Osteopathic clinical medical education is similar to allopathic medical education in many ways but uniquely different in others. Some of the important differences include an emphasis on primary care, training in osteopathic manipulative medicine, and the reliance on community-based hospitals for clinical training sites.The authors explore the historical roots of osteopathic clinical training, describe the typical osteopathic clinical preparation, and discuss the challenges in delivering this clinical training. They describe the significantly different methods of delivering clinical training in three osteopathic medical schools: a traditional academic medical center, a school utilizing a statewide clinical consortium, and a school that employs a regional campus system.The authors used data from the annual survey of the 20 schools of osteopathic medicine operating in 2005-2006 to describe the typical clinical rotation experience of an osteopathic medical student and analyzed outcome data from the Comprehensive Osteopathic Medical Licensing Exam (COMLEX) Level 2-CE and COMLEX Level 2-PE for each of these three systems of clinical training. The overall success on these examinations by students from all three schools suggests that all three methods of clinical training can be successful.