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USCE = United States Clinical Experience, it's a general term that covers any clinical experience in USA.

is an organized training program designed by hospitals and medical institutes to train "externs" by familiarizing them with the US medical care system without allowing them to interfere with patients management.
You might be allowed to take patient history and perhaps examine patients and write patient notes under guidance.
The program usually follows certain rules likes timing, schedules, assignments, insurance liability requirements, etc.
Most externship programs do not pay externs and many of them do require fees to be paid by the trainee in order to enroll in the externship program for certain duration. The term hands-on clinical experience usually refers to externship. Because externship is thought to be more effective than observership in getting students and grads into the US health care system, many commercial companies took advantage of this and started offering Paid Externships for IMGs.

Observership and as the name implies is about letting you observe what's going on, shadowing the profs and doctors in hospital rounds or in outpatient clinics. Observership is usually less organized and tend to have no rules and managed by individual physicians and is commonly seen in private practice. In observership usually you are not allowed to take history or examine or write patient notes [the basic rules is Don't Touch].

Sometimes, medical institutes and Universities cannot offer (externships) to IMGs due to State and local laws and regulations. Such hospitals usually provide observership rather than externship training. For example, Cleveland Clinic Observership Program.

Clerkships usually refers to clinical rotations that are done by medical students. It's a general term. It usually refer to core curriculum, i.e., rotation that have be fulfilled by medical students before they graduate.

Electives is a term used for an academic course chosen by the student from a set of options, as opposed to a required course (called Core Clinical Rotation or Clerkship) which are deemed essential for an academic degree.
Elective rotations tend to be more specialized and usually have fewer students than the usual core rotations. International Medical Students can do electives outside their country, for example in the United States. This can expose them to US healthcare system early on and increase their chances of getting into residency. IMG graduates are not allowed to go into elective rotations once they graduate. See The Complete list of Electives available for IMGs.

Internship is a period of medical training (usually one year) that is a mandatory requirement before a license to practice medicine is granted. Internship timing and duration differ significantly from country to another. In USA, medical students enter their internship when they start residency, that's why first year (PGY1) residents are called interns. In other countries, internship might be a period of clinical clerkship that must be attended before the student is granted a graduate status.

What about Research?
Doing research in academic institutions is of great value for both IMGs and AMGs alike. It's considered as USCE whether it's basic (lab) research or clinical research. Many Universities and research institutes offer a range of positions such as research observerships, electives, and externships. In addition, there are paid research jobs, such as research associate and research assistant, these paid jobs do not require the IMGs to be licensed in USA.
The value of research has been discussed several times in our forums, see threads tagged with Research

Ranking (Which is better Observerships or Externships or Electives or Research?)
If we want to rank them from the best to the least effective in getting you into residency then I'd probably rank them this way; Electives > Research > Externship > Observership
But that's relative, because probably a 3 weeks observership in a prestigious University is better than 6 weeks electives in non-ACGME accredited community hospital.

It's generally perceived that student electives entails the best possible USCE that IMGs can get, since they are organized under a med school faculty and geared toward training. Electives are even superior to Externships in that hospitals allow the elective trainee to take histories, do physicals, write notes (type EMR), present cases, ...etc. There are no States in USA that ban elective international medical students from performing these activities, while as I mentioned above, there might be such restriction with regard to externships.


1 Posts
IMG - Externship/Research dilemma

For an IMG graduate Observership, Externship and Research only seem to be the viable options, so
For Externship/Research is passing the USMLE Steps a pre-requisite or it doesn't matter? Any specific requirements?

Thank you!!

36 Posts
Thanks for the explanation Step Taker.
I've taken Step 1 and preparing for other steps while working as a Research Coordinator after getting an MPH at a US institution.

My boss said I could observe with him whenever he is on call and I've done this for two weeks.
Do you think all these serve as sufficient USCE?

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