Phase I of this study compared students' experiences regarding patient demographics, surgical content, and clinical skill practice in three different hospital settings: university, community, and public. Phase II examines the aspects of clerkship performance that contribute to students' final grades. An instrument to track the experiences of students on their surgical clerkship was developed and piloted. Data were analyzed to compare the frequency of common surgical tasks performed and exposure to various surgical topics and patient demographics as well as to identify factors that explain variance on student grades. Students performed an average of 33 clinical tasks per week and were exposed to a broad range of surgical topics. Analysis of variance results demonstrated no significant differences between public, private, or university settings with respect to students' clinical practice opportunities or content exposure. Clinical evaluations and National Board of Medical Examiners scores account for 75.5 per cent of the variance in students' final grades. There was no significant correlation between patient load and clinical task load with final clerkship grades. The common clinical and didactic components of a surgical clerkship can balance a student's experience with surgical topics and tasks performed. It is important to utilize this information in program review of multisite clerkships to ascertain and enhance the validity of student performance measures.