US Clinical experience. Clerkship, Externship, and Observership

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By now you should have already heard the question on several occasions. Do you have any US clinical experience? If you do, is it a Clerkship, Observership, or an Externship?

Clerkship is medical student clinical rotation at a teaching institution, typically ACGME accredited residency program alongside with residents. The key term here is medical student. A graduate cannot get a clerkship. Most IMGs have already graduated, so you cannot get a clerkship.

Externship is a clinical rotation. There is no formal definition of an externship and technically rotation in an outpatient practice can also be considered a clerkship as long as your MS preceptor agrees that you got adequate exposure to the clinical side of the practice. Externship is also characterized as hands-on experience. You should see patients, work with charts, order labs, etc.

Observership is a clinical observation where observer is not allowed to interact with patients.

Naturally, Clerkships carry the most weight because they are formalized and always equate to hands on clinical experience in a teaching hospital. Externships leave more for interpretation and not all externships are performed in a teaching institution. And finally Observership is defined as no hands-on, so it is difficult to expect your preceptor to have an opportunity to observe you in action.

U.S. Clinical Experience” or USCE cause a lot of confusion. Different programs use different criteria for determining whether one’s clinical experience qualifies for USCE. First of all, all clerkships qualify. This does make much difference of IMGS because you have already graduated and clerkship is not something you can get. Observership typically does not qualify, just because it is not hands-on. Externship qualification varies. Some programs require clerkships to be at an ACGME accredited residency program. Unfortunately getting an externship at ACGME accredited residency program is more difficult than actually getting residency spot. Each program may offer just one two-month externship slot, which translates to 6 externs/year. Most programs consider externships as USCE regardless of location.

So, is the time spent on observerships and externships a good investment? It absolutely is for several reasons:

1. Typically you get U.S. LOR(s) from either experience. Just LORs alone make it well worth the time

2. Most programs qualify externship as USCE. Even though it may not count for some, these would be very competitive programs that you wouldn’t qualify for anyway

3. A record of observership or externship makes one’s CAF much stronger. Remember, only small percentage of IMG applicants has any form of clinical exposure to the U.S. healthcare system. By getting some, you raise above many.

4. A record of experience in specialty of your application proves that you have experienced insides of the specialty first hand and made a concise choice.