Top 10 factors to help you choose the right USCE

  • How do I select which rotation do to? Should I go for the X hospital?
  • Will the rotation with Y preceptor be worth it?
  • Which one will be useful for getting more interviews and for an impactful conversation during the interviews?

We get such questions all the time.
In this blog we  discuss how to select the USCE you should go for? What should you look for when you are planning the clinical experience? What we make the most impact in your interviews and help you tremendously in your match.

This is based on our experience of working with hundreds of IMGs and Caribbean applicants each year on their rotations, application, interview prep and match strategy, and our discussion with various attendings, faculty and programs. This applies to both the electives or the externships- which are rotations you do after you graduate.

We have identified 10 most importance factors that can help you determine which rotation to choose from.  But do understand that each profile is different, each applicant have different constraints. So not all these may be applicable to your situation equally and and these factors should not be considered in in isolation. These are not in any order of importance, since that also will vary by applicant
 
1. Affiliation of the location- the hospital or clinic 
Affiliation/residency program/Top tier program: Name matters!!  Rotations at programs that have residency matters. Also rotations at top university hospitals matters. Like Hopkins, Mayo Clinic and so on

Why is that important? for the simple reason if the hospital has residency program, your chances of getting the interview there increase as well at other programs in the region.
What about places like Harvard, Hopkins and so on? Is it worth doing a rotation there even if the chances of interviews from those places may not be high. Yes indeed!! These names will shine on your CV and when your ERAS CV is reviewed, it will definitely help.

What if you can’t do either of the two? Then try clinics affiliated to residency program hospitals. Many of our students do it and these preceptors are more likely to call programs for you, in many cases also use the same EMR and can take you on daily rounds at the hospitals The point is Your uncle’s clinic  which is not affiliated with any program may not be of much use
 
2.  Letter of recommendation (LOR)
Most likely you will look for LORs. However just a standard templatized LOR is not enough. You need a waived customized LOR. Pick the rotation where you can be reasonably certain you can get good personalized waived LOR. Ofcourse this is one of the things that can’t be taken in isolation. For example if you are getting an opportunity to do elective or externship at say Harvard or Johns Hopkins or Mayo, which may not give and LOR, you still want to consider those rotations.

3. LOR Letterhead
Relates to the first factor and absolutely matters a lot!. Top university letterhead, residency hospital letterheads are preferred even if you do rotations at at clinic. Clinic letter heads may not be that valuable
 
4. Learning you will get
You  want to pick a rotation where you will get good, extensive clinical experience. It should help you refine your critical thinking and ability to make data driven decisions based on evidence. Strong rotations will also give you exposure to patient nteraction/counselling- this is the key skill they will look for when they evaluate you application or interview you. Some of the other aspects to look for are: Access to the EMR and working with teams. Many of our faculty focus on the case presentations as well where you are expected to do several presentations weekly. All this exposure learning will come in quite useful as you prepare your application and in the interviews.

5. Type (Inpatient/outpatient), tele vs. onsite
That is a big decision. With the pandemic much of it may not be in your hands but inpatient experience is very valuable. If you are getting it consider it seriously. Then there is outpatient as well.
While most inpatient experiences are onsite, for outpatient, telerotations have also opened up now. We will have a separate blog on telerotations but the these  can vary from direct patient interaction on video, access to EMR from remote location to a purely didactics rotation, which the focus is on critical thinking and case presentations.

6. Specialty specific rotations
One of the most important factors. Specialty specific experiences help quite a bit. So applying to IM? Work in IM/primary care/sub specialty. While some experiences can be transferrable from other specialties, you should plan well. If your CV is full of Pediatrics rotations, it is unlikely that many IM programs will be interested. This is one of the biggest mistakes students make and something that can’t be undone after you apply. If you think you may want to apply to multiple specialties, plan in advance. Typically 3 to 4 months USCE in a specialty is expected

7. Fee
ofcourse this may be important. So most universities have a standard fee if you apply directly. The challenge is if you use any of the companies to get the rotations. That’s where you will see for the same physician/clinic some people pay 2500 and others paid 1500. We have kept is simple- you pay directly. We work with the physicians to secure a spot- there is registration fee, you get access to our classes, we negotiate bulk discounts and we pass these on. But again don’t take it in isolation- we have seen hundreds of so called ‘free’ rotations, which are fine, but then you may not get customized LORs
 
8. Location
You may not realize it but is is quite important. Locations on the east coast and mid-west for an IMG are important since the residency programs there are more likely to pay attention to the experiences from these regions. You are unlikely to get far if you, say, have rotations from North Dakota or other IMG unfriendly states. The good news is if you have issues with travel, now with telerotations it has become easier. Most of our students in LA, Seattle and Oregon for example we work with them to find rotations in the east coast/Midwest.

9. Diverse experience:
Diversity of experience, of location helps- You don’t want to write the same sentences all over the experiences- observed this, took History & Physical.  So if you have good inpatient experiences, look for something in primary care or outpatient. If you have done a cardiology rotation, try out a GI stint.
Also, from a location perspective, move around. Don’t just stick to one city or one clinic. Yes you have other constraints like family in a city or so on. It can work both ways. Say you live in Michigan, and are doing all rotations in MI- you may become a stronger application for MI, but then may not be as strong for other regions. Programs tend to hire locally.

10. Research options
Many physicians will help you write case reports or do clinical research. These can be useful if you have no research in your profile. Infact many of our partner physicians now offer research, which can help you publish along with the clinical experience you get.