United States Clinical Experience: Observerships in USA explained ! by Izzah Vasim

Hi everyone,my name is IZZAH VASIM and I am currently a student of M.B;BS-4th Yr at KING EDWARD MEDICAL UNIVERSITY,LAHORE.I recently did an OBSERVERSHIP in FAMILY n INTERNAL MEDICINE at STAFFORD,VA,USA.So, I thought I might share my experience as in how I got it,what is the benefit of it in a long run etc.This may certainly be a useful piece of information for those of you who are looking forward to pave their careers in the US medical sysytem.(P.S=THE INFORMATION IN THIS ARTICLE IS PURELY BASED ON MY  PERSONAL EXPERIENCE AND CONTAINS AN AGGREGATE OF THE INFO THAT I GATHERED FROM VARIOUS RELATED WEBSITES ON THE INTERNET.)So,let me start  by clearing some of the terminologies as far as the USCE is concerned in general;

1)WHAT IS MEANT BY USCE?

      USCE stnds for  UNITED STATES CLINICAL EXPERIENCE and that can be in the form of  clinical electives,research electives,observerships,externships.

2)WHAT DO THE ABOVE TERMS MEAN?

   Ok,so many of you confuse and mix up the above terms as far as to what they actually mean,but let me make it clear that all the above terms are totally different.Here's  an explaination for all the above according to MedEdia.com;

elective=electives are the 'OPTIONAL WARD ROTATIONS" that you take at any other teaching/university hospital as a "VISITING STUDENT".Electives can be either clinial or research electives.CLINICAL ELECTIVES in the US are mostly offered by the universities in your final year of medical school.(I don't think there is any place in the US that offers clinical electives prior to Final year)Clinical electives are undoubtedly on top of the list  when it comes to the USCE but let me clear here that IT DEPENDS UPON WHAT FIELD YOU"LL ULTIMATELY CHOOSE eg if you want to go for internal medicine,family medicine,paeds,surgery etc then cliinical electives are definitely the better choice but if you are aiming for pathology,radiology,dermatology etc then research electtives are better.RESEARCH ELECTIVES=according to my information research electives can be taken anytime ie right from the start of your clinical years or even before that at some places.(P.S=electives can only be taken before your graduation.You CANNOT get electives once you graduate)

observership=observerships are a sort of ward/clinical rotation where you have to OBSERVE the physician/attendings but you are not allowed to examine/touch the patients,so,it's more of a PASSIVE LEARNING as  compared to the electives but the plus point is that you can also get an LoR out of your observership as well,so there's NOTHING TO LOSE here!!(P.S=Observerships can be taken either before or after graduation.)

research=research is of a longer duration as compared to research electives and mostly the students enroll in research after graduation/passing the USMLE.the duration is usually of 1-2 yrs but it may vary.The advantage here is that you get ample time to get your study published and get a very good LoR as compared to research electives where the time frame is mostly 4-8weeks.

   Now,having cleared the above basic terms,let me now move on the main part of my article that will focus on US-OBSERVERSHIPS for undergraduate medical students.This portion will cover some major information regarding the observerships as what is their purpose?how to get them?are they of any benefit in the long run?Do the hold any value when it comes to applying for a residency?where in the US can you get observerships easily?what are the requirements?what are the visa requirements for that?etc(P.S=THIS INFORMATION IS ONLY REGARDING THE US MEDICAL SYSTEM,I HAVE NO IDEA ABOUT THE PROCEDURES OF UK,CANADA OR AUSTRALIA)

ok,so here i  begin;

1)WHAT IS AN OBSERVERSHIP?

      An observership is also known as SHADOWING/PERCEPTORSHIP i-e you get to observe the physician/attendings you are working with,attend the rounds,join in the daily discussions but you are NOT allowed to touch the patient or examine him/her.

2)ARE OBSERVERSHIPS BETTER THAN ELECTIVES?

      well,this is a very commonly asked question and the simple answer to this is that ELECTIVES ARE DEFINITELY BETTER THAN OBSERVERSHIPS,but i won't say to completely reject an oppurtunity in terms of an observership if you get them) just on the basis of the above statement as besides learning observerships can also provide you some benefits(which are discussed in the following portion of the article) ,the biggest one being an LoR.So,you are not at all at loss here!

3)WHY TO GO FOR OBSERVERSHIPS WHEN THEY ARE OF NOT  AS EQUALLY GOOD AS ELECTIVES?

  Ok,i must say here that you may find many people/seniors discouraging you when it comes to the observerships by sayin

a)Getting an observership is definitely better than GETTING NOTHING!!!!

b)Observerships(and other USCEs) allow you an exposure to the US HEALTH CARE SYSTEM in general i-e they give you an oppurtunity to carefully watch the patient dealings,nature of work,the code of conduct,the various non-medical aspects of the US health system e.g regarding the medical insurances,the nature of disease prevelance in the differnt parts of the US(as its pretty much different than ours)etc.

4)WHY DID I  CHOOSE OBSERVERSHIPS?

    I went for this  oppurtunity due to the following reasons;

*)Since most of the universities/schools offer clinical electives in final year,so i decided to atleast go for an observership this yr(i-e my 4th yr)rather than wasting it entirely.Also as i am oriented more towards the clinical specialities like FAMILY MEDICINE,INTERNAL MEDICINE,PAEDS,GASTRO(with the first two being my top priorities)i decided to grab an observership instead of research electives.Here, i must mention again that you should choose a way according to your priorites,so please start making up your minds now as to what you are gonna do and then plan your electives/observerhips/research accordingly.As in the US,those candidates are usually on top of the list who are dedicated towards  a ONE-DIRECTIONAL ZONE earlier.

*)Observerships are mostly(well to the best of my knowldege)FREE!I don't think so that there are any programs that require you to pay fees for the applications/processing.Since an observership is mostly a sort of private contract between you and the physician,so you don't have to spend money whereas applying for electives costs money.(By mentioning this point i am certainly not going against the idea of applying for electives,but the point is that you should choose wisely.If you can afford only a ONE-TIME trip to the US then i would say APPLY FOR  ELECTIVES rather than observerhships but for those of you who can go for multiple visits,like me,then definitely get a taste of observerships prior to your clinical elctives)

*)Being a female,i was geographically restricted and since i did not have any teaching hospital in my vicinity i felt that i should atleast grab an observership rather than getting nothing while being in search of electives.

*)I wanted to get to know the US medical system more completely before actually getting myself involved in it and i do feel strongly that this observership has done that for me.I got to know almost every aspect of their system i-e medical/non-medical.

5)WHAT IS THE VALUE OF OBSERVERSHIPS/DO THEY HOLD ANY IMPORTANCE IN THE LONG RUN?

  Ok,honbestly the answer to this question may vary but one thing is for sure that NOTHING IS USELESS when it comes to the USCEs and by saying that i mean that you should virtually grab every other oppurtunity you see coming your way.I have heard people saying that observerships in the long run don't hold any imporatance but that is not true.Although thesy might not be useful when it comes to applying for a residency but they can certainly land you at an elective spot in the US or for that matter get you a  faculty sponsor aswell.There are many residency programs in the Us that don't consider US-observerships as USCe and prefee a HANDS-ON clinical experince but there are many that also prefer the other way round.In support of this i must quote the physician with whom i recently did my observership when i put up this question to her and i quote "MOST OF THE RESIDENCY PROGRAMS ARE SIMPLY LOOKING FOR A CANDIDATE WHO HAS HAD SOME EXPOSURE TO THE US MEDICAL SYSTEM WETHER SHADOWING/HANDS-ON".

so in a nutshell,i would say that go for observerships as:

*)they can still give you an LoR

*)If  by any reason you couldn't  get an elective then grab an observership at least as they can be taken  even after your graduation.

*)Even if a residency program is not considering observership as USCE it will still be looking at a candidate who has done one to be more competitive.

6)DOES OBSERVING A PRIVATE PRACTITIONER HOLDS ANY IMPORTANCE?

  This is also a very commonly asked question and some may answer it in a NO,but i believe it does although to a little extent when compared to other forms of the USCE.Again i would support my statement with the help of following points that I have come across on the internet while talking to some IMGs;

*)Its better than NOTHING.

*)Sometimes,while working with private practitioner/Out-patient setting allows you develop a professional relationship and then the physician may even grant you the permission to perform the physical aspects of the bed-side manner aswell.Again,here, i would like to mention that this happened with me as during my observership in FAMILY MEDICINE i also landed in an out-patient setting where after a couple of days when i developed a repute among the satff over there,the physician(who was extremely friendly)allowed me to get a HANDS-ON experience with the patients,so that turned out to be a big BONUS for me.Plus on top of everything,the biggest advantage i got in that scenario was  that the physician considered my observership as an EXTERNSHIP  during that rotation and hence mentioned in my LoR,which is obviously GOOD.

*)Working with a private practione/out-patient offices grants you more oppurtunities in terms of IMPRESSING the physician with what you've got in terms of knowledge and simple clinical skills and TRUST me that helps a lot.If the physician sees the potential in you,he can definitely open more oppurtunities for you e.g in my case, i did the same and got many recommendations in return.

*)Sometimes in an out-patient setting the physician/admin may even allow you to tag along with their other research projects.e.g in my case i got the oppurtunity to attend the weekly lunch-in discussions and latest res

7)WHAT IS THE PREFERENCE SCALE FOR OBSERVERSHIPS?

   Regarding this question i would like to put up this piece of info that i came across on a blog regarding preference scale for observerships;

  Observership in a university residency program>University affiliated program>Community hospital program>Non-teaching hospital program>Out-patient setting/Private practitioner/group.

8)HOW TO GET OBSERVERSHIPS?

  Ok,this may sound funny but the truth is that there is NO formal/official way of getting a observership.Although there is a general notion among many of us that OBSERVERSHIPS CAN ONLY BE OBTAINED THROUGH CONNECTIONS or THROUGH ANY PERSONAL RELATIVE WHO IS  CURRENTLY A DOCTOR IN THE US, but its not always true as I neither had any connections nor any of my relatives are in the US medical system.Honestly, i also didn't know from where to start until a friend of mine gave me the tip or should i say told me how to get them.In that context i would say that obseverships can be obtained through a TRIAL AND ERROR/RANDOM SELECTION method(if you don't have any connections,although having connections makes it far easier).So,lets just get to the point;WHAT DID I DO?I simply started emailing the physicians in the field of my choice(i-e family med,internal med,paeds)in my vicinity i-e the states of Virginia,Maryland,NY and even CA.I emailed almost a GAZILLION people along with my CV.Here, i would  like to say that since i wanted an oppurtunity very close to my city/town so i narrowed my search even further and focussed on e-mailing the physicians/hospital admins in the area of VA state only.HOW DID IT TURN OUT?honestly,not well,as e.g if i e-mailed 60 people,only 20 replied back and among them only 4-5 with a positive answer(this was mostly because I was an undergraduate student--as they mentioned in their replies most of the times and also because VA isn't that an IMG friendly state as others on the east coast).So,WHAT DID I DO THEN? I simply changed my strategy a little and since i read this tip on one of the web sites that OBSERVERSHIPS ARE FAR EASIER TO GRAB WHEN YOU ARE APPLYING FROM WITHIN THE US THAN WHEN YOU ARE OUTSIDE i-e PERSONALLY MEETING THE PHYSICIAN INCREASES YOUR CHANCES EVEN FURTHER.So,following that i decided to be more DIRECT and since i was lucky enough to have my family there in VA,i asked my dad to go down to the hospitals all by himself and personally meet the physician and guess what,,,IT WORKED!!!!!As my dad fortunately got hold of the HEAD OF THE  PHYSICIAN RECRUITMENT DEPTT at a Local Hospital through his primary care physician(who was also a very nice guy and i give a great deal of respect to him as he was the one who opened the first door for me),now as soon as i got the contact number of the physician recruitment deptt,i started emailing them almost DAILY and requested them to get me an oppurtunity anywhere around the area and It was after almost 2 months of persistent e-mails and fax that i got a positive reply.Here, i must say that i came across quite a few pakistani-american physicians aswell but they turned out to be a DISAAPOINTMENT when it came to the point of providing an oppurtunity for an observership as compared to the american physicians who were atleast courteous enough to guide me if not willing to accept me for the obsevership.SO MY TIP IS THAT NEVER EVER TOTALLY RELY ON THE FACT THAT A FELLOW COUNTRYMAN CAN HELP SAIL YOU THROUGH,RATHER BE CONFIDENT & PERSISTENT AND TALK TO EVERY PHYSICIAN DIRECTLY.TRUST ME THEY(AMERICAN/FOREIGN PHYSICIANS) ARE MORE FRIENDLY,STRAIGHT FORWARD AND COURTEOUS.

9)HOW TO LOCATE A PHYSICIAN?

  Many of the hospitals have their websites where they have a tab of FIND A PHYSICIAN which can help you locate them.Mostly the emails are not available rather its the fax number thats more commonly given and i would say that you can use the fax number to get the email address aswell.or sometimes you can know wether or not you are accepted simply via the fax.So,both ways work absolutely fine.In my case,i GOOGLED the hospitals and subsequently the physicians in my vicinity aswell.Sometimes you also formally request the hospital admin to provide you with email address/fax of the concerned physician if you explain them about your observership rotation(that also worked out for me.)So,in conclusion I would say that its definitely your LUCK that can help you get through.

10)WHAT ARE THE REQUIREMENTS FOR AN OBSEVERSHIP?

    There are no hard and fast requirements for observership although some hospitals do requie you to bring a LIABILITY INSURANCE FROM YOUR OWN SCHOOL(that happened with me) and this is one issue i would like to talk about because all i knew from my search was that observerships don't require you to have any Mal-practice/Liability Insurance  as  you are not examining the patients but when almost every other hospital asked me to bring a LIABILITY INSURANCE FROM MY SCHOOL, i got lil confused and enquired the authorities about it and here is what they replied

   "YOU ARE NOT REQUIRED TO PURCHASE A MAL-PRACTICE INSURANCE SINCE YOU ARE NOT ENROLLING FOR AN ELECTIVE PROGRAM/PATIENT PHYSICALS, RATHER ITS "LIABILITY INSURANCE STATEMENT FROM YOUR SCHOOL" THAT WOULD INDEMNIFY OUR HOSPITAL OF YOUR ACTIONS."

  Now,that was quite a headache as the authorities at K.E had no idea about liability insurance and when i asked some seniors about it they replied that the schools in US provide their students with a liability insurance.So,i again emailed the hospital staff and explained them the situation but a few of them were not willing to accept me without it(this may not be true for other areas in the US,but its true for VA and some places in CA aswell).Thus,the point is that please do confirm from the concerned authorities about that before applying as nobody here has a  clue as to what it is and due to that i had to spend two weeks in an OUT-patient setting.The good thing about every out-patient facility is that they don't have such legal requirements.As far as the mal-practice insurance is required,that is only required for electives/externships and that can be easily purchased from various companies online,the most commonly used by a few seniours being "academicins.com" or "proliability.com".I will mention more on that in my ELECTIVES ARTICLE in future ia but in the mean time if you want to have any  info on that simply go to MedEdia.com and you'll have ample info.

11)WHAT KIND OF VISA IS REQUIRED FOR AN OBSERVERSHIP?

    Any VALID VISA is ok for the observership.Luckily i have a GREEN CARD so no visa issues for me,but for those of you who don't have a visa you can go for an observership on any visa status i-e B1/H1/J1 visa.If you want a detailed info on the visa issue please visit MedEdia.com

12)IS IT WISE TO SPEND MONEY ON OBSERVERSHIP WHEN YOU CAN GO TO THE U.S ONLY  ONCE?

  In my honest opinion i would say NO as that would be just TOO MUCH to spend for TOO LITTLE.So,my advice would be that your first preference should be ELECTIVES but if you somehow couldn't get them then atleast get an observership SOMEWHERE!!!But for those who can afford multiple trips to the US for any reason,please don't waste them and hunt down every best possibility you can!!!

13)WHAT DO YOU HAVE TO DO TO GET A GOOD LoR OUT OF AN OBSERVERSHIP?

   

   the answer is pretty straight forward and that would be JUST BE A GOOD OBSERVER!!and by that i mean : be on time always during your rotation,follow the code of conduct of the facility you are in,always be inquisitive in patient dealings,keep on asking the physician relevant questions and enquiring him about the oppurtunities elsewhere,participate in daily discussions and in the end WORK HARD as that ALWAYS PAYS OFF!!!

 14)SOME USEFUL WEBSITES REGARDING THE USCEs;

  here are some useful websites that i frequently visited during my quest for observerships;

*)MedEdia.com aka Umartariq.com(this is undoubtedly the complete and best website iv ever come across on usce)

*)http://usce.blogspot.com/2007/05/does-observing-private-practitioner.html

*)http://thesuccessfulmatch.blogspot.com/search/label/observership

*)http://www.prep4usmle.com/comments.php?id=18608&page=last#lastpost

*)http://www.residentscafe.com/list_of_hospitals_offering_observerships

*)http://www.residentscafe.com/list_of_hospitals_offering_observerships

   I hope this little piece of info will help out those who are aiming for a career in the US    Best of Luck!!!