Medical Education in the
This document explores all the above options and details the steps required to get a license/certificate for working in those fields. Some conclusions are presented at the end of the document.
Agencies associated with the examination process and getting a practice license are as listed below:
The examination process involves taking the USMLE exams, registering with ECFMG and with the Medical Board of California. Detailed information about them is given below.
Through its program of certification, the Educational Commission for Foreign Medical Graduates (ECFMG) assesses the readiness of international medical graduates to enter residency or fellowship programs in the United States ECFMG certification is a MUST to enter residency programs in the US. ECFMG certification involves taking the USMLE exams. Before taking any of the USMLE steps, one needs to register with ECFMG. The following documents are required for the same:
the above documents MUST be of size 8.5 inches X 11 inches. In
The above registration can take anywhere between 1-2 months. So one to be take into account this time gap too.
USMLE Steps 1, Step 2 CK and Step 2 CS are required for ECFMG certification. Once one has completed these, one can apply for the certification. The certification takes about 2 weeks to process.
The ECFMG certification requires you to list residency
rotations for the MBBS done in
ECFMG has a mailing list to which one should subscribe to get certification news updates and changes.
USMLE examination is a 3-step
examination for entering into medical residency programs in the
Can be taken anywhere in the world. This can be taken after Step 2 CK. But since Step 2 CK uses material studied in Step 1, it is always advisable to take Step 1 before Step 2.
Step 1 has about 350 multiple-choice questions, divided into seven 60 min. blocks, administered in one 8-hr testing session. So itís important to be prepared for a full day of testing.
Preparation time: 6-9 months of study
††††††††††††††††††††††††††††††††††† 3-4 months of study
††††††††††††††††††††††††††††††††††† 1-month review
††††††††††††††††††††††††††††††††††† 1-month restudy
††††††††††††††††††††††††††††††††††† 1-month review
††††††††††††††††††††††††††††††††††† 1-month test taking
Application fee: $675
Step 2 has approx 370 multiple-choice questions, divided into 8 60 min. blocks, administered in one 9-hr testing session.
Preparation time: 4-5 months
Application fee: $675
Step 2 CS has 10-12 patient cases with 15 min for your patient encounter and 10 min to record the post-encounter note.
Can be taken only in the
Preparation time: 1 month
Pre-requisite: Step 1
Application fee: $1200
Step 3 has approx 480 multiple-choice questions, divided into blocks of 35-50 items with 45-60 min to complete each block. There are about 9 computer-based case simulations and each has 25 min for completion. Step 3 is administered in two 8-hr testing sessions.
Case simulations have to be taken in order and one cannot change answers later.
Pre-requisites: for Step 3 are Step 2 CK and Step 2 CS.
Application for Step 3 must be submitted by Sept 1 of the year in which in the exam is to be taken.
Application fee: $610
Step 3 is not a requirement for ECFMG certification, but is helpful when applying for residency programs. It can be taken after submitting the application and one can mention that one is taking Step 3 exam soon.
For each testing block for all tests, you can review and change your answers within the block time limit.
Some of the subjects in these exams like Behavioral Sciences, Statistics, Psychiatry and Public Health are not covered in Indian curricula. So these may require extra preparation and effort.
Once you pass a Step, you CANNOT retake it until 7 years. So it is VERY IMPORTANT to get a good percentage in the first time you pass. Good passing percentage is something like 90 percentile. You are allowed to fail 5 times. You can choose to forgo a test date and take an extension by paying about around $75. If you wish to forgo the retake also, then you need to reapply with the full application fees. For retakes, the retake date will be at least 60 days after the initial test date. So one MUST plan accordingly for the
For Step 1, Step 2 CK you need to specify a 3-month period during which you wish to take the exam. You are allowed to select any available date from that period. The exam request needs to be submitted at least 1-2 months before the 3-month period. For the retake, the 3-month period must be contiguous to the previous 3-month period (during which you didnít take the exam). If specifying a non-contiguous period, then you need to reapply again. Every application takes about 1 month to process. For Step 3, your 3-month period starts the day your application is approved. USMLE step tests are NOT ADMINISTERED in the first 2 weeks of Jan.
Study material for tests can be obtained from Kaplan
(www.kaplan.com). Kaplan also offers live classroom teaching in
It takes about 4 weeks for the scores (Step 1/Step 2CK) to come. Step 2 CS scores can take up to 3 months. Until you have all scores, you cannot apply for ECFMG certification.
This agency offers the USMLE Step 3 examination.
For applying for residency in
1. Completed Forms
2. Certified and Sealed Transcripts and Medical Degree Copies. The certified copies must have the original signature of the dean or registrar of the medical school; be affixed with the official school seal; and include a statement attesting that the copy is a true and correct copy of the original.
3. 2 Fingerprinting (LiveScan) cards.
4. ECFMG certification
Once the initial documents (1 & 2) have been submitted, the board will get back to you in 3 months. So itís best to start this process early. Once all documents have been submitted, it will take about 3-4 months to get the Application Status letter.
The Application Status Letter packet can be obtained by writing to the Medical Board of California.
1.2.††††† Application Process
The application process involves short-listing the
colleges and specialty programs that one wishes to apply to, interviewing with
them to get a feel of whether they like you and might admit you, and then
finally applying to those colleges via the residency match process. Information
about each of these steps is outlined below. Application process also involves
getting up to 3 recommendation letters from your
FREIDA Online††††††††† www.ama-assn.org/go/freida
FREIDA Online is a database with over 7,800 graduate medical education programs. Besides searching for specialty and subspecialty programs, you can also search for training institutions, medical schools, aggregate training statistics by specialty, and career plans of recent graduates.
order to work as a resident in a residency program, one needs a valid US visa.
A visa is not required for US Citizens and Green Card Holders. If the husband
gets a green card after marriage, then the wife also automatically gets a green
card at the same time. If the applicant is neither a
International medical graduates who apply for the H-1B visa must be certified by ECFMG. However, it is the graduate medical education program that petitions the U.S. Immigration and Naturalization Service on behalf of the physician. ECFMG is not involved in the H-1B visa application process. Some residency programs DO NOT sponsor H1-B visa and hence one cannot apply to those programs.
ECFMG is authorized by the U.S.
Department of State to sponsor physicians on the J-1 visa to participate in
To be eligible for ECFMG sponsorship, an applicant must
∑ Have passed USMLE Steps 1 and 2.
∑ Hold a valid standard ECFMG certificate
∑ Hold a contract or an official letter of offer for a position in an accredited program of graduate medical education or training
Provide a statement of need from the Ministry of Health of the
country of nationality or last legal permanent residence. This statement must
provide written assurance that the country needs specialists in the area in
which the physician will receive training. It also serves to confirm the
physician's commitment to return to that country upon completion of training in
In its role as a J-1 visa sponsor, ECFMG evaluates each applicantís eligibility for sponsorship, according to the preceding criteria. For eligible applicants, ECFMG issues Form IAP-66, Certificate of Eligibility for Exchange Visitor (J-1) Status.
Individuals generally apply to the
US Dept. of State for the J-1 visa through US embassies and consulates abroad.
The Form IAP-66, issued by ECFMG, is only one of the elements considered by
consular officials in determining an applicant's eligibility to enter the
ECFMG tracks the status of J-1
physicians after entry to a
ERAS is the Electronic Residency Application Service.
Medical graduates or medical students most commonly used to apply for
specialized graduate training in residency programs in the
The National Resident Matching Program (NRMP) is a
private, not-for-profit corporation established in 1952 to provide a uniform
date of appointment to positions in graduate medical education (GME) in the
International medical graduates who wish to participate in the Main Residency Match must have passed all examinations required for ECFMG certification by the NRMP's rank order list deadline, which is February end. Examinees who take Step 2 CS later than December 31st are unlikely to have results in time to participate in the next yearís match.
One specifies their choice of institutions in the NRMP ranking process. The system then takes oneís choices and matches them with the choices of the colleges. The NRMP releases information about results of the Match over a four-day period during Match Week. Hospitals will forward letters of appointment to all applicants who have matched to their programs after the general announcement of Match results. Applicants are expected to return one copy of the letter of acceptance to the program before the stated deadlines. Both applicants and programs are bound by the Match results.
Note: There are 3 main areas in the
Beginning at noon Eastern Time on Tuesday of Match Week, a brief period of time is set aside for those applicants who did not match to give them an opportunity to contact unfilled programs and possibly secure a position before Match Day. This time period is commonly known as the "Scramble". Applicants can find out whether they are matched or unmatched beginning at noon eastern time on Monday of Match Week from the NRMP System. The NRMP prepares the list of unfilled programs by specialty to help unmatched applicants identify unfilled positions.
If scramble also fails to get you a seat, then you need to try the FindAResident service FindAResident is a powerful, web-based search tool to help you find open residency and fellowship positions. It can put you in direct contact with the programs looking to fill these positions. It is also an effective resource if you wish to change specialty, location or residency program. FindAResident is open year-round giving you access to unfilled residency and fellowship positions ranging from PG-year-1 through PG-year-6 in a variety of specializations.
1.3†††††† Program Availability
∑ Internal Medicine
135+ seats in Bay Area.
Duration: 3 yrs
Av. Work hrs: 70/week
Duration: 3 yrs
Very few institutes in US offer
residency in Microbiology, none in
Duration: 4 yrs
Av. Work hrs: 70/week
466 seats total in US, 39% offered to IMGs last year.
17 seats in Bay Area.
Duration: 4 yrs
Av. Work hrs: 70/week
Only 2 institutes In Bay Area
offer the course, about 8 in
Duration: 4 yrs
Av. Work hrs: 80/week
Data not formalized about other specializations.
Note: All work hours exclude emergency calls and they are only valid for 1st year. Load is slightly less in others years. Work hours were obtained from college websites.
other track for an MBBS from
1. Embark on a research career in a University
2. Become a Professor
3. Join a TODO: (verify) medical organization and work in their lab
4. Join a medical company and do lab related work
This career offers great opportunities in hot fields of genetics, bio-informatics and biotechnology and other biosciences.
To get admission into an MS/PhD program, one needs the following
1. Take the GRE (Graduate Record Examination).
Preparation Time: 4-5 months (depending on how good your English and Analytical Skills are)
2. Take the Subject GRE (most Universities require this).
Subject GRE is basically an exam in a specialized area like Biology or Molecular Biology or Biochemistry or some others.
Preparation Time: 2-4 months
3. Submit 3 letters of recommendation from MBBS instructors
Life in an MS/PhD track is much comfortable with not more than 8 hrs/day.
An MS by itself takes 2 years to complete. A PhD takes 5-5.5 years on an average. Some Universities do not have terminal MS programs and one has to complete a PhD. It is essential that one have a research frame of mind to do a PhD.
Note: MS/PhD programs are offered only by Universities and not by small colleges.
2.3†††††† Program Availability
In the Bay Area, such programs are offered by
∑ Stanford University†††††††††††††††††††††††††††††††† http://med.stanford.edu/phd
Stanford Biosciences Programs has 12 branches offering graduate studies. Intake in each branch is small and competition is very high. Hereís some information on one of the branches:
PhD Program in Microbiology & Immunology
Yearly Intake:††† 6-8 students
Student Profiles:††††††††††† GRE in 80s percentile
††††††††††††††††††††††††††††††††††† Bachelors with First Class
††††††††††††††††††††††††††††††††††† Subject GRE (not given so much weight)
Scholarship Scene:††††††† NIH government grants are only for Green Card Holders and Citizens.
1-2 Fellowship opportunities are available, but given only to exceptional students.
PhD only course. MS given only in exceptional circumstances. Admission not given to anyone who applies for an MS. PhD takes 5-6 years. The course is totally research based. Although some Professors do clinical work, graduate students are mainly restricted to research work.
Job Opportunities:††† Academic research/teaching, Biotechnology Industry.
other cities of
3.†††††††† Master of Biotechnology (MBT)
Master of Biotechnology is a professional program that integrates advanced hands-on training in laboratory-based core biotechnologies with MBA-level business courses in management and marketing. The program prepares individuals for successful careers in fields of biotechnology. Students graduating from this course work in pharmaceutical and biotech firms as Project Leaders, Laboratory Team leaders and Managers. Since this program combines medicine and MBA skills, students can choose to concentrate on either of the skill-set as per their desired job preferences.
3.2†††††† Course Details and Requirements
Course Duration:††††††††††† 2 years
Offered at:†††††††† ††††††††††
Program Intake:†††††††††††† 18† (about 30% Indians admitted to this course)
Applicants this year:††††† 70
Accepted Student:†††††††† Graduates in Chemistry, Pharmacology, Medicine, and Biology
Course Requirements:††† GRE, Subject GRE
Course Prerequisites:†††† Courses in Molecular Cell Biology, Cellular Immunology and Molecular Genetics
Program Director:†††††††††† Dave Bieber ( firstname.lastname@example.org )
One needs to talk to the program director to figure out if one needs to take any of the above course prerequisites. The prerequisites need to be satisfied before start of the course and not at time of application. It is advisable to take at least 1-2 courses at SJSU so that Professors get to know you and you hold a better chance of getting into the program. In order to register for those courses at SJSU, it is advisable to apply to SJSU for a Bachelors (as Bachelor students get preference to register for courses).
4.†††††††† Clinical Lab Scientist (CLS)
CLS is a 1-year certification program offered in various hospitals and colleges. All highly complex blood tests, urinalysis, toxicology, and microbiology ordered by health care providers must be performed by a licensed CLS. Sixty-six percent of the health care decisions are made on the basis of lab test results generated by licensed CLSs. Outside of the acute care environment, CLSs can do research, marketing and sales, education, quality assurance and consulting work. Besides hospitals and clinics, CLSs can work in industrial, research, public health laboratories, forensic and pharmaceutical laboratories.
The majority of CLS work in hospital, independent, and public health laboratories.† Additional opportunities are available in physician office laboratories, molecular diagnostics, biotechnology companies, in vitro fertilization and research laboratories.
General Information about a Clinical Lab Scientist can be found at www.camlt.org/train.html
Requirements:†† Green Card
More detailed information about career opportunities can be found at:
San Jose State University (SJSU) Program:†††††††† www2.sjsu.edu/cls
Univ. of San Francisco (UCSF) Program:† http://pangloss.ucsfmedicalcenter.org/cls/index.html
4.2†††††† Program Requirements
Requirements:†† Bachelors degree
UCSF Program Details:
UCSF has 4 training disciplines in CLS program and the requirements for each are:
1. Microbiology: Required undergraduate courses in medical or pathogenic or clinical microbiology or bacteriology. Courses in immunology, mycology, parasitology, virology, molecular biology, and genetics are recommended.
2. Chemistry: Required undergraduate courses in analytical (quantitative) chemistry and instrumentation. Courses in immunology and molecular biology are recommended.
3. Hematology: Required undergraduate course in hematology. Courses in immunology and genetics are recommended
4. Immunohematology: Required undergraduate course in genetics and immunology. Course in immunohematology is recommended.
Physician assistants are health care professionals licensed to practice medicine with physician supervision. PAs employed by the federal government are credentialed to practice. As part of their comprehensive responsibilities, PAs conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, and in virtually all states can write prescriptions. Within the physician-PA relationship, physician assistants exercise autonomy in medical decision-making and provide a broad range of diagnostic and therapeutic services. A PA's practice may also include education, research, and administrative services.
General information about the Physician Assistant program can be found at www.aapa.org/geninfo1.html
5.2†††††† Course Details and Requirements
Program Duration:††††††††† 15 months
Requirements:†††††††††††††† Green Card
Pre-Requirements:†††††††† 3000 hours (1.5 years) of prior clinical direct patient experience. Residency period cannot be counted as experience. Experience need not be that of a doctor.
††††††††††††††††††††††††††††††††††† Courses in
Anatomy, Physiology and Microbiology MUST be completed from a
Course offering:††††††††††††† Offered
Student Intake:††††††††††††† 50
Number of Applicants:††† 200-850 (depending on economy)
Admission Process Note:
Statement of Purpose (SOP) should talk about workload and pressures handled in the past so that they can get a feel of oneís capabilities. Special achievements/duties in college or work should be highlighted.
Grades are not that important, except for the 3 courses mentioned above.
Once applications are submitted, then scan the applications and invite 100-150 students for interviews. Interview process consists of 2 interviews with faculty members and 1 interview with a student. 1 writing sample (essay) on a topic related to the medical profession in general or the PA program is taken during one of the interviews. After the interviews, around 50 students are selected.
Note:††† This courses requires a Green Card or Citizenship
Most part of the course is preceptorship (i.e. internship with a medical doctor or hospital or clinic). Students should find their own preceptors, although the department does provide help with the same.
The course credits can be used towards a Masters Degree in Public Health (aka. PA course = 1 yr. of MS).
It is pretty
obvious that becoming a practicing doctor in the