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Yes USMLE scores are important - but not everything for a Medical Residency in USA! To be Pre-Informed is to be In Form :-) Sharing Wisdom learned through application experience and mistakes - especially for IMGs / FMGs!

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Tuesday, September 11, 2007

TYPE OF USCE & REQUIREMENTS

First, for the uninitiated : USCE = United States Clinical Experience !

Externships, Observerships, Clerkships, Electives, Mini-Residency, Sub-internships are all types of USCE.

1. Externship or a Sub-internships or a Mini-Residency is like doing a medical school internship in another hospital which gives a good hands-on experience, you are allowed to do physical exams, touch the patients besides histories, case presentations and lab-result followups. Often an externship spans a single department, while a sub-internship or mini-residency may be longer over several specialties.

2. On the other hand, an observership or shadowing means exactly what the english word means - to see and note without touching the patient ! In most cases they consist of attending morning rounds, seminars, student lectures and attending case presentations. You cannot touch the patients and perform physicals.

3. Clerkships or Electives: In most cases a 'Clerkships' or 'Electives' implies that you need to be currently in your 4th year home-medical school internship and will be doing part (one to three months) of those 4th year rotations in the US, after a NOC - No Objection Certificate, from your medical school. You do the same thing as an externships, except that you are still a 'medical student' - not a medical graduate...


Thus, Externships, Sub-internships, Mini-Residencies, Clerkships or Electives are considered true USCE since they give you 'hands-on' clinical experience, whereas Observerships or Shadowing only give you a chance to be a passive observer without being allowed to touch the patient.

Sometimes a program may explicity mention that Observerships do not count as USCE ! For example, the University of Michigan psychiatry residency program at Ann Harbour.

An example of a "Mini-residency" is the Mt. Sinai Mini Residency Program at Miami, Florida, in 13 Specialty areas (300$ per area) . For registration, Info and contacting - Click Here


Be advised that in terms of importance for getting considered for a Residency position :
Clerkships or Electives / Externships / Mini-Residency / Sub-internships > Observerships > Clinical Research


Q. Doc, I only got an observership - no externship. Am I doomed ?
A. An externship may be better, but having an observership is still better than having nothing at all! And having a clinical research experience position at a University hospital is better than having ABSOLUTELY NOTHING. There are thousands of IMGs without any of these..

Q. What Visa Can an IMG do an observership / Externships on ?

 A. Any Visa....Yes it can even be a visitors Visa AS LONG AS as the Observership or an Externship DOES NOT pay you. Any USCE that PAYS you (Like a visiting scholar's position or a paid sub-internship ) would need either an J1 (more common) or a H1 visa to be sponsored by the hospital.

Q. Requirements for USCE ? Do you need USMLE Steps for Observerships/Externships ? ECFMG Certificate ?

A. There is no formal American policy on this - but hospitals may have their own internal demands. It's best to find that out when you contact the guys. As a sample, Click here to check out the requirements of the Baylor Neonatology Observership program. And have a look at USMLE step 1 requirements for the IMG requirements for clerkship at the Mayo Medical Schools. Usually for an externship, most programs may need you to be ECFMG certified, while requirements are usually less stringent for Observerships since there is no patient-touching involved.

To reiterate and irritate ;-) : There are no universal policies on these and you must endeavour to find those out via emails / phone numbers for places listed Here...




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posted by Digitaldoc, MD at 7:41 PM

Comments on "TYPE OF USCE & REQUIREMENTS"

 

Blogger Digitaldoc, MD said ... (September 11, 2007 7:42 PM) : 

Anonymous said ... (June 20, 2006 4:51 PM) :

hi,your replies are really encouraging and informative.
i always go through your blog.
i did externship in the dept of pm&r but i am planning to apply in I.M.
do you think itwill help although it is in diferent deptt but then an externship!!!!.
i would appreciate your response.


Digitaldoc, MD said ... (June 22, 2006 8:42 PM) :

Externship is invaluable hands-on clinical experience..on ur ERAS resume, when u describe ur externship - focus on those compenents that will help IM application...also mention the same on ur SOP, how during the externship you discovered ur aptitude for IM ...shud be good :-)


pidugublues said ... (June 29, 2006 3:54 AM) :

Hi, this infromation is so valuable to me as I am in search of observation/externship. The prob is I am on F1 in Dallas. I Cant go different places as I need to attend my classes. And I dont know any hospital in dallas offering USCE. So what u suggest me to do. Will my Masters degree credits carry any importance for my residency?


Anonymous said ... (June 30, 2006 12:04 PM) :

hi
I am a surgeon from India
Looking for residency/fellowship here?
Is it possible?I have 2 month observer experience.
Thanks


Anonymous said ... (July 01, 2006 7:59 AM) :

Dear digidoc,

My step 1 score is 91/236. I am appearing for Step 2 in july and for CS in august.

I have done MD in pathology and currently i am senior resident in pathology only.

How can i get USCE and is it possible to get i pathology


Digitaldoc, MD said ... (July 13, 2006 7:52 AM) :

Hi...glad its helpin' u. Yes a US Masters in a field related to the specialtly you applying to can certainly attract University programs. Gear your Personal Statement well explaning how your Masters makes you unique and useful to the specialty. Also market your stay in US as something that has dramatically improved your fluency and communication skills :-)


Digitaldoc, MD said ... (July 13, 2006 7:53 AM) :

You can certainly use Summer for some USCE in a nearby city like Houston..


Digitaldoc, MD said ... (July 14, 2006 8:12 PM) :

To the Future Pathologist :-)

Your step 1 scores are good and shud help you get interviews in Pathology, besides ur PG training in pathology. You can request observership positions in Pathology via email to hospitals near where you have relatives in US or friends.. g/l


Anonymous said ... (July 29, 2006 12:42 PM) :

im a little confused..i heard research experience was better that observerships or externships?


Digitaldoc, MD said ... (July 29, 2006 1:12 PM) :

CLinical Residency Programs needs docs who are clinicians first to take care of their patient load and then researchers - hence strong clinical credentials are ALWAYS honoured. IN addition, if there are research credentials, that's like an icing on the cake for University Programs - but again having research will be more attractive than nothing..and also a solid, unique research with publications in major mags like Nature, Lancet, etc. is eye-catching too ..


For non-clinical programs like pathology, research maybe very important
:-)


Anonymous said ... (July 31, 2006 9:54 PM) :

thanx a lot:)


Digitaldoc, MD said ... (August 01, 2006 2:55 AM) :

Reply to the future US surgeon : A friend of mine, as I mentioned elsewhere, did get a surgery prelim position with average scores - observerships and strong US recos helped him. It is certainly possible. Spend good time on researching which surgery programs accept IMGs...


Anonymous said ... (August 28, 2006 10:00 AM) :

dear digidoc

my step 1 score is 90/221 and step2 is 97.I have given my CS.I am applying for the 2007 match.I have enrolled myself in a master's program.I want to know if the credits will count towards my application.will it be advantageous.can i mention it in my personal statement?


meddoc2b said ... (September 04, 2006 4:37 PM) :

Thank you digitaldoc for the wealth of information you have put together on this site.

I would like to get your feedback on my situation. I am a U.S. citizen, have ECFMG certification, and have also passed step III in 2004. I have also done observerships in family practice and psychiatry. However a couple of factors have hindered me from getting a residency position, which I have been applying for since the year 2001. Time since medical school graduation exceeds ten years, and my USMLE scores are no higher than 80, with several attempts on each step.

Since the majority of programs require recent clinical experience, not including observerships, I am considering enrolling in a caribbean medical school as a student with advanced standing, to allow me to do a clerkship (clinical rotations) in U.S. hospitals. Do you think this training is worth the cost ? If so, would it be better to enroll as a third year medstudent and do the core clinical rotations, or as a fourth year medstudent and only do the elective (sub-internship) clinical rotations ?

Thank you in advance for your help.


Digitaldoc, MD said ... (September 04, 2006 5:12 PM) :

Thanks for dropping by ...

If You have already singled out the specialty you wanna do a residency in, then the elective clinical rotations would make sense - if not , all core rotations may help your case. Have u tried all places for externships / subinternships (paid and unpaid ) ? Strong LORs will help the most in your situation - and I wish you good luck ...


Digitaldoc, MD said ... (September 09, 2006 2:03 AM) :

About Masters Programs helping residencies applications = if the masters is related it surely will attract University Programs. Include on ur SOP how the Masters was part of ur whole Grand career Plan :-)


Anonymous said ... (September 12, 2006 6:18 AM) :

Thanks DigitalDOc.....u have done great service on these blogs.

I want to know how long is observership? Is it of predtermined length or one can do of length that suits him/her? Also if it is variable in time, whats the minimum time of observership one should do so that it carries weightage?


Digitaldoc, MD said ... (September 12, 2006 6:49 AM) :

No Formal length , but often the hospital will give you a fixed time to do it , depending on how long will the assigned attending be available.

The general rule is - the longer the better. So when u do land an observership for say 3 months, from the 3 month onwards, start looking at the same place for anohter term - use ur attending's influence to request another attending to allow you to observe him.

g/l


Anonymous said ... (September 12, 2006 7:07 AM) :

Hi digitaldoc
I am studying in 3rd Prof at Maulana Azad Medical College.
Many of my batchmates are planning up for "research elective" at Johns Hopkins.. It is worth it. Please do help me out....


Digitaldoc, MD said ... (September 12, 2006 10:44 AM) :

I would rather do a clinical elective - but if the research has a strong clinical component , that shud be good too. And plus if you will be applying for residencies immediately after med-school, you will be a 'fresh IMG' and will have good chances for a residency anyways..but still, clinical elective rotations will be very advantageous - since they will result in a solid clinical recommendation from a US doc ...


Anonymous said ... (October 14, 2006 8:49 AM) :

hi... i will start my internship which will end end in nov 2007 n i am preparing for step 1, i want to take externship in US pls suggest when shd i apply in hosp..


Digitaldoc, MD said ... (October 14, 2006 11:35 AM) :

You should start the process of contacting hospitals in the US in advance by emailing and attaching ur resume. Since, things are competitive, its better to start early. Once u get a positive reply, then initiate the process with your internship administrator - but also ask about the rules and policies in advance.


Anonymous said ... (November 02, 2006 11:55 AM) :

Hi Digitaldoc,
Thank you for your helping.
I have a problem with my CAF. I didn't know to put observership in Working experience when I applied. Now it is too late for me to add it on. Also I want to add some USCE I get recently. Do you think it is OK to send my USCE update to the programs I applied for by email??

Thank you a lot.

Richlingy


Anonymous said ... (December 20, 2006 11:52 AM) :

hi,

i hv the same ques, can any1 help


Digitaldoc, MD said ... (December 20, 2006 2:14 PM) :

Don't worry to much about it - the program directors will be looking up all experience sections. You cannot add new experiences on the CAF once u submit it , but its a great idea to send updates to the programs you applied to about your new experiences of any time - too keep the dialogue continuing and indicate continued interest in the program


Anonymous said ... (January 21, 2007 4:48 AM) :

hi there digital doc..

I am a foreign medical graduate and am currently in India. I am preparing for my step 1 USMLE which i maybe writing in a month or 2. I have kept my internship here pending coz most electives programmes require you to be still enrolled in a medical college. I want to do a residency in pediatrics so would love and hope to get electives in pediatrics...can i get some advice from you..what do you think is best for me to do..thanking you in advance..


Digitaldoc, MD said ... (January 21, 2007 9:13 AM) :

my advice would be run head over heels after your love ;-) Start contacting US medical schools and read their requirements , and get working on that - after your step 1. electives are easier to get than stressing over observerships and externships later. I was not aware that one can keep one's medical school internship "on hold"


Anonymous said ... (February 18, 2007 9:47 PM) :

hi there.your suggestions in this page are of utmost help to an img. i have passed my step1 with a score of 85.i m planning to take my step2 ck in june and cs in august 2007.i completed my graduate degree in 2005.i m interested in surgery residency but for that USCE is a must for me.what should i do to get an externship in surgery?


Digitaldoc, MD said ... (February 19, 2007 1:08 AM) :

Externships are not always 'formal programs' , but some very busy programs may offer them from time to time. One strategy is to lookup the list of IMG friendly programs in surgery (www.USMLEtoMD.com/imgfriendly) and then get contact info from the websites - write emails or call, and find out. Concentrate on the community programs in New York, where patient loads are often high. One person I know wrote emails to hundreds of programs and did hear back from a few about externships ...so be ready for some hardwork and push yourself to extreme information-finding work via emails / phonecalls / google search !! Other option is agencies like GMCgroup.org and FMG Portal that place you for a fee.


Anonymous said ... (February 27, 2007 8:43 AM) :

hi digi doc....this blog is wonderful..a million thanks in advance..

am kinda novice here..jus got over with my final year exams in karnataka.got a few queries..how do i go about getting usce..is it possible that i take a transfer and do my internship in the us..or else what be the best possible way nd time to get to the us..thanks again


Digitaldoc, MD said ... (February 27, 2007 12:46 PM) :

yes - electives are your best bet and something that probably easier.
1. speak to your internship coordinator and if required the dean of your medical college about the procedures to do an elective 3-month internship abroad (some schools in india call this externship in the sense that it's a internship done outside your own school)
2. apply / write / follow procedures on the website of programs listed on my USCE blog for electives. each program has different requirements.
3. once you get a elective admit, you can work on the visa stamping prep.
4. get started on making ur passport early, if you dont have one..

hope this helps


Anonymous said ... (March 03, 2007 1:45 PM) :

hi digi doc...im a 4th yr med student wanna know if i can get into an externship program...or shud i wait to get my degree


Digitaldoc, MD said ... (March 03, 2007 5:36 PM) :

during the 4th year, if you still lotsa time left on your internship rotations, you can advantage of the electives - which are nothing but externships for med-students.


Anonymous said ... (March 29, 2007 9:57 AM) :

Hi digi doc.

I'm in my final year. Will graduate by Feb, 2008. I haven't done any electives, observorships or research electives in US. All my electives were done in my own country (Pak).

I was wondering if I could apply for any clinical electives in US after I graduate while I prepare for my steps. Or can they just be done before you graduate?

Also, on your site, is there any list of places that offer clinical electives?

P.s: great site. I wish I had come across it earlier.

Saba


Digitaldoc, MD said ... (March 29, 2007 11:15 AM) :

Hi, you are right, electives can only be done while you are still in Medical school. After graduating, you could do observerships and externships, which are tougher to come by. I am maintaining a list of places which offer such experiences formally, or have been known to offer them informally at :

http://www.USMLEtoMD.com/usce

g/l


Anonymous said ... (April 07, 2007 9:07 PM) :

hi digidoc,
first of all,i really have to thank u for making an excellentsite..great man..i need to ask u about something..is LOR AND OBSERVERSHIPS ARE DIFFERENT..and if,,actually my kaka iz a renowed cardiologist in us..but he is a private practitioner..and he got v close friends as rheumatologist and neuro surgeon..so can i get LOR FROM THEM..and digidoc can we get observershis from private practitioners..i really need this info digidoc..plz help me out..


Digitaldoc, MD said ... (April 08, 2007 12:46 AM) :

Yes u can observe private practitioners too - but university setting for oberverships is always more credible - have covered that on this link here

 

Blogger Ashish said ... (September 15, 2007 9:55 AM) : 

hi digi doc thanks for all the information. u are really amazing. i am an ophthalmologist in india. i completed my internship 2003 jan.then ms ophthalm i finished this yr. what are the chances of me getting us residency/fellowship. i am reading for step 1 now. do i need usce lors. do programs prefer fresh graduates since i already completed 5 yrs after my med school

 

Blogger Digitaldoc, MD said ... (September 18, 2007 2:42 PM) : 

Hi Ashish - welcome to USMLEtoMD.com

Since you been into post-graduate clinical training after your medical school - you will not necessary be considered as an 'old IMG'.

US LORs and experiences will help and probaly with your MS in Opth - you may have a good chance even for direct fellowships :-)

Have covered that here

 

Anonymous Anonymous said ... (September 22, 2007 9:59 PM) : 

hi digidoc . i am working with a cardiologist for a month in his office which is attached to a hospital . in the office i take histories and do physical exam . i also work with the doc doing ecg echo and stress test . will this be couted as an externship . i will be ecfmg certified by mid of dec . so am i legal to do an externship before i get certified . i will be getting my lor in mid of oct . should i post it to eras . what should be my line of action . thanks .

 

Blogger Anna Kristina said ... (November 12, 2007 4:14 AM) : 

hi digidoc!

Hello! Thank you for such a helpful and informative site. anyway, I was wondering if it matters when I did my clinical electives. In my school, my elective was my first 4th year rotation, so basically after the summer vacation I went straight to my US clinical elective in cardio and IM and had no idea what i was doing. I didn't get to ask for an LOR since during the electives we rotated with different physicians and the attending in charge of my cardio rotation was kind of a jerk and never returned my evaluation. Do hospitals ask for proof of my USCE? Right now, I only have a photocopy of my IM evaluation and my letters of acceptance. Thank you!

krista

 

Blogger Digitaldoc, MD said ... (January 31, 2008 10:47 PM) : 

Answer1: You can call it an externship if your physician preceptors agrees to calling it so. The legalities are what the program allows ;-) - I don't think anyone will have a problem with that.

Answer 2: Hi Anna, thanks for dropping by :-)

No - residency programs do not usually ask for any 'proof' of your USCE - Neither does ERAS accept any documents or certificates about the USCE, other than the LORs (Letter of Recommendations). A LOR is certainly something they programs would love to see from that experience. You can always ask for LORs in May-June of the year you will be applying to residencies. See if you can get your medical school put in those US electives on their transcript, since it will be a part of your medical school training years. Email all faculty you worked with to see if they would provide you with an LOR later when the time comes. :-) That will be a good assurance and also help keep you in their minds..

 

Blogger Ashwathy said ... (April 3, 2009 12:24 AM) : 

hi digidoc
i just passed final yr and have started my one year period of internship. will i still be eligible for electives? and is step one necessary to apply.

thnks for the wealth of information

 

Blogger Digitaldoc, MD said ... (April 3, 2009 6:05 AM) : 

Yes, you are still technically not graduated from your medical school hence you will be eligible

Step 1 needed or no depends on individual universities rules, look up Here

 

Anonymous Anonymous said ... (June 2, 2009 6:04 PM) : 

hi i have been looking, unsuccessfully for externships for last couple of months. i was about to finally give up and just buy an externship from fmgportal.com. but iwanted to know whether this is a genuine website offering genuine externships or is it a fraud like some other websites i have heard of? and if it is for real then what is the cost of a 3 month externship and do u think it's worth it? hope to hear from u soon, thanks you very much.

 

Blogger Rohan said ... (June 15, 2009 11:29 AM) : 

hi digidoc
thanks for all ur help..they r very valuable..i am coming with a doubt to you

i went thru your blog and found that electives /clerkship/observership r the need of the day

i am graduate of medical college outside india.i completed my 5 yrs there..but we are not allowed to do internship in that country

so i am now undergoing my internship in a hospital in india..

so now i am confused..
am i graduate or am i still a student??
would i still be able to apply for electives or am i left with only observerships??
if i can apply for electives how should i go about it??
need your help for this matter
thanks

 

Blogger Digitaldoc, MD said ... (June 15, 2009 4:19 PM) : 

1. Any paid externship programs, before you pay anything, make sure you can get an agreement that the experience is going to hands on and not just observership - if the organization is unable to provide you a guarantee, then you should be skeptical about spending your money there

2. To Rohan: If you haven't got your medical degree in hand - either provisional or final, then you are not yet a graduate. That internship is going to be counted as part of your medical degree I suppose.

You can do clerkships as a final year medical student.

 

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