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What to Expect During U.S. Clinical Experiences

/What to Expect During U.S. Clinical Experiences

What to Expect During U.S. Clinical Experiences

2018-01-19T00:43:10+00:00

U.S. Clinical Experiences (USCE) at AmeriClerkships Medical Society (AMS) are reserved for active members (either medical students during their vacation times visiting the U.S., or medical graduates in between graduation and start of residency) who are looking to do good for the community at large as clinical volunteers, or are looking to strengthen their commitment to a particular field of medicine by securing letters of recommendation or to improve their chances of securing U.S. residencies. AMS members completing a USCE are not expecting a medical institution to issue credit for the clinicals they just completed (i.e. not for-credit), nor shall their supervising physician require such members to do anything that could be interpreted as the practice of medicine without a license (which is different for each state; simply Google search “practicing medicine without a license in [type in state of your USCE]”  before you begin your USCE).

Please note that:

  • All AMS Certified USCE are insured with professional liability insurance ($1/$3 million), supervised by AMS affiliated U.S. licensed physicians, and set up so that AMS members can see how their licensed supervisors practice medicine in the United States (instead of AMS members being the ones who practice medicine), AND;
  • Conducting USCE as volunteers does not forfeit your rights to post-clinical evaluations or soliciting letters of recommendation by your supervising physicians, AND;
  • There are several U.S. jurisdictions which have limitations placed on visiting rotations by medical students attending non-U.S. accredited Medical Institutions, and medical residents crossing state borders for practice of medicine, and it is every medical professional’s (medical student, graduate, resident or doctor) responsibility to remain in compliance with State Medical Board (SMB) rules & regulations for clerkships and future medical licensure. Furthermore, each AMS member is responsible for securing any needed documents from AMS in order to share with his/her medical institution for permissions or credits, and to allow the medical institution to obtain any necessary permissions from individual SMB (since SMBs will only work with Students or Medical Institution for school approvals & Clinical authorizations, and not AMS) prior to any start of clinicals with AMS. Enrolling with AMS does not alleviate an AMS member’s obligations and responsibilities to remain in full compliance with any state medical board and their medical institution’s policies. Please click here for more details.

Prior to the Start of Your USCE

Begin familiarizing yourself with the medical specialty that you’re assigned to by clicking here. Make sure that you receive your welcome package (mailed to a U.S. address you provide us; email your NCC if you haven’t received it by week prior to your start), which amongst other items will contain your specially sized AmeriClerkships embroidered short lab coat; wear this lab coat and dress business formal at all times during your clinical blocks unless instructed otherwise by your attending. The clinical block(s) you enrolled in will become fully approved and confirmed again once you become Fully Enrolled Certified (FEC). This is also the time that your AMS National Clinical Coordinator (NCC) will contact and introduce him/herself to you as he/she is responsible for the implementation of what you enrolled in with AMS (as outlined in your invoice), and to start you on time. Your NCC is also responsible for emailing (or calling in) your final confirmation to you at the “time of highest confidence“, meaning the time when to the best judgment of your NCC, your clinical location has the least likelihood of changing – which could be as late as the Friday before you begin.  Your confirmation email will contain the name and contact information about your attending, where and when to show up, and any other information that is unique to that site.  You can also view your individually confirmed clinical blocks online via MyClinicals (requires Last Name & Confirmation Number), and search surrounding points of interest (i.e. shopping, airports, rental cars, rental apartments, etc). Lastly but not least, make sure that you have viewed the AmeriClerkships orientation webinar.

Can changes occur? Possibly; your NCC will discuss unusual situations and all options with you in case of an unexpected emergency. But not to worry, as your AMS team is in most cases prepared, and typically has back-up clinical sites for most members. Possible unforeseen changes are also the reason why your NCC wait as long as we can to send out final confirmations (i.e. “time of highest confidence”, such as the Friday before you begin). If a change is initiated by you, then we will do our best to accommodate, but can not guarantee that we will be able to change your original scheduled clinical block(s) since all clinical blocks are scheduled sequentially, so a change made by you will affect future scheduled members at those same clinical sites. For AMS policy on changes, please click here and search for “Changes”.

The Start of Your First USCE Week

Follow the instructions on your confirmation email about when, where and what time to start your first day. Attending physicians are reasonable, but you must make it easy for them to see your commitment to your scheduled clinical block. Start with an open mind, and let your attending know that you’d like to see and experience EVERYTHING that this clinical block has to offer, including late night admissions and multiple hospital visits. Your first location may not be the same location as your future meetings with your attending. Each physician is different, but he/she will most likely quickly evaluate your ability to function within that clinical setting by having you follow them with little to no responsibilities during the first few days. The quicker you learn and adapt, the higher the physician’s expectation of you will be. Don’t ever be late, and always have your own transportation. If you’re visiting the U.S. from abroad, then secure your international drivers license so that you don’t miss out on any clinical experience opportunity, such as witnessing late night admissions or visiting multiple clinical sites/hospitals across town where public transportation is unavailable or unsafe or time consuming. Do not ask for a letter of recommendation until you have seen your clinical evaluation in your final week; otherwise you may risk upsetting the attending and making him/her feel like you’re using them for a recommendation letter, instead of obtaining the clinical experience to show your commitment for that specialty. Again, please review the AmeriClerkships orientation webinar for more details.

During Your USCE

Although each clinical experience is unique, the following is an outline of what our volunteer members can expect to experience, and be encouraged to master during each USCE clinical block:

  1. Professional Qualities and Adaptability: integrity, tolerance, confidentiality, punctuality, reliability, teachability/learnability, bilateral acculturation (accepting U.S., as well as incorporating home culture), initiative, participation, teamwork, receptivity to feedback, mindfulness, dedication;
  2. U.S. Medical Knowledge: basic medical sciences, clinical sciences, access to medical education resources;
  3. Familiarity with U.S. Healthcare System: U.S. culture, HIPAA, insurance, formulary, medico-legal, interdisciplinary healthcare system;
  4. Clinical Skills: Medical Histories
    1. Example of Activity: initially broad inquiries followed by specifics as indicated by Chief Complaint (CC) and History of Present Illness (HPI); rephrase patient responses or offer similes to clarify inadequate answers; sequentially question associated symptoms and pursuit of associations which may not be intuitive; thoroughly explore all risk factors; selectively use of followup questions with deeper probing of critical information; clearly organize patterns of questions from general to specific. THEREFORE with your supervisor in the room and with a patient’s permission you can speak with the patient and write notes (not in patient chart), but you can not conduct a physical exam.
    2. Note: You may discuss findings from the supervised patient encounter with the physician and discuss differentials, but you must never be the one who conducts any physical exams as this is the job of a licensed professional. A physical examination is defined as an evaluation of the body and its functions using inspection, palpation (feeling with the hands), percussion (tapping with the fingers), and auscultation (listening). A complete health assessment also includes gathering information about a person’s medical history and lifestyle, doing laboratory tests, and screening for disease.
  5. Communication Skills: written and spoken English proficiency; patients and families (Strong: Consistently confirms that understanding is clear by repetition, soliciting questions; explains any medical terminology used; always respectful in addressing; genuine effort to understand and respect diverse beliefs and attitudes); with colleagues, nursing and ancillary staff;
  6. Information Technology Skills: electronic medical records, information retrieval (clinical data and reference material);
  7. Presentation Skills: patient and educational presentations, case updates, rounds, discharge, admission,
  8. Included Comments: observations or information that the physician believes would be of value to those who may be assessing this applicant as a potential residency candidate.

At the End of Your USCE

Unless another type of clinical evaluation has been provided to us by you or your medical institution, AMS will email a Post-clinical evaluation to your supervising attending physician that is based on the 6 ACGME Core Competencies. Please click here to familiarize yourself with this helpful table.

Most-all AMS members participate in USCE in order to experience how care is provided to patients in the United States, and to hopefully secure a letter of recommendation that documents their overall performance on the above mentioned competencies. In order to ask your mentor to willingly recommend you to residency, make sure that you do as follows:

  • Follow the above recommendations
  • Earn your LOR, meaning you should put all that you have in performing genuinely and to the best of your abilities
  • Midway through your USCE block: print this page, and ask the attending to give you verbal feedback on the above competencies
  • Toward the end of your 3rd week: ask the attending if its okay for them to complete the AMS clinical evaluation of you in person, next week some time
  • Last week of your USCE: if your attending evaluated you well on all competencies, then ask them if they can support you in your pursuit of residency by writing you a letter of recommendation. Give them a copy of your AMS prepared CV, and ask them to email you a draft copy of the LOR so that you can have your Advisors at AMS analyze it for you (Letter of Recommendation Analysis). Ask if they’d like a copy of your LORA, and if so, then share what AMS provides you with the attending. If not then email the AMS recommendations back to the attending.

Please contact us with any questions.

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