Policies and Procedures

Fourth Year Policies and Procedures

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


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. 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 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 to forfeit one of the available vacation periods. 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. Complete a 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 completed approval must be turned in to the registrars prior to the start of the visiting rotation. 
  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.

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. 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
  • 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
  • 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


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 6, 7, and 8, though for some they will begin as early as Period 4. 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

The policies regarding absences from fourth-year rotations can be found on the Student Resources Sharepoint Site (https://luky.sharepoint.com/sites/medicine/studentresources) under Policies > Academic > Excused Absences – Advanced Development Phase. You need to pay careful attention to this policy as you plan for board exams and residency interviews.

Policy on Duty Hours   Back to Top

Duty hours for medical students are inclusive of all required clinical and educational activities. This includes, but is not limited to, classroom activities, assigned readings, required on-line modules, and required projects. Medical students on clinical clerkship rotations have the following guidelines for duty hours:

  1. Medical students are never to work more than 80 hours per week.
  2. Medical students are to have on average one day out of every seven completely free from all clinical and educational duties
  3. Medical students are to have a minimum of 10 hours off between required in-house activities.
  4. Required in-house activities for medical students cannot exceed 24 hours although a student may need to stay for a few additional hours longer than the allowed 24 hours to maintain continuity of patient care.

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.

Vacation Period Off   Back to Top

With few exceptions, each senior will have three rotation periods off for vacation and Interviews. Students should carefully consider how to best use these months 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 6: Allows additional time for residency interviews that generally begin during this period.
  • Period 7: Allows additional time for residency interviews without clinical or other course responsibilities.
  • Period 8: Allows time for residency interviews that are scheduled during this period.

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

The flex month may be used in the fall to prepare for and/or take either or both USMLE Step 2 examinations as long as the appropriate 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 2 CK by Dec. 31 and Step 2 CS by Nov. 1 are required for graduation.

Students are required to register for an exam date for USMLE Step 2CS by May 31; scheduling earlier is recommended to ensure securing a preferred testing location and date.

Students are required to take USMLE Step 2CK and Step 2CS by December 31 at the latest. Be aware, however, that testing late in the fall means that results of any USMLE Step 2CS retakes (due to failure of first attempt) may not be received before programs determine their rank list.

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):