April 11, 2018



The terms clerkships, observerships, and externships will not be strange to any medical student or International Medical Graduate. These are terms you must be familiar with when talking about clinical experience in the US. They are essential for those who wish to do a residency program in the US. International students, currently studying in the US and who wish to practice the profession there are also expected to gain clinical experience.

The terms clerkships, observerships, and externships may be confusing at times as they’re always used interchangeably. This article will attempt to pinpoint the differences and provide guidance on the merits of each.

The term Clerkship is also referred to as “rotations.” In the United States, Medical students are required to do a two-year basic science program before proceeding to another two years of clinical education. The latter is what is referred to as Clerkship. The school provides clinical experience for the students as part of the requirements to graduate medical school. The main point here is that the clinical experience is provided by the medical school attended by the student, and not by an external facility.

Externships are similar to clerkship but with a slight difference. The clerkship as we have established is a clinical experience gained by the medical student from his institution of learning. On the other hand, Externship is gained from an outside institution.  Externships can be done by both students who are yet to graduate and medical graduates. Candidates who have a flair for competitive specialties may do their rotations or clerkships in other institutions – the purpose of which is to get a recommendation from influential people in that specialty. Medical graduates, on the other hand, do externships for the purpose of boosting their CV or resume.

Both externships and clerkships involve patient care, taking of medical histories and physical examinations. In other cases, the intern is allowed to prescribe and treat under the close supervision of an attending physician.

An observership differs from clerkship and externship in that bit does not require direct patient care. It is done mostly by medical students and graduates for the purpose of getting a recommendation or gaining experience in any area of specialty. Also, while under observership, the graduate can improve his clinical skills and cultural competency. Why observers are not allowed to do patient care is because they have not yet been cleared to practice under supervision in the US. However, the experience gained is of immense value.

Which is best for me between clerkship, externship, and observership?

The determining factors are your goals, aspirations and the level of education you are currently in.

Clerkships are provided by your institution of learning. It is a prerequisite for graduating from the medical school. As a matter of fact, you will obtain some credits for doing a clerkship. If you wish to do your clerkship outside the facility provided by your institution, then the facility you wish to do it in will have to be certified by your institution. It must meet the degree and curriculum requirements of your medical school.

Externships allow you the opportunity to experience and care directly for the patient. You gain a lot of clinical experience here and may even receive some commendations from preceptors. However, you should note that opportunities are always very limited due to legal restrictions. Hence, it is important that you apply early and also apply wide. By applying wide, we mean that you apply to multiple programs as that will increase your chances of succeeding.

Observerships are mainly for those who wish to bridge some gaps in their clinical education. This is seen in cases where students still have some qualifying examinations to write for an extended period of time. This, however, is not ideal. A student who has gaps to fill academically may be frowned upon by the residency program. Gaps in clinical education suggest that the candidate may not be ready to face the rigors of patient care at the start of the residency. On the other hand, observerships can also be done by students who are not able to do externships in their desired specialty or time period. Also, applicants vying for competitive specialties will also have an added advantage as this program may earn them multiple recommendation letters from physicians within the field.

Before going for any of these, carefully analyze your options. Define your goals and critically look at your application. You may be able to spot defects and also see which experience would boost your application.

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