Year 3 and 4 Policies and Procedures
Students in Years 3 and 4 must be compliant with all Student Health, institutional, and training site requirements. These policies describe how students are assigned to clinical sites, how they are supervised and what clinical experiences they should expect to see while rotating.
Please note:
Students who matriculated in 2024 and thereafter are subject to ASCEND policies.
Students who matriculated in 2023 or earlier and who are graduating in 2027 or earlier are subject to the LEGACY curriculum policies.
Students who matriculated in 2023 or earlier who are graduating in 2028 or thereafter will be subject to a mix of policies depending on when their progression was delayed or temporarily halted. These students will be subject to ASCEND policies when they resume or continue their studies.
Legacy Policies
Student Assignment to Learning Experience Policy This policy outlines the instructional time limitations for third- and fourth-year students.
Applicable for: Graduating Class of 2025, 2026, 2027
Approved by: Executive Oversight Committee
Relevant LCME Standards: 10.8 Visiting Students 10.9 Student Assignment
Approval Dates: 6/2/23 4/19/24
POLICY
For learning experiences in Year 1 and 2, site assignments are made randomly by the Curricular Affairs Operations Team. Clerkship and Clerkship Site Assignments are made through the Year 3 and Year 4 Lottery processes. In compliance with LCME Standard 10.9, a medical student with an appropriate rationale can request an alternative assignment when circumstances allow for it.
PROCEDURE
Course Site Assignment Changes
Students may request a different site assignment through the Curricular Affairs Operations Team. Requests approved based on availability.
Clerkship and Clerkship Site Assignments and Changes
Students who require a specific schedule to accommodate a major life event (such as a student’s marriage or the birth/adoption of a child) 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.
A student may request a change to the clerkship or clerkship after the completion of the lottery. Changes may be accommodated on a first-come first-serve basis, up to 4 weeks before the start date. Students must fill out the Clerkship Change Request form to request a change. Availability is determined by the clerkship director. Failure to abide by this deadline can result in the change request not being processed and delay electronic health record access.
Priority Scheduling over Visiting Students
Icahn School of Medicine at Mount Sinai (ISMMS) students have 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 both ISMMS Year 3 and 4 students have been allowed a chance to register.
ISMMS students are given priority over visiting students should there be an unexpected change in schedules during electives.
RELATED RESOURCES
https://icahn.mssm.edu/education/students/registrar/medical-forms
Supervision Policy This policy provides information about expectations of supervision for medical students.
Applicable for: Graduating Class of 2025, 2026, 2027
Approved by: Executive Oversight Committee
Relevant LCME Standards: 9.1 Preparation of Resident and Non-Faculty Instructors 9.2 Faculty Appointments 9.3 Clinical Supervision of Medical Students
Approval Dates: 6/2/23 3/8/24
RELATED POLICY
Required Clinical Experiences
POLICY
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.
Medical students participating in patient care must be supervised at all times. The primary supervising physician must be practicing within the scope of his/her discipline. During instances in which a medical student is participating in a clinical setting where resident/fellow physicians or other healthcare professionals are actively involved in medical student education, it is the responsibility of the supervising faculty physician to assure all personnel provide appropriate supervision of medical students within the scope of their practices.
Levels of Supervision – Direct vs. Indirect
Perform Under Direct Supervision - The student performs a task with the supervisor physically present in the same location as the student; able to provide direct instruction to the student; able to take over patient care duties when necessary.
Perform Under Indirect, but Immediately Available Supervision - The supervisor may not be physically present with the student yet must still provide direct instruction to the student; The supervisor is on-duty, immediately available, and can be called to the physical location of the student for the duration of the student’s task.
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 of the student (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.
General Guidelines
The guidelines below are applicable to all clinical experiences where medical students participate:
In the clinical setting, 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).
Year 3 and 4 medical students are primarily under indirect supervision. In any instance, the supervisor must 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.
The supervisor will review all medical student’s documentation in a patient’s medical record and provide corrections to the record and feedback to the student for educational purposes.
Clinical decisions are never formulated or enacted by medical students without a supervisor’s input.
Orders placed by students in the Electronic Health Record must be co-signed by a supervising provider. Verbal orders and other written orders communicated by students must be reviewed and approved by a supervising provider.
Medical students must be under direct supervision during all medical procedures in which they are involved, except for the four (4) procedures listed below that may be performed under indirect supervision. This includes, but is not limited to, bedside, emergency department, operating room procedures and/or all procedures listed as Required Clinical Experiences (RCEs) for clinical clerkships.
The following procedures may be performed under indirect supervision if both the student and supervisor agree that the student has demonstrated competence to perform the given procedure. ALL other procedures must be performed under direct supervision
Peripheral IV REMOVAL (peripheral IV placement must be directly supervised)
Surgical Scrubbing
Superficial dressing changes (not including internal packing or drains)
Suture or staple REMOVAL (suture or staple placement must be directly supervised)
In all procedures, the degree of supervision needed will consider: the complexity and urgency of the procedure, the stability of the patient, potential for adverse effects, 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.
PROCEDURE
Any students with concerns about the adequacy and availability of supervision they are receiving are encouraged to bring their concerns as soon as possible to the course, clerkship, and/or site director.
Students report on the adequacy and availability of supervision during mid-clerkship check-in meetings and via end of course/clerkship evaluations and questionnaires.
Course and Clerkship Directors review student feedback in evaluations, as well as during mid-clerkship feedback, and provide prompt follow-up to address any supervision concerns that may arise. Multiple concerns regarding the same faculty member will be reported to that faculty member’s department chair.
The Clinical Curriculum Subcommittee reviews data on an ongoing basis to identify any ongoing trends of supervision concerns being reported.
Required Clinical Experiences Policy This policy provides information about the required clinical experiences in the clerkships.
Applicable for: Graduating Class of 2025, 2026, 2027
Approved by: Executive Oversight Committee
Relevant LCME Standards: 6.2 Required Clinical Experiences 8.6 Completion of Core Experiences 9.7 Formative Assessment and Feedback
Approval Dates: 06/02/23 04/19/24
RELATED POLICY
Formative Feedback
Grading Policy
Supervision Policy
Technical Standards
POLICY
Each student in the MD Program at Icahn School of Medicine at Mount Sinai (ISMMS) is required to complete all Required Clinical Experiences (RCEs) for each clerkship.
Each required clinical experience (RCE) is associated with a clinical setting and a level of student responsibility that is expected of all students in order to meet the requirements of the clerkship.
The definitions of the levels of responsibility for RCE-Procedures are:
Active Exposure: Student actively observes the specific demonstrated procedure and subsequently discusses the interaction with the provider
Active Participation (Assist): Student assists in the performance of a specific procedure under direct supervision.
Active Participation (Full): Student fully performs a specific procedure under direct supervision
The definition of the levels of responsibility for RCE-Clinical Conditions are:
Active Exposure: Student actively observes the specific demonstrated skill and subsequently discusses the interaction with the provider
Active Clinical Participation: Student actively demonstrates the skills required in the encounter. This can include obtaining a patient history, conducting a physical examination, interpreting pertinent patient data, and/or presenting the case including a discussion of differential diagnosis, assessment, and plan.
Each clerkship must have a mid-clerkship feedback session with every student where auditing RCEs is a requirement.
If the student cannot complete any of the Required Clinical Experiences by the end of the clerkship rotation, the Clerkship Director or supervising physician must provide the student with an Alternative Learning Experience.
At the conclusion of the clerkship rotation, the student must submit their completed RCEs using the Expectation Summaries report from the school’s electronic logging application.
PROCEDURE
Each clerkship defines the appropriate clinical settings for these experiences, and the expected levels of medical student responsibility.
The list of RCEs for each clerkship must be reviewed annually by the Clinical Curriculum Subcommittee (CCS) prior to the start of the academic year. Any recommended changes to the list of RCEs must be approved by the Executive Oversight Committee (EOC) prior to the start of the academic year.
Approved RCEs required for each clerkship must be listed on the Clerkship Information Sheet (CIS) and communicated to students at the start of each clerkship.
Clerkship Directors or supervising physicians provide suggestions to the student in order to meet the requirement through patient care experiences.
Years 3 and 4 Electives Policy This policy includes information about policies and procedures for Years 3 and 4 electives.
Applicable for: Graduating Class of 2025, 2026, 2027
Approved by: Executive Oversight Committee
Relevant LCME Standards: 6.2 Required Clinical 6.5 Elective Opportunities 11.3 Oversight of Extramural Electives
Approval Dates: 04/7/24
RELATED POLICY
Student Assignment to Learning Experiences
Grading Policy
Leave of Absence Policy
POLICY
Students must successfully complete a total of twenty-eight (28) weeks of elective credit, per the guidelines listed below, during their third and fourth years to graduate. For those students in the InterACT Program, a total of twenty-two (22) weeks is required due to additional clerkship weeks required for the program.
To receive full credit for an elective, students must complete each step of the elective process:
The student must register and be fully approved for an elective prior to the start of the elective.
The student must complete the elective during the approved dates.
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.
GUIDELINES
A minimum of twelve (12) weeks must be completed as clinical electives. A clinical elective is defined as an elective in which the student participates in the direct care of patients or in specialties such as pathology or radiology, that directly connect to patient care.
A maximum of sixteen (16) weeks of Research/Non-Clinical elective(s), for credit, may count towards the graduation requirement
All electives must be completed by the week prior to May Commencement; failure to complete this requirement will result in a June 15 degree conferral date.
Forty (40) hours minimum of contact/work hours are required to receive one (1) week of elective credit.
Students cannot take an elective concurrently with a required clerkship or course.
No retroactive elective credit is given.
Work completed for remediation is not eligible for elective credit.
Longitudinal Electives:
Students are permitted to take longitudinal electives that are listed in the Icahn School of Medicine at Mount Sinai (ISMMS) Electives Catalog in Empower.
Longitudinal electives may be taken concurrently with another non-required rotation (e.g., another elective) as long as the hours do not conflict.
Students on a Scholarly Year or Leave of Absence are not eligible to participate in MD program course work and cannot accrue elective credit.
MD/PhD students in their PhD phase may receive a maximum of four (4) weeks of elective credit in an established ISMMS elective if:
They are a matriculated student in the ISMMS Graduate School and eligible to participate in coursework
They meet the prerequisite(s) for the elective and have the approval of the faculty elective director
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