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.


#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

My Health Career Feature on

<I was recently featured on a health career blog written by Chrystel Wekon; a passionate student doctor at Wake Forest. Here are a few snippets that shed some light into my career path. Disclaimer: this was written and published on;

  • Where are you currently at in your career path and why did you decide to pursue this career path? 

I am a hospitalist (occasionally nocturnist) practicing with an internal medicine inpatient group in London, Kentucky. My background is  in Family Medicine and I completed residency training in 2015. I chose this specialty because it allows me to be involved in all the different specialties of medicine without formally training in them. It essentially offers variety.

  • If you could go back and have a chat with your 1st-year postgraduate self, what would you tell him/her?

 Prepare yourself for success from the start. Pick a major in college that will favor your medical career. Start early. Inform yourself on all the medical specialties and sub-specialties available and learn about what it takes to get there by talking to and working with physicians who are in the field before making a informed decision as to what to specialize in.

  • What advice would you give to a professional student looking to pursue a similar path as yours?

Know what you want, write it out and then ensure that you go for it. Do not give up. Talk to people who are in the specialty of your choice, most importantly – find a mentor. Shadow as many physicians as you can; especially those you admire. Always ask for help along the way. Study extremely hard. Get an accountability partner who has similar goals and help each other grow forward.

  • What is a major challenge you have had to overcome and how did you do so?

 Financial problems and challenges with being a foreign & international medical graduate. These are familiar struggles with studying in the USA as a non-immigrant on a study visa with limited access to sources of income. I couldn’t work my way through school or afford the comforts and sometimes necessities of life that could’ve facilitated the studying process. There are unfortunately residency programs that do not support visa applicants or consider foreign medical graduates into residency.A s for the residency application process, I looked for programs that ONLY supported the visa (J-1) I was going to be eligible for. I focused on programs with previous foreign medical graduates. I diversified my search and did not limit myself to certain geographic locations hence I ended up in Kentucky but still achieved my dreams.

Finances: a family member who is also a US citizen co-signed a private student loan with me, facilitating the process. My parents supported a majority of my tuition. I qualified for tuition deduction for working in the medical library at my Caribbean medical school. I was also awarded a partial scholarship for maintaining a GPA >3.5 each semester.

  • What advice would you give to someone getting ready to start their application process to residency? (if applicable)

Review your personal statement several times; be very specific about who you are and how you will be the best applicant into that program. Have your mentors proof read your personal statement. Research the programs thoroughly, if possible do an AI rotation with them or schedule a visit so you have inside information on where you would spend several years of your life. Show and express direct interest in your top 3 programs to improve your chances of ending up where you may want to work.

  • What is your favorite thing about your job?

I feel blessed when I admit a critically ill patient and after a few days (or weeks) I see them leave the hospital a lot better than when they arrived. The reward is instant. I also love patient education as this helps people improve their lives after discharge and keeps them out of the hospital longer. Secondary or even primary prevention at its finest!

  • Do you have another professional degree, such as an MBA and/or MPH? If so, how has it impacted you?

No, I do not, but I am working on pursuing an MBA to diversify into the business of medicine. Yes, that exists!

  • Can you please walk us through a typical workday?

I get to the hospital at 8 am, drop off my personal items at the office, and pick up my list for the day and head to the floor. The “list” is a list of names of patients whom I will directly offer medical care to on a given day. In simple terms, I am the hospital physician for everyone on my list. I work 12 hour shifts for 7 days in a row and I am off for 7 days and the cycle is repeated till the end of the year. I typically start rounds in the ICU, seeing the most critical patients, discussing with the sub-specialists involved in their care and create a plan of care. From there I move to the step-down/Progressive care unit and finally the med-surg unit. Between patients on rounds I may go to the ER to admit or do consults on new or post op patients. A few months out of the year, I also act as a community-based preceptor for students from LMU doing Internal Medicine Clerkships. On most days I leave the hospital at 8pm, but I also only work half the year (full time hours) for full time pay.

  • How do you manage to balance your work life and your romantic relationship (and family life, if applicable)?

    I work half the month and I am currently single and without children but I still maintain a vibrant social life by traveling, visiting new places and enjoying new experiences.


  • Do you have any passions outside of treating patients? If so, what are they and how do you find time to pursue these passions? (Research, Mentoring, Writing, Fishing, Hiking, Reading, anything really)

Mentoring, reading, traveling, exploring, relaxing on the beach hopping, music, beauty & fashion