Medical Student Guide to Clinical Rotations & Clerkships

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Medical education is a comprehensive combination of lectures, book work, exams, and clinical experiences. Clinical rotations (aka clerkships) constitute most of the patient care experiences your school requires for your program of study. Rotations are often the first practical experience that a medical student will encounter during their studies

These experiences are not only an important learning environment for patient care, but also play an important role in your future residency MATCH. Here we will give you all the information you need to plan, find and excel during your clinical training!

What are Clinical Rotations & Clinical Clerkships in Medicine?

Medical school is traditionally separated into basic sciences and clinical sciences. Basic sciences usually consist of the first two years of medical school and include classroom work, physician and expert lectures, and exams. Clinical sciences are generally the third and fourth year of medical school and are heavily focused on patient-centered experiences in the hospital and clinical practice setting. 

Although this traditional division has become more integrated in recent years, the university you attend will greatly define how your program is scheduled. Clinical clerkships, elective rotations, and observerships are all an aspect of this clinical education aspect of your curriculum. This allows student-patient experience and interaction within the clinical environment.

Clinical experience can be further divided into core rotations and elective rotations. Core rotations vary from school to school and generally include internal medicine, surgery, obstetrics and gynecology, pediatrics, family medicine, psychiatry. Many US medical schools also include neurology and/or radiology, which may not be required for Caribbean and foreign medical schools. Electives, or away rotations, can consist of any specialty of the student’s choice. Some students will seek a subspecialty within a specialty, such as gastroenterology within internal medicine, to gain more specialized knowledge in a field of interest.

Why are these Expereinces Important for Medical Students?

Externships are the backbone of any medical graduate CV looking to go into clinical practice as a physician. For many students, it is the first interaction they will have with patients. For others, it helps to consolidate your past experiences into more complete clinical knowledge. It also provides medical students with leadership skills and interpersonal relationships with other hospital staff. 

The core rotations form the foundational clinical knowledge expected of all physicians. The focus is largely on primary care, while also providing some specialty experience. The experiences assist students in analyzing their more and less desirable future specialty options.

The elective rotations allow medical students to gain knowledge and insight into more specialized fields. When considering a residency program, it is important to have experience and Letters of Recommendation from within that specialty or subspecialty. Away rotations give greater specialty focus and establish networks within the chosen field.

 

*Less commonly, it also allows for the possibility of non-boarded physicians to go into private practice after their intern year. Core clerkships give a more well-rounded knowledge base of common patient presentations in a variety of scenarios.Ex

What are the Types of Clinical Rotations?

Many medical learners don’t realize the importance of the type of clinical training they receive. The environment of their clinical experience can greatly influence the level of education received. It also alerts Residency Directors to potential deficiencies in education. Some types of medical student externships are of greater value and importance. Others may be less educational but suffice for graduation requirements if that is the main focus.

Observerships are of a lower quality of clinical education than the others. They are similar to Shadowing a physician, which many pre-med students have experienced. It often entails the learner following a physician through their day and possibly having minimal interaction with the patients. However, they are generally considered “hands-off” and limit the student’s physical interaction with patients or procedural experience. These are more commonly seen for IMGs who intend to meet their program requirements quickly or at an affordable price.

Traditional, “Hands-on” rotations are the most common type of educational setting for medical learners. This type of learning environment facilitates experiential learning under the mentorship of their preceptor. Students in these types of rotations will perform many aspects of the physical exam and may even engage in surgical and other procedures. Most AMGs will only experience these types of rotations.

Sub-internships (Sub-I; Acting Internship) are a step above regular hands-on experience. The preceptor allows more student autonomy and self-regulation through their learning. Of course, all important decisions are still made and reviewed by the preceptor to assure patient safety. This is the closest representation to the intern year of residency that a student can reach and it reflects strongly on a residency MATCH application. These will generally only be available in ACGME accredited institutions.

The newest addition to medical clerkship options is Tele-rotations (aka virtual rotations). These vary considerably in quality, time management, and acceptance of credits by schools. However, they now give students a wider range of options to gain experience in the clinical setting. Due to the “hands-off” quality of these clerkships, many schools have put limits on the number of rotations within this category you may complete.

Where Can I Find Core and Elective (Away) Rotations?

For AMGs, most of their rotations will come from their own school. Even IMGs are often required to complete their core rotations at specifically partnered hospital sites. This varies greatly among non-US schools so make sure to clarify with your clinical department or coordinator in advance.

For LCME accreditation, all U.S. universities must partner with a hospital in order to provide these services to their students. However, the options within your institution may be limited or highly competitive. This can prevent many medical students from attaining the necessary clinical experience in their desired specialty. This is one reason many students apply for away rotations at other hospitals.

Whatever the reason, elective rotations can be acquired in different ways.  Traditionally, students were often forced to cold-call physicians at neighboring institutions, or request a referral from a preceptor at their home institution. In more recent years, services have been developed to fill this gap and facilitate busy medical learners.

Another path many students opt to explore is medical rotation placement agencies. There are several larger organizations that many students are familiar with and dozens of smaller ones appear every year. These agencies work as mediaries for students and rotation sites. Due to this, they frequently charge application fees, membership fees, charge more for rotations, and do not offer refunds.

We at FindARotation disagree with the actions of many of these agencies and worry that ethical considerations are often overlooked. We are not an “agency” but a marketplace for students and preceptors to take back control of their educational desires. We do not regulate student and preceptor schedules and allow for transparency and flexibility of current and future professionals over their own journeys.

If students decide they do not need to hire an agency, yet also wish to have a convenient network of potential clinical sites at their fingertips, they may wish to consider a rotations marketplace. As far as we know, there are only two currently in existence. One is the Visiting Student Learning Objectives (VSLO) program run by the AMA. The other is FindARotation.

The VLSO program, and the associated Visiting Student Application Service (VSAS), was created by the AMA to help students find verified away rotations in other institutions. However, those that have used the service complain that it is difficult to navigate, often holds inaccurate or outdated information, and still requires a lengthy manual application process for each clerkship. In addition, many newer, smaller, or foreign schools may not have access to this service. There is also generally an application fee whether the student is accepted into a rotation or not.

For those looking for a completely personalized curriculum, FindARotation offers the most varied clerkship options. We also understand that students already have a financial burden and limit our revenues to modest transaction fees. We have to keep the lights on somehow! Any other rotation charges are regulated by the preceptor or institution. 

With our automated systems, we can facilitate clinical clerkships easily and quickly. This reduces our need for large staffing or clunky systems, and saves you money! We are also constantly working to improve the system. If you have not done so yet, we recommend Registering for your free account and begin creating your personalized medical education. You can read our FAQs for more information.

What Types of Clinical Rotations are Available?

The types and locations of clinical sites may also be a consideration for some students. For those looking for clerkships at a residency location, an ACGME accredited hospital offer the safest and most definitive path. To teach residents, a clinical site must obtain ACGME certification. This is generally limited to larger medical institutions and university hospitals. However, some smaller and private clinics have been accredited in recent years. Please refer to the ACGME link below for updated accreditation lists. It’s also important to note that some states require the clinical experience to be at an ACGME hospital in order to be a valid clerkship. See the Guide to United States Clinical Experience (USCE) by STATE for state-specific details.

Community (including University) hospitals represent most of the accredited institutions in the U.S. Larger hospitals have many financial, academic, and technological resources not available to smaller hospitals and clinics. These are great clerkships for those wishing to seek subspecialty fellowships. If you want to find a zebra disease, this is likely where it will happen. However, they are also highly competitive clinical sites for students not attending the internal institution associated with that hospital.

Community hospitals include any facility that is open to the public. This is where the majority of patients are initially treated and offer extensive experience in primary care. They are frequently the first line for protection against the local spread of disease, emergency services for traumas and accidents, and provide many ancillary medical services. 

Non-accredited clerkship locations are also invaluable to many students, especially from smaller, newer, or foreign schools. It is generally not required that your rotation be accredited by the ACGME in order to count for school credit. This leaves many opportunities for learning in a wider array of clinical settings. Be sure to check with your clinical coordinator before requesting a rotation!

Non-community hospitals, such as VA Hospitals, service particular members of the community. They are generally closed to the public for medical services. IMGs are usually not able to apply at these sites. As a general rule, if you could not qualify for U.S. financial aid, you will not be accepted into a VA rotation without special considerations.

Many students also benefit from the use of community (private) practice clinics. These may be small urgent care clinics or a physician’s private office. These clerkships do not provide as robust technological, procedural, or disease variants as the other sites mentioned. However, they provide some of the most needed experiences in the U.S. healthcare system: primary care. Many students aim to serve their local communities or even other areas in need. This may also allow application for the Public Loan Forgiveness Program (PLFP) by practicing in underserved areas. Please see the PLFP Tool to see if this program is right for you.

Lastly, the newest addition to clinical clerkships is the telemedicine rotations (tele-rotations). We address this in more detail in the Types of Clinical Rotations section above. Needless to say, this is still relatively new and each program may weigh these clinical experiences on a case by case basis. Check with your clinical coordinator to see if any rotations offered through FindARotation are right for you.

For all of your clerkship needs, continue on to our Complete Guide to U. S. Clinical Experience by Specialty!

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