So like, I've matched...now what?

Well you’ll receive congratulatory emails from your department followed by a bunch of paperwork you need to fill out, some electronically and some by post. Depending on the hospital and specialty you matched in, the kind of paperwork you receive will differ. Generally they’re vaccination forms, medical clearance, a PPD test, housing application, contact info, BLS/ACLS training, online safety courses etc. Whatever forms your program sends you, fill them out, keep photocopies, and send them back immediately so you get them out of the way and enjoy your vacation before internship. Also they may end up losing your forms, want you to redo them, or they may get lost in the mail so send things early in case you have to re-send them.

IF YOU’RE NOT IN THE LAST FEW MONTHS OF MED SCHOOL RIGHT NOW DON’T READ THIS YET, YOU HAVE ENOUGH TO DEAL WITH AND YOU’LL JUST FREAK OUT. I’M SERIOUS! DON’T DO IT! YOU’VE BEEN WARNED!!!

Send as many of the forms as you can by scanning them onto a computer and emailing them to your program coordinator or appropriate person (first ask if they’ll accept it electronically, of course) and ask them to send their forms electronically as well, if possible. You’ll save money on FEDEXing things, things will get there faster, they won’t get lost in the mail, and you’ll have electronic copies of everything and won’t have to worry about keeping a huge stack of photocopies of everything you sent. Alternatively you can fax things, but email is much faster and more reliable. Unfortunately some things will have to be sent as original copies i.e. by post. The fastest way to send/receive documents to/from the states by post is using FEDEX Express, it takes 2-3 business days. If you give your program the WCMC-Q P.O.BOX 24144 as the address you want your documents sent to, they may tell you FEDEX doesn’t accept P.O.BOX addresses, but that doesn’t seem to be the case for Doha. We have received countless packages from our various residency programs as well as from the ECFMG in Philadelphia using our WCMC-Q P.O.BOX addresses. Just let your program know that.

All of you will have to deal with this residency program paperwork that your hospital requires, and it’s really not that big a deal, just get it out of the way early. Once you get your diploma at the end of April, the registrar’s office will send a form to ECFMG requesting your ECFMG certificate, which states that you passed your Step 1 & 2. Just make sure it gets issued as soon as possible, especially if you hold a non-US passport (you’ll see why shortly). You can track the progress of your ECFGM certification on OASIS.

After this stage, your class will be divided into two groups, those with US passports, and those without. If you have a US passport, go kiss your parents thanking them for not putting you through the hell of getting a J-1 visa and stop reading this blog. Go enjoy your vacation!

If, however, you do not have a US passport, ya-lahwey, keep reading.

Non-US passport holders going for residency in the US will need something called a J-1 visa. Don’t try and get a H-1B visa or some other kind, it’s not preferred and most programs are beginning to specifically request a J-1 visa for non-US passport holders. Getting the J-1 visa was a nightmare and it ruined our vacations. I’ll try and guide you through the process so as to avoid the pitfalls we experienced. Here’s what you do:

As soon as you’ve matched, download the Initial Application for ACGME-Accredited Clinical Training Programs as a PDF from ECFMG. In this PDF you’ll find a checklist of documents that you need to send to the ECFMG so that they can issue you a paper called the DS-2019, which will allow you to apply for a J-1 visa at the US embassy in Doha.

Here are the items on that checklist:

1) CONTRACT OR LETTER OF OFFER. DO NOT, I REPEAT, DO NOT get a “letter of offer”, get a contract. Many of our letters of offer (which is just a letter written by your residency program director stating that you’ll be an employee of whatever hospital) were not accepted by ECFMG and we had to later request contracts, and that just delayed our processing. A contract typically has a place for you to sign and for your program to sign. On the J-1 visa application form checklist, they list some details that the contract should contain (salary amount, dates of employment, etc.), look through it and make sure those items are outlined in your contract. If they aren’t, ask your program to write you a contract containing all the required details, otherwise ECFMG will ask you to resend the contract. Once your program faxes you your contract, sign it and hold on to it, I’ll tell you what to do with it in a bit.

2) FELLOWSHIP PROGRAM DESCRIPTION. You’re doing a residency, not a fellowship so just ignore this item.

3) APPLICATION FOR INITIAL SPONSORSHIP. This is a one-page form contained within the PDF. This form contains 2 boxes to fill in. You can fill in Box A all by yourself. Box B has to be filled in by your TPL (Training Program Liaison). The TPL is the official contact person in your hospital who will communicate with the ECFMG. In my case, it was a lady in my hospital’s GME (Graduate Medical Education) office. You don’t pick your TPL, there’s just someone designated for this stuff. Please, please, please as soon as you download the J-1 visa application PDF, print the APPLICATION FOR INITIAL SPONSORSHIP FORM and fill out box A. Send it along with the contract you need signed from item 1 to your TPL by FedEX Express. You need the original documents with the signatures on them for these 2 documents, that’s why you’re sending them by FEDEX rather than by emailing/scanning them. Along with the contract and APPLICATION FOR INITIAL SPONSORSHIP FORM, you should send an empty, pre-addressed, pre-paid FEDEX Express package. What does this mean? It means you will send a FEDEX EXPRESS package to your TPL containing three items: 1) the contract you already signed and need them to sign, 2) the APPLICATION FOR INITIAL SPONSORSHIP form where you filled out box A and need them to fill out box B, and 3) an empty pre-paid, pre-addressed FEDEX EXPRESS package (it’s really a big cardboard envelope that you fold in half and looks identical to the FEDEX Express package in which it is contained, only it is empty and will be addressed differently, as I’ll explain). This empty FEDEX EXPRESS package should have your TPL’s address written as the “FROM” address and the WCMC-Q address as the “TO” address (in other words, the TO and FROM addresses are switched compared to the package in which this empty package is contained) that’s why it’s called pre-addressed; you’ve already written all the addresses on it. Think of it this way: when you send someone a letter and they want to reply, they have to write a letter and send it in an envelope, right? Well what you’re doing is providing the letter they’re going to send to you (i.e. the contract and APPLICATION FOR INITIAL SPONSORSHIP form which they sign) as well as the envelope they’re going to use to send it to you (i.e. the empty pre-addressed, pre-paid package that already has the address written on it and has it’s postage paid for. It’s like an envelope within an envelope). WCMC-Q student affairs will help you and the school mailroom has these kinds of packages in stock. This way, your TPL opens up the FEDEX package you sent, gets the contract signed, fills out box B in the APPLICATION FOR INITIAL SPONSORSHIP form, and puts them both into the empty FEDEX Express package that you already addressed and paid for, contained within the FEDEX package you sent. This way the TPL doesn’t have to pay any fees, visit the FEDEX office, or write any addresses, they just give it to their mail room. You want to make it as easy as possible for him/her to send these 2 forms to you as fast possible, because these are the only forms among your J-1 visa application forms that your TPL has to sign. Once you have them in your possession, you no longer need to rely on your TPL for anything and you will have total control over your application. This is very important and worth the trouble and cost of sending the pre-paid, pre-addressed packages, because a lot of the delay we experienced with our applications was because our TPL took a long time to send stuff back and forth between us the ECFMG. And whenever the TPL did send something, s/he would send it by regular, slow mail i.e. not express. Get these two forms from your TPL and you will be able to communicate with the ECFMG directly, the TPL is just a middleman and you should eliminate him/her! Supplemented with the APPLICATION FOR INITIAL SPONSORSHIP is the APPLICATION FOR J-2 DEPENDANT SPONSORSHIP. J-2 visas are for your spouse and children since they need visas to enter the states as well. If you don’t have dependants, then you don’t need to send this form. If you have questions, ask Zeinab Ammous (ammous09@gmail.com) in my class about it. She’s the only person who needed J-2 sponsorship for her family.

4) STATEMENT OF NEED: This is a letter from the Qatari government that states they need physicians in the specialty you’re going into, thereby justifying the need for you to go the states and train in that specialty. The assumption being you’ll come back to your country after you finish residency. Coming back to your country is something you can work around of course, but that’s another discussion on it’s own. The WCMC-Q registrar’s office will help you procure this document.

5) C.V. Just print out the same C.V. you used for the residency application you uploaded onto ERAS. Yes, it’s that simple.

6) $200 ADMINISTRATIVE FEE. Go to OASIS and click on “Financial Account Summary”. When a new window opens up, scroll to the bottom and click on “Make an online payment” and add $200 to your account using a credit card. It will automatically be debited from your account once your application is processed by the ECFMG. This comes out of your own pocket, the school won’t pay for it.

7) ADDITIONAL DOCUMENTS:

a. INCLUDE A COPY OF YOUR DS-2019 AND/OR IAP-66 FORM if you’ve had a J-1 visa before. You probably don’t’ have an old J-1 visa so you can just skip this step.

b. PROOF OF COUNTRY OF MOST RECENT LEGAL RESIDENCE IF THIS DIFFERS FROM YOUR COUNTRY OF CITIZENSHIP. Meaning, if you’re not Qatari, you will need a form from the Qatari government stating that you live there. Thanks to my good friend and classmate, Heba, for providing the following instructions non getting this form:

I. go to samar, ask her to prepare letter/make a phone call to Tariq Al-Sewaidy at QF. He will prepare a letter stating you are a Cornell student, you have been resident in Doha from such date to present. Make sure he places your name as is appears on your Passport and that he stamps it.

II. Take it to Immigration Office. If you’re going from tilt roundabout to Merkiah roundabout, you have to go under a bridge, right? The ministry is to the left of that bridge (near the Lebanese fruit & vegetable store), so don’t go into the tunnel, stay above ground and make a U-turn on the roundabout on top of the bridge. You’ll get to a petrol station, take your first right after it, it’s around there.

III. go to the second floor. Tell them you want "6alab shahada lil iqama" or “request of proof of residency”. They can complicate it or make it very simple. ask for the 3akeed A'atiya if they complicate it. you give them 10 riyals an they make the form for you, make sure that they stamp it (someone got it for me from a building next door. They look you up on their system, and write you a letter stating your name, how long you've been in Qatar. Problem is its in Arabic and the guy who types it up in English isn’t always available.

IV. Take it to a certified translator (i went to Al-Amal, they took 30 riyals, Location: take a right at TV roundabout, keep going straight and it's one of the shops on your right, it’s in the same area as Al-Jamiya bookstore before you get to the next roundabout). Have them translate it for you in English and you have your form!

c. OFFICIAL DOCUMENTATION OF FUNDING IF OTHER THAN OR IN ADDITION TO HOSPITAL STIPEND. Meaning, where are you getting the money to live off of during residency? The hospital, duh. Your contract from the hospital should state your salary and that’s enough. So just skip this step as well.

8) RETURN AIRBILL FOR EXPEDITED DELIVERY TO THE TPL (OPTIONAL). This is totally optional. The whole purpose of this J-1 visa application process is so you get a form called a DS-2019 (more on that later). By default, once your J-1 visa application documents are processed, ECFMG will send the DS-2019 to your TPL by regular mail, your TPL will then send the DS-2019 to you in Qatar by regular mail. I totally don’t recommend you take this default path. Nancy chose to do this and the ECFMG sent her DS-2019 to her TPL, but they forgot to address it so it sat in their office for a whole week. And Maryam’s DS-2019 somehow ended up in Chicago and was stuck there for a while. What they’re suggesting with item 8 on this checklist is to send ECFMG a pre-paid, pre addressed package addressed to your TPL along with your J-1 application forms. This way it gets sent to your TPL quicker. But I don’t recommend this since the DS-2019 will have to go through your TPL who will then send it to you. The smart thing to do is to include an empty, pre-addressed, pre-paid FEDEX Express package addressed to yourself, rather than your TPL, when you send your J-1 application forms to the ECFMG. We put the TO address as WCMC-Q and the FROM address as the ECFMG. This way, all the ECFMG has to do is place the DS-2019 form into this pre-paid, pre-addressed package and drop it in the mail. Nothing for them to fill out or fees to pay, and it will arrive in Qatar within 3 business days. This is the same principle as when you are trying to get your contract and the form with box B from your TPL. You’re basically idiot-proofing the process for them and also receiving things quicker since it’s by express. It worked out just fine for Amira and I (we did it this way) and we were able to bypass our TPL. You will need permission from both the ECFMG and your TPL in order to bypass your TPL, just send an email asking your TPL to tell the ECFMG it’s ok with him/her if you receive DS-2019 directly without going through the TPL.

9) COPY OF MEDICAL SCHOOL DIPLOMA. Ask the registrar’s office for this.

10) FULL FACE PASSPORT SIZED PHOTO. The same kind you use for US visas i.e. white-background, ears showing, no smiling, 5x5 cm. Make sure to send an original photo, they won’t accept photocopies.

Once you have all the documents on the J-1 visa checklist, scan them all on your computer for your reference and then mail them by FEDEX Express to ECFMG. Once your application is processed (may take up to 4-6 weeks maximum, but apparently we know people at the ECFMG and they get it done much quicker) they will send you a notification email telling you your DS-2019 has been sent by post. It will arrive in Doha within 3 business days of receiving that email if you did the pre-addressed, pre-paid thing I suggested. Note that your DS-2019 will not be issued unless your ECFMG certificate has been issued. You don’t need the physical certificate, you just need them to have finished processing it. You can check whether it has been processed on OASIS. This all depends on the WCMC-Q registrar’s office sending the request to have it issued as soon as possible and how fast ECFMG can process the request. Also it’s important to have all your J-1 visa application forms mailed to ECFMG early, because they don’t check their mail every day, so you may not necessarily be processed the day that your package arrives to them. You can also track the progress of your DS-2019 online at OASIS or by calling them at 00-1-215-386-5900 (by landline in Qatar) or +1-215-386-5900 (by mobile) and stating your 9-digit ECFMG/USMLE ID number. Hope you didn’t lose that number! You should keep a copy of it and everything else with Raya in case you lose it.

To summarize:

You should sign your contract and fill out box A in your APPLICATION FOR INITIAL SPONSORSHIP form. You then send these 2 papers by FEDEX Express to your TPL and include an empty pre-paid, pre-addressed FEDEX Express package addressed to yourself and from the TPL. Keep calling/emailing your TPL to sign them and send them in the pre-paid, pre-addressed package you provided. It will arrive in Qatar within 3 business days. Once you receive the APPLICATION FOR INITIAL SPONSORSHIP and contract (both of which are now signed by your TPL), gather all the other documents on your J-1 visa checklist and send them by FEDEX Express to the ECFMG along with another pre-paid, pre-addressed FEDEX package addressed to yourself and from the ECFMG. The ECFMG will process your application and send you the DS-2019 in the pre-paid, pre-addressed package you provided and it will arrive in Qatar within 3 business days. You can follow the progress of your DS-2019 on OASIS r by calling the ECFMG. While all this is happening, you should make sure the ECFMG received the paper from the registrar’s office requesting your ECFMG certificate and follow its progress on OASIS or by calling the ECFMG, because the won’t send you your DS-2019 before your ECFMG certificate is issued.

Now you can go to the US embassy in Doha and apply for your J-1 visa! You will need to bring the following items with you to the embassy. Instructions are available on the official website.

1) DS-156. Fill it out online then print it. This is the only one that has to be filled out electronically. This form also has a barcode on the right side of the page, make sure it’s clear when it prints.

2) DS-157: print it off the website, you can fill it out electronically or by hand

3) DS-158: print it off the website, you can fill it out electronically or by hand

4) DS-2019: you need the original form from the ECFMG. You cannot use a photocopy or fax copy and you cannot apply for your visa without this form. I can’t stress this enough.

5) US passport-sized photo: 5x5, full face, facing-forward, white background, no smiling. They’re very strict about the criteria. They recommend Gulf Colors as their preferred photo shop. There’s a branch very close to the embassy and one behind the Hardeez that’s right before Ramada junction as well.

6) Pink and yellow receipts from Commercial bank. You go to any branch of commercial bank in Doha and tell them you want to pay the US visa fee, it’s like 479QR. You pay the bank, and they give you 2 carbon-copy receipts, a pink one and a yellow one. Make sure you have both when you go to the embassy. And if you’re one of those people with a long name, make sure the name written on the receipt contains at least the first three names in your name.

7) SEVIS fee receipt. This is a fee you pay on the US embassy in Doha website using a credit card. It is $180. It is totally different from the $200 administrative fee you paid on OASIS and it’s totally different from the 479 QR commercial bank fee. Once you pay the fee, print an online copy of the receipt. They will mail you the original receipt eventually, but the embassy will accept a copy of the online receipt that you can just print at home. You cannot pay this fee until you receive your DS-2019 since they ask you for 2 numbers that are written on your DS-2019 form. You can do it the night before you go to the embassy.

8) Your passport – must be valid for at least 6 months after the date of your arrival to the US

9) Those are all the documents you need, but bring along a copy of your contract and any other forms you feel are important, just in case they ask. They didn’t ask us though.

Once you have all these documents and have paid all your fees. Schedule an interview for your visa at the US embassy online using the same link I listed above. Actually you can just walk in without an appointment, we all did and it was fine. You can go any day from 8:00-10:00am except Monday, Friday, and Saturday because they don’t do visa interviews on those days. The embassy opens at 7:30 am though so be there like 7:00 or 7:15 so you can be first in line and get through all the security checks otherwise you won’t get out of there till like 10:30am. The purpose of the interview is to make sure you’re not a terrorist and to convince them that you will come back to Qatar after residency. I’m not kidding. They check if your name is on their black list. I have a very common name so my name was black-listed. You will need to demonstrate “strong ties with Qatar” and tell them you want to come back and work in the hospital here and you love it etc. When they ask you “what are your plans after residency, don’t say I’m going to stay in the states and do 3 fellowships and a bunch of research” you’re coming straight back home! It’s a little game you play with the interviewer, just play along. The theoretic purpose of a J-1 is to allow you to study a certain specialty since your country is “in need” of it and then you come back to that country after you complete your training to serve that need. Most people got their visa the very next day after the interview. My name matched that of 14 terrorists on their list so they had to screen my name and it took me 2 weeks to get my visa. If your family is planning on applying for a green card, let them wait until after you have your J-1 visa!!! If your family has green cards, it weakens your ties with Qatar since it means your family will spend a lot of time in the states and you would stay with them. Don’t argue with the embassy, that’s how they see things.

Once you have your J-1 visa, you will need to enter the US with it along with your DS-2019. The immigration officer at the airport will stamp and sign it and then you present it to your hospital as proof of your J-1 status when you go for residency. The J-1 visa you are issued may be valid anywhere between 1-5 years and may be single entry or multiple-entry depending on your nationality (yes, it’s discrimination). If you have a visa that doesn’t last long then you’ll have to keep renewing it every year.

The last thing you need to start residency is your social security number. You cannot apply for a social security number until you have your J-1 visa. Sucks huh? It takes a few weeks so get the ball rolling with your residency program as soon as you arrive in the US

Get all this J-1 crap taken care of as soon as possible, because you get your medical school diploma at the end of April and residency starts mid-June to early July and you have to have your J-1 visa ready by your start date or you can’t start residency. So you’re on a very tight schedule. Because we had so much delay with our processing, 5 of us had to go to NY for graduation (school paid for ticket and hotel) and then fly back to Doha for our J-1 visa interviews since our DS-2019s hadn’t arrived in Doha by the time we left for graduation so we couldn’t schedule interviews at the embassy before travelling. Once we got our DS-2019s we interviewed at the embassy for the J-1 visa and then flew back to the states for our residency orientation (we had to pay for that trip). And the some of us had fly back to Doha AGAIN because our visas weren’t ready by the time orientation came around, so we had to fly back to Doha, pick up our visas and then re-enter the US using our J-1 visas in between orientation and the start dates of our residencies (also paid for that ticket). So think of the money spent on the pre-paid, pre- addressed FedEX Express packages as an investment. I hope you guys can avoid all the delays and BS we had to deal with by using this guide.

Remember:

1) DO EVERYTHING AS EARLY AS YOU CAN

2) IDIOT-PROOF AND STREAMLINE THE STEPS FOR PEOPLE AS MUCH AS POSSILBE AND TRY TO ELIMINATE THE MIDDLEMAN, LIKE YOUR TPL. S/HE WILL JUST CAUSE MORE DELAY.

3) KEEP HARRASSING/CALLING/EMAILING PEOPLE TO GIVE YOU THE DOCUEMENTS YOU NEED FROM THEM. YOUR FUTURE IS AT STAKE HERE. WE CALLED THE STATES NEARLY EVERY DAY DURING THE MONTH OF MAY, TO BEG THEM TO SEND OUR PAPERS, BECAUSE WE HAD SO MANY DELAYS.

The Brothers Karamazov

“Rebellion”, “The Grand Inquisitor”, and “The Devil”, from Dostoyevsky’s "The Brothers Karamazov", are said to be some of the greatest passages in all of western literature and powerful arguments against god’s existence. I’m no evangelist and lately I’ve been questioning my faith. But I was really disappointed by the argument presented in “Rebellion”. The character says that he can’t understand how an essentially benevolent god can allow the suffering of children. He gives several accounts on how some babies were bayoneted etc. in some skirmish. Then he claims that he can’t understand why god would let innocent, sinless children suffer like that and thus god doesn’t exist. But what the hell kind of argument is that to justify god’s non-existence? I feel it is a result of emotionality at the suffering of children and the presupposition that suffering is essentially evil and unjustified when a person free of sin experiences it.

Well this is my argument: to be angry and perplexed at the suffering of children, while condoning it in adults, who have taken a bite of the proverbial apple, is to suppose that suffering is a punishment for our sins. I don’t believe suffering is evil or punitive, regardless of whether it happens to someone who is innocent or guilty. The fact that we all suffer, innocents and sinners alike evidence this.

[As I side-note, I am an avid Platonist and use inductive rather than deductive logic to explain things, as oppose to the popular Aristotelian, deductive approach. I take a “truth” and use examples around me to justify that “truth”. To use this method of reasoning requires the assumption that the given truth is valid, which in turn is based on belief. This is opposed to the deductive approach where you start at the bottom with examples and work your way up to a truth. One cannot argue with examples like, the child was killed. It happened, you couldn’t argue whether it’s true or not. But you can argue with the “truths”. With the inductive approach, I would say, because God exists, such and such is evident. The uncertainty lies with the validity of my assumption of god’s existence. Whereas in the deductive approach I would say, because of such and such, god exists. Here, the uncertainty lies in the conclusion of god’s existence, because though I have provided evidence of god’s existence, there may also be evidence against god’s existence, which I have not discovered yet. The point is there are flaws with both the deductive and the inductive approach and I won’t go into why I prefer the inductive approach right now. Sorry one more thing: to understand the future, we need to use deductive logic, but to understand the past we need to use inductive logic. Meaning, certain things have happened leading up to the present. In order to make assumptions about the future, we need use the evidence we have in front of us i.e. past events and make predictions on future outcomes. For example, in that past Madonna has reinvented herself in accordance with the pop culture of the time to maintain her popularity. When a new pop culture arises in the future, she will re-invent herself again to maintain popularity, as she ahs for several generations. But in order to understand the past our assumption must be about the evidence, rather than the truth. For example, we have a coccyx. That is a truth, reasons leading up to that truth would be that we and other primates evolved from a common ancestor. But that’s something that can be argued with, albeit not very intelligently, but argued with none the less simply because it’s a hypothesis without concrete, tangible proof. I guess that’s why I’m more interested in the past than the here and now, I’m an inductionist, rather than a deductionist. Okay, end of quip.]

I believe that the purpose of suffering in god’s grand scheme is unclear, but a necessary part of the plan. In other words, I don’t always understand why some people have to suffer, seemingly unjustifiably at times. The key word here is seemingly. But I believe that there is a place in the world for it. Not only is there a place for it, but it is also a necessary component of the scheme of things as much as is a fart or the existence of cocoa butter. The very existence of something justifies its legitimacy and validity, because otherwise god would not allow it to exist. This is based on the a priori assumption of god’s essential benevolence. This concept is at the center of what I believe we call “faith” and without it everything falls apart. This is not to say that belief in god’s essential benevolence allows everything in the world to make perfect sense. At times it doesn’t at all. And I think that’s what really confuses the character: the fact that he can’t take things on faith and has to resort to cookie-cutter, all-encompassing rules to make the workings of the world totally deducible by the rules of logic. There some things that cannot be explained logically and we not only have to learn to reason, but learn to believe as well in order to achieve stability and acceptance of the world. I guess logic is a prison for some people that way. Of course I am not denouncing logic. I view logic like rules in the board game of life. We need rules to play the game, otherwise there would be no order in the world and the game could not go on. However by virtue of being rational beings, we must allow ourselves to step outside the playing board and see that the board is on a table, which in turn is in a room, and the board game is part of something much greater that cannot be understood using the simple rules of the board game. In other words, if you imagine a game of chess on a kitchen table, you cannot explain the workings of the different appliances in the kitchen using the rules of chess. We need to think outside the box and make assumptions about things that are beyond us, only then can be existential serenity. Otherwise we’re stuck with angst of “why can’t I turn on this toaster by making it move three spaces in an L-shape, like a knight?! Oh life is so cruel, there is no god, and nothing makes sense!”

Now in “The Grand Inquisitor”, the character tells a parable about Jesus returning to earth and the Spanish Inquisition imprisoning him and denouncing the second coming. The grand inquisitor accuses Jesus of ruining a corrupt church’s plans of controlling people and telling them exactly what to do so that they have no moral decision to make on their own. He charges Jesus with placing a great burden on the shoulders of man, conditioning his salvation on the ability to choose to between right and wrong. But this is too great of a burden for most people, says the inquisitor, and they will be condemned to hell as a result. So the inquisitor believes that the church should take on this great responsibility of choosing between right and wrong for people. This way even if people do the right thing, they still believe they are doing the right thing, because the church told them to and they have blind faith in the church. This relieves the burden of autonomy and moral dillema for people and guarantees their salvation through ignorance. And the only party held accountable for this evil would be the few members of the church. Effectively, they would have condemned themselves, but saved humanity in doing so. To use a concrete example, let’s say you’re Muslim and you don’t consume alcohol and you love tiramisu. Then one day someone comes and tells you tiramisu contains alcohol, so you stop eating it. And you would not be held accountable for your past consumption, because you didn’t know. But now that someone told you, you will he held accountable for future consumption of tiramisu. And so you wish, “Oh if only no one had told me tiramisu contains alcohol.” Well that’s what the inquisitor and his church are doing in the parable, they’re protecting people form the knowledge of right and wrong and thereby protecting them from conscious sin and damnation. Based on this argument, the character telling the parable says he cannot accept the world god has created, because it is not fair. I think this is a good argument to debate, though I would argue against it. But I guess “The Grand Inquisitor” just didn’t impress me, because I had thought of these arguments before. I think “The Brothers Karamazov” would have had a greater impact on me if I had read it at a younger age, it would have blown my mind.

Sorry I totally forgot what “The Devil” was about, and am too lazy to go back and look at it again.

Insomnia - May 26, 2009

It’s nearly 4am. Mr. cookie woke me up at 1:30am because he wanted to go outside and pee. I let him out and then went back to bed and tried to sleep for 2 hours. It then occurred to me that I’ve always been a night person and I’ve been trying to convince myself that I’m a morning person for years. I don’t deceive myself, I just try to keep things under control and scheduled all the time. And I try very hard to stick to my routines, even when they seem inapplicable. I imagine I would have gotten along very well in 50’s society, or at least what pop-culture leads us to believe it was like. I just remembered a title of a buffy episode, “lies my parents told me”. That’s a nice title, haven’t seen the episode yet. I like to think that I listen to life and go with the flow, but really I just try to fast forward through life, hoping to ultimately evade hell and be content with a non-existence when I die. The idea of heaven is inconceivable to me, though hell isn’t, which is counter-intuitive, I suppose. How can one imagine one platonic form without it’s antithesis? If pure pain exists, then so must pure pleasure. But I guess we are not talking about something like the inability to grasp the concept of wetness without the existence of dryness. Rather hell would be an extreme of one concept, pain, while pleasure, it’s opposite can exist without necessarily being expressed in a comparable extreme, like heaven. However if an extreme of one thing exists, then surely somewhere it’s opposite is also expressed to the same degree. Like if we lived in a world totally covered with water, we could imagine a desert planet by virtue of our being persons able to reason it, and never having actually seen desert before. So I guess the “there can’t be black without white” argument isn’t valid. We can imagine something’s antithesis, even if it doesn’t exist. But maybe though we can imagine it, it wouldn’t be possible to have one thing without it’s opposite in the physical world. But then again, this is a world of matter and though anti-matter exists, it doesn’t exist in our world…I’m getting confused. The point is I believe anything that can be imagined, must be capable of existing on some plane. And there are some things beyond our imagination, which also exist and are known only to god I suppose. By that reasoning, heaven must exist. I then started listening to the nina simone discography that I downloaded recently and found that i’m really in to it, or rather, her. I think she’ll me my new music craze, preceded by tom waits. (check out songs by tom waits: kentucky avenue, who are you, downtown train, and that feel. and by the way, scarlett johanson should be killed for covering his songs, she's just awful) I figured the hell with it, this isn’t boredom insomnia and this isn’t anxiety insomnia. I just don’t feel like sleeping. I let nina simone transfer to my ipod as I prayed fajr. Then I went to the kitchen and had bad soy milk and cold chocolate cake. I can never finish a whole banana, it just gets boring. I dumped cinnamon into my palms and smeared it all over my face, because I love the smell of cinnamon. I then decided to got outside expecting it t be unbearable and come back in. But it really wasn’t bad at all, it wasn’t cool, but I didn’t sweat either. I sat and ate my cake while listening to nina simone, then I took my clothes off and jumped into the pool. It felt disgusting, like mosquito infested amniotic fluid. i got out of the water and if nerves are like taught electric cables, it now felt like the little fibers in the cables had frayed and splayed in a million directions and colors, under my skin like microscopic sea urchins. I got out immediately and sat on the plastic furniture until I got dry. mr. cookie’s been very annoying for the past 2 days, ever since I took him to the vet he’s been mistrustful, petulant, whiny and he fears me. I think I’ll make some omgega-3 scrambled eggs with green onion, garlic and sumac. I’m just sitting around waiting for my flight to ny next week, I can mess up my sleep schedule, no problem. I’ll just nap later. Someone once told me “when a man can spend a whole day doing absolutely nothing, he’s learned to live”. It’s getting hot, time to turn on the ac. “I mean air conditioner”. Not to toot my horn, but that faculty roast was funny man, LOL. Ow, I’m getting a headache. That’s what I get for staying up late.

USMLE Step 1 motivation

Hey everyone, you're probably starting to snuggl einto your step 1 routine about now. Remember my pregnancy analogy? Well at some point you're probably feeling bloated, doubtful, and wanting your life back (or to end it). Here's a little morale boost. One of your classmates asked for some advice about your step 1 and I thought I would share it with everybody:

"First of congratulations on making a schedule, it's important to plan your study time early and not just wing it through your Step 1 study period. I think the order in which you do most of the subjects isn't that important. Try a tough topic followed by a light one so you get a good rhythm and don't fry your brian. ATTACK THE SUBJECTS YOU HATE HEAD-ON AND ****EARLY**** (I put a bunch of asters there on purpose), dont run away from them please!!! We have a natural tendency do that and then it comes back and bites us on the ass. It's crucial to stick your schedule though. If you haven't finished studying everything scheduled for a given day MOVE ON!!!! It's more important to cover a broad range of topics rather than focusing on a few. Even if you think it's an important subject, just MOVE ON. You can't afford to get stuck on cardio or GI for an entire week.

If you find this to be a recurring problem and you can never seem to finish your assigned study material for the day, then maybe you are assigning too much on a day and need to spread out the study material over more time.

I would spread microbio and pharm over the entire study period, because it's just rote memorization. There are very few concepts to understand. Flashcards may be useful. It's also better to write out the flash cards rather buying them. When your brain sees things in many ways, reading, writing, listening, video, it retains it better. So you wouldn't be wasting time by writing them out since you would also be learning them at the same time.

I think it's important to have a day off once a week. I see in your schedule that some weeks you don't have any. I would schedule at least one break a week. And if absolutely necessary, you can use that day as a make-up day if you're lagging behind (in addition to any make-up days you may have already scheduled).

I would take a few days off after the triple jump, you need a break. I think of the Step 1 study time this way: BOD -> relax -> cram more than you've ever crammed in your life -> extremely light review day or 2 before the exam i.e. rapid review or flipping through first aid casually -> total relaxation before the day of the exam -> take it -> reward yourself! I see you have left nearly 2 weeks off before the exam. I'm worried you'll forget the material. A lot of students from 2008 and 2009 found that by the end of their study period they were beginning to forget stuff they had studied in the beginning (yes, your suspicions are confirmed, it CAN happen). So one idea may be to shift your study time so that you finish studying closer to the day you take the exam. On the other hand, maybe you're one of those people who like to study everything, finish it early, and then repeat it again (faster than the first time you studied it). I'm only giving you options, I don't know which is best for you, you're the best judge of that. But brain fade (losing info you studied a while ago) is inevitable, you can overcome it by repetition whether it's by listing to Goljan lectures, seeing the same material in a different book, discussing it with friends, or doing questions on it. I like to study alone, but supplement by talking with others sometime. They help you see a material in a new way that you may retain better, correct misconceptions you have, and show you things you missed in material you already "finished".

You may want to do your NBME in the middle of your study period. Just to give an idea of what you're weak in. Even if you haven't covered all the material, it'll tell you what you haven't really learned from stuff you already studied and think you learned well. And it'll tell you what to focus on for the things that you haven't studied yet.

DO QUESTIONS!!!! I BEG YOU!!!! The way USMLE and NBME exams for your clerkships are worded and designed is completely different from the kind of questions you've seen thus far. Get used to the style of the questions, once you start doing them you'll know what I mean. Try and do questions every day. And they may not necessarily be on something you just studied. You could just design a daily test on QBank that randomly selects from all the subjects. This way you'll reinforce the topics you already learned since you might come across it 2 weeks after you've studied and it's starting to fade from memory, it'll help fill in the gaps in subjects you already studied, but maybe missed, and it'll introduce you to things you haven't studied yet so that it'll be easier to learn them once the time comes. Your brian needs to see things over and over again to really retain them.

Don't set high expectations for yourself during the study period. Seriously reflect on how you have studied in the past, what has worked for you, and what your limitations are. Also this is not a month to try new things related to your studying or otherwise. Just be routine.

Lastly make sure to eat, exercise, sleep, and relax appropriately. You need to be in tip-top shape. Throughout the month, keep envisioning yourself studying the material, consolidating it, going to Dubai, getting on the plane, staying at the hotel, taking the exam. It helps to find out about knowledge village's layout, what to expect from the hotel you'll be at, the policies of the center you''ll be taking it at, and the layout and feel of the exam by doing the NBME. This is called image training, it helps you not be stressed out when the time come,s because you would have rehearsed it in your head a million times. I did it for my MCAT and I slept like a baby the night before and felt really relaxed through the exam, because i had visualized it in my head and told myself how it's going to be so many times. I was so busy freaking out about Step 1 that it never occurred to me to do the same thing again!

The most important thing I realized about Step 1, I realized while i was taking the exam. As I was doing the questions it occurred to me: these questions are really easy, I know exactly what they're asking me and I distinctly remember seeing the answer to nearly every question in First Aid. The problem is I just couldn't remember the answer because i was freaking out the whole month and I didn't allow things to sink into my brain. I thought: if only I had just taken it easy and learned the material calmly and routinely, it's such easy material. You don't really need to think about it all, you either you know it or you don't and you just need to recognize the buzzwords associated with certain topics. So don't freak out. Relaxation is something almost all med students have to train themselves to do, we're designed to freak out!

The mind is like a sponge, if you keep it squeezed in your hand then it won't be able to absorb any water.

GOOD LUCK. AND REMEMBER: QUESTIONS, REPETITION, RELAXATION. In a month, you'll have your life back, PROMISE. Just work hard and get it over with so you never have to deal with it ever again, just like organic chem."

Addendum to NY Sub-I month

*Meals* Some money saving tips while in NY: Most of your money will be spent on food! Try not to spend more than $10/meal, $30/day on average for food. If you wanna go out somewhere fancy, that's a different story. If you want to get food from a restaurant, order it on your mobile then go pick it up. This way you don’t have to tip them when you eat in the restaurant or when they deliver it to your apartment. And wherever you eat in NY, no matter how bad the service is, YOU HAVE TO TIP! I’M NOT KIDDING. They get really pissed if you don’t tip them. It’s an unwritten law. The same applies for cabs and private limousines. The hospital food is great both at NYPH and Sloan-Kettering (NYPH is cheaper); eat there as much as you can! The schedule is posted on the door, it’s closed on weekends I think :(. It's cheaper than getting food from outside, plus you get a discount when you show your hospital ID. I don't know if you get on-call meal allowance now at NYPH, we didn't, but I think they may have changed their policy. I got on-call meal allowance at Sloan. A lot of the restaurants and diners on 1st Ave give hospital discounts so always ask and keep your NYPH ID with you. I know Le Gourmet (we ate there A LOT) and The Grill, both on 1st Ave between 68th & 69th street do and so does the McDonald's that's near the hospital. If you really want to go out to a restaurant, most have weekday lunch specials and weekend brunch specials, so eat during the time slots of their specials. We ate at Texas Wraps a lot too, very cheap and filling. I lost weight on my first trip to NY because I didn’t know how to spend my money wisely, but I gained weight on the second trip once I figured it out. So you can eat well in Manhattan and not go broke! You can take your chances with the shawarma guy on the corner of 69th and York. Most people were ok, but a couple got sick. Don’t worry, just diarrhea

*Groceries* On your first weekend before you start your Sub-I, there are some basic things you need from the supermarket: breakfast food & snacks & drinks & instant microwaveable food (don’t get more food than that, you probably won’t have time to cook), plastic plates and cutlery, bottled water, toilet paper, paper towels (not Kleenex, because paper towels can be use to wipe your nose and clean up messes), all-purpose cleaner for the bathroom, lysol wipes (it's like dettol wipes), green Swiffer (it's a green disposable mop/broom you can assemble and throw away once you leave NY. I found it really convenient because you can attach both the dry wipes for sweeping and the wet wipes for mopping. There's no carpet in Olin, just linoleum and tiles. Don't get the purple swiffer and the orange swiffer, they're not necessary. It's best to just buy one green swiffer set and then you all can share it and buy refills as necessary since you will be cleaning on your days off and you won’t all be off the same day. That's what my class did), liquid laundry detergent (it's the most convenient form), a $10 hamper (ask Muhamed Baljevic, he'll know what I mean, they have them everywhere), use a plastic bottle in the bathroom (as there’s no bidet or hose), and your personal toiletries. We usually got our groceries from Gristede's or Food Emporium. At supermarkets, look for the generic brand of things, they are the cheapest. Also don’t buy fruits & vegetables from the supermarket, get it from the vendor that appears on some corners on York and 1st Ave within a block or two. It’s good and cheaper!

*Other shopping* When we first got to our apartments in Lasdon, some of us had mirrors, microwaves and cutlery while others didn't. So I think it depends on what the last tenant left in the apartment. Of course in Olin, there's a community kitchen on each floor so there is a microwave and stove. If you really want to cook, you have to bring you're own cookware and cutlery, the stuff in the Olin kitchen cabinets are for OTHER PEOPLE, so make sure to bring your own and clean up after yourself, there's no maid to clean up after you. You can leave stuff in the community fridge on each floor in Olin. I just put everything in a plastic bag and nobody ever took anything. But watch out, they empty it once a month, don’t worry they’ll out a notice on the fridge. You can find some cheap things for the kitchen, bathroom, and bedroom in Bed, Bath & Beyond on 1st Ave between 60th and 61st street. Good Buy is a nice mini-mart on 1st between 69th and 70th street when you need to buy something and all the shops are too far. It's got basic breakfast stuff, snacks, and toiletries. Don't buy groceries at The Grill, it's a rip-off! Just get take-out from there, avoid the conveniently located Kleenex and cereal.

*Laundry* The laundry room is in the basement of both Olin and Lasdon. There’s a machine where you insert money and it gives you a laundry card, you then refill that laundry card by charging it on that machine as needed. Paper money, no credit. Each load in either the dryer or washer costs $1. I used to wash my colors and whites separately, but then dried them in the same drier so each weekly load of laundry cost me $3 all together. The drier is quite powerful; your clothes may not need to stay for the entire 60 minutes, so watch it. No one ever stole my clothes, so I think it’s safe to just turn it on and go do other things. If you leave your clothes there for a long time though people will transfer it for you. Us that $10 hamper to carry your dirty clothes downstairs, you can leave it in the laundry room, and then put the clean clothes back into the hamper and carry it upstairs to fold. Mine never got stolen. There’s also a free gym in Olin, very convenient, and I think it’s open 24/7, not sure.

*Dry Cleaning* Find a dry cleaner that’s close to your house, I went to one between 70th and 71st on 1st Ave. I paid $2 to wash, iron and starch a shirt, $6 to wash, iron and starch my white coat, and $7 to dry clean my pants. Those prices are pretty standard, but maybe you can find something better. It’s pricey, but I just couldn’t waste my time with ironing (you can get a cheap steam iron and share it, $30 maybe, at Bed, Bath & Beyond FYI) and time is money so it all balances out in the end. Don’t go to the cleaners very often, wear a pair of pants and your white coat for at least a week before you send it and wear the same shirt 2 or 3 times so long as it doesn’t stink. There are no hangers in Olin by the way so just collect the ones you get form the dry cleaner if you haven’t brought your own from Doha.

*Travel* You will use google maps A LOT while in NY. Use the “get directions” option, type in an origin and destination spot in the A and B boxes and it’ll give you the quickest routes with bus and subway timings. It’s great. You use a metrocard, purchased at subway stations, to travel on the subway and bus. Each bus or subway ride costs $2, you must pay for the subway with metro card. If you transfer to other trains/buses within the subway system (i.e. you’re still underground) then you don’t pay anything extra. So if you need to take 2 different subway lines and a bus to get to harlem, you’ll only pay $2. Once you come out onto the street again, you’ll have to pay again to enter the subway system. You can also pay for the bus with money if your card is empty, but you must give the driver exact change in coins (no pennies or paper money). The closest subway station is on Lexington and 68th street (it’s known as the Hunter College Station). Don’t try and be clever and look for a closer station, it’s the closest one, trust me. They’re building another subway on 2nd Ave, but it’ll be years before that’s done. When you look at the subway map, each line (i.e. route taken by that subway train) is represented by either a letter or number (4, 5, 6, M, C trains) and has a color (green, red, blue). Lines with the same color mostly travel in the same direction, but have stops at different points and split off at the end of their routes. For example the 4,5, and 6 trains are all green. A circle around the number/letter of the train indicates that it’s a local train (it’ll stop at every station along the way), a diamond around it indicates that it’s an express train, so it won’t stop at every point. The idea is if you want to travel somewhere far, then you’ll take the express cause it’ll be faster. Some express trains become local on the weekend and the subway tends to be very unreliable on weekends, I would find myself waiting 15 minutes for a train, when you usually wait for like 3 minutes, then going back up to the street an taking a cab. At every subway station, there’s a set of stairs that says uptown and another that says downtown. These are not places, but directions. As the number of the street increases you are going uptown. Just find a good map of Manhattan and you’ll know what I’m talking about. Each train travels uptown and downtown, so if you you’re in Harlem and need to take the 6 train to get home, then make sure you take the downtown 6 train, not the uptown one. If you’re not sure which set of stairs you took, you can look on the actual car of the train it’ll say the number/letter of that line plus the name of the last stop so you know which direction you’re going in (uptown or downtown). It all sounds very confusing, but after functional neuroanatomy, I think you’ll get the hang of it ;) One last thing about travel, when going to another city for Step 2CS or pleasure, use kayak.com. It searches several websites for the cheapest airfares and hotel rates. Almost everyone used it, very convenient. Need a credit card.

*Prayer & Halal* The direction to pray in, from what me and Yasir recall is up 1st Ave (towards the waterfront) and very slightly to the right. While in the hospital you can pray in the meditation room on the ground floor at NYPH or the meditation room on the first floor in Sloan, it’s very close to the escalators, just ask the security. I don’t know about NYPH, but there are prayer rugs in the cabinet in the prayer room in Sloan and Friday prayer is held there. Check for the time, it’s written right outside the door. Please do not pray in the on-call room, resident conference etc. it’s just totally not the place for it. The meditation rooms are very accessible and open 24/7. If you want to go to a big mosque for Friday prayer, there’s a huge one on 96th street and 3rd avenue. We used to go there sometimes, it’s quite clean. Animal meats in NY and in the hospital are usually not halal. If you really want meat/chicken, there are pre-made kosher sandwiches and salads in cafeteria or just look up kosher places to eat on the internet. There’s a Persian restaurant on 2nd Ave between 73rd and 74th street called Persepolis. Everyone really liked it. The meat and chicken isn’t halal, but the lamb is (at least that’s what the manager said) and Persepolis is famous for it!

*Cell phones and internet* Everyone except one person, because of some complicated reason that I forgot, got AT&T sim cards to put in their cell phones. There was a plan where you pay $100 +taxes for a sim card that’s valid for 1 year and is worth $100 of call time. From what I remember, it’s 10 cents a minute for local calls and 20 cents for local SMS. The rate for international calls vary by country, check the AT&T website. $100 is plenty for those 2 months in NY. Plus you can always add more money to the account if it runs out. I forgot how the plan for SMS works. If you have AT&T and call anyone who uses an AT&T cell phone, you can talk to them for an unlimited amount of time for free! So since nearly everyone had AT&T, we barely spent anything on phone calls. The card stays valid for when you come back in the winter for interviews and more electives. Your number will be something like this: 917-207-2408. The first 3 digits is your area code and the other 7 digits is your number. You always have to dial the entire number, including the area code. If you are calling a different area code, add a 1 in the beginning. If you want to call Doha, dial +974 then the number as you would dial it in Doha. 974 is the country code, we have no area code in Doha. If you are calling from a landline, dial 011-974 then the number as you would dial it in Doha. For directions on calling other countries check this website, I found it very useful. There’s no landline in your room, you would have to pay for one. Nobody bought one though; it’s not worth it since we don’t stay long. You are entitled to free internet in your room. Go to the IT department in the basement of NYPH, ask around, it’s near the cafeteria. When you enter the department, it’s walls are made of glass. Tell them you’re a student from WCMC-Q and that your macbook is not tagged by their department (meaning they didn’t put a sticker on the bottom of your laptop, the one you have is from our IT and doesn’t count). They’ll then give you a form to apply for a “new connection”. You give in that form then someone calls you on your cell phone and arranges for a time to come over and set up your connection. They bring a blue LAN connection that connects to the internet outlet in your room. They can’t just give you the cable and you set it up, because there’s stuff they have to type in. it can take like 30 minutes to do it while they’re over, so be patient. When you go to the IT department, make sure you know the number of the internet outlet in your apartment, it’s a alphanumeric code written right next to it. It should be “OH” then a bunch of numbers. Try and all do it at the same time to save the IT guys the trip, they’ll appreciate it.

*Routine* I dedicated one day in the week to do my laundry, clean my room, buy groceries, pick up dry cleaning, and shave. I’d get up and put my stuff in the washer, go get my dry cleaning and do my shopping, come back and transfer my clothes to the drier, clean my room and shave, then get my clothes and fold them in my room while watching sitcoms. I found it to be a very efficient system and I could go the whole week of my Sub-I or elective without having to worry about food, clothes, etc. The last thing you want is to come home late and have to do all this crap when you have to be back at the hospital at 5am the next day. Stick to a routine and you won’t fall into that trap, you need to relax and watch TV shows on your laptop after work! I’m serious by the way.

*Be nice* to EVERYONE both in the hospital and out. To the concierge, NY students, residents, attendings, cafeteria people, patients, people you meet on the streets. For example: the concierges in the dorms really liked the WCMC-Q students, because we were polite and courteous to them. In return, they would tell us when places nearby had discounts, cheap routes to get to places, tell us when we had mail, wouldn’t be anal about leaving our stuff in the lobby/having friends over/having our ID with us at all times, helped us when our apartments needed maintenance (you request maintenance for your apartment online, ask the concierge), and were just helpful in general. The same applies to anyone you meet in NY. NY is a much meaner place than Doha! So people really show their appreciation when you’re nice to them. You already have a good reputation preceding you, not only in this respect, but also in terms of your performance on the Sub-I. So just keep it up! Be nice to each other too, life in NY is much easier f you have your classmates to help you. And don’t be shy to email any of us with questions about in-hospital or out-of hospital stuff. 

Away Elective Experience - Aga Khan Uni Pakistan

Once in your third year of medical school, you start hearing tales of away electives. Away electives indicate clinical or research rotations in, literally, hospitals that are away from your college. For us here, that means any hospital that is not Hamad or New York Presbyterian. While not necessary, many professors and residents recommend doing away electives, especially at places you may be thinking of applying to for residency, to (1) get an idea about the program, (2) let the program see you in action and make a good impression, (3) experience medicine in a developing nation, and (4) have a topic of conversation during an interview. Keep in mind that away electives bring with them an unfamiliar (perhaps even venomous) work environment and/or living situation, something some students would avoid.
In this little blurb, I will give you a brief glimpse of my one-month away elective in Infectious Disease at Aga Khan University Hospital in Pakistan. Initially it was a challenge to adjust to the new environment and approach the slightly arrogant student body. However, in the end, I had a very good experience and would not hesitate if the given the chance to repeat it. During the month, I became good friends with other students, learned a lot from my nice and enthusiastic attending, and saw cases of dengue fever, every form of tuberculosis imaginable, typhoid galore, tetanus, and rabies (diseases I thought I would never see in the 21st century). A large tertiary care private hospital with many lakes and wild life (outdoors, not indoors), it is quite reminiscent of New York Presbyterian in the context of patient workload and hospital beds. While rounds were always in English, most of the interaction with patients occurred in Urdu, a local dialect. The dorms were less than amazing and I was lucky enough to avoid them by staying with family.
In the end, I honestly do not know if it makes a difference in the residency match whether you did an away elective. Think about it, try applying with a friend to make adjusting easier, and keep your budget in mind. Fourth year, I guarantee, will be expensive. If you have any questions, feel free to contact me at fas2003@qatar-med.cornell.edu. Good luck!

Advice to lowerclassmen

I’ve posted the schedule I had for M3 and M4 (third and fourth years of med school respectively) to show you what you’re in for. We hope to supplement it with more information and include it in some kind of student survival guide in the future. Keep in mind that the order of things may be shifted around a bit for your class, but this is generally what you’ll be doing.

Please check the blog every once in a while for updates specific to the various sections.

M-3

·      April-May:

·      Study for USMLE Step 1

·      Beginning of June:

·      Take USMLE Step 1

·      June:

·      2 weeks of Intro to Clerkships

·      2 weeks of Anesthesia Clerkship

·      July-April of next year:

·      Core Clerkships

·      April or May or June:

·      4 weeks NY Sub-I

·      4 weeks elective in the US

       June-September:

·      Step 2 CS

·      Step 2 CK

M-4:

·      July-Graduation:

·      remaining Core Clerkships

·      8 weeks of Doha electives

·      8 weeks of anywhere electives

·      2 weeks ABS course

·      ABS requirement

·      2 weeks MPS III

·      2 weeks Public Health

·      Complete your residency application ERAS

April-May:

Study for USMLE Step 1

You’ll have around 5 weeks to study for Step 1 after finishing BOD (Basis Of Disease) and before starting Intro To Clerkships. This exam is the first part of the United States Medical Licensing Exam (USMLE). It tests everything you’ve learned during the first 2 years of medical school: biochem, anatomy, physiology, embryology, pathology, microbiology, pharmacology, histology  (the basic sciences of med school).

Most people would agree that you need 3 important things to study for Step 1:

CORE RESOURCE 1: First Aid for the USMLE Step 1. This is your Step 1 bible. It is a review book organized by organ systems that encompasses virtually everything on Step 1. If you know this book from cover to cover, you will ACE this exam. However (and of course there is a “however”) it is a REVIEW book and most people can’t just memorize it, because the material is presented in its most minimalist form without much explanation. The school will give you this book for free towards the end of your second year.

CORE RESOURCE 2: The second thing you need is an online question bank. The school will pay for 3 months of access around the same time you get your First Aid book. It will be either Kaplan QBank or USMLE World QBank. Most people agree that the best way to study for Step 1 is by doing questions. With these online question banks, you can design your own tests in terms of content and length. The program also keeps track of your progress and shows you which areas you’re weak in.

SUPPLEMENTAL: Since you will come across areas you have forgotten or feel weak in and First Aid is inadequate for EXPLAINING concepts, you may want to consult other sources to fill in those gaps.  Book series like BRS, Secrets, Crush have publications specific for Step 1 (as well as Step 2, Step 3 and your clerkships) that will help you do that. They are so many of these books out there; it’s about finding a format you’re comfortable with so that the material can seep into your brain easily. For example, I love Secrets, because it presents material in a question-answer format and I learn well from that. Again, it’s not important which of these supplement books you use, just find one that you can understand and retain the easiest. One last point: these books are not necessarily for you to read from cover to cover, but just to consult for your weak areas. You should however try to complete the question banks and First Aid.

 

Beginning of June:

·      Take USMLE Step 1

You do your Step 1 in Dubai. The school will pay for the registration fee, one night at a hotel (their choice of hotel, not yours :P), the airplane ticket, and transport to and from the airport. If no spots are available in Dubai, they will send you to another testing center close by, like Kuwait City.

The registration process occurs in several steps: You must first register for an ECFMG/USMLE identification number. [For a more thorough discussion of the ECFMG, see the ERAS section at the end of the blog]. At this point you select a 3-month eligibility period in which to do the exam. For example, I'll pick an eligibility period of May-July to do my Step 1. Next you print out a Verification Form (Form 186). This document has to be signed by both you and the registrar (Raya) and sent back to the ECFMG to verify your attendance at WCMC-Q. Once they receive the Verification Form, they send you a SCHEDULING PERMIT, a paper you print and keep with you. The Scheduling Permit allows you to pick a specific date to do your Step 1 within that eligibility period, for example, June 2nd. This is based on availability of seats within the test center. That is why it is so important to schedule for Step 1 as soon as possible. It is possible to change your test date for FREE online for a certain time period. I'm not sure about the exact time period. Once you get really close to your test date, you have to pay if you want to change the specific date. It is also possible to extend your eligibility period an additional few months, but you pay $50. Just make sure you do the Step 1 before you start your first M3 course, Intro to Clerkships.

 

June:

·      2 weeks of Intro to Clerkships

You’ll do 2 weeks of Intro to Clerkships, which is a course that “prepares” you for your upcoming clerkships by teaching you how to write a progress note, order labs, read an ECG, draw blood, round etc. You will get a tour of the hospital and the course directors will also give you an introduction to their respective clerkships. You are expected to participate fully, but there is no exam at the end of course.

·      2 weeks of Anesthesia Clerkship

You’ll then do 2 weeks of Intro to Anesthesia. It consists of anesthesia lectures. You’ll also learn how to do oral intubations. Pass/fail exam at the end of the course. It's quite easy, but don't take it for granted.

 

July-April or May of next year:

·      Core Clerkships

During this time you will do most of your core clerkships: Medicine, Surgery, Pediatrics, Obstetrics-Gynecology, Neurology, Psychiatry and Family Medicine. That’s 7 MANDATORY clerkships that MUST be done in DOHA. You can get Pass, High-Pass, Honors, Fail or Marginal on them. The breakdown of your final grade is a combination of NBME (National Board of Medical Examiners) shelf exams, take-home exams, quizzes, write-ups, evaluations, and presentations depending on the specific clerkship. The NBME shelf exams are standardized exams for each clerkship that American medical schools use.

There is no clear cut-off between M3 and M4. Most people do the majority of their clerkships in third year and then fourth year is spent doing electives and the remaining clerkships. The reason for this is electives require you having completed certain core clerkships as prerequisites. For example, if I wanted to do a month of pediatric neurology, I may have to have completed my medicine, neurology, pediatrics and OB/GYN clerkships beforehand. I could then leave my psychiatry, family medicine and surgery clerkships for later in the year. The order in which you do things depends on what electives you want to do, which in turn depends on what specialty you want to go into. If you are going into medicine, you would want to do all of your medical clerkships in the beginning, a couple of medical electives afterwards, and then leave things like surgery till fourth year. This would help you get letters of recommendations and experience in your field early on. On the other hand, that would mean you wouldn’t have any experience in surgery, an important clerkship that would supplement your knowledge for Step 2. It’s a delicate balance and you have to make your schedule work for you depending on what your goals are.

 

April or May or June:

·      4 weeks NY Sub-I 

You are required to do a month of sub-internship in medicine or pediatrics at New York Presbyterian Hospital. This is a graduation requirement. If you do not want to travel to the US, you may do it in Hamad Hospital. However, it is HIGHLY RECOMMENDED that you do it in NY so you get US clinical experience, network, and LoRs (letters of recommendation). It’s called a sub-I, because you are treated as an intern (i.e. a first-year resident). It’s just like your medicine clerkship, except you will function as an intern on your team rather than a student. The people in NY take this very seriously and do their best to treat you like an intern, while respecting your limitations as a student. You will notice the difference between how sub-Is are treated compared to med students (if you get any med students on your team). You will have your own list of patients, take all-night calls every four days (you work weekends too), and cross-cover other interns’ lists of patients on your call nights.

This month was by far the best rotation I had in med school. The way it goes depends on you. If you read up on your patients, come up with management decisions, and carry yourself with confidence, people in the hospital will address you as “doctor” and your residents and attendings will gradually give you more and more independence and responsibility. If you act like an intern, you will be treated like one. If you act like a student, you will also be treated like one. This is a great learning opportunity and a chance to mature as a future physician.

Depending on your schedule, you will do it in April, May or June, because the medicine department can only accommodate a certain number of sub-I’s at a time. It sounds scary, but don’t worry. You will have to learn to think independently and make management decisions, but you can always ask your seniors when you’re not sure about something. This holds true at all levels of your medical career, you will gain more responsibility as you go up the totem pole, but when you’re not sure, you ask your intern. Similarly, the intern asks the resident, the resident asks the chief resident, the chief asks the fellow, the fellow asks the attending, and the attending asks other attendings. There is a hierarchy of command as well as knowledge. It’s a support system that allows you to grow as a doctor, but gives you someone to ask when you’re not sure so you don’t kill your patients.

During this month, you will be assessed by everyone on your team, but all the feedback goes to Dr. Mark Pecker, the vice-chair of medicine, who writes your evaluation. YOU ARE BEING WATCHED 24/7 BY EVERYONE IN THE HOSPITAL, BE ON YOUR BEST BEHAVIOUR. I AM *NOT* KIDDING. Be on your toes and make sure you do your work in a timely and orderly manner. Make us proud!

The school will pay for your round-trip to NY as well as student housing for the 4 weeks. You will stay in Lasdon Hall (where NY M3s and M4s live) as a first priority. If no space is available, you will stay in Olin Hall (where M1s and M2s live, which is not as nice, but what can you do). Both buildings are on opposite sides of the same block, right next to the hospital. No stipend will be given, so you’re on your own for food and personal needs.

·      4 weeks elective in the US

The school will allow you an extra month in NY during these three months to do an elective of your choice. Again, the purpose is to get exposure to a field you’re interested in and get LoRs. They will pay for housing in the med student dorms. If you chose to do electives outside of NY, you have to apply to them and cover the cost of travel and boarding on your own. This can come out of your $3000 M4 allowance (discussed later). 

June-September

·      Step 2 CS

Around this time you should also be thinking about your Step 2 CS. Step 2 CS (Clinical Skills) is just like the OSCE exams you do with Dr. Verjee, except you see 12-15 patients. There’s a First Aid Step 2 CS in the library that outlines the details of the exam. It is a pass/fail exam and a graduation requirement IF you plan on doing residency in the US. Most US med students do this exam at the end of their fourth year, because it’s relatively easy and just a residency requirement, nothing more. This exam can ONLY BE DONE IN THE US, THERE IS NO TESTING CENTER OUTSIDE THE US FOR IT. That’s why you should do it when you are in the states, rather than paying for a ticket to come back and do it later. There are several places to do it in the US, some of us did it in Philadelphia since it’s the closest center to NY and the bus ticket costs about $10. People who registered for Step 2 CS late had to fly all the way to Atlanta, because they ran out of seats in Philadelphia (so register early). Just take a bus NY->Philadelphia the day before the exam, stay at hotel near the test center, do the exam the next day, and come back to NY that night. The travel and hotel fees come out of your $3000 M4 allowance (discussed later).

It’s best to do the Step 2 CS after having done most of your clerkships as well as your sub-I so you have a good idea on how to manage patients. Just make sure you do it while you’re in the states and before you graduate so you don’t have to come back for a second trip.

·      Step 2 CK

The Step 2 CK (Clinical Knowledge) is formatted just like Step 1 i.e. computer-based and really long. You also do it in Dubai. The school will pay for the hotel and flight again. (Don’t you just love being a WCMC-Q student, they don’t get that kind of treatment in NY, you know). You also have to go through a registration process identical to that of Step 1. Rather than being tested on basic sciences, you are tested on your core clerkships. That’s why it’s a good idea do it between M3 and M4. It is a graduation requirement, so theoretically you could do it at the end of M4 right before you graduate, as US med students do. However, as IMGs (International Medical Graduate), you have to impress residency program directors with your amazing Step 2 CK scores, because it’s harder for IMGs to get residency spots. Also, you will probably do better if you do this exam right after finishing M3 as all the clinical knowledge is still fresh. Because seriously, by the end of M4, you will be so focused on your specialty, that you will not remember stuff outside of it. If you don’t use it, you lose it.

 

July-Graduation:

·      remaining Core Clerkships

At this point in my M4, I had done Medicine, Surgery, Pediatrics, OB/GYN, Neurology, NY Sub-I, a NY elective, Step 1, Step 2CS. I had Psychiatry and Primary Care as my remaining core clerkships, Step 2 CK as the remaining exam, and 12 weeks of electives left to do. Let’s go through the other graduation requirements you would have at this time if you were in my shoes.

·      ABS requirement

Your ABS (Advance Basic Science) requirement means you have to do ONE of the following before you graduate:

1)    4 weeks of teaching elective

2)    OR ≥8 weeks of basic science research in M3 or M4

·      ABS course

Next there’s your ABS (Advanced Basic Science) course. DO NOT CONFUSE THIS WITH YOUR ABS requirement. This is something totally separate. YOU HAVE TO DO THE ABS COURSE REGARDLESS OF WHAT YOU DID TO FULFILL YOUR ABS REQUIREMENT. In fact it's kind of confusing and they shouldn't give them the same name. This is a 2 week course of video-steamed, video-conferenced, and on-site faculty lectures presenting recent advances in the basic sciences. Basically this means people will talk about their research and tell you about major medical advances that happened while you were in anatomy lab or on call in the hospital over the last 4 years. It’s about 5 hours of lectures a day for 2 weeks (you’re free on weekends) at WCMC-Q. It’s pass/fail and there’s no exam in the end. You do have to do a 15-minute presentation on an assigned topic though. You will spend most of your time working on your ERAS during these 2 weeks :P

·      8 weeks of Doha electives

·      8 weeks of anywhere electives

To graduate, you are required to do 16 weeks of electives in total.

• 8 of these weeks must be done in Doha
  
• 8 remaining weeks can be done anywhere (Doha, US, or other)
  
• First catch: the mandatory month of sub-I discussed doesn’t count towards your elective time.
  
• Second catch: teaching elective, although it fulfills your ABS requirement, doesn’t count towards your elective time.
  
• Third catch: you can only do 3 months of clinical electives in NY state as by law. This includes your month of mandatory sub-I. Research electives in NY state are fair game, though.
  
• Fourth catch: electives done outside of WCMC or WCMC-Q must be approved by student affairs for you to receive credit for that elective. In other words, make sure it’s a real elective and don’t lie about some elective you did when you were shopping in Dubai instead.

If you plan on doing your residency in the states, it makes sense to try and do most of your electives there to get LoRs and US clinical experience. But since your school in is Doha, you have to do 8 weeks at “your school”. You can get around this by doing a teaching elective to fulfill your advanced basic science requirement. A month of teaching elective in Doha counts towards your 8 weeks of Doha time, but not towards your elective time. So after completing 4 weeks of Doha teaching elective, you still have to do 16 weeks of electives, but only 4 of them have to be in Doha instead of 8. This way you maximize your US elective time, do US electives early in your third and fourth year, and get those LoRs early for your residency application (your ERAS). You can then do your Doha electives at the end of your fourth to fulfill your graduation requirements.

·       MPS III

·      Public Health

Lastly there’s 2 weeks of Public Health and 2 weeks of MPS III, I’ll write about these courses once I’ve had them.

AND THEN..…KHALAS BABA!!!!!!!!!!! YOU GRADUATE!!!!!! WOOOOOOOO HOOOOOOOOO!!!!!!

·      Complete your residency application ERAS

The rest of this blog post will discuss ERAS( Electronic Residency Application Service)

OK, get ready for more acronyms than you’ve ever seen or ever wish to see in one area. Virtually all residencies in the US require you to apply online using ERAS. Remember when you sent in your application for college or med school and it contained your personal statement, curriculum vitae, LoRs, paperwork, etc? Well this is the same thing, except it’s all electronic.

First you must register with the AAMC (American Association of Medical Colleges) during M3. The AAMC created ERAS to streamline the residency application and make it totally electronic. The AAMC will then give you an ERAS token number, which you use to register with ERAS. You then spend all your free time up until the September between M3 and M4 filling out your ERAS. Each program has its own deadline to apply for residency and these deadlines vary between November-January. However it is HIGHLY RECOMMENDED that you submit your completed ERAS to all programs on September 1^st, because that is when ERAS first allows you to submit your application. If not Sept 1^st, then as soon as possible. The reason being it is more likely you will get interviews from programs if you show interest in the program early on. The components of your ERAS are as follows:

CAM (Common Application Form): this is just your demographics i.e. you name, birthday, race, contact info, visa status etc.

CV (Curriculum Vitae): this is where you list your work, research, and education experience with the appropriate contact info

USMLE transcript: you give ERAS permission to receive your USMLE scores from OASIS (On-line Application Status and Information System). The ECFMG is where you register for Step 1, Step 2CS, Step 2CK and store you results. OASIS is a part of the ECFMG (Education Commission for Foreign Medical Graduates). You have to give permission to ERAS to receive your Step scores from OASIS as they are an essential component of your application

PS (Personal Statement): this is where you upload your personal statement for residency. Basically, you write your personal statement in Microsoft Word, then copy/paste it on to the PS tab in your ERAS.

LoR (Letter of Recommendation): Most residency programs will require 3 and allow up to 4 LoRs when you apply to their program. Some programs will allow you to send more letters or require letters from specifics specialties. Using ERAS you will “designate a new letter of recommendation writer” by putting down an attending’s name, institution, department, and position. These will be printed onto a cover letter that you put into an envelope and give to someone you want to write you an LoR. They will then tell their secretary to mail their letter along with the cover letter you gave them to the AAMC and it will become a part of your ERAS. You can track whether the AAMC has received your LoRs using the ERAS Support Services section on the OASIS website.

After filling out all these things, your ERAS will be complete. Once you send your ERAS to programs, it must be complete with the exception of a few things: your must have already designated all of your LoR writers, but the letter needn’t necessarily have already arrived at the AAMC. You must have done your Step 1, 2 CS, and 2K, but it’s OK if the scores haven’t arrived yet, you can just put "completed, waiting for results". Once your LoRs and Step scores arrive, they will automatically be sent to the programs you have already applied to, so no need to apply a second time with your updated application. Your dean’s letter, which is sent directly from the school and not a part a part of your ERAS will be sent in October and programs know that, so it doesn’t have to be sent in the beginning of September with your ERAS. The school will take care of it.

Now all that’s left is for you to pick the programs you want to send your ERAS to. Not as easy as it sounds. You do this with FRIEDA (Fellowship and Residency Electronic Interactive Database). Back in M3, I asked the class of 2008 what FRIEDA was and they said it was somewhere they spent every waking hour outside their clinical duties. Naively, I said, “so it’s like facebook?” And in a way it is, because that’s how much time you will spend on it. So just got ahead and replace your bookmark with it. It's basically a compendium of all the residency programs in the states for every specialty. You can view the details on every program and click on links to the specific program website.

For example if I’m interested in general surgery, I would look at all the general surgery programs. They would be presented in a list organized by which US state they’re in. Then I would scroll down to, for example, Washington, and click on the University of Washington surgery residency program, one of the surgical residencies in Washington state. It would then give a bunch of info on it as well as a link to the program’s website so I can read more about it. I would do that for every program I’m interested in. Depending on your specialty, the number of programs can go from 100-250, if not more. So you need to dedicate a lot of time looking at programs and pick which ones to apply to. Also, you have to pay a fee on ERAS for each program you apply to. The more programs you apply to, the more you pay. The price becomes fixed after 50 programs though. You can apply to any state in the US for residency EXCEPT California. To do a residency in California, you need something called a California Letter. You will have to ask student affairs about that one.

Last but not least, the school will allow you to reimburse up to $3000 during your M4 for electives, interviews, and exams fees. This means you have to keep all your receipts and give them to the school once you come back to Doha and they will reimburse you. The premise for this $3000. This is not typically done in most med schools, but then again they don't have to travel to another country to get all this stuff done. Please remember that you will not be GIVEN money to spend, only reimbursement for your receipts. Legitimate reimbursements are related to electives, interviews, and Step exams. For example: hotel stays, airfare, bus fare, registration fees, ERAS program fees, taxi rides for electives/exams/interviews. You can’t put down things like food and haircuts, OK? Just exercise some common sense. And don't worry: you won't be sent on some wild goose chase to get your money back, as long as you have all the receipts. I handed them in and got my reimbursement cheque 2 weeks later, so it's legit.

MORE ADVISE ON SPECIFIC TOPICS COMING SOON!!! STAY TUNED…