Office of Medical Education

Fourth Year Course Catalog
2011-2012
Fourth Year Policies and Procedures

Prerequisites
Off-Sites
Area Health Education Centers (AHEC)
Extramurals
Residency Interview Period
United States Medical Licensing Examination (USMLE)
Acting Internships
Medical Records/Orders
Acting Intern Orders
Vacation Month
Professionalism
COM Policy on Duty Hours
Official Time Away from Clinical Rotations

Prerequisites
The latitude given a student in choosing fourth-year clerkships is dependent on performance during previous years. The description of each clerkship includes a listing of prerequisites.

Please be aware of the following stipulations:

1. Any student who receives an "Unsatisfactory" grade (U or E) in a third-year clerkship, or for any reason has not completed third-year clerkships, shall not be promoted to the fourth year until the deficiency has been rectified to the satisfaction of the Student Progress and Promotion Committee and the department involved. Repetition or completion of one or more third-year clerkships at the normal beginning of the fourth year does not alter the required number of credits which must be acquired as a fourth-year student.
2. When a student has achieved only minimal performance on a third-year clerkship, a department may recommend to the SPPC that the student include a particular clerkship in fourth-year work.
3. Any student who needs to complete third-year rotations must do so before starting any fourth-year rotations.

Off-sites
An off‑site course is a University of Kentucky course which a student takes away from the tertiary care center, often in a private practitioner's office. The site must be within the state of Kentucky and the student must be supervised by a preceptor who is a member of the College of Medicine volunteer faculty and is not related to the student.

Beginning on May 24, students who have signed up for off-site rotations will be given an opportunity to select from among available preceptors. This process is administered by the departments with the assistance of the registrar. You will be informed via e-mail of the particulars of this process.

Important Note #1: You must submit a Preceptor Assignment Form to the department at least two months prior to the start of your scheduled off-site rotation for fall, no later than the end of December for spring. Some departments may require earlier submission of your request form. The list of preceptors and the request form will be posted on the Student Affairs website and the link will be provided via e-mail on May 24.

Important Note #2: A student must never make direct contact with a physician or a regional AHEC office regarding a rotation unless specifically directed to do so by the department. All communications regarding preceptor placement need to go through the departmental education coordinators (course contacts.)

Area Health Education Centers
The Area Health Education Center program combines the resources of carefully selected community hospitals and physicians engaged in the private practice of medicine to provide rotations for senior medical students. These rotations enable the student to receive a portion of their education in a setting other than that of the University Medical Center in Lexington. All physicians are volunteer community faculty members in appropriate College of Medicine departments. Students select a practice in the specialty and location of their choice for a period of four weeks. During this time the student resides in the community and is instructed and supervised by a physician preceptor. (Travel, housing and meal stipends are typically provided. Some restrictions apply.) This rotation allows the student to experience life in a smaller Kentucky community, participate with a great deal of flexibility and autonomy in delivering medical care in a private practice setting, and benefit from a one-to-one teaching relationship with a qualified and interested voluntary clinical faculty member. Rotations are available in numerous specialties and sites statewide. Each student who does an off-site rotation must submit the AHEC Fact Sheet to the AHEC office at UK at least one month prior to the start of the rotation. The form is available on the AHEC website (http://www.mc.uky.edu/ahec/Students.htm). This form is required to document your rotation and to provide you with reimbursement for some expenses.

Extramurals
An extramural is a clinical rotation done outside of Kentucky and administered by a medical school or residency program other than UKCOM. (Rotations in Louisville done through the University of Louisville and in Northern Kentucky done through the University of Cincinnati are also considered extramurals.) Extramurals are also commonly referred to as visiting student rotations. Extramural clerkships are primarily for students who have shown strong past academic performance. Approval will be limited to three clerkship periods or four periods for students who chose forfeit their available vacation time. Each extramural must be four weeks long, no exceptions.

Students on extramural rotations at other medical schools or programs need to abide by all policies of the host programs, including the absence policies.

Planning an extramural requires an early start and diligence with regards to paperwork and follow-through:

1. Identify institutions that offer extramurals that you would like to apply for. The Extramural Electives Compendium on the AAMC site (http://www.aamc.org/students/medstudents/electives/start.htm) provides a starting place, though the list may be incomplete and the information somewhat dated. Many residency programs also offer extramurals. Residency programs can be researched by specialty and location in the AMA’s Frieda Online. The majority of medical schools and many teaching hospitals are now using VSAS (see #3 below) for extramural applications, and their information is easily found there.
2. Look online for visiting student policies and processes for those institutions in which you are interested. Only make direct contact if you are unable to find the needed information online or if you have specific questions.
3. Applications for extramurals may be done in two ways, depending on the requirements of the host program:


1. Many medical school and a number of teaching hospitals require that students apply through the AAMC’s Visiting Student Application System (VSAS). That system is accessed online at www.aamc.org/programs/vsas/. All students in the class will be given access and authorizations to apply for rotations through VSAS. You will need to inform the registrar if and when you would like your photo and/or transcript uploaded to VSAS.
2. For programs that are not using VSAS, review the online application information to familiarize yourself with the documentation that will be required. Pay special attention to requirements for immunizations, titers, background checks, drug screens, or other requirements that may require follow-up and expense on your part. Print a course/clerkship description to attached to your approval form (see #4).


4. Download an Extramural Clerkship Approval Form.
5. An extramural clerkship must be approved by the designated departmental representative from UK before any certification of your eligibility can be provided. This is the document that allows you to receive academic credit for the rotation. For extramurals that do not require COM certification (such as military rotations,) the signed approval form must be turned in to the registrar prior to the start of the extramural rotation. Your Extramural Clerkship Approval Form with attached clerkship description must be signed by the appropriate faculty member listed (e-mailed approval from the faculty member is also acceptable:
   

6. An affiliation agreement must be in place between the College of Medicine and any extramural site which is not part of an AMA-accredited medical school or residency program. If you are planning such an extramural, including any international extramural, contact the registrar in ample time to allow for arrangements that will include multiple levels of institutional approval. This process may take more than six months.
7. Notify the registrar as soon as you have been accepted for an extramural that you plan to do. She will update your registration to reflect the specific rotation and institution. If you decide to decline an extramural for which you have been accepted, notify the institution immediately and no later than one month prior to the beginning of the rotation.
8. The registrar will provide you with an evaluation/grade form and instructions before you leave for your extramural. It is your responsibility to be sure that a completed evaluation with a final letter grade is returned so that academic credit can be awarded.

Residency Interview Period
In an effort to provide flexibility to students for residency interviews, the fifth period of the fourth-year curriculum covers six weeks.  Student may register for a clerkship which will be offered for four weeks between November 22, 2010 and December 31, 2010.  Departments will specify which four of the six weeks they will offer the course, but it is almost always the first four weeks.  The remaining two weeks are to be used for winter break and residency interviews.

Any additional interview leave must be approved by the course director and is subject to her/his discretion.

Students should recognize that the majority of their residency interviews will take place during Periods 4, 5 and 6. With that in mind, students should carefully plan their schedules to include as much flexibility as possible during these periods. Students should avoid scheduling Acting Internships during these periods, if possible (see Acting Internships below).

United States Medical Licensing Examination
Passing scores on USMLE Step 2-CK and Step 2-CS are required for graduation. Students are expected to register for both exams by September 1 at the latest, and are required to take both examinations by December 31. Students may take USMLE Step 2-CK and Step 2-CS in whatever sequence they like as long as both examinations have been completed by December 31. Failure to register for the exams in time to obtain test dates before the end of the calendar year will not constitute grounds for deadline extensions and may result in sanctions as determined by the Student Progress and Promotions Committee.

Students will not be required to be on call the night prior to the exam and are relieved of rotation responsibilities on the day of the examination. You must notify the Student Affairs office and your course director of your scheduled date at least four weeks prior to the test.

Acting Internships
 Some require special permission of the department as detailed in the course descriptions.  Also note that since acting interns take the place of interns, special duties and responsibilities are assigned and may involve extended rotation dates (Acting Internships may end on the final Sunday of a rotation period as opposed to Friday.)  Try to schedule AI rotations in the months where you will not have interruptions for interviews, USMLE exams, etc., as your attendance is imperative.  Additionally, once an AI is scheduled, the course director may not be able to allow students to drop the course or to change rotation dates.

Medical Records/Orders
Much information in patient charts is written by medical students.  Make sure that you identify yourself as an M4 in the chart.  If you are participating as an acting intern, you should sign the chart as such.  Orders can only be written by licensed physicians, thus any M4 order must be co‑signed by the intern, resident or attending before its implementation.

Acting Intern Orders
Selected senior students may be approved to be acting interns by certain departments.  All students so selected will wear readily visible identification badges during performance of their responsibilities.
 
Acting interns may write orders for patients in general patient care areas.  Acting interns are not authorized to give verbal or telephone orders, or to write orders in critical care units.  All orders written by acting interns must be reviewed and co-signed by the supervising resident or attending physician before those orders are implemented.

The Chief of Staff’s Office will monitor acting intern orders.  Violations may result in but are not limited to the following sanctions: revocation of the acting intern’s order-writing privileges, affect on the acting intern’s grade, and/or other sanctions.

At the VA Medical Center, acting intern orders must be countersigned before they are picked up and acted upon.

Vacation Month
With few exceptions, each senior will have one month of vacation. Students should carefully consider how to best use this month in scheduling their fourth year. Examples include the following:

• Period 1: Allows time to take USMLE Step 2 exams, begin to work on residency applications or to have a break after third year.
• Period 4: Allows time for residency interviews that generally begin during this period.
• Period 5: Allows additional time for residency interviews without clinical responsibilities.
• Period 6: Allows time for residency interviews that are scheduled during this period.
• Period 9: Allows time after the Match for those students moving away for residency to look for a home and prepare to move.

The vacation month may be sacrificed for those students wishing to do an additional extramural rotation or other elective in their fourth year.

The vacation month may be used between Periods 1-5 to prepare for and/or take either or both USMLE Step 2 examinations as long as the strict December 31 deadline is still met.

Professionalism
At all times in the fourth year, students will be expected to act in a professional manner in their interactions with patients and their families, faculty, residents, staff and other students. As such, students must abide by all applicable policies and regulations governing professional behavior including but not limited to the following policies (available on the Student Affairs web site):

• Professional Behavior Code
• Behavioral Standards in Patient Care
• Health Science Student Professional Behavior Code
• U.K. Student Rights and Responsibilities
• H.I.P.A.A. (Health Insurance Portability and Accountability Act)

Policy on Duty Hours
The College of Medicine follows the ACGME guidelines on duty hours, namely that:

1. Medical students are to have on average of one day out of every seven days free from clinical duties.
2. Medical students are never to work more than 80 hours per week.
3. Duty periods for medical students cannot last for more than 24 hours although a student may need to stay a few hours longer than the allowed 24 hours in order to maintain continuity of patient care. Every effort should be made by the student’s resident to get the medical student out of the hospital post-call.

If a student finds that her/his rotation is not in compliance with these guidelines, the student should alert the course director and the assistant dean for Student Affairs right away so they can follow up on this issue.

Official Time Away from Clinical Rotations
Students on outpatient clinic rotations typically have weekends free.  On these rotations, students are allowed up to a maximum of two days off per four-week rotation for official use. Students may use these two days for interviewing or taking USMLE Step 2CK or 2CS.

Students on acting internships have increased patient responsibilities and are expected to be at the hospital more than students on outpatient rotations. Acting internship rotations must still comply with the COM policy on duty hours as listed above. Students on acting internships are therefore allowed four days off per 4-week rotation for official use. Students may use these four days for interviewing and/or taking Step 2-CK or CS. Students are not, however, encouraged to schedule interviews while on acting internships due to the increased patient care responsibilities.

If you have more than 2 excused absences during an outpatient rotation, or more than 4 excused absences during inpatient rotation/acting internship, you may be required by your attending and/or course director to make up those additional excused absences. The rationale for this is that there is a College of Medicine policy regarding the minimum number of days that must be completed in order for you to receive credit for the rotation.

Goals Of The Fourth Year Program
Graduation Requirements
Course Scheduling
Fourth-Year Policies and Procedures
Key Dates
Course Catalog