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This article discusses some of the difficult transitions that an IMG must do into order adjust to and succeed in the US Medical Sector.

Whether you are coming to the US from a Caribbean Medical Program, South America, or Europe, medical students must adjust in order to blend in and thrive in the US Health System.  Because clinical rotations are so hard to get as an IMG, a difficult ask becomes even more challenging when students need to adjust to a new system of Medicine quickly in order to impress their attending physicians and get a potential offer to interview at the hospital for a residency position.  I will discuss some of the challenges that a lot of IMGs will face and some techniques that you can try in order to make the transition much easier to handle.  

Number 1:  Come Prepared to Do Physical Examinations and Histories 

Even if your school has a curriculum that does not focus on patient interaction until your final years of Medical School, not having a solid foundation as you interact with patients will be a quick way for attending physicians to triage promising students from incompetent students.  In the US, medical students interact with patients from the first year of training so they have established techniques and demeanor that will make patients more comfortable.  Physicians will not care about how your medical school in the Caribbean may not allow you to interact with patients until your 3rd year, they expect you to do a good job the second you get to the hospital to begin a rotation.  They will not have time to teach you and residents will grow frustrated with you if you constantly need to be babysat in order to interact with patients.  

The best way to get familiar with a patient even if you don't have access to them in your home country is to befriend another classmate with a similar goal of learning how to talk to patients and creating mock scenarios to force you to practice your conversations with a patient.  A very good tool do use in order to do this is the First Aid for STEP 2 CS study aid.  This book provides 43 cases that are likely to be seen in a medical setting and help you understand what questions are absolutely necessary to ask in order to manage your patients effectively.  The book is very comprehensible and after practicing it multiple times, you will be much more comfortable interacting with a patient and asking tough questions.  

The book also has a logic flow that you can easily memorize so as you ask questions, you flow from Chief Complaint to Past Medical History, Medications, and Social History.  This will help you logically work through your questioning during a Patient History.  You will also have clues to help you decide what exams are necessary during the physical examination.  If you are unfamiliar with some of the tests, use YouTube to know exactly what you are doing in order to make sure that you can complete an examination properly and effectively.  Learning this during a clinical elective during rounding is not the time to show off to a doctor.  This is a time where blending in and not sticking out due to bad techniques is desirable. 

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