Clinical Experience in the United States is the crucial part of your residency application. However, COVID-19 related travel ban has made it difficult for many IMGs around the world to take part in such clinical experience. Simultaneously, remote research opportunities and tele-clinical rotations have been evolving. During the last NRMP match cycle, many candidates have applied with telerotation experience and it is unclear as to how useful they are in residency application. Are these rotations of any use? Are they worth giving a chance and whether these are considered US Clinical Experience (USCE) or not? So many questions are being discussed. Let us take a look.
What is a telerotation? A telerotation is a type of clinical experience where you are not present in person and you participate in it through audio/video or other electronic means. You will be a part of the hospital clinical team and at the end, you are likely to get a letter of recommendation supporting your residency application. The Health Insurance Portability and Accountability Act (HIPAA) privacy act extends to telerotations as well.
There are basically two types (both may fetch you and LoR).
First, like electives, where you see patients, take history, interact with them, you can present cases and may have access to Electronic Medical Records.
Second, like observership, where you can have an attending physician and you will observe him and his team in action.
Telemedicine rotations worth it or not? To answer this question you have to dig deep into why IMGs need USCE.
In the case of electives or clerkships, it is considered hands on experience, that is for undergraduates where you get treated just like american medical students. While for medical graduates, there are observership or externships. In observerships, you can only observe the attending physician, while externships are a mixture of observership and hands on clinical experience.
During USCE, you have an exposure to American Healthcare System, and it shows that you understand this system.
You can get a letter of recommendation from a US trained/practicing physician and will carry the weight in your residency application.
It helps you make valuable connections, friends and acquaintances that can help you to get a research opportunity which may enhance your chances of successful residency match.
It shows program directors that you have the ability to work in a US clinical team.
Doing USCE at the hospital you want to do residency can improve your chances of getting matched. Attending physicians and senior residents at that site can analyze whether you are a good fit for their team or not. In the same way, you will learn lot about the program and help you to prepare your rank list order.
You have to think whether telerotations can fulfill the above requirements or not. Here is the brief comparison of both:
Tele-RotationsOnsite-RotationsAccommodation, Food and Traveling (associated expenditures)Not NeededNeededWork Hours4-5 hours per day (flexible)Whole dayVisaNot required RequiredHands On Clinical Experience and Exposure to US medical systemLimited to history taking.Wide ExperienceNetworking OpportunitiesLimitedMore possibilityCost CheaperExpensiveLetter of RecommendationCould be generic, depending of depth of interactionsLOR can be more specific.Impact on Residency ApplicationLimited information as it is still evolvingWell established concept and is well appreciated by residency programs.
Who should do telerotations?
If you have graduated medical school, have completed or are currently undergoing home country residency training, and can’t travel to the US, telerotations may help you. Since you are already an experienced person, a good telerotation can show that you have gotten yourself familiar with the US clinical system.
You have done some onsite rotations in other specialties and have pretty strong LORs from them. But you don’t have a chance now to do an in person rotation in your desired specialty. In that case, you may benefit from telerotations.
You have completed USMLE, but can’t have any onsite experience because of various reasons (mainly due to travel restrictions). Better to have something than nothing.
You have an excellent CV which sets you apart from others and a great score and you are on a tight budget, telerotations can be a good option.
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