Everything You Need to Know About Observerships or U.S. Clinical Experiences: 2017 Update!

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.

1. 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.
2. 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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There is no doubt that observerships are important for the residency interview match. We have so many clients that have gone through the observership process. It can be absolutely daunting to navigate through the process. Which observerships should I do? How many do I need to do? How much should it cost? How do I get the most out of an observership?

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.

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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