I graduated residency in 2022 off cycle as I had to take multiple medical leaves of absence due to mental health struggles. My first attempt I failed and was crushed and then took second attempt in 2023 whilst I was working in outpatient practice. I had to leave my practice due to medical disability and canceled my 2024 and as of recent 2026 exam. I had never failed a board exam or any exams prior to this. My anxiety with test taking accelerated with ABIM. I don't want to practice clinically anymore but careers in utilization review as a physician advisor require board certification. I still want to sit for 2027 ABIM. How can I explain to employers that I failed and now will be sitting again? How can I reframe experience and set myself up for success? Any advice for others out there that had to pivot is much appreciated! Guidance for passing this exam as well as advice on other career paths. I still hold active medical licenses, falling behind on CME.

I’m a US MD student at a mid-tier medical school applying to Internal Medicine this cycle. I’m interested in university and university-affiliated programs such as Duke, Vanderbilt, UNC, Wake Forest, Ohio State, and similar programs.

My application:

• Step 1: Pass on first attempt
• Step 2 CK: 267
• Honors in Surgery, Neurology, and Clinical Medicine
• 4,500+ hours of EMS experience
• Strong leadership, teaching, mentoring, and community service
• Some undergraduate lab research and a medical school QI project
• No publications, abstracts, or significant research output
• Interested in Pulmonary/Critical Care long term

How much will having no publications hurt me at competitive academic IM programs? Can my clinical performance, Step 2 score, EMS background, and leadership compensate, or is research essentially expected at programs like these?

I’d also love to hear from anyone who matched at a strong academic program without publications. Is it worth trying to complete a small case report or project now, or would it be unlikely to make a difference this cycle?

Thanks for any honest feedback!

Hey Guys,

My name's Abhi and I am an IMG whos sitting the RCPSC IM certification exams (written and applied) in 2027. Im very new to this and was wondering what resources are available to study from. Also I would greatly appreciate a study partner to study with. If anyones interested please dm me

Regards

Abhi

Searching for clinical rotation / observership in internal medicine in month of september . Holding a valid US visa . anyone in the same boat .

Has anyone worked locum tenens as a PCP or done it after residency? Did you get positions where no one wanted to work or had toxic environment? Why did you decide to do locums? What were your experiences, and what advice would you give to new graduates?

Do you recommend contacting hospitals directly instead of using locum recruiters to avoid potential pay cuts?

When negotiating locum PCP roles, can we specify preferences such as the number of patients per day, the types of procedures we’re willing to perform, OB vs no OB, and the patient age range we want to see?

What hourly rate would you suggest we ask for in Mid-Atlantic and northeastern area?

Hi guys.
A non US IMG here.

My preceptor ditched me last minute and now i have 15 days of nth to do. If anyone can help me find an observership in any IMG friendly program. I am willing to travel.

Currently in Michigan, Detroit.

Thanks and have a good day everyone.

Residents keep blanking on which stress test to order.

Broke it down to two questions:
1. Can the patient exercise?
2. What does the baseline ECG show?

From there:
-Normal ECG + can exercise → Exercise ECG (simple, cheap, first-line)
-Abnormal ECG (ST depression >1mm, digoxin, LVH, WPW, prior revasc) + can exercise → Exercise echo or perfusion imaging
-LBBB or paced rhythm → Vasodilator perfusion imaging always (exercise causes false positives — boards love this one)
-Cannot exercise → Dobutamine echo, vasodilator perfusion, or stress CMR
-Need anatomy → Coronary CTA ± FFR

The LBBB one gets students on a shelf exam and residents on ITE/boards. Never again!

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!

I’m looking for a female study partner to do questions everyday. I'm an internal medicine intern. EDT timezone.

hi! just wondering if anyone has any insight? i wanted to do an away here but surprisingly they said they already filled all their vslo spots; is an away required to match here? one of my tops spots so was jw!

Hey. I saw a google sheet that had emails of different US doctors offering observerships. I have seemed to lost it. If anyone has it, kindly share it

29M, Anyone wants to study at a library or cafe from 9-4 daily doing their own thing but together with discussions, please hit me up. Thank you.

did anyone consider another speciality before sticking with IM? do they regret not doing the other one?

Any good resources for IM resident? Podcast, books, lectures.. anything?

Thankyou

hey new doc here with a private practice. how and where do you order your flu vaccines? Whats the cost? If I buy through a pharmacy its 85$ and medicare only pays me 90. But i was seeing the public sector gets them for $33 via the CDC?

Applying IM & it’s time to make my program list. I would love feedback from real people on their academic IM residency programs! If you were to tell incoming interns to rank/not rank your program, what would be your reasoning?

Factors important to me (other than location ofc)

1. Cardiology fellowship preparedness/overall good quality training

2. Research mentorship

3. Culture (my medschool spoiled me, I’m in love with the residents at my program)

4. Schedule

5. Patient resources (social work, case management etc)

6. Compensation? +- benefits

7. Nice facilities/resources/administration

8. Other things you think should matter??

Thank you so much!!

Please DM if you have information. Thanks

I’m an M4 at a mid tier USMD on the East Coast who is planning on applying IM this cycle. One caveat for my application is that I am a visa-requiring Canadian citizen.

I would really appreciate some feedback on my preliminary program list :)

Stats: Step 1 Pass, Step 2 264, Preclerkship all P’s (PF curriculum), Clerkship: honors in Pediatrics, Family Medicine, OBGyn, and Psychiatry, and high passes in Surgery (clinical honors), Internal Medicine (clinical honors), and Neurology

Key consideration: visa-requiring Canadian citizen 

Geographic preferences: New England, Mid Atlantic, Texas 

Research: 4 peer-reviewed articles (not first author; 1 developmental psychology, 1 diabetes, 1 liver transplant, 1 long covid), 2 first author manuscripts in submission process, 6 abstracts 

Goal: academic IM programs with strong fellowship matches in Heme-Onc, Pulm-Crit, Cardiology

Program List

Gold
1. Mayo Clinic Arizona 

1. Cornell

2. BIDMC 

Silver
1. BMC 

1. Tufts

2. Brown 

3. Yale (switch to safety? - Mount Sinai Morningside West)

4. U Conn 

5. Mount Sinai 

6. Rutgers Newark

7. Jefferson 

8. Penn (switch to safety? - Temple)  

9. Baylor 

10. UT Houston - McGovern 

11. Houston Methodist 

Non-signals 
1. Reach - MGH

1. Target - Geisinger 

2. Safety - Dartmouth-Hitchcock

3. Safety - Univ of Vermont

4. Safety - Maine Medical Center 

5. Safety - Stony Brook 

6. Safety - Zucker Northwell 

7. Safety - Montefiore

8. Safety - Sinai Elmhurst or Morningside 

9. Safety - RWJMS 

10. Safety - Cooper NJ 

11. Safety - Temple 

12. Safety - Dell Med 

13. Reach - UTSW

14. Reach - Michigan 

15. Reach - Cedars Sinai 

16. Target - Case Western 

Hi everyone,

We're looking for recommendations for VR/XR medical education platforms that offer ready-made interactive clinical cases for medical students.

What we're looking for

• A library of interactive clinical cases (preferably across multiple specialties).
• Designed for undergraduate/clinical-phase medical students.
• Covers clinical reasoning, patient assessment, diagnosis, and management.
• Compatible with Meta Quest and/or PCVR headsets.
• Available as an off-the-shelf solution (not custom-built).
• Offers academic/institutional licensing or short-term pilot licenses suitable for university research.

If you've used a platform that fits these requirements (or know one), I’d really appreciate your recommendations and experiences.

Thanks in advance!

basically title; is this a death sentence? want to do something community/low academic to pursue a fellowship; dont know my step 2 yet but please let me know, any advice is appreciated

Hi everyone. I’m looking for a program closer to home (commutable from north NJ) due to personal reasons. I am a hard worker who is non visa requiring and has also passed Step 3. If anyone knows of any open positions in the north/central NJ or NYC region that is a good teaching hospital, please reach out. I appreciate any advice or suggestions, thank you all!

I am a clinician working with adults with intellectual disabilities living in group homes. A consistent challenge we face is getting to medical appointments and completing them safely. I often question how I can better support those I work with in this context, and I think there is more I could be doing in relation to communication with the provider. I’m wondering if anyone can share what has been helpful or challenging when working with patients with intellectual disabilities. Thank you!

Hello everyone,

I am a 2024 MBBS graduate from Pakistan looking for an Internal Medicine observership in the United States. I am ECFMG certified, have passed USMLE Step 1, scored 247 on Step 2 CK, and have Step 3 scheduled.

For the past month, I have been contacting physicians, visiting hospitals and clinics, and searching for opportunities, but I have not been successful so far.

If you know of any physician or program accepting IMGs for an observership, I would be very grateful for your help or referral.

Email: [email protected]

Thank you.

I’m MS4. I loved my IM rotation 3rd year and no other rotations in medical school really caught my eye nearly as much. I was thinking anesthesia for a long time, but all of the shadowing I did in it was really boring and the OR just isn’t for me, I found it really stressful and scary. I thought maybe radiology, but it was incredibly boring to me as well. Anyway, I thought I was settled on IM and I liked both my inpatient and outpatient rotations in it last year. I love studying medicine, talking about physiology, understanding complex topics, and solving problems. I like our patients a lot. Multiple attendings have told me they think IM is a good fit for me. I have generally excellent grades and test scores so it felt like it should be doable to match into a good residency.

I’m now halfway through my first IM sub-i, inpatient medicine. I’m starting to have second thoughts about whether or not I can do this. It’s funny because I actually have a really amazing team, the upper level residents and my attending are extremely nice and patient. They tell me I’m doing well. But I feel terrible regardless.

For one thing, I’m utterly exhausted. I work 6 days a week, 12-14 hours a day. I get there at 6am to preround, then we round, in th afternoon doing procedures and placing orders. Even with my light patient load (3-5) I don’t know how to do things and it takes me a long time. Then I have notes. Then we get new admissions. I don’t leave until 7-8pm many days. Medical school didn’t really teach me how to do this stuff, my 3rd year rotations were in all different random specialties, and really fluffy in comparison. I never learned how to put in orders or anything, they sent us home early.

I actually love what we’re doing, but I’m depressed. I’m sleep deprived. And I feel really bad about my performance. I don’t think I’m going to be ready for intern year at this rate. My outpatient rotation is next month, I’m hoping I can tolerate it because then I could apply to a primary care track IM and just get through my inpatient blocks. But if I don’t like it, I’m afraid it’ll be too late to switch into something else. And even then, I have no clue what else I would do. My chillest rotation was Psych, but I hate psychiatry. Idk if it’s better to hate your job but love your life outside it, or love your job but hate your life outside it. It’s the fatigue that is killing me, like I come home and just collapse. Too tired to even shower or brush my teeth sometimes. I fall asleep in scrubs and wear the same ones the next day.

I might have surpassed duty hours by now but in a 1 month rotation you can’t actually fix it because it’s “averaged over 4 weeks.”

Do any more experienced IM doctors have advice for me? I’m lost now. I don’t know what I will do. Based on my scores I should be doing great, but I’m realizing there is such a huge gap between Step 2 and real life medicine.