# (A lot of)Confusion regarding training/practice abroad.



## -Rip-

I'm having a lot of confusion regarding how it really works. I tried asking around but got bits and pieces of information and not a full image. There are lots of terms that I don't clearly understand too.

Here is little background information about me that might be needed to answer. I'm a 2nd Year MBBS student at LMDC, Lahore. Pakistani citizen(only). I did average(not quite good) in first year, but plan to do better from now on.

The questions:

1. What exactly are you talking about when you say 'residency', 'electives', 'house job' and 'internship'?
- What I understand is, Residency and House Job is the same thing. Which is practicing medicine at a hospital under supervision of a senior doctor. We get payed(sometimes not) and the time spent counts in enabling us to practice independently.
- Electives and internship also is same. Which is watching a senior doctor doing his job(the field we chose) in which he might teach us a little bit and question as it happens in our weekly hospital visits. We don't get payed and might have to pay some fees to register as in internee and the time spent would only give us certificate stating the we did an internship at that hospital for x amount of time.

2. Is the house job related to MBBS degree? Do we get it after passing the final year exams or after completing the house job? Are we required to complete the house job before being eligible to practice medicine? Is there any specific time period for house job? Or is it considered done on discretion of the supervising doctor?

3. Would it help doing electives/internship in any Pakistani hospital in securing residency abroad? Which time do you think might be good to go and do internship abroad(3rd, 4th, final, or after mbbs)? I read somewhere that doing internship at 3-4 reputed hospitals helps in securing residency. Do you think its true? If yes, how did the guy do so many? Would he have started from like 2nd-3rd year class, doing each a year?

4. How do I do internship abroad(I still have B1/B2 USA visa till probably 2013-2014)? Does our performance in locals university exams have any effect in getting internship? Or any other factors? Are there any other special expenses(like fees) other than housing, travel, food etc?

5.* Getting Residency abroad:*
- Are we required to(or would it help to) do residency in Pakistan?
- I've heard that UK and USA are best places to go for training. About UK, people say its close to impossible to get a residency there. Is it true? About USA, its comparatively easier and so I read a little about it.
- *USMLE:* When can we appear in STEP-1(after 3rd year or after MBBS)? When do you prefer it? Can we retake it without consequences to improve the score(like in SAT) ?
- People say its easier(and preferable) to get residency in research rather than clinical. What exactly are you referring to when you say 'research' and 'clinical'?(It would be helpful you could tell me a little about research internship aswell)
+ What I understand is that research is like PhD, that you have a some problem/topic and you need to to do some research to provide a solution. In this case, probably assist the senior doctor involved in research. And Clinical being stuff like specialization in some surgery or becoming a practicing physician.
- After completing the residency in US, am I eligible to practice in US? Would I be able to get a job etc and work on getting resident status and later, migrate? Also, Am I eligible to practice in Pakistan? If do specialisation in US, would that be considered, equal to or preferable specialisation(FCPS) done in Pakistan? Or would I be required to do residency again in Pakistan to be considered a specialist? Is research oriented residency like a totally academic field?


I think thats about it. I probably had a few more question but i can't seem to remember what they were related to  .


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## Waleed90

Hey there Rip! You got yourself a pretty long first post here lol. Let me try to help you out a bit. 



> 1. What exactly are you talking about when you say 'residency', 'electives', 'house job' and 'internship'?


 First of all, you pretty much have the basics of a House job and Residency down. You should know that House jobs are for those who graduated from a Pakistani med school and typically run for 1 year. This will enable you to practice Internal Medicine in Pakistan. If you want to specialize in something like Radiology or Neurology then you will be required to enroll in some other programs. I'm not to familiar with the whole process in Pakistan so I cant say much. 
Residency is for those who want to practice medicine in the US and they typically run around 3 years. Further specialization will then require an additional 2-4 years depending on what you want to do. Also all residencies in the US are payed. 
As far as electives and internships go, there are 2 types of electives: Clinical and Research electives. In order to apply for an elective you must be a current medical student. If you are applying for a clinical elective you must also have completed at least one year of clinical rotations at your college before applying to an elective program in the US. At least, that is what is typical for most US elective programs. Remember also that clinical electives at most institutions have a tuition fee. Internships are different from electives because, you actually get credit in your home college for completing clinical electives at an outside institution. Internships are usually something you do separately.



> 2. Is the house job related to MBBS degree? Do we get it after passing the final year exams or after completing the house job? Are we required to complete the house job before being eligible to practice medicine? Is there any specific time period for house job? Or is it considered done on discretion of the supervising doctor?


 Yes, the house job is related to MBBS in that you must complete a year of house job in Pakistan in order to begin practicing yourself. As I said earlier I'm not to familiar with the system in Pakistan but, from my understanding you apply for a house job after you graduate from your medical college. Some people may get it in the same hospital that is affiliated with their school and others may get it some where else. *You do need to complete house job before you begin practicing by yourself*. You could apply for house job whenever you want really but, it would probably be easier to get one if you apply earlier rather than later. 



> 3. Would it help doing electives/internship in any Pakistani hospital in securing residency abroad? Which time do you think might be good to go and do internship abroad(3rd, 4th, final, or after mbbs)? I read somewhere that doing internship at 3-4 reputed hospitals helps in securing residency. Do you think its true? If yes, how did the guy do so many? Would he have started from like 2nd-3rd year class, doing each a year?


 To be honest, doing electives or internships anywhere will always be a benefit. However, I would recommend that you try to do them in the US because that will give more of an advantage compared to doing them in Pakistan. You can start doing Research electives as early as after First year in the vacation period. Clinical electives cannot be done until during or after your first clinical rotation year. Of course, if you are dedicated you can complete 1 elective per year and maybe even two if you can get the timing right! Since you are in your 2nd year I would advise you to begin looking into doing some research electives especially in the US if possible. 



> 4. How do I do internship abroad(I still have B1/B2 USA visa till probably 2013-2014)? Does our performance in locals university exams have any effect in getting internship? Or any other factors? Are there any other special expenses(like fees) other than housing, travel, food etc?


 There is a nice thread about this right here: http://medstudentz.com/medical-students-area/34-how-i-obtained-clinical-research-experience-us.html. This should answer most of your questions about getting an elective in the US.



> 5.* Getting Residency abroad:
> - Are we required to(or would it help to) do residency in Pakistan?
> - I've heard that UK and USA are best places to go for training. About UK, people say its close to impossible to get a residency there. Is it true? About USA, its comparatively easier and so I read a little about it.*


 Well, if your mind is set on doing residency in the US, then there is no need to complete a house job in Pakistan. It is definitely not required and probably wont help that much either. Focus on doing research electives and clinical electives during your time in med school. That will help you most. I don't know about the system in the UK so I can't really compare the two countries but, I can tell you that Pakistani medical graduates get accepted into residency programs across the US every year. 



> - *USMLE: When can we appear in STEP-1(after 3rd year or after MBBS)? When do you prefer it? Can we retake it without consequences to improve the score(like in SAT) ?*


 You are eligible to take Step 1 once you have completed all your basic sciences courses in med school. So, I would say after your first 2 years probably. However most students tend to take it after they graduate or in their final year to allow ample time to study. You will want to ensure that you are well prepared for the USMLE because *you are not allowed to take it more than once if you pass it but do not get the score you wanted*. You are stuck with whatever score you get for about 8 years, last I checked. If you score less than a set minimum, then I believe you can retake it, otherwise if you score an 80% but were aiming for a 90% you are not allowed to retake. 



> What I understand is that research is like PhD, that you have a some problem/topic and you need to to do some research to provide a solution. In this case, probably assist the senior doctor involved in research. And Clinical being stuff like specialization in some surgery or becoming a practicing physician.


 I think you pretty much have the point there. Clinical electives are similar to what you will do in your rotation years in med school.



> After completing the residency in US, am I eligible to practice in US?


 Absolutely! That is what residency is all about! If you don't want to do any further specialization you can apply for a job and possibly get green card and such. Also, you will also be eligible to practice in Pakistan too! I'm pretty sure if you do specialization in the US you keep it in Pakistan as well. 

I hope I helped clear some of your confusion. I'm no expert but I did the best I could! Good luck with your studies. #happy


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