Phase 3 Curriculum

Phase 3 of the MD curriculum builds upon the foundational skills developed during Phase 1 and Phase 2 to prepare IU School of Medicine graduates for supervised clinical practice, scholarship, and service in residency and beyond. This phase includes required core clinical rotations, tailored electives, and the residency-preparation course, Transitions 3. For participants in the optional Scholarly Concentrations program, students also have time to complete their scholarly project and scholarly product and participate in IU School of Medicine Education Day, if not done previously.

Quick Resources

Phase 3 Rotation Schedule – Class of 2024

Phase 3 Rotation Schedule – Class of 2025

Phase 3 Scheduling Process

Electives Catalogs and FAQs

AAMC Electives Compendium: database of elective opportunities at AAMC-member medical schools

Medical Student Advising RoadMap – Phase 3 Resources – Class of 2024

Medical Student Advising RoadMap – Phase 3 Resources – Class of 2025

Important reminders

For the academic year 2023-2024, the Emergency Medicine Clerkship will convert to a satisfactory/fail (S/F) grading scale to promote alignment across all Phase 3 required rotations and electives.
If rotating at the Roudebush VA Medical Center, students are required to contact the VA Education Office (indvaaffiliategroup@va.gov) a minimum of 30 days, but no more than 60 days, before their rotation in order to schedule and complete all the onboarding steps required to rotate at the VA. This 30-day minimum applies to all students, even if they have rotated at the VA previously.

Explore the VA onboarding process

Graduation Requirements

The core curriculum in the clinical years has been gradually transitioning as IU School of Medicine adapts to meet the changing needs of future physicians. IU School of Medicine’s training program allows students to customize their education while enhancing their preparation for and easing the transition into residency. IU School of Medicine’s curriculum provides enhanced clinical training through a combination of best practices and unique innovations, all made possible by the rich framework of our statewide system. In addition to providing a robust core training curriculum and tailored electives experience, Phase 3 provides ample time for preparing for board examinations (e.g. USMLE Step 2), residency program selection, professional development, research, vacation and wellness.

Emergency Medicine Clerkship (four weeks)
Sub-Internship Selective (four weeks)
- Internal Medicine, Pediatrics, Family Medicine, Surgery or OB-GYN
Critical Care Selective (four weeks)
- 2023-2024 Critical Care Selectives Catalog
- 2024-2025 Critical Care Selectives Catalog
Radiology (two weeks)
Transitions 3 (four weeks)
- See T3 FAQ below for further information about the course and specialty focus for each month of Transitions 3.
Electives: A minimum of 20 weeks.
- A minimum of 12 weeks must be established courses (non-special electives) listed in the electives catalog. Be sure to select courses from the catalog for the academic year you will be taking your electives.
- Electives must include 12 weeks of clinical electives (Clinical Practice/Advanced Clinical electives).
- A maximum of two career exploration electives (four weeks) may be used to fulfill graduation requirements.
  - Students in Phase 3 students may not take a career exploration elective, unless it is approved as a special elective.
- You may enroll in more electives than the minimum number required for graduation, as long as you complete all electives prior to the month of your graduation.
- Students who complete all requirements of the Scholarly Concentrations program by Jan. 31 of their fourth year will be awarded the equivalent of eight weeks of non-clinical, catalog elective credit toward graduation. See section on registering for Scholarly Concentration electives on the Phase 3 Scheduling information page.

Enrollment Requirements

In addition to graduation requirements, there are also minimum enrollment requirements for each term: summer term (June–July), four weeks; fall term (August–December), 12 weeks; spring term (January–May), eight weeks. Students should work closely with their lead advisors to ensure that they meet expectations both for enrollment and for graduation.

The school’s flat rate tuition is divided across those three enrollment terms. Students are expected to be enrolled as full-time students in each term over the course of the year; this is also a requirement to receive financial aid as a full-time student. Most students will exceed minimum enrollment requirements in order to complete their graduation requirements within the four year curriculum. Some students may have additional standards set by the school based on personalized circumstances.

Vacation

Phase 3 students can schedule two four-week vacation periods and one two-week vacation period in addition to winter break. Many students choose to take electives or use those blocks to interview for residency programs.

Phase 3 Rotations

Emergency Medicine
Students on the emergency medicine rotation develop critical competencies in diagnosis, management and communication required to care for patients with urgent and emergent conditions in a complex and ever-changing medical system. Autonomy and responsibility are essential for the student to learn fundamental approaches to patients with undifferentiated urgent or emergent conditions.

Emergency medicine students function as the primary caregiver for their patients, working closely with supervising board-certified emergency medicine faculty and senior emergency medicine residents to develop and implement management plans. Students are required to diagnose patients with a focused history and physical examination, taking into consideration not only the patient’s medical condition, but also the psychosocial aspects of the problem. Students implement solutions to these problems under direct supervision of expert clinical educators. Preparation for these advancing levels of responsibility include intensive didactic and high-fidelity simulation training at the beginning of the clerkship, as well as high quality asynchronous online learning.

As primary caregivers, students are expected to:
- Place orders pending faculty co-signature
- Call consultants as indicated
- Arrange patient dispositions and transfers of care
- Follow results of diagnostic testing
- Document patient progress notes in the medical record
Radiology
It is difficult to imagine practicing medicine today without radiology. Therefore, it is vital that students understand how to effectively use radiology in patient care. The radiology rotation is required during the Phase 3 clinical phase of the educational program. This rotation provides students an opportunity to review and integrate key lessons from the first two phases of medical school in subjects such as anatomy, physiology and pathology.

Radiology is also the context in which students will most often visualize the inner structure and function of their patients. Students who study radiology gain an opportunity to form indelible images of disease processes and their treatment including fractures, infections, vascular occlusions, neoplasms and more. Radiology ties together the basic sciences and clinical disciplines in a particularly effective manner, and plays a major role in answering basic medical questions: Is my patient sick? What is the diagnosis? How far has the disease progressed? Is it responding to therapy? Has it recurred?

Through this rotation, students learn:
- How to determine what imaging studies to order
- How to integrate imaging results effectively into patient care
- What basic pathologies in key organ systems look like from the vantage points of different imaging modalities

Sub-Internship Selective

The Sub-Internship, or Sub-I, is a rotation during which a fourth-year medical student takes on an advanced role in direct patient care, attending to progressive frontline duties and responsibilities regarding patient admission, diagnosis, treatment and discharge under close supervision. This experience is an exciting step forward for students and an excellent opportunity to practice and display maturing clinical skills. Students often request letters of recommendation from faculty they work with during these Sub-I rotations so they can comment on the student’s patient care skills at the level expected of a first-year resident.

As recently as 2016, internal medicine was the only Sub-I offered at IU School of Medicine. The school introduced family medicine and pediatric options in 2016 and continues to grow the number of locations and opportunities in those areas. In 2019, in response to student requests, the school added options for Sub-I’s in general surgery and OB-GYN. Each of these specialties are united by a common core curriculum and a focus on teaching senior medical students to perform the core functions of a physician under close supervision prior to entry into residency. Specialty choices can be guided by each student’s lead advisor, career mentor, the Career Development Office or any other Medical Student Affairs Office resources.

Each Sub-Internship specialty allows students fulfill their requirement to complete a Sub-Internship in Phase 3 of the curriculum in one of several highly rated teaching teams that can provide close supervision for advanced inpatient care responsibilities. Some Sub-I teaching teams consist of a faculty member paired one-on-one with a Sub-I student, whereas other services incorporate senior residents and interns into a traditional academic teaching team. This close supervision and supportive learning environment allow Sub-I students to demonstrate competency with all components of hospital admission, reassessment, team changeovers and hospital discharge or transfers between inpatient services.

In order to be successful on the Sub-I rotation, all students expect to have developed the following skills during Phase 2:

Consistently and actively participate in the care of their assigned patients as well as during rounds; the latter activity requires students to speak up and convey their ideas and thought process to their supervising teachers.
Perform an appropriate history and physical examination
Devise a prioritized, patient-centered differential diagnosis and reasonable plan of care.
Possess working familiarity with common hospital EMRs.
Work appropriately with medical interpreters in hospital settings and practice patient-centered communication, including use of appropriate language, taking responsibility for daily updates, calling families or surrogate historians as appropriate and working to achieve patients’ healthcare goals.
Communicate patient information during rounds (oral presentations) and in written documentation.
Demonstrate strong professionalism skills involving team work, punctuality and timeliness of completion of tasks.

Internal Medicine Sub-Internship

Internal medicine is a specialty that focuses on comprehensive medical care (diagnosis, treatment and prevention) for adult patients. Before an appropriate treatment plan of care can be rendered, health care providers must first determine a correct diagnosis. Thus, this field of medicine requires clinicians to apply scientific knowledge and clinical expertise in the care of adult patients. Therefore, the primary goal of this sub-internship is to improve medical students’ capacity to think and function like clinicians in supervised clinical settings. To this end, heavy emphasis is placed on developing the student’s skills at hypothesis-driven data gathering and diagnostic reasoning skills. As the primary goal implies, this Sub-Internship prepares students for residency by fostering independence in supervised settings.
The Internal Medicine Sub-Internship is available at all campuses except Bloomington and South Bend.
Family Medicine Sub-Internship

During the Family Medicine Sub-Internship, students will acquire the skills needed for residency within an inpatient family medicine experience. This Sub-Internship is a robust hospitalist opportunity that incorporates the family medicine philosophy of interprofessional collaboration with all hospital services. Students are assigned to inpatient medicine teams that care for patients in a ward setting. Students are given primary patient care responsibilities with a closely guided experience in diagnostic and therapeutic decision-making.
To be successful in the Family Medicine Sub-I, students must have a strong knowledge of chronic medical conditions, diagnosis, and treatment plans. Students will build on these skills to demonstrate the ability to begin managing exacerbations of and interactions with complex chronic conditions under appropriate faculty supervision.
The Family Medicine Sub-Internship is available at Evansville, Fort Wayne, Indianapolis, Muncie, South Bend, Terre Haute and West Lafayette.
Pediatrics Sub-Internship

The primary goal of the Pediatrics Sub-Internship is to improve medical students’ capacity to think and function like a clinician in supervised inpatient pediatric settings. To this end, heavy emphasis is placed on developing students’ skills at hypothesis-driven data gathering and diagnostic reasoning skills. This rotation fosters students’ growing independence in supervised settings at Riley Hospital for Children at IU Health, one of the nation’s top children’s hospitals. By actively participating in the care of their patients and interdisciplinary patient-centered rounds, students gain exposure to a wide variety of pediatric pathology and world-renowned clinician educators.
The Pediatrics Sub-Internship is only available in Indianapolis.
General Surgery Sub-Internship

The General Surgery Sub-Internship is an advanced experience in general surgery that continues the development of clinical skills for Phase 3 medical students. The curriculum of this Sub-I is relevant to senior students entering future surgical disciplines. These skills include problem-focused history and physical examination, application of medical knowledge to perioperative care, as well as technical proficiencies in surgical clinics, both on hospital wards and in the operating room. Students are given increased responsibilities with the aim of fostering growing independence as they prepare for residency. Students are evaluated clinically by faculty and resident preceptors, with computer-based simulated patient cases, a transitions of care module, a clinical presentation to their surgical teams and basic technical skills.
The General Surgery Sub-Internship is only available in Indianapolis.
Obstetrics and Gynecology Sub-Internship

The Obstetrics and Gynecology Sub-Internship provides students who are interested in women’s healthcare the opportunity to gain necessary knowledge and procedural skills to be successful in their intern year. Students work closely with a team of residents and faculty in both inpatient and outpatient settings, in the operating room, on labor and delivery, and in antepartum and postpartum units of selected high volume academic hospital services associated with the OB/GYN residency program. Students are encouraged to actively engage in all aspects of clinical care, and are expected to demonstrate the skills necessary to assume primary patient care responsibilities upon entry to residency. During resident didactic times, when residents are relieved of clinical duties, students work one-on-one with faculty and are given the opportunity to take on intern-level roles. In addition, Sub-Interns have the opportunity to step into the role of educator, using their experience and knowledge to help guide junior level students through their required clerkship rotation.
The Obstetrics and Gynecology Sub-Internship is only available in Indianapolis.

Critical Care Selectives

The Critical Care Selective rotations provide students with the opportunity to participate in a critical care environment. These rotations have been highly rated by prior students, and these experiences are designed to prepare graduates for the complex clinical challenges they will face in their first months of residency training. The trend of incorporating critical care exposure for senior students is increasingly prevalent in medical schools and this preparation is viewed as providing a valuable advantage by residency program directors. Critical care experiences allow students to develop key experiences most relevant to their future goals with selective opportunities across the state in adult general medical, surgical, pediatric, and neonatal ICU’s as well as subspecialty rotations including cardiac and neurological critical care. These rotations provide opportunities for the student to actively participate in a substantial amount and variety of patient encounters in a critical care setting with expert faculty, including opportunities for advanced care responsibilities (such as order-writing, admission, and discharge documentation) when appropriate to the setting and the level of supervision required in each patient encounter.

What are Critical Care Selectives?

The Critical Care Selectives are four-week rotations that give students the opportunity to participate in a critical care environment. This opportunity has been designed to improve the readiness of our graduates for the complex clinical challenges they will face in their first months of residency training. The trend of increased critical care exposure to senior students is becoming widely prevalent in medical schools and reflects an appreciation for the increasing complexity of healthcare in the 21st century and the educational value of applying foundational sciences knowledge to the care of critically ill patients. This experience is viewed as providing great preparatory value by residency program directors and may be viewed as providing an educational advantage on residency program applications. The creation of the Critical Care Selectives in the Phase 3 curriculum in 2020 marked an exciting development in the ongoing curricular transformation at IU School of Medicine for the benefit of our students.
Why was this Selective added to the Phase 3 curriculum?

The Critical Care Selective addresses the need for additional training in the recognition and stabilization of critically ill patients prior to assuming responsibility for this task in residency. The ability to recognize and begin addressing unexpected critical illness is considered a key professional responsibility of resident physicians and, in the absence of formal training, has previously been identified as a cause of tremendous challenges for junior physicians in the educational literature. In safely supervised critical care settings, students learn to integrate their foundational knowledge of pathophysiology and pharmacology with new skills in advanced communication, medical decision-making and team-based care. This update is designed to significantly enhance IUSM students’ preparation for residency while integrating with the complementary goals of the Sub-I, Emergency Medicine, and Transitions 3 to produce well-rounded and highly prepared graduates.
Are there Critical Care Selectives relevant to my future specialty?

Critical Care Selectives encompass all ICU specialties including medical, surgical, pediatric and neonatal, as well as subspecialty units, such as neuro-critical care and cardiac critical care. The wide array of options available generally mirror the historical distribution of students’ career preferences.
How will I choose a Critical Care Selective?

You will choose your Critical Care Selective from the Critical Care Selectives catalog for your class year. This catalog is designed to make it easier for students to choose a selective that aligns with their individual career goals.

Class of 2024 Critical Care Selectives Catalog

Class of 2025 Critical Care Selectives Catalog
Is there didactic content associated with the Critical Care Selective courses?

Yes! Didactic content is provided on each individual course canvas site for each Critical Care Selective course. Students must complete this content and the associated quizzes as part of their critical care rotations.
Can I preference which Critical Care Selective I take? How does Phase 3 preferencing work?

Yes. You will receive detailed instructions on preferencing in late November to early December prior to the start of your Phase 3 year. The preferencing process occurs in stages. Generally, in the first stage, you will preference your required clinical rotations (see list of required rotations above). (You may also preference one vacation month during the first stage.) During the next stage, you will schedule your electives and additional vacation time. During the final stage, you will schedule your Transitions 3 block. This staged process has been refined over many years and has consistently allowed our students to maximize learning opportunities and plan efficiently. Medical Student Education works to keep students updated on upcoming steps as students progress through each stage of education, and lead advisors are a valuable resource for personalized guidance as well. You will receive specific instructions from the registrar at each stage of the scheduling process. Please see the Phase 3 Scheduling page for more information about the Phase 3 scheduling process.

Electives

Electives provide students with the opportunity to individually tailor the final year of medical school to fit their goals. Electives also round out student training and experiences based on each student’s individualized clinical development and career goals. In collaboration with a career mentor and lead advisor, students select elective courses in their areas of interest.

Electives overview and catalog

Elective Requirements

Students are required to take a minimum number of electives, set for each graduation year (see above under “Graduation Requirements” for more information).
Students can also propose special electives with the special elective request form if they identify opportunities outside of the school’s elective catalog offerings. Special elective rotations may be opportunities within IUSM that are not offered in the electives catalog or opportunities at other institutions. The application process for away rotations at other institutions is complex, varying by institution and specialty. See the VSLO AAMC website to search for opportunities at other institutions.
- A special elective request form must be submitted for ALL non-catalog rotations, including away rotations that students apply for through VSLO/VSAS.
- The completed form and supporting documentation must be submitted a minimum of 30 days prior to the start of the rotation (even earlier for international requests).

Transitions 3

All students must take Transitions 3 during Rotations 10, 11, or 12 of their fourth year at the end of Phase 3. The topics and materials in the course cover common clinical scenarios that all residents will encounter, regardless of residency choice. Additionally, students will explore specialty-specific topics and content. Transitions 3 also includes topics identified by residency program directors as important for interns to know at the start of residency. This course was created in response to student requests, the popularity of the Surgical Bootcamp course and the growing national trend of adding a residency preparedness rotation for all students to cap off their medical school experience.

Transitions 3 includes a mix of live (in person) and asynchronous sessions. Due to the nature of the sessions, the in-person sessions will be held in Indianapolis. Students who reside at a regional campus (not Indianapolis) should apply for housing a minimum of two weeks prior to check in via the MSE Housing Request Form. Indianapolis-based students are not provided with housing for Transitions 3.

Is Transitions 3 (T3) Required?

Everyone is required to take T3 to fulfill their graduation requirements.
What is Transitions 3?

T3 is a month-long course in the spring of your final year of medical school providing opportunities for professional development, medical knowledge review and procedural skills practice making the transition to intern year a smoother one.

When is Transitions 3?

T3 will occur over three months — Rotations 10, 11 or 12. If you are scheduled for a required rotation (Critical Care Selective, Emergency Medicine Clerkship, Radiology, or Sub-Internship) you cannot take T3 during those months. If you have an elective scheduled during the month you want to take T3, you must drop the elective. T3 is a core rotation requirement and cannot be taken in conjunction with any other course/rotation.

Transitions 3 Tracks
Rotation 10	Rotation 11	Rotation 12
Internal Medicine	Internal Medicine	Internal Medicine
Pediatrics	Surgery	Obstetrics and Gynecology
Emergency Medicine	Family Medicine

What if my specialty is not listed or I have a core rotation scheduled during the month my specialty is offered?

All of the T3 tracks will offer residency preparation that is applicable to all students, regardless of their future specialty. If your specialty does not “fit” into one of the tracks above or you have a core rotation scheduled during the month your specialty is offered, please choose a track that fits your schedule that you believe will best prepare you for residency. Example: Ben is applying to Emergency Medicine-Pediatrics. He has multiple Emergency Medicine rotations planned during his fourth year and decides to take the pediatrics T3 track to review this content prior to residency.
Where does Transitions 3 happen?

There will be a mix of live and asynchronous sessions. Due to the nature of the sessions, any in-person sessions will be held in Indianapolis. Students whose home base is another campus will be provided with housing in Indianapolis.
How will Transitions 3 be scheduled? What if I have core rotations all three of those months?

You will sign up for T3 in September of your fourth year via a Qualtrics survey that will be disseminated via the student newsletter (remember to keep the month you want to take T3 available on your schedule). This course is scheduled later in the fourth year than the other required rotations since many students are still deciding on their future specialties during the first few months of their fourth year. Again, while we recommend that you take the T3 track that most closely matches your intended specialty, all of the T3 tracks will offer residency preparation that is applicable to all students. You cannot request to take T3 during a month that you have a core rotation scheduled (Emergency Medicine, Sub-Internship, Critical Care Selective, Radiology) because schedule changes for those cannot be accommodated. You cannot take T3 in conjunction with an elective. If you have an elective scheduled during the month you are scheduled for T3 you must drop the elective.
Can I switch to a different Transitions 3 track if I change my mind about my specialty?

If you change your mind regarding your specialty, we will work with you to change tracks, if at all possible. Please note that we cannot accommodate changes to core rotation schedules.
Will there be enough slots for all students that need to take a particular Transitions 3 track?

The T3 track numbers have been modeled using previous years’ match data to plan for the number of students that may need to take each track.
Does this count as an elective?

No, this is not an elective. This is a core required rotation.
Does this count as 4 weeks of enrollment in the spring?

Yes, this is a four week, four credit course which occurs in the spring so it counts as four weeks of enrollment during the spring semester.
How will Transitions 3 be structured?

The specialty track offerings include Internal Medicine, Emergency Medicine, Family Medicine, Pediatrics, Obstetrics & Gynecology, and Surgery. The course sessions within each track will include a mix of didactics, panel-discussions, high-fidelity simulations, and asynchronous sessions. The tracks were created to include valuable sessions for the various specialties based upon feedback from residency program directors, clerkship and sub-I directors, and residents from each specialty.
You will also have the opportunity to choose areas of interest from a number of other sessions to meet the course requirements. Some sessions will require attendance in person, but several will be offered remotely so that you can take them at your convenience. The course is Pass/Fail, but the feedback you receive in the various sessions will help guide you as you are preparing to transition to your residencies. A goal of the course is for the feedback and experiences to make you more cognizant of the expectations of first-year interns and more confident in your abilities as you make this challenging transition.
Will there be special training for ACLS?

Because of the significant variation in requirements for each residency program, we will not be offering training in ACLS, PALS, etc. in all T3 tracks. However, the Pediatrics T3 track will offer training in PALS and NRP. Residency programs requiring such certification will generally pay for your training or include it during orientation.
Can I take an elective at the same time that I’m taking T3?

No, you cannot take an elective during the same month that you are taking T3. T3 is a core required rotation. If you have an elective scheduled during the month that you plan to take T3, you must drop the elective and try to reschedule the elective for a different rotation month that is available on your schedule.
Why was the Transitions 3 course added to the curriculum?

The T3 course is designed to prepare you for the rigors of residency and the elevated level of responsibility of being a resident. It also provides time to practice fundamental skills that are expected of you on day one of your internships. Transitions 3 is not unique to the IU School of Medicine; it is part of a national trend in recognizing the challenges medical students face while transitioning from medical school to internship year.

According to the AAMC in 2018-2019, 106 medical schools indicated they offer a transition to residency course to help their students navigate the transition from medical school to residency. These transitional periods are challenging. So, schools nationwide are aiming to better support students as they navigate and prepare for the next step in their careers. These courses have received resounding positive feedback from students across the country, as well as residency program directors (see: AAMC News: Boot Camps Prepare Medical Students for Rigors of Residency and AMA News: Pre-residency boot camps prepare med school grads for new realities).

At the IU School of Medicine, this type of preparatory experience has previously been available for students going into surgery. However, we wanted to make it available for all students. In 2020 the course content for the curriculum was introduced in an online virtual format for the classes of 2020 and 2021. The course content received high reviews from students, and their feedback has also been incorporated into plans for the future delivery of the course. The idea is not to repeat what was covered in your four years of medical school, but to give you an opportunity to review key material from the perspective of being an intern, provide hands-on practice for various procedures, and equip you with information you will need as you transition to your exciting and challenging intern year. In this course, you will practice relevant skills necessary for all interns and specialty-specific skills through high-fidelity simulations, didactics, panel discussions, and asynchronous sessions.

Health Systems Science (HSS) NBME during Transitions 3

Why are we taking the HSS exam during Transitions 3?

The examination is being positioned at this point of the medical school curriculum to give us an objective measurement of the full scope of the effectiveness of the Health Systems Science (HSS) curriculum.

IU School of Medicine has been working in recent years to enhance coverage of HSS content throughout the phases so that our students are trained in the three pillars of health care delivery: basic science, clinical science and health systems science. As a reminder, HSS is newer terminology used in medical education to describe the critical competencies that are necessary for us to deliver the highest quality value-based health care in a manner that is both patient and population-centered. In other terms, HSS is a foundational platform and framework for the study and understanding of how care is delivered, how health professionals work together to deliver that care, and how the health system can improve patient care and health care delivery.

You received training in Health Systems Science during your FCP1 and FCP2 courses in Phase 1. Examples of this training in Phase 1 include: the Human Dimensions curriculum and professional development sessions in your FCP1 course, as well as the EBM curriculum and IPE events you participated in during FCP2. Health System Science was heavily emphasized throughout STEPS during Phase 2 with the asynchronous modules: What is Health systems Science, Introducing Health Care Policy and Economics, Essentials of Quality Improvement, Value-Based Health Care, and Systems Thinking in Healthcare. STEPS also included the synchronous sessions: Engaging in Ethics and Everyday Practice, Applied Ethics, Health Care Policy, Population Health Panel Discussion, and HSS Review in Preparation for Step 2. At the end of STEPS, a Community Asset Mapping Project was completed. HSS has also been interwoven this year throughout your Phase 3 core curricula, such as in the Sub-I Transitions of Care modules. All the HSS curriculum has served as a key component of your preparation for Step 1 and Step 2 (where HSS related questions are becoming more prevalent), as well as helping you to gain the knowledge necessary for ACGME residency preparation and Step 3. Most residency programs are in the process of developing a HSS curriculum to help their trainees enhance their skills in this important area as modern physicians are equipped to impact positive changes in health care communities in which they train and ultimately practice, especially to communities and populations in need.
What are the benefits of taking the HSS exam to me and future students?

Participation in this exam will inform the strengths and opportunities of our curriculum and pave the way for additional integration of health systems science across the phases. For the current academic year, further integration of HSS content into Phase 1 has already occurred with the launch of Health Systems Science 1 (HSS1) and Health Systems Science 2 (HSS2). The robust Health Systems Science content that is already offered during STEPS in Phase 2 has continued, with changes based on student important feedback. Additional Health Systems Science content has also been integrated into Phase 3. Next year’s Phase 3 students will also take the Health Systems Science NBME, again with the goal of evaluating our curriculum so that over the course of the next three academic years a solid baseline of the quality of our HSS curriculum will be assessed to ensure we are poising students for success in the HSS domain.
The exam will also be used to continue to give formative feedback to students in this important competency domain. Your performance can be used by you as formative feedback in this area. Similar to other NBME exams, you will receive an individualized report breakdown of your performance. HSS review resources will be available to you on the Transitions 3 canvas site, and you may use those to prepare for the exam if you wish (preparation for this exam is not expected), as well as to review following the formative feedback you receive regarding your HSS NBME exam performance for your personal growth in this area.
Am I required to pass the HSS NBME exam?

Currently, there is not a passing requirement. This exam is being used to evaluate our curriculum and provide you formative feedback on your preparedness for residency in this competency domain. Our hope is that you will try your best on the exam so that HSS curriculum development and refinement for future cohorts is well-informed. However, you will not fail Transitions 3 or be asked to remediate the exam if you do not pass. Resources will be provided for you on the Transitions 3 course canvas site to assist with your preparation prior to and following the exam if you choose to utilize them.
Is there a minimum score requirement for the HSS NBME exam?

For this year’s class, there is not a minimum score requirement. This exam is being used to evaluate our curriculum and provide you formative feedback on your preparedness for residency in this domain. Your class’s performance on the exam (the Class of 2024 and the Class of 2025) will help inform the appropriate cut score requirement for when a minimum score requirement is implemented in a future academic year.
Do I have to take the HSS NBME exam? What happens if I do not show up for the exam?

All Class of 2024 students will take the exam during T3 so that we can hear all student voices and robustly evaluate the strengths and opportunities of our current curriculum and provide you with formative feedback about your preparedness in this domain. Completion of this exam will count as a required component of T3 and students will be given protected time during T3 to complete the exam. Students will be assigned a time to take the exam in person during the in-person portion of their T3 month.
Are there resources available to help me prepare for the HSS NBME exam?

A resources page will be made available on the Transitions 3 canvas site, which will be published prior to the start of the course. You may use those resources to prepare for the exam if you choose, but this is not required. Once you receive your score report, you may also use the resources if there are areas for which you would like additional preparation or review prior to starting your residency training. If you would like more information about the exam content topics, explore the NBME content outline.

Scholarly Concentration Program

Students who complete all requirements of the Scholarly Concentrations program by Jan. 31st of their fourth year will be awarded the equivalent of eight weeks of non-clinical, catalog elective credit toward graduation. If students complete their program prior to the start of their fourth year, they will still receive eight weeks of non-clinical, catalog elective credit and do not need to enroll in a Scholarly Concentrations elective. However, to meet the university enrollment requirements, students will still need to enroll in a sufficient number of regular and/or special electives, in addition to their required Phase 3 core rotations. Students should work closely with their lead advisors to ensure they are meeting their minimum university enrollment requirements and taking advantage of the added flexibility of the Scholarly Concentration program elective credits to pursue meaningful rotation opportunities during their fourth year in preparation for their residencies.

Students participating in the Scholarly Concentrations program who have not completed the program prior to their fourth year can have up to eight weeks of time in the fourth year to complete their scholarly project and/or scholarly product. To ensure Scholarly Concentrations participants meet the university enrollment requirements described above, students will enroll in a Scholarly Concentrations project elective and/or a Scholarly Concentrations product elective during Phase 3. Phase 3 students are encouraged to think about the timing of the SC electives holistically with other elective time to ensure completion no later than January 31 of their fourth year. See the Phase 3 Scheduling page for additional scheduling details.

Other Scholarly Concentrations activities that must be completed during Phase 3, if not done prior:

Complete a Scholarly Concentrations Program end-of-program survey. This will be distributed by the program to students.
Submit a proposal and present a poster at IU School of Medicine Education Day in the spring of their fourth year, if not done previously. The IMPRS Summer Symposium between the first and second years of medical school doesn’t count toward the Scholarly Concentrations requirement.

General Phase 3 FAQs

How do I get letters of recommendation for residency programs?

Clinical experiences and opportunities for faculty reference letters may come from several sources, including Phase 2 clerkships, Phase 3 core rotations, Advanced Clinical Electives (ACE), other Clinical Practice Electives or Special Electives. Faculty often recommend asking for a letter of recommendation during a senior sub-I rotation; bear in mind that this term is often used broadly to refer to any senior clinical rotation with advanced responsibility.

The electives catalog offers a large array of options for the opportunity to get the letters you need. A particular category of electives, called Advanced Clinical electives are great options if you’re looking to actively participate in a robust clinical experience as an integrated member of a healthcare team, with a focus on progressive responsibilities, professional development, and career readiness.

Also, connect with the Career Development Team for more residency preparation guidance and resources, including suggestions for planning elective rotations for your specialty and how to ask faculty if they can write you a strong letter of recommendation.
Are there any more changes to Phase 3 in the works?

We anticipate that from here forward the process will be more about continuous improvement than major change. MSE is constantly evaluating opportunities to improve the opportunities, preparation, and overall experience for our students.
Who can I talk to if I have questions about the curriculum?

Please reach out to us at AskMSE. Your lead advisor is a fantastic resource for personalized questions, and more senior students are a great resource for student experiences.
What if I have questions about planning for interviews, Step exams, and away rotations?

Ask MSE! You will find many answers to common questions already on the Ask MSE intranet. If your question isn’t already there, submit it and build up the knowledge base in our community.

Do you need to talk to someone in person? We are here to support you. Reach out to your lead advisor, the Career Development Team and the Academic Advising Team.