RxPG - RxPG Interview with Dr Anil Chauhan, Radiology Resident, USA

Dr Anil Chauhan (RxPG nick: anilchauhan82) secured a Radiology residency position at the University of Minnesota, USA in last year’s match. Radiology is a highly competitive specialty in US and is extremely difficult for an International Medical Graduate (IMG) to get into. There has been a stream of requests from the RxPG members to interview someone who has achieved such a competitive residency spot in USA and we could of think of no better person than Anil. This time our RxPG moderator AshB tracked him for an interview. A graduate of All India Institute of Medical Sciences, New Delhi, Anil came about as very pleasant and humble yet clear headed and motivated person during the interview. He has been eagerly helping people with his advice about various aspects of USMLE, research and competitive residencies. He shares with us here his pearls of wisdom on the ever confusing path to US.

Q. How do you feel about your success?
A. It feels great because finally my hard work and perseverance has paid. My struggle for 3 years has finally yielded fruit.

Q. How has your journey been?
A. When I look back, it brings mixed feelings to me. I see my story as of an average guy who dreamt big. This is just the start of my long journey but I have crossed the first and biggest hurdle. I have come across lot of different people who influenced this journey of mine in different ways. I decided to go for US during my internship. I got immense support from my family, my mentor at AIIMS and friends, all of which served as a fuel for me. They gave me the strength to fight the odds and face the people who were sceptic about my aim. On many occasions, both in India as well as US, I came across people who discouraged me and advised me to seriously rethink my plans. There were times when my dream seemed impossible to me, but by god’s grace I was able to keep my will and strength to go on and here I am in front of you with a Radiology residency.

Q. Whom do you attribute your success to?
A. Of course the foremost is my family. I can’t forget to mention my mentor in India, my mentors in US and my friends. I would also attribute my success to my teachers at AIIMS. These people were my perpetual support who always boosted my confidence.

Q. What do you think was the secret of your success?
I will give credit to my hard work, patience, research experience, ability to produce ideas, focused approach, goal directed strategy for 3-4 years and overall wishes from family, mentors and friends.

Q. What factors do you consider important to get a residency in US?
A. It changes from year to year. The common factors are scores, strong Letter of Recommendations (LORs), research when accompanied by significant results. Over the last few years US clinical experience has emerged as a very strong factor and can’t be ignored.

Q. How should one go about getting a residency in US?
A. It is a multi-faceted approach. One should start working on it as soon as you are sure of it. Try to finish your steps in time but remember, you can’t afford to compromise on scores and you can’t afford to fail in CS. Try to be involved in research and learn how to do it. If you are really good at it, you can do some research on your own, like a meta-analysis with a small number of studies. USCE is extremely recommended in present scenario and one should have at least a few months of United States Clinical Experience (USCE) before the start of application process. One new approach these days is coming up, better known as research electives. It is for people who decide to go to US in 2nd or 3rd year. It is available at some top universities and proves to be really helpful in future. All this put together also helps in getting strong LORs, which comprise another important aspect of application process. There are a lot of other things, which seem unimportant at times but in reality, play a significant role, like acquiring up-to-date information, setup and improve networking, and getting done with all paperwork on time. These should be started long before preparation for the steps.

Dr. Anil Chauhan

Q. How much time and what resources do you advise for the USMLE Steps?
A. Usually, 4-6 months are considered enough for taking single step. One should have enough free time for 2-4 weeks before exam and stress should be avoided. NBME's self assessment tests are a wonderful tool to assess your actual level of preparation. They are considered the most reliable predictors of your scores. USMLE CS exam preparation usually takes 2-3 dedicated weeks. USMLE Step 3 exam preparation is variable and depends on how busy you are with application process. It should take less time for step 3, if you are fresh with step 2 CK knowledge. Resources for USMLE Step 1 are Kaplan vs. miscellaneous books (including High Yield Series, BRS Series, Lange books for different subjects). Either of them is a good option but reading more than one resource for one subject is not highly recommended. For USMLE Step 2 CK it is mostly Kaplan and few important topics can be read from CMDT. I’ll sum up CS preparation as ‘practice, practice and practice’. UsmleWorld question bank has very good questions for every step, including step 3 and also gives decent feedback about your preparations.

Q. What timeline is usually good for a residency application?
A. It is best to be ECFMG certified before application process starts. Most USMLE aspirants tend to delay steps without solid reasons due to option of changing the dates as many times as you want, but it proves detrimental in the long run. If you finish it early, then you will have enough time for observership, research etc. This does not mean that USCE should be considered at the end; it can go along with the preparations.

Q. Is it important to have Step 3 completed before application?
A. It is certainly desirable but not indispensable. A good USMLE Step 3 score can help to reduce the impact of previous low scores. Most of the times, people take it later in the year to be eligible for H1B visa. However, don’t take this exam lightly under the impression that merely passing it is enough. This leads to lot of people to fail the exam due to suboptimal preparation. This is the toughest step of all and tests your knowledge as well as speed. You should be sure enough about your preparation because a failure can be a big setback to your US residency application. A good Step 3 score can certainly enhance your chances of getting interviews. USCE also helps a lot for USMLE Step 3.

Q. What tips would you give to a USMLE aspirant currently in IInd MBBS?
A. I appreciate the IInd MBBS USMLE aspirants for being clear about their plans so early. They should try to read American texts and just not stick to books required to pass professional examinations. Besides that, try to be thorough with the basic concepts which matter a lot in USMLE steps. At this stage, they should try to get involved in research with prominent faculty members which are known to produce results. The thing that you should consider is that whether you would be able to get a publication in an indexed journal and in time. Even if you can’t get decent publications, this experience will help you to produce results in future, specially while in US. You should focus on learning various aspects of research and I consider literature review the most important part for a beginner. Research Elective (RE) is the emerging option for these which help them a lot in building their CV and getting strong US LORs even before completing MBBS. Another advantage RE is that it might be feasible to enter even the big universities like Johns Hopkins, which otherwise are out of bounds for us, in addition to the fact that such electives maybe available for lot less fees as against the clerkships in US universities.

Q. What tips would you give to a USMLE aspirant currently in Internship?
A. An intern should first decide when he wants to apply for match and prepare accordingly. There is no harm in waiting for one more year if your steps are getting delayed significantly. You should also try to get involved in research as I have outlined in my previous answer. Keep looking for rare cases for case reports which is easy and quick. According to me, Radiology and Pathology departments have plenty of such cases but you should keep looking at other places too. You should get the maximum USCE at same or different programs as this has been important selection criteria recently. I would suggest, stick to an IMG friendly university program for observership, preferably near the interview season because it immensely increases your chances of getting into that program.

Q. If someone gets a low score in steps, what are the options?
A. Scores matter a lot. They are definite screening criteria for match process. You should see three digit scores and not two digits in most cases. More than 240 is excellent, above 230 is considered pretty good while 220 is usually considered above average score and gives you a decent chance to compete even with people with higher scores if you can spruce up other aspects of your CV. However, one should not lose heart at all. Few things should be considered carefully; Scores are not the only criteria but very important criteria in screening. Other less competitive specialties like psychiatry, paediatrics or family medicine may still be gettable with low scores. You should also work hard in building your CV. You can decide to spend one extra year to do this. You should start with clinical experience. You can do medical research in USA, either voluntarily or as research job. Try to publish articles, present papers, collect LORs, have a lot of USCE and have a great network. Try to contact your seniors or people through your US faculty or fellows or residents in same or different programs.

Q. What do you think about the GRE route for a US residency?
A. It is a very controversial issue. Overall, MPH gives you an additional degree which is considered a positive factor in your application, but in itself is not sufficient to get you a residency. MPH programs vary a lot in terms of workload, chances of getting clinical or research experience and good LORs. And finally chances of getting into residency at the same place. I won’t go into the cost and visa issues which everybody is aware of.

Q. How difficult it is to get a Radiology residency in US for an IMG?
A. From the perspective of an IMG Radiology is highly competitive and extremely difficult to get into. There are two major problems, first is lack of Radiology experience for an IMG especially during under-graduate (UG) years. Second is the small number of positions, which makes it more competitive. There is one more thing that in case of competitive specialties in US, people prefer the candidates whom they know in person. Radiology being so competitive, this tendency to interview people who have had some sort of encounter with them increases. This, coupled with other factors like need for good research and recommendations, increases the need for a multifaceted approach that goes much beyond just good scores. Another aspect of the difficulty is the dilemma of your backup branch. Anybody going for Radiology has to be prepared with a Plan B. But, since the application form is single for all your specialties, it is very tough to make your application good for Radiology as well as something like Internal Medicine or Pediatrics. At times you manage to end up with both applications looking like your backup plan. Hence it’s better to go all for Radiology to make your application stronger but then that hurts your chances of getting into Internal Medicine or Pediatrics if you don’t get Radio.

Q. Are there any alternative routes to a Radiology career in USA?
A. First is doing MD radiology from India then follow it up with a fellowship. After four years of fellowship at the same hospital, you may become eligible for the Board certifications and can thereby bypass the residency process. Radiology fellowships are much easier than Radiology residency in US because many Radiology residents tend to prefer private practice or direct academic posts to fellowships.

Second is through a Nuclear Medicine residency in US and then applying for a Radiology residency. But this has its own pitfalls, like there are only 15-20 nuclear medicine programs, most of which are advanced positions. Many of these programs are not IMG friendly and look for specific nuclear medicine and/or physics background. However, I would like to suggest that one should choose nuclear medicine only if you are interested in it.

Q. Describe your Research experience?
A. My first research exposure was in community medicine during my third year and I pursued it for 2 years. After a pause due to final professional examinations, I started looking for research opportunities at AIIMS and started research work in Oncological imaging. I never took a break from research after that and since then it has been part of my life. Most of my research is oriented around imaging in cancer, especially molecular imaging. I have published papers in indexed journals, had oral presentations and poster presentations in different conferences in USA and managed to bag a research award from a pioneer American organization. I also pursued research at University of Minnesota and our team was able to produce significant results which also caught the attention of radiology media. My research experience over this time had significantly improved my ability to generate new ideas and this worked for me.

Q. How important is research in getting competitive residencies in US?
A. Research is very important and it gives you definite edge over other applicants. But you have to understand that research can lend a big boost to your residency application but will not fetch you a residency all by itself. The most important aspect in research is an indexed original article and it is far better if you are the first author. It becomes more important if you want to get into academic or university programs and you are more inclined towards fellowships. The more competitive the specialty the more important is the research component of your application.

Q. What do you think of the role of RxPG in helping for USMLE?
A. Success in USMLE all about being well informed. Forums play a very important role in this context as they provide a large volume of information which otherwise an average student won’t have access to. RxPG is playing this role beautifully by providing a very good platform for this kind of information exchange.

Q. What are your future plans?
I would love to pursue my career in molecular imaging involving MRI and PET. I plan to go for a fellowship in Oncological imaging and/or Body Imaging. I want to be in academics with teaching and research in a esteemed university.