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ICM, Clinical Rotations and Residency

- Damon Sacks, MD

Demystifying: ECFMG certificate, FRIEDA, Green Book, ACGME, MSPE, SOAP, MPA, Scramble -ICM at Aureus - Clinical rotations - Steps to Residency - Info about Dallas area rotations - What residency programs really look for
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ECFMG and ECFMG certificate FRIEDA /Green Book ACGME MSPE SOAP / Scramble
MPA

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 that are accredited by the Accreditation Council for Graduate Medical Education (ACGME). ECFMG acts as the registration and score-reporting agency for the USMLE for foreign medical students/ graduates, or in short, it acts as the designated Dean's office for International Medical Graduates (IMGs) in contrast to the American Medical Graduates (AMGs). It conducts three examinations: Step 1, Step 2CK, Step 2CS. The ECFMG certificate is issued to a physician if he or she passes the above the three exams within a time period of seven years and meets validation credentials.

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Resposible for certifying credentials of IMG’s Uses ECFMG International Credentials Services (EICS) Paperwork is submitted by Aureus for certification on completion of education http://www.ecfmg.org/certification/index.ht ml

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Officially allows medical students to complete residency match Valid for life – does not expire Required to be licensed to practice medicine in ALL states after residency Can apply to residency without certificate but must have when ranking is complete (typically Feb. 22) of matching year. Typically receive 2 weeks after completion if expedited

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ECFMG Certification Requirements: Complete Application for ECFMG Certification.

Satisfy medical science and clinical skills examination requirements (currently USMLE Step 1, Step 2 CK, and Step 2 CS). •Primary-source verification of the required medical education credentials, which include the final medical diploma and final medical school transcript, with medical school.

Source: http://www.ecfmg.org/certification/requirements-forcertification.html

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Officially allows medical students to complete residency match Valid for life – does not expire Required to be licensed to practice medicine in ALL states after residency Can apply to residency without certificate but must have when ranking is complete (typically Feb. 22) of matching year. Typically receive 2 weeks after completion ECFMG Certification Requirements: Complete Application for ECFMG Certification.

Satisfy medical science and clinical skills examination requirements (currently USMLE Step 1, Step 2 CK, and Step 2 CS).

•Primary-source verification of the required medical education credentials, which include the final medical diploma and final medical school transcript, with medical school.

Source: http://www.ecfmg.org/certification/requirements-for-certification.html

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Maintained by the American Medical Association FREIDA online version of ―Green Book‖ Is simply a list of approved RESIDENCY programs – NOT clinical rotations Does not certify ―undergraduate‖ i.e., medical school rotations or programs Is used for future licensing requirements for RESIDENCY only – not medical school requirements

American and IMG med students have NO REQUIREMENT to rotate at FRIEDA listed programs - case in point – all private Family Practice and/or elective rotations Source: http://www.amaassn.org/ama/pub/about-ama/ourpeople/member-groups-sections/medicalstudent-section/membershipservices/choosing-medicalspecialty/general-information.page

The Accreditation Council for Graduate Medical Education (ACGME) is responsible for the Accreditation of post-MD medical training programs within the United States (RESIDENCY). Accreditation is accomplished through a peer review process and is based upon established standards and guidelines Does NOT oversee medical school requirements or clinical rotation validity.

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Formerly called the ―Dean’s letter‖ ―is not a letter of recommendation; it is a letter of evaluation.‖ Name and Purpose‖
◦ The MSPE describes, in a sequential manner, a student’s performance, as compared to that of his/her peers,through three full years of medical school and, asmuch as possible, the fourth year. ◦ The MSPEincludes an assessment of both the student’s academic performance and professional attributes.

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Stands for: supplemental Offer and Acceptance Program Replaced the ―Post-Match Scramble‖ Soap is a series of rounds during which programs make offers; it is not a second Match. Applicants express preferences by applying to programs through ERAS. Programs express preferences with lists of applicants in the NRMP Registration, Ranking, and Results (R3) System. Through the R3 System, program offers are extended to applicants. Applicants could receive multiple offers in any round. Positions offered and accepted during SOAP establish a binding commitment enforced by the NRMP Match Participation Agreement.

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During SOAP, eligible applicants: Can access the List of Unfilled Programs for those positions for which they are eligible. Can apply only to unfilled Match-participating programs. Must use ERAS to apply to programs. Cannot use phone, fax, e-mail, or other services to contact programs. Cannot have another individual/entity (including medical school) contact programs. Can accept positions only through SOAP during Match week. Cannot apply to non-Match participating programs until after Match week. Ineligible applicants cannot participate in SOAP and will not have access to the List of Unfilled Programs.

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―Pre-matching‖ is formally not allowed but reaching out in advance to decision makers is a plus The Match uses an algorithm based on what you want and what programs are looking for to bring the prospective resident and residency programs together You must have ALL paperwork completed to be eligible to match but not necessarily all courses finished Tip: Register early for Match and look at all aspects of application Registration and information: ERAS (www.aamc.org/students/eras/start.htm) and NRMP (www.nrmp.org)
◦ Completed education is likely considered better

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Restrictions on Persuasion – Section 6.0: Formal breach:  (a) a program to request applicants to reveal ranking preferences; or  (b) an applicant to suggest or inform a program that placement on a rank order list or acceptance of an offer during SOAP is contingent upon submission of a verbal or written statement indicating the program's preference; or  (c) a program to suggest or inform an applicant that placement on a rank order list or a SOAP preference list is contingent upon submission of a verbal or written statement indicating the applicant's preference; or  (d) a program to require applicants to reveal the names or identities of programs to which they have or may apply; or  (e) a program and an applicant in the Main Residency Match to make any verbal or written contract for appointment to a concurrent year residency or fellowship position prior to the release of the List of Unfilled Programs.

Source: http://www.nrmp.org/res_match/policies/map_main.html#restrictions

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Serves as a bridge to Clinical Rotations Conducted in White Plains, NY Combination lecture and clinic Family practice in nature

Most important aspects:

 getting comfortable in new environments (offices)  Understanding how to conduct an H&P  How to report findings to a preceptor

What you need:
◦ Student White coat of appropriate length
 Must have Aureus badge on it  Must have your name embroidered  MUST NOT say ―student doctor‖ or something of the sort

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Current Aureus Student ID ACLS in plain view Stethoscope (non-surgical rotations) Scrubs (surgical not paramedical) Professional outfits for clinic
 Ties, dress shirts and slacks (male)  Skirt or slacks with neat shirt (female)

Core Rotations

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Internal Medicine:
Medicine: Pre-Test (ISBN: 0071761497) [OPTIONAL] OB/GYN
NMS Medicine (ISBN: 1608315819) Blueprints Medicine (ISBN: 0781788706)


Surgery

Blueprints Obstetrics and Gynecology (ISBN: 078178249X) First Aid for the Surgical Clerkship (ISBN: 0071448713) Pestana Notes (do a web search) Surgical recall (ISBN: 1451176414)

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NMS Surgery (ISBN: 0781759013) [OPTIONAL] Peds

Psych

First Aid for the Pediatric Clerkship (ISBN: 0071664033) Case Files: Pediatrics (ISBN: Blueprints Psychology (ISBN: 0781782538) Case Files : Family Medicine (ISBN: 007147188x)

Family Practice

Other helpful sources:
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Rapid Interpretation of EKG’s (ISBN: 0912912065) Various First Aid for Step 2 CS and CK Various Q-Banks and Kaplan Series Reviews

Short Review course if necessary  Register early to choose your Step 1 exam date.  Scores usually reported in a few weeks  After ICM most students should take their Step 1 after short final prep  Statistically, delaying taking exam past 6 weeks results in LOWER scores NOT higher scores  Choose and apply to your rotations site BEFORE you take your exam to reserve a spot

Cores: (48 weeks in no particular order)
◦ ◦ ◦ ◦ ◦ ◦ Internal Medicine – 12 weeks General Surgery – 12 weeks OB/GYN – 6 weeks Peds – 6 weeks Psych – 6 weeks Family Practice – 6 weeks

Electives:

◦ 24-30 weeks of your choice
 (see www.americanclinicals.com for list of available rotations)  Most last 2 to 4 weeks

Step 2 Exams
◦ 3 months prior to completion of core rotations – should schedule Step 2 CS and CK
 Step 2 CS can be completed in Houston (short flight)
 Requires 2 days with travel etc.  Can be completed on a weekend  Typical review (1 week)

 Step 2 CK can be completed in Dallas
 Typical review 2-4 weeks max  Often studying while in electives as course load is lighter  Should be using various Q banks and scoring well

Finishing your clinical rotations
◦ 3 months prior to completion of Cores – should schedule Step 2 CS and CK
 Step 2 CS can be completed in Houston (short flight)
 Requires 2 days with travel etc.  Can be completed on a weekend  Typical review (1 week)

 Step 2 CK can be completed in Dallas
 Typical review 2-4 weeks max  Often studying while in electives as course load is lighter  Should be using various Q banks and scoring well

Year Three  October–March

◦ Begin working on your curriculum vitae (CV). Crafting a high-quality CV can take 8-10 hours.
◦ Information for the CV can be used in the ERAS application and provided to those writing your letters of recommendation.

February–June

◦ Review the ―Charting Outcomes in the Match‖ report to assess qualifications and competitiveness for different specialties. ◦ Review residency programs and physician workforce data through the Careers in Medicine Specialty Pages and AMA’s FREIDA.

◦ Begin the MSPE process.
◦ Write your personal statement and have your advisor review it.

Summer

◦ Obtain your ERAS token (a special code) from the dean’s office. ◦ Register for the Main Residency Match (www.nrmp.org). ◦ Register for early Match programs, if applicable. ◦ Review the ―Charting Outcomes in the Match‖ report to assess qualifications and competitiveness for different specialties. ◦ Review residency programs and physician workforce data through the Careers in Medicine Specialty Pages and AMA’s FREIDA. ◦ Begin the MSPE process. ◦ Write your personal statement and have your advisor review it.

February–June

YEAR 4  July–September

◦ Complete the ERAS application using the MyERAS Web site, including the designation of programs where your application is to be transmitted. ◦ Identify additional faculty for writing letters of recommendation.
◦ Begin preparing for residency interviews. ◦ MSPE released October 1. ◦ If you haven’t taken the USMLE Step 2, consider using this time to prepare. ◦ Submit ECFMG paperwork

September–October

YEAR 4  October–January

◦ Residency interviews. ◦ Evaluate and compare residency programs by completing the Residency ◦ Program Evaluation Guide and the Residency Preference Exercise

January–February


September–October
March

Begin entering your Rank Order List online for the NRMP match.

◦ Begin preparing for residency interviews. ◦ MATCH DAY—The third Friday in March; results are formally announced at 12:00pm EST. - Participate in SOAP if needed ◦ Sign the contract with your residency program and prepare to begin residency. Congratulations!

April–June

Letters of recommendations from physicians in your desired field Best with some recognizable sites (ie. Baylor, Northwestern, UCLA, etc) Strong Scores on Step Exams (many programs have stated minimums and will not consider applicants below) Strong MSPE with appropriate electives Published article(s) Research may be a plus Agreeable personality with strong work ethic Lack of potential visa issues

◦ Best if from practicing, experienced physician, not residents

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In 4th year, Texas program helps students complete residency applications to maximize acceptance chances
◦ Dr. John Birbari MD – former decision maker for University of Texas’ Dallas’ Surgical Residency Program personally reviews applications BEFORE submission ◦ Has developed recommendations for IMG students in Texas program

1. Provide a clear understanding of the process and timeline for the Electronic Residency Application Service (ERAS) and theNational Resident Matching Program (NRMP). 2. Review the rights and responsibilities of students in the matching process. 3. Provide information on obtaining reference letters, the Medical Student Performance Evaluation (MSPE) process, and usingvarious electronic resources such as FREIDA and ERAS.

4. Teach students how to write an effective CV and personal statement. (Note: This section can be done as a separate CV and personal statement workshop.)
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5. Make students aware of graduation-related deadlines.

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What if your score does not meet criteria (200 minimum in Baltimore and Dallas)? Hospital policy VS clinical rotation policy Texas clinical program position on Step 1 score What we’re looking for:
◦ Strong exam score ◦ Mature, hardworking student doctors ◦ Good overall MD 1-5 scores

Harris Methodist, Ft. Worth
◦ State of the art, award winning city hospital serving wide range of Trauma to Specialty Medicine ◦ Teaching hospital with ACGME approved Residents and Fellowships ◦ Requires rotation to rotation paperwork for each student ◦ Requires ACLS certification ◦ Requires HIPPA course and formal hospital orientation be completed onsite

Harris Methodist, Ft. Worth (cont.)
◦ Prox Card badges and EMR sign-ins issued to Aureus students ◦ American med students, also rotate here ◦ ***Special Note: Surgical assisting allowed under physician supervision; order pending and interaction with support medical staff

Baylor Medical Facilities (various)

◦ Very large and well funded healthcare system ◦ Renowned for excellent in training American medical students ◦ Name recognition on residency applications ◦ Affiliated research opportunities available for 4th year students

Medical Center of Arlington

◦ Large regional hospital ◦ Hub for specialty medicine and surgery ◦ Affiliated site for American medical student and Aureus rotations

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Real life schedule following practicing physicians Mix of hospital and clinic experience Varied practice models
◦ Traditional Family Practice, Holistic Focused Family Practice ◦ Hospitalist Internal Medicine VS private office

Schedule varies by what cases come
◦ Typically longer hours in cores, less so in electives

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Surgery Rotations at Harris Mix of hospital and clinic experience Varied practice models

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Required attendance lectures on various special interest topics Research and presenting at rounds Evaluations by preceptors Currently no NBME shelf exams

◦ Traditional Family Practice, Holistic Focused Family Practice ◦ Hospitalist Internal Medicine VS Private Office


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Relatively low cost of living when compared to most major cities; high standard of living Low crime rate – Top 5 US metroplex by population Large medical hub with expanding practice opportunities and many residency programs Voted one of the top 5 areas to practice medicine in the US Very large international community – one of the largest Indian and Pakistani communities in the US Special discounted rates on accommodations for Aureus Students Temperate climate with low humidity and mild winters

Clinical Dean: Wayne Hey, DO
◦ 30 years practicing in DFW ◦ Started Urology residency

Clinical Coordinator: Damon Sacks, MD All clinical professors are adjunct faculty at US medical schools

Do we have shelf exams?


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How are we graded?
Where should I live?

◦ No

◦ Letter of evaluations from preceptors ◦ Ft. worth around TCOM or TCU or Irving ◦ Yes

Do I need a car?

Can I change my core schedules?

Will I be waiting between rotations? Can I schedule time off to study?
◦ Yes with approval

◦ Not typically but may in special circumstances

◦ Has not happened yet. Your schedule is back to back