Purpose <p>This study compares clinical internship curricula between Chinese and foreign medical schools through the lens of the Four-Component Instructional Design (4C/ID) model. By analyzing curriculum objectives, content structures, and evaluation frameworks, we aim to identify systemic strengths and distinctive features within each educational context.</p> Methods <p>A qualitative comparative case study design was adopted, selecting ten top-ranked foreign medical schools (Times Higher Education 2024) and ten leading Chinese institutions. Publicly available curricular documents—including syllabi, implementation protocols, and competency assessments—were analyzed through a 4C/ID framework using content analysis, word frequency analysis, and cross-case synthesis.</p> Results <p>Both systems demonstrated structured adherence to 4C/ID principles within their clinical internship programs but revealed divergent emphases. Foreign medical schools focus on “practice,” while Chinese schools emphasize “ability,” suggesting different approaches to integrating authentic tasks. Foreign medical schools build collaborative learning ecosystems, whereas Chinese institutions systematize conceptual knowledge. Extraneous cognitive load is managed through staged, progressive curricula and diverse teaching methods in foreign schools, whereas Chinese schools employ phased skill assessments. Regarding part-task repeated practice, both groups recognize its importance, with foreign schools employing more innovative approaches.</p> Conclusions <p>Applying the 4C/ID model, this study reveals distinct yet effective strengths in the clinical internship programs of Chinese and foreign medical schools. The sophisticated approaches of top-ranked foreign medical schools in managing students’ cognitive load offer valuable insights for medical education reform, potentially enhancing adaptability to the demands of modern healthcare.</p>