Canceled observerships and externships due to coronavirus: What IMGS should do

As I write this in March 2020, we are experiencing the unprecedented wide-ranging effects of the coronavirus epidemic. This has affected so many aspects of life in the United States and worldwide. For residency applicants, this has also caused a number of immediate impacts. For those applicants who are international medical graduate’s (IMGs), one of the immediate effects has been canceled clinical rotations.  I work with a number of IMG residency applicants across the country, and I’m hearing the same story from many of them. From California, to Florida, to Nebraska, my IMG clients are hearing that their rotations have been canceled or indefinitely postponed. In some cases, IMG applicants who had scheduled three, four, or even five rotations have seen all of them canceled.

I've received many emails and phone calls from these applicants, worried about how these cancellations will impact their chances to match into residency in the U.S. In this post, I'll detail what you should do if you've had your clinical experienced cancelled. I'm going to focus on three main areas of advice:

1. Think about other ways to obtain US clinical experience

2. Revise your match strategy, especially as it relates to US letters of recommendation

3. Plan on how to strengthen your application in other ways

Look for Alternatives to Replace Your Canceled US Clinical Experiences While some applicants are hoping that clinical observerships and externships will resume in the summer once the coronavirus situation settles down, this assumes that the situation will be much better by the summer. We all hope that this will be the case. However, no one can say that with any certainty. For this reason, hospitals just can't predict when their programs will resume. Even if the situation is much better by the summer, it's a strong possibility that these programs won't start by then. That's because with so many resources being diverted to the care of coronavirus patients, the hospital leadership that oversees observership and externship programs have their hands full with clinical issues. Whether or not to resume IMG clinical programs simply won't be a pressing issue. Therefore, I believe that many of these programs won't resume for many months. In fact, I suspect that most of these programs won't resume before September, the opening date for residency application submission. Consider Outpatient Clinical Experience in Place of Inpatient Rotations I've seen among my clients a common belief that most (if not all) of your US clinical experience should be in the form of inpatient experiences in order to match successfully. While the best strategy is to have a good mix of inpatient and outpatient experiences, that strategy will have to change this year. Given the current climate of limited inpatient opportunities, I highly recommend seeking outpatient rotations. These experiences will be easier to obtain. And having worked with IMGs for 20+ years, I can tell you from personal experience that many applicants have successfully matched with US clinical experience that is mostly (if not all) outpatient-based. To obtain clinical experiences currently, you won't be able to simply apply to a large institution for an established observership program. You'll have to look elsewhere. I recommend that you first start with your friends, family, and acquaintances. They may know of a physician who will allow you to participate in their outpatient clinic, or they may be able to connect you to one that is open to an observer. If that doesn't work, you should reach out to your medical school's alumni network. Many medical schools across the world have had graduates who've established themselves in the U.S. as physicians. Your fellow alumni may be willing to offer you an opportunity at this challenging time. If they're unable to, you should always follow up by politely asking if they can think of any other colleagues who might be able and willing to do so. If friends, family, or alumni are unable to help, consider reaching out to professional providers of observership or externship opportunities. For a list of these providers, visit the American Medical Association (AMA) website. This page provides information on these programs. MD2B Connect is the company that I founded to provide high-quality observership and externship opportunities, and our details are listed on the AMA website as well. As you make inquiries with these programs, ask them hard questions about their available opportunities. The most important aspect of the experience will be the physician with whom you work. Is he or she a dedicated mentor and educator? Does he or she care about students and their future? Will they be invested in your success? Your mentor determines the quality of your experience, and also has the potential to strongly impact your residency match success if they are able to write you a strong letter of recommendation and advocate for your candidacy. Consider How Your Canceled US Clinical Experience Will Affect Your Residency Match Strategy Beyond having to alter your US clinical experience plan, a canceled rotation will impact another important component of your residency application--your letters of recommendation. The typical recommendation for IMGs is to schedule at least 3 months of US clinical experience. This is the typical recommendation because every 4-week rotation, if all goes well, should result in one U.S. letter of recommendation. The typical residency program requires at least 3 letters of recommendation. If you can't schedule 3 rotations with the time that you have remaining in this match cycle, what can you do? First, we recommend that you stay focused on obtaining US letters of recommendation. A survey of program directors (PDs) asked how they weigh a letter of recommendation written by a faculty member in another country. In this survey, an astounding 93% of PDs felt that these letters were not useful.  That's why LORs from faculty in other countries should, in most cases, be used only as a last resort. Another option would be to work with several physicians during the course of a four-week rotation. While this would net you two letters, there is a potential downside.  You would be splitting your time between two physicians, and that may affect the strength of the relationship you develop with each letter writer. And this, of course, could impact the strength of your letter. Another option would be to obtain a letter from a U.S. physician with whom you've worked in a non-clinical capacity. This could be someone with whom you've done research, community service, advocacy, or other work. And while this letter would not be as useful as a clinical letter, the writer may still be able to comment on those skills and qualities that would be transferable to work as a resident. Consider How You Can Strengthen Your Candidacy For Residency If You're Unable To Find US Clinical Experience If you're unable to secure US clinical experience despite your best efforts, consider how you can strengthen your application in other ways. If you now have 2-3 months suddenly available, there's actually a wealth of opportunities that can make a difference in your community, make an impact in medicine, and strengthen your application. These include research projects, volunteer work, advocacy work, providing translation services, and others. And while this may not have the same impact as US clinical experience, there are many residency programs that value applicants with this type of background. One of our colleagues commented on how frequently Internal Medicine programs asked about her volunteer work with the homeless, highlighting how important such volunteer work is to many programs. Dr. Samir Desai is the author of The Successful Match, faculty member at the Baylor College of Medicine, and founder of MD2B Connect, the nation's most highly rated and personalized provider of hands-on U.S. clinical experience for IMGs. Would you like to receive an excerpt of 100+ pages of The Successful Match 2017: Rules for Success in the Residency Match? Sign up here and we'll email you a copy.