5 Categories of Student Clerkships

/5 Categories of Student Clerkships

5 Categories of Student Clerkships

For U.S. medical licensure issues affecting International Medical Students: Click here

International Medical Students (IMS) are often challenged with the daunting task of having their clerkships verified by teaching hospitals for state licensure purposes. Inability to verify such rotations or lack of proper affiliation agreements will most likely result in that IMS’ loss of the residency position s/he Matched into. To avoid such a catastrophe, below we have listed 5 categories of “for-credit” clinical rotations for IMS, and their availabilities to AmeriClerkships Medical Society (AMS) members:

  1. Category #1: Community Healthcare Experience (CHE)

  2. Category #2: Teaching Hospital Guarantee (THG)

  3. Category #3: THG VERIFIED

  4. Category #4: THG DO-GME VERIFIED

  5. Category #5: THG MD-GME VERIFIED

Important notes and disclaimers:

  • To minimize future scrutiny, it is recommended that you not cross to a lower clerkship category after you begin your rotations (upgrading to a higher category before you begin, and sometimes after you begin may be acceptable and recommended).
  • Both cores & elective rotations should be conducted within the same category, and in the highest number category possible (i.e. #3 is more desirable than #2, where available).
  • Securing an initial medical licensure in the first state is typically much more difficult than subsequent medical licensure(s) in other states; also with the greater need for practicing physicians, state medical boards want to recruit physicians (especially in Medically Underserved Areas), therefore licensure regulations may be less stringent after completion of residency, or becoming board certified, or having secured an unrestricted medical license in at least one state.
  • Click here to learn more about how clinical rotations are verified by various state medical boards, be sure to read our DISCLAIMER* on the bottom of this page
  • Click here for the our Commitments to Clarify + definition of AMS Clinical Features
  • Medical students enrolled in U.S. accredited medical schools (i.e. LCME or DO accredited medical schools) are legally permitted to engage in the limited practice of medicine (i.e. “hands-on”), whereas medical students not attending one of these medical schools may not. The definition of “hands-on” varies, depending on who you speak with (i.e. state medical boards may define it as partial or full practice of medicine, whereas medical residencies may define it as the ability to engage with patients to take student-type histories and physicals).
  • Taking student-type histories and assisting with physical exams alone may not be enough to label an activity in violation of the practice of medicine laws; however if combined with giving opinions or the patients being under the impression that you are their care provider, could put a foreign medical student at jeopardy of practicing medicine without a license. To be safe, AmeriClerkships recommends that non-U.S. medical students to never be unsupervised, and to never give the impression to anyone that they are doctors or have the ability to practice medicine (that includes using the words “Dr” before their names or even their email addresses).
  • Please note that individual medical boards may define “teaching hospital” differently, so at AmeriClerkships we have expanded our definition of a “teaching hospital” to any facility that meets any of the following criteria:
    1. Is listed in ACGME.org, OR
    2. Is listed as an AOA approved Institution or a Program, OR
    3. Hosts the medical students of U.S. accredited medical schools (i.e. LCME or DO accredited medical schools) for their clinical rotations (start with AMA Freida database, but not all clerkship teaching sites are mentioned there).
  • Remember that this page is for informational purposes only, and in NO WAY is it meant to offer any legal advice OR to circumvent your personal responsibilities of ensuring that you meet the licensure qualifications for the states you are planning to apply to for residency and ultimate medical licensure by contacting each state yourself.
  • AmeriClerkships reserves the right to change any of its published information without notice.

Clerkship Category #1

  • AMS Clinical Feature: CHE (Community Healthcare Experience)
  • Start of availability at AMS: Since March 2007 to present
  • Take me to AMS Clinical Site Search for Category #1 clerkships near me: Click here
  • Can AMS members transfer from a lower category into a higher category clerkship prior to start: Yes, upon availability; additional fees apply
  • Acceptable by ALL U.S. medical boards for initial medical licensure: Acceptable by most states, except possibly by OK, TX, MA, OR, IL, NY, CA, VA (and a growing number of states who are adopting the CA list of approved medical schools; subsequent licensures may not be as stringent)
  • Cost: $$$$$
  • Passing USMLE Step 1 required: No
  • Steps to enrollment: Click here
  • Suitable for crossing the U.S. border and securing a medical student B1 visa: No
  • Affiliation agreements: AMS + teaching attending physicians (+ possibly with your medical school, but not with a teaching hospital), therefore rotations ARE NOT “placed at an affiliated hospital”, but rather with the AMS affiliated supervising attending who may be affiliated with hospitals, and may elect to take you to those hospitals
  • Hands-on or shadowing: Experience will be insured for hands-on in outpatient settings (as permitted by patient and attending); opportunities to visit a hospital are NOT guaranteed
  • Registration with Graduate Medical Education (GME) or Medical Staff Office (MSO): There are NO affiliations between AMS and hospitals for this category of clerkships, therefore none of the above are guaranteed nor should they be expected by IMS of AMS
  • Same specialty ACGME (MD) or AOA (DO) accreditation, being issued a hospital ID badge, or any future verification of clinicals: There are NO affiliations between AMS and hospitals for this category of clerkships, therefore none of the above are guaranteed nor should they be expected by IMS of AMS. Some hospitals are considered a teaching facility due to hosting U.S. medical students for their clinical clerkships, without the presence of any residency program.
  • Recommendations to International Medical Student (IMS) thinking about arranging this category clerkships on their own to save money: This category of clerkships is only being offered by AMS to IMS who are under extreme budgetary constraints, and will limit applying to residencies in states that do not currently have any clinical rotation regulations (which can obviously change at any time). Otherwise AMS DOES NOT recommend this category of clerkships to any IMS.

Clerkship Category #2

  • AMS Clinical Feature: THG (Teaching Hospital Guarantee)
  • Start of availability at AMS: Since May 2007 to present
  • Take me to AMS Clinical Site Search for Category #1 clerkships near meClick here
  • Can AMS members transfer from a lower category into a higher category clerkship prior to start: Yes, upon availability; additional fees apply
  • Acceptable by ALL U.S. medical boards for initial medical licensure: Acceptable by most states, except possibly by OK, TX, MA, OR, IL, NY, CA, VA (and a growing number of states who are adopting the CA list of approved medical schools; subsequent licensures may not be as stringent)
  • Cost: $$$$$
  • Passing USMLE Step 1 required: No, with the exception of a few sites
  • Steps to enrollment: Click here
  • Suitable for crossing the U.S. border and securing a medical student B1 visa: No
  • Affiliation agreements: AMS + teaching attending physicians (+ possibly with your medical school, but not with a teaching hospital), therefore rotations ARE NOT “placed at an affiliated hospital”, but rather with the AMS affiliated supervising attending who may elect to take you to a teaching hospital that he/she is affiliated with
  • Hands-on or shadowing: Experience will be insured for hands-on in outpatient settings (as permitted by patient and attending), and in inpatient settings (if permitted by the hospital(s); most non-affiliated hospitals will only allow shadowing). Supervising attending physicians will provide the IMS with the opportunity to enter a hospital 24 hours a day; the IMS is responsible for taking advantage of those opportunities regardless of transportation or time issues. Opportunity for teaching hospital entry with supervising attending are as follows:
    • THG: <50% of the clinical block (CB)
    • Inpatient (IP) THG: >50% of the CB
    • Hospitalist (HOSP) THG: ~99% of the CB
  • Registration with Graduate Medical Education (GME) or Medical Staff Office (MSO): There are NO affiliations between AMS and hospitals for this category of clerkships, therefore none of the above are guaranteed nor should they be expected by IMS of AMS
  • Same specialty ACGME (MD) or AOA (DO) accreditation, being issued a hospital ID badge, or any future verification of clinicals: There are NO affiliations between AMS and hospitals for this category of clerkships, therefore none of the above are guaranteed nor should they be expected by IMS of AMS. Some hospitals are considered a teaching facility due to hosting U.S. medical students for their clinical clerkships, without the presence of any residency program.
  • Should International Medical Student (IMS) set up this category clerkships on their own to save money and time: Not recommended for IMS under any circumstance, since clinical clerkships should carry the appropriate medical student professional liability insurance, and only be completed with attending physicians who have entered into an affiliation agreement with your coordinating agency (i.e. AMS or your medical school) so that you are protected (i.e. physician accountability for outcomes, clinical evaluations and amount of teaching hospital exposure). Also nearly 50% of supervising attending physicians change their minds to host an IMS at their clinical site, causing unexpected delays in you graduating from medical school on time.  Enrolling with AmeriClerkships will help you avoid unnecessary time delays and continuous rejections.

Clerkship Category #3

  • AMS Clinical Feature: THG VERIFIED
  • Start of availability at AMS: June 2008 to present
  • Take me to AMS Clinical Site Search for Category #3 clerkships near meClick here
  • Can AMS members transfer from a lower category into a higher category clerkship prior to start: Yes, upon availability; additional fees apply
  • Acceptable by ALL U.S. medical boards for initial medical licensure: Acceptable by most states, except possibly by TX, MA, CA (CA may accept verified rotations that also host U.S. medical student clerkships, but unclear at this point; also may be changing soon due to Single AOA/ACGME Accreditation), OR, IL, VA (may change; subsequent licensures may not be as stringent)
  • Cost: $$$$$
  • Passing USMLE Step 1 required: No, but highly recommended
  • Steps to enrollment: Click here
  • Suitable for crossing the U.S. border and securing a medical student B1 visa: Yes; student must request AMS for a Letter of Enrollment on teaching hospital letterhead at least 2 months prior to visa interview
  • Affiliation agreements: AMS + teaching hospital + teaching hospital’s staff physicians (+ possibly with your medical school), therefore rotations ARE “placed at the affiliated hospital”, but can also take place in various inpatient and outpatient settings that the teaching attending physician is affiliated with and takes you to visit
  • Hands-on or shadowing: Inpatient and outpatient will be insured for hands-on at the facilities affiliated with AMS (as permitted by patient and attending; not shadowing); no guarantees when visiting non-affiliated facilities
  • Registered with the affiliated hospital’s Graduate Medical Education (GME) or Medical Staff Office (MSO): Yes, however the student is equally responsible for ensuring that his/her hospital processing has been completed, and that all hospital protocols are being followed by the student (pick up or drop off ID badges, not accessing the EHR, being professional to all employees, not violating patient confidentiality, etc.) Hospitals are not obligated to confirm that a student registration for clinical clerkships actually took place, despite there being evidence of such registration. 
  • Same specialty ACGME (MD) or AOA (DO) accreditation: Not guaranteed; some hospitals are considered a teaching facility due to hosting U.S. medical students for their clinical clerkships, without the presence of any residency program.
  • Must be willing to travel anywhere in the U.S. for same specialty ACGME (MD) or AOA (DO) accreditation as your specialty of clerkship for all 72 weeks of rotations (cores & electives): Yes, where available
  • Issued a hospital ID badge: Yes
  • Future verification of clinicals: Teaching hospital (or AMS as sanctioned by the affiliated teaching hospital; fees apply) may verify that your rotations were conducted with their permission, but are not obligated to do so and may defer you back to the supervising attending physician for actual attestation that such clinicals took place. Additionally the opportunity for verification does not guarantee state licensure outcomes (meaning that states may have more clinical rotation requirements than just verification when an IMS is applying for training/full medical licensure [i.e. specialty specific, existence of agreement with your medical school, etc]; click here for additional medical board requirements for IMS).
  • Should International Medical Student (IMS) set up this category clerkships on their own to save money and time: Thousands of IMS apply to a handful of teaching hospitals offering mainly elective specialties upon vacancy, and most are shadowing. Waiting too long to secure U.S. clerkships will cause a gap in your medical education, which is highly scrutinized by residency program directors when granting interviews. Securing hands-on for all cores & electives by IMS on their own is nearly impossible due to intense competition by U.S. medical schools, shortage of rotation slots, a teaching hospital staff physician’s unwillingness to sponsor someone they’re unfamiliar with due to HIPAA and hospital policies, and a student having to deal with all licensure matters on their own. Enrolling with AmeriClerkships will help you avoid unnecessary time delays and continuous rejections.

Clerkship Category #4

  • AMS Clinical Feature: THG DO-GME VERIFIED
  • Start of availability at AMS: July 2018
  • Show me Category #4 clerkships near me online: Available July November 2017
  • Can AMS members transfer from a lower category into a higher category clerkship prior to start: Yes, upon availability; additional fees apply
  • Acceptable by ALL U.S. medical boards for initial medical licensure: Most likely, except possibly CA (most likely changing soon due to Single AOA/ACGME Accreditation; subsequent licensures may not be as stringent)
  • Cost: $$$$$
  • Passing USMLE Step 1 required: Yes
  • Steps to enrollment: Click here
  • Suitable for crossing the U.S. border and securing a medical student B1 visa: Yes; student must request AMS for a Letter of Enrollment on teaching hospital letterhead at least 2 months prior to visa interview
  • Affiliation agreements: AMS + teaching hospital + teaching hospital’s staff physicians (+ possibly with your medical school), therefore rotations ARE “placed at the affiliated hospital”, but can also take place in various inpatient and outpatient settings that the teaching attending physician is affiliated with and takes you to visit
  • Hands-on or shadowing: Inpatient and outpatient will be insured for hands-on at the facilities affiliated with AMS (as permitted by patient and attending; not shadowing); no guarantees when visiting non-affiliated facilities
  • Registered with the affiliated hospital’s Graduate Medical Education (GME) or Medical Staff Office (MSO): Yes (most likely GME)
  • Same specialty AOA (DO) accreditation: Likely yes; if so, you will be placed with GME offices sanctioned by teaching hospitals that are AOA (DO) accredited for every one of your desired core & elective clerkship specialties (i.e. FM core at a hospital with an FM residency; Cardiology elective at a hospital with a Cardiology Fellowship, etc…)
  • Must be willing to travel anywhere in the U.S. for same specialty AOA (DO) accreditation as your specialty of clerkship for all 72 weeks of rotations (cores & electives): Yes, where available
  • Issued a hospital ID badge: Yes
  • Future verification of clinicals: Teaching hospital (or AMS as sanctioned by the affiliated teaching hospital; fees apply) may verify that your rotations were conducted with their permission, but are not obligated to do so and may defer you back to the supervising attending physician for actual attestation that such clinicals took place. Additionally the opportunity for verification does not guarantee state licensure outcomes (meaning that states may have more clinical rotation requirements than just verification when an IMS is applying for training/full medical licensure [i.e. specialty specific, existence of agreement with your medical school, etc]; click here for additional medical board requirements for IMS).
  • Should International Medical Student (IMS) set up this category clerkships on their own to save money and time: Thousands of IMS apply to a handful of teaching hospitals offering mainly elective specialties upon vacancy, and most are shadowing and don’t have same specialty GME. Waiting too long to secure U.S. clerkships will cause a gap in your medical education, which is highly scrutinized by residency program directors when granting interviews. Securing hands-on for all cores & electives by IMS on their own is nearly impossible due to intense competition by U.S. medical schools, shortage of rotation slots, a teaching hospital staff physician’s unwillingness to sponsor someone they’re unfamiliar with due to HIPAA and hospital policies, and a student having to deal with all licensure matters on their own. Enrolling with AmeriClerkships will help you avoid unnecessary time delays and continuous rejections.

Clerkship Category #5

  • AMS Clinical Feature: THG MD-GME VERIFIED (Teaching Hospital Guarantee MD-Graduate Medical Education Verified)
  • Planned availability at AMS: June 2018
  • Show me Category #5 clerkships near me online: Available June 2018
  • Can AMS members transfer from a lower category into a higher category clerkship prior to start: Yes, upon availability; additional fees apply
  • Acceptable by ALL U.S. medical boards for initial medical licensure: Most likely (Also subsequent licensures may not be as stringent)
  • Cost: $$$$$
  • Passing USMLE Step 1 required: Yes
  • Steps to enrollment: Click here
  • Suitable for crossing the U.S. border and securing a medical student B1 visa:  Yes; student must request AMS for a Letter of Enrollment on teaching hospital letterhead at least 2 months prior to visa interview
  • Affiliation agreements: AMS + teaching hospital + teaching hospital’s staff physicians (+ possibly with your medical school), therefore rotations ARE “placed at the affiliated hospital”, but can also take place in various inpatient and outpatient settings that the teaching attending physician is affiliated with and takes you to visit
  • Hands-on or shadowing: Inpatient and outpatient will be insured for hands-on at the facilities affiliated with AMS (as permitted by patient and attending; not shadowing); no guarantees when visiting non-affiliated facilities
  • Registered with the affiliated hospital’s Graduate Medical Education (GME) or Medical Staff Office (MSO),
  • Same specialty ACGME (MD) accreditation: Likely yes; if so, you will be placed with GME offices sanctioned by teaching hospitals that are ACGME (MD) accredited for every one of your desired core & elective clerkship specialties (i.e. FM core at a hospital with an FM residency; Cardiology elective at a hospital with a Cardiology Fellowship, etc…)
  • Must be willing to travel anywhere in the U.S. for same specialty ACGME (MD) or AOA (DO) accreditation as your specialty of clerkship for all 72 weeks of rotations (cores & electives): Yes, where available
  • Issued a hospital ID badge: Yes
  • Future verification of clinicals: Teaching hospital (or AMS as sanctioned by the affiliated teaching hospital; fees apply) may verify that your rotations were conducted with their permission, but are not obligated to do so and may defer you back to the supervising attending physician for actual attestation that such clinicals took place. Additionally the opportunity for verification does not guarantee state licensure outcomes (meaning that states may have more clinical rotation requirements than just verification when an IMS is applying for training/full medical licensure [i.e. specialty specific, existence of agreement with your medical school, etc]; click here for additional medical board requirements for IMS).
  • Should International Medical Student (IMS) set up this category clerkships on their own to save money and time: Thousands of IMS apply to a handful of teaching hospitals offering mainly elective specialties upon vacancy, and most are shadowing and don’t have same specialty GME. Waiting too long to secure U.S. clerkships will cause a gap in your medical education, which is highly scrutinized by residency program directors when granting interviews. Securing hands-on for all cores & electives by IMS on their own is nearly impossible due to intense competition by U.S. medical schools, shortage of rotation slots, a teaching hospital staff physician’s unwillingness to sponsor someone they’re unfamiliar with due to HIPAA and hospital policies, and a student having to deal with all licensure matters on their own. Enrolling with AmeriClerkships will help you avoid unnecessary time delays and continuous rejections.

 


* DISCLAIMER: State medical board policies change all of the time. We may not have the most up to date information, therefore we strongly encourage you to learn about your desired state’s licensing policies on your own, and to continuously stay up to date with that medical board. Furthermore information collected from medical boards of CO, GU, HI, LA, MN, MO, NY, PR, RI, VI and WY are extremely limited, so please contact those jurisdictions if you’re interested to apply to residencies in their states/territories. Although we have taken great care to remain accurate, AMS assumes no liability for any inconsistencies or inaccuracies.

 

2017-08-04T10:06:28+00:00