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The clinical significance of the reaction is indicated either by marked distress that is in excess of what would be expected given the nature of the stressor , or by significant impairment in social or occupational ( academic ) functioning . Practicums and clerkships , as has repeatedly been emphasized , must be recognized as essential and integral parts of the university training , and periods of practice with subjects in clinical settings must be provided . My daughter is finishing her first year of clinicals in nursing school , and has decided that she would rather be a doctor than save doctors asses every day . A recent issue of the Menninger Bulletin ( July 1947 ) describing " The Menninger Foundation School of Clinical Psychology " and the July 1946 " Internship and Externship Programs " issue of the Journal of Consulting Psychology are also of considerable importance in this context . Clinical Science course curriculum ( years 3 and 4 ) must be accomplished within three years from successful completion of USMLE Step I. Inability to complete all of the Clinical Science coursework required for graduation within the 3-year time limit will constitute sufficient grounds for dismissal . Kuakini insistedthat the proper allocation was 53 minutes for clinical patients and 240minutes for research .