The Road to Residency: Dr. Saloni Haldule's USMLE Experience and Aspirations (Part-2)

I had a great time during my clinical electives. It was my first time in that country and living on my own, and I really enjoyed exploring and having new experiences. The focus was on what I learned about medicine, and the experience was fantastic. I had a varied experience during my US Clinical Experience (USCE). I rotated at a community hospital in Brooklyn, then at Yale, which is a top-tier academic institute. I also rotated at a private hospital in Houston. This allowed me to experience different settings and areas, giving me a good taste of the US healthcare system. I was impressed by the priority given to providing standard care and treatment. Their patient flow is much less compared to India, which automatically relieves some pressure and allows you to focus more on the patients you do have. This results in better care for the patients. In every place I worked, our treatment decisions were based on established guidelines for each disease or condition. If we were unsure, we would research and review published papers on the topic. The foundation of medicine there is practicing based on published evidence, and I found that to be wonderful. This is where experience also plays a significant role. In the US, there is also a hierarchy where senior doctors refine their practice, but the foundation is guided by evidence-based practice.

I really appreciated the way the healthcare professionals at this facility connected with their patients. With fewer patients to attend to, they were able to spend more time with each individual, building strong relationships. In comparison, at a government hospital, the large number of patients often makes it difficult to connect with each one on a personal level. I truly value the patient-doctor connection and the ability to empathize with them. I also admired the teamwork at this facility. In the US, they have advanced practice providers and highly trained nurses who work alongside doctors to provide comprehensive care. This multi-disciplinary approach helps to alleviate the workload and improve patient care. Additionally, the presence of social health services personnel, virtual interpreters, and other support staff ensures that patients receive the best possible care.

In the US, during residency, the training is structured so that you can work a maximum of 80 hours a week. This typically involves working 6 days a week for 80 hours. In India, there may be limits on paper, but in reality, there are often no limits. You work until the work is done. The main difference between the life of a medical professional there versus here is that there is some sense of work-life balance in the US.

In comparison to the UK and Australia, where the standard workweek is 40 hours, the US still has an 80-hour workweek. However, there is still some time for personal activities at the end of the day. Many programs prioritize the well-being of residents by organizing retreats and scheduling mentor sessions. This varies by program, but it's crucial for preventing burnout, which is common in the medical field. In the US, a significant amount of time is spent on documentation in electronic medical records, which are more extensive compared to India. In India, most of the time is spent directly with patients rather than behind a computer. This is a notable difference as well.

There were quite a lot of technical challenges I faced. It depends on which institute you are from and how cooperative your institution is with the documentation and paperwork that goes into the process. The ECFMG is the main body that oversees the documentation of international medical students. They recognize only documentation from licensed medical schools. It really depends on how compliant your institute is with the ECFMG guidelines. It was very time-consuming and difficult to obtain paperwork involved in the process.

I made sure to prepare thoroughly for both step 1 and step 2 of the exam. I did several practice runs, simulating the actual test conditions for 8 hours for step 1 and 9 hours for step 2. I planned out my breaks and what I would eat during those breaks to make the experience as smooth as possible. The test center in Mumbai was well-equipped, but quite cold, so I'd recommend bringing a jacket. The exams were physically exhausting, so I brought small snacks like protein bars and juice boxes to eat during the breaks. I also made sure to take regular breaks to eat and use the restroom to keep my energy up. Despite feeling anxious before the exam, once I was in there, I relied on adrenaline to power through.

My goal is to do the Internal Medicine residency in the short run and then I would like to pursue a fellowship. I think I would like to be a specialist of a particular branch than a general hospitalist. I would like to practice at an academic institution where there is a focus on research as well and there is a team of healthcare workers from other branches too for a collaborative treatment for the patients. I would also like to continue to explore my interests outside of medicine and maintain a worklife balance.

For future aspirants, my advice would be to start early. You don't need to start thinking about these things from the first year, but having an idea or at least being mindful of where you want to pursue your training is good. The earlier you know, the more time you have to act on your decision. The biggest advantage that I feel some others had over me was that they were preparing for longer because they committed to this early. You need to decide if this is what you want and figure out your priorities. The number one advice I would give to any aspirant is to study really hard. The subjects you are studying in MBBS are really important. They are going to affect your practice for all the years ahead. It is going to set the foundation for your medical knowledge. My advantage was that I really tried to do justice to all the subjects in my MBBS. So, even though I decided to start late, I was able to give the exams on time. I had a solid foundation from my MBBS knowledge. Anybody who is starting MBBS now, study your subjects well. Whatever works for you - reading textbooks or watching video lectures - do it well. Don’t just do what they ask for exams, but learn your concepts properly. Initially, you might feel that what you study in the first and second year doesn't matter much, but those subjects actually lay down the foundation of how you treat diseases. Take your subjects seriously. Of course, pursue things outside of medicine too, but don’t take your subjects lightly. Always strive to understand what you’re studying. Whether it’s NEET or any other country's exam, if your concepts are strong during MBBS, it will be much easier for you. This is a long and complicated process, so try to get in touch with immediate seniors for guidance. Stay positive, work hard, and all the best!