Sole Purpose 63
Planning Your Externships

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Today's article is for all the fourth-year students preparing for their externship journey—how exciting! Externships, also known as clerkships, Sub-Is, or sub-internships, are month-long rotations at residency programs across the country. During these rotations, fourth-year students gain hands-on experience while exploring different programs and living all over the United States.

Lately, I’ve been receiving a flood of emails from students who will be rotating at my residency program, Ascension St. Vincent in Indianapolis. So, I figured—why not put together some tips and tricks to help you navigate your externships more smoothly!

This guide will be most helpful if you’ve already selected your externship sites, but even if you haven’t, you’ll still find some valuable insights. First and foremost, start by reviewing the AACPM Clerkship website and the CASPR Clerkship Handbook and Calendar. Seriously, make this your best friend. Look up every program you’re planning to apply to or have already secured a rotation at. It is important to note that this information is not always totally up to date but gives a good overview. Keep in mind that while it’s a great resource, it’s not always perfectly up to date.

Now, here’s a big one: always check the CASPR handbook before reaching out to residents or program coordinators with questions. I can’t stress this enough. If the answer is already in the handbook and you ask anyway, it’s not the best look. Trust me, you want to come across as prepared and resourceful—not as someone who skipped the first step!

Get Organized

If you’ve read any of my previous articles, you already know—I’m a BIG list/organization gal. So, naturally, the first thing I did when planning my externships was to create an Excel sheet. (Because what’s better than color-coded chaos?)

I laid out everything I needed to keep track of:

This spreadsheet was a lifesaver. It kept me organized, ensured my family had my whereabouts in case of safety concerns (or if they wanted to send a care package—wink wink), and prevented last-minute travel stress.

I usually book my flights 6-8 weeks in advance to snag the best deals. Some people booked all their flights at once, but honestly, do whatever floats your boat (or, in this case, your plane). As for housing, I usually made sure it was booked around 2 months or more in advance. Just make sure you have a plan! Trust me, a little organization goes a long way in making externship season way less chaotic.

Transportation

When I started externships, I was the ripe old age of 24. That meant I couldn’t rent a car without paying an arm and BOTH legs. And while some cities have amazing public transportation, as a young female, I didn’t feel super comfortable hopping on a bus or train at 5 AM for early rounds.

Most programs list on CASPR whether a car is required, and from my experience, almost all of mine did (except maybe one). So, what did I do? I drove—a lot. My car and I became besties, and my dad even joined me for some epic road trips. (Shoutout to my dad—he is truly the best!)

I did have one month where I didn’t road trip, and my boyfriend’s mom let me borrow her car for the ENTIRE month because she is, quite frankly, an angel sent to Earth. I fully acknowledge that I have the best future mother-in-law in the world.

Now, what if you don’t have a car? There are options!

Bottom line? Check CASPR, ask the residents, and PLAN AHEAD. For my program, Ascension St. Vincent Indianapolis, I tell everyone upfront: you need a car. You simply cannot Lime scooter a 45-minute drive north to Lafayette, Indiana. Trust me. So, whether you’re driving cross-country, borrowing a car from your saintly future MIL or getting creative with your commute—just make sure you have a solid plan in place.

Finding Places to Stay: The Externship Housing Adventure

Let’s talk about housing—because finding a place to stay during externships can be a journey. To be fully transparent, the cheapest place I stayed was $325/month, and the most expensive was $1000/month. Prices vary wildly depending on the city, so be prepared for some sticker shock. I did not have any externships where housing was provided but some externships do!

For most of my externships, I used Rotating Room², which is a popular site for medical students, but I also booked through Airbnb³ or other furnished long term stay websites⁴ when needed. I never used an extended-stay hotel, but I know students who did. Of course, the cheapest option is always staying with family or friends.

Now, let’s get real—everyone has at least one horror story about externship housing. One month, I planned to stay with a friend, but at the last minute, they told me they no longer had space. Cue the panic. I scrambled to find a place and ended up in an Airbnb 45 minutes away (which was not ideal). But silver lining—I stayed with some great people who are still my friends today! Another month? I stayed in someone’s attic. Yep, it was super creepy, but I was working so much that I barely noticed.

Scams are out there, which is why I stuck to Rotating Room and Airbnb—both legit platforms where you can file complaints if something goes wrong.

A pro tip: Check the CASPR website—many programs list recommended areas to stay in and state if they provide housing. Unless you’re okay with less sleep and more driving, I strongly suggest finding a place within 40 minutes of the main hospital. Trust me, a long commute after a 12+ hour day is not the vibe. At the end of the day, externship housing is a bit of a gamble—but with some planning, flexibility, and maybe a good sense of humor, you’ll make it work!

The Cost of…Well, Everything

Let’s not sugarcoat it—fourth-year externships are expensive. Flights? Expensive. Gas? Expensive. Housing? Also, expensive. Honestly, just existing during fourth year feels like it comes with a price tag.

I personally took out more loans during my fourth year than any other year, and that was with me keeping a budget. It’s frustrating, but unfortunately, it’s just part of the medical school experience. I made a budget and mostly stuck to it and that helped me stay sane through all of this. That said, for me, the cost was worth it—I got to travel all over the country, experience different programs, and keep my options open for the best residency fit.

Things to Bring

Packing for externships is a bit of an art. I shared a packing list with a close friend, and we cross referenced it to make sure nothing was forgotten about for our first externship.

Here’s what I brought and why:

I highly recommend that every student on call always carries:

1. Trauma shears – Super useful for quickly removing dressings and helping busy residents.

2. Eye protection – Because you never know when something is going to come flying at your face.

3. Pen and paper to take notes for themselves or the resident

During externships, one of my co-externs got phenol from an ingrown toenail procedure in his eyeball. He immediately lost vision and had to be rushed to the ED. That was all the convincing I needed—I’ve worn eye protection ever since. Plus, keeping your own eyewear saves you the frantic OR scavenger hunt for disposable goggles. Personally, I wear my glasses or Stoggles⁵—but whatever you choose, just protect your eyes. You’ll thank me later.

Externships can be exhausting, expensive, and at times, a little chaotic—but being prepared makes all the difference. Pack smart, plan ahead, and most importantly, protect your eyes.

In Conclusion

Externships were a huge shift from my third-year rotations. I felt like I was living a nomadic life, constantly packing up and moving, far from everyone I knew and loved. Just when I started getting comfortable, it was time to change rotations again, which meant I never really felt settled. It was tough.

On top of that, you're studying for boards, trying to figure out where you want to do residency, and juggling a million other things. It’s a lot to process as a student. If this article helped ease even a little bit of that stress, then I’m glad. Just know that I’m rooting for every single one of you. If you need some comic relief, I wrote an article on all my embarrassing moments and mistakes on externships, Sole Purpose 3 - Some of My Most Embarrassing Moments of Externship. Know that I had ALL these embarrassing moments, and I still matched my #1 and I am doing great in residency.

Think ahead, be prepared, and try to enjoy your externships at least a little. Explore the cities you’re in and really ask yourself if you could see yourself living there for three years. I never would have guessed I’d fall in love with Indiana, but because I took the time to explore and appreciate my month here, I was open to making it my home. You never know where externships will take you—so embrace the experience as much as you can.