Damon_Sacks_Aureus_Presentation

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Aureus UniversitySchool of Medicine

• ICM, Clinical Rotations and Residency
• - Damon Sacks, MD

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ICM, Clinical Rotations and Residency

• Demystifying ECFMG certificate, FRIEDA, Green
  Book, ACGME, MSPE, SOAP, MPA, Scramble
• ICM at Aureus
• Clinical rotations
• Steps to Residency - Info about Dallas area
  rotations- What residency programs really look
  for

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SECTION 1Definitions
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Demystifying the process

• ECFMG and ECFMG certificate
• FRIEDA /Green Book
• ACGME
• MSPE
• SOAP / Scramble
• MPA

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ECFMG

• Through its program of certification,
  the Educational Commission for Foreign Medical
  Graduates (ECFMG) assesses the readiness of
  international medical graduates to
  enter residency or fellowship programs in
  the United States that are accredited by
  the Accreditation Council for Graduate Medical
  Education (ACGME).
• ECFMG acts as the registration and
  score-reporting agency for the USMLE for foreign
  medical students/ graduates, or in short, it acts
  as the designated Dean's office for International
  Medical Graduates (IMGs) in contrast to the
  American Medical Graduates (AMGs).
• It conducts three examinations Step 1, Step
  2CK, Step 2CS. The ECFMG certificate is issued to
  a physician if he or she passes the above the
  three exams within a time period of seven years
  and meets validation credentials.

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ECFMG

• Resposible for certifying credentials of IMGs
• Uses ECFMG International Credentials Services
  (EICS)
• Paperwork is submitted by Aureus for
  certification on completion of education
• http//www.ecfmg.org/certification/index.html

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ECFMG Certificate

• Officially allows medical students to complete
  residency match
• Valid for life does not expire
• Required to be licensed to practice medicine in
  ALL states after residency
• Can apply to residency without certificate but
  must have when ranking is complete (typically
  Feb. 22) of matching year.
• Typically receive 2 weeks after completion if
  expedited

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ECFMG Certificate

• ECFMG Certification Requirements
• Complete Application for ECFMG Certification.
• Satisfy medical science and clinical skills
  examination
• requirements (currently USMLE Step 1, Step 2 CK,
  and Step 2 CS).
• Primary-source verification of the required
  medical education
• credentials, which include the final medical
  diploma and final
• medical school transcript, with medical school.
• Source http//www.ecfmg.org/certification/require
  ments-for-certification.html

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ECFMG Certificate Sample

• Officially allows medical students to complete
  residency match
• Valid for life does not expire
• Required to be licensed to practice medicine in
  ALL states after residency
• Can apply to residency without certificate but
  must have when ranking is complete (typically
  Feb. 22) of matching year.
• Typically receive 2 weeks after completion
• ECFMG Certification Requirements
• Complete Application for ECFMG Certification.
• Satisfy medical science and clinical skills
  examination
• requirements (currently USMLE Step 1, Step 2 CK,
  and Step 2 CS).
• Primary-source verification of the required
  medical education
• credentials, which include the final medical
  diploma and final
• medical school transcript, with medical school.
• Source http//www.ecfmg.org/certification/require
  ments-for-certification.html

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FRIEDA / Green Book

• Maintained by the American Medical Association
• FREIDA online version of Green Book
• Is simply a list of approved RESIDENCY programs
  NOT clinical rotations
• Does not certify undergraduate i.e., medical
  school rotations or programs
• Is used for future licensing requirements for
  RESIDENCY only not medical school requirements

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FRIEDA / Green Book (cont.)

• American and IMG med students have NO REQUIREMENT
  to rotate at FRIEDA listed programs
• - case in point all private Family Practice
  and/or elective rotations
• Source http//www.ama-assn.org/ama/pub/about-ama/
  our-people/member-groups-sections/medical-student-
  section/membership-services/choosing-medical-speci
  alty/general-information.page

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ACGME

• The Accreditation Council for Graduate Medical
  Education (ACGME) is responsible for the
  Accreditation of post-MD medical training
  programs within the United States (RESIDENCY).
• Accreditation is accomplished through a peer
  review process and is based upon established
  standards and guidelines
• Does NOT oversee medical school requirements or
  clinical rotation validity.

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Medical Student Performance Evaluation (MSPE)

• Formerly called the Deans letter
• is not a letter of recommendation it is a
  letter of evaluation.
• Name and Purpose
• The MSPE describes, in a sequential manner, a
  students performance, as compared to that of
  his/her peers,through three full years of medical
  school and, asmuch as possible, the fourth year.
• The MSPEincludes an assessment of both the
  students academic performance and professional
  attributes.

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SOAP

• Stands for supplemental Offer and Acceptance
  Program
• Replaced the Post-Match Scramble
• Soap is a series of rounds during which programs
  make offers it is not a second Match.
• Applicants express preferences by applying to
  programs through ERAS.
• Programs express preferences with lists of
  applicants in the NRMP Registration, Ranking, and
  Results (R3) System.
• Through the R3 System, program offers are
  extended to applicants.
• Applicants could receive multiple offers in any
  round.
• Positions offered and accepted during SOAP
  establish a binding commitment enforced by the
  NRMP Match Participation Agreement.

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SOAP Details

• During SOAP, eligible applicants
• Can access the List of Unfilled Programs for
  those positions for which they are eligible.
• Can apply only to unfilled Match-participating
  programs.
• Must use ERAS to apply to programs.
• Cannot use phone, fax, e-mail, or other services
  to contact programs.
• Cannot have another individual/entity (including
  medical school) contact programs.
• Can accept positions only through SOAP during
  Match week.
• Cannot apply to non-Match participating programs
  until after Match week.
• Ineligible applicants cannot participate in SOAP
  and will not have access to the List of Unfilled
  Programs.

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Summery The match and SOAP

• Pre-matching is formally not allowed but
  reaching out in advance to decision makers is a
  plus
• The Match uses an algorithm based on what you
  want and what programs are looking for to bring
  the prospective resident and residency programs
  together
• You must have ALL paperwork completed to be
  eligible to match but not necessarily all courses
  finished
• Completed education is likely considered better
• Tip Register early for Match and look at all
  aspects of application
• Registration and information ERAS
  (www.aamc.org/students/eras/start.htm) and NRMP
  (www.nrmp.org)

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MPA Match Participation Agreement

• Restrictions on Persuasion Section 6.0
• Formal breach
• (a) a program to request applicants to reveal
  ranking preferences or
• (b) an applicant to suggest or inform a program
  that placement on a rank order list or acceptance
  of an offer during SOAP is contingent upon
  submission of a verbal or written statement
  indicating the program's preference or
• (c) a program to suggest or inform an applicant
  that placement on a rank order list or
  a SOAP preference list is contingent upon
  submission of a verbal or written statement
  indicating the applicant's preference or
• (d) a program to require applicants to reveal the
  names or identities of programs to which they
  have or may apply or
• (e) a program and an applicant in the Main
  Residency Match to make any verbal or written
  contract for appointment to a concurrent year
  residency or fellowship position prior to the
  release of the List of Unfilled Programs.
• Source http//www.nrmp.org/res_match/policies/map
  _main.htmlrestrictions

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SECTION 2Year 3 and 4
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Intro to Clinical Medicine at Aureus

• Serves as a bridge to Clinical Rotations
• Conducted in White Plains, NY
• Combination lecture and clinic
• Family practice in nature
• Most important aspects
• getting comfortable in new environments (offices)
• Understanding how to conduct an HP
• How to report findings to a preceptor

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Preparing for Clinical Rotations

• What you need
• Student White coat of appropriate length
• Must have Aureus badge on it
• Must have your name embroidered
• MUST NOT say student doctor or something of the
  sort
• Current Aureus Student ID
• ACLS in plain view
• Stethoscope (non-surgical rotations)
• Scrubs (surgical not paramedical)
• Professional outfits for clinic
• Ties, dress shirts and slacks (male)
• Skirt or slacks with neat shirt (female)

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Textbooks
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Textbooks for Clinical Rotations Texas
Curriculum

• Core Rotations
• Internal Medicine
• NMS Medicine (ISBN 1608315819)
• Blueprints Medicine (ISBN 0781788706)
• Medicine Pre-Test (ISBN 0071761497) OPTIONAL
• OB/GYN
• Blueprints Obstetrics and Gynecology (ISBN
  078178249X)
• Surgery
• First Aid for the Surgical Clerkship (ISBN
  0071448713)
• Pestana Notes (do a web search)
• Surgical recall (ISBN 1451176414)
• NMS Surgery (ISBN 0781759013) OPTIONAL
• Peds
• First Aid for the Pediatric Clerkship (ISBN
  0071664033)
• Case Files Pediatrics (ISBN
• Psych
• Blueprints Psychology (ISBN 0781782538)
• Family Practice
• Case Files Family Medicine (ISBN 007147188x)

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Next Steps Step 1

• Short Review course if necessary
• Register early to choose your Step 1 exam date.
• Scores usually reported in a few weeks
• After ICM most students should take their Step 1
  after short final prep
• Statistically, delaying taking exam past 6 weeks
  results in LOWER scores NOT higher scores
• Choose and apply to your rotations site BEFORE
  you take your exam to reserve a spot

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Clinical Rotation Timeline - overview

• Cores (48 weeks in no particular order)
• Internal Medicine 12 weeks
• General Surgery 12 weeks
• OB/GYN 6 weeks
• Peds 6 weeks
• Psych 6 weeks
• Family Practice 6 weeks
• Electives
• 24-30 weeks of your choice
• (see www.americanclinicals.com for list of
  available rotations)
• Most last 2 to 4 weeks

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Clinical Rotation Timeline (cont.)

• Step 2 Exams
• 3 months prior to completion of core rotations
  should schedule Step 2 CS and CK
• Step 2 CS can be completed in Houston (short
  flight)
• Requires 2 days with travel etc.
• Can be completed on a weekend
• Typical review (1 week)
• Step 2 CK can be completed in Dallas
• Typical review 2-4 weeks max
• Often studying while in electives as course load
  is lighter
• Should be using various Q banks and scoring well
  

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Clinical Rotation Timeline (cont.)

• Finishing your clinical rotations
• 3 months prior to completion of Cores should
  schedule Step 2 CS and CK
• Step 2 CS can be completed in Houston (short
  flight)
• Requires 2 days with travel etc.
• Can be completed on a weekend
• Typical review (1 week)
• Step 2 CK can be completed in Dallas
• Typical review 2-4 weeks max
• Often studying while in electives as course load
  is lighter
• Should be using various Q banks and scoring well
  

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Graduation/Match timeline

• Year Three
• OctoberMarch
• Begin working on your curriculum vitae (CV).
  Crafting a high-quality CV can take 8-10 hours.
• Information for the CV can be used in the ERAS
  application and provided to those writing your
  letters of recommendation.
• FebruaryJune
• Review the Charting Outcomes in the Match
  report to assess qualifications and
  competitiveness for different specialties.
• Review residency programs and physician workforce
  data through the Careers in Medicine Specialty
  Pages and AMAs FREIDA.
• Begin the MSPE process.
• Write your personal statement and have your
  advisor review it.

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Graduation/Match timeline (cont.)

• Summer
• Obtain your ERAS token (a special code) from the
  deans office.
• Register for the Main Residency Match
  (www.nrmp.org).
• Register for early Match programs, if applicable.
• FebruaryJune
• Review the Charting Outcomes in the Match
  report to assess qualifications and
  competitiveness for different specialties.
• Review residency programs and physician workforce
  data through the Careers in Medicine Specialty
  Pages and AMAs FREIDA.
• Begin the MSPE process.
• Write your personal statement and have your
  advisor review it.

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Graduation/Match timeline (cont.)

• YEAR 4
• JulySeptember
• Complete the ERAS application using the MyERAS
  Web site, including the designation of programs
  where your application is to be transmitted.
• Identify additional faculty for writing letters
  of recommendation.
• SeptemberOctober
• Begin preparing for residency interviews.
• MSPE released October 1.
• If you havent taken the USMLE Step 2, consider
  using this time to prepare.
• Submit ECFMG paperwork

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Graduation/Match timeline (cont.)

• YEAR 4
• OctoberJanuary
• Residency interviews.
• Evaluate and compare residency programs by
  completing the Residency
• Program Evaluation Guide and the Residency
  Preference Exercise
• JanuaryFebruary
• Begin entering your Rank Order List online for
  the NRMP match.
• SeptemberOctober
• Begin preparing for residency interviews.
• March
• MATCH DAYThe third Friday in March results are
  formally announced at
• 1200pm EST.
• - Participate in SOAP if needed
• AprilJune
• Sign the contract with your residency program and
  prepare to begin residency. Congratulations!

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What residency programs really look for in an IMG

• Letters of recommendations from physicians in
  your desired field
• Best if from practicing, experienced physician,
  not residents
• Best with some recognizable sites (ie. Baylor,
  Northwestern, UCLA, etc)
• Strong Scores on Step Exams (many programs have
  stated minimums and will not consider applicants
  below)
• Strong MSPE with appropriate electives
• Published article(s)
• Research may be a plus
• Agreeable personality with strong work ethic
• Lack of potential visa issues

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Residency application help

• In 4th year, Texas program helps students
  complete residency applications to maximize
  acceptance chances
• Dr. John Birbari MD former decision maker for
  University of Texas Dallas Surgical Residency
  Program personally reviews applications BEFORE
  submission
• Has developed recommendations for IMG students in
  Texas program

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Residency Workshop Dallasconducted by John
Birbari, MDOBJECTIVES

• 1. Provide a clear understanding of the process
  and timeline for the Electronic Residency
  Application Service (ERAS) and theNational
  Resident Matching Program (NRMP).
• 2. Review the rights and responsibilities of
  students in the matching process.
• 3. Provide information on obtaining reference
  letters, the Medical Student Performance
  Evaluation (MSPE) process, and usingvarious
  electronic resources such as FREIDA and ERAS.
• 4. Teach students how to write an effective CV
  and personal statement. (Note This section can
  be done as a separate CV and
• personal statement workshop.)
• 5. Make students aware of graduation-related
  deadlines.

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Step 1Results

• What if your score does not meet criteria (200
  minimum in Baltimore and Dallas)?
• Hospital policy VS clinical rotation policy
• Texas clinical program position on Step 1 score
• What were looking for
• Strong exam score
• Mature, hardworking student doctors
• Good overall MD 1-5 scores

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Aureus Clinical Rotations - Texas
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Rotations Sites- DFW

• Harris Methodist, Ft. Worth
• State of the art, award winning city hospital
  serving wide range of Trauma to Specialty
  Medicine
• Teaching hospital with ACGME approved Residents
  and Fellowships
• Requires rotation to rotation paperwork for each
  student
• Requires ACLS certification
• Requires HIPPA course and formal hospital
  orientation be completed onsite

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Rotations Sites- DFW

• Harris Methodist, Ft. Worth (cont.)
• Prox Card badges and EMR sign-ins issued to
  Aureus students
• American med students, also rotate here
• Special Note Surgical assisting allowed under
  physician supervision order pending and
  interaction with support medical staff

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Rotations Sites (cont.)

• Baylor Medical Facilities (various)
• Very large and well funded healthcare system
• Renowned for excellent in training American
  medical students
• Name recognition on residency applications
• Affiliated research opportunities available for
  4th year students
• Medical Center of Arlington
• Large regional hospital
• Hub for specialty medicine and surgery
• Affiliated site for American medical student and
  Aureus rotations

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Day to Day in Rotations Texas Program

• Real life schedule following practicing
  physicians
• Mix of hospital and clinic experience
• Varied practice models
• Traditional Family Practice, Holistic Focused
  Family Practice
• Hospitalist Internal Medicine VS private office
• Schedule varies by what cases come
• Typically longer hours in cores, less so in
  electives

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Day to Day in Rotations Texas Program (cont.)

• Surgery Rotations at Harris
• Mix of hospital and clinic experience
• Varied practice models
• Traditional Family Practice, Holistic Focused
  Family Practice
• Hospitalist Internal Medicine VS Private Office
• Required attendance lectures on various special
  interest topics
• Research and presenting at rounds
• Evaluations by preceptors
• Currently no NBME shelf exams

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About Dallas/Ft. Worth

• Relatively low cost of living when compared to
  most major cities high standard of living
• Low crime rate Top 5 US metroplex by population
  
• Large medical hub with expanding practice
  opportunities and many residency programs
• Voted one of the top 5 areas to practice medicine
  in the US
• Very large international community one of the
  largest Indian and Pakistani communities in the
  US
• Special discounted rates on accommodations for
  Aureus Students
• Temperate climate with low humidity and mild
  winters

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Program Physicians in DFW

• Clinical Dean Wayne Hey, DO
• 30 years practicing in DFW
• Started Urology residency
• Clinical Coordinator Damon Sacks, MD
• All clinical professors are adjunct faculty at US
  medical schools

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FAQ and Common Misconceptions

• Do we have shelf exams?
• No
• How are we graded?
• Letter of evaluations from preceptors
• Where should I live?
• Ft. worth around TCOM or TCU or Irving
• Do I need a car?
• Yes
• Can I change my core schedules?
• Not typically but may in special circumstances
• Will I be waiting between rotations?
• Has not happened yet. Your schedule is back to
  back
• Can I schedule time off to study?
• Yes with approval