IMG Info: Tips for Obtaining Sub-Internships in the United States

By Sarah Wesley

The sub-internship (sub-I) is a 3-4 week period during which final-year medical students work as unpaid interns, often with a much lighter patient load but with all the responsibilities and tasks of an intern.  Many competitive residency institutions require that IMG applicant have completed a minimum of 1-2 sub-Is in the U.S. in order to be considered for a spot.  Some applicants will have the finances and time to complete many more than the required number of sub-Is, and you should specifically research the requirements on the websites of the programs and specialties you are interested in.

Sub-internships are available in:

  • Psychiatry
  • Internal Medicine
  • Family Medicine
  • Radiology
  • General Surgery
  • Cardiology
  • Gastroenterology
  • Dermatology
  • Neurology
  • Sports Medicine
  • Emergency Medicine.

Some programs have an unspoken policy to accept only those individuals who have done an elective with them, and it is to your benefit to inquire as to what proportion of residents did a sub-I with the department before residency.

The goal of all of these sub-Is is to show residency programs that you are competent to practice at the standard expected in American hospitals – academically, culturally, and linguistically.  Furthermore, the majority of your letters of recommendation will come from these sub-Is, so it is important to be academically prepared and treat the internship as a “four-week-long job interview.”

In terms of where to go, you should consider the following criteria:

  • Where you hope to match
  • Where your connections are, and
  • What your budget looks like

Many programs will have extensive fees in the thousands of dollars for a four-week sub-I. On top of the sub-I fees, you’ll need to factor in living costs, traveler’s insurance, malpractice insurance, visas, and plane flights.  If money is an issue at a particular institution of choice, the next best option is to work at a hospital affiliated with the program, or at the very least, in the same region.  That way, when it comes time for interviews and you are asked “Why this hospital?” or “Why this city?”, you can give a good answer.  For example, you can get by paying nothing more than application fees if you go a university-affiliated hospital and not the main one. You will still make a lot of connections, get good letters of recommendation, and gain valuable clinical experience, perhaps more so than if you had been at the main teaching hospital and lost in a sea of observers, medical students, and residents.

Another caveat: if there is a program you really like, and that program indicates that they take only American-trained medical applicants, it never hurts to call the program administrators directly.  When you speak to them and give them your information, they might be inclined to make an exception. Who knows, the chief of the department could be an alum of your school.  Also, connect with alumni from your school who are practicing in the U.S. to see where they are working.

As I mentioned in a previous post, observerships are useful for the personal benefit of experiencing an institution or certain subspecialty, but they will not be regarded as work experience in an American hospital on your application.


30 thoughts on “IMG Info: Tips for Obtaining Sub-Internships in the United States”

  1. can u tell me only final year med school student can apply for sub intenship ,can i apply for subintenship as i have pass mbbs recently

  2. Yes, my understand from all the places I searched for sub-Is was that you have to be a current medical student and will be restricted to observerships if already a graduate. However, I have known people to match with only observerships, but if that is the case, all the people have made a great impression and gotten physicians in the program to recommend them. However, generally these have been family med or internal medicine spots in community programs, not academic hospitals.

  3. what I got from the last comments is that there is no way to a sub-externship position for an international graduate?

  4. Yea, that is correct. If you have already graduated, you will have to do an observership instead. You will also need the TOFLE if English isn’t you’re first language, in addition to the Step 1.

  5. I know the sub-internships are important for IMGs. Is it possible to get an internship after I graduate, or would you recommend an observership??

  6. The information cintained herein is very generic. While everybody claims to know how important clinical experiences in the US are for an IMG who seeks to start residency in the US, NOBODY seems to know about ANY institution within the US that might offer such a sub internship. Until now I couldn’t find ANY hospital in the US willing to accept me (IMG fro Germany) for a sub internship. Even pure observerships are next to impossible to get. So, dear Sarah, your article is a waste of time for most readers.

    1. Mayo has accepted me for a sub-internship and I am a Chinese international medical student. Thus it is definitely possible to obtain a sub-internship as an IMG. I have also acquired internships (not sub-internships) at other institutions such as Emory University as well as Memorial Sloan Kettering Cancer Center. I am sorry that your experience has been like this, but this may not be the cases for every international medical student

      1. can you please give some details? as i am also having a very tough time finding externships or interships as an international medical grad. thanks

  7. FirstAid-RStigall

    Hi Alex.
    Although difficulty in securing a sub-internship in the US may be your personal experience, our Sarah is an IMG, so the scenarios she writes about are indeed drawn from her own first-hand experiences. However, we do acknowledge that the US system is set up to benefit US students over non-US students.

    We know that IMGs are successfully securing residencies in US hospitals and that part of the requirements for those residencies is often a minimum of two sub-internships. With that in mind, IMGs are clearly securing sub-internships in the U.S.


    The information cintained herein is very generic. While everybody claims to know how important clinical experiences in the US are for an IMG who seeks to start residency in the US, NOBODY seems to know about ANY institution within the US that might offer such a sub internship. Until now I couldn’t find ANY hospital in the US willing to accept me (IMG fro Germany) for a sub internship. Even pure observerships are next to impossible to get. So, dear Sarah, your article is a waste of time for most readers.

  8. Hi,
    Can I apply for a sub-internship during the third year of medical school ( and I have done step 1)? And how can we apply?
    Thank you.

  9. iam a 3rd year medical graduate from india,interested to do sub internship in surgery my next year.can this be really useful to me cause the duration of course is limited only for a month and i have to loss my medical school for a month.wat will b the advantages?

  10. Should I apply for elective or sub-intership if I want to apply foe Categorical Surgery? For IMG’s when should we apply for sub-intership? I know most places want international students to be in their final year of medical school to be eligible for Elective, but I don’t know much about sub-intership… Could you shed some light on this?

  11. I might be a little late in this thread but hopefully my experience can help. Most programs only accept internships/electives/clerkship from students in their last year of medical school although each institutions requirements vary and you would have to look at their own requirements by browsing through their website.

    I am an IMG from China and I have successfully secured a month of sub-internship at Mayo Clinic, Rochester location. So it is definitely possible to get one as an IMG. Most institutions require that the applicants have completed step 1 and TOEFL if english is not the language that their courses are taught in.

    Hope this helps!

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