What to Expect Before, During and After U.S. Clinical Experiences with AmeriClerkships

In order to ensure that you continue to have a pleasant experience with AmeriClerkships and our affiliated clinical sites, we’ve compiled a list of most commonly asked questions and addresses the most encountered dilemmas by our past members. You will find much of this content in the AmeriClerkships Enrollment Agreement that you will be asked to sign when you decide to enroll, therefore we encourage you to set aside ~10 minutes to familiarize yourself with how AmeriClerkships operates, and to immediately reply with any questions/concerns.

As disclosed in our Clinical Authorization Letter, visiting students are responsible for correctly informing AmeriClerkships if the type of clinicals they are signing up for is “For-Credit” or “Not-for-Credit” credit. The distinction may seem trivial, but in fact it is quite significant. Below, we briefly discuss some of general laws that govern each type of clinical block; please note that these are not AmeriClerkships policies, but state and federally implemented policies:

For-Credit

For Credit means this clinical rotation is required for you to graduate, and will be a part of your transcript. Your school is aware of this “away” rotation, and will be your primary sponsor throughout your clinical elective. This also means that you may only conduct your clinicals in states where your school has been approved, or states which have no regulations when it comes to visiting student clinical electives. For-credit clinicals have a more limited inventory, offered in fewer states than “Not for Credit”, and under more strict supervisory policies by the U.S. Department of State, and various medical boards (since a for-credit clinical elective may involve the student practicing to be a doctor, also known as practicing limited medicine without a license). Visiting students signing up for this type of CB should ask for a letter of sponsorship from their healthcare school documenting as much details and their approval of all clinical elective(s) taking place in the United States, and that they are in good standing with that healthcare school. AmeriClerkships may also issue a Letter of Enrollment for clinical electives. A student may request the attending physician to complete a school specific post-clinical evaluation. Please note that your school is the credit issuing entity and not AmeriClerkships or any of the healthcare facilities that you enter. If this is your type of clinical block, then it is important for you to read the following links:

Not-for-Credit

Not for Credit means your school has no involvement in this rotation as this is not a part of your curriculum, is being done during your vacation time (not during the regular semester) and therefore, categorized as a volunteer activity. In this type of clinical block, you must not portray yourself as a student doing for-credit clinicals (i.e. introducing yourself as a 3rd or 4th or 5th year medical student, or sharing your diagnostic opinions, etc.) Not for credit type of CB is not work, unpaid, and will not go on your transcript, therefore most state medical boards do not govern this type of experience, and do not care if your school is approved in that state (since again, your school is technically unaware that you are doing this since this is not a part of your curriculum). This also means that you may NOT ask your attending physician to complete a school specific post-clinical evaluation. Also for this type of CB, you are coming to the U.S. to watch medicine be practiced (and not be the one who practices medicine, such as limited practice by medical students from properly processed and pre-approved medical students in for-credit clinicals), therefore categorized by the Department of State (U.S. border control and embassies) as observational. If this is the type of clinical rotations you are signed up for, then make sure that you do not confuse the border patrol officers by telling them you are coming to do clinical electives, as that would be a misrepresentation of your medical school’s involvement.

For-credit U.S. Clinical Clerkships/Rotations (Clerkships) at AmeriClerkships Medical Society (AMS) are reserved for medical students or medical residents who are required to complete a pre-set clinical curriculum by their medical institution for graduation. Clerkships differs from Volunteer U.S. Clinical Experiences (USCE) in that:

  1. All medical students and residents must complete a Clinical Authorization Letter (CAL) in order for AMS to determine if they need to be placed in Clerkships or USCE, in states with no known adverse laws against them conducting their type of clinicals in that state, and;
  2. Some states have policies governing Clerkships conducted by both U.S. and International Medical Students (IMS);
  3. Where and how an IMS conducts Clerkships can affect future licensure: click here to read how AMS is Protecting International Medical Students, and;
  4. There are more than just 2 types of Clerkships (erroneously referred to as “Green” or “Blue Book” rotations): click here for 5 categories of Clerkships at AMS, and;
  5. Their completion will lead to the issuance of credit from their medical institution (i.e. for-credit), and;
  6. Their limited engagement in certain patient care activities may be interpreted as the practice of medicine by certain states (which is different for each state; simply Google search “is medical student clerkship considered “practice of medicine” in [type in state of your Clerkship]).

Please note that:

  • All AMS Certified USCE are insured with professional liability insurance ($1/$3 million), supervised by AMS affiliated U.S. licensed physicians. Upon completion of Clerkships, AMS members may ask for a post-clinical evaluation and solicit letters of recommendation from their supervising physicians.
  • 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 Clerkship

Begin familiarizing yourself with the medical specialty that you’re assigned to by clicking here. Make sure that you receive your printed ID Badge (mailed to a U.S. address you provide us; please contact Credentialing Staff if you haven’t received it by the week prior to your start). Members are responsible for bringing their own short hip-length 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 ACMedical Clinical Coordinator will be available to you, and will finalize all required approvals for what you enrolled in with ACMedical (as outlined in your invoice) so you may start on time. Your Clinical Coordinator is also responsible for emailing (or calling or texting) your final confirmation to you at the “time of highest confidence“, meaning the time when to the best judgment of your coordinator, where 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 at MyClinicals, and search surrounding points of interest (i.e. shopping, airports, rental cars, rental apartments, etc). Last but not least, make sure that you have attended your ACMedical Membership and Credentialing Orientation.

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 backup 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 Clerkship 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 driver’s 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 Clerkship

Although each clinical experience is unique, the following is an outline of what AMS members enrolled in Clerkships can expect to experience, and be encouraged to master during each 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 smiles 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 follow-up 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 Clerkship

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 clerkships 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 Clerkship 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 sometime
  • Last week of your Clerkship: 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.

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 printed ID Badge (mailed to a U.S. address you provide us; please contact Credentialing Staff if you haven’t received it by the week prior to your start). Members are responsible for bringing their own short hip-length 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 ACMedical Clinical Coordinator will be available to you, and will finalize all required approvals for what you enrolled in with ACMedical (as outlined in your invoice) so you may start on time. Your Clinical Coordinator is also responsible for emailing (or calling or texting) your final confirmation to you at the “time of highest confidence“, meaning the time when to the best judgment of your coordinator, where 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 at MyClinicals, and search surrounding points of interest (i.e. shopping, airports, rental cars, rental apartments, etc). Last but not least, make sure that you have attended your ACMedical Membership and Credentialing Orientation.

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 backup 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 driver’s 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 smiles 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 follow-up 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 sometime
  • 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.

Pre-med U.S. clinical experiences are an excellent way for early career students to gauge their interest in medicine, and gain first-hand experience by observing a U.S. licensed physician in their clinical practice. Depending on your skills and the comfort of your physician, you may be allowed to do more than observe, such as learn to take vital signs, scribe in Electronic Medical Records, make a presentation, interact with pharmaceutical representatives, and go to professional meetings. At the end, you may earn a performance based letter of recommendation, which you may use when applying to medical school or other undergraduate healthcare schools.

AmeriClerkships Medical Society (AMS), in partnerships with various Graduate Medical Education (GME) departments is proud to offer rare opportunity for medical graduate members of AMS to enroll in Postgraduate Subinternships (PGSIs) in over 30 specialties, and audition in hopes of being offered a residency interview. PGSIs are designated as AMS-PGY1CONNECT sites, meaning that AMS members have secured residency interviews and even “matched” into such hospital(s). PGSIs are ‘VERIFIED’ sites, which indicates the existence of a clinical affiliation between AMS and the host GME. Additionally as a benefit of being an AmeriClerkships member, PGSIs may be labeled as “Audition” during the months of August to December of each year, which will ensure added attention by various residency team members, including Chief Residents and Program Directors, while being evaluated for a residency interview. Requirements for “auditions”:

  • Make an official request to “audition” in writing at the time of enrollment
  • Become fully credentialed at AmeriClerkships
  • Apply to that residency program during that particular Match season
  • Available only from September to December of each year

An “audition” type subinternship may lead to a residency “interview”, if the PGSI has:

  • Exhibited excellent clinical and patient care skills during their subinternship
  • Passed USMLE Step 1 (or Comlex Level 1)
  • Proven that they genuinely want to be residents at that residency program

An “audition” type clinical rotation tells residency decision makers that you have (or are about to) apply to their program, and want to showcase your clinical skills for serious residency considerations. Auditions are typically scheduled with Program Directors, and very closely monitored by residents at that same clinical site, and may lead to a residency “interview”:

  • Exhibited excellent clinical and patient care skills during their subinternship
  • Passed USMLE Step 1 (or Comlex Level 1)
  • Proven that they genuinely want to be residents at that residency program
  • May be inpatient, or outpatient, or all of the above
  • May be set up directly with a residency Program Director or an Associate Program Director, and not directly processed at a GME office
  • Other conditions may apply

What is “Full Enrollment Certification or FEC” Status? Full Enrollment Certification status requires that all documents (both internal and external credentialing documents) necessary for you to begin your rotation are submitted and approved in advance of your FEC deadline (see below). This also includes attendance to any required orientations run by AmeriClerkships or an affiliated clinical site. Please note that all U.S. healthcare facilities (i.e. hospitals, emergency rooms, surgical centers, clinics, etc.) are regulated by the U.S. Department of Health and Human Services, hence unauthorized entry into such facilities may be deemed as a violation of HIPAA, carry civil penalties, be prosecutable as trespassing by such facilities, and a violation of the AmeriClerkships “ZERO-TOLERANCE POLICY” (explained in your Enrollment Agreement).  AmeriClerkships members may only enter healthcare facilities that they have been expressly authorized to enter after becoming Full Enrollment Certified (documented in the FINAL CONFIRMATION email which is sent to members prior to the start of each clinical block).

When is my FEC deadline? FEC deadlines are based on your clinical rotation start date. To ensure your clinical rotation will start as scheduled, all documents must be submitted and approved no later than 14 days before your scheduled start date. If there are external credentialing documents required by the hospital, then your FEC deadline will be adjusted to allow time for hospital processing as soon as the hospital processing requirements are confirmed by our credentialing team. Late document submission will incur additional fees, including a $199 FASTart1 expedited processing fee.

What types of insured clinical placements do AmeriClerkships offer? We offer both inpatient & outpatient clinical opportunities to 3 categories of members: 1) Not-for-credit clinical experiences to pre-meds, medical students and graduates, including Postgraduate Subinternships for medical graduates, 2) For-credit clinical clerkships/electives to medical students and residents, and 3) For-credit clinical externships to vocational healthcare students (i.e. medical assistants & nurses).

How has COVID affected U.S. clinical rotation opportunities? In more ways than one could imagine, however most importantly:

  1. Only a select few hospitals are permitting any inpatient rotations or observerships;
  2. Most clinical sites and hospitals have prerequisites which you must inquire about and follow;
  3. You must go equipped with your own PPE (K/N95 face masks, gloves, face shields, at least);
  4. Expect much longer waiting times for patients to be seen, and for physicians to see patients;
  5. Telemedicine has never been more popular;
  6. You may be asked to prove you’re COVID negative by PCR or Antigen Test prior to start;
  7. Quarantine period prior to start of clinicals (certain states);
  8. Live Online Clinical and Research Experiences (virtual clerkships), which has been a significant help to those unable to travel to and from the U.S.;
  9. Significantly higher number of change requests, some of which may not be possible;
  10. Much more.

Is there a difference in the type of clinical experience obtained by each of the above 3 categories? Yes, and possible legal limitations. For example, medical student clerkships are educational and needed to graduate (for-credit), therefore require more involvement in patient care (i.e. phlebotomy, initiating exams & 1st assisting in surgeries). In contrast, medical graduate clinical experiences are, by law, recreational activities that are voluntary in nature (not-for-credit) and used to build a residency applicant’s CV by exposing them to how medicine is practiced in the US through assisting with histories, exams, procedures & patient rounds, with possible performance-based letters of recommendations at the end (details: https://acmedical.org/frequently-asked-questions/).

What is an AmeriClerkships ‘Clinical Feature’? Clinical Features outline opportunities for inpatient exposure, varying types of hospitals, attending status, and verification. However during extenuating circumstances, such as a global pandemic, clinical experiences may only be limited to physician’s outpatient clinics and not inpatient facilities and hospitals.

  • ‘Community Healthcare Experience’ (CHE): mainly outpatient, with inpatient unlikely
  • ‘Hospital Guarantee’ (HG): opportunity to visit a hospital < 50% of your time at that clinical site
  • ‘Teaching Hospital Guarantee’ (THG): opportunity to visit an ACGME or AOA-recognized hospital < 50% of your time at that clinical site
  • ‘Inpatient’ (IP): opportunity to visit an HG or THG  > 50% of your time at that clinical site
  • ‘Hospitalist’ (HOSP): ~100% of your time at that clinical site will be spent in an HG or THG
  • Verified’ (V): an HG or THG sanctioned by a hospital, or healthcare system
  • ‘Postgraduate Subinternship’ (PGSI): placed with residency faculty, or program director directly through a Graduate Medical Education department
  • ‘Program Director’ (PD): supervised by a program director as primary attending physician

What is “Method of Participation”? Method of Participation means how you will experience your upcoming clinical block(s) with this enrollment:

In-Person: You show up to the clinic or hospital in-person, and be supervised and gain patient exposure within the U.S. healthcare system on-site. The credentialing process for in-person is often lengthier and includes immunizations and US legal immigration status, which can be more time consuming;

  • Live Online: Instead of showing up to the clinic in-person, you log into a web session or a phone conference line or other means of digital communication with your supervisors and patients remotely, often from the comfort of your home. This often means an much easier credentialing process (no immunization or U.S. legal immigration status required) and in turn, much faster start times;
  • In-Person OR Live Online: You may choose to participate in either method, or elect to have some of your clinical experiences be done via Live Online and others in-person (which will require that you undergo full credentialing).

What determines the quality of my experience with, and outcomes through AmeriClerkships?

  • Your clinical experience is determined by 7 factors: 1) Your level of medical education, 2) The ‘Clinical Feature’ of the clinical site you enroll in, 3) Your availability (ability to meet your supervisor regardless of the time or day of week), 4) Your access to reliable transportation (car, Uber, Lyft is highly recommended), 5) Your willingness to travel to different cities, 6) Your professionalism (always look interested in this specialty, volunteer to do case presentations and be respectful), 7) Live Online (no contact, but may communicate with patients) vs. In-Person (assisting in exams).
  • Your career development experience & Match outcome is determined by 11 factors: 1) Having the time (6-18 months) & ability (both a realistic budget & determination) to follow through with our personalized recommendations, 2) USMLE performances, 3) Commitment to 1 specialty & familiarity with US healthcare culture through 4 to 5 months of residency relevant US clinical experiences, 4) Strength and ACGME focus of your 4 to 5 ‘unwaived’ US letters of recommendation, 5) Your English proficiency, as well as interview & interpersonal skills, 6) Community & volunteer work with specialty-specific non-profits, 7) Your AmeriClerkships Membership level, 8) Having all of the above carefully represented and consistently documented in a high-quality residency application + its supporting documents (including personal statements), aka ‘your medical brand’, 9) Budget to apply to 200+ programs/relevant specialty on time (9/15), 10) Attending, acing & ranking all interviews, and 11) Some luck!

Can the location of my clinical block change from what I originally enrolled in? Unfortunately yes, there is a small chance. Despite our extensive pre-approval & confirmation process, your designated Attending Physician may become unavailable due to unannounced travels, double-booking through local schools, or unforeseen emergencies. Not to worry; we typically have back up clinical sites with the same or better ‘Clinical Features’ on reserve within 50 miles of your original clinical site’s zip code. If we do need to upgrade your clinical site to a more expensive one (within 50 miles of your original site), to preserve your start date, then we will do so at no cost to you.

Can the broadcast location of a Live Online site change? Yes, but less likely.

I don’t want an observership, I want a US clinical experience” or “I want hands-on or externship, not observership” or “Will an observership count towards US clinical experience on my US residency application”? These are common questions/concerns had by medical students & graduates when they sign-up for not-for-credit AmeriClerkships clinical blocks, and are easily explained. Please note our response:

There is NOT a unified definition for the terms US clinical observership or hands-on or externship or rotations or green-book, as each industry or organization defines it to cater to their own needs. For example, the New Jersey Medical Board defines an observership as a visiting medical student having the ability to do a history and physical exam but so long as it is done during time off from school and not for credit and categorized as a volunteer, whereas most residency programs define ‘observership’ as shadowing. Most hospitals define observership as you not coming in contact with patients (i.e. examining), but they may allow speaking with patients (i.e. taking a history on your own stationary). Some hospitals who only allow observerships, may offer read-only access to their EMR systems, but that can vary. The same goes for the term ‘hands-on’ since that implies the actual practice of medicine by state medical boards, but to most medical students and graduates it simply means the ability to take histories and assist with exams.

  • In most cases, students and graduates want to be able to get involved, and if possible, speak with people within a clinic, and they certainly can if the rotations were set up properly and are covered with a $1/3 million professional liability insurance.
  • If your experience was uninsured and not setup through proper channels (such as a residency program offering visiting students clinical electives, or through AmeriClerkships), then you should only shadow. Therefore, so long as you are not practicing medicine without a license (i.e. diagnosing, calling yourself a doctor, or appending your name with an MD or other similar designations, or sharing your treatment with patients, etc.) or misrepresenting your status during that clinical block (i.e. calling yourself a medical student when in fact you are doing not-for-credit clinical experience), and you are legally in the United States, it is not illegal for you to speak with people or come in contact with them if they consent.
  • Also, AmeriClerkships strongly recommends against minimizing your US clinical experiences to 1-2 word phrases, and to instead clearly describe what clinical activities you were exposed to in the “Description” section of your residency application, or during interviews, and to be sure to not engage in any activities that would be viewed as the unlicensed practice of medicine in the United States.

Are AmeriClerkships affiliated physicians employed by AmeriClerkships? No. Supervising attending physicians utilized by AmeriClerkships are independent contractors, who by law are not bound by fixed schedules, rules or locations. AmeriClerkships utilizes its years of experience in communicating with each physician and/or clinical site administrator(s) to help minimize unexpected changes, but that may not always be possible.

Can I decline to drive up to 50 miles in case of a change in an In-Person clinical block? You can, but at that point, AmeriClerkships will have fulfilled its obligations to provide you with clinical experience, and therefore completed the service we were contracted to provide.

Realistically, how often do AmeriClerkships members travel up to 50 miles to get to a replacement clinical site during in-person clinical blocks? Not often; most backup clinical sites are within the same city limits, approximately 20 miles from one another. However, by enrolling with AmeriClerkships, you agree to travel up to 50 miles from your originally scheduled clinical site (again unlikely, but possible) to gain your clinical experience.

Why does AmeriClerkships advise against public transportation? Public transportation is time-consuming, unsafe or unavailable 24 hours/day, and not accessible to city suburbs. Your supervising physician may round at multiple hospitals, take night calls, or visit hospitals located near city limits, and they will not want to inconvenience you if they believe you are unable to make it on time due to transportation issues. Note that asking the physician or their staff for a ride is both unprofessional and filled with potential risks and liabilities.

I am an international medical student and am completely confused and overwhelmed by state medical board laws, the types of clinicals I can perform, and how my clinicals can affect my residency. What do you suggest I do? We completely understand, which is why we have created a very informative page just for you called “5 Types of U.S. Clinical Clerkships for Non-U.S. Medical Students”. Please click here to visit it.

Where can I find a copy of the Enrollment Agreement? Once you complete your enrollment, you will receive an email with the subject “Copy of Your Signed AmeriClerkships Enrollment Agreement” in your inbox. Also, please click here to visit our Terms & Conditions page online.

I am a medical graduate and a doctor in my country; can I examine patients, diagnose and offer treatments on my own during AmeriClerkships clinicals? Absolutely not, unless you are licensed to practice medicine in that US state.

What is included in my {!Opportunity.Type_of_Membership__c}? Click here to review what is included in your type of membership.

How do I upgrade my membership? Please contact {!Opportunity.Residency_Strategist__c} to see if you qualify by emailing {!Opportunity.RES_Email_Contact_Update__c}.

How much inpatient exposure will I have during in-person rotations? Am I guaranteed to go into a hospital? Inpatient exposure is determined by the ‘Clinical Feature’ of your clinical site, your ability to get to the hospital(s), that hospital’s policies, and any extenuating circumstances (such as COVID-19 pandemic). If your supervising attending conducts 4-6 AM patient rounds, or he calls you for a delivery or ER admission at 2 AM, and you’re unable to get to the hospital, because of over-reliance on public transportation, then you are forfeiting your inpatient exposure opportunity.

Can I be supervised residents and/or program directors under the auspices of a Graduate Medical Education Office? Yes, but only in ‘PGSI’ (Postgraduate Subinternship) designated clinical sites (details: https://acmedical.org/pgsi/).

How do I access my membership benefits? Please click here to visit the AMS Resources page; the password will be shared with you once you become a member of AmeriClerkships.

How do I sign up for free members-only webinars, such as Dr. Mizani’s office hour with questions? Please visit https://acmedical.org/online-meetings/. On this page, you will also be able to access all of our webinars and/or meetings that come with your membership such as Career Development Office Hours, Dr. Mizani’s Document Analysis and General Questions Office Hours, as well as any upcoming scheduled webinars.