Upon passing the Final Preclinical Examination at the end of Year 3/Semester 6, students become eligible to enter 80 weeks of clinical rotations. Core clinical rotations (Internal Medicine, General Surgery, Paediatrics, Obstetrics/Gynaecology, Community Medicine, Psychiatry, Emergency Medicine) cover 56 weeks, followed by 12 weeks of compulsory Clinical Selective Modules (Neurology, Orthopaedics, Rural Placement), and 12 weeks of Advanced Medical/Surgical/General Electives (student choice).

Through collaboration between the medical school and the Government of Samoa (and its Department of Health) facilities of the entire Samoan healthcare system are available to train OUM students. The school's primary teaching hospital, Tupua Tamasese Meaole (TTM) is the flagship institution of the healthcare system. TTM Hospital and OUM are both part of Samoa's National Health Complex in Apia. In addition to training at TTM, OUM students rotate among small district hospitals, outpatient clinics and rural medical practices, all supervised by OUM clinical faculty and TTM medical staff.

The OUM curriculum has a strong focus on community-based education. Students are expected to conduct community research projects during the program, as well as complete rural and community-based clinical training during their fourth and fifth years of study. This type of clinical placement provides students with a valuable opportunity to study and experience smaller regional and rural hospitals. Students encounter a wide range of medical and surgical problems that differ from those seen in tertiary referral centres, like TTM Hospital. Part of this community-based experience also involves exposure to rural medical practices which can be very different from an urban practice with its close proximity to tertiary hospitals.