thelegend23

2+ Year Member
Mar 4, 2017
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49
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Medical Student
Hi guys,

I didn't match this year. My scores were okay, I think the main thing missing from my application was USCE. I am working to build up my application by doing step 3 and getting USCE.

Since I already graduated from med school, I can only do observerships or externships.
My question is, which one is more valuable USCE: observerships at inpatient units of hospitals that have a residency program OR externships with companies that charge money (e.g. Americlerkships)?

Pros of doing observerships:
- you get to work with inpatient teams at places where you can potentially apply for residency in the future

Cons of doing observerships:
- getting an LoR can be a challenge since the attending cannot evaluate your clinical skills...most of it is simply observing the team as they manage patients. There is a risk you end up with no LoR
- Some residency programs specifically state on their requirements that "We do not accept observerships as USCE"




Pros of doing externships with companies:
- LoR is guaranteed unless you do something stupid
- They are easier to arrange

Cons of doing externships with companies:
- More expensive
- you are often put in places that have no hospital or residency program affiliation, and most of it is outpatient
- Their LoR may be very generic or be written by doctors that have no residency program or hospital affiliation


Please let me know, which approach is best?
 

Dr. Opout

2+ Year Member
Feb 15, 2015
224
445
81
Status
Medical Student
Hi guys,

I didn't match this year. My scores were okay, I think the main thing missing from my application was USCE. I am working to build up my application by doing step 3 and getting USCE.

Since I already graduated from med school, I can only do observerships or externships.
My question is, which one is more valuable USCE: observerships at inpatient units of hospitals that have a residency program OR externships with companies that charge money (e.g. Americlerkships)?

Pros of doing observerships:
- you get to work with inpatient teams at places where you can potentially apply for residency in the future

Cons of doing observerships:
- getting an LoR can be a challenge since the attending cannot evaluate your clinical skills...most of it is simply observing the team as they manage patients. There is a risk you end up with no LoR
- Some residency programs specifically state on their requirements that "We do not accept observerships as USCE"




Pros of doing externships with companies:
- LoR is guaranteed unless you do something stupid
- They are easier to arrange

Cons of doing externships with companies:
- More expensive
- you are often put in places that have no hospital or residency program affiliation, and most of it is outpatient
- Their LoR may be very generic or be written by doctors that have no residency program or hospital affiliation


Please let me know, which approach is best?
I'd personally do a combination of both, but strategically. So do an observership at a place that has a residency and is IMG friendly. Because it doesn't really matter if you're not hands-on, your attitude and work ethic might impress the right people and get you an interview (this is exactly how I got one of my interviews). Then do an externship for the exposure and LOR.

But if you can only do one and are asking which is best, I'd go with observership. I know some places don't accept it as USCE but doing something at an academic place with a potential LOR is more impactful than doing something at someone's clinic with a definite LOR, in my opinion. Also keep in mind that not all observerships are hands-off. In some cases, if you demonstrate competence, they will allow you to function as a med student and do the work that comes with it. But in any situation, even if you're not actually touching the patient to perform a physical, you can still take a history and present the patient on rounds. That's really the most important part anyway, and the primary criteria upon which you are judged by attendings. Just very politely ask one of the senior residents if you can have a patient or 2 of your own and work out a deal to let someone else do the physical. But to let you take the history and present the patient. They may say that they'll take their own history and physical, but that you can go on your own to take a history and then present on rounds while they chime in with physical findings. But you're the one who is mentioning the assessment and plan, which gets the most points from attendings (and would hopefully lead to a strong LOR). This was also a deal I worked out in my observership.

Hope this helps!
 

thelegend23

2+ Year Member
Mar 4, 2017
72
49
61
Status
Medical Student
I'd personally do a combination of both, but strategically. So do an observership at a place that has a residency and is IMG friendly. Because it doesn't really matter if you're not hands-on, your attitude and work ethic might impress the right people and get you an interview (this is exactly how I got one of my interviews). Then do an externship for the exposure and LOR.

But if you can only do one and are asking which is best, I'd go with observership. I know some places don't accept it as USCE but doing something at an academic place with a potential LOR is more impactful than doing something at someone's clinic with a definite LOR, in my opinion. Also keep in mind that not all observerships are hands-off. In some cases, if you demonstrate competence, they will allow you to function as a med student and do the work that comes with it. But in any situation, even if you're not actually touching the patient to perform a physical, you can still take a history and present the patient on rounds. That's really the most important part anyway, and the primary criteria upon which you are judged by attendings. Just very politely ask one of the senior residents if you can have a patient or 2 of your own and work out a deal to let someone else do the physical. But to let you take the history and present the patient. They may say that they'll take their own history and physical, but that you can go on your own to take a history and then present on rounds while they chime in with physical findings. But you're the one who is mentioning the assessment and plan, which gets the most points from attendings (and would hopefully lead to a strong LOR). This was also a deal I worked out in my observership.

Hope this helps!

Thank You. Definitely agree with you on that. There isn't much time till the next cycle begins. I will try to arrange them quick.
 
Jun 20, 2018
33
19
11
I'd personally do a combination of both, but strategically. So do an observership at a place that has a residency and is IMG friendly. Because it doesn't really matter if you're not hands-on, your attitude and work ethic might impress the right people and get you an interview (this is exactly how I got one of my interviews). Then do an externship for the exposure and LOR.

But if you can only do one and are asking which is best, I'd go with observership. I know some places don't accept it as USCE but doing something at an academic place with a potential LOR is more impactful than doing something at someone's clinic with a definite LOR, in my opinion. Also keep in mind that not all observerships are hands-off. In some cases, if you demonstrate competence, they will allow you to function as a med student and do the work that comes with it. But in any situation, even if you're not actually touching the patient to perform a physical, you can still take a history and present the patient on rounds. That's really the most important part anyway, and the primary criteria upon which you are judged by attendings. Just very politely ask one of the senior residents if you can have a patient or 2 of your own and work out a deal to let someone else do the physical. But to let you take the history and present the patient. They may say that they'll take their own history and physical, but that you can go on your own to take a history and then present on rounds while they chime in with physical findings. But you're the one who is mentioning the assessment and plan, which gets the most points from attendings (and would hopefully lead to a strong LOR). This was also a deal I worked out in my observership.

Hope this helps!
Agree 100%! There will always be someone willing to help out and try to do the same as well. Many residents/fellow don't have the time to look some stuff up and we can do so to help the team and the patients! I struggled at first but I think later I was able to find the balance between not being in the way but helping and making a good impression.
By the way, Dr. Ouput, what did you end up doing? Did you try onlinemeded? Thanks! :)
 

Dr. Opout

2+ Year Member
Feb 15, 2015
224
445
81
Status
Medical Student
Agree 100%! There will always be someone willing to help out and try to do the same as well. Many residents/fellow don't have the time to look some stuff up and we can do so to help the team and the patients! I struggled at first but I think later I was able to find the balance between not being in the way but helping and making a good impression.
By the way, Dr. Ouput, what did you end up doing? Did you try onlinemeded? Thanks! :)
Yeah I think a lot of times observers are a little intimidated and don't feel comfortable asking for more responsibility. Which is a shame because many people are actually very accommodating and want you to learn. And since you're paying for the privilege of being there in many cases, you might as well ask and try to get the most out of it. I'm glad you found the balance because it can definitely be tricky!

Yes I've watched a few meded lectures from intern content. Really highly recommend as a refresher, I've been doing nothing productive study-wise since I took CK in August so it's definitely sorely needed. If there's anything you'd recommend, I'd be happy to hear about it.
 

batmanisreal88

2+ Year Member
May 13, 2017
33
41
81
Status
MD/PhD Student
Good morning wonderful human beings

for those who have no idea who i am. my name is.........jokes aside

i applied for match 2019. did not match but i made some good friends and took away a lot of recommendations from this thread. thank you all.

so what have i been upto
- i got done with step 3 (last week - not the result, just the exam)
- did 2 months of sub internship and 1 month of observership
- will be doing another 1 month of sub internship and trying (emailing hospitals) to secure another one month of observership/externship


so what do i need
- where can i find the match 2020 internal medicine thread
- also guidance as to how to maximize these next 3 months (well 2 and half months)

May the force be with you
Bruce Wayne
 
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May 23, 2018
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someone asked the question and i answered it, period...i made no judgement on how that was relevant to his application or to this years application process.

it is not up to you (or any other poster to limit what one post on any thread)...if you don't like it...you can click the ignore button and you won't have to see it. Or just not respond.

ask yourself why there are so few residents, fellows, and/or attendings that post in threads like these? we try, get told that we have "no clue" to the process and then get tired of it and leave...or never come to these threads to begin with...its not just this one, same things are heard in the pre allo threads as well...to the point that the mods ask us to please go to them to help...most give up.

and MP...you may need to re read my advice..I'm in the group that says Step 3 doesn't help since it is supposed to be taken as an intern...taking it early rarely helps and has the potential to hurt if you fail or score poorly. :bang:
Is this true?

I took it because I need H1B visa and I scored a 251. This won’t help my application?
 

DocSpy332

2+ Year Member
Feb 11, 2017
86
72
71
Is this true?

I took it because I need H1B visa and I scored a 251. This won’t help my application?
I strongly believe that it helps. If you get a score higher than average it will totally not hurt you having it.
After all having step 3 done can help us possibly get a better visa AND fully focus on our intern year.
The last one I would bet, although I can not know for sure, that is something that at least some PDs would love for their interns.
 
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May 23, 2018
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After having gone on a few interviews myself, I wanted to share some things I noticed from other IMGs who were interviewing alongside with me. I understand that coming from another country and interviewing for residency is a very intimidating and nerve-racking process. When I first came to the US a few years ago, I felt the same way and I was very shy and anxious when speaking to physicians and other health professionals. But the truth of the matter is that the culture here is different and being shy was not going to take me anywhere. After getting to know the culture and spending some time here, I learned that I had to be more active and leave that shyness to the side (and I considered myself an introvert).

When I was interviewing, it was very easy to notice which IMGs had already been in the US for x, y, or z, and which IMGs had not. The former were much more active with other applicants, more talkative, and were not shy to ask questions to applicants, staff, or program directors. The latter have been more quiet and have not engaged as much. I understand that it is overwhelming, humbling and nerve-racking. But to all in this forum and future IMG applicants: YOU HAVE ALL BEEN INVITED FOR AIN INTERVIEW! That means you have ALL the qualifications to be a resident at their program. Regardless of whether you are an US IMG, non US IMG, AMG, DO, etc. You were called because the program thinks you have what it takes and you could be a good fit for that place. Try as hard as you can to leave that nervousness to the side and be comfortable with being uncomfortable. I'm not saying it's said and done. But acknowledge that you will feel nervous and uncomfortable, but also acknowledge that you are there because you deserve it. Nobody in the room is better than you. You are all in the same game, at the same playing field. Believe in yourself, believe in your trajectory, and show as much confidence as you can (without being arrogant) with EVERYONE in the room. Engage with other applicants, ask them questions about where they are from, what school they go to, how their training has been, what their interests are, etc. By getting to know other applicants, it will reduce the anxiety as you will start feeling more comfortable in the room. And when you meet your interviewers, remember they are people too! Have a conversation with them as you would with any other person. Be respectful and know how to talk about yourself, show them that you have truly thought about your goals. But also enjoy your conversation. Smile. Have fun. Laugh. Some fine humor here and there never hurts. It's a conversation, it goes back and forth. If they say something and you want to learn more about it, go ahead and ask about it, even if they haven't opened the door for questions. That shows that you are engaged and paying attention.

Believe me, I KNOW it's easier said than done, but we've come all this way. We have all been through SO much, and we can honestly say we are more resilient and perseverant than many of the people that we will encounter in our lifetime. The program wants you. Interviews are the time to show them that you want them just as much. Do your best to show that. Leave your shyness and nervousness at the door, before you walk in. It's our time to show them why our strength and resilience makes us the best candidates.
This was amazing, thank you thank you