|Early Career Johnite Initiative (ECJI)|
HELPFUL INFORMATION FOR BEGINNERS
Residency: Refers to the post doctoral training that you do in US, which is similar to the PG training (MS/MD) in India after finishing MBBS. Please understand that MD degree in the US is given to any medical school graduate (similar to MBBS in India) and you are not conferred additional degrees with further post doctoral training in the US.
Internship: Refers to the first year of residency training.
Fellowship: Refers to the specialty training after completion of residency, similar to MCh/DM in India
IMG/FMG: Refers to International Medical Graduate/Foreign Medical Graduate
USCE: US Clinical Experience
Categorical Residency: Getting into a categorical residency position is like getting into MD/MS in India. Some programs like neurology/radiology etc. would mandate that you do a preliminary year of residency (explained below) or a transitional year (explained below) before you start the categorical residency training. However preliminary year has a different implication if you are applying for a general surgery residency. The residents that are already accepted into a 5 year long surgical residency program are called categorical residents. IMGs as well as the less competitive US graduates usually don't get a categorical position in General Surgery residency right away. Most of the IMGs end up doing 1-2 years of preliminary year before they are selected for a categorical position. On the other hand, it is relatively easy for IMGs to find a categorical position in Internal Medicine. The duration of residency is usually 3 years for Internal Medicine/Family Medicine/Pediatrics, 5+ years for surgery, 4 years for most other specialties such as Psychiatry, Neurology etc.
Preliminary year: This refers to a year of clinical training before you enter a categorical residency training. It is somewhat similar to working as a junior house officer in India (before starting your MD/MS in India). Certain training programs like Neurology, Anesthesia, Physical Medicine and Rehabilitation, Radiology, Radiation Oncology, Ophthalmology, ENT etc mandates a year of preliminary residency training before staring the formal residency training. Preliminary year of residency could be in Internal Medicine or General Surgery. Surgical residencies (e.g. ENT) will require that you do a preliminary surgery year while some other specialties (e.g. Neurology) will prefer a preliminary medicine year. Some programs don't care whether you did a preliminary medicine or preliminary surgery year (e.g. Anesthesia). Again as mentioned before, the preliminary year done as part of general surgery residency training has a different meaning. The reason why you would do a preliminary year of surgery before the categorical surgery residency is that you didn't match into the categorical surgery residency position. In this case, you may or may not be selected into the categorical surgery residency program in the following year, however you do the preliminary year of training in the hopes of improving your CV and candidacy in the program for the next year's residency match for a categorical position.
Transitional year: Equivalent to preliminary year as far as IMGs are concerned, but the only difference is that when a US medical graduate does this track for a year, it usually means that he/she has not fully decided regarding pursuing a medical versus surgical residency. The person doing a transitional year is trained in such a way that he/she can pursue either a medical/surgical residency training in the next year. The transitional year is a lot similar to the typical rotating internship that one does in India with exposure to Internal Medicine, General Surgery, Obstetrics and Gynecology etc.
Clerkships: Clinical rotations done by medical students at US medical schools after finishing their first two years of pre-medical training (which includes Anatomy, Physiology, Biochemistry, Pharmacology, Microbiology, Pathology). Thus these rotations are mostly similar to the clinical postings that Indian medical students do after their I/II MBBS exams, except that each medical student in the US will be assigned 1-3 patients to be followed daily until the end of their month long rotation. Most US medical schools allow and encourage international medical students to do clerkships, but the caveat is that this should be done while an international medical student is still enrolled in the medical college i.e., while doing MBBS. One cannot pursue this after graduation from a foreign medical college. Most medical schools in US charge a monthly fee for each rotation, while a few schools don't (you will still be expected to pay for insurance, travel, accommodation etc). As the policies vary with each medical school, the interested international student should directly correspond with the particular US medical school to find out about the exact requirements. You will also need to provide a No Objection Certificate from the Dean/Principal of your medical college. International medical students doing clerkships are allowed to interview patients, do physical exams, case presentations and daily follow-ups of patients.
Electives: Clinical rotations that one does at other medical schools or hospitals either during medical school days or during residency. Thus the above two options are only possible if an international medical student is enrolled in a medical college in India or if he/she is doing residency training in an accredited training program i.e., an international student doing MS/MD in India may be accepted to some US programs for a brief period of time for an elective rotation.
Externships: Clinical rotations which provide hands-on experience i.e., working as a first year resident (intern) under supervision. The IMG works like an intern and does all the work on the floor. The IMG usually will not have the authority to write orders and prescriptions. The IMG is usually expected to be ECFMG certified (i.e., finish USMLE Steps 1, 2CK and 2CS) to pursue this option.
Observership/Preceptoship: While doing an observership, IMGs are only allowed to observe patients. There's absolutely no hands on experience or physical contact with the patient. You are allowed to attend morning rounds, seminars, lectures and case presentations, but not allowed to do physical exam of the patient. Thus externships are always better than observerships, but are very hard to find. On the other hand, observerships are better than having no USCE, although you can get into good residency programs in the US even without having any USCE.
You can do all the above rotations on any visa as long as they are unpaid, i.e., even on a tourist visa, but rules may vary with each program/institution. You should contact individual programs to find out about these requirements. Any paid rotation can only be done on a J1 or H1 visa, unless you are a permanent resident (green card holder) or a US citizen.
Links for clerkships/observerships
Highly recommended: http://www.aapiusa.org/education/observership.aspx
Observer Programs at MD Anderson (only possible while still enrolled in medical school):
Clerkships at Massachusetts General Hospital (Harvard Medical School) http://www.hms.harvard.edu/registrar/app.html
Link for accredited residency/fellowship programs: https://freida.ama-assn.org/Freida/user/viewProgramSearch.do
IMG friendly Internal Medicine programs: http://www.aimcaana.org/detail.asp?ConCatID=150
Link for STEP2CS coaching, accommodation and externship: www.fmgaffordable.com (very expensive)
Savio John (1996 Batch)