Some General Information

What is an elective/externship/visiting clerkship?

Elective is basically a clinical rotation in a teaching hospital, outside of the jurisprudence of your own medical institute. Many students go for electives to other hospitals, in their clinical years. While the majority of USMLE aspirants go to the US for electives, a few also go for electives within Pakistan. Electives are legally not possible once you have graduated.

Externships: It is just like the electives, but is done after graduation. Most of the US Programs require you to be ECFMG certified before you are eligible for the externship

Observership: Here you just observe, and are not allowed to perform any procedures. It can be called 'shadowing'.

What is the benefit?

First of all, it adds a lot to your experience. You get to know the hospital systems other than that of your own institute. And secondly, US clinical experience counts a lot on your CV when you apply for a residency in the US.

Many people ask, if I don't want to go to the US, what benefit will the elective give me?  For them, electives (especially US electives) are not of much significance, except that it improves exposure & experience.

Electives done at Pakistani hospitals do not carry much significance abroad.

Electives are usually not considered as long as you are in Pakistan. You may not get any worthwhile preference over those who have not done any elective.

Who should go for electives? What's the ideal time?

The ideal time for clinical electives is when you are in the final year of your medical graduation, no matter what medical institute you are attending. Majority of the hospitals offering electives require you to be in the final year... So, its not so useful to apply earlier. Anyone can go for electives, but those who want to appear for US residencies should try to get electives in the US for at least 4-8 weeks. (see below for more details).

The appropriate time to go for electives is the summer vacations of final year, or immediately after the final prof.

Remember: You cannot apply for electives once the result of your final prof is declared.




Dr. Haseeb, MBBS (KEMC 1980), MD, Chair Young Kemcolians Committee, KEMCAANA, USA

Note: All the following info is extracted from the presentation by Dr. Haseeb MD, at the KEMCAANA 'MBBS AND THEN WHAT" SEMINAR.


Unique... Direct exposure to the system

* Cannot stress enough
* Improves the profile of the IMG
* $$$ Involved... go if u can afford
* Good idea about the practice of medicine in the US
* Experience a cultural change
* Communication/confidence
* Opportunity for the Med School Faculty to evaluate
* Letter of reference


* No Good Answers
* A few goon ones:
-North Western
-Univ of Chicago
-Mayo Clinic
-Univ of Massachusetts
-Univ of Minnesota


* Choose 4 or 5
* Be realistic
* Field of interest, if you know
* Will be asked about your areas of interest in almost every interview
- Interviewers know if you lie


* Can you choose where you will work later as a resident/research fellow
-Opportunity: you choose your destiny


* Best time: Summer/ Dec, Jan. Dates are negotiable. Your excuse: VISA!!
* Email to 10-15 programs
- apply to at least 5 most suitable for needs
-Do not wait

Contact Info: Electives Coordinator

Duration: Minimum of 2 months/ 3 months

Expense: $400-500 per month without meals

Health Insurance: Check with the school. Can be purchased from Pakistan

* Realistically, NO
* Possible
* Do not delay: once you have graduated (means result out), you CANNOT!

Clarification: (As recently noted, a large number of Indian students visit this page too, we decided to add something to clear the rule)
In Pakistani system, house job (internship) is done after you are a graduate. ie it is not a requirement for a degree. So, Pakistani Medical Students are not eligible for electives once the final prof result is out. In Indian system, you do not get your degree till you are done with internship. ie internship is a requirement of graduation. This means Indian Students can go for electives during internship. But they cannot go for clinical electives before internship - as u need to be in the last year of your graduation to be eligible for electives.

* Don't waste the opportunity/Visa
* US Students : Residents
-work under a house officer for at least 6-8 weeks
-participate in decision making process
-do your reading regularly




-find a mentor
-pick up a topic

*Research Subject: Epidemiology







Mustafa M. Hassan MBBS (KEMU) BSc (PU); Ahsun Riaz MBBS (KEMU)


1)wat is USCE??
It includes observership,electives,externship...strictly speaking these terms mean differently, however at most of the places in america these terms are used interchangably..

2)Why is USCE required?
I do understand that it is increasing in importance, that you have USCE while applying for your residency.
-It shows that you have been exposed to their medical system.
-It implies that you have seen American patients and have interacted with them
-It gives you a chance to meet truly dedicated teachers and physicians and impress them so as to get letters of recommendation
-It makes you prepared yourself to know what you will be facing once you are a resident

3)Best time to do it??
In my view, it is the best if you are able to get USCE as a student as this solves most visa issues and getting into a clinical elective is much easier as most universities have well organized departments taking care of foreign student electives.
Now, the issue of when to actually go comes into play.

-Most Universities require that you are a final year student

-Remember, you are still a student of KE from the time you take your final professional exam to the time your result is announced

-I think that this is the best time as you have just prepared of your final prof and are able to answer the questions the faculty may ask you (you need to impress them)

4)where to do it??
Okay! This may be the toughest question possible.
The following are the important issues you have to keep in mind as you apply,

a)What specialty are you planning on going into?
It will be useless to do a rotation in rheumatology if you plan to go into ophthalmology.

b)Will you be able to meet the requirements when you apply?
Most good universities which have no tuition expenses like Cleveland Clinic now require that you have taken the Step 1.

c)What are the important things I am looking for in a program?
I advise that if you actually decide to spend 2400 dollars, do some work on the program you are applying to.
-Look for a good faculty with a good interest in research. The websites have full info on the departments and you could contact them to get an idea of the program before applying as well
-Look for Pakistani faculty as they may really help you out
-Look for departments with a good faculty: student ratio. You are bound to get attached to at least one faculty member who is willing to teach and give you responsibilities
-Make sure you have a place to stay before you venture on the elective expedition

5)What you can do now?
-Start preparing your resume
-Start deciding your specialty
-Work hard during your five years of med school 
- If you can take your USMLE Step1 and TOEFL, you meet the requirement of a lot of good programs that cost less

What you need to do 8 months prior to applying?
-Decide where you are going to apply
-See what is required for application
-Visit the websites
-Start getting your immunization records in order

What you need to do 2 months prior to applying?
-Download the application
-Fill them out
-Get them signed from college, where required
-Get at least 8 college transcripts made (you will need to get the clerks on your side for this as they can delay the process a lot)
-Get some letters of recommendation from faculty at KE
-Get insurance (travel health) for the period of your travel from any insurance company, u can get it from Lahore for around 4000 rs.

6) Visa?
Please plan it all so as to get at least one acceptance letter for electives 3.5 months before your planned date of departure
This will give you sufficient time (3 months) to apply for the visa
A period of three months will give the possibly needed time for verification to the embassy

You need to answer the following questions at the time of the visa interview

Why are you going?
For clinical electives. Make sure you have documentation as proof of your acceptance for the clinical experience at hand.

How are you going to pay for the trip?
Bank statements with some money do the trick. A bank statement that has some money circulating is better that one which is static.

Proof of ties with Pakistan?
Property etc.

How do I know you will come back?
Get a letter from college stating that you are student of KE and will remain a student till you graduate upon announcement of the result. It should also state that the college office has all your documents and the documents will be given to you upon graduation.

7)You will be representative of KE where ever you go. Make a good impression, not only for yourself but for the future Kemcolians who apply.
-Work hard. Make sure you are able to continuously impress one or two senior faculty members so as to get good letters of recommendations from them.
-Try to get the letters from the faculty by hand. Otherwise, they may get lost in the mail.

8)issue of cs
if u have plan to take ur usmle exams in near future, then it can be a good idea to take part 2 of usmle step 2 (clinical skill examination ), which is usually a 2 weeks preparation, it is maily an exam of ur communication skill n i blv. tht after doing ur electives u r probably at ur peak as far as ur communication skills are concerned..incase u decide in favour of taking ur exam, make sure to apply 6-8 months in advance.


highly variable, I had to spend around 6000$, but this is just a rough estimation...

application process
(for applying to 5 universities)
: 300-500 Dollars

(for a round trip)
: 1200-1300 Dollars

tuition costs
(there are free ones but it is hard, but not impossible, for us to meet their requirements on time)
: 1000 to 2000 dollars

(it is great if you have a relative or friend in the city as living in big cities like new York and Chicago is EXPENSIVE)
(some universities provide their own housing but that is not cheap as well...mayo clinic and Cleveland clinic housing is an exception as it is not costly and awesome, as i have heard)
: 250-1000 dollars per month

traveling in the city
(all big cities have a month long transit card for unlimited traveling)
: 100 Dollars per month

traveling to other cities
(buy your airline tickets early as they cost very less if you buy them a month beforehand)
(greyhound buses are a good way to travel but you need a lot of stamina for long trips)
(Amtrak trains are good as well but tiring for long trips)

food etc
(depends on you, more or less)
: 200-500 dollars a month

(depends on you, and you only so i will not give an estimate)

there are sales on lots of occasions and the sales are AWESOME

10) things to do before traveling:

3 weeks before ur traveling date, sit with all ur family members n make a list of all the things tht u will need when u are in america..n whenever u remmber something ,add it immediately in ur list , because if u forget, even the smallest of the things like a nail cutter or shoe polish can be troublesome, so make sure u get everything before u leave.. dont forget to take a few medicines n these include a 5 day course of an antibiotic, antispasmodic for abdominal pain, flagyll(metronidazole) for diarrhea, Nsaids like ponstan or some any other pain killer...get ur phone on roaming, or u can get a phone sim for the airport after u land(tht is cheaper than roaming), if u r traveling in jan, feb or march, don't forget to take ur overcoat , cap, muffler n gloves with you.. dont forget to bring .a contact diary with you containing addresses n phone nos of ur friends n relatives in u-s),take ur stethoscope n books with you too...

11)things to do in u-s

whenever u leave ur room whether its at a hotel or other residential area, don't forget to take 4 things with you, ur wallet (containing ur room key,ur money,i.d card, bus pass etc etc), second thing is ur cell phone, 3rd pass port (ur only source of identity in u-s----u cannot afford to lose it so take good care of it---I used to put it in back pocket of my pant ) 4th ur watch..

12)things to do at work place

a) dress code--if u r working in surgery or some sub specialty of surgery, u 'll be wearing surgical kit that is provided by hospital, if u r in medicine or its sub specialties, its dress pant ,dress shirt, dress shoes, tie ,overall with buttons closed....for girls, its dress pants and dress shirts, overall ,don't wear joggers, jeans, t-shirts or shoes with heels....

b) be the first one to come n last one to leave, tht solves a lot of ur problems, work hard, be very very polite, students n residents call their consultant by their sir name, wat i found was instead of tht call them sir or mam, tht worked for me, my friends also used the same tool n it worked for them u can try it:) never say "NO" to anything or any task or assingment tht u r asked to do, even if u r dead tired, show ur committeemen...ask for a letter of recommendation frm ur consultant atelast a week before u leave, so u get it before u leave.....

c)n yes NO discussion on religion or politics....remember it is very very important.....

d) Take thank you cards n also a few small gifts like handicrafts form Pakistan for ur consultants n give them before u leave, after ur electives stay in touch with the faculty members n send them Easter, new yr cards etc so tht they remember you n this can help you in future!!!


Visit this page for information on different institutes offering the electives, and the relevant details.



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