Medical Education in the
Introduction
2.
MS/PhD
3.
Master of Biotechnology (MBT)
4.
Clinical Laboratory Scientist (CLS)
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:
Note that
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 it’s 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.
Notes:
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 didn’t 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.
FSMB (Federation of State Medical Boards) www.fsmb.org
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
5. Photograph
Once the initial documents (1 & 2) have been submitted, the board will get back to you in 3 months. So it’s 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.
In
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
·
H-1B
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.
·
J-1
ECFMG is authorized by the U.S.
Department of State to sponsor physicians on the J-1 visa to participate in
accredited
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
the
In its role as a J-1 visa sponsor,
ECFMG evaluates each applicant’s 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
NRMP (National Residency Matching Program) www.nrmp.org
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 year’s match.
One specifies their choice of institutions in the NRMP ranking process. The system then takes one’s 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
Scramble
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.
FindAResident http://www.aamc.org/students/findaresident
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
· Microbiology
Very few institutes in US offer
residency in Microbiology, none in
Duration: 4 yrs
Av. Work hrs: 70/week
· Pathology
466 seats total in US, 39% offered to IMGs last year.
17 seats in Bay Area.
Duration: 4 yrs
Av. Work hrs: 70/week
· Pediatrics
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.
2.1 Introduction
The
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.
2.2 Requirements
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.
Here’s 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.
Course Details:
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.
·
·
·
·
http://www2.sjsu.edu/depts/Biology/programs/graduate.html
In
other cities of
·
·
·
·
3. Master of Biotechnology (MBT)
3.1 Introduction
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
Profiles
Course Requirements: GRE,
Subject GRE
Course Prerequisites: Courses
in Molecular Cell Biology, Cellular Immunology and Molecular Genetics
Program Director: Dave
Bieber ( dbieber@email.sjsu.edu )
Prerequisite Details:
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)
4.1 Introduction
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:
http://www.ascls.org/jobs/careeropps.asp
www.ascp.org/bor/medlab/careers/page2.asp
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.
5.1 Introduction
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
only at
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 one’s 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