The clinical evaluation phase at St. George’s University (SGU) marks a student’s transition from foundational science to practical application in healthcare settings. This period, comprising the third and fourth years of the MD program, involves hands-on training in hospitals and clinics. Students engage directly with patients and learn from experienced physicians, building the competencies required for postgraduate training and a career in medicine.
The Clinical Placement Process
Clinical rotations begin after a student completes the basic sciences curriculum and passes the United States Medical Licensing Exam (USMLE) Step 1 for U.S. placements. SGU has a network of over 75 affiliated hospitals and clinical centers, primarily in the U.S. and the United Kingdom, which provide a wide range of training environments.
The Office of Clinical Education Operations manages assignments to these sites. Students complete an Electronic Placement Information Form (EPIF) to express geographic preferences related to living arrangements or proximity to home. While the university tries to accommodate requests, placements depend on availability when a student qualifies and are not guaranteed. The final determination may use a lottery system to ensure fair opportunity for all students.
Factors like grades or citizenship do not grant priority in the placement process, as the primary goal is to ensure every student secures a spot for their required training. The university’s affiliated hospitals are considered equivalent in the educational experiences they offer. This makes the final location more a matter of convenience than a difference in quality.
Core Rotations Structure
The third year of the SGU curriculum consists of mandatory core rotations that provide foundational experience across major medical specialties. Family medicine is also a required rotation that may be completed in the third or fourth year. The core rotations include:
- 12 weeks in Internal Medicine
- 12 weeks in Surgery
- 6 weeks in Pediatrics
- 6 weeks in Psychiatry
- 6 weeks in Obstetrics & Gynecology (OB/GYN)
In the Internal Medicine rotation, students manage adult diseases in a hospital setting, following patients from admission to discharge. The Surgery rotation covers the operating room, pre- and post-operative care, and surgical decision-making. Pediatrics focuses on child health, including developmental milestones, common illnesses, and family-centered care.
The Psychiatry rotation provides insight into diagnosing and managing mental health conditions, including conducting psychiatric interviews. The OB/GYN rotation covers women’s reproductive health, from prenatal care and delivery to gynecological surgery. In all core rotations, students function as part of the medical team, taking histories, performing exams, and helping formulate treatment plans under supervision.
Assessment and Grading During Rotations
Evaluation during clinical rotations is a multifaceted process designed to measure a student’s development. The final grade for each rotation combines subjective clinical evaluations and objective exams. This system assesses a student’s knowledge, its application, and their professional conduct in a medical environment.
A large part of the assessment comes from clinical evaluations by supervising physicians, called preceptors. These evaluations assess a student’s clinical skills, reasoning, communication, and professional behavior. Preceptors observe students with patients and the medical team, providing detailed feedback on their performance.
The other component is a standardized end-of-rotation exam from the National Board of Medical Examiners (NBME), also known as a “Shelf Exam.” These multiple-choice tests assess medical knowledge in the rotation’s specialty, and passing all required NBME exams is a graduation requirement. The final grade for a rotation is reported as Honors, High Pass, Pass, or Fail.
Elective Rotations and Specialization
The fourth year is dedicated to elective rotations, allowing students to customize their education based on career aspirations. After completing core rotations, this year helps students explore specialties in greater depth and prepare for the residency application process. The goal is to broaden clinical knowledge and gain more advanced experience.
Students pursue rotations in sub-specialties that interest them, such as cardiology, neurology, or infectious disease, to gain deeper insight into a field. Many also schedule “audition rotations,” which are electives at hospitals where they hope to secure a residency. These rotations allow them to make a direct impression on faculty and program directors.
A strong performance during elective rotations can lead to valuable letters of recommendation for residency applications. Students work with advisors to select electives that strengthen their applications. The university also allows a certain number of electives at hospitals outside the main SGU network to pursue specific interests.