Phase 3 (Year 4)

Overview

The third phase of training emphasizes professional development activities, individualized career exploration and advanced clinical learning to prepare students for residency. In this phase, students engage in robust clinical experiences that feature progressive levels of direct responsibilities in patient care, and they return to basics to explore the importance of their foundational-science knowledge in clinical settings and their ongoing self-directed, lifelong learning process.


Academic Requirements

Phase 3 provides significant opportunities for an individualized, tailored experience in preparation for the transition to residency. Students complete four required courses as well as seven flexible electives.

Required Courses
  • Emergency Medicine Clerkship
  • Radiology Rotation
  • Sub-Internship Selective
  • Transitions 3
Elective Requirements

Students must complete a total of seven electives. Requirements are not mutually exclusive and one elective can fulfill more than one requirement (e.g. an elective can be an away elective and a clinical rotation).

  • At least four of the electives must be established courses listed in the IU School of Medicine Course Catalog.
  • Three of the electives be away or special electives.  
  • Four of the electives must be clinical rotations, one of which is required to be in the Advanced Clinical Elective category, while the others may be from the Clinical Practice category.
  • It is also highly recommended that one of the electives is categorized as a Professional Development or Advanced Science experience.

Navigating the Electives Catalog

All categories of electives are searchable within the IU School of Medicine electives catalog by typing the category name or campus location into the search box. Students select from five categories of electives:

Clinical Practice Electives
Students develop patient care skills and familiarity with the fundamental principles of practicing in a particular specialty.

Advanced Clinical Electives
Students actively participate in a robust clinical experience as an integrated member of a healthcare team. These electives also allow for reflection on professional development and career pathways.

Advanced Science Electives
Students pursue a review or scholarly research experience in the biomedical sciences and explore its relevance in clinical medicine.

Professional Development Electives
Students develop knowledge and skills outside of the traditional medical school curriculum that advance their success in medical practice

Special Electives
Students pursue unique opportunities that are available outside of the IU School of Medicine electives catalog


Scheduling Process 

The Phase 3 scheduling process occurs in multiple stages:

  • The first phase of scheduling prioritizes core clinical rotations and occurs in late fall during Phase 2. These rotations are the highest priority and are most difficult to reschedule.
  • The next phase of scheduling allows students to select customized electives for residency preparation and graduation requirements. This stage occurs in early spring during Phase 2.

These stages ensure students meet graduation requirements and are well-prepared for residency. Prioritization and scheduling are based on each student’s declared specialty interest to ensure all students receive clinical experiences and letters of recommendation that enhance residency applications.

Improvements to the Scheduling Process for Phase 3

The MD education team accelerated the Phase 3 scheduling process from the Legacy Curriculum process (which started the end of March). The Phase 3 scheduling timeline gives students more time to make initial preferences and for the medical education team to maximize final schedules. With the new Phase 3 curriculum, students are able to complete electives that are beneficial to residency applications between April and September. In the legacy curriculum, students were only able to complete these rotations between June and September during their fourth year of education.

Preference Scheduling Considerations

The registrar’s office will look for opportunities to adjust schedules so that students who did not get their higher preference sub-internships will get preferred electives early during Phase 3.

Scheduling and Letters of Recommendation

Clinical experiences and opportunities for faculty reference letters may come from several sources, including sub-Internships, other Phase 3 core rotations, Advanced Clinical Electives (ACE), other Clinical Practice electives, or Special Electives. ACE rotations will allow students to actively participate in a robust clinical experience as an integrated member of a health care team, with a focus on progressive responsibilities, profession development and career readiness.

Planning Away Rotation Electives

Students may use up to three elective slots for away rotations. Coordination of away rotations is a complex process and will also involve completing host school/program application requirements. Many of these opportunities are accessed through the AAMC VSAS website. However, some institutions have their own application process. 

Away rotations are not mandatory and many IU School of Medicine students do not complete any. The importance of doing away rotations varies by discipline and should be discussed with a career mentor or with the Career Development team along with a lead advisor. The application timing for away rotations varies by discipline and location. It is important to remember that many students apply for these opportunities nationally. Therefore, rotation timing and acceptance is unpredictable. The Office of the Registrar will make every effort to work these opportunities into student schedules upon admittance to the away rotation opportunity.

Planning Vacation Time

Phase 3 offers expanded vacation time to accommodate the increasingly complex needs of fourth-year medical students for interviews, life events, and wellness.

  • The mandatory rotations and electives will leave two four-week schedule openings that students can use for vacation time.
  • The Radiology rotation includes an additional two weeks of vacation time. 

In the first step of core scheduling students have the opportunity to designate priority periods to protect during core scheduling.  During elective scheduling, students can use any unscheduled time for vacation/flexible use for later rescheduling of rotations. There is no single optimal placement of vacation time; times should fit each student’s schedule as it develops. Protecting rotations for vacation time as a placeholder for possible “away” rotations or special electives that have not yet been approved or scheduled is not recommended.

April and May Scheduling Reminders

All students are required to attend Transitions 3 in Indianapolis during April 202. This four-week course has been designed for general and specialty-specific residency preparation.

May 2020 features graduation activities, but is otherwise unscheduled time. This period may be used to complete graduation requirements in exceptional circumstances but is subject to approval by Medical Student Education. 

Scheduling Questions

Schedules should be discussed and reviewed with each student’s lead advisor and any career/physician mentors. Students should reach out to their lead advisors with elective questions.


Scheduling FAQs

Why do the scheduling processes for fourth-year required rotations and electives occur in two different steps?

We schedule required rotations (the sub-internship, emergency medicine, and radiology) before electives so you can optimize the mandatory parts of your schedule and request time off for important life events. Once required rotations are scheduled, we begin the elective scheduling process.

What is a Sub-Internship?

The Sub-Internship, or Sub-I, is a rotation during which a senior medical student takes on an expanded role in direct patient care, attending to progressive front-line duties and responsibilities of admission, diagnosis, treatment, and discharge planning for patients with close supervision. This is an exciting step forward for students and an opportunity to practice and display maturing clinical skills. Students often request letters from faculty they work with during these Sub-I rotations so they can comment on the student’s patient care skills at the level of a first-year resident.

Why are there multiple options for Sub-Internships?

Here is a list of all disciplines offered:

  • Family Medicine
  • Pediatrics
  • Surgery
  • Obstetrics and Gynecology
  • Internal Medicine

As recently as 2016, internal medicine was the only Sub-I offered at IU School of Medicine. Family medicine and pediatric options were introduced in 2016 as the school continues to grow the number of locations and opportunities in those areas. Beginning in 2018, in response to student requests, we are excited to add options for Sub-Is in surgery as well as obstetrics and gynecology. As we build these new and exciting opportunities, keep in mind that there are limited slots and locations for some Sub-I rotations. Therefore, we recommend keeping limited availability in mind when discussing your preference with your lead advisor, career mentor, the Career Development Office or any Medical Student Affairs office resources.

How do I choose a Sub-I to preference?

Each student is scheduled into one Sub-I. Our scheduling system is designed to give each student the best possible match to their discipline and timing preferences. Remember that if you are not matched with your first choice of sub-I discipline, there will still be plenty of opportunities to preference Advanced Clinical Electives (ACE) in the discipline you wish to specialize in. These ACE electives are also robust clinical experiences that will be excellent for gaining experience, confidence and potential letters of recommendation. ACE and other elective scheduling will occur in January.

How do I use vacation blocks during Phase 3 scheduling?

The process for preferencing vacation time has not changed. Historically, students have used vacations for personal needs (as noted in the scheduling instructions, please give us this information in the comments section), wellness, preparation for Step 2 exams, or times when they expect to have many residency interviews. As you plan your schedule with the help of your advisors, bear in mind that the required Phase 3 rotations are intensive experiences to prepare you for your first year of residency. While the leadership of required rotations have worked with Medical Student Education to create additional time-away flexibility, these rotations are important portions of your education that have limited capacity for absences. Following the selection and verification of your initial required rotations and vacation, the next phase of scheduling will open for the 7 electives that complete your personalized senior schedule and meet all of your graduation requirements (see sample example diagrams below).

Where does Transitions 3 (T3) fit into the schedule?

All students will be scheduled for Transitions 3 in April of their Phase 3. This course was created in response to student requests, the popularity of the Surgical Bootcamp course and the growing national trend of adding a residency preparedness rotation for all students to cap off their medical school experience. The topics and materials in the course will cover common clinical scenarios that all residents will encounter, regardless of residency choice, along with specialty-specific topics and content that graduates have shared with us. Residency program directors have also shared topics that they wish their interns were better versed in at the start of their programs.

Sample Phase 3 Schedule
How is it that a similar elective is listed as an Advanced Clinical Elective (ACE) on one campus and a Clinical Practice elective on another campus.

In preparation for the 2019-2020 delivery of Phase 3, Medical Student Education reviewed all elective offerings from the past to look for good candidate rotations that could meet the expectations of an ACE, then reached out to the elective directors to confirm their ability to meet the ACE criteria.  The ACE designation was assigned after discussion with the directors and their in-depth knowledge of the elective.  Many, but not all, of these electives felt they could meet the criteria for ACE status and were converted in the current catalog.  Several other new electives were created from scratch to serve as ACE rotations this year.  The number of ACE electives is substantial, but not exhaustive in all disciplines at all campuses.  In addition to the online catalog, which is updated regularly with new electives as they are created, your lead advisors are kept up to date on the list of ACE options and can assist in your search for ACE options.

What if I don’t see ACE rotation in my discipline of interest at my home campus or am unable to get them early in my schedule to help me get ready for residency interviews?

Although we are excited to be able to offer your class the experience of ACE rotations, the Clinical Practice (CP) electives in various disciplines continue to be excellent opportunities to build your clinical experiences and faculty exposure.  The Sub-I and Emergency Medicine rotations, along with the Clinical Practice electives have been the traditional source for senior experiences in the legacy curriculum and served our students well for many years.  It is not necessary to have an ACE in your identified discipline because of these other valuable options.  Working with your lead advisor and career mentor, there are many options for you to consider for experiences within your discipline or related/complimentary fields to meet your needs.

Do I need to do an ACE in my chosen specialty?

No, the ACE experience is meant to further prepare your basic skills for your residency and is not meant to substitute for a Clinical Practice elective in your chosen specialty or in a related Sub-I (when applicable).

Do I need to get a letter of reference from my ACE and therefore need to complete it early in the year?

No, as noted above, other non-ACE electives such as Clinical Practice and Sub-I in your chosen specialty are excellent sources of letters.  Many students may find the experience of an ACE later in the year to be more helpful in preparing for the start of their upcoming residency.

I am considering taking an ACE or Clinical Practice elective at another campus. Is my travel/housing covered?

The school provides housing and travel for students assigned to required clerkships outside of their home campus, but not for electives rotations.  Therefore, travel and housing are not provided for elective rotations done outside your home campus, but the school will help direct students to options that may be helpful at the new campus.  We highly encourage students to consider rotations outside their own campus, as these rotations are highly regarded by students and provide rich experiences.


Clerkship and Sub-Internship Objectives

Emergency Medicine

Upon completion of the Emergency Medicine Clerkship, medical students are able to:

  • Perform and interpret a relevant, problem-focused history and physical examination from a patient presenting to the emergency department with an undifferentiated complaint. (PC1)
  • Formulate and justify a differential diagnosis for the patient’s chief concern, prioritizing the likelihood of the diagnosis and considering worst-case diagnoses. (PC2)
  • Formulate and justify a diagnostic and therapeutic plan, including testing, treatment and disposition, for patients with undifferentiated concerns, acute illnesses and specific disease processes. (PC3)
  • Recognize diseases, injuries and life-threatening conditions that present to the emergency department. (MK1)
  • Explain the etiology, progression and/or prognosis of diseases, injuries and life-threatening conditions that present to the emergency medicine department. (MK2)
  • Interpret clinical data and describe the underlying pathophysiology of common cardiovascular, respiratory, neurologic, traumatic and toxicologic emergencies. (MK3)
  • Provide justifications for interventions to diagnose, prevent, treat and manage a specific patient’s diseases, injuries and life-threatening conditions that present to the emergency department. (MK4)
  • Use principles of evidence-based medicine to evaluate the efficacy of diagnostic and therapeutic options. (MK5)
  • Respond to clinical questions by independently seeking, analyzing and synthesizing evidence-based answers to advance clinical decision-making. (PBLI1)
  • Seek and accept feedback from colleagues, faculty, supervisors, advisors and other health care professionals and incorporate this information into daily practice. (PBLI2)
  • Demonstrate effective team work through collaboration with diverse patients, their supporters, multi-disciplinary health care professionals and other staff in the delivery of respectful and patient-centered health care. (SBP1)
  • Identify a patient’s social context and analyze how it relates to their current state of health. (SBP2)
  • Demonstrate responsiveness to the whole patient by advocating for the patients’ and teams’ needs over their own and treating patients in a fair, unbiased, nonjudgmental manner. (same as common CLO) (P1)
  • Demonstrate responsibility for one’s own learning through daily preparation, full participation in learning activities, initiative in patient care, and timely completion of clerkship requirements.
  • Act in a professional manner by demonstrating compassion, respect, honesty, integrity and punctuality. (P2)
  • Adhere to ethical and legal principles governing medical practice, including maintaining patient confidentiality, gaining informed consent, the provision or withholding of care, identifying and managing conflicts of interest, identifying, analyzing and addressing unethical and unprofessional behaviors, and maintaining appropriate boundaries in relationships with patients. (P3)
  • Communicate effectively with the health care team during provider changes and transitions of care. (ISC1)
  • Communicate effectively with patients and their families. (ISC2)
  • Modify communication styles in accordance with the clinical context and purpose of the conversation, demonstrating sensitivity to differences, values, and needs of others, with attention to one’s personal communication style. (ISC3)
  • Share information accurately in academic and clinical settings both in oral presentations and written documentation including in the medical record. (ISC5)
  • Incorporate health promotion and patient education on the basis of the patient’s or population’s needs. (PC4)
  • Perform and document common clinical procedures using appropriate techniques within the limits of the level of training. (PC5)
  • Determine the appropriate care setting for management of patients with an acute medical condition and use effective strategies to ensure patient safety during transitions of care. (PC6)
  • Explain how behavioral, cultural, economic, educational, environmental, lifestyle and psychosocial factors impact and interact with health, disease, care-seeking, care compliance, barriers to care and attitudes toward care. (MK7)
  • Contribute to a culture of health care and patient safety through compliance with national and institutional guidelines and protocols in addition to reporting real and potential errors or threats and participating in quality improvement activities. (SBP4)
  • Recognizing the role of emergency medicine in providing access to all patients at all hours, identify health care challenges faced by underserved populations and deliver quality and equitable care to all patients presenting with an acute condition. (SBP5)
  • Incorporate elements of shared decision making into communication with patients to facilitate their active participation in their health care. (ISC4)
Radiology

Upon completion of the Radiology Clerkship, medical students are able to:

  • Order the appropriate imaging study, discuss key findings, and interpret data needed for a differential diagnosis. (PC2)
  • Integrate imaging data into a plausible plan of care. (PC3)
  • Correctly identify key imaging anatomy, including normal anatomic landmarks, on common imaging studies. (MK1)
  • Explain the basic principles of radiobiology and radiation protection. (MK2)
  • Using appropriate search patterns, identify and interpret urgent findings on common imaging studies. (MK3)
  • Explain the physical principles underlying each of the imaging modalities. (MK4)
  • Analyze and evaluate diagnostic and therapeutic imaging options using principles of evidence-based medicine. (MK5)
  • Respond to clinical questions by independently seeking, analyzing and synthesizing evidence-based answers to advance clinical decision-making. (PBLI1)
  • Seek, accept and apply feedback to clinical practice. (PBLI2)
  • Establish respectful, effective relationships with faculty, residents and peers as part of interpretation sessions and presentations. (SBP1)
  • Demonstrate responsibility for one’s own learning through daily preparation, full participation in learning activities, and timely completion of clerkship requirements. (P2)
  • Act in a professional manner by demonstrating compassion, respect, honesty, integrity and punctuality. (P2)
  • Adhere to ethical and legal principles in all interactions. (P3)
  • Communicate effectively with members of the health care team by clearly presenting clinical questions and data from the patient encounter. (ISC1)
  • Modify communication style based upon the purpose of the conversation. (ISC3)
  • Construct oral presentations or written documents representing an organized, focused, account of a radiologic case encountered during their clinical rotation. (ISC5)
  • Analyze costs and benefits of common imaging modalities. (SBP5)
Sub-Internship: Family Practice | Medicine | Obstetrics and Gynecology | Pediatrics | Surgery

Upon completion of the Sub-Internship, medical students are able to:

  • Perform and interpret a relevant, problem-focused history and physical examination in a hospitalized patient. (PC1)
  • Formulate and justify a prioritized problem list and differential diagnosis in a hospitalized patient. (PC2)
  • Formulate and justify a reasonable plan of care for a hospitalized patient. (PC3)
  • Differentiate normal and abnormal structure, function, growth, and/or development in a hospitalized patient. (MK1)
  • Explain the etiology, progression and/or prognosis of diseases, injuries, and functional deficits commonly seen in hospitalized patients. (MK2)
  • Recognize clinical presentations and explain the underlying pathology and pathophysiology of diseases, injuries, and functional deficits commonly seen in hospitalized patients. (MK3)
  • Describe the diagnosis, prevention, treatment or management of common of diseases, injuries and functional deficits commonly seen in hospitalized patients. (MK4)
  • Analyze and evaluate diagnostic and therapeutic options using principles of evidence-based medicine. (MK5)
  • Respond to clinical questions by independently seeking, analyzing and synthesizing evidence-based answers to advance clinical decision-making. (PBLI1)
  • Seek, accept and apply feedback to clinical practice. (PBLI2)
  • Identify the role and contributions of and establish respectful, effective relationships with the various members of the multi-professional health care team. (SBP1)
  • Identify a patient’s social context and analyze how it relates to their current state of health. (SBP2)
  • Demonstrate responsiveness to the whole patient by advocating for the patients’ and teams’ needs over their own and treating patients in a fair, unbiased, nonjudgmental manner. (P1)
  • Act in a professional manner by demonstrating compassion, respect, honesty, integrity and punctuality. (P2)
  • Adhere to ethical and legal principles in all interactions. (P3)
  • Establish and maintain respectful relationships with members of the health care team (peers, faculty and inter-professional colleagues) to facilitate the provision of effective care to patients. (ISC1)
  • Communicate effectively with patients and their families by listening attentively, allowing opportunities for questions, and maintaining appropriate eye contact. (ISC2)
  • Modify communication style based upon patients’ reactions and ability to understand. (ISC3)
  • Construct oral presentations and written documents representing an accurate, organized and appropriately focused account of the student-patient interaction.  (ISC5)
  • Incorporate patient education on the basis of the patient’s needs. (PC4)
  • Perform an appropriate written and verbal transition of care between providers and settings that minimizes the risk to patient safety. (PC6)
  • Incorporate knowledge of behavioral, cultural, economic, educational, environmental, lifestyle and psychosocial factors to understand health, disease, care-seeking, care compliance, barriers to care and attitudes toward care, and apply these factors to daily patient care. (MK7)
  • Incorporate elements of shared decision making into communication with patients to facilitate their active participation in their health care. (ISC4)