To accomplish anything great, it takes much planning and execution in order to succeed. Obtaining a residency in the U.S.  is the dream of many students and doctors around the world. Not only are there hundreds or thousands of students from your country, there are more from other countries spanning different continents. Some are more experienced, others more qualified. In order for you to be amongst the strongest applicants in the pool, you have to make yourself stand out above the rest. Ask yourself, what makes you unique? Why should a program director pick you over the other hundreds of applicants that they have interviewed? What characteristics would your friends and family say about you that make you special? If you do not have answers to these questions, you are not alone. It’s not a one line answer. Sometimes it’s not an answer that can just be given in words. Personality is something which is defined by ones actions, how they interact, and truly who they are.

If your ultimate goal is to match into a residency program in the U.S., you must prepare for this well in advance of graduating medical school. Many IMGs make the mistake of focusing their entire time and effort on finishing medical school, and then beginning the struggle to match. If you plan ahead, you’ll be one step ahead of the game. If you look at how well structured U.S. medical schools are, AMGs begin residency immediately after graduation. Many foreign medical schools are not tailored to this, so graduates end up lost and confused, making the same mistakes their seniors have done in the past. The moment you graduate medical school, you have already lost many opportunities to gain clinical experience in the U.S.

The first step in preparation is making a realistic schedule towards your goals. Here is an example of a timeline for a medical graduate from his final year of medical school till Match day. This example is tailored if your graduation date is in December.

December – January      2 months clinical elective at a university in U.S.
February                         Begin final year of medical school, begin ECFMG registration
July                                   1 month clinical elective in U.S., Apply for Step 2 CK/CS
Aug – Oct                         Preparation for Step 2 CK while studying for finals
November                      Finals
December                       Graduation, Step 2 CK
January                            Step 2 CS, collect MSPE/deans letter, transcripts, school LORs
February – April               Preparation for Step 1, start California letter if interested
May                                   Step 1
June                                  Volunteer/Research, collect LORs, start personal statement
July                                    Obtain ERAS token and start application, work on PS
July 29th                           Mail documents to ERAS support services at ECFMG
August                              Confirm uploaded LORs, finalize personal statement
August 31st                      Double check and finalize ERAS application
Sept 1st                            Apply to programs, apply for NRMP Match
October – January           Interview Season
January 15th                    Start on RoL
February 23rd                  Deadline for RoL submission
March 14th                      Match outcome
March 17th                       Match day

This is strictly an example. Dates may be moved around accordingly. If your graduation is in June, you have to plan when to give your USMLEs well in advance of ERAS application deadlines. If you complete your USMLEs during medical school, you’ll have it a lot easier.

Remember, everything takes time! Plan clinical electives early because once you graduate, you may not have the same opportunities available to you as if you were still a medical student. Also collecting , scanning, and approving documents take time, particularly if something was rejected and needs to be repeated. Obtaining an exam date and score reporting also takes some time, particularly the Step 2 CS (exam date 3-6 months in advance, score reporting 2-3 months). This is why it should be done well in advance since test days get full the closer you get to September.

Make your own schedule and try to adhere to it as much as possible. Organization is key! Try your hardest to give your exams on scheduled dates, working up to it. Once you delay something, you lose that stress before an exam and your peak of knowledge may has passed. Plan an exam date, take it, and move on! Delaying it repeatedly will not ruin your schedule, it may end up getting you a lower score than if you had given it earlier. (NBMEs are a great way to assess whether you are getting the score you want). The ERAS application is also very time constricted. Make it your goal to complete everything by September 1st so that you are preparing for interview season and doing your best at interviews (not worrying about exam dates, late LORs, etc.).

Every year you delay applying for residency from your graduation date, you have lowered your chances in matching. Many programs have a 5 year cut-off limit from graduation. Most prefer recent graduates (2 years or less) as they still have good medical knowledge while still comfortable with clinical skills. The longer the gap, the harder it is to come back to a medical setting. Do not get caught up in trying to get a 99 on your Step 1 and wasting a year! Every interviewer will ask you what you did for that entire year, and if you end up saying you were studying for the Step 1 for an entire year, they won’t know if your kidding or serious. Every month from your graduation to your interview date needs to be accounted for. Time gaps where you did nothing are a big “red flag.” Make sure you do not get stuck in them.

Plan accordingly and stick to it.


ERAS Resources for IMGs

Step 2: USMLE