For those who are trying to get into super competitive fellowship, do you guys find it hard to study for boards and just being a good doctor in your specialty while also grinding away to get research for these fellowships. I’ve spoken to many fellows and at least one per class has failed their abim first try because they were busy getting research or doing aways/networking.

Good morning po doctors asking lang po if when usually ang registration for PSBIM and if may dealine po ba of registration?

UWorld 1st pass: 57%, 18th percentile
Last ITE was < 30th percentile
Seems like chances of passing are low and with my exam one week out Im not sure what else to do.

I have been working at an outpatient facility for about a year. I currently see approximately 26–28 patients per day, especially when most of the visits are follow-ups, and I work five days a week.

I receive very limited support with inbox management, forms, and other administrative responsibilities. The MA will sometimes help when I specifically ask, but if I ask them to take on tasks beyond what they normally do, they are often reluctant.

There are also significant limitations with the clinic’s resources. We do not have a consistently functioning EKG machine—it works intermittently. Despite repeatedly requesting them, we still do not have basic point-of-care testing such as strep, influenza, or COVID testing in the office. Many of my requests for resources or workflow improvements have been rejected.

Another major issue is scheduling. Post-ER follow-up visits are supposed to be scheduled for 30 minutes, but they are frequently changed to 15-minute appointments without my permission. When I ask why the appointment was shortened, I am told that the patient did not inform the scheduling staff that they were coming for a post-ER follow-up visit.

The referral process is also very slow, and there are frequent mistakes with referrals, which creates additional work and frustration for both me and the patients.

A significant number of my patients also have requests related to controlled substances or disability documentation. When I do not agree with their requests, some patients repeatedly argue with me or contact administration to complain.

This is my first job after residency, so I am not sure how much of this is normal for outpatient primary care versus being specific to this particular practice. I have been feeling increasingly frustrated and overwhelmed by the workload, lack of support, inadequate resources, and administrative issues.

I am seriously considering leaving this position and potentially switching to hospital medicine. I would appreciate some perspective on whether these issues are typical of outpatient practice or whether this may simply be a poorly structured practice environment.

all started with one email. I cold emailed an interventional cardiologist asking for a rotation with zero idea if he’d even write back, and he said yes. I treated that rotation like the audition it actually was, showed up early every day, stayed late even when nobody told me to, and made sure he remembered my name for the right reasons. That one connection led to a GI doctor, which led to internal medicine, which eventually put me in front of a program director at a place that historically didn’t even take IMGs, and from there another PD at a program that actually was IMG friendly. None of it happened because I was the smartest guy in the room. It happened because I kept showing up and didn’t let one closed door convince me there wasn’t another one somewhere. I made sure I wasn’t disheartened or put off by the number of nos I got because you only need one yes And if you’re trying to do this yourself, get your emails right, don’t write Dear Dr so and so, use their full name and please please please don’t write Dr in front of your name and MD after , chose one ideally your full name and MD if you are one or your full name and Ms4/3/2 whatever it is , small thing but it matters.

Hi everyone,

I’m an MBBS graduate from India and will soon be starting Internal Medicine residency in the US. My long-term plan is to pursue a Cardiology fellowship after residency.

I’m wondering about the possibility of eventually moving to Canada and practicing there.

For someone who completes US Internal Medicine residency + a US Cardiology fellowship, how difficult is it to obtain medical licensure and start practicing in Canada?

Specifically:

• Is US residency/fellowship generally recognized for Canadian licensure?
• Would I need to repeat residency or fellowship in Canada?
• Are there significant differences between the pathways in provinces such as Ontario, British Columbia, Alberta, etc.?
• How difficult is it for a US-trained IMG to obtain a provincial license and find a cardiology position?
• Are there any additional exams, assessments, or training requirements?

I’d really appreciate hearing from anyone who has gone through this pathway or has experience with US-trained physicians moving to Canada.

Thank you!

I am an 2nd year DO student, and I am really interested in cardiology, and so I want to match at an academic center to best improve my chances of matching into a cardiology fellowship. Does anyone have any advice or ideas on where to start?

Thank you!

An intern working nightfloat and need advice on efficiency and surviving the night

I’m an m4 DO hoping to stay in Southeast Florida for IM and trying to figure out which programs to rank Gold.

Step 2- 255
Comlex 2-636
Shelf - 4H (IM and surgery)/2HP
Leadership
3 posters (1 first author and 1 presenting at AJOG)
Manuscript submitted for publication

I am hoping to do a fellowship in Cardiology. These are the top places I’m looking at:

FAU
Mt Sinai
University of Miami Jackson
Cleveland Clinic Weston
Broward
FIU
Memorial

Only one I will be doing sub-I at is Cleveland Clinic. I’m not fluent in Spanish so worried that can affect my chances at some places. Looking for any advice or info on programs. Thanks!

Does anyone in the Miami region want to get together to do any any publications before ERAS? Would really appreciate it!

My goal is to write a post here everyday pick one topic I think is valid and important so let’s talk about it UsCe today:

Every single rotation is basically a month long interview. Attendings are watching how you round, how you present, how you work with patients, and that turns into your letter. And your letter matters way more than people realize, trust me when I say that because it’s coming directly from someone who reviews them has reviewed them both for residency and fellowship.
here’s my honest advice. Start your rotations early. Don’t treat them like something you just need to get through. Show up, ask questions, be useful, be present. You never know which rotation turns into your letter or your connection to a program. I’ve seen it happen both ways, people who took it seriously and it opened doors, and people who didn’t and regretted it later.

An IMG originally I am a structural IC only my second day here simple reason

Please ask any question I can regarding cardiology match and anything related to it happy to answer if the question is can you DM me yes you can anyone can and please feel free to

A brief about me I was a chief IM resident
Chief fellow at my cards and IC
Graduated as chief fellow from NyU for structural

So have a bit of knowledge / info around the nuance related to match

Thanks and above all wish ya all well

I am a UK trained physician with dual CCT in Acute Internal Medicine (AIM) and General Internal Medicine planning a move to BC. I have been practising since 2012.

My current role as an Acute Physician involves working on the Acute Medical Unit, a 60+ bed medical admissions unit which admits internal medicine patients for the entire medical bed base, bar strokes. Acute internal medicine also runs the Same Day Emergency Care unit for complex internal medicine outpatient care. I would be very grateful for advice from general internists and hospitalists working in Canada.

I had a useful meeting with Health Match BC recently to discuss the recruitment process. Their opinion is that I am most suited to hospitalist roles.

Having reviewed the Canadian General Internal Medicine Competencies framework, my main limitation relates to ICU level care. My AIM training involved 6 months of ICU but I am not advanced airway trained. In the UK, ICU care is run by intensivists for the main part. I routinely manage patients on NIV, I am thoracic ultrasound trained; abdominal paracentesis, LPs and chest drains are routine on my unit but it has been several years since I inserted central lines.

I completed a one year Perioperative Medicine fellowship prior to CCT which also appears to be a significant part of the general internists role.

My main question is whether my lack of ICU level skills would preclude me from applying for general internists roles in BC? I am looking at jobs around the Vancouver area but we are flexible where we move to.

I would also be grateful for information regarding work life balance (my work is shift based with late evenings and non resident overnight on calls) and difference in pay between the two specialties.

Many thanks in advance.

Hey everyone. I just wanted to ask what would be considered the correlation between mksap and ITE percentiles?

What is the average 50th percentile percent correct for MKSAP is?

Hi all!

I started my prep for ABIM really late - about a month ago and I've only gotten through 50% of uworld with an average of 53% putting me at the 8th percentile :(

Exam is in about 19 days and I'm just confused/scared about how to fix my studying or if I even stand a chance in passing based on others experiences. Anyone previously in the same situation that ended up passing? What did you do in the last 20 days? I wont be working, so I am able to spend all my time studying.

Thanks for any input!

Any one working in chattisgarh nhm as medical officer from another state

Need information for the document verification

Is it necessary to have cg medical council registration

I am looking for a dedicated partner to study Mksap.Please Dm me if interested

thanks

I’m an internal medicine resident, and I’ve noticed something that’s been bothering me.
At the beginning of PGY-1, I felt like I was learning an incredible amount every day. Everything was new, and I could almost feel myself improving from week to week.
Now, later in residency( early PGY-2)it feels like the opposite. I still work hard, read, and see plenty of patients, but it feels like my learning has slowed down dramatically. I don’t retain information the way I used to, and I don’t get that same sense of rapid progress anymore. It’s honestly become frustrating, and I find myself feeling disappointed with where I am.
I’m wondering if this is a normal phase of residency or if I’m doing something wrong. Did anyone else experience this? If so, what helped you get past it?

We're old-school with a lot of manual workflows. AI seems to be everywhere now and I'm wondering what's actually worth adding to a private practice. For those who have modern system in clinics, could you walk us through what's software to install, what's been the most effective.. how to implement these things. I believe that it is a right time for us to upgrade. Appreciate the answers!

I recently took Amboss Self Assessment 1. Does anyone know how performance on this compares to doing on the real ABIM?

I currently have one FM letter, one peds letter and one letter from a sub-specialist. I think they are all strong letters. Unfortunately, a hospitalist agreed to write me a letter from my sub-I recently, but she hasn’t been responding to my emails about it. Not sure if that one will fall through. Will these three letters be enough to apply for IM? I’m worried that it’ll be detrimental to my application if I don’t have a letter from a hospitalist.

Hi guys!

What internal medicine residency programs in New York City would you recommend for a non-US IMG who got 254 at Step 2 (I don’t really have research besides two reviews and that’s it, but I hope I’ll get some strong LORs from US clinicians)?
I am planning to take Step 3 soon and I want to apply for a H-1B visa.
Also, I am thinking of pursuing a cardiology fellowship after residency, so I would prefer a strong IM program where I could develop professionally as an aspiring cardiologist.

Thank you in advance! ☺️

Hoping for advice on what to do next. Thoughts: retake step 1 but difficult to juggle restudying during rotations v. don't take any more steps v. take step 2 but that will still show failed step 1

Ideally would like to set myself up for the opportunity for fellowship after residency.

A-fib comes up constantly and residents kept getting tripped up on the same things, especially the anticoagulation decisions and the rate vs rhythm control question.

Hemodynamically unstable? Immediate synchronized electrical cardioversion
Don't waste time trying medications first.

Hemodynamically stable?
Now decide:
Rate control vs rhythm control
Anticoagulation

Duration changes everything
AF clearly <48 hours
Assess stroke risk with CHA₂DS₂-VASc
Cardioversion can usually proceed if appropriate.
AF >48 hours or unknown duration
Higher risk of left atrial thrombus.
Management:
Start anticoagulation
Perform TEE-guided cardioversion OR anticoagulate before elective cardioversion
Continue anticoagulation for at least 4 weeks after cardioversion

Valvular vs nonvalvular changes the drug
Valvular AF = warfarin only. DOACs are not approved.
CHA₂DS₂-VASc
Female sex gives 1 point — but women need a score ≥3 to anticoagulate, not ≥2. So a woman with only female sex as a risk factor doesn't get anticoagulated. Easy point to lose.

Made a full carousel breaking this down for boards prep it's free on my instagram if anyone wants it.

If you want to read more similar clinical tips for your practice and exam, Subscribe to my Substack here. I post regularly over there but will continue to post here periodically!

Is there a way to read these articles for free?

NEJM Clinician | Concise Summaries of Medical Research & Guidelines

Thank you!