Let’s start with a very brief introduction: Hello! My name is Aline, and I am an international medical graduate (IMG) from Germany. I used to work in Germany in internal medicine, where I have completed four out of five years of training. Because of interesting developments over the past few years, I ended up in the United States and, because I missed working as a physician, I decided to take the USMLE Step exams and apply for residency. I got lucky and placed during my first residency application season.

I would like to share my experiences, thoughts, and later also some of the processes and steps that got me here over the course of this new column Surviving IM/G on in-House. I hope my stories are interesting, but I also hope that you learn something, and most of all that you want to reach out and connect!

I am currently on my fifth week of residency and, and what can I say: I am obviously learning a lot and working a crazy number of hours — but who isn’t at this stage? But unlike my colleagues, who are fresh from medical school, I am not necessarily afraid or overwhelmed by (sick) patients and balancing knowledge and schematics with therapeutic decisions — nothing is black and white in medicine. 

I matched in a 2+2 program, meaning that I work two weeks inpatient followed by two weeks outpatient. I have my weekends off during outpatient rotations and one day off per week during inpatient rotations. 

To summarize and reflect on my experience over the last few weeks, I would like to share what I like so far, and what I am struggling with logically. 

What I like so far: 

• The teaching during attending rounds is very proficient and beneficial. I have not practiced in over three years now. I get to refresh my memory, but also, I enjoy the so-far very equal-appearing discussions. 
• The friendly relationship between (most) residents and attendings. It is a very welcoming atmosphere. Calling each other on first name basis is new to me, but I always liked that about English-speaking countries. 
• Eventually, I will come to learn the system- and scoring-based decision-making trees. I believe that, once I master that technique better, it will help me become a better physician. 
• The opportunity to learn a lot of (new) things in a different way: once again understanding that there is usually more than one path that will lead to success.

What I am struggling with right now: 

• Presenting patients properly during attending rounds (presenting in either EAP or SOAP format is not the format used in Germany). It seems rather unfamiliar to me to start introducing a patient during the one-liner beginning with pre-existing conditions, to later move to the reasons why he or she presented, and then go to the current condition. Don’t get me wrong: I don’t think it is a bad or even false way of presenting, it’s just not the way I am used to. In Germany, rounds are focused on the most important aspects, so you don’t “waste” anyone’s time. 
• Writing notes about each patient is way more detailed and, in my opinion, almost tedious here. I very much doubt that anyone reads the whole note. To be honest, I have a lot of work to do, to get my note-writing skill up to the expected standard, but I really want to improve. 
• Working with our electronic medical record system (we use Epic), since Germany is not that far yet to have a somewhat standardized EMR system. I am slowly starting to navigate my way around it. 

So, what am I looking forward to this year? I am extremely excited to be treating patients again and to finally getting to know the so-often debated American medical system. I cannot wait to explore how I am going to juggle residency with two kids under two, while hoping that my once acquired medical knowledge will come back and be useful here.

Surviving IM/G

I am an international medical graduate in internal medicine residency (IM/G), sharing my experiences with all of you. If you are an IMG, hopefully you can relate to some of the stories and feel encouraged, because we are not alone. If you are an American-based resident: I hope these stories help you better understand your IMG colleagues a bit better. And above all, I am hoping to hear from you as well: let’s share knowledge, experiences, and pave a path for the many other IMGs seeking to fulfill their dreams in the United States.

Image source: Courtesy of the author.

Aline Gottlieb, MD, PhD (4 Posts)

Resident Physician Columnist

Hillsboro Medical Center

Aline went to medical school at the University of Essen in Germany. She started training at the University Hospital Essen in Internal Medicine with the focus on GI/Hepatology. She then followed one of her former supervisors in 2017 to the University Hospital Magdeburg and continued her training for two years. In 2019, she started a two-year research fellowship at Johns Hopkins University with a scholarship by the German Research Foundation. During that time, she decided not to return to Germany and instead attempt to become a physician in the US. She has started her internal medicine residency this year at Hillsboro Medical Center in Oregon.

Surviving IM/G

I am an international medical graduate in internal medicine residency (IM/G), sharing my experiences with all of you. If you are an IMG, hopefully you can relate to some of the stories and feel encouraged, because we are not alone. If you are an American-based resident: I hope these stories help you better understand your IMG colleagues a bit better. And above all, I am hoping to hear from you as well: let's share knowledge, experiences, and pave a path for the many other IMGs seeking to fulfill their dreams in the United States.