Wednesday, April 22, 2015

Externships or observerships: Can they help an IMG get a surgical residency slot?

A woman writes [some non-essential details have been changed to preserve anonymity. Permission to post this was obtained.]:

I am a non-US citizen medical graduate from The University of The West Indies in Trinidad and am currently an intern in a Caribbean nation. Although UWI has produced great students, you may not be familiar with it.

I would like to become a surgical resident in the US. I have no US clinical experience, but my USMLE Step 1 score was >235.

What do you think about my doing a post-intern year externship (hands on clinical) as opposed to an observership (just observing) in the US? I know that an externship carries more weight as far as applications go, and the only reason I would want to do either of these would be to get recommendation letters from surgeons in the US.

However, since I have already graduated from medical school, getting into an externship will be more difficult because this will no longer be a medical school rotation. I believe that observerships will be easier to get into but are they worth it?

Do you know of any IMG-friendly programs that facilitate this? Do you think that this is a good idea? Do you feel that I will be able to get an externship?

Other than this idea for externship/observership, I am blank for ways to improve my chances of matching to a US program in surgery. Do you have any suggestions?

Thank you for writing and for reading my blog.

Your USMLE Step 1 score is excellent, but as you stated, the lack of any clinical experience in the US might be a problem.

I'm afraid your plan to do externships may not work out. I do not know of any hospital in this country that supports externships for people who have already finished medical school. The issue is that once you graduate from medical school, you no longer have status as a student. There are medicolegal, educational, and funding considerations that I do not think can be overcome.

I am not sure about the availability or value of observerships. My opinion, which may not be shared by others, is that I see no value in observing. How could anyone write a meaningful letter for you if all you did was watch other people take care of patients?

I am also unable to tell you what a letter from a surgeon who works at a hospital nobody knows is worth.

I hope my readers will have some thoughts for you.


Anonymous said...

If all you can get is an observership, take it. Medicine, and even surgery, is about more than Just technical skills. Seeing you work with the team. Come early, stay late. Know every question. If all you want is to"be a surgeon in the USA", that isn't what the USA needs. We need compassionate providers that look to do what is needed and not more. Show a love for people and not just "being a surgeon". All of these qualities will prepare you for life helping people. Then if it doesn't work out that way this time, try again. Find a possible alternate path to helping people. Work to be the best surgeon in other areas if that is all you have. Volunteer in other countries that have larger surgical needs. I've heard crazier stories than someone volunteering in another country with medical charity groups and having it turn into a job. Best of luck. BTW the American dream had been updated. Come here, work hard and care about people and you will live in the best place possible. That makes the dream reality for you and the people around you.

Anonymous said...

Only reason I know this info is because Univ of miami has an observership program, its expensive! Observerships is a big business, but Ive seen students who have observed match. You are treated like any other student. Lots of big name universities: harvard, univ of miami, drexel, etc, have programs for international graduates. Go only to a place that has an established program where you are treated like any of their home students. The universities with established programs have a syllabus, outlined tasks, and you are involved with the team. You won't be able to do a physical exam or touch the patient. To be honest if you are doing surgical observership, then I personally feel its not much diff than what a USA med student days. Yes, you don't get to hold the camera during surgery, big deal. Listen, you will be able to do hnp on your own paper, not official. You will be able to present, you can interact with pts and get a history. Then you will discuss a plan with your attending and residents. Doing an observership can be 1000-3000 a month, but you pay for quality. Do not do a free or cheap observership which wont get you a quality letter or you might end up in a place where you truly are just observing. The name "observership" is quite flawed because you can do a lot still. I believe from a surgical stand point you can be successful if you have a prior surgical background from your country and can contribute to the team here. If you are doing medicine, peds, etc, I feel the same way, if you take initiative you can do really well. Listen, look up the stats, this country still has a lot of IMG's matching, 2000 plus each year. For me that is a lot! There is no reason you cannot be part of that group. Yes, a surgical specialty is harder to match in. But psych, family med, etc are all open game. Pay for an excellent observership and do more than one. At least three months and you need 2-3 solid letters. In medicine, psyc, peds, I don't think its as important the letter comes from a well known attending or chairman. The quality is more important though. If you are doing surgery though, as skepticalscalpel has written above, who is writing the letter can be important, but this won't be a problem if you are at a university. Last, the reason you are doing an observership is to open more doors. Once you meet attendings, go the extra mile, get involved with research, and just show you are committed to this. Again, I have more surgical background, I don't know a lot about matching process for primary care specialties. I just know in miami if you speak spanish and you are good, they will help you. If you don't speak spanish, then your experience as an observer might help you match elsewhere. If you have further questions I am dr.muchogusto on twitter, follow me, and then pm me if you need guidance. Good luck!! Persistence pays off.

Skeptical Scalpel said...

Thanks to both of you for the excellent comments. Some of these observerships cost as much as $3000 for a month. I'm thinking of starting one here at the Skeptical Scalpel blog.

Skeptical Scalpel said...

Someone tweeted me that observerships and externships may not accepted at many programs. I would advise any IMG thinking about doing one of those rotations to look at the websites of many programs before spending money and time on observerships and externships.

Here's a link to the website of a surgical residency program in Massachusetts.

Here's an excerpt:

International applicants must have:

A J-1 Visa or have a U.S. citizen Permanent Resident status. No other Visas will be accepted. (H1B are not acceptable.)
Graduated from medical school within the last two years
A current certificate from the Educational Commission for Foreign Medical Graduates (ECFMG)
Successfully completed the Clinical Skills requirement
Worked in clinical medicine in the United States within the last two years

NOTE: An observership or externship does not fulfill this requirement

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