Hi Jellyn,

I am currently a student in IMU.

The USMLE Step 1 is a different ballgame all together from the standard basic science exam in Malaysia, with much emphasis on subjects such as biochemistry, genetics etc. However, if you study hard for it, you will get a good score, and you may then compete to obtain a residency in US one day in the future.

I took the USMLE Step 1, and one of the things I felt while I was studying for it was actually - loneliness, because I could not find many other Malaysian medical students who are also studying for it. So I hope that more malaysian students prepare for the usmle, and go to US for training and later return home with the specialist skills

Need to let you know a little about some random about US training if you don't know.

Common misunderstanding is : "Just pass Step 1, 2 and 3 then enter US to work"

A few things wrong about that statement :

- you enter US for residency, and residency is a specialization course. All medical graduates in US immediately enter a specialization course, no such thing as houseman rotating through surgery, medicine, pediatrics etc. If you wanna be a surgeon, you enter as a surgical intern (watch grey's anatomy? they are surgical interns in season 1, fresh out of med school. Watch scrubs? same thing)

-you get PAID while training to become a specialist in US : as a trainee, your pay is about USD 54k per year. But pay should not be a factor for you wanting to go US. The factor is the opportunity to train, and 1 day return to serve Malaysia.

-passing Step 1 and 2 qualifies you to enter what is known as the MATCH. Its about the same as applying to local university. You go to individual hospitals for interview. You rank which hospital and which program you wanna train in, the hospital ranks you. You get a MATCH means you are accepted (ie : General Surgery in University of California Medical Center). You compete with every single applicant. Thousands of foreign medical graduates apply each year. Half get MATCHED, half don't... and they can try again NEXT year.

-the timeline is something like this : after/during medical school >> USMLE Step 1 and 2 CK and CS >> interview period >> you rank the programs, the programs rank you >> you get Matched to a program and spend the next 3-5 years training there.

-usually if you enter US at age 24, at around 27 y/o, you will complete specialization aka residency (ie : internal medicine / pediatrics / emergency medicine / neurology) , and at the age of 30, you will complete subspecialization aka fellowship (ie : gastroenterology, neonatology, fetal medicine).

- Step 3 is not compulsory in order to enter the MATCH. It is a bonus if you take it though. Usually US grads will only take it after 1st year of residency (intern year).

This post has been edited by lemontea88: Aug 22 2010, 02:53 AM

This is true. One who has been through all rotations working as a house officer has wider depth, which is good especially in countries whose aim is to have every single doctor know the basics of delivery, fixing a fracture etc.. to be a jack of most trades. A psychiatrist in that country knows how to remove an appendix. But as to the depth of knowledge, I believe if you work immediately in the medical department once you graduate and do not rotate to other department, you will have more experience in managing patients admitted to the medical department (ONLY), compared to one who rotates through multiple departments for 2 whole years.

However, there are also countries who prefer to have their doctors immediately specialize in a field. US is the first, and I know that Singapore is moving towards it too (or already has). The bad thing about this is lack of the width of the knowledge, as mentioned. The good thing about this is you are focused into that particular field, which is especially good for you if you plan to get into a specialty which is more procedure oriented. For example : 1-2 years after graduation, and you are drilling burr holes if you are in neurosurgical training etc.

For example : At the age of 33 years old, you can be a qualified cardiothoracic (CT) surgeon (after med school, 5 years gen surg, 2-3 years CT surg) in a country which immediately specializes you upon graduation. However, in malaysia, the earliest you come be a qualified CT surgeon is 41. And that is assuming you are one of the 6-7 (? not sure of the places, but I know its single digit) who are accepted every year. With 1 Malaysia concept, and me being an optimist, I believe that the acceptance is based on meritocracy.

But of course, another con of this immediate specialization idea is that it forces medical grads to choose which specialty they want, hence, if one is not sure what he/she wants to do, it can be quite a hard decision to make.

I think all in all, whether it is better for a medical graduate to go straight into residency training or to do 2 years as a house officer first depends on the country, the needs of the country. If a country's aim is for a doctor is to be able to serve the community in a small town which has no doctor, that country will have its doctors go through rotations through all the specialty so that he/she will be able to provide basic care for all sorts of cases from A to Z, and he/she will then refer a complicated case to the hospital for the specialist to take care of it.

This post has been edited by lemontea88: Aug 23 2010, 03:50 PM

Yea. Nowadays everybody wants to specialize. I believe, next time, you will look for a family medicine specialist if you have a cold/flu, who will then refer you to an ID specialist (infectious disease) if he suspects that your cold might be more serious than it looks (H1N1 / influenza). Who will probably manage you together with a pulmonologist if your condition worsens significantly.

To simplify it, if you have symptoms of dengue, you will see a normal clinic, who will send your blood for some test.
Following some criteria (ie : dropping platelet count etc), you may be warded in the hospital, put under a care of a house officer, overseen by a medical officer, which is under a specialist in internal medicine.