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Sheriff of Sodium
Приєднався 28 кві 2019
Videos and podcasts on medical education and residency selection from thesheriffofsodium.com
Board certification for exceptionally qualified IMGs: Winners & Losers Edition
For as long as the American Board of Internal Medicine has existed, completing an accredited U.S. residency program has been a pre-requisite to sitting for the internal medicine board exam. But last week, the ABIM announced a proposal that would allow “exceptionally qualified” international medical graduates who complete a U.S. fellowship program to to sit for both their general and specialty medicine boards - even if they did their residency overseas.
This would be a major change to longstanding policies… so you know what that means.
That’s right, it’s time to break it down, Winners & Losers style.
_
NOTES:
1) The ABIM’s video explaining the pilot is here:
ua-cam.com/video/p52BVyjVVNw/v-deo.htmlsi=Z8hbjTdXnHeeGhs-
2) I also referenced a few old Sheriff of Sodium videos…
-The Match, Part 1: Why do we have a Match?
(includes discussion on why we have residency training/history of board certifying organizations)
ua-cam.com/video/jRxHn5l6E4A/v-deo.html
-Bypassing residency for IMGs in Tennessee: Winners & Losers Edition
ua-cam.com/video/VeGqKHYLxYQ/v-deo.html
-The ABIM Under Fire: How Doctors Can Realistically Fix MOC
ua-cam.com/video/aNgf6oYZlcg/v-deo.html
3) If you want to comment on the ABIM proposal, there is a link here:
blog.abim.org/call-for-public-comment-pilot-model-pathway-to-board-eligibility-for-exceptionally-qualified-international-medical-graduates/
_
MUSIC:
“Clutch,” by Nicolas Major.
This would be a major change to longstanding policies… so you know what that means.
That’s right, it’s time to break it down, Winners & Losers style.
_
NOTES:
1) The ABIM’s video explaining the pilot is here:
ua-cam.com/video/p52BVyjVVNw/v-deo.htmlsi=Z8hbjTdXnHeeGhs-
2) I also referenced a few old Sheriff of Sodium videos…
-The Match, Part 1: Why do we have a Match?
(includes discussion on why we have residency training/history of board certifying organizations)
ua-cam.com/video/jRxHn5l6E4A/v-deo.html
-Bypassing residency for IMGs in Tennessee: Winners & Losers Edition
ua-cam.com/video/VeGqKHYLxYQ/v-deo.html
-The ABIM Under Fire: How Doctors Can Realistically Fix MOC
ua-cam.com/video/aNgf6oYZlcg/v-deo.html
3) If you want to comment on the ABIM proposal, there is a link here:
blog.abim.org/call-for-public-comment-pilot-model-pathway-to-board-eligibility-for-exceptionally-qualified-international-medical-graduates/
_
MUSIC:
“Clutch,” by Nicolas Major.
Переглядів: 3 153
Відео
The Man Who Beat the USMLE (in Court)
Переглядів 11 тис.14 днів тому
In 2020, resident sent an email to a state medical board. Attached was a copy of a USMLE score report showing a passing score on Step 3. There was just one problem. The score report was fake. This is the incredible-but-true story of how that resident beat the USMLE in court and received a medical license without ever passing Step 3. _ NOTES: 1. In the United States, there is a public right to o...
Tuition-Free Medical School: Winners & Losers Edition
Переглядів 6 тис.Місяць тому
Earlier this week, Michael Bloomberg donated $1 billion to Johns Hopkins University in order to make the school “tuition free” for (most) students. The announcement generated lots of fawning media coverage and inspired debates and hot takes on social media. So you know what that means. It’s time to break it down, Winners & Losers style. _ References and call-outs, in chronologic order: 1. New Y...
Inside the Sausage Factory: How the USMLE Passing Standard is Set
Переглядів 7 тис.2 місяці тому
How is the passing score for the USMLE determined? And why does the minimum passing score keep increasing over time? In this video, I’ll answer both questions - and provide an overview of the Angoff standard setting method; the Angoff modifications used by the National Board of Medical Examiners; the differences between norm-referenced and criterion-referenced exams; and even review some questi...
FACT POLICE: The USMLE Step 1 Pass Rate
Переглядів 11 тис.3 місяці тому
Have you heard that more students are failing the USMLE Step 1 exam than ever before, or that 25-50% of students are deferring their Step 1 exam because they’re unprepared to pass the test? Me, too! Thing is, there’s a lot of silly, sky-is-falling, and self-interested misinformation out there. So today, I’m back as the FACT POLICE, to explain how we should - and shouldn’t - make sense of change...
Improving Surgical Education: How to Build Windmills - and Stop Tilting at Them
Переглядів 4,4 тис.3 місяці тому
This is a talk I got to give at a meeting of a state chapter of the American College of Surgeons. MUSIC: ‘Clutch,’ by Nicholas Major.
Mailbag: Away Rotations
Переглядів 5 тис.4 місяці тому
Who should do an away rotation - and who should think twice? Where should you do an away rotation? Is it worth doing an away rotation at a program that is unlikely to give you an interview? And how do you excel when you’re on your audition rotation? Once again, it’s time to clear out the old Mailbag and answer your questions. _ NOTES: 1. I mentioned a couple of previous videos in this one. Here...
Do USMLE scores *really* predict patient care outcomes?
Переглядів 8 тис.4 місяці тому
Do patients whose doctors had higher USMLE scores really have better clinical outcomes? A recent paper - written by authors from the National Board of Medical Examiners - claims that they do. Sounds like it’s time for a Sheriff of Sodium Journal Club. _ NOTES: 1. Here’s the paper, which found an association between higher USMLE scores and lower in-hospital mortality and shorter length of stay: ...
Match Day 2024: Winners & Losers Edition
Переглядів 33 тис.5 місяців тому
Match Day 2024: Winners & Losers Edition
Death of a Program: The ACGME vs. Private Equity
Переглядів 16 тис.5 місяців тому
Death of a Program: The ACGME vs. Private Equity
Mailbag: Wrapping Up the USMLE Cheating Scandal
Переглядів 30 тис.6 місяців тому
Mailbag: Wrapping Up the USMLE Cheating Scandal
MORE Emergency Mailbag: The USMLE Cheating Scandal, Part II
Переглядів 18 тис.6 місяців тому
MORE Emergency Mailbag: The USMLE Cheating Scandal, Part II
EMERGENCY MAILBAG: The USMLE Cheating Scandal
Переглядів 35 тис.6 місяців тому
EMERGENCY MAILBAG: The USMLE Cheating Scandal
ERAS and Financial Conflict of Interest at the AAMC
Переглядів 6 тис.7 місяців тому
ERAS and Financial Conflict of Interest at the AAMC
Mailbag: Letters of Intent and Post-Interview Communication
Переглядів 6 тис.7 місяців тому
Mailbag: Letters of Intent and Post-Interview Communication
Mailbag: Questions about the USMLE
Переглядів 3,6 тис.8 місяців тому
Mailbag: Questions about the USMLE
FACT POLICE: Residency applicants and residency positions
Переглядів 5 тис.8 місяців тому
FACT POLICE: Residency applicants and residency positions
A Brief Update on USMLE Score Creep
Переглядів 10 тис.9 місяців тому
A Brief Update on USMLE Score Creep
The Battle for Clinical Training Sites
Переглядів 2,9 тис.9 місяців тому
The Battle for Clinical Training Sites
Touching the Elephant: The Pediatric Subspecialty Shortage
Переглядів 4,2 тис.9 місяців тому
Touching the Elephant: The Pediatric Subspecialty Shortage
The ERAS Preliminary Data Drop: Winners & Losers Edition
Переглядів 4,6 тис.9 місяців тому
The ERAS Preliminary Data Drop: Winners & Losers Edition
Academic Capitalism: Rethinking the Expansion of Subspecialty Fellowships
Переглядів 6 тис.10 місяців тому
Academic Capitalism: Rethinking the Expansion of Subspecialty Fellowships
Mailbag: Help! I’m Getting Kicked out of Medical School
Переглядів 3,8 тис.11 місяців тому
Mailbag: Help! I’m Getting Kicked out of Medical School
Residency Application Mailbag: The Personal Statement
Переглядів 6 тис.Рік тому
Residency Application Mailbag: The Personal Statement
The ABIM Under Fire: How Doctors Can Realistically Fix MOC
Переглядів 2,5 тис.Рік тому
The ABIM Under Fire: How Doctors Can Realistically Fix MOC
The OB/GYN - ERAS Divorce: Winners & Losers Edition
Переглядів 1,9 тис.Рік тому
The OB/GYN - ERAS Divorce: Winners & Losers Edition
The Applicant’s Guide to Strategic Preference Signaling
Переглядів 12 тис.Рік тому
The Applicant’s Guide to Strategic Preference Signaling
The Residency Selection Arms Race: How Orthopedic Surgery PDs can Transform Medical Education
Переглядів 3,6 тис.Рік тому
The Residency Selection Arms Race: How Orthopedic Surgery PDs can Transform Medical Education
Bypassing residency for IMGs in Tennessee: Winners & Losers Edition
Переглядів 12 тис.Рік тому
Bypassing residency for IMGs in Tennessee: Winners & Losers Edition
Great video. You stated that ~60% of program directors were for this. Do you have any thoughts why it’s not higher (or lower) other than belief that doing a US residency should be required?
The problem is that people need medical help, there is not enough doctors to help them. US trained will always get spots in top hospitals, thats how the system works anyway and not any certificate can't change that. Those pathway will lead to only select IMGs getting it who are working at teaching institutions and frankly speaking dont require it at all. Those who have position of an associate or a full professor will never go back to do fellowship or residency.
One crazy fact that deserves more attention is that if 862 people had their step 2 score invalidated (and I’m not sure if that’s correct or it was 832 scores across all USMLE exams and and undisclosed number of total examinees), that would represent a very substantial fraction of the total number of students who took step 2 in Nepal, based on the data shown at the 16:10 mark
From the court filings - it was 832 examinees, which was approximately 40% of the group initially investigated by the NBME (consisting of self-reported citizens of Nepal; graduates of Nepali medical schools; and those who tested at the Nepal test center).
Losers: US-trained doctors saddled with medical school debt bargaining for higher compensation when IMGs colleagues without debt may enthusiastically accept lower salaries (since it is still considerably higher than their native country). Biggest Losers: Unmatched US IMGs drowning in debt Eternal Winners: MBA Hospital Admins and their yacht manufacturers
I think this will cripple usa graduates who go medical school , since img will rule medicine im is already Indian. Medicine
thank you for sharing this, this is not a way to solve the poor retention crisis in IM. People leaving the job because of the hospital not paying a fair share.
Please make video on latest charting outcomes!
I just might. I haven’t scrutinized the data myself yet - but I’ve seen enough bad takes on social media that I may become compelled to respond.
Always love your unique takes!
The gate keeping system in medical training is greedy. How is it done in other countries that have highly trained and competent medical personnel ? The present system is doomed to collapse, only a matter of time. I would argue the European model is superior. It will solve the Physician workforce problems necessitating state legislation to bypass certain stages in the licensure process.
Orthopedics has been doing this for a long time. www.abos.org/wp-content/uploads/2023/04/Part-I-and-II-RP-2024_06_05.pdf See page 13 for the “Academic Pathway.”
Apparently for orthopedic surgeons, you are able to become board certified/eligible if you complete 3-5 years of fellowships and then complete another handful of years as teaching faculty where you are teaching residents.
So, the IMG studies medicine abroad, completes an orthopedic residency also abroad, passes the USMLE Steps 1, 2, and 3, then does a 3-5 year fellowship and gets involved in academics… What’s the easiest path?
Really want to hear your thoughts on the 2024 Charting Outcomes! The research arms race powers onward!
I was swamped last week when the reports came out - so I haven’t had a chance to scrutinize them yet. But I will try to give them a close read soon.
@@sheriffofsodium Some really funky stuff showed up like failed peds applicants having average of 21 research products for example. And plastic surgery and derm now have averages in the mid-high 30’s. Eager to hear your take!
@@raisedincalifornia1828 Oh, I saw that. If I do a video might even include it, just for you - but the short answer is that it’s a distortion related to the small N of unmatched pediatric applicants. Among US MDs, Charting Outcomes only includes n=2 unmatched applicants, one of whom was an MD-PhD.
@@sheriffofsodium Also the fact that "research product" is such a meaingless measurement and can be easily artificially inflated. There's no distinction in charting outcomes between a 1st author nature paper and a middle author poster at an in house med student research day with guaranteed poster acceptance.
How about step 3
General Surgery just recently revamped their policy for granting credit for foreign training. It is much more conservative than the ABIM proposal.
The unmatched US IMGs are always the losers.
totally agree... this is the saddest case. Many have half a millions in debt and cant find a residency spot. when ABIM could open up more training spot....
you must be a HUGE loser if you do not have any visa requirements being an US-IMG and yet still go unmatched
Ahhh yes let’s just keep making it easier for everyone but a US trained physician to practice medicine in the US. Nurse practitioner, CRNA, IMG, PA, ohhh but you silly American trained doctor we have standards for you. You must jump through are arbitrary hoops to ensure quality patient care.
Have you seen all IMG laterally have to go through to match ? Minus all they had to deal with medical school ?
@@lovelylibra7349 brother IMGs have no right to work here!! Go work in the country you trained. Why not help the population you were meant to serve.
@@Thatguy-mo8jd wow spoken like a true xenophobe . I hope you don’t treat patients because I will hate to see how you treat your immigrant patients .
@@lovelylibra7349 So xenophobic to be lectured by an IMG who thinks they somehow deserve to work and match before US doctors. You realize not even all US doctors match right??? Oh wait, but let’s just make sure more people can come here because you deserve it.
@@lovelylibra7349 also ironic you don’t talk about serving the underserved in your own community
as a current applicant to medical school this upcoming cycle, this just feels like a slap on the face. I could have just gone foreign straight out of highschool and gotten trained in cardiology or something and then move to the US and make bank without going into debt or honestly jumping over all the bullshit volunteering, MCAT and other hurdles. Let's be real: physician salaries will just lower once IMGS come into the system and tbh there are better career paths if I'm not making an amount that is commensurate to the effort you put in
How easy would it be to take step 1,2 & 3 After completing your residency in another country ? You think it’s easy at all ??? Do you even know what IMGs do through in other countries as well.????
@@lovelylibra7349 If you want to work here so badly… maybe do a guaranteed path called medical school in the US
@@lovelylibra7349You don’t have a right to work in the US. No one is saying the process isn’t hard for IMGs. Let’s just be honest with each other. Bringing in foreign labor is meant to lower physician wages while not having to pay for medical training in the United States for the foreign labor. If a hospital system wants to fund their own residency positions with their own money to get cheaper labor then do that instead.
@@austinbradshaw3636 you are the same person that will say I’m not against immigrants and refugees I just want them to come in through the proper means and not come in illegally . And once they come in through the proper means you get angry !!! IMGs are NOT taking US medical graduate spots . We get the spots left over after us medical graduates match ! That’s why us medical students match at almost 100% Maybe you should take your time and watch videos on this channel ! Or use your brain 🧠
@@lovelylibra7349 There are not separate matches for US graduates who are largely US citizens and IMGs. Saying spots cannot be taken by IMGs that would have gone to US grads is statistically unlikely. Note how you said US medical students almost match at 100 percent rather than at 100 percent. Perhaps you should use your brain. Also I’d love to know who actually says immigrants should come in legally while also admittedly hating them.
Fantastic thought provoking vid
Seems to me the losers are US trained physicians, in particular those who needed loans to pay for school but you could argue it's still a "loss" for people from wealthy families since that money could have been spent elsewhere. The US physician salary is as high as it is *in part* because of how expensive it is to get to being a doctor. I don't see how this leads to anything other than decreased salaries for physicians. In addition to less educational debt, many IMGs have other motivations for coming here that incentivize them to accept lower salaries than a US-trained physician would. A hospital always wants to pay physicians as little as possible to work there so anything that gives them more leverage to do so will lead to salaries going down.
Pretty much. This helps no one
I'm surprised you didn't mention any losers. I don't think this change would be good for US trained physicians.
Don’t worry we only build walls to make it harder for US citizens…
I know someone who did the radiology residency in my country, we actually finished the residence last year, and he right now is in the usa for fellowship in pediatric radiology, this year he is doing research meanwhile doing the steps, but he already has the vacant for the fellowship program, because he had connections, also so weird because apparently with this path he said he will take the boards and all.
When getting residency is becoming touger and touger for imgs each year why some states allowing to practice without completing us residence and now this latest ABIM scene, doesn't making sense to me.
Exactly
I'm truly shocked, my take was entirely different thinking that being eligible for such fellowship and being in a residency program accredited by the IACGME would be hard. Seems not.
If only these damn patients knew that their exceptionally qualified doc had 31 publications with 116 views and 6 citations..
What about downward pressure on US doctors once the flood gates open ?
Oh, yes - that’s coming.
@@sheriffofsodium losers: current medical students who will see their income go down and competition for job go up.
@@nusaman B-b-but what about the DOCTOR SHORTAGE???
@@sheriffofsodium no shortage in sub specialties (generally speaking) I would have no problem with this program if it was only for primary care or rural areas. But if you end up bringing interventional cardiologist from around the world how are the US trained doctors going to justify the long years of training and accrued debt. The IMG, even if very capable will be willing to work at much lower wages
@@nusamanhopefully that would lead to more American students choosing international med schools and a resulting decrease in US med school tuition. Supply curve shifts usually make more short term losers and long term winners.
Sir could you pls make a video regarding options for residents who leave during the middle of residency? Like they can still get medical license but now what to do
Yes, I could. Most (if not all) states allow full licensure after 1-2 years of postgraduate education - so there will be some practice opportunities available. Depending on the circumstances of the residency departure, it might be possible to complete residency training in the original specialty - but it is an uphill battle. It may also be possible to go into a different specialty altogether - some off-the-beaten path specialties like Occupational Medicine might be worth investigating (again, depending on the circumstances that led to the original separation from residency).
depends on your specialty. I believe you are not speaking for internal medicine or peds as the drop out rate is much lower.
I had no idea IMGs could do fellowship here without doing residency in the usa
but they still need to pass all 3 USMLE steps
Also I think this is specific to internal medicine fellowships, which are sometimes just residencies and not fellowships in other countries (like GI, cardiology, hematology etc.)
Yes You can but You need 3 usmles
Only highly connected IMGs can pull this off
Do they need to do residency in their home country 1st
First!!!
Everyone wake up, the sheriff is back
Why not potassium or bicarbonate?
The problem with osteopathic medicine is that it’s mainly voodoo. If it was that useful I’d imagine Hopkins or Harvard would be using it. In general your average DO student isn’t as smart as an MD. The numbers show it. It’s not to say they’re bad doctors but they certainly didn’t score as high as their md counterparts. Majority of the DO students are only there because they did not get accepted to an md program.
I enjoyed every minute of this story 😂 thank you for sharing it 🙏🏻
not only the min. passing score is increasing, also the questions are getting harder.. so, a double whammy!
Bilateral cellulitis :D
I fucking love legal case analysis UA-cam. Glad this popped up in my feed. Cool little window into a niche thing. Thanks.
He passed MCCQE1 and not Step 3? Isn't the later easier?
If he invested all that time and effort into studying, he would have passed.
Hi (from 2024), average of neurosurgery jumped to a whopping 37!
To the moon, baby
Wonderful video with incredibly poignant points at the end. What a rollercoaster that was, for real. I'm always so shocked when people win lawsuits they shouldn't have a chance of winning simply because of tiny parts of the law that may or may not have been followed. As a doctor, the world of lawyers makes no sense whatsoever to me. Hope Dr. B doesn't harm anyone in practice now...
Propose to ban all Nepali doctors from residency. Both Nepali doctors and Nepali Prometric people are working together to cheat. This shows their characters and who they are as a person. Not just their doctors cheating. Their ordinary people too. A big question on ethics.
Please do a history video!
Your opening statement was the best 4 nurses for every resident That's the work equivalent
Thanks Brian
I wish more PD has such vision
What a wild ride. This is straight out of BCS.
I’m assuming since the video is still up, Dr B’s lawyers haven’t sent you a cease and desist letter….yet
This channel and the contents here is awesome! Watched all the videos and want more 😁 any additional similar channels and podcast that anyone recommends about medical education, economics of healthcare, etc.
I know its the in thing to say its not because of step 1 going pass-fail. But making step 1 pass-fail forced medical schools to optimize their curriculum for high step 2 scores. These new curriculums have shortened preclinical time and have dedicated time to study for step 2. The average score went up for lots of other reasons (better qbanks, memory techniques, videos, etc) but the distribution tightened because everyone is optimizing medical school for one test.
I matched more than a decade ago (whoa!) but the way I ultimately selected between my top two programs was putting both names in a hat, drawing one, and then paying really close attention to how I felt "matching" at that place. I matched at my #1, wonderfully supportive program, still close with all my co-residents and my PD years later. One of my now-colleagues matched the same year at the place that I listed #2, and from his off-hand comments I realize I would have been pretty miserable there. So there's a testimonial for gut instinct!
Watching this as a Brit is really interesting; you're limited to applying for 4 medical schools, which helps keeps things mangable on that end. On the postgrad side, you apply to a specialty, not to a program, and you get interviewed by a national panel. There's no cap on the number of specialties you can apply to. This creates huge issues where competition ratios get massively inflated because everyone applies to general practice (Family medicine) as a backup....... You have match day, we have cascade cycles. Because you can apply to as many specialties as you want, you may end up getting more than one offer, but you can only accept one. Any offer you don't accept gets recycled and offered again in the next round of cascades.....
I think this victory is awesome and he's my hero! Why hasn''t this been made news in FSMB, USMLE, ECFMG, like the Nepal story? Because this guy won and beat them!! They would be invalidated and questioned if they did post it. You made some pretty valid points though in regards to this not just happening to everyone. The fact that this ordinary person, from another country, beat several huge US corporate entities is always a great ending that everyone physician ought to see, especially IMGs! After listening to you, what I learned in short is that FSMB, USMLE and NBME have too much power given to them to either break or make someone's career. And not in a good way. And so my questions are: Who regulates them should students and physicians want to challenge them?? Why are they blindly trusting that these companies know what they are doing or assuming they don't make mistakes? After all they did make one here. Who's to say they haven't done mistakes in the past, which I am positive they have. After all they aren't God! And honestly speaking why should any students or physicians trust them after this?? You should also post the public records for this case. Thank you for sharing!