What is the difference between observership and externship?

An observership is a shadowing-only experience where you watch physicians practice without direct patient contact. An externship (clinical rotation) is a hands-on experience where you actively participate in patient care, write notes, and present cases. Externships carry more weight in residency applications but typically require ECFMG certification or passing USMLE Step 1 and Step 2 CK.

How much does a clinical observership cost in the USA?

Clinical observership costs range from free to several thousand dollars depending on the institution and duration. Many university-affiliated programs charge $500-$2,000 for a 4-week rotation, while some community hospitals and clinics offer free observerships. Always verify fees directly with the institution before applying.

Do I need ECFMG certification for an observership?

Most observerships do not require ECFMG certification since observers do not have direct patient contact. However, externships and hands-on clinical rotations typically require ECFMG certification or at minimum passing USMLE Step 1 and Step 2 CK. Requirements vary by program, so check each listing carefully.

Can I do an observership on a B1/B2 visa?

Yes, most observerships can be completed on a B1/B2 visitor visa since they involve observation only, with no patient contact or compensation. The B1 visa is more appropriate than the B2 for clinical observation. For hands-on externships, a J-1 or other sponsored visa is typically required.

Which hospitals offer free observerships for IMGs?

Several hospitals offer free or low-cost observerships for IMGs, particularly community hospitals and some academic medical centers. Programs at NYC Health + Hospitals facilities, some VA hospitals, and community-based clinics may waive fees. USCEHub lets you filter listings by cost to find free programs across the United States.

How do I find a research fellowship as an IMG?

The most effective approach is cold-emailing Principal Investigators (PIs) at academic medical centers with a tailored message referencing their recent publications. Expect a 2-5% response rate, so plan to send 50-100+ emails. You can also browse research fellowship listings on USCEHub and check institutional websites for posted positions.

What is USCE and why do I need it?

USCE stands for United States Clinical Experience, encompassing observerships, externships, and clinical rotations at U.S. healthcare facilities. It is considered essential for IMGs applying to residency because it demonstrates your ability to function in the American healthcare system and provides opportunities for U.S.-based Letters of Recommendation.

How long does an observership typically last?

Most observerships last 2 to 4 weeks, though some programs offer rotations of up to 12 weeks. The ideal duration depends on your goals: a minimum of 4 weeks is recommended to build enough rapport with an attending to secure a meaningful Letter of Recommendation.

Can I get a letter of recommendation from an observership?

Yes, many observership programs offer the possibility of obtaining a Letter of Recommendation, though it is not guaranteed. The quality depends on the duration of your program, your level of engagement, and the attending physician's willingness. Discuss LOR expectations early in your rotation.

What is the best time to do an observership before applying to residency?

The ideal time is 6-12 months before the ERAS application opens in September. This allows enough time to complete the experience, secure Letters of Recommendation, and incorporate the experience into your personal statement. Many applicants complete observerships between January and June of their application year.

Browse Opportunities

Houston Methodist Hospital

Harbor-UCLA Medical Center

Cleveland Clinic

Harrington Global Observership — University of Miami Miller SOM

Northwestern Feinberg Visiting Students Program

UTHealth Houston — Observer Program

Stanford Medicine — Postdoctoral Research

Fred Hutchinson Cancer Center

University of Chicago Medicine

University of Missouri Health Care

University of Pittsburgh Visiting Medical Student Program

University of Arkansas for Medical Sciences (UAMS)

University of Florida Health / Shands Hospital

UAB International Visiting Medical Observership

Olive View-UCLA Medical Center

Penn Medicine — Postdoctoral Research

MSK MSO — Observership (San Diego)

University of Louisville — Medical Observership Program

Thomas Jefferson University Clinical Observerships

CommonSpirit Health International — Clinical Observation

LSU Health New Orleans / University Medical Center

BronxCare Psychiatry Residency — Volunteer & Observership

NYU Rusk Rehabilitation Physician Observership

USF Health Neurosurgery Observer Program

Ochsner Health — International Observership

University of Kansas Medical Center

Hurley Medical Center (MSU) — Observership

Georgetown / Ruesch Center — International GI Observership

University of Pittsburgh — Postdoctoral Research

MD Anderson Cancer Center

Brooklyn USCE — Clinical Rotations

CU Anschutz Extern Visiting Student Program

UAB Hospital (University of Alabama at Birmingham)

Loma Linda University Medical Center

University of Pittsburgh SOM International Visiting Student Program

WashU International Physician Observer — Head & Neck Surgery

Columbia Psychiatry Observerships

Medical College of Wisconsin / Froedtert Hospital

Yale-New Haven Hospital

Stanford Health Care

Ohio State Wexner International Visiting Scholars Program

Barnes-Jewish Hospital (WashU)

South Brooklyn Health (Coney Island Hospital) — Emergency Medicine M4 Elective

University of Kentucky Medical Center

Mount Sinai — Postdoctoral Research

Cleveland Clinic Florida

NYU Langone International Observership — Dermatologic Surgery and Cosmetics

University of Nebraska Medical Center

Hartford Hospital

University of Mississippi Medical Center

Memorial Hermann Hospital / UTHealth

Harvard Medical School Visiting Students Program

Penn Medicine (UPenn)

Mercy Hospital — St. Louis

UC Davis School of Medicine Visiting Student Program

Northwestern Feinberg — Postdoctoral Research

Saint Louis University Otolaryngology Observership

University of Cincinnati Medical Center

Wake Forest Baptist Medical Center

Washington University St. Louis Visiting Medical Student Electives

University of Washington Medical Center

Temple University Hospital

U Utah Spencer Fox Eccles Visiting Student Program

Penn ENT International Visiting Physician Program

UCSF — Postdoctoral Research

University of Minnesota Medical Center

Panamerican Trauma / VCU International Observership

NAMC Internal Medicine Observership

UT Health Memphis / Regional One Health

UNC Hospitals

DGSOM UCLA Visiting Student Program

NYU Langone Visiting International Physicians Program — Orthopedic Surgery

UW DLMP Global Observership (Pathology)

Vanderbilt University Medical Center

OHSU Visiting Student Rotations

University of Iowa Carver College of Medicine Visiting Students

University of Virginia Health System

Duke Visiting Student Electives

Mass General Brigham Emergency Medicine Clerkship (HMS)