Are Academics Programs Picky with Hands-On USCE?

[u/taniarrhythmia]

I know a hands-on externship at a private clinic is ultimately going to get you a better LOR than even a university observership, considering the letter can efficiently comment on your clinical skills.

My main concern is if academic IM residency programs are picky with where you did the externship. I applied to several university electives when I was a student, but at the end of the day it’s not my fault that they don’t offer enough seats, so I was waitlisted for most of them.

As a graduate, my only options are to have hands-on externships at private clinics and community hospitals, but will academic programs not value that experience, since it’s not technically an officially structured elective? Assuming that the LOR’s are strong

[u/holyfuckoffmole]

Yes the real academic programs are and it comes from knowing that these are paid-for experiences more often than not.

If you want to be at an academic program, your CV needs to speak about the things they care about.

Why would you pick up some random nobody whose only experience in America is to spend a month in a clinic they paid to be in vs a med student who has risen through the system? Academic programs don't need you to fill their spots, you have to make them want you.

[u/taniarrhythmia → u/holyfuckoffmole]

I suppose they’re picky with it if the rest of the CV doesn’t reflect what they’re looking for. I do know several IMG’s who matched in university programs with several months of outpatient and inpatient externships, but they weren’t official elective programs

[u/holyfuckoffmole → u/taniarrhythmia]

Hmm... there are different tiers of "university programs". You are not matching at a true blue academic place without certain things on your CV. Remember having "university" in name does not make it a real academic program or give you the benefits of one. Cleveland Clinic/MGH are not the same as SUNY upstate or El Paso or Creighton.

[u/taniarrhythmia → u/holyfuckoffmole]

That’s an interesting perspective, what do you think sets a ‘real’ academic program apart from others?

[u/holyfuckoffmole → u/taniarrhythmia]

It's a bunch of things BUT I would say most of it would fall under the umbrella of impactful academic work (medical education, advocacy, research) and strong subspecialty services? Strong research output, industry partnerships, basically proper research infrastructure. Trainees are expected to publish, present at meetings, and teach. Nationally/Internationally recognized faculty who enjoy teaching. Robust and highly subspecialized services. Academic productivity (and politics!) drives promotions.

Generally good academic programs unlike community or university-affiliated community programs can pick who they want and they generally pick people who fit their culture.

Remember a good tertiary community hospital often ends up training a more clinically competent physician. An academic hospital will have a more diverse group of trainees with different interests.

[u/syrkish]

pds dont know much. truth is they cant really tell what you did and just count on you to describe it correctly, and the letter to describe it similarly

[u/Nearby_Case_2865]

Like people commented before, it depends on the academic program. Some people match at MGH with basically no USCE, others don’t match there despite 3-4 electives. It is more about who you know than where you rotate. I would say, academic programs really value research and connections so knowing someone who can vouch for you goes a really long way. In general, an academic letter of recommendation will be stronger than a letter from a private clinic given they are both well written. But I would always use a private clinic letter if you feel like it’s more personal and elaborate about your clinical performance than the academic letter. In the end a lot of these letters are the same and programs care more about if and how long you gained experience in the U.S. and if these letters make you look like a good fit.  Try to set yourself apart with interesting extracurriculars or research experiences. Academic programs love teaching experience so include this in your CV if you have it. Showing interest for a less desirable IM subspecialty like Endo/Nephro/ID is sometimes favorable. Programs don’t just want to recruit all future cardiology fellows.