The Inquiry (THINQ) curriculum is an innovative program that delves into four key areas:

1. Scientific and Scholarly Discovery

2. Patient-Centered Advocacy

3. Healthcare Delivery Science

4. Leadership and Professional Identity Formation.

A central feature of THINQ is its longitudinal structure, emphasizing the development of inquiry methods and critical thinking as fundamental to the learning experience. The program's goal is to cultivate students' ability to craft scholarly proposals addressing the multifaceted and challenging aspects of healthcare and community involvement.

During the Pre-Clerkship phase, students develop scholarly proposals. This involves a comprehensive understanding of the specific needs they intend to address, an assessment of the current landscape, and identification of existing gaps that their project could fill. Key skills taught include formulating a focused question of inquiry, conducting a thorough needs assessment, recognizing available resources, and pinpointing unmet needs. Moreover, students are guided in engaging stakeholders and presenting their findings compellingly and persuasively. Overall, THINQ is structured to not only supplement academic learning but also to foster practical skills and insights essential for future healthcare professionals.

Legacy InFOCUS Topics in ASCEND:

The topics from InFOCUS weeks in the legacy curriculum will be seamlessly integrated into the ASCEND curriculum. Essential topics that are critical for success in current and future phases of the curriculum will be thoughtfully incorporated, ensuring their clinical relevance is clear and directly applicable to the day-to-day lives of practicing physicians. Additionally, more specialized topics previously covered during InFOCUS weeks will be offered as standalone selective sessions in the monthly THINQ sessions. Similar to attending a conference with concurrent sessions, this allows students to choose to attend based on their specific interests or passions. This shift marks a move away from the traditional “one size fits all” approach of medical school curricula, towards a more personalized and flexible learning experience.

The ASCEND programming also presents an opportunity for dedicated and consistent non-curricular programming to be seamlessly integrated into the Pre-Clerkship Phase weekly schedule. This strategic change includes the incorporation of dedicated hourly sessions within the MD program weekly template, specifically allocated for student support services, including financial management education and debt counseling. These sessions ensure that all students receive timely information and become familiar with key contacts for assistance and support.

Dr. Ravi Ramaswamy oversees the THINQ Curriculum.

Passing Assessments and Modules

All assessments and modules have a passing grade of 65%. For further information regarding grading please see the assessment and grading policies.

Assessment Methods

Pre-Clinical Correlate Small Group (CCSG) Basics

CCSG Basics are designed to ensure students are prepared with the foundational knowledge needed to participate fully in their CCSG sessions. They consist of multiple-choice questions administered through Blackboard and can be found under the Assessments section.

CCSG Basics open 48 hours prior to the CCSG and are due 1 hour before the start of the CCSG. If back-to-back CCSGs are scheduled, the Basics will be due 1 hour prior to the start of the first CCSG. All due dates will be posted on the Phase 1 Google Calendar.

These assignments must be completed by students within the time limit provided. They contribute to students’ overall module grades, and they are considered low stakes. The correct answers will be released after the Basics are completed.

CCSG Basics are required even in the case of a planned or unplanned absence and cannot be postponed. Students who do not complete the assignment within the designated window will receive a zero. To avoid issues in the event of an emergency, students are strongly encouraged to complete the Basics by the night before the CCSG.

Any approved additional time accommodations will be applied automatically through Blackboard by the Pre-Clerkship team. Students must still initiate the assignment within the scheduled testing window set by faculty; your allotted time will reflect any approved accommodations.

Quizzes

Weekly quizzes are an essential component of the ASCEND modules and focus on material covered in the preceding week.

During the Foundations Block in Semester 1, quizzes are faculty-written and administered through Blackboard. In Semester 2, the majority of quizzes are drawn from the AMBOSS Question Bank.

While weekly quizzes do contribute to the final module grade, they are primarily intended as formative assessments, supporting consistent study habits and providing timely feedback to guide learning.

Quiz Administration

Weekly quizzes are accessed through each respective Blackboard module. For quizzes administered via AMBOSS, access is provided through links posted within Blackboard.

Access to AMBOSS quizzes differs for students with approved testing accommodations. Please review the “Students with Testing Accommodations” section below for details.

Quizzes will be open for two days and will close at 11:59 p.m. (EST) on the second day. Quiz dates and testing windows will be posted on the Phase 1 Google Calendar.

Please note that students must initiate quizzes during the scheduled test window set by the faculty.

Postponing Amboss/Blackboard Quizzes due to Emergency

In the preclerkship phase of the MD program at the Icahn School of Medicine at Mount Sinai, the ability to take an online quiz (Blackboard or AMBOSS) during a prescribed assessment window provides students with flexibility in when and where they take the assessment. Given this flexibility, there are only a few instances when permission to take a quiz outside the window will be granted by the Office for Curricular Affairs.

Students can request an alternate window (which will be granted for the following Thursday during Independent Learning Time) to complete their quiz in the following circumstances:

• Unplanned Absences: Urgent reasons such as illness that physically prevents a student from completing the assessment or a personal emergency. Even if a student has submitted an absence form, students MUST request an alternate window by emailing prior to the conclusion of the assessment window.

• Technical Issues: For any unresolvable technical issue that prevents a student from initiating or continuing with the online quiz. Students must email and the module director within 60 minutes of the reported failure. The Office of Curricular Affairs will respond the next business day to reschedule. Failure to report the technical issue within the timeframe outlined will result in a zero for the assessment.

Planned Absences: Because of the generous (>48 h) quiz window, students may only request a rescheduled quiz if they are celebrating a major religious holiday that spans the duration of the window. Students who anticipate needing an alternate window to accommodate a religious holiday must email 14 days prior to the start of the quiz window.

Students who do not adhere to the policies above will receive a zero on their quiz and will not be allowed to take at a later date.

Rescheduling Amboss/Blackboard Quizzes

Rescheduling an assessment does not extend the original testing window. Students who meet the criteria for an alternate test window will complete the assessment during the standard make-up window, which is scheduled for the Thursday immediately following the assessment close during Independent Learning time (8:00 a.m. – 11:59 p.m. EST).

Students must proactively email preclerkships@mssm.edu to request an alternate test window. Students with approved requests will receive an email with instructions on how to access and complete the make-up assessment.

Anatomy Practical Exams

The Anatomy Practical exam consists of students rotating through a series of stations (e.g., cadaveric, prosection, or image-based stations) with labeled items and answering questions using paper and a writing utensil. After a designated amount of time, students will rotate to the next station.

The Anatomy Practical is a restricted absence day. Absences will only be granted in the case of emergencies (unplanned) or observance of a major religious holiday (planned). Students approved for an absence will be assigned a designated makeup day to complete the practical.

Pathology Practical Quiz

Pathology Practical Quiz is an in-class, team-based exercise where students function as pathologists and diagnose unknown cases (e.g., autopsies and surgical resections). The assessment is open-book, and all members of the same team receive the same practical quiz grade.

The Pathology Practical is a restricted absence day. Absence requests will only be reviewed for approval in the event of an emergency (unplanned) or observance of a major religious holiday (planned).

Team-Based Learning Assessments

Team-Based Learning (TBL) is a structured group learning strategy that incorporates individual preparation, team collaboration, and immediate feedback in a high learner-to-faculty ratio environment. TBL sessions include short readiness assurance assessments: the Individual Readiness Assurance Test (iRAT), which students complete independently in Blackboard, and the Group Readiness Assurance Test (gRAT), which students complete collaboratively in teams. Specific administration and grading details will be communicated by the module team.

Students with approved testing accommodations should refer to the “Students with Testing Accommodations” section below for additional details on the iRAT administration in applicable modules.

Students with an approved excused absence from a TBL session may be eligible to complete a make-up readiness assessment during the standard alternate testing window (the Thursday immediately following the TBL session). To request a make-up, excused students must email preclerkships@mssm.edu prior to the start of the scheduled TBL session. Students with an unexcused absence for the session will receive a zero for the corresponding Blackboard test.

Proctored CAS Exams

All ASCEND modules have an end-of-module summative exam. Summative exams are created by module faculty using the National Board of Medical Examiners (NBME) Customized Assessment Services (CAS). Three out of the fourteen modules will have mid-module exams.

In modules with a single exam, the end-of-module exam covers the full content of the module. In modules with a mid-module exam, the end-of-module exam covers only the material from the second half of the module. All NBME CAS exams are proctored in person.

Mid-module and end-of-module exams are administered on Fridays at 9AM (Eastern Time), with the mid-module exam occurring midway through the module and the end-of-module exam held on the final Friday.

Exam Administration

Scheduled Exam Times

Students are expected to report for their proctored exams by 9 AM on the exam dates which can be found on the Google calendar and academic calendar. The end times provided are approximate, based on starting the exam on time without any complications for students using standard timing.

Please note that NBME technical difficulties, WiFi connectivity issues, personal laptop issues, and/or weather issues have the potential to substantially delay examination end times. Students should take this into account when scheduling travel (flights or any other travel arrangements) after examinations. The school does not guarantee end times and will not reimburse or reschedule a student who misses any travel arrangements due to an extended NBME end time.

Preparation for Exam

Pre-certification is an important step in preparing for the NBME exams as it helps identify potential software conflicts and issues prior to an exam. All students were required to perform pre-certification of their laptops during Basecamp. As there can be periodic updates to laptop operating systems, or you may purchase a new laptop, we recommend that you go through the certification process prior to every exam. The directions can be found here:

One week Prior to Exam

Students will receive a module Blackboard announcement from the Office of Curricular Affairs team detailing the exam location and other important information. Students with approved accommodations will receive verification of approved accommodation by email.

Exam Day

Exams are held in Annenberg on the 12th and 13th Floors classrooms. All in-person proctored exam days are considered restricted days, and planned absences will not be granted unless they are major religious holidays. Unplanned absences are allowed. Make-up days are designated on the Academic Calendar.

1. Students must arrive at their assigned testing room by 9:00 AM to check in, get seat assignments, and set up laptop. Exams start at 9:30 AM sharp. Students who arrive after 9:30 AM will not be allowed to sit for the exam. This rule will be strictly enforced.

2. Students should bring the following items with them:

3. Student ID Badge for identification purposes

In addition students must follow the NBME’s rules and conduct found here and listed below:

1. Do not bring any personal/unauthorized items into the secure testing area. Such items include but are not limited to, outerwear, hats, food, drinks, purses, briefcases, notebooks, notes, pagers, watches, cell phones, recording devices, and photographic equipment.

2. You are not permitted to access any unauthorized items during the exam administration.

3. Do not make notes on your note board prior to entering your CIN or start up code. Once your exam begins, you are permitted to make calculations or notes ONLY on the erasable note board provided.

The proctor will provide instructions to students before the start of the exam.

Any technical issues will be handled by the proctor.

Proctors will have a limited number of back up laptops available in the exam room on exam day.

We encourage you to take the exam during business hours.

Module Exam Scores and Performance

About a week after the exam, your official exam score will be posted to your Module Blackboard gradebook. You will also receive an email from NBME with access to an individual exam profile which provides your exam score and performance by exam subtopic in graph format.

Students will receive a Module BlackBoard announcement from the Office of Curricular Affairs team detailing the exam location and other important information, including verification of approved accommodation if applicable.

Practice of Medicine Exams

Each Practice of Medicine module will include two exams, which consist of one or more clinical cases using Standardized Patients (SPs) and an associated written note, generally hosted in or in partnership with The Morchand Center. In addition, intermittent quizzes will occur.

The exams will utilize a standard checklist or rubric related to the skill being tested (such as history taking, physical exam technique, or documentation). A student must complete enough items on the checklist to be above a set cut off percentage to pass the exam. The Clinical Competency Mentors or the Standardized Patients will score these checklists. Clinical Competency Mentors will not observe students in their own Learning Community in exams.

Practice of Medicine exams will generally occur on Thursdays, and each student will be scheduled for specific times that day. Some exams, such as POM assessment week in the POM 2 module will be scheduled over several days. These days are listed on the academic calendar as restricted days for absences.

Postponing or Rescheduling an Exam

Planned Absences

Per the Preclerkship Absence Policy, days with assessments (Practicals, Proctored CAS Exams, POM assessments, etc) are designated as restricted days, during which absences cannot be requested. These restricted days are indicated on the Academic Calendar.

Students may request an exception to the restricted days policy for major religious holidays (e.g. Rosh Hashana, Eid al-Fitr, Good Friday). Requests for holiday absences must be submitted at least 14 days (2 weeks) in advance. This policy does not extend to religious ceremonies (e.g. weddings, baptisms). Students will be required to make up the exam on a designated make-up day. .

Unplanned Absences

Exceptions for medical or other emergencies are permissible, but students must request an absence prior to the start of the assessment. Students will be required to make up the exam on a designated make-up day. .

Unexcused Absences

Students who do not follow the policies above regarding notification of planned or unplanned absences for assessments will be considered unexcused. They will receive a zero for that assessment.

Students with Testing Accommodations

Approved testing accommodations occur through the Office of Student Disability Services. Accommodations should be requested as soon as possible to ensure adequate time to implement. Please note that accommodations can never be retroactive.

Accommodations are implemented by the Preclerkship team in the Office of Curricular Affairs. If you experience a problem on test day related to accommodations contact

Please be aware that a student’s status as a student with a disability is often noticeable during these exams when accommodations such as extended time, separate location, or alternate test taking devices are used. You may opt out of these accommodations at your discretion by emailing the Director of Disability Services at least 2 weeks before the test date.

For more information:

• Blackboard Quizzes – Students with approved testing accommodations will complete Blackboard quizzes within the designated testing window. Approved extended-time accommodations will be applied by the Pre-Clerkship team and will reflect the student’s approved accommodation.

• Amboss Quizzes – Links to complete Amboss quizzes are posted in Blackboard during the designated testing window. Students with approved extended-time accommodations do NOT use these links. Instead, a student with time accommodations should log directly into Amboss ( where the assigned quiz will appear to them with the appropriate time setting.

• Proctored CAS Exams - For proctored CAS exams, the Pre-Clerkship team will receive students’ approved accommodation information, implement the necessary arrangements, and share relevant logistical details with students via email (i.e., room location, etc.).

Foundations Block

Molecular, Cellular and Genomic Foundations (Duration: 6 weeks)

This foundational module provides medical students with a comprehensive understanding of the molecular, cellular, and genomic principles that underpin human health and disease. Emphasizing the integration of basic science with clinical practice, the curriculum covers the structure and function of genes, proteins, and cells, biochemical pathways in metabolism, mechanisms of genetic inheritance, and the application of genomic technologies to medicine.

Anatomy (Duration: 6 weeks)

This foundational module offers a comprehensive exploration of the human body's structure, from the microscopic to the macroscopic level. Through detailed study of anatomical regions, organ systems, and the developmental processes that lead to their formation, students will gain a profound understanding of the body's architecture and its functional implications. Incorporating hands-on dissection, microscopic analysis, and clinical case studies, the module aims to bridge the gap between theoretical knowledge and its practical application in medicine. This foundational understanding is critical for diagnosing diseases, performing clinical procedures, and appreciating the intricate relationships that sustain human health and function.

Foundations of Immunology & Microbiology (Duration: 5 weeks)

This foundational module is designed to provide medical students with an in-depth understanding of the immune system and the microbial world, including bacteria, viruses, fungi, and parasites. This module integrates the study of the mechanisms of immune response, pathogen biology, infection processes, and the principles of vaccines and antimicrobial therapies. Through lectures and case-based learning, students will explore the dynamic interplay between pathogens and the host immune system, gaining insights into disease pathogenesis, diagnostic microbiology, and the current challenges in infectious disease medicine. Emphasizing both the immune system's protective roles and its involvement in disease, this module prepares students for clinical problem-solving and informed decision-making in medical practice.

Pathology (Duration: 3 weeks)

This foundational module is structured to provide medical students with a fundamental understanding of the nature, causes, and development of disease processes. Bridging basic science and clinical practice, the module covers general and systemic pathology, focusing on the alterations in cells, tissues, and organs that lead to disease. Through a combination of lectures, laboratory work, and case studies, students will learn to correlate pathophysiological mechanisms with clinical manifestations, enhancing their diagnostic skills and therapeutic understanding. The module aims to develop a comprehensive understanding of the molecular, genetic, and environmental factors contributing to disease, preparing students for informed clinical decision-making and patient care.

Integrated Systems-Based Content Modules

The modules in the Foundations block are followed by a sequence of integrated pathophysiology systems-based modules. Integrated within each system-module are relevant content in anatomy, physiology embryology, and histopathology. The 10 organ systems-based modules that follow the Foundations block in Pre-Clerkship Phase of ASCEND:

Neuroscience (Duration: 6.5 Weeks)

This organ system-based module provides an integrated approach to understanding the structure, function, and pathology of the nervous system. Students will explore the complexities of the central and peripheral nervous systems, from the cellular and molecular basis of neural function to the behavioral outcomes of neural processes. This module covers key topics such as neuroanatomy, neurophysiology, neuropharmacology, and the neural basis of cognition and behavior, alongside common neurological disorders. The module aims to equip students with the knowledge and skills necessary to localize, diagnose and manage neurological conditions, understand the principles of neurological treatments, and appreciate the impact of neuroscience research on medical practice.

Behavioral Science (Duration: 1.5 Weeks)

This organ system-based module is aimed at understanding the psychological, social, and biological factors influencing health, illness, and healthcare delivery. It combines principles from psychology, sociology, anthropology, and neuroscience to provide students with a comprehensive understanding of human behavior in the context of health and disease. Students will explore topics such as patient behavior, healthcare provider interactions, the impact of social determinants on health outcomes, stress and coping mechanisms, and the psychological aspects of illness and treatment. This module prepares students to incorporate behavioral science insights into clinical practice, enhancing patient care, communication, and treatment compliance.

Hematology (Duration: 3 Weeks)

This organ system-based module is an in-depth exploration of the blood system and its disorders. It combines theoretical knowledge with practical applications, offering students a comprehensive understanding of hematopoiesis, the physiology of blood cells, hemostasis, and the pathophysiology of hematological diseases. Students will learn to recognize, diagnose, treat, and manage a wide range of blood disorders, including anemias, bleeding and thrombotic disorders, hematologic malignancies, and transfusion medicine. This module emphasizes the integration of clinical findings with laboratory data, enhancing decision-making skills and preparing students for patient care in a clinical setting.

Cardiology (Duration: 5 Weeks)

This organ system-based module offers a comprehensive overview of cardiovascular medicine. This module combines theoretical knowledge with practical skills to understand the heart and vascular system's structure, function, and pathology. Students will explore a wide range of topics, including cardiac anatomy, electrophysiology, hemodynamics, common cardiovascular diseases (such as coronary artery disease, hypertension, heart failure, and arrhythmias), diagnostic methods, and therapeutic interventions. This module aims to equip students with the necessary tools to assess, diagnose, and manage cardiovascular conditions effectively, integrating evidence-based practices and the latest research findings into patient care.

Pulmonary Medicine (Duration: 4 Weeks)

This organ system-based module is designed to immerse medical students in the comprehensive study of respiratory system structure, function and diseases with a focus on their pathophysiology, diagnosis, and management. The module covers a broad spectrum of topics, including the anatomy and physiology of the respiratory system, common pulmonary diseases such as asthma, COPD, obstructive sleep apnea, diffuse parenchymal lung diseases, pneumonia, pulmonary embolism, and lung cancer, as well as advanced concepts in pulmonary diagnostics and therapeutics. Emphasizing a patient-centered approach, the module aims to equip students with the skills necessary for effective clinical assessment, evidence-based management strategies, and the delivery of compassionate care to patients with respiratory conditions.

Endocrinology (Duration: 4 Weeks)

This organ system-based module offers a detailed exploration of the endocrine system's structure, function, and the pathophysiology of its disorders. Students will study hormonal regulation and its impact on homeostasis, growth, metabolism, and reproduction, alongside the diagnosis and management of common endocrine disorders such as diabetes mellitus, thyroid diseases, adrenal disorders, and pituitary abnormalities. Emphasizing evidence-based approaches, the module aims to equip students with the competencies necessary for the effective treatment of endocrine diseases, fostering skills in patient education, and encouraging ongoing research engagement.

Gastroenterology (Duration: 5 Weeks)

This organ system-based module offers an in-depth understanding of the gastrointestinal (GI) system's anatomy, physiology, and the wide array of disorders affecting it. Students will delve into the diagnosis, treatment, and management of common and complex GI diseases, such as peptic ulcer disease, inflammatory bowel diseases (IBD), gastroesophageal reflux disease (GERD), and hepatobiliary disorders. Emphasizing a holistic approach, the module aims to equip students with the necessary skills to evaluate and manage GI conditions effectively, integrating nutritional management, pharmacotherapy, and endoscopic techniques, while also considering the psychosocial and societal aspects of chronic GI illnesses.

Genitourinary, Sexual and Reproductive Health (Duration: 4 Weeks)

This organ system-based module offers a comprehensive examination of the anatomy, physiology, and pathology of the genitourinary system, along with critical aspects of sexual and reproductive health. The module explores a wide range of topics, including urinary system diseases, sexual health, reproductive endocrinology, infertility, and common disorders of the genital system. This module emphasizes a holistic and patient-centered approach to diagnosing, treating, and managing genitourinary and reproductive health issues, incorporating the latest evidence-based practices and technologies. It aims to prepare medical students with the knowledge and skills necessary to provide sensitive, informed, and comprehensive healthcare services in these areas, focusing on the impact of such conditions on individuals and populations.

Renal (Duration: 4 Weeks)

This organ system-based module covers an in-depth understanding of kidney function, the pathophysiology of renal diseases, and their management. It covers key topics including renal anatomy, histology, physiology, pharmacology, as well as fluid and electrolyte balance, acid-base disorders, glomerular diseases, genetic and tubulointerstitial diseases, acute kidney injury (AKI), chronic kidney disease (CKD), glomerulonephritis, and renal replacement therapies. This module emphasizes a holistic approach to patient care, focusing on early detection, prevention strategies, and the latest treatment modalities for renal diseases. It aims to equip students with the knowledge and clinical skills necessary to provide comprehensive care to patients with renal conditions, advocating for patient education and empowerment in managing their health.

Musculoskeletal Pathophysiology (Duration: 3 weeks)

This organ system-based module provides an in-depth understanding of the anatomy, physiology, and pathology of the musculoskeletal system. This comprehensive module covers the structure and function of bones, muscles, joints, and connective tissues, along with the common disorders that affect these components, such as fractures, arthritis, muscular dystrophies, soft tissue injuries, and bone tumors. Students will learn to assess, diagnose, and manage musculoskeletal conditions, integrating pharmacological, surgical, and rehabilitative treatment strategies. Emphasizing a holistic approach, the module aims to equip students with the knowledge and skills necessary for effective patient care in orthopedics and related fields, fostering an understanding of the impact of musculoskeletal health on overall well-being.

Practice of Medicine

The longitudinal Practice of Medicine (POM) module is designed to integrate theoretical knowledge with essential clinical skills early in medical education. This module systematically develops students' abilities in patient assessment, history taking, physical examination, communication, and ethical decision-making, laying the groundwork for their future clinical practice. Through interactive workshops, simulated patient encounters, and reflective practice, students will begin to cultivate the core competencies necessary for patient care. The module emphasizes the importance of professionalism, patient-centered communication, and the basics of clinical reasoning, preparing students for their subsequent clinical rotations and fostering a lifelong commitment to excellence in medicine.

Embedded in POM will be early clinical exposures through the longitudinal POM module with exposures to patient care in simulated and standardized patient experiences as well as ambulatory, acute inpatient, and emergency room settings. A hallmark of ASCEND is its "whole patient" approach, encompassing a vast spectrum of patient experiences from caregiver dynamics to societal factors. This comprehensive design prepares students not only for USMLE licensure examinations but also for the multifaceted demands of contemporary medical practice.

Students will be introduced in POM to their clinical competency mentoring microsystems who will guide them in acquiring clinical skills required in the clerkships. The Clinical Competency Mentoring Program with their longitudinal Clinical Competency Mentors (CCMs), utilizes first-hand observations to provide insightful and timely feedback for the mentees' development, thereby enhancing the learning experience.

At its core, clinical mentoring aims to help individuals reach their full potential by identifying areas for improvement, crafting strategic action plans, and ensuring accountability. These mentors play a crucial role in helping students recognize areas for enhancing their clinical competencies. They assist in setting specific, mutually agreed goals aimed at driving improvements in performance. Furthermore, the mentoring process plays a pivotal role in shaping the professional identity of medical students, fostering their integration into the broader physician community.

To fulfill these objectives, the Office of Curricular Affairs has established 15 specialized clinical competency coaching microsystems per class. Each system comprises a Clinical Competency Mentor (CCM) who guides a group of eight medical students. The focus of these microsystems is to stimulate the development of clinical skills and facilitate continuous learning among students, preparing them for the demands of medical practice. The longitudinal nature of these relationships enables the CCMs to provide ongoing guidance throughout the students' journey of becoming a physician.

The responsibilities of CCMs are spread across the three phases of the curriculum. They are charged with advancing learning and academic progress, fostering the growth of physician skills among students, providing iterative feedback through direct observation, and encouraging continuous improvement.

CCMs conduct individual meetings with students and engage in group activities within their coaching microsystem at specified intervals throughout the curriculum. These activities include individual progress and planning meetings, goal setting based on CCM feedback, iterative observation and feedback in various clinical settings, and continuous quality improvement sessions.

During the Pre-Clerkship phase, CCMs serve as the primary facilitators of the Clinical Skills course, interacting with their students weekly over the initial 16 months of the curriculum. This enables them to directly observe the students as they develop their clinical skills and teach inter-professional teamwork and professional identity formation.

In the Clerkship phase, CCMs observe the application of their students' clinical skills in various training sites. Feedback from these observations provides invaluable insight for students. However, to maintain trust and adhere to the coaching role's student-centered approach, CCMs do not contribute to the summative assessments of their assigned students.

As students enter the Integration and Transitions phase, CCMs continue to guide them through scheduled individual progress and planning meetings, ensuring their continued progression towards clinical competence.

In conclusion, the role of CCMs and the implementation of clinical coaching microsystems offer a systematic and consistent framework. This facilitates the development of clinical competence, professional growth, and the formation of professional identity among medical students as they progress through their medical education.

Dr. Christopher Strother oversees the CCM Program.

Emergency Medicine (Duration: 4 Weeks)

The clerkship thrusts students into the high-paced environment of emergency care. They develop rapid diagnostic skills, emergency interventions, and acute patient management techniques. The clerkship involves real-time patient triaging, emergency procedures, and critical decision-making exercises.

Inpatient Medicine (Duration: 6 Weeks)

This clerkship immerses students in the dynamic environment of inpatient care. They equip with the skills and knowledge to manage hospitalized patients, focusing on diagnosis, treatment planning, and inter-professional collaboration. Engaging directly with patients, students experience the challenges and rewards of internal medicine, supplemented by small group sessions, patient discussions, and bedside teaching.

Neurology (Duration: 4 Weeks)

Building on the foundation of the Neuroscience module in the Pre-Clerkship Phase, the Neurology clerkship dive into clinical neurology, equipping students to diagnose and manage neurological disorders. From migraines to movement disorders and strokes, students navigate the vast realm of neurologic conditions. This clerkship combines ward rounds, patient case discussions, and hands-on neurologic examinations.

Obstetrics-Gynecology (Duration: 6 Weeks)

The clerkship offers students a comprehensive view of women's health, from pregnancy to childbirth and general gynecological care. Students gain hands-on experience in prenatal care, delivery, and postpartum management, while also delving into gynecological procedures, screenings, and surgeries. Interactive workshops, patient consultations, and surgical observations enrich this specialized learning journey.

Palliative Medicine (Duration: 2 Weeks)

The clerkship equips students with the compassionate approach required for the care of patients at the end-of-life and those with serious illnesses. It emphasizes pain management, patient comfort, and ethical considerations surrounding terminal conditions. Through patient interactions, family discussions, and case reviews, students learn the nuanced art of palliative medicine, ensuring dignity and comfort for patients in their final stages.

Pediatrics (Duration: 6 Weeks)

In this clerkship, students are introduced to child healthcare, from neonatal stages to adolescence. The clerkship emphasizes the unique medical considerations for younger patients, covering growth and development, immunizations, and common pediatric conditions. Engagements include patient rounds, growth assessments, immunization clinics, and interactive pediatric case discussions.

Psychiatry (Duration: 6 Weeks)

The clerkship offers a deep dive into mental health, emphasizing diagnostic skills, therapeutic interactions, and patient management strategies. Building on the skills learned in the Behavioral Science module of the Pre-Clerkship Phase, students encounter a range of psychiatric conditions, from mood disorders to more complex neuropsychiatric ailments. The learning is enhanced with patient interviews, therapy sessions, group discussions, and case studies.

Surgery-Anesthesiology (Duration: 6 Weeks)

This clerkship introduces students to the world of surgical procedures and the critical role of anesthesiology. From pre-operative assessments to post-operative care, students witness the patient’s entire surgical journey. The clerkship also emphasizes the principles of anesthesia, pain management, and patient safety. Practical experiences include scrubbing in for surgeries, anesthesia rounds, and post-operative patient management.

The Clinical Apprenticeship Experience (APEX) program at the Icahn School of Medicine is designed to integrate early clinical experiences for medical students, emphasizing the importance of the patient-physician relationship as a core component of professional identity formation. These early encounters aim to ensure students observe interactions between patients and clinicians, which will inform their development as future physicians.

Clinician-Student Matching and Interaction: The program aims to introduce medical students to potential clinicians in their chosen fields. Students will rank-order three preferred clinical fields, guiding the recruitment of suitable clinicians. Once matched, formal introductions will provide students with the clinician’s contact information, location, and assistant details if applicable. The primary focus will be on ambulatory or outpatient-based experiences, allowing students to closely observe clinician-patient interactions. Regular check-ins will be conducted to ensure the first observership is successfully initiated.

Scheduling and Reflective Reporting: Independent learning blocks and outside curriculum hours are recommended for these meetings, strongly discouraging the use of mandatory curriculum sessions for these activities. Students are responsible for any missed curriculum content if they choose to meet during non-curricular hours. Students are expected to submit a reflective report about their experience in the student portfolio system, guided by specific prompts from the program. Additional interactions and meetings will depend on mutual agreement between the clinician and the student. If students decide to change their preferences, the program will make efforts to reassign them to new clinicians.

Emergency Medicine Component: The Emergency Medicine (EM) component of the APEX program involves four-hour shifts within the Sinai Health System, including Mount Sinai Hospital, Mount Sinai-West, Mount Sinai-Queens, Mount Sinai-Morningside, and New York Eye and Ear Hospital facilities. Students are required to wear dark blue scrubs and utilize all necessary personal protective equipment (PPE) from the Emergency Room (ER) to ensure safety and professionalism. This hands-on experience in a high-intensity environment is integral to their training.

By encompassing early clinical experiences, robust communication strategies, and structured interactions with clinicians, the APEX program provides a comprehensive and immersive medical education experience, equipping students with the skills and professional identity necessary for their future careers.

Nisha Chadha, MD Director, APEX Program, Office of Curricular Affairs Associate Professor of Ophthalmology and Medical Education Director, Medical Student Education in Ophthalmology Icahn School of Medicine at Mount Sinai New York Eye and Ear Infirmary of Mount Sinai

During ASCEND Phase 2, assessment is based on workplace-based, longitudinal evaluation of clinical performance, supplemented by standardized written examinations. Assessments are designed to determine whether students demonstrate progressive readiness for entrustment across core functional domains, including knowledge application, clinical reasoning, communication, professionalism, and procedural skills.

Phase 2 assessment is intentionally multi-modal and longitudinal. No single assessment, observation, or examination is intended to independently determine clerkship performance. Final clerkship outcomes reflect aggregate performance across required assessment components.

Assessment formats, requirements, timing, and weighting are determined by each clerkship in accordance with institutional policy. Clerkship-specific requirements, deadlines, and grading criteria are published in the Clerkship Information Sheet (CIS), MedInfo, and clerkship Blackboard site. Students are responsible for reviewing and adhering to these materials.

Passing Assessments and Clerkships

• Passing standards for Phase 2 assessments are established at the clerkship level and aligned with institutional grading and promotion policies.

• To pass a clerkship, students must satisfactorily complete all required assessment components and meet the clerkship's minimum performance standards.

• CIS specify required assessments, grading weights, and consequences of non-completion or unsatisfactory performance.

Assessment Methods

Assessment methods may vary by clerkship but align with the functional domains outlined below. More specific information regarding assessment administration is in the Medinfo app.

Asynchronous, Online, Written Assessments

AMBOSS Quizzes

AMBOSS quizzes may be used by clerkships as formative or low-stakes assessments to support knowledge acquisition and clinical reasoning.

• Quizzes are completed independently and asynchronously.

• Deadlines are set by the clerkship and must be met.

• Absence from clinical duties does not exempt a student from completing assigned quizzes unless explicitly approved by the clerkship.

Written Case Presentations

Written case presentations assess clinical reasoning, organization, and documentation skills.

• Submissions must follow clerkship-specified format, platform, and deadlines.

• Late or missing submissions are subject to grading penalties or failure, as defined by the clerkship.

• Technical difficulties do not excuse late submission unless documented and reported according to clerkship policy.

Synchronous, In-person, Oral Assessments

Oral Case Presentations

Oral case presentations are required clinical assessments.

• Students are expected to be prepared to present when requested.

• Format, timing, and evaluation criteria are determined by the clerkship.

• Failure to complete required oral presentations may negatively impact clinical performance evaluations.

Direct Observation Assessments

Workplace-Based Direct Observation of Clinical Skills

Workplace-Based Direct Observations (DOs) are required components of Phase 2 assessment and evaluate performance in authentic clinical settings.

• Observations occur during routine clinical activities or structured encounters.

• Timing is governed by clinical workflows and clerkship expectations, not fixed testing windows.

• Clerkships define the required number and type of observations.

Structured Clinical Skills Direct Observation (Simulation Center/Morchand Center)

Simulation or Standardized Patient–Based Direct Observations evaluate clinical skills in structured, standardized environments. These assessments may include standardized patient encounters, procedural simulations, or structured clinical skill stations.

• Conducted at The Morchand Center for Clinical Competence in Annenberg 13th Floor.

• Fixed-length stations with standardized scoring tools and trained evaluators and occur at scheduled dates and times.

• These assessment days are designated restricted days.

Workplace-Based DOs and Simulation-Based DOs are distinct assessment modalities. Completion of one type does not satisfy requirements for the other unless explicitly stated in clerkship materials.

All required Direct Observations must be completed in accordance with clerkship expectations to receive a passing grade.

Standardized, Timed, Written Exams

NBME Clinical Science Subject Exams (“Shelf Exams”)

All ASCEND clerkships include an end-of-clerkship summative examination administered by the National Board of Medical Examiners (NBME). These examinations assess discipline-specific clinical knowledge using standardized multiple-choice questions.

• Online, remotely proctored examinations

• Fixed time limits governed by NBME policy

• Administered in accordance with NBME security standards

Exam Administration

Scheduled Exam Times

• Students must report to their assigned Zoom proctoring room by 8:45 AM on the scheduled exam date, as listed on the Google Calendar and Academic Calendar.

• Exams begin at 9:00 AM sharp.

• Students who arrive after 9:00 AM will not be permitted to sit for the exam.

Preparation for Exam

• NBME laptop pre-certification is required to identify potential software conflicts.

• Students are strongly encouraged to re-certify their devices prior to each exam.

• Certification instructions are available at:

One week Prior to Exam

• Students will receive a Clerkship Blackboard announcement from the Office of Curricular Affairs detailing exam logistics and instructions.

• Students with approved accommodations will receive separate communication regarding accommodation logistics.

• Students are responsible for reviewing all pre-exam communications.

Exam Day

• NBME Shelf Exam days are designated restricted absence days.

• Planned absences are not permitted except for approved major religious holidays.

• Unplanned absences due to emergency must be reported prior to the scheduled start time.

Borrowing a Laptop

• A limited number of backup laptops are available for exam use.

• Students who require a laptop may proceed to the laptop storage bin located outside the CA Operations Team Office in Annenberg 13-40, where available laptops may be checked out and must be returned immediately following the examination.

• Laptops are distributed on a first-come, first-served basis.

Clerkship-Specific Blackboard Exams

Some clerkships administer institutionally developed exams.

• Exam format, timing, proctoring, and make-up policies are determined by the clerkship.

• Students are bound by clerkship-specific exam instructions.

• Failure to comply with exam requirements may result in a zero.

Longitudinal Performance Assessment

Clinical Performance Evaluations

Clinical performance evaluations reflect aggregate professional and clinical performance across the clerkship.

• Based on multiple observations by faculty and residents.

• Not determined by a single encounter or evaluator.

• Professionalism concerns may independently affect clerkship outcomes.

Clerkship directors retain final authority in synthesizing performance data.

Postponing or Rescheduling Phase 2 Assessments

Planned Absences

• Assessment days are restricted.

• Religious holiday exceptions require at least 30 days’ advance approval.

• Approved absences require completion on assigned make-up dates.

Unplanned Absences

• Emergencies must be reported before the assessment start time.

• Documentation may be required.

• Make-ups are granted at institutional discretion.

Unexcused Absences

• Unexcused absences result in a zero and may result in clerkship failure.

• Appeals based on misunderstanding of policy are not grounds for reversal.

Students with Testing Accommodations

Testing accommodations are approved through the Office of Student Disability Services.

• Students should request accommodations as early as possible to allow adequate time for implementation.

• Accommodations are not retroactive.

• Accommodations are implemented by the Clinical Curriculum Team in the Office of Curricular Affairs and/or clerkship-specific coordinators.

Students should be aware that certain accommodations (e.g., extended time, separate location, alternate testing devices) may be visible to others during exam administration.

• Students may elect to opt out of approved accommodations by emailing the Director of Disability Services at least two weeks prior to the scheduled assessment.

• For additional information, visit:

Assessment-Specific Implementation

AMBOSS Quizzes

• Students complete AMBOSS quizzes independently within the designated timeframe.

• The Office of Curricular Affairs cannot access or modify individual AMBOSS accounts.

• Only students with approved accommodations may adjust quiz timing in accordance with their approved accommodation.

Proctored NBME Shelf Exams

• The Clinical Curriculum Team receives approved accommodation information directly from Student Disability Services.

• Approved accommodations are implemented in accordance with NBME policies.

• Students will receive email communication detailing accommodation logistics (e.g., testing room, timing adjustments).