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The sound of Silence

A short story by Hamdan Ali Khan, 1st Year MBBS

The old man sat on the beach, barefooted and alone. Silence reigned everywhere except the occasional thrashing of waves which disturbed the acoustic equilibrium. Night it was, the sky filled with a million lanterns, the birds dozing off quietly and the sea like an old pirate sang a silent shanty. Oh! He missed his youth, when he could swim to the Black Rock without drowning, when he could shout at the vast ocean, his resonant voice fading upon the edges of horizon. But all good things come to an end, the voice that once resonated; now a husky whisper. The man who was the fastest swimmer; now an ancient remainder of time and its echoes. The doctors said he had terminal cancer that he would die in a week. He didn’t fear death, he had no family, nothing to lose except maybe the sight when someone would break his 50 years old record. The silence of the calm sea nurtured in him a desire to swim to the Black Rock once again, one last time. He …

Important Terms: Electives, Observership, Clerkships/ Core Clerkships, Sub-Internship, Residency, Fellowship

By Dr. Umar Tariq. Take with permission from

Many students are mistaken when Universities tell them that we don't offer clerkship or you must complete all your clerkships before doing electives.... just because they don't know the difference.... so I am creating a webpage just for basic terms!
Electives: Any optional ward rotation done... clinical electives in usually final year of medical school in Pakistan and others and in pre-intern year in India... research electives can be done anytime! These includes rotations like radiology, cardiac surgery, chest medicine... that are not compulsory! Mostly US/ UK electives are done to get good reference/ letter for your future job/ training positions.
Observership: Any ward rotation in which you observe/watch the attendings, residents, fellows or other medical students but you are not allowed to touch/examine the patient yourself or participate in any sort of activity, though you can watch everyone doing everything... considered to be a passive form of learning as compared to electives! You can also get a letter/ reference from observerships but generally people consider reference letter from electives experience to be better than reference letter from observerships; though I personally believe a very good observership letter is better than an ordinary electives letter. If you get a chance to chose one out of two... I recommend electives!

Clerkships/ Core Clerkships: These are the compulsory ward rotations that you usually in your 3rd year of medical school. These include all the basic compulsory ward rotations of general specialties like Medicine, Surgery, Gynae-Obs, Paeds etc.... when you do your clerkships you don't have any prior clinical experience(that's why Universities usually don't offer clerkships) but when you do electives... you have completed your clerkships(as you can't do final year rotations before doing the basic rotations in 3rd year... Isn't that right?)... and when Universities demand you have completed clerkships... that does not mean you should have graduated(then you are no more qualified for electives) or completed all the electives of your entire medical schoolcurriculum.... it just means that you have completed the basic ward rotations of medicine, surgery, obs-gynae, paeds etc.
Sub-Internship: It is a type of clinical elective(final year rotation) in which you have almost all the responsibilities of an intern but you don't write orders, lab test etc yourself or... have to do so after discussing with chief resident or attendings... under their supervision... so it means more responsibility... thus it is generally considered better learning experience as compared to electives... because you don't sit, assist and observe as a student but work almost like an intern... it is generally very rarely given to international students but if you get one... my advice is.... never miss it!!!
Internship: In India, internship year is the last year of medical school. In Pakistan, UK and some other countries, Internship is referred as "House Job" but it is done after graduation frommedical school. Now Internship in US is like the latter(you do it after medical school, not during medical school or last year of medical school )... in short, the first year of residency is calledInternship. So that means that residency of Internal Medicine means you work as an intern for one year and then 2 more years of residency... similarly in Radiology... you do 4 years of Radiology residency after one year of internship... total 5 years... as far as I know all the specialties have to complete one year of internship... 
One interesting point to note is IMGs from India, have to work as intern two times, once in India during medical school and then in US in first year of residency....
For people of Pakstan on a funny note... please don't consider US residency to be a US house job... I have heard many people saying house job in US is of 3-5 years; house job/ internship is always of one year... let it be US, Pakistan or India...
What you do after internship/house job in US is specialty training just like 4-5 years of PG training of Pakistan... e.g in Internal Medicine, in Pakistan you do one year house job, then 4 years of PG Training after which you become a Internist(IM specialist) and in US, you do one year internship(house job) and then 2 years of residency after which you become a Internist.
Residency: It is the training in the specialty of your choice e.g Internal Medicine, Surgery, Radiology etc... just like PG training or post-graduate training of Pakistan... though in Pakistan, PG training is 4-5 years for most specialties... in US it varies from specialty to specialty...
Fellowship: It is a sub-specialty training. Like in IM, it would be Cardiology, Hematology etc.... In Radiology it would be Abdominal Radiology, Interventional Radiology etc.
Going through the following link might also be helpful.


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