Univ. Puerto Rico Electives for Non-U.S Med. Students

Puerto Rico is a semi-autonomous U.S. Commonwealth territory island located around 1200 Miles off the Florida Coast and the University of Puerto Rico School of Medicine offers electives to Non-US Foreign medical students too, in various specialties.

Here are some details:

Before you read any further, note that besides English, you need to be fluent in spoken Spanish too - merely knowing Hola, Adios and Gracias won't cut it ;-)

Duration: 12 Weeks Maximum
Visa: F1 visas only - No Visitors will be accepted during the Elective
Fees: $25 Per Specialty ( but verify with the document posted below)

Download Eligibility , Instructions and Application Form Over Here [PDF]


Search keywords to this article:

- Electives, Clerkships for International medical students - MBBS

SUNY Downstate Electives for Non-U.S. Med. Students

The fresher a applicant from medical school while applying for residency, the better - add in a hands-on US Clinical Experience to that freshness - that's like an icing on top ;-) That's why clerkships / electives are cool to do.

Here are the Details of the SUNY Downstate Electives Program - which is of course, now neatly indexed on our New York Listing for USCEs on this blog.

SUNY Downstate for International Medical students
Duration: 12 weeks Maximum - Remember the 12-week Clerkship rule of NY State
Fees: $175 for first elective application - $100 for additional electives
Visa: International Students need to get their own visitors visa (Remember to carry their acceptance letter to the visa officer while getting the visa)
HIPAA: Once accepted, the program itself will send you a website link to a tutorial and take an easy HIPAA test online. (Shall write a post about HIPAA tests later)
Application Eligibility and Application Form


Notes:

1. The SUNY Downstate Medical center visiting international student program page begins with prohibiting outside students from enrolling in their clerkships - which potentially might have some of you confused. In the US medical school system, all clinical rotations are called 'clerkships'. Clerkships done before the final 4th year are the same for all without a choice and are called core clerkships' - while the clerkships during the fourth year (also called senior year) are called 'Electives' since they students get to choose.

Since I already made a reference, here are the how the years of any post-high school undergraduate degree in the US are labeled:

1st Year = Freshman Year
2nd Year = Sophomore Year
3rd Year = Junior Year
4th Year = Senior Year


2. As I have already covered, clerkships or electives in American medical schools / Universities are only an option to internationals who are still in medical school - Notice that I did not use the term "IMG" in the title, who have already graduated from their medical schools. For IMGs - observerships / externships / mini-residencies are usually are the the only options for rotating through Hospitals or Universities.

WASHINGTON (WA)

ELECTIVES / CLERKSHIPS
(3rd / 4th Year Medical Students)



University of Washington School of Medicine, Seattle
Duration: Maximum of 12 Consecutive Weeks
Visa: Will Sponsor Student Visas Only (F1) - Visitors Visa Not Accepted
Fees: Need to pay for two credits per week
Application Information



OBSERVERSHIPS

University of Washington Affiliated Hospitals
Specialty: Family Medicine
This is what their Website says:
"We do not offer observerships at the University of Washington Family Medicine Residency program. Our department is, however, affiliated with WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) region residencies and we encourage you to contact our network office for further inquiry (206.685.1856)" ....I say you should make the contact then :-)

BASICS: Electives, Clerkships, Externships, Observerships, etc

So what exactly is the difference between Externships, Observerships, Clerkships, Electives, Mini-Residency, Sub-internships, etc. ?

They are various types of USCE terms that you will come across scattered all over the Internet and USMLE forums. Though I have already clarified the differences on the Tips4Match blog, I guess it's a good idea to put the food where the mouth is ;-) I mean, placing that info on this blog exclusively meant for USCE.

Before we begin, let me clarify that these terms are explained here in the context for International Medical Graduates.

1. CLERKSHIPS or ELECTIVES: In most cases, the terms 'Clerkships' or 'Electives' are clinical rotations granted by US Medical schools to medical students. Note that I said students and Not graduates. This implies that you need to be still enrolled in the 4th year of your home-country medical school while applying and will be doing part (one to three months) of those 4th year rotations in the US. Such rotations, besides being accepted by the US Medical school, also needs a "NOC" - No Objection Certificate, from the Dean of your own medical school or University.

Note: The term '4th year medical school' is often referred to as internship year in some places like India. While in the USA, an Intern is the First year candidate in any Residency program , also called PGY1

Experience-wise, Electives are 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. You are not held liable for errors because of your student status.

Once you graduate out of your Medical school you become an "IMG" for US purposes and you no longer qualify for Electives / Clerkships in the USA, (unless you re-enroll in a US Medical school - Yeah, some rich fellas do so). Instead, IMGs can avail of the following kinds of USCE.


You do the same thing as an externships, except that you are still a 'medical student' - not a medical graduate.

2. EXTERNSHIPS: Externships are clinical rotations for International Medical Graduates that give a solid hands-on experience working as a resident under supervision. You do almost everything that a PGY1 resident does except that your medical notes need to be approved by a resident or attending and you will not have the authority to write orders and prescriptions.


Often an externship spans a single department, while a sub-internship or mini-residency may be longer over several specialties.


3. OBSERVERSHIPS: An Observership or shadowing (Sometimes also called as a preceptorship) 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.



Some places may also call Externships as or a Sub-internships or a Mini-Residency, but the terms are not always strictly externships. Likewise, at times, when a program says "externship" it may actually mean an Observership - so it's upto you find out beforehand, the nature of the rotation.

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 :

"Hands-on Experience is Better than Observerships"

Q. Doc, I only got an observership - no externship. Am I doomed ?

A. Agreed that an externship is better, but having an observership is still better than having nothing at all! 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. At times, the specific Program may need a specific visa type like a student visa, visitors visa, etc. and they will provide a supporting visa letter for the same.


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

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, since you do similar stuff as a resident would, 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 endeavor to find those out via emails / phone.




Search keywords to this article:

- "how is elective different from externship"

WISCONSIN (WI)

ELECTIVES / CLERKSHIPS
(3rd / 4th Year Medical Students)



University of Wisconsin School of Medicine and Public Health
Specialties: Multiple = See List Here
Application Fee : $112.95/-
Criteria / Requirements for International (Foreign) Medical Students
Click here for Online Application

Reader Experience & Advice : "How I secured my Elective"

Since the past few months, I am beginning to see a surge in user contributions to USMLEtoMD.com blogs and I'm Feeling Lucky – yeah just like that Google button! ;-) Since the generous gal contributor to this great article preferred anonymity, lets call our lady Madam-X.

Note: An US Elective (also called a Clerkship) is a medical / surgical rotation option ONLY OPEN for current Medical school Students in their final clinical internship year. Students who have already graduated from medical schools cannot avail this option - they must look for Observerships / externships instead


The Following is her personal experience on how she went about applying for electives / clerkships in US Medical Schools and tips to fellow aspirants. Read on...

"How I secured my Elective in US Medical School" - an experience of a Foreign Medical Student (MBBS)

Step 1: Gathering Information

I came to know about this electives stuff through a friend, who was applying for the same. He mailed to me a list of medical schools where electives are open for international students.
They are mostly already listed on Digitaldoc’s USCE list Blog. I also searched for them via Google by typing various words like visiting students, electives, clerkships for foreign medical students and so on.

Step 2: Collecting Eligibility Criteria

I had to search all these sites and laboriously make a list of their eligibility requirements, the documents required for the application process etc.

- All the websites had a complete and proper description of the exact documents required about their precise selection and eligibility criteria and these differ from program to program. For example, some like mayo Medical School and UT southwestern will require you to pass the USMLE step 1 before the electives begin – while others do not.

- Most of them have similar eligibility requirements like you must have finished your core medical school clerkships – i.e. the ones that we do during our own medical school rotations.

- You must be in your final year i.e. you must be within the last year for graduation, which in India implies that you are an ‘intern’

Step 3: Collecting Information on Documents Required

Again, each individual program website provides a definite list but the common ones are:

- Completed specific application form for each medical school u apply to. This can be downloaded from the Internet in most cases. In that form, you fill your elective choices in descending preferences. They may ask for three or more but you may fill out more to increase your chance of getting an elective

- Resume and its supporting documents

- Medical school transcripts and hour certificate

- Letter from dean of your medical school stating that you are a student in good standing, your graduation date, and that u are allowed to do the elective, along with some other qualities of yours as well as the medical school. In my school, since I was the first one applying for electives so it was hard to convince my Dean that such electives can be done. You may have to obtain No-Objection Certificate (NOC) from your University in such cases, as I did. But if your dean is convinced then no problem will arise.

- Next you need Letters of Recommendation from the Department chair of the field you are applying for electives in

- Full immunization records and proof of immunity by showing antibody titers against Hepatitis B, Measles, Mumps and Rubella. These tests are a bit costly and not available in small towns so be prepared for getting them done early.

- Proof of Health insurance in some cases.

- Some US Medical schools will also require proof of malpractice coverage too which I could not get. If you can get that then a host of schools may be open for you !

Other requirements vary from school to school.
Step 4: Application Fee

Some schools have application fees which need to be sent along with the application packet in the form of draft in US Dollars. Now, most schools have a single fee requirement for 2 electives but some will require you to send two application fees for 2 electives.

Step 5: Mailing out the Application Package

Each medical school site will provides an email correspondence contact who you can ask your queries, they are very quick and informative in their replies and reliable too, than most other people. Send the application packets to the addresses mentioned in the specific application form.

Step 6: Communicating

After about a week, it is a good idea to write an email to the person at the registrar's office (it will be mentioned on the form or the website), that u sent the application packet. Request for acknowledgment of the same and also ask about when can u expect a reply on the status of your application. Some schools reply about the status in a month or two. rest do it only one to two months before your scheduled date of arrival.

Step 7: The Hurrays, Cheers and Visas

Once you are placed for the elective in the medical school, they will ask you for further documents according to the visa they sponsor. It may be J1 or F1 and some instances the visitors visa too. J1 visa in these cases may not be free from the 2 - Year Home country residence requirement rule, so do look into that carefully before you accept.


My Two Cents:

The key to get selected is to act fast . I sent my applications 7 months before my elective start date. This way u can assure that seats are not filled out.Then send in all the documents at the very start so your application is not incomplete ans thirdly fill out choices using your brains. As US students are pref. if u fill out choices they like u have less chances, just like match u know. That’s all I had to say about the elective application process. Hope this helps. God Bless"

*****************

Wow ! Did she say, “That’s all” – I thought this WAS ALL ! Very well written and structured. Thank you ...

I am also hoping she provides us with her with experience and tips DURING her electives, but lets not get ahead of ourselves and wait for Ma’am-X to complete the rotations first..right 

:-)



Google keywords to this blog post:

- "how to apply for electives"
- "how to apply for clinical clerkships in america"

RHODE ISLAND (RI)

CLINICAL ELECTIVES / CLERKSHIPS


Brown University : Brown Medical School Visiting International Medical Students Program
Specialties: Multiple
Application Information
TOEFL not required but an added plus to demonstrate English Fluency.

NEW MEXICO (NM)

CLERKSHIPS / ELECTIVES


University of New Mexico School of Medicine
Specialties: Multiple
Application Information

KANSAS (KS)

CLERKSHIPS / ELECTIVES
( For 3rd / 4th Year International Medical Students)


Kansas University Medical Center, Kansas City
Specialties: Multiple
Application Information
Application Brochure Request Form




EXTERNSHIPS

University of Kansas School of Medicine-Wichita (KUSM-W)
This externship is conducted at the attached Veteran Affairs Hospital (VA hospital)
Specialty: Internal Medicine
Contact: Internalmed-wichita@kumc.edu
Application Requirements:

• Universal Application (Download PDF from NRMP)
• ECFMG Certificate
• Dean's Letter
• USMLE scores: Step 1 & Step 2 CK
• Medical School Transcript

Mail / Courier all the above material to:

KUSM-W
Internal Medicine Residency Program
Attention: Externship
1010 North Kansas
Wichita, KS 67214-3319

Note:
- Many thanks to Padmaraj, MD of SVNGMC, (India) for this information
- Each year, applications will be reviewed in January and July for externship positions in the Spring and Fall, respectively.
- This is a prestigious Externship, and since it is in the VA hospital, it could give you the benefit of making contacts for possible J1-waiver jobs later on when you need one.




Also Read:

- ECFMG Certificate Details
- Dean's Letter Details and Sample
- J1-waiver Sponsors, Specialties and Locations

ARIZONA (AZ)

CLERKSHIPS / ELECTIVES



Mayo Clinic, Scottsdale
Specialties: Multiple - See List
Eligibility Criteria
Application Information - Apply Online
Malpractice Insurance : Provided Free




OBSERVERSHIPS

Maricopa Integrated Health System
Specialty: Internal Medicine
Application Information
IMG Requirements [pdf]

PENNSYLVANIA (PA)

CLERKSHIPS / ELECTIVES
(4th Year Medical Students)



University of Pittsburgh Medical Center (UPMC)
Specialty: Radiology
Application & Electives Description




OBSERVERSHIPS



Children's Hospital of Pittsburgh
This is a possibility since the webpage of Neurology research says this:
"They have also hosted international colleagues in observerships in child neurology."
Read Here

Drexel University College of Medicine, Philadelphia
"Drexel Medicine Physician Refresher Course"
Specialties: Multiple
Click Here for Application Information
Steep Fees !


Penn State College of Medicine
Specialties: Multiple
Application Information


University of Pennsylvania, Philadelphia
Specialties: Multiple
Application Information


University of Pittsburgh Medical Center
Specialty: Critical Care Medicine
This Page actually has profiles of all IMGs who did observerships in Critical Care Medicine -giving us evidence that observerships are offered :-) So you might contact the department and hope to have your own pic show up later ;-)


Temple University Hospital, Philadelphia
Specialties: Internal Medicine (other may be possible)
Internal Medicine Website
(This information is unconfirmed word-of-mouth evidence)


Thomas Jefferson University, Philadelphia
Specialties: Multiple
Visa: They will determine the visa type you will be granted / eligible for (B1/ B2 / J1)
Click here for Application Information


Western Pennsylvania Hospital
Specialties: Multiple
Application & Contact Information

OHIO (OH)

CLERKSHIPS / ELECTIVES
(3rd / 4th Year Medical Students)


University of Cincinnati College of Medicine
Specialties: Multiple
Click Here for Application Info and Application Form
Duration: Maximum of two 4-week electives (total of eight weeks)

Notes:
- Needs Passing USMLE Step 1 Score
- Applications must reach at least 4 weeks before start date





EXTERNSHIPS



Columbus Community Hospital, Columbus
Specialty: Pediatrics
This could be a pot-shot, but I read this information from an IMG's resume posted online who was apparently working full time as an extern in this community hospital. This makes it worth a try - call (614) 445-5000 and ask to be transferred to the deparment of pediatrics


Huron Hospital
Specialty: Internal Medicine
Policy Statement: "The Internal Medicine Program offers externships, observerships to candidates meeting our minimum criteria, but it is not required to be a resident. We do not schedule externships in the months of June or July. Externships are for one month only and must be approved a minimum of three months prior to starting."



University of Cincinnati Academic Medical Center
Specialty: E.N.T. (Otolaryngology)
Note: According to their FAQs Link, "Application are considered on an individual basis by contacting Robert Keith, PhD, Director of Medical Education at robert.keith@uc.edu, Department of Otolaryngology-Head and Neck Surgery, PO Box 670528, Cincinnati OH 45267-0528."




OBSERVERSHIPS



Case Western Reserve University
Specialty: Family Medicine (Only for candidates selected for Interview)
Application Information


Cleveland Clinic
Specialties: Various
Click Here for Application Information
Duration: 4 Weeks or More
[Needs ECFMG Certification]


Cleveland Clinic
Specialty: Clinical Neurophysiology + Epilepsy
Observership Course Information
Duration: 3 Months
Notes:
1. Course if Free - But IMGs and International Medical Students must fund their own stay
2. Good for candidates interested in Neurology Residency !


Ohio State University College of Dentistry
Specialty: Periodontology
Application Information

MICHIGAN (MI)

CLINICAL ELECTIVES / CLERKSHIPS


Wayne State University School of Medicine, Detroit, MI


Henry Ford Hospital, Detroit, MI
Duration: 2 electives Max of 4 Weeks Each
Rotation Dates / Schedules + Application Requirements



OBSERVERSHIPS


Cheboygan Memorial Hospital used to offer, but is no longer offering observerships :-(




Michigan State University : Sparrow Hospital
Specialty: Internal Medicine
Application Criteria


Wayne State University
Specialty: Internal Medicine

This is what the Internal Medicine Department Manual Says about Observerships:

"At this time we are no longer offering observerships. Due to the extreme high volume of applicants that have applied in the past, we are no longer able to accommodate any new observership opportunities. We wish you much success in your future endeavors. " = Which means - you gotta periodically check back with the site


University of Michigan, Ann Harbor
Specialty: Ophthalmology (for IMGs pursuing PG in home-countries
Visa Sponsored: J1 Visa
Application Information

MASSACHUSETTS (MA)

CLERKSHIPS / ELECTIVES
(4th Year Medical Students)



Tufts University School of Medicine
Specialties: Multiple
Application Information


University of Massachusetts Medical School
Specialties: Multiple : List (only Type B & C are for Foreign Medical Students)
Application Criteria



OBSERVERSHIPS


Brigham & Women's Hospital
Specialty: Abdominal Imaging and Intervention (Radiology)
5-Day visiting Observership - Click here to learn more


Children's Hospital Boston, Harvard Medical School
Specialty: Congenital (pediatric) Heart Surgery observership course
Fees: $3000 for two weeks OR $4,500 for 4 Weeks
Click Here for Application Requirements
Click Here for Application Form


Dr. DeGroot's Orthopedic Surgery Clinic : Application Information
Specialty: Orthopedics


Massachusetts General Hospital (Harvard)
Specialties: Multiple
Observership Information
Online Observership Application
Fees: Atrocious ! Upto $4,500 for 5 days and upto $16,500 for 20 days !


Massachusetts General Hospital
Specialty: Stroke and Neuro - ICU Observership Program
Application Form and Visa Instructions

MARYLAND (MD)

CLERKSHIPS / ELECTIVES
( For 4th Year International Medical Students)


National Institute of Health (This one is prestigious !!)
Specialties: Multiple : See List Here
Application FAQs
Online Application Form


University of Maryland School of Medicine
Specialties: Multiple : List
Application Information
Note: It is the policy of the University of Maryland School of Medicine to accept only fourth-year students for clinical experiences who are enrolled in accredited allopathic medical schools which are approved by the Liaison Committee on Medical Education (LCME). We do, however, offer an exchange program with the University of Heidelberg and accept two students each year to study with us for six months. The students are selected by the Dean of Studies at Heidelberg



EXTERNSHIPS


Dr. Barry Mehta
Specialties: Internal Medicine, Family Medicine, Surgery, Pediatrics, Ob-Gyn
Duration: Minimum 7-weeks tp get a Letter Of Recommendation. Schedule
Cost: $4,400 for 7 weeks (Training + Staying)
Call: 410-730-3961, 443-285-9563 (Mobile)
Note: Interestingly, as a reader pointed out on the comments, the same Dr. Barry Mehta was found guilty of fraud and fined $250,000/- for robbing the state Medicaid program. He billed the state for clients that were never present as per this news here. However, the American Medical News also featured the Barry Mehta Externship program, Read the News article here. I was amused that they did not write about the fraud, the article was written by a student of the externship program anyways



Harbor Hospital, Baltimore
Specialty: Internal medicine
Contact Program Coordinator at: 410-350-3565




OBSERVERSHIPS


Johns Hopkins University, Baltimore
Specialties: Multiple
Application Information


Johns Hopkins : Institute of Genetic Medicine
Specialty: Clinical Genetics
Click Here for Application Information


Union Memorial Hospital, Baltimore
Specialties: Medicine + Surgery
Application Information

FLORIDA (FL)

CLERKSHIPS / ELECTIVES



Mayo Clinic, Jacksonville
Specialties: Multiple
Eligibility Criteria
Application Information - Apply Online
Malpractice Insurance : Provided Free




OBSERVERSHIPS


Cleveland Clinic Florida
Specialties: Multiple
Application Form, Fees, Immunization Requirements & Contact Details
Duration: Maximum Two Month
Fees: $350


Medical Surgical Specialists, Naples, Florida
Specialties: Multiple
Observership Listings and Information (If any available) - but I would anyways suggest you contact them even if they say they have no current positions
Application Form [pdf]


Miami Children's Hospital, Miami
Specialty: Pediatrics
Application Information



Mount Sinai Medical Center : Mini-Residency Program (Observerships)
Specialties : ( 4 weeks each - each specialty is treated like a 'course') :
"ANESTHESIOLOGY , CARDIOLOGY, CARDIOVASCULAR SURGERY, GASTROENTEROLOGY, GENERAL SURGERY, INFECTIOUS DISEASE, INTERNAL MEDICINE, MEMORY DISORDERS, NEONATOLOGY, ONCOLOGY /HEMATOLOGY, PATHOLOGY/LABORATORY MEDICINE, PULMONARY & SLEEP DISORDERS, RADIOLOGY "
Cost: $300 Per Specialty
Application Information



Jackson Health System Hospitals
(Includes Jackson Memorial Hospital, South Community Hospital, North Medical Center, Holtz Children Hospital, etc.)
Click here for Application and Policies Info
Application Fee: 200$



University of Miami Miller School of Medicine (Bascom Palmer Eye Institute)
Specialty: Ophthalmology
Additional Information



University of Miami School of Medicine, Miami
Specialties: Multiple
Contact & Application Information


University of Miami School of Medicine, Miami
Specialty: Nephrology
Application & Contact Information



University of Miami, Miami
Specialty: Obstetrics & Gynecology
Application Information & Eligibility
Fee: $250.00


University of Miami, Miami
Specialty: Pathology
Application Criteria & Eligibility


University of Miami, Miller School of Medicine, Miami
Specialty: Physical Medicine & Rehabilitation (PMR - Physiatry)
Application Information


University South Florida, Tampa
"Stephen Klasko Observership Program for International Physicians"
Specialties: Infectious Disease, Anesthesiology, but more may be introduced
Application Information and Application Form

Note: Though This Is mentioned as an "Observership" - the description sounds more like it is ONLY meant for current Medical Students. Remember that while Observerships could be done by both current medical students AND medical graduates - Clerkships are usually restricted only to current medical students