Many students are mistaken when Universities tell them that we don't offer clerkship or you must complete all your clerkships before doing electives.... just because they don't know the difference.... so I am creating a webpage just for basic terms!

Electives: Any optional ward rotation done... clinical electives in usually final year of medical school in Pakistan and others and in pre-intern year in India... research electives can be done anytime! These includes rotations like radiology, cardiac surgery, chest medicine... that are not compulsory! Mostly US/ UK electives are done to get good reference/ letter for your future job/ training positions.

Observership: Any ward rotation in which you observe/watch the attendings, residents, fellows or other medical students but you are not allowed to touch/examine the patient yourself or participate in any sort of activity, though you can watch everyone doing everything... considered to be a passive form of learning as compared to electives! You can also get a letter/ reference from observerships but generally people consider reference letter from electives experience to be better than reference letter from observerships; though I personally believe a very good observership letter is better than an ordinary electives letter. If you get a chance to chose one out of two... I recommend electives!

This page is dedicated to the new updated info. As I am no more doing electives, so I wont be a regular contributor of this page but all the visitors can contribute here. I am really pleased to copy paste the first contribution from vaibhav in the form of a comment under list of universities page. Others can also simply contribute this way by adding a comment and the content would be uploaded here. Thanks!

Mandatory Training Infection Control new

First read the door info and write down that on the paper of sheet along with the mnemonics: PAM HUGS FOSS SODA along with the D/D of that case and also the investigations...NOT TO FORGET THE NAME OF THE PERSON and then write down the SELF MADE mnemonic of HPI
I have already learned System review questions so no need for a mnemonic for them....
and then complications...
so the page is divided into 6 categories

First knock on the door 3 times....SMILE and enter when the person calls you in:

I will start with
1. GOOD MORNING MR. XYZ I am Dr. ABC DEF and am here to see you as your physician today...

2 .Nice to meet you....shake hands

3. Is everything in the room allright for you Mr. XYZ?
and look around too

4. Then cover the naked legs by sayin...LET ME MAKE YOU A BIT MORE COMFORTABLE MR. SMITH

5. Stand back at a distance of 2 feet and DONT CROSS ARMS...look into the eyes and look comfortably asking with empathy...

So, How may I help you today?

the patient begins with the CC

6. you hear it and then say: OH, I AM SO SORRY TO HEAR THAT MR. SMITH. I SHALL TRY MY BEST TO HELP YOU. HOPE YOU DONT MIND IF I TAKE SOME NOTES WHILE YOU SPEAK (and you pick up the paper and pencil)

7. CAN YOU DESCRIBE YOUR CC PLEASE?

and the patient moves on...

now the second part of the history starts: the questions specific to the CC that are there in FA....read that...a MUST! 

HPI (history of present illness)

Ask for: LIQOR AAA

Code:

L Location of the symptom (forehead, wrist…)
I Intensity of the symptom (scale 1-10, 6/10)
Q Quality of the symptom (burning, pulsating pain…)
O Onset of the symptom + precipitating factors
R Radiation of the symptom ( to left shoulder and arm)

A Associated symptoms ( palpitations, shortness of breath)
A Alleviating factors (sitting with my chest on my knees)
A Aggravating factors (effort, smoking, large meals)

PMH (past medical history)

Search for:

PAM HUGS FOSS

Code:

P Previous presence of the symptom (same chief complaint)
A Allergies (drugs, foods, chemicals, dust …)
M Medicines (any drugs the patient used)

H Hospitalization for any illness in the past
U Urinary changes ( esp if diabetic, elderly…)
G Gastrointestinal complains (diet changes, bowel movements…)
S Sleep pattern (waking up/going to sleep…)

F Family history (simmilar chief complaints/serious illness)
O OB/GYN history (LMP, abortions, para…)
S Sexual habits (active/preferences/STD…)
S Social life (job/house/smoking/alcohol…..)

Pain history checklist

mnemonic:

BOOKS
1... usmle world (uw) (there r almost 70 cases ..u need to prepare all of em..there is one case missing ..depression
also psychiatry case questions need to b done from first aid...

2... first aid...wen ur done wid ur cases(uw) 3-4 times..take a mock history on a rough paper n then write the notes
history physical d/d investigations on first aid.they hav provided space just for that..on the next page they hav
indicated how it shud hav bn done...almost 26 cases..
3..if u can..kaplan csa has a gud examination section ..u can memorize the exact commands to b used during physical..

PREPARATION
..get a partner..memorize the scheme(appears undrneath)...take one case..read it for say 15 minutes..leave the book...
start doing the case while ur friend is the simulated pt..at the end ur frend will tell u ur mistakes..take few moments to go over em..n then go
onto the next case...those who think ratalizing the book first n practise later is the way do it..are truly at fault..PRACTISE FROM THE WORD GO..
THOSE WHO ARE GOOD WITH THEIR ROUTINE WILL B successful coz u need to hav everything at ur spinal level..making it a reflex.. don't hav time
to think everything....PRACTICE...

go thru usmle world 4-5 times..may take one month...practise ur notes on first aid...

SCHEME
ull b given 2 pens n 2 papers for each case(total 24 papers)...one paper is 4ruff work n the other one 4 actual
notes that will count...once u r standing facing the door..first the pt will b asked to take his position inside
the room n then ull b asked to slide open the doorway info infront of u..

wat u need to do is that..

1..write the name of pt on top left corner coz ull forget it once ur inside n u need to repeatedly address him/her
using the name..say mr steven or ms barbara not just steven...

Introducing Your Self:
Knock the door before entering. Wait for a while and then slightly open the door and call the patient by last name
Mr. / Ms. Smith! Hello! I am Dr Chebli, I will be your physician today (Shake hands with the patient and look into SP eyes), nice to meet you! I will ask you some questions and do a physical exam on you, is that fine with you?
Let me cover you up”…and while saying so, DRAPE the patient’s legs up to his belly. Then, “So Mr. / Ms Smith, what made you come in today?”
After SP tells you the CC and stops, first EXPRESS SYMPATHY- say, “Oh I am sorry to hear that, I shall try my level best to help you. I hope you do not mind if I write down a few notes while we talk”.
Are there any other concerns that you have? If yes, then ask:”Anything else?
If multiple problems, then ask:” As you have a number of concerns, what seems more important to you?”
Please tell me more about it from the beginning?
What made you decide to get it checked now?
SP in pain, your answer:” Is there anything I can do to help you feel more comfortable right now?”

Pt in great pain:
Ms. Kenfack, I am Dr Chebli, I will be your physician today. I can see you are really suffering. I am here to help you.
I’ll just need to ask you a few questions and do a quick physical exam in order to know what is bothering you. Is that OK with you?
To make you a little more comfortable, let me cover you up.
Is there anything I can do to help you feel more comfortable right now?
Can you please tell me more about what is bothering you?

Silent Pt:
Ms. Kenfack, Hello I am Dr Chebli, I am the phys on duty here today. Ms. Kenfack, I know life can be stressful and even may be hard to come and see a doctor. Take your time; I am here to help you.
Go get napkins and give to the patient. Wait three seconds

by Dr. Aitzaz Bin Sultan Rai.

 Summary:

Observerships, research and externships give you an exposure of healthcare system of
United States and give you an idea of what to expect during residency; (the nature of work,
healthcare facilities, code of conduct for healthcare professionals, the cutting edge
technology, electronic healthcare records, diseases prevalent in a certain geographical area
and the social and cultural values of people of United States). In this issue of the section of
the Road to Residency, Aitzaz and Saima discuss their views about the importance and the
various ways to do an observership, research and externship in the United States.
Why do an observership, research or an externship in the United
States?

Before we give our views on how to find an observership, research or an externship in the
US, let’s first give you a few reasons as to why to opt for these options.

(1) Observerships, research and externships give you an exposure of healthcare system of
United States and give you an idea of what to expect during residency; (the nature of work,
healthcare facilities, code of conduct for healthcare professionals, the cutting edge technology,
electronic healthcare records, diseases prevalent in a certain geographical area and the social
and cultural values of people of United States).

(2) By working with US physicians and researchers, you make “connections” in the System
which pays you a lot later on when you are applying for a residency spot in the US after doing
your USMLE (Unites States Medical Licensing Examination). The name of an imminent
scientist or clinician in the references section of your CV can open many doors for you in your
professional life. The Letters of recommendations (LORs) from the faculty of a renowned

by Dr. Hafiz G Hussain

If one wants to pursue a carrier in fields like Internal medicine or Surgery as most of us do, then clinical research is superior to Laboratory research.
Clinical research is usually related to gathering clinical data and analyzing it. It gives good amount of clinical knowledge as you go through patient’s clinical charts number of times in search of required variables. Also, clinical research is quicker way of getting publications compared to basic lab research. This kind of research is usually carried out by clinical faculty so their recommendations matter more than a basic Lab attending.
 In basic Lab research, researcher has to perform different lab procedures like Centrifugation, ELISA and electrophoresis etc. Though it gives a good amount of experience using these techniques and can prove a great plus if you want to pursue a carrier in pathology or other basic sciences but may not be very helpful regarding Internal medicine or surgery. Publications of basic work are powerful but usually fewer in number.
So if you have choice then, go for clinical research. Again, having any kind of research is superior to no research.
In my opinion Ranking should be like:

1. Paid clinical research
2. Paid basic lab research
3. Unpaid Clinical research
4. Unpaid basic Lab research

The Step 2 CS (Clinical Skills) is the examination that was formerly known as the CSA. To put it as simply as possible, it is just an OSCE with loads of frills. Nothing difficult, I assure you. However, you have to pass it in order to secure ECFMG certification (and hence any chance of matching). So, I would strongly advise that you do not take it too lightly, regardless of what anyone says. Imagine how embarrassing it would be to get a pre-match at the place of your dreams… and having to call them to tell them that you will not be able to join their program because you failed the Step 2 CS…

Earlier, the TOEFL examination was also a requirement for ECFMG certification. However, since the transition from CSA to Step 2 CS, the TOEFL examination is no longer required. The Step 2 CS itself will be used to check your ability to communicate.

The examination is available to be given throughout the entire year; however, it must be given before a certain deadline. It keeps changing. You’ll have to check the ECFMG website (www.ecfmg.org) for the latest information.

There are some recommended times that one should give this exam. The vast majority of applicants are going to visit the USA on a three month visit visa. In this period, it would be highly desirable to give the Step 2 CS, interview at a dozen programs, and perhaps even sit for the Step 3 examination, if you have time. The biggest constraint is the fact that the interview season lasts from November to January – itself being a three month period. So, in order to maximize your chances of getting everything done before your visa expires, schedule the Step 2 CS somewhere in early November. You’ll get it out of the way before you start interviewing. Also, since you’ll land in the USA in early November, you can continue to stay till early February, potentially enabling you to sit for the Step 3 examination.

By Dr. Ahsun Riaz

FORMAL APPLICATION:

There are centers with a proper research fellowship application. NIH and good universities have amazing programs. The problem is that you compete against the same US medical students who have no visa issues etc. and have planned a year beforehand for this research year. (They usually take a year off during medical school or work during their summer vacations.) If you can plan so much in advance, then I recommend that you try this out. Google the websites of these institutions and send out the required documents. I tried this but was not able to get any positive replies.

BACKDOOR APPLICATIONS:

The other way is hard but has paid off. The procedure I used is as follows,

1- Go to US News online. Find the top 30 US medical schools in terms of research.
2- Go to the schools’ websites and find the department you want to do research in.
3- Find faculty members with phone numbers and e-mail addresses. (Make a note of them somewhere.)
4- E-mail them with a general body text and a paragraph specific to the attending’s field of interest with your resume attached
5- Try to mail at least 100 people (20-25 will reply, 3-5 will have a positive tone, 1-2 will have a really positive tone)

Point number 5 is the most variable and depends on multiple factors. Luck and timing help a lot (timing as in applying well beforehand)

What you could do is as follows,

- Please try to search the attending you are going to work with on PubMed and make sure that he/she has at least 10 publications per year as a corresponding author. This will ensure that you will get a chance to get published multiple times.