Where Should You Do Your USCE as an IMG?
- Ash Eighaei Sedeh MD
- May 5
- 14 min read
Welcome, IMGs!
As you plan your U.S. clinical experience (USCE), one of the biggest questions you’ll face is: Where should I do it? Many international medical graduates (IMGs) feel pressure to pursue expensive rotations at brand-name hospitals in hopes of boosting their residency match chances. But are these high-cost experiences really worth it?
At IMG Rotations, we believe in helping you make strategic, cost-effective decisions, not just flashy ones. In this post, we break down the realities behind big-name hospitals, what programs really care about, and how to choose the right USCE for your goals and budget.
Table of Contents
What is USCE and why does it matter as an IMG?
USCE refers to any structured clinical exposure that takes place within a U.S. healthcare setting. For IMGs, USCE is not merely a recommendation, it is a near-requirement for building a credible, competitive residency application. Most program directors expect applicants, especially IMGs, to demonstrate that they can adapt to the norms, expectations, and workflows of American clinical practice. USCE is the best way to prove that readiness.
There are two major types of USCE: hands-on clinical rotations (electives, externships, sub-internships) and observerships. Hands-on rotations involve direct interaction with patients under supervision. This may include conducting histories and physicals, presenting cases during rounds, writing patient notes, or assisting in procedures where permitted. Observerships are more limited in scope and typically do not involve direct patient care. However, when paired with a supportive preceptor who offers mentorship and feedback, even observerships can be valuable, especially in fields like radiology or pathology where patient interaction is more limited by nature.
For IMGs, USCE plays a pivotal role in four key areas:
1. Adapting to U.S. Medical Culture:
U.S. clinical settings differ significantly from those in many other countries in terms of communication style, hierarchy, documentation, legal considerations, and patient autonomy. USCE offers the opportunity to observe and adapt to these standards, helping you avoid missteps during residency.
2. Electronic Medical Records and Protocol Familiarity:
Most U.S. institutions rely heavily on electronic medical records (EMRs), protocol-driven care pathways, and standardized documentation. Gaining exposure to these systems during USCE prepares you to function efficiently during residency, where clinical time is often stretched thin.
3. Letters of Recommendation:
A well-written, U.S.-based letter of recommendation (LoR) from a preceptor who has worked directly with you is one of the most powerful elements of your ERAS application. LoRs speak to your clinical abilities, communication, work ethic, and professionalism in the U.S. context. Most residency programs give considerable weight to LoRs from American physicians who understand what is expected of a successful resident.
4. Confidence in the U.S. Clinical Environment:
For many IMGs, USCE serves as a proving ground. It builds familiarity and comfort in a system that initially feels foreign. You learn how to present cases, navigate patient interactions, participate in interdisciplinary teams, and respond to feedback. This experience boosts confidence and enhances interview performance, where applicants are often asked to discuss their U.S. clinical background in detail.
It is widely accepted that having at least one to two months of recent USCE is a baseline expectation for residency applicants, with three to four months or more being ideal. More importantly, the quality and relevance of your USCE matter. A rotation in your intended specialty, with meaningful interaction and a potential letter of recommendation, will carry more weight than an unrelated observership with minimal feedback.
At IMG Rotations, we specialize in placing IMGs in verified, hands-on U.S. clinical experiences that are aligned with their career goals. Whether you are aiming for internal medicine, pediatrics, psychiatry, or a surgical field, our programs are designed to help you build a credible U.S. clinical profile with preceptors who understand how to support your residency journey.
Ready to explore your options? Browse our current opportunities at www.imgrotations.com, or contact us directly at admin@imgrotations.com for personalized guidance. Your Match journey starts with the right experience, and we’re here to help you find it.
The myth of prestige: Do famous hospitals really help?
For many international medical graduates, the pursuit of U.S. clinical experience comes with the assumption that training at a prestigious academic institution will dramatically improve their chances in the Match. The idea is rooted in the belief that a rotation at a top-tier hospital, especially one affiliated with an Ivy League university or consistently ranked among the best in national surveys, will impress program directors and give the candidate a competitive edge. Unfortunately, this perception is often disconnected from how residency programs actually evaluate applications.
What truly matters in a clinical experience is not the hospital’s reputation, but the depth and quality of your participation. A rotation is most valuable when it results in a detailed, personalized LoR from a U.S. board-certified attending who has directly observed your clinical work. The letter must speak to your competence, reliability, professionalism, and suitability for residency training. If that letter does not exist, or is generic, impersonal, or based on limited observation, the name of the hospital alone carries little weight in a program director’s evaluation.
Top-ranked hospitals frequently offer limited access for international students. In many cases, IMGs are restricted to observer roles where direct patient interaction is not permitted. These observerships may place you in the same department as U.S. medical students or residents, but without meaningful responsibilities or evaluation, they do not contribute substantially to your Match application. Moreover, large hospitals with high clinical volume and administrative protocols often have strict policies that prevent short-term trainees from receiving letters of recommendation, especially those who are not officially enrolled through affiliated U.S. medical schools.
Compare that to a smaller teaching hospital, community clinic, or private practice where a U.S. attending has time to mentor and supervise you. In these settings, you are more likely to present cases, participate in clinical decision-making, write notes, and interact with patients directly.
These experiences not only build your confidence and clinical acumen, but also allow the attending to write a letter that genuinely reflects your skills, growth, and potential. This kind of letter stands out to program directors far more than a vague statement from a nationally known institution that barely acknowledges your role.
The prestige of a hospital is not a guarantee of value. If the rotation is passive, limited to observation, or devoid of personal interaction with supervisors, then it is unlikely to improve your Match prospects. While there is nothing inherently wrong with pursuing a big-name rotation, applicants should understand its limitations and avoid over-investing in name recognition at the expense of substance.
At IMG Rotations, we guide candidates toward experiences that offer hands-on involvement, faculty mentorship, and actionable feedback. These are the qualities that lead to strong recommendation letters and improved Match outcomes. When it comes to clinical experience, substance matters more than branding, and it is critical to choose rotations that allow your strengths to be seen, not just your hospital badge to be recognized.
What program directors actually look For
When it comes to evaluating international medical graduates (IMGs) for U.S. residency programs, many applicants overestimate the importance of institutional prestige and underestimate the value of meaningful engagement and direct evaluation.
However, consistent data from the National Resident Matching Program (NRMP) Program Director Survey and reports from the Association of American Medical Colleges (AAMC) confirm that the most critical elements for selection are performance-based and individual, not brand-driven.
Program directors seek evidence that you can thrive in the U.S. healthcare system, and that comes from how closely and effectively you’ve worked with U.S. physicians in real clinical settings. According to the NRMP's latest Program Director Survey, the most influential factors in ranking applicants include: quality USCE, strong and personalized LoRs, demonstrated hands-on involvement in patient care, and observable attributes such as communication, teamwork, and professionalism.
In contrast, the prestige of the hospital or clinic where you completed your USCE is rarely mentioned as a deciding factor.
Factor | Importance |
U.S. Clinical Experience | Essential |
Quality of Letters of Recommendation (LoRs) | Very Important |
Hands-on Involvement | Highly Valued |
Communication & Professionalism | Critical |
Prestige of Rotation Site | Rarely Mentioned |
Program directors are ultimately seeking residents who will function effectively within their teams from Day 1. They are not looking for passive observers or “rotation tourists,” but rather for future colleagues who are clinically competent, culturally adaptable, and emotionally resilient. A well-crafted letter of recommendation from a physician who has directly supervised your work, observed your clinical reasoning, and can speak to your growth and reliability will carry significantly more weight than a vague letter from a high-ranking institution where you were one of many invisible observers.
In many cases, LoRs from community-based attendings are even more valuable than those from academic giants. Why? Because the community attending likely spent more time observing you directly, working with you one-on-one, and mentoring you closely, all of which allow for a richer and more detailed letter. Program directors can tell the difference between a templated or recycled letter and one that genuinely reflects a physician’s investment in your success.
This underscores an important truth: residency programs aren’t recruiting logos or institutions; they are recruiting people. What matters most is not where you rotated, but how well you performed, how deeply you were engaged, and who can vouch for your readiness to step into a U.S. residency training environment.
At IMG Rotations, we help IMGs secure placements with experienced, board-certified physicians who are committed to mentorship and who understand the kind of support IMGs need to succeed. These are the rotations that yield meaningful feedback, strong LoRs, and real preparation for the next step in your career.
Hidden costs of brand-name rotations
One of the most common misconceptions among IMGs is that more expensive rotations at well-known academic centers automatically translate into better outcomes for the residency Match. This belief often leads candidates to spend $4,500 to $6,000 per month at brand-name hospitals under the assumption that the prestige alone will enhance their application. In reality, many of these rotations offer surprisingly little in return, especially when evaluated through the lens of what actually matters to program directors.
At many top-tier hospitals, visiting IMG students are assigned observer-only roles. These rotations restrict direct patient care, often do not allow students to participate in documentation, and sometimes prevent them from speaking to patients altogether. Clinical presentations may be limited or entirely absent. Even worse, because of institutional policies and high clinical volume, many attending physicians at these sites do not provide letters of recommendation, especially for short-term visiting students. The rotation becomes a passive learning experience, where the candidate gains exposure but not evaluation, mentorship, or support for their Match file.
The cost of such rotations is not just financial. When a student spends several weeks observing without real engagement, they lose an opportunity to demonstrate their clinical abilities and build a strong relationship with a U.S. attending. That lost time could have been used in a more affordable, hands-on setting where the student is involved in case presentations, notes, and daily patient care. These elements are critical for a preceptor to write a credible and personalized letter of recommendation.
Consider an alternative: a hands-on U.S. clinical experience at a teaching-affiliated community hospital or clinic where you are supervised by board-certified attendings, actively contribute to patient care, and have consistent opportunities to receive feedback. These rotations often cost significantly less, typically in the range of $2,200 to $3,500 per month, and offer precisely what residency programs look for: documented U.S. clinical performance and faculty who can vouch for your readiness.
IMG Rotations, for example, offers verified hands-on clinical experiences starting at $1425 per month. These placements include eligibility for a U.S.-based letter of recommendation, personalized mentorship throughout the rotation, and the flexibility to choose schedules that align with your ERAS timeline. Every rotation is vetted to ensure that IMG candidates are not merely observing but participating meaningfully in the clinical team.
In short, brand-name rotations may carry the allure of prestige, but that prestige rarely converts into tangible Match advantages unless the rotation includes meaningful engagement and a strong letter. Rather than paying for a name, focus on paying for access, access to clinical skills, mentorship, feedback, and recommendation. Those are the investments that improve your Match application and prepare you for residency success.
How to choose the right USCE site for you
Selecting a USCE site is one of the most strategic decisions an IMG can make on the path to residency. Not all rotations are created equal, and the right clinical setting can be the difference between a weak letter of recommendation and a powerful endorsement that elevates your entire ERAS application. While many students are tempted to focus solely on the hospital’s name or location, the quality and structure of the rotation itself are far more important.
The first factor to consider is whether the rotation aligns with your intended specialty. Clinical experience in internal medicine, for example, will carry the most weight for a candidate applying to internal medicine residency. While exposure to multiple fields can be helpful for general growth, program directors prefer applicants who have demonstrated a focused interest in the specialty they are pursuing. Specialty alignment also makes it easier to secure letters of recommendation that speak directly to your clinical readiness for that field.
Next, look at the nature of your interaction with the supervising physician. The most valuable rotations are those where you work closely with a single preceptor or a small team, allowing them to observe your clinical reasoning, communication skills, and professionalism over time. One-on-one mentorship is what leads to detailed and credible letters of recommendation. If a rotation is structured in a way that places you as one of many students with limited preceptor access, your chances of receiving a strong letter diminish significantly.
It is also essential to ask whether the preceptor is willing to provide a personalized letter of recommendation. Some programs offer rotations but make no commitment to offering letters, especially if your role is observational. Others may promise LoRs, but only issue generic ones that carry little value in the Match.
A high-quality letter should be specific, detailed, and written by someone who has directly supervised your clinical work in the U.S.
The clinical duties allowed during the rotation are equally important. Does the site allow you to take part in patient interviews, write clinical notes, and present cases to your preceptor? Will you be included in team discussions or morning rounds? Hands-on roles not only prepare you better for residency expectations but also provide more opportunities for your supervisor to evaluate and support your candidacy.
Logistical considerations, such as location and cost of living, should also factor into your decision. Some cities are far more expensive than others, and rotating in a location that strains your finances can add unnecessary stress. At the same time, choosing a site that is too remote may limit your exposure to hospital systems or reduce opportunities for networking. Flexibility in scheduling and placement location can be a major advantage.
Lastly, assess the overall structure and support provided by the rotation program. Are the rotations supervised by board-certified physicians? Is there clear communication about objectives, expectations, and evaluation?
Are students offered onboarding support and academic resources to help them succeed? Well-organized rotations offer a more productive learning experience and leave you better prepared for residency.
If you are unsure how to evaluate your options or want help choosing a USCE site that fits your goals, IMG Rotations offers free personalized advising. We help IMGs secure verified, hands-on rotations in their target specialties, with preceptors who are committed to teaching and mentorship. Book a free call today at www.imgrotations.com and let our team guide you toward the most effective clinical experience for your Match success.
IMG Rotations: affordable, verified, and specialty-aligned
For international medical graduates, securing a meaningful U.S. clinical experience is one of the most important steps in preparing for the residency Match. Yet for many, the process can feel financially and logistically overwhelming. IMG Rotations was founded to provide a smarter, more supportive alternative, one that prioritizes clinical quality, mentorship, and affordability over branding alone.
Unlike many rotation brokers that charge thousands of dollars for access to brand-name institutions, often without guaranteeing hands-on experience or letters of recommendation, IMG Rotations takes a value-driven approach. We partner exclusively with board-certified, actively practicing U.S. physicians who understand the needs of IMGs and are committed to mentorship. Our preceptors not only supervise your clinical work but also offer personalized guidance throughout your rotation, helping you develop the skills, confidence, and professionalism expected of a U.S. resident.
Our pricing is intentionally structured to be accessible. While large academic hospitals may charge between four to six thousand dollars per month, often for observer-only roles, our hands-on rotations typically cost 40 to 60 percent less and can be paid in interest-free installments. This makes it possible for motivated applicants to complete multiple specialty-aligned rotations without sacrificing financial stability.
One of the most valuable features of our program is that we match students with clinical sites based on their desired specialty. Whether you are applying to internal medicine, family medicine, pediatrics, psychiatry, or anesthesiology, our placements are tailored to strengthen your application with direct clinical experience in the field you intend to pursue. This increases your chances of securing relevant, specialty-specific letters of recommendation, which carry significantly more weight during residency selection.
Our U.S. clinical experiences are not only verified and structured, but also flexible. We offer year-round start dates, allowing you to align your rotations with your personal schedule and ERAS timeline. This means you can complete your rotations when they will have the greatest impact, such as during the spring or summer prior to application season.
In addition to clinical rotations, IMG Rotations offers add-on services that address other critical aspects of your Match preparation. These include guided research experiences, residency interview coaching, personal statement review, and CV editing. Together, these services create a comprehensive support system for applicants seeking to present a strong and polished ERAS application.
At IMG Rotations, we believe that access to quality U.S. clinical experience should not be determined by how much an applicant can afford to pay. We are proud to provide high-impact, hands-on opportunities that help our students stand out based on their ability, not their financial background. With a clear commitment to transparency, mentorship, and match-focused outcomes, our team works to ensure that every rotation provides real educational value and tangible application benefits.
To learn more about available placements or speak with an advisor about your Match goals, visit www.imgrotations.com or contact us at admin@imgrotations.com. Let us help you take the next step toward residency with confidence.
Focus on fit, not Fame
For IMGs, the journey to U.S. residency is complex and often filled with pressure to pursue recognizable names. It’s easy to believe that rotating at a prestigious, world-famous hospital will automatically improve your odds in the Match.
But in reality, the name on your hospital badge rarely carries as much weight as the depth of your clinical engagement, the strength of your recommendation letters, and the quality of your mentorship during the rotation.
Residency program directors are not looking for applicants who stood in the corner of a large academic institution. They are looking for future residents who have demonstrated reliability, clinical competence, communication skills, and professionalism in a U.S. healthcare setting.
Those qualities are best reflected through hands-on involvement, active participation in patient care, and detailed letters of recommendation written by preceptors who know you well, not through the prestige of the hospital where you rotated.
When selecting a U.S. clinical experience, the question should never be “Which site is most famous?” Instead, ask yourself: “Where can I make a real impact? Where can I build relationships with mentors? Where will I be observed closely enough for my preceptor to write a strong, personal letter on my behalf?”
This is why choosing the right site is far more important than choosing the most recognizable one. Smaller community-based teaching hospitals and private practices with committed preceptors often provide a better educational environment for IMGs. These settings allow for more direct interaction with patients, greater involvement in documentation and case presentations, and closer supervision by attending physicians.
These are the factors that lead to genuine growth and successful Match outcomes.
At IMG Rotations, we encourage you to think strategically about your goals, not just in terms of residency applications, but also in terms of your overall career development and well-being.
A thoughtful, hands-on rotation aligned with your target specialty will not only prepare you for the realities of U.S. residency training but also help you develop the confidence, clarity, and credentials that stand out in a competitive Match cycle.
IMG Rotations: Your Trusted Partner for U.S. Clinical Experience
If you're preparing for the ERAS 2026 application cycle or just beginning to explore the pathway to U.S. residency, IMG Rotations is here to support you. We offer verified, specialty-aligned U.S. clinical experiences with mentorship, letter of recommendation support, and flexible scheduling. Our advisors can help you identify the placements that offer the best fit, not just the biggest name.
Explore our current opportunities at www.imgrotations.com, or reach out to our team at admin@imgrotations.com to schedule a free consultation. The right rotation can open the right doors. Let us help you find it.
