How to Secure a Clinical Rotation in the US: Part 2 – Your Top Questions Answered

Dr. Ahmad
Feb 6
5 min read

Updated: Mar 18

(Part of Our Continuously Updated Series on Securing Electives & Observerships in the US)

🚀 New to clinical rotations? Start with our General advice before diving into these FAQs.

Introduction:

Securing a clinical rotation in the US can be overwhelming. Whether you're a medical student looking for electives or a graduate seeking US clinical experience (USCE), this guide answers your most common questions.

1. General Questions About US Clinical Rotations

What are US Clinical Rotations, and why are they important?

Clinical rotations in the US allow international medical students (IMS) and graduates (IMGs) to gain hands-on experience in the US healthcare system. They are crucial for those planning to apply for US residency, as they:

✅ Provide Letters of Recommendation (LoRs) from US physicians

✅ Offer exposure to US medical practices and patient interactions

✅ Strengthen your ERAS application for the Match

2. Eligibility & Requirements

Who is eligible for US clinical rotations?

There are two primary categories:

Medical Students (Electives/Sub-Internships)
- Typically available in the final years of medical school
- Often require USMLE Step 1
- Must apply directly to US medical schools offering electives
Medical Graduates (Externships/Observerships)
- Must have graduated from medical school
- USMLE is not always required
- Easier access through third-party organizations like AMO Opportunities

Do I need to take the USMLE before applying for rotations?

Medical students: Some US medical schools require Step 1 for electives.
Graduates: USMLE is not required for observerships but is recommended if you plan to apply for residency.

3. Application Process

How do I apply for a US clinical rotation?

There are two main routes:

1️⃣ Direct Applications to US Medical Schools (For students only)

Competitive & limited spots
Typically require Step 1, TOEFL, high GPA
Longer processing time
Expensive ($3,000 - $5,000 per month)

2️⃣ Third-Party Providers (AMO, VSLO, etc.)

Faster process, easier access
No Step 1 or TOEFL required for many rotations
Available to both students and graduates
More flexible scheduling options

💡 We work with AMO Opportunities to help students and graduates secure US rotations. Learn more here.

How early should I apply for a rotation?

For US medical schools: At least 6-12 months in advance due to long processing times.
For third-party providers: 2-3 months in advance is typically enough. *If you don't have a valid US visa, then you should apply 6 months in advance.

What documents are required for applications?

📌 Common Requirements:

CV/Resume
Medical School Transcript
Letter of Good Standing (for students)
Immunization Records
Passport/ID
USMLE Scores (if applicable)

💡 Need help with your CV or personal statement? We offer CV and document review services—check them out here.

4. Costs & Funding

How much does a US clinical rotation cost?

💰 Costs vary depending on where you apply:

Direct Applications to US Medical Schools: $3,000 - $5,000 per month
Third-Party Services (AMO, etc.): $2,000 - $3,500 per month
Hospital-Based Observerships: Sometimes free, but harder to obtain

💡 Use discount code SAIOO250 to save $250 on AMO rotations!

Are there scholarships or financial aid for electives?

Unfortunately, scholarships for US rotations are rare. However:

Some universities offer fee waivers for low-income students.
Some third-party providers have occasional discounts (we offer a $250 discount through AMO, this offer always changes so you should check with us before you apply inchalla).

5. Choosing the Right Rotation

Should I choose an inpatient or outpatient rotation?

Inpatient rotations (Hospitals): Best for internal medicine, surgery, and subspecialties.
Outpatient rotations (Clinics/Private Practices): Best for family medicine, pediatrics, psychiatry.

💡 If applying for residency, prioritize rotations that provide LoRs on hospital letterhead!

6. Letters of Recommendation (LoRs)

What type of LoR is best for the Match?

✅ US-based LoRs from attending physicians

✅ Hospital letterhead is preferred over private clinic LoRs

✅ Specialty-specific LoRs strengthen your application (e.g., an Internal Medicine LoR for an IM residency)

How many LoRs do I need?

You can submit up to 4 LoRs in ERAS, but most applicants have at least 2-3 US LoRs.

7. Types of Rotations: Telehealth, Observerships, or Hands-On?

What’s the difference between telehealth (virtual rotations), observerships, and hands-on rotations?

There are four main types of clinical rotations:

1️⃣ Hands-On Rotations (Electives & Externships)

Direct patient interaction (examinations, charting, procedures).
Only available for final-year medical students (Electives) or graduates (Externships).
Best for: Those needing strong Letters of Recommendation (LoRs) and hands-on experience before applying for residency.

2️⃣ Observerships

No direct patient contact (shadowing only).
Best for IMG graduates who did not get US electives but still want US clinical experience (USCE).
Best for: Graduates who need to show familiarity with the US healthcare system but don’t have USMLE scores yet.

3️⃣ VSLO (Visiting Student Learning Opportunities, formerly VSAS)

The official AAMC portal for applying to US medical school electives.
Only available to students at certain affiliated international medical schools.
Check our Medical School List for VSLO-participating institutions.

4️⃣ Telehealth (Virtual Rotations)

Remote rotations where students review cases, discuss treatment plans, and interact with physicians via Zoom.
No hands-on patient experience but still counts as USCE.
Best for: Those who can’t travel but still need a US-based LoR.

👉 Not sure which is best for you? Check our Comprehensive School List to see which programs accept students vs. graduates and offer hands-on rotations.

If I didn’t do electives as a student, should I still do observerships or hands-on rotations as a graduate?

Yes, but it depends on your goals.

💡 If you’re applying for US residency:

Hands-on externships are highly recommended because residency programs prefer candidates with recent US clinical experience (USCE).
Observerships are better than nothing, but they’re not as strong as externships because they lack direct patient care.

💡 If you're just trying to learn more about the US system (but not applying for residency soon):

Observerships or telehealth rotations might be enough.
However, some graduates choose third-party hands-on rotations (e.g., AMO Opportunities) to get LoRs on hospital letterhead, which can still strengthen an application.

🚀 For a full breakdown of which medical schools and programs accept graduates for rotations, check our Medical School List.

8. Duration of Clinical Rotations: How Long Should They Be?

How long should I do clinical rotations in the US?

Most rotations last 4 weeks (1 month).
Some universities and hospitals offer 2-week rotations, but 4 weeks is preferred for getting a solid Letter of Recommendation (LoR).
Students planning for residency should aim for at least 2-3 rotations (8-12 weeks total) to maximize exposure.

9. How Does Clinical Experience Help in the Residency Match?

How much do US clinical rotations help in getting a residency match?

Clinical rotations directly impact your Match chances because:

✅ They provide strong LoRs from US physicians.

✅ They demonstrate familiarity with US healthcare in your ERAS application.

✅ They allow networking with attendings who can help with residency interviews.

✅ Some programs offer observership-to-residency pathways (very rare, but possible).

💡 Important: Some residency programs require hands-on USCE (not just observerships). Check our Medical School List to see which institutions offer strong LoR opportunities.

📌 Next in this series: Direct Applications vs. Third-Party Rotations – Which is Right for You?