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In 2016, I first began considering residency programs in the United States. More often than not, I was met with discouraging comments, told that it was going to be impossible and that I was crazy to even consider it. Fast forward seven years later, I successfully completed my PGY-1 year of anesthesiology residency. The process is not impossible as an IMG, but it is a tedious and difficult journey, one that requires constant support and determination. I can now say that the journey was absolutely worth it, and I encourage you to put your best foot forward.
Let me start with a brief background about me. In 2018, I graduated from Warwick Medical School in the United Kingdom. From August 2018 to August 2019, I worked as a Foundation Year 1 doctor, an intern equivalent in the U.K., while simultaneously starting my Masters in Public Health. In September 2020, I applied for a residency position through ERAS, the Electronic Residency Application Service. I matched in March 2021, and I started anesthesiology residency at the Rutgers New Jersey Medical School in July 2021.
My journey from an IMG to an anesthesiology resident can be broken down into three categories: the essentials, the extras, and my personal experience.
The Essentials
To qualify for the ERAS application and match cycle, you will need to complete your USMLE Steps 1 and 2 CK (Clinical Knowledge), Occupational English Test (OET), and be certified by the Educational Commission for Foreign Medical Graduates (ECFMG) by the time you match; this includes being a medical school graduate. In addition, letters of recommendation, a strong personal statement detailing your experiences in anesthesiology, and a medical school performance evaluation from your medical school are required for your application. These are your essentials. With the recent change in Step 1 from a three digit score to pass/fail, many IMGs are worried they will be put at a disadvantage. This is where your Step 2 CK and extras come in.
The Extras
I often get asked by many IMG applicants how important research experiences and hands-on U.S. Clinical Experiences (USCEs) are. Let me start by saying, research experiences are not a necessity to match, but rather a bonus and boost to your application. According to the 2020 Charting Outcomes in the Match data for IMGs released by the National Resident Matching Program (NRMP), the average number of research experiences for IMGs who matched is 1.9 for U.S. IMGs and 2.7 for non-U.S. IMGs.
USCEs, on the other hand, are something I would like to argue for as more of an essential extra. Medical students in the U.S. have the opportunity to do “away rotations” where they spend 4 weeks in a hospital outside of their home institution to experience their specialty of interest in another setting, network, and get letters of recommendation. IMGs are at a disadvantage in that many are unable to come to the U.S. for an extended period of time for a rotation. Some medical schools abroad have scheduled “elective periods” where IMGs can opt to spend time in the U.S., whereas others may come after graduation. A USCE, no matter the duration, is one of the most valuable experiences IMGs can partake in. It gives them the opportunity to learn how the U.S. healthcare system is run, in addition to networking experience, mentorship, and letters of recommendation.
Other extracurricular activities that fall into the extras include volunteering, leadership positions, and additional educational degrees, such as a masters or Ph.D.
My Personal Experience
In 2021, 3.4% of U.S. IMGs and 4.5% of non-U.S. IMGs matched into anesthesiology. In 2022, 3.7% of U.S. IMGs and 4% of non-U.S. IMGs matched into anesthesiology. The numbers look daunting and matching into anesthesiology as an IMG is not an easy feat, but it is possible with a strong application, supportive mentors, and beneficial resources.
Unlike most of my U.S. peers applying for residency, I did not go from graduating medical school straight into a residency program. I took the time to perfect my application, despite increasing my number of gap years. After graduating medical school in 2018, I chose to stay in the U.K. to complete a year of training because it meant I would enter my residency program as a PGY-2 equivalent, in terms of knowledge and clinical skills. During that same year, I enrolled in a Masters in Public Health program to strengthen my credentials and improve my research skills, experiences that would be valuable as a resident at an academic institution.
Prior to graduation, I completed 4 weeks of USCE in early 2018. I was very fortunate to have left my USCE with two life-long mentors who were crucial to my application process. One of them wrote me a letter of recommendation, and the other mentored me throughout the interview season, helping me network with various program directors, chairs, and attendings. I stayed in contact with my mentors throughout my journey, updating them on my progress and heeding their advice.I wish there was a foolproof guide to matching into anesthesiology as an IMG, but every applicant is unique with different backgrounds and experiences. I hope that, in sharing my journey, you can better understand the intricacies of the process and how to put your best foot forward. Please feel free to reach out to me with any questions about matching as an IMG. I wish you the best of luck on your journey to anesthesiology.
About the Author:
Cynthia Tan graduated from Warwick Medical School in 2018, and she is currently a PGY-2 anesthesiology resident at Rutgers New Jersey Medical School.
Posted August 2022
