Hello, my name is Mirai Omote a fourth-year medical student at Kanazawa Medical University in Japan. I am a student intern at Team WADA.
Recently, I was blessed with the amazing opportunity to speak to Dr. Ito, a Med-Peds trained physician currently practicing in the United States. Currently, there is not very much information on Med-Peds from the perspective of a physician who graduated from a Japanese medical school or an International MedicalGraduate (IMG). Therefore, I thought I would write a blog post on the overview of Med-Peds residency and also share what I learned from Dr. Ito.
On July 10th, 2021, Team WADA streamed an interview with Dr. Ito, who completed his Med-Peds residency followed by subspecialty fellowships and is currently working in Washington D.C. as an Adult Congenital Heart Disease Cardiologist.
If you have not yet seen the interview, I highly recommend you check it out. The link is here:
Dr. Ito is the person who ignited my interest in Med-Peds and is my inspiration. I first learned about Med-Peds through an article he wrote in the book 「米国医師留学のすべて」(The complete guide to practicing medicine in the U.S.), published by 日本医事新報社 (Japan Medical Journal). It is a collection of articles written by Japanese medical school graduates who have personally experienced U.S. residency and fellowships.
Dr. Ito’s background:
Seiji Ito M.D.
2004 Graduated Ehime University School of Medicine
2004-2006 Okinawa Chubu Hospital
2006-2007 U.S. Naval Hospital Yokosuka
2007-2011 University of Missouri Kansas City, Internal Medicine and Pediatrics Residency Program
2011-2014 New York University Medical Center, Pediatric Cardiology Fellowship Program
2014-2015 University of Washington Medical Center, Adult Congenital Heart Disease Fellowship Program
2015- Current Children’s National Hospital (Washington D.C.) Cardiologist
Assistant Professor of Pediatrics, George Washington University School of Medicine and Health Sciences
Dr. Ito currently works as an Adult Congenital Heart Disease Cardiologist at the Children’s National Hospital in Washington D.C. and treats all ages ranging from newborns to adults.
His week consists of 3 days at the outpatient clinic, a day of cardiac MRIs, visiting inpatients, and doing consultation services for patients with Adult Congenital Heart Disease. He has been practicing medicine for nearly seventeen years, fourteen of which have been in the United States.
What is Med-Peds Residency?
Med-Peds is an abbreviation for Internal Medicine and Pediatrics. The residency consists of four years, comprising two years of rotations in Internal Medicine and the remaining two years of rotations in Pediatrics. Internal Medicine residency and Pediatrics residency are both well-known residencies, but many people are unaware that there is a combined residency where you can do both specialties called Med-Peds. When completed, Med-Peds residents can take board exams for both the American Board of Internal Medicine and the American Board of Pediatrics.
If you pass both, you can practice as a double board-certified physician. After Med-Peds residency, some people go on to practice primary care while others pursue subspecialties. Med-Peds residency graduates can apply to the same fellowship programs as categorical Internal Medicine graduates and Pediatrics graduates.
Spots Available and Number of Programs
As of the 2021 Match, there were 77 programs and a total of 385 resident positions offered. Most programs take about 4 to 6 residents each year, giving a personal impression of a friendly and close-knit feel to the programs. 23 IMGs matched in 2021, making up 6% of the total matches of that year in Med-Peds. 7 of them being US-IMGs and 16 of them being Non US-IMGs. The percentage of IMGs matching into Med-Peds residency seems to be about 6 to 8% every year.
Med-Peds residency is provided by facilities that provide both Internal Medicine and Pediatrics residency, so facilities tend to be larger in scale, many of them University or University-affiliated programs.
Med-Peds historically originated from the East Coast, which is the reason why most programs are located in the Mid-East and East Coast, while on the West Coast, Family Medicine holds a strong presence with some Family Medicine providers also covering inpatient care in some practices.
Matching into Med-Peds as an IMG
In the 2021 residency Match, the percentage of IMGs that matched into Family Medicine, Internal Medicine, and Pediatrics were approximately 25%, 40%, and 19%, respectively. Thus, with the percentage of IMGs that matched into Med-Peds being 6%, this number seems extremely low compared to its counterpart residencies.
However, according to Dr. Ito, he believes the number of IMGs applying to Med-Peds residency is relatively low. He also said there are only 3 or 4 Japanese medical school graduates he knows of who are currently working in Med-Peds.
With Med-Peds being a combined specialty, there is a possibility that not many IMGs know about this residency, inevitably leading to the low percentage of matches. If so, the low percentage may be less of a concern than how it looks. Cardiology, Intensive Care, Infectious Diseases, Genetics, and Allergy subspecialties are some examples in which pediatrics and internal medicine commonly overlap, and there are Med-Peds residency graduates who go on to these subspecialties.
The Difference Between Family Medicine
Family Medicine residency is a 3-year program where maternity care, gynecology, and general surgery are integrated into the residency curriculum. Family Medicine tends to be outpatient-focused and commonly practice less inpatient care than Med-Peds. As a result, many people who choose Med-Peds are interested in pursuing a fellowship in fields other than obstetrics or want to place emphasis on inpatient care.
That is it on the overview of Med-Peds. Next, I would like to write about Dr. Ito’s experience of preparing and applying for residency.
About the USMLE ~Dr. Ito’s experience~
Dr. Ito began to study for the USMLE in his 4th year of medical school after a classmate invited him to study for it together. Starting from the middle of 4th grade, he began to have more time on his hands, and preparing for the USMLE became his primary focus.
He states the way he prepared was by solving many question banks and textbooks. At the beginning of his preparation, even if there were a question he didn’t understand, he would simply read the explanation and move on to the next question. He says the key is to keep going and not stop. By continuing, he would realize what types of questions he often gets incorrect and what topics he doesn’t understand. Then, he would turn to textbooks and deepen his understanding of the topics with which he has difficulty. By repeating this process, he was able to cover everything that would be tested and finished this phase of his preparation by the end of 5th year. Starting from 6th year, he solved questions, referred to his textbook, read the First Aid, highlighted important parts, and reviewed his notes.
One to two months before the exam, he would prepare by doing mock tests of seven blocks just like the actual exam. After he finished, he would see how many questions he got correct, review the incorrect questions, refer back to the First Aid, take notes, and read textbooks to deepen his understanding.
He took Step 1 at the beginning of 6th grade and scored in his late 90s on the scaling system used at the time. This high score is something he feels helped when matching into Med-Peds.
After finishing his graduation exam in November during his 6thyear, he took Step 2CK in December, just before the JapaneseNational Examination for Medical Practitioners in March. He scored in his 90s, a high score on the scaling system used at the time.
The decision to go into Med-Peds and the matching process ~Dr. Ito’s experience~
Dr. Ito says he had been thinking of specializing in Adult Congenital Cardiology when he was in Japan, so it was a natural decision for him to choose Med-Peds. Med-Peds enables physicians to care for all age groups and was also another aspect that he valued.
When applying to Med-Peds as an IMG, it is common to also apply for Internal Medicine and Pediatrics, but Dr. Ito only applied for Med-Peds programs. Out of the approximately 80 programs, he applied to about 40 programs and was called for interviews from approximately 10 of them. He states that he didn’t apply to famous university programs, for he thought the chance of getting interviews would be slim and didn’t apply to completely community-based programs, for he was planning to apply for fellowships after residency.
If one really wants to match that year, applying to several specialties could be an option but it depends on the case is what Dr. Ito implies. It is important to reflect on your personal situation and make the decision that is best for you is what he states.
Being invited for an interview from 10 programs may be more than usual for an IMG. I asked Dr. Ito what the key to getting many interviews is and what he thought were the strengths of his application.
What he brought up first was his 1-year experience at the U.S. Naval Hospital in Yokosuka. He conveyed to programs that that year was like a transitional year. He emphasized that he was able to become familiar with the U.S. medical system and gain U.S. clinical experience through that year. He adds that his USMLE scores and the fact that he was a PGY-3 likely strengthened his application.
Figure out what field interests you most and to what degree you can make decisions with the information you have at the time. Keep your possibilities open, but at the same time, gradually reduce them and make them more focused. These are the words Dr. Ito gifted me that have left a profound impression on me. I was also greatly encouraged when he told me it is not impossible to match into a Med-Peds residency as a Japanese medical school graduate.
Though speaking to Dr. Ito, who has excellent first-hand experience in Med-Peds, I was able to better understand my goal of becoming a Med-Peds physician. Based on the information he shared, I created a plan, realized what I needed to do, and became even more motivated to continue to work hard.
With the wide variety of choices in Med-Peds, diverse career paths as a physician, and endless possibilities life holds, I hope to experience countless events and based on them, regularly take the time to think about my dreams and aspirations and what I need to do to make them a reality. I hope to continue to work diligently and complete the goals in front of me one at a time tobring myself closer to the self I want to be.
Last but not least, thank you so much to Dr. Ito for generously answering all of my questions in great depth. Thank you for graciously making time out of your busy schedule to talk to me on Zoom. I cannot possibly thank you enough.
If you would like to find out more about Med-Peds, please check out the following website.