Phase 3 Curriculum

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

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

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.

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.

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.

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.

The obstetrics and gynecology sub-internship provides students who are interested in women’s health care 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.

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 health care 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.

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 students’ preparation for residency while integrating with the complementary goals of the sub-I, emergency medicine clerkship and Transitions 3 to produce well-rounded and highly prepared graduates.

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.

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 2025 Critical Care Selectives Catalog

Class of 2026 Critical Care Selectives Catalog

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.

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 open block month during the first stage.) During the next stage, you will schedule your electives and additional open block 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.

Everyone is required to take T3 to fulfill their graduation requirements.

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.

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.

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.

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.

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.

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.

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.

No, this is not an elective. This is a core required rotation.

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.

The specialty track offerings include internal medicine, emergency medicine, family medicine, pediatrics, obstetrics and 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.

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.

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.

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.

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 health care 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.

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.

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. 

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.