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What is the best way for international medical graduates to pass the boards so they can get into a residency? My friend is an american who trained in mexico. He has been back 5 yrs and can't find a way. He has taken boards part 1 twice and part 2 once. Now he thinks it takes $8000 for a Kaplan review to get through the test. Some countries seem to have the students who pass quickly others stuggle. Any ideas or suggestions as to what he should do? Thanks

Optional Information:
Male , Age: 54

Already Tried:
He has tried First Aid, other review books. Subject review books.

Customer (name blocked for privacy)

Hi there - I need a little clarification to try and help. Did he pass step 1 and 2 of the boards, or did he just past step 1 and needs to pass step 2 in order to enter a residency program here in the states? Step 2 has changed a bit in the past few years.

Let me know and I'll be happy to help. Preparing for and taking the boards can be painful, and as someone who has used Kaplan before (for step one only, then I did step 2 without prep help) I think that I can help steer him/her in the proper direction.

Let me know.

Take care - Dr. Fay

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Reply to Jon Fay's Post: He has not passed Part one or Part two. It is not easy learning medicine in Spanish. He did graduate and do 6 months of internship in Mexico before he ran out of money and came back to the states. He is very motivated and bright. I just don't know enough of the process to help him. I have allowed him to work in my office as a PA under my direct supervision and the patients like him alot. I am concerned at his age he would not get a residency anyway. He wants to continue so I thought I would ask.

Thanks for the info. I can't imagine trying to learn medicine in a different language. He must be darn smart if he is able to practice at any level in a non-native language.

I think that you friend could very realistically make it into certain residency programs these days, so long as he would be happy in an internal medicine/family practice/pediatric residency (so a generalist program). These, each year, have a number of unfilled spots because recent grads have tended to focus more on specialties that have the potential to be more high-paying. Although there are 17K US med grads each year, there are something like 24K residency spots, so at least 7K international medical grads (IMGs) make it into US programs. I know that I certainly worked with a bunch of them. So there are spots within programs, even for those that are IMGs and for those who have had problems passing the boards.

This brings up another issue. Programs look down a bit on folks who have tried, failed, and then eventually succeeded to pass the steps. But, again, many internal medicine programs, or other generalist programs (perhaps in less-desireable regions of the country, as well) would be willing to take a candidate such as your friend. So there are options.

But the fact that he has tried and failed the boards on a few occasions will make it harder for him to find a residency and it is also a bit of a psychological factor when re-taking the boards. There is a certain amount of pressure, knowing that you have previously failed the exam.

I think that, in order for him to feel confident and also for him to succeed, that he will have to prepare to the absolute hilt. I used to teach for Kaplan, and I've used their materials, and they can work quite well. That being said, most of my classmates and I did not use Kaplan (or other test preps) in med school, with one exception. They offer a huge bank of practice questions (called Qbank), subdivided into different specialties and areas, that you can take and then have scored. This allows you to over time practice using very similar materials to the actual exam, and to figure out what areas are deficient, and then see improvements in those areas with new questions. I think I would recommend Qbank to anyone studying for either step, and it was a couple of hundred dollars per exam (not bad considering the exam costs $1K per sitting).

Kaplan, of course, also offers a zillion other test formulations, and I imagine that they actually are pretty good. I used to teach the MCAT so I am not familiar with the USMLE materials directly, but they have a reputation as the top test prep company, and I know that their materials generally meet that rating. I would think that your friend would benefit from these, and if he wants to spend $8000 on them, then he should. If it helps him prepare for the tests, exhaustively, and makes him feel prepared (and he can afford to spend $8000), and he passes the exam, then it would be well worth it. I think that a careful review of what Kaplan offers will allow him to pick out exactly what is good for him.

Age can be another factor, of course. But, as above, there are a number of programs that would be happy to take an applicant like him simply because no one else is beating down their doors. He may end up in an internal medicine program in Witchita (nothing against Kansas ;-), but that is o.k. Maybe, afterward, he could get into a pulm or cardiology fellowship, if that's what he wants. But at least it is a start.

So, I think that it is great that he wants to try again. I think that he should make darn sure that this time he is prepared to the absolute hilt, and that he has studied like never before. With the proper preparation and help, I think that he could definitely make it into a program here in the states. God knows, we could certainly use more people as dedicated and "great with patients" as he.

I hope this helps. Let me know if you have any more questions, I'm more than happy to try and help in any way whatsover. I really hope that he makes it.

Take care, both of you - Dr. Fay

Edited by jcfay on August 14 2006 at 9:11 PM

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