If you are an IMG who wants to pursue a residency program in the United States, you may wonder why you need to have US clinical experience (USCE) before you can even apply.

For those of you who have completed residency training in your home country, it may seem like a ridiculous or pointless requirement.

Getting USCE is a way to demonstrate your clinical skills and knowledge within the context of the US healthcare system. It shows that you are familiar with the standards, protocols, and expectations of US medical practice, and that you can communicate effectively with patients, colleagues, and supervisors.

It gives you the opportunity to get letters of recommendation from US physicians who can vouch for your abilities and skills working within the context of the US healthcare system.

Unfortunately, your professors and colleagues who have not practiced in the US cannot attest to this, because they don't have the experience of working in the system here. That's why letters of recommendation from your home country don't count.

Believe me, no one is challenging the value of your medical education.

But, in order to succeed in the residency match, your application needs to mirror the applications of US applicants as closely as possible.

We don't take the credentials of US applicants for granted; if we did, then students from top schools would not need to submit letters of recommendation. We would just say, "Hey, this person went to Harvard Med. Therefore, they must be pretty good. We're going to grant them an interview on that basis alone."

It doesn't work like that.

It's a huge, huge problem for IMGs that US applicants show up with very specific letters attesting to their fitness and skill set as it pertains to their chosen specialties, while IMGs frequently show up with a grab bag of letters from multiple specialties. Many of the letters are observership letters.

These mostly attest to your passion for and desire to train in a specialty. That's it. 

You need to show up with the same letters as US applicants if you want to be a competitive applicant for the residency match. And the simplest way to get those letters is to complete as close to the same trainings as US med students are completing.