Government Medical College Chandigarh Old Students Association
CONQUERING THE CLERKSHIPS
Divyanshoo Kohli & Harshabad Singh ('03)
What is a clerkship?
It is a hands-on clinical training provided in US medical schools. The medical student is made a member of a clinician’s team and he/ she learns medicine from the other members. Essentially, it is like the clinical/ practical at our own medical school (Pre-final or final year).
Why should it done?
For a couple of reasons:
1. Learn about the US style of medical school training
2. The clerkship counts as US clinical experience: A huge plus for residency aspirants
3. CS prep: The clerkship can serve as the preparatory ground for the USMLE Step 2 CS. In fact, I recommend that the CS book should be briefly glanced before the clerkship so that one can learn how to interact with a patient in US settings (compared to the Indian style, it is a bit like maggi ketchup: Its different!)
4. Letter of recommendation: A clerkship is the best way to get a US LoR, which can be instrumental in getting a residency.
When should it be done?
The clerkship is open to medical school students in the final year. In India, this translates into the internship (Last year of the course). Ideally, one should apply in the Third Prof (part 2) as the slots fill up pretty fast. Also, apply for the later dates that are more likely to be available.
How much will it cost me?
Nothing! But it is likely to leave a huge hole in the wallet of your parents. The travel should be around Rs 55,000 (USD 1,000). The cost of living varies by the city but a ballpark figure of USD 250 per week for food and stay is a good index. The fee for the clerkship again varies: From about USD 175 per month in SUNY to about USD 400 per week in Rochester, NY. The public universities are generally cheaper than the private ones. Many universities offer a ‘package deal’ that covers food, tuition, boarding and malpractice insurance. All in all, clerkships are not for the faint hearted- it involves ‘serious’ money.
What is malpractice insurance?
Malpractice insurance is a cover for any negligent or malafide act done by the doctor/ student. It is a MUST to have insurance or the university will not consider the application. The insurance cover can be expensive (over USD 1000) but firms like the Academic Groups offer very cheap rates as well. (http://www.academicins.com/)
How to apply?
The basic stuff you would need:
1. Letter from the dean/ director certifying that you are a bonafide student in the last (not final year) year of the 5.5 year MBBS course of this medical college and you expected date of graduation is ____.
2. Malpractice cover: you can write that ‘Malpractice insurance cover shall be available after the confirmation of clerkship dates’ when you are applying.
3. Letter of Intent: It should explain why you want to do a clerkship in that specialty
4. CV: ensure it confirms to the US style
5. Immunization record: most hospitals have a varying format. A letter from a doctor from the hospital detailing your immunizations and TB tests along with the titers from an accredited lab is the best one-size-fits-all solution.
6. Application fee: self-explanatory
7. Optional: TOEFL score and NYSED letter. I recommend that you should appear for TOEFL so that the US school is sure that your English skills are good. The New York State Education Department letter is needed if your clerkship will be in NY State.
How should I choose a US medical school for a clerkship?
First choose a state (friends/ relatives/ seniors who can host you) where you want to go or have contacts in the faculty (for the jugaadu folks!). Go to www.usmletomd.com/usce and on the right a list of all states in the US is present. Click on the relevant state and a list of the hospitals that offer clerkships will be displayed. Go to the website of the medical school and asses the fees and availability of seats. Email the coordinator and ask for further guidance. Indicate if you will need a visa. If you already have a tourist visa - great! Also, take a look at this website: http://services.aamc.org/eec/students/ for links and preliminary information regarding clerkship programs in most medical schools. Go from A-Z and search for suitable programs. You can pick a program where you desire to match or you can do it in one of the top med schools in the US where you might not have a great chance of matching, but a strong LOR from that medical school would carry more weight.
How to choose a specialty for a clerkship?
Try and place your favored/preferred branches in your top choices but do include a relatively non-competitive specialty in your last choice, especially so if you are applying for a very competitive spot (eg-cardiology, GI, emergency medicine). Remember an international medical graduate will only be scheduled after the host school’s own students and other American graduates have been scheduled.
Some schools offer sub-internships which might be available to IMGs. In a sub internship you function independently almost as an intern (PGY1) would, admitting patients, writing patient notes, calling consults, writing medical orders. This obviously is a much tougher rotation than a consult service in any specialty but gives you much more time on the floor, more interaction with attendings and hence the opportunity of obtaining a stronger and more personal letter of recommendation.
What about logistics like stay and carrying money?
It is cheap and advisable to stay with family/ friends (time to dust the family album!). Else, try to find cheap accommodation online (craigslist.com). The student advisor at the medical school can be of great help as well. I recommend that you use the State Bank of India Videsh Yatra card and not carry too much cash. It works like an ATM card. Also check the weather and pack clothes accordingly. Minnesota and New York states have four to five months under snow while the California sun can put the Indian summer in, well, shade.
OK. I got the clerkship. Now what?
Congrats! Start by throwing a party for friends. Then, STUDY. Your knowledge base must be robust to ensure that you get a good LOR. Try to find someone preparing for CS and practice a couple of cases with that person. Brush up your presentation skills. Also, bow your head in reverence to Acharya Mandy at http://gmccosa.org/careerseries_011.htm
Some other tips:
1. Be on time, work super hard, respect your colleagues especially your intern/fellow with whom you will be spending most of your time on a clerkship.
2. Read about your patient’s disease and apply it to your patient. Uptodate (www.uptodate.com) is one of the most popular references in the US and essentially summarizes the most current medical evidence based on a review of hundreds of peer-reviewed journals. Search for recent articles on pubmed, the web portal of the National Library of Medicine, regarding your patient and make contributions towards patient management during rounds.
3. Following up on your patients is very important, unlike in final year where we never see the patient again after presenting the case to an attending.
4. Try and make special reference to the non medical problems of your patient- social support, end of life care decisions, etc.
5. Respect patient rights and confidentiality. Be sure you are don’t breach any HIPAA guidelines.
6. MOST IMPORTANTLY- BE A TEAM PLAYER. No one wants a brilliant student on their team who is a pain to work with.
Ok. Been there, done that. Now what?
Balle! Now guide your juniors, send feedback to GMCCOSA and get set for the steps! Your suggestions and criticism is also solicited, as ever!
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