Advanced Year (MS4) Policies (COM 2018 and Beyond)

General Information

The senior year affords you a unique opportunity to individualize your education, to read in depth in chosen areas, to tailor your program of study to fill in gaps in knowledge, to explore new areas of possible career interest, and to integrate what has been learned in your third year. If you plan your fourth year wisely, you will graduate with knowledge of medicine sufficient to give you confidence entering the residency years. Specific goals for the fourth year are:

  1. To broaden students' horizons beyond a narrow specialty area;
  2. To assist those who are uncertain about a career specialty path by allowing a broad range of opportunities;
  3. To provide an opportunity to explore areas in depth;
  4. To allow students who need to gain additional experience in the areas of deficiency.

Specialty Advisors

In planning the senior year, students are urged to take advantage of the guidance and expertise of the faculty in the preparation of their elective schedule. Each department has designated a list of faculty who serve as "Specialty Advisors" who can provide information regarding that specialty, residency programs in that specialty, and recommended electives. This list of "specialty advisors" is provided to all third year students at the senior year schedule meeting in the spring semester.

Course and Electives


Every student must satisfactorily complete a subinternship in Internal Medicine (MEDI 4100) or Pediatrics (PEDS 4400). Subinternships generally run from the 1st Monday of the month through the last Friday of the month.

Subinternships can be taken any time in the senior year. This experience must be completed at SUNY Downstate’s University Hospital/Kings County Hospital Center, or one of the designated affiliates. You may take more than one subinternship during your senior year. The Office of the Registrar, through the Electives registration process, assigns the time blocks for the subinternships. All subinternship sites are scheduled through the department chair's offices at SUNY Downstate’s College of Medicine. Do not approach the affiliated hospitals for an assignment.

The subintern's schedule follows the daily housestaff's ward schedule, including night and weekend "call," and attending rounds. The call schedules for each specific hospital and department will apply. During subinternships, a month is defined as a full month with variable starting and ending dates per institution. This may mean that the time commitment for a subinternship rotation will supersede any vacation or recess as it appears on the academic calendar. Withdrawal from any subinternship requires 8 weeks prior notice.

The subinternship is not a prerequisite for a chairman's letter of recommendation for residency and can be scheduled for the end of the senior year instead of at the beginning. If you have performed poorly in a clerkship and you plan to enter that discipline for residency training, it is to your benefit to schedule your subinternship in that field early in the fourth year to demonstrate improvement before your residency faculty letters of recommendation are written.

You should not schedule a subinternship during a period of time when you expect to also have residency interviews. It is not permissible to absent yourself from your subinternship without prior discussion with your course director for approved time off or submission of appropriate medical documentation for an excused absence.

Primary Care II — Geriatrics/Palliative Care

Every student must satisfactorily complete a required 4 week Geriatrics rotation to meet the Primary Care II requirement. The dates of the Geriatrics rotations coincide with the elective dates for the academic year. Students will register themselves for this requirement during their registration period. You should not plan to do residency interviews during your Primary Care II rotation. Any absences from Primary Care II are subject to the same rules of prior discussion with the course director for time off or documented medical absences as pertain to clerkships.

Electives Program & Translational Sciences (TSEL) Requirement (20 weeks (credits) OVERALL Requirement)

  1. No more than 8 weeks of clinical electives in any one subspecialty discipline applies towards the 16 week graduation requirement.
    • The following fields are counted as subspecialties:
      • Anesthesiology
      • Dermatology
      • Emergency Medicine
      • Internal Medicine Subspecialties ( i.e. GI, ID, Rheumatology, Hem-Onc, etc.)
      • Neurology
      • Neurosurgery
      • Obstetrics and Gynecology
      • Ophthalmology
      • Orthopedics
      • Otolaryngology
      • Pathology
      • Pediatric Subspecialties (i.e. GI, ID, Cardiology, Rheumatology, Hem-Onc., etc.)
      • Psychiatry
      • Physical Medicine and Rehabilitation
      • Radiation Oncology
      • Radiology
      • Plastic Surgery,
      • Cardiothoracic Surgery
      • Gastrointestinal Surgery
      • General Surgery (i.e., Surgery SubI, etc)
      • Urology
  2. No more than 8 weeks of away (extramural) electives will count towards the 16 week graduation requirement.
  3. No more than 8 weeks of research electives will count towards the 16 week graduation requirement.
  4. No more than 4 weeks of senior credit will be granted for non-clinical based electives (so-called “Reading” electives). Specifically, students may not exceed taking 4 weeks of History of Medicine, Biomedical Ethics, Case Development in Case Based Learning, Medical Toxicology, Medicine and Literature, Writing in Medicine and/or Literature in Medicine or any other elective labeled as a reading elective. Two weeks of two may be taken or four weeks of one of these courses.
  5. Students must take at least 4 weeks of "selective" Advanced Year credit chosen from a list of courses that will count as selectives. Courses taken as selectives will NOT count against the 8 week maximum in a subspecialty.

    (MD/PHD students are except from taking the TSEL requirement. HOWEVER, they are required to take an additional 4 weeks of clinical electives following the distribution of requirements above)

Students are permitted to register and take additional electives over and above the 16 week elective requirement. Students who wish to take more than 8 weeks in any one subspecialty, research or wish to participate in more than 8 weeks of extramural electives may do so by registering for extra weeks.

Students are strongly encouraged to use their senior year of medical school to broaden their knowledge base as general physicians by taking electives in fields different than those that they will ultimately practice.

Restrictions on Concurrent Electives

You are not permitted to take two full-time electives at the same time. Each week of clinical credit is defined by approximately 30 hours of time commitment.

Research Restrictions toward Graduation Requirements

Ph.D. dissertations/theses, including those of MD/Ph.D. students, may not be used to fulfill senior elective graduation requirements in the College of Medicine. Research taken in the Ph.D. portion of the M.D. /Ph.D. program may not be used to receive credit towards senior year elective requirements for the M.D. degree. Research performed while on a Leave of Absence from the College of Medicine may not be used to fulfill the senior elective graduation requirement.

Non-Credit Electives

Clinical electives offered to Foundations 1 & 2 students may not be applied towards Advanced Year elective graduation requirements.
Core Year (MS3) electives offered in the Core clinical year may not be applied towards Advanced Year elective graduation requirements.


Students participating in the Armed Forces Health Professions or National Health Service Corps (NHSC) Scholarship programs and receiving annual stipends may receive full academic credit for Advanced Year electives taken which do not currently appear in active Course Catalog. However, to receive advanced year academic credit, the course must be an acceptable educational experience, approved by the appropriate SUNY Downstate department chair and your clinical assistant dean. Therefore, a "Proposal for Extramural/Tailor Made Elective" form must be completed.

Prerequisite Requirements

Students must meet all prerequisites of a course before they will be permitted to take an elective course.

To Receive Elective Credit

You are not eligible to receive credit for any elective course until the required forms are on file in the Office of the Registrar.

Definition of Intramural, Tailor-Made and Extramural Electives:

  • Intramural elective - one which appears in this Course Catalog
  • Tailor-made elective - an elective which does not appear in the Course Catalog which a student creates or designs (research or clinical) with a faculty preceptor. It may to be done here at SUNY Downstate or at one of our affiliate hospitals.
  • Extramural elective - an elective taken at another medical school or clinical site.

All extramural and tailor-made electives taken for credit which do not appear in the Course Catalog, must have prior approval of your clinical assistant dean, the faculty sponsor of the elective, and the corresponding SUNY Downstate department chair before you are permitted to take the course. NO retroactive credit will be given for Intramural, Extramural or Tailor-made electives. The Proposal for Extramural/Tailor-Made Elective form in the Office of the Registrar is used to register for ALL extramural or tailor-made electives (courses not in this site).

Length of Electives

Generally, electives are four weeks in length. A number of electives listed in the Course Catalog are approved for two week time periods (2 credits), to permit flexible scheduling options. Electives for less than two week time periods are not permitted.

Except for these electives, credit assignment for electives of less than 4 weeks or more than 4 weeks must be reviewed and approved by the Electives Committee, and cannot be altered after the course has received approval as described; or as it appears in the Course Catalog. A research elective is one example of a course that may be approved for an eight week period.

Course Evaluation Forms

New Innovations System is used for summative evaluations for all required coursework. For tailor-made electives and extramural electives (away electives or electives which do not appear in this book) and all electives including ICU courses, are mailed directly to the preceptor by the Office of the Registrar. Your preceptor must return the forms directly to the Office of the Registrar within two weeks of the completion of the course. No credit can be granted for any elective until the elective evaluation form is received in the Office of the Registrar.

Elective Evaluations and the Medical Student Performance Evaluation (MSPE)

Only course work completed and evaluations received in the Office of the Registrar as of August 30 may be included in your MSPE (formerly the Dean’s Letter) for residency applications. The earliest date that your MSPE may be mailed is October 1, even for early or military matches. If you wish to have any electives, subinternships, or clerkships completed after August 30 considered in your residency application process, you should ask your faculty preceptor to write a letter of recommendation on your behalf.

Elective Time Requirements

Electives or subinternships taken on a full-time basis (full-time is generally defined as approximately 30 contact hours per week) are considered to be seven day commitments. The individual faculty preceptor defines specific schedules. The School's recommended start and end dates are listed in the front pages of this book. However, a faculty preceptor reserves the right to set the dates for his/her elective.

Religious Observers

Students who are Sabbath observers or those expecting to be absent due to religious holidays, or other valid excuses, must notify their clerkship or elective course director at least four weeks prior to the start of the clerkship or the elective. Call schedules and other assignments may need to be adjusted. This is particularly important for subinternships.

Parking & Electives

Students taking an elective at Kings County Hospital or University Hospital may go to the Faculty-Student Association Office in the Student Center to purchase weekly booklets of parking tickets to be used at the Health Science Center Foundation Lot on Winthrop Street. The cost is $4.00 per day.