Immigration

1. Could you talk more about visa for US residency?

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   If you are not already a citizen or legal resident of the United States, you will need to get a visa. The two visa options for foreign medical graduates in residency programs are the H1-B (Temporary Worker) and J-1 (Exchange Visitor) visas. After being accepted to a residency

   program, your visa may be sponsored by your institution or by the ECFMG, but the United States has specific visa regulations for certain countries, so you may want to consult the U.S. embassy in your country in order to find out about possible visa restrictions.

   J-1 visa

   • The most common visa for international medical graduates (IMGs)
   • Sponsored by the Educational Commission on Foreign Medical Graduates (ECFMG) or the Residency Program institution.
   • Valid for one year, renewable annually
   • Requires a two-year home country physical presence after residency completion
   • Applicants must pass USMLE steps 1 and 2 CK, have a valid ECFMG certificate, and have a contract for a residency program

   H-1B visa

   • A temporary worker visa sponsored by the hospital where the resident will train
   • Valid for up to three years, renewable for another three years
   • Applicants need to provide a copy of their medical school diploma, ECFMG certificate, USMLE pass results, and residency offer letter

2. As a Canadian applying to the US, can I apply to US Residencies that do not support the J1 visa? Am I eligible for a H-1B visa?

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   ECFMG can also support your Visa if the institution does not. Generally students needing a Visa i.e. non US Citizens or US Permanent Residents apply for a J1 as the number of H1B visas are limited and harder to secure.

3. If I have just applied for my EU passport this fall, and am applying for intern year in October, will this classify me in the EU passport category?

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   The experience in the past has been that simply applying for the passport is not sufficient. You will need to have it or proof of citizenship. It’s really not about the passport. It’s about proving that you are a European Union citizen.

Examinations

1. When should exams for Canadian residency applications be taken? When would you write the Canadian board exam?

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   This is the current recommendation.

   USMLE 1
   GEM students – summer following Year 2
   5yr Program – summer after Year 3

   USMLE Step 2 CK
   GEM – summer following Year 3
   5yr Program – summer following Year 4

2. Can you briefly explain the MCCQE, NAC etc?

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   The Medical Council of Canada is an organization responsible for the assessment and evaluation of medical graduates through a standardized examination. Upon successful completion of the examination, the qualification of a licensure of the Medical Council of Canada is granted. This is essentially a quality check. It is not a license to practice. That responsibility rests with each individual province. Although lately, they are beginning to organize into a common license, which crosses several provinces.

   The Medical Council (MCC) runs the MCC Qualifying Exam (MCCQE). There used to be a part one and part two of this, but part two was suspended in May 2021. See here for details of the Part 1 exams. https://mcc.ca/examinations/mccqe-part-i/

   The National Assessment Collaboration (NAC) is an exam which all IMGs must take before residency. It is an OSCE and conducted in Canada at various sites usually in May and September.

3. Do you need to still do the Canadian board exams if you finish residency training in family medicine outside of Canada?

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   The short answer is no but only under certain circumstances.
   There are pathways to certification through the College of Family Practice of Canada (CFPC) other than doing Canadian college exams. Briefly, this applies to family doctors who have graduated from an accredited program and who have an active unrestricted license to practice. There is also an academic track.

   See here for more details.

   Alternative Pathways to Certification in Family Medicine

   In addition, some Provinces, such as Nova Scotia will grant a license to practice with restrictions without CFPC certification but these are not trainee positions.

   Requirements and Conditions for Supervised Practice as the Most Responsible Physician

   Licensure Application

   As an aside the Canadian system does not use the term boards, that is a US term.

Clinical Electives

1. What is the way to secure clinical observership and/or electives.

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   Observerships are easier to arrange than electives and can be done through personal or professional connections. They are still subject to provincial regulatory processes, so it is necessary to check the website of the College of Physicians in each province to ensure that you are compliant with all the requirements. Observership are less valuable than electives because you do not get hands-on experience with the patients.

   Electives in Canada are arranged through the AFMC portal.This system was set up by the medical schools to manage the large number of applications, which they receive for electives. In addition, the practice of medicine has become more complex and the requirements around students interfacing with patients needs to be tightly regulated. The process is straightforward to follow but unfortunately demand for electives consistently outstrips supply.

2. Can you do an observership or an elective as a first-year student?

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   When you do an observership, you do exactly what it says, you observe. There is no hands-on patient interaction and no decision making. You can do observerships at any stage of your career. Observerships are less valuable than electives, because of the lack of clinical interaction, but they are useful in building networks and getting a sense of the culture in each discipline. Although you will not be making clinical decisions you will have access to confidential information. There is, therefore, a process for applying for observerships. This may vary by province and state.

   Electives are sometimes divided into pre-clinical and clinical. Pre-clinical could be anything around learning the theory and practice of medicine. Clinical electives are those where you function in an almost junior resident or intern capacity in which you are given a lot of responsibilities in a very supervised setting. In order to be able to function in that capacity, you need to have completed the core pre-clinical training.

3. Is it true that the summer after 3mb students can start to do electives in the US and Canada?

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   Yes, but most locations require that you have successfully passed USMLE Step 1.

4. For US experience during the summers before year 3, does the US research/ observership opportunities prioritize US citizens or would it be the same for Canadians?

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   Whereas US students may have more access to opportunities within their own institutions, students studying in Ireland routinely secure observerships in the US and Canada. Research opportunities are probably easier to arrange within your own University in Ireland and this experience would absolutely be well regarded.

5. Does every school offer Canadian clinical electives during the school year, or would it have to be in the summer?

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   The Canadian medical schools offer electives throughout the year. Electives may not be available in every discipline at every time. It depends on other commitments. However, if by every school, you mean the Irish universities, then they do not always allow electives during the year. There are set times determined by university as to when you can take electives overseas, and others when you need to be home for the core curriculum. Check with your School’s International Team.

6. Are non AFMC organized electives considered non-official?

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   All medical schools and activities in Canada should go through the AFMC portal. The reason for this is that there is a certain amount of background checking of credentials and insurance and vaccinations which needs to happen before electives. In addition, it reduces the amount of administrative time which each school needs to spend on processing electives. If an elective is arranged outside of the AFMC portal it really has nothing to do with the Canadian universities.

7. What time during my medical school should I start doing clinical experience? Is it possible to take electives in your first year or second year? Or is this only available towards the end of your education?

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   It’s good to get clinical experience at every stage of the medical school. If however, you mean elective clinical experience then that needs to be done after you’ve done your core rotations. Schools do not want to put you in a position beyond your clinical competence. That’s bad for you and for patient care so generally it is later years only.

8. I have been told that medical schools in the U.S. allow electives only if your Irish medical school has a prearranged agreement with them. Is there a list of U.S. medical schools that have pre-arranged agreements with the Irish medical schools?

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   No, that is not correct. It helps if your university has an arrangement with certain medical schools, but it’s not a requirement. Sometimes it’s easier to get electives in some of the universities that are perhaps a little less known. Also, electives can be arranged through private companies like AMO and ACE.

9. Can you talk briefly about unofficial electives in Canada (using connections)?

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   Given the limited opportunity for electives through the AFMC portal in Canada, it’s tempting to use friends or family connections or rather methods to arrange an elective clinical rotation. We urge you to practice extreme care and to make sure that the provincial requirements are complied with. There are obligations on your supervising physician, which are outlined for Ontario in the link below. Doing electives outside of the portal raises issues regarding insurance and compliance with provincial laws. It is not recommended. Each province has somewhat different regulations on this, but in general the same road supply.

   https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Professional-Responsibilities-in-Medical-Education

10. Do you have any advice for finding and contacting Irish-grad pediatricians in Canada? For individuals who may not have many connections, what are some strategies to connect with physicians across Canada/US? Particularly for assistance with establishing electives and residency matching

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    Building professional networks is important. It allows you to connect with individuals who can give you insights and opportunities to advance your career. It can help with research and advice. In medicine people work in teams and they rely on each other to make decisions and deliver care plans. One way that a team leader or program Director knows that you can be trusted and are reliable and responsible is to have the assurance from somebody they know, or somebody in a similar position, that you have functioned well in the capacity.

    One way to build connections is through the international office in your medical school. They may have lists of alumni who are in practice in different disciplines and parts of Canada and the U.S. Alumni are usually very happy to connect and provide advice. If there is not an alumnus list, you could ask your consultant when you are rotating on paeds. Sometimes schools have interest groups of students.

    Electives in Canada are organized through a central process run by AFMC (the association of Faculties of Medicine of Canada). See this website. https://afmcstudentportal.ca. Personal connections are not important or a factor in getting electives.

11. When you do electives at hospitals, do they expect that students will ask them for a LOR?

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    All attendings recognize that students need letters of reference, and they’re all used to getting multiple requests for them. It does require a certain amount of time on the part of your attending physician. Generally, it’ll take about 30 to 60 minutes so it’s not a minor ask. However, they will generally be happy to do it if you ask nicely.

12. If you did a single elective in Canada, could you get 2 reference letters from 2 different doctors you worked with in that same elective?

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    Perhaps not ideal but certainly better than not having enough references. The problem is it’s unlikely that two physicians on one elective would get to know you sufficiently well to be able to write a strong reference. However, it’s OK and if necessary, would do it.

13. Are ROMP electives more official than using connections?

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    Yes. Rural Ontario Medical Program electives are funded and supported by the Ontario ministry of health and long-term care.

    https://romponline.com/learning-opportunities/

14. As someone who is hoping to go back to the US for residency, would it be better to do all 8 weeks of summer electives in the US, especially for LORs, or would committees prefer/equally value splitting those electives between the US and an underdeveloped country (such as Vietnam or Tanzania, as offered through volunteer programs such as M.O.V.E.)?

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    Electives in developing countries are valuable from both the clinical and professional point of view. Obviously, there is some flexibility about this. If you’re interested in infectious disease, for example, and you do electives in a major infectious disease situation in low-income countries, that clearly carries a lot of value. They do carry weight with potential program directors. However, they really don’t tell program directors much about your ability to function in high income countries. It would be better to do those clinical experiences earlier in your undergraduate years and maximize the number of electives which you can get in the US.

15. How long does an Observership have to be? Is it fine if it is 2-4 weeks?

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    2-4 weeks is a very adequate amount of time for your supervising physician to get to know your skills.

16. I’m only in first year med, would the summer electives be something that would only be available after a certain year? Would our college help organise our electives or do we need to find electives ourselves?

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    Electives are only available after a certain year when your core clinical competencies are complete. You can still do research electives and observership, which can be very helpful. There is some variation between schools in Ireland with regard to when they will allow electives, and there is also variation between schools in Canada as to when they will accept students. It’s best to check both of those factors before you proceed.

17. How important is it to secure an elective in the provinces you are hoping to match to?

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    Somewhat but not critically important. It gives you an opportunity to check out the program and the local medical culture, gives you an opportunity to shine, and the opportunity to connect with people who may be able to support your application. That said, it is not by any means a requirement.

18. How far in advance do you have to reach out in order to organise an elective? Also, would doing an observership carry much weight in summer after third year?

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    Once the AFMC opens up in the Fall, you should be ready to apply. You will be eligible to apply for clinical electives after you’ve completed your core clinical competencies. Electives are better than observerships, but observerships are certainly a valuable experience.

19. If we’re unsure what specialty we want to do, how would you recommend applying to electives, (do programs want you to have all your electives in that specialty?)

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    Programs do not need you to have done all of your electives and their specialty. Generally speaking, people are clear on the main career pathways. If not family medicine, then usually they are trending to one of the medical specialties, such as the surgical specialties, laboratory, medicine, or radiology. There are very few people who are totally undifferentiated between medicine and surgery near the end of medical school. If, for example, you’re interested in one of the medical subspecialties then, in Canada, you have to do internal medicine first anyway before you choose a discipline such as cardiology. So, it makes sense to do electives in internal medicine and its related branches.

20. How difficult is it to enter into an Irish training scheme as a Canadian who finished their medical school training in Ireland and an Intern year?

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    Applications for Irish training schemes are based on a three tier system. First options go to CAO match applicants, then EU, then non EU with work permits and then non EU without work permits. So, it depends on citizenship and work permits plus, of course, what you are applying for. Certainly possible to match.

21. Does doing an intern year increase your chances of matching back in Canada?

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    On balance probably not. There are pros and cons to doing an intern year. You get to take a bit of a breather and earn some income after the stress and strain of medical school. It does give you a chance to consolidate your skills. The Irish undergraduate system does not really have a clerkship in the same way that the North American one does. Doing an internship allows you to fill any clinical gaps and acquire extra skills. You can also do some research during the intern year or perhaps get into subcommittees and do some leadership work. That is always helpful.

    The UK is another option. UK postgraduate education is a very high standard overall and after completion of the foundation years, it may be possible to move into family medicine or specialty training. You can find details of the application process here:

    https://foundationprogramme.nhs.uk

22. What is the benefit (or is there any difference) between having university affiliated vs non university affiliated electives from an application perspective?

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    The best possible reference is from a member of the residency training group from the institution to which you’re applying. It doesn’t get better than that because they will be able to choose the trainees. However, a non-university affiliated referee is also potentially perfectly good. There are many prominent and highly respected physicians who are not affiliated with university centers, and they may be well known to the program directors.

Research

1. How do you suggest we seek out research opportunities?

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   First step is to figure out what’s important to you. What really interests you and what would give you energy if you were doing the work. It’s better that your research projects dovetail with your career plans so having some idea about what you want to do in postgraduate education really helps. Once you know that, speak to Faculty and ask around to see who is involved in the areas that interest you. Arrange to meet them or send them an email and see what happens. Researchers generally are very curious and want to bring others into the team because they’re excited about their work. They’re usually very approachable and certainly there is no harm in asking but have an idea about what you want to achieve.

2. Do you know if having research is only valuable if there is a publication involved? I am involved in research but do not have a publication and I am interested in family medicine.

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   Publications, especially in high impact journals, are good, but they’re not the only part of research that’s important. Being able to come up with an idea, develop a hypothesis and begin to solve the problems, especially in the context of writing a well structured research protocol are important. A lot of work and research is preparation and getting that right results in good answers. Getting it wrong means that the project is not likely to be successful so by all means highlight contributions you’ve made around research projects and development.

3. How important is research during med school? How do we juggle writing the USMLE, electives, and research?

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   It is somewhat, but not critically, important. The most important thing is managing your physical and mental health and doing as well as you can in the academics. Coursework and becoming a good clinician is job one. Anything after that is a bonus. Research is fine if you have the opportunity, the interest, the networks, and it energizes you. Best to avoid it if you find it’s one of the things draining your batteries and stressing you out.

   Research is important for a number of reasons. It’s one way to demonstrate many of the attributes outlined in the CanMeds framework. Your work may show your ability to work in teams, to communicate, participate in scholarly activities, display professionalism, and ethical behavior. In addition, it gives program directors one more criterion to use in ranking applications. For example, if there are a lot of applications for a residency position, somehow the cut needs to be made. Researcher work is often assigned a score in the ranking, and someone who has published will receive credit for that.

   In terms of what to do and how to balance it all, there are a couple of principles. Try to find something which energizes you and which is of interest to you. Don’t get involved in a subject which doesn’t interest you. That will just add more to your work list and burn you out. If the project aligns with what you wish to do in your future career, that’s certainly an added bonus. Try to get involved in something meaningful to you as opposed to ticking the box.

   Research activity varies all the way from simply taking a methods course, to asking a question and beginning to develop a project around that, to perhaps writing a case report or contributing to a project which is underway. Doing original work involving randomization and trials would be extremely unusual. Getting a project underway, perhaps to the level of writing an abstract and submitting it to a meeting for a poster or oral presentation would be very helpful. Consider working in a team around a topic.

   It’s important to remember that research is simply asking questions, and it can be in any field including the Humanities, history of medicine, art and medicine, or the basic sciences. There’s really no limit to what you can include under the research umbrella.

4. Also how important is research as part of my application for residency?

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   Different programs and different institutions put different weights on research. For all of them research is important but for some it really is kind of a dealbreaker. So the answer really is that it depends. It depends on which program and it depends on which university the program is situated in. In general, having a good research project gives you a competitive advantage over other applications who do not have that.

5. How much does the number of publications matter? Any recommendations on this? How important is it to have published a research paper?I heard it’s very important to have a lot of research to apply to the US. How much research and should it be published?

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   A number of publications in high-quality high impact journals is ideal, but it is exceptionally unusual, if not impossible, to do that in med school. It’s even better if your work lines up with what you want to do in residency. Most people who have a significant research part on their CV developed it before they went to medical school. It’s not so much about the number of publications as it is about quality. Participation in one paper in a high impact high-quality journal is far more valuable than multiple publications in low impact journals.

6. What kind of research experience is seen as beneficial for Canadian residencies (ex for internal med, peds or something more competitive as anesthesia)? Does it matter if it's clinical, lab, or reviews? Are all publications seen as equal?

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   All research experiences are valuable—whether it’s putting in the effort to develop a well-thought-out protocol or contributing to a publication in a high-impact journal. It’s better if your research speaks to your residency application, but that’s not necessary. Many of the attributes of a good research program apply equally well to residency training. All publications are not seen as equal. One good publication in a high impact journal is worth a lot more than a lot of publications in a low impact journal.

7. Does it matter if our research is in the US or Ireland?

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   With Research, it’s really about the quality rather than the location. Being on site in the US certainly allows you to develop contacts with clinical and non-clinical scientists, but many researchers in Ireland are connected very closely to institutions in North America. Unbalanced that it’s done in the US, but the most important thing is the quality of the work and the people you’re working with.

8. For US application: does the research experience have to be related to the field you are interested in or can we have random projects?

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   Ideally, your research activities speak to your residency program direction. For example, if you’re interested in general surgery, it’s better to have a project around surgery. Similarly, if you’re interested in neurology, research projects on neuroscience clearly add strength to your application. However, many research aspects are universal such as the ability to work in teams, organize your team here and to develop a strong with problem-solving

9. With regards to family medicine, what field of research would be important to contribute to or would benefit my CV?

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   Every field of research is relevant to family medicine as it is such a broad discipline. If there’s any bias in family medicine towards research, it might be towards projects which are more person orientated. Projects around the Humanities tend to go over quite well because it shows your connection to people in society.

10. It was recommended to get involved in research that can be applicable to many specialties/areas of medicine, could you talk more about this and give some suggestions/examples?

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    There are two factors of play here. For some disciplines, such as for example, plastic surgery or dermatology, there are many more applicants than there are residency positions and research can be a factor in matching.

    Some disciplines are very competitive, and program directors have to use some criteria to decide who gets the positions. Research is one of those criteria. If you have a research background or publications related to the discipline for which are applying, it is an advantage. Some disciplines, such as anatomical pathology, are not quite so competitive and research is perhaps less important, but it is helpful.

    In terms of what to do if, for example, you were applying to internal medicine, it would be very useful to have spent some time working on a project with an internist around an issue related to the practice of internal medicine. Similarly, if you were applying to general surgery, it clearly helps to have a project which relates in some way to the practice of surgery. The second issue at play is that the Universities vary In their culture. Some are more research oriented while others might have a leaning towards humanities and a more holistic view.

    Suggest you become familiar with this data.

    https://www.carms.ca/data-reports/r1-data-reports/

11. How worthwhile is it to be doing research from a previous career field (biomed engineering) that you have been involved in for a long time, instead of trying to find research that is strictly medicine?

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    It is really helpful. The skills that are applied in executing successful research projects are very much aligned with those described in the CANMEDS framework. It would be even better if your previous career research output aligned with what you want to do in residency. That’s a very convincing argument for the program Director. Biomed engineering wold be applicable in many branches of medicine. You worked hard to acquire that skill set and it is important to carry it forward.

12. How important is it to take up leadership roles / do research in the first year of med school?

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    Leadership as one of the CANMEDS roles. Physicians need to be leaders in a collaborative, communicative way with other healthcare professionals. We have a duty to lead in certain areas and developing that skill is important. Program directors will certainly take notice of any leadership positions which you’ve taken and that will be a useful to put on your résumé.

13. How could we go about getting funded/employed research opportunities in the US when we are still in school in Ireland? Is it possible to pursue employment as a research assistant remotely?

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    It’s very unlikely that you could get funded or employed research opportunities in the US while still in Ireland. That really is unlikely to work for the employer, although possibly there are some research projects and some research activities such as data analysis which could be done remotely. You could certainly email around the major research institutes and see if there are openings, but it seems unlikely that there would be

USA

1. For people planning on applying to the US in the cycle after they graduate, is the 4 weeks of electives in the US still a requirement?

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   It’s not necessarily a requirement but you are unlikely to secure a residency with no clinical elective. A clinical elective does not necessarily have to be undertaken in the US although it mey be an advantage.

2. If I wanted to go back and do residency in Canada but later, want to work in the US what would the steps be?

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   First, you would need to take the USMLE and fulfill any other requirements, e.g. proof of english language proficiency.

   As an already qualified physician, your pathway would depend on your specialty. You will need to check with the relevant specialty regulator in the State where you are applying for a job. It’s quite common for qualified physicians from outside the US to pursue Fellowships in the US so that is an option also. But overall, yes, it is not uncommon for physicians trained outside the US to come to the US to practice medicine.

3. I was wondering if you could elaborate on applying to the US if we are a Canadian wanting to get back to Canada primarily. The thing I want to know is whether you can apply to both? I heard you can get in trouble if you get matched into US and have a Canadian application and vice versa?

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   You are touching on a very important issue. This emerged as a problem for the first time post COVID. As it stands at the moment, if you apply to the United States and Canada, your application is taken as a single entry into the system. The U.S. system may offer you a position before you are offered a position in Canada. If you refuse the position in the United States, you
   will be withdrawn from the Canadian match. This creates a real dilemma for people who primarily want to get home to Canada but also want to hedge their bets for having an application in the U.S. system. It’s a very difficult problem, and the provincial Premiers are working at the moment to get that change to how it was done formerly. Bottomline here is don’t apply to the
   United States unless you will accept the offer if you’re given it. You can apply to the states and withdraw your application, but if you’re going to withdraw, do it before you’re offered a position.

4. If we are Canadian but applying to the US, can we do our residency in the US but then apply to a fellowship back in Canada?

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   There is no problem with doing that. You might find it a little bit more challenging to get to the fellowship position as programs in Canada may favour students who have gone through their system, but there’s no formal block to doing this.

5. As a Canadian student, I plan to apply to Canada and the USA - however if I were to get multiple Canadian interviews, I know I will be inclined to withdraw from the USA system because if I match I will get withdrawn from Canada. When would it be “safe” to make that call? (i.e., how can I know if my interview was successful enough to make that call?)

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   Unfortunately, there is no way to be certain that you are safe. Indicators that you’re on safe ground would include a large number of interviews and positive feedback from program directors. They will not, however, tell you that they will offer you a position. It’s a really tough situation. If the opportunity arises and the situation seems appropriate, you could explain to the Program Director of interviews the position that you’re in. It’s possible that you might get some unofficial indication of how positively they’re feeling about you, but generally they’re very careful about any indications like that.

6. So what is the purpose of applying for and doing a preliminary program?

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   There are a few reasons why one might apply to a preliminary program. Preliminary programs usually come as either one year of internal medicine or one year of general surgery. One reason to apply is that people might not be entirely sure which field they want to specialize in, so they start broad in order to get a better feel of each specialty as a preliminary resident prior to committing to a categorical spot. Another reason might be to get your foot in the door in a program you wish to be at, or to use that preliminary year to apply into a more competitive subspecialty. An example of this could be doing a general surgery preliminary year at a program then reapplying to either gen surg or a more competitive sub specialty like ortho or plastics at that program now that you have made connections within the hospital.

7. For U.S. residency: what is the advantage of applying for a preliminary (instead of categorical)? Is it better for more competitive specialties?

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   There are some advantages to applying for a preliminary instead of a categorical program. Being a Preliminary applicant will help you make connections within the hospital during a transition year that you might not be able to make prior to working there if you do not match in a categorical spot. Most people apply to the preliminary year as a backup to categorical in order to still work and gain experience as a resident, but will have to reapply to the match the following year. Preliminary applicants are useful for surgery residencies who did not initially match and want to gain more experience for next year’s match, as well as for medicine applicants to gain a better appreciation for medicine subspecialties prior to committing to a categorical residency. For the most part, however, it is more advantageous to be accepted into a categorical spot in order to avoid going through the match process again.

8. Just to confirm, is it minimum 3 LORs that must come from U.S. electives? Also, when applying to U.S. electives, is it helpful to have LORs from research PIs? (And is there a template we can send to PIs when requesting these?)

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   Most programs will document specifically how many LORs they require for application. Usually it is required to have 3 to 4 LORs with one being a dean’s letter and others being letters of your choice. You are free to use research PI’s as a letter, but it is based on individual circumstances. The letters are not required to be from US electives exclusively. Usually with regards to a template, there could be some generic forms online, however research PIs will have you detail your work/experiences for them for which they will base their letter around.

9. With regards to applying to the US - is US specific experience required in terms of clinical electives etc.? Considering it is sometimes hard as a non-US citizen to get opportunities over there during the summer.

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   Most programs require at least four weeks of US clinical experience in order to apply to US residency programs. Whether that be through remote online electives that US institutions host or in-person may differ, but it is definitely recommended to get in-person clinical experience in the US for at least those four weeks.

10. Now that step 1 is pass/fail instead of a score, would you say there are other factors that are playing a more important role in the application process?

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    The interview process in the US seems to be very ‘holistic’. The program and interviewers want to know you as a person. Clinical experience, extra-curriculars, research experiences and hobbies are also a big component of your application and interview.

11. When is the best time to start prep for step 1, I am in my 3rd year and have concerns whether it's too late?

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    Basing went to take step one and step two Is different per four year, five year, and six year programs. Generally, it is recommended to be taking step one after your didactic years and prior to your hospital based clinical rotations. This is due to the fact that step one is mainly chorus science based. Is recommended to be taking step two prior to application season for US residency as you will have more time to be dedicated to electives and not juggle the stresses of applications, electives, and board studying.

12. Do you think we shouldn’t apply at all to the US if we fail Step 1 or is it worth taking it again?

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    It is definitely worth taking again especially now that it is pass/fail. This application process is very much transitioning to a holistic review for which grades alone will not be the determining factor, however they do play a large role in decision-making. Step two has more weight on it now that it is the only three digit score.

13. Would you recommend writing Step 2 CK before or after US summer electives? Did the summer electives help for knowledge in terms of writing that test?

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    If you are able to write Step 2CK prior to US summer electives, it is strongly recommended. It can be difficult with medical school exams around May-June, but is definitely doable. Not only does completing Step 2CK provide more clinical and medical knowledge prior to electives but allows you to focus on your elective and get the most out of the experience. An added bonus is having more free time to explore a city you may be interested in!

14. What does “couples matching” mean, and how does that help you application into matching in a specific program? How does the admissions committee view that?

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    Couples matching is the process of applying to residency with the goal of ending up in the same region, school or program as your partner. This essentially means you are interviewing and applying ‘individually’ but will rank your programs as a ‘couple’. With anything, there are pros and cons to this process. Pros, would include reaching out to programs that your partner has already received any interview, increasing your chance of an interview as well. Cons, you will have to make compromises and decisions in terms of ranking programs and locations.

15. What would be a “safe” number of interviews to have during the Match (for the US)?

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    There isn’t one magic number. Each candidate’s application will look differential, with a different number of specialities, programs, locations and regions applied to. If you apply broadly across the country and to more specialities, you are likely to receive more interviews. At the end of the day, having a strong, well put together application and being prepared for your interviews will take you a long way.

16. Would it still be helpful if we did clinical electives in another country even if we are aiming to apply to the US?

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    Any clinical experience you have is valuable to your application. If you are hoping to complete residency in the US, an elective in the US is not required, but may be highly favorable in your application. That being said, unique experiences can make you stand out in a positive way on the interview trail. Training in Ireland is one of the unique experiences interviews love to talk about. This is a positive aspect of being Irish US or Non-US IMG.

17. I’m applying to the US as an undergraduate medicine student. Is there any bias/anything to look out for for students who will be a couple years younger than US residents?

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    There is no bias against students who went straight from high school to Irish medical school. Several students at the five or six year programs match into very competitive programs and subspecialties, and I have not heard of this being a roadblock for potential applicants.

18. For the US: What is “signalling” in the residency application process?

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    Signalling is used in two ways. You can signal your top five regional preferences for which you can request a cluster of states based on region (which can be found online via web search), as well as signalling five programs specifically that you would like to notify you are highly interested in. Programs within your region of preference will not be notified, however individual programs that you signal will. Use this to your advantage as it is a helpful tool in obtaining “safety” programs, realistic programs, and stretch programs.

19. Do you think Irish Non-US IMGs are at an advantage compared to other Non-US IMGs?

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    I wholeheartedly believe that Irish IMGs are at an advantage over non-Irish IMGs. Typically, Ireland/UK, South Africa, Australia, and New Zealand are recognised as one-to-one with North American programs and have much less difficulty applying/being accepted into US residencies than other IMGs. Some Irish programs are recognised as US home institutions which also makes it easier for Irish students.

20. If you have experience as an observor in the U.S., is this weighted similarly to having elective experience on applications?

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    Observerships usually do not carry the same weight as electives as they are less interactive and are not as similar to how residency rotations are. This is obviously different on a case by case basis, and some observerships are more interactive than others. Generally, however, it is recommended to gain formal elective experience over observerships. Observerships are a good way to get US experience, make good connections for electives/LORs/interviews, and get accustomed to the system and are very valuable and of themselves. They should still be taken seriously and you should put your full effort towards them despite not being a formal elective.

Canada

1. Are letters from Canada still meaningful for US applications?

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   Absolutely. US and Canada are closely allied in medical training.

2. Are there any statistics on the acceptance rates or percentage of IMGs that get spots in Canada? I know we can see the number accepted into each position, but I am wondering about how many people apply compared to how many are accepted.

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   CARMS does not publish the data online, but we know from conversations with people associated with the process that the match rate for Irish graduates is high and approximately 70%. You can increase your chances of matching by applying to Family medicine, as well as other disciplines, applying to as many universities as possible, making sure that your CV fits your application and making sure that you create a very positive impression when you do electives or observerships. Strong letters of reference combined with a CV, which demonstrates commitment goes a long way towards ensuring the program director offers you a position.

3. if I wanted to go back and do residency in the USA but later on wanted to work in the Canada what would the steps be?

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   Yes, you can work as a physician in Canada after finishing a US medical residency, especially if you are certified by an American Board of Medical Specialties (ABMS) board. However, the process involves more than just your US residency, including specific provincial licensure steps, potential exams, and a work permit if you are not a Canadian citizen or permanent resident.

   Licensure and certification

   ABMS certification: U.S. physicians with ABMS or ABFM (American Board of Family Medicine) certification can get a full, independent license immediately in several provinces like British Columbia, Alberta, Saskatchewan, Manitoba, Nova Scotia, New Brunswick, and Prince Edward Island.

   Provincial licensure: You must apply to the specific provincial medical regulatory authority where you wish to practice.
   Credibility and exams: You will need to verify your credentials with the Canadian Medical Protective Association (CMPA) and may need to pass the National Assessment Collaboration (NAC) Examination or other required exams.

Alberta

1. How does applying to Albertan programs differ from the rest of Canada?

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   The requirements for Alberta are laid out in this web link. https://www.aimg.ca/

2. Question for Dr.Dempsey, I’m originally from Alberta now studying in Ireland, and I know to get into Alberta residency you must have lived in Alberta, however since you’ve finished your GP training in Ireland first, how was that process coming to Canada as a full trained doctor?

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   If you are coming to Canada (Alberta specifically) after GP training, there are likely 1-2 exams that you will need to sit. The exams have varied over the years and the CPSA website would have the most up to date information on exam requirements. However, you are very well placed to work here quite easily as the Irish GP designation MICGP is readily recognised here and translates to the CCFP designation (which they award to you).

3. Question for Roisin while working in Alberta: Have you heard of any changes with regards to residency for IMGs in Alberta?

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   Alberta is not generally regarded as IMG friendly for electives or residency. However this year Alberta did not fill all the family med residency spots with Canadian grads. Therefore they will likely need to review their approach and become more open to Canadian-IMGs. It would be worth watching for possible changes in next year’s IMG specific residency spots.

Quebec

1. How did people go about matching in Quebec?

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   Basically similar to outside Quebec. Build your connection base in Quebec as you go through med school, if you can. Do electives when you reach that stage in your career. These are arranged through the AFMC portal.

   There are, however, some issues particular to Quebec. One issue with matching into Quebec is that you will not be able to apply to Carms during your final year; you would have to wait until the following year. As a result, you would have a gap year between finishing medical school and
   starting residency.

   This is because Quebec requires your medical degree to go through an approval process, which requires you to physically obtain our degree and scan a copy of it to them. However, you only physically receive the degree at graduation in June, but at that point, the CARMS matching process will have already been over since match results come out in March.

   As a result, you have to wait for the next application period, which only opens in the Fall.

   The other issue is that if you are a Canadian citizen and go through the whole degree approval process, you are now considered to be a part of the “regular” applicant versus the particularstream, meaning you would be competing with students who completed medical school in Quebec (or another Canadian province) for a spot, making the process very competitive.

   – Contributed by Julia Rodighiero TCD

2. For people that matched in Quebec, did a lot of them do intern year in Ireland? or France or Belgium?

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   The number of students from Quebec is very small. There is no data that I am aware of thenumbers doing an internship. France and Belgium would likely require an EU passport to take a position. Ireland has waived that for the intern year for students studying in Ireland.