Background <p>Early stages of medical training are vital to ensure the academic performance of medical students. In conventional medical programs, students tend to be exposed to clinical training in the final years of their studies. However, this strategy has been profoundly reconsidered in recent years, with growing evidence showing that early clinical exposure (ECE) might enhance cognitive and effective learning outcomes for medical students. Nonetheless, there is insufficient information on the particular influence of ECE on medical competencies. Therefore, this systematic review aimed to evaluate the impact of ECE on the competency development of medical students.</p> Methods <p>An online search for potential studies was conducted on five major electronic databases (PubMed, CINAHL, Web of Science, Cochrane Library, and Google Scholar) using keywords related to Early clinical exposure, competency, and medical students. This search was limited to English-written records. Furthermore, studies were included if they involved medical students subjected to ECE during pre-clinical years. Quality appraisal was conducted depending on the study designs, with the MINORS used for non-randomized studies and Cochrane risk of bias for randomized studies.</p> Results <p>Fifteen studies enrolling 2579 medical students were reviewed. These studies included 1 randomized study, 7 cross-sectional studies, 2 quasi-experimental studies, 1 qualitative study, and 4 non-randomized interventional studies. Data from the included studies revealed that ECE significantly improves the clinical skills of medical students compared to the traditional teaching method. Studies also reported that the majority of medical students agreed (strongly agreed/agreed) that ECE improved their communication skills, problem-solving skills, empathy, professionalism, and confidence to deal with patients. Furthermore, evidence suggests that ECE improves the medical knowledge of students by motivating them to learn and bridging the gap between theoretical knowledge and real-world clinical practice.</p> Conclusion <p>ECE has the potential to enhance the competency of medical students. Therefore, this systematic review supports the integration of ECE in the undergraduate curriculum to ensure that students acquire the skills needed to provide high-quality patient care.</p> Clinical trial registration <p>PROSPERO: CRD420251055152.</p>