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"

Building a HISTORY in the States

These tips and tricks are entirely based on the advice of a VERY wise senior. When you first come to the States for residency, you will need a couple of things to setup.

SIM CARD
Firstly a mobile number. Given that a good number of residents come from outside the States, having a network which gives you free calling to your home country is a BONUS. That's where UltraMobile comes into place. I know in my previous post I said H2O is good, but trust me when I say that UltraMobile is the real deal. For 30$ per month, you get unlimited calls to India with 1GB of 4G data, which is PRETTY IMPRESSIVE! It also has an option of getting nano sim, so in case you decide to upgrade your phone, which many of you will do, it has got your back covered! :) You can get the initial sim on Ebay for 10 bucks which gives you the first month for FREE!
It is totally up to you on how risky you want to be. If you want to buy it directly from UltraMobile, here is your link

BANK ACCOUNT
Next is for earning cash back when you open a bank account. Generally find the bank which your institute has a tie up with. Go to their site and check for any promos that they are running. They might have an offer that should you open an account with their bank you will get a bonus of $ XYZ for signing up!!! which is PRETTY AWESOME!
P.S.- I used Keybank and got 1/3 of a $1000 :P

CREDIT CARD
The last trick that again, my senior taught me, was regarding getting a credit card. Most of the USA banks DO NOT give you a credit card UNLESS you have a credit history. However, Discover does give you one with no credit history with a credit line of $1500 which is PRETTY COOL! So in case you are still hunting around for a credit card do head out to Discover and check it out. You can shoot me an email @ neilnf@gmail.com if you want a referral, following which you and I get a referral bonus for $50 each.

That's it, folks!

UPDATE: Just FYI for the bank you need a direct deposit to get the bonus. For both SSN is needed. For the credit card you need address proof as well.


If you do have any other tricks, please do let me know. After all we are here to help each other! :)

Driver's License in the States

The Driver's license test generally has 2 parts. 

Knowledge and the ACTUAL driving test

If you have an Indian license, take the same along with the following documents

1. Passport
2. I-94 printout
3. Letter from employer stating that you work there
4. SSN- Details on how to get one is in the previous post.

For the knowledge test, you can practise online by doing practise one's according to your respective States. You can get few here (http://driving-tests.org/) In Ohio, the test has 40 questions and you just have to get 75% of the questions to clear the exam and then schedule your DRIVING test.

Best of luck!

P.S.- I read the manual and did the above questions. Most of the questions just need plain common sense answers :) So it really won't take too much time.

Timeline for a Match!

Since a lot of people have asked me how to create a timeline and what happens when, thought will write this post so that all get benefitted :)

N= Your desired year of matching

By April-June (N-1)

• Request your ERAS token. (opens somewhere in April/June/July)- Frankly do not remember when- http://neilnf.blogspot.in/2014/08/how-to-get-eras-token-in-order-to-apply.html
• Start requesting letters of recommendation.
• Strengthen your application by having USCE 

By August (N-1)

• Be ready with your personal statements and have your LOR’s uploaded
• Be done with all your Steps (Step 1, Step 2 CK & CS) and if possible graduate and be ECFMG certified since some programs require ECFMG-certification before applying.
• Finalize your documents and upload as necessary. 
• If you haven’t taken Step 3 do consider taking it as it could strengthen your residency application.
• Know which colleges you plan to apply to, which are IMG friendly or so. Talk to your seniors and check where they applied and stuff.

 September 15^th (N-1) Check the date!

• AAMC’s MyERAS opens! Apply early and stay organized.
• Step 1 and Step 2 CK scores are strongly encouraged to be considered for interviews.
• Sometime later register with the National Resident Matching Program (NRMP)

 From October (N-1)- January or February (N)

• It’s time for interviews!
• Be patient as many programs invite interviewees late into January or February

 February (N)

• By mid Feb submit your rank order list.

March (N)

• Get your match results.
• If you didn’t match, consider the Supplemental Offer and Acceptance Program (SOAP) to find your spot.

March To June (N): 

• Matched Candidates should start and complete Visa Processing if needed and find a place to Stay during this period

July (N):

• Residency Begins after initial 1-2 weeks of Orientation and ACLS + BLS training 

PS- 

• ERAS creates a CV for you
• It is said that latest to apply is by September end at least since most programs finish downloading all their applications by the last week of September.

Some kind person named Dr Harshal Awasthi has painstakingly written about the Matching process and terms. You can find the link HERE or here

Another guide to Residency by some guys from Pakistan is HERE

My Match 2015 timeline

This is the simplest way I could tell how I Matched and what I did in each month.

Hope this helps some of you :) All the best.

P.S.- I applied with my CS pending on Sept 27th 2014.

Step 1                              Feb 10th                    
Step 2 CK                       July 24th                    
Step 2 CS                        August 12th                  Pass 1st attempt (Result- October 8th)
Graduated                       October 09th
ECFMG certified            October 29th
Step 3                              December last week     Awaiting results (Update 25th March 2015- Pass)

Research - 2 ICMR projects and 1 college project.

Applied to

Pediatrics
     42 programs.
     10 interviews.

People who MATCHED could you please fill in this Excel sheet :)

Year	Month	What I was doing
2013	March	M.B.B.S. Internship starts	Electives hunting without Step 1 scores
	April	Chilling plus Intercollege fests plus USMLE material hunting.
	May
	June
	July
	August
	September
	October
	November	Step 1
	December
2014	January
	February
	March	Proper electives hunting with Step 1 scores + little CK studying
	April
	May
	June	Step 2 CK
	July
	August	Electives +  Step 2 CS
	September
	October	Graduation and Credentials verification
	November	Interview season + Step 3
	December
2015	January
	February	Praying to Match + Junior Residency
	March	Match

Google Voice and it's uses for USMLE

Did it ever happen that try what you may, your mobile service provider’s voice-mail just refuses to get set-up??!!

I experienced that and I am thankful that it happened, else I would not have stumbled upon Google Voice. The only unfortunate part was that I really did not realized the potential of it until late in the interview season, to be frank towards the end.

So before I go into the details let me explain the reason why this post is here. The first thing that most of us do when our plane lands in the States is to hunt for a USA mobile service provider. Once that is done, it becomes the mode of contact for you and almost everyone else you get in touch with. But have you ever thought that once you are done with your electives, and it’s time to come back how will they contact you or vice versa? I do agree WhatsApp is a wise alternative, but it is generally registered on your home country number, which I do not think you will share with all of them except for the residents or your colleagues. Here is where Google Voice comes to the rescue.

So once you have finalized a decent USA mobile service provider and have the sim in hand, it is the ideal time to set up your Google Voice account. The different options for buying a sim are mentioned in my other post here. Registering for Google Voice is pretty simple and straightforward and the link is here. Once registered, there is an option to opt for a Google Voice mobile number, where you get pretty cool phone numbers to choose from to be frank. My number for example is +1-916-936-3451 (+1-916-93NEIL1). You can try various combinations and options to get a cool one for yourself. Once you have finished fiddling around to get a number, I would recommend you share this number with all your colleagues instead of the USA service provider’s number. The reason being, should anyone call you it automatically gets forwarded to your USA service provider’s number and, supposing you are unable to answer your phone when they call, Voice offers a voicemail service which even transcribes the voicemail to text which you can read when you do check your phone.

The advantage of Google Voice is that it does not lapse like the number that you get from your service provider should you not recharge it for 2-3 months. I mean once you  are back in your home country, why will you want to recharge your US number and not even use it? So even though your US number will be disconnected, should people message or call your Google voice number you will still receive the messages or calls on Voice or Hangouts, whichever is convenient for you. Last but not the least you can also call and send messages (SMS) from your Google Voice number as long as you have a working internet connection.

Hope this post helps future USMLE aspirants who can make complete use of this simple but potentially amazing offering from Google.

Disclaimer – I am not being paid anything by Google for this :P

Finances in the States

Regarding finances the general notion or idea is that we take maybe say around $1000 cash in hand and $1000 in cards as I mentioned in my earlier post which you can find here. Now the problem with carrying $1000 in hand or in the luggage is that you have the eternally worried about getting mugged, if not that, then where to keep the money and last but not the least remembering these places and trust me it is no small joke. I almost lost $200 in a day, thanks to my awesome super secret hiding spot, that my mind so conveniently kept it a secret even from me. Thankfully one rainy day I remembered where it was, retrieved the money and became $200 richer. My advice in this post would be to open an account in Bank of America [BOA] (since this is the easiest and most accessible bank all over the States). Easiest in the sense that this is the ONLY BANK that I know off that does not require an address proof to open an account in the States. The steps to be followed when you go to open an account would be as follows

1. Carry 2 forms of ID (a) Passport containing a valid visa (b) Driver’s license or election card from your home country. Please note that it should be in ENGLISH for it to be valid. 

1. Money to open the account- Either your entire cash-in-hand or $100-$200

The features of the account are that the minimum balance should be $300 if not mistaken, or you will be charged a monthly fee which I think is around $ 5-10. Now BOA is kind enough to give you a grace period of 2 months to build your balance to the target minimum balance of say $300. This 2 months period is generally the time by which you would be done with your electives or interviews and can close the account, withdraw the money and return home for no additional cost to you.The advantages that I felt of having an BOA account were as follows

• The card that they give has your photo on it, along with your name and hence you can use it as an ID proof instead of whipping out your passport every single time.

• The bank statement that you get has your name and the address that you staying at and you can use it as address proof in various places.

• The staff are really courteous and sweet and generally answer all queries

• You can withdraw the needed amount, when and where you want without having an additional transaction fee of $2 should one use their countries' foreign currency cards. This I think was the MAIN reason I opened the account. Saved me the need to roam around with wads of cash in my pocket :P

I may be wrong in some things and they might change the rules later. But I used the bank and was very happy with my experience and hence the post. Pardon the grammar, was half asleep when I typed this out.

Step 3

This post is more on the exam than on a study plan for sure since I feel that is more confusing than the study preparation itself. Basic format of the NEW exam is as follows

DAY 1

• Total exam duration - 7 hours
• Has 6 blocks – 42-43 questions with 60 minutes for each block.

DAY 2

• Total exam duration 9 hours in total. Has 2 parts
• Part 1 –

o   6 blocks with 33 questions and 45 minutes for each block.

• Part 2 – (CCS)

o   13 case simulations with each being either 10 or 20 minutes in length.

The MAIN change according to me is in the scheduling of the exam. I mean in the new pattern you can schedule day 2 of your exam at a different date but at the SAME test centre and within 14 days.

Materials I used:

1. OLD MTB 3
2. USMLE world - Qbank, CCS, UWSA
3. Archer introductory videos

The general question on everyone’s mind at the moment I think is should I read my basic science book like 1^st aid for Step 1 and go through biochemistry and learn the enzymes and also to buy the new MTB 3 (I have not read it so not sure about MTB 3 new addition) My advice would be a firm NO, as I feel step 3 is basically the same as CK but they are more focused on the management aspect of the patient and how you can apply your BASIC science concepts. At least for me it wasn't like step 1 where I had to mug up a couple of enzyme names and know the deficiency of which causes what and so on and so forth. My advice would be prepare the same as you would for the old step 3 examination. In addition to the Uworld qbank do the Uworld self-assessment test and USMLE.org practice materials.

Coming to the CCS part of the exam I felt this part was my Achilles heel. I would highly recommend doing the Uworld CCS cases as many times as possible and read the explanation. Also Uworld also gives you a PDF handout for 40 to 50 cases which I think is good enough. Furthermore to help in CCS there is a person called Archer who has a course.  I recommend watching his CCS Strategies video which is 2.45 hours long which gives you a quick over view of CCS. Also do the CCS cases that USMLE has on their web site.

The difficulty of the questions were essentially according to me like Step 2 CK, but as I do not have my result I would not like to say anything for sure. Also I felt day 2 was tougher than day 1 but some guys I spoke to felt both days were easy. Any how my study time was around a month and a half technically with studies being in between interviews and Christmas festivities. At the moment as my result is unknown I cannot exactly say whether it was sufficient or not but hoping for the best.

Good luck to all who are giving it soon!

(Update 25th March 2015- Pass)

List for electives/observerships

Last updated on 21st June 2015

I have no idea whether the list still holds good or no.

But during my search for electives in addition to umar tariq and electives.us the following lists come in handy.

Note : Links below open in a new window- On the top right corner of the new window click the Skip Ad and then you get the list. (Google Drive)

1. List 1
2. List 2
3. Observership opportunities  - Post from Facebook actually
4. Compilation - Some great people put together a HUGE list
5. Harshal Awasthi - Really great tips for applying
6. Dinesh Vinayak J- Good tips for new observers 

NOTE- Some people have contacted me saying that the links do not open. Do try the following.

• Check that the pop up blocker is turned off since the links open in a new tab/window.
• Add https:// before the web address
• Use a laptop or computer if does not work in your phone
• Ad blocker is turned off at least till you download the files

P.S.

• If you are the owner of the list or need me to take it down would gladly do so should you contact me. 
• Please add in the comments section if there is any mistake or additions that should be done.
• This is not the MOST updated list. Recommend mailing (emailing) the colleges to check if there are spots available.
• Kindly apply for electives spots towards the end of the year or in the beginning since there are higher chances to get opportunities then.
• Lastly no matter how bleak your chances are DO NOT GIVE UP!
• Do share the post if it helped you.
• Best of luck!!

Tips while travelling in the States

Few tips that I feel people who are going around for interviews must know.

Sites which you can use prior to booking your travel plans.

Wanderu – This site helps to compare the prices of all the competitive bus lines that I know of like Boltbus, Greyhound and Megabus. My advice is to use Wanderu to find out which dates would be the cheapest to travel and once that is figured out, make an account online in the respective bus-lines and book on those dates. You might actually get a discount if you book via the home page of the bus company site. E.g.: https://www.boltbus.com/

UPDATE They have a mobile app too now :)

Sky scanner - This site helps you compare the cheapest fares that the various airlines have. It is similar to Wanderu but for flights. This site also happens to have an android app, so would recommend having that on your phone.

Uber- People who I have met during interviews, as well as my awesome cousins that helped me in my interview journey told me about the Uber app, which helps one get around in the city. The first ride is free up to $15 provided you have a promo code which I happen to have which is g1xi2. Using this you would get your 1^st ride worth $15free and I would get $15 in return, so a win-win situation here I would say. Please note that you would need a credit or a debit card to open an account. I would suggest using your international travel card.

Lyft-  This is similar to Uber. Found out about this during residency. The first ride is free up to $20 provided you have a promo code which I happen to have which is NEIL1421 or NEILNF. Using this you would get your 1^st ride worth $20 free and I would get $20 in return, so a win-win situation here I would say. Please note that you would need a credit or a debit card to open an account. I would suggest using your international travel card.

Trip it -  It helps you organize your journeys and keep track of when each of your bus or flights are. The cool feature about this is that once you organize your trip, you can share it with your family who can then track when and where you are headed out to. It automatically incorporates your travel plans much like Google Now. Tripit has both a site and an app which you can use while traveling.

Coming to my personal experiences with the bus lines.

Megabus-http://us.megabus.com/

Features

• Double Decker bus. 
• Has free Wi-Fi, charging points (some are overhead and some are below your seat).  
• Need only your confirmation number to board.

Cons

• They do not have a dedicated depot spot and the pickup or drop off spot will generally be on the road along with a signpost which says Megabus.

My personal choice for a seat is the lower seat, left side and near the aisle, since I am a little tall I like to keep my leg hanging in the aisle and stretch it a little.

Greyhound- https://www.greyhound.com/

Features

• Single Decker bus. 
• Has Wi-Fi, charging points. 

Cons 

• You have to have either print out your ticket or choose the will call option and collect your ticket at the bus station. I find this extremely old-fashioned since I do not like carrying around a paper ticket.

Here too I choose an aisle seat since I get space to stretch my legs.

Bolt Bus: https://www.boltbus.com/ 

Features

• Single Decker bus. 
• Has Wi-Fi, charging points. 
• Have to show the email that was sent to your email in order to board the bus.
• Feel this has the best of both worlds i.e. Greyhound and Megabus.

General advice

• Expect delays on the bus lines even though you may be on time.
• Keep your expectations low by telling yourself that there will be no Wi-Fi or the charging points won't work
• During boarding, they may ask for some sort of identification. For international graduates, a passport should work. 
• Regarding the criteria that you should have your address on the credit card, I would say do not sweat it. You can book via your travel card and show your passport as ID if asked.
• There is a restroom in ALL the buses, which I feel is a really decent feature.
• Lastly, suppose the place you stay at is along the way I would suggest you ask the driver if he could drop you on the road near it and he will generally oblige or at least in my case he did. I tried this with a Greyhound driver since otherwise, I would have to walk around 3 miles in the cold winter on the highway. A colleague of mine walked and I must say it does not sound like a pleasant experience.

I will try updating the post as and when I travel along.

Good luck

Disclaimer: The post is totally based on my own experiences during traveling. So do not hold me responsible should you not have a similar experience.

UPDATE :

Transit: This app helps get the real-time update for the nearest bus or train. So you do not have to download each city's individual metro or rail app. 

Citymapper: This app also functions like the above but is available in only the major cities and metros in the States