Medical Licensing Exam for Physicians Who Just Graduated Medical School

Note: If you completed a residency or internship prior to moving to Israel, you will NOT be required to take an exam.

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If you completed medical school but did not start a residency or perform an internship, you are required to do a one year intership ('stage') before entering residency. In order to qualify for an internship spot, you must pass a particular licensing exam. The following is one person's impressions of the exam:

I graduated from the University of Toronto in June 2004, and took the licensing exam on August 5 2004. I thankfully passed and proceeded to move with my family to Israel in December 2004. Since then I have completed a Stage at Shaare Zedek and I'm now making plans for residency. All my advice is based on what I went through in 2004. I hope that it is still relevant.

REGISTERING FOR THE EXAM:
The exam is given 2x per year: once in the summer and once in the winter. As I'm sure you know, you must first pass the exam before you are allowed to enter a Stage. The exact date of the exams seems to vary (sometimes July, sometimes August).  Registration had to be done by sometime in late May (but I think that these deadlines also change year to year).

The exam is administered by an office called: The Scientific Council - Israel Medical Association. Phone #s: 03-610-0416 or 03-610-0444. The person in charge of administering the exam was Professor Y. Shenker. This is probably the first place to contact for questions.

You could not, however, register directly with this office. Registration was done via the Agaf Rishui Mikzaot Refuah, who seem to have a number of offices to serve the various regions of Israel (Jerusalem, Tel-Aviv...). They deal with a wide variety of issues pertaining to licensing MDs, including Stajier's from Chutz La-Aretz. I dealt with a lady named Chana Nitzan at the Jerusalem office.
Her phone # is 02-621-7348. Fax # is 02-621-7398. 
She can be reached by phone during the following hours:
Sunday, Thursday: 9:00-13:00
Tuesday: 12:30-17:00

She told me that in order to register I had to provide the following:

• MD diploma
  
• official transcript
  
• teudat zehut
  
  I also had to fill out some registration forms.
  
  This presented a number of problems for me:
  -I hadn't made aliyah yet, so I didn't have a teudat zehut
  -I hadn't graduated yet so I didn't have a diploma
  -thankfully, my brother who lives in Israel had mailed me the registrations forms, but if he hadn't, I would have had to get a hold of them.
  
  I was told to contact the "Menahel Agaf Rishui Mikzaot Refuah", Dr. Amir Shanon, to speak to him about my issues (his phone number is 02-670-5820). I asked Nefesh b'Nefesh to contact him for me (since my Hebrew was fairly limited at the time). His original response was that I couldn't write the exam without a diploma. Fortunately, via protectzia (connections), I was able to
  appeal my case to Dr. Shannon, who agreed to let me register for the exam under the following conditions:
  -Instead of a diploma, I submitted a letter from my medical school indicating that I had completed all my requirements for my MD degree and that I would be receiving my diploma at my graduation ceremony in June

-Instead of a making Aliyah, I obtained a visa 4b (arba-bet) which is used
to make Aliyah. I submitted this visa along with my registration forms.

My registration package was approved and forwarded to the Scientific Council - Israel Medical Association (Professor Shenker).

I later received confirming my registration and providing the details of the exam (date, time, seat location...). I had all mail sent to my brother’s Jerusalem address.

A few days before the exam I flew to Israel. Because I was under the assumption that I would be expected to show a Teudat Zehut, I made Aliyah. As things turned out, no one ever asked me for a teudat zehut when I arrived at the exam - ie. I may have made Aliyah unnecessarily at the time.

STUDYING FOR THE EXAM:
-Unfortunately, I'm not sure what advice to give.
-The exam is multiple choice. It is divided into a morning part and an afternoon part. You can take the exam in English, Hebrew, Arabic, Russian (maybe other languages too). Apparently you need 60% to pass.
-My brother and two friends graduated from medical school in Canada in 2000 and wrote the exam then. They all passed and never seemed to make a big deal out of if.
-On the other hand, I spoke with a European MD who had failed the exam on his first try (passed on the second). He said that the exam was extremely hard. He said that a lot of the questions are taken directly out of USMLE prep books, and that I should spend months going through any USMLE prep book that I can find. He also said that the pass rate for the exam was under 10%,
which I found difficult to believe (apparently it is because the vast majority of people writing the tests trained in low-quality medical schools in e.g. Russia).
-I found it hard to resolve the advice of the European MD with my brother's, and I'm still not sure who was right.

I chose to prepare as follows:
-I used the First Aid for the USMLE2 in order to review my knowledge.
-I practiced the multiple choice tests in two books: (1) NMS Review for
USMLE2, and (2) Brochert USMLE2 Mock Exam.

(It took me approximately 3 weeks to do all this.)

-The European MD recommended doing the Harrison's Self-Assessment and Board Review. The book has 800 MCQs that seemed overly difficult. I chose not to use it because I felt that it was I would be investing too much time on internal medicine (given the limited time that I had for preparing).

When I wrote the exam, I found the morning session to be surprisingly easy. I felt very confident that I would easily pass, and I was frustrated that I had spent so much time worrying and preparing. Then I wrote the afternoon part...
The questions were extremely difficult. The questions were highly specialized (eg. as if they asked an obstetrician for a question that only an obstetrician could answer versus a family doctor). I left the exam really uncertain about the outcome. I didn't come across one question that I remembered seeing in the NMS or Brochert tests. Ironically, I was told that a fair number of questions were taken from the Harrisons self-test. I think that in retrospect, I would have invested a lot less time into going through the prep books, and more time into reviewing my medical school notes a lot more in depth.

Approximately 6 weeks after writing the exam I received a notice that I passed. After that I was mailed a form on which to rank my choices for my Stage location (the Hagralah). My brother and friends recommended choosing Shaare Zedek. They felt that although it was much less academic than Hadassah, it was a much friendlier and easier place to work. I followed their advice and luckily got my first choice.

Someone mentioned to me (after I wrote the Israeli exam) that they thought MDs from the USA didn't have to take the exam if they passed the USMLE2. I think it is definitely worth clarifying whether passing the USMLE2 is enough. It was a huge hassle to write the exam and the questions were fairly challenging.

Since I've been here, I've met some other MDs who also took the licensing exam (another from Canada, and one from South Africa). They also went through similarly frustrating experiences. One was told (by the Jerusalem office) that they could register for the exam without a mispar zehut, and then found out a few weeks before the exam that the registration was never authorized because there was no teudat zehut! In general, I found that the administrative staff I had to deal with think with "Rosh Katan" - they want to get off the phone as quickly as possible and aren't interested in helping solve your problems.

RESIDENCY:

-It is important to know that olim chadashim are entitled to some degree of funding from the Misrad Haklitah.-In general the Misrad Haklitah will fund you for 6 months.

-This can be very helpful in getting your foot in the door of a residency spot that would otherwise be unavailable.

-Of course, if you can find a residency that can start you on a regular teken immediately, you should do so (the salary from the Misrad Haklitah is lower).

-You must open a Pincas Hitmachut before you begin residency. Otherwise any time you spend as a residency may not be counted!

-If you happen to have a research background (e.g. published 3 papers) then you can qualify for assistance from the Misrad L’Klitah B’Madah (02-675-2767). They will provide funding for up to 3 years, although the salary is fairly low. Once again, this is only an option you’d want if you couldn’t be accepted to your residency of choice with regular funding.

I'd like to help minimize any frustration for you. Please let me know if there is anything else that I can help you with. If you happen to find out anything new, I'd appreciate you letting me know so that I can provide accurate information to anyone else that asks me.

Sincerely,

Josh Kruger
joshua.kruger@utoronto.ca

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