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

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"

The road to residency: how I got into a competitive specialty with low Step 1 score, no research and no electives

The following post is from one of my colleagues and good friends from residency. I know a lot of great medical students give up on their dreams should they not match in the first attempt. This post is for such individuals to tell you that there is light at the end of the tunnel! Dream big and you will make it!

"I first decided to study for the USMLE when I read questions from First Aid to USMLE that was sitting on my friend’s shelf (Thanks Nishchit). After reading that book, I was convinced that the training I would get in the United States would be the kind of training that would suit my personality and allow me to grow. I was right. I am a fourth-year Med-Peds resident at Case Western Reserve University- MetroHealth Medical Center, Cleveland, about to enter a fellowship in Critical Care Medicine at University of Pittsburgh Medical Center (UPMC), Pittsburgh. I am living my dream.

It wasn’t easy getting here though. In addition to being an IMG from India and needing a visa, I had a low Step 1 score, a good Step 2 score, passed CS and Step 3 in first attempts, and had no elective experience. I had only one month of observership when I first applied for Internal Medicine. I had no research or volunteer experience. Oh, and did I mention that I was three years out from my graduation? Needless to say, I didn’t match the first time. It was hard. It was crushing. After almost two years of studying, spending money to go the United States and having the right intention of simply wanting to learn, I didn’t match. I sat on the curb of a busy street in Bandra and cried my heart out. My partner who was sitting next to me cried with me.

I woke up the next morning, opened my laptop and looked at my resume. I looked at all the things my profile was lacking. I needed more US clinical experience and I needed to do volunteer work. At that time was working in an ICU in Mumbai. My work was shift based and it wasn’t hard for me to find another job. I found an LGBT clinic in Mumbai and started working as the staff physician. The clinic was located within the office of a large non-profit which had connections to the United States. (I did not know that at the time) I worked hard and made connections with two US physicians. One I reached out to myself- a Med-Peds physician running an LGBT clinic in Ohio and the other a Family Medicine physician who had come to the Mumbai clinic for a conference. The Med-Peds physician decided to take me on as an observer. The Family Medicine physician got me interviews at his program. I worked hard during my observership with the Med-Peds physician and got into the residency program there. 

It all seems smooth now, as I recount the steps I took to get a residency in the United States. It wasn’t easy though and often I wondered what I would do if I failed.

My path is unique and can hardly be replicated. But I have found that the common thread between my story and other success stories is ‘persistence’.

USMLE scores are extremely important, but they’re not all that matter. If your scores are not good, make sure the recruiters see your other qualities that will make you a good resident. My profile wasn’t very good on paper, so I set out to correct that. I also knew that I was a hard worker and people liked my work, so my goal was to demonstrate to my future boss that I would make a good resident. It worked. I got into a highly sought after residency program.

The road to a residency in the United States is a long and hard, but in the end, it is fair and I assure you that you will grow as a physician. However, before you embark on this journey, make a commitment to yourself that you will get into a residency program in the United States.

You WILL fail if you give up! But you WILL succeed if work hard and persevere! Failures that come along the way are only to make you stronger, to make you a better professional. So take that in your stride and work on making yourself a more attractive candidate. The rest is, as they say, up to what some call God, some luck and some providence. 

Varun Shetty

varunshetty@protonmail.ch"

His story continues here http://neilnf.blogspot.com/2017/12/the-road-to-fellowship-aiming-for-stars.html

Medical training license for Ohio residents

The application for training license for new residents is pretty straightforward and self-explanatory. But here is the simplest explanation for filling out the form.

State of Ohio Training Application Medical Training Certificate applications are available online at the State Medical Board of Ohio website: http://med.ohio.gov/DNN/PDF-Folders/Applicant/TrainingCertificateApplication.pdf

It is a 27-page document. The following page numbers are to be co-related with the same.

Page 8-

- Choose MD

- If you do not have SSN leave it blank

- For physician address- you can use your home country address if you do not have a US one at the moment

Page 9-

Leave ECFMG certificate expiry date blank

Page 11

Put the dates you stayed in USA and state traveling for interviews

Page 19-

You can use your home country's notary for the Affidavit but let them know it is a legal document and then do some fancy stuff and charge you the same

Page 24

Leave the expiration date blank

If you are an IMG you do not have to fill pages- 23, 25  

Once the form is done contact your program on how to go about after the same.

Internship

This is regarding internship aka 1st year of residency in my program

General rules

Most programs make each module lasting 4 weeks, and they generally start on a Monday in internship. There are a TOTAL of 13 modules for the academic year, with a month for vacation

The first month was more of getting used to the EMR system in the hospital while figuring out how to get from home to hospital and back! Another part of starting new in a place is figuring out transportation. Should you be in New York, the public system is well connected. However, in Cleveland, the same is not true! You will need a vehicle if you intend to survive internship, at least that is what I think! Let me give you the following example- If I take the bus daily, I will take an hour to reach work, but if I have a car I will reach the SAME place in 20 mins, which translates to 40 more minutes of sleep! Who says no to that! 

Lastly, it takes every resident, in my opinion, a good number of days to learn how to function in a new unit. But, I feel as long as you have good seniors, you will thrive, no matter where you are! 

EMR (Electronic Medical record)

Things that I would recommend future applicants to look for is definitely the EMR (electronic medical record) system which a hospital uses. For example, my program uses EPIC, which is PRETTY powerful. We do NOT have written documents and thanks to a tie up with different hospitals within the EPIC ecosystem we are able to access patient records in other hospitals as well. 

As an intern trying to learn the ins and outs of Epic, took me a GOOD amount of time ~a month, and that too I only knew the basics. Till date I keep finding out new things about epic, both from my current interns as well as the attendings I work with, to say the least.

Things the EMR is used for - writing daily progress notes, results for labs that were sent and at times to mail another physician via the patient workspace about patient information. When I started my residency, my PD and chief, realizing that we as IMG's have a lot to learn placed us in electives, which helped us learn how to function in epic without getting too overwhelmed. For my good fortune, I had a co-resident, with who I powered through learning EPIC.

Modules

Wise wisdom from a senior of mine- 'Internship is not about learning, it is more about surviving! You are in a new place, with new colleagues, learning new etiquettes and to top it you have a NEW EMR to figure out, the best you can do in this year is to survive! You will start learning in your junior and senior year; so make mistakes and don't be shy to ask questions, as you are here to learn!' And now that I am in the 2nd year of residency I cannot but express how true those words are! Internship is more about getting to work and getting your responsibilities done in time i.e. time management.

Most programs have the same set of modules, but just different names. Our program has a good mix of general floors, subspeciality floors, outpatient experience, ED, electives, NICU and vacation in internship. 

I started off with electives, which for me was perfect, I used to have a good amount of teaching, and given we had to get certified in BLS, NRP and PALS, my attending used to let us off for the needed amount of time! I loved the attendings who I worked with and I imbibed some of their signature moves, so to say, because they were so good! 

For the next rotation I went into NICU, this for many of the pediatric residents, seems to be the bane of their existence. For this, I went in with advice from a senior, who said 'You either hate the NICU or you love it, there is nothing in between!'  I had amazing seniors in the NICU, who helped me out, not only by helping me write progress notes, but by also doing some of them on my first day when they realized I was freaking out and sweating buckets!! Here knowing dot phrases (things we use in epic to auto populate results) plays a major role!

And then finally I went into the floors! Again I had amazing seniors! I still won't forget the first day I did my pre-rounds, I was a mess. My seniors, to whom I am ever thankful for, took me aside and pointed out what was wrong and ways that I could improve, and after that floors were a piece of cake. Towards the end of the rotation I even was told that compared to what I did on day 1, I was a much better resident at the end! The work times for floors as an intern is hard! You have to reach early in the morning, so as to finish pre-rounding, which includes knowing the overnight events, labs that were sent if any and a focused physical examination. Here I feel in addition to talking to the overnight resident, the nurses play a major role, as they know minute by minute play of what happened with each patient. Learning to admit and discharge patients along with discharge summaries, is a MAJOR role done by interns. Towards the end of internship you realize what labs to focus on and how to present cases better, things like lab trends make more sense that just reporting numbers! In floors, you depend on your co-residents to help you out with work like admission and discharges, seniors for tips and tricks with EMR and nurses and finally the attending on how to interact with patients!

In the States there is something called as a resident team clinic (continuity clinic)- This is a place where you get to see every week on a particular day, a set of kids for well child visits. You become a child's pediatrician, something that I am sure most of you want to do! You get to see a child grow up in front of you which is a wonderful experience.! In this team clinic, you are generally with a preceptor who helps in molding your general pediatrician skills. There are so many things you can learn from you preceptors if you only let them teach you! The urgent care clinic is considered the outpatient experience. You get to see a wide variety of illness from colds to rashes to asthmatics to what not! You learn to figure out which is a sick vs, not sick kid!

Lastly, we also have a rotation in the newborn nursery which I must say was really amazing for multiple reasons! One since you have cute babies there and 2 because my attending was amazing and 3 because my colleagues were hilarious! 

As your residency progresses, you will learn that your co-residents play a MAJOR part in how you like your program. Even seniors, since if you don't know anything they are the people who can guide you to the correct answer. In my program at least, my batchmates are really amazing! Everyone steps up if the work is too much for one to handle! Lastly, we throw random functions for no good reason! 

Fellows, though people say are not good, I feel if you use them in the right way they are the best people to have. For example, you are interested in a particular sub-speciality, fellows help in telling you what things you should look for in a program and they are also more approachable compared to attendings given they are younger as well as they know what a resident is going through! 

Now at the end of my internship, the only thing I look back and think, if I had to do it over again I would not change anything! The entire year was one roller coaster ride, but it was worth it!

If there is any grammatical error, please excuse it! Just wrote this in an hour for people who are going to come over for residency!

Personal Statement Tips

Firstly, ignore the grammatical errors in the post, was a bit tired! :P

Now to begin, a good number of individuals have asked for tips on how to write a Personal Statement for the Match. There are a million results that pop up when you google search personal statement & your specialty.  

Tips for writing PS

• http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section/transitioning-residency/writing-your-personal-statement.page?
• http://www.med.unc.edu/ome/studentaffairs/residency-and-the-match/residency-application-process/cv-personal-statements
• http://www.cmu.edu/hpp/apply-to-schools/personal-statements/tips.html
• http://www.cws.illinois.edu/workshop/writers/tips/personalstatement/
• http://www.accepted.com/medical/residencyessays.aspx

These are a few sites which give you sample personal statements

• http://www.medfools.com/personalstatements/
• http://www.usmleweb.com/showarticleef.html

It is hard to create one, that is for sure, but you must attempt to make one at least. Firstly just read a couple to know what a personal statement should have. Keep reading online PS's till you get that one which strikes you that your life was shaped like that one. 

Once you have created your personal statement, keep reading and re-reading it. Send it to your OLDER siblings or friends to proof-read it. Once this phase is done and ALL GRAMMATICAL ERRORS are corrected send it to your seniors to check if they are impressed by it. For heaven's sake DO NOT THINK THAT THEY ARE JOBLESSLY sitting around just to read your PS. They have a lot of other commitments. If they do give you a feedback well and good, if not still thank them for going through, since they have taken time from their busy schedule to actually read it.

Lastly, before FINALLY uploading it on ERAS, do check it for Plagiarism. You really do not want to use a completely copied PS from the web. It there is NO originality in the PS, you can be rest assured it will be discarded by the PD. Try to have 80 or higher original content

These are a few sites that help you in the plagiarism area

• http://smallseotools.com/plagiarism-checker/
• http://www.plagtracker.com/

A reader even suggested the following link https://www.websiteplanet.com/blog/best-plagiarism-checking-tools/  with their review as follows 'What I like the most about the article is their honesty and objectiveness when choosing/ranking the best and more accurate plagiarism check tools available out there, in addition, they suggested a few free tools, so it’s great for someone who would want to try it'

Finally, this is how I structured my PS

1. An opening line by one of my profs or an online quote which hit me hard and caused me to think.
2. An event which caused me to like the field (in my case pediatrics)
3. Why this field, I mean to say what is so special about it and what I have done to show my interest in the field
4. Steps I have taken to be prepared for residency in the States
5. My strengths and why the program should choose me
6. Summary- Which has the HIGHLIGHTS of the PS