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๐Ÿ๐Ÿ•+ ๐–๐€๐˜๐’ ๐“๐Ž ๐๐Ž๐Ž๐’๐“ ๐˜๐Ž๐”๐‘ ๐‚๐•๐Ÿ“„

Updated: Jun 21, 2020

This post is intended for students that are ๐ฃ๐ฎ๐ฌ๐ญ ๐ฌ๐ญ๐š๐ซ๐ญ๐ข๐ง๐  their USMLE preparation to doctors that are ๐š๐ฉ๐ฉ๐ฅ๐ฒ๐ข๐ง๐  this year!!

Some points are easy to improve, other ones require time and hard work, and some other ones you can only do on a specific time of your carrier.

So it's very important that everyone reads this!!

1. ๐’๐“๐„๐ ๐’๐‚๐Ž๐‘๐„๐’

Get GREAT Step scores

I won't talk about this much, since it's the one thing that everyone will tell you, and ๐—บ๐˜† ๐—ฝ๐—ผ๐˜€๐˜๐˜€ ๐—ฎ๐—ฟ๐—ฒ ๐—ฎ๐—ฏ๐—ผ๐˜‚๐˜ ๐˜๐—ฒ๐—น๐—น๐—ถ๐—ป๐—ด ๐˜๐—ต๐—ถ๐—ป๐—ด๐˜€ ๐˜๐—ต๐—ฎ๐˜ ๐—ป๐—ผ ๐—ผ๐—ป๐—ฒ ๐˜๐—ฒ๐—น๐—น๐˜€ ๐Ÿ˜ƒ

If you have attempts or low score in one exam, ๐š๐ข๐ฆ to get an excellent score in the next one. Also Step 3 is ALWAYS a plus!

2. ๐‘๐Ž๐“๐€๐“๐ˆ๐Ž๐๐’

Covid-19๐Ÿฆ  issue: I know now itโ€™s difficult times due to the current pandemic, I heard that some hospitals are starting to accept students for in site rotations and other ones offer tele-rotations.

Iโ€™m not a fan of tele-rotations, but if you really need to apply this cycle and thatโ€™s the only way you can get your US LORs, then there is no option and you will have to do it.

Even though most of them are expensive, itโ€™s not the same as if you are in campus seeing patients. But as I mentioned, if you want to apply this year, thatโ€™s the option.

Always remember your goal here is to impress your attendings and aim to get GREAT PERSONALIZED LORS! ๐Ÿ™Œ โœ‰๏ธ

I'll talk with my PD after I meet him again July 1 about his insights about tele-rotations and make a post about it.

Doctors probably won't specify when they write your LOR that it was a "tele-rotation".

They will say that you saw patients, how knowledgeable and nice to work you are, ways that you impressed them, how you always went that extra mile, etc.

I don't think that will clarify that "tele-rotation", since that's not the main point of a LOR.

The main point is talking about you, how great your are, nice to work with, etc.

Also when you fill out ERAS, you will put "observership" or "clerkship".

Once you are in your interview they may or may not even ask you about it.

I'll soon make a live instagram video on @doctor.sebas clarifying everything about tele-rotation. 

๐ˆ๐ฌ ๐ข๐ญ ๐›๐ž๐ญ๐ญ๐ž๐ซ ๐ญ๐จ ๐๐จ ๐š ๐ฅ๐จ๐ง๐ ๐ž๐ซ ๐ž๐ฅ๐ž๐œ๐ญ๐ข๐ฏ๐ž/๐ž๐ฑ๐ญ๐ž๐ซ๐ง๐ฌ๐ก๐ข๐ฉ ๐š๐ญ ๐จ๐ง๐ž ๐ฉ๐ฅ๐š๐œ๐ž ๐จ๐ซ ๐š ๐ฌ๐ก๐จ๐ซ๐ญ๐ž๐ซ ๐จ๐ง๐ž ๐š๐ญ ๐ฆ๐ฎ๐ฅ๐ญ๐ข๐ฉ๐ฅ๐ž ๐ก๐จ๐ฌ๐ฉ๐ข๐ญ๐š๐ฅ๐ฌ?

It really depends, if you will get 2-3 amazing, personalized LORs from that program and can also get involve in research, then take that longer-elective option. By going to multiple hospitals, you also boost your chances of making more/wider connections.

๐‘๐จ๐ญ๐š๐ญ๐ข๐จ๐ง๐ฌ ๐ข๐ง ๐ˆ๐Œ๐†๐ฌ ๐ฉ๐ฅ๐š๐œ๐ž๐ฌ

Pros: You will make connections, they will get to meet you, and you impress them well enough, you can match with them!

๐Ÿ‘‰This is the option that I recommend the most to ๐จ๐ฅ๐ ๐ ๐ซ๐š๐๐ฎ๐š๐ญ๐ž๐ฌ or people with ๐š๐ญ๐ญ๐ž๐ฆ๐ฉ๐ญ๐ฌ/ ๐ฅ๐จ๐ฐ ๐ฌ๐œ๐จ๐ซ๐ž๐ฌ.๐Ÿ‘ˆ

Cons: If you are applying to multiple places, LOR from this places wonโ€™t count as much a LOR from a top Hospital.

๐‘๐จ๐ญ๐š๐ญ๐ข๐จ๐ง๐ฌ ๐ข๐ง ๐“๐Ž๐ ๐ก๐จ๐ฌ๐ฉ๐ข๐ญ๐š๐ฅ๐ฌ

Pros: A LOR from this places will help you a LOT, even though we probably wonโ€™t match there, it will still help you TONS!

Eg, I got my LORs from Cedars Sinai, #8 hospital in the USA. I really impressed the doctors and they wrote amazing LORs.

Getting LORs from a top place WILL make you a difference, even if they don't won't take you there for residency! 

I knew that I wouldโ€™t match at Cedars since I was doing my research in plastics, and applying to OBGYN, I didn't work much in the OBGYN department, and also they havenโ€™t accepted IMGs for the last 10+ years!


โ€ขRotations in community, IMG friendly hospitals will give you a chance to impress those doctors and match with them.

โ€ขRotations in TOP hospitals will give you a chance to impress those doctors, and match in other hospitals with their LORs.

3. ๐‹๐„๐“๐“๐„๐‘๐’ ๐Ž๐… ๐‘๐„๐‚๐Ž๐Œ๐Œ๐„๐๐ƒ๐€๐“๐ˆ๐Ž๐๐’

Get great, personalized, from US doctors. Programs really donโ€™t care much if we were chair of a deparment in our home contry, or pretty much anything that we did there (except research and residency to some degree).

They donโ€™t know the hospital or the way we do things in our home countries. They want to see that you gained the trust, and impressed US physicians. This is the most important fact after our Step scores.

Also those LOR must be AMAZING!

โ€œGenericโ€ Letters of recommendation are trash. PDs can tell right away when the doctor knows you well and was impressed by you, or he just copied and paste the letter and just changing the name.

If you didnโ€™t do a rotation, then do research and get them that way, or contact family, friends or even people that went to your same medical school and try to see if they can offer help you out with this on some way.

I know a lot of you don't know anyone that pursued this journey and don't have any contacts or connections. It happened to me, and I made groups and chats with students and doctors from my country and now we are the first ones from that group to match, being 7 argentinains matching in different hospitals in the USA :)

Always remember to help yourself and others along your journey!๐Ÿ’–

4. ๐‘๐„๐’๐„๐€๐‘๐‚๐‡

If you are applying for IM or FM then itโ€™s not that very necessity, it will definitely help though. But donโ€™t worry too much about it. It will help you to make contacts, and build a strong CV for sure!

If you are applying to a surgical or another competitive specialty, then research is almost a must.

5. ๐‘๐„๐’๐„๐€๐‘๐‚๐‡ ๐…๐„๐‹๐‹๐Ž๐–๐’๐‡๐ˆ๐

If you are applying for a surgical specialty some programs love to see tons of publications. I wouldn't waste extra time though, time is precious - waste is wisely. Donโ€™t commit for too long if you wonโ€™t get much out of it.

๐Ÿ‘‰If you are a repeat applicant, then you can get a research fellowship to make contacts, and build a strong CV for sure.๐Ÿ‘ˆ

๐ƒ๐จ ๐ˆ ๐ก๐š๐ฏ๐ž ๐ญ๐จ ๐๐จ ๐ซ๐ž๐ฌ๐ž๐š๐ซ๐œ๐ก ๐ข๐ง ๐ญ๐ก๐ž ๐ฌ๐š๐ฆ๐ž ๐ฌ๐ฉ๐ž๐œ๐ข๐š๐ฅ๐ญ๐ฒ ๐ญ๐ก๐š๐ญ ๐ˆโ€™๐ฆ ๐š๐ฉ๐ฉ๐ฅ๐ฒ๐ข๐ง๐  ๐ญ๐จ?

Not necessity, as IMGโ€™s we take what we can. If you can thatโ€™s great, you canโ€™t you are still getting the experience and getting some publications!

โˆ™ Eg, I did research on heart transplant and then on Plastics & Reconstructive surgery, and applied to OB/GYN.

6. ๐๐„๐‘๐’๐Ž๐๐€๐‹ ๐’๐“๐€๐“๐Œ๐„๐๐“

Make sure you really work on it, start from now if you are applying this cycle. I made on my page on what to do till application day and how to use FREIDA.

I will soon make a post on write a ๐๐ž๐ซ๐ฌ๐จ๐ง๐š๐ฅ ๐’๐ญ๐š๐ญ๐ž๐ฆ๐ž๐ง๐ญ and what kind of ๐˜„๐—ผ๐—ฟ๐—ฑ๐—ถ๐—ป๐—ด you should use.

Make sure to have many doctors and also non-doctors reviewing it.


If you are applying to 2 different specialties then you have to make 2 different PS, and get LORs that mention you interest in that specific speciality.


For each speciality that you apply, you need to make a personal statemen, mentioning why you choose it and why you will be excellent at it.

โ€ขExample #1:

If you apply to Internal Medicine and Family Medicine, ask the doctors that are writing your LOR to make them unique for each one.

You will also need a LOR from a doctor of that speciality and just for that one.

โ€ขExample #2

If you apply to OB/GYN and General Surgery.

You can do this: Get a LOR from a general surgeon just for surgery

Get a LOR from a OB/GYN just for OB

The other two can be from any other doctor, and just tell them to change the speciality that you are interested.

โ€ขExample #3

Applying to Neurology & Neurosurgery

Make sure to get one from a Neurologist just for Neuro, one from a neurosurgeon just for neurosurgery

The other two can be from other doctors, that just change the specialty that you are applying.

It doesn't always have to be like that also, I applied for OB/GYN and I had 1 from a OB/GYN doctor, 1 from a plastic surgeon, and 1 from a cardiologist.

As IMGs we need to take what we can, making the MOST out of everything - ALWAYS!

As I mention previously, I'll make a Youtube video on how to work on your Personal Statement & clarify this one more time.

7. ๐•๐Ž๐‹๐”๐๐“๐„๐„๐‘ ๐–๐Ž๐‘๐Š

Many people will tell you that volunteer doesnโ€™t count. Well let me tell you something, starting as a volunteer and working my way up making connections and meeting people is what eventually got me my research position, externship, publications and LORs. You can read on my previous post on how I got my research position.

8. ๐˜๐„๐€๐‘ ๐Ž๐… ๐†๐‘๐€๐ƒ๐”๐€๐“๐ˆ๐Ž๐

As you already know, YOG does matter to some hospitals and they have a cut of depending on how long ago you finished medical school

Some programs only accept fresh graduates. Eg, 1-2 years out of medical school, another programs 2-4 years/ <5 years.

But overall, I would say like around 60% donโ€™t look at that. (Correct me if Iโ€™m wrong).

Now I will tell you something a lot of people do with their YOG.

I didn't know about this when I was a student and also I wouldn't be able to do it myself since I had to graduate and get my license to work in my country ASAP to start making money, since at that time I didn't have almost any money during because I stoped working and my savings were over.

This is what a lot of people do:

They postpone their graduation to study for the steps and also to still be able to do clerkships.

Why do this?

โ€ขPoint #1: They will study for the steps while "still in med school", take the exam and then look as they "just finished school". The thing here is that you total time in school will be prolonged and PD might ask you about this, but I still see a lot of people doing it.

โ€ขPoint #2: As a student you can get so many more Hospitals to rotate and be hands on. Due to liability issues it's very hard to find a "hands on" rotation after you finish school and they are way more expensive after you graduate.

9. ๐‡๐Ž๐Œ๐„๐“๐Ž๐–๐ ๐‘๐„๐’๐ˆ๐ƒ๐„๐๐‚๐˜

I mean hometown residency if you already did your medical residency in another country outside the USA.

๐ƒ๐จ๐ž๐ฌ ๐—ถ๐˜ ๐ก๐ž๐ฅ๐ฉ ๐ญ๐จ ๐ฆ๐š๐ญ๐œ๐ก?

I would say yes - most of the times helps, especially for surgical specialties.

๐—ก๐—ผ๐˜๐—ฒ: If you have hometown residency some programs consider your YOG by the time that you finish your residency, so thatโ€™s good news for all the IMG specialists out there!

10. ๐‚๐Ž๐”๐‘๐’๐„๐’ & ๐€๐–๐€๐‘๐ƒ๐’

Try to take courses and win awards that will improve your CV.

I posted a way to get free ACLS, BLS and PALS.

You can find it on my highlighted stories on my Instagram @doctor.sebas and follow step by step.

Itโ€™s not by AHA. But itโ€™s good to learn life support and also you get the certificate ๐Ÿ™‚ and itโ€™s free!

I think very good thing even though itโ€™s not aha. ERAS doesnโ€™t specify that it has to be by AHA. They just ask if you have it and you can say YES! Once you start residency your Hospital Will pay for those same courses by AHA :)

11. ๐Œ๐๐’๐„ - ๐†๐ซ๐š๐๐ž๐ฌ ๐ข๐ง ๐‚๐ฅ๐ž๐ซ๐ค๐ฌ๐ก๐ข๐ฉ๐ฌ -๐‚๐ฅ๐š๐ฌ๐ฌ ๐‘๐š๐ง๐ค๐ข๐ง๐ 

These factors will mainly count if you are an AMG.

IMGs shouldโ€™t worry about this much really, but if you got great score/ top class ranking/ honors student Iโ€™m sure it will make a difference too, everything good here that adds up makes a difference!

Remember that the way to make a castle is by piling up small bricks ;)

12. ๐๐‘๐„๐‹๐ˆ๐Œ๐ˆ๐๐€๐‘๐˜ ๐˜๐„๐€๐‘

Many programs offer this, mainly for surgical specialties and thatโ€™s a way a lot of IMGs get into the system. It means that they offer you only a PGY-1 year in the program; and then you will have to continue your PGY-2 in another place or maybe there if you are lucky and a spot opens up. A lot of doctors than donโ€™t find a PGY2 position after their prelim year, would apply again to a residency program, but this time categorical. Since now they have 1 year of USCE experience, it will boost their chances of getting a categorical spot.

Something that not many people know is that itโ€™s "FREE" to apply for a preliminary position if you applied for a categorical in that same program through ERAS. 

This is how it works:

You choose the categorical position in ERAS, but also select the preliminary one, and you will only have to pay for one!! I didnโ€™t know this until the moment that I submitted my ERAS payment!! No one ever told me before.

I explain more about difference between categorical & prelim on a previous post.

13. ๐‹๐€๐๐†๐”๐€๐†๐„๐’

Work on your english accent, try to sound very good and understandable.

Many people take courses on how to improve the english accent. If itโ€™s necessary, do it.

Itโ€™s another way to improve a CV and will also help you BIG TIME for you STEP 2 CS exam.

If you can learn an extra language will also help.

Eg, if you are applying in NY and know Spanish it will definitely help. If you are applying in Michigan and know Arabic will help also.

14. ๐•๐ˆ๐’๐€ ๐’๐“๐€๐“๐”๐’

Don't requiring visa will help in some degree. But still there are plenty of IMGs friendly hospitals that sponsor it.

Eg, 33% of the residents in my hospital require visa.

Also I have friends that met their love of their life, married, got a GC, and applied for residency as a green card holder.

15. ๐„๐—๐“๐‘๐€๐‚๐”๐‘๐‘๐ˆ๐‚๐”๐‹๐€๐‘ ๐€๐‚๐“๐ˆ๐•๐ˆ๐“๐ˆ๐„๐’

This will:

โ€ขMake you a better CV

โ€ขBe more unique

โ€ขBe a person more interesting to talk to during an interview and in life in general.

Your hobbies are also something that people underrate, 
but I would say that they are important too and say a lot about you.

If you traveled โœˆ๏ธ๐Ÿ—บ๏ธto 20 countries, or you can make bread๐Ÿฅ– and pasta from scratch, if you read tons of books๐Ÿ“š, made a prothesis with 3D printing๐Ÿ–จ๏ธ, have a yotube channel ๐Ÿ“ฝ๏ธwhere you teach something to people, if you played professional sports ๐ŸŠโ€โ™€๏ธ๐Ÿคธ๐Ÿฟโ€โ™‚๏ธ๐Ÿคบ, etc.

 These are all things that will make you stand up and sound different, bringing that extra spice to the table.

16. ๐˜๐Ž๐”๐‘ ๐–๐Ž๐‘๐ƒ๐ˆ๐๐†

Believe it or not, the way you write and phrase your experience on your CV will change it big time.

If you want to check out my previous posts on I pasted the exact way that I phrased my work, research and volunteer experience on my ERAS CV.

On there 2 posts you will find I what I wrote on my ERAS: 1. How did I get my research position 2. My credentials & Tips to match

I will soon make a free course video on how to MAKE a CV step by step and I will talk about this also.

17. ๐˜๐Ž๐”๐‘ ๐๐„๐‘๐’๐Ž๐๐€๐‹๐ˆ๐“๐˜

This is something that no one is thinking about, but it will help a lot at the moment that you are interviewed, and you must consider it.

As I mention on a previous post:

Start with being nice, humble, willing to help and approach people, also be approachable and kind to others! People can tell when you are doing something because you really mean it , or to take advantage of the situation (specially interviewers).

I know in medical school a lot of people are into themselves, very competitive and donโ€™t like to share things.


โ€ขIf your friend needs your notes because he couldnโ€™t show up to class:


โ€ขIf someone doesnโ€™t understand a concept that you know very well:


โ€ข If you find out but something important:


Program directors and the other interviewers can sense you right away when you are a greedy person, that human that only moves their butt if they need something for themselves.

 Please if you are committed to this USMLE journey, also commit HELPING OTHERS!

These are all ways to IMPROVE a CV, as mentioned I will soon make a free course video on how to MAKE a CV step by step. But in order to fill it up, you need to work on these things!!

Iโ€™ll also soon make a free course on how to improve your interviewing skills and everything about interview season.

If you are a fresh graduate, unmatched applicant, or have low scores, then you can take some time to work on your CV 
to the FULLEST! ๐Ÿคพ๐Ÿปโ€โ™‚๏ธ๐Ÿคพ๐Ÿปโ€โ™‚๏ธ๐Ÿคพ๐Ÿปโ€โ™‚๏ธ

I understand that now we can't do much due to COVID, and some students can't apply this year because they don't have their STEP 2 CS and they don't fall into any pathway

ECFMG stated on their website that the 5 pathways options are only for this year applicants.

I would recommend those people to work on their CV for next year.

You can work and boost any point that I mention previously, don't just stay home playing games, "waiting for a miracle to happen" or a "hit or luck".

Miracles happen to those that work hard for them, not to those that just wish for them. ๐Ÿ’ซ๐Ÿ’ซ ๐Ÿ’ช๐Ÿ™ ๐Ÿ’ฅ๐Ÿ’ฅ ๐Ÿ™Œ โ˜€๏ธโ˜€๏ธ

Positivism, staying focused, disciplined, not listening to negative comments, working hard and remember your purpose is what will make you get there!

I know also that this year seems kind of a lost year for some people, and means we are adding one more gap in our CV. But if you work on the things that I mentioned - It won't be considered a "GAP time" or a "RED FLAG".

Covid is not an excuse to not improve your CV, of course you can justify not having US rotations or research due to Covid and PD will understand that completely.
But they won't understand why you didn't improve all the aspect of your CV!

Some people after all this hard work will call that you 
"have luck", they don't know how much sweat, tears, pain and gain are behind that "luck" that they are talking about.

Guys one more thing:

Please do learn how to search and find information by your own, the reason I created my page is to put everything together here. But I get tons of โ€œgoogle questionsโ€ that you can eaily find the answer by pasting it on google; If you want to impress people, do your homework first!

Itโ€™s not about impressing me or not, I donโ€™t care about that, but if you get used to doing your own research and your own homework, thatโ€™s the way that you:

WILL IMPRESS the DOCTORS and get GREAT PERSONALIZED Letters of Recomendation.

Iโ€™m not telling you itโ€™s going to be easy. Iโ€™m telling you itโ€™s going to BE WORTH IT.

Also make sure to read all my previous posts on, Itโ€™s all USMLE, consice stuff, that I wrote to help you be different, make the difference, and have everything that it takes to MATCH in the USA!

Another point that I look for when writing my posts is to help you to evolve and become a better version of yourself, more kind & humanistic.

Hospitals are not looking for ROBOTS ๐Ÿค– to see their patients.
They are looking for HUMANS with a big heart ๐Ÿ’–, empathy and kidness ๐Ÿ™Œ 

As you probably have seen in other pages, you won't find anywhere else all this info together, knowing this stuff ahead of time will help you and your mates.

Support my work & help your friends by sharing my post with them on groups :) 

Love you all!๐Ÿ’–๐Ÿค—

Thank you for all your nice messages with so much love & support! ๐Ÿ˜๐Ÿ™

Sebastian Arruarana, MD

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Dec 20, 2023

We are currently looking for providers across the USA. We provide medical billing, coding, credentialing, and licensing services. If you partner with us to bring in more clients, we offer a very good percentage for each client that comes with your reference. Your job will be to bring in clients, and we will provide the services to them. You'll receive your percentage every month from the revenue we generate from that provider. All transactions will be transparent. We can provide copies of the company registration, IRS documents, and all certificates, as well as references from providers we are currently working with across the United States.

Let me know if we can discuss this further in a quick Zoom or callโ€ฆ


Sofรญa Salvia
Sofรญa Salvia
Oct 28, 2023

Hola! Soy estudiante de medicina en la UBA Argentina, en mi รบltimo aรฑo y buscando informaciรณn sobre la residencia medica en estados unidos, en OB GYN tambiรฉn. Quisiera saber si es posible quedar en los hospitales Ivy League o si directamente es imposible como IMG. Debo estar en el 1% mejor de mi clase, eso cuenta de algo? Tambiรฉn quisiera saber si es verdad que Stanford no te da LoR como dice en la pรกgina: GRACIAS!!!!


Thank you so much for sharing all these points and jotting it down together!


this is amazing dr sebas


Frank Carrijo
Frank Carrijo
Oct 29, 2020

WOW.. I don't even know how to begin explaining how amazing this post is, one of the best blog post I have read on the subject so far. I wish I had seen this much earlier. Thank you doctor Sebas. You really are helping all of us in a huge way...

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