title: Course Offerings in the Fourth Year of Medical School: How U.S. Medical Schools Are Preparing Students for Internship.
abstract: The fourth year of medical school remains controversial, despite efforts to reform it. A committee from the Clerkship Directors in Internal Medicine and the Association of Program Directors in Internal Medicine examined transitions from medical school to internship with the goal of better academic advising for students. In 2013 and 2014, the committee examined published literature and the Web sites of 136 Liaison Committee on Medical Education-accredited schools for information on current course offerings for the fourth year of medical school. The authors summarized temporal trends and outcomes when available.Subinternships were required by 122 (90%) of the 136 schools and allow students to experience the intern's role. Capstone courses are increasingly used to fill curricular gaps. Revisiting basic sciences in fourth-year rotations helps to reinforce concepts from earlier years. Many schools require rotations in specific settings, like emergency departments, intensive care units, or ambulatory clinics. A growing number of schools require participation in research, including during the fourth year. Students traditionally take fourth-year clinical electives to improve skills, both within their chosen specialties and in other disciplines. Some students work with underserved populations or seek experiences that will be henceforth unavailable, whereas others use electives to "audition" at desired residency sites. Fourth-year requirements vary considerably among medical schools, reflecting different missions and varied student needs. Few objective outcomes data exist to guide students' choices. Nevertheless, both medical students and educators value the fourth year of medical school and feel it can fill diverse functions in preparing for residency.
authors.affiliation: D.M. Elnicki is professor and director, Ambulatory Medicine Clerkship, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.S. Gallagher is clerkship director and associate professor, Department of Medicine, State University of New York at Buffalo School of Medicine and Biomedical Sciences and Buffalo General Hospital, Buffalo, New York.L. Willett is professor and associate program and subinternship director, Department of Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers, New Jersey.G. Kane is interim chair, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.M. Muntz is clerkship director and associate professor, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.D. Henry is clerkship director, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut.M. Cannarozzi is associate professor and clerkship director, Department of Medicine, University of Central Florida College of Medicine, Health Sciences, Orlando, Florida.E. Stewart is associate program director, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.H. Harrell is clerkship director, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida.M. Aiyer is associate dean for academic affairs, Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, Illinois.C. Salvit is director of medical student education, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.S. Chudgar is director, Undergraduate Medical Education, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.R. Vu is associate clerkship director, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: D Michael
authors.initials: DM
authors.lastname: Elnicki
authors.forename: Susan
authors.initials: S
authors.lastname: Gallagher
authors.forename: Laura
authors.initials: L
authors.lastname: Willett
authors.forename: Gregory
authors.initials: G
authors.lastname: Kane
authors.forename: Martin
authors.initials: M
authors.lastname: Muntz
authors.forename: Daniel
authors.initials: D
authors.lastname: Henry
authors.forename: Maria
authors.initials: M
authors.lastname: Cannarozzi
authors.forename: Emily
authors.initials: E
authors.lastname: Stewart
authors.forename: Heather
authors.initials: H
authors.lastname: Harrell
authors.forename: Meenakshy
authors.initials: M
authors.lastname: Aiyer
authors.forename: Cori
authors.initials: C
authors.lastname: Salvit
authors.forename: Saumil
authors.initials: S
authors.lastname: Chudgar
authors.forename: Robert
authors.initials: R
authors.lastname: Vu
mesh_terms: D002982:Clinical Clerkship / Q000379:methods*; D002983:Clinical Competence; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods*; D006801:Humans; D007396:Internship and Residency; D012577:Schools, Medical; D014481:United States