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My Voyage For Residency From PATIALA To PHILADELPHIA


 VOYAGE FROM KING EDWARD TO PHILADELPHIA

by IRFAN AHSAN, MD

IN THE NAME OF ALLAH, THE MOST BENEFICENT, THE MOST MERCIFUL.
“FA BI AYYYEEE AAALAAEE RABBI KUMA TUKAZZIBAAN!!! “

MOTIVATION AND INTRODUCTION:
The Unfortunate event of Medulloblastoma in my younger sister leading to permanent blindness despite successful surgery and chemo-radiation sparked in me a desire to become physician. Coming from a small city Dera Ghazi Khan, I entered in KEMU (former KEMC) in November 2004 and graduated in March 2010. Road to USA had never been easy. I was motivated by my parents and elder brother Adnan Khalique to reach the highest as I am the first one ever in my family who was going to become a physician and dreamed of training abroad as physician. But for me burning the boats was not an option so it had to be in this way in the form of many twists and turns till first step of success(Residency). I was looking for shortcut to settle early and was inclined toward going to Australia and that’s the reason I didn’t do any electives. After graduation I contacted my seniors in USA and Australia. I did Istikhaara for the first time in my life with a belief that Allah will guide me. Next day after considering all the pros and cons I decided to start USMLE on the very first day of my house job in May 2010 and never repent on decision. I am thankful to Allah, my parents, siblings, friends and seniors who were strength for me and guided me in this journey.


USMLE STEP 1 AND HOUSE JOB:
I did one year of house job in Urology, East Medicine, ENT unit 1 and Neurosurgery.
 Only medicine rotation was tough when I was not able to study properly but it was a learning experience for me. Others were minor wards. I used to come to college reading room and after clinical round I used to study. That gave me approximately 10 hours to study daily.

Materials used for Step 1.
 Kaplan Series
 Step 1 lecture videos of Behavior sciences, epidemiology & Biostatistics, Genetics of Biochemistry, and Physiology.
 First Aid USMLE Step 1.
 Goljan pathology (only multimedia slides), CT Scans slides.
 Kaplan Q series ( Not much useful as questions were totally different styles and out dated)
 UWorld Qs pool (offline) -----I would recommend do it online now.

I did total 4 official reads.
 1st read: Kaplan books and first aid
 2nd read: Kaplan books, first aid and UW offline subject wise. (UW score was approx 77%)

NMBE 2 offline: 166 correct answers. Score was <95
 3rd read: Kaplan books and then UW offline all together. Goljan slides and CT scans.

NBME 3 offline: 182 correct answers out of 200. This gave me confidence that I am going well.
 4th read: Only Kaplan, Goljan slides, CT Scans, last review pages from first aid.

NBME 7 online: Score was 245
I did quick last reading of Kaplan in 7 days and did FRED step 1 just 2 days before exam and got only 13 wrong questions.
Exam date: September 30, 2011.
Actual score: 257

Tip:

1. Things have changed now so always do recent NMBE exams online as your assessment.
2. Always be consistent and don’t let yourself distracted by risks. Every destination has its own hurdles and success never comes without dedication.
3. Study in reading room and better to study with a partner so that you can discuss concepts.



FCPS PART 1 AND MEDICAL OFFICER:
3 days before my step 1 exam I reluctantly went to appear in interview of medical officer through Punjab public service commission.
After step 1 I took a break to enjoy and during that my brother got married. So had a lot of fun, visits and functions to cheer up and regain freshness of mind. I took part 1 exam after 45 days of my step 1 exam in November 2011 and studied only anatomy and Murad Questions in 3 days before part 1.
Outcome: Alhamdullillah I cleared my fcps part 1 exam and was selected as medical officer through PPSC.

USMLE STEP 2, PG SHIP AND USA VISA:
I started step 2 CK next day of my part 1 exam in November 2011. Meanwhile I joined East Medical ward as PG Trainee in January 2012 and got my job of medical officer transferred to Mayo to work as PG/MO.
Main reason to join PG ship was rotations were easy in East Medicine, needed a training job to apply for USA visa and wanted to decrease some burden of finance on my parents. Alhamdulillah my visa came back in 5 days.

Materials used for Step 2 CK:
 Kaplan series
 MTB 2 for internal medicine only
 MTB 3 twice.
 UW Questions pool twice offline.

I did total 4 reads of Kaplan. It took me approx 7 months to take step 2 with PG ship.

My assessment scores were:
NBME 1 & 2 offline: 82% (after 3rd read----don’t remember score of NBME 1)
Fred Step 2: 83%
Date of Exam: June 30, 2012
Actual Score: 255

Tip: Take your exam when you are ready and secure minimum score of >240. This is life time one shot. Do your best in these exams.

IELTS and BACKUP FOR QATAR:
I took my IELTS exam on July 21 and got 7 bands. Booked my ticket and came to USA on August 2nd, 2012.

USMLE STEP 2 CS EXAM: Philadelphia Center.

Material used:
 First Aid CS
 Uworld for CS
 Iqbalian notes
 Recent cases.

During preparation of my CS, my case presentation and interaction was good but typing speed was not so good and was not able to finish patient note on time. So with fear of failure I delayed my exam and with that my result window for CS moved to December 2012 and I was officially out of Match last year. I practiced recent cases of Philadelphia as such on my friends who appeared before me. So no case was new for me.
Exam date: 14th September 2012
CS Result: December 05, 2012
Outcome: Passed CS in first attempt but at cost of being out of match because of incomplete application.

Tips:
 Practice, practice and practice on different CS partners to get exposure to different subjects.
 Remember your questions and Review of System on your finger tips.
 Gather all the recent cases and ask your friends about what was presentation.
 Appear in CS when you are sure of your performance because if you fail your chances of match will decrease by more than 70%.
 Try to appear in exam with full application. If you get your result of CS in first week of October, you should give it a shot and go for full match if your credentials are good.

FIRST MATCH 2012-2013:
I applied to only 30 programs of internal medicine on 15th September 2012. My credentials at the time of application were:
Step 1 score: 257. Step 2 CK Score: 255. Step 2 CS: Result expected on December 2012, 1 year house job and 7 months PG ship experience of internal medicine from Pakistan. Two oral presentations and 1 review article from Pakistan. No USCE, No Step 3.
Final Note: I got no interview call and I was expecting none because of incomplete application.

USCE:
I applied for observer ships at different places but got no response and then talked to Majid Toseef bhai. He invited me and I joined Harper University Hospital for externship in Cardiology for 2 months.

USMLE STEP 3:
I started preparation with externship and took me 3 months to take my step 3 exam.
Material used:
 MTB 3
 UW Step 3 offline (I would advise to do online).
 CCS by UWorld online
 Fred Step 3 practice material
 Archer lectures for CCS cases
 UWSA offline; 77%

Exam date: January 22- 23, 2013.
Actual Score: 216
Reasons for this low score were some unfortunate events in my family and my life plus my registration for step 3 got rejected because of wrong notarization dates. So I had to register again on urgent basis.

Tips:
 Do UW Step 3 online and take UWSA online.
 Try to understand approach to patient in CCS.

DECISION BETWEEN HAMAD MEDICAL CORPORATION QATAR and COMING BACK TO USA FOR RESEARCH:
On January 25th, 2013 I went to Qatar for interview at Hamad Medical Corporation and was selected at Rank # 3 for residency in Internal Medicine. Went to Pakistan and joined as Medical officer in my home town, started making some money waiting for contract from Qatar. Reason of going to Qatar was an excellent backup if I don’t get any reason to come to USA again and apply for match from Qatar. Meanwhile, I applied at many places for research position. I got response from a University for research in Neurology program and at the same time I got contract from HMC in April. Researcher was giving me J1 visa so with name of Allah I joined research with a hope to achieve what me and my family dreamed of for me.

ERAS 2013-2014:
I applied to total 140 Programs (70 Internal Medicine Categorical, 24 Preliminary Internal Medicine, 36 Neurology, and 10 Transitional Internal Medicine programs) in September 2013.
Golden Tip: Apply broadly and try to fill gaps in your CV.
P.S: I didn’t get any preliminary interview call. I got preliminary interview from where I had Advance neurology interview.
My Credentials at time of application:
 Step 1 score: 257.
 Step 2 score: 255
 Step 2 CS: Passed in first attempt
 Step 3 score: 216
 Pakistan Experience: 1 year of house job, 7 months of Post graduate residency in internal medicine, 4 months of cardiology experience.
 USCE: 2 months externship in cardiology, Detroit.
 Research: 2 oral presentations and 1 review article from Pakistan, 1 review article from USA submitted but not published, 1 abstract submitted in American Academy of Neurology.
 All LORs form Experience of USA,
 Graduation year 2010.
Visa Status: J-1 Research Scholar.

INTERVIEW JOURNEY:
33 Hospitals, 18 States... A hunt that I will never forget in my life and stories to tell my grand children J
· I appeared in 27 programs and cancelled others.
 I Started interviews in Mid October and finished by first week of February.
 Best interview tips: are to be nice to everyone and keep smile on your face. Try to get involved with everyone and give them your best and memorable time so that when you leave they remember you like a friendly person who they would love to work with. Observe satisfaction of residents in the program as well as environment within the program matters a lot. Always contact someone already in that program and share your experience with your fellows who have applied for match too.
 I had 18 Internal Medicine Residency Program Interviews and 15 Neurology Residency Interviews. I was looking for programs with academic strengths, environment, fellowships in cardiology for internal medicine and stroke for neurology, and/or a program offering H1 visa. Medicine has been my first choice to match.

Programs I Interviewed in Medicine:
1. Westchester Medical Center/NYMC, Valhalla, NY
2. Grand Rapids Medical Education partners, Grand Rapids, MI
3. Rochester General Hospital, Rochester, NY
4. University of Oklahoma, OK
5. University of Toledo, OH
6. Presence Saint Joseph, Chicago, IL
7. Abington Memorial Hospital, Abington, PA
8. Mercy Catholic/Sister of Charity, Buffalo, NY
9. Saint Francis Hospital, Evanston, IL
10. Albert Einstein Montefiore/Wakefield campus, Bronx, NY
11. Saint Agnes Hospital, Baltimore, MD
12. Berkshire Medical Center, Berkshire, Massachusetts
13. Howard University Hospital, Washington DC
14. Woodhull Hospital, Brooklyn, NY
15. Saint Barnabas Hospital, Bronx, NY (Pre-match)
16. Bronx-Lebanon Hospital, Bronx, NY (I cancelled this)
17. Lincoln Medical and mental Center, Bronx, NY (I cancelled this interview)
18. Brookdale University Hospital, Brooklyn, NY (Pre-Match: I cancelled this interview)

Programs I interviewed in Neurology:
1. Wayne State University/Detroit Medical Center, Detroit, MI
2. SUNY at Buffalo, Buffalo, NY
3. University of Alabama, Birmingham, AL
4. University of Missouri, Columbia, MO
5. West Virginia University, Morgantown, WV
6. University of Florida, Gainesville, FL
7. Case Western Reserve University hospitals, Cleveland, OH
8. University of Tennessee, Memphis, TN
9. University of Kentucky, Lexington, KY
10. University of Louisville, Louisville, KY
11. Albert Einstein Healthcare Network, PA
12. Drexel University, PA
13. University of Texas, Galveston, TX (I cancelled this interview)
14. Cooper University healthcare, Camden, NJ (I cancelled this interview)
15. University of Nebraska, NE (I cancelled this interview)

My Top 5 programs in ROL:
1. Westchester Medical Center/NYMC, Valhalla, NY------Medicine
2. Abington Memorial Hospital, Abington, PA--------------Medicine
3. University of Oklahoma, OK---------------------------------Medicine
4. University of Alabama, Birmingham, AL------------------Neurology
5. Case Western University hospitals, Cleveland, OH-----Neurology.

ALHAMDULILLAH MATCHED AT:
ABINGTON MEMORIAL HOSPITAL, ABINGTON, PA.

MATCH TIPS:

 Apply wisely and broadly.
 Try to get at least 3 months of USCE( Better if it is Hands-on)
 Research can get you a university program but not important to match in community program.
 Take Step 3 before applying or by maximum First week of October as most community programs prefer those who have taken step 3.
 Start working on your personal statement from July and get it reviewed by at least 2 people and one preferably from some Gora person.
 Start working on programs to select and interact with them from July-August Email them your credentials and ask for possibility of becoming competitive candidate for their program.
 Contact program after applying from first week of October. Don’t look like desperate person. Be confident and talk politely to get an interview call.
 Keep contact after interviews, send personalized thank you notes and greeting on special occasions. It’s always better to send personalized and customized thank you cards to your top 5 programs. I send via this link online. http://www.cardstore.com/ . Check for promotion codes and you will get discount.
 Contact your seniors in the program for recommendation. I didn’t contact anyone for interview call but it varies from case to case. Also contact seniors for one night accommodation as this will save you a lot of money and trust me more than 80% seniors are willing to accommodate you or arrange accommodation for you. I had to get hotel only in one interview.

For cheaper accommodation you can also try www.airbnb.com and http://www.hiusa.org/ present in downtowns of major cities.
 Try to make good credentials, improve communication and English, understand ethical and moral values of western culture, be nice to everyone you meet.
 Ultimately, trust Allah, Believe in yourself and always keep in touch with your family as they have sacrificed a lot for you.



I have shared my personal experiences till match. All the best to everyone and remember in prayers. J

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