Fourth-Year Curriculum Overview

The fourth year of medical school advances the clinical education that started with the first LACE course to the point of competency that merits the granting of the Doctor of Medicine degree. There are nine required courses and electives over a period of 11 four-week blocks.

Near the beginning of the fourth year, the students should have obtained a basic understanding of which specialty programs they wish to consider, and then budget enough time to interview at those residency programs. The requirements and timing for course selection follow this philosophy. The logic of which courses are taken first is a crucial factor in matching for residency. Advisors will need to sign off on students’ course selections.

Required Courses

Sub-Internship (Sub-I)

The required four-week sub-internship selective is designed to further develop medical students’ patient care knowledge, skills, and professionalism so that they become successful interns in residency training. The Sub-I provides students an opportunity to assume more responsibility for their patients and refine their physical exam and diagnostic skills and enhance their medical knowledge. The students’ level of responsibility during these rotations represents an important step in making the transition from a medical student to a resident.

This inpatient rotation can be taken in internal medicine, family medicine, pediatrics, surgery, psychiatry, and/or obstetrics and gynecology. Fourth-year medical students may complete more than one Sub-I. Students often select sub-internships based on their specialty of interest. They also often seek rotations at institutions they wish to pursue residency training. 

During the Sub-I, fourth-year medical students will take nearly full responsibility for patient care under the supervision of faculty. Students function as close to the level of an intern as possible. They will be responsible for the initial evaluation of patients and treatment course. Students will follow patients from admission to the hospital through developing treatment plans, recommending orders for tests and medications, arranging for consultations, and collaborating with other members of the team such as nurses, medical assistants, physical therapists, social workers, and other learners.

The rotation will promote patient safety through hand-off and sign-out processes that emphasize safety in transitions of care. It will also underscore communication skills, interprofessional collaboration, professionalism, system-based learning, and support a culture of patient safety and respect.

Radiology

The radiology course provides a comprehensive introduction to the basics of imaging and its role in virtually every aspect of clinical practice. During this four-week course, offered four times during the fourth year, medical students will gain familiarity with the breadth and appropriate use of diagnostic and interventional radiology. Topics in this self-paced course include indications for imaging; review of anatomy through imaging; technical aspects and strengths and weakness of different imaging modalities; safety issues in pregnancy, contrast use, MRI, and contrast allergy; and basic imaging findings and differential diagnoses. Students will also be exposed to more cutting-edge utilization of image-guided procedures and treatments.

Future physicians will develop a sense of partnership with radiologists, regardless of their planned area of practice. A solid foundation in radiology allows students to utilize their clinical skills and rely on cultural sensitivity to formulate and optimize an imaging approach for providing excellent, holistic care to all patients – whether in the emergency department, hospital, outpatient clinic, or any other healthcare facility.

It is recommended that students planning radiology as a specialty take a radiology elective in addition to this required UCR School of Medicine radiology course.

Critical Care Medicine

The Critical Care Medicine selective is designed to expose students to critical illness and basic physiologic principles that will serve as a foundation throughout their professional lives as physicians.

While this selective will expose students to a broad experience in the care of critically ill patients, the focus of this experience will be on physiological and evidence-based management of critical illness. During the four weeks, students will be challenged in areas of medical knowledge; patient care; interpersonal and communication skills; professionalism; critical appraisal and quality improvement; and societal awareness and responsiveness.

This selective can encompass activities in several different clinical settings. While students may not master all aspects of critical care by the end of this selective, students are expected to achieve a level of competence appropriate for a first-year resident.

The clinical site will be a licensed critical care unit (e.g., a medical ICU, surgical ICU, cardiac care unit, neonatal ICU, pediatric ICU, or similar unit). Students identify preferences for sites from a list of approved critical care rotations and can apply to sites based on their preferences and pedagogical and organizational needs. Students will be expected to attend clinical duties full-time (minimum 36 hours per week). Overnight and/or call duties may vary depending on the clinical site.

Transition to Residency

Instructed over four weeks in March, Transition to Residency reviews knowledge that is critical for new interns using a mixture of simulation, small-group learning, traditional lectures, and self-study.

During the first half of the course, students will review core topics relevant for all rising interns. This includes lifesaving certifications, common procedures such as central lines and intubation, and soft skills like hand-offs, patient communication, and end of life care. Students will have a chance to practice the skills they learn using both simulation and standardized patients. During the second two weeks, students will break into groups depending on their future professions, with tracks focusing on surgery, psychiatry, family medicine, emergency medicine, pediatrics, general adult medicine, and obstetrics and gynecology. Coursework is tailored to meet the needs of each profession. Each track culminates in simulations that draw upon all the knowledge and skills covered in the course. 

Electives

Five required elective blocks are scheduled in the fourth year for medical students to complete clinical and/or non-clinical (research, scholarly activity, or study) rotations of their choosing. 

Clinical rotations can be completed at UCR Health, UCR School of Medicine affiliates in the local region, at locations within the University of California Health system, or other locations domestically and internationally through the AAMC Visiting Student Learning Opportunities (VSLO) program. Students wishing to do rotations at other locations must receive approval by the School of Medicine.

Students can choose up to two blocks of non-clinical electives, totaling eight weeks of research, scholarly activity, or study. The research or scholarly activity project is approved in advance by the senior associate dean for research, and the requirements for satisfactory completion of this elective include prior agreement with a faculty mentor who will also provide a written evaluation at the end of the elective, and a written report from the student, which can be in the form of a brief scientific report, a draft manuscript, or poster. The study elective is approved in advance by the fourth-year director, and the requirements may include reading articles, journals and/or online learning modules totaling a minimum of 20 credits/hours per week, along with a one-hour meeting with a designated faculty mentor in the specialty.
 

Vacation Blocks (2)

It is recommended that students schedule their vacation blocks strategically, such as taking time off for travel to residency program interviews that typically occur between November through January. To facilitate this, the UCR School of Medicine recommends that at least one of the vacation blocks be taken during the November through January interview season.

Example Schedules