Category Archives: USCE (US clinical exp)

6 powerful ways to get USCE

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Do more observerships and externships, get more USCE… BUT HOW??

 

USCE is one of the most important pillars of your residency application. But it is becoming just as hard to get it as is residency itself. I get at least one email every day asking about how to get more USCE. A lot of IMGs have emailed many faculty members but have not received a single reply back.

If that is your problem, read this article. It will give you six ways to get observerships, externships, and research positions. I have yet to meet an IMG who was unsuccessful in getting USCE after using these 6 steps.

1. Local physician groups of your country of origin (AAPI, APPNA etc.) :

Don’t just show up at their events and ask each and every physician if they can let you shadow them in the clinic or hospital. Attend their meetings a few times. Be a friendly person in the crowd. See if you can volunteer for their events by asking the chairperson if he/she needs help. Then, when they starting knowing you a little bit since you have been going to the meetings regularly, ask them if they can let you rotate with them for a couple of weeks.

2. Contacts:

Knowing a faculty member/PD in a residency program is the highest level of contact. But most of us do not have that. Friends/neighbors in the US who know doctors, previous mates from medical college who are now residents, neighbors from back home who know someone in the US who is a doctor are contacts too. Use them. Don’t be shy now. You are going through the most decisive time of your career. Once you get into residency, you can pay them back or send them a thank you gift card.

3 .Conferences:

If there is a medical conference in your city or close to where you live, try to attend that. I recently met a family medicine resident who met the program director of his residency program at once such conference, got to know him and got matched at his program. Even if you don’t meet the PD, you will meet a lot of faculty members. You don’t have to befriend everyone, but just by being present there for 2-3 days, being friendly and chatty, people will start to recognize you after a couple of days. Take contact information of those who you connect with the most and stay in touch. Registration for these conferences is not very expensive if you select a student rate.            

Pro tip: Email them before you register and ask them if they will let you volunteer at the conference which provides free entry and tons of exposure to faculty members.

4. Previous rotations:

This was my go-to method to get more USCE than I can handle when I was applying. Once your current rotation comes to end, ask the attending you are working with if he has a colleague, friend or someone he knows in cardiology, GI or any other field you are interested in who you can go talk to and ask for a rotation. Repeat the process after each rotation. 

5. Masters, Ph.D. programs:

I do not advocate joining one of these programs just to match but if you are in one already or have graduated, email your mentors, faculty, friends from these programs and ask them if they know someone who would let your rotate with them. This is how a lot of people get job opportunities in the US. Through their alumni circle. Again, this is no time to be shy and think “I don’t’ want to bother them, they probably don’t even remember me now”.                         

Pro tip: If you don’t try, you will never know. And there is nothing to lose.

6. Mass emails:  

This is explained in the detail here.

 

These are very effective six steps that will get you into a rotation or research position. Most IMGs sent out ineffective emails for a few days and give up. That is using only one of the six methods to get USCE and that too not doing it right. No wonder they are unsuccessful. Be more aggressive in pursuing your dreams.

Tips and tricks for getting US clinical experience

Once I completed my USMLE step 1, I started thinking about  applying for observerships/externships, The first thought in my mind was me standing in scrubs and white coat with bunch of other residents and the attending in a hospital wards. I soon realized that this is not always the case because I was getting no replies back for my emails from the attendings.

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Attendings in university hospital and community physicians get many emails from IMGs every month asking for clinical rotation. Only a few of these applicants get positive replies from the physicians.

What do these selected few applicants do that hundreds of others IMGs don’t. What made them get an observership or externship over many other IMGs with much higher scores?

I was one of those IMGs. I emailed hundreds of attendings for clinical experience and did not get even one reply back. At first, I thought it was because of my low scores. Then I made a few changes to the emails I was sending and I started noticing that attendings were replying back. Not all had USCE opportunities for me but some did. It was still better than no response at all.

In this post, I will show you exactly what I did to go from zero replies to ending up scheduling 5 observerships, 1 externship and 1 research volunteer experience (which later turned into a published paper and part time job)  in just a few weeks

These are the same techniques I later used to secure away rotations during my residency. 

EMAIL HACK # 1: PUT YOURSELF IN THE ATTENDING’S SHOES

Let’s look at two promising IMG candidates who sent me emails for USCE:

Candidate 1 tells me about their stellar scores, dedication to pursue internal medicine residency, strong work ethics and accomplishments in home country.  Later, in the last paragraph she tells me that she wants to come over for 3 month externship.

Candidate 2 tells me that they want to shadow me for a week during my rounds and understand the work day of an internist.  She is applying for internal medicine residency. She has checked with the coordinator of my program and her credentials and visa are in order as long as she finds a faculty member to agree to her rotations.

Who do you think I will feel more comfortable to come in for a rotation?

If I have one spot in my practice to accommodate a student, candidate 2 is by far the most likely to be selected.

EMAIL HACK # 2: MAKE YOUR EMAILS SHORT

Once again, think about what goes in the attending’s mind when he opens his mailbox in the morning. He has a few emails with subject “elective sponsorship request’ or “observership inquiry” or something similar. He knows what it is about. If he is even a little bit inclined to offer the observership, he wants to know when and how long the student in planning to come. But he has to read about 3 paragraphs before he finds this information, he has lost interest already.

EMAIL HACK # 3: DO THE WORK FOR THEM

This is the hard part but incredibly rewarding. When I first joined my workplace, I had no idea what were the rules of the institution for observership or externships. So I ignored most of these emails. Then one day, I got an email from an IMG which blew my mind. He had already asked the program coordinator of the department about rules before he emailed me.  In his email, he told me exactly what the policies were so I did not have to figure them out. All I had to do was say YES!

EMAIL HACK # 4: GRADUALLY ADVANCE YOUR RESPONSIBILITY

If you do the things mentioned above, you will most likely get an observership. After about a week of observing, you will get a feel of what his work is like, when he is busy and when he has some down time. By now, the attending will also be a little more comfortable with you being around.  He would have realized that it’s not that bad (maybe even helpful) to have a student shadow him around. At this point, you can tell him that that as an IMG, ‘hands on’ experience is a sought after feature by program directors. Tell them you would love to stick around a little longer and take histories and perform brief exams on the patients. Tell them, you have checked with the department and you can get the institution HIPAA certificate. Most likely, the attending will be fine with that.

If you get an externship using above tools, great job!  You can buy me a coffee later. But if you don’t’, no worries.  IMGs get hung up on externship vs. observership debate. I had a month of hands on externship in a community clinic. The interviewers were more impressed with my LORs from observerships because the attendings genuinely enjoyed having me around and mentioned it in the LOR

There you go guys. If you have not had success getting USCE after hundreds of emails then there might be something wrong in your emails. I wasted many valuable months spamming inboxes of attendings in local university with long unfocused emails. Then, I made these changes and I had more obersverships available (for free) then I could attend.

Identify the mistakes..

A medical student recently approached me for clerkship rotation in the university where I work. She obtained my information from my parents back in my home country. She contacted me through WhatsApp informally . She made some mistakes that I see other IMGs making in formal email communications as well. If you identify what mistakes others make, you will not make them yourself. Here is our WhatsApp conversation:


 

Student: Hi Dr. D, I got your number from your father. I need your help

Dr. D: Hi, I was aware you will get in touch. How can I help you?

Student: I am finishing up my medical school and internship in 2016. I will give USMLE step 1 after that. I want to do pediatrics in US. How are the chances for IMG?

Dr. D: I am glad you are thinking ahead. Chances for an IMG are pretty good.

Student: How is the pay in pediatrics?

Dr. D: The pay is variable depending on the practice and specialization.

Student: Can you give me a general letter of recommendation?

Dr. D: I don’t know your work so I cannot give you a LOR. Also, there is no general recommendation letter. Get a letter in the field you are going to apply.  I have a few friends who practice pediatrics. I can arrange for you to work with them and if they like your work they will give you a strong LOR on university letter head.

Student: When can I come for pediatric elective? Where will I live?  Also, I want to get some research published in PubMed. Can you help me?

Dr. D: Pubmed is a database of research journals. If you get your research published in one of the major journals, it will show up on PubMed. If you have worked on some research, I can guide you to get it published or presented at a major conference.  We can arrange for you to come in January- Feb for pediatric rotation. Once your travel plans are set, we will make accommodation arrangements.


 

First of all, I must applaud this student for working on her application in advance.  She is also well aware of things she will need to build a strong application.  If she would tweak her approach a little bit, she will have much better results with her application.  Since, my father’s friends referred her, I was patient with her. When I get emails like this from people I do not know, I am not as receptive. Here is how she could make people say yes more often to her requests:

  1. Do not mention pay in any of your conversation with people. This was an informal communication, so it is somewhat acceptable. But not at the beginning of conversation. We all think about it; we just don’t talk about it. That is what google is for.
  2. There is no such thing as a general recommendation letter. Always try to get your letter of recommendation in the field you are interested in. If one or more of your letters are from another field, ask them to write about something specific. They can write about your work ethics, professionalism, communication etc.

I learnt this after my cardiology observership. At the end of my rotation, I requested the cardiologist for a LOR. He asked me what I wanted him to write in the letter. I did not know the answer to that. He explained me that since it was an observership, he could not mention clinical skills in the letter.  I was always there on time, pretended that I was super interested all day (even though I was tired) and discussed cardiology topics with him. So he mentioned my professionalism, enthusiasm and knowledge of cardiology concepts in the letter.

Some letter writers will ask you to write a letter for them, which they will edit and sign. Keep these things in mind when you are writing a letter for yourself

  1.    Most doctors are busy and do not have time or incentive to host a medical student for a rotation. So make it easy for them to say yes.  In this case, student asked me when can she come for the rotation, where will she live etc. She is making it hard for me to say yes.  First get the rotation schedule. Then you can arrange for accommodation letter. There are online resources to find an apartment or room (rent.com, trulia, craigslist, university student group, Airbnb etc). You can ask the physician for recommendation on safe neighborhoods around the hospital.
  2. When asking for research publications or experience, it is better to look up what research the physician is working on. Then you can be a part of it if you are interested. If you are not, you can ask their guidance to proceed with your own research interest

 

In this case, after a lot of back and forth, I was able to schedule a rotation for this student in pediatrics with my friend who practices general pediatrics . She had some research work in medical school which she presented in an international pediatric conference.

We, IMGs are the most competitive residency candidates for residency programs. 1 out of every 3 doctors in the US is an IMG and there is still need for more doctors.  But we lose our confidence for reasons like low scores, accent problems, old IMGs, social anxiety or sometimes just feeling inferior to American graduates for no clear cause. The medical student I mentioned above seems bright and proactive. She just needs a little confidence boost and a little guidance to get her a great residency spot.

Stay awesome!!