Research versus observerships!

This is a dilemma to many applicants. Yes, especially those who are not familiar with what program directors of different specialties seek in an applicant. Actually it is not only the type of specialty you are seeking that determine your plans but also the type of program do matter which have same impact on your decisions. Feels confusing, right! Let me make it simpler for you. Community programs which are stud with IMGs will seek hard working folks rather than those chilling in research. They would pick up those with more clinical experience specifically externships and observerships. However those programs which are less IMG friendly which means more relaxed programs and usually these are the higher tier university programs they care to have candidates who can help them on with there research projects. Also tough specialties like neurosurgery and orthopedics would select those with research more than would an internal or family medicine program care.  So it's not really only whether research or observership that matter but also which specialty and where you are applying to matters too.

Are foreign LORs of any importance?

International medical graduates always have this question about letters of recommendations they get from their clinical instructors overseas. The question usually asked is like: Does the LOR s from India or Pakistan or any other country have weight is the residency application. The big myth is that most IMGs think that their home LORs are less important than their US letters. Actually program directors like to know about your real clinical background beside that you get from USCE rotations. A ratio of 2:2 is the perfect combination we noticed in those successfully matching. Bottom line is USCE is a big positive in your ERAS application but not without your home based letters of recommendations as well.

General Requirements for USCE

What are the requirements for USCE like observerships, electives and externships?

The requirements will vary from program to another but in general here what most might request from IMGs:

i- If you are seeking electives some programs will request that you be in your clinical years in medical school (equivalent to 3rd and 4th medical school years in the US. You can not do electives after you graduate, however, you can still do observerships and externships after graduation.

ii- Most of the programs will put a certain fee for each month of such experience which usually ranges from 500 to 1000 $.

iii- Evidence of immunizations: this will vary from program to another but will usually

1. Varicella, rubella, titers, and/or immunizations MMR (mumps, measles and rubella)
2. Recent documented TB test or recent chest X-ray (<1year) if known TB positive
3. Proof of hepatitis B immunity (serology)

iv- Apply EARLY ahead of time. These spots are limited and fly like hot cookies. Some programs are even booked 1 year ahead. In most cases spots are given on first come first serve basis.

v- If you are not a US Citizen or Green Card holder IMG then you will need  B-1, B-2, J-1, H-1b, or O-1 visa. You can ask the sponsoring institution to send you a support letter for the visa application where you can present it to the local US embassy in your country.

NB: If you are seeking US LORs that will help you match, you need to do observership in an ACGME certified program, you can find the full list of those offering such experiences to IMGs in this list: USCE.

How to make your CV stronger for residency?

There are really few things that you can do to make your profile sound perfect especially that program directors have already trained their eyes how to quickly scan applications during the extremely busy match season where each of them will receive thousands of applications via ERAS.

You need to focus and improve these points that usually graphic the attention of program directors which include:

1- USMLE scores: Usually USMLE step 1 is the strongest indicator of your level. This is true especially for AMGs who apply as medical students yet not done with their remainder steps. For IMGs both steps are important as it gives an overall idea of overseas graduates. In general, USMLE scores are important for competitive specialties like Radiology and Neurosurgery as well as most residencies hosted by university institutions. However for less competitive specialties especially in community programs other criteria usually overcome the need for superb scores which we will talk about it below.

2- USCE: Different types of  United States Clinical Experience is available for IMGs but unfortunately not all of the are really available compared yo the enormous number of IMGs applying to such spots. Although externships are the most desired but they are the least available. Most IMGs who are successful in getting to residencies dill end going 1-2 observerships and get US LORs which really help them earn the necessary interviews yo match. Large bug not least the research experience which can enrich your profile is also shrinking as institutions are cutting budgets and trying to save the invaluable pennies in this tough economic situation the nation is experiencing.

3- Residency back home for IMGs can replace the above two factors in the appropriate stetting. For example, if you you have average scores and no USCE your back home IM or whatever residency you did or are doing can definitely grab the eyes of the programs to your application as the directors usually like to see people with strong clinical background in their program rather than hiring those who by heart books without any clinical confidence or practice experience.

4- No visa need is also an important factor in an applicant where program directors can save money for their institutions. I am not encouraging anybody here to get married for the purpose of getting green card but am just trying to encourage those who have it or are IMG US citizen to look at these programs who don't sponsor visas where they have good chances but also they have to consider visa sponsoring institutions where also their chances are bit better for the same reason as well.

5- Although the fresh graduates are more lucky but this is usually true for AMGs. Don't worry much about year of graduation cut offs set by programs if you have continued clinical experience or previous residency. If you are still in medical school, try to get of the USMLEs as the information is still fresh in your mind and hence you will save much time and apply early to the residency match.

6- Connections don't work much especially that program directors want to be on the safe side when picking their residents. However connections can help you getting into interviews and then the remainder is your duty to impress the faculty on the interviews.

Sample Letter of Recommendation for Residency LOR

These are Residency LOR template two for each specialty with detailed guidelines how to format your LOR whether you were the chairman on the student helping his attending writing the letter.. These LOR samples are to guide the writer on how to do one for the applicant who did clerkship, residency, observership or other clinical experience with him.

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