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2019-2020 Catalog [ARCHIVED CATALOG]
School of Medicine: Fourth Year
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In contrast to the first three years of the medical school curriculum, during which students follow a fixed schedule, the M4 year provides considerable flexibility. Although the M4 curriculum contains some required elements, students have considerable latitude to design their educational programs to fit their individual needs and interests. The M4 year is intended to provide each student with a well-rounded educational experience, building on the knowledge and experiences of the first three years and preparing the student for postgraduate training.
Descriptions of electives appearing in this catalog were prepared by the faculty of the department offering the elective and by the Office of Medical Education. At present, the information in this book is accurate to the best of our knowledge. However, policies, procedures, and faculty listings may change from time to time. Any questions regarding descriptive material of a particular elective should be directed to the appropriate departmental elective course director.
Role of the Student
Each student should have identified a clinical faculty advisor. It is the responsibility of the student to contact the advisor to discuss possible career choices and other factors that might directly or indirectly affect the 4th year elective schedule. Each student is responsible for developing a 4th year schedule that is a well-rounded educational experience meeting all graduation and site compliance requirements. The student should be proactive in communicating in a timely and honest manner with the M4 coordinator and Office of Medical Education regarding scheduling of interviews and elective rotations.
Role of the Faculty Advisor
The advisor should play more than a passive or permissive role and should be able to supply perspective to developing the student’s educational program. In most instances the most satisfying programs result from a strong collaboration between student and advisor. The role of the advisor is dual, combining personal, supportive counseling with study and career guidance; helping the student to develop an overall plan for the entire elective year and assisting with interviewing skills and evaluating residency programs. The advisor should be available for periodic consultation and should take an active interest in the success of the elective program and the student’s performance.
Role of the Elective Course Director(s)
The student must negotiate with the intended directors to reach agreement on the extent of supervision and the resources required to achieve the objectives. If the directors cannot provide the resources or feel that the objectives for the elective are unable to be obtained due to time needed away from the rotation for interviews, the student must seek an alternative elective course. The Course Director is responsible for completing the final evaluation for the student. At the director’s discretion another faculty member can be assigned to this role.
Role of the Department Chairman
The Department Chairmen have an important role in ensuring that the resources - faculty, space, time and interest - are available for both intramural and extramural electives. The Elective Course Director must notify his/her department chairman prior to agreeing to supervise an elective to ensure that there is no infringement on the educational or other resources required for the core curriculum.
Role of the Associate Dean for Clinical Education
The Associate Dean for Clinical Education, in cooperation with the Vice Dean for Academic Affairs and the Medical Education Committee (MEC), oversees the operation of the electives program. The Associate Dean for Clinical Education will review and approve each student’s planned program, and may return an unsatisfactory program to the student for revision, or may prohibit a student from taking an extramural elective if it is felt to be inappropriate. All electives not in this catalog, with the exception of those offered through VSLO, must be approved by the Associate Dean for Clinical Education. All schedule changes will require approval from the Associate Dean for Clinical Education. When necessary, the Associate Dean of Clinical Education will seek the advice and counsel of the Vice Dean for Academic Affairs and the Medical Education Committee.
In order to graduate from the Eastern Virginia Medical School with the M.D. degree, students must satisfactorily complete all elements of the prescribed four-year curriculum. Students must have successfully completed all requirements of the M1, M2 and M3 years before beginning the M4 year.
Requirements for Promotion to M4
- All clerkships must be completed with a passing score prior to beginning the M4 year
- Family Medicine
- Internal Medicine
- Psychiatry
- Obstetrics & Gynecology
- Pediatrics
- Surgery
- Advanced Cardiac Life Support Course (ACLS)
- Compliance with EVMS health requirements
The M4 Year
The M4 year is designed to promote a well-rounded educational experience (NOT a preliminary internship). Use the M4 year as an opportunity to broaden your horizons, not to get an early start on specialty training.
- Includes 32 weeks of full-time, scheduled, supervised, and evaluated educational experiences.
- 20 weeks of required electives
- Acting Internship (4 weeks)
- Ambulatory Care (4 weeks)
- Critical Care (4 weeks)
- Community-Engaged Learning Capstone (2 weeks)
- Interprofessional Education (2 weeks)
- Transition in Practice Series: Residency (4 weeks)
- 12 weeks of elective time
- Includes 12 weeks of unscheduled time for professional development and personal use.
- Additional clinical or basic science rotations
- USMLE Step 2 study
- Interviews
- Vacations/Travel/Personal Time
- Students are allowed to work with faculty to design clinical experiences other than those in this Catalog. The process for creating an individualized experience or away rotation is described in detail in this catalog. Please plan ahead as there are multiple compliance requirements and deadlines that must be met.
- Students MUST TAKE USMLE Step 2 Clinical Knowledge (CK) and USMLE Step 2 Clinical Skills (CS) before September 30, 2019 and must PASS in order to graduate.
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Required Rotations - 20 WEEKS Acting Internship (AI)
Must be completed at EVMS or an affiliated site
Affiliated sites include:
- Bon Secours, Hampton Roads
- Children’s Hospital of The Kings Daughters
- Naval Medical Center Portsmouth
- Sentara, Hampton Roads
- Veteran’s Affairs Medical Center, Hampton
The Acting Internship (AI) elective is designed to encourage senior medical students, regardless of desired future specialty, to assume patient care responsibilities similar to those of an intern (PGY-1 resident), including night call. Acting interns should carry patients independently of interns and have similar duties, schedules, and didactic sessions as interns. They should work all shifts with their teams. They should take ownership of their patients and be the primary point person regarding their care. They should be increasingly (but safely) independent in their clinical practice but able to recognize when help is needed.
By the end of the acting internship, students should be proficient and efficient in handling the daily tasks of an intern, demonstrating expected behaviors for an entrustable learner including:
- Performing complete and accurate history and physical exams in an organized fashion
- Prioritizing a differential diagnosis following a clinical encounter
- Recommending and interpreting common diagnostic and screening tests
- Entering and discussing orders and prescriptions
- Documenting a clinical encounter accurately in the patient record
- Presenting an oral presentation of a clinical encounter
- Forming clinical questions and retrieving evidence to advance patient care
- Giving or receiving a patient handover to transition care responsibly
- Collaborating as a member of an interprofessional team
- Obtaining informed consent for tests and/or procedures
- Identifying system failures and contributing to a culture of safety and improvement
Available Acting Internships
Ambulatory Medicine (AMB)
May be completed at any LCME-accredited school or under the supervision of a physician with an active faculty appointment at an LCME-accredited school.
The Ambulatory Medicine (AMB) elective is intended to allow senior medical students to participate in the evaluation and management of patients who present with a wide variety of disorders in a setting where physicians provide primarily outpatient care. A minimum of 5 half days per week (averaged over the course of the elective) must be in an Ambulatory setting providing direct patient care (not in a shadowing role).
By the end of the ambulatory medicine elective, students should be proficient and efficient in the management of an outpatient in a clinic setting, demonstrating expected behaviors for an entrustable learner including:
- Performing complete and accurate history and physical exams in an organized fashion
- Prioritizing a differential diagnosis following a clinical encounter
- Recommending and interpreting common diagnostic and screening tests
- Entering and discussing orders and prescriptions
- Documenting a clinical encounter accurately in the patient record
- Presenting an oral presentation of a clinical encounter
- Forming clinical questions and retrieving evidence to advance patient care
- Collaborating as a member of an interprofessional team
Physical Medicine & Rehabilitation
Critical Care (CC)
May be completed at any LCME-accredited school or under the supervision of a physician with an active faculty appointment at an LCME-accredited school.
The Critical Care (CC) elective is intended to expose senior medical students to the evaluation and management of seriously ill patients, often in intensive-care settings, with the goal of learning how to appropriately evaluate the emergent patient. Students should be increasingly (but safely) independent in their clinical practice and able to recognize when help is needed. Students should work all shifts with their teams, including night call.
By the end of the critical care elective, students should be able to develop a thorough, systematic approach to the rapid recognition, evaluation, treatment, and disposition of the critically ill or injured patient, demonstrating expected behaviors for an entrustable learner including:
- Recognizing a patient requiring urgent or emergent management
- Prioritizing a differential diagnosis for a critically ill or injured patient
- Recommending and interpreting common diagnostic and screening tests
- Entering and discussing orders and prescriptions
- Presenting an oral presentation of a clinical encounter
- Forming clinical questions and retrieving evidence to advance patient care
- Collaborating as a member of an interprofessional team
- Obtaining informed consent for a test or a procedure
- Performing general procedures of a physician
Interprofessional Education (IPE)
7 hours of face-to-face course work and simulations at EVMS on assigned Monday for all EVMS students.
Student can sign up during another elective if approved and excused by that elective course director.
The Interprofessional Education (IPE) elective is intended to expose senior medical students to an interprofessional team approach to patient care. This course will engage students from a variety of healthcare backgrounds to work together online and in person over the course of 2 weeks, culminating in a day-long standardized patient workshop utilizing telehealth and home healthcare monitoring technology.
By the end of the interprofessional education elective, students should be able to identify core competencies for interprofessional practice and collaboration and describe the benefit and necessity of interprofessional team approaches in complex health systems, demonstrating expected behaviors for an entrustable learner including:
- Forming clinical questions and retrieving evidence to advance patient care
- Collaborating as a member of an interprofessional team
Transition Into Practice: Residency Readiness
Required course for all EVMS students in Block 10
The Successful Transition to Effective Practice (STEP) course is a required rotation intended to prepare senior medical students for residency.
By the end of the STEP course, students should be able to identify core competencies for effective practice, demonstrating expected behaviors for an entrustable learner including:
- Performing complete and accurate history and physical exams in an organized fashion
- Prioritizing a differential diagnosis following a clinical encounter
- Recommending and interpreting common diagnostic and screening tests
- Entering and discussing orders and prescriptions
- Documenting a clinical encounter accurately in the patient record
- Presenting an oral presentation of a clinical encounter
- Forming clinical questions and retrieving evidence to advance patient care
- Giving or receiving a patient handover to transition care responsibly
- Collaborating as a member of an interprofessional team
- Recognizing a patient requiring urgent or emergent management
- Obtaining informed consent for tests and/or procedures
- Performing general procedures of a physician
- Identifying system failures and contributing to a culture of safety and improvement
Service Learning Capstone
Capstone’s Purpose: Capstone is designed to help you synthesize your service-learning experiences, especially as related to the social determinants of health (SDOH) presented in your served audience. In most cases, the capstone project will also fulfill the requirement for producing scholarly work.
- You can fulfill the course requirements by presenting at a peer-reviewed conference, publishing in a peer-reviewed journal, or submitting a poster of your current work.
- The deadline to submit the Capstone Project is February 13, 2020.There are two parts to this turn-in:
- The project itself (poster templates can be found on the MD2020 Service-Learning Blackboard)
- Brief document describing your group members’ individual contributions.
Once you submit your product, we will evaluate and provide feedback. If refinement or revision is necessary we will allow you to accomplish that. Projects will be accepted for display at the Service Learning Capstone Day in April of your M4 year.By the end of the Capstone course, students should be able to identify core competencies for effective practice, demonstrating expected behaviors for an entrustable learner including:
- Identifying system failures and contributing to a culture of safety and improvement
- Collaborating as a member of an interprofessional team
- Recognize when a patient is in a specific at-risk group and identify preventive measures
Scholarly Activity
All EVMS students are required to complete one of the below courses prior to the beginning of block 10. A scholarly product must be submitted to receive credit.
Patient Safety
Other electives that meet the definition of this course category may be submitted for approval to fulfill this requirement using the M4 Elective Objectives form.
Elective Rotations - 12 Weeks
Many of the electives in the catalog can be used to satisfy any of several different requirements. For example, SUR 404 - Shock/Trauma can be used to satisfy the Acting Internship (AI) requirement, the Critical Care requirement, or can serve as an elective rotation.
- Each 4-week rotation can only be used to satisfy ONE requirement.
- An M4 rotation MAY NOT be used to remediate a failed M3 clerkship.
- Students may not schedule electives in which they will be directly supervised or graded by members of their immediate family (parents, grandparents, spouses, siblings, in-laws or children.)
- Students will plan “full-time” electives based on four-week blocks. Four week blocks may be developed by students into two, two-week block electives provided that proper procedures for developing electives are followed. Electives may not be planned for less than two weeks in duration. (NOTE: Two-week rotations should include AT LEAST 10 scheduled work days.)
Away Electives
Except for the required Acting Internship (AI) rotation and STEP course, any of the required or elective rotations may be completed at sites other than EVMS-affiliated institutions. EVMS encourages students to do M4 rotations at other medical schools. These can be very valuable and enjoyable experiences, and they may help to strengthen your application for residency training. In planning for these rotations, you should be aware of the following rules:
- Students may do a maximum of 4 months (a total of 16 weeks) at locations other than EVMS
- Away rotations must be done at an LCME accredited U.S. Medical School.
- If your desired rotation is described in the catalog of the host school, that description can be used to complete the EVMS Electives Objectives form. If the elective is not described in the host school’s catalog, students should follow the instructions for developing elective rotations below.
- The majority of U.S. medical schools now require that applications from visiting students be submitted through the Visiting Student Learning Opportunities service (VSLO) managed by the Associate of American Medical Schools (AAMC). Information is available from the Office of Medical Education (Dr. Janet Winner) or directly from the AAMC. Some medical schools use their own individual applications. Information for each school can be obtained from the school’s website.
- Most schools accept applications from visiting students in the spring, but may not confirm your acceptance until late spring or early summer. Most schools, including EVMS, make every effort to accommodate their own students before accepting visiting students. For extramural electives for which you have not yet received confirmation, indicate the expected rotations on your scheduling form and attach your elective objectives form.
- When you receive your letter of confirmation (approval of rotation from outside school) please forward the letter of approval and elective objectives and description from the school’s catalog to m4@evms.edu
- If your application is not accepted, we will assist you in adjusting your schedule.
Creating Your Own Away Elective
- Identify the site. All non-VSLO away electives require an affiliation agreement between EVMS and the site. The site must either be affiliated with EVMS or another LCME accredited institution. Obtaining agreements can be a lengthy process spanning several months. Please plan accordingly.
- Consult with your advisor, the appropriate department chairman, Associate Dean of Clinical Education, or the Vice Dean for Academic Affairs regarding your goals and objectives.
- Complete an Elective Objectives Form describing the skills, knowledge or values/attitudes the student wishes to achieve. Use the following links to help you write objectives: New Bloom’s Taxonomy and Learning Objectives Easy Generator.
- Review the objectives with the proposed course director, who must be a board certified physician or other comparably credentialed individual and must hold a faculty appointment with EVMS or another LCME accredited institution.
- Submit the form to Charlene Cooper at m4@evms.edu. The proposed elective will be routed to the Associate Dean of Clinical Education and the appropriate Department Chairman for review. The affiliation agreement and faculty status will be verified during the review process.
- This process should be completed more than 30 days prior to the start of the elective. Electives will not be approved if submitted less than 14 days prior to the start of the elective.
- An email notification of final approval must be received prior to participating in any created elective at EVMS or any other LCME accredited school.
International Electives
International electives offer tremendous insight into healthcare around the world and allow students to cultivate cultural competencies and interdisciplinary skills that will contribute to being an effective, compassionate and patient-centered provider and advocate for underrepresented communities in the United States and worldwide. To register for an international elective through EVMS, students need to follow these steps:
- Meet with Dr. Alexandra Leader to discuss interests, available programs, goals and objectives.
- Complete the Global Health paperwork packet including the following EVMS Risk Management forms: EVMS International Travel Application, International Travel Assumption of Risk and Release of Liability.
- After the EVMS Risk Management forms have been fully approved, Global Health will email an approval to the student. The student can then register for the course.
- When registering for an international 999 or 998 course, attach the approval email to the objectives form.
Please note: students will not be able to receive credit for international electives when the following have not been completed/are not in place:
- Affiliation Agreement(s) between EVMS and international site(s) or NGO are fully executed
- The course has a Course Director who holds a faculty appointment at an LCME accredited institution
- Travel is approved by both EVMS Risk Management and Global Health
- The course has been approved as part of the student’s schedule by the Associate Dean for Clinical Education
Elective Periods and Deadlines
| Blocks |
Deadline for Changes |
| 1) July 1 - July 26, 2019 |
June 17, 2019 |
| 2) July 29 - August 23, 2019 |
July 15, 2018 |
| 3) August 26 - September 20, 2019 |
August 13, 2019 |
| 4) September 23 - October 18, 2019 |
September 9, 2019 |
| 5) October 21 - November 15, 2019 |
October 7, 2019 |
| 6) November 18 - December 13, 2019 |
November 4, 2019 |
| 7) January 6 - January 31, 2020 |
December 13, 2019 |
| 8) February 3 - February 28, 2020 |
No changes allowed after December 13, 2019 |
| 9) March 2 - March 27, 2020 |
| 10) March 30 - April 24, 2020 (EVMS students complete TIP during this block) |
| 11) April 27 - May 15, 2020 |
- SCHEDULES: Deadline for completed EVMS M4 schedules: May 1, 2019
- STEP 2: must be completed before September 30, 2019
- ADVANCED CARDIAC LIFE SUPPORT: - must be completed before December 13, 2019
- SCHEDULED TIME OFF: Winter Break: December 14, 2019 - January 5, 2020
- GRADUATION: May 16, 2019
Note to Visiting Students: 4th Year Visiting students may apply for electives during the blocks listed above. However, confirmation of rotation cannot be given before May 2018.
Schedule Submission and Approval
In reviewing a student’s proposed program, the Associate Dean of Clinical Education, Vice Dean for Academic Affairs, and the Medical Education Committee will use the following guidelines:
- The program shall be well conceived and consistent with respect to fulfillment of the educational needs of the student.
- The program shall be commensurate with the capabilities of the student.
- The educational opportunities selected shall be of a quality sufficient to justify the expenditure of time requested.
- The required rotations listed must be included in each student’s planned program. A longitudinal ambulatory care elective will not satisfy the requirement for the four week ambulatory care rotation.
- Students cannot change the designation of an already completed rotation.
Schedule Changes
- A Drop/Add request form must be completed and submitted to the M4 Coordinator NO LESS THAN 14 days in advance of the beginning rotation date with approval from the elective supervisor of the elective being ADDED. If an Objectives Form is necessary this also should be submitted. (See Drop/Add form and deadlines for changes on the following pages). Credit for rotations will not be given to students who fail to follow the proper procedures for changing an elective.
- The M4 Coordinator (Charlene Cooper) will review the requested change and approve or disapprove the request based on the balance of the student’s schedule and requirements. If the request is approved, the student may then proceed to change the rotation. The student must forward confirmation that the elective supervisors for both the elective being dropped and the rotation being added have been notified.
- Under no circumstances should a student make schedule changes prior to receiving approval by the M4 Coordinator. Changes WILL NOT be accepted if submitted less than 14 days in advance. Credit for rotations will not be given to students who fail to follow the proper procedures for changing a rotation. No changes to schedules will be allowed after December 14, 2018.
- To submit a drop/add schedule change request use the following link to Caspio.
Grading System
The requirements for Honors, High Pass, and Pass are based on departmental policy that will be discussed with the students at the initiation of the clerkship or elective. Honors, High Pass, Pass, or Fail are the only notations sent to the Registrar’s Office and appearing on transcripts.
Implications of the Grade Fail: In the event a student fails a clerkship/elective, the Course Director shall recommend both to the student and the Student Progress Committee, an appropriate remedial program. The remedial program may include taking an examination and/or repeating all or a portion of the clerkship. The recommendation is reviewed by the Student Progress Committee, which makes the final decision regarding the student’s academic progress. The Student Progress Committee uses guidelines outlined in the Policies and Procedures for Student Evaluation and Progress regarding promotion of students through the education program at the medical school. At the completion of the approved remedial activity, the student will be given a grade of pass or fail. Both grades (e.g., F/P) remain part of the student’s record and transcript.
Some departments allow students who fail the written examination but have passed other portions of the clerkship to remediate the examination before receiving a final grade for the clerkship. Remediation must occur within 2 months or a grade of “Fail” will be assigned.
Clinical Education Site Compliance
All 4th year EVMS students will be required to complete pre-rotation compliance requirements for Sentara facilities by June 8, 2019. Students will be enrolled in and communicated with via Blackboard to facilitate completion.
For electives taking place at facilities other than Sentara, students are required to complete all site-specific requirements a minimum of 30 days prior to the start of the elective. All requirements for our local health systems will be housed in one central Blackboard course, MD2019 M4 Clinical Experience Requirements, which students will have access to on May 1, 2019. An email announcement will be sent out through Blackboard when the compliance course opens.
Any student who has not completed the necessary required compliance activities will be prohibited from starting their elective. This delay may impact your ability to complete the scheduled elective and may impact your ability to graduate on time.
Visiting Students
- All visiting students must apply through the Office of Education, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA 23501. If a student contacts a department, the student must be referred to the Office of Education. Confirmation for Electives is granted by the Office of Education.
Only persons currently enrolled in an LCME accredited U.S. medical school are eligible to apply for admission to the Electives Program at EVMS.
- Visiting students may take only senior year electives. Third year clerkships are not open to any visiting students. A visiting student must have satisfactorily completed all basic science courses (including physical diagnosis) and, by the start date of the requested elective, the applicant must have completed satisfactorily a minimum of thirty-six (36) weeks of full-time clinical experience during which the student’s primary responsibility was to follow patients on a teaching service. This experience must include at least four (4) separate disciplines from among the following: Family Medicine; General Internal Medicine; Obstetrics and Gynecology; Pediatrics; Psychiatry; and General Surgery. Experience in each discipline must be at least four (4) weeks in duration. No elective will be approved for a discipline in which the requisite core clinical experience has not been satisfactorily completed.
- An elective application form must be completed for each elective requested and approved by the visiting student’s medical school official, authorizing these experiences. This form must be submitted no later than four weeks prior to the beginning of an elective in order to be considered. Visiting student application materials may be found on our EVMS web-site.
- Each request for an elective must have the approval of the sponsoring department and the Office of Education.
- In most cases, confirmation for electives will be given as soon as possible after the May 1st deadline for EVMS students. EVMS students have first priority for electives.
- Visiting students are limited to a maximum of twelve weeks of electives at EVMS, except under special circumstances. (Requires approval from the Vice Dean for Academic Affairs)
- A non-refundable application fee of $150.00 must be submitted along with the application materials. Each visiting student must register with the EVMS Registrar’s Office prior to beginning the elective. A student identification card will be issued by our Human Resources Office, Eastern Virginia Medical School, following registration.
- Visiting students must have adequate health insurance coverage to take electives at EVMS. Proof of personal health coverage can be submitted with the application packet or presented at the time of registration. Visiting students must also provide proof of HIPAA training, Blood Born Pathogen training and a Criminal Background report with the application packet. The EVMS Health form completed by a health care provider must also be submitted along with your application.
- Each student is responsible for obtaining accommodations during his/her stay here.
- No stipend will be paid by EVMS to visiting students taking electives for credit.
- EVMS will provide evaluations to the sponsoring institutions, but credit for elective experiences will be given by the institution granting the M.D. degree to the student.
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