When I first started clinical rotations, I was in Internal Medicine, and on my first day of outpatient clinic, I followed a 4th year student who was back for an elective. We did all our vitals, and complete history and physical to present to our preceptor. As I watched the 4th year student talk to some of the patients, I thought to myself, wow, kind of a showoff maybe? He was telling patients how to change their lifestyles, and why they were taking certain medications. I was thinking to myself, but that’s the doctor’s job, he should be explaining all this and we should wait for him.
But looking back, he was absolutely right. As I ended my Family Medicine rotation I realized that’s what I’ve started doing automatically as well with time - I just didn’t realize or notice until recently. Because as you get better at your H&P, and learn as you go, you are essentially the patient advocate. Patient’s ask you questions, and you answer them. Essentially, that’s what OSCEs try to teach us too - we explain what tests we are doing while doing them, and what we are looking for.
My friend was saying that in our FM clinic, one patient asked her why she was doing a Neer’s test, and she explained she was looking for a rotator cuff impingement. Plenty of patients come in with diabetes and hypertension, and it becomes somewhat automatic to help them with their lifestyle. Are you compliant with your meds? How is the exercise regimen going? How’s it going cutting back on all the red meat?
Because basically, the patient spends more time with the student. We will present to the preceptor/attending, who will come back in to the patient room, quickly glance and say our notes are well, and make sure everything else is ok. The patient get refills, etc, but we as students are counseling and educating. The doctor doesn’t always have all that time. And you get better at it as time goes, and soon it’s just a normal part of your routine.
We make jokes that friends and family will ask us medical questions, but that we’re just students.
But that’s exactly it. We’re students.Always learning. Always teaching. Always advocating. And soon it becomes your life and you do it without even knowing. The role of the student is an important one - and except for the occasional patient who wants nothing to do with a student, most of them really do look up to you and appreciate you (especially if you have wonderful bedside manner)!
Alright guys, a whole lot of info coming at you. For my premed followers, I want you to seriously evaluate if going the Caribbean med school route is truly worth it, and if you are willing to take on extra anxiety and stress. That being said, a different post on that to come again, but the ask box is always open!
So, the point of this post is to talk about the recent pathways ECFMG came up with for those students who were unable to take Step 2 CS in order to be eligible for certification. These include:
Eligibility for All Pathways
Applicants who are eligible to pursue ECFMG Certification based on one of the pathways include those who:
Have not already passed Step 2 CS.
Are not barred by ECFMG from pursuing certification.
Are not barred by USMLE from taking a Step or Step Component from August 1, 2020 to January 31, 2021.
Have not failed a USMLE Step or Step Component (Step 1, Step 2 CK, or Step 2 CS) two or more times.
Have taken or been registered for any USMLE Step or Step Component since January 1, 2018.
Pathway 1: Already Licensed to Practice Medicine in Another Country Applicant has held a full, unrestricted license or registration to practice medicine in any country at any time on or after January 1, 2015. License does not need to be currently valid. The license or registration has not been subject to disciplinary action.
Pathway 2: Already Passed a Standardized Clinical Skills Exam for Medical Licensure - General Medical Council: Professional and Linguistic Assessment Board (PLAB) Part 2 - Australian Medical Council: Clinical Examination Part 2 - Medical Council of Canada: Qualifying Examination Part 2, National Assessment Collaboration Examination - Medical Council of New Zealand: NZREX Clinical - Medical Council of Ireland: Pre-Registration Examination System (PRES), Level 3
Pathway 3: Medical School Accredited by Agency Recognized by World Federation for Medical Education (WFME) Applicant’s medical school is currently accredited by an agency recognized by WFME (and meets other ECFMG requirements). See the list of eligible schools. Date of graduation must be on or after January 1, 2018. An authorized school official must attest to applicant’s clinical skills.
Pathway 4: Medical School Participates in U.S. Federal Student Loan Program Applicant’s medical school currently participates in the U.S. Federal Student Loan Program (and meets other ECFMG requirements). See the list of eligible schools. Date of graduation must be on or after January 1, 2018. An authorized school official must attest to applicant’s clinical skills. Pathway 5: Medical School Issues Degree Jointly with a U.S. Medical School Accredited by Liaison Committee on Medical Education (LCME) - Weill-Cornell Medicine - Qatar - Duke University - National University of Singapore Medical School
Now, why are these so troublesome and problematic? They are barring many intelligent and qualified students to go into Match 2021 who would have otherwise been ok if they had Step 2 CS under their belt. The ECFMG is allowed to enforce certain requirements, but they should give time for policies to go into effect, like one year, not one abrupt day:
They originally had the policy that all schools must be accredited by 2023. One Caribbean school with an adequate curriculum consisting of OSCEs, shelf exams, and more had a site visit for accreditation in May, which was postponed due to COVID. This school has previously had students match every year, but according to the new rule, students might not be able to go into Match this year.
USMLE itself allows multiple attempts on Step exams, and although it definitely is frowned upon, a student should be given an equal chance to justify himself in his personal statement, or even personal interview if granted.
Pathway 2 is unfeasible as well since many countries have postponed their exams too, and there are still travel restrictions, quarantines imposed, and even monetary issues for students. As a US IMG, going to Canada to take the NAC exam will be an added $2300, plus travel expenses, and housing, along with 14 day quarantine. Plus, ECFMG hasn’t even refunded the money for Step 2 CS yet.
The required English proficiency exam in lieu of CS: more info has yet to come, but how would this be equivalent? CS tests you on clinical skills and empathy, along with English proficiency. Prometric centers are still cancelling exams on students without proper notice, so how would this work? Plus, if a student can even get to the point of getting a program interview, that’s where they can showcase their language skills and people interactions, no need to pay another whatever hundred dollars just to take an English test.
The ECFMG should be helping IMGs, but at this moment many students are feeling helpless and lost about what their future holds. It will be difficult for many to wait one year or even more, before being able to apply for Match, which further poses the issue of programs considering graduation time; and the advice from many to go into research is always easier said than done - many programs are halted at the moment, and many students do not enjoy having research forced upon them. It’s also not that easy to just find a research place that will take you.
The pandemic of course was unexpected, but it is unfortunate that healthcare students and professionals are suffering the blunt end. Hopefully the ECFMG will be flexible and understandable and can deliver on options encompassing all IMGs asap. And hopefully more people will keep contacting them and advocating for IMGs. If it helps, there are two petitions, here, and here.
My resident says this with a sigh to our six man team: him, two interns, my fellow 4th year, the third year, and I, slouched, curled, and slumped in various positions on plastic rolling chairs in the unusually quiet 7th floor workroom at 6PM. No one wants to go home. Everyone feels a responsibility that tethers them to the hospital, that does not disappear, even when your heavy white coat is hung in a closet or thrown on the floor.
