Top Three Things FMGs/IMGs must do to match into US Residency. 

As both an international and foreign medical graduate I have gone through the mills of this process. Between switching visas and learning the ropes only by experience I can confidently tell you some of what you need to know to begin this journey. 

1. ACE the Boards.

This post may as well end here. Board Scores are VERY Important. When I applied into residency in 2011, USMLE step 1 scores greater than 240 were highly desirable. High step 1 (and step 2) scores represent you as a competitive, strong applicant who is less likely to become a burden in training and more likely to excel in your specialty of choice. 

During my year as chief resident at a family medicine program in Kentucky I was easily drawn to portfolios with competitive scores. Your scores on step 1 have the power to make or break your application as an FMG. You need to prove how you are equally competitive especially with US graduates. Most students from US schools have the benefit of being able to use the reputation of their medical schools as leverage, this advantage is absent for FMGs unless you’re from a world renowned school. As chief, a high board score also translated into a higher probability of success on USMLE step 3 and eventually family medicine boards (which we take in April during the 3rd of year of residency training prior to graduation). 

2. Apply strategy in your observer-ship (clinical rotation) process. 

Yes, you should definitively shadow a practicing clinician but you have to be very strategic. Do shadow in more than one specialty but at least one of each category i.e. general adult medicine, medical subspecialties, general surgery, pediatrics and a surgical sub specialty. Certainly tailor this based on your desired field of future practice. You may need a few months of US clinical experience. In my opinion one observership for 30 days isn’t sufficient for anyone without US clinical experience. You need to use this time to expose yourself to the way medicine is practiced differently here in the US from where you were trained. It can serve as a step 2 CK board prep tool as well. Do look for clinical scenarios that tie into your board review prep to make your medical knowledge memorable. 

The second aspect to being strategic is to use this as an opportunity to network! Yes, in medicine who you know matters! Begin by picking out residency programs in the state where you live by visiting the ACGME website (for MD/MBBS degree holders). Do check other less saturated states as well such as in the Midwest, Deep South and SouthWest. Do appropriate research on these programs -including how many FMGs/IMGs have been previously admitted to these programs, visa sponsorship (if necessary) and the requirements for residency application. Most programs require US clinical experience for varying time frames. Once all these criteria are met I suggest you pick up the phone and call them to request an observership. The best option if you can afford it is to drive up to the residency coordinator’s office and have a one on one inquiry session. The worse that will happen is that they don’t accommodate your request in which case you will try the next program on your list. I remember calling programs directly to inquire about scheduling a visit and then disclosing intentions to apply during such visits. 

The most important part about strategizing is to request to do your observership (or rotation for carribean med students) with the program director (PD) or assistant PD. Essentially; ensure that your preceptor is directly involved with the program. You are trying to advertise yourself as a desirable, hard working future applicant. Remember that. 
In one instance; during the time when I was torn between pediatrics and adult medicine (before I settled into Family Medicine) – I took the bus to a certain reputable children’s hospital in Chicago to request information on a pediatric clerkship with the residency program director! I got in. I was the only FMG during that entire month, my counter parts were students from Rush University and one other Chicago based medical school. At the end of my rotation the PD sat me down and was clear as to how impressed she was with my work ethic and drive and expressed desire to review my application if I applied. I believe if I chose to do pediatrics I would’ve trained there. Easily. 

3. Start Early.

A common mistake I see among FMGs is procrastination. If you are a Carribean medical student – do not wait until the end of your 2nd year to start mapping out the above strategies. Start on day 1 of medical school. You know the programs in your community at home – so start there but don’t end there. If you’re outside of the US and planning a transition then start working on your boards long before you move. As soon as you’re settled then begin your networking process. You can never be too aggressive. You are a goal getter. That’s all. Again; the worse that could happen is you get rejected. I was rejected too, many of my successful, smart and brilliant co-residents (FMGs and non- FMGs alike) all have varying stories of rejection throughout medical training. What matters most is you cannot afford to give up. Trust God, trust your process and try again even after multiple failures and rejection. 

Life is not about what happens to you but what you do with what happens to you.

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#mindfulmed: How MINDFULNESS is keeping me stable.

No, I am not crashing! Set your pads down, you wouldn’t need the crash cart for this one. J

The excitement that follows completing residency (especially if you opt out of fellowship) is often so strong that it seldom accompanies a plan to excel as an attending. I have only been an attending physician for 19 months now and I am well aware that there is a lot to learn in my future but this fact cannot steal from what I have already experienced.

In my opinion, with any career in life, one is going to have to develop a strategy that offers balance and productivity in order for us to stay sane at home and deliver at work. This is where mindfulness comes into play for this new younger and hot- but-not-so-fresh-off-the-press attending.

“Mindfulness” in my relatively short practice of medicine has become a tool that helps me transform what could’ve been an unpleasant experience into a more appealing one. It keeps me enjoying the present moment, leaves me with a new meaning to distress and gives meaning to undesirable circumstances.

It is only natural that when I saw this handle #mindfulmed trending among the medical community on Instagram I chose to share my 2 cents. Reading other virtual colleagues posts made me smile because I realized I was not the only one who has redefined the psychosocial medicine of mindfulness to achieve happiness at work or at home.

If you read nothing else from this post, just remember that these are the 5 things I practice to remain a well-balanced individual. Obviously these come after the fact that I work with phenomenal people and absolutely love my job as a hospitalist!  All these factors combined  makes it easy to excel at work daily. But, I still tend to practice these 5 things when faced with stress filled situations.

  1. Realign my focus
  2. Realize my territory of influence
  3. Reset my gratitude
  4. Repurpose my shortcomings
  5. Redesign my presence

    In these ways I am able to transform even the most stress filled moments into lessons or more pleasant experiences.

Now if you are one for details and that wasn’t enough for you can continue to read the specifics.

To Realign my Focus – I very simply look at the bigger picture. This is the creates way to achieve mental balance. This happens a lot at work and all the times I begin to find reasons to want to complain about “dysfunctional stuff”, I quickly remember days I prayed for where I am now. Overcoming the odds as a foreign medical graduate and infiltrating the system were more challenging than any other scenario I can possibly find myself in. Instead of complaining, I look for a way to improve “said situation”, I question myself as to whether my role in the moment could be one of resolution – whatever that may be.

To realize my territory of influence gives me reason to endure the most unpleasant occurrences. At some point I realized that when I aspired to attain greater heights, with that came greater responsibilities. As a doctor some people’s lives depend on your acts of heroism but also a lot on your mistakes. It is my responsibility to be patient and kind to people especially during the most vulnerable of times as is the case with the sick and dying. It is irresponsible to think that you can be a community leader in service to patients and coast along without having to support others or facilitate life for other people. The added weight which can seem stressful comes with the territory. Very simply said “heavy is the head that carried the crown”. But, I add, that to stay in balanced mode “go ahead and adjust the crown”.

To reset my gratitude helps me find joy in hurtful situations. I started this kick where I write down the most mundane and tiniest things that I am grateful for. Yes even the crazy stuff. When you work in healthcare and see so much hurt, loss and pain it is easier to be grateful for good health but I don’t end there. I mean I am thankful for crazy stuff  i.e. even perfume, nail polish, French toast, my purse, you name it. It leaves me feeling like I found gold in a thrift store.

To repurpose my shortcomings I begin by doing the soul searching and mortifying task of accepting self-fault. This is hard, but with maturity comes humility. Meekness facilitates the process of identifying the ways in which I have fallen short of my own expectations of self. Once I have identified a failure, (usually after briefly basking in self pity/correction #fixitjesus) I quickly look for ways to refurbish the lessons from the experience. It is certainly true what they say: its not about what happens to you as much as what you do with what happened to you.

Redesigning my presence enables me to remain in the moment. I am so easily distracted (aren’t we all?) by mid rounds chatting, unexpected outcomes, healthcare news or political debates, other people etc. I try to mentally realign my focus by bringing my mind back into my present moment; pleasant or unpleasant and just deal with it. I have realized that it’s best to go through the unpleasantness of a season than to skip through it, because it somehow always knows hot to catch up with me.

Now, I know this applies to everyone in every walk of life, my life only seems to be partially consumed by medicine. Feel free to replace specific scenarios with whatever is applicable to your current routine.

IMG_4284 copy.pngNina

An Open Letter To The Confused Anglophone Cameroonian Youth

 

I woke up with a heavy heart for the anglophone youth of Cameroon. I was a first-year student at the University of Buea during one of the first strikes in 2004; you bet I was confused. I’d never been one to fight, so I left town in a taxi to Douala, determined to find another alternative to my first dream of being a doctor because that was not going to work for me. On a day like today when the Cameroonian youth is celebrated, I feel the need to encourage someone whose life or future is threatened by the political gestures that continue to keep them out of school.  Here is an open letter to all those affected by the current condition in our beloved country.

Dear Young People,

Education is important and in an attempt to demonstrate peacefully, the “wiser ones” among us have decided a peaceful strike is a way forward. In this, you may find yourself with nothing to do but first; do not befriend idleness.

To the young men, I pray that you will not be misled or distracted. Drugs & crime can become enticing ways to make a living. Do not fall for the lie, instead harness the strength of your creativity. Great inventions came from men stuck in basements and college dormitories. There are still tons of books off the internet, share and read books that enhance your thought process. Remember that anything that does not align with your original purpose is a distraction. You can teach yourself a new trade or work on a skill or sport. Distractions are meant to deter you from your path. Do not allow your life to go to waste, the noble way to make a living is the one you learned when you were younger – Hard work

To the young women, you did well when you decided you wanted to be an influential and productive member in your society. You chose to take the opportunity to educate yourself which was not always available to your mother or grandmother. The strike can leave you feeling shorthanded but remember your life cannot be wasted without your consent. Continue behind the plow, let your hobbies flourish, get involved with sports too, master those innate gifts and above all continue to educate yourself outside the classroom. Do not allow the richer men to distract you with alternatives to your personal success. Make wise decisions young girl, form relationships with mentors and older women who inspire you. Continue to aspire for your version of greatness and if your first dream dies in this process, dream another dream.

Love,

Nina

 

“Youth Day in Cameroon is celebrated annually on February 11. The celebration of the holiday reflects awareness and recognition of youth significance for the country. The first celebration of Youth Day in Cameroon was held in 1962, a year after British Southern Cameroon and French Cameroon unified.”    source anyday.com

How To Thrive Through Confusing Times

Last night, I read a personal email from my immigration attorney advising me against travel outside the US at this time, she expressed concern about uncertainties which may or may not apply to me now but could in the future.  In the last few weeks, I have received information from my family in Cameroon about the disruptions to daily life at home. Some of my cousins have been out of school for several weeks, my mother’s private practice is struggling in the aftermath of the political tensions primarily affecting Anglophones. Internet services are indefinitely suspended in both English-speaking regions of the country dampening communication between citizens and family members in the diaspora.

All these things are limiting, unfair, unjust, threatening, annoying, aggravating or whatever word you may choose to fit my emotions. When we are faced with subtle threats to our existence, it is very human to choose helplessness over hope, anger over grace and to ask why all this is happening?

 

So, in my quiet time that is exactly what I did. I asked God how to live thrive survive cope exist during such confusing times.  For anyone like myself; without legislative power, voting rights or physical presence where I can have an immediate impact on pressing issues that affect my life and family today, here are a few things I believe He deposited in my heart.

  1.  First; Trust in His (God’s ) Sovereignty.


    “As for God, His way is blameless. 
    The word of the Lord is tested [it is perfect, it is faultless]; He is a shield to all who take refuge in Him. ” Psalm 18:30

    Choose to believe that God has a better plan, then give your plans and solutions to Him to lead you in His path. The best way to trust wholly is to realize your limitations but without failing to recognize your authority. The difference being that your authority comes from submission to God’s authority.  He functions with an eternal perspective and has a place for us to offer hope and restore our communities but we need to seek Him to find out how to do it.

  2. Then; Pick Your Battles Wisely.

                 “I have told you these things, so that in me you may have peace. In this world, you                        will have trouble. But take heart! I have overcome the world.” John 3:33

    We have to resist the urge to focus on the distractions to our purpose during such times. Prayer, petition, service, encouragement, hope –  are a few things we can offer one another to help through the healing process of many who may equally feel helpless. Contrarily, public arguments and rumination of the facts do not seem to get us closer to a solution but help to fuel anger and strife. So, choose to focus on the ball in your hand and play with that. Choose to run your own race in the best way Godly possible.

As I implement both concepts, I hope to maintain my peace and continue to thrive now and even when the dust settles.

Love,

Nina.

 

5 Practical Ways To Achieve Your Goals for 2017.

There something about a new year that gives us hope of a new beginning. It is amazing how inspiring the sidereal year has become for us. We make decisions during this time and though most do not last, some have been able to change the trajectory of their lives by sticking with the simple choice to experience change. I do not believe in the new year new me bullcrap, but, I do agree that we should all take inventory of our lives on a daily basis and make changes where necessary. What I found difficult in the past was maintaining good habits, you know, that power to do what you desire or willingness to be what who you want to be. These five traits have helped me manifest change in areas where I have sought them the most.

1.Be Strategic

Proverbs 24: 6  MSG
… Strategic planning is key to warfare; to win, you need a lot of good counsel.”

Building a strategy is key; it the equivalent to creating a road map. It involves brainstorming on an action plan in a  personal, clear and realistic manner. It is easy to get lost in the big picture, being strategic focuses on the pieces that bring the picture together. Like when I set out to cut my student loans in half in 2016, my strategy was to first create a budget,  then tally what I owed against what I brought in, take inventory of my expenses and make cuts on non-pressing issues. Once I realized that was not enough to meet my monthly pay-off-student-debt-in-two-years target, I had to increase income by working twice as hard than was necessary to meet my plan. I am still doing this today but 12 months in, it is working! I think it worked because the action plan was clear, precise and I made strides to get to where I wanted to be. This changed my goal from a wish to a manifestation in my life.

2. Be Intentional

Before creating an action plan towards any goal, determine what the reward will be. If this reward is pleasing to you, then hold it up in your mind as the end point you want to attain. This will keep you wanting and likely make it easier for you to achieve your goal. After you’ve created your action plan, the next step is to start carrying out the very specific steps you’ve brainstormed on especially when you do not feel like it. Practice makes perfect. Prior to 2016, I participated in group mission trips but never planned and carried out one by myself. With the Lord’s leading I carefully mapped out my solo mission trip to a village in Cameroon last year and that turned out to be the life changing peak experience of my year! I experienced spiritual, personal and professional growth through that trip alone. The same thing happened with the aggressive debt repayment plan. My first few large debt repayments were difficult, I did not want to work any harder than I typically did, sometimes I was even torn between other responsibilities and debt repayment, but I was committed and I am still slaying behind that plow. Deliberate action is a sign of true discipline and maturity, particularly when it involves sacrifice. Trust yourself and stick to your plan even when you meet resistance.

3. Be Accountable

Eccles 4:9
” Two are better than one … For if they fall one will lift up another. But woe to him who is alone when he falls and has not another to lift him up.”

The 3rd step to getting what you want is to find people who are like-minded and keep accountability with them. When I chose to “work out more in 2016”, I certainly did not get intense with working out until I found a gym buddy who pushed me and very well near trained me (Go Suzanne!). This was also true when I needed a spiritual accountability partner to pull through a 21-day fast in preparation for the new year in 2016. We were able to keep each other stirred up (Go Yoyo!). As the proverb goes; Iron does indeed sharpen iron. This works with preparing to pass a major exam,  raising godly children,  growing your relationship with God or even making healthier food or lifestyle choices.

Another thing to do is to study the lives of people who are where you want to be, learn about the character traits that got them there, read about them or speak directly with them. Mentorship facilitates your life. If you plan on being an entrepreneur, designer or whatever career you choose to pursue-speak with someone in the field. It is always easier to learn from other people’s mistakes.

4.            Be Visual

Fortunately, we are visual beings and there are several studies in psychology that purport this idea. Until you can see your goal in your mind, only then can you truly manifest it. There are several ways to do this but they all involve writing it down FIRST! Write your goals down! Useful tools can include hosting a vision board party, journaling your ideas and certainly using them as prayer points. Whatever you do, keep that written idea within eyesight. You have to see it to keep the dream alive in your mind.Pray yourself into it, psych yourself into it, speak words of positivity and inspiration over your life, make declarations and affirmations that bring you closer to carrying out your action plan, say them out loud and deliberately, discuss them with your accountability partner, write them down and post them where you can see daily (next to the bathroom mirror).

5.            Be IT

IT = whatever dreams/aspirations/desires/wants. Speak as though you are already living out your goals.  I admire Trent Shelton’s vigor to inspire millennials and he always says to “Live It, BE IT, breathe IT”. I think this sums it all up. Be what you choose to see in your life. Be what you wrote down in your journal. Stand firm in what you believe, and you should believe in your ability to be the best version of who God created you to be. If you do not have the self-confidence to carry out your purpose it wouldn’t work.  Go forth and make your life great again. 

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Love,

Nina

29 Things I would’ve loved to tell my younger self.

Birthday mode got me reminiscing …

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About Faith & Religion:

  1. Keep God first in your life, it is foolish to do the contrary.
  2. Develop a personal relationship with God and discover HIM for yourself particularly outside the walls of a church.
  3. Worry less but instead trust God more; he has a great plan for your life and God’s love for you is protective.

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About Love & Relationships:

  1. Do not ignore love when it is clearly offered to you. Avoid intentionally breaking a man’s heart.
  2. If your man loves you, he will show it to you. Words are cheap, actions require actual effort.
  3. It is okay to wait for your “Boaz”, just bask in the peace of your waiting season.
  4. It is okay to be vulnerable in love because this allows transparency and eventually authenticity.
  5. Your crush doesn’t owe it to you to reciprocate your infatuation. Your thoughts got you into the emotional soul tie, thus only your thoughts can equally get you out of it.
  6. Make the people in your life feel protected in your acts of love and kindness, go the extra mile to make them feel secure in the protection of the love you offer.
  7. You do not need to go on a date just to appease the suitor; it is okay to say “no” even without lying or a crappy explanation.
  8. Be in contact with your emotions, being completely open is a strength that keeps you authentic and relatable.
  9. Love everyone and everything you do relentlessly, hold nothing back.
  10. Cherish your friendships and try to maintain them even at a distance. You miss great connections when you ignore the relationships God has placed in your life.
  11. When in conversation allow people to complete their sentences, listen more and talk less, this is just wise.
  12. Call your mother/family members a lot more frequently, a “tomorrow” with your family is never guaranteed.
  13. Keep your family as a top priority

Continue reading “29 Things I would’ve loved to tell my younger self.”