Phase 3 of the MD curriculum builds upon the foundational skills developed during Phase 1 and Phase 2 to prepare graduates for supervised clinical practice, scholarship, and service. This phase includes required clinical rotations, electives and the residency-prep course, Transitions 3.

Quick Resources

Graduation Requirements

Class of 2020
  • Emergency Medicine Clerkship (4 weeks)
  • Sub-Internship Selective (4 week)
    • Internal Medicine, Pediatrics, Family Medicine, Surgery or OB-GYN
  • Radiology Rotation (2 weeks)
  • Electives: A minimum of 28 academic credits
    • A minimum of four elective months (16 academic credits) must be established courses (non-special electives) listed in the Elective Catalog
    • Electives must include four Clinical Practice electives, one of which must be an Advanced Clinical Elective
    • A maximum of two Career Exploration Electives (4 academic credits) may be used to fulfill graduation requirements.
    • An Advanced Science or Professional Development elective is highly suggested
Class of 2021
  • Emergency Medicine Clerkship (4 weeks)
  • Sub-Internship Selective (4 weeks)
    • Internal Medicine, Pediatrics, Family Medicine, Surgery or OB-GYN
  • Radiology Rotation (2 weeks)
  • Critical Care Selective (4 weeks)
  • Electives: A minimum of 24 academic credits
    • A minimum of four elective months (16 academic credits) must be established courses (non-special electives) listed in the Elective Catalog.
    • Electives taken must include three Clinical Practice/Advanced Clinical electives
    • A maximum of two career exploration electives (4 academic credits) may be used to fulfill graduation requirements
    • An Advanced Science or Professional Development elective is highly suggested
Class of 2022 and Beyond
  • Emergency Medicine Clerkship (4 weeks)
  • Sub-Internship Selective (4 weeks)
    • Internal Medicine, Pediatrics, Family Medicine, Surgery or OB-GYN
  • Critical Care Selective (4 weeks)
  • Electives: A minimum of 24 academic credit
    • A minimum of four elective months (16 academic credits) must be established courses (non-special electives) listed in the Elective Catalog.
    • Electives must include four Clinical Practice or Advanced Clinical electives.
    • A maximum of two career exploration electives (4 academic credits) may be used to fulfill graduation requirements.
    • An Advanced Science or Professional Development elective is highly suggested.

Vacation Time

Phase 3 students can schedule two four-week vacation periods in addition to winter break and a two-week block before/after Radiology. Many students choose to take electives or use those blocks to interview.

Required Phase 3 Rotations

  • Emergency Medicine
  • Radiology
  • Transitions 3
  • One Sub-Internship Selective
    • Internal Medicine, Family Medicine, Pediatrics, Surgery or OB-GYN

Emergency Medicine and Radiology

The emergency medicine and radiology rotations build upon the clinical and professional skills developed during Phase 2 of the curriculum. These required rotations offer broad exposure to key areas of medicine, allowing students to develop skills across a breadth of topics. Students work with a health care team, sharing a high level of responsibility and actively participating in the care of undifferentiated patients.

Emergency Medicine

Students on the emergency medicine rotation develop critical competencies in diagnosis, management and communication required to care for patients with urgent and emergent conditions in a complex and ever-changing medical system. Autonomy and responsibility are essential for the student to learn fundamental approaches to patients with undifferentiated urgent or emergent conditions.

Emergency medicine students function as the primary caregiver for their patients, working closely with supervising board-certified emergency medicine faculty and senior emergency medicine residents to develop and implement management plans. Students are required to diagnose patients with a focused history and physical examination, taking into consideration not only the patient’s medical condition, but also the psychosocial aspects of the problem. Students implement solutions to these problems under direct supervision of expert clinical educators. Preparation for these advancing levels of responsibility include intensive didactic and high-fidelity simulation training at the beginning of the clerkship, as well as high quality asynchronous online learning.

As primary caregivers, students are expected to:

  • Place orders pending faculty co-signature
  • Call consultants as indicated
  • Arrange patient dispositions and transfers of care
  • Follow results of diagnostic testing
  • Document patient progress notes in the medical record

It is difficult to imagine practicing medicine today without radiology. Therefore, it is vital that students understand how to effectively use radiology in patient care. The radiology rotation provides students an opportunity to review and integrate key lessons from the first two phases of medical school in subjects such as anatomy, physiology and pathology. 

Radiology is also the context in which students will most often visualize the inner structure and function of their patients. Students who study radiology gain an opportunity to form indelible images of disease processes and their treatment including fractures, infections, vascular occlusions, neoplasms and more. Radiology ties together the basic sciences and clinical disciplines in a particularly effective manner, and plays a major role in answering basic medical questions: Is my patient sick?  What is the diagnosis?  How far has the disease progressed?  Is it responding to therapy?  Has it recurred?

Through this rotation, students learn:

  • How to determine what imaging studies to order
  • How to integrate imaging results effectively into patient care
  • What basic pathologies in key organ systems look like from the vantage points of different imaging modalities

Sub-Internship Selective

The Sub-Internship, or Sub-I, is a rotation during which a fourth-year medical student takes on an expanded role in direct patient care, attending to progressive frontline duties and responsibilities regarding patient admission, diagnosis, treatment and discharge under close supervision. This experience is an exciting step forward for students and an excellent 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.

As recently as 2016, internal medicine was the only Sub-I offered at IU School of Medicine. The school introduced family medicine and pediatric options two years ago in 2016 and continues to grow the number of locations and opportunities in those areas. In 2019, in response to student requests, the school added options for Sub-I’s in surgery as well as OB-GYN. As the school builds 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 other Medical Student Affairs Office resources.

Internal Medicine Sub-Internship

The Internal Medicine Sub-Internship is one of the available rotations that IUSM students may take to fulfill their requirement to complete a Sub-Internship in Phase 3 of the IUSM curriculum. Internal medicine is a specialty that focuses on comprehensive medical care (diagnosis, treatment and prevention) for adult patients. Before an appropriate treatment plan of care can be rendered, health care providers must first determine a correct diagnosis. Thus, this field of medicine requires clinicians to apply scientific knowledge and clinical expertise in the care of adult patients.  Therefore, the primary goal of this sub-internship is to improve medical students’ capacity to think and function like clinicians in supervised clinical settings. To this end, heavy emphasis is placed on developing the student’s skills at hypothesis-driven data gathering and diagnostic reasoning skills. 

As the primary goal implies, this Sub-Internship prepares students for residency by fostering independence in supervised settings. All students are expected to actively participate in the care of their assigned patients as well as during rounds; the latter activity will require students to speak up and convey their ideas and thought process to their supervising teachers. 

Family Medicine Sub-Internship

During the Family Medicine Sub-Internship, students have family medicine resident experiences and acquire the skills needed for residency. This Sub-Internship is a robust hospitalist opportunity that incorporates the family medicine philosophy of interprofessional collaboration with all hospital services. Students are assigned to inpatient medicine teams that care for patients in a ward setting. Some teams are only a Sub-Intern and faculty member (hospitalist). Other teams consist of an attending physician, a resident physician and one or two interns. Students are given primary patient care responsibilities with a closely guided experience in diagnostic and therapeutic decision-making.

To be successful in the Family Medicine Sub-I, students must have:

  • Strong knowledge of chronic medical conditions, diagnosis, and treatment plans. Students will build on their skills in ordering appropriate imaging and labs.
  • Familiarity with Hospital EMRs.
  • Familiarity with the use of medical interpreters in hospital settings and how to communicate patient information during rounds (oral presentations).
  • Strong professionalism skills involving team work, punctuality and timeliness of completion of tasks.
Pediatrics Sub-Internship

The primary goal of this Sub-Internship is to improve medical students’ capacity to think and function like a clinician in supervised clinical settings. To this end, heavy emphasis is placed on developing students’ skills at hypothesis-driven data gathering and diagnostic reasoning skills. This rotation fosters students’ growing independence in supervised settings at Riley Hospital for Children at IU Health, one of the nation’s top children’s hospitals. By actively participating in the care of their patients and interdisciplinary patient-centered rounds, students gain exposure to a wide variety of pediatric pathology and world-renowned clinician educators.

Surgery Sub-Internship

This Sub-Internship is an advanced experience in general surgery that continues the development of clinical skills for Phase 3 medical students. These skills include problem-focused history and physical examination, application of medical knowledge to perioperative care, as well as technical proficiencies in surgical clinics, on hospital wards and in the operating room. Students are given increased responsibilities with the aim of growing independence as they prepare for residency. Students are evaluated clinically by faculty and resident preceptors, with computer-based simulated patient cases, a transitions of care module, a clinical presentation to their surgical teams and basic technical skills.

OB-GYN Sub-Internship

The OB-GYN Sub-Internship provides students who are interested in women’s healthcare the opportunity to gain necessary knowledge and procedural skills to be successful in their intern year. Students work closely with a team of residents and faculty in both inpatient and outpatient settings, in the operating room, on labor and delivery, and in antepartum and postpartum units of Sidney and Lois Eskenazi Hospital. Students are encouraged to actively engage in all aspects of clinical care, and are expected to gain the skills necessary to assume primary patient care responsibilities. During resident didactic times, when residents are relieved of clinical duties, students work one-on-one with faculty and are given the opportunity to take on intern level roles. In addition, Sub-Interns have the opportunity to step into the role of educator, using their experience and knowledge to help guide junior level students through their required rotation.


Electives provide students with the opportunity to individually tailor the final year of medical school to fit their goals Electives also round out student training and experiences. In collaboration with a career mentor and lead advisor, students select seven elective courses in their areas of interest.

Elective Categories

Clinical Practice Electives

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

Advanced Clinical Electives (ACE)

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 may pursue unique opportunities that are available outside of the IU School of Medicine electives catalog

Elective Requirements

  • Students are required to take seven electives
  • One of these electives must be an Advanced Clinical elective, which provides a robust patient care experience complementary to the Sub-internship
  • It is highly suggested that students take at least one professional development elective and one advanced science elective to round out the Phase 3 experience
  • Students can complete up to three away electives within the required seven. However, the application process for away rotations is complex, varying by institution and specialty. See the VSLO AAMC website to search for opportunities at other institutions.
  • Students can also propose special electives with the special elective request form if they identify opportunities outside of the school’s elective offerings.

Elective FAQs

Will I receive Advanced Clinical Elective credit toward graduation for an elective I took in a prior academic year? 

Advanced Clinical Electives (ACE’s) are newly designated in the 2019-2020 academic year, and the designation is specific to the Phase 3 curriculum. Credit for electives taken in prior academic years would count as Clinical Practice, not Advanced Clinical, for the purposes of graduation credit. A Phase 3 student on an Advanced Clinical rotation will typically have higher expectations and responsibilities than a Phase 2 student, according to level of training. The intent of the ACE is to complement your Sub-I and give you advanced responsibilities as a senior student in your chosen area in order to better prepare you for residency. You may take more than one ACE to fulfill your clinical practice goals, as all ACE’s are also considered clinical practice elective.  

For quick reference, the class of 2020 graduation requirements for electives are: a minimum of 7 months of electives, of which a minimum of four elective months must be established courses (non-special electives) listed in the Elective Program Catalog. Electives must include four clinical electives, one of which must be an Advanced Clinical Elective. A maximum of two Career Exploration Electives may be used to fulfill graduation requirements.  The full policy guidelines are available on the Handbook on MedNet. 

What are the electives options?

See the elective catalog and talk with a lead advisor. Updates to the elective catalog are traditionally published every December or January prior to the coming academic year.

Why are some electives 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).

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.

Do I need to complete my ACE elective early so I can get a letter of reference for residency applications?

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.

Transitions 3

All students take Transitions 3 in April of their fourth year at the end of Phase 3. The topics and materials in the course cover common clinical scenarios that all residents will encounter, regardless of residency choice. Additionally, students will explore specialty-specific topics and content. Transitions 3 also includes topics that residency program directors wish their interns were better versed in at the start of residency. 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.

Transitions 3 FAQs

Why was the Transitions 3 course added to the curriculum?

The Transitions 3 (T3) course is designed to prepare you for the rigors of residency and the elevated level of responsibility of being a resident. It is also time practice fundamental skills that are expected of you on day one of your internships. Transitions 3 is not unique to IU School of Medicine; it is part of a national trend in recognizing the challenge medical students face while transitioning from medical school to internship year.

According to the AAMC in 2016, 83 medical schools indicated adding a transition to residency course to help their students navigate the transition from medical school to residency. These transitional periods are challenging. So, schools nationwide are aiming to better support students as they navigate and prepare for the next step in their careers. These courses have received resounding positive feedback from students across the country, as well as residency program directors (see: AAMC News: Boot Camps Prepare Medical Students for Rigors of Residency and AMA News: Pre-residency boot camps prepare med school grads for new realities).

At IU School of Medicine, this type of preparatory experience has previously been available for students going into surgery. However, we wanted to make it available for all students.  The idea is not to repeat what was covered in your four years of medical school, but to give you an opportunity to review key material from the perspective of being an intern, provide hands-on practice for various procedures, and equip you with information you will need as you transition to your exciting and challenging intern year. In this course, you will practice relevant skills necessary for all interns, as well as specialty-specific skills through high-fidelity simulations, didactics, panel-discussions, and asynchronous sessions.

Is Transitions 3 required?

Yes, all students in the Class of 2020 onward will be required to take Transitions 3 during the month of April.  Everyone should count on being in Indianapolis for at least the first part of the month (the length of time will vary depending on your track). Indianapolis housing will be provided for students who lived on a campus outside of Indianapolis during their fourth year.

How will the Transitions 3 be structured?

Transitions 3 will start with an exciting kickoff event on March 31, 2020. This event will provide time for you to come together as a class to have some fun and celebrate embarking on your final month of medical school.

The course sessions will begin on April 1, 2020. Each specialty will have a “track” that includes required and recommended sessions for students in that specialty. The course sessions within each track will include a mix of didactics, panel-discussions, high-fidelity simulations, and asynchronous sessions. The tracks were created to include valuable sessions for the various specialties based upon feedback from residency program directors, clerkship and sub-I directors, and residents from each specialty.

You will also have the opportunity to choose areas of interest from a number of other sessions to meet the course requirements. Some sessions will require attendance in person, but several will be offered remotely so that you can take them at your convenience. The course is Pass/Fail, but the feedback you receive in the various sessions will help guide you as you are preparing to transition to your residencies. A goal of the course is for the feedback and experiences to make you more cognizant of the expectations of first year interns and more confident in your abilities as you make this challenging transition.

Did you take away the surgical boot camp?

The surgical boot camp is not going away!  It is being incorporated into Transitions 3 as the surgical track. This has been a very successful and popular program in the past and it will be expanded to accommodate increased enrollment. The surgical boot camp specifically focuses on topics and skills that are clinically relevant to students pursuing a surgical internship. The surgical boot camp involves a mix of interactive lectures, collaborative activities, group discussions, and skills sessions. These elements cover the various topics relevant to first-year interns, such as obtaining informed consent, wound assessment and care, surgically-relevant radiology, laparoscopic skills, operating room etiquette, etc. We are really excited to build upon the successes of the surgical boot camp and provide that type of experience for all of our students, regardless of their chosen residency discipline.

When will we receive the Transitions 3 Schedule?

The Transitions 3 team is in the process of finalizing the specialty-specific tracks based on feedback from program directors, clerkship and Sub-I directors, and residents.  Our team anticipates having the schedule for the required portions of Transitions 3 available by this fall, at which point you will be able to build your schedule for the entire month. The goal is to offer some flexibility during the month of April so that you have time to prepare for graduation, find housing if you are moving to a new city, catch up with friends and family while also fulfilling the requirements of Transitions 3.

Will there be special training for ACLS?

Because of the wide variation in requirements for each residency program, we will not be offering dedicated time during Transitions 3 for ACLS, PALS, etc.  However, residency programs requiring such certification will generally pay for your training or include it during orientation.  If you need to obtain this training prior to starting your residency, you will have ample time during the month to schedule this around the Transitions 3 sessions.

General FAQs

How do I get letters of recommendation for residency programs?

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.

The electives catalog offers a large array of options for the opportunity to get the letters you need. A particular category of electives, called Advanced Clinical electives are great options if you’re looking to actively participate in a robust clinical experience as an integrated member of a healthcare team, with a focus on progressive responsibilities, professional development, and career readiness.

Also, connect with the Career Development Team for more residency preparation guidance and resources.

What does a sample schedule look like?