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US Residency Guide

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You need to register for ECFMG online as a first step. First, you will create an ECFMG On-line Services account. Second, obtain a USMLE/ECFMG Identification Number (ID). Third, receive your ID and password from your email, and finally obtain your scheduling permit. Once you have your permit, you can start scheduling your Step 1&2 at Prometric test centers in nearby countries “Jordan, Tel Aviv center in the 48/Occupied lands, Egypt” and CS in the US. VIDEO1, VIDEO2

  • Make sure your name in the ECFMG account matches your name on your medical diploma, medical school transcript, and passport. These documents go hand in hand when it comes to document verification and your visa application.
  • Read ECFMG Policies and Procedures regarding irregular behavior that might bar an individual from future examinations.
  • Choose the dates of your exam carefully, rescheduling is not without fees and you will not guarantee finding other dates that suit your schedule.
  • Travel a couple of days before your exam, get yourself a break from studying, and have fun. In addition, you want to make sure you have enough time to travel and cross borders.
  • If you live in Gaza, you might want to consider moving to another country and staying there as a transitional period. You can do clinical attachment/observership in Jordan/Egypt and during this time you can study and do the USMLE steps.

ECFMG has many online services that you need to be familiar with, including CVS On-line.

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It is highly recommended to be ECFMG certified by June of the year you are planning to apply for U.S residencies. Test scores are released on Wednesdays after three to four weeks of your exam date. Additionally, you need to allow time to become ECFMG certified after completing your exams. Historically, delays in score reporting had been announced about one month ahead. This is short notice for such an important phase and therefore, always plan for bumps in the road. You might start with Step 1 or Step 2 as you wish, but it is better for you to do both before the CS exam. Once you pass the three exams, you are automatically ECFMG certified and will receive the certificate, which is valid for seven years. Once you pass an exam, you cannot retake the exam to improve your scores; seven years have to pass before you can do it again. If you fail an exam, you will have 3 more attempts within 12 months, for IMG as yourself, failing an exam is a BIG problem and will minimize your chances in even getting an interview.

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You need to register for ECFMG online as a first step. First, you will create an ECFMG On-line Services account. Second, obtain a USMLE/ECFMG Identification Number (ID). Third, get your ID and password in the email, and finally obtain your scheduling permit. Once you have your permit you can start scheduling your Step 1&2 at Prometric test centers in nearby countries “Jordan,   Tel Aviv center in the 48/Occupied lands, Egypt” and CS in the US. VIDEO1, VIDEO2Make sure your name in the ECFMG account matches your name on your medical diploma, medical school transcript, and passport. These documents go hand in hand when it comes to document verification and visa application.

  • Read ECFMG Policies and Procedures Regarding Irregular Behavior that might bar an individual from future examinations.
  • Choose the dates of your exam carefully, rescheduling is not without fees and you will not guarantee finding other dates that suits you.
  • Travel a couple of days before your exam, get yourself a break from studying, and have fun. In addition, you want to make sure you have enough time to travel and cross borders.
  • If you live in Gaza, you might want to consider moving to another country and staying there as a transitional period. You can do clinical attachment/observership in Jordan/Egypt and during this time you can study and do the USMLE steps.

ECFMG has many online services that you need to be familiar with, including CVS on-line.

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USMEL Step 1 tests your knowledge in basic medical sciences, so the best time to do it is the summer after your third year in medical school, although it can be taken later. You might want to consider this reading material to prepare for the exam. VIDEO1, VIDEO2

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USMLE Step 2 tests your knowledge in clinical sciences, so the best time to do it is just after your graduation. You might want to consider this reading material to prepare for the exam. VIDEO1

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This is the exam that you need to prepare for the most. Studying medicine abroad equips you with vast medical knowledge and enables you to score high on Step 1 & 2. Step 2 CS is more about communication skills and time management. Mock patient interviews that prepare you for this test are highly encouraged. Find a practice partner or two and simulate the encounter with them using a timer. You might do this test any time after your Step 1 or Step 2. Your application will be stronger if you are ECFMG certified at time of submission – “Early Sept”. If you plan to do your exam in the summer during your medical school years or after graduation, make sure to apply for this test at least six months in advance. This will help you schedule it on the date you wish and gives you time to issue your B visa. Having the scheduling permit and the date of the exam will increase your chances of getting your visa in a timely manner. First Aid for Step 2 CS should be your primary preparatory resource, while the Kaplan series are also very useful guides for this test. You might choose any of the five test centers for the CS exam. VIDEO

Top-tips:

  1. It’s preferable to book your test at least 3-6 months in advance. You can use the e-mail notification services to get the latest updates about the available testing days. Alternatively, you can add the Check4Change extension to your browser.
  2. Having at least 1-2 months of US Clinical Experience (e.g. elective/observership, etc) before the test is a clever idea to prepare yourself for U.S. clinical practice, especially communication skills.
  3. It doesn’t matter which center you will take your test at, but most IMGs choose Houston or Chicago as they have more international SPs who have a relatively clear and understandable accent.
  4. If you don’t have a study partner, the best thing to do is to come to one of the nearby hotels (e.g. Park Inn) where you can find a lot of students/graduates who prepare for the test very well. Another important spot is Kaplan Center, where they conduct the Step 2 CS preparation course. Many students practice there, and it is very likely that you find a study partner. You can also post on the various USMLE forums found online.
  5. In addition to the First Aid book, YouTube videos are extremely helpful.
  6. It’s very important to train yourself on fast typing and use the official patient note online entry form.

Time management is also very important; PAMA’s best advice is to use this wonderful application which exactly simulates the exam timing.

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Before the exam:

  1. Do a simulation of the exam. Do 7 or 8 uworld blocks – with breaks in between – or 2 consecutive NBMEs or UWSAs. This way, you’ll be familiar when you start to lose your concentration or feel hungry and when you will need a longer break between the blocks.
  2. This is optional, but doing the practice test in the prometric format helps to reduce the tension of the exam. This is also considered a test drive and by doing this, you ll know exactly where the prometric is.

The night before the exam:

  1. Sleep well. Your memory and logic will be tested tomorrow. Your brain should be ready for engagement.
  2. Sleep without taking any medications, but if you have to, make sure that this is not the first time you try them.

Exam morning:

  1. Arrive early to the prometric. You’ll sign some papers and pass a simple security check.
  2. Wear comfortable clothes with less pockets and shorter sleeves.

Blocks and breaks:

  1. Skip the tutorial.
  2. By doing this, you’ll have a complete one hour break instead of a 45 minute break.
  3. Pre-schedule breaks according to the previous simulation. Enter the exam with a plan in mind about using your breaks. Choose what best suits you based on what you felt during the simulation that you previously did.
  4. Eating, drinking and using the restroom.
  5. Use your breaks wisely. Eat small things/snacks during breaks to avoid hypoglycemia during the exam, and eat a small sandwich/breakfast before the exam to have some energy to start. Don’t forget to visit the restroom during your breaks.
  6. Staying in the exam hall. You don’t have to leave the hall during your break. If you want to take a fast 5 minutes break, you can simply stay where you are, close your eyes, relax your mind and continue your exam when you feel ready

While solving blocks:

  1. Reading the question/the last line first.
    Always read the last line first in all USMLE exams; some questions are answered only by reading this last line! This is useful especially in pharmacology questions. This will help you to save some valuable seconds. As a rule, read the last line first then go back and read the question normally.
  2. Highlight any abnormal findings.
    When you read a question, highlight the age, sex and where the patient was admitted (ER, outpatient). Also highlight any abnormality like hemodynamic instability, chest pain, etc. Your eyes will focus on these findings and will try to associate them to reach a diagnosis.
  3. Omit distractors.
    Many sentences are just fillers to distract you. For example, a myocardial infarction in a 70-year old male, a person who smokes only occasionally or who drinks on weekends.
  4. Resist the urge to reread, simply mark and go on.
    Read the question and apply the hints mentioned above. If you don’t know the answer yet, read the highlighted parts again, if you still don’t know the answer or you are not 100% sure of it, pick the one you feel is the right one, mark the question and move to the next question. You may get back to this question only when you finish answering all other questions.
  5. Leave abstracts and drug advertisements until the end.
    This applies for Step 2 CK and Step 3 exams. Abstracts and drug advertisements are very lengthy and they may take a lot of time in addition to the fact that a lot of statistically insignificant data is thrown here and there. When you see an abstract or a drug advertisement, choose any answer then move on and go back only when you finish all other questions.
  6. Don’t leave unanswered questions.
    Even if you don’t have any clue about a question when you read it, choose an answer, mark it, and go on. Having a 20% possibility to answer the question right (supposing a question has 5 choices) is better than having nothing. In general, don’t change your first answer, your first hunch is most probably the right one. Change your answer only if you are sure that the one that you chose is wrong.
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You will receive an email four weeks after your test date. The test report will be available on your ECFMG account for 120 days. The report will include your name and score, in addition to detailed graphical performance. VIDEO

Now that you have successfully passed all the examination requirements for ECFMG certificate “USMLE Step 1, Step 2CK and CS”, you will need to pass the Medical Education Credential Requirements. ECFMG verifies every applicant’s medical school diploma with the appropriate officials of the medical school that issued the diploma and requests that the medical school provide the final and original medical school transcript. Once the above verification process is complete, you will receive your ECFMG certificate. Should you finish all the required exams before your graduation from medical school, you will still need to graduate and get your diploma before you can get the ECFMG certificate.

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  • It includes clerkships or electives (hands-on for undergraduates, usually final year students), externship (hands-on, usually for graduates) and observership/ visiting physician program (hands-off, usually for graduates).
  • Hands-on vs hands-off? Hands-on means that you will be allowed to participate in all clinical work exactly as U.S. medical students, i.e. taking history, doing physical examination and some clinical skills, allowed to scrub in surgical operations. Meanwhile, hands-off means you are not allowed to do anything from the above mentioned clinical tasks, i.e. you are only allowed to observe the team without active participation. However, you are expected to participate in round and meeting discussions; this might be your chance to impress attendees and get their letter of recommendation.
  • The importance of having USCE: USCE is very important for all applicants to U.S. residencies, both medical and non-medical:
    • Medical:
      • Improve your knowledge and clinical skills.
      • Familiarize yourself with the U.S. health system.
      • Compare your level to U.S. medical students.
      • A great opportunity to conduct research and participate in conferences.
      • Improve your communication skills.
      • Getting letters of recommendations, which are an integral part of the residency.
    • Non-medical:
      • Cultural exchange.
      • Make new friends and connections.
      • Have fun!
      • Explore your interests in different fields.
  • How to get USCE?
    In general, there are two paths to get USCE:
    Formal: Contacting the university/hospital through their portal by following their guidelines. This is the most popular and the most secure and guaranteed way to get USCE. However, it might be more expensive, and your chance might be lower compared to those who have connections. Informal: Can be easier and less expensive than the formal method. It bypasses the application process and is usually done by directly contacting a faculty member who will secure the position for you.
    Requirements:
    • Basic:
      • Application form, CV/Resume, and recommendation letters from one of the professors in your home institution.
    • Other:
      • Fees (application and/or tuition)
      • TOEFL
      • USMLE Step1 scores (becoming increasingly important for the application process; about 90% of the U.S. hospitals require them for getting clerkship/elective)
      • Health and malpractice insurance: The best insurance company according to students’ feedback is the International Student Insurance Company.
      • Cover or motivation letter. You may use the UCLA guide on how to write cover letters.
  • Cost:
    The cost varies based on many factors including, the value of application or tuition fees, the type and location of your accommodation, your ability to prepare your food by yourself and the timing of your elective (flights booked for summer are usually very expensive). Here are some funding resources for Palestinian medical students living in Gaza Strip or West Bank:

How to apply for residency

There three services you will end up using through the application process. These are ECFMG’s OASIS, MyERAS, and NRMP. We will walk you through the timeline and milestones of this process:

  1. Get ERAS token:

This is done through OASIS, this should be done in early June.

  1. Sign up for MyERAS

After you receive your token, you can sign up and then login to MyERAS. You can also install and use MyERAS app.

  1. Start on your CAF

This is the main document into your MyERAS account, it will include your demographics, examinations, academic achievements, publications, hobbies, etc. Make sure not to rush and confirm information early on. You will need to keep adding and editing content to the last minute. You will need to confirm it before you apply to programs and you will need to assign it to all programs.

  1. Upload Your Documents
  • Curriculum Vitae (CV aka resumé)

Both the format and content matter here. You might want to consider using the UCLA guide to write your CV. Make sure your CV is accurate, updated, easy to view, and has all pertinent facts the viewer wants to see.

  • Medical School Transcripts

Although you may have already provided a transcript for ECFMG Certification “original”, you are still required to submit a “copy” to ERAS Support Services via ECFMG’s OASIS.

  • USMLE Transcript

The USMLE transcript contains your examination history for all the steps, and it includes any fail attempts. You need to request these transcripts through ECFMG’s OASIS and there is a one time $80 processing fee.

  • Personal Statement(s)

This is a very important document that you should give lots of attention to writing. It is read by all people who will either select your application for interview or end up interviewing you. People paint a picture of you when they read your personal statement. They will expect an energetic or ambitious person, should you say so about yourself. The point is, reflect yourself in your personal statement and talk about your own experiences that you can elaborate more about during the interview. Describe yourself in the work environment, talk about your motivations in life, what inspires you, and what you care about the most. Also describe the social aspect of your life and career, such as marital status, what sports you like, and what consumes your time beyond medicine.

Make sure that you get your personal statement proofread. You don’t want a language barrier or limited skills in prose give you less than the credit you deserve. We suggest that you write a draft and then seek professional help for proofreading. There are many editing services available and specialize in personal statements for medical students, we encourage you to use them. An alternative is to ask senior colleagues who have the experience to review your personal statement.

You might want to write more than one personal statement, for different specialties, but also within the same specialty.

  • MSPEs (aka Dean’s Letter)

Deans in U.S. medical schools use objective data, including attendings evaluations and student progress, to issue MSPE. Your medical school dean might want to use one letter format for all students, but letters should be different from each other. Please refer to the AAMC sample and content of MSPE.

  • LoRs

Your LoR should be written professionally, follow a standard format, on a professional letterhead, and signed by the author. It should be carefully reviewed for accuracy and grammatical errors. It is preferable you get your LoR from a U.S. faculty member who can reflect on your U.S. clinical experience or who have a professional relationship with you. If this is not an option for you, then try to get a U.S. boarded faculty to write your letter and include their contact’s “email”.

It is recommended that you waive your right to view your LoR, this sends a strong message about your transparency and that you don’t have any weakness to hide. Having that said, you should only ask those who will willingly write a strong LoR. 

  • Photo

Make sure it is professional, wear a suite and a tie, and add a decent smile.

  1. Choose ACGME Accredited Programs

You can choose as many as you want, but you need to choose wisely since it is an expensive process. Highly competitive programs have the luxury of choosing from a very large pool of applicants. So, unless you are confident that your application and credentials stand out among all U.S. applicants, you should not apply to such competitive programs. You might have a chance in these programs if you know someone there who can put a word in for you, or you have done an elective with one of its faculty, or published a paper with one of its researchers. You should also refrain from applying to programs that don’t consider IMGs at all for visa issues, these programs usually take U.S. citizens and Green Card holders only. There is no one credible source for IMG friendly programs, and what might be friendly for one medical school or nation might not be friendly for another. Also, a program might change its policy regarding IMGs over time and it is not wise to label programs based on their history. Having that said, these are the programs where Palestinian and Jordanian candidates match the most; a list of U.S. IM programs that offered interviews in 2019, and IM friendly programs.

  1. Start submitting Your Application to ACGME Accredited Programs.

After you have chosen your programs and assigned the appropriate documents, you can now submit your application. This step is usually done in early September, programs start receiving applications around mid-September, and receive MSPE on Oct 1st. After that, programs start sending offers for interviews. Please review the ERAS timeline for MD residency.

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A Practical Approach to Residency and Fellowship Interviews:

You made it to the interview day, which is one of the most important milestones in the residency and fellowship application process!

This is the day you present your case to referees who are interested in recruiting the strongest candidates for their program. We will break down the interview day into three phases: pre-interview day, interview day and post interview.

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Some of the residency programs will have a pre-interview dinner the night before the interview day. Although this meant to be casual dinner, this may count toward your final score in the residency program. Make sure to interact with the program coordinators, chief residents, and any representative from the residency program. Show them that you are interested and want to learn about their experiences.

Before and after the dinner, go online and review the residency program web-page. Make sure you are fully informed about the program and prepare four to five questions to ask the faculty who will interview you the next day about the program. The goal of these questions is to get more information about the program, but to also show the interviewer that you did your homework and you are ready to start next July as an intern or a fellow in the program.

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This is your chance to present your case! Some people consider it a show and it is. Why? Because, you must be prepared and present your case flawlessly, you have to be engaged with the audience, and use body language to express yourself. Here are some hints that will make your interview successful:

  • Prepare answers to frequent questions that are often used by residency and fellowship programs. Below are some examples:
    • Tell me about yourself. The goal of this question is to break the ice between you and the interviewer and give you the opportunity to talk about special aspects of yourself that are not in the medical field. You can talk about your family, where you came from, how you got into medical school, and any interesting events in your life that drove your decision to pursue medicine.
    • Strength and weakness points. Often, interviewers use this question to document in their score cards why you deserve to be considered. This is an important question and make sure you answer it correctly. The answer for strength points should start by saying that you have an excellent group of residents and candidates because you have an excellent program, but I would be also an excellent fit because I will be an excellent team player (give an example or why), I am hard worker (why), I will drive your in-training exam score up (in case your scores in USMLE are excellent), etc. For the weakness points, you would like to mention something that you worked on and it is now a strength point. For example, you were obsessed with the details of physical examination, which would slow you down, but with practice, you are more fluent in documenting these findings with the same accuracy.
    • What drives your passion for the specialty? You must present the driving factor for applying to the program.
    • Tell me about your research experiences/publications. You must be very ready and know all the details about everything in your application, including your personal statement.
    • Do you have questions about our program? Prepare one to two questions, start by saying that the website or the presentation on the day of interview was clear and very informative, just that you have one or two brief questions. Ask about research opportunities, if residents/fellow complete publications, how the faculty help learners to publish, would you have the opportunity to teach medical students, etc.
  • Here is some important advice you need to use during the interview:
    • Dress using the business dress code: tie, shirt, and suit.
    • Shake hands with all interviewers, look the interviewers in the eye.
    • Maintain eye contact.
    • Keep a subtle smile, do not look goofy, but the interviewer should see that you are a pleasant person. They are looking for pleasant people to work with.
    • If you feel you went off track in one answer, do not let it take you in a downward spiral. Do not think of it and maintain your composure.
    • Talk with passion; you have a lot of things to talk about.
    • Print out pictures of special events such as volunteer activities you did, color print your publications and have a copy to hand to each interviewer.
    • Bring with you a writing pad and a pen, write down your questions and important discussion points with the interviewer.
  • Make sure to take the contact information of your interviewers from the coordinator.

The following video contains very helpful directions and advice.

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It is an option to send a thank you email to your interviewer; it is preferable that you send the email if you had a great interview. We would say 30% of candidates send thank you emails, and in less than 5% it makes a difference as the final score is already sent to the residency/fellowship coordinator after the interview. But, if you choose to do that, here are some hints:

  • Write in perfect English, there should be zero errors in the email, especially punctuation. Have somebody with English experience review it for you.
  • Do not send generic thank you emails or letters, these are useless. Use specific discussion points from the interview in the email such as your publications, research, research opportunities etc.
  • Do not send letters/cards, these are outdated. If you decide to do so, you should have exemplary, clear hand-writing, otherwise it will count against you!
  • Maintain contact with residents/fellows from that program and send them greeting emails on Christmas (December 24), New Year’s, and Martin Luther King Jr. Day (the third Monday of January), which usually fall in the interview season.
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Residency and fellowship programs use different criteria for ranking candidates, but these programs use the same items to score the candidates with different scoring systems. These are the items that the programs use to score candidates:

  1. Medical school. Nowadays, programs prefer candidates from American Medical Schools over International Medical Schools, but there is a shortage of graduates from American Medical Schools, which always gives an opportunity for International graduates to match. Programs prefer graduates from medical schools which have experience in training some of their graduates in the years before, which means you will have a good chance if one of the current residents in that program is from your medical school.
  2. USMLE scores. The higher your scores, the better your rank, but it is not the only criteria. Having more than one attempt in USMLE CS is a negative point and some programs may limit their interviews to candidates with one CS attempt.
  3. In the form of abstract, peer reviewed publications, research experience with no publications. Focus on writing case reports if you are applying to the residency program out of medical school and do not waste your time, unless you have the time and experience, in engaging in long research projects that may or may not be published. Do cite any peer reviewed publication that will differentiate you from most of the candidates for this program.
  4. Ability to teach, teaching experience. You want to make sure you talk about that in the interview.
  5. Team player. Programs are looking for a candidate that will be an excellent team player, will be pleasant, and know what theyare getting into. The last thing programs want to do is to recruit a resident who will NOT be happy in their program and give the program director a headache! Be sure to show that you are a team player, pleasant, and will be happy.
  6. Language, communication. Practice the interview; make sure to spend time to soften your accent, if you have one, by listening to American English broadcasting and to repeat words as they spell it.
  7. Dress is important, use neutral colors. The way you sit and talk with confidence is important as well. Talk English all the time, even if the interviewer uses the same first language as you.
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After you conclude your interviews, you will want to submit your Rank Order List (ROL). The National Ranking Residency Program (NRMP) uses a complicated algorithm to match residency spots with candidates. Here is some advice for you:

  • Rank the program that you like the most on top, then the next one. The NRMP algorithm gives an edge to your preference over the program preference. Which means even if you have less of a chance in matching with Johns Hopkins, that’s in case you interviewed there, rank Johns Hopkins the first.
  • Rank all programs that you interviewed in, unless there is a horrible program that you do not want (we have never encountered this scenario).
  • Make sure you submit your list before the deadline.
  • Even after final submission, you can still come back and make edits.

Match results will be announced during the third week of March, please refer to the NRMP calendar for details. You are informed about matching versus not matching, and then on the third Friday in March you are given further details about your matched program.

In the unfortunate situation of not matching, you will then need to know about the SOAP program. SOAP stands for Supplemental Offer and Acceptance Program®. It has replaced what was previously called the scramble process. More detailed information can be found at NRMP website here. In the unfortunate event of not matching, your next step is to apply for positions that were not filled in the match. Occasionally, few top-tier programs intentionally leave some spots unfilled with no intention to fill them as they consider only the highest quality applicants. In order to participate in SOAP, you need to have been registered for that NRMP cycle. One week prior to match day, you will receive an email confirming your eligibility.

The process as described by NRMP website is as follows.

  • At 11:00 A.M. ET on Monday, SOAP-eligible applicants can access the List of Unfilled Programs in the R3 system.
  • At 2:00 P.M. ET on Monday, SOAP applicants can prepare and send up to 45 applications in the ERAS system. Programs can begin viewing SOAP applications in ERAS at 3:00 P.M. ET.

This means that if the system is congested or crashes in the first few minutes, your chances are not affected, and you still can send your application. You simply log in to ERAS and send a new regular application to the program of interest.

  • SOAP applicants are prohibited from using any means other than ERAS to apply to programs and must refrain from any other contact until programs initiate contact with them. School officials or other entities acting on the applicant’s behalf also must refrain from contacting programs. Applicants who violate SOAP policies will be investigated and could be barred from participation in SOAP the following year.
  • Programs interview applicants in whom they are interested. Programs vary in how they manage the SOAP process: brief telephone or online interviews are common. Program directors cannot ask applicants to indicate whether they will accept an offer if one is extended through SOAP. Interviews begin on Monday and continue through Tuesday.
  • At 12:00 P.M. ET on Wednesday, applicants begin receiving offers through the R3 system. Offers are issued in order of a program’s preference list and according to the number of unfilled positions remaining in the program. Applicants do not create preference lists during SOAP.
    • SOAP includes three Offer Rounds: 12:00 P.M. ET and 3:00 P.M. ET on Wednesday, and 9:00 A.M. ET on Thursday.
    • For each Offer Round, applicants have two hours to accept or reject offers in the R3 system. Offers not accepted or rejected expire automatically.
    • Offers rejected or expired will not be extended again to the same applicant in future SOAP Offer Rounds.
    • Positions offered and accepted during SOAP establish a binding commitment enforced by the Match Participation Agreement.
  • The List of Unfilled Programs Is updated five minutes after the end of each SOAP Offer Round.
  • SOAP concludes at 11:00 A.M. ET on Thursday.
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Your visa will be sponsored by ECFMG. A Training Program Liaison (TPL) from your residency program initiates the process by submitting your profile to ECFMG. It is your responsibility to follow up with your program coordinator and contact ECFMG to ensure everything is running smoothly. Remember to be polite in your communication and obtain time frames and next steps.

If you are present in the U.S. at the time of application initiation, and then you leave to a different country, you will be required to scan and upload a copy of your boarding pass as evidence of departure. This is required as the DS-2019 form would not be released unless you leave the U.S. and the administrative process is different if you plan to stay.

Please visit the ECFMG site for details about the application process and the required documents.

The entire process described above leads to issuance of DS-2019 form. This serves as your permit to enter and work in the US. Your next step is to schedule an appointment at the U.S. Embassy for the visa. On the day of the interview, you will need to bring the SEVIS fee receipt, DS-2019, and additional visa appointment documents. Due to recent political events, we highly recommend bringing the ECFMG fact sheet which was specifically issued for such purpose.

Upon arrival to the U.S., have your visa, DS-2019, and any welcome/invitation letters and contract available with you for any unforeseen circumstances.

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Most of you are coming on a visa, and will need to apply for a Social Security Number and start building credit history. So, buying a house is not an option, and even if you can it might not be a good idea for the following reasons;

  • You might lose money if the market tanks
  • You will move anyway for your fellowship or to practice somewhere else
  • You will need to maintain and repair the house, which can take all your residency salary
  • You are stuck with the house even if you don’t like it, like the neighborhood, or like the commute to the hospital.

You are advised to rent a studio, apartment, or a house, depending on the size of your family. Regardless of what you choose to rent, you need to pay attention to several details. Please make sure it is affordable, as it should not exceed 30% of your total after tax income. Ask about the amenities; you don’t need a pool, but a covered parking space is a big plus, especially if there is lots of snow where you matched. Also make it close to public transportation, you might not have a car the first few months, and your car will need repaired every now and then. Safety is a big factor in pricing in the U.S., so please don’t be tempted by the low-price accommodation. Ask your program and co-residents about safe zip codes, “especially in big cities and in the downtown area”. Apartments vary in their appliances, while all have basic kitchens, some might not have a washer/dryer in the unit, others have a shared one for the whole building. Also, not all have a garage and at least a one car garage can be very convenient, especially if you have kids. If you live in a big apartment complex you can then enjoy available utilities including a pool, gym, library, business office and so on.

It is not easy to figure all the above on your own – you will need help. The ones before you have already figured out the details and it is a smart strategy to follow suite and rent where most have rented.

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Congratulations! You made it through medical school, residency interviews, and the match. Today is your first day at residency: feeling nervous?! No worries, this is natural, you just need to be well prepared.

Being an outstanding student by itself doesn’t guarantee you will excel during residency. You must take several things into consideration to survive and thrive in your first month and year of residency. Here are few helpful tips for you through your first month in residency:

  • Your residency has already started the day of your interview:
    • Get the contact information for the residents you met on the day of your interview. Those residents are invaluable resources to help you know your new hospital and program, as well as the area you will be living in for the next few years. Learn from the residents what are the program’s expectations of you and to fit in quickly.
  • Make sure to arrive early to the states to attend the orientation:
    • Each program arranges a sort of mandatory orientation which provides all the information you need on ID badges, medical insurance, parking, getting to know hospital floors, using EMR system and where you can get a cup of coffee or some rest if you need it. The last thing you want to do is to miss it.
  • First impressions matter:
    • This matters not only to you but also to graduates from your medical school and country. The last thing you want is to get stuck with a bad reputation among your attendings and staff for the rest of your residency.
    • Dress and look professional.
    • Show up on time or even earlier.
    • Be courteous, nice, and respectful to others. Smile to everyone. You’ll be working with these folks for a long time. Build bridges, not walls, with others.
    • Be involved and show interest during patients’ round, morning reports, etc. Ask questions during discussion and give answers when you know.
    • Know your stuff whenever you are presenting a case or giving a talk. Review labs, patient history, and previous physician and nursing notes. Faking your way through things won’t work. Your preceptors have been in your shoes, and they can tell when you are unprepared and guessing.
  • Mistakes are inevitable but there’s no place for your ego at the hospital:
    • If you mess up, please admit it and don’t argue. Showing remorse and acknowledging your mistakes is the least your program director expects from you. Please remember that every resident makes mistakes, only the good ones take responsibility. Learn the most from it, shake it off, and move forward.
  • Never lie about something you did or did not do:
    • It can compromise patient care, cost you your training, and makes you less trustworthy. Take responsibility for your actions or lack of actions, always.
  • Know your limitations:
    • If you don’t know something, ask! You are there to learn, and no one expects you to know everything. There is nothing worse than saying you can handle something when you know you can’t.
  • Be organized:
    • Find out what you will be doing for the next year: Be familiar with your internship year rotations schedule, the in-training exam, how to study for it, etc. Know how to access study resources.
    • You will have many tasks to perform, attend rounds, order and review lab tests, and see lots of patients. With all that you will be juggling, it is easy to get mixed up. At the start of your residency, develop your own ways to stay organized and keep track of all you have to do. Whether you use apps, a written planner, or leave yourself notes, find ways to keep yourself on track.
    • Organize your time: Get enough sleep so you function well at the hospital.
    • Get to know the different weekly curriculum meetings, like morning reports, journal club, etc. Go well prepared for them as not only you would learn the most but will also leave a very good impression about you amongst the attendees.
    • Make up your mind about what fellowship you are interested in, if any. It’s very important to plan ahead for that so you can show interest and approach the people who could help you get the fellowship you want, whether it is your program director, consultants, residents, etc.
  • Research:
    • Research is a very important part of your training. Be familiar with the resources your hospital provides for research. Ask your senior residents for help. Come up with your own research ideas and discuss it with an attending who can supervise you. Try to work in research in the same fellowship field you want.
  • Have a healthy and social life:
    • Residency life is a busy and time-consuming one, however, having a social life is a healthy and important thing to help you go through your residency. Don’t live the residency life at the expense of the social one, you must balance between the two of them.
  • Try as much as you can to eat healthy. A healthy mind lives in a healthy body.
  • Read:
    • It is vital to the practice of good medicine, and this comes through reading, reading, and reading. Read about the cases and diseases you encountered at the end of your day. Make a list of subjects you need to read for the next week or month and stick to it.
  • Getting your car, rental place, cell phone, and other services:
    • Social Security Number “SSN”: You can do none of the above without it. It is like your identity number, but is way more than that. This number is going to be your digital code as long as you are in the United States, even after you become a citizen. Make sure to keep it safe and secure, this is not to share with anyone. You will need it to build a credit history, sign up for services like cable TV, phones, heat, electricity, etc. You will also need it to rent a place and to rent or buy a car. Please read the following on how to apply for SSN.
    • Credit score: Your financial well-being will be measured using this score. You will build it over time, the higher it is the better will be your chance to get a loan. You will need loans to buy a car, and in the future a house. This score can be poor, good, very good and excellent. It all depends on how you manage your credit cards and loans. So, make sure to open a bank account, you will need your SSN for this step. Then, have your bank issue you a credit card in addition to your debit card. You can also issue a credit card through other creditors and banks. Please read the following on how to build a credit score from scratch.
    • Your program, friends, and coresidents are a great resource. 
    • Finally, it’s normal to feel completely lost at times, but it’s very important that you keep going on, continue to learn as much as you can every day, and be proud of yourself!
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Statistics from 2019 match, prepared by JAP facebook group about applicants from Jordanian universities. 

This page was created by

Ahmed Daraghmeh, MD

Majdi Hamarshi, MD

Marcel Ghanim, MD

Nezam Altorok, MD

Osaid Alser, MD

Yousef Khelfa, MD

Murad Masri, MD

Important resources and official websites:

  • Forum for Arab Medical Students
  • Palestinian American Physicians
  • Jordanian American Physicians
  • Comprehensive Guide for IMG Applying for U.S. Medical Residency
  • Interview Guide Videos
  • ECFMG Website Guide
  • Detailed Roadmap PDF File from AMA
  • Important Guide: Writing letters of recommendation, statement letters, deanship letter, and others

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