Clinical background is commonly a highlighted point in your credentials. Several hospitals look for applicants who possess experience handling patients and feel comfortable with the bureaucratic paperwork part of a patient file. Another important reason for clinical experience is that during your time at a hospital, you may obtain a LOR from attending physicians. The more experience you have, the better for your application. If your experience is at a renowned hospital, it will booster your application even more.

Usually, this is no problem for AMG's, since clinical clerkships give enough experience, and their medical education is oriented toward clinical practice in the US. Although, apply for externships before graduation is highly recommended since it offers a great educational experience and the opportunity for an audition at that program. It may be of concern for PD's while considering IMG's, since they are aware that medical education, as well as clinical practice, is considerably different in other countries. Requisites in terms of USCE vary between different hospitals. Some programs consider it of extreme importance and request that their IMG applicants have no less that 1 year of USCE. Other centers find it irrelevant when considering an IMG application and accept your background at your home country as a valid part of your application. This means that if you are an IMG with no USCE, you still can obtain a residency position but it will decrease considerably the number of hospitals to which you can apply, and of course your credentials will not outstand.

There are different types of USCE. Externships offer a time at a hospital during which you can attend conferences, rounds, and if the patient agrees you can be present or even participate during clinical encounters, therefore it is considered as "hand-on-patient" experience. Observerships are quite similar to externships with the difference that you are not allowed to have contact with patients, you can just observe and because of that it is also known as "shadowing". During research electives or fellowships, you can assist in the development of investigation studies, and sometimes even publish a paper. Obviously, hand-on-patient USCE is the most useful for IMG's and is the one you should aim to obtain.

Ideally, all your USCE rotations should be completed before you enter the match. Therefore, to obtain enough USCE you must plan in advance. If you are still a medical student, you should apply for externship positions since several universities have educational programs for international students and those are a lot easier to obtain than externships for graduates. Each rotation commonly last one month, but duration can vary according to your possibilities and hospital policies. Basically, there are three ways to get rotations at American hospitals; you can search in the internet for programs that offer elective positions and send a formal application, you can contact friends who already did their rotations and ask them how to get yours, or you can present at a hospital and personally ask to participate in an elective rotation (it sounds extremely bold, but it results pretty often). An elective rotation is usually a very expensive thing to do; not only housing, transportation, and food have to be considered, but at some hospitals a fee will be charged as part of your application. All expenses should be considered while planning your trip, and see if such investment is affordable to you.

While rotating, you must show that you are a trustworthy and enthusiastic person. That means that you should always offer yourself to participate presenting a case, preparing conferences about any topic, taking calls, etc. Make the impression that you are a non-complainer hard working physician by being the first to arrive and the last to leave the hospital, attend during weekends, holidays, and never complain about excessive work. Always smile to all staff no matter position, and be very friendly and polite all the time. Don't forget to ask for a LOR to the physicians that mentored you during the rotation, once you feel that enough confidence has been established.

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