The Cell Structure of an International Medical Graduate's Journey

Kelly Meza, MD


January 18, 2022

International medical graduates (IMGs) are graduates of non-US or non-Canadian medical schools, regardless of US citizenship status; they represent one quarter of all physicians currently practicing in the United States. The top three countries where IMGs are from include India, Pakistan, and the Caribbean, offering diverse perspectives and unique experiences that create more equity in the US healthcare system.

IMGs pursue training in the United States for a variety of reasons, including better job opportunities, high-quality training, family ties to the US, and challenging political situations in their home countries. There must be a strong commitment for the individual to leave the familiar and pursue the long, expensive, and challenging road of moving to a different country, facing extremely difficult exams (many times in a different language than the one they train for in medical school), and cultural differences. The entire process to get certificated by the Educational Commission for Foreign Medical Graduates (ECFMG) can take an average of 3 years, and only 60% complete the process. In 2020, from those who applied to the National Resident Matching Program, 40% of them failed to match for a residency program.

The ECFMG certification process requires the candidate to pass the first 2 steps of the United States Medical Licensing Examination (USMLE). A way for IMGs to establish some form of comparability with US medical graduates is outperforming with high test scores on USMLE exams. This is crucial because program directors have little first-hand knowledge of medical schools outside of the US. For IMGs, having research experience and publications in international journals is also recommended to have a well-rounded application.

The difficulty of the exam and the need for high scores have resulted in the development of a number of expensive agencies that offer help with USMLE preparation that IMGs sometimes cannot afford. Therefore, finding a strong and supportive nonprofit community during this journey is crucial for many IMGs to utilize their utmost potential and remain motivated. Around the world, there are many of these groups that have different focuses, such as question bank discussions, flashcard memorization, or simply keeping company during long hours of study in virtual libraries. These groups are composed of people with different levels of preparation but with the core principle that we should all share our knowledge and resources.

During this process, there are moments of personal sacrifice where we realize our weaknesses and strengths. We are under the pressure of time, money, and/or family expectations. Hence, IMGs pursuing USMLE imitate cells and begin to integrate and work together.

Nucleus: In every group there is always a leader who controls the cell activity. Most of the time this person is at the end of the journey and wants to conduct a fast review and sometimes act as a teacher. Because when you teach, you learn twice and never forget, with the main goal to make the "high yield" concepts part of your DNA.

Ribosomes: Being able to solve difficult questions and approach them with simplicity is like ribosomes translating RNA into a beautiful protein. After the end of the journey, we should all be able to transform into mature ribosomes and rock the test!

Mitochondria: There is always an optimistic group member who encourages and energizes the entire group. Because being able to solve 200 questions a day or read 40 pages in an hour takes a great deal of ATPs.

Cell walls: Cells have strong columns which are symbolized by those who are always available for library calls, no matter if it is their birthday or a holiday. They never allow sessions to break from the schedule.

Cytoplasm: Where all the organelles are together. These are represented by the many free virtual platforms — Skype, Telegram, Twitter, etc. — that allows us to survive as a cell.

These members connect in different ways, most of them join these groups (cell) through social media or invitations from colleagues. Once you are in this big matrix, you can decide whether you create your own group (cell) by inviting other members to join or become part of an existing group. When the group leader successfully completes the exam, another member will take the lead and ensure that the group (cell) continues to survive and remain beneficial to incoming members.

This process can take several months or even years because we may never feel confident enough to face the tests. The support system I found in many of these groups made my journey a powerful experience that molded me into a better colleague, teacher, and leader. We laughed, cried, and celebrated every member's success. Hearing a baby cry in the middle of the session, or a child asking for her mom's attention, was sometimes heartbreaking. Yet, at the same time, it filled us with energy and motivation to make the sessions productive. We understood that the process of studying is made up of persistence and racing against the clock.

During this journey, it is also important to join other types of groups where you can find mentors that have successfully completed this process. I found this with Duma Lab and Latinas in Medicine. Their wisdom and guidance were beneficial for me to learn to lead my own group (cell) along with their support and motivation.

The road to passing these exams is long and arduous, but if you are considering embarking on this journey, I leave you with what Narjust Duma, MD, said to me when I asked her about doing my residency training in the US: "Many of us go through the same process. It's possible!" This simple yet powerful quote was inspiring because it reminded me that many of my role models in medicine went through the same process and experienced the same feelings. It is always important to remember that we are truly never alone on this journey and that our community is an invaluable asset.

Here are some helpful resources for IMGs:

AMA IMGs section

IMGs' journey Twitter

Inside the Match Twitter

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About Dr Kelly Meza
Kelly Meza, MD, is a Peruvian doctor pursuing US medical residency. She is passionate about translational research, medical education, and bridging disparities and information barriers in medicine. She is the recipient of the 2018 Future Clinical Researcher Scholarship by the American Academy of Neurology. She is dedicated to promoting safe and healthy environments for her peers.

Connect with her on Twitter: @KellyMezaMD

The Duma Lab, formerly known as the Social Justice League, was founded in August 2019 and focuses on social justice issues in medicine, including discrimination and gender bias in academic and clinical medicine, cancer health disparities, and medical education.


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