Externships & Clinical Clerkships for IMGs in the USA

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Are you interested in knowing what clinical rotations and externships are? Well, before that, you will have to understand who international medical graduates (IMGs) are. A graduate from a medical school outside a country is a foreign medical graduate or an IMG. Students interested to become licensed physicians in the US will have to be clear about the above. Let us delve deeper into clerkships and externships in the following section.

US Clinical Experience

It does not matter if you are a fresh international medical graduate or a doctor with decades of experience. If you are an international medical graduate, you will be better prepared to apply for a residency program if you have US Clinical Experience (USCE). USCE is not mandatory for a foreign medical graduate but will be favorably looked upon when you apply for the residency program.

USCE is a hands-on experience providing patient care in a US medical environment.

What is considered USCE?

• Externships
• Clerkships (in the US or Canada)
• Sub-internship (similar to externship)

What is not considered USCE?

• Observerships or shadowing
• Volunteering
• Research experience
• Experience in other countries

The above cannot be considered USCE.

What is Clerkship or Clinical Rotations?

Clinical rotations are part of a medical curriculum. It involves students having to spend time as part of a medical team. During this process, they learn what is involved in various medical specialties. The term rotations here refer to the process of students rotating through various specialties. Clinical rotation helps students gain hands-on experience. These are a mandatory part of the curriculum and are required to obtain a degree. The students are closely guided by a supervisor. So, it is quite a low-risk, guided method of gaining experience.

Clinical clerkship is a term that is used interchangeably with the term clinical rotations. In some curricula, in the US, medical school extends for a period of 4 years. During the second half of their time in medical school, students spend time rotating through clerkship in various medical specializations. Clerkships or rotations are generally categorized into Core and Electives. Below is a list of common core and elective rotations.

Core Rotations

• Internal medicine
• Surgery
• Pediatrics
• Psychiatry
• Obstetrics and gynecology
• Family medicine

Elective Rotations

• Neurology
• Emergency medicine
• Anesthesiology
• Radiology
• Ambulatory medicine
• Intensive-care medicine.

The patient interaction and hands-on patient care help medical students gain an insight into what every day would look like once they start a medical practice. This is one of the reasons clerkships are of crucial importance.

What is an Externship?

Externships are quite similar to clerkship but differ in one key aspect. While clerkships are part of the medical school curriculum, externships are not. Externships are not directly provided by a student’s medical school. For example, if you are looking to apply for a competitive specialty and your medical school does not offer a clerkship in the same, you will have to look for institutions that do. While this is a viable option for students of medical schools, it is also a great option for graduates. Medical school graduates can join an externship to gain experience or to strengthen their resumes. For instance, IMGs can use an externship in the US to gain experience there.

Importance of Clinical Experience for IMGs

The increasing competitiveness of the medical field pushes international medical students to get involved in clerkships and externships to gain a better clinical experience. Clinical experience is an essential part of the medical profession. The reasons are:

• When applying for residency, USCE can make your ERAS application look promising.
• Gain first-hand knowledge of US healthcare practices and environment and show that you can handle the US medical environment.
• Assists in expanding your network and connections in the US medical community (mentors, experienced doctors, and peers).
• It helps you get an US-based recommendation letter and references.

So, how do I get US Clinical Experience (USCE)?

It is a complicated process to gain USCE. You have several avenues you can take to reach your destination. All these methods have different efficiency levels and success rates. You will have to consider your needs before setting up on any of these paths.

• Direct placement through a hospital – Although it is not a straightforward process as it sounds, it is an excellent option. Most hospitals do not provide the opportunity of taking up an externship. Even after all this, it does not hurt to inquire if a medical school program or an affiliated hospital offer an externship opportunity.
• Paid Placement Services – It is the most common means of acquiring USCE. Plenty of services exist, to help IMGs gain USCE. But make sure that you research potential services to ensure that they provide the experience you are looking for. Contact them, ask a lot of questions, and read reviews before making a decision.
• Residency Forums – Keep a close eye on residency/USMLE forum sites to find USCE opportunities provided by hospitals. This is quite rare but is worthwhile enough to spend some time each week.

The big question is, do all residency programs require USCE?

Having USCE can increase the number of residency programs that you can apply to as an IMG. But not all residency programs require USCE.

• Some programs do not require USCE but prefer a candidate with USCE over someone without.
• Some residency programs mention USCE as a requirement to qualify for applying.
• Some residency programs require USCE and specify a minimum required amount.

In conclusion, having US clinical experience only helps you with getting placed in a good residency program and also expands your choices.