What your doctor is reading on Medscape.com:
MAY 16, 2020 — I didn’t stumble into medicine; I ran into it.
After my first semester of college, I took a leave of absence to fulfill my military service with the Republic of Korea Marine Corps. While running during training, I often thought about my future. All of that thinking led to me running farther and faster. Eventually, I ran myself right into multiple injuries.
Luckily, those injuries sparked a curiosity in the human body, training, nutrition, and physiology. I decided to become a doctor who could help patients return to activity. To fulfill my dreams, I knew I needed training in the United States, one of the leading countries for sports medicine.
By the time I had taken United States Medical Licensing Examination (USMLE) S
tep 1 and Step 2 Clinical Knowledge (CK), as well as exams to qualify for a Korean medical license, I was close to burnout. But I had no time to rest before I was running again. This time, I was racing against the spread of the coronavirus around the world.
Close but No Exam…
On March 13, I arrived in the United States from South Korea to take the USMLE Step 2 Clinical Skills (CS) exam. This was supposed to be my last test before qualifying for Educational Commission for Foreign Medical Graduates (ECFMG) certification, a requirement for international medical graduates (IMGs) to match into US residency programs.
Knowing that time was against me, I bought a plane ticket that left just 2 days later. My exam was scheduled for April, but I was hoping to arrive in the United States and reschedule to a date that was sooner. Even if rescheduling didn’t work, I was planning to stay until I could take the exam. My parents were…not happy. Not only was there a virus spreading, but they also wanted to spend as much time together as we could before my residency training abroad.
When I landed in the Atlanta airport, I was worried that an immigration officer would ban my entry; more and more countries were refusing Koreans at that time. When I got through, I felt a sense of relief. I turned on my cell phone and logged into the ECFMG website. I had been carefully monitoring for any changes—day and night—since February. The last update was just before I put my cellphone into airplane mode. Everything was still on. When I logged in at Atlanta, I read the latest news: “Testing centers will be closed.” My sigh of relief turned into a sigh of grief. As fast as I was moving, the coronavirus was faster.
A few days later, the US embassy announced that it would suspend issuing visas until further notice. This put another opportunity in jeopardy. I had been accepted to the master of public health (MPH) program at Harvard University starting this summer and had communicated with professors about research opportunities. One of the reasons I worked so hard to finish Step 1 and 2 CK before graduation was so I could focus on that research. Many IMGs take a gap year or two so that they can take these exams in order to complete obligations associated with their institutions and to participate in observerships at US hospitals. I had managed to complete most obligations in advance. Suddenly, all of my efforts were in vain.
An Uncertain Future
I spent 2 weeks in the United States doing literally nothing other than receiving heartbreaking news after heartbreaking news. The conferences I hoped to attend were canceled. My research presentation there was supposed to strengthen my CV. My observerships were canceled next. Those were going to help me gain clinical experience in the United States and build relationships that could lead to recommendation letters.
I became hopeless and insecure about matching into a US residency program. Dejected, I came back to Korea. I was under strict government-controlled self-quarantine for another 2 weeks. Being stuck in my apartment was frustrating, but the uncertainty about my future was even more suffocating.
The testing center for Step 2 CS has extended its closure until at least August. Given the unavoidable human-to-human contact during the exam, it may be delayed even further. Plus, Step 2 CS testing appointments are notorious for limited spaces and often fill up at least 3-4 months in advance. The number of examinees who require rescheduling is likely to far exceed the available spots. This process is even more complicated for IMGs who need visas just to take the exam. Many of us will struggle to secure a date that will let us meet deadlines for residency application. We will potentially need to forgo the next Match. My friend and I expressed these concerns in the Korean Journal of Medical Education.
Even IMGs preparing for the 2022 Match are affected. They may not be able to participate in any clinical experience or research opportunities in the United States this year. Visa services are still suspended. The Harvard MPH program has decided that summer sessions will be held remotely. I doubt that virtual or online education will have the same value without actual onsite research experience. As an aspiring academic physiatrist, this is a huge concern for me.
I know that this distress is sincerely nothing compared with what those who suffered from COVID-19 and lost loved ones have experienced, but the uncertainty is still disturbing. Updates about Step 2 CS keep coming but rescheduling is still delayed. Knowing that I won’t be able to receive an F1 visa for the MPH program this summer, I accepted a job as a hospitalist and started working as a research fellow here. I want to make a “Plan B” for my future, but given the ever-changing situation, I don’t know what I can realistically do.
Some hope does remain. Certain specialties are now suggesting that residency programs consider waiving requirements like Step 2 CK/CS at the time of application and pushing back deadlines. Also, on May 8, the USMLE announced that it was exploring virtual methods of administering Step 2 CS. This is encouraging, but no specific timeframe has been given.
With all of the factors being considered, we IMGs are largely being left out of the picture. We are an especially vulnerable minority in this chaos. The climb toward residency in the United States as an IMG is now more difficult than ever. Perhaps if someone could at least assure us that we are part of the plan, it would give us something to keep running toward.
Hyechang “HC” Rhim recently graduated from Korea University College of Medicine. He is also a contributing editor for the Korean edition of Runner’s World and received an award for his research at the British Association of Sport and Exercise Medicine in 2019.