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Application for Clinical Electives

This page is intended to explain various components of Elective application procedures with an overview of the entire process in practice. Minor procedural variations are always there and vary from institute to institute. Regardless I will try to cover all 'variety' of such variations.

The huge list of requirements my seem scary to start with, however NOT every institute will require you to satisfy all the requirements described on this page. BUT if your are an extraordinarily fortunate person or you work hard enough that you are able to manage all possible application requirements described on this page, then most probably you can apply to almost any US medical institute that has a policy of accepting students (including international students) for Elective/Clerkship positions.

I assume that you have already read or are adequately familiar with the content discussed in sections : Getting stated and Types of USCE, of this website. If not, then it is advised that you do so now. This page can wait until you have matured your baseline knowledge required to understand what will be discussed here.

So lets Start it !

The MOST basic requirement for Clinical Electives program at almost every Medical School or Hospital in USA is that you must be a final year medical student in good standing who has completed his/her Core Clinical Clerkships at his/her parent/home medical school and must have your institute's dean's/principal's approval to undertake the desired elective course. If you cannot satisfy this basic requirement, you cannot apply ANYWHERE for a CLINICAL ELECTIVE rotation. Example: if you are not a final year medical student but rather a 1st/2nd/3rd yr student or so-you will not have completed your Core Clinical Clerkships, Or conversely if you are a Graduate-you are no longer a medical student and electives are only for students. In either case you would not be able to apply for electives.

If you are a 1st/2nd/3rd year medical student who is reading this, don't be disheartened, the only thing you have to do at this point in time is to wait till you grow up to acquire final year status. This does not mean that you should stop reading. Its impressive that you have discovered this website so early and tells me that you are smart and focused right from the beginning. Keep visiting this website in order to keep yourself updated, and when YOUR time will come you will know EXACTLY what you need to do and this will save you a lot of time and effort compared to your peers. So Good Job!

If you are a graduate, then options are abit limited, but focussed struggle can be fruitful in securing Observerships/Externships. I advise you to continue to read as the application procedures are very similar for Elective/Observership etc.


For purpose of simple understanding , I have grouped the application requirements into specific categories. I will discuss each of these individual 'groups' in detail separately.

1. Application forms : The purpose of an application form, from the point of view of an elective coordinator is to verify in order of importance: a) that you are a final year medical student. b) if you have completed your core-clerkships or atleast satisfied their minimum requirements c) You are not faking and you have your dean's approval (in shape of your institute's seal on forms) d) The rotations and dates you are interested in e) your personal information.

the answers to a)-e) MUST be yes or favorably conclusive. Or your application processing will be delayed or rejected.

Other information like: if your institute provides insurance coverage,or you have had OSHA training is secondary, and does not adversely effect your application if the answer is no on the application form ! ( will explain 'Why' and 'What those things are' later-see filling forms and/or below for details).

Example : Take a look at the application form of Baylor College of Medicine, a very well reputed institute to apply for electives.

Dont worry about terms that you dont know YET, you will know them soon, just read on.

For more details and guidance on filling forms click here


2. Accademic Requirements : This group of application materials deals with documents that demonstrate your academic competency. The list below enumerates in aggregate, the most commonly requested proof of accademic related documents. Dont freak out, Not every institute will ask for all of these. But as I am trying to create a 'general awareness' on requirements, I have to consider all that requirements requested by various institutes inorder to creat a super max 'complete list.'

a) Transcript. Most commonly and almost every institute will ask for your transcript. A transcript is a document that is supplied to you by your institute when requested. It is a record of evaluations of all the professional exams that you have taken so far since the start of your medical training. It also enumerates what courses you have taken and your performance in the form of marks or grades or GPA, depending on your institute. It should mention the duration of your clerkships, proving that you have completed your core-clinical clerkships in (medicine Surgery etc) and preferably should mention your overall class rank or percentile. This document is a basic requirement and almost every student has it. Every institute has its own pattern of transcripts, you can better check that out with your University registrar.

b) Toefl (Test Of English as a Foreign Language) Exam result. Documentory evidence of English speaking proficiency. Most institutes will ask you for it. Some institutes like harvard Medical School and Yale University will prefer your application over others if you have taken it. This exam evaluates your reading, listening, speaking and writing capabilities and provides you with a score. If you have a score of 26 or above in all individual sections, then you are safe to apply almost anywhere. The greatest emphasis is on the speaking section, try to score as high on it as you can.

Only a few places will waive TOEFL requirement if the medium of instruction is English, in that case your University/College Dean may need to supply you with a verification letter. Example: Mayo Clinic, University of North Carolina.

More information about the TOEFL exam can be explored by visiting their official website.

c) USMLE Step 1 result. Most Universities ( about 80%-just my estimate) now require you to have taken USMLE Step 1 as a requirement for elective application. A lot of places like State University New York (SUNY) and Memorial Solan Kattering Cancer center, where Step1 was not an application requirement before, now ask for it. My hunch is that over time, the rest 20% of Universities will eventually update their list of requirements to incorporate Step 1. The point is to realise the importance of taking Step 1 and to start planing accordingly ahead of time. For institutes that ask for it, there is no way around, and myths of 'Step1 waiver' are old, and no longer practical because of increasing competition. For obvious reasons, your application cannot be preferred over someone who has taken step 1 if you havent (as now quiet alot of people do take it before graduation) and the truth is that your's will simply be ignored or rejected if you ask for a waiver, because the elective coordinator will already have a better pool of candidates to choose from for the limited spots he/she has available. More details about USMLE Step1 can be reviewed on the page Getting Started of this website.

For those who believe that it is too late for them to take step 1 now: not having been able to take step 1 before graduation does not still close all doors of elective opportunities. You can try your luck for institutes that do not have this requirement- but my general analysis is that they will charge you alot. Two good examples of places that do not require USMLE Step 1 as a requirement, but are reasonably affordable are Baylor College of Medicine and Northwestern University, with an overall expenditure (excluding living and traveling) sums up to be around $1100-1500- thats the cheapest you will get without step 1 for most Universities. For comparison, Cleveland Clinic provides absolutely free electives with free residence but it requires you to have taken USMLE Step1.

d) HIPAA (Health Insurance Portabiliy and Accountability Act): It is a compulsory short course that all visiting medical students are expected to complete (depending on the institute) either before or after acceptance into an elective program.

This course is usually an online short course (2-3hrs) dealing with professional mannerisms towards protecting patient's confidential information in a hospital environment e-g minor things like how to discard patient information on paper, and what is 'their' institute's policy on sharing specific type of patient information with outside authorities (like some other hospital etc).

You dont have to worry about it so much, because the practical use of this knowledge is minimal at the level of student, and no matter how many of such courses you take, the practical side is very different and you will develope that sense only when you are 'in the system'- (My opinion). And dont panic, never on earth will your attending ask you questions about HIPAA to test your knowledge on that. Even elective coordinators think of HIPAA as a mere formal requirement. Courses are separate if you intend to do a 'clinical' or a 'research' elective.

If your home institute does not provide such training/course, you will be prompted to take the course, and the elective coordinator of the institute will help you in acquiring it. Most institutes will have availability of such courses on their website, where upon after completion you will take a quiz and you will be expected to pass with 80-90% correct answers as a minimum and you will then recieve an online certificate which you can print and submit with your application as proof. Others will have you do it when you start your rotation or may be on the orientation day.

To get a sense of things, take a look at the instructions file on acquiring HIPAA on Johns Hopkins University website


e) OSHA (Occupational Safety and Health Administration): Like HIPAA, OSHA is not a pre-elective aproval compulsory requirement. Another name for the similar course is 'Universal Precautions against Blood/Air born pathogens or infection control course.' This course is about general precautionary measures that should be taken in dealing with potential contaminants in blood and air. Example: info on how to dispose a syringe needle after drawing Blood, or what precautions can you take to avoid getting a needle stick injury. The quiz at the end of the course will also test your knowledge about the spread of air/blood born diseases like AIDS, TB, Hepatitis etc. In my opinion, this course is less tourtuous than HIPAA to complete.

Most institutes will require you to provide proof of such training only after you have been accepted into their program (example: Memorial Solan Kettring Cancer Center elective program). If you havent done such training at your home institute, then most programs will have you do it at the start of your elective rotation by showing you slides or videos relating to it (example: Mayo Clinic).

If you are applying to an institute in New York State, then there is another application requirement that you need to obtain. This requirement is the New York Eligibility Letter (see below non-accademic requirements) and one of the requirements to obtain this letter is to supply them with OSHA training certificate from a New York state approved infection control course providers. These providers do not provide these courses for free but rather charge a reasonable fee for it around $25-50. As of now I am not aware of any website that offers such course for free.

f) CPR training: CPR Card (BLS (basic life support) for Healthcare Provider level from the American Heart Association). This is one 'out of the box' requirement, requested by University of Wisconsin and a few other places. Most US medical students take BLS during their undergraduate training (usualy before their 4th year). There is no other institute that asks for the same requirement to my knowledge. If you have never been to USA before, then I dont think that you will be able to acquire that kind of training, If some how you can, or your home institute hosts such courses in accredation to American heart Association, then this institute is a good option, because its a top notch University with minimal application fee and no requirement of USMLE step1.

g) Prior US Clinical experience: If you have survived the previous panic of CPR training requirement by University of Wisconsin, here's another one: They also require you to have acquired prior US clinical experience in form of an elective at some other US institute before they will consider your application at U Wisconsin. Again this uneasy requirment is also pretty much only requested by the University of Wisconsin and no other institute as such.

Other institutes like Northwestern University, prefer your application over others if you have had prior USCE before your rotation will start at their institute, but its not a mandatory requirement. From my personal experience, I think it is very true not about just Northwestern but almost every other place no matter they specifically ask for it or not. So if you have prior USCE, it will be a BIG plus to your application even more so if you are interested in Surgery.

3. Non-Accademic requirements:

These requirements eat your time like a hungry linon who eats a loaf of meat after 10 days of starvation. Enlisted and discussed below are a list of non-accademic requirements, and like I said before, not every institute will ask for all of them.

a) Immunization and health form/certificate: Every institute will require you to submit a verification 'document' validating your Immunization status. Most institutes will ask you to have their immunization form filled and signed by a physition providing his or her contact information. Some will also ask for an institutional/physician stamp (example: Northwestern University) on the form.

Generally you are expected to supply them with evidence of immunity (either vaccination dates/ serologic antibody titers or disease Hx) against the following diseases:

1) Tuberculosis, if positive an X-ray is required,

2) Tetanus/Diptheria/Petrusis,

3) Mummps, Measels, Rubella,

4) Varicella (Chicken pox)

5) Hepatitis B :vaccincations and/or evidence of serologic immunity.

6) Menningococcal meningitis : Vaccination. (this one is usually optional but Yale University mandates it if you are intending to secure housing on their campus)

For better understanding you can view the immunization form of Northwestern University as an example.

Some institutes have specific peculiar requirements, e-g Northwestern University does not accept Montox (TB) test results from your home country, but will require you to acquire one from US or at their institute before you start your rotation. In another example Case Western Reserve University, requires to also provide immunization dates for your Polio vaccination-not a very strict requirement though.

b) Dean's Letter: Out of all the non-accademic requirements, Dean's letter is the most important. Almost every institute where you intend to apply will ask for its submition as a part of their application requirements. This dean's letter is not the same as the one required for residency application.

If you are a Registrar or Dean of a medical institute reading this information then it is strongly advised that you take into account all the factors discussed below inorder to formulate a COMPLETE standardized dean's letter, so that it can satisfy the application requirements of majority of the US based medical Universities to which your institute's medical stutents will be applying. Faliure to comply with these basic requirements can result is rejection of elective application.

Deans letter is the letter that your Institute's Dean/Principal writes about you, validating that you are a student at their institute in good standing who is allowed to undertake an elective course outside his/her parent institute. This is ofcourse just the main summary, however there's more to Dean's letter than just that.

A COMPLETE dean's letter should clearly convey that you are a final year medical student enrolled for X years of undergraduate medical trainning course (or your degree name e-g MBBS) at their institute with your session starting dates. It should state your expected date of graduation. General comments about your personality or conduct are also mandatory and it should convey that you are a student in good standing. There should be a clear statement stating that you are approved to undertake the elective course for accademic credit.

Other 'variable/non-compulsory' components of deans letter can be comments on your english speaking skills or a statement that the medium of instructions at their institute is English, criminal background check (see below) or a statement verifying that you have never been involved in mis-conduct or crimminal activity ever since your enrollment at their institute. (examples: Cleveland Clinic and Case Western Reserver University asks for this requirement in dean's letter) If your medical school provides coverage for your Health Insurance and/or Malpractice Insurance, then it should be mentioned in the letter as well (example: National Institute of Health (NIH) requests that your dean's letter should specifically mention about health/malpractice insurance coverage). If you are applying in New York State, then you probably will also be applying for New York Eligibility letter (see below) whose requirement is that your dean's letter should also specify the duration of your elective period and the institute's name in NY where you will be doing your elective.

For non-immigrant visa application at the US Embassy in your home country, if you intend to also use your Dean's letter as proof that you will be coming back to your home country after completing your electives, then it can be useful if there is a mention in the Dean's letter that you are expected to return after completion of your elective course and that you will have to take your Final year exam inorder to graduate. It may also state that all your pre-medical original diploma/certificates and related documents are submitted with the registrar's office which will be released only upon graduation.


c) Malpractice Insurance or Professional Liability Insurance: This requirement is the most problematic out of all non-accademic requirements in my opinion- one reason being that there are ony 2-3 reliable insurance companies that provide such coverage. It adds an unecessary bulk to your overall application expenditure, has the potential to delay your application considerably, and depending on whether or not you are able to obtain it, it can even shorten your list of institutes to where you are interested in applying and I hate it!

This insurance is supposed to protect/cover your expenditure against law suits that a patient potentially can protest against you, if he/she thinks that you have done harm to him/her. Practically, when I asked related questions to senior residents on my rotations, majory of them replied by saying that ' firstly there is HARDLY anything that a medical student can do wrong because of controlled supervison, and secondly the patients are not stupid ! They will Sue the attending instead of a medical student, so that they can make more money that way.'

The malpractice insurance policy that you purchase should atleast provide coverage of $1million/$3million. One exception is SUNY Downstate which requires a malpractice insurance coverage of $3million/$3million. Dont think of it interms of the amount that you will have to pay to purchase this insurance. You will be able to purchase it for around $200-300 for 4 weeks of electives. The Company you purchase it from should provide such coverage in USA. This also indirectly means that the company should be US based.

I personally believe malpractice insurance is a BIG monoply on part of Insurance companies to make easy money. They are fully aware of the fact (from their experience) that students hardly will ever need their help, but they know that its like a compulsory requirement to acquire one on part of the student- and that there is no other way round. They exploit the fact that most international medical schools do not cover malpractice insurance for their students and so charge huge money which is BAD.

The tragedy is that except for a few, no institute wants to bother about the fact that paying for malpractice insurance substantially hurts the pocket of international students for no good reason, which is sad and disappointing. If places like Mayo Clinic, Northwestern University, University of Texas x 3: Houston,San Antonio and Southwestern, Johns Hopkins and University of Wisconsin, provides malpractice insurance for no additional cost or as low as $20-50, then EVERY UNIVERSITY SHOULD and NONE is poor enough that it cant, because its practically never going to cost them any buck as students wont do harm to patients.

d) Health Insurance: It is a relatively easier and cheaper requirement compared to Malpractice insurance (in my opinion), because there are alot of companies that offer such type of insurancce. Unlike malpractice insurance which is required by some, almost every Institute requires you to provide proof of Health Insurance coverage at the time you submit your application. Travel health insurance = Health insurance and you can purchase it from your home country. Cost varies with increasing age. Most institutes ask you to provide evidence of coverage of about $50,000 to 100,000. To acquire such coverage you may need to pay an amount of around $40-90 for 4 weeks. It may cost you cheaper if you purchase it from a local company at your home country.

e) Crimminal Background Check/Police Clearence: Complicated as it may sound, its not so much difficult to complete this requirement. It is requested only by a few institutes (example: Case Western Reserve University and Cleveland Clinic). There are two ways to satisfy this requirement. 1) Either you can consult your district Police officer to issue you a character certificate or 2) Your college/University Dean/adminstrative official/registrar can issue you a letter statining that ever since you enrollment you have been an individual with sound moral character who has not been involved in any illegal activity. The former method has more weightage, but the latter option is an acceptable alternative.

f) New York Eligibility letter: Every institute in the New York State requires you to submmit New York Eligibility Letter in the time frame: after acceptance into an elective program and before the start of your rotation. It is a state requirement that you should obtain permission from the New York State education department in shape of obtaining NY Eligibility letter if you wanna do an elective at any institute in NY state. You cannot apply for the New York eligibility letter if you do not already have an acceptance from the institute that you are interested in applying. This is because you need to submit the "institute's approval letter" along with the New York eligibility letter request form for the issuance of New York Eligibility letter.

The usual sequence is that you apply for to an institute in NY, that institute approves your application, then you apply for NY eligibility letter telling the NY State education department that you have been approved for an elective/clerkship by an XYZ institute in NY state, and that you want to pursue your elective but require state's approval. The NY state education department then verifys that whatever you are saying is accurate, verify's your medical school and then issues you an NY eligibility letter which you then submit to the institute that accepted you making your elective participation legal. No institute in NY will allow you to undertake an elective course (even if they previously accepted your applicaiton) if you do not submit them a NY eligibility letter.

Your midical school must be enlisted in the WHO directory and/or IMED/FAIMER

It may sound like a big hassel but, it is relatively easily attainable and the fact that you already have an acceptance from your prospective institute makes the process easier and the wait less painful. The following are the requirements that need to be fullfilled inorder to apply for an NY eligibility letter.

1) NY Eligibility letter form

2) Evidence on Infection control course completion(same as OSHA).

3) Approval letter from the hospital/Institute in which you will perforn your elective (s).

4) A letter from your dean verifying that you are approved to undertake that particular elective/clerkship for credit.

5) A cheque/draft of $30 payable to New York State Education Department

Regarding electives/Clerkships in New York State, Please note that you should not do electives for more than 12 weeks, or you will be renderd ineligible to apply for residency in New York in future. However this rule does not apply if you have completed your electives collectively for 12 + weeks in some other states (may or may not include NY), provided that the elective period in NY is still less than 3 months.

If you want to do clerkships in US for more than 12 weeks, then you need to have taken USMLE step 1 or equvilant (like Complex 1), the rest of the process is similar.

Other forms of USCE like observerships are not subjected to this rule.

g) Faculty Sponsor for an Elective: For international students some reputable places like Emory University, University of Washington, University of Wisconsonin, Johns Hopkins University will only consider or prefer your application if you know or have contacted a faculty member who is willing to sponsor your elective rotation. This requirement is usually difficult to satisfy if you already do not know any of that institute's staff member in the department of your desired rotation. But if you are one of those fortunate people who is lucky enough to have recieved a faculty member's supportive response, then you should definitely connsider pursuing your elective application at that institute. I advocate in favor of this because if you are able to fullfil other requirements for that place, then its a Definite acceptance, compared to other places where you have applied with lesser probability of acceptance.

One way of searching for a faculty member sponsor is by strolling through the website of these institutes and then searching for the faculty names in individual departments. Every institute has a specific method of employee/staff e-mail 'structure'. you will have to figure that out on your own because its variable from institute to institute. You can start from analysing the e-mail address of the elective coordinator and then 'calculate' the formula for making an e-mail out of a given name for that particular institute. After that you search for the faculty names, 'make' their e-mail from their name using that formula and then send them e-mails. No pains no gains!

Always remember, US doctors highly respect hardworking, honest and enthusiastic people who are passionate to learn in the specialty of interest. Who knows, when your star shines, and someone is able to see the light in you and is able to recognize your abilities, where all it costs you is some additional effort and a nicely written e-mail. My advise: Always avail your opportunities and never run away from hardwork, and its your commitment to your work that will make you stand distinctively out of a pool of thousand others. It might sound like a sentimental speech to you at this point, but sooner or later you will realize for yourself that this really is the reality and the right force that drives you through your way to success ! Your potential faculty who will be sponsoring your elective, might have been in your shoes at some point in his carrier, so do not underestimate your chances of acceptance and their sense of judgement !

h) Faculty letter (s) of recommendation: Most Institutes, if not all, will require you to submit atleast 1 or 2 or maximally 3 letter(s) of recommendation in addition to the Dean's letter. These do not necessarily have to be from US based faculty, and letters from professors or faculty at your home institute can suffice the requirement. Preferrably the letter should come from a faculty member who has accomplishments in your desired speciality of elective. For example: a letter from a clinical professor of medicine will be considered more credible if you intend to apply for an Internal Medicine elective. The letter should sufficiently comment on your clinical skills. Some institutes like SUNY Downstate will supply you with their own letter of recommendation 'form' that you need to have your faculty complete and enclose it into a sealed confidential envelope, which you can then submit along with your application.

4. Additional Supportive documents: This category of application requirements include documents that are not an absolute requirement but they 'polish' your overall application. You are not dependent on someone's approval or skills to add these to your application and these DIRECTLY express your own self, personality and accomplishments and makes you application presentable at a glance to who so ever reviews your application. If you know how to make use of these documents as tools correctly, they will emensely help you stand out. Refer to the list below for specific details.

a) Personal Statement: This is the single document which is the most unique in every application. Via this statement you convey your passion/interest in the specialty of your choice and their institute. You discuss about your accomplishments, and your future plans and then explain how this elective will help you to accomplish those goals. You also discuss what makes you different from others and what you like about their institute ! Remember that its your speech, where you must reveal your entire self to the audiance in a manner that they are forced to pay attention to and like what you want to tell them. In my opinion there are no rules to writing a personal statement other than the fact that it should be interesting and specific to your case, so never bother about what others tell you whats 'right or wrong', Do it just the way you feel like how its supposed be done !'. Also train yourself to listen to your instincts

b) Resume/Curriculum vitae (CV): Firstly, there is no as such difference between the two terms, but however the term Resume is used more frequently in USA. A resume is a structured, to the point, representation of your professional accomplishments since the start of your accademics. It is difficult to explain the organization of a resume without an example, take a look of this sample resume and then follow the text below for explaination.

Your resume should accurately convey all your achievements. It should prominantly highlight your distinctive accomplishments. (yes ! just like this line.) Be brief ! do not use lengthy sentenses, say more while using few words. The quality of language that you use in your resume and personal statement are strongly indicative of your maturity and professionalism. From my experience: Minor as these things may sound-but they are really important. Your accomplishments may loose their credibility if your resume and personal statement do not complement the level of skill you claim. Most attendings hightly value their own personal judgement and would draw conclusions from the impression they get from your overall application rather than basing their decision on what you tell them specifically. Your application should strike in his head that its comming from an intelligent young man who knows how to do stuff !!!

To summarize, your resume should have dedicated portions for the following areas: Professional goals and objectives, Education, Accademic accomplishments, Clinical Experience, Research Experience, awards/achievements/memberships, Extra-curricular activities.

c) Cover Letter/Letter of intent: It is essentially the same as personal statement in context. National Institute of Health and the University of North Carolina use the term Cover letter which means the same as personal statement. Letter of intent is somewhat different in that its brief and you dont need to describe your future goals and your current accomplishments extensively, but you rather focus on why you wanna do that elective at their institute and you briefly summarize your documents that you have enclosed in your application packet. After reading this letter the elective coordinator should know where he/she needs to send your application, and whats included in the envelope.


Man ! ....this one took a lot of time to complete.....

Hope you got benifit from all what I wrote. Have a nice day and good luck with your application !



Jahanzaib Idrees



Last updated september 2010