Pediatric board preparation

Senior recommendations and advice
The predicted breakup for the board questions:

• Between 60-70% MCQs are from concepts asked in the previous years 
• Between 20-25% MCQs are questions asking a more difficult concept but from the same topics from previous years
• About 5-20% of the questions are newer topics/very difficult or impossible questions

Therefore, its almost impossible to pass without doing the previous years questions!!

Application procedure

• Opens in January or somewhere over there and it is administered over 3 day period in mid-October
• Prior to sitting and writing it you will NEED a PERMANENT license to take the boards. My sincere advice is to start applying for it early. However, it also depends on where you are practicing/doing the fellowship. Since some states like MA, do not allow a permanent license for IMG's unless you have completed a residency (3 years of training in the States)
• Do note- You can register for exam w/o license but need proof of it prior to writing the boards
• Once registered for the exam they will send you an email maybe 2-3 weeks later telling you can schedule your exam. I took my test on Day 2. 

Documents needed for above
By early July

• Copy of your medical school diploma + English translation, if necessary
• Copy of ECFMG Certificate or documentation of successful completion of the MCCEE or Fifth Pathway/FMGEMS

By October 1st of the year you are writing

• Copy of your valid (current), unrestricted medical license 
• The copy of the lice must include the expiration date and must be issued before October 1st 
• Please note that temporary or training licenses are NOT acceptable 

The exam itself

• Approximately 335 questions divided across 4 sections, with each section having roughly equivalent content, difficulty, and length
• 4 sections, 84 questions per section, 1 hour 45 minutes/section
• Most of us finished at least 2 sections with about a half 20-30 min to spare
• 3 Breaks: OPTIONAL
• 15 min, 60 min, 15 min
• Passing score: weighted score of 180, ~75% questions correct.
• Each exam is different, and some exams are “harder” than others, but are weighted accordingly to give you a scaled score from 0-300

Things that I used for the preparation are as follows

My first year ITE was pretty good. I attribute that to my Step 3 knowledge. However, my 2nd year ITE was not great. Started reading from the Medstudy books system wise and doing questions, system-wise (the video shows how to do it). I even bought the medstudy flash cards. My 3rd year ITE was good and I just kept at what I was doing till then. Towards the end of 3rd year, kept glancing through 'Laughing your way through the Boards'. Recommended by my seniors and attending. Loved it

PediaLink

The following video has tips that I used for studying.

Medstudy
The following video has tips that I used for studying from Medstudy

OneNote

Best of luck.

P.s.- I passed the boards! Yay. I am now a Board Certified Pediatrician.

Applying for Canadian Visa from the US

Decided to write on this given felt that it was one of the most confusing visa's I have applied for.

The following website is a good place to read up on the prelim stuff.
https://www.desi-compile.com/applying-canadian-visitor-visa-step-step-guide/
I, unfortunately, had issues with my browser (Chrome- given it was translating pages and kept redirecting me a million times)

Online application

1. Go to the following page and determine your need for the visa/travel https://www.canada.ca/en/immigration-refugees-citizenship/services/come-canada-tool.html
2. Once done, they will give you a reference code and a document checklist to keep handy and will help you to fill the visa document.  I had the misfortune where my browser kept giving me the following error  



ERROR Message that I kept getting

3. Realized after surfing a million pages and after installing adobe a number of times that it was just a glitch on the system and once you download the PDF (IMM5257E)  it will be sorted out. This means you will get a fillable application.
4. Once you are done downloading the application and filled it in create a MyCIC login via this link
5. Most likely you will have to register for a GCkey (if you have never applied for a visa prior to this)
6. Once logged in choose ‘Visitor visa, study and/or work permit’ service to continue. You will be asked to enter the personal reference code you received in the step above. (P.s.- I kept getting redirected at this point- I finally used internet explorer and then things went smoothly thereafter)
7. Follow instructions thereafter and it should be smooth sailing. You will have to upload documents (travel history and family history etc), pay stubs, employer letter and what not. At the end of this, you will pay for the application and then finally submit it.
8. You will then receive an email stating that they have got your application.
9. Within next 1-2 business weeks (please check processing times online- it depends on the place where you have applied from), you will receive an email from CIC asking you to submit your passport to VAC (Visa Application Center). This indicates that your application was approved and now CIC needs your passport to stamp the visa. (This step is the most confusing part of the process as the email from CIC is not descriptive enough and causes confusion among applicants).

Sending the passport

1. Follow the link in the letter sent by CIC above- https://www.canada.ca/en/immigration-refugees-citizenship/services/application/account/where-submit-passport.html
2. Find the center based on geographic location. In the USA it is either LA or New York.
3. Find the VAC website which should be mentioned below the options available.

This is the most confusing part of the application.

1. You will have to submit the following in the mail (by UPS)
1. Cashiers check/Money order- Get it from nearby local businesses which might charge 1 dollar to do the same. A bank may charge you 7 dollars which is half the cost of the money you are sending. ($19.90). The fees are listed here. I guess when I submitted my application this place just opened up and hence there was no UPS return fee available, which I expect will change with time.
2. Letter from the embassy
3. TTS services consent form
4. Passport
5. Return shipping label by UPS (go to the nearest UPS store who will help you out with this)

Got my passport back in 2-3 weeks (again no updates from the VAC center regarding the reciept of my passport or no. Thankfully I had UPS on my side and I knew they had definitely received it but still it was nerve wracking waiting for an answer)

Hopefully, this helps a bit. Best of luck!

Indian passport renewal in the USA

Most residency and fellowship programs give only 1-2 weeks of vacation at a time. This makes it difficult to renew one's passport back home in India. Hence, it is easier to do the renewal in the States while you are working and don't really have a pressing need for the same.

I would recommend/it is recommended to renew your passport in the States at least 1-2 months prior to the expiration of your current passport. Generally would be recommended to do at 2- 3 months prior to future travel plans and the visa renewal, but would talk to the attorney processing your legal paperwork (like H1B or J1 renewals)

To be frank, the renewal process is pretty straightforward. Go to this website and follow instructions as is https://passport.in.ckgs.us/howtoapply. But just in case, I found a really helpful link to someone's personal experience on renewing their own passport. https://www.am22tech.com/renew-indian-passport-usa/

My personal timeline with the renewal process

• Sept 18th- Submitted my passport application
• Sept 19th- Under process with the consulate 
• October 3rd- Returned from the consulate
• October 4th- Shipped back to me
• October 5th- Received my new passport

A couple of tips 

• There is generally a notary at the place where you work who will notarize your documents for free
• Passport size photos are 2*2 in the States. The cheapest spot I found was in Costco, but people have used Walgreens Walmart CVS etc. They are pricey just FYI
• Renewals can be done on the basis of a petition. One does not need an approval to apply for the passport

Moving tips for residents

Now that I am moving given a job change just a couple of tips for those who will be doing the same next year. Broken it down into phases

Looking for a new place
Apps that kind of help you scope out the places and average rent. Generally, 1-2 months is ideal timing since old tenants move out and you would be moving in.

• Trulia- https://www.trulia.com/-  It gives you a sense of security, given you know the crimes that have taken place in the area and the average rent in the same region. Please note there might be a LOT of brokers in this place so you may have to pay a broker fee, WHICH IS A LOT! 
• Apartments.com- https://www.apartments.com/ - This was a lifesaver for me in my hunt, since I was expected to shell out a LOT for an apartment. And the ones I saw were pretty expensive compared to the size. In my head, apartment complexes were nonexistent in the place I was moving to. However, on this site, you can see the different complexes and the average rent that it might be, which was super helpful and extremely relieving. 
• Apartment List- https://www.apartmentlist.com/- This site helps you in shortlisting apartments based on your preferences of distance and budget.

Utilities/Mail
- Do note that you will have to end your electric/water accounts at your old place and start one's at your new place
- USPS has an amazing service whereby you can change your current address to your new one at this place and not worry about losing mail
- This is a website which helps in managing your electric utility bill. You get $25 off your electric bill via this referral link. The big reason I like it is that you can use your credit card when paying bills which helps in earning points. Review on Arcadia can be found here.

Bank accounts
- I would check whether your current banks have good coverage in the place you are going to move to. Eg- Chase is great in Ohio, but BoA is better on the East coast. Similarly, KeyBank is a major player in Ohio, not so much on the East coast.
- So either close or keep your current accounts depending on what suits your requirements.
- Update your mailing address with the accounts so as to not have issues when you make transactions.

Credit Cards
- This would be a good time to open a new credit card had you not already done so last year. Link to my credit card recommendations is here and flying tips with Amex referral is here. This is the link with all my current credit cards

Selling your old things
Apps like LetGo and OfferUp work well, or you can sell your furniture to your juniors/colleagues if you do not like to transact with unknown people.

If you have more tips please post below, or send me an email with your comments and I will update the same.

Step 3 preparation by Puneet Baweja

Hi all the following post is by Puneet in regards to preparation for Step 3.

Preparation Materials: Master The Boards Step 3, Step 2 CK UWorld notes, Uworld qbank and CCS. 

Preparation: Go through MTB properly once before starting qbank. I added in ccs portion about halfway through the qbank. I had about nine days between the two parts, therefore, the week before each exam I concentrated only on the relevant material. 

Day 1 - Foundations of Independent Practice (FIP): This is basically CK along with basic science correlations. Concentrate on your uworld CK notes and all the basic science in MTB. As for Biostats, go over all the cases in uworld once a couple of days before and create your cheat sheet for the equations. In the real exam, Biostats use up a lot of time therefore if it seems like it could take a while just click something and move on… come back to it if you get time at the end of the block. 

Day 2 - Advanced Clinical Medicine (ACM): This is all about managing comorbidities, risk and prognostic factors. Go over your step 3 uworld notes for this. So make sure you know which risk factor matters more in each patient and know where to pick treatment over investigations. Don’t even bother looking at biostats or basics anymore. Your notes for CCS will help here as well since it’s all management, therefore, don’t wait too long to start CCS. 

CCS: This again requires work if you’re not a resident. Familiarize yourself with the software, it’s all about practice. Approach this like CS- Have a plan of what to do and which differential diagnosis to suspect depending on patient history. Know how to order each investigation in the most convenient way, as in type in oxy to select oxygen therapy as well as pulse ox at the same time. Also, the week before day 2, as I went through MTB, go over all the diseases a general physician should be able to treat in CCS manner. This way you won’t forget the specific investigation and treatment in the real exam. Also, don’t forget to go over the ccs software on USMLE's website since it’s a bit different than uworld.

Best of luck!

Puneet
drpbaweja@gmail.com

A million moving parts

The following post is by one of my colleagues at work. An amazingly inspiring story to keep persisting when all the odds are against us!

"It is a gamble. There are a million moving parts to matching to Residency and despite everything we do, there are powers beyond us that determine how those million parts fall together. But fall they will, and you will have an answer on the 15th of March. That is the best thing about this whole journey. Closure. I was lucky. Very lucky. I had a lot going against me. I applied for residency at the age of 28, 4 years after I'd graduated from an obscure medical school in China. I had lower end scores, no step 3 and I needed a visa. I matched in my first attempt.

 Here is my story.

It was 2014 and my boyfriend of 5 years and I would spend hours discussing ways of avoiding the inevitable course our futures held, had we stayed in India with our social limitations on just being us. I wanted out. Soon after graduating, I worked with the organization of my dreams-Doctors without borders. 3  years with them allowed me the privilege to serve in the poorest and most dysfunctional parts of India. South Chattisgarh, Eastern Nagaland by the border with Myanmar, Mumbai. I did my time and worked hard. In my last project in Mumbai just as I joined the project, I had 2 colleagues leaving to begin their Residency. This serendipitous moment planted the seed in me to think of the USMLE's. I had never really thought about it prior to that.

30 days later, I quit my job, convinced my parents and boyfriend that this our future and started the journey. I had no idea the rollercoaster ride I had just thrown myself into.  This was the biggest risk I had ever taken. I started off by deciding on a timeline to get things done. My biggest struggle was getting Clinical experience opportunities. Every hospital that offered observerships required step scores or personal recommendations. I got lucky early when I applied to observe under an ID doctor at a  hospital in Florida that accepted me simply based on my personal statement and my past ID experience with MSF.  A lesson for all of you is try to tie your past life experiences into your application. It really helps. My ID observership was a huge success. I was diligent during the month, came in earlier than the residents, left after, attended lectures, helped out the team, reached out to other faculty and got myself on board 6 publications that help me to this day! Another tip for all of you is to try to network with other faculties in the hospital you are doing an observership in. You won't believe the doors that will open  with a simple email to a professor in the hospital(I introduced myself as an observer in the hospital which I was--gave my email a lot more relevance)

My second observership was a disaster. I made a cardinal mistake of doing my observership in a specialty I had no interest in.  I struggled with showing interest in contrast to my previous observership. Lesson number 3- Might be obvious but please do electives in subjects you are interested in - Your passions drive a lot of your juju and people can easily spot when you don't have your heart in it. It's funny because I was in cardiology.  My third observership was at a community hospital in Cleveland that was fortuitous in that it put me on a path that would eventually lead me to Residency. I again used my rule number 1  which is getting in touch with other physicians while I was on this rotation, except that this time I started emailing attendings and contacts outside the hospital. I noticed I had a colleague from my MSF years doing his residency in Cleveland and reached out to him and he connected me to a physician at the Family Medicine clinic of the program I eventually matched into.

This opened a lot of doors. I was able to learn more about the program in an area of medicine I was passionate about and it showed. At the end of the rotation, I got a stellar recommendation and the program very likely factored that in when they ranked me. I interviewed at a couple of other places but my heart had already been set on this program. On March the journey came full circle when I opened the email. I had matched!

In hindsight, I would give the following advice

-Networking matters! Help is found in the most unlikeliest of places. Reach out to other doctors at the hospital to possibly extend rotations

-Do observerships/rotations in a field of medicine you are interested in

-Figure out what your life story is and if you feel it is not extraordinary --make it! There are a million NGO's looking for volunteers, it will give you a nice context to weave your narrative

I wish you all the best and ask you to be hopeful! I matched in the face of a million odds. It is possible. The other side is beautiful.

What if you don't match

-try again a second time. Do rotations that are in programs with residencies

-Think about alternate medical careers-Not the best option if you want to do clinical but Clinical Informatics is a great option-there is an increasing demand for FMG's with a medical background to get involved. Another option is the pharmacy industry. There are always options available if you look closely. You will probably have to do a few months of unpaid work before you get your foot in the system.

Rahul Shenoy

rshenoy@metrohealth.org"

Fellowship application timeline

This is regarding my fellowship application for Pediatric intensive care application. This is based on my personal journey. I had a LOT of help during the same and I am ever thankful for my mentors, seniors and colleagues for guiding me through the way.

First off, once you have decided you want to pursue a fellowship I would start working on building contacts in the field. I spoke to my seniors and mentor and asked what I could do to make myself more marketable.

Couple of things that I did/things that were recommended

• Away electives- If your program lets you do so. Generally, helps in building rapport with attendings at other programs and thereby your network.
• Research in the field of your interest/application
• Presentations: Try presenting at a National conference if possible in your 2^nd /3^rd year of residency prior to applying for a fellowship if possible.
• Work on your personal statement during your down-time in 2^nd year. Since this is generally the bane of existence for most residents

For Pediatric fellowship the time line is a bit as follows

Somewhere in the middle to end of June	Apply for a token to create an ERAS account
End of June to 2nd week of July	- Work on the ERAS application. - Get LOR’s (take into consideration that your attendings are busy and have a life of their own! They will take at least 2-3 weeks to write you a STRONG LOR. Do consider that it takes 5 business days to upload the same to ERAS. The Program Director LOR has to be one of the 3-4LOR’s that you send to programs) P.S.- You should be dropping hints to them in the end of May that you are expecting them to write LOR’s for you in case I missed mentioning that.
2nd week of July	You can technically apply if your application is ready to the programs. P.S- The programs CANNOT see your application yet
July 15th	Moment of truth. This is when the real application begins, and programs call for interviews
July 15th till the mid November	Interviews take place here. So, a lot of post call travelling and leave requests and what not. Finances/travelling tips for fellowship interview in another post that you can find here
Mid October to end of November	Work on your ROL. Trust me a month seems like a LONG time
End of November to Mid December	The MAGICAL match process takes place in NRMP. Start praying for good news.
Mid December	Cheers! You have matched at your desired program!  If not take part in SOAP (post-match scramble in residency)

Please note: NRMP token opens somewhere in between. I do not remember the exact date unfortunately.

Tips on looking up programs

•  Talk to seniors, attendings on the places you are applying to PRIOR to applying.
• Visa is another criterion that some of us used prior to applying. Unless you do not have such restrictions
• FRIEDA is a good place to read on programs as well
• Lastly email the coordinator for places that you have no information on. They will generally get back to you within 2-3 days.

 Hopefully this helps all individuals who will be applying the following year for fellowship! Best of luck and fingers crossed