|Early Career Johnite Initiative (ECJI)|
Picture Courtesy Dr C Varun Batch 1999
Welcome to the Early Career Johnite Initiative (ECJI) of the SJMCAANA chapter. It gives us immense pleasure and gratification to establish an official platform to streamline the process through which our juniors can obtain appropriate guidance and assistance from the alumni in their quest for a residency/post doctoral training in the US. We hope that this process would eventually be self-sustaining and self-perpetuating, as the juniors who receive our assistance take up the eventual leadership of this initiative to keep this noble mission going. We would like to thank the SJMCAANA leadership, both present and past, as well as the various alumni who provided us the support and encouragement to make this vision come true.
SCORING SYSTEM TO EVALUATE RESIDENCY APPLICANTS
Academics (up-to 25 points)
Number of honors/distinction in pre-clinical years (1 point each up-to 6 points) (Anatomy; Physiology; Microbiology; Pathology; Biochemistry; Pharmacology)
Number of honors/distinction in clinical years: (1 point each up-to 5 points) (Surgery; Medicine; Obstetrics/Gynecology; Pediatrics; Community Medicine/Orthopedics/ ENT/Ophthal)
USMLE Scores: STEP1: 85-90: 1 point; 91-95: 2points; 96-99: 3 points; STEP 2 CK: 85-90: 1 point; 91-95: 2 points; 96-99: 3 points; STEP 2 CS Pass: 1
Research projects: 1-2: 1 point; >3: 2 points; Abstracts/publications (presented/published): 1 point for each, up-to 5 points
Extra-curricular aspects (up-to 25 points)
Interpersonal and communication skills: (up-to 10 points)
Professionalism/conduct & character (up-to 10 points)
Bonus points for extra-curricular activities and other accomplishments (up-to 5 points)
Final score out of 100 (total scorex2)
P.S. Although we have given only 3 points for USMLE scores >95, this is the most crucial part of application to residency programs that is within your control. Most university programs do not give out interview offers for those with scores <92-95, which means that you will be competing only with applicants who have excellent scores in a given program. So aim for 99/99 for steps, which will make things a lot easy for you and us! For those that do not manage to score high, please make sure that you apply early to as many community based programs as possible and try to improve your CV with outstanding letters of recommendation and electives/externships.
Savio John (1996 batch)
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)
USMLE PREPARATION TIPS FROM RECENT TEST TAKERS
Greetings! I am a Johnite from the batch of 2004. Glad to be part of this brilliant initiative by the Alumni. I hope to give you an idea of how to go about studying for the USMLE Steps. I will list out in detail how I went about preparing for the Steps. Please do talk to other seniors as well because there are many different methods out there which have worked well. Listen to many seniors and make an individualized schedule. Individualized planning is most important. The following is what worked for me. I gave my Step 1 in September 2010, Step 2 CK in January 2011, and Step 2 CS in March 2011.
First, I will try to address some common initial questions.
I started to prepare for the Steps only after Internship. I was not working anywhere and could dedicate a lot of time for preparation. As far as I know, this is how it has been happening in John’s. In other colleges however, many students give their steps during MBBS (usually Step 1 in early 2nd year and Step 2 CK in 3rd year). While this is definitely possible, my personal opinion is that it is very difficult to manage MBBS exams, extra-curriculars, and research (I think research has caught on big time among students and is very important) and at the same time, get a good score in your USMLEs (you should aim for 99, it is not that difficult). If you know anyone who did manage to give the exams during MBBS and got good scores and think you can do it please do take their advice and give it a go.
To Kaplan or not to Kaplan:
This depends on a lot of factors. At Kaplan, they show lecture videos and provide notes. They also conduct good mock tests and have people to readily clear doubts about the exams, visa etc. The last time I checked (2010), they charged around Rs. 60,000 per Step (Step 1 and Step 2 CK). For this, you get a place to study and a chance to interact with other USMLE aspirants. However, if you are confident of studying yourself or if you have company for combined study and a good environment to study in, joining Kaplan may not be necessary. You will need the Kaplan notes and videos though. They are essential, especially for Step 1.
For Step 2 CS, the Review course by Kaplan in the US is highly recommended by many. It’s a 5 day course followed by a mock exam. In 2011, it was around $2400. Again, if you have a partner to practice cases with (preferably someone also preparing for the exam), it can be done without Kaplan.
About the exam:
This exam tests you on 1st and 2nd year subjects: Anatomy, Physiology, Biochemistry, Genetics, Pathology, Microbiology, Immunology, Pharmacology and Behavioural Science.
It has 322 MCQs, administered as 7 blocks of 46 questions each (1 hour per block). You will have a TOTAL break time of 1 hour which can be used between whole blocks. This exam is given at a Prometric Center in any major city in India.
Step 2 CK (Clinical Knowledge):
About the exam:
This exam tests you on clinical subjects: Internal Medicine, Surgery, OBG, Paediatrics and Psychiatry.
It has 352 MCQs, administered as 8 blocks of 44 questions each (1 hour per block). You will have a TOTAL break time of 1 hour which can be used between whole blocks.
The questions in Step 2 CK are longer than Step 1 and are usually cases. They often times give the diagnosis at the end of the case description and ask what should be done next. The focus is more on clinical aspects. This exam is given at a Prometric Center.
Step 2 CS (Clinical Skills):
About the exam:
In this exam, you essentially have to take cases. There will be 12 standardised patients (actors). You have 15 minutes to take a history and perform a focused examination following which you will have ten minutes to write/type a patient note (from July 2011, only typing is allowed). You are then scored by the actor based on your history taking, examination, bedside manners, professional rapport, english proficiency etc. and your patient note. More details about the exam are given well in First Aid and USMLE and USMLE World websites. This exam can only be given in the US – Atlanta, Chicago, Los Angeles, Houston or Philadelphia.
My Study Plan for Step 1:
I started in April and gave the exam in September. First, I read the following books and watched video lectures after reading each topic:
Anatomy (low yield; the amount of material is disproportional to the amount of questions asked. Do not get stuck with this and spend too much time): Kaplan notes; High yield – Embryology notes
Physiology: Kaplan notes; Kaplan videos
Biochemistry & Genetics: Kaplan notes; Kaplan videos
Pathology (most important, very high yield, for step 2 CK as well): Goljan Rapid Review; Goljan Audio Lectures
Pharmacology: Kaplan notes; Kaplan videos (must watch)
Microbiology & Immunology: Kaplan notes; Kaplan videos (especially important for Immunology)
Behavioural Science: Kaplan notes; Kaplan videos
Following this, I read First Aid for Step 1. It’s a very good review book, focusing on important information and concepts. After that, I did what I believe helped me the most. USMLE World (www.usmleworld.com) is an online Question Bank of about 2000 questions with good discussions. I subscribed for a 1 month period and did ‘random’ block tests till all questions were covered. This took about 20 days. Questions that you want to revise again can be ‘marked’. I did these marked questions for the next 10 days. 1 month Qbank subscription + 2 self-assessment exams of 2 weeks each is $130.
Always make notes of the things you want to read again. Take notes of flowcharts or tables from USMLE World when possible(USMLE World disables your clipboard for copyright enforcement and it’s not easy to copy paste anything or take a screenshot). The week before the exam I went through the notes I had made, the pictures and a little of First Aid as well.
Remember, Step 1 is very concept based. If you get the concepts in you can work backwards and derive the right answer from the choices most of the time. There is no negative marking. Common sense and educated guesses can go a long way.
How to evaluate yourself:
If you consistently score 65% correct answers on your USMLE World tests then you’re well on your way to a 99. Their self-assessment exams give you a score and are quite good.
A more conventional assessment tool is the NBME assessment exam (https://nsas.nbme.org/nsasweb/servlet/mesa_main). They will provide you with a score but without answers or discussions. So this is more for satisfaction purposes. Taking this assessment too close to the exam when it’s difficult to change your exam date may work against you in case you happen to get a low score on the assessment. So take it with adequate time to spare before the exam.
My study plan for Step 2 CK:
I started in October 2010 and gave the exam in Jan 2011. Like in Step 1, I started with Kaplan notes. I did not watch the videos. The material is less compared to Step 1 and can be covered fast.
Following this, I read ‘Step 2 Secrets’ by Adam Brochert. It’s a good book but I don’t think it was necessary. This book can be skipped. The main resource I used was USMLE World. This time I took a 2 month subscription + 1 self-assessment exam for 2 weeks ($145). I Proceeded as I did in Step 1. The evaluation I followed was also the same.
My study plan for Step 2 CS:
The key to this exam is practicing with a friend (preferably one who’s also preparing for the exam). First Aid is a very good book for CS. Follow First Aid well and practice. Bedside manners, knocking before entering the room, making eye contact, introducing yourself, draping, showing empathy are important, as is good communication with the patient and asking permission each time, while being pleasant and speaking confidently and slowly. All this is well highlighted in First Aid. USMLE World also has good cases to practice and clinical examination videos which can be helpful (1 month subscription is $50).
I hope this helps in giving you an idea of how to plan your preparation. If you have any doubts, you can contact me by email. All the best!
List Of Scholarships for Indian Students
The Clarendon Scholarships http://www.clarendon.ox.a c.uk/about/
The Exeter K. Pathak Scholarships http://www.exeter.ox.ac.u k/documents/studentships/
The Rhodes Scholarships http://www.rhodesscholars hips-india.com/
Oxford funding search tool http://www2.admin.ox.ac. uk/studentfunding/awards/ search.php5
External scholarship schemes for Indians:
The Commonwealth Scholarships http://www.britishcouncil. org/india-scholarships- commonwealth.htm
The Felix Scholarships http://www.britishcouncil. org/india-scholarships- other- scholarships.htm#oxford- cambridge-society
The HSBC Scholarships http://www.hsbc.co.in/1/2/ miscellaneous/about- hsbc/hsbc-scholarship- programme
The BP Scholarships http://www.bharatpetroleu m.com/scholarship/scholar ship.asp
The Oxford and Cambridge Society of India – http://www.oxbridgeindia.com/
The Narotam Sekhsaria Scholarships http://www.nsscholarship.net/
The Overseas Research Student Awards http://www.orsas.ac.uk/
The Dorothy Hodgkin Postgraduate Awards http://www.rcuk.ac.uk/hodgkin/default.htm
The Exeter K. Pathak Travelling Fellowship Exeter College Oxford OX1 3DP UK
Dr. Michelle C. Fernandes
For more Infomation about these scholarships see the link below
For Juniors who aspire to go to Singapore
Let me introduce myself, Im From Batch of 1997 (UG) and MS Ortho (2006),currently working in Singapore
At the outset I would discourage any Johnite Post MBBS to take this Route,for a simple fact that the system is undergoing a great change.Till 2009 they were following the UK based system where Students after House officership/Internship would become Medical officers in rotation for 6months each in their chosen departments,in due course they would be applying for BST (basic specialist training) once you exit from BST would need to Go for Advance specialist training (AST) ,This was the system till 2009-10.
Now they have adopted the American system and started the Residency program which will take off in a Phased Manner first batch set to Join in May 2011.
This year Residency results were quite disappointing only few foreigners were selected,that too for less competitive specialities like Geriatric Medicine, Rehabilitation Medicine.
Here they are in need of people but not for training posts they need at service level, so you should be extremely Lucky to Get into Training with the present Circumstances,where they are mainly taking the locals,followed by perminant residents.
The requirement is such that i applied for Paeds Ortho fellowship but The HOD asked me to Take up a service job where i will be given privileges of a fellow.
Further more its a very small country so naturally oppurtunities are limited.
Having said this If somebody still wants to come in i would say try for 2 years and after that its not happening then try alternate routes.Its Ok after post PG if you come in and work for 1-2 years it will be counted as overseas experience.But Post MBBS its a big gamble if you dont get placed then its kinda of waste of precious time.
However we need to see and asses for 1-2 years more to form an opinion because the Residency programme is still in its Phase 1 so once its fully operational a better clearer picture would evolve. But as of now its a big gamble for interns to take this route compared to USMLE.
Hope this was useful and clear for the students who are aspiring for a career in Singapore
Further,should you need any more clarifications you may reach me on
+65- 91133917 willing to assist any johnite who needs help
Kind Regards Sumanth
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.
4. My uncle has a private practice in the US and has offered to allow me to do an observership with him. Should I take him up on his offer?
It is always better to do an observership in a hospital setting. That way, you could learn much more by virtue of being exposed to the educational program of that hospital. In addition, you get to network more, understand the system better, and make yourself a better candidate for the residency match. However, if you find yourself in the US without a hospital-based observership in hand, by all means, do join private practitioners in their clinic. If nothing else, you would be able to learn the style of how to communicate with patients (which is extremely different from the way we do things in India) as well as with ancillary staff in the ‘American way’(which is also a very, very important skill to learn). It would be a good opportunity to get to know and imbibe some aspects of the culture here, which would help you communicate better – all of which will shine through during your interview, and even while you do your residency in future.
5. Macha! I have secured an observership/ externship at St. Janardhanan’s Hospital in Springfield (…). How do I best go about making good use of it?
Congratulations! You have managed to get your toe (not even foot) in the door. You must first of all be clear about what you should get out of this opportunity. First off, you should be able to get a Letter of Recommendation from a US based physician at the hospital where you have got in. This Letter of Recommendation would be used at the time you apply for interviews. All those who apply for the interviews have ‘good’ letters of recommendations. You need to get a SUPER-DUPER one that really stands out. In order to get this, you need to exceed the expectations of the supervising attending. This gets harder year after year, because each year these attending come across candidates who are equally driven to perform…
BUT, I’m just an observer, what can I do??
Number one: Be keen to learn, and participate in rounds. If you are asked to present a case, make sure that you know each and everything about your patient. You should even have his lab values down pat. Your presentation should be clear, coherent and concise. Most importantly: your THOUGHT PROCESS and REASONING should be logical, sound, and should make sense. You SHOULD have differential diagnosis, and you should also know the reasons why you would favor one diagnosis over your differentials. You should read up about the management of these cases (No relying on textbooks here – many textbooks are outdated by the time they are printed.) You should pull out the latest review articles and guidelines about the management of the particular condition, and be able to briefly talk to the treating team about these guidelines (Guidelines? Review Articles? Journals? – How do I do this? Well, if you think that PubMed is a popular Bar where Doctors go to booze, you have a long way to go, and could even think of reconsidering the path you have chosen). Even if you are not asked to take a case and present it, you should read up about every single case that you come across, and have the management and discussion at hand (or in head), so that if the attending/ resident asks you for ‘your thoughts’, you would have something concrete to talk about, and thus ADD TO THE KNOWLEDGE POOL of the treating team. Of course, it goes without saying that you should not make yourself look like an obnoxious know-it-all; you are there to discuss, not to dictate. In addition, you are allowed to disagree (pick your battles), but NEVER make the resident/ intern look bad in front of the attending – you will earn their wrath, and negative feedback from them to the attending, would torpedo your chances of a good letter of recommendation from the attending.
If you come across interesting cases, volunteer to help write them up as case reports. Of course, you would have to include the names of your attending and resident in your case report. This way, you would learn a lot about the particular disease condition, you would have proof of your productivity, you would increase your standing with the attending, and also have something more on your CV that you can brag about during interviews. In recent history, a particular Johnite managed to write up and publish three case reports during the course of an observership – needless to say, this helped considerably during the interview season.
ALWAYS BE PUNCTUAL, well-dressed, diplomatic, amiable and do not get involved in the politics that you might have around you. The importance of punctuality cannot be over-emphasized. The ‘chalta hai’ attitude must be left behind. Attend all the teaching sessions that you can, even if they might be a little boring. You will learn something new, and you never know when that would come in handy.
6. Should I pay for an observership/ externship?
This differs from place to place. Some training hospital do require a fee for the processing of your papers; some don’t. However, a rule of thumb is to stay as far away as possible from companies who offer paid observerships/ clerkships/ externships (‘Americlerkships’ is one such company). This is because program directors often do know that the letters of recommendation that you procure from such ‘corporate’ paid-observerships would not be an accurate representation of your performance. Physicians enrolled in these programs would go out of business if they were to ever provide any candidate with a ‘bad’ Letter of Recommendation, and so would provide only good ones. The credibility of their letters is therefore dubious.