Medical students or junior doctors in the UK may be interested in gaining US clinical experience for many reasons. Unfortunately, many trainees do not know how to arrange these and there is a common misconception that it is difficult to do so.
Why seek US clinical experience?
Career planning
Ophthalmology trainees may hope to pursue a fellowship in the US. While there are many similarities, the US healthcare system is different from that of the UK, and some UK-trained doctors may not feel comfortable working in a different system. It may be attractive to gain short-term US experience to better understand how ophthalmology is practised there before committing to a longer time frame in North America.
Some doctors may want to pursue specialist training (residency) in America. An opportunity to seek advice from current residents and better understand training opportunities available in residency programmes may guide their decision-making. Additionally, the chance to meet ophthalmologists there and gain a letter of recommendation from a US-trained physician may be beneficial to their application for residency.
Enjoy America
Medical students may fancy an elective in certain American cities to experience what it is like to live in a different environment. Tourist attractions, including the Las Vegas Strip, the Grand Canyon, the Statue of Liberty, and South Beach Miami, are all easily accessible in their respective states. Usually, medical electives are at the end of the academic year, and it is attractive to combine a vacation with a learning opportunity.
What are the perceived barriers?
USMLE
Some institutions require visitors to have completed US medical licensing exams (USMLE). Many UK medical students and trainees have not completed this exam as it is not required to become an ophthalmologist in the UK. Not only is it time-consuming to sit these exams with the consensus suggesting preparation for the three exams require more than one year of revision, but it is expensive, with the average cost being over £1000 [1].
Some institutions, including Ivy League schools such as Harvard, Stanford and Yale do not require visitors to sit USMLE exams. Contacting a doctor outside of a teaching hospital and asking to shadow them for a few weeks may be possible. This can be done through cold emails or using websites like AMOpportunities [2].
Funding
Some institutions ask visitors to pay a fee to join them. The average cost of the elective experience itself is between $1000–3000. Institutions may have mandatory requirements to participate in the elective, which leads to additional fees, including application fees, the cost of private vaccinations, and malpractice insurance.
Living in a different country for an extended period of time also involves the additional cost of travel and accommodation. Some institutions may provide this free of charge or connect you with private landlords who lease to students at a discounted rate. Fees can also be reduced by contacting fellow students and sharing accommodation for the duration of the attachment.
There are grants, schemes and scholarships available that may supplement the cost associated with US experiences, including the Royal Society of Medicine elective bursary, Royal College of Ophthalmologists elective bursary, and local medical school bursaries. One website that highlights bursaries available for electives is the Medical School Council [3].
Visa limitations
British passport holders should not experience issues accessing a US visa. Currently, an ESTA waiver is needed to travel, and it is easily completed as an online form.
Some UK medical students or junior doctors may not be British citizens. For passport holders of other countries, a US visa may be required to enter the US and for a hospital to allow them to visit. Typically, a tourist visa (B1/B2) is sufficient for temporary electives and can be gained at one’s local embassy.
How you can gain US clinical experience
Apply for clinical clerkships
Clerkships allow for involvement in patient care and the ability to work with the medical team. These are advantageous to pursue if one is considering applying to US residencies as they offer the opportunity for supervisors to evaluate a student’s performance and write a comprehensive Letter of Recommendation (LOR). An LOR is part of the application process for US residencies, and the LOR content can greatly improve a candidate’s ability to match into a programme. It is important to note that one can get an LOR from other types of attachments, but due to the nature of a clinical clerkship, there is more opportunity to display clinical skills and, therefore, more to speak about in the LOR.
Apply for observerships
Observerships allow you to attend clinics and surgeries without being involved in direct patient care. One can join the medical team during the day on a ‘hands-off’ approach. Many fear that they may not learn a lot through this experience. However, one can maximise learning through: (a) asking questions, discussing exciting cases with seniors, (b) looking at rare operations / procedures, and (c) reading patients’ notes.
The benefits of pursuing observerships include cheaper costs, as these opportunities are less expensive than clinical clerkships, and easier accessibility, as they are more likely not to require USMLE scores.
Apply for research clerkships
Some institutions (especially Ivy League universities) invite international medical students to participate in virtual and / or in-person research. This is particularly attractive if one has lab-based research interests or is interested in participating in a particular doctor’s research. This is advantageous to (a) learn more about a particular topic, (b) gain research skills, (c) publish or present research work, (d) create a stronger application for specialty training in both countries, and (e) create long-term relationships with researchers, as you collaborate on projects that typically extend beyond the official research clerkship time period.
Summary
US clinical electives may allow students to witness and / or partake in unique research and / or procedures they may not see in the UK. One may be able to participate in these experiences without having undertaken USMLE exams or suffering large fees.
Further reading
1. Best electives in the US. The Match Guy.
https://thematchguy.com/electives-us/
2. So you want to be a surgeon: Ophthalmology. American College of Surgeons.
https://www.facs.org/for-medical-professionals/
education/programs/so-you-want-to-be-a-surgeon/
section-iii-surgical-specialties/ophthalmology/
3. How to organise an amazing medicine elective abroad. Backpacking Scrubs.
https://backpackingscrubs.wordpress.com/
2022/01/30/how-to-organise-an-amazing
-medicine-elective-abroad/
References
1. USMLE. The Medic Portal.
https://www.themedicportal.com/application-guide/
studying-medicine-in-the-usa/usmle/#:~:text=
How%20much%20does%20USMLE%20
Step,cost%20you%20around%20%C2%A31073.
2. AMOpportunities.
https://www.amopportunities.org/
3. Elective bursaries. Medical Schools Council.
https://www.medschools.ac.uk/studying-medicine/
current-medical-students/elective-bursaries
[All links last accessed January 2025]
Declaration of competing interests: None declared.
