Fourth-Year Curriculum

Students continue clerkships into the fourth year, as well as take electives, and some may elect to do a subinternship. Students must complete Step II of the United States Medical Licensing Exam (USMLE) before December 31.

Throughout the fourth year, students will also be planning and applying for residency.

A detailed calendar is provided, listing the order in which the above steps must be completed in preparation for graduation.

Fourth-Year Clerkships

Required clerkships that may be taken in the fourth year are:

Primary Care Clerkship

Students usually complete the Primary Care clerkship during their fourth year. The schedule is divided into two main parts: patient care at a practice site and group sessions. At the practice site, students are assigned to a principle preceptor. The student meets with the preceptor at orientation, in the middle of the clerkship and at the end of the clerkship to provide feedback.

Some other ways to complete this rotation:

• At an away site, with the permission of the clerkship director
• Over the course of a year in the weekly Wednesday Evening Clinic in the Primary Care Center
• At the student-run HAVEN (Health Care, Advocacy, Volunteerism, Education and Neighborhood) free clinic, which meets Saturdays at the Fair Haven Clinic

Students should check with the clerkship director for required prerequisites and approval to complete the clerkship at these sites.

Integrative Clinical Medicine Clerkship

In the spring of the fourth year, students attend one final required course – Integrative Clinical Medicine: The Biological, Social and Behavioral Bases of Clinical Medicine. During the first two weeks, two clinical case studies are considered. The third week includes daily workshops on the occurrence of mistakes, working with difficult patients, genomics and professionalism.

The integrative clinical medicine clerkship is offered at the same time as a course led by the Emergency Medicine section, which focuses on preparatory skills for internship. It includes advanced training in sexuality issues, social and ethical challenges in medicine, and the latest medical informatics. Attendance is mandatory. 

Electives

Electives are clerkships that students elect to take. Many students take multiple electives, often in other parts of the world. Electives are scheduled in the spring of the third year, and are sometimes taken late in the third year. Scheduling an elective is done with the elective coordinator in the Office of Student Affairs. A full listing of the electives Yale offers can be obtained from that office.

Most electives are four weeks long. However, students may arrange to spend less than four weeks with a preceptor. Performance on an elective of longer than two weeks will be evaluated in the same way as required clerkship. Electives of two weeks or less use a pass/fail evaluation.

• Consult the registrar's guidelines on scheduling electives

Subinternships

A subinternship is an advanced clerkship that offers students the chance to be part of a patient-care team and with a higher level of independence and responsibility. Most subinternships are scheduled in the last few rotation months of the third year or in the fourth year.

Students must complete the required clinical clerkships in the department in which they plan to do a subinternship, but we strongly recommend that students complete most if not all required clinical clerkships before starting a subinternship.

• Consult the registrar's guidelines on arranging a subinternship

USMLE Step II

The USMLE Step II exam is divided into two parts: Step II Clinical Knowledge (Step II KC) and Step II Clinical Skills (Step II CS). Both must be taken by December 31 of the final year, but we recommend that you take them early in the fourth year immediately after finishing your clinical clerkships.

Students will go to the University of Connecticut early in their fourth year for a standardized patient exercise similar to USMLE Step II CS. This is excellent preparation for the Step II CS exam.

Passing USMLE Step I and both parts of Step II is required for graduation from Yale Medical School. The tests must be taken before December 31 so that anyone who fails has enough time to retake the test before graduation.

• Consult the registrar's guidelines on scheduling and paying for USMLE Step II

MedMentor Program

Students planning their fourth year may want to consult a MedMentor – advisors in each department who are available to help students with career decisions.