Transcript Clinical Electives

Clinical Electives
Akbar Herekar
Sub-internship – Neurosurgery –UNM
Sub-internship – Neurology – UNM
Research Elective – Neurogenetics – Northwestern University
Glossary - Terms
• Elective – Placement by choice
• Attending – equivalent to a consultant in Pakistan
• Clinical clerkship – clinical rotation/elective
• Sub- I: 4th year American medical student = Our final year
• SOM: School of Medicine
Medical Electives
Research
Clinical
Laboratory
Clinical
Observer
ship
Elective
SubInternship
Undergraduate
Clinical
Elective
Observership
Subinternship
Observership
• Virtually anywhere in America
• “OBSERVER”-ship – Limited or no patient contact
• Shadow resident/attending
• Learning experience (comparatively limited)+ LOR +
networking
• Easily possible through contacts
• Good as last option for undergraduates
• Can be converted into an elective
• Dr. Luni will talk about observership after graduation
Clinical Elective
• Rotation of ‘choice’, in a university/hospital at home or
abroad.
• Usually 4 weeks but variable
• Position: 3rd year American medical student
• Most places in the US
• Ample patient contact – usually limited patient management
• Foreign exposure/experience + LOR + networking
Sub-internship
• Only real difference from Elective – Position: 4th year medical
student
• Offered by limited places in the US especially to foreigners
(UNM, University of Texas schools and few others)
• USMLE step 1 invariably required
• More patient contact, patient management
• Suggested time: Final year
• If you do very well you can secure your residency
Impact
• Foreign learning experience
• Increases residency chances overall
• Increases placement chances within the same program
• Networking/Contacts
• Last, but definitely not the least – LOR(s)
When
• During clinical years (Core clerkships required)
• Suggested time: Fourth and final year vacations
• (Most require final year status)
• Start planning 6-8 months in advance
• Application should be submitted 6-2 months before electives
• Earlier you apply the better your chances
Applying for the elective
Selection
of elective
Specialty
Hospital
Choosing a specialty
• Reason for elective specialty choice:
• For experience in the field of interest to aid residency chances
• Eg. Neurology
Medicine
Psychiatry
Neurology
Neuroradiology
• To explore an area of interest in medicine
• Whatever you can get
Neurosurgery
Choosing a hospital
• Offerings
• Pre-requisite completion
• State/city
• Climate
• Finances/relatives
• Visa status (UK, Singapore good backups)
• Starting point: On-line Extramural Elective Compendium:
• http://services.aamc.org/eec/students/
USMLE
step 1
Pre-requisites
that effect
your choices
TOEFL
Money
Note: Requirements are mostly requirements by the elective coordinator or Elective
office. It is possible to waive off any requirement by superseding the office itself i.e..
Through contacts, sweet talking or using your brain.
Institutions: No step 1, No TOEFL, No
fees
• NYU SOM
• $100 application fee to be paid on first day of elective
• Approval from dean NYUSOM
•
http://www.med.nyu.edu/registrar/electives/requirements_lcme.html
• Henry ford hospital, Detroit
• Easiest application process that I’ve seen
•
http://www.henryford.com/body_program.cfm?id=37384
• University of Connecticut school of medicine
• Tend to be unresponsive
• Easy application
•
http://medicine.uchc.edu/prospective/visiting/index.html
Institutions: No Step 1, No fees BUT
TOEFL required
• National Institute of Health (NIH)
• NIH Clinical center, no med school but have programs with
reputable institutes such as JHU
• TOEFL or Step 2 CS
• Mainly clinical trial patients
•
https://www2.cc.nih.gov/apps/publicForms/cep/forms/cepApp.aspx
• University of Louisville SOM
• Only Dow Medical College and AKU students are eligible
•
http://medicalstudentaffairs.louisville.edu/visiting-student-clerkships
Institutions (Good): Minimal fees, require Step
1, BUT MAY ACCEPT A STEP 1 WAIVER
• Mount Sinai SOM
• F1 short-term visa requirement
• Application fee non-refund around $500
•
http://www.mssm.edu/static_files/MSSM/Files/Education/Student%20Resources/Electives/Foreign%20Visiting%20Students/ProspectiveVisitingStudents_2011.pdf
• UT-Southwestern
• Internal Med, Emergency Surg, Surg at Baylor require step 1
•
http://www.utsouthwestern.edu//utsw/cda/dept20676/files/397167.html
Institutes: Don’t require step 1, but
have fees
• Emory University
• Faculty sponsor required. $180 per month
•
https://emorymed.emory.edu/Public/CurriculumPublicPages/CourseInformation.aspx
• University of Texas, at Galveston
• F1 required
• $750 - $1000 per month
•
http://www.utmb.edu/enrollmentservices/prospect/visiting_students_index.html
• University of Rochester SOM
• $100 app, $350 per week elective fee
•
http://www.urmc.rochester.edu/education/md/prospective-students/cached/information-application.cfm
• Tulane University SOM
• Application fee $300, no refund, TEMPORARILY CLOSED
•
http://tulane.edu/som/StudentAffairs/visiting-students.cfm
• Northwestern university
• $1200 fee
•
http://www.feinberg.northwestern.edu/AWOME/visiting-students/index.html
Institutes: Require step 1, have
minimal or no fees
• Cleveland Clinic
•
http://portals.clevelandclinic.org/cclcm/ElectiveProgram/Applying/tabid/4304/Default.aspx
• Mayo Clinic
•
http://www.mayo.edu/msgme/clerkships.html
• University of New Mexico
•
http://hsc.unm.edu/som/oss/Visiting_Students.shtml
• University of Cincinnati
•
http://www.med.uc.edu/medical/MedEd/Visiting/index.cfm
• Suny Downstate Medical College, New york
•
http://sls.downstate.edu/registrar/visiting/international/index.html
• Duke University
•
http://medschool.duke.edu/modules/som_registrar/index.php?id=4
• Louisiana state university
• Virginia Commonwealth University SOM
•
http://www.medschool.vcu.edu/md/m4_electives/international_students.html
• Wayne State University
•
http://www.med.wayne.edu/student_affairs/records_registration/electives/VISITFRM1.PDF
• And so on…..
Institutes: Money mongers!
• Yale University
• Upwards of $3500
•
http://medicine.yale.edu/globalhealth/international/electives/index.aspx
• Weil Cornell Medical College
• Upwards of $2000 + $200
•
http://med.cornell.edu/international/for_int_stu/index.html?name1=International+Health+Interest+Group&type1=2Active
• Harvard University SOM
• Upwards of $3500
•
http://www.hms.harvard.edu/registrar/aServices/xClerk.html
• Alpert SOM, Brown
• Upwards of $3600
•
http://med.brown.edu/education/visiting_international.html
Procedure
• Different requirements for different hospitals
• Contacts vs. no contacts
• No harm in using contacts but don’t prefer contacts over
choice
• If you want to do nephrology and you have a contacts in
pediatrics, apply for nephrology, you will get in
• No contacts? Not a problem.
What you need
• Make a folder (Dow style!)
• 10 photocopies of marksheets
• 10 photocopies of enrollment card
• 10 photocopies of Dow ID card
• Atleast 1 photocopy of grade book
• 10 photocopies of your NIC
• 4 pictures
• Printout of colleges where you wish to apply
• Blank A4 pages and pen for hands on application
writing
Getting an NOC
• NOC – No objection certificate is necessary for 2 reasons
• Required by principal to stamp your application
• Can you used to forego attendance for allotted time
• Write an application to Dr. Masroor (or whoever will replace
him) for NOC. Write an application + enrollment card copy +
nic copy + latest marksheet copy
• After NOC is signed by the dean (2 to 3 days), take this noc to
the finance department and get a voucher made for an NOC.
• Go to UBL and pay this voucher.
• Then submit both the voucher and the NOC with attached
documents to AFTAB
• After NOC is ready (1-5 days), get a 2 photocopies
To,
Dean of Clinical Sciences
Dow Medical College
Subject: NOC for electives
Dear Sir,
I, Bashir Chabutra, student of final year, Dow medical college, final year roll
no: 123, enrollment no. DUHS/D/2222/2007, would kindly request an NOC
for electives. My stated elective is for a period of 4 weeks at Massachusetts
General Hospital from 22nd July 2011 to 21st August 2011. Attached along is
NOC, ID card, Marksheet and Enrollment card.
Thanking you in anticipation,
Bashir Chabutra
Final Year
Dow Medical College
Roll no: 123
Things you may need:
• Dean’s letter of good standing/LOR: Application
to principle (ATP)+ ID + EC + Marksheets (M) +
Voucher (V) + Aftab
• IMED letter – ATP + ID + Marksheet + Shahab
• Letter of proficiency in English: ATP +
• Consolidated Marksheet: Application +
Photocopy of log book + M + V + ID etc
• USMLE Waiver = ATP + Consolidated marksheet +
M + ID etc
Immunizations
• All vaccines AKU
• Atleast 1 month before titers
• All titers Rahila Lab (Mohd. Ali Society)
• Show proof of vaccination
• Montoux AKU or Sindh Lab
• AKU for MMR and Hep B
Malpractice insurance
• Usually worth $1 million required
• EFU insurance – Rs. 6500 premium for Rs. 1
Million
• Online website
• www.academicins.com
• http://www.medicalprotection.org/uk/
• (For UK, Singapore, Australia)
Application
• Fill application with all requirements.
• Write application to principal stating you have obtained
or are applying for electives at this particular place.
Attach NOC plus relevant documents to application and
give to AFTAB (0-7 days, depending on his mood)
• Send off your application (Always use TCS or Fedex)
(Dow) Tips
• One NOC is valid for as many applications as you want in that
time period
• If you’re applying to many places at the same time give in your
forms together and ‘bargain’ with AFTAB, get 2 applications
signed on 1 voucher.
• Some places require applications from Dow directly
• Buy white large envelopes from photocopy shop
• Get them stamped and sealed by shahab/aftab
• Send them from Dow’s address
Visa
• Dr. Ali khan will be talking about visa
Travel Fare
• Your choice
• ISIC – International Student Identity Card
• Up to 30% discount
• Limited seats
• No miles
Accomodation
• University accommodation
• Family/Friends
• Craigslist, beds4meds, sublet.com
• Close to hospital
Transport
• Month pass for bus or train
• Usually discount with student card
• Don’t use Taxis
• Walk
• Google maps is a life saver
Setting a good impression
• Study before going
• SOAP notes
• Examinations
Setting a great impression
• Always dress well unless you’re wearing scrubs.
• Carry required instruments
• Don’t be late
• Can I leave? Is there anything else I can do?
• Do weekend and evening calls
• Be friendly and courteous at all times
• PRESENT PRESENT PRESENT
PRESENT PRESENT PRESENT
• Present cases – Everyday!
• Start 1 patient, increase daily
• End of week 1, present 5 patients
• Mostly floor
• Don’t get careless or overconfident
• Make atleast one proper presentation
• Topic from Pakistan
• Topic seen in rotation (keep your eyes and ears open)
• Topic you’re good or very interested in.
•
Make your presence felt, they should feel your absence when
you’re gone
Usual elective day (Surgery)
• 0500 - reporting time
• 0600 - put in SOAP notes
• 0630 – morning rounds
• 0730 – OT or ICU rounds
• 1600 – OT ends go to ward
• 1600 – 1830 Scut work
• 1830 – Evening rounds
• 1900 – Is there anything else I can help with?
LORs
• Most important
• In-hand or by direct email/letter
• Direct email, more value, but impact required
• LOR FROM ATTENDING, NOT RESIDENTS
• Impress the attending
• Speak up in rounds
• Use your charm
• Create a relationship
LORs
• For in-hand, tell attending about a week before
your elective ends
• For direct email, make your attending write the
letter the day you are leaving
• Give updated CV
Acknowledgements
I would like to thank Dr. Muhammad Ali Khan and Dr. Faraz Khan
Luni was their support and guidance and Dr. Junaid Ashraf for his
cooperation without which this seminar could not have taken
place.