International medical graduates

What this is — and what it is not

Many of our observers are international medical graduates building a US residency application. We want to be direct about what this experience is, because the distinction matters on your application.

What it does give you: sustained exposure to how an American outpatient specialty clinic actually runs — the documentation burden, the insurance and prior-authorization work, the team structure, the patient-communication norms, and the pace. For a graduate trained in a different system, that context is genuinely valuable and is often what interviewers probe.

Why this rotation is different

Most of your training happens in settings built around acute illness: a problem appears, gets treated, and resolves. Endocrinology is largely the opposite. Our patients have conditions they will live with for decades, managed through hundreds of small decisions made mostly by the patient, at home, between visits. The visit is a checkpoint in a long process, not the event where the treating happens.

That changes what good care looks like. Data becomes central — a CGM download is 2,000 data points about someone’s life. Adherence is a diagnosis, not a verdict: when a plan isn’t happening, the clinical question is why. Titration is the skill, not drug choice. And the system — prior authorization, formulary tiers, insulin pricing — determines outcomes as directly as pathophysiology does.

Your objectives

You arrive with a medical degree, so we set the bar at understanding the system rather than the medicine. By the end you should be able to:

• Describe how an outpatient endocrine visit is structured in the US, from rooming through documentation, coding and follow-up
• Explain how insurance coverage, formulary tiers and prior authorization change what a physician can actually prescribe
• Describe the roles of the MA, nurse, educator, pharmacist and front-desk staff, and how a patient moves through the clinic
• Observe and describe US norms of patient communication — shared decision-making, teach-back, non-stigmatizing and person-first language
• Discuss the endocrine conditions you observed with current, applied knowledge — the level expected of you in an interview
• Articulate what professionalism and confidentiality looked like in practice, with a specific example you witnessed

Chronic disease management, insulin titration and diabetes technology are the highest-yield areas to be able to discuss in an internal medicine or family medicine interview. Use the clinic for that.

What you may do

Your scope is the observer scope, regardless of your medical degree. US licensure, not prior training, sets this boundary.

Letters of recommendation

We know a letter is often the reason you are here, so our policy is deliberately explicit:

• Letters are written only for observers who demonstrate exceptional performance — consistent professionalism, preparedness, active engagement, and a positive contribution to the clinic
• A minimum of 40 hours is required before a letter will be considered
• Any HIPAA violation, attendance issue or behavioral concern means no letter
• Passive, unprepared or disengaged observers will not receive one
• A letter will describe what you actually did — an observership — because that is what we can honestly attest to

If you are unsure whether you qualify, ask. We would rather have a direct conversation than have you be surprised late in an application cycle. Full policy on the observer program page.