6 Questions to Ask Before Booking a U.S. Clinical Rotation

For many IMG’s, the process of finding reliable and trustworthy US clinical experiences can often be stressful, time consuming, and costly. However, finding clinical experiences that provide a rewarding experience is extremely important as the Letters of Recommendations gained from these experiences, as well as the experience itself, are an imperative component of their US residency application. 

While it’s easy to get caught up going down the rabbit hole of university rotations, cold emails, and rotation agencies, it’s important to find a rotation experience that works for you and your unique backgrounds and goals. And, more importantly, remember that not all rotations are equal. Doing your research and asking the right questions can be the difference between just finding a rotation or finding a rewarding and exceptional clinical experience.

In this blog post, we’ll go through the checklist you can use to help you choose a high-quality, rewarding rotation that will impress residency program leadership.

1.) Is This a Hands-On Rotation or an Observership?

Before booking or finalizing any rotation, it’s important to confirm if the experience will be hands-on or an observership. This one factor can significantly affect your experience and your residency application. Hands-on clinical experience allows you to take part in patient encounters, such as taking and presenting patient histories, uploading progress notes or using the EMR, and performing physical exams under the preceptor’s supervision, while an observership only allows you to shadow the physician. While every single hands-on aspect might not be a part of the rotation experience, it should still include some hands-on components.

Having hands-on experience is important for residency programs to demonstrate your ability and familiarity with the U.S. healthcare system. It also shows that you will be ready to take on the responsibilities of being a resident. Lastly, having hands-on experience will result in a stronger Letter of Recommendation since the letter writer will be able to attest to your performance and the things you did during the experience.

2.) Who Is the Preceptor and Are They Actively Practicing?

When evaluating a U.S. clinical rotation, it’s essential to look closely at who your preceptor is and whether they are actively practicing medicine. A strong preceptor should be currently seeing patients in clinical and/or hospital settings and ideally have experience teaching international medical graduates (IMGs) U.S. medical students. Preceptors who are actively involved in patient care can offer more relevant, up-to-date clinical exposure and insight into how the U.S. healthcare system truly functions.

From a residency program’s perspective, the credibility of your preceptor matters—letters of recommendation from recognized physicians carry significantly more weight, as they signal that your evaluation comes from a trusted clinician who understands current standards of care, resident expectations, and the demands of U.S. training programs. Alternatively, letters of recommendations from “black-listed” physicians who take on too many rotators at once and write the same generic letter for every student are going to hurt you more than help you. Because of this, you may also want to ask how much time you'll spend with the preceptor and if there will be any other students rotating with you.

3.) What will the duration of the experience be?

The amount of time spent with the preceptor can significantly impact the contents of your letter. This is because, over time, you can grow a strong professional relationship with the preceptor, as well as improving your clinical skills throughout the duration of the experience. For example, in a two-week rotation experience, it might take you a full week or two to learn the ropes and become comfortable with the tasks you’ll be performing. This only leaves you with one more week to perform well, establish a professional relationship, and impress your preceptor. Additionally, the shorter the rotation experience, the less clinical cases and patients you’ll be exposed to.

Participating in a rotation experience that is 4-weeks in duration or longer gives you ample time to adjust to responsibilities and grow a professional relationship with the preceptor. This way, the preceptor can provide you with an impactful letter of recommendation that attests to your clinical skills, knowledge, and character.

4.) Will I Receive a Strong Letter of Recommendation (LoR)?

A strong letter of recommendation (LoR) can benefit your residency application in a positive way, so it’s important to clarify the details before booking a rotation. Ask who will write the LoR and whether it will come directly from your clinical preceptor—since residency programs generally value letters written by physicians who have personally supervised your work.

You should also confirm whether the letter will be specialty-specific, as these factors add credibility and relevance in the eyes of program directors. If you’re doing a rotation in a subspecialty or different specialty than the one you’re planning to apply, you will want to ask your letter writer to acknowledge the specialty you’re applying to.

Additionally, understanding the timeline for delivery with your letter writer is equally important. It is especially important to ask this question if you’re closely approaching the ERAS deadline. Be sure to ask the rotation coordinator or the preceptor about timeline in advance so you’re not left waiting during application season. Keep in mind that you should expect around 4 weeks for ample time for your letter writer to complete and upload your LoR.

When it comes to the format, many people believe that the type of letterhead is the most important aspect of the letter. However, this is a common misconception. Residency programs are most interested in the content of the letter, rather than the letterhead its written on. For example, you could receive a LoR on University letterhead, but the letter could be completely generic. While the letterhead is from a prestigious institution, this would not be enough to impress residency programs as it does not showcase to your clinical skills and knowledge.  Having a letter that attests to your skills and knowledge and shows residency programs that you are ready to become a resident will be most beneficial to your overall candidacy.

Ultimately, LoRs are an essential part of your residency application and are used by residency programs to assess your clinical ability, professionalism, and readiness for U.S. residency training. Making sure your letter reflects this in a way that showcases your abilities is essential to getting that residency interview.

5.) How Personalized Is the Rotation Placement?

One thing to consider when finding clinical rotations is how the rotation aligns with your personal background and future goals. For example, some things you might ask yourself are:

• Does the specialty of this experience align with my career goals?

• Do I have any geographic preferences or constraints?

• Will this experience help me enhance my clinical skills?

It’s important to understand the type of experience you’re looking for and how it will benefit you.

Having experience and LoRs in the specialty you plan to apply to is very important to residency programs. In fact, the results of the 2024 NRMP Program Director Survey showed that ‘letters of recommendation in the specialty’ was rated a 4.2 for mean importance out of 5 (5 being most important) when it came to deciding who to interview.

As for geographic preferences, you may have family who live in the U.S. who you’d like to stay with or nearby for support or housing during your experience. Or, if you are planning to apply to residency programs broadly, it might make sense for you to do rotations in different locations, to show programs that you are geographically open. Ask yourself what’s right for you and understand what opportunities there are out there.

Whatever your personal preferences or goals are, it’s important to keep in mind that a rotation experience is for your own benefit. Not every rotation is “one-size-fits-all” and learning what’s most important to you is essential to finding a rotation that’s the right fit for  you.

6.) What Happens After the Rotation Ends?

A high-quality U.S. clinical experience shouldn’t end on your last day in the clinic. Ask whether the program offers continued mentorship after the rotation, including access to advisors or mentors who can help you gain feedback, strengthen your CV, and provide you with guidance. Ongoing residency guidance, such as advice on ERAS strategy, application advice, and interview readiness, can be especially valuable for navigating the U.S. residency match since it is such a complex process.

At MD2B Connect, our main goal is to provide you with guidance and mentorship before, during, and even after your rotation ends. The support we offer doesn’t end on your last day of the rotation. You’ll have access to monthly webinars, expert guidance from our own co-founder, Dr. Samir Desai, and our team’s dedicated support. While one of our top goals is to put you into a rewarding rotation experience, our #1 priority is to help you match into a U.S. residency program.

Conclusion

In conclusion, asking these 6 questions before booking your US clinical rotation is imperative to ensure you have a rewarding experience. By asking questions about the duration, preceptor, hands-on capabilities, letter of recommendations, and what happens when the rotation ends, it’ll help you better understand if this rotation experience will work for your unique goals and preferences.

When deciding, you should consider important factors such as mentorship, quality, and legitimacy over just price alone. We hope that these tips set you up for success at gaining what’s most important: rewarding US clinical experiences.

Ready to book your next clinical rotation?

MD2B Connect offers 4-week US clinical rotations to US and international medical graduates. We offer over 170+ rotations in various specialties and cities across the United States. Our process is focused on putting you into a rotation that fits your unique case and preferences. Because of this, we always start by having a free introductory meeting with each of our clients to get to know them on a personal level. From that meeting, our team creates a rotation recommendation plan specifically for you, based on your input during the meeting and our knowledge of our rotations.

While we want you to get the most out of a rotation experience, our #1 priority is to help you match into a US residency program. Because of this, we provide expert guidance and mentorship before, during, and even after your rotation ends. Let us show you why we’re the most trusted and highest-rated rotation provider. Our team is excited to welcome you to the MD2B Connect family!