Home MedEducation & Residency How To Get U.S. Clinical Experience (USCE) – Everything You Need To...

How To Get U.S. Clinical Experience (USCE) – Everything You Need To Know

United States Clinical Experience (USCE) refers to hands-on or hands-off clinical experience working in a U.S medical environment. It is one of the most important factors that will help you secure a residency position.

This is a step-by-step guide to finding U.S. clinical experience. It contains everything you need to know about the different types of U.S. clinical experiences, the requirements, the financial aspect and how to find these types of rotations for free.

Clinical Experience

Types of U.S. Clinical Experience

There are two main types of U.S. clinical experience. The first is electives and the second is observership.


Electives are a type of u.s clinical experience in which you have hands-on experience like examining patients, putting notes in the medical record and if you are doing a surgery rotation, you get to scrub in and participate in the surgery. You basically get responsibilities similar to a U.S medical student.


During observerships, you go to the hospital and observe medical care. You get to participate in rounds and attend the conferences but you don’t get to participate in patient care. You don’t have hands-on experience, you don’t get to take a history, examine patients, put notes in the medical records or participate in surgery if you’re doing a surgery rotation. The hands-on clinical experience during electives makes it more important than observerships.

There is a third type of clinical rotation which is called an externship. This type of rotation gives you some degree of hands-on experience. It varies between the institutions or where you’re doing the rotation but it is kind of in-between electives and observership.

Electives give you the opportunity to show your clinical skills, participate in care, and get letters of recommendation. It is also possible to get letters of recommendation from observership. But consider yourself to be an attending and you see a student who examines patients, participates in surgery, puts notes in the medical records, and is a part of the medical team compared to somebody who is just observing and answering questions, which one of the two would you write a better letter of recommendation for? Definitely, the one who was involved and was part of the team.

The downside of electives is that you have to be a medical student which makes many international graduates do observerships instead. IMGs, in most cases, travel to the U.S. after they graduate and the chances for electives are already over.

Requirements for U.S. Clinical Experience


As mentioned earlier, in order to be eligible to do an elective, you have to be a medical student at the time of your application. It is possible to apply for electives when you are a medical student and begin when you are a graduate.

The requirements vary by institution. Most schools in the U.S. require you to have your USMLE Step 1 before applying for electives. Some schools require you to have spent a certain number of years in your school before you’re eligible to apply for an elective.

Institutions that don’t have the requirement of Step 1 generally require you to pay some amount of money for that elective which can be as much as four or five thousand dollars for one month of elective. Some institutions also require you to have taken an English proficiency test whenever you’re applying for an elective.

Observerships and Externships

The requirements for observerships and externships are not as strict as the ones for electives but they vary from one institution to another.

The USMLE Step 1 or spending a certain number of years in medical school are not requirements for observerships or externships.

Electives and observerships require you to submit some evidence of immunization, medical tests, and health insurance for the duration of your stay. You will also be required to provide malpractice insurance to cover for situations when something happens to a patient as a result of your mistake.

Financial Aspect of U.S. Clinical Experience

This also varies a lot. For electives, you may find institutions that charge $200 or $300 and some that charge up to $5000 or $6000 for a 4 weeks rotation. For observerships, it could be free and it can also cost between $500 to $2000. The costs varies and depends mainly on the institution you are applying to.

In addition to paying the fee of the elective, you have to support yourself. You have to think about feeding, accommodation and transportation asides from the fee of the rotation itself. For those requiring a visa to travel to the U.S, the clinical rotations are done on a B1/B2 visa. Some institutions ask for J1, some require F-1 visa but most U.S. clinical experience is done on a B1 visa

How To Find U.S. Clinical Rotations for Free

There are some companies that can provide you with U.S. clinical experience for a high fee but these type of rotations through these companies are either externships or observerships. You don’t get to do electives which are the best type of U.S. clinical experience.

The best way to find electives is to check the website of the institution you’re interested in doing an elective at. On the website, click on the link for visiting medical students or electives and find out the requirements. A lot of schools do not accept international medical graduates, so make sure that they do.

Some schools require you to apply six months or maybe a year in advance. So with your Step 1, this is always something to consider. It is important you finish your Step 1, apply and do the elective before you graduate. All these things have to be considered whenever you’re deciding to pursue electives in the United States.

There are situations where your school might have some type of relationship with certain institutions in the U.S. and they allow you travel for an elective in that institution in exchange for students from that institution to do some type of rotation in your own school. Check with the with your school and find out if they have these types of related relationships with U.S. medical schools. If you have some type of connections, through friends or family members, with doctors in the U.S., this might help in getting the elective.

There are two main pathways to apply for an observership in the U.S. The first is having a connection with a physician in the U.S. who can sponsor these types of rotations for you. This is because observerships are not generally posted on the school’s website. There is no formal application process like the electives. The time required to get approval for an observership is much faster than for electives which can take months to appprove.

Another way of getting an observership is by emailing physicians that you’re interested in working with. This occurs most times when your connections are of a different specialty from what you are interested in doing. You can email physicians who graduated from your school or country as this might increase the chances of them responding to you.

You can also choose to email physicians who graduated from different countries if you are interested in their type of work. Make sure to write a very nice individualized email that explains that you know what they do and you are really interested in what they do. You can attach your CV, mention your goals and explain why you are reaching out to them.

Finding an externship is quite similar to an observership. The only difference is that some institutions have regulations that would allow people who graduated to have some type of hands-on clinical experience while other institutions don’t allow any type of hands-on clinical experience once you graduate.

Important Points to Note When Applying for U.S. Clinical Experience

  • Pursue clinical experience in a specialty you are interested applying to for residency.
  • Try to do electives if possible because they are extremely more valuable than observerships and externships. You get to do hands-on clinical experience, get letters of recommendations from people within your specialty and electives are generally done in institutions that have residency programs.
  • Be very careful in the choice of your U.S. clinical experience, where you do it and who you do it withas you don’t want to be wasting your time and money on something that would not help you in your residency application. Doing clinical experience in private clinics or community hospitals that don’t have residency programs would not be that helpful for your residency application.
  • Rotating with mentors who are well known within the field and can help you with your residency application in institutions that are recognized across the U.S.would be way more beneficial and better use of your time and money.



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