New York State's 12-week Clerkship Rule Explained

We often receive questions regarding New York State’s 12-week rule for clinical clerkships.  As many of our rotations are held in New York City and Utica, it would be best to clear the air with regards to this oft-confused rule.

Essentially, NYS will not allow you to become a resident if you have completed greater than 12 weeks of clerkships/electives in a country other than the one where your medical school is located (with certain exceptions).  A key note to remember is that this rule only applies to you if the clerkships/electives were part of your medical education curriculum.   If you participated in clerkships/electives on a voluntary basis, outside of your medical education curriculum, then these will be exempt from this rule and there is no restriction on the amount of clerkship/elective experience you can undertake.  Additionally, if you are enrolled in a clinical experience program as a graduate, then this does not apply to you and you have no restrictions.

We’ve listed the actual NYSED Clinical Clerkship clause at the bottom of the post, in case you wanted to take a look at the full clause in greater detail.

On a slightly confusing note, there is a list of medical schools approved by the New York State education department (NYSED) that are exempt from this rule and have no restrictions on the amount of clerkship/elective experience outside of the medical school home country.  See below for an updated list:

List of medical schools “approved” by the NYS:

• American University of Antigua, Antigua
• American University of the Caribbean, St. Martin, Netherland Antilles
• The Autonomous University of Guadalajara, Guadalajara, Mexico
• English Language Program, University of Debrecen, Medical and Health Science Center, Medical School, Debrecen, Hungary
• English Language Program, Medical University of Lublin, Lublin, Poland
• English Language Program, Medical University of Silesia, Katowice, Poland
• Fatima College of Medicine, Manila, Philippines
• International Health and Medicine Program, Ben Gurion University of the Negrev, Beer-Sheva, Israel
• Kasturba Medical College, Manipal, India
• Medical University of the Americas/Nevis, Nevis, West Indies
• Ross University School of Medicine, Roseau, Dominica
• Saba University School of Medicine, Saba, Netherland Antilles
• St. George’s University School of Medicine, St. George’s, Grenada
• St. Matthew’s University School of Medicine, Grand Cayman, Cayman Islands

The clause in its entirety:

§60.2 Clinical clerkships.

1. Definitions: As used in this Part:
   1. Clinical clerkship as used in this Part shall mean a supervised educational experience which is part of the clinical component of a program of undergraduate medical education, which takes place in a general hospital or in an equivalent health organization acceptable to the department and which is performed in accordance with all requirements of the jurisdiction in which such facility is located.
   2. Long-term clinical clerkship shall mean a clinical clerkship which, in the aggregate of all clerkship experience received during two academic years, exceeds 12 weeks.
2. Students enrolled in medical programs registered by the department or determined by the department to be equivalent to such programs, or students whose clerkships shall not exceed an aggregate of 12 weeks in two academic years may serve in clinical clerkships.
3. Except as provided in subdivision (b) of this section, students enrolled in medical programs not registered by the department may serve in clinical clerkships in teaching hospitals in this State provided that:
   1. the student was engaged in a clinical clerkship in this State prior to May 1, 1981;
   2. the student was enrolled in the medical school on or before September 25, 1980 and has provided evidence of having obtained a satisfactory score on the medical sciences knowledge profile examination taken prior to July 1, 1985, a passing score on Part I of the Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS), or an acceptable score on a satisfactory equivalent examination;
   3. the student was enrolled in the medical school after September 25, 1980 and has provided evidence of having obtained a satisfactory score on the medical sciences knowledge profile examination taken prior to July 1, 1985, a passing score on Part I of the Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS), or an acceptable score on a satisfactory equivalent examination, provided that the program in the medical school attended has been determined by the department, after a site visit conducted at the expense of the applicant by persons designated by the department and experienced in medical program evaluation, to meet substantially the requirements of section 60.1(a)(1) of this Part and of Parts 50 and 52 of this Title except any provision thereof that states or implies that a particular form of governing body is required, and provided further that formal agreements satisfactory to the department have been executed between the medical school and the hospital(s) in which students from the school are to be engaged in clinical clerkships, which specify responsibility for planning, managing and supervising clerkships in each subject area, and further that the department shall be notified by the medical school of any changes in such agreements, including termination or the initiation of new agreements; or
   4. the student was enrolled in the medical school after September 25, 1980 but before May 1, 1981 and has provided evidence of having obtained a satisfactory score on the medical sciences knowledge profile examination taken prior to July 1, 1985, a passing score on Part I of the Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS), or an acceptable score on a satisfactory equivalent examination and the medical school in which he is enrolled has submitted a formal application for approval pursuant to paragraph (3) of this subdivision.
   5. The satisfactory score specified in paragraphs (2), (3) and (4) of this subdivision shall be a score comparable to the performance on Part I of the National Board of Medical Examiners examination of students who attend medical schools registered by the department or accredited by an accrediting organization acceptable to the department.
4. A clinical clerkship may be performed only in a clinical subject or subjects in which the teaching hospital has a residency program accredited by the Accreditation Council on Graduate Medical Education, or an equivalent accrediting agency acceptable to the department, or which is part of such a program through affiliation(s) approved by the Accreditation Council on Graduate Medical Education, or an equivalent agency acceptable to the department. The requirements of this subdivision shall not apply to students who were engaged in clinical clerkships in this State prior to May 1, 1981. To engage in a clerkship which, in the aggregate of all clerkship experience during two academic years, will not exceed 12 weeks, the student shall present a letter of eligibility if issued by the department.
5. No teaching hospital shall be under obligation by virtue of these regulations to accept medical students in clinical clerkships, and any medical school or teaching hospital may impose standards for admission to clinical clerkships which exceed the standard set forth in this section.
6. Establishment of Advisory Committee on Long-Term Clinical Clerkships.
1. Upon consultation with the Board of Regents, the Chancellor shall appoint an Advisory Committee on Long-Term Clinical Clerkships. The Committee shall serve in a consultative and advisory capacity on matters pertaining to the standards and process for approving international medical schools to place their students in long-term clinical clerkships in New York State and shall perform such specific tasks as are assigned by the Department or the Board of Regents.
2. Composition of the committee. The committee shall consist of:
   1. one member of the Board of Regents, who will serve as co-chair of the committee along with the chairperson of the State Board for Medicine;
   2. the chairperson of the State Board for Medicine or another member of the such board designated by the chairperson, who will serve as co-chair of the committee along with the member of the Board of Regents;
   3. the Executive Secretary of the State Board for Medicine, who shall be a non-voting member of the committee;
   4. one representative of the Department of Health;
   5. two physicians who are experienced in the evaluation of medical education programs;
   6. two representatives of international medical schools approved by the Department or Board of Regents to place their students in long-term clinical clerkships in New York State;
   7. two representatives of medical schools registered in New York State; and
   8. two representatives from hospitals that serve as sites for clinical clerkships in New York State.
3. Terms of members. The terms of the members of the first committee appointed pursuant to subparagraphs (v) through (viii) of paragraph (1) of this subdivision shall be so arranged that the terms of two members shall expire on June 30, 2013, the terms of two on June 30, 2014, and the terms of two on June 30, 2015, and the terms of two on June 30, 2016. Thereafter, all members appointed pursuant to subparagraphs (v) through (viii) of paragraph (1) of this subdivision shall be appointed to serve a term of four years each, beginning with the first day of July next following the ending of the term to which each, respectively, is to succeed, except that an appointment to fill a vacancy created other than by the expiration of a term shall be for the unexpired term. Members shall serve no more than two terms in succession, except that a member may serve a succeeding third term if at least one of the preceding two terms was less than two years in duration. Members may again serve two terms in succession after a gap in service of at least four years.
4. Duties of the Advisory Committee on Long-Term Clinical Clerkships. The committee shall gather and study existing research on relevant issues, such as health workforce demands and trends, health workforce diversity and Board of Regents policy determinations. Based on such research and policy determinations, the committee shall:
   1. make recommendations regarding the standards to be applied in assessing applications by international medical schools for approval to place their students in long-term clinical clerkships in New York State;
   2. make recommendations regarding the process to be followed in assessing such applications for approval to place their students in long-term clinical clerkships;
   3. appoint an appropriate site review team from a roster of individuals approved by the committee; and
   4. after consideration of the site review report, issue a report and recommendation, with minority opinions reflected, as to whether an application for placement of students in a long-term clinical clerkship should be approved.
5. After consideration of the committee’s recommendations, the Department shall make a recommendation to the Board of Regents as to whether an application for authorization to place students in a long-term clinical clerkship should be approved. Upon approval by the Board of Regents, the medical school shall be authorized to place students in long-term clinical clerkships in New York State pursuant to standards and/or limitations prescribed by the Board of Regents.
6. Until the Board of Regents approves the new standards and processes for approval for the placement of students in international medical schools in long-term clinical clerkships, schools currently approved for such purpose will continue to be subject to the current standards and processes prescribed in subdivision (c) of this section.

REFERENCES:

NYSED.gov