Transferring From a Foreign Medical School into the US

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. 

Two More Essential Tips to Help You Adjust to the US System 

Number 2:  Learn How to Do Patient Notes ASAP 

This is a great way to impress your residents and your attending physicians.  Regardless of how well-versed you are in writing a patient note, each resident has a different style that they like in their notes and during a clinical elective, the best thing you can do is make the resident's life easier. This is the most important thing you can do if you are wanting to have a strong letter of recommendation. You may not like the idea of doing someone else's work without getting paid, but when interviews are being handed out, Testimony from a resident can go a long way into determining whether you will get that invitation.  It is in your best interest to start typing as quickly as possible.  

This is what residents spend at least 75% of their day doing so if you are able to help a resident with these tasks, then they will definitely put in a good word for you to the attending physician and that will make a letter of recommendation very strong for you. 

Number 3:  Do an Elective in a Category You ARE NOT Interested In First 

No matter how much effort you put into preparing for an elective in the US, there are going to be growing pains that can make your experiences in the US frustrating at first.  It is a foreign system and can be tricky to maneuver through if you do not have anything to compare it to before.  A good policy to follow is to not do an elective in the field you are interested in doing as your first elective.  If you are interested in Internal Medicine, do an elective in Family Medicine first to learn how to talk to patients, learn how to write notes, and then by the time you do your Internal Medicine rotation in 4 weeks, you will have a higher level of comfort in that field so you can impress more.  

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During a clinical elective, 4 weeks fly by quickly so you have to make your impression count as best as you can.  You need to be one of the first ones in the hospital every morning and one of the last to leave at night.  You do not have a long time to get familiar with the US system and if you are worried about the "New York rule,"  you only have 12 weeks to get letters and make your impression in the system. Physicians can easily tell who is motivated or not during rounding so make sure you are always prepared for rounds, have logical support for your management recommendations, and ask intelligent questions.  Reading journal articles or peer-reviewed journals are good habits to learn too because you will be doing these soon enough anyway so you might as well get accustomed to it now and use it as another opportunity to show off and set you apart from your peers.  

If you are still uncomfortable with some aspect of the process, ask a resident or even a nurse to help you at the end of their obligations.  Most people in Medicine are willing to help if you ask them politely so "ask and you shall receive" the help that you need.  Being able to improve quickly in a short period of time reflects great on your work ethic and character.  Do not waste these opportunities.