Observerships or Externships

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Dr. Iamacatwoman,

Thank you for your information about a letter of the Dean. I checked it. As you told me, I have to modify it. Did your Dean give it to you and you submit it to the programs or the Dean submit it to the programs directly?
Would you mind sending me a draft of your letter from the Dean?

I appreciate your information.
 
I can't send you a draft of my letter, but i looked at examples given in First Aid for the Match and The Successful IMG and just based my letter on those. I submitted all the documentation myself, but that was just because I wanted to review everything and I didn't trust my medical school/international mail. And you dont submit documents to the programs directly, you submit them to ERAS and the programs will download your application from there.

And I agree with KC - Huh?
 
Thank you, Dr. iamacatwoman.

That's a great information. I will buy the book.

Gato.
 
You're very welcome. It took me ages to figure out how everything worked. I discovered these forums very late in the game. Hope that you get your letters sorted out!
 
Hi. Thank you for that great information you have just given. I'm an IMG and I already did an externship before and I want to do it again, just that now I know I want to go to Internal Medicine (last externship was on family practice).

I have some questions too:
-I'm not sure if nephrology or endocrinology. Should be my externships of general internal medicine or what?
-How is the process for applying for those subspecialties? First I do Internal Medicine and THEN apply again for the subspecialty? (in my country there is a defined lenght of time of internal medicine for each subspecialty).

Thank you in advance
-----------------------------
"The best runner is the one that ignores being in a race"
 
Nephrology and Endocrinology are both fellowships of 2 years after 3 years of Internal Medicine residency. You apply for the fellowships after completing the IM residency.
You might want to read about those in IM and its subspecialties forums.
 
Dr Cox, you said earlier in this threat "You cannot get an externship if you are not a medical student. All you are eligible for is an observership unless you can find someone to give you malpractice insurance. Otherwise, you are restricted from clinical contact with patients and can only observe."

So is it possible to do clinical electives after graduation if malpractice is available? I thought they were only limited to final year students regardless of the malpractice issue.
I feel this question would be answered by asking every medical school directly but I'd appreciate it if anybody got any idea.
 
rox said:
Dr Cox, you said earlier in this threat "You cannot get an externship if you are not a medical student. All you are eligible for is an observership unless you can find someone to give you malpractice insurance. Otherwise, you are restricted from clinical contact with patients and can only observe."

So is it possible to do clinical electives after graduation if malpractice is available? I thought they were only limited to final year students regardless of the malpractice issue.
I feel this question would be answered by asking every medical school directly but I'd appreciate it if anybody got any idea.
Click to expand...

The issue is almost always malpractice. So while programs may say they only accept final year students, this is because getting malpractice for a visiting student is relatively easy. Getting it as a non-licensed physician is not and is horribly expensive, so most programs won't even try.

I have yet to see someone post on SDN that has found affordable med mal as a graduated student doing an elective in the US. If you can, contact some programs and see if they will accept you.
 
Pathinterpreter said:
Hi. Thank you for that great information you have just given. I'm an IMG and I already did an externship before and I want to do it again, just that now I know I want to go to Internal Medicine (last externship was on family practice).

I have some questions too:
-I'm not sure if nephrology or endocrinology. Should be my externships of general internal medicine or what?
Click to expand...

You can do them in whatever you want.

-How is the process for applying for those subspecialties? First I do Internal Medicine and THEN apply again for the subspecialty? (in my country there is a defined lenght of time of internal medicine for each subspecialty).

Thank you in advance
-----------------------------
"The best runner is the one that ignores being in a race"
Click to expand...

As Faddy Acids notes, these are both fellowships which are applied for before completing your IM residency (usually apply during the year before your last year in IM residency).
 
I know some international undergrad who bought a malpractice for 1200$/year to use it for electives, so it's possible as opposed to the general belief that it's not. I have no idea about graduates. I'll check that out sometime and let you know guys.
 
Yeah, it's affordable but usually international students don't know where to get it from and how. Plus, they prefer to go to a place where malpractice is provided and spare themselves all the paper work.

I suggested once that SDN contact some companies interested in providing these insurances and make them available through SDN just like the Test Prep Week but I guess it was not taken seriously.
 
It is generally not a problem for undergrads to get malpractice insurance. Even if your school or the place you are visiting doesn't offer it to you, you can (as noted above) purchase it relatively reasonably.

The PROBLEM is getting reasonably priced malpractice insurance once you are no longer a student, have graduated and do not have a medical license. THAT is what I was referring to above as being difficult to obtain.
 
Kimberli Cox said:
The PROBLEM is getting reasonably priced malpractice insurance once you are no longer a student, have graduated and do not have a medical license. THAT is what I was referring to above as being difficult to obtain.
Click to expand...

I agree with that.

For fun, I once got a few quotes from reasonable companies when I was applying for my license and subsequent moonlighting privileges. Before I had my license, middle-of-the-road policies were anywhere from around $9000-$16000 a year! :eek:
 
Blade28 said:
I agree with that.

For fun, I once got a few quotes from reasonable companies when I was applying for my license and subsequent moonlighting privileges. Before I had my license, middle-of-the-road policies were anywhere from around $9000-$16000 a year! :eek:
Click to expand...

Which, BTW, is more than my current policy as an attending costs (at least this year...it goes up every year I'm in practice).
 
Kimberli Cox said:
Which, BTW, is more than my current policy as an attending costs (at least this year...it goes up every year I'm in practice).
Click to expand...

Wow that's awesome! I've heard horror stories about medical malpractice policies costing up to $100k...but I think this is only in certain states like PA, IL, FL, etc.
 
Blade28 said:
Wow that's awesome! I've heard horror stories about medical malpractice policies costing up to $100k...but I think this is only in certain states like PA, IL, FL, etc.
Click to expand...

Its around $8K this year, $15 or so next, then to the mid 20s and then apparently it maxes out around $50K/year here for general surgery. But you're right...many of the PP attendings I worked with in PA were paying around $100K/year.:oops:
 
Dr. iamacatwoman,

I checked "The successful IMG". But the book is not available currently.
I called UCSD bookstore. They don't have the books. I put an ad saying I want to buy the book in SD network forums. No responses yet. Would you sell me your used one if possible?

Thank you.
 
rox said:
Yeah, it's affordable but usually international students don't know where to get it from and how. Plus, they prefer to go to a place where malpractice is provided and spare themselves all the paper work.

I suggested once that SDN contact some companies interested in providing these insurances and make them available through SDN just like the Test Prep Week but I guess it was not taken seriously.
Click to expand...
if you think that its important, just because it wasn't posted, doesn't mean that you weren't taken seriously. alot of things happen along the way of getting things set up. You can post a link to it in our links secton and PM me the link as well and I can try to contact the company again.
 
Kimberli Cox said:
Its around $8K this year, $15 or so next, then to the mid 20s and then apparently it maxes out around $50K/year here for general surgery. But you're right...many of the PP attendings I worked with in PA were paying around $100K/year.:oops:
Click to expand...

Yeah, PA is notorious for ridiculous premiums. Tort reform, anyone?
 
GATO said:
Dr. iamacatwoman,

I checked "The successful IMG". But the book is not available currently.
I called UCSD bookstore. They don't have the books. I put an ad saying I want to buy the book in SD network forums. No responses yet. Would you sell me your used one if possible?

Thank you.
Click to expand...

Did you do a Google search? Amazon doesn't have it, but other places do.
 
GATO said:
Dr. iamacatwoman,

I checked "The successful IMG". But the book is not available currently.
I called UCSD bookstore. They don't have the books. I put an ad saying I want to buy the book in SD network forums. No responses yet. Would you sell me your used one if possible?

Thank you.
Click to expand...

Hi GATO.

If you do a search for it on Amazon, you should find it. It's $20 used/new. I just found it. :thumbup:
 
iamcatwoman said:
Hi GATO.

If you do a search for it on Amazon, you should find it. It's $20 used/new. I just found it. :thumbup:
Click to expand...

I placed my order of it in Amazon.
As if someone responded to my ad.

Thank you, Dr. iamacatwoman.
 
GATO said:
I google-searched. But still can't find it.
Click to expand...

I see you already found it, but Barnes & Noble, among others, was also selling it.

I just typed the title of the book into a Google search box.
 
I'm glad to know it was taken seriously. I hope it will be available to all international SDNers.
 
How should I contact about whether or not the departments in the hospitals accept observership when they don't mention observership?
Should I contact the directors of the departments or the directors of residency programs or someone else?

Thank you for your information.
 
iamcatwoman said:
With great difficulty. Your choices are to submit non-US LORs (in which case you will need some kick ass Step 1 scores and want to train in one of the less competitive specialties) or to submit US LORs.

To get US LORs you would need to organize some USCE as the LORs are suppose to recommend both yourself and your clinical skills. You should definately try to get US LORs as it will greatly increase the number of programs who will consider your application. Some PDs told me straight out that the only reason I was offered interviews over other IMGs was because of my US LORs.

The list of aims given by Kimberly Cox is bang on. There are some decent books out there with advice for IMGs: "First Aid for the Match" and "The Successful IMG - Obtaining a US Residency" and more detailed timelines. Ask around at your medical school and amongst doctors where you are as you'd be surprised at how many others are going through the same process. Talk to your medical school Dean and faculty - see if your school/anyone has links to a US hospital.

As for how to get USCE, you have to be creative. The most straight forward way is to get busy on the phone and email and contact all the programs/hospitals listed on FRIEDA and ask them if you can spend a couple of months with them. Most hospitals have a Continuing/Graduate Medical Education (CME or GME) department who will deal with this.
VA hospital are apparently more easy to get placements at.

Failing that, the next best thing is to start contacting private doctors offices. There are lots of physicians out there from other countries who may be more sympathetic towards helping out a fellow IMG.

If you're still a medical student then you are at an advantage as you can still apply for an externship which will allow you to obtain Hands-on USCE which is like GOLD! However, if you leave it until you graduate then it becomes really (REALLY) difficult to get an externship and most hospitals will only offer Observerships which technically do not allow hands-on work which will mean that your LOR from here probably won't be able to comment on your clinical skills, and consequently will not help you much in applications.

More and more hospitals are requiring a fee. USF in Tampa wanted $1000 for just one month of observership and they stressed that I was in no way to have hands-on experience, which as far as i was concerned = waste of time and money. Miami charges about $400 for one month of a "Mini-observership". I can't remember what that actually means. But if you persevere, you should be able to find something for free.

It's frustrating at the moment, but keep optimistic. Getting good LORs are totally worth the effort and will make your application/interview/match period much less stressful.

miaow
Click to expand...
hey Iamcatwoman, Thanks for your information, how did you contact the private doctors? Did they ask you to be covered by malpractice insurance before having clinical experience with them? Did you to pay them while working with them? how much of experience did you get with those private doctors? And do I need to contact every hospital to ask if they offer clinical experience to foreign medical graduates?
 
You're a med student, right? As discussed by Dr KC and myself earlier, your first port of call should be to hospitals which run ACGME residencies. Get hold a list (look at Freida or the Green Book), find the ones that you're interested in, check out their websites, and then it's a case of getting hold of the residency cooridinators/faculty members/CME department through email/letters and asking to do an observership/externship with them. Most hospitals will either allow IMG observers or no. Most will allow International Med Students do an externship. So yes, you will have to contact the hosp to ask if they will offer placements for FMGs.

There is a major difference between observership (technically no hands-on USCE) and Externship (hands-on USCE). As you're still a student, try for an elective/do an externship as LORS about your hands-on USCE is what your really want.

getting experience with private physicians will only be useful in most cases if you've already got placements at ACGME residency hospitals as some programs will only consider experience at hospitals with ACGME residencies as REAL experience so you'd be limiting your pool if you only got experience with private physicians. Getting this sort of experience requires an element of creativity and initiative. Start telling EVERYONE you meet your situation and that you want to do some work experience. That's what i did, and through the most random ways I started to meet physicians who were keen to have me join them for a bit, and then through them I met more physicians etc etc. I kid you not, one such physician was some random guy that i met in a parking garage that I recognised as someone who lived in my building, who then ended up being a faculty member of a local big residency program.

My situation was different as I actually moved to the US and was in the process of becoming a US Resident when I was looking for USCE, so I had the luxury of time and situation. But if you're in a different country, you'd probably need to follow more conventional/official routes, and there are no official routes when if comes to getting experience with physicians outside of hospitals. Find out what previous graduates from you school have done - It's very possible that some have gone on to work in the US and then see if you can do a placement with them. Do a google search for physicians originally from your country and now practicing in the States. These are strategies that I know others have tried.

I did not have malpractice insurance. But then, I was ALWAYS supervised and my hands-on experience was pretty limited, I wasn't running around putting in central lines and chest tubes by myself. Most of my experience was taking H+Ps (which were always done in front of a supervising physician or at least reviewed by one). This is a dicey area - I was upfront with the physicians that I worked with that I had no insurance and left it up to them to let me join them or no.

My experience consisted of taking (alot) of H+Ps - so I would take the full admitting histories, examine the patients, formulate the plan. I either did this infront of a physician, or I did it after the physician had already seen the patient and then presented it during rounds (very much like when I was a med student). This way the physician was able to see that i was well trained in the most basic of clinical skills and probably the most important one for a PGY1 to be competent at. In some cases I would dictate the notes too. I attended both specialty and primary care clinics where I was again able to get involved with patient consultations and basic examinations. I worked alot with the nurses/nurse practitioners, spent time with the pharmacists, physios, respiratory therapists etc.. but that was out of personal interest as i wanted to see more about US Healthcare. I did alot of woundcare - dressings and wrapping, no debriding.

This is turning out to be a really long post, so I'll wrap it up.

I have to stress that you should try to get experience at ACGME residency hospitals first. Experience at private offices/hospitals should only be used to enhance whatever experience you already have or if you are unable to get experience at ACGME hospitals.
 
By the way, when I was looking at hospitals websites offering externships for international students, I found many that have no tuition fees but the application costs around $300. Does that mean that I will check with them, and if they will take me I will apply. Or do I have to apply to every hospital and wait for the response?
Because if so, one can waste thousands of dollars without getting anything!!




And on a different note, Merry Christmas everyone!!
 
Basically, you apply to every hospital you're intersted in. The fees usually are not refunded in case you are not approved. There should be no reason to be rejected if you meet the requirements.

If I were you, I'd pick one hospital and make sure to meet the requirements, and probably apply to another one as a back up plan.
 
FaddyAcids said:
By the way, when I was looking at hospitals websites offering externships for international students, I found many that have no tuition fees but the application costs around $300. Does that mean that I will check with them, and if they will take me I will apply. Or do I have to apply to every hospital and wait for the response?
Because if so, one can waist thousands of dollars without getting anything!!




And on a different note, Merry Christmas everyone!!
Click to expand...

As noted above, there is generally no reason you would be turned down for an externship provided you meet all the stated requirements.

So apply to a few hospitals you would be interested in and assume you will be accepted, as long as you meet their requirements.
 
Just to reemphasize this point, of all my school students who applied for US clinical electives, I don't know any one who was not approved.

However, I know a couple of unlucky guys who were not issued visas. You might want to have this in mind, and probably have a back up plan in another country.
 
Back up plan in another country?! After going through all the sh** of the USMLE?:D


I am thinking of going next year to take Step 2 CS and try to get 1 or 2 electives. Do you think it is a good idea to take the CS exam when I am still a student and before taking Step 2 CK?
 
It is up to you. I just wanted to let you know.

It became a trend recently to take CS while doing electives. Again, I know some people who passed it even before taking Step 1 and Step 2.

I think your plan is fair. I'm planning on doing the same thing.
 
I think that is a good plan (ie, coming to the US to take the CS exam while doing some electives). Frankly, for most FMGs, the CS is the hardest exam to pass...some of it may have to do with cultural differences in interactions and perhaps differences in training. That stuff is hard to teach. SInce you have to be here anyway for the exam, it makes sense to do ti all at once.

Also bear in mind that if you are going through the US match, you will have to be in the country to interview as well, so some people take CS then while in the states in the fall (ok as long as all your exams are done by ROL date in mid February).
 
Isn't there any courses that should be taken before the CS exam?
 
Blade28 said:
What courses?

A review/prep course?

Or do you mean medical school classes?
Click to expand...

I have to agree - I know that Kaplan does a prep course for the CS, but I dont think that it's needed. It's all about communication skills (afterall, it has replaced the English proficiency test that all IMGs used to have to take). The hardest thing about the exam was getting everything done in a short time ie taking a FOCUSED history and performing a FOCUSED physical exam and then frantically writing everything out in (10?? I can't remember how long it was, but I do remember nearly running out of time a few times!) minutes afterwards. There's not much medical knowledge being assessed. In fact, you're not suppose to give a definative diagnosis with any of the cases.

I found the whole thing to be WILDLY artificial, like one of those driving tests where you never actually go on the road.

All I did was browse through a book to familiarise myself with writing a patient note (which was the only thing that I identified as being any different from the training that I had already recieved), and practice a few basic examinations on my husband (just to see if I still remembered how to!) a few days beforehand.
 
remember to always introduce yourself, wash you hands before and after examining the patient, and NEVER NEVER NEVER leave the patient naked (doing this is equivalent to driving on the wrong side of the road during your driving test ... which is possible ... I know!).
 
Well, I'm always driving on the wrong side in my country! :D

I meant a preparation course. I'm just worried to take this exam when im still a student, do you think it's ok to do so?
And im afraid to put it off to the following year when being interviewed as Dr. Cox noted earlier because if i fail i will have to wait for the next Match.
 
FaddyAcids said:
Well, I'm always driving on the wrong side in my country! :D

I meant a preparation course. I'm just worried to take this exam when im still a student, do you think it's ok to do so?
And im afraid to put it off to the following year when being interviewed as Dr. Cox noted earlier because if i fail i will have to wait for the next Match.
Click to expand...

hmmm, well I think that it depends on how much clinical stuff you've done. It also depends on how confident you are with the cultural differences. I trained in the UK and found it very easy to adapt to the CS exam style. Would you have done any primary care or EM before taking the CS? Will you be spending any time in the US doing externships prior to the exam? These will definately help you with the preparation especially with taking a focused history and physical exam.
 
Yes I will try to get a couple of electives and take the CS exam, I guess that may also help.

And thank you very much for the great advices.
 
iamcatwoman said:
I'm sorry, I was wrong. Here is a link to the MSPE Template from the AAMC:
http://www.aamc.org/members/gsa/mspeguide.pdf

It's pretty comprehensive
Click to expand...

Dr. iamcatwoman,

Thank you for your advice.
I have a question. Can I submit MSPE to ERAS myself after I get it from the Dean of my medical school or does the Dean have to submit it directly to ERAS?
I checked the template. It will take time for the Dean to create it. I think I should request him right now. But I don't even register ERAS. That's why I want to know whether or not I can submit it to ERAS myself. From your thread, it seems to be OK. OK?

Thank you.

GATO.
 
GATO said:
Dr. iamcatwoman,

Thank you for your advice.
I have a question. Can I submit MSPE to ERAS myself after I get it from the Dean of my medical school or does the Dean have to submit it directly to ERAS?
I checked the template. It will take time for the Dean to create it. I think I should request him right now. But I don't even register ERAS. That's why I want to know whether or not I can submit it to ERAS myself. From your thread, it seems to be OK. OK?

Thank you.

GATO.
Click to expand...

Yes, you can submit all the paperwork yourself. But you have to register with ERAS and create an account to which all your paperwork will be downloaded.
 
oh, and when you submit paperwork to ERAS, try to make sure that every piece has your AAMC ID no on it somewhere. This will just help prevent loss/misdirection of your precious papers!
 
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