Update – 7/9/2017.
We wanted to provide an update to this post. Observerships are very important when it comes to residency applications for IMGs. The simple reason is that program directors want to know that you’re familiar with the U.S. healthcare system. Specifically, they want to know you are familiar with navigating the electronic medical records, rounding, and interacting with nurses and support staff.
The problem some of our clients have is that they simply don’t have the time or funding to have completed significant observerships. How many is enough? The answer is definitely at least 1 month at a U.S. hospital. Typically, our successful clients have 2-3 months of observerships. More than this becomes only minimally beneficial.
What if you are applying and only have completed 1 observership or even ? We have two tips for applicants to overcome this.
- Put it in your personal statement. If you know you won’t have an observership to describe in detail in your ERAS application, you can explain in your personal statement that you have several observerships planned or scheduled in the future.
- Mention it in your interviews. You can definitely be pre-emptive and explain that you have several observerships scheduled at Hospital X with Doctor Y to build your confidence and readiness for residency.
These tips can be helpful – they may even snag you a few extra interviews.
Original Post
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We hear you. This can be a really challenging process because there are so many observerships out there. In this article, we’re going to talk about observerships. We’re going to provide some advice and tips. At RIQ, we are passionate about helping IMGs (either foreign or American) match to their residencies of their dreams. To this extent, we’ve even wrote an article on observerships published in the top medical education journal, Academic Medicine.
We want to help guide you through the process and provide some usable tips. At the end of the article, you’ll see an updated table at the end of the article to help guide your decision-making. We have on financial relationships to any observershps.
How Common are Observerships?
The data is clear. A lot of IMGs end up completing observerships. The main purpose of observerships is to demonstrate to program directors that you are comfortable and capable of operating within the United States healthcare system. This is especially important if you graduated medical school greater than three years ago.
Data from the Educational Commission of Foreign Medical Graduates (ECFMG) shows that more than 90% of American citizen and non-citizen IMGs report some type of U.S. based clinical experience before successfully matching. The most commonly cited form of U.S. clinical experience by IMGs is the observership. 65% of IMGs who eventually match report an observership at either a training institution (40%) or a private practice (25%).
Most foreign IMGs will complete observerships. If you’re a U.S. citizen and graduated from a Caribbean medical school, you may have the opportunity to complete a clerkship your medical school coordinated with a U.S. based hospitals. Clerkships and observerships differ in several respects. First, clerkships have hands-on patient experience such as history taking and physical exam skills given existing medical malpractice coverage for student trainees. In addition, it is assumed that clerkships offered through hospitals with medical school affiliations have curricula goals aligned with requirements outlined by the Liaison Committee for Graduate Medical Education. In contrast, observerships are designed for the foreign IMG after medical school graduation. Clerkships, in general, are far more regulated compared to observerships. We’re going to focus on observereships.
Here’s What We Found
There is a wide range of observerships marketed to IMGs across the country. Tertiary academic centers, community hospitals, private physician practices and medical associations all offer observerships. There are also several for-profit broker services as well. Given the unregulated nature of these programs, the range of promised experiences and costs are highly variable.
In regards to cost, some programs were advertised as without cost to the candidate outside of living expenses while others charge $5,000 USD per month. The length of these experiences varied from a few days to several months. In addition, the clarity of outlined goals of each observership program also varied greatly. The majority of observerships do not clearly indicate an experience description or learning objectives for candidates. However, some observerships such as the one offered by the Oklahoma State Medical Association did provide learning goals including key elements of practice in the United States including exposure to electronic medical records and patient privacy regulations. Furthermore, for-profit services such as FMG Portal market observerships as mechanisms to improve the candidate’s likelihood to match. Another for-profit service (Chicago Clerkships) even promises a letter of recommendation. Although the American Medical Association suggests that observerships should be not-for-profit, there is no enforcement mechanism in place.
What Should I Look For in an Observership?
Before you sign up and especially before you pay, it’s very important to do your homework and ask a few questions. You want to make sure that your time is not wasted. Given limitations to direct patient contact, observerships should include exposure to key aspects of practicing medicine in the U.S. including exposure to the use of electronic medical records. Observers should have the opportunity to receive feedback on their presentation skills, history taking and physical exam abilities on standardized patients or simulations. Ask if there are opportunities to work with a specific attending for continuity. This will help you obtain a strong letter of recommendations. Typically, the fees collected by institutions with observerships should directly reflect the cost of administering the program.
Making the Most of Your Observership Program
Picking the right observership requires consideration of multiple factors. These factors include cost, geography, or specialty. The length of time also can vary significantly from a few days to several months.
Here are tips.
- Pick an observership from a reputable hospital, preferably an academic medical center. These centers build the strength of your ERAS and CV. It provides strong credibility to your application.
- Ask about what the day to day experience is like in the observership before signing up, especially if the observership is charging money. The director of the observership should give you a fairly detailed account of what experience will be like. You are looking for meaningful experiences where you have an opportunity to learn how to work in a U.S. hospital. Feel free to even ask about research opportunities.
- If you complete an observership, try to complete one that is at least 4 weeks in length. The reason for this is several fold. First, you are able to demonstrate your growth and develop across time. It gives you a better chance to develop a connection with an attending in order to strengthen an eventual letter of recommendation.
- Try your best to set up a meeting early-on with the attending physician responsible for the observership. In the meeting, ask about any research opportunities or case reports. Emphasize your interest in working on any form of project or quality improvement initiative. Your goal is to get involved as much as possible.
- One week before the end of your observership, set up another meeting with any attending or the observership organizer about a letter of recommendation. We even recommend offering to compose the majority of the letter summarizing your experience and contributions. Emphasize how appreciative you are for the opportunity.
- Beware of observerships that promise you a letter of recommendation or make other promises that don’t seem realistic. We want to emphasize that there are many observerships out there that are $0 cost to you. Sometimes it takes more time for those programs to get back to you. This doesn’t necessarily mean you should spend thousands of dollars. It’s always good to do your homework first.
We hope this article and our list of programs are helpful to you guys. Please leave a comment with any questions.
Steve
Category | Program | Medical School Affiliation | Cost ($/month) | Length (weeks) | Application Requirements | Experience Description and Restrictions | Advertised Outcomes |
---|---|---|---|---|---|---|---|
Academic Medical Centers | Cleveland Clinic | Yes | $1,000 | 4 | Application Non-refundable fees ECFMG certificate | Weekly rotations with sub-specialties | No certificate of completion LOR at discretion of faculty |
University of Texas Southwestern Medical Center | Yes | None mentioned | 6 | Application LOR J1 visa Letter of good standing Health insurance Medical school diploma Immunization Proof of sufficient funds | Must be supervised 100% of the time Cannot participate in direct patient care, decision making, scrubbing or surgery May attend conferences | LOR at discretion of program director | |
University of Texas Medical Center at Houston | Yes | $200 -$1,000 | Variable | USMLE scores CV | Outpatient or consult service placement | None mentioned | |
Baylor Hospital | Yes | $1,000 | 12 | Application Health insurance Immunization J1 visa Liability insurance Drug screen Background check | Not permitted to wear white coats HIPAA online course | Certificate of completion | |
University of Missouri Hospital | Yes | $500 | 12 | Application Health insurance Immunization VISA | Directly observe attending physicians No direct patient contact Participate in conferences Participate in ongoing research activities | None mentioned | |
New York Presbyterian Hospital | Yes | $1,000 | 12 | Application CV Waiver of liability Faculty sponsor | No direct patient care activities | None mentioned | |
University of Miami Hospital | Yes | None mentioned | 12 | Application Health insurance Immunization VISA | Directly observe attending physicians No direct contact with patient care No direct experience with research activities | Certificate of completion | |
University of South Florida Hospital | Yes | None mentioned | 4 | Application LOR Medical school transcript USMLE scores CV | None mentioned | None mentioned | |
University of Pittsburgh Medical Center | Yes | $5,000 | 8 | Application Personal statement CV Online interview | Discuss care plan with attending physicians Familiarization with electronic medical records Exposure to radiology images under supervision Observe procedures Access to library resources Attend educational conferences No direct patient care | Certificate of completion Feedback from faculty | |
University of Chicago Medical Center | Yes | None mentioned | 24 | Application Health insurance Immunization Faculty sponsor CV Medical License LOR Letter of sufficient funds | No details provided | Feedback from faculty | |
George Washington University Hospital | Yes | None mentioned | 8 | Application Immunization VISA CV LOR Personal statement Medical school transcripts | Basic overview of the U.S. healthcare system | Certificate of acknowledgement | |
Harborview Medical Center | Yes | None mentioned | None mentioned | Application Immunization Personal statement | No direct patient care | None mentioned | |
Thomas Jefferson University Hospital | Yes | None mentioned | None mentioned | No formal application Health insurance Immunization | Observe clinical practice under faculty guidance Learn basic financing of U.S. health care Participate in daily teaching rounds Participate in daily discussions of patient care | None mentioned | |
Houston Methodist Hospital | Yes | $1,200 | 8 | Application Health insurance Immunization VISA English proficiency CV Background check Immunization Visa/Passport Proficiency in English CV Background check | None mentioned | None mentioned | |
Community Hospitals | St. Vincent Hospital | Yes | None mentioned | None mentioned | Faculty sponsor | No description provided | None mentioned |
Griffin Hospital | Yes | $750 | 4 | Application Immunization CV USMLE scores ECFMG certificate TOEFL score LOR | No direct patient care Familiarization with the U.S. medical system Presentation of H&P on daily rounds Review laboratory values Review radiology Develop a therapeutic plan Contribute to daily progress notes | Evaluation based on attending feedback Evaluation from resident feedback LOR at discretion of faculty | |
Mt. Sinai Medical Center (Miami) | No | $750 | 4 | Application Immunization CV USMLE scores Medical school diploma Personal Statement | Observe patient care in daily rounds Participate in discussion, conferences, didactic sessions, teaching rounds, morning reports, grand rounds, tumor boards. No direct patient care No direct access to the EMR | None mentioned | |
Allegheny General Hospital | No | None mentioned | 4 | None mentioned | No direct patient care | None mentioned | |
Good Shepherd Medical Center | No | None mentioned | None mentioned | None mentioned | None mentioned | None mentioned | |
Baptist Health South Florida | No | None mentioned | None mentioned | Application | No direct patient care | None mentioned | |
Florida Hospital | No | None mentioned | None mentioned | Application | None mentioned | None mentioned | |
North Shore Medical Center | No | None mentioned | 4 | Application Immunization CV Background check Application fees | No direct patient careCan only observe patient careInpatient only working with residents and medical studentsCan attend conferences/meetings | LOR at discretion of faculty | |
Hurley Hospital | Yes | None mentioned | 4 | Application CV USMLE scores ECFMG certificate LOR | None mentioned | None mentioned | |
Physician Practice | Innova Physicians | No | None mentioned | 4 | Faculty sponsor | No direct patient care | None mentioned |
Medical Association | Oklahoma state medical association | None | 250+ 900 | 12 | Application Immunization Processing fee | Observe on hospital rounds and clinic Observe procedures Attend teaching conferences Review clinical data Review laboratory data Review radiology Develop a therapeutic plan Develop communication skills | Letter of completion LOR at discretion of faculty |
For-Profit Services | Chicago Clerkships | Variable | $2,200 | 8 | Application CV Personal statement Processing fee | Hands-on clinical experience Offers both inpatient and outpatient experience | Certificate of completion LOR guaranteed |
FMG portal | Variable | $1,600 | 8 | Application CV Personal statement Processing Fee | Strictly designed to match residency program requirements applied to IMGs | LOR at discretion of faculty | |
Americlerkship | Variable | $1,400 | 8 | Online profile | Hands-on clinical experience | Certificate of completion LOR at discretion of faculty |