There are also externship programs available for medical students that have graduated or that are ECFMG certified, meaning that you have passed Step 1, CK & CS. These are hands on practice of medicine without supervision. These externships are rare, being that they are essentially the same as a clerkship, but since they are for graduates and not for credit. Externships are available on occasion, but rarely at teaching hospitals. These are the best type of hands on US based clinical experience an IMG can get, but it is important to remember that these are very rare, and only for ECFMG certified students. Since most students do not become ECFMG certified until they are applying for a residency, these are very beneficial if you did not match with a program.