Curriculum: Fourth Year
July Through May (32 weeks)
- One 4-week required SMHS Acting Internship (AI)
- Seven periods of electives (28 week total)
- 12 weeks for Step 2/interviewing/extra electives/vacation
The fourth-year program includes eleven periods. All fourth-year students must take one required SMHS acting internship (AI) and seven four-week electives during their fourth year. In order to prevent overcrowding on any one campus, sixteen weeks must be scheduled to be completed on the student's assigned clinical campus in the fourth year. The required acting internship must be completed at UND SMHS.
Some electives are unique to a specific campus. Students may choose to use one of these unique electives (designated by a 95** course number), to count as a home-campus elective.
International rotations arranged through individual departments are not considered on-campus rotations. Students may not participate in international electives during match week.
Students in the fourth year of medical school may not take more than a total of four electives in a single specialty. Within these four electives, no more than two may be general electives in the specialty and no more than two may be in a single sub-specialty area unless they wish to forgo a vacation month in which case they may take three. This includes the acting internship requirement. The only exemption applies to students applying in Emergency Medicine who may take 3 General Emergency Medicine courses, however, one must be at UND SMHS.
Year 4 Benchmarks
- Obtain a history and perform a physical examination (EPA #1) and present the information orally (EPA #6) for both complete and focused patient encounters.
- Document accurately and succinctly information gained during patient encounters using an electronic medical record. (EPA #1, #5)
- Form an appropriate differential diagnosis and document the clinical reasoning behind that differential. (EPA #2)
- Recommend and interpret common diagnostic and screening tests. (EPA #3)
- Formulate and update an accurate problem list for patients under their care.
- Communicate effectively with patients and their families regarding differential diagnoses, treatment options and care plans in light of social, cultural and economic factors affecting the patient’s healthcare. (EPA #1, #3)
- Work effectively as a member of an interdisciplinary healthcare team including being able to call a consultant and request a consult. (EPA #9)
- Give and accept patient handoff reports for transitions in care. (EPA #8)
- Formulate accurate and appropriate patient care orders and prescriptions. (EPA #4)
- Recognize a patient requiring urgent or emergent care and initiate the appropriate initial steps in that care. (EPA #10)
- Effectively receive and give feedback.
- Obtain informed consent. (EPA #11)
- Research a clinical question relating to patient care with appropriate evaluation of resources and use of evidence-based information. (EPA #7)
- Formulate appropriate and evidence-based diagnostic and treatment plans for common medical conditions.
- Demonstrate the ability to translate basic biomedical science principles into clinical care of patients
And will have:
- Completed all assigned rotations in a professional, ethical, confidential, and respectful manner. This will include appearance, timeliness, completion of assigned tasks and interactions with patients, families, coworkers and staff.
- Completed the assigned curriculum in patient safety and quality (EPA #13)
Entrustable Professional Activities (EPAs)
EPA 1: Gather a history and perform a physical examination
EPA 2: Prioritize a differential diagnosis following a clinical encounter
EPA 3: Recommend and interpret common diagnostic and screening tests
EPA 4: Enter and discuss orders and prescriptions
EPA 5: Document a clinical encounter in the patient record
EPA 6: Provide an oral presentation of a clinical encounter
EPA 7: Form clinical questions and retrieve evidence to advance patient care
EPA 8: Give or receive a patient handover to transition care responsibility
EPA 9: Collaborate as a member of an interprofessional team
EPA 10: Recognize a patient requiring urgent or emergent care and initiate evaluation and management
EPA 11: Obtain informed consent for tests and/or procedures
EPA 12: Perform general procedures of a physician
EPA 13: Identify system failures and contribute to a culture of safety and improvement
Standardized Acting Internship (AI) Objectives
|Objectives||Competencies||Year 4 Benchmarks|
|1. Obtain a history and perform a physical exam||3.1||1|
|2. Present the history and physical in a concise, well-organized format||3.7||2|
|3. Form and prioritize a differential diagnosis. Select a working diagnosis.||3.3||3|
|4. Discuss orders and prescriptions and construct evidence-based management plans.||3.4, 3.8||4|
|5. Select screening and diagnostic studies and labs and interpret the results of these tests.||3.2, 3.3||4, 14|
|6. Recognize patients who are critically ill or require emergent care and initiate the appropriate initial steps in that care. Reassess patients on an ongoing basis and adjust plan of care as appropriate.||3.5.1||10|
|7. Document the clinical encounter in a timely fashion||3.7, 5.7||2|
|8. Communicate effectively with patients and their families regarding diagnoses and plans of care with respect for cultural and socioeconomic backgrounds.||3.9, 4.1||6|
|9. Work effectively as a member of the interprofessional healthcare team including giving and accepting patient handoffs at transitions of care.||3.5.4, 7.5||7, 8|
|10. Research a clinical question relating to patient care with appropriate evaluation of resources and use of evidence-based information.||1.6, 1.10, 2.7||13|
|11. Formulate or update an accurate problem list for patients under his or her care.||3.3, 3.7||5|
- Students meet with their designated career advisor to select a tentative schedule. The tentative schedule must be coordinated, reviewed, and approved by the career advisor.
- The student's 4th year Campus Dean will review the schedule.
- Preceptors will review and approve requested rotations.
- The approved schedule will be e-mailed to the student by the campus office.
Schedule changes should be requested as soon as possible.
Students should contact their home campus office by phone or e-mail to request schedule changes.
To register for a Senior Elective or Acting Internship (AI) that is offered on another UND School of Medicine & Health Sciences Campus, the student should contact his/her Campus Dean's administrative office for assistance. The Campus Dean's administrative office will request the off-campus elective and coordinate arrangements with the student, the off-campus Dean's Office, and the Office of Student Affairs and Admissions to finalize the student's schedule and to assure he/she is registered appropriately for the off-campus elective.
Students will use VSAS to apply for away electives and acting internships at participating schools. To obtain instructions for filing for a senior elective/acting internship to be taken at an out-of-state institution not participating in VSAS, students must contact their home Campus Dean's office. Students are responsible for scheduling and making all necessary arrangements for senior electives/acting internships under the direction of the other institutions. The students also are responsible for any additional required fees incurred for out-of-state electives/acting internships. The campus office will review the application materials and forwarded necessary forms to the appropriate administrative offices. Upon notification, the Office of Student Affairs and Admissions will register the student for this elective. Away electives/internships must be affiliated with an LCME accredited school.
Course acronyms and numbers for fourth-year electives are identified as follows:
- BIMD - Biomedical Sciences
- FMED - Family Medicine
- MED - Interdisciplinary
- IMED - Internal Medicine
- NEUR - Neurology
- PSYB - Psychiatry and Behavioral Science
- OBGY - Obstetrics & Gynecology
- PATH - Pathology
- PED - Pediatrics
- RAD - Radiology
- SURG - Surgery
- 91** - Bismarck (Southwest) Campus
- 92** - Fargo (Southeast) Campus
- 93** - Grand Forks (Northeast) Campus
- 94** - Minot (Northwest) Campus
- 95** - All Campus (Course only available/offered at one campus)
- 90** - Off Campus
Fourth-year students will apply knowledge learned through online IHI modules to a patient safety/quality improvement project. Modules will be completed by the end of period 7 and by the end of period 9; the one page proposal must be submitted to the Campus Dean for evaluation. The project is a requirement for graduation eligibility.
For more information, please contact the appropriate campus office.