Clinical elective at NIH vs other electives

summer_l

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Apr 1, 2016
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    I'm a medical student in the UK looking to do a 4-week elective in the US this summer, mainly to gain some experience of the US healthcare system but also to spend more time in my specialty of interest in a different environment.
    I was recently accepted for a clinical elective in Cardiology at the NIH, which I'm really excited about. I know the NIH is very subspecialised and the patients there have rarer conditions or are being treated under research protocols. So I'm just wondering, in the event I apply for a residency in the US in the future, would it be better for me to do the NIH elective, or should I instead gain my US clinical experience in a more 'normal' hospital setting?
    I'd really appreciate any thoughts and advice :)
     

    Gos81238ia

    Irish med school, US residency, Canadian practice
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    Mar 8, 2012
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      I recently matched to a US residency. You will definitely want to do a US elective at some point before you apply. Most programs do require that candidates have some US clinical experience. Many programs apply a filter to the ERAS applications they receive and filter out anyone who doesn't have a US elective, or who has fails on the step exams etc. The total length of US experience they require varies, but myself and most of my classmates only had one month and that suited us just fine. The second reason you want to do an elective in the states is for the letters of recommendation that you will later use for your ERAS application. Programs want to see letters from US doctors at US hospitals; that shows them that you have worked in the American system and did well enough to impress the doctor who's writing the letter for you. When they look to hire IMG's, they want someone who isn't going to drown in the first few weeks of residency, someone who will be able to adjust to the system and pick up new things quickly. Finally, doing an elective in the US serves as an "audition" for the program, if you do it at a program you will be applying to. If you impress the team and the program director, they will be a lot more willing to match you!

      The elective at the NIH does sound like a great opportunity and for your own learning, it would be. In terms of your goals to match to the states, that elective would carry a lot less weight than any American elective.
       
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      summer_l

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      Apr 1, 2016
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        The elective at the NIH does sound like a great opportunity and for your own learning, it would be. In terms of your goals to match to the states, that elective would carry a lot less weight than any American elective.

        Congrats on your match! And thank you so much for your reply and for that advice, that's really helpful to hear! I wanted to clarify what you mentioned at the end - are you saying that the NIH clinical elective wouldn't carry as much weight as any other US clinical elective? Is this because it's not a traditional type of hospital but more subspecialised/research-based? I should be able to obtain a LOR from the NIH though. Only trying to clarify so I make the right decision when picking where I do my elective! Thanks again for the help :)
         
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        Gos81238ia

        Irish med school, US residency, Canadian practice
        7+ Year Member
        Mar 8, 2012
        179
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        Canada
        1. Attending Physician
          Congrats on your match! And thank you so much for your reply and for that advice, that's really helpful to hear! I wanted to clarify what you mentioned at the end - are you saying that the NIH clinical elective wouldn't carry as much weight as any other US clinical elective? Is this because it's not a traditional type of hospital but more subspecialised/research-based? I should be able to obtain a LOR from the NIH though. Only trying to clarify so I make the right decision when picking where I do my elective! Thanks again for the help :)

          A) It won't fulfill the requirement to have US clinical experience, that will be a big problem since most programs require that.
          B) It won't be a American letter; I'm sure you could get a letter saying you did well and your clinical skills were good, but it won't be a letter showing you were able to work well in the American system - ie. you can work in the American style team, you can use electronic medical records etc.
          C) You would be wasting an opportunity to audition for a US program that you might want to go to

          Essentially, even though its obviously a great hospital, doing an American elective at ANY American hospital would be more beneficial. If you can do this elective AND one in the states, that would be fine to get your US experience in, but you would be at a big disadvantage with no US experience.
           
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          summer_l

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          Apr 1, 2016
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            A) It won't fulfill the requirement to have US clinical experience, that will be a big problem since most programs require that.
            B) It won't be a American letter; I'm sure you could get a letter saying you did well and your clinical skills were good, but it won't be a letter showing you were able to work well in the American system - ie. you can work in the American style team, you can use electronic medical records etc.
            C) You would be wasting an opportunity to audition for a US program that you might want to go to

            Essentially, even though its obviously a great hospital, doing an American elective at ANY American hospital would be more beneficial. If you can do this elective AND one in the states, that would be fine to get your US experience in, but you would be at a big disadvantage with no US experience.

            Oh wait I'm wondering if this is a misunderstanding...the NIH Clinical Center is in the States!! It's based in Bethesda, Maryland. Since it's not a traditional hospital in the sense that patients are only brought in if the NIH is conducting research on their problem, rather than anyone being able to turn up, my question was more about whether this would matter. I'd still be supervised by US doctors and would be seeing patients and getting involved with their management. I'd be working with the Cardiology consult service, attending to the Cardiology-based needs of the patients in hospital and those attending as out-patients. But it doesn't work like the traditional US hospital in terms of insurance and stuff like that. It's all government funded.
            I really appreciate you giving me this advice! And really sorry if I wasn't clear before!
             
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            Medstart108

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              Oh wait I'm wondering if this is a misunderstanding...the NIH Clinical Center is in the States!! It's based in Bethesda, Maryland. Since it's not a traditional hospital in the sense that patients are only brought in if the NIH is conducting research on their problem, rather than anyone being able to turn up, my question was more about whether this would matter. I'd still be supervised by US doctors and would be seeing patients and getting involved with their management. I'd be working with the Cardiology consult service, attending to the Cardiology-based needs of the patients in hospital and those attending as out-patients. But it doesn't work like the traditional US hospital in terms of insurance and stuff like that. It's all government funded.
              I really appreciate you giving me this advice! And really sorry if I wasn't clear before!

              Wow it sounds awesome this is the first time i've ever heard of the NIH Hospital. Let us know how it goes!
               

              Gos81238ia

              Irish med school, US residency, Canadian practice
              7+ Year Member
              Mar 8, 2012
              179
              131
              Canada
              1. Attending Physician
                Oh wait I'm wondering if this is a misunderstanding...the NIH Clinical Center is in the States!! It's based in Bethesda, Maryland. Since it's not a traditional hospital in the sense that patients are only brought in if the NIH is conducting research on their problem, rather than anyone being able to turn up, my question was more about whether this would matter. I'd still be supervised by US doctors and would be seeing patients and getting involved with their management. I'd be working with the Cardiology consult service, attending to the Cardiology-based needs of the patients in hospital and those attending as out-patients. But it doesn't work like the traditional US hospital in terms of insurance and stuff like that. It's all government funded.
                I really appreciate you giving me this advice! And really sorry if I wasn't clear before!

                Oh I thought you meant a hospital in England! In that case, that sounds fantastic. As long as you get some exposure to patients in a way that you can get a letter describing how you interacted with patients thats fine. It will be such a fantastic experience with the clinical trials and such, definitely go for it!
                 
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                summer_l

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                Apr 1, 2016
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                  Oh I thought you meant a hospital in England! In that case, that sounds fantastic. As long as you get some exposure to patients in a way that you can get a letter describing how you interacted with patients thats fine. It will be such a fantastic experience with the clinical trials and such, definitely go for it!
                  Thank you so much! I really appreciate your advice. Wishing you all the best with your residency!
                   
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