Dr. Thinker: Letter of Recommendation (LOR)

FAQs

1.      How to get a good LOR?

-           It’s very simple.  The doctors in the USA are very friendly. They just expect you to know basic knowledge.

A.      Be on time – very important.

B.      Come to the hospital at the same time your resident or fellows come and leave along with them, even if they ask you to leave early.

C.      Read a topic, or something related to the cases you see and ask your resident or the attending some intelligent doubts in that topic. This way you are building up a rapport without sounding dumb when they talk about that topic.

D.     Volunteer to take a case or present a topic. Don’t wait for them to give you work.

Dr. Thinker: Research

FAQs  

1.      What are the types of visa on which you can join research?

A.      Research Volunteer/Intern: B1 visa

-          It is an unpaid position.

-          Your visa could be B1/B2, but at the port of entry the customs officer usually stamps B2. So, make sure you ask him to stamp  B1 if you are going for this kind of research.

B.      Research Assistant: J1 visa

-          This could be paid or unpaid position.

C.      Post doc: J1 visa

-          Paid or unpaid depending on the funds.

-          They usually have a commitment for 2 years. But, sometimes you can break it after an year depending on your attending.

Dr. Thinker: United States Clinical Experience (USCE)

USCE – United States Clinical Experience

Types of USCE:

A. Clerkship: It is considered hands on clinical experience.  You MUST try your best to do this no matter what.
Eligibility: You should be a medical student and not graduated yet.
(For Indians: Internship period is still considered as not yet graduated.)

- The best clinical experience.

- This is what the programs look for.

- The LORS from this have a great value.

B. Observership: Not a hands on, just shadowing another doctor.

Eligibility: Either a medical student or after graduation

- Not considered as a USCE by most of the programs.

- Some hospitals might let you touch and examine patients, but legally you are not supposed to.

- Best to fill the gap between graduation until residency application or end of the season.

- A reasonable time spent a big university or a community hospital that takes IMGs into residency is fruitful.

C. Externship: Hands on clinical experience.

Eligibility: After graduation

- Some programs doesn’t consider it as USCE as this kind of experience is mostly offered by private agencies or at private clinics.

- The LORS can mention it as hands on.

- Best to do if you haven’t had any clerkships

Dr. Thinker: USMLE STEP 2CK and STEP 3

I am not going to explain this in detail as I already did it for USMLE Step1. The approach is the same. Once you are done with Step1 exam, you will get a hang of it and you are going to become your own master of USMLEs.

USMLE STEP 2 CK

When is the ideal time to give it? – It’s best given asap after USMLE step1. It will save a lot of time as your basics would be strong and fresh.

Duration: 3 months if given immediately after USMLE STEP1. Otherwise 4-6 months.

Resources: MTB 2, MTB3, Uworld

Practice Tests:  1. UWSA    2. NBME forms 1-7

Dr. Thinker: USMLE STEP 2 CS

When to give it? 

1.      Ideally give it after your clerkship or observership, as you will get to know how to talk to patients in the USA.

2.      It can be given before step 1 or after. It doesn’t matter. I gave it before step 1.

Dr. Thinker: USMLE STEP 1

USMLE STEP 1

Ideal Duration: 6 months (But, remember it varies from individual to individual)

Resources: Kaplan notes, Kaplan Videos, First Aid, Uworld

 Alternative resources:  If  you are aiming for high scores    

Dr. Thinker: FAQs regarding the application for USMLE Step exams

These are some of the questions I had encountered on multiple occasions from many people.

1.      Can we change the testing center from some country to the USA or from the USA to some other country?

-          Yes, you can change from any country to another country.

-          Just call ECFMG customer care. They will give you a number to which you can fax your request. You will just have to write your details and the request “Please, change my testing center from “current country” to “the country you want”, on a white paper and sign at the bottom.

-          If you change your testing center from any other country to the USA, then you will get a refund for the testing center surcharge fee(150$) that was earlier charged in your country.

-          If you change your testing center from the USA to any other country, then you will be charged a testing center surcharge fee depending on the country you are changing it to.

Dr. Thinker: My journey

I am sharing my story mainly for those who go unmatched or thinking of giving up at
every hurdle that comes in the USMLE path. I didn't match at my first attempt, too. We may not
have the same problems overall, but I totally understand what you would be going through. I
didn’t have any financial troubles ( thanks to my parents and brother), but emotionally it was a
nightmare until Mar 14, 2016, considering the fact that even my family wouldn't have been
happier with me giving it an another try( can't blame them).

Journey: We think we need some help or seniors for securing electives and all. In reality- it’s
just an excuse we give ourselves. Of course, having them will make it easy, but not having them
isn’t the end. I did it all by myself with the help of google. That's one reason I keep answering
queries on usmle pages, as not everyone has someone to back to them up. Remember -
Contacts don't just happen for everyone, you make them!!

Dr. Thinker: Note

DON’T GIVE UP

 You may not match this year,

 you may not match the next year.

 But, you will have to and for sure will match one season.

 As, matching can only be delayed and not denied.

 Provided, you don’t GIVE UP.

Dr. Thinker: A path to USMLE contents page

Hey everyone!

Our new awesome author Dr. Raja Chandra (Pen name: Dr. Thinker) is going to share his USMLE experience with us in the next few posts. He is also planning to write a few funny posts. Who is excited? :D

He took out his precious time and wrote everything he had come to learn about USMLE in the past couple of years. This is a contents page that helps you navigate so that you can read what is pertinent to you at this stage :)

Hope it helps! Good luck.

Thanks a lot for sharing this with us, Dr. Thinker! :D

Step 2 CS: Writing examination in patient note

Hello! In this post, I'll be noting some points how to write a patient note for step 2 CS. Especially, focusing on short forms that can be used in the exam.

I have noticed that writing the note in ALL CAPS is better and it does save a lot of time. Similarly, instead of using the "colon : " you could use the "dash - " and it'll make life simpler.

Step 2 CS: Loss of consciousness

Differentials:

Seizure - Ask for shaking, tongue biting, rolling of eyes, incontinence

Hypoglycemia - Sweating, fatigue, excessive hunger

Orthostatic hypotension - Ask for palpitations, positional syncope or hypotension associated with large meals. Medications can cause this. Counsel this patient properly by warning them and ask them to get up slowly, etc.

Vasovagal syncope: What were you doing when you lost consciousness?

Step 2 CS: Amenorrhea

I am just trying to set a sequence of questions to ask in the exam, tests to order and examination to do so that I am not all over the place in the exam.

So here's what I am going to do if a case of amenorrhea shows up - Ask about general menstrual history and then go to symptoms specific for differentials:

Anatomy and Neuroanatomy - How to Study

Hi guys, I'm Jay once again, and I passed my Anatomy and Neuroanatomy subjects today in my first year. yayyyy!! :D

So I thought I'd share some facts about how I studied anatomy in my MS1 or First year of Medicine.

First, which books to read?

Is Homosexuality a disease? Is Gay a gender? (Sex, Gender and Sexuality)

We got these questions, many times in our Whatsapp study groups! No, is the answer to both questions. Let's find out why and lets find out much more information about what is Sex, Gender and Sexuality(Sexual Orientation)!

Neonatal screening test mnemonic

Hello! The mnemonic for neonatal screening test is:
"BCG PH"

Mucosal edema and effect on absorption of diuretics in CHF

Say, a patient comes in with exacerbation of heart failure. He was previously well controlled on a good drug regimen including oral lasix. It is a tendency to give diuretics (Like furosemide) in the ED intravenously (Even though they can tolerate oral meds). Ever thought why?

Step 2 CS: Noisy breathing

I think mnemonics aren't required for every case if you have the correct thought process, you will ask the right questions.

Hyperkalemia

Hey everyone! Here are some review questions about hyperkalemia:

What is the physical examination finding you are likely to see in a patient with hyperkalemia before you order an ECG?

Antibiotics that can penetrate pancreas mnemonic

Hello!

There are only a few antibiotics that can penetrate infected pancreatic necrosis, a complication of acute necrotizing pancreatitis. These are carbapenems, quinolones and metronidazole.

How do I remember these antibiotics? Mnemonic!

Diagnosis of celiac disease

So today, we were discussing differentials of weight loss when someone mentioned celiac disease. What tests do you usually order to diagnose celiac disease?

We answered:
IgA endomysial antibody (IgA EMA)
IgA tissue transglutaminase antibody (IgA tTG)
IgA deamidated gliadin peptide (IgA DGP)

But there is something else which also needs to be ordered if these tests are negative. Do you know what it is?