Sorting Through the Confusion: Observerships, Externships and Clerkships

There are a variety of terms used to describe clinical education used by the international medical community.  While they are often used interchangeably, each term refers to a specific kind of experience – some more valuable then others as viewed on your residency application.  Quality clinical experience relevant to your choice of specialty is often the tipping point factor in an applicant’s candidacy.  What are these terms and how do they differ?  See the list below (not in any particular order of importance) and further sections of the site will delve deeper into their differences and clarify the importance, or lack thereof, of each:

a)    Externships

b)    Clerkships

c)    Clinical Electives

d)    Observerships

Understanding the Difference:

To truly understand each term above, you must first understand the structure of medical education in the USA and how it differs from international education:

After completing two years of basic sciences education in a classroom setting, students then proceed to complete approximately two more years of clinical education.  These final years of clinical education are referred to as clerkships and/or clinical rotations.  Therefore, by its nature, the term ‘clerkship’ typically implies that these programs are geared towards students with the aim of gaining clinical education credit.  These programs are split up into Core & Elective courses.

Through their direct clinical hospital affiliations, US medical schools provide these rotations as part of their curriculum in US-based accredited hospitals.  The same can be said for some Caribbean and international schools, which have direct agreements with hospitals as well.  Schools do exist that do not have direct affiliations with accredited clinical sites yet have students interested in gaining medical education training in the US.  Oftentimes, these schools allow their students to substitute the clinical training with supplemental training abroad that they will grant credit for.  These rotations are often called “away rotations” and are approved by clerkship directors as part of the student’s medical education criteria for graduation.

Once students graduate, some may still need to gain US clinical experience to satisfy a litany of clinical experience requirements if they wish to increase their chances of matching in a US residency program.  This is where the terms Observerships and Externships come into play.  Each refers to a different type of clinical experience and we will speak about each one’s importance more in-depth in other sections.

How does this impact the international community?

Touching on “away rotations” above was just one aspect of how the international medical community interacts with US medical education to aid their students’ eventual goals of gaining a US residency position.  Many international students are part of MBBS programs, which are structured differently than the MD program model of two years of classroom education, in addition to two years of clinical education.

Typically, the MBBS program is a shorter overall program length, aided by the fact that many countries do not require an undergraduate degree prior to enrollment.  While the shortest path to becoming a full physician for a US medical student would be the 4 years or less of undergraduate education plus the 4 years of medical school education plus the 3-5 years of residency – the international student could complete a 4 and a half year MBBS program to become ready to apply for US residency.  Going back to earlier, though, each residency program typically requires (or at least recommends) having US clinical experience (USCE) in the field of application.  How would a MBBS graduate then fulfill these requirements having already completed their medical education training?  Supplementally with research, externships, observerships, and more.

Keep reading and we’ll explain.