Clinical observership programs are a way for international medical students and graduates (IMSs, IMGs) to gain US clinical experience (USCE). Observing medical learners accompany a physician throughout their daily clinical tasks and gain valuable hands-off training. These clinical rotations may or may not be accredited depending on your school’s academic requirements.
Students seeking medical observerships in the US should first be familiar with the local healthcare system. Your medical education will be tested, as will your English language skills and interactions with patients and other staff. Familiarity with the clinical settings you may be hosted at, navigating electronic medical records (EMRs), and participate in your preceptor’s teaching rounds will be expected of all learners.
How do I Find a US Observership Program?
Foreign and international medical students and graduates may locate clinical sites in several ways. The most common include asking peers, friends, and family if they know a physician who may host their clinical rotation. This is the easiest way as a referral from someone within a preceptor’s or program coordinator’s network will increase the likelihood of the trainee being accepted.
Another traditionally popular method is to “cold call” physicians. This includes calling clinics and hospitals, emailing office assistants, or reaching out to the physician directly. However, this usually does not lead to a high success rate. Students will usually need to reach out to many doctors to gain a single observership. Physicians are also very busy and many may become annoyed at receiving numerous calls, emails, or social media messages.
If your medical school does not provide any hospital affiliations to explore, or not in your specialty of interest, many are forced to turn to placement agencies. These rotations agencies provide a much wider array of options, but they come at a very steep price. Clinical experiences through these companies may cost hundreds to thousands of dollars per week. They usually have non-refundable application fees, Many learners have reported negative experiences with such companies as well.
Rotations marketplaces are a relatively new concept in this field. Unlike the VSAS/VSLO system, students do not need to come from a particular school to use them. They are also much more affordable as there is no agency in between the healthcare learners and the preceptor or clinical site. It puts more responsibility on the learner to properly schedule, complete documentation, and communicate with healthcare professionals at the site. However, it also allows for more personalized education and control over educational experiences.
Why Observership Programs are Important?
To increase the chances for a successful residency program Match, IMGs have to compete with their US counterparts. This means that increasing your health care training and developing a stronger curriculum vitae is very important.
This can be a great opportunity to also gain valuable letters of recommendation, develop professional networks, and demonstrate competencies in the clinical setting. As many medical learners already have an idea of which specialty they would like to pursue, this also gives more opportunities for a reference letter within that chosen specialty. Those are considered much more important during residency Match applications than a generic one from another medical specialty.
What are the Different Types of Observerships?
There are a variety of clinical observership programs that are marketed for international medical graduates within the US. Many community hospitals and clinics, private practices, and medical associations offer these educational programs. The exact experience, schedule, and clinical care responsibilities will depend on each location. Here are the basic clinical settings a medical student may find these programs in:
- Observerships at private clinics are the most common and easiest to find. However, they are considered of lower quality to many residency directors.
- Smaller hospitals are also a great place to look. One negative is that all hospital staff must go through more rigorous steps and documentation. This usually means more time delays and higher costs for the student.
- Teaching hospitals are the best, but usually don’t hold many observership options. However, if they will accept you for externship training this is your best option. It gives the best hands-on experience and variation in learning environment. These types of rotations also reflect more strongly for residency program directors.
Depending on your budget, time frame, and career goals all of these options are worth exploring. Not every residency director is going to weigh the clinical environment as harshly as others may. It’s more important to have extensive knowledge, a good bedside manner, and stronger LORs in many instances.
What are the Requirements for Applying to Observership Programs?
All observerships will require that a medical learner be either a current student (with a letter of good standing from their school) or a medical graduate. Some opportunities will only allow registered learners while others may prefer that the individual already hold an MD or equivalent. There may also be other requirements, such as completion of certain core rotations before beginning this clinical rotation.
All US students need current immunization records, a background check, drug screening, liability insurance, health insurance (where applicable), a recent physical exam, and many other forms of documentation to complete clerkships in the United States. However, non-US observers will have many other activities they may need to complete before applying.
Depending on the clinic or hospital, you may need to be basic life support (BLS) certified as well as hold a current OSHA and HIPAA certification. Step 1/Level 1 or Step 2/Level 2 exam scores are also required at certain locations. Make sure to have a current and valid visa (most commonly J-1), the Test of English as a Foreign Language (TOEFL) score, and an ECFMG certificate ready in case those are required. Remember, as communication skills are vital to proper patient care English fluency may heavily impact your student evaluations and later residency match chances.
What Students Should Expect
An observer can learn much and gain valuable experiences even in the least active clinical settings. Some rotations will have much more downtime between patient visits than others. Utilize this time properly!
Ask your clinical supervisor on or before the first day what expectations they have of you. Knowing which activities are allowed and which are prohibited can prevent stressful situations from arising later on. Connect with your leading physician and colleagues as much as is allowed. They may become great resources for not only your education but also career placement later in life. Of course, always respect the boundaries of your peers, preceptors, and patients.
When you have free time, use it to study, discuss difficult topics with colleagues, and even gain experience with the labs and equipment available to you. Always ask permission first, but most preceptors enjoy when a student is taking an active role in their self-directed learning.
Preparing for Your Rotation
Your clinical experience may vary in duration but the most common is the four-week program. This allows a learner more time to gain exposure to that particular medical setting, patient population, and common patient illnesses for that specialty. It’s also less chaotic than shorter duration experiences, which require a student to constantly shift their schedules, transportation options, and other logistical considerations.
A student observer should plan months in advance as spots are often limited and can fill up quickly. Waiting until the last minute is not likely to produce positive results. Beware of all application deadlines, don’t wait until the last minute, and verify that everything has been received! Mistakes happen, documents get misfiled, and you don’t want to miss an opportunity due to a clerical error.
Once you have secured a spot, contact the appropriate department, clinical coordinator, or office manager that will be creating your schedule. Double check all information and, if possible, try to have a copy of the schedule sent to you. It’s never a good look to be late on your first day, even if it was due to a miscommunication. Consider also reading our How to Prepare for Your First Clinical Rotation article for more details.
How to Stand Out
Communication with your preceptor will lead to the most successful outcomes. The sooner you understand their needs for your help, your responsibilities, and how they run their practice the better. However, being aware of their spoken or written expectations is only part of the equation. To really stand out, medical students that can pick up on unspoken cues or decipher the deeper meaning of thier attending’s needs will progress much further. Many physicians are busy, stressed, and may not communicate in the most effective manners. Empathy is not a trait reserved for patients alone!
Besides developing a stronger emotional intelligence, there are other skills that can assist an observer shine. Those that can display teamwork and leadership skills are likely to become stronger healthcare professionals. Physicians know this and they will respect these qualities in a trainee.
The goal of any medical observership program is to gain valuable insights into the healthcare system. Even being limited to collecting patient histories, there are many clinical and non-clinical learning opportunities available. If you are engaged and interested, you can even come away from this experience with a Strong Letter of Recommendation!
