International Medical Graduates of Idaho Meeting Notes February

International Medical Graduates of Idaho Meeting Notes February

International Medical Graduates of Idaho Meeting Notes February 28th, 2015 Possible Next Steps Develop collective study group options for USMLE; spread cost of study tools Explore more about dentist model of taking US License Exam and then returning to medical school for 1-2 years to get the clinical experience requires support from medical school Invite US doctors to join the group and get involved in the conversation Additional perspective Figure out a more accessible model for doctor shadowing for individuals (US doctors are aware of how it works for program/system, but not for individuals) Investigate expansion of WWAMI medical student support Figure out how to be a state advocacy on behalf of IMG of Idaho - Two doctors from WWAMI presented to the legislature on the need for more doctors in Idaho Nathanial will send the names Develop a case that articulates the benefit(s) for the State of Idaho to use tax payer dollars to expand WWAMI, in part, to support IMG path to medical relicense in Idaho For example

IMG of Idaho are doctors who are more likely to stay, whereas others will leave to other states to practice IMG of Idaho doctors have extensive experience (i.e.,100 patients/surgeries a day in a war zone for two year straight is more than most US surgeons might see in a career) Invite other key contacts related to WWAMI, VA, University of Washington medical school to present to IMG of Idaho group There are 3 Types of International Medical Graduates (IMG) US IMG US Citizen Planned to attend International Medical School Goal is practice in US Competitive in ERAS and w/ AMG Country Sponsored IMG Refugee IMG Wealthy countries partner with universities and hospitals - i.e., Gulf countries like Saudi

Arabia, UAE, etc.. Goal is practice in US IMG but due to partnerships, students train/research in US & its paid by home country govt US residency salary paid by home country govt Competitive in ERAS & Match w/ AMG Immigrated to US for safety due to unrest in home country Never planned to come to US to practice medicine Multiple barriers to get into a US residency program - Certified credentials - ERAS preference ranking - US clinical experience - Time since graduation from med school Traditional Path to Medical License: AMG vs. IMG American

Medical Graduate (AMG) Vs. International Medical Graduate (IMG) Arrive to US Goes through National Medical Boar d Examination (NMBE) / American Medical Asso ciation (AMA) United States Medical Licens e Exam (USMLE ) 1. 1.Basic science, written - 13 system / 10 disciplines 2. Clinical science - written & practical

3. General Medical Knowledge Electronic Re sidency Appl ication Syste m (ERAS) Match/ Interview Selections Residency Looks easyits NOT if you are a IMG that is a refugee! NOT NMBE/AMA Instead, Education Commission for Foreign Medical Gr aduates (ECGMG) Credential Evaluation Unstable home country = long process (YEARS!) United States Medical Licens e Exam (USMLE) 1.Basic science, written - 13 systems/ 10disciplines. 2. Clinical science - written & practical

3. General Medical Knowledge Median USMLE Score is 220-225; IMG needs 240-245 to help even the playing field IMG is not getting ANY Clinical Hands-on Experience in US during this time Electronic Re sidency Appli cation Syste m (ERAS) Match/ Interview Selections Residency Here is where the REAL CHALLENGE LIES Selection Priority: 1) AMG 2) US IMG 3) Non-US IMG Selection preferences: high USMLE Score, time since graduation to USMLE, clinical experience in US, recommendations from US doctors. Publication, Master and/or PhD NOT COMPETITIVE

In ERAS & Match despite years of actually practicing medicine International Medical Graduate (IMG) Barriers to Medical Residency 1. Not fresh medical school graduates 2. 3. Process for getting foreign credentials evaluated can be long, particularly if issuing body is an unstable country with political unrest Time between graduation date and USMLE Time from ECFMG to USMLE w/o hands-on experience with patients since arriving to US Lack of recommendations and/or recommendations that are relevant to program directors (i.e., demonstrates candidates competencies against residency program standards) US medical students often have dual degree options (i.e., Medicine + PhD., Medicine + Masters, etc.) IMGs lack this option Doctors salary in residency in US is paid by Accreditation Council Graduate for Medical Education (ACGME) 4. 5.

6. Fund from ACGME comes from Medicare (tax payers $$), so there is A LOT of policy associated with this. Residency Programs not motivate to take risk (go outside the bounds of traditional ranking) because they need maintain their program standards to maintain accreditation ACGME requires an 80% medical boards pass rate Physicians Assistant program is a alternative path BUT it proves challenging as well. 7. Program sees through motivation to become a practicing MD as opposed to a PA which can impact acceptance into program Other?? Resources to Explore A excellent new report from Massachusetts on the role of immigrant healthcare professionals. Includes 4 recommendations to improve opportunities for IMGs and the US healthcare system and economy. http://www.miracoalition.org/images/stories/gac_task_force_report_final-12.18.14.pdf. A new advisory issued by ECFMG warning IMGs about new organizations that are illegitimately posing as certification agencies: http ://origin.library.constantcontact.com/download/get/file/1113015049867-299/ECFMG-release-Sep-16-2 014.pdf

Accelerated Nurse Practitioner program at Florida International University http://fep.fiu.edu/, Accelerated Nursing program at Idaho State University http://www.isu.edu/nursing/accelerated.shtml Medscape report about the resident Salary and Debt 2014; slides, 2, 6, 10 & 28 provide a good snapshot http://www.medscape.com/features/slideshow/public/residents-salary-and-debt-report#1 ACGME website: https://www.acgme.org/acgmeweb/ Current Options to Get Doctor Interactions/ Clinical Experience/ Doctor Recommendations IMG Prep - can be valuable experience & only requires passing 1 step in USMLE to participate BUT Expensive (to cover salary and liability insurance to allow for patient interactions) Mostly focused in east coast Limited selection of doctors Observerships Today Mrwan Sweedan (Boise) and Ali Makki (Twin Falls) are doing this, but it really does not provide benefit to residency application because there is not clinical patient interactions its only observing the doctor Physician Assistant (PA) or Nurse Practitioner programs

Challenges with getting into PA school and being able to get financial aid/loans to fund the 2 year program because already have an MD Nurse Practitioner is less valuable than PA in gaining clinical experience because cannot prescribe medications US Medical License Exam (USMLE) USMLE will not release exam results without ECFMG In 2022, ECFMG to implement a policy to not recognize any non-US medical school that do not follow American medical school system Three Parts to USMLE 1. Basic (all theory) 13 subjects 2. Clinical (2-part) a. Clinical Knowledge (CK) theory; 9 hour exam b. Clinical Scale (CS) medical knowledge, communication & ethics - practical exam with 12 patients; exam is pass/fail 3. General Medical Knowledge can take before residency or during residency (usually AMGs take it during); 2-day exam that can be taken over two consecutive days or spread out. There are agencies and resources across the country to help prepare and pass the USMLE USMLE Tools (from Ali Makkis Handout) www.ecfmg.org - IWA/OASIS & For USMLE step 1, 2 CK-CS/Application & registration www.usmle.org - Qbank (more than 2000 exam-like questions with detailed explanations) www.kaptest.com all the tools and prep to pass all 3 parts of

the USMLE including online and live classroom options; Qbank (more than 2000 exam-like questions with detailed explanations) www.medquestreviews.com The amazing Dr. Conrad Fischer, MD; Steps 1,2 & 3 video lectures; Books to master the boards for step 2CK and step 3 www.nbme.org The most reliable and accurate assessment selfassessment exam for Steps 1, 2 & 3 www.prometric.com To schedule the LONGEST day in your life ever to take the big test Helpful Residency Stats Resident salary in NW averages ~$71K/year vs. other areas of us the at ~$55K/year. But, ~73% of all residency programs are west of the Mississippi, so chances to get accepted in residency program in the NW is lower. 1 in 5 doctors in the US had to work in the New England area (i.e., Boston etc.) at one point in their career. http://www.medscape.com/features/slidesho w/public/residents-salary-and-debt-report Residency Programs General Overview 1. University hospital 2. Community hospital affiliated with a university 3. Community hospital without university affiliation There is a feasible alternative to the University Hospital residency programs VA (Veterans Affairs): the biggest healthcare system in the US with residency programs affiliated with various universities

including University of Washington Medical School University of Washington in Seattle is also a WWAMI medical school Possible Areas Global Talent Idaho Can Help Partnership with the Idaho Department of Labor (IDOL) in an effort to access funds for dislocated workers that alleviate some of the costs associated with relicensing and reestablishing a medical career. Rosa in Twin Falls Stacey Shegrud at the Boise Idaho Depart of Labor English language resources Global Talent Idaho Job Seeker Training Program 1:1 coaching and workshops on the key components of the American job search. Orientation to Global Talent Idaho & General American Cultural Norms Marketing Yourself in the US Job Search Interviewing Skills Networking Skills Practice Interviewing Surviving the American Workplace Mentor Program job seekers can be matched with a volunteer mentor, a professional with American work experience, who provides individual coaching, resume and cover letter support, and industry knowledge

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