Once medical students complete their time in the classroom, they move on to what many consider to be the real reason they went to med school in the first place: treating patients. This transition usually occurs during the second or third year depending on the length of a school’s pre-clinical curriculum, and is comprised of clerkships (a.k.a. “rotations”), selectives and/or electives, sub-internships, and away rotations. In addition to gaining clinical experience, students have the opportunity to do more advanced scholarly work. If you are considering medical school, here is an overview of the opportunities and experiences you may have during the clinical years.
The core clerkships beginning in the second or third year of medical school are mandatory for all students. They typically include rotations through some variation of the following: neurology, internal medicine, obstetrics and gynecology, pediatrics, psychiatry and surgery. During these clerkships, students treat patients under the supervision of a faculty member, fellow, or resident. The length of core clerkships can range from several weeks to several months. Students may be able to choose the order in which they do their rotations, depending on the program.
Some schools also mandate a certain number of selectives, which cover more specialized areas (as compared to the more general core clerkships). Students are usually given the option of several selectives to choose from—much like a college that has distribution requirements, but lets students choose which courses to take within a given distribution area.
Georgetown University School of Medicine, for example, offers a multitude of selectives ranging from anesthesia to child psychiatry; students choose one two-week selective to complete during their third year. Other schools, however, mandate specific selectives: the University of Connecticut School of Medicine, for example, has three “required, non-call rotations that have been designed by the faculty to meet specific academic needs or provide educational content that we feel should be experienced by all internal medicine trainees.” These three selectives are in dermatology/ophthalmology, neurology, and musculoskeletal medicine. Still other schools have extremely flexible options for selectives: the Mayo Clinic Alix School of Medicine, for example, allows students to choose from a list of available options or self-propose a selective block, which can include 1-2 weeks “to rest, relax, and enjoy time with family and friends after a particularly difficult academic block.” How about that!
Schools also offer a certain amount of elective time, which can span a variety of areas. As the UConn School of Medicine puts it, while selectives are required rotations designed to meet specific academic objectives, electives (which, like selectives, are non-call) “are chosen by housestaff to enhance a particular interest, pursue an academic pathway, or investigate a subspecialty interest more deeply.” At the Dartmouth Geisel School of Medicine, for example, students in their third year can take up to eight weeks of clinical electives along with the seven required clerkships. Thus, even when completing the universal core clerkships, there is still substantial room for personalization during the clinical years.
During a sub-internship, also called an “acting internship,” students assume even more responsibility than during clerkships—a level comparable to that of an intern (someone who has already graduated from medical school). “Sub-Is” or “AIs” typically occur during the fourth year of medical school; students tend to choose sub-Is in an area that they are considering applying to for residency. At Yale School of Medicine and Boston University School of Medicine, for example, students are required to complete one sub-internship in the specialty of their choice during their final year of school.
Away rotations provide a unique opportunity for fourth year medical students to explore residency opportunities at other institutions. To streamline the process of applying, there is a universal application through the AAMC, known as the Visiting Student Learning Opportunities (VSLO) program. However, policies vary by school, so it is important to carefully research the specific program you are planning on applying to. Pritzker School of Medicine explains that some specialties, such as dermatology and emergency medicine, essentially require students to complete away rotations before applying for residency.
There are additional opportunities available to medical students during their clinical years. Many schools offer a focused, in-depth experience in a specific area of interest. Several medical programs, such as Weill Cornell Medical College, Alpert Medical School, and Columbia University’s Vagelos College of Physicians and Surgeons, offer a scholarly concentration program, which allows students to participate in an in-depth study of a particular area of medical practice or research under the mentorship of faculty. Certain schools, such as Duke University School of Medicine, dedicate an entire year to scholarly research.
Another important element of these years is dedicating sufficient time to prepare for the United States Medical Licensing Examinations (USMLE) Step 1 and Step 2. However, it should be noted that the timing of these exams varies widely among different medical schools.
The clinical years of medical school are fundamental in shaping students’ future paths. During this time, students gain hands-on experience treating patients while pursuing scholarly endeavors and delving deeper into their individual interests. It is essential to carefully compare the curricula of various medical schools so that you ultimately attend a program that is compatible with your future goals.