Post-clerkship rotations represent a pivotal phase in medical education, offering students invaluable opportunities to deepen their understanding across medical subspecialties. This period allows for a transition into the role of a consulting physician and provides experience in primary patient management within outpatient settings. Considering that a significant portion of a clinician’s career is dedicated to office-based practice and consultations, these elective rotations are strategically designed to immerse students in these crucial aspects of medical practice. Furthermore, they offer exposure to a spectrum of common diseases that are less frequently encountered in inpatient internal medicine wards. Students will refine their skills in specialized history taking and physical examinations tailored to specific subspecialties, while also gaining proficiency in the appropriate utilization of specialty-specific diagnostic tools. Our comprehensive Fourth Year Programs are structured to include both subinternship and elective rotations, available at a diverse range of institutions, from military facilities to civilian hospitals worldwide, thus fostering a broad understanding of Uniformed Health Services Civilian Medicine practices.
The overarching objectives of the post-clerkship period are meticulously designed to equip students for the rigors of Graduate Medical Education – encompassing internship and residency training. Crucially, it aims to cultivate advanced clinical decision-making capabilities. This is achieved by guiding students through a developmental progression, moving them from the foundational ability to Report medical information, to skillfully Interpret complex clinical scenarios, and ultimately to confidently Manage patients and effectively Educate them regarding their health. This educational philosophy is encapsulated in the synthetic “RIME” model, a cornerstone of modern medical pedagogy.
The post-clerkship curriculum incorporates a six-week dedicated study period for the USMLE Step 1 examination, followed by an intensive six-week module of advanced curricular instruction known as “Bench to Bedside and Beyond” (B3). The B3 module serves as a crucial bridge, further integrating foundational basic science principles with advanced clinical concepts in a sophisticated context. It also includes formal, rigorous training in essential life-saving skills, namely Advanced Life Support (ALS) and Advanced Trauma Life Support (ATLS) protocols. Following these foundational elements, students engage in advanced clinical rotations alongside a variety of elective rotations. These elective experiences are instrumental in helping students refine their career aspirations and make informed decisions regarding their optimal choices for internship and residency, whether within uniformed health services or civilian medicine. The USMLE Step 2-CK examination is also strategically scheduled to be taken during this period, marking another critical milestone in their medical journey.
A distinctive feature of the post-clerkship period is the opportunity to undertake a Capstone project. This Capstone project is conceived as a longitudinal, in-depth exploration of scientific inquiry within a field of the student’s individual interest. The scope of Capstone projects is intentionally broad, ranging from traditional basic science research endeavors to integrative, operational, translational, or clinically focused projects. Students who opt to complete Capstone projects are allocated a dedicated block of up to three months within the post-clerkship period to fully engage in this significant scientific pursuit, fostering deeper expertise applicable across both uniformed health services and civilian medicine.
Required Advanced Clerkships
To ensure a well-rounded clinical foundation, certain advanced clerkships are mandated during the post-clerkship period. These include:
- Anesthesia (if not successfully completed during the core clerkship period)
- Neurology (similarly, if not completed during the core clerkship period)
- Emergency Medicine
Required Sub-Internships (Choice of 2)
Students are required to select and complete two sub-internships from a diverse list, which typically includes:
- General Surgery
- Family Medicine
- Pediatrics
- Psychiatry
- Internal Medicine
- …and a range of other specialties
These sub-internships provide immersive experiences in various medical disciplines, preparing students for the complexities of both uniformed health services and civilian medicine environments.
Selectives
The curriculum structure provides students with seven ‘selective’ blocks, allowing for personalized learning pathways. Notably, students who have previously completed Anesthesia or Neurology as a Core Selective block are granted an additional ‘selective’ block, totaling eight. The options for these selective blocks are extensive and designed to cater to diverse interests and career goals. They encompass traditional sub-internships for focused clinical experience, clinical electives for exploring specific areas of medicine, operational/humanitarian rotations to broaden perspectives, and specialized research opportunities, including the in-depth Capstone project. Students are strongly encouraged to consider completing an elective in behavioral health, recognizing its growing importance in all facets of medicine, from uniformed health services to civilian medicine.
Capstone Program: Fostering Advanced Scientific Inquiry
The Capstone Program, as an integral component of the post-clerkship period, offers a unique and valuable opportunity for students to engage in self-directed discovery and advanced scientific inquiry as they progress through their MD program. This optional program is designed to cultivate independent learning and research skills, crucial for future leaders in both uniformed health services and civilian medicine. Prospective Capstone participants are encouraged to initiate planning for their faculty-mentored project well in advance of the post-clerkship period. This proactive planning involves identifying a suitable project mentor, engaging in detailed discussions regarding study design methodologies, and securing all necessary institutional approvals. A dedicated time allocation of up to three months within the post-clerkship phase is specifically reserved for students to dedicate themselves fully to the formally assessed Capstone project.
These student-selected longitudinal projects exhibit remarkable diversity, spanning the spectrum from fundamental basic (bench) research to impactful clinical research, innovative education research, performance improvement studies aimed at enhancing healthcare delivery, operational studies focused on healthcare systems, and various public health projects addressing community health needs. Project proposals originating from students are carefully considered on an individual basis, ensuring alignment with academic rigor and student interests. Planning and development are ongoing with students throughout their third and fourth years of study, allowing for flexibility and refinement of project scopes. Depending on the student’s specific interests and the nature of their chosen Capstone project, the research work may commence earlier in their medical education journey and proceed in either a contiguous, uninterrupted timeframe or a non-contiguous, phased approach, accommodating the demands of both uniformed health services and civilian medicine career paths.
