For medical students progressing toward a career as a physician, core clerkship rotations are a key milestone.
Lasting between four and eight weeks at many medical schools, the core clinical clerkships consist of internal medicine, surgery, obstetrics and gynecology, pediatrics, family medicine and psychiatry. But which one is going to be the most difficult?
Data analyzing medical student clerkship performance, along with insights from medical students who recently did their rotations, reveals that the answer is likely to vary from person to person.
How medical students grade out
A 2020 study published in the Journal of Graduate Medical Education analyzed clerkship grades submitted through the Electronic Residency Application Service (ERAS) by applicants to one orthopaedic surgery residency.
Researchers reviewed grade distribution of applicants across the six clinical clerkships. The data came from 86 medical schools that provided grade distribution information and used the "honors, high pass, and pass" assessment system.
Researchers found that the spread in performance was similar across all six rotations. Here was the median honors rate across the specialty rotations:
- Psychiatry—41%.
- Obstetrics and gynecology—35%.
- Family medicine—33.5%.
- Pediatrics—33%.
- Surgery—32.5%.
- Internal medicine—32%.
Researchers also found that the variation in honors rates was far greater between institutions than between rotations themselves. For example, in surgery, some medical schools awarded honors to as few as 5% of students, while others granted honors to as many as 67%.
These findings, the study’s authors highlighted, reveal the inconsistency in clerkship assessment across undergraduate medical education and the need for more standardized assessment across all medical schools.
It’s also worth noting that the sample of applicants to a single orthopedic surgery program is likely to have some variation from the broader population of students applying across all specialties and programs.
What makes a clinical rotation hard?
In speaking to medical students, the aspects of a rotation that can make it more physically or mentally taxing include work hours, patient load and familiarity with the subject matter.
AMA member Sneha Kapil is a fourth-year medical student in Florida and serves as section alternate delegate of the AMA Medical Student Section Governing Council for the 2025–2026 term. She found pediatrics, her first rotation, difficult because much of the information on the patient population had not been a major focus in her preclinical learning.
Kapil felt as though she was suddenly “thrust into a new world with different medical conditions and different vitals for children.
“You pick up entirely new knowledge. For example, what’s considered a normal heart rate in a child at various ages. That was difficult just by the nature of how much new information you have to absorb, especially when there’s a shelf exam at the end.”
In the rest of this AMA news article, medical students will get valuable information regarding:
- Which clinical rotations may require the most time commitment.
- The clinical rotations that require the most knowledge and shelf exams.
- Why an open-minded approach to all six rotations can lead to success.
- What to know before you start your clinical rotations.
- Tips and tricks to thrive in your clerkships.
