The Ministry of Education, Sports and Culture has taken increasing interest in the usefulness and importance of clinical clerkships for 5th-and 6th-year medical students. This paper is the product of a symposium at the Nagoya University School of Medicine which was convened to examine the role of clinical rotations for medical students in the United States and Japan. This paper contains: an overview of medical education and the role of medical student clinical rotations in the United States; observations on being a clinical clerk in the United States; observations on being a clinical clerk in Japan and experiences of Japanese medical students in the United States; an integrated summary of the problems of clinical rotations in the United States; and experiences of Japanese medical students in clinical rotations in the United States. Clinical clerkship for 5th-and 6th-year medical students can only be developed and implemented with careful thought, significant time, and adjustment to new systems. Nevertheless, adoption of clinical clerkship in Japan has great potential for improving the quality of medical education in Japan.