GUIDING IMGS TO MATCH INTO THEIR DREAM US RESIDENCY
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Basics of USMLE for IMGs

1/5/2019

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USMLE VISA Guide for Electives/Observership & Research

 
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If you are an International Medical Graduate (IMG) looking for elective, research or observerships as part of your USMLE journey, you want to ensure you have the right visa.
The first step to applying for an elective or an observership involves applying to the program, ofcourse.
Once you have received an invitation or acceptance letter from the program or the hospital, the next hurdle is obtaining a visa. Here we discuss the different categories of visas as relevant to IMG physicians. But the focus is not on the post-match (J or H1) visa.
 
Remember it the Discretion of the Embassy/consulate whether to issue or deny a visa. The hospital or the program has no say in it. It can only advice you in the process. 
 
More importantly: Our team does not offer legal advice. This is just an information post. For any specific questions on your case, you may want to seek legal advice.
 
There are three basic categories of visa that you can be issued.

  • B1/B2 also called the business class/ tourist visa
  • F1 student visa
  • J1 student exchange visitor visa (the home rule may apply to this category of visa class. Explained in details later in the article).

APPLYING FOR A VISA- Step by Step guidance

Log into your regional Consulate website (we have used an example from India). The process may vary for different nationalities, so do your due diligence.

  1. Determine your visa type by reading Common Non-immigrant Visas . Each visa type explains the qualifications and application items. Choose the visa type that applies to your situation.
  2. ​The next step is to complete the Non-immigrant Visa Electronic Application (DS-160) form. All information must be correct and accurate. Once the form is submitted, you cannot make any changes. If you need assistance, please consult an immigration lawyer or translator. You will need your DS-160 number to book your appointment. 
  3. Once you have determined the correct visa type and completed the DS-160, you must pay the visa fee. The visa fee page lists the visa types and correlating visa fee in US dollars and native currency.
  4. You are almost ready to schedule your visa appointment! Now you will need to login to your profile with the same credentials you used to pay your visa fee. Once you are in the system, you will see your dashboard.
  5. Click on Schedule Appointment on the left-hand side menu. This will start the process for scheduling your appointment.  
  6. You must schedule two appointments, one for the Visa Application Centre (VAC) and one for the visa interview at the Embassy or Consulate.
    1. First, schedule your appointment at a Visa Application Centre. This appointment will allow you to go to one of the five Visa Application Centre locations to have your fingerprints and photo taken. This appointment must be at least 1 day before your visa interview appointment at the Embassy or Consulate.
    2.  Second, schedule your visa interview appointment at the Embassy or Consulate. 

7. You will need three pieces of information in order to schedule your appointment:

  • Your passport numbers
  • The visa application fee receipt number.
  • The ten (10) digit barcode number from your DS-160 confirmation page.
 
  •  As you go through the process you will be able to select your visa type, enter personal data, add dependents, select your document delivery location, confirm visa payment, and schedule your appointment.

8. Following your visit to the Visa Application Centre to have your photo and fingerprints taken, you will then visit the U.S. Embassy or Consulate on the date and time of your visa interview. You will need to take along:
  • A printed copy of your appointment confirmation letter,
  • Your DS-160 confirmation page stamped at the VAC
  • Your current and all old passports, Supporting Documents as per your visa type

TYPES of VISA
 

The B1/B2 visa 
 
The most common visa applied by IMG applicants is the B1/B2 visa as it has many advantages. You may also take the Step 2 CS exam with this visa category although there are limitations and the State Department has not provided any direct information about visa category for Step 2 CS.
 
For electives/ observership, the B1 visa is permitted by the State Department. However, remember that this is not always the case. There have been applicants who have been called into second screening during and immigration officers have questioned the validity of this visa class for electives. Be prepared to articulate, explain and show the immigration officer your intend is just for the electives (and you will not receive any remuneration for it). You may state that the State Department website has clearly permitted B1 holders to pursue electives in their FAM manual- the official guidelines to visa classes and process.
 
NOTE: Many immigration officers in the Custom and Border patrol are unaware of this!!!
 
The State Department website has the following information regarding the B1/B2 visa
 
B1: Business associates, travel for a scientific, educational, professional or business convention,
B2: tourism/recreation-non-scientific/business purpose.
 
The B1/B2 visa is usually issued together but it is advisable to Mention the B1 class when applying.
 
Important Tips:
  1. the B1/B2 visa class only permits you to stay for six months. Any rotation more than six months is not permitted under the B1/B2 visa class.
  2. All activities must be unpaid and you cannot receive any form of payment or work under this class of visa.
  3. It is advisable to stay less then six months at all times and extensions may be sought but may jeopardize your future travel to US. 

The F1 visa – (Full time) Student visa

The F1 visa is a student visa and is different from the B1/B2 visa. The biggest advantage of the F1 visa is that it allows you to travel for a complete period time for your study. If, for example, you have applied for an MPH program this is the class of visa you will be applying for. The process is essentially the same for applying however you would need an I20 Form issued and an additional processing fees is required called the SEVIS fees the student exchange and visitor information system.  The fees are 180$ currently but can change.
 
You must show you are able to support your stay and study in the U.S.A when you apply for this class of visa.
 
You may be eligible to apply for a  Social Security Number with this class of visa and also for a US driving licence.
 
There is no home rule or “2-year rule that applies for a student visa”.
Please note you must be enrolled in a full-time course and there are limitations to how many working hours you may be permitted to work in on a student visa. If you are applying for only electives, observerships or any other hands-on experience from outside US, you are not eligible for this visa.


The J1 visa – The student exchange visitor Visa

This is also the  “residency visa for physicians" in many cases (The residency programs mainly offer this class of a visa or the H1B visa). It has the two-year home rule- which means you must return to your home country or country from where the visa is issued and upon return and for two yearsyou will be ineligible to apply for another class of visa - the State department website does allow waivers application under certain circumstance and most IMGs after residency will file apply for waiver jobs.
 

There is an exception to the rule which you should know as you apply for research jobs.

Many IMG applicants to residency programs also secure this visa for research jobs (prior to residency). 
A special class of visa for medical researchers who are not under the 2-year rule can be permitted in a few cases.
If you get a ‘research J1’ Please make sure no two-year rule annotations are made on the visa sticker once you have received it.  The application process is essentially the same. However instead of an I20 you will receive a DS2019 form that will be approved by the Department of Homeland Security and you will need this form to pay your SEVIS fees and apply for the visa.
 
You may apply for a Social Security Number with this class of visa and will be eligible to even apply for a driving licence.
 
J1 can be a tricky visa specially for IMGs seeking research positions, please be sure to talk with the immigration and legal department prior to applying for this visa.
However, majority of J1 visa are approved and this remains the best visa to get approved.
 
As mentioned above once you secure your USMLE residency spot, applicants may apply for a J1 waiver in the USA and will be eligible to remove the 2-year home rule conditions.  
 
It is best advice to read the guidelines from the FAM manual of the State Department to be well versed with which class of visa is best suited. Read below for some important sections from the FAM manual. Remember every country will have different wait times and delays in visa processing its best to apply early.

Good luck in your visa application. 

THE FAM MANUAL ON THE B1/B2 VISA CLASS:
 
(Copy from the official FAM Guidelines).
FAM 402.2-5(E)(3) (U) Clerkship
(CT: VISA-412; 07-21-2017)
a. (U) Except as in the cases described below, aliens who wish to obtain hands-on clerkship experience are not deemed to fall within B1 visa classification.
b. (U) Medical Clerkship:  An alien who is studying at a foreign medical school and seeks to enter the United States temporarily in order to take an “elective clerkship” at a U.S. medical school’s hospital without remuneration from the hospital.  The medical clerkship is only for medical students pursuing their normal third- or fourth-year internship in a U.S. medical school as part of a foreign medical school degree.  (An “elective clerkship” affords practical experience and instructions in the various disciplines of medicine under the supervision and direction of faculty physicians at a U.S. medical school’s hospital as an approved part of the alien’s foreign medical school education.  It does not apply to graduate medical training, which is restricted by INA 212(e) and normally requires a J-visa.)
c.  (U) Business or other Professional or Vocational Activities:  An alien who is coming to the United States merely and exclusively to observe the conduct of business or other professional or vocational activity may be classified B1, provided the alien pays for his or her own expenses.  However, aliens, often students, who seek to gain practical experience through on-the-job training or clerkships must qualify under INA 101(a)(15)(H) or INA 101(a)(15)(L), or when an appropriate exchange visitors program exists (J). 
FAM 402.2-5(F)(3) (U) Medical Doctor
(CT: VISA-288; 02-22-2017)
(U) A medical doctor otherwise classifiable H1 as a member of a profession whose purpose for coming to the United States is to observe U.S. medical practices and consult with colleagues on latest techniques, provided no remuneration is received from a U.S. source and no patient care is involved.  Failure to pass the Foreign Medical Graduate Examination (FMGE) is irrelevant in such a case.
ALl about USMLE
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1/5/2019

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Is USMLE is right for an IMG?: A step by step approach

 
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Every one of us want to be compassionate pioneering doctors that bring a difference in the society in their own way. The method to decide the optimum route to that ideal depends on how we paint the image of such a Doctor. Is it with innovate hues of research, colors of compassion for patient care etc. Our priorities of how we see ourselves in the future is highly important to decide this path. Each country has its own set of positives. Some international educational hubs include USA, UK, Singapore, Australia. If one ventures abroad its always to learn something new so that they can make a difference back home and the world at a large scale. 
Steps to decide that include:
1. Setting up priorities: how do you envision your future, where your passion lies. Some particulars to consider include diversity of patients, clinical exposure, research potential, fellowship prospects while balancing one’s personal life.

2. Research: if research is something close to someone heart they need to analyze research potential along their education. Pioneer institutes in U.S.A. and U.K. provide platforms for cutting edge research with appropriate technology and support in form of grants for deserving candidates.

3. Quality of education is a very important factor. This along with clinical exposure in terms of quantitative and qualitative patient exposure is highly important.

4. Match rate: the degree of acceptance of international students is important to consider.This varies for each specialty in different countries and it would not be proper to generalize it into one statement. It can vary across surgical and medical branches.
This can be analysed by looking into appropriate match statistics provided by international bodies for their programs.
Some of these include:
  1. A) For U.S.A.: Match data provided by National Resident Matching Program (NRMP) is an ideal way to analyze it the match rate in the specific specialty of  your choice. (http://www.nrmp.org/main-residency-match-data/)
  2. B) For U.K.: Competition ratios can be looked into, which provide a measure of approximate no of candidates for a seat available in the said specialty.  (https://specialtytraining.hee.nhs.uk/Competition-Ratios)

5. Clinical exposure: number of cases and degree of clinical exposure and clinical experience available. This is based on the setting university hospital/private hospital and further streamlined based on the logistics of the hospital one gets the opportunity to learn in.

6. Acceptability of current education: It is important to research the validity and acceptance of your current educational qualification in the 'registrable' degrees register of the country you want to study in. You should check that your medical school is a part of world directory of medical schools which is generally widely accepted.  (https://www.wdoms.org/)

7. Prospects for fellowship: is important to be considered if one wants to specialize in a particular field to gain expertise. Countries like U.S.A., U.K. and Australia provide unique fellowship opportunities leading to exposure to latest medical advancements which add as a valuable skill set once you return to your home country. One must also ensure that if one has completed post-graduation/residency in one’s home country then international institutions that have formal affiliation with one’s home school offer a potential bright pathway to pursue further higher academic opportunities like clinical physician observerships and fellowships.

8. Value upon returning to home country: is a factor that needs to be considered. As bringing a new skill set and most importantly acceptability of the international qualification/ degree is highly important in the place you want to settle. For example, for India one must check the list of recognized post graduate/residency qualifications.
 
9. Experience of seniors: is like the guiding torch to decide the pathway. Discussion with seniors who are studying abroad or have returned home after their international education is important to understand the social and economic factors which play a vital role besides the academic aspects. It helps chalk out possible routes and academic opportunities besides providing unflinching emotional and moral support.
All the best!

Dr. Nitya Beriwal, USMLESarthi's campus ambassador from Lady Hardinge Medical College, New Delhi, wrote this informative post.
All about USMLE
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1/5/2019

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Cost of USMLE from start till you match

 
Here we provide a detailed breakdown of the cost of your USMLE journey from start till you match. These costs may vary with applicants, as you will see below.

To be accepted into a US residency program, you need to be ECFMG certified, for this you need to take two steps of the United states medical licencing exams. Step 1 (Basic Sciences), Step 2CK- (Clinical Knowledge) and the Step 2 CS- (clinical skills only conducted in U.S.A.). These exams form the basis of a screening test for medical graduates. Whether you graduate from a US medical school (American Medical Graduate or AMG) or from anywhere outside US (International Medical Graduate or IMG), ECFMG certification is required before you can start your residency.

USMLE Step 3 is not a requirement for ECFMG certification and can be taken prior or after a residency match or during your first year of residency (different programs have different criteria), however, for most IMGS it does help your application during the Match cycle if taken earlier.
The breakdown below is an estimated cost of the U.S. residency process and this is just a guide. It may differ based on the duration of United States Clinical Experience (USCE) or other factors.

The cost of exams
We begin with the basic cost of the exams (as of 2018 and in US dollars)
Prior to taking an exam a copy of your medical degree and Transcripts needs to be physically send to Philadelphia to be verified and a basic token from ECFMG is $75. The cost of sending would be approximately $100.
After your token is approved you are eligible to take the USMLE exams. The website is here.
You may choose to have coaching for the exams from different coaching companies and this would be added cost.

You can take Step 2 Ck first and then Step 1 or vice versa. There is no such rule on to which you may take earlier.
The registration fees for Step 1 Is $910 (the exam can be taken in your home country in any approved USMLE Prometric centres), if you happen to cancel or reschedule the exams, an additional charge of 0-$569 may apply, depending on the date of changing.
After completing the Step 1 and after you have received your score it is time to take the step 2 CK exam. Again, this exam can be taken from you home country and would cost an approximately $910 and any rescheduling would cost 0-$569. Price may vary again depending on the date change.

After receiving your Step 2 score. You may schedule a CS exam in the U.S and you will receive a letter from ECFMG that will allow you to travel to the U.S.A to come take the exams ( the permission to grant you a visa is at the discretion of the State department applicants should not assume there is a guarantee of a Visa if you have a CS invitation letter from ECFMG. But majority of the applicants do receive visa).

The USMLE Step 2CS is only conducted in the U.S.A and the cost for registration is $1565. The exams can be taken in different designated locations in U.S.

Hands-on experiences/observership costs

It is also during this time you would engage with different programs for an observership or to try to get any form of USCE in the form of research or electives.
Very few programs offer free observerships. Paid observerships/ electives/ externships and range from $1000$- $3000 per month depending on the program. Remember this is just cost for attending the observership/elective and an expected cost of $50 for lodging and utilities is expected per month. If you are interested in exploring USCE, our team can help. Please check our externships page.

A minimum of 3 months in three different programs is required for having sufficient USCE. Please note it is possible to be sponsored for a free research program and this may help you in cutting down your cost. Living expenses and travel and lodging should be taken into consideration and could vary between $500-$1000 a month.
Once you have completed the USCE, you will need to travel back home for visa applicants, the US visa will limit your stay to a maximum of six months for most applicants (depending on your country), you may request an extension however this can jeopardize future visa approvals. The flight ticket prices may vary with the season you are travelling in.

Application and Interview costs
Now it is time to apply for the Match. You first need an ERAS token. The token costs $75. After this you need to selectively apply to programs of interest. If you plan to apply to approximately 150 programs it would cost about $3000. The ERAS website is here.
 
During this time, it is advisable to live in the U.S and this added cost would not include your interviews. If you do have approximately 5 Interviews in the season, an approximate cost of $3000 should be assumed, depending on where you receive your interview and your base location. For IMG most of the interviews are from the East Coast and it is advisable to stay around that area and you may share accommodation to reduce cost.

Finally, most applicants will need to register with NRMP, which is another $85, without late free. The NRMP match fee is listed here. 
 
So, the total cost of the entire process would be approximately $12,000-$15,000 from start to finish hoping you match the first time. This approximates the cost and may vary with individuals depending on several factors noted above.
All about USMLE
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1/5/2019

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Top 10 Tips for IMGs to match into USMLE residency

 
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Dr. Nandhini Sehar, who wrote this blog, is an IMG, currently PGY3.
​

If you are an International Medical Graduate, or IMG, whether you will be applying for the first time or are a repeat applicant, whether you are an old graduate or recent, low scores or 250+, if you understand and follow the 10 basic rules, you will have a successful Match.

The Match ‘formula’ has the following 10 variables
  1. Exam scores- including step 3
  2. YOG
  3. CV (Experiences- observership/research/volunteer)
  4. Letters of Recommendation
  5. Contacts
  6. Location
  7. Visa
  8. Program selection 
  9. Communication
  10. Interview

Lets discuss each one of these

​
  1. Exams including step3
  • Scores cannot be changed
  • so forget about them and think about appropriate explanations as to why you got those scores- practice how to talk about them
  • If you know exams are not your strength- consciously work on other parts of the cv and building your strengths
  • Work on complementing them with real world work experience
  • Know that everyone cannot get high scores and that’s ok- don’t lose confidence

2. Year of graduation
  • Again cannot be changed- but know that you’re working with a ticking clock
  • Think of substantiating your time off with something tangible- masters, extensive research, home country PG
  • Don’t waste time on observerships
  • Rather work in a paid position of some sort- scribe, paid research (if possible) so they know someone has already trusted you as an employee and willing to pay you and you are obviously still in touch with medicine
  • Many American grads who are pharmacists/ clinical pharma research switch to medical school- they are a wealth of knowledge because they round with doctors and we cannot function without them.

3. CV
  • Find deficiencies and fix them- especially important for repeat grads
  • find new experiences rather than repeat the same ones
  • Because the cv tends to look like- observership in university of xyz- “took patient history, physical exam, involved in mtx plan” over and over again.
  • The best applicants( into any residency or even general undergrad college admissions in this country) are the ones who always have varied experiences on their CV and bring something new to the table. That’s why people are able to switch professions and choose medicine at a later age
Repeat applicant CV- which specialty to focus on?
  • Narrow the specialty choice to 1 or 2
  • Most applicants decide that internal medicine is too hard- but they have a cv full of medicine experiences
  • Don’t get bits and pieces of med, ped, psych, family, neuro. They can easily tell it is a back up
  • But Some experiences can be easily leveraged for example
    Research in cardiology- can be used for medicine/ peds
    Scribe job in primary care- can be used for IM/FM
    Genetics experience- for peds/ psych- because they frequently have behavioral issues
    Peds experience for peds neurology
    FM for those with Ob Gyn residency
  • So have smart/ relevant backup option and be realistic in your approach so that you can marry your overall profile and interest with what is possible. We see it all the time. Students using psych/ peds as a back up- they can easily tell from your interview, even if get the IV for your backup specialty.
CV and observerships
Given the difficulty IMGs face in getting hands-on experience, most will take the observership route. But remember the purpose
  • Useful for program to see you and watch how you perform
  • Think of it like a mock interview
  • Useful in programs where you have a good chance of matching
  • If you want to prove you have some experience in the specialty
  • Good to demonstrate interest in a program during communication( emails asking for a day or week of observership because you are highly interested)
  • Make quick contacts in the program and get someone who can recommend you within the program- more important than outside letters
  • Prove that you would like to remain in the same location.
  • Most useless are clinic observerships- don’t waste your time in ‘father’s friend’s clinic’
  • However, everything beats a gap- sitting at home doing nothing.
CV and research
  • Great for people who have their CV in order already- and don’t know the next step
  • Proves commitment to the specialty
  • May use it to apply for two specialties if used properly
  • Shows something tangible on the CV
  • Shows you are capable of producing results
  • Steer interview conversation
Research Do’s
  • Do make clear goals for your research
  • Talk to mentor before hand and make expectations clear- will you get atleast 1 publication for the time you put in
  • Will you be able to get a good letter- usually possible only with 6 months or more
  • Do look for clinical experiences within research- shadow mentor, talk to patients about consent and study enrollment, any sort of patient contact
  • Look for the next step- e.g. if you are doing a literature review- go to prospective studies, involve in biostats, work with more mentors
  • Be enthusiastic and eager to learn
Research Don’ts
  • Go to a place without knowing why
  • Be unrealistic in your expectations
  • Waste time where there is no growth- eg don’t gather data for 6 months. Ultimately you are building your capabilities, residency will come but you want to be in a place where you are constantly learning and gaining new skills until you get noticed
  • Continue work with a mentor who is not supportive.
For more about Research, read our blogs in the Research Experience category
CV and Volunteer activities
  • Volunteer at local organizations to prove that you’re actually interesting
  • E.gg Child life volunteer for peds
  • Make new friends and contacts
  • Almost all AMGs have rich volunteer experience
  • Shows them you are involved in the local community.

4. Letters of Recommendation
  • Most overlooked aspect of the Match (by most IMGs)
  • Customized, specific letters will get you many more interviews
  • Home country LORs are not relevant in most cases, unless you are a very recent grad.
  • Do your best to get atleast 3 US LORs
  • Clinic LoRs don’t matter
  • Don’t write your own LORs. Atleast show it to an expert. PDs read hundreds of LORs. They will know instantly the difference if an Attending has written your LOR or has just signed off on the one you wrote
  • Always use waived LORs

5. Contacts
Another myth: “You can only match if you have contacts”.
  • Typical IMG definition of contact is ‘family friend, uncle, spouse’, in the program. While that is certainly true but the US definition means ‘professional network’
  • If you are spouse of an attending or resident at a program, you hit a jackpot (in most cases)- your chances of match at that program are very high indeed
  • Build your professional network (contacts) using the observerships, research, hands-on you do
  • Attend relevant conferences. Many conferences are attended by PDs, current residents
  • you can leverage your network to get more interviews and even get on the Rank List (yes, that happens)- depending on how strong your ‘contact’ is

6. Location
  • Your chances are highest in and around your current location, but remember some states are more IMG friendly than others (for example tough for you if you live in the State of Washington/Seattle)
  • Shows that you are committed to staying in the area- puts you in a better position than applications coming from far away because they are less likely to rank the program and vice versa
  • Double edged sword- realize that other programs far away will be less likely to take you for the same reason. So choose wisely. Or have good explanations
  • If you live in an IMG unfriendly state- be flexible- have experiences in other states
  • There are always exceptions

7. Program selection
  • Ones that suit your cv and experiences
  • Look at resident profiles/ graduates
  • Make a case for why you belong there
  • And how you can add value to them
  • Eg- community programs like people with clinical experiences who they don’t have to train
    University programs- like people who are capable of producing research
  • Start early and save $. if you start researching programs early September you will end up wasting a lot of money since you may end of applying to programs which are not a fit.

8. Visa Status
  • Biggest myth: US IMGs (those who don’t require visa) will match easily. NRMP data shows that the match rates for visa seeking IMGs and those who don’t require visa is very similar
  • If you don’t need visa it opens up some more programs for you.
  • In any case, for a majority of applicants, visa status is what it is.
  • Select programs that align with your visa status

9. Communication
  • Select 20-30 programs. Focus on them
  • Put all your strengths in an email and send to them
  • Research programs well. Don’t send generic emails
  • Ask for observership (yes, see above, doing obvership at residency programs can help)
  • Remember its more of an elimination process rather than a selection process
  • Don’t worry about making a great impression vs many small good impressions

10. Interviews
  • This is where the rubber meets the road
  • Residency interview is the make or break for Match
  • Maybe your previous interviews went well but for some reason you didn’t match- work on interview skills
  • Put yourself in the position of the PD and think about what they are looking for
  • Make a list of everything that you have to offer and hand yourself over on a silver platter
Good luck!
All about USMLE
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    Basics of USMLE

    In this section, USMLESarthi team covers topics which will help IMGs make an informed decision about USMLE and residency in USA. Like with other sections, our panel members, campus ambassadors and other guest physicians have contributed to the various blogs.

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