In the past decade the number of US trained medical students that selected residency training in the primary care specialties has steadily declined. A 2008 poll of 4th year medical students reported only 2% planned to choose primary care residency programs as their first choice. Of course that represents a tremendous opportunity for IMGs to fill the potential vacancies at those US residency programs. US residency programs prefer candidates who have demonstrable clinical experience functioning within the US healthcare system. Inasmuch as all those who pass the USMLE Parts 1& 2 are intellectually prepared for matriculating in a US residency program, the chief barrier to being accepted is that an IMG must overcome the residency program Director’s hesitancy about whether the IMG has the wherewithal to be able to successfully assimilate into the culture of their residency program. Our Externship provides IMGs an opportunity to demonstrate their abilities and receive a letter of recommendation (LOR) from a credible source attesting to the likelihood of their success in a US residency program.
The clinical setting is a private primary care practice in Santa Clara, California, the heart of Silicon Valley and minutes from the sprawling urban center of San Jose, California. Our clients are a racially diverse group of highly literate, high functioning, professional people and their families.
Roger Washington MD, FAAFP, the program’s Director is a Board-Certified Family Physician and a Fellow of the American Academy of Family Physicians. He completed his medical training at Stanford Medical School. He is a former Associate Professor of the San Jose Family Practice Residency Program and is currently the Chairman of the Department of Family Practice at Good Samaritan Hospital in San Jose, California. He has received numerous awards recognizing his clinical competency including San Jose magazine’s “Top Doc” award and the “Patient’s Choice” award.
Under Dr. Washington’s tutelage the Extern will have the opportunity to function, as would a Family Practice Resident doing a four-week clinical rotation in outpatient medical care with the exception that there will be no independent physical examination of patients, i.e. California Medical Board guidelines will be followed closely. Outwardly the Extern will not represent himself to clients as a doctor or physician, but the Extern will have the opportunity to demonstrate to Dr. Washington the scope and depth of his clinical acumen.
In addition to acquiring the US healthcare clinical experience that US Residency Programs require of IMG applicants, Externs will have the opportunity to demonstrate to Dr. Washington they are indeed capable of performing to the standard expected of graduates of a US medical school program. Dr. Washington will evaluate each Extern for their grasp of the medical sciences; their ability to present their clinical findings and formulate an Assessment and Plan; their clinical judgment; their ability to communicate with patients and form a provider-patient relationship with patients; their ability to communicate with other members of the healthcare team including physician consultants, and their ability to adapt to the realities of functioning within the peculiar constraints of managed care.
The Extern will be first to consult with the patient performing an interview regarding the client’s presenting complaints. After presenting their assessment and plan to the attending and the attending confirming the findings, the Extern will have the opportunity to assist in coordinating the appropriate tests, prescriptions, patient counseling and follow-up care. Notwithstanding, in all circumstances our intention is to maintain strict compliance with all statutes regarding the licensed practice of medicine, in particular Business and Professions Code sections 2052 concerning the unlicensed practice of medicine, and section 2069 concerning the scope of participation of medical assistants. Also, we respect our clients’ expectations regarding the standards of our care.
Upon completion of the Externship the Extern will receive a LOR certifying their participation and describing their level of clinical acumen and proficiency. In effect, the LOR summarizes Dr. Washington’s observations regarding the Extern’s projected suitability as a candidate to a US residency program.