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United States Clinical Experience (USCE) detailed Insight

              United States Clinical Experience (USCE)

By: Waqas Nawaz M.D

This is really important part of steps journey. I will try my best to explain it in the simplest way. Those days are over when people with triple 99 only used to get residencies .USA hospitals now require some clinical experience inside USA before you apply. Students work under supervision in hospitals and get L.o.Rs.

There are 3 forms of USCE ( research is not part of USCE -a big misconception):

1. Electives 2. Externship 3. Clinical Observer Status (Observer-ship)

1 Elective:
Doing clinical work in USA while you are not graduating is called elective. Most people do it in 4th yr / final yr vacation or immediately after final year. Each elective comprises of 4 week rotation in which you get one L.o.R. It is the best form of USCE. Some universities offer it free while others have some fees. People who have done step 1 are very likely to get electives for free in good universities. Elective also solves the visa problem as you get a 5 yr visa on basis of electives which helps you later as well. ( the website that has list of universities offering electives with requirements.

2 Externship:
It's same as elective except that it is after final year. If you do a clinical rotation as undergrad it is called elective and if you do it after graduation, then it is called an externship (I did Externships). It is less valuable than elective, but more than an observer-ship. 3, 4 months are enough

3 Clinical Observer Statuses:
This form of USCE is less valuable than externship. The difference is that you see the patients in a same way as in externship, but you don't touch the patient (in externship you physically examine patient). You act as an observer and you observe how your mentor examines him. Most of the hospitals provide either electives or observer-ship rare hospitals provide externship.

It is not a clinical experience. It is scholarly activity that takes at least 1 year and should be followed by publication in order to be effective.

USCE of 3 months is enough. It is very likely that in 3 months you may have 5 L.o.Rs as well.

Article By: Waqas Nawaz MD
Montefiore Medical Center, Bronx, NY, USA.


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