|Early Career Johnite Initiative (ECJI)|
OBSERVERSHIPS and EXTERNSHIPS 101
1. What’s the difference between an Observership and an Externship?
When you do an observership, you can only ‘observe’ a physician (or a group of physicians) as they interact with patients. You might be given limited computer access to go through patient records (Lab values, vital signs, radiology/pathology reports, etc.) but you would not be actually able to directly put in any orders, or do any procedures (even minor ones, like placing an IV line, or doing an ABG – even if it is under supervision). In some instances, you may be able to speak to the patient on your own, and probably do a basic physical examination – but these would be under direct supervision of the attending/ resident in-charge. You are not officially allowed to present the cases that you see during rounds – though in some settings, you may be asked for your thoughts/ extra input about interesting cases.
An externship is also called a sub-internship in some places, and this allows you privileges similar to those of medical students, i.e. you have the freedom to interview and examine patients (after introducing yourself), may be able to put in orders for basic lab investigations, and can perform minor procedures (Really minor ones) under supervision of a resident/ attending. You could also be allowed to put in a note in the patient’s chart (which would nevertheless have to be reviewed and co-signed by a resident), and even present the case during rounds.
Observerships are generally done by those candidates who have completed their medical degree. In our context, this means that this is the option for those who have completed their internship.
An externship/ sub-internship is usually done by those who are still medical students. In the Indian context, completing medical school means getting one’s degree in hand; this means that one would have to complete internship for the same. Hence, being an intern in India, one is still considered to be a medical student, and such a person can still apply for an externship in the US.
2. Why is it easier for a medical student to get an externship, and why is it so difficult for a medical graduate (Those who have already completed training) to get one?
When patients are admitted to training hospitals in the US, they sign a document stating that they understand that they may be seen and examined by medical students and other trainees during the course of their hospital stay. In case of any legal issues, there is only a limited case that can be brought against trainees; the hospital would not need to spend too much of its resources in defending someone who is in training – they are bound to make mistakes – they would instead have to defend the supervising attending.
However, a medical graduate is already technically a doctor, and is not supposed to be making mistakes. Defending them is going to be an extra hassle for the legal department of the hospital, and would be difficult, especially for those doctors who are not yet certified to practice in the US (Read: Not yet ECFMG/ Board certified). So, to minimize the risk to the hospital, they prefer to keep such people ‘hands-off’, so that they would not be liable for their actions.
3. How do I go about getting an observership or an externship in a hospital setting?
Many reputed training hospitals and universities have externship or observership programs already in place. However, there is no exhaustive list of such programs yet. The best way to go about finding such an institution would be for you to first decide which part of the US you are going to be based in, and then write to each and every hospital in and around that place, along with your CV (Note: A shoddy CV would kill your chances), USMLE Scores (if available), and a list of referees. Bear in mind, that there are hundreds of medical students and graduates applying all over the country for such positions, and that you may be placed on their waiting list. So, it is best to apply early, and apply as far and as wide as possible.
The ECJI does try to help junior Johnites secure externships/ observerships, but we are still not able to guarantee this to all who seek our help. If a Johnite is an attending or a resident at one of the places where you are applying, the ECJI could try to put both of you in touch, and most senior Johnites are happy to put in a word at the program to improve your chances of being selected to do your externship/ observership. Again, it is not a 100% sure that they could pull you in, and you would need to do a lot of scutwork on your own as well. Google around for the latest information, and use every single contact that you might have.
Note: A shoddy CV that is difficult to read, riddled with grammatical errors and typos, as well as a poorly worded covering letter would DESTROY your chances of getting an observership/ externship. The St. John’s Career Guidance Cell is an invaluable resource that has excellent guides who are willing to take time off to help Johnites create a CV. It would be totally unacceptable for a Johnite – with this great resource at hand – to come up with a poorly formatted CV. It is not personal, but if you were to email a bad CV to anyone asking for help getting an observership, this might lead that person to think that you are a person who lacks drive, and who has a lackadaisical attitude to life; you run the risk of being ignored, or even worse, blacklisted.