Clerkships, Externships and Clinical Observerships Explained

Often times these terms are used interchangeably by students and graduates which can lead to confusion for those seeking opportunities in US clinical experience.


Typically, the structure of medical education is as follows:  Medical students spend the first 2 years of medical school in the classroom gaining the basic science knowledge.  Here they study Anatomy, Physiology, Biochemistry, and Pharmacology among other things.  The 3rd and 4th years of medical school are spent off campus gaining clinical experience in hospital settings.  This is commonly referred to as clerkships or “rotations”. Clerkships are a part of the school’s curriculum and required to graduate. These typically have direct patient care or “hands on” experiences.


Refer to clinical experiences not directly provided by the medical school’s curriculum. These types of rotations can be done by undergraduates as extra-curricular or as graduates seeking additional exposure or clinical edge to the competing environment.  These typically have direct patient care or “hands on” experiences.

Clinical Observerships:

Refers to a clinical experience that does not involve direct patient care. This experience is generally sought by Undergraduates and graduates alike.  It is not part of the course work and serves to strengthen individuals’ application by learning US clinical practice.  As 1/3 of Internal Medicine residency is spent in the ambulatory setting, it is important to gain this appreciation.  This is also the opportunity to gain greater exposure and experience with a particular specialty, obtain letters of recommendation for applications and improve their clinical skills and cultural competency. The restriction on patient care is largely for malpractice insurance issues.

Like any other field of study, when applying for a residency position, gaps in clinical education raises questions.  This becomes an increasing concern the longer one graduates from medical school.  For example, a person who graduated this past year should naturally flow into residency.  In contrast, someone who graduated one or two years earlier raises the question “what have you been doing for the past ___ years to keep abreast of medicine?  Will the applicant be ready to provide direct patient care?  Observerships provide continuity and, when earned, they provide letters of recommendation from physicians within the field.