Medication reconciliation (MedRec) is an essential health care function that is particularly relevant to pharmacists’ expertise and a learning opportunity for pharmacy students. Our objective was to assess change across clinical competence, confidence, and communication skills after the completion of a MedRec rotation by second-year pharmacy students. A retrospective post-then-pre-survey including 29 questions was developed/delivered to students after the completion of required MedRec hours. The primary end point was the change in 3 domains via summed scores from individual questions. Cohen’s difference (d) was used to determine group effect size change. The secondary end points included individual question change, perceived patient impact, and subgroup analyses. Of 115 second-year pharmacy students, 81.7% (n = 94) participated in the study. Students self-reported increases on the Likert scale (0–10) of 2.49 ± 1.90 in clinical competency domain, 3.57 ± 2.13 in confidence domain , and 3.12 ± 2.15 in communication skills domain, representing statistically significant and large group effect changes across all 3. A total of 21 of the 22 individual questions had large group effect changes; 1 question (nursing communications) had a moderate group effect change. Student perception of MedRec impact on patient care (Likert scale 0–10) was positive: post-rotation score 7.39 ± 1.57. To the best of our knowledge, this is the first larger-scale study that examines student-evaluated outcomes of a MedRec-based rotation. Students self-reported high levels of post-rotation competency across all domains; students from ethnic minorities and with less work/MedRec experience increased their lower pre-rotation scores to statistically similar post-rotation scores, compared with non-minority and more experienced peers. Further study of the model and outcomes is advised.