Message from the Associate Dean for CurriculumDear Students,I apologize for the long gap between updates. You will notice that we have reformatted the update to make it easier to navigate to sections of interest without having to scroll through the entire update. Clicking on the links in this paragraph will take you directly to those sections. Since our last update several important changes have been made to COVID testing protocols, isolation and close contact guidelines and masking expectations. These changes are outlined in the COVID & Vaccination Guidance section of this newsletter. The EPCC has been busy as described in the EPCC Update section. Over the last month, the committee has revised policies related to the use of students in research, STEP timelines and the move to Pass/Fail for Clerkship Grading. The Bylaws for the EPCC have been revised to enhance the representation of elected members and as part of the Medical Education Strategic Planning process the committee approved the new YSM Educational Competencies and Sub-Competencies. In the New Initiatives section, you will see information on new resources that will be provided to students to assist them in assessing their fund of knowledge prior to entering clerkships (MS2s), and for MS2s and MS3s to have access to UWorld QBanks for Step2CK board prep. You will also see a description of the Inclusive Language Initiative that is now live on the MD Program website. To get information about the ongoing activities in each of the phases of the curriculum (Pre-clerkship,Year 1, Year 2, Clerkships, and ATP) see the appropriate sections. We hope that you find this new update format more user friendly. Please feel free to provide feedback to me on the format or content of the update and if additional sections would be helpful.Finally, the suffering and challenges faced by the people of Puerto Rico and Florida because of the recent storms is heartbreaking. I hope we all can keep them in our hearts and prayers. As some of our community may have friends, relatives, and colleagues in these areas, they may also need our support. Please take a moment to let them know that they can reach out for support. In addition, everyone should be aware of the many support services available at YSM.Sincerely,Michael Schwartz, PhDCOVID on CampusYale Covid infections for the period from September 21st through October 5th are illustrated below.In the YNHH hospitalist report on October 10th: The YNHH COVID inpatient census was 70 inpatients (a decrease from 75 last week)The YNHH COVID ICU census was 8 with 3 intubatedCOVID & Vaccination GuidanceWe encourage everyone to be mindful of the risks that certain settings may pose, such as large group indoor gatherings, and to take appropriate precautions. In these settings mask as much as possible and limit your participation where many may not be masking. If you test positive for COVID or are feeling ill, you should not attend curricular sessions.Masking on CampusAs of September 26, masking will be optional in most spaces on campus and on university transit vehicles, with certain exceptions:While classroom masking is optional in most cases, given the wide range of classroom settings and configurations, individual instructors are permitted to continue to require masking in their own classrooms or instructional spaces.If individual students feel that a medical condition warrants others to be masked in an educational setting they may work with the Yale Student Accessibility Services (SAS). If SAS deems it appropriate, they may request instructors to require all students be masked as an SAS accommodation. In these cases, the student working with SAS will not be identified to the class or instructor.Individuals who choose to mask for their own safety or to protect others are free to mask in all settings. Yale does not provide masks for use in educational settings. Faculty have been requested to alert students ahead of time so that they know to bring a mask.Students are expected to have a mask available if masking is required. Symptomatic TestingStudents who develop symptoms suggestive of COVID-19 should mask and test as soon as possible, preferably with a rapid antigen test (RA test) if available. If the result of the RA test is negative, or a RA test is unavailable, individuals should test with a PCR test through the Testing Program and remain masked until the results return.Testing as soon as possible when symptoms arise is extremely important to ensure timely access to effective COVID-19 treatments.If you test positive, and are isolating off campus, follow the guidance of Yale Health which requires:Day 0 = the day you took your COVID-19 test.The duration of isolation is 7 days from the date that the positive test was collected.You may return to work/school at day 8 if you’ve had no fever for 24 hours and your symptoms are improving. Please remain masked at all times until day 10.Up-to-date information for isolating and quarantine guidance for on and off campus students can be found here.Close ContactsClose contacts do not need to quarantine following exposure. If you are a close contact you should:Test 2 times in 5 days: upon notification of exposure and 5 full days after your last close contact exposureMonitor for symptoms for 10 days. If symptoms develop, self-isolate, and schedule symptomatic testing.Observe the following recommendations for 10 days from the date of exposure:Wear a well-fitting mask when around others in their homes or in public settings.Take precautions if traveling.On-campus students may not eat in dining halls, or other indoor spaces, but may eat outside or alone. To-go dining meals are available from the dining halls. Off-campus students should restrict indoor dining (except at own residence). All social gatherings are discouraged during this period.Up-to-date information for close contacts can be found here.Flu VaccinationsIt is mandatory for all Yale Medical students to be vaccinated. This is required as part of the Community Compact for all Yale students and is required of all healthcare workers. All second-year students should have received their flu shot by September 30th as this is required to participate in your Clinical Skills Hospice Rotations that will be starting in mid-October.The deadline for all 1st, 3rd, 4th, 5th Yr. MD students and MD-PhD Students in the Lab is October 21, 2022.If you have not already done so, please review the options for getting your flu shot this year with the Find Your Flu Shot Tool and make the choice that works best for you. Check out the Yale Health’s flu page, it’s a great resource with additional information and will be updated throughout the flu season.The final flu clinic on the med school campus will be held on Friday, October 21 from 9:00 am – 3:00 pm in the Harkness Lounge/Ballroom (367 Cedar Street)To request exemption for the flu vaccine requirement, students must complete an Influenza Vaccination Medical or Religious Waiver Form and email it to firstname.lastname@example.org. A hyperlink to this form can be found on the Yale Health Flu page noted above.Up-to-date Information for Isolating and QuarantineUp-to-date information for isolating and quarantine guidance for on and off campus students can be found here. If you have questions you can communicate with the YSM Health and Safety Leaders (HSLs): Associate Deans Michael Schwartz and John FrancisReporting COVID-19 Infection from a Test Outside of the Yale Testing ProgramThose who have a documented history of a positive test or symptomatic COVID-19 disease should not, in general, be retested within 90 days of a positive testIf you test positive for COVID-19 with home tests or at non-Yale University testing centers you should submit a copy of the test and any related medical records for review to Yale Health by completing the online form*. You are also encouraged to call your Yale Health care provider to discuss treatment options.Once confirmed, if part of a required testing program, the individual will be automatically exempted from gateway and routine testing for 90 days from the date of the positive test.Individuals who are tested through one of the Yale University test sites in the Yale Testing program will automatically have their testing requirements paused for 90 days.Obtaining Rapid Antigen Test (RAT) Kits from Yale HealthAt-home test kits are covered for Yale Health members at no cost through the pharmacy benefit. To utilize this option, members are required to complete this online request form. The pharmacy will process orders so that tests can be picked up by noon the next business day. Please note that this option is largely dependent upon the availability of home test kits for purchase by Yale Health Pharmacy and may be subject to change based on stock. NOTE: This option is not available to students who waived Yale Health Hospitalization/Specialty coverage, however, tests are available for purchase at the Yale Health Pharmacy.Other COVID-19 Health and Safety RequirementCurrent information about requirements related to masking, campus visitors, travel, and other activities is available here. Students should consult this site regularly. The Yale Community Compact requires students to comply with all COVID-19 health and safety measures. COVID-related policies are subject to change based on prevailing public health conditions and guidance. Questions about these policies may be directed to Associate Deans Michael Schwartz and John Francis, the YSM Health and Safety Leaders.Educational Policy and Curriculum Committee (EPCC)The EPCC meeting on September 28th was devoted to discussing revisions to the YSM Access to Medical Students as Research Subjects and the USMLE Step Graduation Requirements policies. In addition, the committee reviewed the 2019 recommendations of the MSPE/Clinical Grading Task Force related to clerkship grading.Access to Medical Students as Research Subjects Policy: The existing policy focuses on the use of medical students as research subjects to ensure that issues of power are addressed and to consider potential student burden. The policy revision was intended to address changes in membership, to provide clarity on the materials required and process of approval, and to indicate that approval of research by the committee is not intended to imply approval to access student data that is under the stewardship of medical education.USMLE Step Graduation Requirements Policy: This policy is intended to make students aware of the expectations for taking and passing the Step 1 and Step 2CK exams to meet graduation requirements. Included in the proposed revision was a date that dual degree students must take and pass these exams by prior to entering the dual degree program. This date replaced more ambiguous guidance in the policy. In addition, the guidelines tied to the study periods for these exams were amended to reflect changing views on the importance of these exams for residency applications based upon the move of Step 1 to pass/fail. Concerns raised in the committee discussion related to the language in the guidelines and if it felt more like policy than guidance resulted in the tabling of the vote on the policy. The revised policy will be added to a future agenda after further revision addressing the concerns of some committee members. Pass/Fail Clerkship Grading: In 2018, the AAMC recommended changes to the format and composition of the MSPE that included guidance in several areas including the representation of student grades, ranking, professionalism, etc. At the same time, the YSM EPCC had devoted several sessions to looking at revising the grading rubric for assigning clerkship grades of Honors, High Pass, Pass and Fail. As the revisions of the AAMC guidance on the MSPE and the clerkship grading discussions in the EPCC were so intertwined, the Deputy Dean for Education charged a task force to research and make recommendations to the school for how to address both the MSPE guidance and YSM clerkship grading. The task force provided its recommendations to the Deputy Dean in late 2019, however due to the changing of the YSM Dean, and the COVID pandemic, the recommendations were not acted on. The current EPPC began discussions of clerkship grading using the task force recommendations, input from all students obtained through surveys distributed by the second-year class presidents, and with the addition of the knowledge gained from the temporary move for clerkship grading to pass/fail that was necessitated by changes in the learning environment due to COVID between January 2020 and December 2022. Based upon these discussions, the EPCC voted to move clerkship grading to Pass/Fail starting with the 2023 Clerkship year and going forward each year thereafter. It was also recommended that a group be formed to help think about increasing the level of formative feedback for clerkship students to ensure they are aware of their progress in meeting the YSM Competencies. The EPCC meeting on September 14th was devoted to final approval of the new YSM Competencies and Sub-competencies, revision of the EPCC Bylaws and approval of the Harassment and Mistreatment Report for the period of 1/122 to 6/30/22.YSM Competencies and Sub-competencies: The committee continued the discussion of the YSM Competencies which was begun in the EPCC meeting on August 3rd. A revision of the Competencies proposed in the August 3rd meeting was presented that addressed many of the concerns and recommendations of the committee. The new YSM Competencies were approved pending a small adjustment to one of the sub-competencies in the Professionalism Competency domain. The Competencies will be posted on the medical education website in a few weeks. Anyone wishing to see the competencies before they are posted can email me for a copy at email@example.comEPCC Bylaws: As part of the self-study in preparation for the LCME accreditation visit in October 2023 the committee was asked to review and approve a revision of the EPCC Bylaws. The revised bylaws provided additional clarification of the committee processes and recommended changes in membership to increase the voting membership for at-large faculty and to decrease the number of ex-officio voting members. Student voting membership was unchanged. After discussion, the committee voted to approve the revised Bylaws to go into effect on January 1, 2023. The revised Bylaws will be posted on the medical education website in the coming two weeks.Harassment and Mistreatment Report for the period of 1/1/22 to 6/30/22: The committee reviewed the preclerkship, clerkship, elective and subinternship Harassment, Mistreatment and Bias reports for the period of 1/1/22 to 6/30/22. Reports included student reports of Harassment, Mistreatment and Bias obtained from end of course, clerkship, and elective student evaluations. Each report required the director of the course, clerkship or elective and the relevant department chair to respond to the report characterizing the process taken to evaluate each incident and the actions taken to dress the reported incident. The role of the EPCC is to determine if the actions taken as described in the report were sufficient or if additional information or actions need to be provided. The committee voted to approve the report. New InitiativesUSMLE Comprehensive Basic Science Self-Assessment VouchersTo assist students in self assessing their knowledge readiness for the clerkship period and to allow students to assess their understanding and assimilation of the content that they have acquired in their courses, we will be providing all MS2s a token to take the USMLE Comprehensive Basic Science Self-Assessment. This self-assessment is a practice test designed for students planning to take the USMLE Step 1. It features multiple-choice questions on content typically covered during basic science medical education courses. The self-assessment is delivered through the MyNBMESM Examinee Portal.MS2s will receive an email from Susan Larkin within the coming week which will contain your voucher number and instructions for redeeming the voucher for the USMLE Comprehensive Basic Science Subject exam. MD students can use this voucher to take the exam at any time they feel it is advantageous in their preparation within a year of receiving the voucher. However, we strongly encourage MD students to use this voucher and take the exam prior to starting the Clerkships in January. MD/PhD students are required to use this voucher and must take the exam prior to December 31, 2022, as indicated in an email to second year MD/PhD students from Dr. Kazmierczak on September 22. Any questions on the MD/PhD requirement should be directed to Dr. Kazmierczak.UWorld Reimbursement for MS3 Students taking Step 2CK in 2023As indicated in an email to all current clerkship students from Deputy Dean Illuzzi on September 22nd, the YSM Alumni Fund is providing reimbursement for their purchase of the UWorld USMLE Step 2 CK Qbank with 360-Day Access ($573.24) to all students taking Step 2 during 2023. To process the reimbursement, please complete this form. You will be asked to include the date of the UWorld purchase, the date you are taking the Step2 CK exam and will be required to attach a copy of your UWorld receipt.Only students taking STEP 2 CK in 2023 are eligible for reimbursement, and reimbursements can only be processed if purchased within 365 days of the dated receipt. If you have any questions, please contact Megan Pendagast (firstname.lastname@example.org).UWorld USMLE Step 2 CK Qbank, 360-Day Access for MS2 Students Entering Clerkships, January 2023The YSM Alumni Fund is providing the funds for the school to provide all MS2 students the UWorld USMLE Step 2 CK Qbank with 360-Day Access. During the Transition Course in December 2022, MS2 students will receive a voucher that can be used to provide access to the Step 2 CK Qbank. The voucher can be redeemed at any point within one year of receiving it and once redeemed will provide 360 days of access to the Q-Bank. Features of the UWorld Qbank package can be found here.Unlike the reimbursement offer for current clerkship students, MS2 students should not purchase the package on their own as reimbursement will not be possible since the vouchers, we will provide in Transition are tied to an institutional purchase package.Inclusive Language InitiativeWe are proud to inform all students, staff and faculty of the school of medicine about the official release of theYSM Inclusive Language Initiative. The Office of Curriculum in conjunction with the Health Equity Thread are dedicated to providing an inclusive learning environment where all students, faculty, and staff feel recognized and respected. As part of this commitment, the Inclusive Language Initiative sought to provide a glossary generated by a committee of faculty, staff, students, and community partners who have aimed to provide a resource to facilitate learning across the medical school. It is also intended to provide a shared mental model for students and faculty to be able to engage in scientific and patient care discussions.Language, like science, is not static and changes as we learn more and validate our findings with others. The current glossary is intended to be a living document that will be reviewed and evaluated periodically to ensure that it continues to meet its intended mission. We encourage you to read the forward on the Inclusive Language Initiative describing the goals, philosophy, and guiding principles the committee used to create the Inclusive language Glossary. There is also a link at the bottom of the webpage for providing commenting and formative input. We are grateful to Drs. Talwalkar and Sheares for their skillful and visionary leadership of the initiative and to the many individuals that you will see acknowledged on the website for their tireless and passionate contribution to this initiative.Preclerkship CurriculumMandatory Attendance Sign InOver the last year we had suspended mandatory attendance sign in as we tried to determine a consistent process for clinical skills, mandatory trainings, and patient-based sessions in the curriculum. We have now reinstituted the sign in process for all mandatory sessions using BlueDogs. The Office of Curriculum will monitor attendance for required events. If a student anticipates missing a mandatory session due to one of the acceptable reasons, they should communicate with the Office of Curriculum in advance, when possible. In cases involving illness and unexpected emergencies, students should notify the Office of Curriculum as soon as possible. Students wishing to discuss personal reasons for absences may contact the Associate Dean for Student Affairs. If you will miss a mandatory session for to an acceptable reason you should notify your section leader and: for integrated courses contact Marion Miller. for Clinical Skills and the ILCE contact Tracy Yale.Acceptable reasons for missing mandatory sessions:Personal illness or illness in immediate family memberTo seek health-related careDeath in the familyReligious holiday observancesParticipation in a scientific conference where the student is the lead author/presenter and directly participating in the conference presentationThesis related research of critical importance when it is impossible for the activity to be conducted at any other time. In accordance with the mandatory attendance policy, all mandatory curriculum sessions are noted on the BlueDogs schedule/calendar. Students failing to sign in or missing a mandatory session will receive email reminders after each missed session and this information will be provided to the progress committee after the third unexcused absence. More details will be provided by Tracy Yale and Marion Miller in an email this week.Year 1 | Class of 2026Master and Longitudinal Course UpdateGenes and Development continues with a wrap up of genetics and the start of hematology. The self-assessment will open on Friday, October 21st, and there will be an in-class review of the self-assessment exam on the morning of Monday, October 24th. There will be a Simulation Session on the afternoon of Tuesday, October 25th. Reminder to be viewing the on-line drug development modules as part of the pharmacology thread portion of this courseProfessional Responsibility continues Wednesday afternoons.The Human Anatomy course starts on Friday, October 14th. Following a brief introduction to the course, the class will go to the Anatomy Labs and meet their donors and learn about the lab. The first lab will be on Monday, October 17th. Please check BlueDogs for instructions on how to prepare for the lab. In preparation for the first Anatomy lab, please complete the Anatomy Lab Group survey by Tuesday, October 11th.Please check the BlueDogs learning management system with the filter settings on “Preclerkship” for details of the MS1 and “Year Two” for MS2 schedules.If you have questions, concerns, or suggestions about the Pre-Clerkship curriculum, please contact the Pre-Clerkship Co-Directors Dr. Peter Takizawa and Dr. Michael DiGiovanna, or the Manager of the Preclerkship period, Marion Miller.Clinical Skills Course - MS1sAt this point, you’ve covered most of the basics related to the medical interview. You’ve learned the 5-step beginning, the “clinician-centered” middle of the interview, and the importance of discussing more sensitive content as part of the social history. In the weeks to come, you will continue to practice these skills as you work with upper-level students (October 13th, 20th and 27th). On October 20th, in addition to small-group interview practice, you will attend a large-group session where you’ll learn about ending the visit, including methods to assess that the patient has understood what you are trying to communicate. After the session on October 27th, you will submit a write-up to an upper-level student within 24 hours. Look out for details in a forthcoming email and find information about the medical write up posted to BlueDogs on October 27th.As you recently heard in Dr. Donroe’s introduction to physical exam, consider investing in your own PE equipment. All students are required to have their own stethoscopes, penlights, and reflex hammers. While the practice rooms in Harkness are equipped with otoscopes, ophthalmoscopes, and blood pressure cuffs for your use, purchasing your own equipment will expand your opportunities to practice. High quality equipment lasts for decades. To order your PE equipment, please go to www.mkamed.com. Click on Student Order Form and enter the Yale custom code: 1029ysom. The vendor’s contact information is on the website if you have any questions. The order deadline date is October 28th, and the delivery will be November 15th. If you wish to demo equipment before purchasing the vendor will be on campus on October 20th from 12-1pm in ESH 20.The required text for the physical exam portion of the course is Bates' Guide to Physical Examination and History Taking. You can purchase the 13th edition of Bates at a 30% discount using code wzp45mft on the publisher’s website. Students who have access to recent versions of the book may use those instead of purchasing the 13th edition. Copies of this book are also available in the library.If you have questions, concerns, or suggestions about the CS curriculum please contact Dr. Jaideep Talwalkar or Tracy Yale or any of your CS faculty.Interprofessional Longitudinal Clinical Experience (ILCE)There will be no clinical coaching sessions in the week of October 10th in order to prepare for Oral Presentations small group workshop sessions to take place in the following week. For the Oral Presentation workshop, all students will get their scheduled zoom sessions, prep materials, and final instructions by this upcoming weekend. Looking forward to the upcoming month, we will be having the “Taking a Substance Use History” workshop on November 4th, thus no coaching sessions will take place in the week of October 31st.If you have any questions, please feel free to email Dr. Alina Tsyrulnik, MD, ILCE Co-Director or Danette Morrison, ILCE Coordinator. We look forward to seeing you soon.Year 2 | Class of 2025Master and Longitudinal Course UpdateConnection to the World continues and the second self-assessment will open on Friday, October 14. Several sessions in the next couple of weeks will have patients. Please check BlueDogs for the dates and times of those mandatory sessions.Populations and Methods continues Wednesday afternoons.Please check the Blue Dogs learning management with the filter settings on “PreClerkship” for details of the MS1 and “Year Two” for MS2 schedules.If you have questions, concerns, or suggestions about the Pre-Clerkship curriculum, please contact the Pre-Clerkship Co-Directors Dr. Peter Takizawa and Dr. Michael DiGiovanna, or the Manager of the Pre-Clerkship, Marion Miller.Clinical Skills Course Update MS2sOn October 11th, we will discuss trauma and resilience by welcoming a survivor of child abuse into our classroom. It is critical that we help our invited guest feel safe and respected when she joins us to share intensely personal and emotional stories. For this session, please wear your white coat and mask, keep all electronics silenced and out of sight after you sign attendance in BlueDogs, and arrive to class at least 5 minutes early. We will not let latecomers in once class has started. Importantly, given the incidence of family violence, it is likely that some of you are survivors. In addition to the usual material in BlueDogs, review the email from September 12th with more details about these sessions, including support resources for students.Your Fall Rotation assignments begin the week of October18th and continue for five weeks. You will be seeing real patients during meany of these sessions, so be on time and come prepared. Check your schedule and materials posted to BlueDogs in advance as these sessions take place at various locations and times. Hospice assignments will go out this week. Please bring a mask to all Clinical Skills sessions since we will continue to follow mask requirements of the health system when patients or clinical skills practice are part of class activities.If you have questions, concerns, or suggestions about the CS curriculum please contact Dr. Jaideep Talwalkar or Tracy Yale or any of your CS faculty.Medical Coach Experience (MCE) The Medical Coach Experience has seven sessions remaining to practice your history, physical exam, oral and written presentations, and clinical reasoning skills with patients. We look forward to celebrating with you and your MCE coaches the passage of the Class of 2025 to the clinical years on December 1st from 6:00-8:00pm in Cohen Auditorium.If you have questions, please contact Dr. Barry Wu or Tracy Yale.Transition CourseThe last week of instruction prior to the winter break and the start of your clerkship year will include the Transitions course. The course begins the weekend of October 15th and 16th with ACLS training. The course resumes the week of December 12th. Topics that will be covered will help to prepare you to transition into the clerkships. Some of the sessions are mandatory, including a couple on the last day of the course December 16th. Thus, for travel planning purposes, please expect to not be able to leave New Haven until 5pm on that last day. The final schedule for the Transitions course is now posted in BlueDogs.Preparation for Clerkship YearIn preparation for the second phase of the curriculum, the “Integrated Clerkship Year”, the Office of Student Affairs will be having an in-person, Clerkship Information Meeting on Thursday, October 13th in SHM L-115.4:00 pm – 5:00 pm Clerkship Information Meeting (All second year MD & MD-PhD students) - Hosted by Dr. David Hersh, Director of Clerkships5:00 pm – 5:30 pm MD-PhD Clerkship Information Meeting (Second Year MD/PhD students) - Hosted by Dr. Tamar Taddei, Associate Program Director, MD-PhD ProgramTopics of Discussion: Introduction to the integrated clerkship curriculum, clerkship preference entry process, important policies, student assessment in the clerkships, clerkship precedes, etc. Registration via YaleConnect (CampusGroups) or contact Terri Tolson.If you have any questions about the Transition or the clerkship period, please contact Dr. David Hersh or Gina Franco.Clerkship YearImportant Information About Clerkship SchedulesThe clerkship year will culminate on December 16th with post-cede activities for each of the clerkships. These activities are mandatory. Please do not arrange to travel out of town until after 5pm unless you have heard directly from the clerkship leadership that the day will end earlier.The deadline for requesting time away from the clerkships during the current clerkship block to attend a research conference has passed. Such a request at this time will be denied unless there are extenuating circumstances. If a student feels that their situation meets that threshold, they should complete and submit the Request to attend Conference Form to Gina Franco and include the reason for the late request.Thank you to those of you who have already volunteered to teach during the upcoming Transitions course for the students in the class of 2025 during the week of December 12th. We still have openings for “Day in the Life of…” and EPIC training sessions. Please let Gina Franco and Dr. Hersh know if you are interested in helping.If you have any questions about the Clerkship period, please contact Dr. David Hersh or the Manager of the Clerkships and ATP, Gina Franco.Advanced Training PeriodPeer/Student Feedback on Electives and SubinternshipsIn the Box collection of peer student feedback regarding electives and subinternships, there are student reviews of their experiences on specific electives and subinternships and a file with electives/subinternships that directors feel are helpful in learning skills related to pursuing their specialty as a career choice has been added. The materials in this folder will be updated 1-2 times per year so that anonymity may be preserved. Additionally, we are working with the surgical sub-I directors to create concurrent electives that offer more experiences for career exploration and learning prior to committing to a subinternship.Allowable electives and subinternships during the ATP:SubinternshipsNo more than a total of three subinternships are allowed in the same specialty.Most students who choose to do three sub-I’s in the same field will do 1 at Yale and 2 at away institutions.Keep in mind that it’s important to complete one of the sub-I’s at Yale to receive clinical assessment and support from your home institution.Most medical schools throughout the country participate as host institutions in VSLO but there are a very small percentage who are not participants. Should you select to complete a sub-I at a non-VSLO institution, that sub-I will count towards 1 of the 3 sub-I’s in the same specialty, including sub-I’s completed internationally.ElectivesStudents can take an unlimited number of electives.There are no restrictions on the total number of electives to take in any specialty.Electives can be completed at Yale or at a VSLO host institution or non-VSLO away institution.Capstone CourseA reminder to all students anticipating graduating in 2023, the Capstone course will be from February 27th to March 24th. Attendance at Capstone sessions is mandatory, and you should anticipate needing to be in New Haven during this period. The Capstone course is designed to provide a review of important topics prior to starting your internship. It includes common scenarios in the simulation center as well as boot camps in the various specialties.If you have any r questions about the Capstone course please contact the course directors, Dr. Barry J. Wu and Dr. Oluwatosin Adeyemo or the course coordinator, A Gould.If you have any curricular questions about the Advanced Training Period, please contact Dr. Rachel Liu or Gina Franco.You should also feel free to reach out to Dean Francis, your academic advisor, or a student affairs staff member with any questions about your requirements or schedule during the ATP.