sachida
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I earlier posted on what to look for during an observership. I have few more questions.
I have PhD, few publications and waiting for step 1 results.
while preping for step 2 I have started observership in hematology clinic.
It is really fun to see patients after 6 yrs of research.
Attending and fellows are really nice. Fellows beleive I can even start eliciting history and do preliminary examination but attending seem to strictly wanting to stick to the "observer label".
I want to have strongest LOR possible, do you think doing what fellows are suggesting will generate it? Ofcourse, I will not do it before taking attending in confidence.
I do have some concern with the fact that this observership and next couple planned (nephro/neuro) are all speciality clinics. I intend to go for int. medicine. Do you think I should try to get something in int medicine?
Some one mentioned on the forum suggested that there is minimal usce requirement in some programs- how long they ask for?
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| pete31
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some hints from my particular experience...
minimal usce requirements...it depends on the specific field and program..you should contact PD directly or try to find it out on program's websites...
any subspecialty in Int med is ok for experience, I believe "hands on experience" is better than just observership...but experience is experience and again it depends on the program
gl to allof us
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| sachida
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Thaks pete for your input. I will appreciate if senior members on forum can give some feedback. Or may be I post long things and people dont like to read it through (not sure).
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| doc_droc_apurva
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minimal means a couple of weeks.. nephro/hemat oship sounds good for im.. it can be "observer" have the attending write h&p on lor.. get a strong lor.. doesnt matter who he is..
agree with pete. 1 thing is certain. once u get into a decent im prog - ur fship is secure due to ur phd..
gl
apurva
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| LisaM
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Sachida, I would be careful about following the advice given by the fellow as patient confidentiality is a seriously big issue here. As an observer, I am very careful not to handle patient notes at all, introduce me as a visitor or observer and only perform an examination if the attending asks me to after he/ she gets persmission on my behalf. Very rarely do I ask a question to the attending (always outside the patient's room) and if I am asked a question (which is rare) I try to give the most comprehensive and intelligent answer I can. Remember, the label for now is "observer". Soon enough, things will change and we will be on the other side of the chair! 
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| doc_droc_apurva
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i strongly disagree with lisas comment.. no1 can harm u on pt confidentiality.. thats the attendings headache.. do things under permission.. dont be a cowboy - but dont be a pr advocate also.. the hipaa and stuff is bs.. trust me - i have written notes and orders and even discharge forms.. dont worry. just try as much as u can to impress. ask a question a pt.. show off to the fullest.. will help the attending when writin a reco letter..
i know this sounds absurd.. worked perfectly for me..
apurva
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| pete31
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apurva is correct...i had the chance to write patient notes and progress notes and that is one of the reasons i got a strong letter of recomendation from a progam.Do as much as you can and that is the only way you show your ability to attendings
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| sachida
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I am just taking clues from fellows and attending. Let me give you an example...the patient files are all collected at the conference room (where fellows and attending do their work). I try to go early and read couple of them. Also help staff with whatever I can..They are very nice. Fellows and attending like that I know few things about patient and that they dont have to "tell" me everything. They are also nice to almost brief me even before we go to the patient room They introduce me as "Dr. XX" and just tell them that he will be rounding with us today. They do not introduce me as an observer or physician who will take care of them. I like it that way.
I listen most of the time. Sometimes patient this being advanced academic instituition are interested in knowing what I do. Once I tell them about my background many of them are more then willing to co-operate. But I dont do anything without consent from attending. After 4-5 days, attending has started handing me over prescriptions, advice notes and things like that to deliver to the patient.
When she is out of time, she asks me to review the file and give synopsis. She wants me to ask questions. I do that when we are leaving the patients room or are in the conference room.
Overall, i agree with apurva, I do think lot of labels and regulations are flexible and if worked smartly you can do more then "observe"
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| naina
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hi sachida,
ur post is very informative ,thank u very much and to other members aswell, i just wanted to know in which place r u doing ur observership?
thank u
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| LifeInTheFastLane
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Let me add my side of the story: My observership pattern is different from the ones already posted: maybe since my setup is different. I am taking my "tryst with destiny" in a tertiary referral cardiology clinic at a premier institute, which like most other institutes of its caliber, scoffs off IMGs. However, getting back to the issue at hand, my observership is based in an Outpatient clinic - hence, followup and stuff like that are automatically ruled out. The doctors I am working with are HIPAA worshippers (i agree with apurva that this is BS..nonetheless, I had to take a HIPAA certification just to attend this clinic...so you know what they think of it!). They are very strict about my roles - about what I am supposed to do and what I am not - I observe and discuss stuff with the docs at best - I am not supposed to interact with the patients in terms of taking a history/doing a physical. Anyways, the docs I am working with are of national and international renown, which means impressing them with knowledge is kinda difficult. Upside are the discussions we hold, they are so stimulating, about latest stuff in research and all, but they often leave me out of breath. I dont know whether this experience will qualify as observership (though I am doing strictly that!) and what sort of recommendation letters I will get from these stalwarts!
Time will tell, by which it will be too late....goodluck guys..
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| chemamr
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sorry  but what is HIPAA certification??? could you explain it to me please? i have no idea about it. 
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| LifeInTheFastLane
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Health Insurance Portability and Accountability Act (HIPAA) of 1996 ...
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| LifeInTheFastLane
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There was a certification course at the institute I was (and am) working at....which was posed as a requirement for me before I could stand in my consultant's office and gape at the patients!
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| chemamr
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thanks
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| sachida
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Well, there are few factors that help me a lot with observership.
1. It is the same institute where I did my PhD and am still doing post-doc fellowship
2. My advisor is well known researcher on international level and heads several committees on BMT area.
3. I went into observership after my boss wrote glowing emails to MD PhDs in the center. They pointed me to specific attending to do observership.
4. I do have all kinds of regulatory training and hipaa training with research prespective. I am not sure if it is different for patient-physician relationship
5. I still DO NOT do physical and do limited history.
It is clear from experience of "life in the fast lane" that doing these observership in the best of the best places have drawbacks in terms of how much you can do. They have to protect their interest and reputation. And we are too small for them to risk it. I guess if you go to little toned down places you may have better access to patients and attending.
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| sachida
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Naina, I am sorry I can not reveal the institute at this point since as much as I love to help others like me, I do not want some one go at the same place and tell them about all I talk on the forum. Sorry.
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| LifeInTheFastLane
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You are right sachida, frankly, if I had the resources, I would go to one of those IMG hubs for observerships instead of this institute, since thought its "best of the best", it doesnt serve the purpose of an IMG.
A hammer of 24k gold is little good when you have to drive in a nail in d damn wall!
Besides, I have heard of people matching at the places they did theri observerships, you can never, ever, EVER expect to have this advantage at a high institute, we are IMGs from "dubious" medical schools and "dubious" training after all!
No offence intended, just the bare facts!
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| naina
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hi sachida,
i just wanted to know the city/state and not the institute, anyways..cool
thanx
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| doc_droc_apurva
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my 2c...
better to do an eship at a crappy comm hosp than a hands off oship at harvard.. and ppl have done "hands on" usce at the best of places too.. try to gain the confidence of ur attending and u will be fine..
politically incorrect forever
apurva
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| sachida
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its washington DC
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