Fourth Year

*To continue delivering forward-thinking and innovative programming, Icahn Mount Sinai is launching a re-envisioned curriculum.  

ASCEND, the new MD Program curricular name, will debut during the 2024 academic year. For more details, visit our Change Now website.

The Year 4 curriculum at the Icahn School of Medicine at Mount Sinai (ISMMS) prepares students for residency training through experiences designed to promote advanced knowledge and skill development in an individualized manner. The year offers ample elective time for senior students to design a course of study that is both personalized and defining.

Innovative opportunities in the Year 4 curriculum include:

  • Sub-internship options in a variety of fields
  • Core competency training in economics and law in medicine, teaching skills, and leadership in health care
  • Specialty-specific skills-based preparation for supervised practice in residency
  • Medical Student Research Day to showcase student research and scholarship
  • Opportunities to graduate with "Distinction in Research," "Distinction in Medical Education” and/or “Distinction in Global Health”


Sub-Internship in Medicine, Pediatrics, Obstetrics and Gynecology, or Surgery: As a fourth year student, you chose and complete one of four sub-internships. The four-week sub-internship provides senior students with increasing responsibility for patient care and an opportunity to function as a more fully integrated member of the medical team on the inpatient services. You render direct patient care and assume all the responsibilities of an intern with a reduced load. The sub-intern works directly under the resident and/or fellow and is responsible for discussing all care issues with the house staff on a daily basis. The sub-intern also works closely with the service attending.

Sub-internships include:

Emergency Medicine This four-week clerkship helps students improve their evaluation and presentation skills and practice medical decision-making under the supervision of emergency medicine faculty. Clinical experiences in the Emergency Department allow students to evaluate patients of all ages with acute, urgent, and critical complaints; develop their procedural skills; and apply evidence-based medicine principles to plan appropriate diagnostic strategies and therapy.

Introduction to Internship This two-week clerkship focuses on developing skills for internship. Topics include acute management issues and advanced communication and procedural skills. Teaching modalities include small-group sessions, evidence-based medicine exercises, and simulator encounters. The clerkship is offered in the second semester of the fourth year.

InFocus 8

InFocus weeks are innovative and immersive courses taught through all four years of the ISMMS program. They provide core curricula in topics critical to medical practice and biomedical research in the 21st century. During these weeks students have no other class obligations. In Year 4, the two-week InFocus block focuses on leadership, teaching skills, and the economics and law of medicine. Year 4 students join together for small-group sessions, team-based activities, and interactive discussions. Scheduled during the first two weeks of March, this session encompasses the Medical Student Research Day and concludes with Match Day.

The core curriculum focuses on the following topics:

  • Leadership in Health Care
    This core leadership skill-building curriculum is designed to provide competency in navigating and implementing reform in a complex health care system through self-reflection on leadership qualities and barriers to effective leadership, effective communication and multi-disciplinary cooperation, conflict management and negotiation, and vision development.
  • Teaching Skills
    This InFocus theme provides a comprehensive foundation in the principles of practical teaching techniques. Students participate in small-group workshops about learning theories and effective teaching techniques, and practice their skills.
  • Economics and Law of Medicine
    These sessions introduce you to core concepts in health care economics and law. Through interactive discussions and presentations, you explore funding, payer systems, health reform, and financial management. You learn from legal experts to support your understanding of the regulatory aspects of medicine, medical malpractice, intellectual property, and litigation and licensure.


Electives facilitate self-directed learning and encourage students to experience new opportunities and explore career options. Students have a generous 18 weeks of elective time in Year 4. For more information, please visit Electives and Experiences.