Few tips while going for an elective!

Beginning of your big day

Day 1 

1. As you arrive at the hospital have a big smile on your face.
2. Meet the program coordinator and thank her for the opportunity.
3. She will help you in getting your daily routine schedule, ID and access to the computers along with EMR (Electronic Medical Records). Do it as soon as possible since you will be lost without it.
4. You will be taken to meet the residents and fellows who generally are very sweet and welcoming.
5. Introduce yorself to them and keep smiling
6. Try to remember all of their names. If you miss out on a few, try sneaking a look at their ID badges. 
7. Try asking the Residents/ other students who have been in the rotation earlier than you for the routine schedule, the Attending on service and try building a rapport. Also find out what time are you supposed to come in the morning  the next day.

Day 2- : Your routine day begins.  

• Dress yourself professionally. 
• Wear the apron.
• Try to be in the hospital before the residents come and read up on the cases via the EMR.
• You can go with one resident while he is pre-rounding on his/her patients and see how they talk and examine a patient. It is very useful and at the same time you learn new tips and tricks.
• You can also build a good rapport with the nursing staff. Some of my nursing staff were decent enough teach me a few tricks which I do not think even the residents knew. 
• Say good morning to everyone you meet. Talk to everyone. You feel happy and so do they.

Regarding asking for a Letter Of recommendation.

This is the most crucial part at the end of your elective. I found the following tips useful

• Prepare yourself well.
• Get an appointment with the Attending whom you have a good rapport and have worked for a substantial amount of time
• Look good and confident
• Meet him/her in the office.
• Have a copy of your resume and personal statement in hand

  

What to talk during the meeting for LOR-

• Don't talk about the LOR at first. (I almost made this mistake)
• Talk once again regarding your background and how you enjoyed the elective.
• Talk about what all things you learnt during this elective.
• Thank him/her for teaching you all these days.
• Talk about the resident, fellows whom you worked with.
• Strongly ask for guidance / suggestions from the attending in all your future plans.
• Lastly ask if he WOULD BE COMFORTABLE writing you a STRONG LETTER OF Recommendation as you are planning on residency in the States. If he says yes without blinking then you can be rest assured you will get a decently written LOR but if there is hesitance, you might as well not ask again.

FINAL DAY:  

1. Try to meet everyone you worked with.
2. Thank them for the opportunities you had and tell them how you enjoyed being there.
3. Get their mail or Facebook ID’s to be in touch with them later.

Edited from the original post here

Clinical Skills - Nightmare of the lot!

Trust me I underestimated many aspects of this exam and really earnestly repent doing so. I hope that by the end of this article, you will overcome the mistakes that I did and realize how to avoid common pitfalls and be better prepared compared to me. Few things I want to tell you before I start with my experience are the following

1. The cost: It burns a HUGE hole in your pocket. It is nearly double the other exams, not taking into account the additional travel and hotel expenses you would have to face while going to testing center.
2.  Don’t Wait. Schedule Early: This is one think I wished I knew earlier. Do try to schedule early, because oftentimes test dates are difficult to find. Furthermore it can take up to three months to receive your results. Also you have the eligibility criteria for a year and this is WAY more than the 3 month period that you get for the other steps. You can find out when your results will come by checking the following link: Reporting Schedule
   Also to get the desired date you can use an app called check4change. A brief intro on how to use the app is given HERE.
3. Know that the examiners are scoring you on 3 aspects and you have to pass all 3 components individually in order to clear the exam. The 3 components are: Communication Interpersonal Skills (CIS), Spoken English Proficiency (SEP), and Integrated Clinical Encounter (ICE). The exact details and directions can be found in First Aid CS and Neeraj notes.
4. Prepare Appropriately: Which leads me to my last most important part of the post – PREPARATION.   PRACTISE PRACTISE PRACTISE. There is nothing more important than this. Best would be to practice with a friend who is also taking the exam so that you both can correct each other or you can try practicing in a group. Make your test day feel so comfortable that it is like “just another day of practice.”

MY JOURNEY!

Let me start off by saying it had TOO MANY pitfalls and this is not ideal. But if I could get through this exam, then you can definitely!

My preparation time would be, say around a month on off and a PROPER week before the exam.

Preparation books - 

1. First Aid CS (use the latest edition since there are changes)
2. Neeraj Notes - Link is here or here
3. Online youtube videos (Mentioned in the post)

I initially started my preparation with one of my awesome seniors who guided me for my Step 1 preparation, who is Ms. X in my 1^st Step 1 post. Initially I used to play the role of the patient for her, so that I could learn from her how to actually take a case. After a week she told me that I should try asking her questions and play the role of the doctor. It was then that I realized it is not easy playing the role of the doctor. You had to ask all the right questions in a time frame of just 15 minutes. But as I practiced I figured out my short comings and became better with time or at least I felt like that. 

Later I had to study for my Step 1 and hence I could not practice with her. Furthermore she had to go for her electives. Anyhow moving on, I gave my Step 1 and thanks to god cleared the exams not with flying colors but with some colors none the less J And then there was the elective hunting in between and studying for CK.

Finally my close friend who was also preparing for the USMLE, suggested that we start practicing for the CS, which I thought was a good idea. So we decided we will try practicing say an hour or 2 daily by doing alternate cases as patient and doctor. That way within 15 -20 days on-off practicing we were done with most of the cases. Initially we thought of trying to do a simulated case scenario of at least 5 patients but do not think it went through, since we each had our own commitments to attend to. After that, in the month of June if not mistaken, I started earnestly preparing for my CK, I think earnestly would be an overstatement but none the less, I started preparing for it. Finally I gave my CK on the 24^th of July and then flew to the States on the 28^th of July. I did not touch my books for CS after my CK exam since I thought I anyhow knew everything and I deserved a break. How mistaken I was! My exam was on the 11^th of August and that too in Los Angeles where people on the forums have said is a definite flunking testing center for IMG’s, second only to Philadelphia. I wish that at least would have driven me to think of studying :(

On the 1^st of August I opened my books and everything that I thought I knew looked like Greek and Latin. I could not even remember how to take a proper case anymore! I had lost touch with my case taking skills!! With only 10 days remaining for the exam I started panicking like I always do. I tried talking to my friend but guess he was a little too busy to answer my questions which were kind of dumb now that I look back at them. I tried getting study partners online and on Skype by posting on Facebook, USMLE forums if anyone wanted to practice but to no avail. It seemed like no one was giving the CS other than me then which was kind of weird and scary. It was a night mare to be in my place to tell you the truth!

Finally, as always, I tell my parents of my unfortunate plight and as always they are supportive and they say do not worry, God is there! The next day while I was talking to my dad, I have no idea what got into him to say that, but he told me to let him be the patient and let me practice on him. Initially I thought it would be a disaster since my dad is a non-medico and it is kind of difficult to make him understand what I need him to tell me but boy was I wrong, my dad was a PRO at this!! Barring the 1^st case, for the rest of the cases my dad kept rattling out the complaints like a proper standardized patient. I was truly amazed by that! Now, seeing that my dad was getting all compliments from me, my mom feeling jealous joined the bandwagon and from no patients, I had 2 standardized patient to try my skills on :) Thankfully to God’s grace someone replied to my posts in the forums and said they would practice with me and I got more patients to practice on. I also called on my friends in India who readily accepted the challenge of being my patient so also my sister. Trust me this may sound really funny when reading, but when you are in my situation, you will realize Necessity is the mother of Invention! I gradually started picking up on speed and my timings were coming within 8 minutes for the questions and counselling, and I allotted around 7 minutes for errors, physical examination, knocking on the door and other routine stuff. Towards the end, my senior called me again and asked how was my studies going and then she gave me an awesome tip which I feel all of you must try asking your patients if everything is going downhill according to you – ‘Can you tell me what do you think is wrong with you?’ . This may seem like a dumb question but in the exam it was a life saver!! Could never thank her enough for this J

One of my study partners, sent me the link to an awesome video by a lady named Laura Miranda. I do not know who she is or what she is doing right now, but her videos are splendid! The one that I want you to definitely watch is this one which has all the mnemonics that you could use for your exam is THIS video. You can watch her playlist on how she prepared if you have time, but I did not go through it due to time constraints. There is another lady named Karine Darbinyan, who has very painstakingly taken the effort to make a playlist on videos regarding how to type the patient note which I had found to be very useful.  The playlist link is THIS

During my electives I had really sweet residents, fellows and Attendings, who knowing I had my exam, allowed me to tag along with them when they were talking to patients and made me realize that I had it in me to clear the exam. There are numerous to name but would want to say that they are at UC Davis and I pray they are all doing awesome!! This may sound funny but on the last day my Attending, who is a super awesome Nephrologist back in California, even had a mock patient interview with me in front of the residents and fellows. Guess many would back out from such an opportunity, but I grabbed it with both hands and tried my best to interact with her as the patient, using all the knowledge and dialogues I learned while following my residents and fellows. Though initially it was embarrassing, I felt that it was an awesome experience which helped me boost my low confidence that I was ready for the exam. My luck was so good that everyone even told me where I went wrong and what I could do to improve my patient handling skills.

Finally I flew to Los Angeles on the 9^th and stayed with my cousin who is a super chilled out dude! He even told me to relax and that my exam would go fine and I will be awesome. I have no idea somehow my entire family knows I will be awesome except me:O So on Saturday, he and his wife took me to see Hollywood and I got photos clicked with the Minions and had an awesome Saturday, free from tension. The next day I went for Mass, where I prayed fervently to God to pass me somehow and save my sorry ass as he always has. The priest in the church also gave the sermon which kind of echoed my thought to just blindly trust in God and he will do the rest. I was filled with confidence then. That evening I practiced one final time making my cousin the patient, to which he readily agreed and even provided me with the instruments that I could use during examination, thanks to his wife.

Doomsday August 11^th finally arrived. Before going to the exam center, my cousin and his wife prayed for me and then I went to the exam center. I was confident I would do okay types since I knew I just had to do 10 patient encounters decently well to pass the exam. Once I enter the center the receptionist gave me a broad smile and told me to show her my scheduling permit, along with the confirmation letter. I was then sent to a room where the guy checked my stethoscope and then gave me some ID number and I sat down with the rest of the test taker. It went exactly as it is picturized in the video given here 

In my exam center most of the test takers were Americans and some of them looked so confident that I wanted to wet my pants in anxiety. Later I do not know what got into me but I just made small talk with the 2 girls next to me who were sweet enough to talk back and then I felt calm and realized this is just an exam to see whether you can talk to a patient properly and guide him correctly on the next course of action. They do not expect to see a wonder doctor now, they want a kind comforter and I said to myself this is what you are good at, be cool, smile and comfort them. Another word of advice that my senior gave was do not go in as a doctor to boss them around but go in as a friend to comfort. She said if the patient is smiling at you when you close the door, you can be assured you will pass the exam.

When I started my encounter with my patients let me tell you this- My first patient was a disaster! I did not even get to the counselling aspect when my time was up:O My next patient went a little better, but after this my patient encounters started going better than the earlier ones and I started getting into the groove of asking questions and chatting with them. Let me give you an example I had a grandfather as a patient, and I asked on how were his grandchildren which seemed to brighten him up and whenever I did anything painful, I used to try to divert his attention to his grandchildren and finish the maneuver then. That way he was also happy and I got my work done too. When I came out of the exam I felt that I mostly will pass but as it is human nature I started doubting my abilities and started thinking that I would flunk since it started flashing by me the countless mistakes I did. I kept praying fervently to God to pass me and finally when I got my results on the 9^th of October and I saw that I passed I could not stop thanking him enough.

Last but not the least there is a site called Targetusmle.com I think you can try practicing your patient notes here, since when you click on submit, the PN comes to your email ID, which is really awesome. But I would recommend always practicing on the one given in usmle.org site since there are line and word constraints, which are not present in targetusmle.

People who read this post I would only request you to share this blog to your friends to help as many people as possible, since I was helped by my friends and seniors and only wish to help others. Finally my humble request is to please pray that I match this year along with my friends.J

Step 2 CK experience

Preparation time of around 2 months properly.

Books referred to

• Kaplan Notes and Videos
• MTB 2 (Master the Boards)
• MTB 3
• 20 cases videos by Conrad Fischer
• Flashcards by Conrad Fischer

Now my method of studying was like this. Initially tried watching the Kaplan videos the same way I watched it for Step 1 using 3X speed, but this time I did not repeat the mistake of marking in Kaplan textbooks, but marked them in MTB directly since they generally are the same.

There is a lot of confusion on what to read for Step 2. I would say the following. For all internal medicine stuff MTB 2 and all other subjects MTB 3. This is what I did regarding the 2 books and how to read them. Say at the moment I am reading an IM related topic, my base book would be MTB 2. I would quickly go through the book and later quickly scan through MTB 3 and see if there is anything extra or if it the same. If I found anything interesting or better explained in the MTB 3 I would copy it into the base book or make a reference in MTB 2 that the particular topic was well explained in MTB 3. So this way covered both books simultaneously and learned new stuff if any. I know it sounds a bit tedious but you might as well slog now than cry later.

Towards the end of the study period I would recommend using the flash cards. If you can't, then recommend at least Fischer's 20 cases. You will definitely remember them during the exams since they are funny and very graphically explained. I did not give any NBME’s so don't ask me about it. I only gave a UWSA and got a score of 238.

Regarding USMLE world utilization, I would advise this while studying MARK QUESTIONS that you feel is too much to remember or write down in the book, no matter whether you got it right or wrong, so that towards the end prior to your exam, you can do ONLY those MARKED questions and nothing else. Because in the end it comes down to how many times you have done USMLE world and how much you can remember and how quickly.

Finally at times you might feel you are ill prepared for the exam since you just heard someone give some long convoluted explanation for something which you have a simple way to understand, follow your method because it way more easier to remember and reproduce at the exam.  I mean some person I studied with knew all the anti-arrhythmics and which class they belonged to. I naturally started panicking that I have no clue about that. I just knew adenosine or some drug was used for the problem and that was the end of it. He even explained the idea behind it, but now that I look back it though it made me wiser it did not help me in any way for boosting my confidence or score since if you the basic gist of why something is done it should be enough.

Lastly please don't think you don't know anything and that you will mess up, trust me you won't. Taking my own case let me tell you that I even wanted to delay my exam or so to say drop the entire year and prepare for the exam later. But my mom firmly told me if I delay this exam she will not be sponsoring the rescheduling fee and that was just 2 weeks prior, so imagine my plight then. She happily even states that she has full confidence that I will get a good score. I tried convincing her otherwise but to no avail. 

Finally when doomsday arrived I only thought I would be flunking but by the grace of god and of course my parent’s prayers got a decent score of 242. Not too bad I must say at least for the effort that I put just happy it a decent scoreJ

This was in short my study method. I owe my scores to god definitely and so also to my parents and friends for praying for me.

People have asked me which book is good for what. The following is how I did it. You might have your own preference. Stick to what is good for you.

MTB 2

• Infectious Diseases plus MTB 3 ending
• Allergy and Immunology
• Cardio
• Endo
• Pulmonary
• Rheumat
• Hemat
• Gastro
• Nephro

MTB 3

• Preventive
• Dermat
• Surgery
• Peds
• Obs
• Gyn

Read BOTH

• Onco
• Radio
• Psyche
• Emergency/Toxic
• Ethics

First trip to the States

After getting your visa your next major hurdle is the packing regarding what to take to US on your first trip since everything looks important when you look at it. Initially I was very apprehensive about this trip because this was my first trip to the States and was scared of being profiled due to ethnicity. However my siblings and cousins told me that it is seen only in movies and not in reality and my god how true they are. People are extremely friendly to the point that even if you randomly meet a stranger and ask him for directions which are not in his path, he may not only guide you but might actually give a drop to that place. I was pleasantly surprised. 

Just a note before you start reading. This post is meant for people who like me are really worried about what to carry and what not. Also there may be a lot of grammatical errors in the post. Kindly ignore them and take what is required :) 

BEFORE FLYING

THINGS TO BUY & DO in India/ Home country

Hospital: Carry a decent number say 3-4 trousers, 5 shirts and 3 ties as these are allowed to wear at hospital. You can add sweaters too if you are going in winter or cold weather. One suit or blazer is enough, although I never used it but it differs from place to place. You usually wear an apron in the hospital, so you can use the suit in presentations or formal meeting or when asking for an LOR. Also a stethoscope and maybe even a torch

Apron/ Lab coats: Do carry two, since it is expensive to get a lab coat in the States. They are generally compulsory everywhere in hospital. For medical students like us, the style of lab coat is short waist length (just crossing your hips) and full sleeves. Better look at the HOUSE MD TV show to get an idea :P

Shoes: Plain black or brown shoes normal leather style is used. Do take an extra pair if you feel that it might break before going to the States.

Casual wear: Carry few jeans (2) and casual t-shirts (4) for roaming around the city. Good pair of sneakers.

Innerwear & socks: Buy at least 10 sets of them, coz you will not be doing your laundry every day, but usually weekly or even fortnightly.

Medicines & Stationery: I carried one packet of medicines (PCT, Cetirizine, Volini etc.). Do carry since they are very expensive and NOT OTC in the States. I highly doubt a prescription is needed unless you have a serious disease like asthma or DM and you would need to carry your medications on the flight.

Gifts from your country: Always take small tokens as gifts when you part with each of your mentors. People like them a lot and it indirectly tells them that you cared enough to bring them gifts all the way from home. Would advise taking small size items, nothing huge.

Miscellaneous stuff: Stationery, pens, soap, tooth paste brush and other daily items. Here’s a tip I got from someone, have a paper in your hand and write down things that you need to use daily so you don’t forget to take them when needed. Even though you have weight limitations it is always better to buy it cheap from India rather than buy the expensive stuff in the States.

Plugs & Convertors: Best is to buy a multi-convertor from India and an extension cord with multiple ports in order to use your laptop, cell phone charger (they generally have 110-220v on the adaptor.)

Food: Learn some basic cooking before coming which can help you to save a lot of money. Prepared food is expensive in USA, compared to eating at home, even if packaged. If you want to save money, try to have 1-2 meals every day at home. Finally try to meet all your ‘long distant relatives/long lost family friends’ in the nearby areas to satisfy your cravings for home cooked desi food. Trust me you will want to eat Indian food after a few weeks. I tried not to spend more than 10$ a day on food, either outside or at home.

Finances/ Cards: I used the ICICI bank travel card which gives you a good rate if you buy a minimum of 500 $ and goodies like travel insurance. Best is to ask the sales representative about the details of the card. They charge if not mistaken 150 bucks for the card and later no charges. I also bought a Thomas Cook multiple currency Card which is also decent. You can do the entire procedure online rather than visiting the agent since they charge an additional 250 bucks if you do it via the agent. The online version is cheaper and easier. Lastly bought a card from HDFC from the travel agent who was sweet enough to give me a decent discount on the rate since have been doing business with them for the earlier trips to Europe. (Trade Wings for the guys in Mangalore) PS - I am not being paid anything for this, but recommend them since they are really friendly.

FINAL PACKING:  You have to fit all the above into the following bags

·         Check-in baggage- 2 bags 23 Kgs each (50 pounds)

·         Carry-on bags -A laptop bag (1) and a small trolley bag (1).

In summary 2 check-ins plus 2 carry-ons equalling a total of 4. The carry-ons generally have a limit of 8 kgs and in general should be able to fit the overhead compartment of seats. Usually, any liquid, gel, knife, scissor, blade, shampoo or aerosol items are not allowed in the carry-on baggage; though one can carry all these in the checked in baggage. Generally they do not weigh the carry-ons, however once they had weighed my bag and even though it was a bit on the heavier side, the lady on the counter was courteous enough to allow me to check-in that bag for no additional charge J  

You will get your check in luggage at your FINAL destination, but always confirm with the person who checks it in where you would have to transfer or collect your baggage, since different airlines have different policies regarding that. Also at the counter they give you a baggage tag, THIS IS IMPORTANT at-least till you collect your luggage at the final destination, since if you do lose your luggage, god forbid you do, you will NEED THE TAGS. I also strongly recommend to write your name, address, contact number on a piece of paper and then paste it on all your bags. Sometimes, the bags gets lost and such information on bags helps airlines identify your baggage; the last thing you would like to have after landing in US, would be to get your bags lost!

AT THE AIRPORT:

Security checks in the airports: Before entering any gate/ lounge area for connecting flights, you have to go through security check again. You have to remove your belt, shoes, wallet, cell phone and any other metallic item. If you are carrying a laptop/ notebook, make sure you take it out of the laptop bag and put it separately in a tray without anything else in it. Note: You can carry an empty water bottle.

First of all, you pass your luggage and yourself through security check. Then you go to the counter of your airlines, show them your e-ticket/passport/visa, get your boarding passes and submit your baggage except the carry-ons. After that, you might have to pass through another security check and then through the immigration/visa officers. After that you enter the lounge go to the gate number mentioned on the boarding pass. When it is boarding time, they make an announcement and you board the plane. Make sure you are at the gate at the boarding time (generally 30-60 min before departure time).

Note you need a ROUND TRIP TICKET for entering into the States, else you will have to buy the return ticket then and there and it will NOT be to your liking. If you are unsure of your dates, it would be best to buy your tickets via a travel agent since you really do not want to have the additional burden of cancelling and rescheduling your tickets when you are in the States. Also in case you plan to buy stuff from the States like electronic stuff like a mobile phone or Laptop, better declare the stuff like the ones you carrying at India else you would have to pay a hefty price when you get them back.

BEFORE LANDING:

Customs: Before landing US, you are given a customs form in the flight. You have to mention the total worth of all your baggage, your name, passport number and other details on it. You have to submit your filled and completed custom form over there and then do a security check on your bags.

Visa Clearance at the Point of Entry: Once you reach US, stand in a queue with the other passengers and then wait for your turn to be called to the visa officer. There are separate queues for US Citizens, Green Card holders (US Permanent Resident), Immigrant Visas and Non-immigrant Visas; make sure you are standing the right queue (generally immigrant visa); look closely towards all the signboards before going towards any queue. It is always better to be in the start of the queue when de-boarding; you get free early and thus might be in time for your connecting flight.

Once your turn comes, the visa officer takes your passport, looks at the visa, takes a small interview (from where you are coming, why you are coming, when you plan to leave, who would be paying for your stay etc.) and stamps your passport allowing you to stay in US. Carry almost all copies of documents you carried for visa interview. Maximum duration on a B1/B2 visa is 6 months. Make sure you collect all your belongings, carry-on baggage and especially passport before leaving.

The things they always ask for is

1. Return ticket (vide supra)

2. Reason for travel (elective acceptance letters, CS confirmation letter etc.)

3. Place of stay in USA (carry an email or invitation letter with address, phone number of the person you staying with)

They may ask you stuff like what is an elective and stuff like that. So at times it may sound like a re-interview of the visa. But note that you are a medical student going for a US clinical experience/ CS exam and not a thief, be sure of what you say and be confident.

Collecting Baggage: Once cleared from visa, you now have to collect your checked-in baggage at the baggage claim area; follow the signboards to find the baggage claim area. You should have their tags with you all the time, which are provided to you when you checked/submitted your baggage and got boarding pass for your first flight. It’s convenient to have a cart to carry your baggage. Once you have the trolley look for the station number where your baggage would come, it is displayed on the monitors in the baggage claim area. Once identified, go there and collect your baggage. Once you have collected your bags you would have to your passport and visa to another person before proceeding towards the next flight. 

Connecting Flights: Once you have your bags, go towards the counter of your connecting domestic flight, show your passport and boarding pass, check in your baggage, you may have to show the baggage tags to them otherwise you will have to pay for baggage.

Remember, on domestic flights you have to pay for checked bags but if you have a connecting domestic flight as an international passenger, you don't have to pay for checked bags (if they are not over-sized or over-weight) and to prove that, you need to show your baggage tags. Once your baggage is checked in, you head towards the gate number of your connecting flight.

Generally it takes 2-4 hours to get cleared from customs, visa, collecting and checking in baggage and then reach the connecting flight gate. So it is advisable to have at least 4-5 hours of lay-over on your port of entry (first city you land in US). No meals are served on a domestic flight, so it is better if you eat something if you have a long connecting flight.

AFTER REACHING USA

Once you have reached your final destination, you head towards the baggage claim area, collect your baggage and go to your new home. Welcome to USA! Have a nice time! :D :P

Travelling from/to Airport: You can get a taxi if you live near to the airport. I recommend Super shuttle- It is way cheaper than the normal cab fare. They generally take $20-25 to take you from/to Airport from/to your place. You can make the booking and pay online but I recommend paying at the airport (PS- They may have a discount online, which reduces the cost). Usually they have a counter near the baggage claim area; just look around and you would find a Super shuttle counter (ROYAL BLUE COLOR). Tell them your destination, pay them and they ask you to write your name and contact number on a paper for them. Then you wait for 10-20 minutes and their shuttle arrives. It is a shared transport (like a minivan Eg- Big huge ass TATA SUMO/ Omni) and you might have to wait a bit to reach your place because the driver might drop other passengers before you. If the taxi cab/super shuttle driver (or a waiter at your hotel) is really helpful you can give him  a $1-2 tip. However it is NOT A MUST as I feel you are technically a student and not earning.

Residence: People find it difficult to find places to stay before visiting US for the first time. Though on-campus housing is the best/ safe it is not always available. People have said trying craigslist.org or airbnb.com can help. Never used them but it is wise to ask for the pictures of the room and the place and to confirm the total rent including all the utilities (including gas, electricity, water, internet etc.).

Google Maps: This tiny app is a life saver in the States. You can use it to get around places in the States. If you are selecting public transport, make sure you select the right time of travel, you will be provided with all the details e.g. bus number, route, stops etc.

Travelling within US- Frankly, people in the States generally do not use public transport very often. So you might have trouble finding local buses like you find in India. But always good to check on google maps before giving up hope.

Travel by air is the fastest and best I feel. If you book early (1 month in advance you can get good rates. You can also use an app called skyscanner and put a watch list) Airlines charge $ 25 for the 1^st checked in bag and $35 for the 2^nd which is a lot. You can try booking on Jet Blue or Southwest airways where they seem to have free checked in baggage, but the flight cost is equally expensive. So choose wisely!

Finances: Please note that for withdrawing there is an additional $2 charge per transaction. However if you use it while shopping i.e. swiping for payments they don't have any surcharge. Also a trick that I happened to stumble upon, while making purchases in the stores there generally is a cash back option, so just in case you happen to run out of cash, you can use this method to get up to $10 without any additional charges.

Cell phone: Please do not go by what people tell you regarding Sims and plans and stuff like that. I would advise you to go to the nearest supermarket store like Target or Walmart. They generally have a host of options. In my case I bought a sim card which was only $35 compared to the plans which the rest had to offer like 50$ or 60$ for T mobile or AT&T (H2O wireless- The plan details were unlimited calls and messages plus an additional 500 MB data, with an hour or so of international calling which was more than enough for my needs; since the hospital generally has guest Wi-Fi which is a KILL, and is unlimited with good quality speed) I mean the number is ONLY for people to contact you on an emergency basis and for fellows or residents to contact you in case there is an exciting new case so why spend a fortune on it?

Online calling / VoIP: There are a host of applications which can suit your needs. But I would say Google voice calling is the best. I initially had no number to call people, so I used it to make free calls. There is an app called Hangout dialler + which helps you to make calls via the phone. Skype has an offer called unlimited world calling and you get the first month free. This is a bogus I feel since if you do not ask for a refund before the month ends they charge you for the entire month regardless of whether you used the feature or not.

Lastly best of luck to all you guys. You will be awesomeJ

I had found the following sites very useful during my intial data gathering for my trip: http://umartariq.com/node/158 and http://www.umartariq.com/node/171

Additional info by Bhaumik Shah 

• For free call within US&Canada = MagicJack App ;
• backpage.com to check for shared accomodation & HostelWorld.com for hostels & cheap hotels for people who are visiting for a week or two; 
• Skype/Viber for India Calling if someone doesnt want to get US number..as it will save atleast 55 bucks...
• For food= Deep paratha ( paneer maratha & many more), Haldiram sabji, from Rumi's market or Patel Brothers or some local indian store...
• Look for a host who has bike(bicycle) if you want to save money for local transport specially when couple of miles away...or one can buy new bike(bicycle) which costs approx 70 bucks and then you can sell..