Rounds to Residency

The IMG Roadmap with Nina Lum MD

Dr. Nina Lum shares advice for International Medical Graduates (IMGs) in how to be competitive with U.S. graduates when it comes to landing a residency.

  • [01:29] The Ego Problem in Academic Medicine
  • [03:51] Why Nina Creates Content for IMGs
  • [07:28] Social, Academic and Financial Challenges of IMGs
  • [10:17] Why IMGs Should Plan Early for Residency
  • [14:45] How to Get a Strong Letter of Recommendation for Residency
  • [21:22] How IMGs Should Respond to the New Pass/Fail Step 1 Exam
  • [25:52] How to Gain Specialized Experience Outside Clinical Rotations

Dr. Nina Lum is a family medicine hospitalist and the host of the IMG Roadmap Podcast as well as The IMG Roadmap eCourse and The Encouraging Doc blog.

Challenges Faced by IMG Students

After completing her residency, Dr. Lum managed to secure a well-paying position with a block schedule (one week on/one week off). She began to think about the struggles she faced to get to this point, and felt sick and tired of watching fellow IMGs stumbling and struggling on three main problems:

  1. Writing applications
  2. Networking
  3. Competing with their US graduate counterparts.

She narrowed down the problem to a lack of information, a lack of specific knowledge, and a lack of mentorship. So, Dr. Lum decided to create content for IMGs.

Also, there are three main challenges faced by IMG students:

  1. Social challenges – which include stereotypes and stigmas.
  2. Academic challenges – like being assigned to only community-based residency programs, instead of getting exposure from both community programs and academic facilities.
  3. Financial challenges – like not having enough money to get the best resources to prepare for an exam.

Dr. Lum encourages IMGs to prepare early on, gathering specialty-specific information before beginning rotations, because later on they will be too caught up with preparing for their board exams.

Letters of Recommendation

Dr. Lum has designed a method for getting a good recommendation. Firstly, do two to three rotations in your desired specialty, so that you get more than one or two letters of recommendation for residency. Secondly, before you begin a rotation, understand the flow of your rotation and who you will be interacting with (attending versus resident) so that you feel comfortable and so that you can identify a potential recommendation letter writer. The letter writer should be the highest ranking person on the team — usually an attending.

Thirdly, before you begin the rotation, contact your attending physician and ask them for the resources that you need to read up on to excel at your rotation. For example, the books, sites or research platforms that they use as a reference. This demonstrates that you are eager to learn. Fourthly, during the rotation, show up and be engaged. Volunteer for tasks, even if they are menial tasks. Opt to present your patient, and use question banks to engage in critical thinking. Next, at the end of the first week of your rotation, ask your attending physician what you should do to get a strong letter of recommendation later on.

The Board Exams

With regards to the new pass/fail USMLE Step 1 Board Exam, Dr. Lum encourages IMGs to continue to prepare as usual. She suspects that there may still be some sort of categorization of students who perform better or worse. But regardless, basic sciences are an important part of a medical education, and students should be intrinsically motivated to learn it.

For IMGs who only decide on a specialty after completing their clinical rotations, Dr. Lum encourages them to participate in clinical observerships or other experiences in their desired specialties. Although it is ideal to do a clinical rotation in your specialty, it is not the end of the world if you do not, and you can pursue observerships. It is important to filter out good versus predatory observerships. A good rule of thumb is to choose observerships that are affiliated with a multidisciplinary teaching program, because these are vetted by the Accredited Council for Graduate Medical Education  (ACGME).

Check out Dr. Lum’s e-book The IMG Guide to Clinical Rotations on the US Wards. Check out Dr. Nina Lum’s website which includes IMG-focused blog posts, a podcast and a course. Do also check out her Instagram.

Sign up for a Free Coaching session with Chase DiMarco, sponsored by Prospective Doctor! You can also join the Med Mnemonist Mastermind FB Group today and learn more about study methods, memory techniques, and MORE! Do check out Read This Before Medical School.

Chase DiMarco

Chase DiMarco is an MS, MBA-HA and MD/Ph.D-candidate. He is the founder of MedEd University, a free medical education resource, the host of the Medical Mnemonist & Rounds to Residency podcasts creator of several medical education platforms, and CEO of FindARotation clinical rotations service.

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