IMG Guide to the US Medical Licensing Exam USMLE

USMLE Info and Advice

Workin’ in the USA

Completing clinical electives in the US is a very important step in a successful match for any applicant, but especially for the IMG. Remember, your medical school back home may be the most famous institution in your country, but chances are your program director and residency committee do not know anything about your school, or how medical training is conducted in your country. They are unfamiliar with the structure, duties, and responsibilities you had while in training. For this reason, it is key to complete clinical rotations in the US, ideally in specialties you are interested in applying for. This is also one of the best places to obtain letters of recommendation for your application (more on this later.)

When to Complete Your Rotation

If you have planned well, the best time to complete your rotations are while you are still a medical student. This is good for several reasons. Many academic centers in the US will host international students, but are less inviting of international medical grads. If you are a student, any malpractice concerns will likely be taken care of by your host institution and that means you will function as part of a team of US residents and students and have the full duties of a US student. This will help “prove” to others that you’re qualified to be a physician in the US. Also, if you are unfamiliar with the ward structure of US medical teams, you’ll be able to learn the function and the culture of the medical team while having the “excuse” that you are still a student. Generally, residents are more understanding of mistakes or knowledge gaps for students than they are of trained physicians.

If you are already a practicing physician who has completed medical school outside the US, it is still important for you to complete rotations at US institutions, but you may be limited to observerships where you shadow US residents and attendings. This is less ideal because you will not have hands-on patient contact and it may be harder to secure a strong letter of recommendation from these experiences.

Where Oh Where To Look for an Elective

Many electives available to medical students may not be listed in a convenient place, and some may be by arrangement only. Just because an elective is not advertised doesn’t mean you cannot do it! Be creative.

First start by checking with your own medical school’s student affairs office to see if they have any established relationships with US institutions for clinical electives. If they do, then you’re in luck! Many schools have exchange programs with US medical schools. If not, try contacting any alumni or personal contacts you may have in the US. IMGs already practicing in the US may know of elective opportunities in their local areas.

Next, look at the websites of academic hospitals and medical schools in geographic regions you are interested in rotating thru. The medical student sections of these websites may have information. If the information is not easily found, try emailing the student affairs office of the medical school for information, or the medical student coordinator of a residency program. Alternatively you may email the program coordinator of a specialty residency program (ie. The admininstrator of the internal medicine program you are interested in). Finally, you may also email the administrator (or faculty) in the department you wish to complete a rotation in. Try to focus your emailing to places where you know they have medical students already rotating, in order to make things easier.

Check with your own department’s faculty to see if they know of any US faculty. Often they can use these personal connections to make a phone call or an email on your behalf to see if they would be willing to host an international student. Often faculty can create an elective without jumping thru all the paperwork needed that you might need to do going thru “official channels.”

In your email or letters with US faculty or staff, be sure to explain your interest in the field, and explain any research or other special interest in the field. For example, if you are trying to obtain a cardiology rotation, you may say 2-3 sentences regarding your interest in management of coronary artery disease, the new management strategy in acute MI, or desire to manage cardiac patients in an intensive care unit setting. Also consider stating a few sentences on your current level of training in your country and any applicable experience you have in that field. Keep your messages brief, and to the point. If you don’t hear back after 7-10 days, call or email again to confirm receipt of your original message. Be sure not to seem pushy, and always be polite!

Commercial Companies May Offer Electives

There are a number of commercial entities which offer placement of IMGs at US hospitals. While these may be your easiest option, prices may be relatively expensive, so try to look around yourself and exhaust your own resources first. It is unclear whether letters of recommendation from these types of institutions may be viewed by program directors as less desirable than others, since there is a commercial venture and profit making behind some of these rotations. Be sure to ask for references from students/physicians who have already completed rotations thru any commercial company you are considering.

Blueprints Medicine (Blueprints Series) by Vincent B Young

Blueprints Family Medicine (Blueprints Series) by Martin S Lipsky

Blueprints Clinical Cases in Medicine (Blueprints Clinical Cases) by Jonathan Li

Elective Behavior
Set Your Goals High

When you are completing a rotation in the US, remember to be on your absolute best behavior. Your goal in these rotations is threefold: 1. Learn about the US system of medical training, 2. Show that you can perform as a highly skilled team member (and gain an outstanding letter of recommendation), 3. Learn about the medical specialty you are rotating in. To do this and to stand out, remember to go the extra mile in everything you do. While other students on the rotation may take the experience lightly, remember that these rotations did not come to you easily, and you may have had to go to great lengths to secure them. Make them count!

Work, Work, Work

On your rotation, take every opportunity to see more patients, take more call, and look up articles and research. If you are offered the chance to take an extra day off, or leave early, DON’T DO IT! Be sure to shine on your rotation. Also be sure to be early to every meeting, rounds, and learning experience. You want to appear well prepared and knowledgeable every chance you get. This may be especially true if you are rotating at a county hospital or other setting where resources may be tight. The attending will hopefully notice you are pitching in and working hard.

If your rotation has a scheduled afternoon off or other “down time” ask your attending if they have other clinics you could attend. Often attendings may have their own personal clinics or other clinical duties separate from the team. Usually they would be delighted to have additional help where they are rotating. If other activities are not available, head to the library to read on your patients, or patients of others on your team. You may be asked for your opinion on patients you are not directly involved with.

What’s in it for Me?

Beyond the learning experience you’ll gain from rotating at an academic hospital, and the knowledge you’ll learn about being a resident in the US by working with and talking to residents, you’ll want to come away with something more tangible for your time and effort: a Letter of Recommendation. (more on this later).

Meet with your attending or rotation coordinator early to see what types of things will be expected of a rotating medical student. Ask early about letters of recommendation. Be sure to mention that you are interested in completing a residency in the US and that you want to know what is expected of you in order to earn a “great letter of recommendation for residency.” If you ask early, the attending will be more likely to pay attention to you during the rotation and will probably be able to write you a much stronger letter than if you wait until the last day.