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Students must successfully complete all basic core clerkships prior to beginning the senior year.   Student who failed one clerkship are usually allowed to take the course over at the beginning of their senior year.  If you have not completed all clerkships as a result of a "Leave of Absence", or for any other reason, you must take this clerkship at the beginning of the senior year.

The final year of medical school is designed to strengthen areas of weakness, explore possible specialty choices, enhance clinical insight and develop skills that will make the student a better physician.

Students will apply knowledge from the basic and clinical sciences that they have gained during the past three years.  The senior year is designed to promote professional diversity and personal growth; its flexibility enables students to use this time to explore areas of interest, above all, to pursue active experiences in-patient care sufficient to provide the basic skills necessary for doctor/patient interaction.

The overall goal for the senior year is to encourage and facilitate the acquisition of perspective in the student’s chosen area of future practice, as well as medicine in general, to provide an opportunity for exposure in specific areas of clinical interest, to improve readiness for residency by strengthening areas of weakness by providing advanced learning experience with increased responsibilities, and to encourage further development of basic science and research interest.

The senior year requirements for the Doctor of Medicine degree include 40 weeks.

Of the 40 weeks, 16 weeks must have the following required selectives:

• 4 weeks of Medicine (see approved list) - Choose 1 from the required list
• 4 weeks of Surgery (see approved list) - Choose 1 from the required list
• 8 weeks of a Primary Care selective (see approved list)
• or 4 weeks (1 month) of Primary Care Selective (see approved list) and 4 weeks (1 month) of an Ambulatory Care Selective (see approved list)

Of the 40 weeks, 16 weeks may be electives (see approved list).  There are four basic types of electives.

• Acting Internships – Student will function as a part of a team on a teaching service and required to take call.
• Consults – Student will be under direct supervision of house staff and attending and will provide consultation to other in-hospital services.
• Preceptorship – Student will be under direct guidance of one faculty member.  This may be clinical or basic science.
• Research – Individual programs by prior arrangement on an individual basis.

Of the 40 weeks, 6 weeks may be used for vacation /professional development and interviewing for residencies.  You cannot take all 6 weeks consecutively.  You may split these 6 weeks into two-week blocks to help with interviewing and Step 2.

Of the 40 weeks, 2 weeks have been allotted for the required “Transition into Residency”

You must successfully pass USMLE Step 2CK and Step 2 CS  by April.  (See “Promotion and Graduation”).

The East Carolina University awards degrees in August, December, and May.  The School of Medicine has a formal hooding ceremony at the May commencement only.  In order to be considered by the Student Review & Promotions Committee for graduation, the minimum requirements must be completed by the degree date.

Students who wish to postpone graduation must obtain permission from the Office of Student Affairs.

• No elective may be taken more than once at the same site.
• No student will be allowed to take more than 12 weeks (3 months) in any one specialty.
• The maximum number of alternative electives will be 12 weeks.  Alternative electives are defined, as educational experiences not coordinated by the Brody School of Medicine faculty members.  In general, these electives are outside the confided of North Carolina, but they may also be within the state.  Any electives taken within the state area not listed in the catalog my be considered an extramural elective.
• Students, who are deficient academically or on the basis of conduct, will not be able to take any extramural electives until the deficiency has been removed for the student's record.
• all third year clerkship must by successfully completed before any extramural electives are scheduled and before you begin your senior year of medical school.

The third and fourth year clerkships and selectives constitute the Core Clinical Experience at the BSOM.  For both MEDICINE and SURGERY, the core clinical experience consists of 12 weeks of instruction, spread over the third and fourth years, at the BSOM designated sites.  You must choose the four-week senior component of this Core Clinical Experience from the approved list.

During your senior year, you are required to complete primary care/ambulatory care selectives. You may choose to take one selective from the primary care selectives list and one selective from the ambulatory care list or you may choose to take two primary care selectives.  It is not recommended to choose the same selective if choosing two from the primary care list.

Primary Care and Ambulatory Care requirements may be done away.  If you plan to do a Primary Care or Ambulatory Care requirement away, or as an Individual Designed Selective (IDS), you will need to complete the necessary paperwork 30 days in advance of the start of the selective.  The completed paperwork must be turned into the Office of Student Affairs,  BSOM, Brody 2S-20,  Greenville, NC 27834 or you will not receive credit for the experience.

The Course Director at the conclusion of each course must evaluate a student’s performance.  The evaluation is a part of the student’s permanent academic record and is available for review by the student.  There is a policy for appeal of an evaluation, should the need arise (see “Grade Appeal Process”). 

The student is responsible for assuring that all evaluation forms are promptly returned.  Faculty will evaluate the performance of each student enrolled in a selective and forward a completed M-4 Student Evaluation form to the Office of Student Affairs.  Students are evaluated on the following categories:

• Amount of factual knowledge
• Ability to use medical literature and general resources of medical information
• Clinical skills (history, physical laboratory)
• Problem-solving ability and clinical judgment
• Procedural skills
• Interpretation of data
• Verbal and written skills
• Punctuality, conscientiousness and initiative
• Acceptance of responsibility
• Ability to work with others
• Ability to obtain confidence and cooperation of patient
• Displays intellectual honesty and integrity

Each evaluation will be given a letter grade:

• “H” - HONORS - Upon the discretion of a department or course faculty, exceptional students may be designated as having earned “Honors” in a discipline.  Such a commendation should be used only to recognize exemplary, independent scholarship and superior achievement beyond course requirements. 
• “A” - EXCELLENT - The grade reserved for a student whose performance in a course, clerkship or other learning experience is clearly outstanding.  This grade is awarded to a student demonstrating intellectual curiosity and competence that sets him/her apart.
• "B” - GOOD - The grade given to a student whose performance in a course, clerkship or other learning experience clearly exceeds the minimal requirements established by the department or course faculty.
• “C” - SATISFACTORY - The grade given to a student whose performance in a course, clerkship or other learning experience meets the minimal requirements established by the department or course faculty.
• “F” - FAILURE - A failing grade given to a student whose performance in a course, clerkship, or other learning experience does not meet the minimal requirements established by the department or course faculty awarding the grade.
• “P” - PASS - The grade given to a student who successfully completes the requirements in skill courses which utilize a PASS/FAIL system of evaluation.

When appropriate, the following notations may also be made on the student’s official transcript:

• “IP” - IN PROGRESS - Indicates that the regularly scheduled course, clerkship or other learning experience has not concluded.  A grade will be assigned upon completion of course requirements.
• “I” - INCOMPLETE - indicates that the regularly scheduled course, clerkship or other learning experience has not been completed due to extenuating medical or personal circumstance.  It is not to be used as a qualified pass or fail and is to be viewed as a nonprejudicial entry on the student’s record.
  

For all alternative experiences, a student must be in “good academic standing” with the university before the Assistant Dean for Student Affairs will approve an application for an elective.  A copy of the final approved application and a copy of the course description must be returned to the Office of Student Affairs 30 days prior to the projected starting date of the experience.  It will be the student’s responsibility to insure that the Office of Student Affairs receives all appropriate documentation and evaluation information.

Students will be required to show proof of health insurance.  In addition, some schools may require the Hep B and Varicella titers.  Currently enrolled medical students will be covered under the medical school’s professional liability policy that will apply to off-campus experience with the exception of international experiences

OFF-CAMPUS EXPERIENCE
A student may take a total of three months of experiences at sites away from The Brody School of Medicine.

To arrange electives off-campus, please do the following:

• Consult catalogs in the Office of Students Affairs or via websites of the host school.
• Obtain a course description from the catalog or off the website of the host school.
• Complete the appropriate Applications for the host school.
• Return a copy of the approved application and the course description to the Office of Student Affairs.

Alternative Experiences are subject to:

1. Approval by the Curriculum Committee under the policies created by the Curriculum Committee.
2. Time allotted for the completion of the required rotations.
3. Requirements of individual remediation established by the Student Promotion and Review committee.
4. Approval by the Assistant Dean for Student Affairs

Additional Information
Non-BSOM electives are electives taken in locations outside those in the BSOM system.  The BSOM Curriculum Committee, Departmental Faculty or students may generate these electives. 

It is recognized that diversity in education is valuable.  Occasionally, education needs and goals of individual students are met better in another educational environments.  The option of taking electives outside the BSOM system will be available to students in “good academic standing”. 

Non-BSOM elective requests must be accompanied by a description of the elective and a letter from the sponsor indicating willingness to accept the student for the period indicated and willingness to abide by the learning objective described.  The Assistant Dean when reviewing the request may request additional information regarding the elective.

Individually Designed Electives are student-generated electives.  Electives are designed by the students to meet specific educational needs for which there are not existing electives.  A complete description of objectives for the experience, method of evaluation, and explanation by supervising individuals must be submitted.  The Assistant Dean when reviewing the request may request additional information regarding the elective.  The Curriculum Committee must also approve these electives.

Students who are not in “good academic standing” in other electives will not be permitted to take electives away from the BSOM system.  Students must be in good standing at the time of application for an elective and at the time of the rotation.

REQUEST FOR NON-BSOM AND INDIVIDUALLY DESIGNED ELECTIVES MUST BE SUBMITTED TWO MONTHS IN ADVANCE.

If the selective does not fit into the above categories, the student must follow the procedure for an Individually Designed Selective (IDS) and obtain appropriate approval prior to beginning the selective.  A list of objectives must accompany the Individually Designed Selective form.

Individually designed selectives (IDS) experiences may include, but are not limited to, research in basic or clinical science areas, off-campus experiences not listed in a catalog. 

The following guidelines govern development of the individually designed selectives (IDS):

• Complete the IDS application (available in the Office of Student Affairs, Brody 2S-20)
• Completed application will include: Student’s Name, Title of Selective, Start Date, Faculty/Preceptor’s Name, Address/Location of Selective, Phone Number and Fax Number, Objectives to be accomplished during the selective (minimum of 3), Description of activities.
• IDS Applications that are not complete will not be accepted for consideration.
• Return the completed IDS application, with all signatures, to the Office of Student Affairs.
• The Office of Student Affairs will review the completed IDS application.  The purpose of the review is to determine if the IDS is equivalent to course already offered and if it is an acceptable senior experience that may meet a requirement.

To arrange electives at Duke, Wake Forest or UNC
The University of North Carolina in Chapel Hill, Duke University in Durham, Wake Forest University in Winston-Salem, and The Brody School of Medicine have agreed to take medical students from the other North Carolina schools into their elective programs.  All three schools will accommodate the medical student for a length of time to correspond with that student’s academic calendar when possible.  After the initial sign up of each school’s own students for the elective programs for the academic year, other students will be accepted.  No tuition will be charged to the visiting student.  Each student will be responsible for his/her own housing facilities.  Tuition and fees are waived through this N.C. Exchange Program.

To arrange electives at Duke, Wake Forest or UNC, please do the following:

• Consult catalogs via websites of the host school.
• Give the Office of Student Affairs in writing your requested courses), with dates.  (Use North Carolina Exchange Form)
• The Office of Student Affairs will make arrangements with the host school.
• The Office of Student Affairs will notify you when courses have been approved by placing copies of the approval letters in your mailbox.

Office of Medical Education web site provides the policy and procedures & required documents for international rotations.  You may link to the site at the URL below; choose the link “International Medicine Rotations” on the left hand side; site requires you to login using your normal ECU ID and password.

http://www.ecu.edu/medicaleducation

A student’s schedule will be reviewed and approved by the Office of Student Affairs.  Changes to an approved schedule must be submitted to the Office of Student Affairs, Brody 2S-20, thirty days before the beginning of the selective.  Because selectives carry professional obligations and responsibilities, a student may not be approved to drop an AI.
 
Students may drop and/or add only with the written permission.  Drop/Add forms are available in the Office of Student Affairs, Brody 2S-20, Brody School of Medicine, Greenville, NC 27834.

Drop/Add procedures were developed by the request of the Course Directors to provide a mechanism whereby they can monitor and control changes in their courses.

All scheduled changes must be completed 4 weeks prior to the start of the elective.  See the Office of Student Affairs to determine the availability for the elective desired and obtain a drop/add form.  The form must be used both to drop and add any elective and should then be returned to the Office of Student Affairs.  This form requires the personal signature of the involved departments.  Course Directors may refuse to approve the change if they believe it is either not in your best interest or it is detrimental to the quality of the over-all educational program of the school.  Since obtaining the necessary signatures may be difficult, if you must, start well in advance.

If circumstances prevent a student from completing a scheduled elective, he/she will be required to make up the elective time or receive an unsatisfactory grade for the elective.

Drop/Add must be completed 4 weeks before the beginning of the elective.  If the Office of Student Affairs does not have you registered for an elective, you will not get credit for it, even if you had the preceptor’s approval and completed the work.

There are 40 weeks available in the curriculum.  A minimum of 34 weeks must be successfully completed to meet the requirements for the M.D. degree.  Students needing time for residency interviewing, travel to and from alternative experiences, USMLE study time, clerkship remediation time, or time for personal or professional activities are expected to use their vacation time.  Students will not be permitted absences from electives except for medical or emergency reasons.  

During your senior year, you are allotted 6 weeks to use towards vacation/professional development and interviewing for residencies.  You cannot take all 6 weeks consecutively.  You may split these 6 weeks into two-week blocks to help with interviewing and Step 2.  Taking vacation in April is not permitted.  

Course Directors for Acting Internships are absolutely under no obligation to give you time off of any rotation with the exception of Thanksgiving, Christmas holidays and Match Day.  If you are registered for their course, they have a right to expect you to be there.  If you need to take a few days to interview, you have to arrange for them during your own time.  Many course directors will work with you for some short periods of time off their rotations, but only if you have made arrangements with them in advance.  You can’t just expect it.  Even when you have an excused absence from a rotation, such as for an interview or illness etc., you should expect to make up the time in some way.  Student Affairs may approve you for one day off from a two-week rotation and no more than three days off from a four-week rotation.  However, a course director has the right to be more strict with days off.  So, communicate with the course directors when needing time off.  

Mandatory Holidays for senior medical students are Thanksgiving and Christmas/New Year Holiday.  Seniors also receive Match Day (3rd Thursday in March) off.  If a medical student does not obtain a position in the NRMP Match, they also receive off the two days (Tuesday and Wednesday) before Match day, the so-called “scramble days”.  Other holidays for senior medical students are at the discretion of the course director or may be delegated to the resident on the service.  The student is expected to assume in many respects, the role of a physician, and in doing so, to recognize the needs of patients for attention and the needs of the service for coverage, regardless of weekends and holidays.

Taking more than the allowed number of absences will result in a grade of incomplete until course requirements have been fulfilled.  You could also receive a “F” grade if the course director feels you have not met the objectives of the course or have not been in attendance enough to grade you.  The grade of “F” is a permanent on your academic transcript.  

Clerkships and Selectives carry professional obligations and responsibilities.  In case of illness, unexpected personal need, or professional obligations that require absence from a selective or clerkship with an attendance requirement, the student must fill out an Excused Absence Request Form (in the Office of Student Affairs).  The information provided will be reviewed, on an individual student basis, and an excused absence may be issued.  Students are responsible for notifying the Office of Student Affairs first, then the appropriate persons (faculty, attending, and residents) of an impending absence.