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What is USCE?
Residency programs willing to consider internationally trained applicants like to know that they have some sense of how medicine is practiced here in the US, either through more formal experiences such as clinical rotations, or through clinical externships, observerships, or medically related work experiences.
There is no formalized system of application for the non-rotation clinical experiences, so IMGs network with those who have found USCE to learn where they found them, and investigate local hospitals and clinics to find and request opportunities. These are usually unpaid experiences lasting anywhere from 1 month to several months, depending on what the hospital or clinic is willing to offer. Other IMGs choose to pay fees to commercial firms to find US clinical opportunities for them. The terms observership and externship are often used interchangeably, although externships tend to be more formalized, supervised and participatory than observerships.
USCE exposes you to the healthcare environment, administrative systems, technology and general US culture. You may have the opportunity to be directly involved in patient care. In addition, you may develop relationships with various professionals that could benefit you later when applying for residency, as well as having them as references on your CV.
How to find USCE opportunities:
Since there is no formal application process to find such experiences, you must search online for likely spots at larger hospitals, medical school affiliated hospitals, etc., and find the contact information. Prepare a cover letter briefly explaining what you are seeking, when you would like to do it, and for how long you want it. List your medical credentials and attach a CV with your contact information. Your cover letter need not be that elaborate, but write a specific letter for each location. Email or send to as many sites as you can, and then follow up in a week or two by phone or email to ask if they can offer such an experience.
Expect most to say they don’t offer it – often due to patient privacy and HIPAA (Health Insurance Portability and Accountability Act). But persistence pays off, and if you keep at it, you will find an opportunity. It is worth the effort as so many programs now expect you to have this experience, and youcan usually get a letter of recommendation (LOR) from it. Both doing the experience and having a US written LOR are very, very helpful in increasing your chances to match.
Other opportunities for USCE:
- Use hospital and medical school websites to watch for opportunities in your area (research grants, surgical assistant jobs, etc.).
- Explore indigent clinics, public health offices for jobs and volunteer opportunities.
- Check out non-profit groups that serve the disabled and the elderly.
- Look for any Continuing Medical Education (CME) courses offered locally. These are often free and a great way to get to know US doctors, who might let you shadow them.
- Consider volunteering in almost any capacity at a hospital, school or clinic. You may make key relationships while becoming familiar with the facility and how they manage patient care.
Malpractice Insurance:
Some experiences will require that you purchase malpractice insurance. To find such insurance, contact the insurance commissioners’ office in the state in which you will do the experience. Ask if they can provide a list of carriers licensed to cover for malpractice in that state. Then it is a matter of calling each one and asking about rates. Another suggestion is to ask other IMGs who have had to pay for coverage which carrier they used.
Companies offering USCE services:
We cannot comment about most of the companies who offer services to find USCE for people. You should check with the Better Business Bureau to see if there are any reports (positive or negative) about companies that may interest you. Also, do an internet search to read postings by other IMGs about their experience with various companies.
Remember: it takes time. One student wrote: “I started by researching places 6 months back. It takes time and patience. There is no specific answer or solution. You will have to send 100’s of emails and network at a few selected places close to where you live.”