An International Medical Graduate's Advice for Navigating a U.S. Career in Medicine.
Kristina went to Medical School in the Philippines and offers a unique perspective on how International Medical Graduates can navigate becoming a practicing doctor in the U.S. She also discuss her passion for Medical Missions and for bringing health and wellness to people from all walks of life.


SPEAKERS: Kristina, Brooke Smith

Kristina 00:00
I had met them when we did like a medical mission. And my job at that time was to kind of do a physical examination and check on the children, especially because of them had, you know, worm issues. So you would see a lot of these children who were very malnourished. But you know, their bellies were huge, and they just weren't wearing you know, you could tell they're their clothes, were just like, dirty.

Brooke Smith 00:41
Welcome to MDF Instruments crafting wellness podcast. Today, we would love to introduce you to Christina. Hi, Christina.

Kristina 00:50
How are you doing today?

Brooke Smith 00:50
I'm doing very well.

Kristina 00:54
I'm so honored to even be on here. So thank you guys for inviting me to join you. Well, thank

Brooke Smith 00:59
you so much for joining. Can you kind of just tell everybody a little bit about yourself?

Kristina 01:04
So I am an international medical graduate. So for short, that's IMD. It just means that I had done all my medical education in the Philippines or if your IMG in general, it would be in your home country. And I am currently in the US because I am trying to pursue a residency or a spot to practice as a medical physician or like a licensed physician

Brooke Smith 01:32
here in the US. That's amazing. So where are you at? In your process? You did all of your you're from the Philippines and you've done all of your education up until you finished? And then you came here? Can you give us a little bit of a timeline of what that looks like?

Kristina 01:47
Oh, I basically, like I mentioned I did all in medical education in the Philippines. And then as an IMG you're not really required to go through medical school again, here in the US, thank goodness, what you need to do is to take licensure exams or which is known as the US, Emily's, and that's kind of like where I am right now I preparing for my second exam. And after I pass all of the other qualifying exams, that's when I apply for residency to match. And then I can basically practice or make it sound so easy, but there's really not, I can practice as a licensed physician once I get past you know, doing all the exams and whatnot.

Brooke Smith 02:30
Okay, great. Can you tell us what us MLA stands for? For anyone who doesn't know?

Kristina 02:36
So us Emory stands for the United States licensure, medical exam, it's required, even for American Medical graduates before being able to actually practice as physicians here in the US. So it's basically this very rigorous, and expensive process that we all have to go through if you want to get

Brooke Smith 03:01
was looking a little bit through your Instagram, and I noticed, um, you offer a lot of great advice on how to study and stress relief and like all of that stuff. But I also kind of wanted to just, is it true that the process is actually like, there's three separate tests, is that right? There are three separate tests.

Kristina 03:20
And for imgs, like me, are international medical graduates, we can choose which step to take amongst the step one, step two CS and step two ck, but we're required to pass all of those exams are formed, they go on to Step three. A lot of programs here in the US don't really require you to take Step three, right before residency starts. So you can kind of overlap that with like your first year of residency and like, study for it, then. But yeah, it is a three or technically four step process that we all have to go through

.Brooke Smith 04:03
Okay, that's really great to know. I didn't know that. So yeah, for everyone listening, it sounds like you have to do step one and step two, at the very least. And then when you get into your residency, you can start working on getting through the other end of that test. So in I noticed on your Instagram as well, you were talking about the difference the difference between in the Philippines what is considered like an internship or residency versus here in the US like what that difference was and how you kind of it was like a hard thing for you to wrap your brain around just the light light, the language difference of calling something an internship versus a residency, because I know that internships here are something kind of different. Can you kind of highlight that a little bit?

Kristina 04:46
Yeah, of course. So I'm glad you brought this up because it really was confusing to me at first. So I'll start with the Philippines and talk a little bit about my what are what we consider the medical world is like internship. It's basically divided into two separate ears. The first year, which is called the junior internship year is our last year of medical school. And it's basically where we go through this like one year training rotating and all departments in the hospital. So, for example, you would rotate through surgery or ob gyn and pedes, internal medicine, all of that stuff for the entire year. And then once we've graduated medical school, we do our postgraduate internship, which is also known as like our senior internship year, we're kind of already part of the workforce, but not really at the same time. This is like pre residency still. And again, we do another year of training at the hospital that we choose to apply to internship for. And we're basically given like more responsibilities as a senior intern. And we're sort of like shut away mostly like residents and scrubbing and all ours, things like that. That's the main difference is internships here is considered like your first year of residency. So when I first came here, I was always kind of like interchanging the two, two, and it was confusing at first, but then it made sense. I guess, when you say internship, you're here in the US, it's more like, you know, you're kind of like the baby in the hospital, because you're still kind of like, trying to learn the ropes and trying to adjust to like this new schedule and all these responsibilities. But those are the main like differences between what internship is like for the Philippines and your requests,

Brooke Smith 06:50
that's really great information, because I'm sure that's a question that a lot of international students want to kind of get info on, because it can be very confusing. And, you know, the way they do something in one place is not always going to be the same as we do it here. And that means a different thing. So that's a really great point to kind of come across. Yeah. And so getting into that a little bit, where are you in your usmle journey.

Kristina 07:15
Currently, I had already taken a step to CS which is more of like, you having to be on site and interact with patients. So you're basically being graded on like how you interact with patients, and you come up with management, are you done, done that last year and pass that so that's one, like one off like the list and I'm currently studying for, I feel, and I think most of like, medical students and international medical graduates can agree with me on this, but I'm currently studying for step one, which is the hardest exam to prepare for just because it's so it's so heavy in terms of like information and a lot of the residency programs like base your, your performance in this exam as to whether or not you can be accepted. So it's it whatever you get in the step one score can reflect what specialty you get to match in is like a huge factor, basically. So that's where I'm currently at right now.

Brooke Smith 08:24
If someone were to not pass that part of the exam, or they do it again, or you get one of those things where you do it. And if you don't succeed at that point, you have to kind of take another direction.

Kristina 08:40
Oh, well, you certainly can take it again. It will kind of like reflect, of course, when you apply to residency and the program directors kind of see that Oh, you failed step one. But personally, I don't think it like if you did fail it I don't think you should. kind of like tell yourself Oh, I guess this isn't meant for me like medicines, not for me. It I believe that like a great doesn't really reflect what you're going to be like as a physician and you're practicing. You're talking to patients, patients not really asking you what did you get in step one, you know, things like that. So I think it matters more, you know, what you are as a physician compared to like, you know, your grades. Nobody pays attention to that when you're actually in practice. But no, you can take it again. It probably will raise like a red flag for no programs, but it certainly isn't, you know, the end all be all if you do fail it.

Brooke Smith 09:40
Yeah, you are not your GPA. We're all very around people. And yeah, just because you fail something doesn't mean you can't keep going and try again. And then how long have you been here in the US? I'd love to talk a little bit about your experience just just getting here and what that was like and how you decided to come here. A little bit of your backstory for IBM to get to know how you even found your passion in medicine, and how this how you've been kind of got to where you are now.

Kristina 10:09
Yeah, I love that question. So, like I mentioned, I did all my medical education in the in the Philippines, I was also born and raised there. And I have always wanted to pursue residency here in the US, I think there wasn't like one defining moment where I just kind of like woke up and was like, Okay, I guess I'm gonna go to the US and eventually might be residency there. In practice, it was more of like a build up. It started when I was in medical school. And I just felt like, there were so many opportunities here in the US, for me to kind of grow as not just as a physician in the future. But as a person. I always like tell my mom that like I'm, you know, I'm, like, really independent. And so I wanted to explore what was out there. And so after I did my last year, my senior year of internship after I did that I decided to come to the US start preparing for my first exam, which is step two CS. And it wasn't easy at first, just because I came here on my own. A lot of the times you'll have like, imgs, when like connections here and like you'll have family or friends to, like hang out with. But I do have family, let's like spread out here in the US. But when I came here last year, I was living on my own, I did not obviously all my friends and my family were in the Philippines. And so everything was so new to me, because I was literally, figuratively, alone. And I felt very strange. Even though I have visited the US many times before, when I was growing up, it was still kind of a shock to me, just because I needed some kind of, you know, familiarity around me. But I didn't always get that even something as simple as like, you know, food, that reminds me I'm home, it wasn't all, always something that I can access. I didn't have a car, I was staying in a college dorm, to save on money. And basically, you know, just tried to figure out like, how to get around how to navigate this entire process, I will say it was lonely. And so I it took me a while to adjust. And I think people need to keep that in mind. If you are coming to like us and you want to pursue the usmle ease. There's a huge adjustment period. So I don't want people to think that you know it, you know that if they go through depression, or if they're anxious about something? It's 100%. I think everybody goes through that. And I don't think anybody should give themselves a hard time for you in that way. So yeah, and after I accepted UCS, I basically just kind of, I did have a, like a major hiccup. Because I had failed. Step two CS First, the first time I took it, and and that was, you know, kind of hit me very hard. I eventually tried to get myself back up. I think a huge part of me failing it was because I was so I think I was so confused. I was so lost, not having any kind of guidance or support, like, physical support for my family. And I'm very, like family oriented. So that was a huge factor, amongst other things. And so I kind of like had to pick myself back up again, and then prepare for another round of you know, step two CS a second time, and they quickly passed it. So and I was able to move on to like where I am now. But yeah, I since moving here, I have already lived and like this is my third city that I am in right now. And it was you know, it's such a whirlwind. And it's only been like less than two years. But I feel like already, like done so much as an international medical graduate just because you're having to adjust to a lot when you're here, especially when you're alone. But that's pretty much like a quick summary.

Brooke Smith 14:30
I know that for just for the regular us student, that going through medical school is extremely difficult and not and I can't even imagine how difficult it was for you to leave your home, your family, your friends, like everything you knew, to come here to pursue something to pursue your dream of becoming a doctor. Here in the US and working here, I think you're audibly brave. And for everybody watching, it's an it's inspiring to see that, as difficult as this is, to go ahead and say, I already know, before I do this, how many challenges and how hard this is gonna be. And I could sit here and do the do the easier route, even though it's still hard. Or I can really kind of just go out and where I don't know anyone and go Go for it. And you did that. And I want everybody watching to take that and take that to heart and to really think about it's you only have one life. And I think you're a great example of listening to your heart. And going in the direction you feel you want to go in, no matter the challenges that you know you're going to face. And I know that being in a new place, and like the comforts that we normally have that can get us through things you are like, I don't have my family, I don't have my friends. And even the comfort you brought on a little bit about food, but comfort that you take in that because it reminds you You're home and you're in a place you're in a room. That's not easy. And the fact you're so successful at for everyone watching as well, it's not, it wasn't smooth sailing, it's not, it's not ever going to be smooth sailing, things are gonna pop up you might feel attached to you might have to take a little time off to deal with, you know, health issues, or family problems or anything like that. But those are just kind of detours on your path. And you can always with perseverance, can stand back up and pull yourself back up and say, I know where I'm going, I know where I want to go. And I'm not gonna let this deter me. I believe in myself, and I'm going through this, and I think you exemplify that to a tee. And I think it's so inspiring. And for everyone watching, I really want you to take that in. Because it's not easy. But anything worth doing is never easy. That's it's a saying for a reason. So you're in Texas, and I know, with COVID-19 there's been some sort of discrepancy between people believing, you know, oh, the masks don't do anything, as opposed to the masks do something. What as a medical professional, where do you kind of stand on that? And has that been difficult for you just kind of frustration or anything like that deal with dealing with COVID-19 at all, and how has it affected you.

Kristina 17:34
Um, so I think that frustration started, like even before COVID-19 hit its peak. And I think it was very, because as somebody who's is a medical profession or in is in healthcare, it was, it was just stressful for me to see that. I could say maybe my colleagues or people who are working on the front lines are having to deal with the effects of people not following things like, you know, social distancing, or wearing masks, something that could easily be done if you really wanted to, but I was very much fresh, frustrated when I saw the news that broke out and you know, states like Florida, where people are going to all these beaches, and still kind of like partying during spring break. And I think I was just, you know, I felt horrible for my colleagues, not just because I couldn't be on the front lines with them at the moment because I'm still preparing for my exams, but also because they're the ones who are having to kind of, you know, pick the hit. And there have been physicians and other health care workers like nurses who have taken their own lives here in the US. And there also have been other even in other countries that have done this because there's just an oath for filming, I can only imagine what they're feeling what you see in the news isn't even probably like a fraction of what doctors are going through on a daily basis. I'm not talking about the stalkers, but you know, nurses, especially in respiratory therapists, and just basically the whole team that are trying to keep everyone together and trying to like, manage all of these patients. And it makes me like I said, frustrated because not only does it take a toll on their physical health, but also their mental health. There was a nurse, rather adopter in New York I believe we took her own life just because while she was working in the E AR she had, she was infected with COVID-19 and because she was so scared that she would infect her patient Since she decided to just take her life because it was just too much, and that's probably not even, you know, the only reason behind that there could be another, a bunch of other factors that could lead to that. So, yeah, it's frustrating because it's completely, this is a pandemic, and everybody in the world is affected. That's what's so scary about it. But not a lot of people are taking this seriously.

Brooke Smith 20:24
You really touched on several I think, important things. One is mental health and in healthcare in general, you know, there's a lot of burnout that can happen, even preparing nursing school, medical school, all of it, there's there can be burnout there, then once you're in, there can be burnout. It's very stressful job. And then you on top of that, a global pandemic, and all the items and everything that people have to work to save and protect us is it's been going now for, you know, some months, it's been going a long time. It's, it's really, really a difficult thing. And I know, on your, your all of your social handles, you talk a lot about mental health, and not something that a lot of people talk about, because people don't want to say, Hey, I'm struggling right now, this isn't easy. I'm, I'm depressed, and I don't know why or, or I'm really stressed out, I need a minute. And I feel like people don't can't, they don't take that time for themselves, or they don't want to say I need help. But I think it's so important. For everyone watching to know like, you have to take care of yourself, and you know yourself best. So if you're feeling burnt out, or you're feeling stressed out, or you're feeling sad, reach out to people, you know, there are people who want to help you who love you. Reach out to Christina reach out to MDF, reach out to us because we're here to help guide you connect you there, you're not alone, there are people out there who understand what you're going through. For all the international medical students like yourself who come over here who are feeling alone, you can reach out to Christina, I'm sure she would love to hear from you and help guide you. Because we are not alone in a global pandemic, we can feel even more alone and isolated. But through all of our wonderful technology, we're able to connect right now you know, you're in Texas, I'm in LA, where we are in this podcast. So find ways to kind of come together and get through this, you know, as one and get through this together. Because it is really sad. There are a lot of healthcare workers who have passed from COVID-19. As an addition to also take your own lives, it's actually been very high. It's been a lot of stories about it. And also just people, people who aren't even in health care who are doing who are so depressed with this global pandemic. So just know that you're not alone. And you have allies and advocates that want to be there for you. For everyone watching to know that. And you also talked a little bit of I really want to talk about our kind of your mission work. I know, we posted on our page a little bit about.

Kristina 23:12
So I'm glad you're bringing this up because it is something that I actually learned from or learned about through my mom. So even when I was younger, we were always kind of like as a family, we were very much involved in charity work. And I think my mom and my dad really instilled that in us when we were growing up. So I remember when I was younger, just a bit of backstory before I talk about that. I celebrated my can't remember if it was like my fifth or sixth birthday at a pediatric cancer hospital. And of course, when you're a kid, as long as you see balloon TCK, you see food, you hear music, you know, as a party, it doesn't really matter where you are. So I always really enjoyed that. And every Christmas, we would kind of invite, you know, street children in the Philippines to get together and he would get food and things like that. So it's something that my, my parents really like, made sure we were a part of. And so when I was in my fifth year, or my senior internship, that's when I kind of like was introduced to the mammalian tribe. And they're actually one of the Forgotten tribes of the Philippines. There's a number of them. And the one I'm directly you know, working with at the moment is called the NAMM tribe. And very fortunate because the head Person of the foundation, who we're working with, as well as kind of, she's in charge of bringing people together to help this community and You're taking a community that's very old fashioned, not even the word for it, but they're very, very, they stick to kind of their tradition. So they're the type of people who won't wear shoes. And they won't take a bath for days, they won't let the women take a bath for days, just because the men think that is a way to kind of be a little bit more flirtatious towards other men, you know, things like that. So hygiene isn't really like a huge priority. So when Sally Sally's, the head of the foundation, that helps the Mongolian community, and my mom kind of, you know, met each other, my mom invited me to go to a wherever the money is, or the element tribe are at the moment, and it's, it's in a provincial area of the Philippines. So you would have to take a boat, and then a bus, and then basically several forms of transportation just to get to like another island, which is where they are. And I had met them when we did like a medical mission. And my job at that time was to kind of do a, you know, physical examination and check on the children, especially because of them had, you know, worm issues. So you would see a lot of these children who were very malnourished, but you know, their bellies were huge, and they just weren't wearing, you know, you could tell they're their clothes were just like, dirty. And you can tell that like, taking showers for like days or even weeks, months. And seeing that a lot of these people didn't even have like a source of livelihood. And they were very far from the like, the the hospital, and that provincial areas. And very, like I said, it's a province. So everything's like spaced out. And when I did physical examinations, I had an encounter with a patient there, who just took his blood pressure, and he was like, in the 180s, or like, up to 200. And he just, these are just the people who don't have time to go to the doctors, or they don't even have money to go to the doctors and get checked. Some of these people have probably even never had a consultation with a physician in their lives, just because they don't have money, no source of livelihood, and not no access to like health care. And so that's kind of where it started. And when I found out that there were so many things that this community needed. I had talked to my mom about it sat down with the head of that foundation, Sally and talked to her and said, I will try and make this like my mission, and try to get as much people involved as possible. So I started doing clothing drives, and I would ask my friends from not just like who were medicine, but everybody else who was willing to donate, and we would kind of do like food as well. And then we would basically gather toys, books, you know, for children there who were really trying to get the education as much as they could in such a limited setting. And we tried to like deliver what we could and then we would board the bus and basically take the boat, do all of that. Just my mom and myself. And we'd ask for like some help. But that's basically how it started. And I do plan to continue on, and focus on them until they're actually you know, hopefully they reach a point where they can fend for themselves is basically the goal that I have in mind.

Brooke Smith 28:56
So beautiful. Thank you so much for doing that and your mother. And that's incredible. I think, you know, people who are going to healthcare and to medicine, you have hearts that want to help people you want to bring health and wellness and just vibrance to people's lives. Because you know that without health, it's really hard to have joy because you're in pain or you're just not feeling well. And your loved ones are worried about you cause a lot of stress. And they think you just, I were so honored to have you on our podcast, doing such incredible work like that. And also, I would love Love, love to share anything about that and how anyone watching can help how MDF can help with this mission. So please, please let us know. If you have anything you can see now that people can kind of get on board to help with that so great and we'll link that as well in this video for people to kind of go to right um,

Kristina 29:58
so first of all, Thank you for allowing me to even talk about this, because it's not always easy to kind of get the help that you need, especially when you want to help a group of people. So if anybody would like to kind of help if you are in the Philippines, for example, and you want to, you know, to your own medical missions, or if you want to help them in terms of there is a program called sponsor child or anybody from the money and community, which basically means that you'll be supporting them financially. And I do have a list that I can share with anybody who's interested. It's not just you know, financially supportive,you do want to send books, clothes that you no longer need. study material,send books, clothes that you no longer need. study materials. for the children, medications, which is really important. If you are in that pharmaceutical company, and have, you know, excess medications that you can donate, that would be so appreciated. And they also have a program or, yeah, an opportunity for McGann's to kind of like start their own livelihoods. So if you can provide funds for let's say, you know, you know, chickens and things like that, which obviously will be Sally's, kind of like, risk area of responsibility. But other than that, if there are other ways you want to help, or if you want me to send you a list of ways that you can help, please feel free to just reach out to me, I can kind of be like your middle person between Sally who was the head of the foundation. we can kind of get started from there. So whatever handles that you can kind of see on this podcast, which would make back to me, please don't hesitate to reach out, it would mean the world to help these children and

Brooke Smith 32:02
this community. Absolutely. And we have we support you fully. And please also let us know if you ever do. Go and do some more medical missions. If you need supplies, we'd be more than happy to supply those to you and anyone who is going on this level permissions with you, though, please don't hesitate to reach out to us. That's for anyone wanting to we with our crafting wellness initiative. We love to do these things around the world. That's great, too. And then also, Christina, I did just really want to touch base on changed the subject a little bit. I wanted to just kind of talk about any other interests that you have, aside from healthcare and medicine, I think I saw a little bit about cooking and food. So I would love to just just go into that a little bit so that people can kind of get to know the other side of you as well.

Kristina 32:51
Yes, so um, yeah, probably my favorite thing ever to talk about is food. But um, that's kind of why I decided to create the Instagram account and kind of link it to like food, it's a great way for me, at least personally to kill me to kind of like take my mind off things. And it sort of served as a coping mechanism. So in terms of like, you know, cooking, baking, I didn't really cook when I was in the Philippines, I did bake. And I certainly ate food. But, um, when I came here, and, you know, found out that I didn't really have anybody else to kind of like, cook for me, because usually it's my mom, or somebody my family and we're a huge Filipino family that loves to get together and just cook, eat, talk. That's our culture. Food is a way to get together and catch up and feel good about you know, about life in general. That's how we celebrate life too. So it's definitely like, linked to so many good things in our family. And so when I came here, I figured I would kind of like learn how to cook Filipino dishes just so I don't get as homesick as I already am. And I had to learn I had to like talk to my mom and ask for like all these recipes that she would cook for me. And I would do my own research. And once I started, I guess like cooking food that I normally would have back home. That just made me feel so much better. And then I like to feed my phone, a lot of Instagram like I like to take pictures and my take videos of what I'm making. And so that was fun for me. And I decided to kind of share that side and in a way wanted, you know, for medical students or graduates like me to find out ways that they can cope with being away from home. So it could be through making food from your home country, or at least if there's like a restaurant nearby that you can kind of like order from just to kind of give you that sense of home. And in on like on the subject of baking, which is my first love, you know, before cooking. When I was I think around like 11 or 12 I started my own cookie business. And when I say business, it was just me making my cookies and selling them to like my schoolmates. You know, things like that. And my grandmother, and pretty much like everybody, my family is such a great cook, but my grandmother used to have like a bakery when they were younger. So I grew up baking, I just make sure they they taste good, but I'm not gonna like decorating cakes or anything like that. I have an aunt who does all of that good stuff. Like he's really creative. And an all i'm not creative whatsoever, I just like to eat. But yeah, that's something I like to do to take my mind off things.

Brooke Smith 36:09
Yeah I think it's great to have like, something that kind of it feels very therapeutic, it kind of balance. I love cooking as well. So it's kind of just the process of picking out the ingredients and deciding what you're going to make. And then you know, up and just you know what's going in your food and then sitting down and enjoying it and having a nice conversation and just kind of bringing you back down and reminding you what is really actually important, which is our family and our loved ones. And more of the simple things because I think it's so easy to get caught up in, oh, this and that I have this to do and this to do and that. But really, I think it's a great way to kind of center and say, you know, this is actually what's important. And this is why this is what I'm doing all of this for is for more.

Kristina 36:50
This. It's good. Keep that in mind. Yeah. And I just wanted to add that when I was growing up, or even before I came here, it was sort of like my mom's rule that when we had dinner at home, everybody had to like sit down and get together and catch up. And like you said, it's so easy to get caught up in what we're doing on a daily basis, especially workwise. So bynars, or like eating with my family or friends are a great, great way to kind of like pause a little bit. And just like breathe and enjoy. So yeah.

Brooke Smith 37:27
Great. Nice. Well, Christina, thank you so much for joining our crafting wellness podcast. We were so honored to have you today. We're gonna link all of her information below. Also, you can go check her out, you can check out her medical missions and all of her doing. So check that out below. And thank you so much, Kristina.

Kristina 37:47
Thank you so much for having me. I enjoy this and I'm so honored to even be here.



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