What is U.S. Clinical Experience (USCE)?

U.S. Clinical Experience (USCE) refers to clinical exposure gained in U.S. hospitals, clinics, or medical institutions. For International Medical Graduates (IMGs), USCE helps familiarize them with U.S. medical practices and improve their residency application.

Why do IMGs need USCE for U.S. residency match?

IMGs need USCE to boost their residency match chances. It strengthens their ERAS application, provides strong Letters of Recommendation (LoRs), and ensures familiarity with U.S. healthcare systems and patient care protocols.

What types of USCE are available for IMGs?

There are several types of USCE: externships (hands-on clinical rotations), clerkships (for medical students), observerships (shadowing U.S. physicians), research fellowships, and telemedicine rotations.

What are the costs of USCE for IMGs?

The cost of USCE varies. Observerships range from $500 to $3,000 per month, externships and clerkships cost between $1,500 and $5,000 per month, while some research fellowships are free or offer stipends.

Types of United States clinical experience or US clinical experience (USCE) for international medical graduates (IMGs): Which one is best for your residency match?

For International Medical Graduates (IMGs), securing U.S. Clinical Experience (USCE) is a crucial step toward a successful residency match. But not all USCEs hold the same value in the eyes of program directors. Understanding the different types of clinical rotations and knowing why hands-on experience is the best can make a huge difference in your application.

1. Hands-On rotation (Externships & Clerkships) – The Gold Standard US Clinical Experience

💡 What is it?Hands-on clinical experience allows IMGs to directly participate in patient care under the supervision of a U.S.-licensed attending physician. These rotations mimic the role of a medical student or intern, offering valuable exposure to the U.S. healthcare system.

🔹 Externships – For IMGs who have already graduated from medical school.🔹 Clerkships – For current medical students doing core or elective rotations in U.S. hospitals.

✅ Why It’s the Best Type of USCE for IMGs

Boosts Residency Competitiveness – Shows program directors you can function in a U.S. medical setting.
Earns Stronger LoRs – Preceptors write detailed, performance-based letters, which carry more weight than observership LoRs.
Develops Clinical Skills – Learn electronic medical records (EMR), physical exams, and case presentations.
Improves Communication – Master medical English, patient interactions, and teamwork in a real clinical setting.

2. Observerships – Limited but Still Valuable

💡 What is it?An observership allows IMGs to shadow a U.S. physician without direct patient contact. This is a non-hands-on experience.

✅ Pros:

Useful for IMGs with visa restrictions or who lack U.S. experience.
Offers an introduction to hospital workflow and U.S. medical practice.
Some observerships offer letters of recommendation (LoRs).

🚨 Cons:

Less competitive than hands-on experience.
No direct patient interaction, so LoRs may carry less weight.

3. Research Experience – Strengthens Academic Profile

💡 What is it?IMGs can engage in clinical or basic science research at a U.S. institution. While research isn’t direct patient care, it significantly enhances residency applications, especially for competitive specialties like radiology, dermatology, and surgery.

✅ Pros:

Strengthens CV with publications and conference presentations.
Demonstrates analytical and academic skills to program directors.
Increases chances of matching into academic hospitals.

🚨 Cons:

Not a substitute for USCE – Should be combined with hands-on experience.

4. Telemedicine & Virtual Rotations – The New Alternative

💡 What is it?Virtual rotations involve online case discussions, telemedicine consultations, and remote learning under U.S. physician supervision.

✅ Pros:

Great for preparing you for hands-on experience
Ideal for IMGs impacted by visa or travel restrictions.
Can lead to LoRs if performance is strong.
Some programs accept virtual experience, but not all.

🚨 Cons:

Not equivalent to hands-on rotations in program directors' eyes.
Less immersive than in-person USCE.

Which Type of USCE Should You Choose?

If you want to maximize your chances of matching into residency, hands-on clinical experience is the best choice. However, combining hands-on rotations with research, observerships, or virtual rotations can make your application even stronger.