any IMG in this SOAP?

[Giemsa]

If anything, the system here should be like it is in Canada, where all Canadian applicants get a first shot at residencies, and whatever is left over is up for grabs.

Actually, in Canada only Canadian citizens / permanent residents are eligible for residency. There is no "left over".

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[LouisianaDoctor]

Well on a third hand, it makes some sense that the US residency program selection process would favor US educated students who incidentally have incurred US federal loan debt.

With all due respect to any and everyone, if I was applying for residency training in a country other than my own, I would absolutely be shocked if they did not favor their own citizens over me.

I whole-heartedly agree with you. US residency positions are paid for by US taxpayers. It only makes sense that these positions go to our doctors first. In fact, I would be rather upset if a US-born doctor (AMG or FMG) is sitting on the sidelines while an IMG is taking the spot. I am a US FMG, so I am very appreciative to have received a residency spot.

 

[gringodoc]

What pisses me as an American IMG off about the whole system is that I basically applied to 2 tiers of programs, more competitive programs where I was competing against mostly American grads, and backup programs where almost everyone was a FMG, to fall back on. From 3 of the 5 competitive programs, I received what were basically "ranked to match" e mails. At nearly all of the interviews for the FMG style programs, they would say that they might prematch "1 or 2" "highly qualified candidates". When I went to make my ROL between my 4 backup programs, there were 5 spots TOTAL left. They prematched almost all their positions. I never pursued a prematch at these programs because they universally sucked super bad, like the residents could barely speak English sucked, and thought Id risk the match at one of the more competitive places. I had been getting some positive feedback and thought Id take my chances. D'oh!

In short it seems to be a big game with everybody lying their ass off. I kind of got that feeling on the interview trail but didnt want to admit it to myself.

 

[bacteroides]

same boat brother, especially with the "ranked to match" emails.

i ranked >10 programs and really thought i'd be OK...now i'm wondering what i'm gonna do for a year.

i didnt rank as many but felt confident...unfortunately it didnt pan out. what do u think is a good number? most ppl say 10-12 but i guess now 15+ is more like it?..

maybe with no prematches next year, it'll be more of an even playing field with regards to available spots in the lower tier programs

 

[psychobob]

I whole-heartedly agree with you. US residency positions are paid for by US taxpayers. It only makes sense that these positions go to our doctors first. In fact, I would be rather upset if a US-born doctor (AMG or FMG) is sitting on the sidelines while an IMG is taking the spot. I am a US FMG, so I am very appreciative to have received a residency spot.

I pay taxes and have 200k in US loans. I hope that becomes a criteria in the next match.

 

[PrimaryCareAppl]

Perhaps we should all push for the H.R. 2251: Resident Physician Shortage Reduction Act of 2009. No one after a bachelors degree + Med School (and with 200k in loans) should be left out of residency to complete his or her training.

 

[IronDoll]

Perhaps we should all push for the H.R. 2251: Resident Physician Shortage Reduction Act of 2009. No one after a bachelors degree + Med School (and with 200k in loans) should be left out of residency to complete his or her training.

As much as I believe that AMGs are given a preference over IMGs for a reason, I do not think this should be the case. While reading his forum, I've stumbled over a couple of posts by people who have over 300k in loans, due to having o repeat years of school, had multiple failed usmle attempts, etc, and I have to say - even if one of those people (I dont want to point to anyone particular here, so let's just stick with the general type) manages to graduate and gets a guaranteed residency spot, I am going to be really worried, cause there is no way I want such a person to be treating me or any of my relatives.
And I do not think that any of PDs really cares about how much any of AMGs has in loans, that is not their problem, that is not relevant to them. They just want to hire someone they know will do got, wont screw up their patients. US Med school gives him somewhat of a guarantee for it's graduates, so he naturally prefers AMGs. On the other hand, if there would be an IMG that he is for some reason sure of, he might take that IMG over AMG easily. That's just my opinion.
The other thing - most IMGs are paid so little in their countries, that a loan they took to pay for the steps is, in terms of paycheck ratio, comparable to the loan you have after medical school. Not saying that you or PDs should care about this, just wanted to give you another perspective on this question.

 

[sunset823]

While reading his forum, I've stumbled over a couple of posts by people who have over 300k in loans, due to having o repeat years of school, had multiple failed usmle attempts, etc,

You don't have to have taken extra years or multiple attempts to have over 300k in loans - even going the straight and narrow, some med schools are just that expensive, especially now. Not naming any names...

I guess in the broader debate I fall on the side of US grads should get priority (though not necessarily a guarantee) cuz, yes, we are drowning in debt and we need a way to pay it off, while international grads do have the alternative option of staying in their home country that is not available to us. The new system (more US schools, all in for the match next year) was designed to squeeze out foreign grads (caribbean or elsewhere). As a non-white person, I'm anything but xenophobic, but that's just the way it is.

 

[BigRedPremed]

It's just much harder to evaluate IMG's. Grades and rec letters are useless. As a PD, you really only have the USMLE scores to go on. Many IMG's study for YEARS for these tests. No offense but I'm not sure that a score of 225 obtained after 2 years of studying is more impressive than a score of 215 obtained after 4 weeks of studying, which is typically what happens at US medical schools.

 

[IronDoll]

I don't have any problem with people going to an expansive med school and having over 300 or even 400k of loans, only with multiple attempts, failed courses and general stupidity. (And I am not saying that if you fail a course or an exam you are stupid and not worthy of being a doctor, I am talking of extreme cases here).

I am an IMG and a permanent resident and going back to my home country is not really an option - the average pay for the doctor would be $5000-10000/year there... I'd rather do something else here, not even getting up from the couch for $5000.

 

[PrimaryCareAppl]

As much as I believe that AMGs are given a preference over IMGs for a reason, I do not think this should be the case. While reading his forum, I've stumbled over a couple of posts by people who have over 300k in loans, due to having o repeat years of school, had multiple failed usmle attempts, etc, and I have to say - even if one of those people (I dont want to point to anyone particular here, so let's just stick with the general type) manages to graduate and gets a guaranteed residency spot, I am going to be really worried, cause there is no way I want such a person to be treating me or any of my relatives.
And I do not think that any of PDs really cares about how much any of AMGs has in loans, that is not their problem, that is not relevant to them. They just want to hire someone they know will do got, wont screw up their patients. US Med school gives him somewhat of a guarantee for it's graduates, so he naturally prefers AMGs. On the other hand, if there would be an IMG that he is for some reason sure of, he might take that IMG over AMG easily. That's just my opinion.
The other thing - most IMGs are paid so little in their countries, that a loan they took to pay for the steps is, in terms of paycheck ratio, comparable to the loan you have after medical school. Not saying that you or PDs should care about this, just wanted to give you another perspective on this question.

I see your point. However, would you agree that there are hundreds of graduates with decent scores, good school performance, out of residency, with loans, that would benefit from opening more residency positions?

 

[netdevil]

It's easy to say 'train in your own country'... I understand many apply in US cos they want to b in US...but there also others who apply cos they don't have facilities back in their own country.

Its not wrong to acquire better education and provide better patient care..

The question here is whether the US medical system respects this feeling and provides fair oppurtunity to IMG's...I think an overwhelming number whether IMG/AMG would reply as 'NO'.

 

[IronDoll]

I am not sure about "hundreds". Last year there were 971 unmatched AMGs and, I guess, most of those were able to find a spot in the scramble. So, there might be a certain number of good students that went unmatched due to bad luck, but I don't think it's a big number. As to opening new residency positions - then you might face an oversupply of doctors and general drop of reimbursement in medicine. No one wants that to happen (and it is happening anyway), because then people out of residency would still have trouble paying their loans. But maybe medical schools would become less competitive and therefore cheaper... But it's a really looong shot.

 

[gutonc]

i didnt rank as many but felt confident...unfortunately it didnt pan out. what do u think is a good number? most ppl say 10-12 but i guess now 15+ is more like it?..

For an IMG? Who failed to match the first time around?

How about "all of them?" Seriously...you need to go on 20-30 interviews (if at all possible) and rank every single program. Period.

 

[bacteroides]

For an IMG? Who failed to match the first time around?

How about "all of them?" Seriously...you need to go on 20-30 interviews (if at all possible) and rank every single program. Period.

of course i would rank every one of them...i was referring to the previous poster who ranked 10..i didn't have as many ivs

 

[gutonc]

of course i would rank every one of them...i was referring to the previous poster who ranked 10..i didn't have as many ivs

The answer is the same. 10 is a good number to rank for a solid AMG applicant. IMGs and anyone with any other red flag needs as many as humanly possible.

 

[PrimaryCareAppl]

I did not explain myself. I was talking of the "hundreds" of AMG and IMG (US citizens that studied abroad). I think it would be unfair to state that all or most of those IMGs are not qualified. Now with regards to an oversupply of doctors, I believe that once the Patient Protection and Affordable Care Act goes into full effect on 2014 and 30,000,000 additional patients will be in need of a doctor, who is going to treat them? Yes, Medical Schools are recruiting more students (more money) and there is more encouragement to go into primary care. However, what is the benefit if we still have a bottleneck of restricted number of residency positions? That was the argument of H.R. 2251: Resident Physician Shortage Reduction Act of 2009. I am seen patients in clinic now that have to wait "months" before they can be seen.

 

[DrAwsome]

It's easy to say 'train in your own country'... I understand many apply in US cos they want to b in US...but there also others who apply cos they don't have facilities back in their own country.

Its not wrong to acquire better education and provide better patient care..

The question here is whether the US medical system respects this feeling and provides fair oppurtunity to IMG's...I think an overwhelming number whether IMG/AMG would reply as 'NO'.

Again with this!! The US doesn't have to "respect your feelings" or anyone else's. You are not from here, and the US does not have to "provide fair opportunity for IMGs." Like I said, it's not the role of the US to provide non-US citizens with opportunities! It it not the US fault that your country does not provide good opportunities for development. So like I said before, if you are dissatisfied with the opportunities here, you can train elsewhere. No one is forcing you to apply here.

As someone else pointed out when I did not get a spot I really wanted initially, no one "owes me" anything, and I am an AMG with good credentials. If I am not owed anything, neither are you or any other IMG. So for reiteration-US does not owe you or any other IMG any opportunities or fairness, the system is set up for AMG grads to obtain positions. If you are lucky enough to score a position, be thankful.

Thank your lucky stars that you are not in Canada, because you could not even apply there. If you don't like the process that the US provides-again!! train elsewhere.

 

[docmed2012]

I don't think you need to have failed attempts/stupidity to accumulate $300K in student loans...this is the norm for a lot of smart caribbean students. I know students with great scores from the caribbean who are graduating with about 275-300K in loans after 4 years.

 

[SOAPonarope]

It's easy to say 'train in your own country'... I understand many apply in US cos they want to b in US...but there also others who apply cos they don't have facilities back in their own country.

Its not wrong to acquire better education and provide better patient care..

The question here is whether the US medical system respects this feeling and provides fair oppurtunity to IMG's...I think an overwhelming number whether IMG/AMG would reply as 'NO'.

1) If you "don't have facilities" in your country to train further (which I HIGHLY doubt) then you probably should have fairly assessed that situation before embarking upon medical education in such a poorly prepared system. That is not the US residency training system's problem. It is yours.

2) "The question here is whether the US medical system... provides a fair opportunity to IMGs... answer is no" Actually, that is not the question here. But to answer it: you have a more "fair" shot at our system than any American grad would have in most foreign systems.

And to IronDoll, that equated IMG travel/fees for steps to massive medical education debt....

We all had to travel and pay fees, but US grads don't "have a paycheck" from a job in another country either.

 

[PrimaryCareAppl]

Again with this!! The US doesn't have to "respect your feelings" or anyone else's. You are not from here, and the US does not have to "provide fair opportunity for IMGs." Like I said, it's not the role of the US to provide non-US citizens with opportunities! It it not the US fault that your country does not provide good opportunities for development. So like I said before, if you are dissatisfied with the opportunities here, you can train elsewhere. No one is forcing you to apply here.

As someone else pointed out when I did not get a spot I really wanted initially, no one "owes me" anything, and I am an AMG with good credentials. If I am not owed anything, neither are you or any other IMG. So for reiteration-US does not owe you or any other IMG any opportunities or fairness, the system is set up for AMG grads to obtain positions. If you are lucky enough to score a position, be thankful.

Thank your lucky stars that you are not in Canada, because you could not even apply there. If you don't like the process that the US provides-again!! train elsewhere.

Not trying to intrude but would like to clarify to avoid misunderstandings:

AMG = US School Medical Graduate, US Citizen.
IMG= International School Medical Graduate, US Citizen.
FMG=Foreign Medical Graduate, International Medical School, Non-Citizen. (Could be a permanent resident)

 

[PrimaryCareAppl]

I am not sure about "hundreds". Last year there were 971 unmatched AMGs and, I guess, most of those were able to find a spot in the scramble. So, there might be a certain number of good students that went unmatched due to bad luck, but I don't think it's a big number. As to opening new residency positions - then you might face an oversupply of doctors and general drop of reimbursement in medicine. No one wants that to happen (and it is happening anyway), because then people out of residency would still have trouble paying their loans. But maybe medical schools would become less competitive and therefore cheaper... But it's a really looong shot.

I did not explain myself. I was talking of the "hundreds" of AMG and IMG (US citizens that studied abroad). I think it would be unfair to state that all or most of those IMGs are not qualified. Now with regards to an oversupply of doctors, I believe that once the Patient Protection and Affordable Care Act goes into full effect on 2014 and 30,000,000 additional patients will be in need of a doctor, who is going to treat them? Yes, Medical Schools are recruiting more students (more money) and there is more encouragement to go into primary care. However, what is the benefit if we still have a bottleneck of restricted number of residency positions? That was the argument of H.R. 2251: Resident Physician Shortage Reduction Act of 2009. I am seen patients in clinic now that have to wait "months" before they can be seen.

 

[deleted103644]

Not trying to intrude but would like to clarify to avoid misunderstandings:

AMG = US School Medical Graduate, US Citizen.
IMG= International School Medical Graduate, US Citizen.
FMG=Foreign Medical Graduate, International Medical School, Non-Citizen. (Could be a permanent resident)

Nope, that's not the consensus. IMG = FMG, you need to specify if the person is a US citizen separately.

The NRMP calls both US citizens and non-citizens IMGs if they trained abroad.

 

[DrAwsome]

1) If you "don't have facilities" in your country to train further (which I HIGHLY doubt) then you probably should have fairly assessed that situation before embarking upon medical education in such a poorly prepared system. That is not the US residency training system's problem. It is yours.

2) "The question here is whether the US medical system... provides a fair opportunity to IMGs... answer is no" Actually, that is not the question here. But to answer it: you have a more "fair" shot at our system than any American grad would have in most foreign systems.

And to IronDoll, that equated IMG travel/fees for steps to massive medical education debt....

We all had to travel and pay fees, but US grads don't "have a paycheck" from a job in another country either.

Precisely. I could never understand this level of entitlement!! These foreign grads come to a country that's not their own, and want to be given preference over AMGs. Not going to happen. If anything they should be thankful that they have ANY opportunity to train here. And the reality is that they don't come here because of "lack of training facilities" or to "provide better patient care" but rather to make $$. Not that there is anything wrong with the American dream, but let's be realistic here. If i wanted to go to India and apply for a residency they would laugh at me. The US is one of the few countries that does provide opportunities, and yet these foreign applicants complain and feel entitled. To me, this is mind boggling!

 

[DrAwsome]

Nope, that's not the consensus. IMG = FMG, you need to specify if the person is a US citizen separately.

The NRMP calls both US citizens and non-citizens IMGs if they trained abroad.

^ What he said.

 

[deleted103644]

And sadly, when many of them do end up finding a position, they are lazy, don't have good work ethic, etc. I have seen it so many times I don't have a ton of empathy. I have seen a lot more lazy and incompetent foreign grads than good ones.

Be careful - there are some great FMGs out there too and some lazy AMGs. I defended one of your other statements, but this IS the kind of thing that can get you in trouble.

 

[PrimaryCareAppl]

Nope, that's not the consensus. IMG = FMG, you need to specify if the person is a US citizen separately.

The NRMP calls both US citizens and non-citizens IMGs if they trained abroad.

Thank you for the correction johnnydrama. But now I am confused... what do you call a foreign student (non citizen, non resident, with visa) that graduates from a US Medical School. Non Citizen AMG?

By the way (and thanks again for clarification) the point was that people should specify to avoid telling a US Citizen IMG to go back to his country

.

 

[PrimaryCareAppl]

Once again, strongly agree with johnnydrama. This type of statements/attitude is not seen with good eyes by PDs. Specially if the program does already have a significant number of IMGs.

 

[deleted103644]

Thank you for the correction johnnydrama. But now I am confused... what do you call a foreign student (non citizen, non resident, with visa) that graduates from a US Medical School. Non Citizen AMG?

By the way (and thanks again for clarification) the point was that people should specify to avoid telling a US Citizen IMG to go back to his country

.

They're just called AMGs.

Aside from possible visa issues, a non-citizen AMG is at no disadvantage, so there's usually no point in making that distinction.

 

[MedicalMoose]

Aside from possible visa issues, a non-citizen AMG is at no disadvantage, so there's usually no point in making that distinction.

Bingo. And if there is a foreign citizen that managed to obtain access into a US medical school, that would be super impressive. Money talks...

 

[Mochepoire]

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[Mochepoire]

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[Law2Doc]

ECFMG and its organizational members define an international medical graduate (IMG) as a physician who received his/her basic medical degree or qualification from a medical school located outside the United States and Canada. The location of the medical school, not the citizenship of the physician, determines whether the graduate is an IMG. This means that U.S. citizens who graduated from medical schools outside the United States and Canada are considered IMGs. Non-U.S. citizens who graduated from medical schools in the United States and Canada are not considered IMGs.

Right. You aren't being discriminated against because you are foreigners, you are being discriminated against because of a lack of LCME standardization and oversight of your education, or more specifically your clerkship rotation. PDs are comfortable with the degree of knowledge and skill set someone coming out of an LCME credentialed program will have. They are a known commodity. They will have had US hospital clerkships that pass muster. They will have been prepared better for the experience if being an intern in a US hospital than many other paths, regardless if how much "medicine" you know eg on USMLE because the PDs aren't hiring you purely for knowledge, they are hiring you for application of that knowledge in a very specific set of circumstances. They basically want to be able to turn you loose on the wards and not have any complaints from attendings, staff or patients. So basically it's a branding issue. PDs are comfortable with the LCME "brand" and express brand loyalty. Doesn't matter if Royal Crown tastes pretty good and is cheaper, And maybe even has better ingredients, the consumer still overwhelmingly buys Coke.

 

[Sarcoidosis]

I was trying to avoid writing on this tread, but just so tempting...

I am an FMG. I agree with the sentiments expressed by the AMG's here. Ultimately, Nationalism is important and it is rather obvious that preference should be first be given to US residents (Citizens and permanent residents equally). As is the case in Canada, but again the Canadian health care system in not privatized. In the US Healthcare institutions are a business and the bottom line is to give the position to someone that will be the most profitable.

As obvious a statement as this sounds, Money is the driving force for everything in this world. ERAS, ECFMG, NRMP, USMLE, multiple lobbying groups that support Carribean Medical Schools are going to ensure that International Graduates are part of the American Medical System because these organizations are making a lot of money.

 

[Mochepoire]

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[gutonc]

there are many countries in this world in which students are in charge for wards, who have very strong clinical knowledge, who gained their skills in real life situations (not talking with SPs). more than that, some of those students are coming from countries with a long medical tradition and with medical schools older than "the oldest hospital in the country, from the time of Benjamin Franklin"

so don't generalize here. it is not black and white- there are gray areas too, it is not LCME versus others. not all of the IMGs are the IMGs you are thinking about.

I think you missed his point. It's not that the education at many non-US medical schools isn't excellent, it's that there's no quality control system that PDs are familiar with (like LCME) and so, unless a PD has personal experience with graduates of a particular foreign med school, it's just much easier to take an AMG who comes from a school where you know what the educational/training standards are.

coming back on topic, what do you say about SOAPing programs which prefer to remain with the slots if they cannot find any AMG?

That's their prerogative. Most categorical programs will try to fill one way or another. But prelim programs (esp Gen Surg) will find it easier to go unfilled.

 

[Mochepoire]

.

 

[Mochepoire]

I think I saw somewhere that ECFMG wants to try the LCME accreditation for some medical schools from abroad. In my oppinion it would be a very good thing.

 

[gringodoc]

Again with this!! The US doesn't have to "respect your feelings" or anyone else's. You are not from here, and the US does not have to "provide fair opportunity for IMGs." Like I said, it's not the role of the US to provide non-US citizens with opportunities! It it not the US fault that your country does not provide good opportunities for development. So like I said before, if you are dissatisfied with the opportunities here, you can train elsewhere. No one is forcing you to apply here.

As someone else pointed out when I did not get a spot I really wanted initially, no one "owes me" anything, and I am an AMG with good credentials. If I am not owed anything, neither are you or any other IMG. So for reiteration-US does not owe you or any other IMG any opportunities or fairness, the system is set up for AMG grads to obtain positions. If you are lucky enough to score a position, be thankful.

Thank your lucky stars that you are not in Canada, because you could not even apply there. If you don't like the process that the US provides-again!! train elsewhere.

While I agree with much of the content, the manner that you deliver it is appalling. Its not the USA's fault you dont have training opportunities? I know an Iraqi guy who had a price put on his head for being a doctor after the US invasion.

No the US system dosent owe anything to any IMG/FMG, but to imply as you and others have that they should just be happy about trying to stay in their home countries and not do anything is ignorant. In the country where I studied, the only residency spots are given to people with political connections, no matter what your credentials are. Imagine if your ancestors had just stayed in their respective countries and not tried to improve their lives. Attitudes like what you are portraying are why nobody likes Americans. I've heard it called Insular Ignorance.

To get back on topic, good job to everybody who got a spot, and to those who didnt, keep on keepin on.

 

[Powel6016]

How did FMG/IMGs do the in SOAP? Anyone get any interviews or spots?

Or was it mostly AMG dominated?

 

[Leo Aquarius]

I'm American, and I'm not ignorant about what goes on in other countries with regard to advancing up the health care system chain. My parents are from a foreign country. So don't be ignorant yourself and make stereotypes. We Americans are so diverse that it's impossible to paint us with a single brush-stroke.

My country, your country, doesn't owe foreigners anything. It's up to you, the foreigner, to work your ass off to make it in another country just like everyone else who came before you has done. Get it? Good.

And please, don't try to portray the "everyone else dislikes Americans." You say this, yet you are dying to come here for training. You don't have to slide the insult our way. As you know, Americans are made up of foreigners who became American (for the most part). Americans are more diverse than most other countries, and we are well aware of how other systems work.

 

[DrAwsome]

I disagree with you. It is what it is-it is a huge incredible blessing to be born here, without a doubt and to live in the US. However, just like I and others have pointed out, it is not the responsibility of the US to provide foreigners with training opportunities. Foreigners are welcome to apply and hope for the best, but it is what it is. Nothing ignorant about it. Once again your sense of entitlement is just mind blowing. I find your statement quite ironic-so no one likes "Americans and America" yet you and a whole lot of others IMGs are trying to train HERE? Don't you find it hypocritical? I'm sorry, I find it hard to deal with your attitude. So again, if we are soooooo bad, and no one likes us, don't train here. Already biting the hand that feeds you, quite sad.

You can't have it both ways-if we are bad, you can choose to train in your respective country. If you want to come here so badly, then it can't be THAT bad huh? And like I said, most countries all over the world don't even give foreigners a chance so you should be incredibly thankful to have ANY opportunity here.

FYI-I wasn't even born in the US, and came under appaling circumstances, none of which I am going to share on this forum. My dad was a doctor in our country, which is not exactly the most transparent, and he got a good residency, and did quite well. So I do not buy the sob stories. I have been able to experience the situation from both sides of the coin. Like many of us have made it very clear, it is not the responsibility of the US to train you. The end.

 

[DrAwsome]

I'm American, and I'm not ignorant about what goes on in other countries with regard to advancing up the health care system chain. My parents are from a foreign country. So don't be ignorant yourself and make stereotypes. We Americans are so diverse that it's impossible to paint us with a single brush-stroke.

My country, your country, doesn't owe foreigners anything. It's up to you, the foreigner, to work your ass off to make it in another country just like everyone else who came before you has done. Get it? Good.

And please, don't try to portray the "everyone else dislikes Americans." You say this, yet you are dying to come here for training. You don't have to slide the insult our way. As you know, Americans are made up of foreigners who became American (for the most part). Americans are more diverse than most other countries, and we are well aware of how other systems work.

Right on dude! I love the "everyone else dislikes Americans" comment, yet they are desperately trying to come here! I made the same comment down below, super hypocritical. This dude is out of line-he wants the US to provide him with training opportunities, while at the same time spitting in our faces because we are so bad that no one likes us.

 

[jcu]

 

[DrAwsome]

+1

 

[jacobidoc]

there are many countries in this world in which students are in charge for wards, who have very strong clinical knowledge, who gained their skills in real life situations (not talking with SPs). more than that, some of those students are coming from countries with a long medical tradition and with medical schools older than "the oldest hospital in the country, from the time of Benjamin Franklin"

and those in that situation probably matched

 

[Mochepoire]

.