When you enter the clerkship phase of medical schooltraditionally during the third yearyou are getting exposure to your future in the form of your core clinical rotations.

Lasting between four and eight weeks, at most schools, the core clinical clerkships consist of internal medicine, surgery, obstetrics and gynecology, pediatrics, family medicine, psychiatry, neurology and radiology.

Students have autonomy in their clinical rotations in that they can schedule them as they see fit. Is there a right way to do it? A medical student and resident offered insight on that question.

Kevin Perez is a second-year medical student at A.T. Still University School of Osteopathic Medicine in Arizonaone of 37 member schools of theAMA Accelerating Change in Medical Education Consortium.

When Perez begins his clinical rotations, he plans to start with the ones that are the most broadly applicable.

Im going to pick the most holistic ones first, Perez said. So, Im probably going to pick family medicine. Its slower paced, and it gives you a better understanding of what being a doctor is. So, surgery and EM [emergency medicine] would probably be what Ill do toward the end.

According to Luke Burns, MD, a second-year ob-gyn resident at Michigan Medicine, the rotations that give you the best knowledge base to build upon are going to depend on your preferred medical specialty.

If you want to do ob-gyn, youre going to want to do surgery first, so youre really good at surgery and know how to scrub into a case, Dr. Burns said. Likewise, if you want to do pediatrics, maybe do medicine first, so you have some inpatient experience before you go to the wards.

Perez is planning on going into emergency medicine. Because of that, he plans to do that rotation later in his training.

It's graded kind of subjectively, Perez said. Because of that, your performance and how much you know coming in, are going to define how well you do. If you want to do EM, you want to do well in that rotation for when you apply to EM residencies later. Picking it as your first one wouldnt be a great idea, unless you are truly ready. You only get one shot.

The key metric on which clerkship performance is evaluatedand one which residency programs take into considerationis a medical students scores on shelf exams, which come at the conclusion of a core rotation.

One really important thing I didnt realize would happen is I got better at taking shelf exams, Dr. Burns said. My shelf scores improved as the clinical year went by. If you feel a little shaky taking exams, theres some advantage to making it so your most important exams come at the end.

You may not know what you want to do when youre entering clerkships. But youre likely to know a few specialties you dont want to do. It makes sense to load those at the front of your clerkship schedule.

The common philosophy is to schedule the things you dont want to do first, Dr. Burns said. If you dont want to be a pediatrician, do that rotation first. Because its the one youll cut your teeth on, youll mess up on it, and by the time you get to the next thing, the theory goes, youll know what to do and how to impress attendings and residents.

In Dr. Burns case, he scheduled his ob-gyn rotation as his second-to-last rotation.

That was always the plan, he said, because then it would mean that it wasnt the very last thing, so I had time to change my mind and I had time to get my [subinternships], those important rotations for my fourth year, in order.

When thinking about scheduling core rotations, Dr. Burns acknowledged that it can be a difficult for people who dont know what they want to go into. But, he added, its not the end of the world if medical students wind up doing clerkships early on in specialties they decide to pursue for residency.

For additional tips on a number of relevant medical school topics, including scheduling clinical clerkships, visit the AMA Career Planning Resource.

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The science of scheduling: When to do key medical school rotations - American Medical Association