Transferring from the Caribbean: Preparing for the Interview

July 7, 2007

iserson.jpgThere are a lot of things you should do for your interview, and Iserson’s Getting into a Residency covers all of them. I bought this book a month before I anticipated any interviews and read it cover to cover in the first two days. I was left dumbstruck by this book. When speaking about special situations like being an FMG, his advice is that the most important thing you can do is transfer to a US medical school. That knocked me in the head. There is a chapter called “The Questions – The Answers” that lists over 300 questions that people have been asked in residency interviews, what these questions are trying to discover about the interviewee, and strategies for handling them. I sat down and typed out every single question, printed them out, and then spent the next week forming my best answers. He will teach you how to stand, how to sit, and how to pack your suitcase so that things do not wrinkle. What to wear, what never to say, and what to do before during and after the interview are all topics that are covered very well in this book. If you walk into this interview without a resource like this, you are making a mistake.Why am I recommending a book about getting into a Residency? As a transfer student, you are already in medical school and are expected to know a little more about the field, its problems, and your place in it. There is an assumption made that if you have the grades and the recommendations to transfer, then you must be a very serious and driven medical student. Serious, driven medical students know what they want and have researched how to get it. In this way, you are much like a residency applicant who knows what type of physician he wants to be, where he wants to live, and which program will help you achieve this.

After reading this book, doing the research that it outlines for each institution to which I was applying, and answering all of the questions, I was in a place where I could enter the interview confident that I had not forgotten anything and that I had prepared as well as I Possibly could have. The confidence that comes when you can stop worrying about these things is invaluable, and I highly recommend the book for this purpose.

carnegie1.jpgThe second book I recommend it Dale Carnegie’s How to Win Friends and Influence People. This book changed my life. The way I read people’s response to what I say, the way I understand what they are saying, and how I handle every situation has been informed and altered by this book. I can say with confidence that a great deal of the good that has happened to me in the last year has happened because of the way I handled situations after reading this book. During my interview day, I saw so many of the other students making mistakes (some of them crippling) that are outlined by Carnegie. There was also one applicant that I noticed because she was so expertly handling the same questions and situations that were killing the other applicants. After the day was over, I told her that out of the entire field, she had her best foot forward the entire time and that if anyone was going to get in based on their interview today, it would be her. She emailed me a week later with the good news that she had been offered a spot. Do yourself the favor of reading this book. There are almost 500 reviews at Amazon.com (avg 5 stars). Here is a review of the book and how it changed someone else’s life.


Transferring from the Caribbean: Getting the Timing Right

June 29, 2007

Depending on your academic calendar, the timing of your application and your options may change. As an SGU student, I will speak about our problems specifically.

Students that begin in August have a good chance to apply for a second year spot at the end of their first year. Most schools begin accepting applications in February march, interview in June, and accept at the end of June/July for an August start date. Having completed only a year of medical school, you likely have had little time to explore research and develop strong relationships with the faculty that may write your recommendations. The school does not have much to use when considering you. They have your first year grades (mostly useful in comparing you to your classmates) and your MCAT scores. Know that you will be competing against people with a 4.0 and a 30+ MCAT. If you can get a hold of someone that has successfully transferred into the second year, ask them who wrote their recommendations. There is a good chance that this person has a reputation for endorsing strong students.

If you are planning on applying for a third year spot at the end of your second year, you will find this to be much harder. Most schools will want to see your USMLE Step 1 score when considering your application. Any January students from the term ahead of you will have already taken their Step 1 and have scores in hand. It will be very hard to compete against someone that already has a 99 even if you end up with a similar score. You can still apply for a third year spot at the end of your third year (which means repeating a year of clinical work). If you decide to do this, know that it will not be enough that you are “so far ahead” of the other applicants in terms of experience, the school will want to see that you have Honors in your clerkships.

Students that begin in January have more options. As a January student, I had the option of applying for a second year spot halfway through my second year. In this way, you have the opportunity to demonstrate A-level work on the second year material that you would have to repeat, you have a little more time to develop relationships with the faculty in hopes of having a strong letter of recommendation written, and you have enough time to become involved in research or other projects that might set your application apart.

You are also well positioned to apply for a third year spot at the end of your second year. Finishing in December, you will have five months off until you begin your clinical rotations. You can use this time to prepare as much as you need to for the USMLE Step 1, you have time to receive your scores and submit them by April (two months before the application deadlines), and you have plenty of time to make sure that your essays, recommendations, and transcripts are heading in the right directions. You also have an opportunity to pursue research or some other project to strengthen your application. The drawback is that you will have to begin your clinical rotations before the interviews begin. This means moving to a new area, finding a place to live, and taking time off to interview. I went through this and recommend starting your rotations instead of deferring them (if you defer, you may have some difficult questions to answer in the interview), subletting an apartment for two months instead of committing to a lease that you may have to break (and leaving any roommates in a difficult situation), and giving ample notice to your site director that you may need to take some time off for interviewing.


Transferring from the Caribbean: Which Schools Accept FMGs?

June 29, 2007

It changes. Coming from the Caribbean, you are part of an institution that is outside of the Liaison Committee on Medical Education (LCME). Almost all the medical schools in the US and Canada are LCME-accredited and this is the requirement to move between them as a transfer. Few schools elect to consider non-LCME students. To find out which schools accept non-LCME students, I went to the AAMC’s website for transfer policies by school. I asked to search by policy then narrowed my search by selecting ALL schools in ALL regions and selecting all the boxes accept for the first four (LCME-accredited applicant, Osteopathic applicant, Dental applicant, Oral and Facial surgeon applicant). This generated a list of 54 institutions accepting transfers into the second year and 73 accepting applicants into the third year. There is some overlap.

I then sat down and called every single institution to ask about their transfer policy for non-LCME students. This is important to do if you are serious about transferring and this level of effort will separate you from your peers. You will find out before applying if a school that has always accepted transfers has recently changed its policy, has no availability this year due to an oversubscribed first year class, or has recently begun to accept transfers. There have been cases where the school said “no” over the phone, the student applied anyway and was then offered an interview. The determined student will always have an advantage over the complacent student. Decide which one you are going to be and then plan accordingly. The programs that I contacted told me that the information on this site concerning number of available spots is inaccurate, so do not let a “0 spaces available” stop you from inquiring. Plus, it builds character.

There are several schools that often have spaces available nd are well known to those that frequent the discussion boards. These school are:

1. Drexel University

2. George Washington

3. New York Medical College

4. Northeastern Ohio University College of Medicine (NEOUCOM)

5. SUNY Upstate

6. Tulane University

7. University of Medicine and Dentistry, New Jersey (UMDNJ)

In addition to this list, I was able to confirm that eight other schools would accept non-LCME applicants. I do not feel like I have given too much away with this list as it is available everywhere, but if you are willing to search for the remaining schools than you deserve to be separated from others for your effort. Do not forget to call the medical schools in the state where you have residence. Several state schools do not accept non-LCME applicants but do accept applicants that are residents of the state regardless of school affiliation.

As the information begins to pile, it is a good idea to remain organized. Open a spreadsheet with a space for the school, its application deadline, fee, email contact, phone number, application cost, number of required recommendations from undergraduate and medical faculty, required transcripts, etc. Happy hunting.


Transferring from the Caribbean: Why?

June 29, 2007

I wrote a guide about attending a Caribbean medical school, singing the praises of St. George University. I kept a blog for two years at the Rumors Were True shedding light on some of the uniqueness of the island experience. SGU was a place that invited me to test my mettle and gave me the space to realize my potential in medicine. I love the school, the Caribbean, and still count it as the first great decision that I made in a new life of great decisions.

Then I transferred to Drexel University College of Medicine. Why?

When I applied to SGU, I knew that I wanted to be a physician in the United States, that medicine was the only thing that I felt could fulfill me as a profession, and that no matter what obstacles I faced I was going to make this happen. I was not sure what I wanted to do in medicine and it was important to me that as many doors remain open as possible. Going to the Caribbean (you will be told) can close many doors, and you will hear people tell you that you cannot do such-and-such if you come from the Caribbean.

SGU has an earned reputation for producing strong students and their residency placement list each year boasts this, showing students in fields such as Anesthesiology, Diagnostic Rad, ER, Ophthalmology, Orthopaedics, and Urology. The list of residency placements between 1997 and 2002 impressed me particularly when I decided on SGU. That said, my understanding of the residency application process has matured to reveal things previously missed.

The first is that Foreign Medical Graduates (FMGs) are able to accept residency placements outside of the match. This can be to the advantage of FMG applicants that might be able to secure a spot now that they would not get if they waited for the match (plenty of stories of this happening). The list available through SGU does not draw a distinction between how their students’ placements were secured, so looking at the list alone does not tell you how you can expect to fare when it is your turn to open the letter on Match Day. The second thing I have come to appreciate is that while there is a bell curve for desirable fields, there are bell curves within those fields for desirable residency programs. For example, while Orthopaedic surgery is a desirable field and incredibly competitive on the whole, there are Orthopaedic residency programs that are incredibly desirable and those that are less so. If your goal is to become an Orthopaedic surgeon coming from the Caribbean, this is certainly possible. If you want to do Orthopaedics at the Mayo Clinic, this truly approaches the impossible. It is also important to keep perspective on how many students are able to place into these fields. If only three students from your school made it into the specialty that you want and your class size is somewhere near 600, you need to honestly asses where you stand in your class and if it is likely that you will be one of the three in the coming years.

The process of “auditioning” for certain programs is also at issue. SGU has many hospitals for its students in the New York and New Jersey area and you are more or less free to complete your rotations and electives at any of them. When it comes time to apply for residencies, it is sometimes a good idea to complete an “away” elective at the desired hospital. In this way, the program gets to see your stuff and give you a much better look when it comes time to invite people into their program. This process of completing “away” rotations is open for US medical students but is much more difficult for FMGs, and this is because of reciprocity. Reciprocity is the agreement that schools like Mayo will accept and train a Harvard student during an elective “away” rotation with the understanding that Mayo students can be accepted and trained at Harvard should they so choose (an example from NYMC). These agreements are often non-existent between Caribbean schools and their US counterparts. If you plan on staying in the New York/New Jersey area and completing your residency training at one of the hospitals already associated with SGU, then this is not an issue. For those looking to enter competitive programs spread across the US, this is an issue that puts you at a disadvantage.

Finally, insomuch as residency program directors and medical school administrators represent an Old Boy’s Club (I have no idea if this is true or its possible extent) where a well-placed phone call can mean your application at the top or bottom of the stack, I wanted that resource available to me. I wanted to make sure that the clinicians that were teaching me were also faculty with my university and that their professional connections could be opened up to me should I impress them. Moving from the islands to the US left me with the feeling that my mentor, advisers and teachers were largely unavailable to me and that any influence they could have offered stopped in the tropics.

It is good to be aware of these concerns, but they are not unique to anyone. As an FMG, when it comes time for you to answer the “why transfer?” question at your interview, you are not setting yourself apart by regurgitating this. This may be fine since the interviewer is looking for someone that knows why he is doing something as opposed to being just another guy that heard he should apply for transfer since he has good grades, but it does not help the interviewer remember your answer.


Embarrassment of Riches

June 14, 2007

Short version: many good things have happened.

Long version:

I took two months to study for the USMLE Step 1, a test that covers the first two years of medical school, and while in Cambodia on my 6 week tour of Southeast Asia, I found out that I scored a 240/99 (the goal I set for myself). While studying for this test, I began editing a review book (First Aid for the USMLE) just for fun and submitting my corrections and suggestions to the authors. They contacted me and asked for my CV, and now I am working for them and credited as an author on the 2008 Edition of the book. During this time, I applied for transfer to several medical schools in the US. Drexel University in Philadelphia invited me for an interview. What follows is the story of that interview and the outcome.

***

Forgive the writing style. For the last week, I’ve been reading The Remains of the Day which is narrated by a proper English butler.

Last Wednesday, Friday, this past Monday and this Wednesday, Drexel invited people to interview for positions in the 2nd and 3rd year. There are 5 spots available for 3rd year and 16 interviewees. There are 4 spots available for 2nd year and 21 interviewees. Of those interviewing for 3rd year, I know six very well. I chose to interview on the last possible day so that 1) I would be remembered best, 2) I would be compared to no one else on my interview day, and 3) to learn as much as I could from people that had gone earlier in the week. This worked out well.

With my little attache case filled with my updated resume, research papers, Welcome to Grenada guide, and a few other things I took the train from NY to Philly, slept the night at a Bed and Breakfast, and headed to the interview. There were eight other students interviewing this day (all for second year). I was the last to arrive before 9am and took the head of the table. I introduced myself to the room, memorized everyone’s name and school, and started the room talking (they were staring at each other when I showed up). I am now always aware that I am being evaluated from the moment I walk in the door and that certain things (like command of a room, ease with strangers) are things that are always on display. Having done this so many times in Asia, I was very comfortable.

My interview went well. I was interviewed by a woman with whom I had spoken once previously on the phone. I had heard from other students that they only had 30 minutes to interview and that it was hard to get their message across in that time. I was aware of this as I shook her hand and sat down.

She then stared at me for four seconds.

“I have some presents for you,” I offered, at which point I opened up my little case and pulled out my updated documents. “This is my updated CV, and I’m very excited about the newest edition. I can’t wait to tell you about it.”

“Ok, then tell me.” I then told her the story of the First Aid Errors, how the job was offered to me, and that I was now a Contractor for Dr. Tao Le to manage the online site for the books. I was glad to have this out in the open early. She then began to ask me pointed questions and the tone of the interview was serious. I got the strong impression that she wanted to flush out people that didn’t know what they were doing with their life as she asked, “Why Drexel? Why Medicine? When did you decide Medicine? What will you be doing in five years? What sort of projects will you do if you come here? Explain to me exactly how your research was conducted.” And so on.

Oh, and my favorite: Why not become a writer?

I did my best to maintain eye contact, avoid looking away, and to sit with back straight and forward from the chair towards her. I have read that this makes you appear more interested and interesting. At every opportunity, I would answer in such a way as to lead the next question and in this way I was able to talk enthusiastically about things for which I had real enthusiasm. This made it easy to smile and hold her attention in a way that drew a smile from her.

And with that, she asked if I had any questions. The night before, I had prepared six questions that sounded specific but were in fact broad and I figured this would cover me, but I ended up not using them. Instead, I asked about very practical things like, “Do Drexel students take advantage of international rotations?” I knew the answer to this, but asked anyway to bring up the fact that I understand the importance of being bilingual and have plans to do a rotation in Ecuador (with Aunt Lucy and Uncle Fred) and that I have already traveled and have stories to tell you that will kill some time and make you think that I am well-rounded and interesting.

I told her about Laos and how much I loved the people. I told her about filthy, filthy Cambodia and the Killing Fields. I told her about the motorcycle trip in Vietnam with Kelly’s heroics, our first stitches, and the pictures that I’d show her if only she’d accept me. The interview ended with her telling me that they would decide later that day (or possibly on Thursday) who would be accepted and that I would know either Thursday or Friday.

So the interview was split very much in two and while I handled myself as well as I could have in the first half, I think we both enjoyed the second half much more. After this, my day was over. I then went down to the bookstore, bought Drexel stationary, and wrote her the following letter.

Dear Mrs. XXX,

As a writer, I depend on stories. There is something extra and hidden between the lines of a good story that would be harder to see if stated simply. You can imagine a much more interesting version of “he went to medical school,” for example. As an applicant, I notice when others have higher scores and I worry that someone might not see my stories tucked between my A’s and B’s. I wanted to thank you for inviting me to interview; it was my chance to show you some of the extra and hidden parts of my life that otherwise might have been missed on paper.

For Drexel, I hope to become a great story.

Sincerely, Me.

I would have mailed it, but as I said, the decision was being made later that day. I left the envelope with her secretary and caught the train back.

***

After working on an ulcer all day Thursday, I was called at 6:00pm. Drexel offered me a spot in their 2009 class and I took it immediately. This weekend, I fly to Las Vegas to give a speech at an Anatomy Research Congress and to share the good news with my mentors there. I’ll be giving the speech, then flying back to New York to pack up my life in Brooklyn and move to Philly.

What a ride.

Thank you, everyone, for taking an interest in my stories over the past two years. The encouragement to continue writing is what opened up so many of victory.jpgthe doors that I ended up walking through in medical school. I never could have guessed that they would have taken me here, and I wanted to celebrate this awesome thing with all of you.

Thank you so much,

Topher.
Drexel University Class of 2009.


Brevity is the Soul of Wit

May 19, 2007

A friend asked in a letter,

Still thinking of being a people doctor? have you switched at all more toward research?

The question has been on my mind a lot, and I guess it had built up enough pressure. My response was disproportionate.


Therefore, since brevity is the soul of wit, and tediousness the limbs and outward flourishes, I will be brief:It’s funny. I’m applying to transfer into a US medical school pretty soon which means a handful of personal statements. And for all the writing that I’ve done, I still have no idea how to do it correctly. I’ve tried to get to a point in my life where I understand who I am and why I do the things that I do, but I’m just not there yet. Which is fine, it just makes it hard to convince someone else that you’ve got the reigns in your hand, so to speak. It’s always ugly, but whenever you can’t prove or demonstrate something positively, there’s always the reductio ad absurdum. As far as I go, it’s the best I can do.

As it stands, I’m still curious about damn near everything. I have a folder called “million dollar ideas,” one called “essays” and one called “research.” I see problems everywhere and I love obsessing over solutions, and all of these interests pull me deeper into medicine. It’s just so deep and so wide, there’s enough room for anyone to lose themselves or find themselves. That’s why I’m here, I guess.

I’ve always joked with people when they ask me, “So why do you want to be a doctor?” My typical answer is that I’d be too bored with anything else, and that’s a half truth. I only see the rest when I work backwards:

I’d love to be a surgeon, but the malpractice risk and insurance along with dropping pay are off-putting, so I guess I want to be paid well according to my skill and don’t want to enter a field where that may not happen. I’d love to be a pathologist with all the time to write, do research, dissect. But I’d miss the patients. I’m reluctant to admit it, but I would miss the satisfaction that comes from someone you’ve treated thanking you with their eyes. Internal medicine is appealing for the challenge of trying to know everything about everything, but the patient exposure is above what I’d like and the pay seems off the worth. I guess I want to see people, but not all the time. I want to write, I want to teach, I want to cut, I want to cure, I want to be paid what I’m worth and I want time to enjoy the fruits and to share it with a family. I have two years left to figure out if anything fits those criteria, but from here things still look pretty messy.

I still don’t know what I’ll end up doing, but I hold fast to the belief that something fits. I want to transfer because I feel like I’m running out of time to make that decision cleanly. More exposure, more people, more resources and all of it right now would go a long ways to convincing me that I’d seen the field, taken stock, and decided on my future. If it turns out that there’s some unanswered question that I think I can tackle and is worth my life’s efforts, then I want to be exposed to it. I worry, a lot, that I’ll miss that opportunity if I stay with my current school.

The facilities, the people, and the open doors of a US medical school would be an embarrassment of riches for me at this point. In the time that I’ve studied with less, I feel like I’ve used everything available so that now, finally, I know how valuable those opportunities are and I’m ready to make the most of them. I’m praying for the chance.

Until that happens, I won’t know if it’s people or research.


Applications Away!

March 21, 2007

applications.jpgIt’s done. At eight o’clock tonight, I sent out the last FedEx package and now my home is empty of all things “transfer”. A few schools wanted to know what high school I attended. Even after two years of medical school and having taken the boards, they still wanted to know what my undergraduate science GPA was. Will you ever stop haunting me, 3.145 Science GPA?

I’m past the point of handling AIDS kittens for the homeless Inuit clans of Alaska, so I had to scratch real hard for an essay topic.

Would it surprise you that for all the writing that I do, I can’t write a personal statement to save my life? That’s not true. I can’t write a good personal statement to save my life. I’d love to post all of them here so that we could all share a hearty laugh, but I’ve decided that I’m competing with other students and the advice here is too easy to find. I’ll post them all after the last deadline of June 1st. We’ll laugh then.

I was sort of shocked at how much of a pain in the ass it all was. It took three solid days of inefficient work to get every application, every transcript and test score, every recommendation and every check heading in the right directions. One school wanted my reasons for transfer. Another wanted my compassionate and compelling reason for transfer. Another wanted the name of the family member dying of a flesh-eating bacteria that was already attending their medical school whose care would require my transfer so that I could be by her side as we both wrote SOAP notes. But only if I was a resident of the state.

It stretches my imagination none to think of students looking at some of the applications that I just waded through and deciding, “Screw it. Not worth it. I’ll apply somewhere else.” I hope they all do.