Year 3/4 Student Information

Structure of Year 3 and Year 4 Curriculum

Year 3 at Dartmouth Medical School begins with a required three-day orientation which runs from Tuesday to Thursday of the week prior to the start of the first clerkship. Orientation covers both clinical and administrative topics required prior to the start of clerkships. The dates for orientation in 2005 are June 21-23. Orientation to the first clerkship takes place on Friday, June 24 and the first clerkship begins on Monday, June 27.

Year 3 is made up of six 8-week blocks and most students will take the following six clerkships during these blocks: Inpatient Medicine, Surgery, Pediatrics, Psychiatry, OB-GYN/Women's Health, and Family Medicine. Clerkships are scheduled through a lottery system which takes place during late April of Year 2.

Medicine and Surgery clerkships each run for 7 weeks plus two days. When time is added for their orientations (the Friday afternoon at the very end of the preceding 8-week block) they each receive 8 weeks nominal credit on the transcript (rounding to nearest week). Each must be scheduled and completed by the end of August of the fourth year.

Pediatrics, which is made up of several smaller blocks or rotations covering both inpatient and outpatient activities, also runs for 7 weeks plus two days. It receives 8 weeks nominal credit on the transcript (rounding to nearest week). It needs to be completed by the end of December of the fourth year.

Family Medicine and Psychiatry each run for a total of 7 weeks. They have agreed to take the "normal" run of 7 weeks and two days, and to provide a long weekend break of 4 full days at the end of each clerkship. They are able to do this because their entire block is spent at the same location, making it easier to provide two break days at the end of the block. They each handle the timing of that long weekend a little differently. In Family Medicine, students are off Thursday through Sunday of week 7, then return for clerkship activities at Dartmouth on Monday and Tuesday of week 8. In Psychiatry, students have a 4-day break from the Saturday of week 7 through Tuesday of week 8. They each receive 7 weeks nominal credit on the transcript (rounding to nearest week), but are viewed as co-equal with other major clerkships. These clerkships need to be completed by the end of December of Year 4

OB-GYN/Women's Health is a 7-week clerkship, also co-equal with the other major clerkships. The schedule includes two weeks of inpatient labor and delivery, two weeks of GYN surgery and three weeks of outpatient clinic. The schedule varies depending on number of students assigned to a site. The clerkship needs to be completed by the end of December of Year 4.

A course called "Interdisciplinary Clinical Exercises (ICE)" is held every 8 weeks on the final Tuesday, Wednesday and Thursday of each block, for 4 to 8 hours per day, for a total of about 80 contact hours. OSCE's (see below) are also part of this course. Students are expected to attend all ICE sessions. The course is pass-fail, and carries 2 weeks credit on the transcript. There will be periodic assessments of knowledge, which take the form of a self-study web-based open book quiz after each 3-day cycle. All requirements of the ICE course must be completed by June 30 after the end of Year 3. A more detailed description of this course can be found later in this handbook.

OSCE sessions occur three times per year, on Tuesday, Wednesday, or Thursday evening of week 8 during Blocks 2, 4 and 6 (October, February and June). Each student will do a total of three OSCE's over the course of Year 3. Students are assigned to one of 6-7 different OSCE cases depending on the clerkships completed over the previous 16 weeks. Feedback goes to students (areas of strength and weakness) and clerkship directors (so they can see how well their clerkships are covering necessary skills, etc). OSCE performance is assessed on a pass-fail basis. A student needs to pass both the knowledge portion (see above) and the skills (OSCE) portion of the ICE course to receive the full 2-week credit. In the rare situation when a student fails either portion of this pass-fail course, the Assistant Dean for Clinical Education will develop a pathway for remediation that should be completed early in Year 4.

Orientation to all clerkships takes place on Friday at the end of each 8-week block. All third year students are together at Dartmouth at this time for the ICE course and will be able to attend. This timing also allows travel time over the weekend, as needed, to the next clerkship site. The clerkship experience itself begins on Monday morning of week 1.

Other requirements for the Year 3-4 continuum include:

• Outpatient Medicine (4 weeks)
• Neurology (4 weeks)
• Subinternship (4 weeks)
• Electives (12-24 weeks)
• Year 4 coursework (Clinical Pharmacology, Health Society and the Physician, Advanced Medical Sciences, ACLS/PALS). This is done in February-March of Year 4.

Outpatient Medicine runs for a full 4 weeks, with orientation the Friday preceding. Some students may take Outpatient Medicine during the summer at the start of Year 3, or near the end of Year 3, but a majority of students will take Outpatient Medicine during Year 4. If taken during Year 3, the other 4 weeks of the 8-week block will be spent doing an elective or the required 4-week Neurology clerkship. Students on Outpatient Medicine in the last half of an 8-week block are not required to attend the ICE session in that block (but should complete an OSCE if scheduled), but are still responsible for completing any quizzes or assignments. Videotapes of sessions and printed handouts will provide the basis for completing assignments. Students need to complete Outpatient Medicine by May of Year 4.

Neurology is a 4 week required clerkship generally taken during Year 4, though a few students may take it in Year 3. Inpatient sites have a pre-requisite of Inpatient Medicine or Surgery. Students on Neurology in the last half of an 8-week block in Year 3 are not required to attend the ICE session in that block but, as with Outpatient Medicine, are still responsible for completing the ICE requirements. Students need to complete Neurology by May of Year 4.

The subinternship must be at least 4 weeks in length and is done in Year 4.

A few students who have important academic reasons for doing so, may take an elective in Year 3. This will require displacing an 8-week clerkship block into Year 4. Electives in Year 3 require the approval of the Assistant Dean for Clinical Education. Students on elective during the last half of an 8-week block are encouraged to attend the ICE session in that block.

Back to Year 3/4 Student Information