U.S. Clinical Experience (USCE)

If you’re planning on applying for a medical residency position in the US, you should ideally start early. We speak about the steps you need to take to get there here.

In this article, we’ll be talking about United States Clinical Experience (USCE). Like we mentioned earlier, you should be planning to go for electives in the States early on, before graduating from your medical school back home. The reason for this is because it’s much easier to get that experience by applying through your medical school to certain places that accept international visitors.

Not only is USCE one of the most important things you can do to help your chances of matching (some programs won’t even consider you without USCE), it will also give you the opportunity to get letters of recommendation (LOR) from US physicians which are also another very important asset to have for the match. Not to mention, this is your chance to experience the US healthcare system and culture for yourself. You’ll end up spending years training in States, and this experience can definitely help you make the right choice. You might end up falling in love with a program and having done a clinical elective there will help you tremendously. Another advantage of applying before graduation is that the done electives would be part of your medical school rotations curriculum requirements.

Another big reason to go on these rotations prior to graduation is that most hospitals won’t accept graduate physicians for clinical rotations due to important factors like legal liability. So although it isn’t impossible, it becomes more difficult to get these experiences for a graduate physician and doing them as a medical student will make your life easier.

To learn more about clinical rotations for international students in U.S. hospitals, you can always Google it and read through posts on Reddit, Usmle-forums, and other forums.

There is a ton of information on the subject out there, so try to do a thorough search for hospitals that offer electives as well as private companies that help IMGs get USCE. One thing I would say about dealing with these companies is that you should be careful. You want to make sure that the experience you’re getting is an externship and not an observership (more on that below). One other thing is that you make sure you will get a LOR with official letterhead that is not generically written. Some people spend thousands of dollars and then get generic and unusable (no official letterhead) LORs in return.

What’s the difference between an externship rotation and an observership rotation?

The main kinds of rotations that IMGs can go for are externships and obververships. For all intents and purposes, only externships are considered USCE and these are the ones you should go for. In essence, these are the differences between the two:

• Externships: Experiences where you will function like a medical student with direct hands-on experience and contact with patients. These are a bit more complicated to get but are very valuable and are the only kind of rotation that is considered to be USCE by most, if not all, programs.

• Observerships: Experiences where you observe/shadow the attending physician or residents in their element working in the hospital. You are not allowed contact with patients. These are generally easier to get, but are much less valuable than externships and are not considered USCE by the vast majority of programs.

If you are a graduate physician without clinical experience in the United States, there are some ways to obtain clinical experience. If you do find rotations, they will likely be observerships which are much less valuable than the externships you can do before graduation. Your options will also be very limited because, as mentioned before, most hospitals do not accept medical graduates in their rotations.

So how do you get USCE?

Getting any of these opportunities will vary from one applicant to another. There’s no single way to do it and in most cases it will depend on the effort you put in to find opportunities. Here are some things you can do:

• You might have friends or contacts working in a certain hospital that can help set something up.

• Talk to your hospital attendings and medical school administrators, they might be able to help get you these opportunities.

• Some hospitals have applications for IMGs and may require you to have done at least one USMLE exam, but it depends on the program.

• In other cases, you’ll have to work on a kicker email that you can then personalise and send out to doctors or hospitals you’d be interested in working with.

• You could also get opportunities through private companies with the disadvantage of being expensive and the possible drawbacks we mentioned earlier.

In some cases, you might be lucky like in my case where my medical school worked on connecting medical students interested in pursuing a career in the US to hospitals in the States for elective opportunities. High-performing students were also granted externship scholarships to take care of expenses while overseas. Again, there are multiple ways and it depends on how much you look for them.

We hope you found this helpful, you can comment below if you have any questions!

Oh BTW, here’s a graphic from the 2018 NRMP Program Director Survey where we've higlighted the importance of the topics we've talked about in this post.