Everything you need to know about Electives & Observership

What is meant by elective?

  • The elective is a training period spent in a hospital in America. You could apply while you are still undergraduate but not after graduation.

Which is better elective or observership?

  • The elective is Hands-on Experience which means you can deal with the patients, take a history, do a physical examination and participate in treatment plans and if you were in surgery electives you could participate as an assistant. Observership is Hands Off which means you can't touch the patients. You literally just watch but still better than nothing. And therefore, the electives are more valuable when you apply for the Match.

How could I find the universities that offer electives?

  • Almost all of the universities in America have elective programs. You can enter the university website you want to travel to, and search what are their requirements, application fees and when is the application process. Most people will start searching in the big names such as Cleveland Clinic, Yale, Mayo Clinic, MGH, UMass, Johns Hopkins, UCLA, UAB, Baylor, MD Anderson

  • There was a website called http://electives.us/ but the website is currently not updated but still a good place to start as it has most of the places that offer Electives Program

  • Check if your university is participating in the Global Health Learning opportunities: GHLO.

  • Through paid agencies: AMO opportunities, FMGFMGFMG portal, ACE,

Required papers?

  1. Evidence of some vaccinations or Titers: https://goo.gl/IyBYuE

  2. Personal photo and passport photo

  3. - Letter of Good Standing: https://goo.gl/75p2BW

  4. - Academic Transcript

  5. - TOEFL - Some places do not require TOEFL and only a paper proving that you have studied medicine in English Waiver: https://goo.gl/HDWDpo

  6. - Malpractice Insurance from here: http://www.ampirrg.com

  7. Health insurance.

How much does it cost?

  • There are two types of fees that are paid to universities Application fees and Tuition Fees Some universities require one of them. Others require both., the cost varies from hospital to hospital and from state to state so if you live in an expensive city like Boston you will find expensive rent. If you are in a cheap city like Birmingham. It will be less than that, But on average, you can get 500-600 dollars for a room, Food 150-200 dollars a month And you need to balance between a cheap and remote place and a nearby and expensive place

How to find housing?

  • - talk to someone you know - On https://www.airbnb.com/ - On Craigslist but you need to be careful - On https://rotatingroom.com/findRoom.php - ask the hospital for housing list if they have - If you got stuck, search a hotel on booking.com for two days till you got to the mosque and you might find many places available there. All that you need is to establish connections.

How to gain the most of an Elective?

  • - Try not to get elective for just one month only as it will take a while until you understand the system, break your fear of English and deal with the patients you will find that the month has ended. - Always send to the doctor you gonna be working with to ask him about recommended readings to help you understand most of the cases you gonna see and get exposed to. It will make a big difference and the doctor gonna see that you are hard worker not just here to be lazy - try to be the first one to arrive and the last one to leave so that doctors know that you are a hard worker and write a good LoR for you - Work on the weekends especially if the Doctor who you will be working with is on service for one week. - Always try to participate in the discussions and if you do not understand Ask. You might meet students in the Elective already had 20 electives before and may have more information than you. So you need to ask and discuss and show that you really want to learn - If you don't ask for extra work no one gonna offer it for you or ask you to do something. They were working without you and gonna continue working the same after you leave. You are just a guest for 1 month. If your supervisor gave you one case, ask for more. Offer to help the residents on weekends. - Read about your cases and discuss them with your supervisor. - Always ask your supervisor about his opinion of your performance and how you could improve yourself. - always try to meet the Residency Program Director and the Chair of the department to know what they are searching for in the Applicant and get their opinion about your CV as a Career Counseling

If I meet the Program Director what questions should I ask?

  1. How many applicants do you get every year?

  2. How many do you invite for an interview?

  3. On which bases do you pick people for interviews?

  4. How many do you take into your program?

  5. How do you define a good applicant?

  6. Do you have a specific cut-off USMLE score?

  7. Do you think I should apply ASAP or do you recommend doing some research fellowship first?

  8. How competitive is getting a research fellowship position here?

  9. Does it make any difference whether the LoR is old or new?

  10. What type of Visa do you sponsor for the matched applicants?

  11. What are the things I should stress on in my CV and what should I dismiss? And always try to get a printed copy of your CV to get his opinion.

How do I request a LoR?

  • You have to work hard to deserve to ask for a good personalized LoR.

  • ask all doctors who you worked with them long enough. You won't lose anything. But don't go ask a doctor you worked with him for two days.

  • You will meet doctors with limited time if you asked him many times and he doesn't care,

  • don't ask anymore (have dignity 😅) at that moment if he writes it, he gonna do this just to get rid of you and it's gonna be a terrible LoR

  • There’s a big difference between nagging and reminding your supervisor. If you asked for a LoR and the doctor said that he is okay to write you one and he is satisfied with your work. He might not write it for 2 weeks. He didn't neglect you. He is just overwhelmed with many tasks. Send a nice email saying that you know that he is busy and you are offering help if it is applicable.

  • Always give your CV to the Doctor when he agrees to write you a LoR. He might find something unique and add it to your letter making it a strong personalized LoR.

  • make an ERAS Account and let him upload it waived for you. It's more valuable.

  • Opportunities for electives?

  • Good chances if you meet all the requirements.

  • The big obstacle is always in Step 1 and the TOEFL


"How to make the best out of your rotation (Obsie/Elective)?"

This is the time that most of you apply for observerships and electives. But, the entire process doesn't end with getting a rotation. It is important that you all put forward your best version and gain a reasonable letter of recommendation and if possible, future contacts.

I have noted down the most common questions that I frequently receive from fellow applicants and drafted them here.


Q. I have received my rotation confirmation and I start soon. What can I do in the meanwhile for a favorable impression? THINGS THAT ONE MUST DO BEFORE THE START OF THE ROTATION

Be in touch with the person who you have received the rotation confirmation from and get the contact of the attending who you will be rotating with. Get in touch with them.

Stuff you need to ask in advance or on your first day of rotation- 1. Inform the attending who you are and tell them you would be rotating with them with the specified dates. Ask them if there is anything required of you to do prior to your start date.

This will prepare the attendings to expect you on the first day. Will save a lot of confusion and creates a good impression, trust me.

2. Ask if there are any preparatory materials that you can go through before the start date of your rotation.

This will give them the impression that you are eager to learn. If they don't end up suggesting any specific study material, they will tell you what cases to expect out of your rotation. Most times, they do have study materials they provide with but only if specifically asked. [In my Hem/Onc rotation, after I requested for appropriate study materials, I was provided with important research articles in both hard copy and soft copy. Another student who was rotating with me hadn't requested it and didn't know anything about that until I told him the other day.]

3. Find out when you are supposed to report for your first day. Mostly, it would be mentioned in the offer letter and some self-scheduled observerships don't have it. Be ON time.

(***Some institutions allow email contact with your attending prior to your rotation start dates and some don't. If your institution where you have the rotation scheduled doesn't let you do that, you need to ask in person when you start on your first day.***)

Other than that: Go through the topics of that specific sub-specialty in which you would be rotating. --- revise your step 1 notes. Basics are tested a lot. --- go over your CS patient case mnemonics.


Part B Q. This is my first day of the rotation, what do I do?// THINGS TO DO ON YOUR FIRST DAY OF ROTATION

If you haven't been in touch with your attending, go over the Part A stuff.

In addition to that - 1. Discuss what your duties and responsibilities are: Ask them what they expect out of you. Only if you know what you are supposed to be doing, you can give your best.

2. Discuss the attending's approved Patient case presentation format: Ask how they like the case to be presented; some prefer a long version, some like to have a short 2 min version, and some prefer more focus on the management part So, know who you are presenting the case to

3. Know when to arrive and when you leave. Always be early. I can't stress this enough. ALWAYS. Not just early than your attending, but also the other staff members. [In one of my rotation, the head staff nurse is well known to be early, and I used to be early than her. She talked about this to my attending and told him how I am always before time.]


Part C Q. What can I do during my rotation period to have the best results?// THINGS TO DO DURING YOUR ROTATION

1. Most importantly, Tell the attending your career plans on how you are planning to apply for the residency match and that you are looking for a letter of recommendation at the end. (This is best done in the 1st week of your rotation. Plan it out.)

If you inform them earlier, they will pay attention to you and observe if you have what it takes for them to write a letter. At the very least, you will have their attention.

2. Talk to your residents. Talk to the other staff. -- Let them know who you are and politely ask for guidance. -- Ask for pointers from your residents. Be friendly.

3. Know the Names of all the people you get in contact with: especially the attendings, residents, any person. It will be later on easy to get contacts.

4. Actively, ask if you can do a ppt or oral presentation at the end of your rotation or in between. Take all the chances.

5. Take the initiative to write 'patient notes'. And, get feedback. Don't use any templates. Make your own.

6. Present your own cases. Doesn't matter if you didn't personally do the physical examination (as an observer you can't). But, request to present your own cases.

7. FEEDBACK. Ask for feedback weekly or bi-weekly depending on how your attendings change shifts.


***TIPS for a good Patient Case Presentation***

Most of the attendings expect this out of your case presentation:

S = subjectivity : What did the patient present with// chief complaints

O = objectivity: what did you find in the patient// pertinent findings and physical examination (for physical examination follow CS exam terminology)

A = assessment: a short summary in 2-3 lines which includes S, O and your Dx

P = plan : what is your management plan// treatment

In the end, add - specific concerns of the patient - any social issues to be taken care of - any follow-up issues to be kept in mind

[This is what I summed up after my rotation experiences, there can be variations]


***TIPS for a good ppt/ oral presentation***

-- Choosing the topic: Choose a topic that hasn't been presented recently. Ask around what topics have already been presented in the last few months. Discuss your chosen topic with your attending and ask if it has been presented.

-- Use research articles as references for your presentation, so that you have the latest information.

-- Include the 'basics'. If you are having a talk on the latest advances in CML, talk about the disease and the epidemiology before you go into your actual topic.

-- *Have printed copies of the 'references' you used for your presentation and give it to the people attending your presentation.*


Q. When is the best time and HOW to ask for a Letter of Recommendation?

During the mid-end of the rotation (3rd week) would be an appropriate timeline. Never do it in the end when you are leaving in a day or two.

How - Fix an appointment with the attending who you want to request a Lor from, other than during the usual clinic/hospital patient care timings. (It is better if it is the same attending who you have frequently asked for feedback during your rotation and talked about your career plans with as suggested in part B)

It is rude to ask up front while you are among many others. At least, make sure yourself and your attending are the only people there when you raise this topic.

Have your CV polished, a printed copy and also a soft copy ready to send an email.

It's always better to keep a note of what cases we see every day. (Literally noting down in a book - avoid names, MRNs for HIPAA. ) My attending after 4-5 months of my rotation asked me to send a list of cases that we cared for together since that enabled him to write a specific personalized letter (in his opinion).

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