Thursday, April 7, 2016

Dr. Thinker: United States Clinical Experience (USCE)

USCE – United States Clinical Experience

Types of USCE:

A. Clerkship: It is considered hands on clinical experience.  You MUST try your best to do this no matter what.
Eligibility: You should be a medical student and not graduated yet.
(For Indians: Internship period is still considered as not yet graduated.)

- The best clinical experience.
- This is what the programs look for.
- The LORS from this have a great value.

B. Observership: Not a hands on, just shadowing another doctor.
Eligibility: Either a medical student or after graduation

- Not considered as a USCE by most of the programs.
- Some hospitals might let you touch and examine patients, but legally you are not supposed to.
- Best to fill the gap between graduation until residency application or end of the season.
- A reasonable time spent a big university or a community hospital that takes IMGs into residency is fruitful.

C. Externship: Hands on clinical experience.
Eligibility: After graduation

- Some programs doesn’t consider it as USCE as this kind of experience is mostly offered by private agencies or at private clinics.
- The LORS can mention it as hands on.
- Best to do if you haven’t had any clerkships

1. What type of Visa is needed?
- B1/B2

2. How to get USCE?
- This question irritates people the most when you ask them without even putting minimum efforts.
- The easiest and the first thing to find a USCE is to do a google search.
- Type something like “Hospitals in the USA offering electives/observerships/externship for foreign medical students”.
Or “hospital name – visiting international medical students electives”.
- Finding an Observership is more easy.  Google for random university or community hospitals. Go to their webpage, look for your desired specialty or subspecialty, open the faculty page, check if they mentioned their email ids. Just email them. If you can’t find the email id of the faculty, email the program coordinator or the administrator. If you can’t find any email id then move on to another hospital.
- You can ask the email ids of the coordinator or the doctors from someone who has done an elective or obsie at that particular hospital. Or ask your friends or seniors who are now residents at that hospital.
- If, you are in the USA, just walk into a nearby hospital with your CV and talk to the program coordinator. Or email an attending asking for an appointment.

3. Private organizations offering clerkships/externships: I would strongly suggest not using these for clerkship unless it is a last resort. The best way to do a clerkship is by directly applying to university that is providing it. The hospitals provided through these are usually private clinics.
A. Americlerkships
B. Chicagoclerkships
C. Fmgportal

4. Hospitals that offer USCE:
This is just a small list I remember.

Clerkship: All the hospitals prefer TOEFL

Without Step scores:
A. Yale - Paid
B. Harvard - Paid
C. Weil Cornel - Paid
D. John Hopkins - Very minimal fee
E. NIH - Free

With Step scores:   
A. UNC - Paid
B. Jefferson
C. UT southwestern, Dallas
D. Cleveland Clinic, Ohio
E. Case western, Ohio
F. St Joseph, Arizona

Observership: From my experience, you can try at any random hospital, especially university based.
A. Albert Einstein, Philadelphia
B. Allegheny General, Pittsburgh
C. USF, Florida
D. Moffitt Cancer Center, Tampa
E. MSKCC, New York
F. Mt. Sinai, New York
G. Maimonides, New York
H. UAB, Birmingham
I. University of Texas, Houston
J. Methodist, Houston
K. St. Luke’s, Houston
L. UNMC, Nebraska
M. MD Anderson, Houston
N. Duke, NC
O. Staten Island University, New York
P. Griffin Hospital, CT
Q. Tampa General Hospital, Tampa
R. St. Vincent, Worcester
S. Washington Hospital Center, DC

A. Jackson park, Chicago
B. Heart and vascular institute, Detroit

5. Ideal duration of USCE?
- There is no such fixed duration.
- 3 months of clerkship is the best as most of the programs are now having this requirement.
- Few programs now have a requirement of 6 months.
- So, ideal number of months of USCE goes from 3 months to as many as you can.
- If  you are a recent graduate (for eg: graduated 3-4 months or less before September of the year of residency application), then even one or two months of USCE with a couple of good letters is fine.

6. What is your role during a clerkship?
- It’s just like internship or final year medical school.
- You will get to see patients on your own first, then you will present it to your resident, who will then go to see the patient along with you. Later in the day you will present the same case to the attending (doctor), who would ask you simple questions regarding your thoughts, management and future plan. Then you would see the patient again with the attending.
- You will get to use the electronic medical records, where you right your findings. Your attending has to sign it before it goes on record.

7. How many months in advance should you apply for a clerkship?
- Apply atleast 6-9 months in advance of your desired month of electives to have a much better chance of securing one.
- (For Indians) I have seen some people from the north applying in final year MBBS, for the months right after final exams. You can finish your elective during the duration in between finishing final exams and the start of internship. This way, you don’t have to postpone your internship end date by more than a couple of months and also you will be able to apply for the residency match in the same year of internship completion (graduation).  You can apply for clerkships in those programs which don’t need step scores.

8. How many months in advance should you apply for an obsie/externship?
- Whenever you can. As early as possible.

1. Keep your electives/obsie as widespread( with respect to regions) as possible. Doing an elective/obsie in a particular region can help getting interviews from that region and it also shows that you are willing to go where ever without any preferences.
2. Once you are in the USA, it becomes very easy to find more electives or obsies.
3. Even if you don’t meet certain requirements of a program, there is no harm in contacting them.
4. If they can’t offer you one right now, don’t just leave it there. Send a thank you email for their time and mention to let you know if anything opens up in the future. Be in regular contact.
5. Get done with TOEFL whenever you can. Even if you are not planning to apply for clerkship at that moment. TOEFL score is valid for two years.

1. Americlerkships
2. Chicagoclerkships
3. Fmgportal
4. List of hospitals


  1. Hey dude nicely written... i hv already graduated from med school
    So... altogether how much expense will b there.. if u cn provide a rough estimate.. il b very thankful

  2. Do you have to take TOEFL even if your a US citizen studying medical school abroad (away from the US)...i.e. a US-IMG??

  3. This way, you don’t have to postpone your internship end date by more than a couple of months and also you will be able to apply for the residency match in the same year of internship completion


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