IMG asking about US clinical experience... again

[RRoguish]

Hi everyone, I'm new here (quite obvious I think) and I would like to say what a great big forum this is.

Here's my introductory spiel… I'm an IMG, no US clinical experience, ECFMG certified, green card holder, live in Southern California. I am truly interested in pursuing Psychiatry (then either Pain, Child, or Addiction psych)… or… Anesthesiology (then Pain, then maybe another residency in Psych or a Psychology PhD).

I've searched the SDN forums for threads on gaining more US clinical experience, a lot showed up but none really answered the questions in my head quite sufficiently. So forgive me for starting yet another thread on USCE.

I've compiled a list of ideas below. My goal is to get some good solid USCE that would prepare me for Anes or Psych, at the same time finding a job that would actually pay the bills would be great as well. I would really appreciate just receiving whatever input you may have on them:

o Applying for externships - pretty straightforward here

o Shadowing a doctor - what exactly is the best way to go about this, as I have no connections to doctors in this neck of the woods whatsoever. My plan is to go door-to-door… contact doctors in Psych/Anes, send them a resume and ask if they would like to take me in (as some sort of apprentice, observer, assistant?) I'm not sure if it's even possible to shadow an Anesthesiologist...

o Actually getting a paying job that at the same time gives me some USCE - see, whenever I do a job search in Health Care, it seems that even with my education I am only qualified for such High School or GED level positions like "Counselor" in a youth mental health program, or maybe a craigslist ad like "Medical Assistant: no experience or certification needed, we will train you." Any other ideas on what to keep my eyes peeled for?

o Getting a job in research - this will probably pay, but I do think it's a long shot as it may not even be considered real clinical experience

o Volunteering - right now I am thinking of things like mentoring or counseling youth, the bereaved, etc. Perhaps taking calls in a suicide help line? Something to do on the side.

o Doing a Transitional/Prelim year - which I would likely have to do for Anesthesiology anyway. How does this work, if a hosptial takes me in for a transitional year, do they require or expect that you do your PGY-2 with them too? Or can I actually just choose to go into a transitional year for the purpose of gaining USCE? (The terms Transitional and Preliminary confuse me too).


Thank you so much in advance and am anticipating your comments!

---

Members don't see this ad.

 

[Winged Scapula]

Moving to International Forum (you'll likely find more responses there)...

 

[Knight_MD]

Hi everyone, I'm new here (quite obvious I think) and I would like to say what a great big forum this is.

Here's my introductory spiel… I'm an IMG, no US clinical experience, ECFMG certified, green card holder, live in Southern California. I am truly interested in pursuing Psychiatry (then either Pain, Child, or Addiction psych)… or… Anesthesiology (then Pain, then maybe another residency in Psych or a Psychology PhD).

I've searched the SDN forums for threads on gaining more US clinical experience, a lot showed up but none really answered the questions in my head quite sufficiently. So forgive me for starting yet another thread on USCE.

I've compiled a list of ideas below. My goal is to get some good solid USCE that would prepare me for Anes or Psych, at the same time finding a job that would actually pay the bills would be great as well. I would really appreciate just receiving whatever input you may have on them:

o Applying for externships - pretty straightforward here

o Shadowing a doctor - what exactly is the best way to go about this, as I have no connections to doctors in this neck of the woods whatsoever. My plan is to go door-to-door… contact doctors in Psych/Anes, send them a resume and ask if they would like to take me in (as some sort of apprentice, observer, assistant?) I'm not sure if it's even possible to shadow an Anesthesiologist...

o Actually getting a paying job that at the same time gives me some USCE - see, whenever I do a job search in Health Care, it seems that even with my education I am only qualified for such High School or GED level positions like "Counselor" in a youth mental health program, or maybe a craigslist ad like "Medical Assistant: no experience or certification needed, we will train you." Any other ideas on what to keep my eyes peeled for?

o Getting a job in research - this will probably pay, but I do think it's a long shot as it may not even be considered real clinical experience

o Volunteering - right now I am thinking of things like mentoring or counseling youth, the bereaved, etc. Perhaps taking calls in a suicide help line? Something to do on the side.

o Doing a Transitional/Prelim year - which I would likely have to do for Anesthesiology anyway. How does this work, if a hosptial takes me in for a transitional year, do they require or expect that you do your PGY-2 with them too? Or can I actually just choose to go into a transitional year for the purpose of gaining USCE? (The terms Transitional and Preliminary confuse me too).


Thank you so much in advance and am anticipating your comments!

I second these points... esp research and prelim. Can an IMG get a prelim (e.g. general surgery) without USCE? I was planning on getting my USCE through prelim...

Thanks

 

[Winged Scapula]

prelim general surgery positions are not very popular so its quite possible that you could get a position without USCE.

it seems a bit self-defeating though to try only for Prelim and not Categorical, but if you are not in a position to get USCE (ie, already graduated), then I suppose its the best option.

 

[Knight_MD]

...but if you are not in a position to get USCE (ie, already graduated), then I suppose its the best option.

Well wouldn't a post-grad observership qualify as USCE?

Please, if it doesn't count (or is v.weak) then let me know... I'm supposed to contact someone this week who could help me get a 2-months observership...

I mean how else could I get an American LOR...

If it isn't exactly USCE, then I'm better off saving a huge sum of money and time that could be better spent studying for my USMLEs...

What about a Canadian observership... useless in US residency applications?

 

[Winged Scapula]

Well wouldn't a post-grad observership qualify as USCE?

No, simply observing someone isn't clinical experience. It is a very weak way of learning about the US medical system. The point of getting US clinical experience is to allow supervisors to see you "in action" with patients - how do you interact with them, examine them, come up with differential diagnoses, etc. An observership doesn't allow you any actual physical contact with patients.

I mean how else could I get an American LOR...

Unfortunately, if you've already graduated, then your options are fairly limited, you can't do anything which resembles practicing medicine.

If it isn't exactly USCE, then I'm better off saving a huge sum of money and time that could be better spent studying for my USMLEs...

Obviously there are people who match every year without any US clinical experience. You'd be better off talking to someone who has actually traveled this route to see if they felt that observerships were helpful - but the conventional wisdom in the past has been that they are not very.

What about a Canadian observership... useless in US residency applications?

Same difference - its not CLINICAL experience. The observership experience is better than nothing, so only you can decide whether or not its worth the money and the hassle because there is no guarantee you'll match by doing or not doing one.

 

[RRoguish]

Knight... From what I hear, observership (especially one in Canada) doesn't quite cut it because it's not hands-on clinical experience. I suppose it's better than nothing though, and as long as it doesn't cost you too much like you said. Unless you're getting an observership in a program you're going to be applying for, maybe a better idea would be to look for a doctor you can shadow. That would be like an observership, but at least you don't have to pay.

I was thinking maybe getting a Medical Assistant job (in a field related to your career choice) with as much hands on experience the doctor will let you have. A Physical Assistant job would have been better because they do more doctor stuff and less clerical work, unfortunately all PAs need to have gone through 2 years of studies + certification via an exam. With MAs, no formal schooling is required and certification is optional depending on the doctor. This is what I've gathered researching online. So perhaps get an MA job (I found craigslist.org to start with has a lot of postings), concentrating on back office instead of front office so you'll do less filing/billing/answering the phone/greeting patients... and more time in the exam room.... though the bulk of the work is probably going to be about autoclaving, prepping the exam room, preparing the materials etc.... Hopefully more history and vital signs as you gain the doctor's confidence.

Gaining USCE as a post-grad FMG seems so difficult!!! I'm also confused about applying for a transitional year in order to gain USCE... Is that what FMGs are supposed to do for USCE, or is transitional year mainly for those looking for their base training for their future strictly categorical programs like Rad, Anes, Ophtha, etc? The reason I ask is because it might turn out to be quite competitive with program directors prioritizing applicants whose goals are more than just to gain clinical experience..... Or would they even care? Any clarification and tips on this would be welcome..... By the way I am also trying as much as possible to remain in the Southern California area. Is GS prelim here easy to get into?

Thanks.

 

[Knight_MD]

Thanks a lot... this makes sense.

Unfortunately, if you've already graduated...

Well this is complicated. Here, after our final year results are out, we have to spend a year of internship (House Officer) before being officially graduated. And till then, our results are "in the process of accreditation at the University council".

I didn't ever get a satisfactory clear-cut reply from any US med school as to my eligibility for an elective. I'd hate to know later than I could have taken an elective now.

And Roguish, I had my fair share of dirty work, so no thanks! I don't believe it would be much of a help either...

Yeah I heard -shocking as it is- that getting an observership is even harder than matching at a residency...(!) That is because the observer is mainly a medico-legal burden on the hospital, who helps at nothing.

However, some require medicolegal insurance from the observer (e.g. Duke's uni, US$ 5000)... I wonder if that makes it a hands-on experience.

Well if getting an observership won't help, what else could I do to boost my application for prelim surgery? Is there anything at home/US that I can do?

 

[Winged Scapula]

I'm also confused about applying for a transitional year in order to gain USCE... Is that what FMGs are supposed to do for USCE, or is transitional year mainly for those looking for their base training for their future strictly categorical programs like Rad, Anes, Ophtha, etc?

Transitional years are designed, as you note above, for those going into other fields. They are fairly competitive as they are much more "cushy" and relaxed than Preliminary years in Surgery or Medicine. It would be difficult for an FMG to get into one without having matched into an Advanced Specialty.

The reason I ask is because it might turn out to be quite competitive with program directors prioritizing applicants whose goals are more than just to gain clinical experience..... Or would they even care? Any clarification and tips on this would be welcome..... By the way I am also trying as much as possible to remain in the Southern California area. Is GS prelim here easy to get into?

Thanks.

The US system just isn't set up to assist those in your position. Preliminary or Transitional positions are not designed to provide you with USCE but that doesn't mean that they cannot be used as such. As I noted above, Transitional Years (TY) are pretty hotly competitive as it would be much easier to get a Prelim Medicine or Surgery position. I can imagine that PDs would prefer to fill a position with someone who is also matching or already matched into Rads, Derm, etc. than with someone just looking to get USCE - that said, some would prefer to fill the position than let it go open.

Cannot comment about whether or not Prelim GS in So Cal is "easy" to get into - there will be some programs which are and some which are probably more competitive. Look for places that have non-designated Prelim positions - the designated ones will be for those going into Ortho, ENT, Uro, etc.

 

[Winged Scapula]

Thanks a lot... this makes sense.


Well this is complicated. Here, after our final year results are out, we have to spend a year of internship (House Officer) before being officially graduated. And till then, our results are "in the process of accreditation at the University council".

So you might technically still be considered a student which would open up US clinical electives to you, although it may take some finagling of the semantics involved (ie, not calling yourself an intern, but rather completing final year objectives until graduation). Your school would have to state that you were still on student status though, not sure if they would be willing. Undoubtedly the US adminstrative clerk reviewing your application will look for that statement and if he/she sees something like "intern", "house officer", etc. will assume you have graduated and refuse your application.

I didn't ever get a satisfactory clear-cut reply from any US med school as to my eligibility for an elective. I'd hate to know later than I could have taken an elective now.

Although it depends on what answer you have received, it might help being "more American" in the process; that means being more proactive. Adminstrative types in academia are notoriously slow at getting things done and often don't prioritize your request. Obviously you don't want to antagonize them but just sitting back and waiting for an answer from them is probably not going to be fruitful. If they responded that they cannot give you a definitive answer until their own students have registered, well that's a pretty common scenario and in that case you either have to chose another specialty or just wait, but contact them as soon as their enrollment period is up.

However, some require medicolegal insurance from the observer (e.g. Duke's uni, US$ 5000)... I wonder if that makes it a hands-on experience.

Maybe, maybe not. Probably just a way to protect themselves if you say or do anything which could be interpreted unfavorably in a US court of law.

Well if getting an observership won't help, what else could I do to boost my application for prelim surgery? Is there anything at home/US that I can do?

I'm not sure you need to do anything for boost your application for Preliminary Surgery. Its not very competitive, although its getting more so as Categorical positions are hot. There are usually hundreds of open positions after the match and of course, you would be eligible to take a position outside of the match as an Independent candidate. I don't know that being a medical assistant is very helpful; I mean if you were in the country for a year and needed a job, I could understand that but not to do it for a few months when all you'll be doing is taking vitals, putting patients in rooms, cleaning the rooms, etc. Hardly gives you a chance to show yourself off. You'd be better off with an observership IMHO which at least gives you the chance to discuss DDx, patient management, etc. with the supervisor.

 

[RRoguish]

... don't know that being a medical assistant is very helpful; I mean if you were in the country for a year and needed a job, I could understand that but not to do it for a few months when all you'll be doing is taking vitals, putting patients in rooms, cleaning the rooms, etc. Hardly gives you a chance to show yourself off. You'd be better off with an observership IMHO which at least gives you the chance to discuss DDx, patient management, etc. with the supervisor.

That's true! I was thinking more about just part time to help pay some bills while at the same time being in a medical environment. And perhaps make some useful connections.... While simultaneously doing externship/observership etc...

 

[Knight_MD]

Well I already have the official signed, stamped statement from my faculty that I "have successfully completed The Bachelor of Medicine and Surgery in December 2006 and the final result is in the process of accreditation in the University council."

I believe it does work at some medical schools, however, I believe I've also heard that a similar applicant was black-listed at the ECFMG after he told them during the elective that he was serving the "House Officer year" at that time. And I guess you would agree, no USCE -be it an elective at Harvard- is worth that risk....

Which really puzzles me. Some schools won't give you an elective in Surgery till you've passed the clerkship at your home school, well what if it was a final year clerkship? That makes little sense.

Thanks tremendously for your help anyway...

 

[RRoguish]

Transitional years are designed, as you note above, for those going into other fields. They are fairly competitive as they are much more "cushy" and relaxed than Preliminary years in Surgery or Medicine. It would be difficult for an FMG to get into one without having matched into an Advanced Specialty.

Pardon my ignorance... does this mean I have to apply for both Transitional and Anesthesiology programs in the same year, and succesfully match in the two programs??? Or just the advanced program, because how can you match in two programs....?

 

[Winged Scapula]

Pardon my ignorance... does this mean I have to apply for both Transitional and Anesthesiology programs in the same year, and succesfully match in the two programs??? Or just the advanced program, because how can you match in two programs....?

Yes.

In general, for Advanced matches which require a Preliminary Year (of either medicine, surgery or transitional), you apply for both the Advanced position and the intern year at the same time. Some programs will offer both into a combined residency, but this is not always the case.

You match into two programs, because you are applying for a one year position (the prelim or TY) which starts next year, and the advanced position which starts the year after. You submit two Rank Order Lists, one for each, and hopefully match into both. Of course, it is always possible to match into the advanced position and not the prelim and vice versa.

 

[Winged Scapula]

Well I already have the official signed, stamped statement from my faculty that I "have successfully completed The Bachelor of Medicine and Surgery in December 2006 and the final result is in the process of accreditation in the University council."

Sounds like that won't work then.

I believe it does work at some medical schools, however, I believe I've also heard that a similar applicant was black-listed at the ECFMG after he told them during the elective that he was serving the "House Officer year" at that time. And I guess you would agree, no USCE -be it an elective at Harvard- is worth that risk....

While I often doubt the "fmg-rumor mill", I agree that its probably not worth the risk. BTW, you mention Harvard...I hope you are not falling into the common FMG trap of thinking that you have to do a clerkship or obvservership at some internationally well known US program. There is NO reason you need to do this at Harvard or any of the other big name places which often charge an arm and a leg for tuition. Your object (and excuse me if this doens't relate to you) is to get USCE, this can occur anywhere and the experience is no better at Harvard (and may in fact be worse given the number of layers between you and the faculty, what with students, residents and fellows) than at Podunk hospital X. As long as the program you are considering has an accredited residency program in the specialty you are considering, it is adequate for USCE and getting an LOR.

Ok...off my soapbox.

Which really puzzles me. Some schools won't give you an elective in Surgery till you've passed the clerkship at your home school, well what if it was a final year clerkship? That makes little sense.

Thanks tremendously for your help anyway...

The purpose is that they want you to have the basic training before you are allowed to come for the visiting elective/clerkship/observership. Most US students do Surgery in their 3rd (second to last) year. If you do Surgery as a final year clerkship, it doesn't make much sense to come to the US for an elective (which wouldn't be the same rotation as those who are doing it for their Core rotation) when you haven't done the prerequisite rotation. Its just a difference in timing, which makes it more difficult for you to get the rotations you need on time.

 

[GATO]

am taking externship in GA using IMGprep now. It is expensive. The admin is not good. realized that I don't need to use IMGprep. You should contact doctors' secretaries directly or the doctors (if they don't have their secretaries) directly. You should buy your malpractice insurance by yourself. It costs around $900 a year. The rotation costs around $700 for 4 weeks, but it depends on the rotation. You don't need to pay for the company. During the first rotation, you should get more information of the externship opportunity from your fellows in the rotation. Then you should apply to another rotation. By the way, I think externship is not allowed in CA, NY, and Philadelphia. You should be careful.

 

[Medstart108]

I'm sure whatever the problem was it was solved sometime between yesterday and 6 years ago....