Year 3 and 4 Policies and Procedures

All students are required to take USMLE Step 1 prior to InFocus 5 (the start of Year 3) unless permission for a deferral has been granted by Student Affairs.  If a student is unable to pass this examination on the first attempt, s/he will be in Monitored Academic Status and removed from the clerkship setting at an appropriate interval and cannot sit for any Shelf Exams until a passing score is recorded on Step 1. Student Affairs will help the student develop an individualized plan for studying and retaking the exam. If the student fails the exam a second time s/he will be placed in Serious Academic Status and must appear before the Promotions Committee which will approve a plan for remediation. If the student is unable to pass Step 1 on the third attempt by the following June, s/he will be dismissed. In addition:

• Students must be in compliance with all Student Health and affiliate site requirements before beginning clerkships.
• Students may plan their schedule to incorporate elective time during their third year (see guidelines for away electives listed below as well as section on Year 3 and 4 Electives)
• There will be no elective credit for studying for the boards after a failure on USMLE Step 1.
• There will be no elective credit for repeating clinical portions of failed clerkships.

Scheduling of the year 3 clerkships is done through a lottery process. In the spring of the second year of medical school, the 3^rd year clerkship directors present to the students with all of the required clerkship clinical site options and advantages of working at each site. Students are then introduced to the lottery process by the registrar, which is the way in which the students can rank their selections by the site they prefer and the order in which they prefer to take the clerkships in 3^rd year.

Immediately following this informational meeting, in the spring of year 2, the students have one week to complete their preferences before the registrar runs the lottery and fills in the maximum spaces allowed by each site for each rotation. Once the results of the lottery are posted to the students, they have a 10 day one-to-one switch period, in which they can work with another student to switch schedules or clinical sites without the knowledge of the clerkship directors. The one-to-one switches are managed through the registrar’s office. Once the 10 days are over, the registrar publishes the final schedules and any changes that are made subsequently must go through the Clerkship Change Form process, which involves getting the clerkship director’s approval.

Scheduling of the year 4 clerkships is done through a lottery process, similar to that of year 3. Student must submit their preferences to the registrar in the spring of year 3 to obtain a schedule of their required clerkships and requirements.

RELEVANT LCME STANDARDS:

10.9: Student Assignment
5.10: Transfer/Visiting Students

PURPOSE AND SCOPE:

To outline responsibility for and the process of assignment of students to learning experiences and responding to requests for change.

POLICY:

Clerkship and Clerkship Site Assignments

1. Clerkship and Clerkship Site Assignments are made through the Year 3 and Year 4 Lottery processes organized and overseen by the Registrar.
2. Students rank their selections by the site they prefer, and the order in which they prefer to take the clerkships in Year 3 and Year 4.
3. Students have the opportunity to do one-to-one switches with other students 10 days after the lottery.
4. Final decisions for the site assignments are made by the Registrar who references the the number of allowed students per site, as provided by the clerkship directors.
5. Students who require a schedule to accommodate a major life event must fill out a Special Schedule Request Form during the lottery process which allows them to determine the order of their schedule based on their needs. Requests are sent to the Office of Student Affairs who reviews and approves the request. The Registrar lets the student know of the decision and provides any special instructions for the lottery process.

Clerkship and Clerkship Site Changes

1. Students are notified about the Clinical Clerkship Change process during the Year 3 and 4 Lottery meetings and during each clerkship orientation.
2. Changes are allowed, on a first-come first-serve basis, up to 4 weeks before the start date, if there in room in the clerkship
3. Availability is determined by the clerkship director(s).
4. The Clinical Clerkship Change Form (signed by the Clerkship Director(s) when approved) must be submitted to the Registrar’s Office no less than 4 weeks prior to the start of the clerkship.
5. Failure to abide by this deadline can result in the change request not being processed and delay EMR access.
6. The criteria considered in evaluating the requests are availability within each clerkship and clinical site. These criteria are reviewed and approved by the clerkship director, registrar, and compliance team. Once approved, the student’s schedule is updated in the Student Information System.
7. CLERKSHIP SITE COMPLIANCE REQUIREMENTS: If a student is switching to a clerkship that is scheduled at MS Beth Israel, MS Brooklyn, MS St. Luke’s, MS West, Bronx Lebanon, the Bronx VA, or Elmhurst, students are responsible for ensuring they have met the compliance requirements of that site.

Visiting Students

1. ISMMS students get priority in enrolling in electives across the health system prior to visiting student enrollment in these electives. Electives are not available for scheduling for visiting students until ISMMS Year 4 students have been allowed a chance to register.
2. ISMMS students are given priority over visiting students should there be an unexpected change in schedules during electives.

PROCEDURE:

1. Students are introduced by the Registrar to the 3rd year lottery process in February of Year 2 and to the 4th year lottery in January of Year 3. 
2. Students rank their selections by the site they prefer, and the order in which they prefer to take the clerkships in 3^rd year. Students have one week to complete their preferences before the registrar runs the lottery and fills in the maximum spaces allowed by each site for each rotation.
3. Students who wish to request a Special Schedule Request must submit the Special Schedule Request Form by the due date during the Year 3 or Year 4 Lottery in order for it to be considered.
4. Students have a 10 day one-to-one switch period, in which they can work with another student to switch schedules or clinical sites to allow ease of switching without the knowledge of the clerkship directors. The one-to-one switches are managed through the Registrar’s Office.
5. Once the 10 day one-to-one switch period is over, the Registrar publishes the final schedule (in March of Year 2).
6. Students are notified about the Clinical Clerkship Change process during the Year 3 and 4 Lottery meetings and during each clerkship orientation.
7. Any changes subsequent to this must go through the Clinical Clerkship Change Form process, as described above.

ACCOUNTABLE DEAN OR DIRECTOR: Senior Associate Dean for Undergraduate Medical Education and Student Affairs and Senior Associate Dean for Undergraduate Medical Education and Curricular Affairs

REVIEWED BY: Clinical Curriculum Committee, Registrar’s Office, Office of Student Affairs

APPROVED BY: Curriculum Steering Committee

DATE APPROVED: January 16, 2019

Flextime in year 3 is ½ a day off per 4 weeks of required clerkship time. Flextime in year 4 is the one week after Match Day where no required clerkships will run. Students can see in advance what the Flextime days are in each clerkship by looking at the Clerkship Information Sheet in the clerkship’s Blackboard course or their class organization under Resources for Years 3 and 4.

RELEVANT LCME STANDARDS:

9.1 Preparation of Resident and Non-Faculty Instructors

9.3 Clinical Supervision of Medical Students

PURPOSE AND SCOPE: This policy applies to individuals who supervise medical students across all courses and clerkships at all training sites. The purpose of this policy is to ensure that the school adheres to expectations that protect patients and ensure student safety, and to describe the mandatory training, teaching, and assessment skills required to be a medical student supervisor.

Appropriate supervision ensures that medical students are provided with opportunities to learn that are progressive and commensurate with the student’s level of training and in accordance with the supervisor’s level of training and specialization.

Supervisors in the Clinical Setting

A supervisor has the capacity to allow a learner to receive progressive responsibility for patient care. Examples of possible supervisors include:

• Attending Physician of The Mount Sinai Health System and/or its affiliate training sites
• Teaching Physician in the outpatient environment of The Mount Sinai Health System and/or its affiliate training sites
• Resident Physician, Intern, or Fellow in a Graduate Medical Education (GME) program of The Mount Sinai Health System and /or its affiliate training sites
• Allied health professionals, such as Nurses, Physician Assistants, Nurse Practitioners, Social Workers, etc. of The Mount Sinai Health System and/or its affiliate training sites
• Direct Supervision: The supervisor is physically present in the same location as the learner; able to provide direct instruction/feedback to the learner; able to take over patient care duties if and when necessary.
• Indirect Supervision: The supervisor may not be physically present with the learner; however, they are on-duty, immediately available, and can be called to the physical location of the learner if and when necessary. 

Levels of Supervision – Direct vs. Indirect

The limitations for the requirements of proximity and timing of supervision, as well as the specific tasks that a student may perform without direct supervision depends on various factors, including:

• the level of training (i.e. year in medical school);
• the skill and experience of the student within the scope of the clinical care situation;
• the familiarity of the supervisor with the student’s skills;
• the acuity of the situation and the degree of risk to the patient.

Clinical Supervision – General Guidelines

• In the clinical setting (in-patient or out-patient), Year 1 and 2 medical students are under both direct and indirect supervision and are engaged in low acuity situations (for example, conducting a history on a patient), while medical students in Years 3 and 4 are primarily under indirect supervision. It should be noted that in any instance, the supervisor should always be available.
• the course/clerkship/site director will determine who can supervise the medical student, such as fellows, residents, and/or appropriately credentialed allied healthcare providers.
• All medical students, during the course of their educational curriculum, may conduct medical interviews and perform physical examinations on patients with their consent.
• The supervisor will review all of the medical student’s documentation in a patient’s medical record and provide correction to the record and feedback to the student for educational purposes.
• Clinical decisions and orders are never formulated or enacted by medical students without a supervisor’s input. Student documentation of the components of evaluation and management within a patient’s record must be verified by the supervisor before they are considered a part of the patient’s record.

The above guidelines are applicable to all clinical experiences where medical students participate.

Procedure Supervision - General Guidelines 

• Medical students may be assigned to provide patient care services for medical procedures, under direct supervision.
• It is required that a medical student be appropriately directly supervisedduring all clinical procedures in which they are involved; including, but not limited to bedside, emergency department, and/or operating room procedures. 
• The degree of supervision needed will take into account: the complexity of the procedure, the stability of the patient, potential for adverse effects, and the demonstrated competence, and responsibility of each student in order to ensure the safety and comfort of the patient and the student.
• In all cases, the supervisor must have privilege or authorization to perform the procedure in which they are supervising.

How ISMMS Monitors Supervision

Any students with concerns about the adequacy and availability of supervision they are receiving are encouraged to address their concerns as soon as possible.

Students report on the adequacy and availability of supervision during mid-rotation check-in meetings and via end of course/clerkship evaluations and questionnaires. Students are instructed to contact their Site and/or Course or Clerkship Director regarding any immediate concerns with supervision. Additionally, reports can be made to the Medical Student Confidential Compliance Hotline, as well as to the UME Clinical Coordinator for Clinical Sites, within the Department of Medical Education.

Course and Clerkship Directors review student feedback in evaluations, as well as during mid-rotation feedback, and provide prompt follow-up to address any supervision concerns that may arise.

The Clinical Curriculum Committee reviews data on an ongoing basis to identify any ongoing trends of supervision concerns being reported.

PROCEDURE:

1. Students report on the adequacy and availability of supervision during mid-rotation check-in meetings and via end of course/clerkship evaluations and questionnaires. Students are instructed to contact their Site and/or Course or Clerkship Director regarding any immediate concerns with supervision. Additionally, reports can be made to the Medical Student Confidential Compliance Hotline, as well as to the UME Clinical Coordinator for Clinical Sites, within the Department of Medical Education.
2. Course and Clerkship Directors review student feedback in evaluations, as well as during mid-rotation feedback, and provide prompt follow-up to address any supervision concerns that may arise.
3. The Clinical Curriculum Committee reviews data on an ongoing basis to identify any ongoing trends of supervision concerns being reported.

ACCOUNTABLE DEAN OR DIRECTOR: Co-Directors of the Curriculum and Senior Associate Dean for Undergraduate Medical Education and Curricular Affairs

REVIEWED BY: Clinical Curriculum Committee. Office of Graduate Medical Education

APPROVED BY: Curriculum Steering Committee

DATE APPROVED: January 16, 2018

Clerkship Directors disseminate the work hours policy to clerkship faculty and house staff at Mount Sinai and affiliates. The policy is outlined below and is also noted on the clerkship cards. Site evaluations allow students to share their experiences related to work hours. Medical Education reviews the evaluations on a quarterly basis to determine compliance with the work hours policy. Feedback is then provided to the clerkships.

• If a student is required to be on overnight call, then the student is required to be off duty by 9 am the next morning
• If no overnight call is required on the clerkship, then evening call ends at 9 pm and the student is expected to return the next morning (no earlier than 5 am on any service)
• In hospital on-call frequency: no more than every third night
• Minimum time off between duty hours: must have eight hours off between shifts including after a 24-hour shift.
• Students are expected to attend to clerkship duties on the day before their Shelf Exam. Clerkship duties should end no later than 5 pm on that day.

Students must attain competency in certain required procedures prior to completion of medical school. The attainment of proficiency in skills is crucial to a student’s ability to function as a successful intern. Students must be provided direct supervision of procedures until proficiency can be demonstrated. There are certain procedures that students cannot do without direct supervision.

There are two (2) categories of procedures:

1. Required Procedures: “Required Procedures” are those for which all students much achieve competency in order to graduate. Students must do each procedure three times under direct supervision and log each time in the Electronic Diagnosis and Procedure Tracker (PXDX).
2. Suggested Procedures: “Suggested Procedures” are those procedures for which we recommend that students attain proficiency, but are not required for graduation.

Required Procedures	Venipuncture IV placement NG tube insertion Urethral Catheterization of male patient Urethral Catheterization of female patient
Suggested Procedures	EKG Intradermal skin testing Removal of urethral catheter from male patient Removal of urethral catheter from female patient Dressing changes Suture removal Throat cultures

Documenting Procedures in Clinical Skills

It is expected that students will attain competency for the procedures during third-year clerkships. However, students must complete their required procedures by the end of their fourth year in order to graduate. The requirement is for each student to perform each procedure under supervision at least three times. The Emergency Medicine Clerkship, as well as the Sub Internship Clerkships provide ample opportunities for students to perform procedures that they are unable to complete during the third year.

RELEVANT LCME STANDARDS:

9.7: Formative Assessment and Feedback
8.6: Completion of Core Experiences

PURPOSE AND SCOPE:

Must-See Diagnoses are required core experiences. Completion of the Must-See Diagnoses for a clerkship is a joint obligation between the student, the student’s clinical instructors, and the clerkship/site director. The process of reviewing the experiences periodically may also provide students and supervisors opportunities to give and receive feedback about the clerkship. In order to ensure that students have adequate exposure to a variety of specialty-relevant presenting complaints and to comply with LCME guidelines, students are must-see to log certain diagnoses into our web-supported tracking system. Must-See Diagnoses logging is intended to help students meet educational goals of the clerkship.

POLICY:

1. Clerkships will establish and publish a list of Must-See Diagnoses (Dx) that students must complete to meet clerkship requirements. Each must-see diagnosis is associated with a clinical setting (ambulatory vs. inpatient) and a level of student responsibility.
2. Must-See diagnoses are reviewed annually by the Clinical Curriculum Committee to ensure relevance. The clerkship’s Must-See Diagnoses list can be found on the back of the Clerkship Cards handed out on the first day of each clerkship and in the MedInfo app, and students should enter their exposures to these diagnoses in an on-going fashion throughout the clinical years.
3. Students are also to enter their role with the patient for each specified diagnosis. Diagnoses Roles are: Interviewer, Examiner, Assessment/Plan Developer; Interviewer and Examiner; Interviewer and A/P Developer; Examiner and A/P Developer; Interviewer, Examiner and A/P Developer. The CCC has agreed that the minimum requirement for each must-see diagnosis seen in a patient encounter should at least be at the level of Interviewer.

• • Interviewer – The student has the primary responsibility of actively gathering any patient-related historical information
  • Examiner - The student has the primary responsibility of actively performing a focused or full physical examination on a patient
  • A/P Developer - The student has the primary responsibility of synthesizing patient-related information to generate a general working diagnosis and/or an initial diagnostic and/or management/therapeutic plan. This includes participation in activities that achieves the same purpose such as work rounds and preceptor-led sessions
  • Interviewer and Examiner – combined definitions from above
  • Interviewer and A/P Developer – combined definitions from above
  • Examiner and A/P Developer – combined definitions from above
  • Interviewer, Examiner and A/P Developer – combination of the 3 definitions above

1. Mid-way through each clerkship students will meet with the Clerkship Director or another supervising physician and should print a copy of the Diagnosis Summary report to bring to this meeting.
2. Each clerkship must have mid-clerkship feedback session with each student in order to check with students for outstanding Must-See Diagnoses (Dx) prior to the completion of the rotation as well as a set of alternate strategies for completing Must-See Diagnoses in the event that the student cannot complete them.

PROCEDURE:

1. Students must log their Must-See Diagnoses (Dx) in One45 in an ongoing manner throughout the clerkship based on clerkship requirements.
2. Each student should discuss any outstanding Must-See Diagnoses (Dx) with the supervising attendings and residents along the way during the rotation, and with the site director. If a student is unlikely to accomplish all of the Must-See Diagnoses (Dx) through patient care experiences, despite best efforts, the student and site/course director should discuss alternate ways of learning that material.
3. Alternative activities will be scheduled on an individualized basis, based on the likelihood of the student getting the Must-See Diagnoses (Dx) during their time remaining in the rotation.

ACCOUNTABLE DEAN OR DIRECTOR: Co-Directors of the Curriculum, Senior Associate Dean for Undergraduate Medical Education and Curricular Affairs

REVIEWED BY: Curriculum Steering Committee, Clinical Curriculum Committee

APPROVED BY: Executive Curriculum Committee

DATE APPROVED: January 16, 2018

Must-See Diagnosis and Required Procedure Tracker (PxDx)

Each clerkship has a “Must-See Diagnoses” list, which can be found on the back of the Clerkship Cards handed out on the first day of each clerkship. These diagnoses are selected to ensure that students have adequate exposure to a variety of specialty-specific presenting complaints. In order to monitor compliance and meet LCME guidelines, students are required to log these diagnoses into our web-supported tracking system (One45). Students are required to enter their exposures to these diagnoses in an on-going fashion throughout the clerkship. This information includes their role in the interaction with the patient; possible roles include Interviewer, Examiner, Assessment/Plan Developer, and Procedural Assistant. Mid-way through each clerkship, students will meet with the Clerkship Director and should print a copy of the Diagnosis Summary report to bring to this meeting. The Clerkship Director or supervising physician will review the report to monitor the students’ progress in encountering the diagnoses and can guide the student to additional learning experiences if necessary.

In addition to the “Must-See Diagnoses,” students are expected to attain competency in certain procedural skills prior to graduation from medical school. The attainment of proficiency in these skills is crucial to your ability to function as a successful intern. Each required procedure must be completed under supervision a minimum of three times over years 3 and 4 and you are expected to log these procedures into our web-supported tracking system, One45.

RELEVANT LCME STANDARDS:

9.7: Formative Assessment and Feedback
8.6: Completion of Core Experiences

PURPOSE AND SCOPE:

Students benefit from faculty feedback about their performance, both as an external measure of achievement and in informing how they may continue to improve. It is essential to provide feedback while a clerkship is in progress so that students have an opportunity to improve or to remediate deficiencies before the end of the clerkship. This policy applies to clerkship directors, site directors, other supervising faculty physicians and residents, and medical students.

POLICY:

1. Students must receive feedback from supervising faculty and/or clerkship site directors midway through the clerkship. This feedback must include review of the electronic log of Must-See Diagnoses (Dx) as well as an assessment of the student’s performance in comparison to clerkship objectives.
2. This feedback must include review of the electronic log of Must-See Diagnoses (Dx) as well as an assessment of the student’s performance in comparison to clerkship objectives. See Must-See Diagnoses (Must-See Diagnoses (Dx)) Policy.
3. Clerkship Directors are responsible for ensuring each student receives mid-clerkship feedback.
4. Students are able to comment on whether they received mid-clerkship feedback in the Clerkship Evaluation after each clerkship. Aggregate data on compliance with mid-clerkship feedback is distributed twice yearly to the Clinical Curriculum Committee (CCC).

PROCEDURE:

1. Mid way through a clerkship, the supervising physician and/or clerkship site director provides feedback to the medical student.
2. Each student should discuss any outstanding required diagnoses (Must-See Diagnoses (Dx)) with the supervising during the mid-clerkship feedback.
3. Students log whether they have received mid-clerkship feedback in the clerkship evaluation form in One45.

ACCOUNTABLE DEAN OR DIRECTOR: Co-Directors of the Curriculum and Senior Associate Dean for Undergraduate Medical Education and Curricular Affairs

REVIEWED BY: Clinical Curriculum Committee

APPROVED BY: Curriculum Steering Committee

DATE APPROVED: January 16, 2019

The Icahn School of Medicine at Mount Sinai uses the NBME Clinical Science examinations to assess student performance on the last day of each clerkship which occur in the third year. These standardized, objective, and discipline-based exams require medical students to solve scientific and clinical problems. Test scores reflect the learning specific to a student’s clerkship experiences, as well as their educational development resulting from the overall medical school experiences. Exams are designed to provide medical schools with an effective evaluation tool and useful examinee performance data that can be compared with a large representative group of examinees at the same stage of training.

Students are required to take the Shelf Exam on the last day of the clerkship as scheduled, and can expect to receive instructions on where to report for this from Blackboard and from the Clerkship Coordinator. The one exception is the Inpatient Medicine Clerkship, which takes the Medicine Shelf Exam in week 11 and the Family Medicine Shelf Exam in week 12 of the 12 week module. The standard Shelf Exam is 2.75 hours in length and online, though students will be required to arrive early to receive instructions.

Policy Regarding the Day before Shelf Exams

Students are expected to participate in clerkship activities the day before the Shelf Exam. However, students should not be assigned call responsibilities that day. All clerkship duties should end by 5 pm.

COMPASS 2 is a mandatory graduation requirement conducted during the third year of medical school composed of a standardized patient component and a clinician moral reasoning component.

Objectives of this six-station standardized patient assessment are to assess students’ abilities to apply knowledge, concepts and principles, demonstrate fundamental clinical skills, including clinical reasoning skills, essential to safe and effective patient care under supervision, and demonstrate effective interpersonal and communication skills with patients.

Competencies assessed include taking a relevant and focused history, performing an appropriate and focused physical examination, effectively communicating with a patient, integrating and applying data gathered to diagnostic hypotheses and accurately documenting findings and plans. Standardized patients rate students on patient-centered data gathering of historical information, physical exam, communication, and interpersonal skills. Students review their patient notes on each case.

COMPASS 2 also includes a clinical moral reasoning exercise during which students apply medical ethical reasoning to a patient case scenario and develop a written and oral presentation for the ethics faculty.

COMPASS 2 is a graduation requirement and students who do not meet competency standards are required to successfully complete a plan to meet these standards. The plan is determined by the COMPASS 2 faculty competency committee. The plan to meet competency may require participating in activities or assessments with other students.

Activities to meet competency standards must be completed before the student can take USMLE Step 2 CS and prior to the date that the score is guaranteed available before the NRMP decisions by programs. Any costs of prescribed plans outside the institution will be shouldered by the student and may require a change in the student’s schedule. Failure of to complete the competency process will also bring the student to the Promotions Committee.

Before taking the required Sub Internship, a clinical refresher is strongly encouraged for those students returning from scholarly leave into Year 4. The student is encouraged to discuss the clinical refresher with the Faculty Advisor or Director of Electives.

Students may take these examinations in any order, but for the Academic Year 2018-19 students must take Step 2 CS by September 8, 2018 of their fourth year and Step 2 CK by December 31 of Year 4 to allow time to retake the examinations should it be necessary. We recommend students take Step 2 CS between August 1 and September 8, 2018. It should be noted that some residency programs require documentation of USMLE Step 2 CK and/or CS prior to ranking the student in the match (mid-February of the graduating year for the NRMP, late December or early January for the Urology and Ophthalmology matches).

• Students must record a passing score on the USMLE Step 2 CK and CS examinations on or before the third attempt. Failure to do so will result in administrative withdrawal from the Icahn School of Medicine.
• For any student with a current Fail in a clerkship or in a USMLE exam at the time of the NRMP deadline (usually in February of graduation year), all programs to which the student has applied will be notified. In accordance with NRMP policies, a student who is at risk for not being able to attend residency on July 1 will be withdrawn from the Match.

General Information

Students must successfully complete a total of 28 weeks of elective credit in order to graduate. For those students in the InterACT Program, a total of 22 weeks is required due to longer clerkship weeks required for the program.

Students may take clinical electives during the third and fourth years at the Icahn School of Medicine at Mount Sinai, our affiliates, or at off-campus scholarly institutions. Students may also design clinical or research electives or seek out international experiences via Global Health electives.

The following guidelines apply to all types of electives:

• Forty hours are required to receive one week of elective credit.
• You are only permitted to take one one-week elective (40 hours completed within a consecutive seven-day time period); you also are permitted one additional one-week elective in the form of a longitudinal elective (40 hours of elective time completed over a period of weeks or months; must be one of the longitudinal electives listed in the Icahn School of Medicine electives catalog). All other electives must fall between two to four weeks in length.
• You cannot take an elective concurrently with a required clerkship. Longitudinal electives may be taken concurrently with another non-required rotation (e.g. another elective) as long as the hours do not conflict.
• The maximum amount of time permitted for research or non-clinical electives is 16 weeks total in Years 3 and 4.
• Elective application forms must be submitted to the Assistant Registrar, with all required signatures, no less than two weeks prior to the desired start date of the elective.
• No retroactive credit will be granted for an elective.
• If a student wishes to repeat an elective that has already been taken, it is possible to do so, however, elective credit will not be given for the subsequent course(s).
• Any request for an elective greater than four weeks in length requires additional approval by the Senior Associate Dean of Student Affairs.
• Preparation for USMLE Step 2 CK is built into the Year 4 schedule with a Step 2 CK Board Review course that, if attended in its entirety, counts as two weeks of elective credit.
• Work completed for remediation (including remediation for Step 1 and/or Step 2) is not eligible for elective credit.

To receive full credit for an elective you must complete each step of the elective process:

1. Select and register for the elective.
2. Complete the elective.
3. Ensure that your mentor/preceptor has submitted an evaluation of your performance.
4. Complete your evaluation of the elective.

Selecting and Registering for an Elective

Icahn School of Medicine Electives

• Browse the online electives catalog.
• Select the elective for which you wish to apply and click the “Register for Electives” button on the detailed view screen
• You will receive three emails generated from the system during the registration process:
  • An email informing you that you have requested the elective and it is PENDING DEPARTMENTAL APPROVAL
  • Next, an email informing you that the department has approved the elective and it is PENDING REGISTRAR APPROVAL
  • A final email informing you that your request to add the elective has been APPROVED BY THE REGISTRAR
  • You must receive the final email to be fully registered for the elective and receive credit; no retroactive credit will be applied.
• Your login is your student e-mail address and your password is your life number. You should change your password once you have successfully logged into the EMS under Account Management.
• You may access your account anytime online
• If you have any issues with the approval process, contact the Assistant Registrar or the Director of Student Electives.
• The maximum amount of time permitted for non-clinical electives is 16 weeks total in Years 3 and 4.

Clinical Tailor-Made Electives

• Students wishing to design their own clinical elective(s) with a specific Icahn School of Medicine faculty member or a faculty member from an outside institution may do so by submitting the Elective Registration: Clinical Tailor-Made form to the Assistant Registrar. The form can be accessed online via the Medical School Forms web page.
• Once you have completed the form, it needs to be reviewed and approved by the following: Assistant Registrar, Mentor/Preceptor, and the Director of Student Electives.

Tailor-Made Research Electives

• Students wishing to design a research elective with a specific Icahn School of Medicine faculty member or mentor from an outside institution may do so by submitting the Elective Registration: Tailor-Made Research Elective form (MD, MD/PhD, or MD/MPH)to the Assistant Registrar. The form can be accessed via the Medical School Forms web page.
• Once you have completed the form, it needs to be reviewed and approved by the following people: Assistant Registrar, Mentor/Preceptor, and the Associate Dean for Medical Student Research
  • MD/MPH students also require the approval of the MD/MPH Program Director
  • MD/PHD students also require the approval of the MD/PHD Program Director
• The maximum amount of time permitted for research electives or other non-clinical electives is 16 weeks total in Years 3 and 4.

Electives at Other Schools and Institutions

Visiting Student Application Service (VSAS)

• Students are required to use the AAMC’s Visiting Student Application Service (VSAS) to register for electives offered at schools that are VSAS Host Institutions.
• Visit the AAMC website to view a list of VSAS Host Institutions.
• Once registered through VSAS, students will need to complete the form, Elective Registration: Electives at Other Institutions (Required for all Away Electives, VSAS, and non-VSAS), which can be found on the Medical School Forms web page.
• For supporting documentation required by the host institution please contact the Assistant Registrar.
• To complete your registration for the elective, submit to the Assistant Registrar the following: a description of the elective, a confirmation of your acceptance from the host institution, and the completed Icahn School of Medicine form, Elective Registration: Electives at Other Institutions. (Required for all Away Electives, VSAS, and non-VSAS)

Non-VSAS

• Contact the host institution directly to request the elective.
• Students will need to complete the Elective Registration: Electives at Other Institutions (Required for all Away Electives, VSAS, and non-VSAS), which can be found on the Medical School Forms web page.
• For supporting documentation required by the host institution please contact the Assistant Registrar
• To complete your registration for the elective, submit to the Assistant Registrar the following: a description of the elective, a confirmation of your acceptance from the host institution, and the completed Icahn School of Medicine form Elective Registration: Electives at Other Institutions. (Required for all Away Electives, VSAS, and non-VSAS)

Tailor-Made Electives at Other Schools

• Students can also request to complete Tailor-Made Electives at other schools. Students must have a mentor at the site responsible for awarding the grade. The student must complete and submit the appropriate form (Elective Registration: Clinical Tailor-Made or Elective Registration: Tailor-Made Research) to the Assistant Registrar and to the Director of Student Elective or the Associate Dean for Medical Student Research at the Icahn School of Medicine for approval. The online forms can be found on the Medical School Forms web page.
• The maximum amount of time permitted for non-clinical electives is 16 weeks total in Years 3 and 4.

Please Note: Medical Schools in different U.S. states may require students to pay for a background check and toxicology screening. As of June 2012, medical schools in Florida and Tennessee require this documentation. Please check with the school to which you are applying to make sure you have met any updated requirements.

Global Health Electives

Global Health Electives are available to 3rd and 4th year students and include all electives outside of the United States. Students may only take a Global Health elective if it is offered at a Canadian medical school or if it is listed among the Global Health Elective courses in the elective management system.

Funding is not usually available for Global Health electives unless otherwise noted in elective descriptions.

The registration process for Global Health electives is as follows:

• Register for your elective for your requested dates through Empower at least 60 days before your day of departure.
• If applicable, register/apply for the in-country program of your elective externally.
• Complete the Global Health Elective Application form (link available on the Global Health Blackboard Page) at least 45 days before your day of departure. You will be asked to attach a letter certifying you have been accepted to the program.
• Once you have received academic approval, complete the Travel, Health & Safety Registration form (link available on the Global Health Blackboard Page) at least 30 days before the day of your departure.

Once you have successfully completed the Travel, Health & Safety Form with all of its requirements, your elective will be approved in Empower. Note that we are unable to offer retroactive credit for electives and we cannot accommodate last minute requests given the complexity of planning and approving Global Health electives.

Year 3 Students and Away Electives

In general, the Icahn School of Medicine students wishing to do away electives will do so in the fourth year. From time to time, a student may have a reason to do an away elective during elective time in Year 3. The following should be considered:

Students must meet the prerequisites set by the institution they are visiting.

Students should recognize that they may not be as prepared as they would be in Year 4 with the benefit of all or most of the clinical clerkships. In general, assessments done at the away elective is set at a standard for a Year 4 student. Students may not know the “system” and logistics at an away location and with a shorter allotment time of elective in Year 3, it may be difficult to acclimate to new systems in time to be able to have an effective elective.

Any elective done outside of an LCME-approved school must have the approval of an Icahn School of Medicine at Mount Sinai Director of Student Electives and that approval must acknowledge that this mentor approves the elective for the student in Year 3.

If there are any questions or concerns, students are encouraged to meet with the Director for Student Electives or their Faculty Advisor to discuss.

Ensuring that your Mentor/Preceptor has Submitted an Evaluation

Electives at Icahn School of Medicine

Towards the end of your elective, including away electives, you must deliver to the mentor/preceptor the Elective: Evaluation/Grade Form, available on the Medical School Forms web page, which the mentor/preceptor will complete and return to the Registrar's Office at the conclusion of the elective. It is the student’s responsibility to ensure that this form is completed and returned to the Registrar's Office (Email or Fax: 212-369-6013) at the conclusion of the elective.

Electives at other schools

If you are doing an elective at another institution and they wish to use their own institution’s form for evaluation rather than the Icahn School of Medicine form, the mentor/preceptor may complete their institution’s form and submit that to the Assistant Registrar. It is the student’s responsibility to follow-up with those schools to receive your grade and communicate that to the Assistant Registrar.

How Electives are Graded

All electives are graded Pass, High Pass, Honors or Fail.

Completing an Evaluation of the Elective

Electives at Icahn School of Medicine

All third- and fourth-year students are required to evaluate each elective experience AND the preceptor through our evaluation system using their existing login and password. Evaluations assist us in understanding and evaluating the effectiveness of the electives. Evaluations must be completed no later than four weeks after receiving a notification via email. If a student does not complete the mandatory evaluation four weeks after receiving notification, the student will receive an Incident report and no credit for the elective. Please refer to Student Conduct section of Handbook on Incident reports. If the MSPE has been submitted, it will be amended and re-uploaded to reflect this breach of professionalism. The evaluations must be filled out in order to receive credit for the elective.

Electives Review System
Students are encouraged toensure that they are on track with meeting their elective requirements for graduation by logging in to their Empower account.

Medical Liability Coverage

The Icahn School of Medicine at Mount Sinai provides medical students with medical liability when providing medical services as a part of approved educational activities. Students are not covered while participating in unapproved activities or rotations. During students’ third and fourth years, coverage does not apply for an activity unless the entire registration process has been followed and the activity has been officially listed on your schedule. To assure that you are covered for a specific activity, inquire in the Registrar’s Office or view your student transcript on the Empower student information system here. When rotating outside the School of Medicine, you may be requested to provide a letter from the School showing proof of coverage; that letter may be obtained from the Assistant Registrar in Annenberg 12-70.