NK9

Apr 26, 2018
164
265
41
Status
Medical Student (Accepted)
Relax. You will learn in residency. There's nothing you can do to prepare. Seriously this will be the last time you can relax before you'll pretty much be working the rest of your life.
Can't argue with that. Thank you!
 

thelegend23

2+ Year Member
Mar 4, 2017
69
49
61
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?
 

Dr. Opout

2+ Year Member
Feb 15, 2015
223
442
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!