Fourth Year Curriculum

Four students sit side by side outdoors

Advanced Clinical Phase

GUSOM Fourth Year Requirements:

  1. Fourth Year students must complete two different four week Acting Internships (one “Required” and the other “Selective”) (Please see the COME criteria for an Acting Internship below). Students are required to complete both their Required and Selective AIs.
    1. The “Required AI” is a four week Acting Internship in either the Internal Medicine Wards or in the Medical Intensive Care Unit (MICU).
    2. The “Selective AI” is a four week Acting Internship selected from a list of Acting Internship experiences that have been officially approved by the Committee on Medical Education (COME).  Acting Internships from other institutions or electives not on the list reviewed and approved by the COME will not be accepted as fulfilling the school’s requirement
  2. Four weeks of Emergency Medicine, including ACLS certification. Per the Emergency Medicine Clerkship Director, students interested in pursuing Emergency Medicine can do their EM clerkship in either the 1st or 2nd block of the year. 
  3. Twenty-four weeks of electives of the student’s choice, up to four weeks of which can be used for Step 2 CK or CS board study. All electives require advance approval from the appropriate Department Chair/Division Chief and the Office of Medical Education.
    1. Intramural electives are electives that are done within GUSOM oversight at one of our primary affiliate institutions in the DC area. For a list of intramural electives arranged by department, see below.
    2. Extramural electives are electives that are done outside GUSOM at another institution. There is an application process for all extramural electives (Hard copies of these forms are also available in the Office of Medical Education). Students are responsible for ensuring that the attending who observed them during their extramural elective completes a grade for them and submits it to the Registrar’s Office. Click here (new window) for the Fourth Year Evaluation form.
  4. Clinical Pharmacology week (normally the last week of April).

The Fourth Year Lottery

The Fourth Year Lottery is comprised of two parts.

Tier I: In late February/early March, lottery preferences for your Required AI, Selective AI and Emergency Medicine rotations will be solicited. At this time in the third year, you will be asked to state the field to which you will be applying for residency and the degree of certainty that you have for that field.

Throughout mid-March to late April, students will have the opportunity to investigate potential extramural electives (AWAYS). 

Tier 2: In late April/early May, students will be asked to fill in the rest of their schedule by declaring when in their schedule they plan to ask for an AWAY and lottery preferences for intramural electives (LOCAL) will then be completed before being opened up for visiting students.

COME Criteria for Approved Acting Internships (AI)

The Committee on Medical Education has the responsibility for ensuring the quality and standards of the curricular requirements for graduation. The goals of the Acting Internship (AI) program at Georgetown are to acquire skills and knowledge beyond a typical clerkship, and to have responsibility similar in level to an intern of that specialty.

The following standards should be applied to all current AIs at all sites:

  1. All AIs will be asked to submit a description of their compliance with these issues to the Clinical Clerkship Subcommittee, and review of these standards will be incorporated into regular curricular review.
  2. Students must have first call responsibility for patients, with adequate supervision.
  3. Students should have a patient load comparable to the PGY-1 resident on service.
  4. Students must take in-house call (daytime or nighttime)—and may be required to take call at the current ACGME frequency of residents.
  5. Students should have cross-coverage responsibility where appropriate.
  6. Students primarily will learn management skills at a level of the non-specialty physician, and be expected to master a list of important procedures as determined by the clerkship director.

GUSOM Fourth Year Courses:

A list of fourth year courses, both intramural and extramural (away rotations), can be found in the GUSOM Fourth Year Course Catalog.