Clinical ElectivesAkbar Herekar

Sub-internship – Neurosurgery –UNMSub-internship – Neurology – UNMResearch Elective – Neurogenetics – Northwestern University

Glossary - Terms

• Elective – Placement by choice

• Attending – equivalent to a consultant in Pakistan

• Clinical clerkship – clinical rotation/elective

• Sub- I: 4th year American medical student = Our final year

• SOM: School of Medicine

Medical Electives

Research

Clinical Laboratory

Clinical

Observer ship Elective Sub-

Internship

Observer-ship

Clinical Elective

Sub-internship

Undergraduate

Observership• Virtually anywhere in America

• “OBSERVER”-ship – Limited or no patient contact

• Shadow resident/attending

• Learning experience (comparatively limited)+ LOR +

networking

• Easily possible through contacts

• Good as last option for undergraduates

• Can be converted into an elective

• Dr. Luni will talk about observership after graduation

Clinical Elective

• Rotation of ‘choice’, in a university/hospital at home or

abroad.

• Usually 4 weeks but variable

• Position: 3rd year American medical student

• Most places in the US

• Ample patient contact – usually limited patient management

• Foreign exposure/experience + LOR + networking

Sub-internship

• Only real difference from Elective – Position: 4th year medical

student

• Offered by limited places in the US especially to foreigners

(UNM, University of Texas schools and few others)

• USMLE step 1 invariably required

• More patient contact, patient management

• Suggested time: Final year

• If you do very well you can secure your residency

Impact

• Foreign learning experience

• Increases residency chances overall

• Increases placement chances within the same program

• Networking/Contacts

• Last, but definitely not the least – LOR(s)

When• During clinical years (Core clerkships required)

• Suggested time: Fourth and final year vacations

• (Most require final year status)

• Start planning 6-8 months in advance

• Application should be submitted 6-2 months before electives

• Earlier you apply the better your chances

Applying for the elective

Selection of elective

Specialty Hospital

Choosing a specialty

• Reason for elective specialty choice:

• For experience in the field of interest to aid residency chances

• Eg. Neurology

• To explore an area of interest in medicine

• Whatever you can get

Medicine

Psychiatry

Neuroradiology

Neurosurgery

Neurology

Choosing a hospital

• Offerings

• Pre-requisite completion

• State/city

• Climate

• Finances/relatives

• Visa status (UK, Singapore good backups)

• Starting point: On-line Extramural Elective Compendium:

• http://services.aamc.org/eec/students/

Note: Requirements are mostly requirements by the elective coordinator or Elective office. It is possible to waive off any requirement by superseding the office itself i.e.. Through contacts, sweet talking or using your brain.

Institutions: No step 1, No TOEFL, No fees

• NYU SOM

• $100 application fee to be paid on first day of elective

• Approval from dean NYUSOM• http://www.med.nyu.edu/registrar/electives/requirements_lcme.html

• Henry ford hospital, Detroit

• Easiest application process that I’ve seen• http://www.henryford.com/body_program.cfm?id=37384

• University of Connecticut school of medicine

• Tend to be unresponsive

• Easy application• http://medicine.uchc.edu/prospective/visiting/index.html

Institutions: No Step 1, No fees BUT TOEFL required

• National Institute of Health (NIH)

• NIH Clinical center, no med school but have programs with

reputable institutes such as JHU

• TOEFL or Step 2 CS

• Mainly clinical trial patients• https://www2.cc.nih.gov/apps/publicForms/cep/forms/cepApp.aspx

• University of Louisville SOM

• Only Dow Medical College and AKU students are eligible• http://medicalstudentaffairs.louisville.edu/visiting-student-clerkships

Institutions (Good): Minimal fees, require Step 1, BUT MAY ACCEPT A STEP 1 WAIVER

• Mount Sinai SOM

• F1 short-term visa requirement

• Application fee non-refund around $500• http://www.mssm.edu/static_files/MSSM/Files/Education/Student%20Resources/Electives/Foreign%20Visiting%20Students/ProspectiveVisitingStudents_2011.pdf

• UT-Southwestern

• Internal Med, Emergency Surg, Surg at Baylor require step 1• http://www.utsouthwestern.edu//utsw/cda/dept20676/files/397167.html

Institutes: Don’t require step 1, but have fees• Emory University• Faculty sponsor required. $180 per month• https://emorymed.emory.edu/Public/CurriculumPublicPages/CourseInformation.aspx

• University of Texas, at Galveston• F1 required• $750 - $1000 per month• http://www.utmb.edu/enrollmentservices/prospect/visiting_students_index.html

• University of Rochester SOM

• $100 app, $350 per week elective fee• http://www.urmc.rochester.edu/education/md/prospective-students/cached/information-application.cfm

• Tulane University SOM• Application fee $300, no refund, TEMPORARILY CLOSED• http://tulane.edu/som/StudentAffairs/visiting-students.cfm

• Northwestern university• $1200 fee• http://www.feinberg.northwestern.edu/AWOME/visiting-students/index.html

Institutes: Require step 1, have minimal or no fees• Cleveland Clinic

• http://portals.clevelandclinic.org/cclcm/ElectiveProgram/Applying/tabid/4304/Default.aspx

• Mayo Clinic• http://www.mayo.edu/msgme/clerkships.html

• University of New Mexico• http://hsc.unm.edu/som/oss/Visiting_Students.shtml

• University of Cincinnati• http://www.med.uc.edu/medical/MedEd/Visiting/index.cfm

• Suny Downstate Medical College, New york• http://sls.downstate.edu/registrar/visiting/international/index.html

• Duke University• http://medschool.duke.edu/modules/som_registrar/index.php?id=4

• Louisiana state university• Virginia Commonwealth University SOM

• http://www.medschool.vcu.edu/md/m4_electives/international_students.html

• Wayne State University• http://www.med.wayne.edu/student_affairs/records_registration/electives/VISITFRM1.PDF

• And so on…..

Institutes: Money mongers!

• Yale University

• Upwards of $3500• http://medicine.yale.edu/globalhealth/international/electives/index.aspx

• Weil Cornell Medical College

• Upwards of $2000 + $200• http://med.cornell.edu/international/for_int_stu/index.html?name1=International+Health+Interest+Group&type1=2Active

• Harvard University SOM

• Upwards of $3500• http://www.hms.harvard.edu/registrar/aServices/xClerk.html

• Alpert SOM, Brown

• Upwards of $3600• http://med.brown.edu/education/visiting_international.html

Procedure

• Different requirements for different hospitals

• Contacts vs. no contacts

• No harm in using contacts but don’t prefer contacts over

choice

• If you want to do nephrology and you have a contacts in

pediatrics, apply for nephrology, you will get in

• No contacts? Not a problem.

What you need

• Make a folder (Dow style!)• 10 photocopies of marksheets• 10 photocopies of enrollment card• 10 photocopies of Dow ID card• Atleast 1 photocopy of grade book• 10 photocopies of your NIC• 4 pictures• Printout of colleges where you wish to apply• Blank A4 pages and pen for hands on application

writing

Getting an NOC• NOC – No objection certificate is necessary for 2 reasons• Required by principal to stamp your application• Can you used to forego attendance for allotted time

• Write an application to Dr. Masroor (or whoever will replace him) for NOC. Write an application + enrollment card copy + nic copy + latest marksheet copy

• After NOC is signed by the dean (2 to 3 days), take this noc to the finance department and get a voucher made for an NOC.

• Go to UBL and pay this voucher. • Then submit both the voucher and the NOC with attached

documents to AFTAB• After NOC is ready (1-5 days), get a 2 photocopies

To,Dean of Clinical SciencesDow Medical College

Subject: NOC for electives

Dear Sir,I, Bashir Chabutra, student of final year, Dow medical college, final year roll no: 123, enrollment no. DUHS/D/2222/2007, would kindly request an NOC for electives. My stated elective is for a period of 4 weeks at Massachusetts General Hospital from 22nd July 2011 to 21st August 2011. Attached along is NOC, ID card, Marksheet and Enrollment card.

Thanking you in anticipation,

Bashir ChabutraFinal YearDow Medical CollegeRoll no: 123

Things you may need:

• Dean’s letter of good standing/LOR: Application to principle (ATP)+ ID + EC + Marksheets (M) + Voucher (V) + Aftab• IMED letter – ATP + ID + Marksheet + Shahab• Letter of proficiency in English: ATP +• Consolidated Marksheet: Application +

Photocopy of log book + M + V + ID etc• USMLE Waiver = ATP + Consolidated marksheet +

M + ID etc

Immunizations

• All vaccines AKU

• Atleast 1 month before titers

• All titers Rahila Lab (Mohd. Ali Society)

• Show proof of vaccination

• Montoux AKU or Sindh Lab

• AKU for MMR and Hep B

Malpractice insurance

• Usually worth $1 million required• EFU insurance – Rs. 6500 premium for Rs. 1

Million• Online website• www.academicins.com• http://www.medicalprotection.org/uk/

• (For UK, Singapore, Australia)

Application

• Fill application with all requirements.

• Write application to principal stating you have obtained

or are applying for electives at this particular place.

Attach NOC plus relevant documents to application and

give to AFTAB (0-7 days, depending on his mood)

• Send off your application (Always use TCS or Fedex)

(Dow) Tips

• One NOC is valid for as many applications as you want in that

time period

• If you’re applying to many places at the same time give in

your forms together and ‘bargain’ with AFTAB, get 2

applications signed on 1 voucher.

• Some places require applications from Dow directly

• Buy white large envelopes from photocopy shop

• Get them stamped and sealed by shahab/aftab

• Send them from Dow’s address

Visa• Dr. Ali khan will be talking about visa

Travel Fare

• Your choice

• ISIC – International Student Identity Card

• Up to 30% discount

• Limited seats

• No miles

Accomodation

• University accommodation

• Family/Friends

• Craigslist, beds4meds, sublet.com

• Close to hospital

Transport• Month pass for bus or train

• Usually discount with student card

• Don’t use Taxis

• Walk

• Google maps is a life saver

Setting a good impression

•Study before going

•SOAP notes

•Examinations

Setting a great impression

• Always dress well unless you’re wearing scrubs.

• Carry required instruments

• Don’t be late

• Can I leave? Is there anything else I can do?

• Do weekend and evening calls

• Be friendly and courteous at all times

• PRESENT PRESENT PRESENT

PRESENT PRESENT PRESENT• Present cases – Everyday!

• Start 1 patient, increase daily

• End of week 1, present 5 patients

• Mostly floor

• Don’t get careless or overconfident

• Make atleast one proper presentation

• Topic from Pakistan

• Topic seen in rotation (keep your eyes and ears open)

• Topic you’re good or very interested in.

• Make your presence felt, they should feel your absence when

you’re gone

Usual elective day (Surgery)

• 0500 - reporting time

• 0600 - put in SOAP notes

• 0630 – morning rounds

• 0730 – OT or ICU rounds

• 1600 – OT ends go to ward

• 1600 – 1830 Scut work

• 1830 – Evening rounds

• 1900 – Is there anything else I can help with?

LORs

• Most important

• In-hand or by direct email/letter

• Direct email, more value, but impact required

• LOR FROM ATTENDING, NOT RESIDENTS

• Impress the attending

• Speak up in rounds

• Use your charm

• Create a relationship

LORs

• For in-hand, tell attending about a week before

your elective ends

• For direct email, make your attending write the

letter the day you are leaving

• Give updated CV

Acknowledgements

I would like to thank Dr. Muhammad Ali Khan and Dr. Faraz Khan

Luni was their support and guidance and Dr. Junaid Ashraf for his

cooperation without which this seminar could not have taken

place.