Program helps Hispanic IMGs qualify for U.S. residencies

Officials say UCLA's innovative three-step course will increase the number of Spanish-speaking physicians for California's underserved.

By — Posted March 3, 2008

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The University of California, Los Angeles, has started a one-of-a-kind program that may start a trend among medical schools serving large Hispanic populations, experts said.

The pilot program prepares international medical graduates who speak English and Spanish for family medicine residency by coaching them through the multistep U.S. Medical Licensing Exam and giving them clinical observerships.

Gilberto Cota, MD, who graduated from medical school in Mexico, is one of the first to go through the 14-month program. He had been in the United States for two years and was studying for the USMLEs when he heard about the pilot through Welcome Back: International Health Worker Assistance Center, a program that helps international health care professionals prepare for U.S. health careers.

"My dream was to become a physician," he said.

Dr. Cota finished the UCLA program in 2007 and is waiting for the National Resident Match Program results. He interviewed at several residency programs, a feat many IMGs fail to accomplish. As he awaits his Match, he is teaching Spanish medical terms to UCLA medical students and helping with a family medicine research project.

"I feel called to serve the underserved; that's why I went into medicine," Dr. Cota said.

If program participants land a residency, they must practice in an underserved California community for three years afterward.

Patients waiting

The need is great, officials said.

Hispanics make up 36% of California's population and nearly half of the Los Angeles area. Meanwhile, 4% of the state's physicians are Hispanic. Nationally, 30% of Hispanics report that they do not have a regular health care source.

"Our goal is to address health care disparities by getting more bilingual doctors into California's underserved Hispanic areas," said Michelle Bholat, MD, MPH, program co-director and family medicine department vice chair at UCLA's David Geffen School of Medicine.

Since the program began in 2006, two IMGs have completed the pilot and are in their first year of residency. Nine other IMGs in the program will participate in this year's Match.

UCLA's program is unique, said Carol Aschenbrener, MD, executive vice president and head of the Assn. of American Medical Colleges' medical education division.

"I don't know of anything like this," she said. "Getting physicians into underserved areas is an intractable problem, so I hope it will help meet that goal."

AMA Board of Trustees Chair Edward L. Langston, MD, said there is a large need for U.S. clinical experience among IMGs seeking residencies.

"This program sounds innovative and exciting," Dr. Langston said. "This is a respected university system trying to meet California's needs."

The AMA's IMG Section also hopes to create more clinical observership options for IMGs and is developing guidelines it hopes will help interested state medical societies set up such observerships.

To be accepted into the UCLA program, IMGs have to pass a diagnostic test that examines their medical knowledge. They cannot have previously failed the USMLEs, because such failures make them less attractive residency candidates.

The program has three segments. Program A is a six-month prep course for the basic science USMLE Step 1.

Those who pass it take part in Program B. University faculty help IMGs prepare for the USMLE clinical skills and clinical knowledge tests, an effort that includes eight weeks of clinical skills training.

If they complete that step, participants start Program C, an eight-week observership at UCLA family medicine clinics. Throughout the program, IMGs receive a $1,000 to $1,500 monthly stipend.

The program costs $500,000 a year to operate. Funding comes from private foundations.

Blanca Campos, MD, who already had passed all three USMLE steps, participated in Program C, observing patients while under the supervision of a doctor.

"The program gives you opportunities that are really hard to get," said Dr. Campos, who is originally from Costa Rica. "When you apply to residency, most [program directors] want you to have had U.S. experience."

She found Spanish fluency an advantage when communicating with the large number of Hispanic patients who came through Olive View-UCLA Medical Center, where she did her clinical observership.

"They feel very comfortable being able to express themselves with someone who can really understand them," Dr. Campos said. "I catch things that others don't. Even if you speak Spanish pretty well, depending on the country, some words don't mean the same thing."

She is waiting for Match Day on March 20 to find out where she will be spending her next three years of residency. "I'm extremely anxious to start," she said.

UCLA's initiative has caught the attention of others.

Rolando Castillo, PhD, director of San Diego's Welcome Back center, would like to replicate UCLA's program in his area. So would Carlos Jaén, MD, PhD, department of family and community medicine chair at the University of Texas Health Sciences Center at San Antonio.

"This is an innovative and socially responsive program," Dr. Jaén said. "It's clear that we need to continue our efforts to increase the pipeline for developing more Hispanic doctors. The reality is there aren't enough coming forward, and the need is huge."

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Helping IMGs land a residency

A University of California, Los Angeles, program is geared to provide more physicians to treat California's Hispanic population. The pilot is open to international medical graduates who are fluent in English and Spanish and willing to practice three years in an underserved area. Here are the three parts to the pilot:

Program A
Goal: Passing USMLE Step 1
Time length: 6 months
Stipend: $1,000 a month for 4 months
Other details: UCLA pays the $3,400 tuition for the Kaplan USMLE program.

Program B
Goal: Passing USMLE Step 2
Time length: 6 months
Stipend: $1,500 a month for 6 months
Other details: Participants study for and take the clinical knowledge and skills parts of the USMLEs, with support from the UCLA family medicine department. Training includes an 8-week clinical skills course.

Program C
Goal: Training in a clinical observership
Time length: 2 months
Stipend: $1,500 a month for 2 months
Other details: Competitive USMLE Step 1 and 2 scores required. Besides observership, participants receive guidance on their residency application and a letter of recommendation.

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