by Dr. Aitzaz Bin Sultan Rai.

 Summary:

Observerships, research and externships give you an exposure of healthcare system of
United States and give you an idea of what to expect during residency; (the nature of work,
healthcare facilities, code of conduct for healthcare professionals, the cutting edge
technology, electronic healthcare records, diseases prevalent in a certain geographical area
and the social and cultural values of people of United States). In this issue of the section of
the Road to Residency, Aitzaz and Saima discuss their views about the importance and the
various ways to do an observership, research and externship in the United States.
Why do an observership, research or an externship in the United
States?

Before we give our views on how to find an observership, research or an externship in the
US, let’s first give you a few reasons as to why to opt for these options.

(1) Observerships, research and externships give you an exposure of healthcare system of
United States and give you an idea of what to expect during residency; (the nature of work,
healthcare facilities, code of conduct for healthcare professionals, the cutting edge technology,
electronic healthcare records, diseases prevalent in a certain geographical area and the social
and cultural values of people of United States).

(2) By working with US physicians and researchers, you make “connections” in the System
which pays you a lot later on when you are applying for a residency spot in the US after doing
your USMLE (Unites States Medical Licensing Examination). The name of an imminent
scientist or clinician in the references section of your CV can open many doors for you in your
professional life. The Letters of recommendations (LORs) from the faculty of a renowned
hospital in US are always looked favorably by program directors of residencies and
fellowships.

(3) If you opt for an externship, it will count as your US clinical experience (USCE). Due to
growing number of highly qualified candidates from the world, the competition is fierce to get
a residency spot. Many residency programs want to see USCE as a prerequisite to apply into
their residency program. If you don’t have USCE you are simply screened out from the list of
eligible candidates for interviews for those programs who require USCE.

(4) If you choose to join a research team, you may get some quality publications which do
carry some weight age when screening candidates for interview and more importantly at the
time of ranking candidates for the residency spots. Even if you are not able to publish a few
research papers, your experience in a research team will reflect your genuine interest and
aptitude for research which is seen highly favorable by many university residency programs.

What to Choose?

Among observership, research and externship, if you have to choose one; go for externship
because it carries the highest weight age of all three. Externship is called a “mini residency”. 
During externship you get “hands on” clinical experience as you are actively involved in
patient care; you can take history, examine the patients and get involved in patient
management along with residents. But the problem is that most of the hospitals do not allow
externships due to tough laws of patient privacy and HIPAA (Health Insurance Portability
and Accountability Act) rules.

The bottom-line, however is, that get whatever you can; may it be research, observership or
externship, but prefer externship over research and observership.

How to find a research position, observership or an externship?

Regarding research, first of all to be very honest emailing professors or other research
scientists does not help much. Most of the directors of research don't open any mail that
would be related to a research opening or volunteering; that's what my Principal Investigator
told me, but exceptions are always there. So you should try and mail the researchers but the
chances of ending up in a spot are not much as most of the researchers get hundreds of such
mails daily from all over the world and they are screened by their spam filters unless they
have an open position. And if you are away from US and the only thing you can do is to email
the researchers then my advice would be not to send a generic mail to all the scientist and
wait to hit the jackpot. Do your homework well, send an individualized email to every
scientist, know his research well, find his publications on pubmed and make an appropriate
cover letter which should show your genuine interest in the research that person is doing.

If you are lucky enough to be in US then the best bet would be to meet the researchers in
person. Take a well written CV and a cover letter with you. But before going to any person
you should spend some time and find his areas of interest, his current and previous research
projects so that you can have common grounds during discussion with that person.
If you don’t have previous research experience , my advice would be that not to ask for a
“Paid” position as nobody is going to pay you from day 1 without enough research skills and
experience. Try to volunteer in some lab for 2-3 months, learn some basic research
techniques and you can later get paid in the same or some other lab if the investigator is
satisfied with your research work.

Another important factor when deciding to work in a research lab is to choose to work with a
researcher who is a big shot in his field as his reference would count when you would be
applying anywhere for any type of work. One way of finding out if the person is a big name is
to search his name on pubmed.gov and find out the impact factor of few of his publications.
But that may not be true in every case.

Regarding observerships, the same would apply. However, the difference in this case would
be that you should contact renowned clinicians through email, phone calls or better still meet
them in person. Another good option is to find an M.D., PHD who is involved in both research
and direct patient care and start volunteering in some of his lab work and then later begin
attending clinics with him, if he is still doing them.

Externship as I previously mentioned are difficult to get but if a certain program offers
externships, then they will have a certain office dedicated to it and you can email or call
them. But for externships these hospitals usually charge you a handsome amount for a
limited period of time and you also have to buy malpractice insurance; but all that spending
is worth it.

Types of Research:

Now coming to what kind of research you should join. There are two basic types of research:
(1) basic science or bench research and (2) clinical research. There are advantages and
disadvantages of both.

For most types of clinical research, the plus point is that there often there is patient contact,
for those who are not interested in typical lab work. However at the same time if you talk
about bench research, the plus point is that often you get hands on experience on latest lab
techniques such as RT PCR, luciferase assay, western blots etc but to get a publication in
basic science research is relatively more laborious and difficult. But if you are interested in
lab work and are considering in pursuing a PhD as well, then the latter may be a better
choice.

Few things to do during your student life:

During student life do not miss any opportunity to get involved in any sort of research
project going on in departments you are rotating no matter how simple it is. Do electives in
US during your clinical years and above all never miss your clinical wards.
At the same time, try to learn a couple of softwares, which will help you a lot in research such
as SPSS (Statistical Package for Social Sciences) and other research related softwares.

Important Lessons to Learn

(1) Externships, observer ships and research should be done to get overview of healthcare
system of US, make some connections in US or to publish few papers.

(2) Externship should be preferred over observership and research.

(3) It’s always better to meet the relevant person in person rather than emailing them and
if email is to be done it should be individualized.

(4) You can choose clinical or bench research depending upon your aptitude, the length of
time available and your future career goals.

(5) One should not miss any opportunity to get involved in any research or clinical project
during student life and to learn few statistical softwares.

(6) Discourage the practice of ‘mass e-mailing’. Day by day, this wrong practice is increasing. Often, you would find students wasting hours in emailing the same request to
almost every other professor to whose email address they can get their hands on. This is a bad practice. Emailing if required should be very individualized and personalized. Along with this, you should first decide if the person’s research area is of any interest to you. In some cases, people end up working in a project in which they have no interest, which in turn
leads to months of precious time wasted.

Even worse is the practice of getting accepted for a research position, using it to get a US VISA and then not going to them. This unfortunate practice too is on the rise. This not
only brings a bad name to your institution, but to your country as
well. These practices should be avoided and discouraged.

At the same time, as the authors mentioned, do not miss upon any opportunity in your home country and college.

These days the undergraduate research especially in Pakistan & India is gaining a lot of momentum. Few of my colleagues have gone onto publish their group work in one of the world’s biggest journals. The lesson is not to underestimate the importance and the good research work that you can do at your own home institution. It is certainly more fruitful than wasting hours everyday mass mailing and getting no response.

Reference: Rai AS, Mughal, Mughal SA. Observer Ship, Research and Externship in the United States. 10/90
Student J 2007. 1 (1): e5.