Thread: How to Succeed at AUC

Well tonight I am feeling generous. Since I've been through all of medical school (at AUC) and residency, I will pass along my pearls of wisdom or mindless ramping whichever you choose to call them after reading them.

#1 - Get Ready for a Change.

If you are the typical AUC student then you have applied to US schools or schools from your home country and were not successful in gaining admittance. Congrats you were rejected. Feels horrible doesn't it?! Yeah I went through it too. Don't despair as you were accepted into AUC and now were given a 2nd chance. Don't blow this one. Medical school basic sciences is TOUGH, it was at the time the toughest thing I had ever done, PERIOD. Like most caribbean students when you applied to a US school either your grades were not good enough and/or your MCAT wasn't good enough. Both of which is usually due to Not Studying Enough / Preparing for class and/or MCAT. If you want to succeed, you-will-need-to-CHANGE.


#2 - How to Change

Great you've agreed to buckle down and really study this time huh? Well considering your study habits kept you from having better grades or doing better on the MCAT, better re-learn how to study and learn quick. When they use the analogy of medical school is like drinking from a fire hydrant, its soooo accurate. The material is NOT difficult to understand at all, its the sheer VOLUME of material you must learn.

Let me stop there. Remember I said "LEARN", NOT memorize which is two different things.

When you learn something you understand it, you can manipulate the information. That is what being a doctor is about, applying what you learn. Don't get me wrong, you will memorize a lot of useless info and mostly important info. But here is the key that will help you make it out a star and rock your boards. When you understand a topic you are much more likely to remember it, than memorizing tables or definitions which you will forget after the exam.

In order to learn how to study and Learn Material instead of memorizing it, you have to understand a bit about the brain. Its like any other organ in our body, especially the muscles. When we overtax our muscles from working out they hurt and the more you exert them the more they will protest and hurt. If you overdo it, you will be less likely to exercise them again for fear of pain. The brain works similarly in that if you use your brain more than usual it will get tired and resist changing its structure to accommodate all this new information you are trying to learn. Like any muscle you have to exercise it consistently without fatiguing it and it will grow stronger. (i.e. your memory and problem solving skills will improve with practice.

#3 - Reading Material is DIFFERENT than Recalling Information

Studying notes from class is NOT reading them over and over and over again. If you want to see an example, read any page in a novel over and over for 10x. Think you know it well? Put the book down and in 1 hour write out what you remember from memory and try to copy it down on a blank sheet of paper word for word. I'm sure you didn't' do this, but you get my point. Its difficult to remember all the details and copy it. But how many times have you recited quotes from favorite movies word for word and could someone which move that is from, what was happening in the movie when the quote was said and now remember other funny quotes about the movie,etc. Your goal when studying material is to find ways to remember the material by making it interesting and useful to you in chunks and bits at a time.

Different people study different ways, but I think that using this method will help anyone improve their memory and your going to need lots of it.


#4 - Efficient Studying

Now to the meat, how do you study for medical school? Well to each their own, but here is what I did and it worked great for me. Keep in mind that each day you will have new material from each class you have. On average this is 3-5 classes a day. You must also keep up on the previous material and incorporate the new material each day and be ready for your exam after a few weeks of material is given. Your looking at 3-5 weeks of lectures, 5 days a week x 3-5 classes. At worst your looking at around 125 days of lecture between exams. You must be able to understand all that material and apply it on exams, not just regurgitate terms on a test. Very few classes in medical school rely on strict memorization besides Anatomy.

Each day Mon - Fri after attending each class I would take notes on what was covered in class to clarify later. Then when getting home around 3-5pm I would rest for 1 hour and then start studying. I would recopy the days notes into an Excel Spreadsheet in a question and answer format. I would use each slide for the lecture and make a question and then beside the question place an answer. I would have to be creative and make as few questions as possible to cover the lecture material. After finishing with that days lecture notes, I would review 2-3 of the previous days lecture notes by asking myself some of the questions I created for those lectures.

I would repeat this for every class and would have extensive banks of questions and answers covering every lecture for every class. The 2-3 days before exam I would increase my review to include more lecture review questions and on the day before review all my questions. If I had an answer memorized for a question, skip it as you know it. You need to spend your time trying to recall the answers for the questions you stumble most on. Don't' study what you know, study what you don't know.

#5 - Weekends are YOUR TIME

Study hard Mon-Fri and take Sat and Sunday OFF. Go to the beach, relax at home and recuperate. I couldn't totally relax, and would at least review 1-2 lectures from each class in the evening, but wouldn't use my whole day up. This way you don't miss out on the island and what it has to offer. CAUTION: Don't over do it, but don't deprive yourself either. Usually before tests I would study more on weekends, but still the majority of my times was relaxing.


# 6 - Do USMLE Questions OFTEN

The professors try to taylor their exams to mimic the USMLE exam questions often. This is not a guarantee, but is often the case. By studying USMLE questions on the topic your learning about in class, you can reinforce it and solidify it better.

Also this prepares you for the USMLE style questions early on. Then when 5th Semester comes around you have seen sooo many usmle questions you will start seeing repeat questions, yeah!! This will prepare you best for the USMLE Step 1 and the comprehensive final. There will be times when you will see similar questions on the exam that you may have seen on a USMLE qbook and get some extra points out of it. When I was there the Library had a set of binders called Bio-Test that had hundreds of multiple choice questions on different topics and are a great study aide.

#7 - People will Decelerate and/or drop out.

This may be you, I hope not though. You will develop a group of friends and learn together, but chances are some of them will drop out or decelerate and you will loose touch with them. Its a fact of life, get used to it and DON'T LET IT HAPPEN TO YOU.

#8 - Do WELL ON STEP 1

Do questions, questions, questions. USMLE World, Kaplan Q-bank, Q-books, etc. This will be your best gauge as how well you know the material. If you miss a question, review the material on why you missed it then move on. Don't re-study questions you got right its a waste of time. Do so many questions you start seeing repeats, repeats, repeats and your average improves. Then set a date and take the exam.

#9 - Clinical's

If you make it off the island and do well on your USMLE Step 1, congrats. Clinicals is down hill from here. 90% of them are showing up and doing what your asked. You will study some and learn, but it will not be as bad as basic sciences. Though, don't totally give up in clinicals as its important you do well and get good evaluations. You should NEVER fail a clinical rotation for any reason, this looks BAD for residencies. If your having family problems, medical, etc then seek HELP EARLY or get accommodations from the rotation or school and if you must ask to withdrawal or postpone your rotation. Some rotations if you withdrawal you could fail them, so best to just NOT FAIL them. Remember 90% is showing up and doing what your told and learn when you can.

Some rotations are hard, some are easy. Most are ok. You will have to do skut work, get used to it as a medical student. You will have to get up earlier than everyone else for some rotations and work harder then the residents for some. This is the exception, not the rule. Most are fine.

#10 - Residency

Less than 50% of IMG's (International Medical Graduates) will match into a residency program. Its the norm now, and considering US medical schools are increasing their class sizes and there are min to no increase in overall residency spots. Expect this rate to decrease more as time goes on.

Let that sink in.

Out of all the US IMG's that submit a rank list for their preferred programs for residency, about 49% in 2012 matched to a program. These are people who made it off the island and through basic sciences and clinicals and passed all their board exams. Then only 1/2 of them actually get a spot in the match.

This doesn't include the people who take positions outside of the match, but I am not sure how that would influence the numbers. Still its a stark wake up call to IMG's. This means you could potentially waiting an entire year working whatever you can waiting for next years match cycle. And those student loans don't stop being due because you didn't get a position in a residency, have fun making those payments.

#11 - Final Thoughts

This is a path not for the light hearted, it is a long road that has many bumps and in the end you are still competing for residencies with US Students. You will have to work HARDER than US Students, LONGER than US Students and accept LESS CHANCE of getting a residency for all your trouble and almost double the tuition cost and repayment. Its not fair, but the way it is.

Think long and hard before making the jump, thats a lot of STUDENT LOANS that WILL BE REPAYED if you graduate or not.

Thank you!

What percent of those who fail to match match the year next?

Thanks.

Great Question. I don't have the answer to that statistic. Im wondering the longer you wait the more difficult it may be to get a position. Anytime there is time off from medical school you have to explain this on your application.

Great post, and glad to see that none of it was sugar-coated!

Another bit of advice which I may have mentioned in the past, but is worth repeating again...be smart in the match!! As Macgyver mentioned, many US IMG's don't match. Some of these people just did poorly and didn't have a strong enough application. However, I think that these are by far the minority, and most people didn't match because they didn't go about the match the right way. Don't be one of these people! DO NOT wind up in the scramble (SOAP)! The SOAP is not good for caribbean grads and if you don't match in the main match, you may wind up not matching at all. Each year you sit out, it's likely going to get more difficult, and less likely you'll get what you want. So here's what you need to do to get your best shot at matching (and I'm speaking only strictly of how to work the match, not the obvious do well in school, pass the boards, etc.)

1. Apply to as many programs as possible. It doesn't matter what it costs you - it's insignificant compared to your total loan burden which you won't be able to pay off if you don't match.
2. Rank every program that interviews you, unless you are 100% certain that you'd be absolutely miserable in that location and so miserable in fact, that you'd prefer to not have a job at all, while your loans continue to accrue interest.
3. Rank your first choice first, whether or not you think you have a chance. NRMP details exactly how the match works and how it favors the applicant's preference when running the match, so I won't go over it here. The basics of it is that ranking a program you don't think you have a shot at can not hurt your chances at places you do think you have a chance, but you might be surprised what you wind up with! Some people ignore this advice, and I have no idea how they just don't get it after NRMP makes it so clear.
4. Apply to back ups, Apply to back ups, Apply to back ups!!!!! This may be the most important piece of advice you could take, if you're applying for anything other than peds, IM, or FM (and if you are applying for back ups, these should be them. Anesthesia is not a back up for radiology...unless you happen to be lsmith). Once again, this comes back to the fact that you do NOT want to wind up in the SOAP system if there's anything at all you can do to prevent it. It doesn't matter how great you think your chances are for the program you really want, you had better have a back up! I know of MANY people, including myself, that did not take this advice and wound up scrambling. I got very lucky and scrambled into a decent family medicine spot. I got very lucky again this year to finally match into my chosen specialty. Many others did not get as lucky; don't take the chance. Again, it is better to wind up somewhere in a program that may not be your first choice than to have no job at all. The other advantage to applying to back ups is that if you do wind up having to go into a second choice specialty, at least you can choose which program you'd prefer in that specialty. If you are lucky enough to find a spot in the SOAP, you'll probably have no choice as to which spot you got, and it's probably not going to be a place you would have chosen on your own.

The fact of the matter is that it's extremely difficult to get most any specialty that is not primary care coming from the caribbean. It's certainly not impossible and if it's what you want, then you should go for it. But do be realistic, and absolutely be prepared with a backup. You see the match list and the fact that there are a handful of people who got very competitive spots. Maybe you'll get lucky and be one of them. But, what you don't see is how many people applied for, and did not get, those competitive spots. I don't have any proof to back it up, but anecdotally I'd guess that there are far more people who applied and weren't successful than the number who go the spots.

Study hard, work hard, have a good attitude in rotations, do whatever you can to help the residents, and don't forget to have a little fun along the way. It's a long ,sometimes awful, and often not fair road, but it comes to an end. Best of luck!

Great post. Thanks for the insight and advice.

Originally Posted by slevit1MD

Great post, and glad to see that none of it was sugar-coated!

Another bit of advice which I may have mentioned in the past, but is worth repeating again...be smart in the match!! As Macgyver mentioned, many US IMG's don't match. Some of these people just did poorly and didn't have a strong enough application. However, I think that these are by far the minority, and most people didn't match because they didn't go about the match the right way. Don't be one of these people! DO NOT wind up in the scramble (SOAP)! The SOAP is not good for caribbean grads and if you don't match in the main match, you may wind up not matching at all. Each year you sit out, it's likely going to get more difficult, and less likely you'll get what you want. So here's what you need to do to get your best shot at matching (and I'm speaking only strictly of how to work the match, not the obvious do well in school, pass the boards, etc.)

1. Apply to as many programs as possible. It doesn't matter what it costs you - it's insignificant compared to your total loan burden which you won't be able to pay off if you don't match.
2. Rank every program that interviews you, unless you are 100% certain that you'd be absolutely miserable in that location and so miserable in fact, that you'd prefer to not have a job at all, while your loans continue to accrue interest.
3. Rank your first choice first, whether or not you think you have a chance. NRMP details exactly how the match works and how it favors the applicant's preference when running the match, so I won't go over it here. The basics of it is that ranking a program you don't think you have a shot at can not hurt your chances at places you do think you have a chance, but you might be surprised what you wind up with! Some people ignore this advice, and I have no idea how they just don't get it after NRMP makes it so clear.
4. Apply to back ups, Apply to back ups, Apply to back ups!!!!! This may be the most important piece of advice you could take, if you're applying for anything other than peds, IM, or FM (and if you are applying for back ups, these should be them. Anesthesia is not a back up for radiology...unless you happen to be lsmith). Once again, this comes back to the fact that you do NOT want to wind up in the SOAP system if there's anything at all you can do to prevent it. It doesn't matter how great you think your chances are for the program you really want, you had better have a back up! I know of MANY people, including myself, that did not take this advice and wound up scrambling. I got very lucky and scrambled into a decent family medicine spot. I got very lucky again this year to finally match into my chosen specialty. Many others did not get as lucky; don't take the chance. Again, it is better to wind up somewhere in a program that may not be your first choice than to have no job at all. The other advantage to applying to back ups is that if you do wind up having to go into a second choice specialty, at least you can choose which program you'd prefer in that specialty. If you are lucky enough to find a spot in the SOAP, you'll probably have no choice as to which spot you got, and it's probably not going to be a place you would have chosen on your own.

The fact of the matter is that it's extremely difficult to get most any specialty that is not primary care coming from the caribbean. It's certainly not impossible and if it's what you want, then you should go for it. But do be realistic, and absolutely be prepared with a backup. You see the match list and the fact that there are a handful of people who got very competitive spots. Maybe you'll get lucky and be one of them. But, what you don't see is how many people applied for, and did not get, those competitive spots. I don't have any proof to back it up, but anecdotally I'd guess that there are far more people who applied and weren't successful than the number who go the spots.

Study hard, work hard, have a good attitude in rotations, do whatever you can to help the residents, and don't forget to have a little fun along the way. It's a long ,sometimes awful, and often not fair road, but it comes to an end. Best of luck!

I laughed hahaha

did not mean to post anything here

Thanks for the info, would you consider Emergency Medicine to be a competitive residency?

Also, do you think doing extremely well on step 1 USMLE would be the biggest help when applying for residencies? thanks

EM was the only specialty in this year's match to fill EVERY SINGLE SLOT through the match.... all 1600+ of them. It has become extremely competitive.

A great Step 1 score won't guarantee you a competitive residency, but a terrible score will almost certainly exclude you from one.

Doing well on Step 1 is only half the equation though. Even if you do very well on Step 1, the vast majority want to see you follow that up with an equally good Step 2. And ER is not going to get any easier to match into.

Couldn't have said it any better than Slevit as far as the match goes. Take his advice seriously and use it.