It is a well known fact, that introduction to the US system of medicine be it via an externship or observership is crucial these days for matching into a program. Though there are exceptional candidates with stellar CVs and stupendous scores who can match without the effort of observership, there are a great many candidates who are struggling. This is due to the fact that their CV is not as strong as they would like and they are planning to boost their resume with additional accomplishments. However, given the sheer number of applicants going through the motions of applying, the opportunities for observership or externship are extremely limited. There are plenty who wish to do the same but cannot because there are just not enough places which will accommodate the candidate applicants. There is a small way out for such folks. If they have not been successful as getting a full fledged observership post, then there are other avenues that they can explore.
This would generally apply to those applicants that are already in US and are headquartered in a US city and begin their application operation from there. Narrow the list of teaching hospitals close to you and correspond with the medical residents, Chief residents, program director or faculty. The most pivotal people in this case are the PD and the chiefs. Ask if you can sit in for didactic sessions as a way to reintroduce clinical medicine back in your life. Some possible avenues are,
1. Morning report
2. Noon conference
3. Journal club
4. Grand rounds
The list above is a good place to start and you will have a better chance at getting this than a full fledged observership.
Morning report is usually mandatory for the residents and interns and one or few cases are discussed with the emphasis on teaching critical and clinical thinking. Noon conferences are usually powerpoint presentations or talks with specific subjects or topics. Journal club activities may not be available in all programs, but if present is another chance for exposure. One or two articles are chosen and then discussed. With enough exposure you might even manage to squeeze out a letter of recommendation (LoR) from the faculty involved! Bottom line being, use every chance to make good connections, you never know which one will pan out in the end.