Observer ships vs Electives and how
to impress your attending.
Scores! Scores! Scores! Everyone will tell you that scores
are all it takes for you to land a US residency. While scores are of course
important there is more to a strong candidate beside scores. Match committees
take a more holistic approach towards reviewing applicants. With step 1 going
pass/fail, arguably the more important step exam, more focus will be placed on
other aspects of the application.
USCE (US clinical experience) while not required for
applying to residency, is perhaps the most important non-score part of the
application. The importance for UCSE depends on the specialty you are applying
to, for example Medicine would put more weight on it than say pathology.
Generally, program directors want to know that you are familiar with the US
health care system and won’t need a lot of training/help while starting
residency. Since last year, most UCSE programs have stopped taking applications.
However recently they are slowly starting back up again as we reach a semblance
of normalcy.
UCSE comes in various
forms observer ships, electives and clerkships and they can be expensive. Of
course, you need to buy the ticket and arrange accommodation/ food, both of
which can set you back $1000 each for a month, the tuition fee for these
rotations can vary ranging from free to almost 6k. If finances are a concern,
you can filter programs according to tuition fee. Generally, academic center
UCSE is superior to community hospital/ private clinic UCSE and the lORS from
there carry more weight. As for how much UCSE is enough, the more the better
but aim for more than 3 months. If that is not manageable don’t worry people
match without UCSE too.
Observerships-
can be done after graduation.
Disclaimer: I haven’t done many observer-ships so my
information on them would be limited.
Generally, as the name applies you are only allowed to
observe and not supposed touch the patient or be actively involved in the care,
however you can usually take histories in most programs. Think of it as a’ fly
on the wall’ scenario. However, they do add to the application as you are
seeing the US healthcare system at play. You can see what role is played by OT(occupational
therapy), PT( physio therapy) , social work, and insurance agents. While you
might not be using the EMR (electronic medical system) yourself, but you can
get an inkling of how it works. You will probably be shadowing a consultant, so
you just follow them around wherever they go. It is possible to get a strong
letter from an observership, which is one of the primary goals of UCSE. Some
attending will allow you to do a physical exams too, it depends on where you
are at, but for most observerships you don’t. I would encourage you to present
as many cases as possible to your attending as that is pretty much all you can
do to get a letter.
‘Electives’-
requires you to be a student
Probably the best UCSE you can get. Sure, there are types
within electives too, sub-internships being the best elective type. How they
differ from observership is that you will be acting like a PGY-1 resident. It
involves waking up early, rounding in patients, presenting cases, examination
etc. You will have your own epic access and will lookup patient details
yourself and get to interact with more residents/ fellows as you are an acting
independent provider. Electives can be tough so don’t think about them as an
excuse to visit the States. As electives are a formal visiting program and
usually not ‘contact’ based, hospitals do keep a record of your time there. A
good evaluation can help you land a residency at where you rotated.
Clerkships
I have not done any clerkships so will refrain from talking
too much about these, but my understanding is that they are hands-on and can be
done after graduation. If someone would like to add to this section, please
reach out to me.
How to
excel in your UCSE.
A common misconception is that people think that they will
be correcting an attending’s mistakes or coming up with innovative management
plans etc. let me dispel this rumor, you as a medical student/early grad and
probably don’t know much. Your clinical acumen cannot compare to that of a
fellow/ attending.
What makes for a good evaluation then? Honestly, your
personality is probably the most important factor here. Good social skill can
take you a long way, no one expect much from you. Just be fun to work with and
teach. Show interest, ask relevant question, and know your patient thoroughly.
By relevant questions: I don’t mean asking an attending
about the pathology of a particular disease or the standard management of a
disease. Good questions are something you probably won’t find in a book and can
be answered by someone who has accrued years of clinical experience. Maybe add
some hypothetical situations in there. Doctor’ what if the patient presented
this way would you still manage him the same way’.
Know your patient thoroughly. You probably being the most
junior member in the management team will have the lightest workload. The few
patients you are assigned, know them well, dig deep in the EMR record.
Attendings don’t have time to look at every patient detail and if you can
provide a relevant point that can act as a lynchpin in their management plan,
it could do wonders for your evaluation.
Perhaps, the most important
point here will be nice to everyone, show that you want to learn and get
better.
Generally,
Academic center UCSE> Community hospital UCSE> Private
clinic UCSE
the LOR importance also follows the same trend, though a
personalized letter is always better than a generic one, albeit even from a
clinic.
-Izhan Hamza
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