Welcome to the student & trainee section of the Kuwait Health Initiative!

This page will provide prospective residents with information pertaining to medical training in the United States.  You will find advice on electives, the united states graduate medical education application process, how to optimize resumes and personal statements as well as a wealth of recommendations on international medical graduate-friendly programs.

Step-by-step approach

First, you must ask yourself what it is you want from the united states’ medical education system.  Are you seeking a different educational experience, a way to differentiate yourself from your colleagues?  Are you looking to set up a research partnership with a leading researcher?  Do you want to optimize your application to residency programs by placing yourself on the map?  More importantly, do you want to make a difference in Kuwait?

Whatever your reasons are for seeking education in the United States, be organized and well prepared.

Know your specialties.  Know which fields are deficient in Kuwait (i.e. where most of the difference can be made).  Know what is involved with training and practicing in each of the different specialties.  Know what opportunities are available upon your return.  Know whether you are interested in an academic career or a purely clinical employment.  Know how and when to take your medical licensing examinations.  Communicate and do not forget to google everything!

Know that to increase your chances of entering residency programs in the U.S., you must be recommended by people known to this environment.  This is why elective time in North America is crucial.

Step one

Register for your USMLE exams.  There are three different tests you need to worry about, two mcq exams done in Kuwait at the Amideast Salmiya Center (Step 1 and Step 2 CK) and an oral exam done in the U.S. (Step 2 CS).  The TOEFL is no longer required for ECFMG certification.  You can now apply online using their interactive web application.  Try to complete these exams before finishing medical school.  Trust me, it’ll make your life so much easier.

The Educational Commission for Foreign Medical Graduates (ECFMG) is the official organization sponsoring foreign students and graduates.  Essentially, everything goes through it.  So, carefully read and know its information booklet.  It has all the necessary information pertaining to exam registration, certification, medical education credentialing, and visa sponsoring.

Step 1 is traditionally considered to be the toughest test due to its basic sciences content.  However, keep in mind that its result is used as a screening tool by residency program directors.  In the recent years, USMLE has rendered this test increasingly clinical by introducing a majority of clinical vignettes with less emphasis on hardcore biochemistry, pharmacology or physiology questions.  It is an eight-hour exam divided into 60-min blocks.  The minimum passing score on the three-digit scale is 185.  It remains 75 on the two-digit scale.

Step 2 CK is similar to your finals with all the major medical specialties (medicine, surgery, peds, em, public health, ob/gyn. etc.) represented.  It wouldn’t be a bad idea to take this test shortly after your written finals.  It is a nine-hour exam and the minimum passing score is 182/75.

Step 2 CS is an oral exam taken at one of the U.S. test centers.  You will be seeing 12 standardized patients (i.e. actors) within an eight-hour session.  It tests three major components: The overall clinical encounter (i.e. data gathering and documentation), your interpersonal skills (i.e. politeness, bedside manner, questioning skills, information sharing), and your proficiency in English.  It has a pass/fail scoring system.

These exams are absolutely do-able if you focus the right amount of time and attention in your preparation.  As a good starting point, I highly recommend using the First Aid study guides.  They are available for each exam, have great ratings, and provide the “need to know” facts to succeed.  To strengthen weaker areas, they provide a ranking of the best books per subject.  Through a subscription to USMLEasy.com and USMLERx, the authors provide online access to a huge database of high-yield exam questions with explanations and test-taking strategies.  As long as you do not lose yourself in unnecessary readings, a month should be enough to prepare for each mcq test.  For the Step 2 CS, you can also use the First Aid guide.  I used the previous edition of the “Mastering the USMLE Step 2 CS” which gives you a bunch of common clinical scenarios and a checklist of things you need to have done to pass each patient encounter.

Other resources that some have used in the past are the Kaplan courses.  These are basically intensive sessions reviewing core material and exam questions over a period of weeks at designated test centers.  Feedback from people who have taken these courses was, in general, positive.  The drawbacks are the location (Egypt appears to be the closest center) and the cost.

With a little motivation you should be able to complete your requirements within just a few months.  Once done, you’ll be eligible for entering GME training in the United States.

Step two

Once you’ve begun your ECFMG certification process and, of course, prior to your final year of medical school, start looking into doing electives in the United States.  Decide how long you are willing and able to travel for and what experience would be the most beneficial for your future plans.

Example:  You decide to train in emergency medicine.  This means that you will need at least two letters of recommendation from emergency physicians.  Therefore, seeking elective time in emergency medicine is an obvious necessity.  If you have more than a month to spare, consider also doing electives in critical care and/or internal medicine since most of emergency medicine is critical care and medicine.  You get my drift?

Unfortunately, not all universities grant foreign visiting students elective time.  However, as you’ll see from the list below, a large number do including many elite institutions.  So, with your goals in mind, browse the different web sites seeking the electives best suited to achieve them.

The Student Doctor Network and the Association of American Medical Colleges have a comprehensive list of institutions accepting foreign students.  Below are updated links for U.S. and Canadian electives:

Alabama:

University of Alabama, Birmingham 

California:

University of California, Los Angeles

University of California, San Fransicsco

University of California, Davis

University of California, San Diego

Connecticut:

Yale University,  New Haven

Colorado:

University of Colorado, Denver

District of Columbia:

George Washington University, Washington

Georgia:

Emory University, Atlanta

Illinois:

Northwestern University, Chicago

University of Illinois, Chicago

Kansas:

University of Kansas, Kansas City

Kentucky:

University of Louisville, Louisville

Louisiana:

Tulane University, New Orleans

Louisiana State University, Shreveport

Massachusetts:

Harvard Medical School, Boston

Tufts University, Boston

Michigan:

Wayne State University, Detroit

Minnesota:

Mayo Medical School, Rochester (also available in Scottsdale, AZ and Jacksonville, FL)

New Mexico:

University of New Mexico, Albuquerque

New York:

Albany Medical College, Albany

Albert Einstein College of Medicine of Yeshiva University, Bronx

University of Buffalo, Buffalo

Weill Medical College of Cornell University, New York

Mount Sinai School of Medicine, New York

New York University, New York

University of Rochester, Rochester

North Carolina:

University of North Carolina, Chapel Hill

Duke University, Durham

Wake Forest University, Winston-Salem

Ohio:

Ohio State University, Columbus

University of Cincinnati, Cincinnati

Pennsylvania:

Thomas Jefferson University, Philadelphia

University of Pittsburgh, Pittsburgh

Rhode Island:

Brown Medical School, Providence

Texas:

University of Texas Southwestern Medical Center, Dallas

University of Texas, Galveston

University of Texas, Houston

Baylor College of Medicine, Houston

University of Texas, San Antonio

Vermont:

University of Vermont, Burlington

Virginia:

Virginia Commonwealth University, Richmond

Washington:

University of Washington, Seattle

Wisconsin:

University of Wisconsin, Madison

Medical College of Wisconsin, Milwaukee

British Columbia:

University of British Columbia, Vancouver

Manitoba:

University of Manitoba, Winnipeg

Nova Scotia:

Dalhousie University, Halifax

Ontario:

McMaster University, Hamilton

University of Western Ontario, London

University of Toronto, Toronto

Quebec:

McGill University, Montreal

Step 3

By now, you should be familiar with the ECFMG certification process and the medical institutions providing access to elective time.  Not to be repetitive but the trick is to time things correctly.  By the summer of the year preceding your entry into a GME program, you must know what specialty you’re interested in, have performed or secured elective time and started investigating programs of interest.  For the latter, you may opt to google the hospitals you’re interested in or look up the ACGME web site for a list of all accredited programs in the U.S.

People apply to places based on the programs’ acceptance rate of international medical graduates (IMG), personal research interests, exposure to an indigent population (e.g. county or community-based practice) versus a more select patient base (e.g. geriatric, foreign nations, mixed pediatric and adult, etc.). programs are essentially split into public and private institutions.  Keep in mind that, as a general rule, acceptance to graduate medical education programs in the United States remains a tough endeavor, even with a scholarship at hand, but certainly feasible nonetheless.  It also greatly depends on the chosen specialty.  Some are extremely competitive or have little experience in dealing with IMGs or sponsored trainees.  This is where education comes in handy and where our foreign bureaus (embassies) could provide the most help.  The more you are demanding support from our cultural offices, the more likely things will change and relationships will be established with elite medical institutions.

When starting your applications for residency, you should begin by visiting ECFMG’s ERAS web site.  It has all the info you need to successfully go through the application process.  In brief, you will need to register with ERAS after July 1 (the electronic residency application service) after you receive a token from ECFMG.  Of note, ECFMG acts as the designated Dean’s Office for foreign medical grads.  Via ERAS, you will electronically submit your CV, personal statements and complete the common application form (CAF).  The medical school transcript, letters of recommendation (LOR), photograph and other supporting documents need to be mailed to ECFMG for them to scan them into the system.  You’ll also need to request from ECFMG to submit your ECFMG certification status and USMLE transcripts on your behalf.  All this can now easily be done electronically via ECFMG’s OASIS application.

ERAS allows you to choose various programs, which do not need to be in the same specialty, and assign different LORs to different programs making the application process a whole lot easier.  The more programs you pick, the more fees you’ll have to pay.  Next comes the NRMP’s Match.  This process allows you to rank your list of top programs (the programs will rank you after the interviews) and ultimately match you with a program that has ranked you highly.  This occurs some time in mid-March.  For sponsored trainees, it is often the case that an agreement is reached with the interested training institution and the Match process is bypassed.  We’ll get to that in a bit…

Coming soon:

Optimize your application package

Life as a resident

and lots more…