graduate and get your diploma before you can get the ECFMG certificate.
How to get USCE (Elective/Clerkship, Observership)
- It includes clerkships or electives (Hands-on for undergraduates, usually final year students), externship (hands-on, usually for graduates) and observership/ visiting physician program (Hands-off, usually for graduates).
- Hands-on vs hands-off? Hands-on means that you will be allowed to participate in all clinical work exactly as US medical students, i.e. taking history, doing physical examination and some clinical skills, allowed to scrub in surgical operations.While hands-off means you are not allowed to do anything from the above mentioned clinical tasks, i.e. you are only allowed to observe the team without active participation. However, you are expected to participate in round and meetings discussions, this might be your chance to impress attendings and get their letter of recommendation.
- The importance of having USCE: USCE is very important for all applicants to US residencies, both medical and non-medical:
- Improve your knowledge and clinical skills.
- Familiarize yourself with the US health system.
- Compare your level to US medical students
- A great opportunity to conduct research and participate in conferences.
- Improve your communication skills in
- Getting letters of recommendations, which are an integral part of the residency
- Cultural exchange.
- Make new friends & connections.
- Have fun!
- Explore your interests in different fields
How to get USCE?
A formal way; In general, there are two paths to get USCE:
it means contacting the university/hospital through their portal by following their guidelines. This is the most popular and the most secure and guaranteed way to get USCE. However, it might be more expensive, and your chance might be lower compared to those who have connections. And informal, this can be easier and less expensive than the formal method. It bypasses the application process and is usually done by directly contacting a faculty member who will secure the position for you.
- Application form, CV/Resume, and recommendation letters from one of the professors in your home institution.
- Fees (application and/or tuition)
- USMLE Step1 scores (becoming increasingly important for the application process; about 90% of the US hospitals require them for getting clerkship/elective)
- health & malpractice Insurance: The best insurance company according to students’ feedback is the International Student Insurance Company
- Cover or motivation letter. You may use the UCLA guide on how to write cover letters.
The cost varies based on many factors including, the value of application or tuition fees, the type and location of your accommodation, your ability to prepare your food by yourself and the timing of your elective (flights booked for summer are usually very expensive). Here are some funding resources for Palestinian medical students living in Gaza Strip or West Bank:
How to apply for residency
- Get ERAS token:
This is done through OASIS, this should be done in early June.
- Sign up for MyERAS
- Start on your CAF
This is the main document into your MyERAS account, it will include your demographics, Examinations, academic achievements, publications, hobbies, etc. So make sure not to rush and confirm it early on. You will need to keep adding to it and editing its content to the last minute. You will need to confirm it before you apply to programs and you will need to assign it to all programs.
- Upload your documents
- Curriculum Vitae (CV aka resumé)
Both the format and content matter here. You might want to consider using the UCLA guide to write your CV. Make sure your CV is accurate, updated, easy to view, and has all pertinent facts the viewer wants to see.
- Medical School Transcripts
Although you may have already provided a transcript for ECFMG Certification “original”, you are still required to submit a “copy” to ERAS Support Services via ECFMG’s OASIS
- USMLE Transcript
The USMLE transcript contains your examination history for all the steps, and it includes any fail attempts. You need to request these transcripts through ECFMG’s OASIS, there is a one time $80 processing fees.
- Personal Statement(s)
This is a very important document that you should give lots of attention to. It is ready by all people who will either select your application for interview or end up interviewing you. People paint a picture of you when they read your personal statement. They will expect an energetic or ambitious person should you say so about yourself. The point is, reflect yourself in your personal statement, talk about your own experiences that you can elaborate more about during the interview. Describe yourself in the work environment, talk about your motivations in life, what inspires you and what you care about the most. Also describe the social aspect of your life and career, are you married, what sport do you like, and what consumes your time beyond medicine.
Make sure that you get your personal statement proofread. You don’t want the language barrier or limited skills in prose give you less than the credit you deserve. We suggest that you right a draft and then seek professional help for proofreading. There are many editing services available and specialize into personal statements for medical students, we encourage you to use them. An alternative is to ask senior colleagues who have the experience to review your personal statement.
You might want to write more than one personal statement, for different specialties, but also within the same specialty.
- MSPEs (aka Dean’s Letter)
Deans in US medical schools use objective data including attendings evaluations and student progress to issue MSPE. Your medical school dean might want to use one letter format for all students, but letters should be different from each other. Please refer to the AAMC sample and content of MSPE.
Your LoR should be written professionally, follows a standard format, and on a professional letterhead and signed by the author. It should be carefully reviewed for accuracy and grammatical errors. It is preferable you get your LoR from a US faculty who can reflect in your US clinical experience or a professional relationship with you. If this is not an option for you, then try to get a US boarded faculty write your letter and include their contacts “email”.
It is recommended that you waive your right to view your LoR, this sends a strong message about your transparency and that you don’t have any weakness to hide. Having that said, you shouldn’t ask anyone to write you LoR, and only ask those who will write you strong ones for sure.
Make sure it is professional, wear a suite and a tie, and add a decent smile.
- Choose ACGME accredited programs
You can choose as many as you want, but you need to choose wisely since it is expensive process. Highly competitive programs have the luxury of choosing from a very large pool of applicants. So, unless you are confident that your application and credentials stand out among all US applicants you should not apply to such competitive programs. Your might have a chance in these programs if you know someone there who can put a word for you, or you have done an elective with one of its faculty, or published a paper with one of its researchers. You should also refrain from applying to programs that don’t consider IMGs at all for visa issues, these programs usually take US citizens and Green Card holder only. There is no one credible source for IMG friendly programs, and what might be friendly for one medical school or nation might not be friendly for another. Also, a program might change its policy regarding IMGs overtime and it is not wise to label programs based on their history. Having that said, these are the programs where Palestinian and Jordanian candidates match the most; list of US IM programs that offered interviews in 2019, and IM friendly programs.
- Start submitting your application to ACGME accredited programs.
After you have chosen your programs, assigned the appropriate documents, you can now submit your application. This step is usually done early September, programs start receiving applications around mid-September, and receive MSPE on Oct 1st. After that programs start sending offers for interviews. Please review the ERAS timeline for MD residency.
Interviews “Oct to Nov”
Practical approach Residency and Fellowship Interviews:
You made it to the interview day, which is one of the most important milestones in the residency and fellowship application process!
This is the day you present your case to referees who are interested in recruiting the strongest candidate for their program. We will break down the interview day to three phases, pre-interview day, interview day and post interview.
Some of the residency program will have pre-interview dinner the night before the interview day. Although this meant to be casual dinner, but this may count toward your final score in the residency program. Make sure to interact with the program coordinators, chief residents and any representative from the residency program. Show them that you are interested and want to learn about their experiences.
Before and after the dinner, go online and review the residency program web-page. Make sure you are fully informed about the program and prepare 4-5 questions to ask to the faculty who will interview you next day about the program. The goal of these questions is to get more information about the program, but of course to show the interviewer that you did your homework and you are ready to start next July as an intern or a fellow in the program.
This is your chance to present your case, some people consider it a show and it is. Why, Because, you must be prepared and present your case flawlessly, you have to be engaged with the audience and use body language to express yourself. Here are some hints that will make your interview successful:
- Prepare answers to frequent questions that are often used by residency and fellowship programs, below are some examples:
- Tell me about yourself. The goal of this questions is to break the ice between you and the interviewer and give you the opportunity to talk about special aspects of yourself that are not in the medical field, talk about your family, from where did you come from, how did you get into the medical school, any interesting events in your life that drove your decision for medicine.
- Strength and weakness points. Often, the interviewers use this question to document in their score cards why you deserve to be considered, this is important question and make sure you answer it correctly. The answer for strength points should start by saying that you have an excellent group of residents and candidates because you have an excellent program, but I would be also an excellent fit because I will be an excellent team player (give example why), I am hard worker (why), I will drive your in-training exam score up (in case your scores in USMLE are excellent), etc. For the weakness points, you would like to mention something that you worked on and it is now a strength point. For example, you were obsessed in details of physical examination, which will slow you down, but with practice, you are more fluent in documenting these findings with same accuracy.
- What drives your passion for the specialty? You must present the driving factor for applying to the program.
- Tell me about your research experiences/publications. You must be very ready and know all the details about everything in your application, including your personal statement.
- Do you have questions about our program? Prepare 1-2 questions, start by saying that the website or the presentation on the day of interview was clear and very informative, just you have one or two brief questions. Ask about research opportunities, do residents/fellow publish, how the faculty help learners to publish, would you have the opportunity to teach medical students, etc.
- Here are some important advices you need to use during the interview:
- Dress using the business dress code, tie, shirt, and suit
- Shake hands with all interviewers, look the interviewer in the eye.
- Maintain eye contact.
- Keep providing subtle smile, do not look goofy but the interviewer should see that you are pleasant person. They are looking for pleasant people to work with.
- If you feel you went off track in one answer, do not let it take you in downward spiral. Do not think of it and maintain your composure.
- Talk with passion; you have a lot of things to talk about.
- Print out pictures of special events such as volunteer activities you did, color print your publications and have a copy to hand to each interviewer.
- Bring with you a writing pad and a pen, write down your questions and important discussion points with interviewer.
- Make sure to take the contact information of your interviewers from the coordinator.
- The following video contains very helpful directions and advices.
It is an option to send thank you email to your interviewer; it is preferable that you send the email if you had a great interview. I would say 30% of the candidates send thank you email, and in less than 5% it makes a difference as the final score is already sent to the residency/fellowship coordinator after the interview. But if you choose to do that, here are some hints:
- Write in perfect English, there should be zero errors in the email, especially punctuation. Have somebody with English experience review it for you.
- Do not send generic thank you emails or letters, these are useless. Use specific discussion points from the interview in the email such as discussions about your publications, research, research opportunities etc.
- Do not send letters/cards, these are outdated. If you decide to do so, you should have exemplary clear hand-writing, otherwise it will count against you!
- Maintain contact with residents/fellows from that program and send them greeting emails in Christmas (December 24), New Year and Martin Luther King (third Monday of January), which usually fall in the interview season.
Criteria for candidate selection by residency and fellowship programs
Residency and fellowship programs use different criteria for ranking candidates, but these programs use the same items to score the candidates with different scoring systems. These are the items that the programs use to score candidates:
- Medical school. Nowadays, programs prefer candidates from American Medical Schools over International Medical Schools, but there is shortage of graduates of American Medical Schools which gives always an opportunity for International graduates to match. The programs prefer graduates from medical schools which they have experience in training some of their graduates in the years before, which means you will have a good chance if one of the current residents in that program is from your medical school.
- USMLE scores. The higher the better your rank, but as you can see it is not the only criteria. Having more than one attempt in USMLE CS is a negative point and some programs may limit their interviews to candidates with one CS attempt.
- In the form of abstract, peer reviewed publications, research experience with no publications. Focus on writing case reports if you are applying to the residency program out of the medical school and do not waste your time, unless you have the time and experience, in engaging in long research projects that may or may not be published, but of course if you have peer reviewed publication that will differentiate you from most of the candidates for this program.
- Ability to each, teaching experience. You want to make sure you talk about that in the interview.
- Team player. The programs are looking for a candidate that will be excellent team player, will be pleasant and know what he is getting into. The last thing the programs want to do is to recruit a resident who will NOT be happy in their program and give the program director headache! Be sure to show that you are team player, pleasant and will be happy.
- Language, communication. Practice the interview; make sure to spend time to soften your accent, if you have one, by listening to American English broadcasting and to repeat words as they spell it.
- Dress is important, use neutral colors. The way you sit and talk with confidence is important as well. Talk English all the time, even if the interviewer uses the same first language as you.
After you conclude your interviews, you want to submit you Rank Order List (ROL). The National Ranking Residency Program (NRMP) uses complicated algorithm to match residency spots with candidates. Here are some advises for you:
- Rank the program that you like the most on top, then the next one. The NRMP algorithm gives an edge to your preference over the program preference. Which means even if you have less change in matching in Johns Hopkins, that’s in case you interviewed there, rank John’s Hopkins the first.
- Rank all programs that you interviewed in, unless there is a horrible program that you do not want it (we never encountered this scenario).
- Make sure you submit your list before deadline.
- Even after final submission you can still come back and make edits.
Match results will be announced during the third week of March, please refer to the NRMP calendar for details. You be informed about matching vs. not, and then on the third Friday in March you be give further details about the program you matched at.
In the unfortunate situation of not matching, you will then need to know about the SOAP program. SOAP stands for Supplemental Offer and Acceptance Program®. It has replaced what was previously called scramble process. More detailed information can be found at NRMP website here. In the unfortunate event of not matching, your next step is to apply for positions that were not filled in the match. Occasionally, few top-tier programs intentionally leave some spots unfilled with no intention to fill them as they consider only the highest quality applicants. In order to participate in SOAP, you need to have been registered for that NRMP cycle. One week prior to match day, you will receive an email confirming your eligibility.
The process as described by NRMP website is as follows.
- At 11:00 AM ET on Monday, SOAP-eligible applicants can access the List of Unfilled Programs in the R3 system.
- At 2:00 PM ET on Monday, SOAP applicants can prepare and send up to 45 applications in the ERAS system. Programs can begin viewing SOAP applications in ERAS at 3:00 PM ET.
This means that if the system is congested or crashes in the first few minutes, your chances are not affected, and you still can send your application. You simply log in to ERAS and send a new regular application to the program of interest.
- SOAP applicants are prohibited from using any means other than ERAS to apply to programs and must refrain from any other contact until programs initiate contact with them. School officials or other entities acting on the applicant’s behalf also must refrain from contacting programs. Applicants who violate SOAP policies will be investigated and could be barred from participation in SOAP the following year.
- Programs interview applicants in whom they are interested. Programs vary in how they manage the SOAP process: brief telephone or online interviews are common. Program directors cannot ask applicants to indicate whether they will accept an offer if one is extended through SOAP. Interviews begin on Monday and continue through Tuesday.
- At 12:00 PM ET on Wednesday, applicants begin receiving offers through the R3 system. Offers are issued in order of a program’s preference list and according to the number of unfilled positions remaining in the program. Applicants do not create preference lists during SOAP.
- SOAP includes three Offer Rounds: 12:00 PM ET and 3:00 PM ET on Wednesday, and 9:00 AM ET on Thursday.
- For each Offer Round, applicants have two hours to accept or reject offers in the R3 system. Offers not accepted or rejected expire automatically.
- Offers rejected or expired will not be extended again to the same applicant in future SOAP Offer Rounds.
- Positions offered and accepted during SOAP establish a binding commitment enforced by the Match Participation Agreement.
- The List of Unfilled Programsis updated five minutes after the end of each SOAP Offer Round.
- SOAP concludes at 11:00 AM ET on Thursday.
J Visa application
Your visa will be sponsored by ECFMG. A Training Program Liaison (TPL) from your residency program initiates the process by submitting your profile to ECFMG. It is your responsibility to follow up with your program coordinator and contact ECFMG to ensure everything is running smoothly. Remember to be polite in your communication and obtain time frames and next steps.
If you are present in the US at the time of initiation of the application, then you leave to a different country, you will be required to scan and upload a copy of your boarding pass as evidence of departure. This is required as the DS-2019 form would not be released unless you leave the US and the administrative process is different if you plan to stay.
The entire process described above leads to issuance of DS-2019 form. This serves as your permit to entering and working in the US. Your next step is to schedule an appointment at the US embassy for the visa. On the day of the interview, you will need to bring the SEVIS fee receipt, DS-2019 and the additional visa appointment documents. Due to the recent political events, we highly recommend bringing the ECFMG fact sheet which was specifically issued for such purpose.
Upon arrival to the US, have your visa, DS-2019, and any welcome/invitation letters and contract available with you for any unforeseen circumstances.
Most of you are coming on a visa, will need to apply for Social Security Number and start building credit history. So, buying a house is not an option, and even if you can it might not be a good idea for the following reasons;
- You might lose money if the market tanks
- You will move anyway for your fellowship or to practice somewhere else
- You will need to maintain and repair the house, which can take all your residency salary
- You are stuck with the house even if you don’t like it, like the Neighborhood or like the commute to the hospital.
You are advised to rent a studio or apartment or a house depending on the size of your family. Regardless of what you choose to rent you need to pay attention to several details. Please make sure it is affordable, it should not exceed 30% of your total after tax income. Ask about the amenities, you don’t need a pool, but a covered parking space is a big plus especially if there is lots of snow where you matched. Also make it close to public transportation, you might not have a car the first few months, and your car will need repair every not and then. Safety is a big factor in pricing in the US, so please don’t be tempted by the low-price accommodation, ask your program and co-residents about safe zip codes “especially in big cities and in the downtown area”. Apartments vary in their appliances, while all have basic kitchen, some might not have a washer/dryer in the unit, others have a shared one for the whole building. Also, not all have a garage and at least a one car garage can be very convenient, especially if you have kids. If you live in a bid apartment complex you can then enjoy the available utilities including a pool, GYM, library, business office and so on.
It is not easy to figure all the above on your own, you will need help. The ones before you have already figured out the details and it is a smart strategy to follow suite and rent where most have rented.
Orientation and first month in training
Congratulations! you made it through medical school, residency interviews, and the match. Today is your first day at residency, feeling nervous!! No worries, this is natural, you just need to be well prepared.
Being an outstanding student by itself doesn’t guarantee you will excel during residency. You must take several things into consideration to survive and thrive in your first month and year of residency. Here are few helpful tips for you through your first month in residency:
- Your residency has already started the day of your interview:
- get the contact information for the residents you met at the day of your interview. Those residents are invaluable resource to help you know your new hospital and program, as well as the area you will be living in for the next few years. Learn from the residents what are the program’s expectations of you and to fit in quickly.
- Make sure to arrive early to the states to attend the orientation:
- each program arranges sort of mandatory orientation which provides all the information you need on ID badges, medical insurance, parking, getting to know hospital floors, using EMR system and where you can get a cup of coffee or some rest if you need it. The last thing you want to do is to miss it.
- First impressions matter:
- this matters not only to you but also to graduates from your medical school and country. The last thing you want is to get stuck with a bad reputation among your attendings and staff for the rest of your residency.
- Dress and look
- Show up on time or even earlier.
- Be courteous, nice, and respectful to others. Smile to everyone. You’ll be working with these folks for a long time. Build bridges not walls with others.
- Be involved and show interest during patients’ round, morning reports, etc. Ask questions during discussion and give answers when you know.
- Know your stuff whenever you are presenting a case or giving a talk. Review labs, patient history and previous physician and nursing notes. Faking your way through things won’t work. Your preceptors have been in your shoes, and they can tell when you are unprepared and guessing.
- Mistakes are inevitable but there’s no place for your ego at the hospital:
- if you mess up, please admit it and don’t argue. Showing remorse and acknowledging your mistakes is the least your program director expects from you. Please Remember that every resident does mistakes, only the good ones take responsibility. Learn the most from it, shake it off and move forward.
- Never lie about something you did or did not do:
- It can compromise patient care, cost you your training, and makes you less trust worthy. Take responsibility for your actions or lack of actions, always.
- Know your limitations:
- If you don’t know something, ask! You are there to learn, and no one expects you to know everything. There is nothing worse than saying you can handle something when you know you can’t.
- Be organized:
- find out what you will be doing for the next year: Be familiar with your internship year rotations schedule, when is the in-training exam, how to study for it, etc. Know how to access the studying resources: Library, up-to-date,
- You will have many tasks to perform, attend rounds, order and review lab tests and see lots of patients. With all that you will be juggling, it is easy to get mixed up. At the start of your residency, develop your own ways to stay organized and keep track of all you have to do. Whether you use apps, a written planner or leave yourself notes, find ways to keep yourself on track.
- Organize your time: Get enough sleep so you function well at the hospital.
- Get to know the different weekly curriculum meetings, like morning reports, journal club, etc. Go well prepared to them as not only you would learn the most but will also leave very good impression about you among the attendings.
- Make up your mind about what fellowship you are interested in, if any. It’s very important to plan ahead for that so you can show interest and approach the people who could help you getting the fellowship you want, whether your program director, consultants, residents, etc.
- Research is a very important part of your training. Be familiar with the resource your hospital provides for research. Ask your senior residents for help. Come up with your own research idea and discuss it with an attending who can supervise you. Try to work in research in the same fellowship field you want.
- Have a healthy and social life:
- Residency life is a busy and time-consuming one however, having a social life is a healthy and important thing to help you go through your residency. Don’t live the residency life on the expense of the social one neither the other way around, you just need to tune up the balance between the two of them.
- Try as much as you can to eat healthy. A healthy mind in a healthy body.
- It is vital to the practice of good medicine, and this comes through reading, reading, and reading. Read about the cases and diseases you encountered at the end of your day. Make a list of subjects you need to read for the next week or month and stick to it.
- Getting your car, rental place, cell phone, and other services:
- Your program, friends, and co residents are a great resource. Two new terms you will need to learn quickly:
- Social Security number “SSN”: You can do none of the above without it. It is like your identity number but is way more than that. This number is going to be your digital code as long as you are in the united states, and even after you become a citizen. Make sure to keep it safe and secure, this is not to share with anyone. You will need it to build a credit history, sign up for services like cable TV, phones, heat, electricity, etc. You will also need it to rent a place and to rent or buy a car. Please read the following on how to apply for SSN.
- Credit score: your financial wellbeing will be measured using this score. You will build it overtime, the higher it is the better will be your chance to get a loan. You will need loans to buy a car, and in the future a house. This score can be poor, good, very good and excellent. It all depends on how you manage your credit cards and loans. So, make sure to open a bank account, you will need you SSN or this step. Then have your bank issue you a credit card in addition to your debit card, you can also issue a credit card through other creditors and banks. Please read the following on how to build a credit score from scratch.
- Finally, it’s normal to feel completely lost at times but it’s very important that you keep going on, continue to learn as much as you can every day and be proud of yourself
- Your program, friends, and co residents are a great resource. Two new terms you will need to learn quickly:
Ahmed Daraghmeh, MD
Majdi Hamarshi, MD
Marcel Ghanim, MD
Nezam Altorok, MD
Osaid Alser, MD
Yousef Khelfa, MD
Murad Masri, MD
Important resources and official websites:
- Forum for Arab medical students
- Palestinian American physicians
- Jordanian American Physicians
- Comprehensive guide for IMG applying for US medical residency
- Interview guide videos
- ECFMG website guide
- Detailed roadmap PDF file from AMA
- Important guide to writing letter of recommendations, statement letters, deanship letter and others
- Website for residency application ERAS
- USMLE official website
- USMLE bulletin
- Official national resident matching program