The preparation for residency application in the United States should ideally start early. Getting U.S. Clinical Experience (USCE) has become challenging with time, particularly after the COVID-19 pandemic. Therefore, preparation is essential to achieve your goals. Ideally, one should apply for these experiences before graduation from medical school, particularly for International Medical Graduates (IMGs). There are several considerations when looking for clinical experiences in the United States. First, applying for clerkships or rotations as a medical student is much easier than after graduation. Most U.S. hospitals do not accept that graduates perform clinical experiences if they are not part of their study plans during medical school. Multiple medical schools have affiliated programs in the United States where getting experience could be feasible. Asking your school officials can be a good start. Another advantage of applying before graduation is that the electives would be part of your curriculum. However, most IMGs seek USCE after graduation making it more difficult to obtain such opportunities.
To learn more about clinical rotations for international students in U.S. hospitals, you can perform a google search with queries such as:
– Clinical electives in the US for international students.
– Clinical clerkship for international students in the US.
You can also get a lot of information in forums such as:
There is a lot of information on this subject, so it is recommended to investigate the hospitals that offer electives and certain private companies that can also help you get clinical experiences.
For graduates (the most common situation) without clinical experience in the United States, there are several ways to obtain it. However, the options are limited because, as mentioned before, most hospitals do not accept medical graduates in their rotations anymore and COVID-19 restrictions have limited offices and physicians offering those activities. It is important to understand why USCE plays a crucial role in the residency application process. First, USCE is required by most programs. Although USCE is not mandatory, it does make a candidate stronger when there is a meaningful experience. Second, USCE allows one to get letters of recommendation (LOR), which is critical during your application and interview process. Perhaps, getting the LORs is the main reason why it is important to put effort into getting USCE. Finally, getting USCE will allow you to speak about your experience taking care of patients in the United States during your interviews.
The USCE options include:
- Observations: Experiences in which a practicing attending physician is observed (shadowing).
- Research: Usually in a research laboratory or a hospital.
- Externships: Experiences similar to observations but with more exposure and contact with patients (hands-on experience). Overall more complicated to get but not impossible.
Here are some considerations to keep in mind:
- Networking: Networking is incredibly important when seeking opportunities. You can start by speaking with faculty members and officials from your medical school who may have had experience with previous students coming to the United States for experiences and training. Contacting friends and colleagues who have gone through the process is also beneficial as they may give you important tips to be successful. Consider contacting attendings who share your nationality or another feature that can help you connect. Certain networking apps to consider include LinkedIn, Doximity, Facebook, and others. Attending conferences and meetings can help you meet attendings from different parts of the US that could offer you an opportunity to work with them as well.
- Research: Finding research opportunities may be easier, given that there are formal research positions that can be offered to IMGs (for example, research fellowships). Most of these experiences can be obtained at academic institutions. Examples include Mayo Clinic, Yale, Cleveland Clinic, and others. You can find information by using search engines or contacting people you know who have done it in the past.
- Other academic opportunities: Although not mandatory, consider programs such as Ph.D., MPH, and others if you are interested, as they will allow you to network and meet faculty who can offer you other experiences or may be willing to write letters of recommendation for you.
- Paid clerkships: Several companies offer clinical experiences for a fee. Examples of companies that offer clinical experiences include Medclerkships, Americlerkships, AMOportunities, and others. The fees are expensive and usually provide you with four weeks of clinical experience in the area of interest (for example, internal medicine). Although this option should be considered a last resort since it is not as highly regarded as other experiences due to the involved fees, USCE could be obtained using this method as well. During the COVID-19 pandemic, virtual experiences were created by these companies to allow IMGs to get some experience when the limitation of physical contact is present. However, an in-person experience would be more valuable. Nevertheless, this is still an option when no other options have been found.
For more information, please refer to the following links:
- https://www.kaptest.com/blog/residency-secrets/2012/10/09/how-to-find-usce-united-states-clinical-experience/
- https://www.kaptest.com/blog/residency-secrets/2016/06/01/the-imgs-guide-to-finding-us-clinical-experience/
- http://www.usmlematch.com/us_clinical_experienced.htm
- http://medclerkships.com/explaining-clerkships-observerships-externships/
Even though it is difficult to find a meaningful experience, it is not impossible to get. Being proactive and dedicated is essential in this process. It takes a long time to get an experience. Do not get discouraged, and keep trying until you find the best option. Consider all the possibilities that we have mentioned above.
We hope this information is helpful.
Good luck!
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