United States Clinical Experience for IMGs

7 min read – Published On: March 20, 2023 – Categories: Medical School

In this blog, we will talk about US Clinical Experience (USCE) for international medical graduates (IMGs), why is US clinical experience important? How much does USCE cost? What are the types of US clinical experience? And how do I get clinical experience in the US as an IMG?

What is United States Clinical Experience (USCE)?

USCE refers to the clinical rotations done in the United States to gain experience in the desired specialty. Usually four weeks in duration, it helps to understand the intricacies, holistic functioning, and overall work culture of the specialty. Doing USCE in an institute with your desired residency increases the chances of Matching at the residency program.

What is the purpose of a USCE?

USCEs serve as a window into the healthcare system in the United States and provide insight into the functioning of a particular branch of medicine. It allows you to test whether you would be a good fit into the US medical system and the desired branch of medicine. It also helps to build contacts in the specialty and build a network for residency. Most residency programs have USCE as a mandatory criterion for applicants. A letter of recommendation (LOR) arising from your clinical rotations is of pivotal importance during the Match® season. The experience gained translates into an important section of the ERAS CV and also paves way for questions during the residency interviews.

What are the types of USCE?

There are three main types of USCE; Observerships, Electives, Sub-internships, and Externships.

  1. Observerships are clinical experiences where a student/graduate shadow a physician in their daily activities around the hospital, clinic, or during surgeries. It is important to note that not all residency programs consider observerships to be USCE.

  2. Electives on the other hand are hands-on clinical experiences for medical students usually in a hospital setting. Roles and responsibilities include patient history taking, physical examination, charting on the EMR (electronic medical records), patient rounds and procedures (supervised by an attending or a resident).

  3. A sub-internship, commonly called ‘Sub-I’ is an elective where final-year medical students are handed the role and responsibilities of an intern/first-year resident. They expose you to the rigor and intricacies of the residency and provide a sneak peek into the life of a resident physician.

  4. Externships (sometimes called hands-on observership) entail the same responsibilities or less than that of an elective but are meant for medical school graduates.

US Clinical Experience – Gastroenterology Hudson Valley New York

This clinical rotation will be with a board-certified Internal Medicine and Gastroenterology physician in Hudson Valley, NY with over 15 years of clinical and academic experience.

How much does a USCE cost?

The short answer is between $0-$6000. Where some USCEs are available for free of charge, these tend to be rarer nowadays.

Fees for electives can be divided into application fee (non-reimbursable fee generally between $100-$500 to evaluate your application) and the rotation fee (between $300-$6000 for a 4-week elective).

The widespread closure of USCE for visiting students due to the COVID-19 pandemic posed a threat to gaining clinical exposure. However, opportunities for international students are gradually opening up. Most of the available USCE for international medical graduates (IMGs) today are paid observerships/externships and can range between a few hundred to a few thousand USD. 

Bear in mind that the cost of living is not covered by the rotation and differs between US cities significantly (e.g. New York is way more expensive than Maddison, Wisconsin).

What is VSLO?

Visiting student learning opportunities (VSLO) is a program by the Association of American Medical Colleges (AAMC) for medical students to pursue elective opportunities away from their home institution. A VSLO affiliation of your home school opens a wide array of opportunities for clinical rotations in premier US medical schools. Although it is easier to obtain an elective via VSLO, many institutions offer rotations without it.

What are the requirements for a USCE?

  1. Student vs. Graduate: The primary requirement for an elective is to be a medical student. Observerships and externships are less rigid on this criterion and are available for graduates. Note that the medical student status must be valid at the time of the elective, not just at the time of application.

  2. STEP1: Many institutions require a USMLE Step 1 score when you apply for an elective. However, most observerships and externships do not request STEP 1 or STEP 2 CK.
  1. Year of medical school: Most electives require you to be in a particular year of medical school (generally final years of medical school) at the time of the elective. Observerships and externships are less strict about that.
  1. English Knowledge: If you are applying as an international medical graduate (IMG) from a school outside of the United States, it is not uncommon for institutions to require an English proficiency test such as the TOEFL, OET, or IELTS.
  1. Malpractice insurance is also a necessity for electives and externships as they involve direct patient care. These can be obtained from the institution or externally. However, observerships generally do not require malpractice insurance.

USCE with no STEP 1 needed

Hands-on US Psychiatric Clinical Experience- Hollywood FL

What visa does a USCE require?

Most of the clinical rotations for IMGs require a B1/B2 travel visa for USCE. However, some require an F visa or a J1 visa. These are rare and requirements vary between institutions. While some provide an acceptance letter for visa purposes, the requirement for one should be conveyed to the institution upon acceptance for the rotation. We recommend you reach out to a lawyer for visa-related questions.

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 USCE?

The ideal way to find electives is to explore the institution’s website for opportunities for visiting medical students. Not all institutions offer elective opportunities for IMGs and each has its requirements and criteria for visiting students. Interested candidates are expected to apply six months or more before the required dates of rotation.

Observerships and externships tend to be lenient with the requirement from students such as USMLE Step 1 score, time from application to rotation, etc. This type of rotation can be found either on the institution’s website or through companies that connect students with physicians. Approvals/ confirmations for observerships and externships are also quicker when compared to electives which may take up to months from the date of application.

Hands-on US Clinical Experience- Hobbs New Mexico

This inpatient and outpatient fully hands-on clinical rotation will be with a board-certified physician in Hobbs, New Mexico. The physician is trained in internal medicine and pediatrics and runs a busy practice/urgent care.

Observerships can also be sought by reaching out to physicians who work on your topics of interest. This would require you to write a specific and individualized email with your Curriculum Vitae (CV) to entice your reader into accepting you for the rotation. The success of this method is limited and chances improve if the physician is directly known to you or through a contact.

CV Editing

Our editing goes beyond language and grammar corrections to structural editing and content advising based on your personal story and achievement.

A point to note for observerships is that some physicians can admit their patients privately to a hospital with a residency program without being affiliated with it. This means that residents of the program do not involve in the care of the physician’s patients and that although the physician works at a hospital that has a residency program, the physician is not related to the residency program at all. This would limit your interaction with the residents which is an important experience to gain during clinical rotations. It is recommended to do thorough research before accepting any opportunity.

Which is the best type of USCE?

A hands-on clinical rotation is preferred to an observership. A USCE which provides an opportunity to perform a history and physical, round on patients, and allows charting in electronic medical records (EMR) system would be of the highest relevance. A sub-internship would top the list closely followed by an elective. An externship/ hands-on observership trumps an observership in that the former provides the opportunity for hands-on experience and patient care.

Do you need medical malpractice insurance for USCEs or electives?

While both electives and externships generally warrant medical malpractice insurance, observerships do not.

What are Research rotations?

Research rotations are generally 3-6 months rotations focused on research. These are often unpaid rotations with application details and requirements found on the institute’s website. They offer research-based learning under the guidance of a principal investigator (PI) and help develop hands-on skills. Research publications from these experiences are valuable to strengthen your CV and serve as a point of discussion during residency interviews.

Research Course

The research course will teach you how to take a research project from idea to publication and in which I will share my 3-year experience of clinical research in which I had over 100 publications and 80 presentations.

Final thoughts on USCE

A clinical rotation is a golden opportunity to portray your medical skills. First impressions do matter, so be conscious of your actions, words, and appearance. Always be courteous, non-judgemental, and humble. No matter how good you might be, no one appreciates a student with an arrogant and callous attitude. Your sincerity and hard work will directly reflect on your LOR, so strive to perform at your best. Punctuality is an important quality for a physician, so do not be tardy to the hospital without a genuine reason. Arrive early, pre-round on your patients, complete your notes and be aware of the significant patient-related events and lab values. Try to network with residents and attendings as this will prove beneficial during the Match season. Be proactive and attempt to collaborate with residents and researchers on their ongoing projects, if allowed. Display enthusiasm and a positive learning attitude as it will encourage teaching from both attendings and residents. Be a team player, as it is an excellent quality for a resident to possess and practice good communication skills, with patients and peers alike. Dress formally, or in scrubs, if allowed. Good luck finding a USCE and hope you have a great experience!

By Dr.Vikyath Satish & Dr. Malke Asaad

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