Super Star Blogs!

A Guide To Completing Secondary Applications

By Josten Overall and Nick Arlas | July 21, 2017

It seems like all of the pre-meds we run into these days are all in full-on secondary mode, and if you’re reading this you might be too. If you haven’t received secondaries yet, don’t panic! It’s just a matter of time before these apps start showing up in your inbox!  It can be a stressful time, as the onslaught of additional apps seems to come all at once post-verification by AAMC. At first it’s exciting, then a bit unsettling, and finally it can be overwhelming. Remember, the secondary application is a critically important part of every medical school application. This is your opportunity to sell yourself on why you’re a great fit for each school that invites you to fill out a secondary. While your primary app is your introduction to medical school programs by highlighting your metrics, work and volunteer experience, the secondary application is your opportunity to persuade each program why you are a candidate whom they should interview. Here is our list of top tips for writing strong, powerful secondary essays!

1. Know the school:

As a medical school applicant, it can be challenging to remember key details about each school to which you apply; however, it is important to understand the school’s mission statement and other unique aspects about the program or curriculum. Having a good understanding of the school and being able to identify why you specifically applied to that school, will help you answer questions that ask about “fit,” “how you identify with the mission statement,” and “how will you contribute to the class and community once accepted.” To do this, visit the school’s homepage and spend some time clicking around. We strongly recommend that you do your research before diving into a secondary app. You may find a specific opportunity that you are excited about, such as a student-run free clinic, a research institute, or a volunteer opportunity. These are things you should mention in your essay, and it shows the school that you actually want to go there and that you know what you’re talking about.

2. Take breaks!

If you ever find yourself hitting a mental roadblock while writing secondaries, remember that it’s more than okay and often necessary to take breaks! Leaving the mental and physical space in which you write your secondary essays, will allow you to recharge and return to your writing space with an open mind and new-and-improved ideas. Taking a break to grab a snack, go on a quick walk, or do something else that you love, will allow you to make productive use of your time, and not become too overwhelmed by the writing process.

3. Provide concrete examples:

Many secondary essay questions will ask you to describe a previous experience or role how that applies to your interest in medicine or to your future success as a medical school student. While you may describe the general details of why that experience was significant, describing a specific example and how that impacted you will may your message even more powerful. For example, you may detail some of the work that you did on a medical mission abroad; however, describing a specific scenario of a significant interaction you had with a patient, colleague or community member, will paint a more vivid picture of what you contributed to and learned from that unique experience. Many applying students will share similar volunteer, work, research and outreach experiences, so using a personal narrative or example will allow your essay to shine!

4. Have others review your work:

Just as when you were writing your personal statement for your primary application, receiving feedback is an important part of writing your secondary essays. You may have also learned that having multiple peers, mentors, or academic faculty review your personal statement can be overwhelming. Each person who reads your essays will have different perspectives on what works well and what doesn’t; you must take any suggestions with a grain of salt. If there was someone who helped you put your best self forward in your personal statement, they are a good person to consult for your secondary apps as well. Reach out to reviewers who can help you make sure every word counts, and that you are conveying exactly what you mean. Over time, you may find that you have become quite adept at secondary essays, and feel that you no longer need to reach out for support. If so, know that you now have the confidence and skill to write some great secondaries!

5. Recycle, but with caution:

A classic mistake that you’ve probably heard is that someone copy/pastes an essay and forgets to change the school name. One of the authors (cough Nick cough) accidently repeated two sentences in separate questions for the same school by doing this. With so many of the prompts overlapping or asking the exact same question, it is important to recycle your responses but to do so carefully. Done right this will save you time, but it can lead to rushing the process which makes you more likely to make the copy/paste mistake. To avoid this, read all of your essays carefully, and customize each one. For example, you will come across an essay about what your experiences are for the upcoming year, and this one is ripe for recycling. However, each school will ask it slightly differently, and have different character requirements. Use the framework from earlier essays, and build out a custom response for each subsequent secondary that asks the same or a similar question.

6. Response time is important:

Secondary season is a rough time for everyone going through the app cycle, but this is a time to really push yourself. It will be a true test of your endurance, especially if you are balancing other commitments like work or school. Set yourself up with a scheduled time each day to work on your secondaries, and push yourself to have a quick turn around time. Interviews are granted on a rolling basis and it is in your interest to have your application in as early as possible. Prioritize the schools that you are most interested in and work your way down the list. Celebrate the victory of each submission and know that they will get easier as you complete more of them and can draw on material that you’ve already created (see tip #5).

7. Use forums for specific information, but do not dwell:

Much like a surgeon you want to know exactly what you looking for when spending time on SDN. Navigate for the school specific thread and use Control-F to search key terms related to your inquiry. Do not get sucked in to whether people have heard back about interview invites, as it does not help you and can be an added source of anxiety during an already stressful time.

8. You can still add schools to your application:

You are still able to add schools to your primary application, and those of you that have applied to a small number of schools might consider increasing your chances by adding some more schools. It’s still relatively early in the cycle, so take a look at the MSAR and apply to as many schools as you can afford. Note: you should only apply to schools that you would actually go to if you were accepted.

9. Money stuff and when to ignore a secondary:

You may find that you applied to a school that you actually are not interested in, and know that it is OK to ignore a secondary invitation and decide not to apply to a school after all. At nearly $100 dollars a pop, knowing that it’s all right to let a few go can help you save for airfare and interview travel expenses. You should feel comfortable ignoring a secondary if you are no longer interested in the school.

10. Remember you are running your own race, and it’s a marathon!

By now you’re probably getting a play-by-play from all your premed friends about how the app cycle and secondaries are progressing. Ignore the noise and focus on your applications. It is crucial that you stay disciplined, work on them every day, and take comfort in knowing that this challenging time is not going to last forever. If you keep your blinders on and run your own race, you will be in a better spot than if you spend time worrying about what other people are doing.

Best of luck to all of you!

Top 5 Tips to Build a Valuable Network

You’re only as strong as your network, and that’s as far as success will take you. Unfortunately, this is something many people do not learn early enough in life, or do not take seriously. In America, we are made to believe that if you have confidence in yourself, you can accomplish anything…That’s not necessarily true. Yes, confidence is part of the equation, but we typically accomplish more together than alone.

I have been amazed by the feedback we’ve received from PreMed StAR students pertaining to how much this community means to them. Multiple students have reached out to us and noted that this network has added extreme benefit to their premed journey. Each time I read one of these messages, I am pleased because I know these individuals are understanding the significance of team, community, and network!

It is important that you strategically grow your network. The people closest to me all bring something of unique value to the table. No two are exactly alike. They are all serious about their life’s work (not job, but work…there’s a difference) and they are all generous. These are the type of people you want in your network if you desire to accomplish great things, and these are five tips to help you build such connections.

1) Explore: You can’t grow your network if you’re not willing to meet new people. This is the first barrier that you must overcome. If you want to grow your network, you have to want to grow your network. In order to do that, you must step out of your comfort zone to meet new people. Also, a key part of exploring is meeting different people. A network full of people just like you isn’t nearly as valuable as a diverse network with people of varied backgrounds, experiences, careers, etc. Be willing to explore, meet new people, and learn new things.

2) Give More Than You Receive: This is perhaps the most important aspect to building a valuable network. In today’s society, we are told to focused on self. We are taught that we should go out and “get ours”, don’t worry about other people. That is a mistake. At the heart of everything you do, benefiting others should be the primary driver. The byproduct of helping others is they will see that you genuinely care, and in your time of need, they will be honored to stand by your side.

3) Listen: This is the little secret that drives many people straight up the ladder of success. Have you ever been in a meeting where one person is talking and talking……and talking. I don’t mean that annoying guy or gal who everyone knows is off their rocker, but rather, the person who is able to trick people into thinking he or she has the best ideas in the room. I’ll share this little truth with you, more often than you may realize, the intelligent and devoted individuals who actively and intensely listen then speak are the real movers and shakers. You can’t know what people need if you don’t listen to them. You can’t solve a problem if you can’t describe the problem. If you master the art of listening, you can more effectively accomplish tip number two above.

4) Invite: A mistake that many people make is trying to jump on board other peoples’ train too early. When I say invite, I don’t mean invite yourself to their function; on the contrary, I mean invite them to your function. The fear of rejection too often prohibits us from inviting people to join our activities and into our lives. Yes, we do get rejected many times, but this isn’t because people don’t want to be around us; it’s just that people are busy. If you think someone is worthy enough for you to invite them somewhere, that means other people probably agree and have also invited them somewhere. Don’t be afraid to extend an invitation. Just make sure you pick up the tab.

5) Confirm Via Connect: In 2017 part of networking means connecting on social media. It’s a really strange thing actually. If you’re not connected with me on Facebook then we mustn’t really be friends. That’s obviously not true, but that’s how many people feel. As a premedical student, of course I would suggest you connect with other premeds on PreMed StAR. The simple action of sending a connect request to somebody when they are not present shows that you were thinking about them.

Build a valuable network. You might not think it’s worth your time to start working on this today, but tomorrow you’ll want to have it. One last piece of advice, always remember that the network is not about you. It’s about leveraging each other so you can serve others. That’s why we’re here, to help others!

Let me know which of the five is your favorite, and what other tips you have!

Congratulations to Kirsten! Premed of the Week!

1. Tell us a little bit about yourself.  My name is Kirsten, but call me Kirsti. I major in Biology with a chemistry and a studio art minor. I grew up in Idaho and I’ve been skiing since I was 2 years old. I moved to upstate New York my senior year of high school, and I began my college career at SUNY Plattsburgh. I loved my friends and many of my professors, however ultimately the school wasn’t for me. I recently transferred to Union College where I will start classes in the fall, but to be honest I’m super nervous to start all over again!

2. Who was your favorite teacher in school and how did he or she impact you?  Honestly my favorite teacher has been life itself. Okay don’t roll your eyes, I promise this isn’t just a lame and cliche cop-out of the prompt; I’ll explain: When I was 10 years old a nauseating stomachache began to plague me and I often felt like a blunt knife was stabbing my abdomen. This made being a kid and going to school extremely hard. I am now almost 21 and I still have this stomachache along with multiple new symptoms that accumulated along the way, and none of the specialists I’ve seen so far have offered an effective diagnosis. I was often accused of fabricating my pain to get out of class or when my homework was late. I sometimes wished someone could feel what I felt so they could know how much I cared and that I wasn’t lazy – I was hurting. I have always been ambitious despite my challenges and by junior year of high school I realized I needed to pick myself up in order to succeed. I didn’t need other people to understand or sympathize and I began to realize pity was not going to help me. I befriended hard work, motivation, and determination and I finally understand why the phrase “you are not your illness” is a wonderfully overused chesnut.

3. When did you first decide you wanted to become a doctor and why?  If you had asked 7 year old me what I wanted to dress up as for career day in elementary school I would have asked for a white coat and stethoscope, so in theory I actually always knew I wanted to be a doctor.

After contracting my mystery illness I found myself in many different doctor’s offices over the years and I went through a plethora of tests. I found the whole process so interesting. No amount of questions about what they were testing for, why, and how the test worked would satisfy my growing curiosity about medicine and the human body. I now see my illness as sort of a blessing as I know much of the medical system inside and out from the patient’s perspective. I have also experienced many different types of pain all over my body and I feel this will help me understand and empathize with my future patients in a way no textbook or psychology class can teach. So now I kind of have to follow my dream, right?

4. What area of medicine are you interested in?  Surgery all the way! Probably plastic surgery because it’s so artistic and I can’t think of a better career than being able to work with my hands every day.

5. What’s the coolest experience you’ve had so far on your premedical journey?  My college adviser had been so kind as to set me up with a mentor who is an anesthesiologist. He took me into as many surgeries as I requested and I was lucky enough to see a wide range of surgical specialties. Although I am not interested in anesthesiology for my future career, my mentor absolutely LOVED his job. There was not a day he wasn’t excited to be in the OR by 7 am even after working for so many years. One day while prepping for a case, eagerly drawing all sorts of drugs into syringes, he looked over at me and said, “ I love this sh*t!

6. What is your favorite book?  The Power of Now by Eckhart Tolle because Tolle is THE BEST.

7. Tell us one thing interesting about you that most people don’t know.  I was an acrobat for about 5 years and for a little while I would have been perfectly happy running away with the circus.

Top 5 Reasons Why Students Drop-out of Medical School

I write this blog in order to prepare premedical students for the road ahead. I want you to understand common obstacles facing medical students so you can be better prepared to overcome them. Medical training is akin to a rollercoaster pulling you through the highest of highs and the lowest of lows. On one hand, medical school is extremely challenging but rest assured, it is very tough to get dismissed from medical school. Plain and simple, most US medical schools are extremely supportive and want you to succeed. Students often get many chances to prove themselves before they are booted out of medical school. Despite this, the four-year graduation rate for M.D. students dropped from 96% in the 1990s to 81% in the 2009-2010 matriculating class. So, what is causing students to drop-out you ask? Here are five reasons why students drop out of medical school.

1. Unprepared or Overconfident: No matter who you are, medical school comes with a steep learning curve. You can never be fully prepared for medical school but simply being prepared is good enough. Being underprepared or overconfident can be dangerous. By unprepared, I am not referring to academic challenges. Those who have made it this far have already proven they are academically gifted enough to succeed. Some students who struggle are unprepared in their expectations of medical school. A student who is easily distracted should not reside an hour away from school next to a nightclub. Do not tempt yourself like that. Students should not expect to sleep-in daily or be regulars at happy hour. One thing that sets unprepared and overconfident students apart is their failure to gather crucial information. Often times, these were students who were overly arrogant and felt that by asking questions they would show a sign of weakness. While other students know the big exam was moved to a different lecture hall, Mr./Ms. Unprepared will show up to the wrong hall and miss the exam.

As soon as that “acceptance” letter arrives in the mail, students should begin searching for housing, planning finances, understanding the curriculum, and networking with other students. You don’t want to be dealing with these while med school has already started.

2. Family Stress: A close friend of mine battled with this daily in medical school. Her husband was not very happy that she was studying late into the evenings. It saddened her terribly that she missed her daughter’s first day at school and then her dance recital. These things took a toll on her and by our 3rd block she called it quits. To this day, she still looks back and wonders “what if” she had stuck through and became a doctor but in the end, she feels she made the best decision at that time. There are others who unfortunately have loved ones fall sick during their schooling. Life is very unpredictable and sometimes the decision to take a break makes sense but hopefully one will hang tough or return when they are ready.

When you get that “acceptance” letter, make sure to begin preparing your friends, significant other, and family on what they can expect from you over the next four years.

3. Burned Bridges: Be very careful with what you say and how you treat others (especially around a medical campus and on the internet). You can never judge a book by its cover. If you do, that book just may make life miserable for you. I still remember a buddy of mine who had a firecracker personality. I played basketball with this guy a few times a week. Let’s just say I witnessed a number of altercations between him and other medical students on the court. What many of the first-year students did not know was that this guy was a chief resident and in a few years, rose to a very high position in the medical school. When students make mistakes, or perform poorly in medical school, a committee typically presides over their case. It would be very unfortunate if one of those committee members is someone that student has burned bridges with. In today’s global age, the medical community is tighter than ever. Therefore, there are only a few degrees of separation between everyone.

Once you get that acceptance letter make sure you stay on your best behavior. Remember, that person you are talking to could be your upper resident, faculty, or boss one day. Here is a hint for you during your interview trail. Be friendly to everyone because you do not know who you are engaging and who is watching you. While I took premeds on their interview tours I made sure to speak to the dean about the students who I found to be friendly and especially those who were courteous with the nurses and the cleaning staff. Those to me were the team players.

4. Illness: This is one of the saddest reasons to say goodbye to a classmate. It feels as though everyone expects medical students and physicians to be supermen and superwomen. Well, it’s not so when it comes to being sick. As med students, you are exposed to many unique bugs. Med school also has a way of turning students into transient hypochondriacs as they learn about the pathophysiology behind diseases. Stressors may push susceptible individuals towards depression and substance abuse. In fact, a recent study showed that 27.2% of medical students had depression or symptoms of it and 15.7% sought psychiatric treatment. Schools are doing more these days to address this problem but students must be bold enough to seek help before it gets too late.

Once you get that acceptance letter to medical school, make sure you see your doctor and do your best to get a clean health bill of health or learn coping strategies to deal with stress and adversity. Never ever be afraid to seek help.

5. Wrong Career Choice: Believe it or not, after spending years as a premed and matriculating into medical schools some students realize medicine is just not for them. Our first day dissecting cadavers in Anatomy proved to be too much for a classmate of mine. She fainted and eventually gained consciousness only to see a room full of students and professors surrounding her. This unfortunately shook and discouraged her drive to become a doctor but I believe she eventually gained enough courage to rejoin us. A very intelligent friend of mine left med school to obtain his PhD as he thought he could touch more lives through his research. Yet another friend of mine completed her medical school, residency, and GI fellowship only to leave a very promising academic career at a well-known institution to become a beautician. She felt medicine was more a dream of her parents and not something she was truly passionate about.

When you get accepted to medical school, do a lot of soul searching and make sure this is what you really want to do.


1. Caulfield M, Redden G, Sondheimer H. Graduation rates and attrition factors for U.S. medical school students. Association of American Medical Colleges. Analysis in Brief 2014;14:1–2.

2. Rotensterin LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, Sen S, Mata DA. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 2016

Written by Dr. Daniel

Image Credit Pixabay

5 Things You Should Know Before Looking for Extracurriculars 

Extracurriculars are an important part of any premedical student’s journey to medical school. Beside test scores and GPA, your extracurricular activities are one of the most important components of your medical school applications. Your involvements and activities become one of the best ways for schools to gain insight on who you are as a person and what kind of student (and future doctor) you might be.

Admittedly, you are probably juggling school, work, and other commitments that prevent you from being able to jump on any project that catches your interest. Here are five things to consider before looking for another extracurricular activity.

1) Reflect on what you’ve done before moving forward

This is arguably one of the most important things to consider before looking for new internships or volunteer opportunities. Be sure to take some time to reflect on ALL of your involvements over the past few years and write them down. (Tip: Fill out your PreMedStar profile to keep your involvements catalogued for future reference.) Once you’ve taken the time to get everything noted down, take a step back and look at your CV as if your were an admissions officer. Pay close attention to the types of activities and dates of duration. Types of activities can be anything ranging from clinical experience, research experience, community service, campus involvement, leadership positions, etc. Medical school admissions is becoming much more of a holistic screening process. Ideally, you want to demonstrate that you are a well-rounded and broadly interested/experienced person. Do you notice that all of your activities fall within one category of involvement? Are any of your categories filled with outdated activities? Do your hours of engagements fall much lower in one category compared to others? These types of questions may help point out any gaps or critical components missing from your extracurricular involvements.

I want to point out that there is no formula for doing all of the right pre-med activities. If any of your activities are unorthodox or unique, highlight them. Pursuing a career in medicine is a huge commitment. Be sure to support your candidacy as a medical student through your involvements. You want to make sure you have sufficient exposure (total hours/duration committed) to research, direct patient care, and leadership experience while also not limiting yourself to just those involvements.

2) Figure out what you’re passionate about

Ideally, everything you list as an involvement will also be something you’re interested in. The idea is that over the course of your time in university, or the years leading up to your application, you will have explored different interests and dedicated significant amounts of time to the activities you’re most passionate about. Signing up for an activity that you are passionate about will feel much less like a requirement and be more enjoyable and beneficial to you in the long run. Never sign up for something just because you feel like you need to. It’s normal and expected that somewhere along the line you will find a volunteer opportunity that doesn’t align with your interests. Get everything you can out of the opportunity and move forward knowing that you’ve put in a genuine effort and explored the opportunity.

3) Be realistic about the time you can commit

Your premedical years can be one of the most taxing and stressful times of your life.Your amount of free time each week is most likely limited by school, work, and other outstanding commitments. Before jumping into a bunch of new activities, be realistic in reflecting on the amount of time you can actually commit. You can’t rush your way into gaining experience. I’ve had multiple pre-med advisers and medical admissions officers tell me that the journey to medical school isn’t a sprint- they’re looking for the marathoners. For example, it’s not enough to say you have significant research experience when you’ve only committed one quarter to working in a research lab. Realistically, every internships/volunteer experience is different. Some of them may be designed to fit within the timespan of a summer or winter break. Besides these exceptions, here is the general rule I was told. You typically want at least one year of commitment. Two years shows significant commitment, and three plus years even more. As mentioned before, you can’t rush experience. If you know you can’t commit to a weekly activity, look for something that is every other week or once a month and plan on staying with them longer to gain that hands on experience over time.

4) Get creative in your hunt

There are tons of people looking for the same opportunities as you. Don’t get discouraged if you aren’t able to find what you’re looking for right away. I’ve had a few friends on PreMedStar ask for tips on how to find clinical/research experience. I will probably make another blog exploring this topic in further detail, but for now here is my shortlist of ways to find what you want. After graduating from university I found it extremely difficult to find new clinical volunteer opportunities as most of the positions I found were prioritized for undergraduates. I had to get creative. I began to search for opportunities that were not affiliated my university or those near by. Never underestimate the power of networking- reach out to people you already know who are in the field you are interested in gaining experience in. If that doesn’t work, look elsewhere. I found a surprising amount of opportunities on LinkedIn,, craigslist, and random google searches for positions. If you are persistent and put yourself out there someone is bound to respond.

5) Don’t be afraid to try new things

My last piece of advice is don’t be afraid to try new things. Jumping into a new field may be daunting at first, but there is no way you can come out of an opportunity knowing less than you did before. Explore all of your interests. Look for new things that get you excited and spark your creativity and curiosity. Take advantage of this time to really figure out who you are and what interests you. Most importantly, enjoy your journey and make it a good one. 

How to Sleep Better to Perform Better

How much sleep do you get each night? Is that enough? I’m willing to bet that most of you could use a little more. Thinking back to my premedical days, I could have used a lot more. Those of us with Type ‘A’ personalities often believe that we accomplish more when we sleep less.   That’s not necessarily true for a few reasons: (1) Sleep helps consolidate and solidify our memories (2) Sleep helps us reduce stress levels, and (3) Sleep helps decrease inflammation.

Certainly, there are many more benefits of proper sleep hygiene, however these should remind us not to fall into the trap of believing sleep is a waste of time (something which I often think to myself). Knowing these truths, how can you improve your sleep hygiene and in turn, improve your performance as a premedical student?

1) Daily Exercise: As little as 15 minutes of exercise a day can improve the quality of your sleep. There’s just something special about a decent workout that relaxes your body and makes it easier to sleep well. Perhaps it’s the physical fatigue or just a placebo effect of sorts, but regardless, it works!

2) Adhere to a Sleep Schedule: Among the more important things you can do is stick to a schedule. Having a set bedtime isn’t only for children. Many of the most successful businessmen and women adhere to a strict sleep schedule. It is often said that it takes 3 weeks for something to become habit, so force yourself to go to bed at a specific time for 3 weeks, and expect your internal clock to take it from there. Note, this includes weekends.

3) Bed Time Routine: Having a consistent bed time routine will help you adhere to your sleep schedule. It will also allow you to relax before going to bed. Make sure your bedtime activities are distinct from your other activities and strictly associated with sleep time. For example, some people have a cup o hot chocolate and read for 10 minutes prior to bed each night. It’s typically a good idea to avoid television or any other electronic device. Just dim the lights, read a little, say your prayers, and go night night.

Sleep plays an important role in your success as a premedical student. In order for you to perform at your best, you need quality sleep in adequate amounts. Don’t feel guilty to get in that bed a little earlier than usual, and don’t feel guilty if you don’t fall asleep on that chemistry book.

So, let me ask you this, do you get enough sleep each night? If not, what can you do to fix that problem?

Image credit: Pixabay

5 Things to Consider When Applying to a Caribbean Medical School

To apply or not to apply? That is the question.

There are many strong opinions held about Caribbean medical schools. Some believe these schools provide great opportunities for students who have had set-backs, or foreign status keeping them from getting into a US medical school.  Others oppose this option with no exception. There is no doubt that Caribbean medical schools can and do produce some very well-trained physicians, but in some cases, this comes at a cost. It should be noted however that International medical graduates (IMGs) contribute heavily in addressing the US doctor shortage by making up roughly 25% of the physician workforce.

I have met many IMGs who begrudgingly admit that they did not thoroughly investigate the offshore route before accepting their admission.   I also know some who took this route and wouldn’t change a thing.  After researching and discussing with a number of my colleagues, I offer advice in their own words and propose areas to research and consider prior to accepting admission to a Caribbean medical school.  The simple truth is that for some, this option is viable, and for many, it’s not.  You have to do your research and be well informed ahead of time.


You need to understand that not all 60+ Caribbean medical schools prepare you to practice medicine in the United States and some will not allow you the opportunity to get federal loans. Regional programs train students to practice medicine in that particular island or nearby areas while offshore programs train students to practice medicine in the US and Canada. Offshore programs will typically mandate students to do their 3rd and 4th year clerkships in the US. Accreditation ensures that schools are providing quality training to their students. The National Committee on Foreign Medical Education and Accreditation (NCFMEA) is responsible for reviewing the different accrediting bodies to make sure their standards match those of the US and Canada. This will determine if students attending that international medical school can receive US federal loans. Furthermore, schools must have state-approval to allow clerkships and approval is also required for IMGs to legally practice in the 50 states. Be very diligent since some wording like “recognized” or “approved” may be misleading when investigating accreditation. Understand if they are referring to regional standards or US/Canada standards. Also know whether or not your program of interest is on probation or any other disciplinary condition.


Larger and better recognized Caribbean medical schools are for-profit and can be quite pricey. IMG’s who have attended these schools are often left with loans in the $250,000 – $320,000 range while US medical schools tend to be on the order of $50-100K cheaper. Interest rates tend to run higher than 5 percent for medical students. As mentioned earlier, only schools that are NCFMEA-recognized will allow students to receive US federal loans. Tuition at larger Caribbean medical schools can be very expensive but you must also be aware of the many other fees. These include the cost of living expenses one would pay at a US school but one must also factor in travel as well as costs for examinations and prep courses which can be very pricey. With this type of price tag, you want to make sure you complete your training.


“We started out with 1,000+ students in my class, but at the end I felt like a quarter or more of my class was no longer with us at graduation.” -Yvonne (IMG)

The medical training journey is a tough road that only the disciplined can traverse successfully. Caribbean medical schools are no exception to this but they come with their own unique set of challenges. While US medical schools may sometimes “hold their student’s hands” through the training process, this may not be the case in some international medical schools. Many IMGs have informed me that they felt like they were “just a number” and it was difficult at times to get the proper resources. Therefore, one has to be extremely self-disciplined and resourceful. With such large class sizes, there is a diverse student body. The weeding-out process will start very early and eliminate those who probably should never have been in medical school in the first place. Some have poor or inadequate work ethics, lack of motivation, or inability to properly balance their tasks. Others are forced to withdraw due to unforeseen hardships. Different programs have their own unique requirements (such as attendance) which must be met in order not to be booted out. Scoring systems vary among programs and material learned varies. In order to sit for the Step 1 exam, schools require their students to take additional tests including the National Board of Medical Examiners (NBME) and the Comprehensive Basic Science Examination (CBSE). Failing these exams may disqualify you from taking the Step 1 exam and may lead to dismissal from the school. According to the 2016 United States Medical Licensing Exam (USMLE) performance data, 72% of non-US/Canadian schools passed the Step 1 exam compared to 94% of US/Canadian students passed.


“As an IMG, I felt very discriminated against during the residency matching process. It was important that I was realistic in the programs I applied to and in the end, I applied to 100 programs.” -Paul (IMG)

As an IMG, it is nearly impossible to match into a US residency program without outscoring US trained grads on their USMLE. According to the National Resident Matching Program (NRMP), 53.9% of US IMGs and 50% of all IMGs (including non-US IMGs) matched into a US residency program in 2016. Compare this to the 98% match rate for US trained seniors. This can be very painful for those who fail to match especially if they have loans to pay back. This is more reason why IMGs must outshine others on their board exams and clerkships. Furthermore, good networking skills is a must. It would be ideal if the school offers clerkships at programs that also train residents. This is a question you should definitely ask and if you are a non-US IMG you will also want to know if there is Visa sponsorship at that residency program. The Educational Commission for Foreign Medical Graduates (ECFMG) is the standard used in evaluating IMGs who intend on practicing in the US. Students must also take the same examinations that US med school students take (USMLE Step 1, Step 2 CK and Step 2 CS) but must first gain a diploma from an institution registered in the International Medical Education Directory (IMED) in order to be granted an ECFMG certificate and enter a US residency program. Despite all the hard work and effort, some residency programs still simply do not consider IMG applicants. According to the NRMP 2016 Program Director Survey, only 64% of the programs responded that they typically interview and rank US IMGs while only 49% would consider non-US IMGs.


“The international experience enables you to build cultural competence and self-confidence while adapting to a new environment.” -Tony (MS4)

“As a non-US student, I don’t believe I was as shocked living in a third world environment than many who came from the US.” -Yvonne (IMG)

The breathtaking beaches, beautiful wildlife, and exotic foods. It certainly appears to be 2-4 years of training in paradise and away from many distractions. Depending on where the school is located, you may be exposed to a new language and different culture. While this can be an amazing experience you must also realize that there certainly will be challenges. Being so far away from family and friends may make for some very lonely months. The local stores, sporting events, and foods you are accustomed to experiencing likely will not be readily available. Prices will also likely be different than what you are used to. If there are special diets, hygiene products, medications or devices you require it would be wise to see if they are available in that area. A friend of mine was flown back to the US after developing an illness and this took a huge toll on her training. Sometimes you long for a hug from that friend or a good home cooked meal from mom. Be sure to inquire about internet access and how best students communicate with loved ones (video chat, calling cards, etc.).


Bonus: Stereotypes

Some IMGs experience discrimination and bias during their clinical training. These individuals feel that they have to prove themselves during clerkships and during residency despite sometimes having higher scores on their exams. Rest assured, much of this dissipates as they begin to practice medicine as medical doctors. Those who are able to stay the course and make it through as IMGs have definitely earned my respect. In the end, patient’s want a well-trained physician with good bedside manners no matter the medical school they attended.

In summary, I have addressed some key areas that every premed should investigate for themselves prior to accepting an offer for an offshore medical school. The question of whether one should attend a Caribbean medical school really must be answered by one’s own self. If an offshore school is not a student’s first choice, I recommend that they always consider other options (retaking classes, post-bacc, research) which may strengthen their candidacy first but if this has been done already or other limitations exist I would make sure they are able to check these boxes prior to proceeding:

o I am 100% certain that being a medical doctor is really what I want to do

o I am financially secure and/or will be okay paying off a debt even if I don’t complete my degree

o I am a very good test taker or am certain I will be

o I am very self-motivated and disciplined

o I can adapt well to new environments

o I am willing to study harder and focus more than ever in my life

o I am willing to do my own research about the different schools

“Although you are a premed now, think ahead and really do your homework to ensure that this is right for you. I had my rough days, but would I do it all over again? Yes.” -Yvonne (IMG)

Written by Dr. Daniel

Resources and References:




USMLE Performance Data:


NRMP 2016 Match Results:

NRMP 2016 Match Program Director Survey:

van Zanten M, Parkins LM, Karle H, et al. Accreditation of undergraduate medical education in the Caribbean: report on the Caribbean accreditation authority for education in medicine and other health professions. Acad Med. 2009 June;84(6): 771-775.

Congratulations to Sarah! Premed of the Week!

1. Tell us a little bit about yourself. I am from Katy, Texas – born and raised! I grew up in a small town (which is not so small anymore) and am a first generation college student majoring in psychology. I enjoy cooking, watching inspiration YouTube videos and TedTalks and free-style writing, in my spare time. I try to give back to my community as much as possible in various ways!

2. Who was your favorite teacher in school and how did he or she impact you? I have 2 favorite teachers. One from high school and one from college. Mrs. Williams was my high school Health teacher. She identified my strengths and encouraged me daily to become a better person. Whether it was showing us how to properly do CPR or teaching us how to be kind to one another, I will never forget her impact on my life. When my father passed away, 1 day before my high school graduation, Mrs. Williams and her husband came to my home for condolences. When she left, I opened the card she gave me and in it was a check to help me buy my books for the first semester of college. She is truly an angel. My second favorite teacher is Dr. Kristin Anderson – professor of psychology. She impacted my life so profoundly after taking her Social Psychology course. She taught me how to stand up for myself, to see through the biases we are faced with on a daily basis and how to think for myself critically and logically. She opened my eyes to the disparities we face as a society and how to be a better individual to have a positive impact on our communities. She is a brilliant professor and her impact on my life will be longstanding.

3. When did you first decide you wanted to become a doctor and why?  It was when I saw the reality of medicine first hand that I decided to be a physician. My dad tragically passed away in 2009 and was taken to the Texas Medical Center where we were told that the doctor’s couldn’t do anything to save him. I remember sitting on the ground thinking, “I will do everything in my power to save someone else’s parent”. And I have a mission to do this. Medicine is science and science is being revolutionized every single day and new treatments and medicines are being made. I want to be a doctor to improve and maintain good health of the people. I want to be a physician to educate people on the fact that an ounce of prevention is worth a pound of cure. I am so certain that I have the capability to do this and in turn, give someone else’s dad, mom, brother, sister, aunt or uncle a longer, healthier life.

4. What area of medicine are you interested in? I am interested in Emergency Medicine and Primary Care, both. As an ER physician, you are on the front line of defense. It is such a critical responsibility and with proper training, the ability to treat carries a wide impact. I know this as I have been a scribe in the ER for 5 years. I am also interested in primary care because I have a knack to educate, promote, and inspire. As a primary care physician, I can manage my patient’s health on a long term basis and create lasting, personal relationships with them.

5. What’s the coolest experience you’ve had so far on your premedical journey?  The coolest experience I have had so far as a pre-med was being given the opportunity to be involved in a medical research paper with a team of doctor’s. It was with this research paper that I experienced first hand the pressures of medicine: working 2 jobs as a scribe and a medical assistant, being in college, studying for the MCAT and working on the paper to meet a deadline gave me a realization that my journey isn’t going to be easy – but it will be worth it. And when the paper was accepted to be published and is now on PubMed – every minute of stress was worth it!

6. What is your favorite book?   My favorite book is “The Alchemist” by Paulo Coelho. I always encourage everyone to read this book at least once as the story teaches us about the essential wisdom of listening to our hearts and following our dreams, no matter how many obstacles we may face.

7. Tell us one thing interesting about you that most people don’t know.  An interesting thing about me – I have visited 11 countries and speak 5 languages!


“I am allergic to oxygen, water, air, food, and oh yes, people”, Dr. B remarked. He was hyperbolically repeating the words of one of his patients as he viewed a medical history. The paranoia that most patients feel after undergoing so many procedures is real. Some even diagnosed themselves with some deadly ailment before coming to see the doctor. It was a gloomy Tuesday morning as the summer’s simmering heat was quelled by the rain showers which does not seem to be holding back any of its potentials. I got to the general surgery office and we had about 14 patients on the schedule between 9am and 12pm. We saw patients within the age range of 17yrs to 73yrs old. The operating room is where I familiarize myself with surgical techniques, teamwork skills, and the human anatomy. On the other hand, in the exam room, it is just the doctor with critical thinking and people skills and the patient with concerns.

Patient A was in a wheelchair in the exam room. She seemed frail and her gait shuffled every other second. As Dr. B helped her to the bed for examination, she staggered and trod slowly until she made it up to the bed. The questions began to fire like action potential in neurons from Dr. B. After several questions, he then asked if she had pain above her navel or below it. He stressed that the answer is important in making the right diagnosis. She waved over her entire belly to indicate where she felt the pain. When asked to point to the pain, she initially pointed up and then later she pointed below. I could feel Dr. B getting frustrated. I think most patients don’t realize that physicians need the patients help in order to provide the highest quality care that they deserve. Being a physician is not a one-sided task; patients have to be engaged and responsible for their right diagnosis by being honest and exact in the best way possible.

After standing all morning long, I caught a break to study before returning to the room where I would be watching three consecutive colonoscopies. The coldness of that room would have taken me to my heels but I wanted to learn so I had to take it all in. Although I was just going to observe from the room corner, Dr. B showed me how to use the endoscope. The procedure felt gross to me until Dr. B started finding polyps in the colon of these patients. He clipped them off. Polyps are usually harmless but some could develop into cancer which can be deadly if not caught early. I thought to myself that maybe physicians’ bravery to withstand even the grossest things during their course of practice isn’t born out of some dauntless gene but out of the sincere desire to get positive outcomes that would lead to a patient’s overall wellbeing. After all, medical students do cringe sometimes during gross anatomy lab. Earlier in the day, we had seen patients who had intestinal diverticulitis (inflammation of the diverticula). So, during the colonoscopy, Dr. B showed me the diverticula on the monitor: they are small pouches in the colon.

colonoscopy room right after patient 1 was wheeled out

The following day at the office, I was looking at the CAT scan of patient B who had a bilateral mastectomy. She had been undergoing chemotherapy and radiation but chose to stop it because the side effects were overwhelming. While analyzing CAT scan, Dr. B saw that the cancer had metastasized to her liver. She has masses in her liver which she knew not of. The oncologist should have discussed that with her so Dr. B refrained from addressing that issue during the examination but he strongly encouraged her to talk to her oncologist about her CAT scan result. Patient B’s fatigued eyes bore the pain that she has undergone and the slightest of hope she had struggled to gather. She asked the doctor if she could go back to work not knowing that another battle awaits her. I wish I had a magic wand. Nice people don’t deserve pain.

That same day, I was supposed to watch a surgery where the entire colon would be removed(colectomy) due to a patient’s poor decision making. He had developed a colon cancer which was caught very early and was advised to get it removed. He denied undergoing any surgery even after his daughters persuaded him to do something about it. Eventually, the cancer developed to the extent that it attached itself to the abdominal wall and protruded out of his belly. Now he has to get colectomy and have a colectomy bag attached to his abdomen so that all the waste can be disposed of. What I learned from this is that it is important to help patients understand their conditions and elucidate the imminent risk without sounding too forceful. Doctors tend to want the best for their patient while respecting their autonomy. This represents a dilemma that cannot be avoided during one’s course of practice. Yet, it is one of those things I guess, with time, doctors learn to grapple with. I cannot think of not worrying about a patient that makes a bad decision that could cost his/her life or quality of life.

The last day in the OR, I watched and participated another gall bladder removal surgery. I noticed that no two people are the same. The diagrams in the book are the same, however, in reality, one has to critically assess the anatomy of different patients. The gall bladder was detached by clipping cystic duct and cystic artery. If Dr. B had gone by the available heuristic, he wouldn’t have detected that the arteries were branched which made it two. He had clipped only one previously. Then thirty minutes later, I watched the removal of a breast tissue that had been marked by a pathologist for biopsy.

Last day in the operating room

It was an incredible experience and over four days, I learned so much than I ever thought I would. My perspective towards medicine was shaped in a unique fashion. Seeing different facets of being a physician- the meritorious aspects, the dreary aspects, and the inevitable dilemma zone- made me appreciate the nobility and uniqueness of medicine. A physician could be cracking jokes with his staff to cutting a patient open to making life changing decisions for patients. Many times, I parallel my lab work on cell culture with treating patients: I had to make sure everything is sterile, make a treatment plan, execute my plan, and incubate the cells for optimal growth. This parallelism becomes faulty when I think of patients as having hearts, loved ones, dreams and aspirations, bucket list, and so on. My takeaway from this experience is that, in a broad sense, we as premeds are entering this profession to help people but, in a subtle sense, we are really interested in medicine to restore hope in people and guide them through the decision-making process regarding their health. When one stares at death straight in the eye due to an ailment, one looks out for help because one feels helpless. But, through the provision of help and compassionate care from physicians, the once staggered hope one has for living and in life is alleviated with renewed vigor.

A second chance at life…

A second chance at life…..

It’s amazing the impact that one person can have on another. As a paramedic, you work with a partner and sit inside of an ambulance waiting for your unit to be given as assignment. Once given, you turn on the lights, flip the siren and proceed into the unknown. The dispatcher give you a brief description of what may be going on, but 99% of the time, it’s totally different. It’s that 1% that makes me realize how much I love helping people and want to become a physician.

My partner and I were given the call for a cardiac arrest in the subway station. Honestly, when we see something like that, most of the time the patient isn’t in distress at all. The patient is usually sleeping or intoxicated. When we arrived, the patient was not only having CPR done to her, but she was traveling with her 3 year old son at the time. My patient was a 33 year old woman. Just looking at her, you would never assume that she would have a massive MI (Myocardial Infarction). The police and firefighters were busy with crowd control and my partner and I started our intervention.

Any time you work up a cardiac arrest its an emotional experience. What makes it even harder is when the patient is so young. This woman was dead and we are given the task of trying to bring her back to life. With CPR continuously being done, we secure her airway via intubation. Because of the fluid loss, her vasculature was poor. So we had to drill a hole into bone using an intraosseous needle. This allowed us to give her medication and replace the fluids she lost. After about 15 minutes, we noticed that her heart went into v-fib (ventricular fibrillation), so we defibrillated her. This happened about 4 times. Finally her heart stabilized to the point where we were able to safely carry her out of the subway.

We notified the hospital and the ER staff was waiting for us. Drenched in sweat and high off of adrenaline, me and my partner were hopeful that she would make. Walking back to the crew room, I saw the patient’s son and he asked me if his mom would be okay. All I could say is that your mom is a very strong woman and she would so proud of how brave you are. He smiled. 🙂

This happened a few months ago. And now, I’ve received an invitation to a “Second Chance Brunch”. This woman not only survived, but she has suffered no deficit. Aside from having a pacemaker/defibrillator placed, she 100% okay.

I am so grateful for experiences like this one. As a medic, I’m with the patient at the beginning of the story, but as a doctor, I’ll get to see the patient all the way to the end. I want to be able to complete the story. Life is so precious, and being able to help people is such a gift. Doctors are definitely servant-leaders, and that’s what we aspire too be.



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