The following is a guest post.  It's a contribution article from a graduated Saint James School of Medicine student.

Well the time has come, I am ECFMG certified. Thank you Almighty for such a great success. It's such a relief and I can't believe it's done. It was a long journey and accomplishing it is a great feeling. Of course the journey is not over yet; now I have to work on getting into residency but I'll put that worry to the side and enjoy this moment and just reminisce on all the work that was put into it.

The process of getting the ECFMG certificate is a very simple process and SJSM did a great job in helping me get it. They were very supportive in getting my papers done fast and getting my credentials verified so the certificate would arrive at my house.

The following is a guest post.  If you want your article published on this blog please email your article.

The process of getting the ECFMG certificate can be a bit confusing and there is no clear instructions to get it unless you call the organization up for instructions, and I did just that.

What is the ECFMG?
It's the Educational Commission for Foreign Medical Graduates, and it's the body that oversees the validation for international medical graduates for residency.

What is the ECFMG Certificate?
It's just a document that says you have fulfilled the criteria by the ECFMG and you are clear to start residency and you can take the USMLE Step 3.  Keep in mind, you need the permission of the State, that you reside in to take the USMLE Step 3; however, the criteria for each state varies.

Also, getting the certificate actually boosts your opportunity to get into residency.  Therefore, the faster you get the certificate, the better.

What is the process to get the certificate?

Let's face it, if you are an IMG you will have challenges and it you should recognize that there will be tremendous amount of obstacles before you land on a residency spot.  The biggest obstacle will be where to get a residency. What I noticed is that some students will apply blindly to numerous residency programs without researching. You should always research to see if your school is approved in the state and you should also research to see if the residency program will accept you. Most states don't DISAPPROVE Caribbean medical schools and they have the APPROVED list of schools.  If your school is not in the DISAPPROVED list then it's good; however, some residency programs will only accept students from schools in the state's approved list.

According to the IU Health Ball Memorial Hospital Family Medicine Residency Program web site:

Before applying, please visit the Indiana Licensing Board's web site to determine if your school is approved for licensure in Indiana. If your school is not on the "approved" list, we will not be able to consider your application.

According to the Indian Licensing Board, Ross, Saba, SGU, and AUC are the only foreign schools which are approved. And all other schools which are not in the disapproved list are taken in a case by case manner. Some schools in Indiana will not consider students if they are not in the approved list. So, students from SJSM, MUA, Xavier, AUA, AGU and other schools, don't bother applying in Indiana. Don't waste your money in applying for programs in states that your school is not approved in.

Another issue you need to consider is when will you get your medical license. Residents usually sit for USMLE Step 3 after the intern year of residency and get their license. However certain criteria have been changed and now some states require residents to complete their entire residency in order for the state to issue their medical license if their school is not from the approved list.

According to the Georgia Medical Board:

Graduates attending schools not listed in the Medical Schools Recognized by the Medical Board of California must complete three (3) years of post graduate training in a program accredited by the ACGME.

Basically post graduate training is residency and you have to finish your residency in order to get your license.

According to the Alaska Medical Board web site, it doesn't have much restrictions except just passing your boards and be a legal US resident.  The following is from the board's medical statues & regulations:

Sec. 08.64.225. Foreign medical graduates.
(a) Applicants who are graduates of medical colleges not accredited by the Association of American Medical Colleges and the Council on Medical Education of the American
Medical Association shall
  (1) meet the requirements of AS 08.64.200(a)(3) and (4) and 08.64.255;
  (2) have successfully completed
     (A) three years of postgraduate training as evidenced by a certificate of completion of the first year of
postgraduate training from the facility where the applicant completed the first year of internship or residency and a certificate of successful completion of two additional years of postgraduate training at a recognized hospital; or
     (B) other requirements establishing proof of competency and professional qualifications as the board considers necessary to ensure the continued protection of the public adopted at the discretion of the board by regulation; and
  (3) have passed examinations as specified by the board in regulations.
(b) Requirements establishing proof of competency under (a)(2)(B) of this section may include
  (1) current licensure in another state and an active medical practice in that state for at least three years; or
  (2) current board certification in a practice specialty by the American Board of Medical Specialties.
(c) In this section, “recognized hospital” means a hospital that has been approved for internship or residency training by the Accreditation Council for Graduate Medical Education or the Royal College of Physicians and Surgeons of Canada.

Be smart and research before applying for residencies so you will save your self time and money and increase your chances of getting a residency.

The following was an email from a blog reader.  I think the reply I gave should answer questions for some prospective students.

I just wanted to know if you could tell me the challenges applying for residency that come with being a caribbean student. I know the obvious issues but what can you do to get around it besides having a good score?

Hello,

Unless you graduate from the offshore schools of Ross University, St. George University, or American University of the Caribbean, you may run into a good amount of obstacles to gain residency. Most Caribbean medical schools are not approved in all 50 states. My school Saint James School of Medicine, is about to reach 15 years in which the school will apply to big states like Texas and Florida for licensing. Usually it's a case-by-case basis for license approval in those states. Luckily my school has not been disapproved in any states. A good number of states follow the California approval list and so some Caribbean medical schools may not be approved.

Another issue is if you are Canadian then some program will not accept you unless you are also a US citizen or a US green card holder. Some residency programs will not sponsor visas for foreign grads, that's where US citizens who went to offshore schools have the advantage.

At the end of the day, the Step 1 and Step 2 CK scores matter. Some programs look at your Step 1 score and some programs look at your Step 2 CK score, and others may look at both. So it's a good idea to score high in both tests with Step 2 CK score being higher than Step 1 score.

Another issue could be your letters of recommendation. Some schools have good rotation posts in which students get good LORs but others may not so it depends on the school and what rotation spots they have.

Also, with more American medical schools being built and more American medical grads are applying to primary care, IMGs will have high competition since residency spots have not increased significantly. Therefore, it's better to go to a US med school, the second option would be to attend the top three Caribbean medical schools which I listed: Ross, AUC, and SGU.

As you know the USMLE Step 2 CS has gotten harder.  Before the candidate just has to list 5 differential diagnosis and 5 diagnostic workup. Now with the new change, candidates must now list 3 differential diagnosis and give the reason of why those differential diagnosis were chosen.  Due to this change even American medical students are failing. 

Here is a Cheap Solution

One of the SJSM students, who is living in Hyde Park, is offereing hands on teaching for students who need help studying and practicing for the USMLE Step 2 CS. He said the first hour is free and it's $20 per case to practice. He will be the SP and he will go through each case thoroughly with the students.

He passed USMLE Step 1, USMLE Step 2 CK, and USMLE Step 2 CS; therefore, he is fully ECFMG certified. He is finishing up his 4th year. Instead of paying $1000+ to Kaplan and other institutions, get hands on experience from a fellow student will help the teaching a lot better because he was in the same position as us. He did all his core rotations in Chicago and he is currently finishing up his electives. Remember this is open to ALL MEDICAL STUDENTS, regardless of which school you are from. He can also Skype with you if you are not living in Chicago.

If you are interested then please contact us, and you'll get a reply back with his contact information.

This relates to the recent events of Bonaire campus becoming the subcampus of Anguilla. Saint James School of Medicine Bonaire is scheduled to be completely closed in December 2014 and operations to be continued in Anguilla after December 2014. The question is, should I stick with SJSM or should I transfer out?

You have to consider several things and everyone's situation is different. First think about how far you are in your MD. If you are in basic sciences on the island or in AICM and still haven't registered with the ECFMG then you have the option of transferring out without any problems.

For those who are not familiar with the ECFMG, it is the US medical organization you need to register with in order to take your USMLE tests since you go to a non-US medical school. When you register with the ECFMG, you basically tell them who are and what school you started medical school with. After registering with the ECFMG, they will know everything after you make any changes you make afterwards.

If you are in AICM 5th semester and you didn't pay for the 6th semester or above, and you didn't register with the ECFMG yet, then you have an option to transfer.

However, for us clinical clerkship students, we have to finish what we started because we already paid the majority of the tuition. Also we already took USMLE Step 1 and some of us are already registered for USMLE Step 2 CK or CS or both so, there's no point in transferring. Transferring after all we did will only make things more complicated with the SJSM, ECFMG, and with residency.

Since our transcript will show that we transferred, it will have a minimal impact from what I was told. The reason is we are transferring from one campus to another, yet we are still with the same school. Therefore, we still have one transcript.

So that's my two cents about transferring. So, if you transfer, make sure you look at all your options and angles before doing so.