Top 10 Tips for IMGs to match into USMLE residency

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

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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!

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