Tuesday 18 October 2011

types and opportunities for USCE



To identify, categorize and expand on jobs that are commonly associated with USCE (United States Clinical Experience).


USCE and related information was obtained from online resources. Google search was used to parse information using search terms related to USCE.


A list of job profiles that have a recurring association with USCE was identified. These are listed below. They were categorized into divisions based on what defines a USCE per majority of residency program requirements. Three categories were evident and have been used in this article and have been depicted in the figure 1.

Figure 1. USCE network

1. Externships
This is considered as singularly the best avenue for US clinical experience. When most programs mean USCE, this is what they are looking for. For most FMGs who have graduated from a medical school it is exceptionally difficult obtain this. The reason being, externship by definition is an intensive, full time training for medical students (M1 –M4) in a field of their choice.

1. Observership
Observer-ship to a university or university affiliated community hospital is the second best. This provides you with opportunity to obtain LORs from the faculty. Networking is the most efficient way to secure an observership. One resource is to get in touch with your seniors who have already matched. Ask them if they have seen observers at their institution. If not then does not mean you cant. Get contact information from them and you can even ask them to vouch for you.

From article on observerships found here:
“The shotgun spam strategy. Obtain emails of the directors or senior faculty of multiple places all over the US. see this link on finding emails of faculty. Send emails to everyone on the list, requesting an opportunity to observer their clinical practice. Stress how important this opportunity will be for your future. Then follow this up with phone calls. This is more labor intensive but also has a higher yield.

The targeted snipe approach
Target some senior high value faculty and arrange to have a meeting with them. Dont forget to forward a short resume to the them prior to the meeting. Be earnest about why you would specifically like to rotate through that institution and specifically with them (are they in psychiatry, neurology or nephrology? is it the absolute field of your interest).
Know where your chances are the best. Do not write to program director or coordinator, in my experience they don't have much power over who gets to rotate through what. Correspond with the department heads of program or senior faculty (that are usually NOT the PD). Another way is to shadow a clinician in private practice (See below). This also works but LORs may not be considered as valuable than faculty from academia.”

2. Medical assistant
Medical assistants are health care providers who perform administrative and clinical tasks to support the work of medical doctors and other health professionals. They perform routine tasks and procedures such as measuring patients' vital signs, administering medications and injections, recording information in medical records-keeping systems, preparing and handling medical instruments and supplies, and collecting and preparing specimens of bodily fluids and tissues for laboratory testing. In the United States, the AMERICAN ASSOCIATION OF MEDICAL ASSISTANTS (AAMA) represents the profession. Medical assistants have traditionally held jobs almost exclusively in ambulatory care centers, urgent care facilities, and clinics. (..From Wikipedia)

3. Registered nurses
A registered nurse (RN) is a nurse who has graduated from a nursing program at a university or college and has passed a national licensing exam. There are plenty of information online regarding nursing schools. Most universities have nursing programs and the requirements may differ slightly from state to state. There are also some online universities that offer nursing courses, which can be taken in conjunction with, hands on classes.

4. Respiratory therapist
Respiratory therapists evaluate, treat and assist with diagnosis of respiratory/pulmonary diseases. In the United States, Registered Respiratory Therapists evaluate and treat patients with a great deal of autonomy under the direction of a pulmonologist.

Respiratory therapists are found in schools as asthma educators, trained RRTs prescribe and manage previously diagnosed respiratory patients in physician clinics (US), execution of sleep studies in sleep lab for diagnosis of sleep-related illnesses, as members of “rapid response teams” in inpatient settings, integral part of ICU care teams. The AMERICAN ASSOCIATION FOR RESPIRATORY CARE is a professional organization representing respiratory clinicians in the United States. (..From Wikipedia)

The Commission on Accreditation for Respiratory Care (CoARC) is the organization responsible for the accreditation of respiratory therapy educational programs. Accreditation status of each program is constantly updated and can be verified by contacting:

Commission on Accreditation for Respiratory Care
1248 Harwood Road
Bedford, Tx 76021-4244

5. Physician extender/Assistant
Physician assistants conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, and write prescriptions. Physician assistants work in hospitals, clinics, and other types of health facilities, and exercise autonomy in medical decision making as determined by their supervising physician. The professional requirements typically include at least two years of post-graduate education. They are educated in the medical model designed to complement physician training, rather than in the nursing model as nurse practitioners are. Physician assistants are not to be confused with medical assistants, who perform administrative and simple clinical tasks with limited postsecondary education, under the direct supervision of physicians and other health professionals. In the United States, the profession is represented by the AMERICAN ACADEMY OF PHYSICIAN ASSISTANTS.

There are 150 PA programs. More information is available at the PA program directory at paeaonline.org. PA training is usually 2 to 3 years in duration. A graduate from an accredited PA program must pass the NCCPA-administered Physician Assistant National Certifying Exam (PANCE) before becoming a PA-C; this certification is required for licensure in all states. The U.S. Department of Labor Bureau of Labor Statistics report on PAs states, "...Employment of physician assistants is expected to grow 27 percent from 2006 to 2016, much faster than the average for all occupations...” This is due to several factors, including an expanding health care industry, an aging baby-boomer population, concerns for cost containment, and newly implemented restrictions to shorten physician resident work hours. …(From Wikipedia)
Figure 1. USCE network

6. University hospital based training
University hospital based para USCE training can be obtained only when you network with the hospitals themselves. Some programs offer such opportunities on their website. CCF.org, which is Cleveland clinic, offers such opportunities. One avenue for University hospital based USCE is to talk to office assistants in department of medicine/psychiatry/family medicine/neurology at Veterans Affairs Medical centers (www.VA.gov). You can find the nearest VA hospital near your location in the US and use that opportunity to call up the offices and see if they will allow for observership.

7. Private hospital based
Community based hospital and private medical institutions are another opportunity for obtaining USCE. Here the technique for getting around is different. In private practice, physicians have a huge influence on the administrative architecture. Therefore, if there is a faculty physician who will put in a word for you and endorse you, then it will be easy for you to be plugged into the system as an observer. If you personally know of a physician, then this would be a perfect opportunity for you to work on networking you way into a USCE. Another method, which may get you surprising results, is to get emails of the physicians and write to them an earnest email asking an opportunity to be interviewed. This way you are not asking for a USCE spot but asking for them to evaluate you before they put in a word for you. Be courteous, polite, provide contacts and references, give some personal details and ask if they would consider. They can ignore either the message, or write back saying they can or cannot help you. Perhaps, I will work on a template letter than you folks can edit and use for your purpose..(drop me a word or two on facebook, like here if you think this will benefit you)

8. Clinic based
Many private companies also offer ‘programs’ and ‘services’ to place IMGs in clinic-based practices with large sums of money. If you have $$$ to spend then this may be a better option as you are taking advatage of a set up network of agents, physicians and places. IF you don’t have the money to spend then you can network for yourself. This is where the power of Internet and phone comes to play and you can brute force your way into a USCE by talking to all the private practitioners in the area. The formula remains the same. Present your propositions, give some personal details, provide contact information and references and be very very polite.

9. Clinical research co-coordinator
The Clinical Research Coordinator (CRC) is responsible for conducting clinical trials using good clinical practice (GCP) under the auspices of the Principal Investigator (PI). There are two organizations that provide certification for the CRCs: Association of Clinical Research Professionals (ACRP) and the Society of Clinical Research Associates (SoCRA). ACRP offers the only accredited* CRC designation in the field, the Certified Clinical Research Coordinator (CCRC®) and SoCRA offers the designation of Certified Clinical Research Professional. ACRP's CRC and CRA Certification Programs are accredited by the National Commission for Certifying Agencies (NCCA), the accrediting body of the Institute for Credentialing Excellence. (..from Wikipedia)

This is a credentialed post, meaning any one of the above can become a CRC. You could be an RN, and APN, PA-C, RRT and are eligible to be credentialed to be a CRC. In order for MBBS or FMGs to become CRC, you need to contact the institution and learn of their policies for such employment. Graduate students can thus in this way get into the clinica fields at the same time working in their research institution.

1. Graduate research assistant
There are many graduate schools, which provide PhD and Masters programs in life sciences. If you ultimately want to switch to residency and being a physician in US then it is better to work in fields of virology, microbiology, immunology and genetics rather than plant sciences or veterinary pathology. This way you can make a better justification for changing from your research field to medicine. Being a graduate student has its advantages, you can earn while you are preparing for your boards, or apply for programs. You can also get to know faculty and physicians in the university where you are training to secure important experiences like observership, CRC jobs etc. How to obtain research experience can be read here --> here


  1. Very helpful post. Thanks a lot.

  2. hi,i am planning to do an observorship in canada as i have a relative there who is a doctor in edmonton uni.will this be counted as usce???

    1. your question has been answered on the other page: residency chances calculator. Good luck

  3. This comment has been removed by the author.

    1. If you are able and can do the maximum allowable period, that may be towards your advantage for a few reasons
      1. Longer durations = higher chance of forming meaningful relationship with faculty and make stronger connections
      2. Longer duration = chance of getting a really good letter of recommendations
      3. Longer duration = more varied exposure
      etc, you get the point.
      I would imagine doing all 20 weeks in US to be better in the long run if you are committed to pursuing medical residency in US

    2. This comment has been removed by the author.

    3. This comment has been removed by the author.

    4. McGill is in Canada. Their health care delivery system is quite different from US. So in true sense it wont be USCE it will be CCE. However, patients are patients everywhere so if you are getting an opportunity to keep in touch with clinical medicine and there is nothing else on the horizon for you, then recommend taking it. LIke I have said previously, having a diverse portfolio under the belt can be helpful. That being said, you will perhaps lose out on the advantage of making connections on the home turf


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