Observership; How to Select a Program?

You are a medical graduate and spent 5-7 years in medical school depending on the region/country and type of degree, and clinical training requirements of medical school. Medical training includes various types of clinical training such as fellowship, residency, internship, clerkship, elective, externship, and observership. Some of these training mediums are for-credit and others are do not have any academic credit. Non-academic credit trainings are used to enhance clinical experience and gain the understanding of clinical systems.

We will be going over observerships today with an in-depth review of the definition and various factors associated with selection of an observership program.

What is an Observership?

Observership is usually a brief (4-8 weeks) rotation done by a medical professional or in some instances pre-medical students to gain hands-off clinical experience in a clinical setting e.g, hospital or an outreach clinic. The duration of observership is not absolute and can be less than four weeks or more than eight weeks.

In other words, it is an experience where individuals with or without prior medical education can observe medical professionals as they care for patients and families for a specific period of time in any healthcare facility or organization. It also do not carry any academic credit.

Observership vs Shadowing

The main difference between observership and shadowing is the involvement of observer in rotation. In shadowing, observer only follows the day-to-day activities of the attending physician. However, observership is the combination of shadowing and some sort of active participation. This participation can be in the form of topic presentation, case discussion sessions, or a question answer session. Shadowing usually does not result in a recommendation letter but observership can yield a letter.

Hands-on vs Hands-off Clinical Experience

These are the two major types of clinical experiences which medical professionals encounter throughout their medical career.

  • Hands-on clinical experience involves a more active role. There is a direct interaction with patients and the student, trainee, or a physician who manages clinical conditions under supervision. It includes but is not limited to history taking, physical examination, management of diseases, and prescribing medications. Electives and externships are examples of hands-on clinical experience.
  • Hands-off experiences generally comprise shadowing and observational learning. A learner shadows a physician or team during their daily schedules and often present a topic in rounds or conferences. Observerships and shadowing are categorized under hands-off clinical experience.

Research Observership; Is it real?

Recently, the use of observership has also been extended to observe research methods in a lab or clinical setting. This type of observership and termed as ‘Research Observership”. The utility of observership in research is very limited. It is also restricted by immigration laws of some countries (specially United States).

Key Selection Metrics:

Here are the key factors which should be considered when deciding to apply or select a clinical observership rotation:

  1. Career plan
    • Career plan is one of the most important factors in the search and selection of an observership. Gaining clinical experience is important for induction in training spots all over the world. Although hands-on clinical experiences are favored more, but observerships still play an important role in shaping the career path.
    • A medical graduate who wants to train in a place outside of his/her country of graduation is often at disadvantage as compared to the graduates of home country for several reasons including lack of clinical experience in that country. Observerships help international physician to better understand the epidemiological patterns of diseases and differences in clinical protocols.
  2. Networking
    • These rotations provide opportunities to acclimatize to the clinical environment and functioning of health systems in a country where physicians aim to train in future. It also opens the avenue of networking and building professional ties. These rotations help not only to reach the set goals but also facilitate navigating the medical career.
  3. Future goals
    • A goal directed approach can help to better navigate the selection of observership programs. If a physician is interested in the field of surgery, s/he should pursue an observership rotation in a surgical department or any surgical sub-specialty.
    • Similarly, if an applicant is a neurology residency aspirant than spending time as an observer in a neurology department will yield better outcomes. It will also increase the chances to acquire a training slot in the desired field.
  4. Experience
    • Observership can also be an invaluable source of learning. An observer who is able to attend the morning meetings, clinical rounds, and conferences will naturally gain more insight into the system than an observer who was not given an opportunity to attend these.
    • The credibility of a hospital or a center providing observership and reviews of previous observers are very important in this regard. Observer must also have some idea of active board certifications of attending physician(s) and the quality of LOR.
  5. Location
    • If an applicant has a family in a specific city or state, the decision is simple but this is not true for most of the residency training candidates. Some people love to live in big cities and others are enjoy small towns.
    • Observerships can be used to both target the programs of top choice in a location of interest or can be used to gauge a prospective region where an observer plans to spend three-six years in training.
  6. Changing the career path
    • If you are considering changing your career pathway or want to make a transition to a field in which you do not have a first hand experience, observerships are a great place to start. For example, if you want to shift to a career with a limited patient contact, you can set up a pathology or a radiology observership to see if it really suits you before diving deep into it.
    • Transiting to a related specialty is relatively easier. Consider that your CV is oriented towards internal medicine residency and now have changed your mind in the favor of pediatrics residency. You can search for an observership in pediatrics to connect with the field, acquire related experience, and recommendation which will increase your chances for a pediatrics residency training slot.
  7. Value
    • Any experience should add some sort of value to you on paper or in your skill-set. Before you finalize your observership, ask yourself this question: What value addition is this rotation going to bring to my portfolio?
  8. Travel
    • Observership also provide an opportunity to travel and explore new cities/towns. It also serve as an important introductory experience to the culture of host country. However, international travel has it’s own challenges including cost, preparation, and leave from work.
    • Travel restrictions amidst the COVID19 pandemic has made travel extremely difficult. Many medical schools have developed online rotations or virtual elective programs for medical students. The original aim of such rotations was to bridge the gap from cancelled in-house clinical rotations.
    • Various institutions and clinical training centers are also offering virtual observerships. Moreover, if you are considering applying fora clinical residency program in the US and are unable to travel you can shadow an American Board certified physician in your home country.
  9. Visa
    • If you are a non-US international medical graduate (non-US IMG), observership programs conducted within United States will require you to obtain visa from the embassies in your home country (except few countries which are exempt). The visa category usually granted for observerships is B1/B2 (travel/visit visa).
    • Please know that not all institutes issue letter for visa support. Please visit the websites of designated embassy and follow their recommendations. You can also contact your peers who completed the visa process for similar reasons. If you have complications in your visa application, please follow the instructions of officials from embassy or seek help from experienced attorneys.
    • For countries other than the US, contact the relevant departments of those countries where you wish to go for your observership.
  10. Cost
    • Observership is often associated with hefty cost and it is an important and usually the final deciding factor. However, it should be noted that the observership fee is only one component of the total cost. Observer must also add housing and travel expenses to estimate an actual amount that an observer will have to pay.

Top Ten Factors for Selecting an Observership Program

Please cite this article as:

Observership; A guide for International Medical Graduates (IMGs). Furqan, M.M

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