November 13, 2013 To: UVM College of Medicine Class of 2015 Students From:

Via Electronic Mail
November 13, 2013
To:
UVM College of Medicine Class of 2015 Students
From:
Christa H. Zehle, MD
Associate Dean for Students
Planning for Advanced Integration (Mandatory Meeting)
Re:
Dear Students,
Congratulations on reaching the final stages of your Clerkship Year! By this time, I am sure many of
you are beginning to think about the next phase of your medical education and wondering what this will
look like. This memo is intended to address many of your questions about the Advanced Integration
level of your medical education.
Meetings
There will be a mandatory class meeting on Monday, November 25th, in Med Ed 200, from 6:30pm to
8:30pm to review and answer any questions about planning your Advanced Integration year and the
scheduling process. DINNER will be provided (Please email dietary restrictions to
[email protected]). There will also be an opportunity to ask questions about the
Advanced Integration Year to a Class of 2014 student panel.
If you have additional questions about the Advanced Integration year, you may schedule a meeting with
your PCR Mentor/advisor, or contact Kiersten Hallquist ([email protected]) to arrange a
meeting with myself, or with Dr. Waterman or Dr. Feldman who will be covering for me while I am on
maternity leave. Things you may review include:
1) Your progress in the Clerkship Year to date.
2) Any concerns you have about your experiences and/or evaluations.
3) Your current thoughts about specialty choices.
4) Your selection of a faculty specialty advisor.
5) Your plans and goals for Advanced Integration.
6) Any problems or concerns you wish to bring to our attention.
Exams
End of Clerkship Level CSE [Per the UVM COM Student Handbook]
To be eligible to take the CSE required at the end of the Clerkship Level, all required clerkship
coursework must be successfully completed. Passage of the CSE is required for graduation. Failure of
the CSE after one attempt requires remediation and retake of the exam which is offered in the summer of
same year. Failure on the second attempt requires review by the Committee on Advancement. Students
should not take the USMLE Step 2CS examination (described below) until they have taken the CSE.
11/13/2013
You will receive more information about the End of Clerkship Level CSE from Cate Nicholas, in early
December, with dates and information about registering for this exam. This is a required component of
the VIC that you must pass in order to complete the Clerkship Year. The CSE will be excellent
preparation for the Clinical Skills portion of USMLE Step 2. Please note that you are not eligible to take
this CSE until you have successfully completed each of the 7 clerkships.
United States Medical Licensing Examination (USMLE)
You are required to take and pass USMLE Step 2 Clinical Knowledge before January 1, 2015. It is
strongly recommended that you take Step 2 CK before the middle of August, 2014, so that your results
are reported before the residency application due date, in September, 2014. This also allows time for a
repeat of the exam, should you need it, so that your graduation will not be delayed or called into
question.
You must pass USMLE Step 2 Clinical Skills before the end of April, 2015. I strongly recommend that
you take the USMLE CS exam before December 31, 2014, so that the results are reported before
programs rank applicants in February, 2015. The exam is given in five cities: Atlanta, Chicago, Houston,
Los Angeles, and Philadelphia. It is a one-day exam and is given Monday through Saturday. You may
not take it during a month when you are doing an Acting Internship (AI). Slots fill early, so be sure to
register for this exam as early as possible. You may be excused from elective rotations for a maximum
of 2 days to take the USMLE Step 2 CS. EVERYTHING you need to know about USMLE can be found
at the NBME website (www.nbme.org).
Advanced Integration Requirements
Your Advanced Integration phase of the Vermont Integrated Curriculum begins 3/17/2014 and ends
4/30/2015. Please see the attached Advanced Integration requirements grid for details.
You will need to choose either the general major or the surgery major.
1) A common question for many 3rd year students is how to choose between the surgery major, or
the general (non-surgery) major. The choice is based on one’s best estimate regarding career
direction. However, you are not expected to have finalized that decision at this point and, even if
you have, all opportunities within the curriculum leading to the M.D. degree are available to all
students in the College of Medicine.
Please note that this decision is reversible - you can switch out of the surgery major before
September 2014 and you can switch into it at any point, as long as sufficient time remains to
complete the requirements. Your assessment will determine which major will better serve your
educational needs.
To help make this decision, you can use this general guideline:
- Students who plan to apply in general surgery choose the surgery major
- Many students who plan to apply in urology choose the surgery major
- Some students who plan to apply in neurosurgery, orthopedic surgery, plastic surgery, or
ENT choose the surgery major
- Occasionally, students planning to apply in ophthalmology, ob/gyn, or emergency medicine
choose the surgery major
11/13/2013
-
Very rarely does a student within other specialties choose the surgery major
2) Students in either major are required to do two AIs at Fletcher Allen Health Care (FAHC) or
Danbury Hospital (DH).
3) One of the AIs for all students in either major must be in Internal Medicine AI at FAHC or
DH. Dr. Mark Levine is the course director for the required Medicine AI component of the
curriculum. There is a formal curriculum for this AI, including didactic and discussion sessions
focused on skill development. Evaluation will include assessment of clinical performance on
patient care teams, assessment of quality of written documentation, assessment of skills by
faculty in a formal assessment context, assessment via a 4-station CSE, and a knowledge-based
examination to assess understanding of common clinical situations. The AI in the medical
intensive care unit will not fulfill this requirement, nor will AIs in other specialties.
4) All students may take up to 6 weeks of vacation during the Advanced Integration curriculum.
One vacation month is generally used for completing residency interviews, and it is most
commonly taken in December or January.
5) All students may take one 4-week reading month to prepare for the USMLE exams. The
reading month does not count as a month of vacation and you receive 4 weeks of credit for this
month.
6) Students are not expected to schedule residency interviews or USMLE examinations during AIs
or teaching months. Once scheduled for an AI, a student may not drop it unless s/he arranges for
a student to take his/her place, or unless the department concerned excuses the student.
7) Students in the general major are required to take a surgical specialty/subspecialty month
(SSM) composed of two weeks within two different surgical specialties or subspecialties, or 4
weeks of a single specialty or subspecialty. That requirement is usually fulfilled at FAHC, but
students may consult Dr. Ted James, in the Department of Surgery, for permission to fulfill it
elsewhere.
8) Students in the general major are required to complete a teaching practicum or a scholarly
research project (see attached). Students in the surgery major meet this requirement as part of
the surgery major, which requires a scholarly research project.
9) In addition to the two required AIs, the surgery specialty/subspecialty requirement, the
emergency medicine rotation and the teaching requirement (if such a month is taken – see
attached), students in the general major must complete clinical or research elective rotations,
with the optional reading month being considered one of the electives, to total 48 weeks of
rotations in the Advanced Integration level.
10) Students electing the surgery major may switch out of it prior to September 1, 2014. After
September 1st students in the surgery major will be expected to complete all surgery major
requirements. Dr. Ted James is the director of the surgery major. Requirements for the surgery
major include:
11/13/2013
a) One Acting Internship in surgery at FAHC
b) Either the SSM described in #7 above, or a second AI in surgery at FAHC or at a
preapproved (by Dr. James) alternate location
c) One Acting Internship in internal medicine at FAHC or DH (as required for all students)
d) 4 weeks of emergency medicine
e) Gross anatomy, the requirement for which may be fulfilled by taking a February
dissection rotation; by working as a teaching assistant in the first-year Human Structure
& Function course in October, November or December; or, by taking elective rotations in
autopsy pathology, surgical pathology, or diagnostic radiology
f) A scholarly research project completed under the direction of faculty of the Department
of Surgery and presented in a formal symposium in April or May, prior to graduation.
Students may choose to spend 4 weeks of elective time working on their projects. Dr. Ted
James is the director of the scholarly project component of the surgery major.
g) The Surgery Residency Readiness Course, given in March of the graduation year.
h) Additional clinical or research electives, with the optional reading month included
i) A total 48 weeks of rotations in the Advanced Integration level.
Choosing a Specialty Advisor
All students will need to select a specialty advisor prior to the Oasis scheduling process, which begins
on December 9, 2013. Please contact the Specialty Director (see attached) in your field of interest, and
they will assist you with selecting an advisor in their department. If you are undecided about a specialty,
you may list your current advisor (your PCR mentor) as your advisor until you have selected a specialty
or you can select an advisor in the specialty in which you are most interested. You can always change
advisors if you change specialties. As you prepare for applying to residency, it is important to have an
advisor in your specialty of choice who is familiar with the application process, matching in that
specialty, and career pathways within that specialty.
Please notify Emma Faustner of your advisor choice by Friday, December 6th. You will not be able to
participate in the scheduling lottery if you have not identified an advisor.
Extramural Rotations
Many students wish to do rotations at other sites during Advanced Integration, while other students
prefer to do all their rotations at our affiliated clinical sites. This may be a matter of personal choice, or
may be important for for your chosen specialty. The Careers in Medicine website lists which specialties
recommend extramural rotations under the Training and Residency Tracks tab. Students may also
want to travel to other institutions to be close to family and friends, work in an environment with a
different mix of patients, or experience medicine in a different culture.
Students often wait until after they have received their UVM AI schedules in February before applying
for extramural rotations. Often, the other institutions are not ready to act on your applications until after
they have scheduled their own students. The process of planning and applying for extramural rotations
extends through much of Advanced Integration. Do not expect to have everything finalized by March.
11/13/2013
Many institutions impose a limit on the number of rotations for visiting medical students. Eight weeks is
a common limit. Some institutions require that students pass the USMLE Step 1 before their applications
are processed. Most institutions charge a registration fee, and some charge substantial tuitions.
You can learn about opportunities at other institutions via the web, where you will be able to download
an application. Emma Faustner in the Office of Medical Student Education can assist you with the
application process. You will need to provide evidence of current HIPAA and infection control training,
up-to-date immunizations and TB skin tests, verification of your student status at UVM, and liability
insurance coverage. A significant number of institutions require a recent physical examination, and
some require an updated criminal background check, so you may wish to plan accordingly.
Many schools have become participants in the AAMC’s on-line Visiting Student Application Service
(VSAS). Contact Emma for authorization to use that service.
Rotations in the Indian Health Service and the Alaskan Native Health Service fill early. If you are
interested in doing one of those rotations, or an international elective, it is advisable to plan/apply early.
Students should be advised that all extramural rotations will require advance approval from the
Office of Medical Education before the rotation will be allowed onto the student’s schedule for credit.
Any extramural done without approval will not earn credit toward graduation. Extramurals may not be
added retroactively, after they have already been done. It is expected that most established rotations at
LCME accredited medical schools will be readily approved.
Letters of Recommendation for Residency Applications
Some of you have asked about requesting letters of recommendation from faculty you have worked with
during the Clerkship Level. Generally, it is advisable to wait and seek letters from faculty who can
evaluate your work at a more advanced level, during an AI.
If you wish to request letters of reference now, you should obtain a cover sheet to request the letter. You
can download a copy of the COM generic Letter Request Form on Comet > Lounge > Student Affairs >
green Residency Application button, scroll down to “Letters of Recommendation”. Letters should be
addressed “Dear Program Director” and sent to Emma Faustner, in the Office of Medical Education,
where they will be kept on file until next fall. Your reference letters will not be due until midSeptember, 2014, so you have plenty of time to arrange for the letters.
Careers in Medicine
The Careers in Medicine website has some helpful information about Choosing a Specialty and Getting
into Residency. Please familiarize yourselves with these sections of the CiM program and let our office
know if you have any questions.
This is an exciting time in you medical education, however it may occasionally seem confusing or
overwhelming. We are here to help, so please do not hesitate to contact our office with any questions or
for assistance during this final phase of the VIC. If you are unsure who to contact in the office, you may
email the [email protected] account and we will direct your questions to the
appropriate person.
11/13/2013
Thank you and good luck!
11/13/2013