Policies and Procedures

Fourth Year Policies and Procedures

Prerequisites
Off-Site Rotations
Area Health Education Centers
Visiting Rotations
Special Electives
Acting Internships
Medical Records/Acting Intern Orders
Residency Interview Period
Official Time Away
Policy on Duty Hours
Interview Period Off
Vacation Period Off
USMLE
Professionalism

 

Prerequisites    Back to Top

The latitude given a student in choosing fourth-year courses is dependent on performance during previous years. All courses require promotion to fourth year. Some courses have additional prerequisites noted in the course descriptions.

Please be aware of the following stipulations:

  1. Any student who receives an "Unsatisfactory" grade (below 70.0) in a third-year course, or for any reason has not completed third-year courses, shall not be promoted to the fourth year until the deficiency has been rectified to the satisfaction of the Student Progress and Promotion Committee and the department involved. Repetition or completion of one or more third-year courses at the beginning of the fourth year does not alter graduation requirements of fourth year.
  2. When a student has achieved only minimal performance on a third-year course, a department may recommend to the SPPC that the student include a particular course in fourth-year work.
  3. Any student who needs to complete third-year rotations must do so before starting any fourth-year rotations.

Off-site Rotations     Back to Top

An off‑site course is a University of Kentucky course which a student takes away from the tertiary care center, often in a private practitioner's office. The site must be within the state of Kentucky and the student must be supervised by a preceptor who is a member of the College of Medicine community volunteer faculty and is not related to the student.

Off-site rotations may take place in AHEC areas, medically underserved parts of Kentucky, or non-AHEC areas, primary in Lexington.

Beginning on in late May, students who have signed up for off-site rotations will have the opportunity to request AHEC regions. The placement process is administered by the individual departments. 

Important Note #1: You must submit your Off-Site AHEC Region Ranking Form online within a week of the opening of the request process for Period 1 and 2, at least three months prior to the start of your scheduled off-site rotation for Periods 3-8 (September to February) and no later than the end of December for Period 10. Some departments may provide you with an alternate process. 

Important Note #2: A student must never make direct contact with a physician or a regional AHEC office regarding a rotation unless specifically directed to do so by the department. All communications regarding preceptor placement need to go through the departmental education coordinators (course contacts.)

Important Note #3: AHEC placements are becoming more difficult as the number of health science students in Kentucky continues to grow.  If you are enrolled in an off-site rotation, have submitted your Off-Site Rotation Request Form by the deadlines above, and have not been placed 14 days prior to the start of the rotation, please let the registrars know immediately.  We can work with you get you enrolled in an alternate course.   

The full procedure can be found HERE.


Area Health Education Centers    Back to Top

The Area Health Education Center program combines the resources of carefully selected community hospitals and physicians engaged in the private practice of medicine to provide rotations for senior medical students. These rotations enable the student to receive a portion of their education in a setting other than that of the University Medical Center in Lexington. All physicians are volunteer community faculty members in appropriate College of Medicine departments. Students provide their preferences for AHEC regions, or participate in the placement process determined by the course director. During the off-site rotation the student might reside in the community, and is instructed and supervised by a physician preceptor. (Travel and housing reimbursements are typically available. Some restrictions apply.) This rotation allows the student to experience life in a smaller Kentucky community, participate with a great deal of flexibility and autonomy in delivering medical care in a private practice setting, and benefit from a one-to-one teaching relationship with a qualified and interested voluntary clinical faculty member. Rotations are available in numerous specialties and sites statewide. Each student who does an off-site rotation must submit the AHEC Fact Sheet to the AHEC office at UK at least one month prior to the start of the rotation. The form is available on the AHEC website (http://ahec.med.uky.edu/fact-sheet). This form is required to document your rotation and to provide you with reimbursement for some expenses.


Visiting Rotations   Back to Top

A visiting rotation is a clinical rotation done outside of Kentucky and administered by a medical school or residency program other than UKCOM. (Rotations in Louisville done through the University of Louisville and in Northern Kentucky done through the University of Cincinnati are also considered visiting rotations.) Each student is limited to three visiting rotations, or four for students who chose forfeit their available vacation period. Each visiting rotation must be four weeks long, no exceptions. Approval by a designated UK faculty member is required prior to submission of any applications (see #3 below.) Students on visiting rotation rotations at other medical schools or programs need to abide by all policies of the host programs, including the absence policies.

Planning a visiting rotation requires an early start and diligence with regards to paperwork and follow-through:

  1. Identify institutions that offer visiting rotations that you would like to apply for. The AAMC’s Visiting Student Application System (VSAS) is being used by the majority of programs and contains most or all of the information you will need to apply to those programs. Additional residency programs can be researched by specialty and location in the AMA’s Frieda Online. Look online for visiting student policies and processes for those institutions in which you are interested. Only make direct contact if you are unable to find the needed information online or if you have specific questions. Applications for visiting rotations may be done in two ways, depending on the requirements of the host program:
    1. Many or most medical schools and residency programs require that students apply through the AAMC’s Visiting Student Application System (VSAS). That system is accessed online at https://services.aamc.org/20/vsas/. All students in the class will be given access and authorizations to apply for rotations through VSAS. You will need to inform the registrars if and when you would like your photo and/or transcript uploaded to VSAS, as well as any other documents that need to be provided by the registrars.
    2. For programs that are not using VSAS, review the online application information to familiarize yourself with the documentation that will be required. Pay special attention to requirements for immunizations, titers, background checks, drug screens, or other requirements that may require follow-up and expense on your part. 
  2. Download an Visiting Rotation Approval Form from the Fourth-Year Resources Page.
  3. A visiting rotation course must be approved by the designated departmental representative from UK before any certification of your eligibility can be provided. This approval document allows you to receive academic credit for the rotation. For visiting rotations that do not require COM certification (such as military rotations,) the signed approval form must be turned in to the registrars prior to the start of the visiting rotation. Your Visiting Rotation Approval Form with attached course description must be signed by the appropriate faculty member listed (emailed approval from the faculty member will be accepted in lieu of a signature on the form):

DEPARTMENT

REPRESENTATIVE

LOCATION

Anatomy

Wayne Cass

 

Anesthesiology

Arundathi Reddy, M.B.B.S.

N-204, UKMC aru.reddy@uky.edu

Behavioral Science

H. Jean Wiese, Ph.D.

107 COM Office Bldg. mjwiese@uky.edu

Biochemistry

Louis Hersh, Ph.D.

MS-607B, UKMC mlhersh@uky.edu

Dermatology

Stuart Tobin, M.D.

N109E Nursing Bldg. sto223@email.uky.edu

Diagnostic Radiology

Arthur Lieber, M.D.

A-125 Kentucky Clinic

Emergency Medicine

Sameer Desai, M.D.

M-53, UKMC sdesa3@uky.edu

Family & Community Med

William Elder, PhD

K-309, Kentucky Clinic welder@email.uky.edu 

Micro & Immunology

Alan Kaplan, Ph.D.

MS-411, UKMC makaplan@uky.edu

Medicine

Kristy Deep, M.D.

304 Wethington kristydeep@uky.edu

Neurology

Amy B. Hessler, D.O..

L-442 Kentucky Clinic amy.hessler@uky.edu

Neurosurgery

Craig Van Horne, M.D.

MS-108B UKMC craigvanhorne@uky.edu

OB/GYN

Wendy Hansen, M.D.

C-367, UKMC wfhans2@ uky.edu

Ophthalmology

Julia Stevens, M.D.

E-302, Kentucky Clinic jlstev@uky.edu

Orthopaedics

Raymond Wright, M.D. (contact Chris Tutsch)

K-400 Kentucky Clinic chris.tutsch@uky.edu

Pathology

Janna Neltner, MD

MS-155, UKMC mjmhack0@uky.edu

Pediatrics

Elizabeth “Berry” Seelbach, M.D.

Kentucky Children’s Hospital berry.seelbach@uky.edu

Pharmacology

Nada Porter, PhD

MS-315, UKMC mnadap@uky.edu

Physiology

Brian Jackson, Ph.D.

MS-581, UKMC brian.jackson@uky.edu

Preventive Medicine

Scott Prince, M.D.

2400 Greatstone Pt. tprince@uky.edu

Psychiatry

Jim Norton, Ph.D.

292N College of Pharmacy Bldg. jnorton@email.uky.edu

Radiation Medicine

Mahesh Kudrimoti, M.D.

N-013, UKMC mkudr0@email.uky.edu

Rehabilitation Medicine

Sara Salles Shahid, D.O.

Cardinal Hill ssall0@email.uky.edu

Surgery

Raleigh Jones, M.D. (meeting required)

C-236, UKMC rjone1@uky.edu

  1. An affiliation agreement must be in place between the College of Medicine and any visiting rotation site. The registrars are working diligently with UK legal to establish agreements with sites to which students apply.  Until an agreement has been finalized, there is no guarantee that it will be, you should have a back up plan for this block.
  2. Notify the registrars as soon as you have been accepted for an visiting rotation that you plan to do. If you decide to drop a visiting rotation for which you have been accepted, notify the institution immediately and no later than one month prior to the beginning of the rotation. Keep a record of your cancellation in case it is needed later.
  3. The UKCOM evaluation form is available to programs in VSAS.  The registrars will also email you an evaluation/grade form and instructions while you are at your visiting rotation. It is your responsibility to be sure that a completed evaluation with a final numeric grade is returned to the registrars so that academic credit can be awarded.

Special Electives   Back to Top

Sometimes a student has an opportunity to do a course that is not in the published curriculum.  It might be a research rotation in a department that does not list a research course in the catalog.  Or it might be a unique course that you’ve designed with your faculty mentor.  In order to obtain approval for a special elective:

  1. Write a letter to the Student Progress and Promotions Committee (SPPC) requesting permission to do the elective and providing a brief description of your learning objectives and the work you will be doing. Send the letter to the dean of Student Affairs or the registrars.
  2. Ask your faculty mentor to write a letter of support for your special elective and send it to the dean of Student Affairs or the registrars.

You will be informed as soon as SPPC has taken action on your request. If approved, the registrars will create a course section and register you for the elective.


Acting Internships   Back to Top

Since acting interns take the place of interns, special duties and responsibilities are assigned and may involve extended rotation dates (Acting Internships may end on the final Sunday of a rotation period as opposed to Friday.) Try to schedule AI rotations in the months where you will not have multiple interruptions for interviews, USMLE exams, etc., as your attendance is imperative. Additionally, once an AI is scheduled, the course director may not be able to allow a students to drop the course or to change rotation dates.

Primary Acting Internships

Qualifying rotations will provide students with the experience of an intern, being primarily responsible for the complete care of inpatients on the rotation. While on the rotation, students should be assigned a workload equivalent to 50% of that typically assigned to an intern on that service. For the patients under their care, students must perform and be assessed on the following activities under the supervision of a resident or attending:

  • Perform the initial evaluation of patients assigned to the service
  • Write admit and daily orders
  • Develop their own diagnostic and therapeutic plans
  • Write discharge notes
  • Communicate with the patient and family members regarding care plans
  • Communicate with consultants and other healthcare professionals as necessary
  • Provide cross‐coverage, assisting with urgent/emergent medical issues
  • Transition patient care to another healthcare provider

Upon successful completion of a primary acting internship rotation, students must be competent to independently perform the following entrustable professional activities:

  • Write progress notes that communicate patient status and management plans
  • Provide accurate and concise documentation of a hospital discharge
  • Manage transitions of care by performing a patient handover to another health care provider
  • Write, dictate, and/or enter safe and appropriate patient orders
  • Provide focused information and a defined clinical question when requesting a consult

Each entrustable professional activity must be specifically assessed during the clerkship rotation, and documentation of student performance must be submitted with the final grade.

Secondary Acting Internships
Qualifying rotations will provide students with direct patient care experience, and students should be assigned a workload equivalent to 50% of that typically assigned to an intern on that service. While on rotation, students should be directly responsible for patient care.

While on rotation, students should be directly responsible for patient care.

Students on inpatient rotations must perform and be assessed on the following activities under the supervision of a resident or attending:

  • Perform the initial evaluation for patients presenting to the service
  • Develop their own diagnostic and therapeutic plans
  • Write a complete progress note documenting the management plans of the service
  • Assist with procedures performed by the service
  • Communicate with the patient regarding care plans and laboratory or test results

Students on outpatient rotations must perform and be assessed on the following activities under the supervision of a resident or attending:

  • Perform the initial evaluation for patients presenting for a clinic visit
  • Develop their own diagnostic and therapeutic plans
  • Write a complete progress note documenting the clinic visit
  • Follow‐up on laboratory or tests ordered during the visit
  • Communicate with the patient regarding care plans and laboratory or test results

Other Acting Internship Options
Primary and Secondary Acting Internships are identified in the course descriptions and the Graduation Requirements section of the fourth-year catalog. If you are scheduling a special elective or off-site rotation that you believe will qualify as a Secondary Acting Internship, you may request approval via the following process:

  1. Provide a written request to the Curriculum dean and the dean of Student Affairs no later than three months prior to the start of the rotation.
  2. The request must include the name of the rotation, the location (name of preceptor, clinic/hospital/medical school/residency program), a course description if available, and an explanation about how the rotation will meet the three criteria for Secondary Acting Internships (see above.) The decision will be made at a meeting of third-year and fourth-year course directors.
  3. Rotations will not be approved as Secondary Acting Internships retroactively or once the student has begun the rotation.

If you are scheduling a visiting rotation that is identified by the home school as a sub-internship or acting internship, it will qualify as a secondary acting internship. If you are uncertain whether or not a visiting rotation will qualify as a secondary acting internship, please provide the course description to the registrars for determination.


Medical Records/Acting Intern Orders   Back to Top

Much of the information in patient charts is entered by medical students. Make sure that you identify yourself as an M4 in the chart. If you are participating as an acting intern, you should designate that in the chart.

Acting interns are not authorized to give verbal or telephone orders, or to enter orders in critical care units. All orders entered by acting interns must be reviewed and co-signed by the supervising resident or attending physician before those orders are implemented.

The Chief of Staff’s Office will monitor acting intern orders. Violations may result in but are not limited to the following sanctions: revocation of the acting intern’s order-writing privileges, effect on the acting intern’s grade, and/or other sanctions.

At the VA Medical Center, acting intern orders must be countersigned before they are implemented.


Residency Interview Period   Back to Top

Students should recognize that the majority of their residency interviews will likely take place during Periods 5, 6 and 7, though for some they will begin as early as Period 3. With that in mind, students should carefully plan their schedules to include as much flexibility as possible during the key periods. Students should avoid scheduling Acting Internships during these periods, if possible (see Acting Internships, above).


Official Time Away from Clinical Rotations

Students on outpatient clinic rotations typically have weekends free. On these rotations, students are allowed up to a maximum of two days off per four-week rotation for official use. Students may use these two days for interviewing or taking USMLE Step 2CK or 2CS.

Students on acting internships and rotations that include weekend shifts have increased patient responsibilities and are expected to be at the hospital more than students on outpatient rotations, including time on weekends. Acting internship rotations must still comply with the COM policy on duty hours as listed below. Students on acting internships are therefore allowed four days off per 4-week rotation for official use. The specific days off must be approved by the course director or attending in charge of the rotation. Students may use these four days for interviewing and/or taking Step 2-CK or CS. Students are not, however, encouraged to schedule interviews while on acting internships due to the increased patient care responsibilities.

Regardless of the reason for any absence, the student must submit an online Absence Request Form.

If you have more than 2 excused absences during an outpatient rotation, or more than 4 excused absences during inpatient rotation/acting internship, you may be required by your attending and/or course director to make up those additional excused absences. The reason for this is that there is a College of Medicine policy regarding the minimum number of days that must be completed in order for you to receive credit for the rotation. Students most often make up time for rotations as soon as they have completed their last rotation of the year.

Quick reference:

  • If you don’t work weekends – 2 days off
  • If you do work weekends – 4 days off

Policy on Duty Hours   Back to Top

  1. Medical students are to have on average of one day out of every seven days free from clinical duties.
  2. Medical students are never to work more than 80 hours per week.
  3. Duty periods for medical students cannot last for more than 24 hours although a student may need to stay a few hours longer than the allowed 24 hours in order to maintain continuity of patient care. Every effort should be made by the student’s resident to get the medical student out of the hospital post-call.

If a student finds that her/his rotation is not in compliance with these guidelines, the student should alert the course director and the assistant dean for Student Affairs right away so they can follow up on this issue.


Interview Period Off   Back to Top

With few exceptions, each senior will have one rotation period off for residency interviews.  For most students, this will be Period 7 (January.)  Students in specialties that use the San Francisco Match and students in the Military Match will have earlier interviews and should take their interview periods earlier.  Students in specialties that begin and end interviews earlier than most should take their interview periods earlier. All students must schedule their interview periods for Period 4 to Period 7 (October to January.)

In order to find out if your specialty of choice holds earlier-than-normal interviews, please seek the advice of training directors and current residents in that specialty.

Each student must take one rotation period off for interviews.  This cannot be taken along with a vacation month during the Spring semester.  This time cannot be used for additional rotations.  No student may take more than nine four-week courses during fourth year.


Vacation Period Off   Back to Top

With few exceptions, each senior will have one rotation period off for vacation. Students should carefully consider how to best use this month in scheduling their fourth-year. Examples include the following:

  • Period 1: Allows time to take USMLE Step 2 exams, begin to work on residency applications or to have a break after third year.
  • Period 5: Allows additional time for residency interviews that generally begin during this period.
  • Period 6: Allows additional time for residency interviews without clinical or other course responsibilities.
  • Period 7: (If not being taken as the Interview Period Off.)  Allows time for residency interviews that are scheduled during this period.

The vacation month may be forfeited for those students wishing to do an additional visiting rotation or other elective in their fourth year.

The vacation month may be used in the fall to prepare for and/or take either or both USMLE Step 2 examinations as long as the appropiate deadlines are still met.

This cannot be taken along with an Interview month during the Spring semester.


United States Medical Licensing Examination   Back to Top

Passing scores on USMLE Step 2CK and Step 2CS are required for graduation.

Students are required to select an exam date for USMLE Step 2CS by April 30 at the latest. 

Students are required to take USMLE Step 2CS by September 30 at the latest, and are strongly encouraged to take the exam earlier.

Students are required to select an exam date for USMLE Step 2CK by September 1 and to take the exam by December 31 at the latest.

Students may take USMLE Step 2CK and Step 2CS in whatever sequence they like as long as Step 2CS has been completed by September 30 and Step 2CK has been completed by December 31.

Failure to register for the exams in time to obtain test dates before September 30 for Step 2CS and  December 31 for Step 2CK will not constitute grounds for deadline extensions and may result in sanctions as determined by the Student Progress and Promotions Committee, which may include but are not limited to the following: a later graduation date and/or being withdrawn from the Match by the College of Medicine.

Students will not be required to be on call the night prior to the exam and are relieved of rotation responsibilities on the day of the examination. You must notify the Student Affairs office and your course director of your scheduled date at least four weeks prior to the test.


Professionalism   Back to Top

At all times in the fourth year, students will be expected to act in a professional manner in their interactions with patients and their families, faculty, residents, other health care professionals, staff and other students. As such, students must abide by all applicable policies and regulations governing professional behavior including but not limited to the following policies (available on the Student Affairs web site):

No