1. ICM, Clinical Rotations and Residency
- Damon Sacks, MD

2. - 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

4.  ECFMG and ECFMG certificate
 FRIEDA /Green Book
 ACGME
 MSPE
 SOAP / Scramble
 MPA

5.  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.

6.  Resposible for certifying credentials of IMG’s
 Uses ECFMG International Credentials
Services (EICS)
 Paperwork is submitted by Aureus for
certification on completion of education
 http://www.ecfmg.org/certification/index.ht
ml

7.  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

8.  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/requirements-for-
certification.html

9.  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/requirements-for-certification.html

10.  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

11.  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-
specialty/general-information.page

12.  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.

13.  Formerly called the ―Dean’s letter‖
 ―is not a letter of recommendation; it is a
letter of evaluation.‖
 Name and Purpose‖
◦ The MSPE describes, in a sequential manner, a
student’s 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
student’s academic performance and professional
attributes.

14.  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.

15.  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.

16.  ―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)

17. 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.html#restrictions

19.  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 H&P
 How to report findings to a preceptor

20.  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)

22.  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)
◦ Other helpful sources:
 Rapid Interpretation of EKG’s (ISBN: 0912912065)
 Various First Aid for Step 2 CS and CK
 Various Q-Banks and Kaplan Series Reviews

23. 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

24.  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

25.  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

26.  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

27. Year Three
 October–March
◦ 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.
 February–June
◦ 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 AMA’s FREIDA.
◦ Begin the MSPE process.
◦ Write your personal statement and have your advisor review it.

28.  Summer
◦ Obtain your ERAS token (a special code) from the dean’s office.
◦ Register for the Main Residency Match (www.nrmp.org).
◦ Register for early Match programs, if applicable.
 February–June
◦ 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 AMA’s FREIDA.
◦ Begin the MSPE process.
◦ Write your personal statement and have your advisor review it.

29. YEAR 4
 July–September
◦ 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.
 September–October
◦ Begin preparing for residency interviews.
◦ MSPE released October 1.
◦ If you haven’t taken the USMLE Step 2, consider using this time to
prepare.
◦ Submit ECFMG paperwork

30. YEAR 4
 October–January
◦ Residency interviews.
◦ Evaluate and compare residency programs by completing the Residency
◦ Program Evaluation Guide and the Residency Preference Exercise
 January–February
◦ Begin entering your Rank Order List online for the NRMP match.
 September–October
◦ Begin preparing for residency interviews.
 March
◦ MATCH DAY—The third Friday in March; results are formally announced at
12:00pm EST.
- Participate in SOAP if needed
 April–June
◦ Sign the contract with your residency program and prepare to begin
residency. Congratulations!

32.  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

33.  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

34.  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.

35.  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 we’re looking for:
◦ Strong exam score
◦ Mature, hardworking student doctors
◦ Good overall MD 1-5 scores

37.  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

38.  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

39.  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

40.  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

41.  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

42.  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

43.  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

44.  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