December 3, 2021

Caribbean IMG, a perspective from a successful story after struggle.

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Medical school is over for me and I thought it would be a good idea to share my experience given that I used this forum considerably during my medical/pre-medical school years and found it rather helpful.
In particular, I want to share my story from the moment I applied to medical school to match date. One of the reasons that inspired me to write my story is that for the most part, people only write to complain/criticize, and those that had a good experience/success rarely share their positive experience so when “naive” students read forums like this (and I was one of you not too long ago!) the take-home message is a lot scarier than it probably is.

First, a little bit of my background. I was born in Cuba and immigrated to the US when I was 17-18y old. Finished high school here in the US and joined a community college to pursue a career in engineering. As luck would have it, after ~2 years I serendipitously got exposed to a medically oriented course and in the spot realized that I needed to change my career. So this is where my medical career starts, 2 years into college with absolute no idea about the proper way to approach to applying to this highly competitive field. In fact, not only I was oblivious to the many requirements I needed, I was also fairly ignorant about the way college/university works in the US and on top of that, my English at that point was mediocre at best.

At this point, I transferred applied and got accepted for a transfer into the University of Miami. Perhaps not a super prestigious university, but by no means a bad university either. In fact UM at the time (and still is) was ranked in the top 50 US universities. I mention this not as some sort of bragging, believe me, if you keep reading you will find out I am really in no position to brag, but rather to give you some perspective about my pre-medical school performance, achievements, etc.

I started taking most of my pre-medical requirements at my own discretion. That is, I really did not seek for advisor/counselor advice regarding which classes to take or in what order. At the time I would tell myself (and perhaps I wanted to believe it) that making an appointment with one of those counselors was a waste of my time (or his/hers) and that I could figure this “simple” stuff on my own. The truth is that I was a bit shy about my less-than-great English at the time and also I was too cocky. This resulted in some poor performance in very critical pre-medical requirements. In particular Organic Chemistry and Physics. While most of my undergrad courses were As with just a couple of Bs sprinkled, my Orgo/Physics grades were Cs which certainly did not help me when applying to medical school. The rest of my grades looked rather well, in fact, my gGPA at the end was ~3.46 and sGPA ~3.56. I know, not impressive for a pre-med. Do keep in mind that I was juggling a part-time job (~20hours/week), research (~20h/week), volunteer work (~10h/week), in addition, my English for at least the first 2 years of college was rather poor (most of the B’s were in english/literature courses). I was not a bad student by any measure, in fact, my very last semester I was carrying 18 all science courses (including master-level biology/chemistry courses) while doing all the beforementioned extracurriculars. I mention this to stress the importance of seeking advice early on. I am no genius but I am a smart person and I know I could have done a lot better had I seek assistance and had I managed my pre-medical requirements better. I take full responsability for my shortcomings but the rest of my story could have been substantially different if I had taken the time to meet an advisor a few times during my 3rd and 4th year of pre-medical.

At this point in the story, you know my GPA is mediocre as far as pre-medical students are concerned. My MCAT was not better either. I know the MCAT have changed over the years, and to be honest I dont remember the exact numbers I got but suffice it to say that my Science scores (biological and physical sciences) both were exactly average while my reading comprehension was 2 standard deviations below average with the writing sample also beeing rather poor. As a result, my “composite” was a bit below average and my GPA was also below average. At the time of my application to medical school, there was an Excel sheet flying around these forums that the student would enter the grades/MCAT and the sheet would calculate the schools that would “likely” consider me. The top half of the schools in that list was completely out of reach, the 3rd 25th percentile was “long shot” and the bottom 25th percentile is the one I was supposed to be aiming at.

This is another time where I made a colossal mistake. Again, this mistake could have been avoided had I spoke with a few counselors. The mistake in question is that I applied to 6 US medical schools. Yes, you read correctly, just 6. And to make things worse, 2 of those 6 were from the “out of reach” category simply because they had sent me promotional mail to my house and I figured that if they took the time to send me such mail, that I was at least on their radar (poor judgement on my part). So in practice, I only applied to 4 US medical schools. I did not even get interviewed once and only one of those 4 asked me for the secondary/supplemental application, the rest never asked for more documents.

At this point, I had 2 choices. I could either go to a Caribbean Medical School or I could take another year and either continue undergrad to raise my GPA and MCAT or work on a master degree to apply for the next cycle with better credentials. At that time, a family member had just recently graduated from Ross University (one of the “top” Caribbean Schools) and he highly recommended me the school. So I attended their seminar and applied to the university. The interview occurred on July and I assumed that they would take a few weeks or perhaps even months before I would hear back from them. So when I went to the interview, I was under the impression that I was being considered for the January semester (Caribbean school have rolling semesters that begin on Aug/January/April) so when they asked me “If accepted, when are you going to join us” I enthusiastically replied “as soon as possible”. This was a colossal mistake as the interviewer followed up with “good, you start on August” (next month). I really did not want to start that soon, for one I had no travel documents at the time (I had an expired Cuban passport, no US passport, no US citizenship), I was still working on my research/part-time and perhaps, more importantly, I had not taken time off to relax/vacation since I moved to the country just 5 years earlier so I was pretty burned out. It was too late (or at least that was what I thought) I had to endure, push forward and join the August semester. I felt that if I said “wait a minute, I really want to take some time off to put my things in orders, I’ll come on January” I would be risking my last chance at getting into medical school. That was silly of me, my stats were mediocre by US standards but were far above average for the school, they wanted me as much, if not more, as I wanted them. Asking them for a semester off to put my things in order might have even been considered as a sign of maturity.

So I started my first semester at Ross University. The first semester was a bit rough in the island, my grades were not the best but were acceptable. I had spent 18 years of my life in a country that in terms of amenities/freedom compares very poorly to Dominica, however, after 5 years living in the US I really had a hard time adapting to 3rd world conditions again. Having my friends and family far away did not help either. I endured the first semester. The second semester was a lot easier, my grades improved considerably, I felt the content being taught was easier to remember and I certainly felt more comfortable living in the island.

During my semester break after my 2nd semester I was diagnosed with a benign tumor and although benign, it was a locally invasive tumor in a rather inconvenient place so I had to take that semester off to have surgery. This is where things started to go bad for me. The time off meant that my friends now were in a different (more advanced) semester, that all that “adaptation” I worked for during semester 1 and 2 now was out of the window. When I returned for my 3rd semester I started having academic problems and in fact, I failed the 3rd semester. I returned later that year and repeated the 3rd semester with mediocre grades. My problems did not end here, In fact, I also failed the 4th semester. At this point, the process of dismissal from the institution was started. At this point, all the snobish/elitist people in the forum (if they read this far) are thinking “the only thing worse than attending a Caribbean school, is getting kicked by one”. And I deserve the criticism. The truth is I got myself into this awful situation because of not seeking help when I needed it, not recognizing that there was a problem and many other reasons that are too much to enumerate.

Luckily, I applied for an appeal and it was granted to me. So I returned for my 4th semester a 2nd time (remember I had repeated 3rd semester already). At this point, I pass the 4th semester. This also meant that at this point I was a full year behind schedule for graduation (1 semester lost for surgery, 1 semester repeated, I had to sit out 1 semester because I was on probation and then repeat 4th semester).
This is the moment where most students would take Step 1. My school has a very interesting policy. They make us take an exam that the school call COMP which basically consists of a Prometric-administered test with NBME question (very similar to the practice NBME tests). The school has a policy that in order for you to be allowed to sit for Step 1 you must have passed that COMP test with a certain grade which would be equivalent to the minimum passing grade of Step 1. The school allows you to take the comp 3 times with the option to appeal for a 4th. Most students pass this exam in the first or 2nd attempt (makes sense, at this point most students should be ready to pass the step 1). I barely passed it on my 3rd attempt with just a couple points over the minimum. It was finally time to take step 1, and after 1-month studying I took it and 4 weeks laters I got my result: 196 (at the time the passing score was 192, so yes I passed it, but just barely, in fact, I was within the SEM).

If you have read this far, my condolences, but also know that this is when I officially reached rock bottom. This is when the story changes dramatically. I know my step 1 was awful but somehow I felt relieved. At this point, I felt that since I passed, all that had lead to that point was behind me. I could now focus on improving. I enjoyed my 3rd year very much, in fact, it was my favorite. My grades from this point until graduation date were the highest for the reminding of my clinical semesters. At some point, the topic about “specialty” came up during a conversation with one of my 3rd-year preceptors (Internal Medicine) and I shared that I wanted to go into Internal Medicine. My preceptor had no idea about my grades and the only indication of my medical school performance as my performance under her supervision and she dismissively told me “you won’t have a problem, you are a great student you will get IM no easy. The reality is that I was well aware that my chances at a residency at this point were grim, and IM was surely out of the question. I this point I should have been aiming for less competitive specialties. So I confronted my preceptor and explained that IM was a long shot for me and shared my grades/step1. At this point she agreed with my first assessment that IM was a long, long, long shot. In fact, her attitude seemed to shift rather rapidly into the “don’t even bother applying to IM as that won’t happen, put all your eggs in the FM basket” and she offered to help me get residency into FM (she was a FM doctor working as a Hospitalist, that is how she ended up being my IM preceptor). I accepted her offer. However, I was not deterred. I was going to apply to some IM programs regardless. I had already made a mistake of not applying to enough medicals schools when I was in pre-med years. I was not going to repeat the same mistake.

As I was saying. My grades were excellent for my 3rd and 4th years. But part of this dramatic change is a result of changing my study habits. During my third year I read the following books:
Step Up to Medicine
Step Up to Surgery
Pestana Notes
Step Up to Pediatry
Psychatry First Aid
Mayo Clinic Internal Medicine Board Review
Goldman-Cecil Medicine, 2-Volume Set (this is a reference book, I read a few chapters and used sporadically thorugh 3rd/4th year but did not read/studied the whole book as for the others).
I also read/completed the questions of the following books:
MKSAP 15 for students
Case files Medicine
Case File Surgery
Case Files Pediatry
Case Files Family Medicine
Case Files OBGYN
Case files psychiatry
Completed the following question banks:
Kaplan ~80% (this is, in my opinion, the worse and most boring, out of touch)
USMLE-RX Q bank (100% once, 2nd time ~30% – in my opinion, far superior to Kaplan and 2nd only to uWorld. Also it is very cheap so well worth it)
uWorld (100% once)
Also did all the STEP 2 practice tests (4x NBMEs + uworld self-assessment)

As a result, my step 2 improved significantly. In fact, I got a 247 which was 51 points improvement over my Step 1. More importantly, I felt a lot more confident for the test. I know what you are thinking, it must have been a fluke, someone that repeated 2 semesters, that failed a COMP examination twice and just barely passed it on the 3rd time and barely manage to pass Step 1 by 4 point is not supposed to get a 247. Let me assure you that this score was real, my NBMEs ranged from 236 points (lowest) to 252 highest and the uWorld Self-Assesment was spot on with a 247. This certainly gave me much needed confidence. I was dreading showing up in an interview with another mediocre score. This gave me the last bit of momentum that I needed to go into the interview season. In addition, I passed the step 2 CS in one attempt, hardly an achievement but it could have certainly been a possibility if you only take into account my first few semesters of medical school and an indication of my performance.

During the application seasons, besides the poor performance early on, another thing was hurting my application. My step 2 CS was not released until October. For US graduates that is absolutely no problems but for IMGs it is recommended that we go into the application season with both steps 1/2 CK scores as well as CS for obvious reason. Receiving my CS score in October is not the end of the world, but it is conceivable that I lost a few opportunities to interview because of this (presumably because I might have been filtered). Being an IMG myself, I was advised to apply very broadly and to multiple specialties. My school’s official recommendation is to apply to your main specialty and to at least 1 “backup” (they call it “parallel plan” but basically they mean backup) specialty and that for each specialty you apply to no less than 100 programs (although they recommend 200 programs). Again if you are an US graduate you might be surprised because perhaps you only have to apply to 20-30 but this is the reality for IMGs. I ended up applying to ~230 IM programs and to 90ish Family Medicine programs. I want to make clear that I applied to many more IM programs than FM simply because there are far more IM programs than there are FM programs. I put as much work into my FM applications and interviews as I did for the IM ones. Also, I would not have felt any worse matching at an FM program instead of IM as at the moment my goal is to become a hospitalist and I could have done the same either way.

At the end of the application cycle, I had attended 7 interviews in total. Four of those interviews were for IM programs. Two of the programs had university affiliations the rest were a community. I loved all of the programs very much, I would have been very happy in all of them and ranking them was a hard process because I liked them all!

This story is quite long, but it ends with me matching in my #1 IM program. I felt that I needed to tell the whole, long, story because I wanted you to know that if you are in a bad situation (perhaps a bad step score, or a repeat semester, or a failed step1) it is unlikely that your bad situation is as bad as mine was just a couple of years ago. I wanted to make sure that you knew that if Medicine is really what you want you should not give up. If you work hard to improve, you can overcome almost any awful performance in the past. If you just did poorly in your step 1, please don’t dwell on it. Study hard and rock on step 2. If you failed something in your first or 2nd year, don’t give up, work harder and do better on 3rd and 4th. ASK FOR HELP the moment that you realize you are not performing at your best. It is unlikely that whatever you think is hurting your chances is worse than what was hurting mines.

If I had come to this forum right after my step 1, with a score of 196 and 2 failed semesters in a Caribbean School I am sure I would have received plenty of unanimous advice to drop out and cut my losses. And at that time I was at my lowest, it is not entirely out of the realm of possibilities that I might have followed such advice. So that is the reason I wanted to share this LONG story, I wanted to make sure to share at least 1 positive story to counter the dozens and even hundreds of story that end with the “cut your loses, medicine is not for you”. If this is what you love and you don’t see yourself doing something else, please don’t give up and instead try harder, much harder.

P.S. At one point I might share my experience with Ross University. I just wanted to quickly comment that although I had my issues, in particular during the semesters I was studying on the island, I am very happy I attended this school. I can’t say that if I had the opportunity to do it all over again and I could have gone to a US school I would do exactly the same. But what I can say with certainty is that Ross prepared me very well. My shortcomings early on were just that, mine, my fault. The school prepared me well, the school gave me a second and then a third chance. Critics might want to point out that they gave me a chance simply because they get money from me but the reality is they took a risk giving me that chance. In the event that I would have failed (from their point of view, a very likely scenario given the fact that I had performed so awful up to that point) I would have severely impacted the numbers that they need to keep “healthy” to continue to receive Financial Aid Tuition money. In other words, they smart thing for them would have been to let me go and they did not. Instead, they helped me and they have continued to help me at every step of the way (including residency application, etc). I will be very grateful to Ross University and the staff of this school and I owe my success in part to their help.

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  1. What an inspiring story! You honestly made me feel like there’s still hope. Do you mind if we talk and give me some advice about my situation? I would appreciate it so much

  2. Why didn’t you do Rx or Uworld for Step1 initially?

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