Medical school clerkships are when you finally get to step outside the classroom after two years of in-class training and practice medicine in a real clinical setting. There are several core clinical rotations you will participate in during your third and fourth years of medical school, and regardless of where you currently believe your interests lie, you must give each of them your all.
In this post, we break down which medical school clerkships are required, what each of them entails, how to order them based on the specialty you want to one day pursue, and key tips for making the most out of each clerkship.
What Are Medical School Clerkships?
Medical school clerkships, also known as clinical rotations, are training periods where medical students practice medicine under the supervision of established doctors. Each rotation lasts several weeks and focuses on a single medical specialty. Once the rotation is complete, students then rotate to a different clinical specialty—hence the name.
Clerkships provide medical students with hands-on experience interacting with patients and medical staff in each part of the hospital and healthcare clinic. Students diagnose and recommend treatment plans for patients just like a professional doctor; however, their work is closely monitored by a senior physician who evaluates their performance and determines if the treatment plan should be approved.
Medical school clerkships usually occur during the third (MS3) and fourth (MS4) years of medical school. While the medical school curriculum will differ from one school to the next, generally, year three will consist of a number of required core rotations, such as general surgery, internal medicine, family medicine, and psychiatry.
During fourth year, students are able to choose elective clinical rotations so that they can study and explore the fields of medicine they find most intriguing. The availability of elective rotations will vary from school to school.
For more information, read our guide on Clinical Rotations: Medical School Clerkships Explained.
Core Medical Clerkships
What to expect from your rotation, what you need to know, and the logistics around it all depend on which rotation you’re participating in. There’s a wide range of clinical rotations, and which ones you need to complete depends on each school’s requirements. There are, however, seven core rotations that are required for most schools: general surgery, internal medicine, family medicine, obstetrics and gynecology, neurology, psychiatry, and pediatrics.
Additionally, your school may require other rotations, or you may choose to pursue them as electives. Other clerkships may include cardiology, pathology, emergency medicine, radiology, anesthesiology, intensive-care medicine, ophthalmology, podiatry, orthopedics, and many more.
For the purposes of this guide, we will stick to examining the seven core rotations. Be sure to save our comprehensive guide for each of the core rotations listed below. These guides include essential foundational knowledge and the resources you’ll need to succeed.
1 | Internal Medicine
Internal medicine doctors are the generalists of generalists. They treat an extremely wide variety of medical conditions from acute or chronic to common or rare to complex or straightforward. They understand the complex interplay of each organ system and are heavily involved with direct patient care.
During the internal medicine rotation, you will learn a massive amount of medical knowledge, especially when it comes to developing practical skills and diagnostics. You will learn to evaluate your patient’s medical history and main complaints and differentiate between conditions to make a diagnosis. You will also practice skills like reading electrocardiograms (EKGs) and chest x-rays, as well as minor procedures like ultrasounds, intubation, and more.
You will spend most of your time making rounds, diagnosing and treating patients with the assistance of your attending physician.
Internal medicine is one of the most essential core clerkships, as it can lead to a number of other specialties. Plus, it’s important to note that the content of the USMLE Step 2 CK exam is 50-60% internal medicine.
Learn more with our complete Internal Medicine Clerkship Guide.
2 | Family Medicine
Family medicine is the center of primary care and has a lot in common with internal medicine, as family medicine physicians know a little bit of everything. They treat the broadest range of patients and illnesses, and it’s the specialty of choice for doctors who want to treat both the young and the old.
Family medicine is the first line of defense for less urgent health concerns. During this rotation, you will learn to provide preventative care and treat patients of all ages for a variety of diseases and illnesses. If you hope to practice primary care in an outpatient clinical setting or are interested in practicing medicine in rural locations, you will find this clerkship especially intriguing.
You will practice health screenings to detect pathologies like diabetes, hypertension, and hyperlipidemia. You may also focus on specific procedures, such as delivering babies, steroid injections, or colposcopies.
For more details, check out our complete Family Medicine Clerkship Guide.
3 | OB/GYN
OB/GYN is a hybrid core rotation, which means it has elements of both clinical medicine and surgery. Both hopeful future surgeons and clinicians can hone their skills with this clerkship.
OB/GYN has two components: obstetrics and gynecology. Obstetrics is the medical and surgical management of pregnancy, and gynecology is the medical and surgical management of the female reproductive tract.
OB/GYN is the specialty that deals with the female reproductive tract and the delivery of babies, which makes it more noisy and chaotic than other specialties. Since births do not follow a straightforward 9-5 schedule, the OB/GYN clerkship can be quite unpredictable.
You will often perform annual exams, such as breast exams, pelvic exams, pap smears, and STD screens. You may also perform birth control insertion and removal or even help to deliver babies.
Learn more with our comprehensive OB/GYN Clerkship Guide.
4 | Pediatrics
Pediatrics deals with providing care for babies, children, and adolescents, all the way from birth until the age of 25. Essentially, it’s the equivalent of internal medicine, but you’re treating children instead of adults.
Children have their own unique physiology, and this physiology continues to evolve as an infant grows from a toddler to a child to an adolescent. Therefore, certain medications that are safe for adults may be dangerous for children.
You will learn which medications are unsafe for children, practice skills like the vaccine scheme for young adults, and test your knowledge of pathologies common to different age ranges.
This clerkship is typically packed with supportive attendings and staff since most chose the specialty due to their passion and enthusiasm for the field. This means it’s a great opportunity to hone any clinical skills you feel could be stronger.
For more details about what pediatrics entails, read our Pediatrics Clerkship Guide.
5 | Neurology
Neurology deals with the non-surgical management of a wide range of central and peripheral nervous system disorders. In other words, neurology is concerned with the nuts and bolts of the brain, such as pathologies of the neural and glial cells or brain vessels.
Neurologists treat everything from headaches and migraines to strokes and seizures to incurable and devastating diseases like dementia, Huntington’s disease, and amyotrophic lateral sclerosis (ALS).
You will learn how to provide care for severe patients in an inpatient setting and admit patients in an outpatient setting.
For more details, including how you can make the most of this rotation, read our complete Neurology Clerkship Guide.
6 | General Surgery
The general surgery clerkship is an entry point for students who want a career in surgery, and it also serves as a source of potential recommendations for future surgical away rotations you’ll need to take in order to advance on this career path.
This rotation is heavily focused on skill acquisition as opposed to knowledge acquisition. Although the pathologies are domain-specific, your hands-on skills make or break your chance of becoming a surgeon.
Depending on the type of surgery, you may assist by suturing or knot tying, but you may also spend time watching surgeons perform surgeries on a screen. Be warned: This rotation is extremely difficult, as it involves early mornings, long hours, and serious technical skills.
If you don’t think surgery is your thing, give it your best effort before dismissing it; however, if things refuse to click after deliberate effort, don’t worry. You can still practice clinical reasoning in the wards and with consults. Anesthetists are also always open to speaking about their craft.
It may go without saying, but If you hope to become a surgeon, it is imperative that you treat this core rotation with absolute care and attention.
Learn more with our complete General Surgery Clerkship Guide.
7 | Psychiatry
Psychiatry is the field of medicine focused on understanding and treating psychological distress and mental health disorders, primarily through the use of talk therapy and medication. Psychiatrists use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) to evaluate a patient’s symptoms and determine if they show signs of a diagnosable disorder.
However, psychiatrists can also help patients with conditions that aren’t necessarily classified as DSM illnesses, such as psychological distress that comes from pain, trauma, or other high-stress situations.
In the psychiatry rotation, you will learn to diagnose, prevent, and treat mental disorders and illnesses. You will help manage care for patients by making medication adjustments, balancing side effects, and counseling patients when their symptoms change. You may also care for patients in inpatient psychiatric wards when patients are a danger to themselves or others or cannot meet their basic needs.
It’s an emotionally-challenging rotation and about as far from surgery as you can get. But regardless of your interests, it’s important to fully apply yourself and give it your all.
Learn the ins and outs of this rotation with our comprehensive Psychiatry Clerkship Guide.
How to Order Clerkships
Every medical school is different. Some allow you to order your rotations yourself, whereas others determine the order for you. If you are able to choose your rotation order, apply the following advice.
If you have a specific specialty in mind, strategically place it in the middle of your clerkships after you have acquired a foundation of experience and technical skills.
Placing it first, when you’re just getting used to your third year clerkships, will make it hard for you to impress your seniors and attendings. You also don’t want to place your specialty of interest last, as you’re sure to be exhausted. Plus, if you find you don’t actually like the specialty, you’ll have to pivot late in the game, which is bad news.
Also, by not placing it last, you’re better able to collect the number of references you need to apply to away rotations and residency programs.
Any clerkship you want to pursue as your specialty is best placed second or third out of the four quarters of the year.
The first question you have to ask yourself when determining how to order your clerkships is if you want to get into a surgical specialty or a medicine specialty.
If you want to go into surgery, it’s a good idea to put OB/GYN before it because OB/GYN has an OR component, which will allow you to practice your suturing and scrubbing. When your surgery clerkship rolls around, you can feel more confident in your technical skills. If you are passionate about OB/GYN, it would be the reverse—place the surgery clerkship before OB/GYN.
Now, this will mean quite a stretch of long hours, but if you want to stay fresh in that environment, it’s a good idea to place these rotations together because they are similar. However, you do not want to place these clerkships at the beginning.
Students often place internal medicine before surgery as surgery does feature a lot of internal medicine on the shelf exam. Therefore, if you want to go into surgery, place internal medicine first, followed by OB/GYN, and then surgery. However, since this is quite a heavy load, some students sprinkle neurology or psychiatry in between to give themselves a break.
What’s most important is placing the clerkship you’re most interested in in the middle when you’re at your peak.
If your focus is medicine, it’s a good idea to put things like psychiatry, neurology, and pediatrics first so that you get a strong foundational sense of medicine and the specialties within it. When it comes to placing surgery, you can place it at the end or wait until after your Dean’s Letter.
If you’re able to choose the order of your rotations, where you place surgery and medicine are the most important components.
You must decide whether you want to look good in surgery or medicine and prioritize your clerkships accordingly. It’s also important to be careful about stacking the big ones all at the beginning, such as internal medicine, pediatrics, surgery, and OB/GYN. These clerkships are often six to eight weeks, so completing all of these back-to-back will result in a tremendous workload and could lead to burnout. Strategically place lighter clerkships like psychiatry to give yourself a bit of a break.
Tips to Make the Most of Your Clerkships
Each of your clerkships will be a unique experience, requiring different resources, technical skills, and knowledge. For specific advice and the foundational knowledge you need for each rotation, view the detailed guides we shared above.
The following tips can be applied to all of your core rotations, as well as any elective rotations you choose to participate in.
Be Proactive
Even if you have a shelf you’re studying for, start researching your next clerkship a week before it begins to give yourself a strong head start.
Will specific note taking skills be required? Physical exams? Start asking people about the rotation and utilizing the resources your program provides. You do not want to go in blind. It is critical that you find your footing before you even enter the clerkship.
Be proactive by studying and reviewing what will be expected of you early.
Understand the Setting and Logistics
What is the setting or context of your new rotation? Do you need scrub training? An ID? How will you get there? What’s the travel time? What’s the patient population like?
Make the trip to your clerkship the weekend before your first day to minimize nerves and ensure you won’t be late on the big day. Leave no room for surprises.
Understanding the environment you’ll be working in, the skills you need to succeed, and the people you’ll be working with ahead of time means it will take less time to adapt, leaving you free to focus on the content of your rotation immediately.
Be Communicative
Be very communicative with your people, whether that’s the clerkship coordinator, the clerkship director, or the residents you’re assigned to. Communicate more than less, as this decreases the burden on the people who are hosting you. Plus, it shows you are proactive and want to learn.
It’s also essential to ask for feedback from your preceptors. How are they finding your performance? What can you do to improve? Asking these questions while you’re still immersed in the rotation will give you time to make adjustments before you are graded. If you wait until the end of your clerkship to ask about your performance, it’s too late to improve upon it.
Listen attentively and always be receptive to your preceptor’s feedback. Each suggestion or piece of criticism is a chance to grow as an individual and hone your skills. Do not become defensive or argue, as this will certainly hurt your final grade. You are not a professional physician yet, so take all of the advice you get and receive it with maturity and humility.
Find Enthusiasm for All Rotations
Be enthusiastic. Even if you’re certain you want to go into neurosurgery, give psychiatry equal effort and enthusiasm because those grades still make it into your Dean’s Letter (unless you place it at the very end.) Scoring poorly in any of your rotations, regardless of where your interests lie, is a red flag on residency applications.
Put yourself in the shoes of someone who is pursuing the specialty during each of your clerkships. It will be more interesting, the time will go by faster, and you’ll enjoy it more.
Do your best, be curious, ask questions, and have fun. Always remember you are there to learn, not simply to check off the boxes. Each piece of medical knowledge or technical skill you acquire makes you a better physician, and every attending has something to teach you.
Lead With Empathy and Kindness
Be kind to absolutely everyone you encounter, regardless of whether or not they are kind to you. You will meet and interact with all kinds of different people, from nurses to receptionists to techs to janitors to doctors to patients to patients’ families. While it’s no doubt easier said than done, leading with empathy and kindness is essential to your success.
Medicine is a team sport, so it’s critical that you learn how to play well with others early on in your training (and hopefully even before). You become a part of the team as soon as you enter your rotation, so it’s important to act as such.
Not only is it important to get along with the hospital staff, but keep in mind that going to the hospital is a very scary thing for most people, and some people handle this stress better than others. Just because someone is rude to you does not justify being rude to them in return. They are scared, and you are there to help.
Also, medicine is an extremely tight-knit community. Your attendings and the hospital staff are watching and evaluating your every move; losing your temper or being rude is never acceptable, no matter who you’re talking to. This kind of behavior can easily end up in your evaluation and can negatively impact your grade.
Treat others as you want to be treated, and always lead with kindness and respect.
For additional clerkship advice, read 5 Tips to Honor Medical School Clerkships or watch the companion YouTube video.
Succeeding in Your Medical School Clerkships
While extremely rewarding, clinical rotations are also extremely time-consuming and challenging. You will typically work 12-14 hours a day or more, and you may be required to work weekends or be on call. On top of this, you need to find time to study for your shelf exams and USMLE Step 2 CK.
You must also soon decide which specialty you want to pursue and prepare residency applications.
But the good news is you’re not alone.
Med School Insiders offers a number of Residency Admissions Consulting Services designed around your specific needs. We can help you prepare for residency with application editing, interview prep, and mock interviews. And if you’re struggling to choose a specialty, order your rotations, or navigate your future, our one-on-one advisors can help you determine and design the ideal path for you.
View our library of resources, including guides on the entire residency application process, how The Match algorithm works, how to choose a specialty, and more.
