Our Medical Education Strategy As Prospective USIMGs

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I know, I know--I should be studying for the Philippine NMAT as we're scheduled to take the exam on December 1st in Los Angeles. That's less than one month away. Granted, it was only one week ago that my husband and I both decided that we will be pursuing our calling to go to Med School...in our 30's. Yes, we will humbly accept all the prayers that we can get, not only because we are aging (albeit gracefully), but because we also have a growing family to feed.

I tend to plan with at least the beginning of the end in mind--allowing contingencies along the way, of course. However, I'd hate to prepare for the Philippine NMAT without first solidifying our Medical Education Strategy as Prospective USIMGs (a USIMG is a U.S. Citizen who is a graduate of an International Medical School), with the following Strategic Intent:

Become a God-fearing, high-performing, well-rounded, and globally-conscious "MD couple"

A strategy would not be complete without desired end states (I just couldn't resist wearing my Strategic Planning hat, hence some of my friends like to call me the "MBA Mom"...in short, I am a self-professed nerd). My husband has yet to approve these (by the way, being a nerd = sounding official), so let me start off with the proposed Desired End States (that include but are not limited to):

1. Become practicing MDs in the United States within the same vicinity, with the State of California as our target starting point (most Philippine Medical Schools are recognized by the Medical Board of California)
2. Be able to go on medical missions preferably in the Philippines, Okinawa, and some of the Pacific Islands (we both like to embrace our ethnic roots)

...and this is just Phase I.

Great, now it's 3:00AM in Hawaii. Let's continue, nonetheless...

In order to achieve those desired end states, we need to chart out a path. Enter: Measures of Effectiveness (MOEs)

Proposed MOEs shall include (without limitation):

• For Desired End State #1:
• Pass the Philippine NMAT according to our preferred medical school's standards/cut-off score
• Obtain Notice of Acceptance and successfully enroll in a Philippine Medical School recognized by the Medical Board of California
• Pass the USMLE (Step 1, Step 2 CK, and Step 2 CS) with a target score of 240+ (and no lower than 228), preferably taking Step 1 after our 2nd year in medical school (if the school administration would allow us to do this vs. having to take all of the tests after graduation--ouch!) Update: I was told that the Philippine medical school of our choice would allow us to take the Step 1 after our 2nd year. And, last time I checked the ECFMG website, we can take the USMLEs in the Philippines (at an added cost).
• Remedy "medical school training deficiencies/clinical rotation weeks" between what our preferred Philippine medical school offers and what California law requires, prior to graduating (this will most likely be a future blog post) Update: I called the Medical Board of California (Phone Number is 1-800-633-2322) and they do require a minimum of 72 weeks of clinical rotations before graduation. This can either be accomplished in the U.S. or in the Philippines. I also spoke with the Philippine medical school of our choice and we can do U.S. clerkships as early as the 3rd year as long as the Dean approves (we can also delay graduation, if needed, in order to meet the Medical Board of California's minimum requirements for clinical rotations). There are a number of U.S. hospitals with a university affiliation that are open to having international medical students (to date, being Harvard, Mayo, Orlando Health, etc. There are fees involved, so please check out their websites or contact them for the most up-to-date information). From what I read, ACGME-accredited U.S. clerkships are better than doing observerships and externships (some don't even allow for the latter due to liability). In addition, obtaining strong Letters of Recommendation during U.S. clerkships is very helpful when matching for residency. 
• Graduate from our preferred Philippine medical school
• Obtain ECFMG Certificate (after obtaining a diploma and passing USMLE Step 1, Step 2 CK and Step 2 CS)
• Get "matched" as a "couple" (a program exists for this with a great matching rate) in the U.S. National Resident Matching Program
• Enter ACGME-accredited residency program in the United States as a couple
• Pass USMLE Step 3
• Register for a fellowship (as desired)
• For Desired End State #2:
• To Be Determined

Of course, we'll need to develop Measures of Performance (MOPs) to correlate with the above MOEs--this is how we'll know how we are doing at each Project Assessment stage. For the sweet purpose of sleep, I will not completely enumerate the MOPs now; but just to give you an idea, we will need to set targets and thresholds for the items outlined below, as these will inform the MOPs.

• Number of hours to study for the Philippine NMAT (study schedule and frequency will then be detailed in the Operations, Actions, and Activities section, which happily remains floating in my sleepy head)
• Number of medical schools to send our applications to
• Number of hours to study for the USMLE
• Number of clinical rotation hours to complete before graduation

As part of the Implementation Plan, we'll definitely need to develop a Project Schedule and Timeline as well as establish Project Milestones. Doing so will help us identify risks, avoid project delays, plan for contingencies, and monitor our budget--just to name a few.

Here are a few important questions to ask during one of our periodic Project Assessment stages:

• Did we reach our milestones?

• Did we obtain our diploma on time?
• Did we obtain our ECFMG certificate on time?
• Did we finish and pass all of our USMLE exams on time? 

I had read in some forums that the timing involved in reaching the aforementioned milestones plays a critical role in getting matched during residency.  If you do things right, you may get matched in the same year as you graduate. Otherwise, you will have to wait...up to 2 years, in some cases. (NOTE: I have yet to prove the validity of this information.)

Anyway, it's time to get some sleep. It's almost 6:00AM HST.

Goodnight and Happy Aloha Friday!


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Disclaimer: I am not connected with any of the organizations mentioned in this blog post in any way. The information I provided was gleaned from personal research on the Internet and is not intended to replace or invalidate the information, policies, and procedures listed by any of the said organizations. For the most up-to-date information, please visit these organizations' websites directly.