About the Fourth Year

While the fourth year is generally elective in nature, it is expected that certain requirements will be met - the first being the completion of at least one intensive advanced clinical clerkship, or equivalent, which will demonstrate the student’s ability safely to care, by themselves, for acutely ill patients 24 hours a day. The second requirement is the completion of one of three “Return to the Classroom” selective months, with lecture/seminar format, which emphasize the foundation of medical knowledge and the critical appraisal of data rather than the day-to-day aspects of patient management. The required “Return to the Classroom” month focuses on one of 3 areas (Clinical Pathology, Pathophysiology, or Pharmacology) and also includes weekly Clinical Practice (CP4) sessions and twice weekly sessions in Biomedical Informatics. The Clinical Practice sessions foster collegial discussion of challenges facing physicians and medicine today. The Biomedical Informatics sessions focus on both concepts and practical skills that will prepare graduating students for the role of informatics in their future clinical careers.

During the third year, the student begins a series of decisions which culminates in a choice of a particular residency program for postgraduate education. During March and April of their third year, the students plan their fourth year elective curriculum. To make the best choices, the students must consider where their interests lie and then decide what to study, at which institution, and at which point in the year.

To help the students become aware of the decisions to be made and the options available, the Senior Associate Dean for Student Affairs (x5-3806) provides information in the form of memoranda and meetings throughout the year. Advisory Deans also provide numerous opportunities for students to meet with and learn about different residencies. At the same time, the student is supported by the class ahead as well as the Dean’s Office.

All fourth year students are required to take the United States Medical Licensing Examination (USMLE II - Clinical Knowledge and Clinical Skills) no later than November 30, 2009. Passing Clinical Knowledge is required of all students for graduation from P&S.

Phone/web registrations are scheduled for April, July, October, and February for fourth year students.

• December of their third year, students meet with the Senior Associate Dean for Student Affairs and with faculty from P&S affiliates for a planning session about the fourth year and discussion of the various elective opportunities.
• In January the Senior Associate Dean commences meetings with each student individually to review their academic achievements and discuss plans for fourth year and residency applications.
• In February, there are a series of meetings at which fourth year students advise the third years on how to plan their elective schedules.
• In April of the third year, students begin the process of telephone/internet registration for fourth-year electives.
• In May, the Senior Associate Dean for Student Affairs meets with the entire class to go over the residency application process step by step.
• In June, students meet in a series of small-group discussion sessions with individual clinical department chairmen and senior faculty in the various specialties in which they may be interested.
• To help students with their decision-making, the P&S elective catalog is available on-line: Web address: (http://cpmcnet.columbia.edu/dept/ps/electives)
• Brochures from residency programs throughout the country are available in the Dean’s Office, as well as evaluations by students who have visited them in previous years.

By the start of their fourth year, all students are involved in registering for the National Residency Matching Program (N.R.M.P.), requesting letters of recommendation from the faculty, and researching on-line programs that might fit their needs. At a meeting with the Senior Associate Dean for Student Affairs, the student selects a faculty advisor in the field of medicine in which the student is interested in pursuing a career. With the help of the advisor, the students identify residency programs they may be interested in and follow the necessary procedures for applying.

Most interviewing for residency programs is done during December and January. By the third week in February, the various programs and applicants across the country have ranked each other in order of preference and submitted their rank order lists to the National Residency Matching Program. Each applicant is then matched to the most preferred program on their rank order list that offers him/her a position, and each program matches the most preferred candidates who accept its offer of a position. The final match is announced on Match Day in March of the fourth year.

Clinical Practice IV

Constance Park, M.D., Ph.D.

Course Director

Email: cmp4@columbia.edu

In Clinical Practice IV students return to the classroom for weekly discussions during their Back to the Classroom Selective. Goals of this course are 1.) To provide an opportunity for students to reflect on their profession, their goals, and their training while considering the mission of medicine and what it means to them as individuals. 2.) To encourage habits of open communication between colleagues as they work together to identify and address contemporary challenges in medicine throughout their careers. 3.) To explore major challenges facing medicine today. The four sessions are:

• Challenges and Strategies in Disease Prevention: Life style changes, cardiovascular disease, and stroke.
• Our Changing Health Care System: Economics, Organization and Ethical Challenges.
• The Physician and Patients near Death: Loss and grief, healing and curing, what can be done when nothing can be done.
• Selective Topics with attention to self-care. These include Physical Therapy, Pain Management, Human Rights, Economics, Nutrition, and Topics in Complementary and Alternative Therapeutics.

Clinical Months

Students are required to complete a total of eight electives. Five of the eight electives must be clinical and five must be completed at Columbia and/or its affiliated hospitals. All students must have one sub-internship/advanced clinical clerkship and one “Return to the Classroom” selective. No more than two months of electives in a particular specialty are permitted.

Research

Students interested in research may spend two or more months on a research project. As recipient of a National Institutes of Health award to encourage student research, P&S is able to offer a number of funded Research Fellowships to fourth year students undertaking a research project. Research programs now underway in P&S are described in Chapter 12.

Electives at P&S

The College of Physicians and Surgeons, through its affiliated hospitals (Bassett HealthCare, Harlem, Helen Hayes, New York-Presbyterian, Stamford and St. Luke’s-Roosevelt) offers in its Elective Catalog over 300 electives, covering an extraordinary range of areas in both research and clinical medicine.

Web address: http://cpmcnet.columbia.edu/dept/ps/electives

Preceptorships

An elective that has grown in popularity with P&S students is the preceptorship, a resurgence of the old apprentice system, whereby a student selects a preceptor in a given field and stays with that person throughout the working day and night, for an entire month. Currently more than four out of every five fourth year students select preceptorships for one or more months. Most of these preceptorships, some 150 months, are in clinical medicine; however, as many as 60 fourth year student-months are spent in research preceptorships.

Fellowship in Urban Medicine and Immigrant Health

Focusing on Manhattan’s lower east side, this fellowship, established by the Center for the Study of Society and Medicine at P&S, is designed to help future physicians understand the unique health care plight of immigrants; it encourages them to pursue careers in Primary Care.

Extramural Programs

Students may spend three months at extramural programs, that is, at Institutions not affiliated with the College of Physicians and Surgeons. Each year, approximately three out of every four P&S students take one or more electives away - at other U.S. medical schools and in countries throughout the world.

International Exchange Programs

The following is a list of international medical schools that have formal exchange programs with the College of Physicians and Surgeons at Columbia University.

Country	Institution	Web Site
Armenia	Yerevan State Medical University	http://www.ysmu.am
Australia	Flinders University of South Australia University of Sydney	http://www.flinders.edu.au http://www.medfac.usyd.edu.au
Chile	Clinica Indisa	http://www.indisa.cl
China	Fudan University Guangzhou Medical College Peking University Health Sciences Center	http://www.fudan.edu.cn http://www.gzhmc.edu.cn email: donzhe@mail.bjmu.edu.cn
France	University of Marseille University of Paris (MICEFA) American Hospital in Paris	http://www.timone.univ-mrs.fr/medecine/index.html http://micefa.org/american/programme/medicine.html http://http://www.ahpf.org
Germany	Heidelberg University	http://www.med.uni-hd.de/studiendekanat
Ireland	Royal College of Surgeons in Ireland Trinity College	http://www.rcsi.ie/medical_school/student_electives http://www.tcd.ie
Israel	Ben Gurion University of the Negev	http://cpmcnet.columbia.edu/dept/bgcu-md
Italy	University of Padova	http://www.unipd.it
Japan	Keio University Tokyo Women’s Medical University	http://www.med.keio.ac.jp/index.html http://www.twmu.edu.ac.jp
Korea	Hallym University Seoul National University	http://www.hallym.ac.kr/main.htm http://plaza.snu.ac.kr/~bklife/english/e_index.html
Lebanon	American University of Beirut	http://www.aub.edu.lb
Romania	University of Bucharest	http://www.unibuc.ro/en/main_desprenoi_en
South Africa	University of the Witwatersrand	http://www.wits.ac.za
Spain	Universidad de Navarra	http://www.unav.es/admision/titulaciones/doctorados.html
Sweden	Göteborg University	http://www.gu.se
Thailand	Chiang Mai University	http://http://www.grad.cmu.ac.th
United Kingdom	St. Bartholomew’s and London School of Medicine & Dentistry University of Edinburgh, Faculty of Medicine	http://www.mds.qmw.ac.uk http://www.ed.ac.uk
Venezuela	University of Zulia, Maracaibo	http://www.arg.luz.ve