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Get the Terms Right!

Many students are mistaken when Universities tell them that we don't offer clerkship or you must complete all your clerkships before doing electives.... just because they don't know the difference.... so I am creating a webpage just for basic terms!

Electives: Any optional ward rotation done... clinical electives in usually final year of medical school in Pakistan and others and in pre-intern year in India... research electives can be done anytime! These includes rotations like radiology, cardiac surgery, chest medicine... that are not compulsory! Mostly US/ UK electives are done to get good reference/ letter for your future job/ training positions.

Observership: Any ward rotation in which you observe/watch the attendings, residents, fellows or other medical students but you are not allowed to touch/examine the patient yourself or participate in any sort of activity, though you can watch everyone doing everything... considered to be a passive form of learning as compared to electives! You can also get a letter/ reference from observerships but generally people consider reference letter from electives experience to be better than reference letter from observerships; though I personally believe a very good observership letter is better than an ordinary electives letter. If you get a chance to chose one out of two... I recommend electives!

Clerkships/ Core Clerkships: These are the compulsory ward rotations that you usually in your 3rd year of medical school. These include all the basic compulsory ward rotations of general specialties like Medicine, Surgery, Gynae-Obs, Paeds etc.... when you do your clerkships you don't have any prior clinical experience(that's why Universities usually don't offer clerkships) but when you do electives... you have completed your clerkships(as you can't do final year rotations before doing the basic rotations in 3rd year... Isn't that right?)... and when Universities demand you have completed clerkships... that does not mean you should have graduated(then you are no more qualified for electives) or completed all the electives of your entire medical school curriculum.... it just means that you have completed the basic ward rotations of medicine, surgery, obs-gynae, paeds etc.

Sub-Internship: It is a type of clinical elective(final year rotation) in which you have almost all the responsibilities of an intern but you don't write orders, lab test etc yourself or... have to do so after discussing with chief resident or attendings... under their supervision... so it means more responsibility... thus it is generally considered better learning experience as compared to electives... because you don't sit, assist and observe as a student but work almost like an intern... it is generally very rarely given to international students but if you get one... my advice is.... never miss it!!!

Internship: In India, internship year is the last year of medical school. In Pakistan, UK and some other countries, Internship is referred as "House Job" but it is done after graduation from medical school. Now Internship in US is like the latter(you do it after medical school, not during medical school or last year of medical school )... in short, the first year of residency is called Internship. So that means that residency of Internal Medicine means you work as an intern for one year and then 2 more years of residency... similarly in Radiology... you do 4 years of Radiology residency after one year of internship... total 5 years... as far as I know all the specialties have to complete one year of internship... 

One interesting point to note is IMGs from India, have to work as intern two times, once in India during medical school and then in US in first year of residency....

For people of Pakstan on a funny note... please don't consider US residency to be a US house job... I have heard many people saying house job in US is of 3-5 years; house job/ internship is always of one year... let it be US, Pakistan or India...

What you do after internship/house job in US is specialty training just like 4-5 years of PG training of Pakistan... e.g in Internal Medicine, in Pakistan you do one year house job, then 4 years of PG Training after which you become a Internist(IM specialist) and in US, you do one year internship(house job) and then 2 years of residency after which you become a Internist.

Residency: It is the training in the specialty of your choice e.g Internal Medicine, Surgery, Radiology etc... just like PG training or post-graduate training of Pakistan... though in Pakistan, PG training is 4-5 years for most specialties... in US it varies from specialty to specialty...

Fellowship: It is a sub-specialty training. Like in IM, it would be Cardiology, Hematology etc.... In Radiology it would be Abdominal Radiology, Interventional Radiology etc.

Going through the following link might also be helpful.

bhai m getting a bit confused abt dese terms ..our clinical postings in India started frm my 2nd year (3rd sem)..  v had all postings ranging frm med, surg, obgy to radio, paeds, ent ortho acc 2 d academic year.. (but for med, obgy, surg, paeds - tho v had them as subjects in pre-internship year, v had postings ritefrm 2nd year)

after dis v'l hav our postings again in internship,i.e, next year... so which of dese are core clerkships n which r electives???

Dear andy!

I think all our ward duty we do during our 2nd year to final years are core clerkships, coz we do mostly basic non-invasive duties. in US too, core clerkships deal more with history, examination and pimping. When we pass our exams we ascend to  more responsible training in internship. that is equivalent to electives in USA. But in India, during our internship year we call the rotations as electives: 'we have to choose and do two 15 days rotataion among anesth, radio, psych, skin.. MCI calls these as electives. But USA calls all the final year as electives'. So when referring to USA, we also call our whole internship year as elective duration. The word elective means to choose as all US studenst choose the type of subject and duration of electives for their whole final year!  (with some restriction as to minimum subjects type and duration)

And andy, best of luck for final profs. and do post that journal list asap. i also need it, have 2 articles near ready to publish. i'l be indebted!

Best Wishes

abid hussain (not verified)

Sat, 11/14/2009 - 18:31

thanks a lot for this information#..i m a freqent silent visitor to  this site ... really it helps me a lot . thanks a lot

best ragards

abid

joyeeta (not verified)

Thu, 04/15/2010 - 11:44


first of all my sincere thanks for such an enlightening website..never read through any website more informative than this. i m a medical graduate( internship completed) from china,i have cleared my mci screening and awaiting my registration with medical council of india. wat am i elgible to apply for please let me know coz i m getting a bit confused with all the terms.

umar

Sun, 04/18/2010 - 08:11

In reply to by joyeeta (not verified)

Thanks a lot for your kind words... I m glad that I m able to help so many people from different parts of the world... God bless u!

As far as I understand, as u graduate u r no more eligible for elective but u can certainly do observerships and externships...

Visitor (not verified)

Tue, 05/18/2010 - 18:42

hey hello...


am stuck in a strange situation here..i want to do electives 7months after my internship in india[in mean time i planned for step1] still as a student cos wantedly postponed my graduation and so i'll be graduated a year later than the actual time...so will that affect my profile and how can i justify that during my interviews? is it worth taking that risk for the sake of clinical experience?

i wud be really grateful if somebody helps me out in this..

thanks in advance..

i think its ok to do so...actually i m also doin the same n i m plannin for 8 months of elec.................once i raised the same q n some expert told me it matters taking the risk esp if u r eyeing for residency in surgery or radiology..............

its ok if you want to do ur electives after 7 months of ur intern in india. for how many months do u want to do the electives? ur graduation will be delayed only by the time period u take off to do the electives. why do you say u will graduate one year after the expected time?? and if ur graduation is extended by 3 months or so it wont be that big a problem as long as you are interested in usmle. seemingly u r talking about missing one attempt in All India PG entrance and hence losing one year. but u have to decide on your priorities, AIPG or USMLE. u cant have both. 

and sure 3 month delaying of internship for gaining clinical experience will definitely help you in residency application. so basically its fruitful.. its not only the clinical experience you get but many things allied with it:

1. ur CV for residency is strengthened

2. u have a chance of getting good LORs for residency

3. u have a chance of getting into research while working in electives itself

4. u have an opportunity of making a good rapport with ur attendings (under whom u do the elective training) and can later get attached with them for research which will again help in ur residency application.

i hope this answers your questions and doubts.. good luck.


okay that was useful but my exact question is [probably i've conveyed it wrong]...i completed whole 11months of internship here in india and left the last month so dat i wont be graduated and still be a student and i started preparin for step1...then after that i wanna go for electives...so i wud be late by a yr than my classmates in getting graduated [say 5-6 months for step1 and 4-5 months for clerkship and CS-so a a total of 1 yr]...actually i applied for universities during my intership..i cudnt get any..so thought i'll give step1 so that i'll hv better chances of getting clerkship in branch and university of my choice.. but on the otherside i'm afraid how to justify that [i mean completing internship a yr later than usual time] in the interviews..will that be a big prob or can be managed? 

so now again is that worth taking that risk for the sake electives? i've already made up my mind but juss wanted it to be more clear and transparent...

Electives are useful. U will have to weigh the importance of electives against delaying graduation. If you get electives at a good place, thus leading u to LOR and later research it will go a long way in ur residency.. Also you can get attached to some hospital/nursing home during the time you are on leave form your medical college and show it on your CV that you were attached there and working there. Hope that answers your question.

pawan sagar (not verified)

Fri, 06/04/2010 - 09:29

hello

am a final yr student and am thinkin for taking clerkship next year . but when i visited the site, i got confused by these electives. i wanna know wats the difference between them ? which is more important for later pg in a us university? and finally when do we have do them???  plz someone help n pull me outta this misery!!!

thanks

clerkships are your rotations of basic clinical subjects like surgery, medicine, paeds etc... US electives are final year "away" rotations in US which can be both in basic clinical subjects and other clinical specialties/ sub-specialties like radiology, nephrology, pulmonology, infectious diseases, endocrinology etc

XYZ (not verified)

Fri, 06/04/2010 - 12:16


ASA.. im final year student(kemcolian).. i wanna do electives in california but im just confused when i see long list of universities offering electives but r really expensive.. i can go 4 electives b4 september.. plz help me out 4rm where to start so that i can do electives in california.. im really upset.. thinking am i late 4 electives?? i hope ull help me in sorting this out

regards

XYZ

try places like ucsf, ucsd, ucla and others... I dont think there is a university in california without any fees... if u r looking for free electives, try NIH...

aditya (not verified)

Fri, 06/25/2010 - 19:27

sir i'm right now in 2nd yr of my medical college in india, i was wondering what is the right time to go for observership,since it is just a shadowing does that mean i can apply for it in 3rd year....i'm bit perplexed as of now because off late i attended one seminar in which i was told that observership is meant for medical graduates.....plz help me, thnx :)

Its requirement vary from place to place but you can certainly do it whenever you want..... even as a medical student... I did it at the end of my 3rd year and start of 4th year... it is a learning experience... so according to me you can do it whenever you want... you just want to show your eagerness to learn to your attending and that is how a medical student should "really" be.....

Hesham (not verified)

Thu, 10/28/2010 - 16:56

thank you Omar Bahai so much !!! you are giving a great help here may Allah reward you with the best you wish for :)

I need your advice regarding the electives, my university has an affiliation with a good medical school in US that usually does not offer electives to international students but those from the affiliated ones, so I applied for it, and I didn't know that the acting internships are better than the electives, so basically I chose one month of acting internship in internal medicine and another month on either cardiology or gastroenterology, I have very little time to submit a new application so I am thinking of doing 2 months of acting internship instead of one acting internship and another elective, so please tell me what you think!

I will be spending around 6 months of electives in the US, so I thought that if I secure the acting internships from the  affiliated university and then I can do electives on the other 4 months as they are easier to get ...

I am also wondering about another thing, there are three acting internships offered by this university, the first one is at the university hospital, the second is at a well reputed tertiary care hospital and the the third one is in a veterans affairs hospital, both the veterans affairs and the tertiary care hospital have night calls every fifth night, so is there any difference where you get the acting internship whether in a university hospital or tertiary care or  veterans affairs ? and is it better to have the LOR from a university staff doctor than from veterans affairs or tertiary care hospital?! 

please let me know what you think, I have very little time to submit a new application with any modifications! 

thanks in advance brother .

sahil (not verified)

Wed, 11/03/2010 - 09:24

thank u so much for such a beautiful information.. can u provide me the sites to apply for clerkship nd electives....i dont have them...i need them urgently...it would be greatful of you...

Ray (not verified)

Wed, 01/12/2011 - 10:23

Hi...The information is really very helpful.Thank you. My question may seem repetitive but i need your advice here. Am left with one and a half months of my internship/ house job. Got no openings any where for either clerkship or observership. But i know i should be doing them for better opportunities, so should i delay graduating and keep trying to get accepted and in the mean time give steps or should i dive in blind and rely totally on my steps.

   Please do reply.Thank you.

sufyan (not verified)

Tue, 01/18/2011 - 06:04

actually bhai in table of contents of elective in McGill University........in description of elective in departmnts like rheumatology ,emergency medicine etc they r asking only clerkship students can apply in these departments.......i am confused by ths statements...bhai i have completed 4 months rotation in medicine,surgery and gyn/obs,and some electives like elective in cardio thoracic surgery,Medical oncology ets are available to only POM (clerkship)students....and some electives for pre clerkship students plz tell me currently i am in 3rd year nd when i will go for elective at that time i will be in 4th year .........nd before going i will complete 4 months rotations in gyn/obs,surgery,medicine,pead,pscy..........plz guide me which departmnts i should chose....deprntmnts for clerkship students........departmnts for POM (clerkship students) and pre clerkship students departmnts.

Best Regards


Sufyan Sadiq

Jainil J Shah (not verified)

Mon, 03/07/2011 - 18:23

hi umar bhai,

I am doing my Internship in India. It is about to be over by end of Mar,2011. I want to apply for Electives following my Internship. My date of Graduation from college dat is Date of receiving the certificate is Dec,2011. I can get a letter from my dean saying my graduation is in Dec,2011. would my application be accepted following my internship for electives? if not, what according to you should I go (for better than observership)? And what does Externship mean and what is its value? 

Zaheer Anjum (not verified)

Sun, 03/13/2011 - 06:29

I got electives call from Mount Sinai in ENT for June 2011

Visitor (not verified)

Mon, 03/21/2011 - 15:48

Hi umar,

Im an IMG(pre intern).

Your site is really helpful,I want to know what is externship and how different is it from electives?. and as you said clerkships are essential,what is the time when you can do it. I have already finished my final year and about to begin my internship in april 2011. So please answer in terms of:

1. whether I can still do my clerkships ?or they can be done only in 3rd yr?

2. Can electives be done anytime,I mean after internship,/during internship?

3.Again,what are externships?Is it possible to go for externships during internship in India without delaying your year of completion. What I want to ask is ,whether there are institutes in India(even if selected) who allow a combination of intern and externship within the same year?

4. Lastly I want to confirm whether observerships are only possible during medical undergrad time? For someone like me who has finished final year, can I still pursue them or is it not done?


Visitor (not verified)

Sat, 06/04/2011 - 13:37

What is a selective? I am getting a selective at a big university for 2 weeks and an elective of the same department's sub-specialty for 2 weeks. Is it advisable to take it?

adnan (not verified)

Sat, 10/01/2011 - 20:52

Umar bhai i searched on harvard wepsite and came to know that we can apply for clerkships also....and step 1 was not mentioned mandatory...so it means that anybody can apply for that or it is manadatory same as electives in harvard?

srivalli (not verified)

Wed, 10/12/2011 - 17:18

HELLO UMAR BHY

          Recently i got married to a girl she completed her b.tech.Both are trying to go US.As i did mbbs i want to do mph.she wants to do ms.I want to know who has higher rate of success to get visa so that other can go as dependent.

hira (not verified)

Tue, 11/15/2011 - 19:27

hey umar bhai i wanted some guidence form u
i shall b very thankful to u for this
i am intersted in research programs n hav contacted a fewbut most require letter of recommendations from the teacher (online or thru email)
and i dont think any of my teacher uses emails n all i can get LOR from them on paper but online it would b difficult
what should i do in this situation
regards

Visitor (not verified)

Fri, 12/16/2011 - 01:43

hi i am a student from india..idid my internhip a yr ago i want to take up usmle..but have no idea wher to start...ther r so many things on ur web site i don knw wher to start ,,

i have applied for id verification yet only

will starting this late wil b a tabbo on my cv...? one ful year of dedicated work can get me through.....plz pz help umar bhai..

hi umar bhai!

you mentioned that internship for Indian students is part of their degree so they can do electives even during housejob.Now,the same rule has been implemented in Pakistan.Does that imply we can also do electives after final year?

NAlvi (not verified)

Sat, 05/19/2012 - 22:13

Hello and Salaam Alaikum!

Thank you very much for a very helpful site for prospective doctors and professionals. Jazak'Allah for your countless efforts! :)

I have a few queries if someone can help clear them out for me.

I will be applying for electives in my 5th year, without giving my Step 1. Having said that, my primary interests include opthalmology and surgery.

1. I am confused as to find a good clinical elective for opthalmology, preferrably sth that encompasses a bit more work than an observership (which is likely to be the case for sth like opthalmology).. any suggestions and advices? the most established I know of is the John Hopkins elective, but like I said, clinical is what I am hoping for..

2. I know a few programmes providing subinternships for surgery. However, not many from my university have gone for surgery subinternships. If someone has had an experience and would like to guide me in so, it would be veryy helpful!

 Thank you so much!! :)

Visitor (not verified)

Thu, 10/25/2012 - 12:45

 Sir I have just 5 more months left for my completion of my internship..jus planned to do usmle...but I haven't started anything till date..not even single step given...no toefl...should start everything from scratch..can I think bat electives now...am I too late..is there any chance of me getting into elective with 5 months time???

shivam (not verified)

Mon, 04/29/2013 - 06:23

Sir I have 2 months left before my internship completes....and i havent given step 1 yet....so how to appply for electives and if it isnt possible is there any other substitute for electives..immediate guidance needed...

Visitor (not verified)

Sun, 06/02/2013 - 20:46

Hello sir, Actually I'm into the 5th month of my internship at a med school in India...recently decided to prepare for USMLE....considering internship is taken as the final yr of MBBS curriculum here, should I be applying for electives or clerkship? Also I wont b having my step I scores available before applying for the electives/clerkships...in that case how to go about the whole procedure? Looking forward to your reply...

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