It's so frustrating to me that I see IMGs who fail to match taking actions that won't make any impact on their ability to get interview invitations. Too often, I see them

1) Decide to get an advanced degree, so that they stand out (like an MPH)

2) Get attached to a lab so that they can at least collect a paycheck while they prep for the match

3) Apply for more observerships (because money is tight)

None of these are the answer.

If there is any question about your clinical abilities at all, the only way to reassure programs is to demonstrate your clinical excellence. You do not do that through any non-clinical activity. You do not do that effectively through observership alone, because it's so limited.

I can't emphasize this enough--the letters that come from your hands-on USCE are the cure to almost everything that could hurt your residency application.

Are you an old IMG? Get some extra USCE.

Do you have USMLE step failures? Get some extra USCE.

Do you have a gap in your training? Get some extra USCE.

Do you have old letters? Get some recent USCE.

That letter of recommendation that vouches for your skills in a specific specialty, on the most basic level, fills the gap for programs and assures them that you can be trusted with their patients.

It's the cure for what ails your residency application.