Essential Checklist for International Medical Graduates on Clerkships

Thriving in US Clerkships as an International Medical Graduate: The Ultimate Step-by-Step Checklist

Navigating clinical clerkships as an International Medical Graduate (IMG) is one of the most pivotal phases of your journey toward residency in the United States. These rotations are often your first chance to demonstrate your clinical skills, professionalism, and adaptability in the U.S. healthcare system—and residency programs pay close attention.

This expanded checklist is designed specifically for IMGs to help you prepare strategically, perform at your best day-to-day, and leverage each clerkship for long-term residency preparation. Whether you are just starting to explore US Clinical Experience (USCE) or are about to begin your first rotation, use this as a practical roadmap to stand out.

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Understanding Clerkships in the Context of Residency Preparation

What Are Clinical Clerkships for IMGs?

Clinical clerkships (also called clinical rotations or electives) are structured learning experiences where medical students or recent graduates work with real patients under supervision. For IMGs, these rotations—especially in the U.S.—serve multiple critical purposes:

• Bridge classroom knowledge to bedside care in a new healthcare system
• Demonstrate readiness for residency-level responsibilities
• Earn strong US letters of recommendation (LoRs)
• Build clinical confidence with common cases, procedures, and communication
• Show adaptation to American medical culture and documentation standards

Residency program directors consistently emphasize that strong, recent US clinical experience is one of the most influential factors in selecting International Medical Graduate applicants.

Why an Organized, Intentional Approach Matters

Excelling in clerkships is not just about being “smart” or clinically knowledgeable. Programs are looking for residents who are safe, reliable, teachable, and easy to work with. An organized approach helps you:

• Reduce stress, uncertainty, and last-minute scrambling
• Focus your energy on high-yield clinical skills and interactions
• Make a lasting, positive impression that can translate into strong evaluations and recommendations
• Build a clear narrative for your residency personal statement and interviews

The following sections will walk you through a practical, IMG-focused checklist from pre-rotation planning to post-rotation follow-up.

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1. Pre-Clerkship Preparation: Setting Yourself Up for Success

Thorough preparation before day one separates average rotations from outstanding ones. Aim to be logistically ready, clinically warmed up, and mentally prepared.

1.1 Research the Specific Rotation and Institution

Not all clerkships are the same. Tailor your preparation to the specialty, hospital, and region.

Key areas to research:

• Specialty expectations

  • For Internal Medicine: common diseases (CHF, COPD, diabetes, sepsis), inpatient workflow
  • For Surgery: pre-op/post-op care, basic wound care, sterile technique, common surgical emergencies
  • For Pediatrics: pediatric dosing, vaccine schedules, growth and development milestones
  • For Psychiatry: interview structure, safety assessments, common diagnoses (MDD, schizophrenia, bipolar disorder)

• Institution-specific culture and protocols

  • EMR system used (Epic, Cerner, etc.)
  • Typical team structure (attending, senior resident, intern, students)
  • Start times, call expectations, dress code

How to gather this information:

• Program or hospital website
• Orientation materials or clerkship syllabus
• Former or current students (especially other IMGs)
• Social media groups, forums, or IMG communities

Arriving with realistic expectations reduces anxiety and helps you integrate smoothly into the team.

1.2 Organize Administrative and Credentialing Documents

IMGs often have extra paperwork. Start this process early to avoid delays.

Essential documents may include:

• Proof of enrollment or graduation (from your medical school)
• Dean’s letter or transcript (translated if needed)
• Immunization records (MMR, Varicella, Hepatitis B, TB test, COVID-19 requirements)
• Background check and/or drug screening
• Health insurance documentation
• Visa and travel documents (if applicable)
• Professional CV tailored to clinical experience and interests
• USMLE scores or proof of exam registration (if required by the site)

Create a digital folder and a printed folder with all key documents. This level of organization projects professionalism and saves time when coordinators or attendings request information.

1.3 Verify Required Certifications: BLS and ACLS

Most US hospitals require current Basic Life Support (BLS) certification; some also prefer or require Advanced Cardiovascular Life Support (ACLS).

• Ensure certifications are current for the full duration of your clerkship
• Take courses from recognized providers (e.g., American Heart Association)
• Review algorithms and practice scenarios to feel confident in emergencies

This not only satisfies institutional requirements but also equips you to respond appropriately in critical situations, which is highly valued in evaluations.

1.4 Academic and Clinical Knowledge Refresh

In the 2–4 weeks before your rotation:

• Review high-yield topics for that specialty using trusted resources (e.g., UWorld, AMBOSS, OnlineMedEd, specialty-specific handbooks)
• Create quick-reference notes or index cards (e.g., antibiotic choices, common orders, differential diagnoses)
• Practice writing sample H&Ps and progress notes in English to get comfortable with structure and phrasing

For IMGs whose training was in another language, intentional practice with English medical terminology and US-style documentation is particularly important.

1.5 Connect with Peers, Residents, and Former IMGs

Networking begins before your rotation starts.

• Reach out via email or LinkedIn to:
  • IMGs who previously rotated at that site
  • Residents or fellows from your home country or school
  • International medical offices or clerkship coordinators

Ask targeted questions, such as:

• “What do attendings value most in students here?”
• “How can I prepare to be helpful from day one?”
• “Are there any unwritten rules or pitfalls I should know?”

This insider information can significantly flatten your learning curve.

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2. Day-to-Day Clerkship Execution: Performing at a High Level

Once the rotation begins, consistency matters more than perfection. Programs want to see reliability, growth, and initiative.

2.1 Time Management and Daily Structure

Clerkships can be physically and mentally demanding. A predictable routine helps you stay effective.

Build a daily system that includes:

• Before work (30–60 minutes):

  • Review your patients’ overnight labs, vitals, and new notes
  • Update your “plan” for each patient so you can present efficiently on rounds

• During the day:

  • Keep a small pocket notebook or digital note app for:
    • To-do lists (labs to follow, imaging to check, consults to see)
    • Teaching points from attendings and residents
    • Questions to research later

• After work (1–2 hours):

  • Read briefly about your patients’ conditions using UpToDate or guidelines
  • Prepare for next day’s patients and potential new admissions
  • Dedicate time to rest, food, and sleep—burnout harms performance and learning

Tip: Treat your clerkship like a marathon, not a sprint. Daily, incremental studying and reflection compound over time.

2.2 High-Quality Documentation and Note-Taking

Strong documentation skills are crucial for residency preparation and patient safety.

For patient notes (H&P, SOAP, progress notes):

• Start with structured templates:

  • Chief complaint + HPI (organized, chronological, focused)
  • Past medical/surgical history, medications, allergies, social and family history
  • Objective data: vitals, exam findings, labs, imaging
  • Assessment: prioritized problem list and concise reasoning
  • Plan: clear, actionable steps for each problem

• Ask residents to review your notes and offer feedback on:

  • Clarity and organization
  • Clinical reasoning
  • Appropriate level of detail

For your personal learning notes:

• Create sections such as:
  • “New diagnoses I saw today”
  • “Important management points”
  • “Mistakes I won’t repeat”
  • “Questions to ask tomorrow”

Over time, these notes become a personalized mini-textbook, extremely useful for interviews and personal statement writing.

2.3 Professionalism, Punctuality, and Reliability

Residency programs often say they would rather work with a reliable, teachable student than a brilliant but unreliable one.

Display professionalism by:

• Always being early: Aim to arrive 15–20 minutes before expected start time
• Following dress code: Clean white coat, professional attire, conservative appearance
• Respecting everyone: From nurses and custodial staff to attendings and patients
• Maintaining confidentiality: Be careful with patient data in hallways, elevators, and social media
• Owning your mistakes: If you forget a task, acknowledge it, fix it, and learn from it

In written evaluations, phrases like “always on time,” “hard worker,” “pleasant team member,” and “eager to learn” are powerful—even more so when combined with strong clinical performance.

2.4 Communication and Interpersonal Skills in a New Culture

For many IMGs, communication style can be as important as medical knowledge.

With patients:

• Use clear, simple language and avoid unnecessary jargon
• Practice active listening: sit if possible, maintain eye contact, summarize what the patient said
• Be especially sensitive to cultural differences, health beliefs, and language barriers
• Always confirm understanding (e.g., “Can you tell me in your own words what the plan is?”)

With residents and attendings:

• Ask concise, thoughtful questions like:

  • “Could you help me understand why we chose this anticoagulant instead of another?”
  • “Is there any way I can be more helpful on the team tomorrow?”

• Clarify expectations:

  • “How many patients should I follow?”
  • “Would you like me to write full H&Ps or just progress notes?”

With nurses and allied health professionals:

• Introduce yourself and learn their names
• Ask for guidance respectfully (e.g., “I haven’t done this in this hospital before. Could you show me how you usually do it?”)
• Recognize that nurses often know patients best and can be strong allies in your learning

Strong interpersonal skills can significantly influence how your performance is perceived and how supportive your team will be in your residency application.

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3. Core Skills Development: Building Competence and Confidence

Your clerkship is a live training ground for the skills you’ll need as a resident.

3.1 Clinical Skills and Bedside Techniques

Identify and prioritize essential clinical skills relevant to each specialty:

• Universal skills:

  • Comprehensive and focused history-taking
  • Full and focused physical examinations
  • Presenting patients succinctly
  • Writing orders (under supervision)

• Procedures you may encounter:

  • Venipuncture, IV placement, arterial blood gas drawing
  • Suturing basic lacerations, wound care
  • Placing urinary catheters, nasogastric tubes
  • Assisting in simple procedures or OR cases

Strategy:
Tell your resident: “I’m very interested in improving my [e.g., suturing] skills. If there are opportunities, could you please let me know so I can observe or assist?” Consistently showing initiative leads to more hands-on chances.

3.2 Evidence-Based Medicine and Clinical Reasoning

Residency programs expect IMGs to practice evidence-based medicine.

• For each new diagnosis you see, quickly look up:

  • First-line treatments
  • Key diagnostic criteria
  • Major red flags or complications
  • Any landmark guidelines (e.g., ACC/AHA for cardiology, IDSA for infectious disease)

• During discussions, gently incorporate evidence:

  • “I read that recent guidelines recommend X as first line. Is that why we chose this medication?”

This depth of understanding distinguishes you as someone already thinking like a resident.

3.3 Seeking, Receiving, and Using Feedback

Many IMGs struggle with feedback due to cultural differences or fear of criticism. In US Medical Education, constructive feedback is expected and valued.

Make feedback part of your routine:

• Early in the rotation:

  • “I want to make the most of this clerkship. Could you let me know if there is anything I should adjust in how I present or manage patients?”

• Mid-rotation check-in:

  • Ask your attending: “How am I doing so far, and what can I do better in the remaining weeks?”

• After specific tasks:

  • “Do you have any suggestions on improving my note from today?”

Then, act visibly on the feedback. When attendings see that their suggestions lead to change, they are more likely to write strong, personalized evaluations and letters of recommendation.

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4. Networking and Professional Branding During Clerkships

Your clerkship is not only an educational experience but also an extended job interview.

4.1 Building Professional Relationships Intentionally

Aim to leave each rotation with:

• At least one attending who knows you well enough to write a detailed letter of recommendation
• One or two residents who can advocate for you informally and offer guidance during the Match process

How to build these relationships:

• Share your story when appropriate:

  • Why you chose medicine
  • Why this specialty interests you
  • Your journey as an International Medical Graduate

• Volunteer for opportunities:

  • Present at case conferences or journal clubs
  • Help with small QI or research projects if offered
  • Stay a bit later when the team needs help finishing tasks (within reason)

Be genuine; faculty can quickly sense whether you’re only present for a letter or truly invested in learning and contributing.

4.2 Joining Professional and Specialty Associations

Clerkships are the ideal time to start formal networking.

Consider:

• Joining organizations like AMA, ACP, ACS, APA, or relevant specialty societies at student/trainee rates
• Attending local chapter meetings, grand rounds, or virtual conferences
• Introducing yourself as an IMG interested in residency and asking for advice

These connections can lead to future research collaborations, observerships, and strong mentorship relationships.

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5. Reflection, Self-Assessment, and Post-Clerkship Follow-Through

The most successful IMGs don’t just complete clerkships—they extract maximum long-term value from them.

5.1 Structured Reflection for Growth

At least once a week, set aside 20–30 minutes for reflection.

Consider journaling briefly on:

• What went well this week? (e.g., a strong patient presentation, good interaction with a challenging patient)
• What didn’t go well? (e.g., missed labs, weak understanding of a diagnosis)
• What did I learn about myself as a future physician?
• What will I do differently next week?

Over time, these reflections reveal growth patterns and provide powerful material for your personal statement, interviews, and future applications.

5.2 Preparing for Future Residency Applications

Immediately after the rotation ends—while details are fresh:

• Update your CV with:

  • Number and type of procedures observed or performed (if appropriate)
  • Specific responsibilities you held
  • Any presentations or projects you completed
  • Names and titles of key supervisors

• Draft bullet points on:

  • Memorable patient cases
  • Challenges you overcame
  • Instances that confirmed your interest in a particular specialty

These notes will serve you months later when you’re crafting ERAS entries, personal statements, and interview stories.

5.3 Requesting Letters of Recommendation (LoRs)

Timing and approach matter.

• Ask within 1–2 weeks of finishing the rotation
• Choose attendings who:
  • Worked closely with you
  • Saw your progression and work ethic
  • Practice in your target specialty (ideally) or can attest strongly to your clinical ability

How to ask:

“In working with you, I’ve learned a great deal and felt that you’ve seen my growth closely. I’m applying for [specialty] residency. Would you feel comfortable writing me a strong letter of recommendation?”

Provide:

• Your updated CV
• Personal statement draft or short summary of your career goals
• A reminder of key cases or contributions they might highlight
• Deadline and method for letter submission (e.g., ERAS, institution portal)

5.4 Expressing Gratitude and Staying Connected

Professional courtesy and long-term networking are both important.

• Send thoughtful, personalized thank-you emails to:

  • Attendings
  • Residents who mentored you
  • Coordinators who helped with logistics

• Periodically update them (a few times per year) about:

  • USMLE progress
  • Application timeline
  • Match outcomes

This keeps relationships warm and shows you value their mentorship.

5.5 Common Pitfalls IMGs Should Avoid

Be aware of these frequent issues:

• Neglecting self-care: Chronic sleep deprivation and poor nutrition undermine learning and performance. Aim for sustainable routines.
• Being too passive: Waiting to be told what to do instead of offering help or asking for responsibility can be misinterpreted as disinterest.
• Overcompensating with overconfidence: Be honest about your limits. Patient safety and humility matter more than appearing “perfect.”
• Ignoring non-physician staff: Nurses, pharmacists, and other team members greatly influence how you are perceived and often share informal feedback with attendings.
• Not asking for feedback or letters in time: Delayed or generic letters can weaken your residency application.

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Frequently Asked Questions (FAQs) for IMGs About Clerkships and Residency Preparation

1. Why are US clinical clerkships so important for International Medical Graduates?

US clerkships provide:

• Direct exposure to the U.S. healthcare system, EMR, and team-based care
• Objective evidence of your clinical skills, work ethic, and professionalism in a US setting
• US-based letters of recommendation, which residency programs value highly
• Opportunities to confirm (or reconsider) your specialty choice based on real patient care
• Experiences and stories you will use in residency applications, personal statements, and interviews

For many IMGs, strong clerkship performance can significantly offset other challenges in the residency selection process.

2. How can I stand out positively during a clerkship as an IMG?

You stand out by consistently:

• Arriving prepared and on time
• Knowing your patients well and presenting them clearly
• Showing genuine curiosity and reading about your cases
• Taking initiative (within your scope) and asking to be more involved
• Being respectful and collaborative with the entire healthcare team
• Demonstrating growth over the course of the rotation

Many attendings are especially impressed when students proactively seek feedback and then visibly improve.

3. What should I focus on in my clinical notes during clerkships?

Your notes should be:

• Organized: clear structure (HPI, ROS, physical exam, assessment, plan)
• Relevant: focus on information that influences diagnosis and management
• Accurate: correctly document vitals, labs, imaging, and exam findings
• Reasoned: your assessment should show logical thinking—why this diagnosis is likely and others are less so
• Actionable: each problem in your plan should have clear next steps

Ask your resident or attending to review a few of your notes early in the rotation and incorporate their suggestions.

4. How should I handle critical or negative feedback during my rotation?

• Listen fully without interrupting
• Ask clarifying questions if needed: “Can you give me an example so I can better understand what to improve?”
• Avoid being defensive—view feedback as a tool for growth, not a personal attack
• Thank the person for their honesty
• Demonstrate change quickly where possible and, if appropriate, follow up: “I tried your suggestion on my last two presentations. Is this closer to what you had in mind?”

Programs respect IMGs who can accept and use feedback maturely; this is a key residency trait.

5. How does networking during clerkships help my residency application?

Networking during clerkships can:

• Lead to strong, personalized letters of recommendation
• Connect you with mentors who guide you through exam strategy, specialty choice, and application timing
• Open doors to research, quality improvement, or academic projects
• Provide insider information about specific residency programs and what they value
• Offer emotional and professional support during demanding parts of the Match process

Approach networking as building genuine professional relationships, not just “collecting contacts.”

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Clerkships are more than a graduation requirement—they are your primary stage to showcase your readiness for residency as an International Medical Graduate. With deliberate preparation, consistent performance, and thoughtful reflection, you can transform each rotation into a powerful stepping stone toward your Match success.