Pre-residency opportunities in the USA

[vlncll]

I'm an international medical student, currently finishing 3rd year of my country's 6-year MD program. I am interested in going to residency in the USA, and I hear that matching in residency for IMG's is especially hard if one does not have any prior clinical experience in the US (even more for some of the specialties I'm looking for, like ophth and otolaryngology). So, regarding the acquisition of clinical experience (and maybe of some letters of recommendation), there are some questions I'd like to ask:

1) What is the difference between the concepts of clerkship, observership, electives, "visiting student" (sorry, English is not my primary language, it may seem obvious to some but not to me).

2) What does the requirement of having completed all "core clerkship" mean? In my country we go through all the main subjects in medicine in the first 4 years and then we have 2 years of pure practical activities in the university hospital. Having completed all core clerkships would mean, in my case, being in 5th or 6th year?

3) Which of these activities (clerkships, electives, observership and so on) would count as "clinical experience in the US" and would give me the biggest chance of making some acquaintances and getting a recommendation letter?

4) Which are some med schools or hospitals with programs like those that would accept a student with my profile (international med student who hasn't completed all core clerkships, no USMLE steps yet, 114 in TOEFL ibt and an interest in opht and otolaryngology)? I hear Allegheny West Penn and Mount Sinai in New York do.

5) Is a match in ophthalmology or otolaryngology in the USA too much to think of for an IMG (I mean, the default answer is "no", but please answer being really realistic)?

6) Being in the 3rd year of a 6-year program is too early to be thinking of all that?

If anyone could shed some light over these questions it would be very helpful. Thank you guys in advance

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[WedgeDawg]

I'm not in medical school yet, so I might very well be mistaken, but my understanding that given how competitive ophthalmology and ENT are for US graduates, the chances of an IMG matching into one of these specialties is effectively 0. Perhaps some of the more experienced posters can give you a better idea or more information on that.

 

[Winged Scapula]

I'm an international medical student, currently finishing 3rd year of my country's 6-year MD program. I am interested in going to residency in the USA, and I hear that matching in residency for IMG's is especially hard if one does not have any prior clinical experience in the US (even more for some of the specialties I'm looking for, like ophth and otolaryngology).

Matching for all FMGs (to distinguish from US citizens training outside of the country) is difficult, even with US clinical experience. See the NRMP Charting Outcomes in the Match for rates of obtaining US training positions.

So, regarding the acquisition of clinical experience (and maybe of some letters of recommendation), there are some questions I'd like to ask:

1) What is the difference between the concepts of clerkship, observership, electives, "visiting student" (sorry, English is not my primary language, it may seem obvious to some but not to me).

Clerkship: usually a clinical rotation completed during the final 2 years of medical school. "Core" clerkships are Surgery, OB-Gyn, Pediatrics, Internal Medicine, and Psychiatry. Some schools may also require other rotations. International students are not eligible for Core Clerkships in the US.

Observership: exactly as it sounds. You have no clinical duties and are simply "observing" the US physicians work. This is the only rotation available to already graduated physicians, due to malpractice and licensing issues. These are not desirable and every effort should be made to get US clinical experience prior to graduation from medical school as observerships don't allow for much evaluation in regards to your clinical skills.

Electives: these are rotations outside of the required core specialties. They are typically done during your final year of medical school but some programs allow them earlier. They can be clinical or research based. They are often used to get more experience in a certain field (say ENT) or to make connections/show interest in a field for residency application purposes. Foreign students are usually only allowed to complete electives in the US during their final year. Some may require evidence that you have passed the USMLE Step 1, have health and malpractice insurance, etc.

Visiting student: exactly as the name implies. This is a student who is not a full time matriculant of the university where he/she is doing their rotation. Thus, you are "visiting".

2) What does the requirement of having completed all "core clerkship" mean? In my country we go through all the main subjects in medicine in the first 4 years and then we have 2 years of pure practical activities in the university hospital. Having completed all core clerkships would mean, in my case, being in 5th or 6th year?

As noted above, the core clerkships are typically Surgery, Internal Medicine, Pediatrics, Psychiatry and Ob-Gyn. Electives generally require completion of some or all of these. For example, if you wished to do an elective in ENT, they would likely require that you had completed your core rotation in General Surgery. Or if you wished to do Gyn Oncology, that you had completed OB-Gyn prior to that rotation. When you complete these is obviously dependent on your particular program but most US students finish them during our 3rd year.

3) Which of these activities (clerkships, electives, observership and so on) would count as "clinical experience in the US" and would give me the biggest chance of making some acquaintances and getting a recommendation letter?

They all "count" as USCE, but by far the best are electives (as I noted above, you are not eligible for a Core Rotation; and note that an elective = clerkship). Avoid observerships if at all possible.

4) Which are some med schools or hospitals with programs like those that would accept a student with my profile (international med student who hasn't completed all core clerkships, no USMLE steps yet, 114 in TOEFL ibt and an interest in opht and otolaryngology)? I hear Allegheny West Penn and Mount Sinai in New York do.

I am not aware of an accurate up to date list which details programs that accept international students for electives. Perhaps some of the other users are. However, bear in mind that most are going to want completion of core clerkships and perhaps USMLE Step 1.

5) Is a match in ophthalmology or otolaryngology in the USA too much to think of for an IMG (I mean, the default answer is "no", but please answer being really realistic)?

Unlikely. These are two of the most competitive residencies in the US. See the above link to Charting Outcomes for numbers of FMGs who match, average Step 1 score, etc. Most FMGs who find competitive residencies in the US (and it does happen) have likely spent several years working the research labs, making connections etc and are not right out of medical school.

6) Being in the 3rd year of a 6-year program is too early to be thinking of all that?

No. The problem most have is waiting until they are almost done and delaying application.

 

[bashwell]

Exactly what @Winged Scapula said!

Also, as far as I'm aware, there is no master list. You pretty much have to contact programs one by one. And in my experience (I'm in Australia) the vast majority require Step 1 just to apply. Only a handful don't. But you never know, that could change by the time you're looking to apply to programs for USCE. So make sure you sit or take Step 1. It opens a lot more doors as far as applications for electives.

Or you could come to Australia. It's beautiful here.