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How to Find U.S. Clinical Experience for FREE?
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How to Find U.S. Clinical Experience for FREE? A Complete Guide to Electives and Observerships in the U.S.
How to find U.S. Clinical Experience for FREE? Do you find this task complicated and hard to follow as an IMG? Well take a seat, and buckle up as we answer these most commonly asked questions about U.S. clinical experiences (USCE):
- What are the various types of U.S. clinical experience?
- What are the requirements for each?
- What is the financial cost involved with partaking in a U.S. Clinical Experience?
- How to find rotations for FREE?
1.What are the various types of U.S. clinical experiences (USCE)?
There are three main types of USCE: Electives, Observerships and Externships.
Electives:
- A type of U.S. clinical experience in which you have hands-on experience which often includes examining patients, putting notes in the electronic medical record (EMR), and participating in surgeries (in case of doing a surgery rotation). Through this elective experience, you get the same responsibilities as a U.S. medical student.
Observerships:
- With observerships, you get to observe medical care in a particular hospital, take part in rounds, and attend conferences.
- The main difference is that you cannot participate in any kind of hands-on patient care such as examining patients, writing history, putting notes in the EMR, and participating in surgeries.
- Most hospitals will not even grant you access to the medical records database. This limits your ability to learn about patients and participate in rounds.
Externships:
- The third type of USCE is externships which lies between an elective and an observership.
- The responsibility during this type of rotation will vary by the institution you are working in. Some institutions give you hands-on experience and others do not.
Should I do Electives or Observerships?
If you had to choose one type of U.S. Clinical Experience “USCE” you should definitely consider doing an Elective, because it allows you to have the hands-on experience that U.S. Medical Student receive and the ability to get an individualized letters of recommendation that would boost your C.V.
2.What are the requirements for Electives and Observerships?
Electives:
- Being a medical student at the time of participating in the elective.
- Having your USMLE Step 1 Exam score (most institutions ask STEP1 but some do not).
- Finishing a certain number of years in your medical school to be eligible to apply (most institutions ask you to be in your final year of medical school).
- Some institutions ask for some type of an English proficiency test (TOEFL, IELTS, etc).
- Malpractice insurance - in case you make a mistake while taking care of a patient during the elective.
- Health insurance - in case you get sick or have health issues.
- Immunization forms and/or health records
Observerships & Externships:
- The criteria in these types of rotations are much less strict. No USMLE Step 1 test score is needed; you do not have to be a medical student at the time of applying, therefore, you can do it even after graduation; and there is no requirement regarding a minimum number of years completed in medical school in order to apply (but again the requirements may vary by institution).
Most institutions ask for immunization forms while doing observerships/externships and some might ask for health insurance as well.
What visa do I need when doing electives or observerships?
Most students do electives or observerships under the B1/B2 category. Some institutions sponsor a J1 or F1 for electives or observerships.
3.What is the financial aspect of U.S. Clinical Experience?
The fees vary a lot between institutions and the type of rotation. So, let’s start with them one by one:
Electives:
- You must differentiate between the application fee and the rotation fee. The application fee is usually non-refundable even if you do not get accepted. The reason is that many students apply to get an elective spot and only a few students are accepted. Generally, the application fee is around $300 but it varies by institution.
- The elective fee is generally anywhere from $200 to $6000 for only one elective (generally a 4 week rotation). You pay the elective fee after you have been accepted by the institution for that elective rotation.
Observerships & Externships:
- It might be FREE sometimes or cost up to $5000 USD.
Besides paying the fees of the rotation you also have to support yourself (rent, transportation, basic daily needs), all of which should be taken into consideration. The cost of living in the U.S. has been discussed in another blog.
When searching for a place to stay during the rotation, AirBnB or a hotel are the more expensive options. Consider taking a look into Rotating Room which is a platform created to help visiting medical students find places to stay from other trusted students or professionals.
4.How to find rotations for free?
We have all heard about the companies that can provide you with USCE, but generally speaking, these companies only provide you with externships or observerships. Companies generally do not provide you with electives which are the best type of USCE.
How to find electives?
For finding electives, search the websites of different institutions (you can find a full list on the ACGME website or doximity ). You can also check out the list of the best hospitals in the US and their requirements for electives.
Then, search these websites for visiting medical students, electives, away rotations, or even simply rotations for medical students. You will then be able to see all the requirements and deadlines for these electives.
Here is an example of the visiting medical student page from the Mayo Clinic. You can see on this page, under the application process, the requirements, deadlines, and everything you need to know about their application process.
Our elective list has a detailed list of requirements for those applying to electives.
U.S. Clinical Experience
Our multi-specialty rotations ranging from hands-on to observerships will give your application the boost it needs!
How to find observerships or externships?
You can find observerships or externships through networking connections or companies
- Connections: these could be from friends, friends of friends, family members, friends of family members, graduates from your country or medical school etc.
- It is more difficult to secure electives through connections only as the requirements must be met to be accepted for an elective. But it always helps if you know someone.
- Connections through your medical school: Some medical schools have a collaboration with medical schools and hospitals in the US which will facilitate the process of electives for their students. Ask your medical school’s dean/vice deans if there are any collaboration between your medical school and US institutions
- Emailing physicians who graduated from your country or medical school. People empathize with people from their own city or country. Send a very nice, individualized email, attach your CV, and mention your goals. This might help you get an observership for free.
- Companies: There are multiple companies that can help you secure an observership/externship spot. We do not recommend a certain company but we recommend being vigilant about certain criteria when choosing a company and/or a rotation.
- Do the observership at an institution that has a residency program. This helps increase your chances at a place that might actually take you when you apply for residency.
- We do not recommend doing the observership with a private doctor in a private setting. Some private doctors might be affiliated with some institutions but having the logo on the letter of recommendation is not enough. The doctor who you rotate with should preferentially be directly involved in a residency program and have very strong connections to the program director or other members of the residency selection committee.
- Doing the rotation in a setting where you directly work with residents is also recommended.
So just keep these factors in mind when looking at different companies and what they offer.
U.S. Clinical Experience
Our multi-specialty rotations ranging from hands-on to observerships will give your application the boost it needs!
Do you get letters of recommendations from electives, observerships, and externships?
Yes. Most students usually get a letter of recommendation (LOR) after a rotation. However, you have to ask for it. Most physicians will not offer you the LOR unless you ask for it. So, make sure to discuss this topic about a week before the end of your rotation. If you are applying to the MATCH® in a few years from the rotation, ask the physician to write the letter and save it for you so you can use it when you apply to the MATCH.
Letters of recommendations from electives are generally much stronger than those from observerships as the physician writing them can testify to your clinical or surgical skills which are much harder to assess when you are just observing a student during an observership.
You can refer to our YouTube video on Letters of Recommendation here.
When should I apply for electives or observerships?
Electives are more time sensitive than observerships since you need to do them before your graduate. Also, most electives require you to apply at least 3-6 months before your elective start date. So, you have to have Step 1 done and your full elective application at least 6 months before graduation. That is why early planning is key in securing electives.
For observerships, generally availability depends on spots available from the company you are securing it from or the schedule of the physician you are contacting.
To check the list of electives in the best hospitals in the US and their requirements, go here
For a list of US residency programs and IMGs in these programs, check this blog post
5.Final piece of advice:
- If you are planning to do a U.S. Clinical Experience "USCE", do it in the specialty you are applying to match into, try to do electives, if possible. They are more valuable than observerships and externships. Plan early as applying to an elective and getting accepted takes months.
- Plan early as applying to an elective and getting accepted takes months
- Be very careful with where you do your USCE and with whom, because you do not want to waste your time nor your money on something that will not help you in your residency application.
Now, we would like to hear from you all on what the main problems you think you will face as an IMG going through your residency journey? And how you anticipate solving them?
🏥For Match and Residency advising, check out our one-on-one advising plans:
https://tmg.wpcodix.com/residency-advising/
And good luck with your future projects everyone!
By Hasan Najjar
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