What are clinical rotations? To put it quite simply, rotations are a time during medical training in which medical students get to learn in a real clinical setting. After two years of in-class training, medical students participate in a number of core clinical rotations in their third year that allow them to interact with patients and practice medicine with the supervision and guidance of established, practicing physicians.
Let’s discuss what happens during clinical rotations, including what students can expect, when they occur, the core rotations covered, and how to succeed.
What Are Clinical Rotations?
Clinical rotations, also known as clerkships, are training periods in which medical students practice medicine under the supervision of established physicians. They are known as rotations because students train in a single medical specialty for several weeks, then rotate to another clinical specialty.
During clinical rotations, medical students gain hands-on experience interacting with patients and medical staff in all parts of the hospital and healthcare clinic. They diagnose and recommend treatments for patients like an established physician would, but their work is monitored by a senior physician who evaluates and determines whether to approve their treatment recommendations.
Clinical rotations generally occur during year 3 and 4 of medical school. Typically, year 3 consists of several required rotations, including internal medicine, general surgery, pediatrics, psychiatry, obstetrics and gynecology, family medicine, and neurology.
In year 4, students may choose elective clinical rotations that are not required so that they can explore different fields of medicine that interest them. These vary from school to school and can include specialties such as emergency medicine, anesthesiology, radiology, intensive-care medicine, orthopedics, cardiology, ophthalmology, pathology, podiatry, and many more.
What Is the Purpose of Clinical Rotations?
The primary purpose of clinical rotations is to give medical students hands-on experience practicing medicine. Until clinical rotations, medical students have primarily trained in a classroom setting. During clinical rotations, students begin interacting with patients and practice the fundamentals of clinical examination, evaluation, and treatment.
Training during clinical rotations allows students to put what they have learned in the classroom into practice and experience the nuances of medical care in a real-world setting. At this point, medical students have learned the textbook definitions of various pathologies and what symptoms those pathologies may cause. During clinical rotations, they see how these symptoms actually appear in their patients and experience the complexity of how symptoms may differ based on patient age, gender, comorbidities, and other factors.
Another purpose of clinical rotations is to give medical students experience in various medical fields, so they can determine what specialty they will pursue as a practicing physician. They learn clinical fundamentals during the required rotations, such as internal medicine and general surgery, but they also choose which electives they will take so that they can explore the specialties that interest them.
Learn more: How to Choose a Medical Specialty — 6 Steps.
When Are Medical School Rotations?
In the US, medical school generally lasts four years. The first two years are primarily classroom-based training, and the latter two years require students to be in the hospital or clinic during clinical rotations. The first two years are often called preclinicals (MS1-2). The third year is required clinical rotations (MS3), and the fourth year is electives (MS4).
For more information on what occurs during each year, read our guide: Medical School Timeline (All 4 Years Explained).
Clinical rotations begin in MS3 with required clinical rotations and continue in MS4 with elective rotations. Medical students still need to study and take tests during MS3-4, but in addition, they spend much of their time in a hospital or clinic. On top of objective measures of performance like tests (USMLE), medical students are also subjectively evaluated by the senior physicians and medical staff who supervise them, and this can play a large role in their overall grade and ability to gain strong residency recommendations.
Each rotation lasts between four to twelve weeks, depending on the school and the field of medicine. The core rotations often last slightly longer than electives, the former 6-12 weeks and the latter 4-8 weeks. At the end of each rotation, the student takes a shelf exam to test what they learned and practiced over the course of the rotation.
Most schools require core clinical rotations in internal medicine, general surgery, obstetrics and gynecology, pediatrics, family medicine, and neurology. These core rotations are done in MS3, and at the end of their third year, students take the second of three US Medical Licensing Exams (USMLE) required to obtain a medical license, known as USMLE Step 2CK.
The last of the clinical rotations take place during MS4. These are usually elective rotations and are often pass/fail rather than graded, which takes a little pressure off of students. However, this year can still be quite challenging, especially if a medical student wishes to enter a competitive specialty, such as plastic surgery or dermatology. During this year, students are also preparing their applications for residency, which is the period of training that follows medical school.
Save our comprehensive ERAS Residency Application Guide.
What Are the Core Medical School Rotations/Clerkships?
For most schools, the required core clinical rotations are:
- Internal medicine
- Family medicine
- General surgery
- Obstetrics and Gynecology
Additionally, some schools may also require other core rotations, such as emergency medicine, radiology, or anesthesiology, but this is not typical.
The internal medicine rotation provides medical students with the opportunity to understand what it’s like to be an internal medicine doctor, sometimes known as internists. In this specialty, internists diagnose, treat, and prevent an extensive number of diseases and illnesses in adult patients. This is perhaps the most important of the core clinical rotations because USMLE Step 2CK, which medical students take at the end of the third year, is heavily geared toward internal medicine.
During this rotation, medical students learn a vast range of medical knowledge, especially developing diagnostics and practical skills. Students will learn to evaluate their patient’s medical history and main complaints and differentiate between conditions to make a diagnosis. They also practice skills like reading electrocardiograms (EKGs) and chest x-rays, as well as minor procedures, such as intubation, ultrasounds, steroid joint injections, and more.
Much of a student’s time is spent making rounds, which is when they practice diagnosing and treating patients with the help of their supervising doctor.
During the family medicine rotation, students learn to treat patients of all ages for a variety of diseases and illnesses and provide preventative care. This specialty is especially appealing to those who want to practice primary care in an outpatient clinical setting or are interested in practicing medicine in rural locations.
Students learn preventative care and practice health screenings to detect pathologies such as diabetes, hypertension, and hyperlipidemia. They may also focus on specific procedures, such as delivering babies or colposcopies.
Pediatrics is similar to internal medicine, but it specifically deals with caring for babies, children, and adolescents from birth until age 25. During this clinical rotation, medical students learn to provide specialized care suitable to the unique and changing physiology of children.
They learn which medications are unsafe for children, practice skills like the vaccine scheme for young adults, and test their knowledge of pathologies that are common to different age ranges.
Neurologists specialize in the non-surgical management of disorders of the central and peripheral nervous system, including things like headaches, strokes, seizures, and dementia. The rotation includes caring for severe patients in an inpatient setting as well as admitting patients in an outpatient setting and continuing care.
Obstetrics and Gynecology (OB/GYN)
In the OB/GYN clinical rotation, students learn about care during pregnancy and childbirth and the treatment of the female reproductive system. Students often perform annual exams, such as pelvic exams, breast exams, pap smears, and STD screens. They may also perform birth control insertion and removal or even help to deliver babies.
The clinical rotation of general surgery focuses on practicing technical skills, such as maintaining sterile technique and suturing. Depending on the type, students may assist in the surgery by suturing or knot tying, but they may also spend time watching surgeons perform surgeries on a screen. This rotation is notoriously difficult because of the early mornings, long hours, and technical skills required.
In the psychiatry rotation, students learn to diagnose, prevent, and treat mental disorders and illnesses. In this emotionally-challenging rotation, students help manage care for patients by making medication adjustments, balancing side effects, and counseling patients when their symptoms change. They may also care for patients in inpatient psychiatric wards, where patients are a danger to themselves or others or cannot meet their basic needs.
Succeeding in Clinical Rotations
Clinical rotations are both rewarding and exhausting. After two years of classroom study, students finally get to participate in patient care. Ultimately, it is extremely enjoyable to work with a healthcare team to develop a treatment plan that helps a patient improve.
However, this is an incredibly draining time, as students typically work 12-14 hours a day or more and may have to work weekends or be on call. On top of this, students must also find time to study so that they can pass the shelf exams and USMLE Step 2CK.
It can be a challenging time for students as they navigate a new way of learning; plus, they must soon make decisions about the specialty they want to pursue.
We share tips on how to succeed during your rotation in another guide: 5 Tips to Honor Medical School Clerkships.
- Know how you’ll be evaluated
- Be kind to everyone
- Ask for feedback
- Take advantage of your downtime
- Focus on being instead of doing
Learn from soon-to-be resident and Med School Insiders team member Wasiq Nadeen as he shares how to succeed during your final years—What I Wish I Knew Before Medical School Rotations.