Match Q & A: Do I need U.S. clinical experience (USCE) to get interviews?

Yes — U.S. clinical experience (USCE) is one of the top 3 factors that residency programs consider when offering interviews, especially for IMGs.

It’s technically possible to get interviews without USCE, but most programs will pass unless you have a strong substitute (such as U.S.-based research with strong letters of recommendation, or exceptional Step scores). USCE is especially important for applicants with low Step 2 CK scores.

💡 Expert Insight: 

According to the NRMP Program Director Survey, U.S. letters of recommendation — most often earned through USCE — were ranked the #2 most important factor when deciding who gets interviews. (The only factor rated higher was a passing Step 1 score.)

But not all USCE is equal. To maximize impact:

  • Prioritize hands-on externships at teaching hospitals (not observerships)

  • Confirm the site requires malpractice insurance and allows direct patient contact

  • Secure a strong letter of recommendation from an attending physician who supervised you closely

USCE also demonstrates clinical readiness, helps you avoid red flags from long gaps, and gives you stories to reference during interviews and in your personal statement.

For many IMGs, it’s the missing link between getting filtered out — and getting invited in.

🧠 Understanding the Levels of U.S. Clinical Experience (USCE):

  • 🩺 Observership

    • Shadowing only — no hands-on experience

    • No direct patient care, charting, or interaction

    • Least valuable for interviews or letters of recommendation

  • 📘 Clerkship

    • Hands-on clinical rotation for current medical students

    • Usually arranged through official school affiliations

    • Valuable for U.S. MD/DOs — but limited access for IMGs

  • ⚕️ Externship

    • Hands-on rotation for medical graduates

    • Involves direct patient care, charting, and active participation

    • Must include malpractice insurance to be legitimate

    • Strongest option for IMGs seeking quality LORs

  • 🏥 Private Practice Experience

    • May offer interaction with patients but lacks structure

    • Not affiliated with a teaching hospital

    • Often viewed as lower-tier USCE by residency programs

  • 🎓 Preliminary Year (PGY-1)

    • Full first year of residency in a specific specialty (e.g., medicine, surgery)

    • Counts as ACGME-accredited GME (not USCE)

    • Often leads into a categorical position

  • 🔄 Transitional Year (PGY-1)

    • Broad clinical training in various departments

    • Ideal for applicants unsure of specialty or entering advanced programs

    • Not technically USCE, but still valuable GME experience

  • 📝 Limited License to Practice

    • Some states (e.g., Missouri, Arkansas) offer limited licenses to IMGs

    • Allows working under supervision in clinical settings

    • Can build your credibility, earn income, and improve interview chances

    • Requires ECFMG certification and visa-independent status (USC/GC/EAD/H4)

      Wondering whether you should take Step 3 before USCE? Here’s when it makes sense.

Answered by Dr. Brian — Residency Interview & Match Expert.

Private consultant to residency programs across the U.S. and former Medical Director at Kaplan Medical International.