USCE is a signal amplifier: it reduces perceived risk for programs. Your objective is not “a certificate,” it is credible clinical exposure + a strong Letter of Recommendation (LOR) that reads like a US supervisor would write for a US trainee.
Observership vs Externship
Observerships are typically shadowing (limited hands-on). Externships are structured clinical placements with more active participation (rules vary by site and visa status). Always confirm allowed activities in writing.
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Step 1 — Decide your target specialty first
USCE is most valuable when it matches your ERAS narrative. Pick a primary specialty, then build USCE in that domain (or adjacent) to avoid a fragmented story.
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Step 2 — Build a US-style packet
Prepare: 1-page US-style CV, short cover email, immunisation proof, BLS/ACLS if relevant, and a one-paragraph “what I can contribute” note (reliability, documentation, presentations, QI).
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Step 3 — Acquire placements using volume + precision
Send 50–100 targeted emails: program coordinators, hospital education offices, attending physicians with IMG history, alumni networks. Track outreach like sales: pipeline, follow-ups, conversions.
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Step 4 — Earn an LOR (don’t just request it)
Deliver: punctuality, concise presentations, clean note-writing if permitted, proactive reading, and 1–2 high-quality patient write-ups. Make it easy for them to describe you as safe, diligent, and teachable.
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Step 5 — Operationalise LOR collection
In ERAS, LORs are uploaded by the letter writer via the Letter of Recommendation Portal (LoRP). Provide: bullet-point highlights, cases you handled, and your personal statement draft so the letter aligns with your narrative.
LOR quality > number of LORs
A generic LOR (“hard-working doctor”) is weak. A high-signal LOR includes specificity: performance under time pressure, clinical reasoning, teamwork, communication, and professionalism — plus a clear recommendation.
SourceAAMC ERAS: Letters of Recommendation + LoRP overview
Open Link SourceAAMC ERAS: Applying to residencies (central hub)
Open Link