Post by Admin on May 3, 2014 2:33:10 GMT -5
Electives in the US
What are Clinical Electives?
A clinical elective in the US is a hands on clinical experience (clinical rotation) acquired by medical students as undergraduates in either medical universities or hospitals, aiming at gaining clinical experience and Letters of recommendation LORS
I am a medical student, I want to continue my education in the US, how do I get started ?
The most important step to continue medical education in the US is the USMLE
The second most important step is US clinical experience USCE
What exactly is USCE ? It is basically a clinical work experience gained from working in a US based hospital. Electives/Clerkships are the most respected and valued form of USCE. The biggest limitation is that you cannot do electives after you have graduated. Some university hospitals require you to have your USMLE Step 1 result for electives. Note that all places do not have step 1 requirement.
Types of US Clinical Experience
US Clinical Experience (USCE): It is a US hospital based working experience in a clinical specialty. When you claim that you have USCE, you are expected to be well oriented and skilled with routine functioning of a US hospital. It includes general skills like interacting with patients (history/physical), inputing their records into the electronic system, coordination with nurses and staff, and a general sense of hospital working.
For practical purposes, you can obtain 2 types of USCE.
1- Hands on Clinical Experience - patient contact
a) - Clinical Elective : A clinical elective is an optional away rotation that a final year medical student can do outside the hospital of his/her parent institute to gain Clinical Experience. It can be at your home country and it can be at any other country in the world, but if your ultimate aim is to apply for a residency in USA, then your elective in a US based hospital will be most valuable in your Resume. They are usually 4 weeks in duration.
b) - Clerkship: It is a compulsory medical student clinical rotation that is part of your curriculum (for this reason sometimes also referred to as core clerkships) at the affiliate hospital of your parent institute.
c) Sub-internship: It is the most superior form of USCE that an applicant can have. The major difference between elective is the on-call participation with your team. This means that you spend the whole/most part of night with your team in addition to your day rotation.
d) Externship: This form of USCE is inferior to elective/clerkship/Sub-I because there is no guarantee that the training is supervised- in other words you are on your own.
2- Non-hands on Clinical Experience:
a) Observership: clinical experience is limited due to "no or minimal patient contact."
b) Research Elective: It is a research experience at a reputed University that medical students can undertake for academic credit. They have no comparison to a Clinical Elective because its not USCE.
Remember that Research alone cannot compensate for USCE deficit, unless it is done for an extended period and is rewardingly fruitful with publications and you are able to build strong contacts during the process.
Internship: In USA Internship is the first year of postgraduate training (PGY1) in the specialty of your choice. In other simpler words the 1st year of your residency training is an internship year and the person undertaking internship is an Intern.
Application for Clinical Electives
Requirements:
1) Be a final year medical student in good standing who has completed his/her Core Clinical Clerkships at his/her parent/home medical school and must have your institute's dean's/principal's approval to undertake the desired elective course. If you cannot satisfy this basic requirement, you cannot apply ANYWHERE for a CLINICAL ELECTIVE rotation.
APPLICATION COMPONENTS
1. Application forms : The purpose of an application form, from the point of view of an elective coordinator is to verify in order of importance: a) that you are a final year medical student. b) if you have completed your core-clerkships or at least satisfied their minimum requirements c) You are not faking and you have your dean's approval (in shape of your institute's seal on forms) d) The rotations and dates you are interested in e) your personal information.
the answers to a)-e) MUST be yes or favorably conclusive. Or your application processing will be delayed or rejected.
2. Academic Requirements : This group of application materials deals with documents that demonstrate your academic competency.
a) Transcript: is a document that is supplied to you by your institute when requested. It is a record of evaluations of all the professional exams that you have taken so far since the start of your medical training. It also enumerates what courses you have taken and your performance in the form of marks or grades or GPA, depending on your institute. It should mention the duration of your clerkships, proving that you have completed your core-clinical clerkships in and preferably should mention your overall class rank or percentile. This document is a basic requirement and almost every student has it.
b) TOEFL (Test Of English as a Foreign Language) Exam result: shows your proficiency in english.
c) USMLE Step 1 result: most universities now require you to have Step 1 scores. Therefore it is important to start planning accordingly.
d) HIPAA (Health Insurance Portability and Accountability Act): It is a compulsory short course that all visiting medical students are expected to complete (depending on the institute) either before or after acceptance into an elective program.
This course is usually an online short course (2-3hrs) dealing with professional mannerisms towards protecting patient's confidential information in a hospital environment.
e) OSHA (Occupational Safety and Health Administration): Like HIPAA, OSHA is not a pre-elective approval compulsory requirement. Another name for the similar course is 'Universal Precautions against Blood/Air born pathogens or infection control course.' This course is about general precautionary measures that should be taken in dealing with potential contaminants in blood and air.
f) CPR training: CPR Card (BLS (basic life support) for Healthcare Provider level from the American Heart Association).
3. Non-Academic requirements:
a) Immunization and health form/certificate: Every institute will require you to submit a verification 'document' validating your Immunization status. Most institutes will ask you to have their immunization form filled and signed by a physician providing his or her contact information.
Generally you are expected to supply them with evidence of immunity (either vaccination dates/ serologic antibody titers or disease Hx) against the following diseases:
1) Tuberculosis, if positive an X-ray is required,
2) Tetanus/Diphtheria/Petrusis,
3) Mumps, Measles, Rubella,
4) Varicella (Chicken pox)
5) Hepatitis B :vaccinations and/or evidence of serologic immunity.
6) Meningococcal meningitis : Vaccination
(There is minimal difference between the vaccination requirements between universities, here we almost mentioned all the required vaccines)
b) Dean's Letter: Out of all the non-academic requirements, Dean's letter is the most important. Almost every institute where you intend to apply will ask for its submission as a part of their application requirements. A COMPLETE dean's letter should clearly convey that you are a final year medical student enrolled for X years of undergraduate medical training course at their institute with your session starting dates. It should state your expected date of graduation. General comments about your personality or conduct are also mandatory and it should convey that you are a student in good standing. There should be a clear statement stating that you are approved to undertake the elective course for academic credit.
For non-immigrant visa application at the US Embassy in your home country, if you intend to also use your Dean's letter as proof that you will be coming back to your home country after completing your electives, then it can be useful if there is a mention in the Dean's letter that you are expected to return after completion of your elective course and that you will have to take your Final year exam in order to graduate. It may also state that all your pre-medical original diploma/certificates and related documents are submitted with the registrar's office which will be released only upon graduation.
c) Malpractice Insurance or Professional Liability Insurance: This insurance is supposed to protect/cover your expenditure against law suits that a patient potentially can protest against you, if he/she thinks that you have done harm to him/her.
d) Health Insurance: Travel health insurance = Health insurance and you can purchase it from your home country.
e) Criminal Background Check/Police Clearance: There are two ways to satisfy this requirement. 1) Either you can consult your district Police officer to issue you a character certificate or 2) Your college/University Dean/administrative official/registrar can issue you a letter stating that ever since you enrollment you have been an individual with sound moral character who has not been involved in any illegal activity. (not required by all universities)
g) Faculty Sponsor for an Elective: Most programs require you to have a faculty as a sponsor. One way of searching for a faculty member sponsor is by strolling through the website of these institutes and then searching for the faculty names in individual departments and emailing them directly. (not required by all universities)
h) Faculty letters of recommendation: Most Institutes will require you to submit at least 1 or 2 letters of recommendation in addition to the Dean's letter, preferably the letter should come from a faculty member who has accomplishments in your desired speciality of elective. (sometimes required from a professor in the specialty you are applying for)
4. Additional Supportive documents: This category of application requirements include documents that are not an absolute requirement but they 'polish' your overall application.
a) Personal Statement: This is the single document which is the most unique in every application. Via this statement you convey your passion/interest in the specialty of your choice and their institute. You discuss about your accomplishments, and your future plans and then explain how this elective will help you to accomplish those goals. You also discuss what makes you different from others and what you like about their institute.
b) Resume/Curriculum vitae (CV): A resume is a structured, to the point, representation of your professional accomplishments since the start of your academics. The quality of language that you use in your resume and personal statement are strongly indicative of your maturity and professionalism.
To summarize, your resume should have dedicated portions for the following areas: Professional goals and objectives, Education, Academic accomplishments, Clinical Experience, Research Experience, awards/achievements/memberships, Extra-curricular activities.
c) Cover Letter/Letter of intent: It is essentially the same as personal statement in context. Letter of intent is somewhat different in that its brief and you don’t need to describe your future goals and your current accomplishments extensively, but you rather focus on why you wanna do that elective at their institute and you briefly summarize your documents that you have enclosed in your application packet. After reading this letter the elective coordinator should know where he/she needs to send your application, and whats included in the envelope.
Summary
Why do electives
-Gain US Clinical Experience (USCE) improves the chance in matching
-Obtain letters of recommendation
-Build connections
-Improve spoken English
-Can open the door for research fellowships
-Training for the USMLE Clinical skills exam
Who can apply for electives and when ?
-Medical students in their clinical years , specially the last year of medical school.
-If you do not recieve your final medical diploma except after a mandatory internship then you can do electives during that period
-Many elective rotations require that you finish Step 1 before you apply, so try to finish it early with a score high.
Application process - Simple non-detailed steps
1) Signed University Application from your medical school
2) LORS from your faculty staff
3) Good Standing Letter from your Dean/Vice Dean
4) Transcript
5) Immunization Forms/ Titers
6) Letter stating your English Proficiency level
7) Buy Malpractice Insurance
8) Buy Health Insurance
Some universities may require
Step1 usmle score - TOEFL with a high score in speaking component- HIPPA Training
Important websites for elective information
AAMC list (46 institutions): Official AAMC database. Outdated in most of its info. services.aamc.org/eec/students/index.cfm
MedEdia List (51 institutions): www.mededia.com/node/18
J. Idrees Blog (26 institutions): slightly less than MedEdia's, but VERY organized, and updated regularly. Here, electives.us/unilistims.html . Credit to Dr. M. Kandeel
Lists like FREIDA online, and ACGME programs are more useful during Match application, or searching for observerships/Externships, and NOT electives.
You can also search each medical school for its elective requirements. This is how you can do that : List of USA MD Medical Schools ( They call them LCME-accredited school) is found here: www.lcme.org/directry.htm . Get the name of the school, go to Google, and type: [School X Medicine Elective], and then the relevant page usually shows up. This will give you the most up-to-date URL. Note that in this comprehensive list, many schools DO NOT accept IMGs.