Advice for International Student Applicants

Santiago Batista Minaya, MSIII, St. George’s University School of Medicine 

As we approach residency application season for the 2020 cycle, fourth year students are preparing to put their best foot forward to match into EM. For international medical graduates (IMGs), this process presents some unique challenges. Here, we summarize some key points of advice from a recent EMRA Hangouts session geared specifically towards US and non-US IMGs.

Who are the panelists?

1. Dr. John Madden, Associate Dean of Students and Director of Career Guidance and Student Development at St. George’s University School of Medicine, Grenada, West Indies (JM)

2. Dr. Dorian Alexander, Residency Program Director and Director of Critical Care at Brookdale University Hospital and Medical Center, Brooklyn, NY (DA)

3. Dr. Keya Patel, Emergency Medicine Resident (PGYII) at Rush University Medical Center, Chicago, IL (KP)

What are the chances of matching, based on Step 1 score?

JM: Based on data from the NRMP 2016-2018, with a 220 (which is still below the mean) as a US citizen you have about a 38% chance of matching. If you are a non-US IMG, you have about a 26% chance. Even with a 260, a US citizen IMG still has less than an 80% chance of matching. 

What type of elective rotations should you do in fourth year?

JM: I suggest things like emergency ultrasound, emergency pediatrics, critical care, etc. If your USMLE Step scores aren’t great, you need to have a backup specialty such as family medicine, pediatrics, etc.

Do you have any advice for those IMGs seeking fourth-year EM away rotations whose medical schools do not participate in VSAS?

KP: The best place to start is at your school. At St. George’s, our clinical department had a spreadsheet with information about each clinical site with which we were affiliated and what rotations were on offer. If your school has something similar, this is a great place to start. You can also obtain your school’s Match data and contact the programs that are matching students from your school to enquire about obtaining an away rotation in their ED. Also, in general, look to your upperclassmen and speak to them about what they did. Start early!

JM: Even if a particular program states that they only accept VSAS applicants, still reach out to them and see if you can set up a rotation with them directly. Some places will say no but sometimes they understand and will still let you rotate there. 

What are SLOEs?

JM: EM is the only specialty that uses SLOEs (Standardized Letters of Evaluation). I advise students to have two SLOEs from institutions that have EM residency programs and two more letters from one of internal medicine, OB, pediatrics, family medicine, etc. Make sure to discuss your strategy of getting into an EM residency with an advisor of some sort. If you don’t have one through your medical school, seek out a mentor during one of your rotations. Make sure that your mentor is aware that you are an international medical student applying into EM.

How do you stand out and do well?

DA: You have to make yourself known. Create a little elevator speech about yourself, shake hands, and introduce yourself properly. Take the time to meet the chairman of the department, the program director, the assistant program director, etc. After a good shift with someone, send an email to that person saying “thank you.” It really goes a long way as a student. It helps you to be remembered. We are not only trying to gauge a student’s didactic knowledge, we want to see who you are as a person and how you are interested in EM. One specific aspect is what is commonly referred to as the “EM mindset.” Are you thinking like an EM doctor? As a student, you probably don’t know what an EM doctor thinks like and that is OK. You are not supposed to know but you are supposed to want to know and be enthused to learn that. 

At what point should one consider a back-up plan?

JM: If you have less than 230 on the USMLE Step 1 and/or USMLE Step 2 CK, you should consider a backup or parallel plan. For example, you can apply to family medicine and later do a fellowship in EM, ending up in the field. 

DA: Along those same lines, if you rocked the board exams but didn’t necessarily rock your EM rotations, you should consider a backup. You might love EM but sometimes you might not have the mindset for EM. That is okay! 

KP: Keep in mind that if you are applying to a backup specialty, you also need to set up away rotations early on for that specialty. Do your due diligence for your other plan: obtain letters of recommendation, plan away rotations, and write a second personal statement. Keep all of that in mind when planning your fourth year. 

What factors does an EM program director (PD) use when deciding whether to interview a candidate?

JM: Here are the top five factors, based on the National Resident Matching Program (NRMP) PD Survey: 1. USMLE Step 1/COMLEX score; 2. Letters of Recommendation/SLOEs; 3. MSPE/Dean’s Letter; 4. USMLE Step 2 CK; 5. Personal Statement 

What about in determining the ranking of the applicant?

JM: The top five factors are as follows (based on the same survey): 1. Interaction with faculty during interview and visit; 2. Interpersonal skills; 3. Interaction with house staff; 4. Feedback from residents; 5. USMLE/COMLEX Step 1 score 

How do you have a good interview?

DA: You have to be yourself! We don’t want students who are trying to be someone they’re not. On that same note, we don’t want students who are being someone they think we want. If, for example, you are interviewing at an academic program (research, publishing, etc.) and you’ve never done academics a day in your life, that’s OK! They want you as an individual, so really and truly be yourself! Be memorable for the right reasons.

KP: One of the most important questions that you want to answer now is: “Why EM?” Whether that’s because of the awesome people you get to work with, being a “jack-of-all-trades,” procedures (without having to scrub), the lifestyle, cool fellowship opportunities, etc., you want to be able to answer this. 

We hope you found this summary helpful. Here are some more general tips that arose during this EMRA Hangouts discussion: 

• Go to every single EM interview that you are offered

• Attend all the pre-interview socials

• Research each program before you arrive 

• Expect questions like: “Why do you want to come here? Why EM?” 

• Be prepared to discuss any “red flags” on your application such as gap years, a poor Step 1 score, failed clerkships, etc. Do not avoid the question and do not lie. Make sure to acknowledge the “red flag” and put a positive spin on it. 

For more information about non-traditional pathways, applicants with gap years, questions regarding research and more, watch the full EMRA Hangout here.