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. 


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.


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.


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!


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.

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3 thoughts on “Tips and tricks for getting US clinical experience

  1. “Candidate 2 tells me that they want to shadow me for a week ….”

    I understand that for a busy practitioner it may be convenient and safe to allow someone to shadow for a ‘week’, then taking burden of arranging formal electives/ observerships, but my question is what purpose does a week’s worth of shadowing serve anyone.

    The reason I ask is because I got myself into a very similar situation a few months ago. My opportunity to shadow a doctor was arranged informally by a contact. He told me that the doctor agreed for one-week only, but said that he may agree to more after getting to know me first. Unfortunately, that didn’t work out and at the end of that week, I realized that the doctor was going out of town anyway.

    Thinking that a standard LOR is of a minimum four-weeks duration, I did not even bother him to write a recommendation for me. I thought that a few days is too brief to know someone enough to be able to comment on the myriad aspects of a candidate’s personality, knowledge and work skills that are relevant for a good LOR.

    Please let me know of your opinion about this.

    1. I agree, 1 week will not fetch you a strong LOR. But one week is better that not doing anything for that time period. Also, it is a networking opportunity where this particular doctor can introduce you to his/her doctor friends with whom you can work/rotate. I understand that it may not work out every time, but it is an opportunity. If you don’t have to spend too much money to travel/stay for this week rotation, it can’t hurt.

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