OverviewofthePathwaysPost-PCEPhaseoftheMDCurriculum

Contents(lastupdated2/19/18):I. BriefSummaryofPathwaysPost-PCERequirements/Timing p.3

Readthissectioninitsentiretyfirst!II. NotesonAdvisingandSampleSchedules p.7III. AdvancedIntegratedScienceCourses(AISCs) p.11IV. EssentialsII:AdvancedSocialandPopulationSciencesforMedicine p.16V. ClinicalElectives,Sub-Internships,andtheClinicalCapstone p.17VI. ScholarlyProjectRequirement p.19VII. HSTandMD-PhDStudents p.20VIII. MD-MBA,OtherMastersDegrees,andResearchYears p.22IX. Appendix:PathwaytoResidencyTimeline p.24AsstudentsinthePathwayscurriculumatHMSanticipatethepost-PCEperiod,theyfindthemselveswithmanyexcitingoptions,chancestoexplorefieldsofinterest,hundredsofelectiveopportunities,andmore.Thepost-PCEphaseiswhenmanythingsthathavebeenfuzzybecomeclear,andstudentshavetheincredibleexperienceofbecomingincreasinglyconfidentintheirabilitytotakecareofpatients.ThisprospectislikelybothexcitingandabitdauntingsincetheHMScurriculumisfairlyprescribedfrommatriculationrightthroughthePCE.Asstudentsembarkonthenewexperienceofcreatingastudycard–andtheprocessforalltheadd-dropsthatoftenfollow–theiradvisorsguidethemthrougheverystepoftheprocess.Whilethisdocument–andthemanyinformationandadvisingsessionsthatareprogrammedinforeachclass–areinevitablyfocusedonlogisticsanddetails,themostimportantthingtorememberisthatmoststudentsfindthepost-PCEphasetobethemostenjoyableandenergizingpartofmedicalschool,sincetheyhavetheopportunitytotailorsomuchofittotheirpersonalandprofessionalinterests.ItisimportanttorememberthatlessthanhalfofallstudentshaveanyideawhatspecialtytochoosewhentheyfinishthePCE,andgenerationsofstudentshaveusedthepost-PCEperiodtohelpfigurethatout.ForstudentsreadingthisearlierintheirHMSjourney,pleaserememberthatallthedetailsandlogisticsincludedherearenotintendedtocausestressthattheyshouldalreadybefartheraheadthantheyareinnarrowingdownaspecialtychoice.TowardtheendofthePCE,studentsareaskedtosubmitpreferencesforhowtheywishtoorganizethefirstnine-monthperiodafterthePCE(October–JuneofYearIII)throughaphasedsetofelectronicstudycardsthatareduebeginninginearlyAugust,andtherearemultipleadvisingsessionsandclassmeetingsorganizedwellinadvanceofthattimeeachyear.Appendedtothisdocumentisalsoa“PathwaytoResidencyTimeline”detailingfutureclassmeetingsandothereventsthataretimedtoensurestudentshavealltheinformationtheyneedtomakechoiceswellinadvanceofmakinganydecisions.Forexample,since

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selectionofadvancedclinicalclerkshipsrequiresanunderstandingofwhatdifferentdisciplinesexpectinaresidencyapplication,weholdaseriesofresidencyprogrampanelswellinadvanceofwhenstudentsneedtosubmitpreferences.Thesesessions,includingmoredetailedinformationabouthowtheResidencyMatchworks,areorganizedincollaborationwithPCEandclerkshipdirectorstoensureallstudentsarereleasedfromclinicalresponsibilitiestocometoTMEConthoseevenings.MostofthematerialinthisdocumentrelatestoPathwaysstudents,althoughsomeoftheinformationalsorelatestoHSTMDstudentsandtotheHSTandNewPathwayMD-PhDstudentswhoarestillcompletingthePCE.CommonrequirementsforallHMSstudentsincludetherequirementstotakeandpassUSMLESteps1,2CSand2CK,therequirementtotakeandpasstheHMSComprehensiveExaminthesummerafterthePCEisfinished,and–forallstudentswhomatriculatedin2015orafter–theClinicalCapstoneCourse.ThereisalsoasectionwithinformationforMD-MBAstudentsandotherstudentsdoingcombineddegrees.Eachsectionendswithasetof“frequentlyaskedquestions”(FAQs)aboutthattopic.ChecklistforReference:HMSGraduationRequirementsforPathwaysMDStudentsRememberthatallstudentsshouldhaveatleasttwomaingoalsforthepost-PCEphase:todeterminethespecialtytheywishtoapplyinforadvancedtrainingandtoensuretheyhaveabroadfoundationinmedicalsciences.Linktoacademiccalendarfoundhere:https://meded.hms.harvard.edu/academic-calendars• ComprehensiveClinicalSkillsExam:SummerafterPCE• AdvancedIntegratedScienceCourses:2xfour-weekcourses,atleastoneinYearIII*• EssentialsII:1xfour-weekcourse,YearIIIorIV• Clinicalelectives:Atleast3xfour-weekclinicalelectivesatHMSaffiliatedhospitals• Scholarlyproject:

o December31,YearIII-Project/mentorproposaldueforglobalhealthprojectsonlyo April15,YearIII-Project/mentorproposaldueforallotherprojectso 2-5monthsfull-timeSiMo March1,YearIV-Finalreportdue

• Sub-InternshipinMedicineorPediatrics–1xfourweeksbyJulybeforegraduation• ClinicalCapstone:1xfourweeks–January,February,MarchorApril,YearIV• Fulltimeenrollmenteachsemester• Steps1,2CSand2CKrequiredforgraduation(furtherdetailsforalloftheabovefollow)*TheseAdvancedIntegratedScienceCoursesarenotrequiredforMD-PhDstudentsI.BriefSummaryofPathwaysPost-PCERequirementsandTimingUSMLE(PassingSteps1,2CSand2CKrequiredforgraduation):

• TakeStep1byDecember31ofYearIII;

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• TakeStep2CSbyNovember1ofYearIV;• TakeStep2CKbyDecember31ofYearIV.

StudentsfinishingthePCEinSeptemberwillgenerallytakeaboutsixtoeightweekstostudyforStep1,usingeitherOct-NovorNov-Dectostudy,alongwithaweekortwoofvacation(USMLEexamscanbescheduledforanydayoftheweekexceptSundaysandholidays).Atleastonemonthofcredit-bearingactivity(typicallyinOctoberorDecember)mustbetakenduringtheOct-DecquarterofYearIII,suchasaclinicalelectiveorsub-I,Essentials2,aSiMmonth,theAdvancedClinicalPharmacologycourse,ortheHBSMedicineandManagementCourse(whichisrequiredforMD-MBAstudentsandwhichrunsparttimethroughthesecondhalfofthisthree-monthblock–seebelow).Exceptionstothisrequirementforonemonthofcredit-bearingactivitymayberequestedfromastudent’sAdvisoryDeanforpersonaloracademic/learningreasons,andtheserequestsareconsideredforapprovalbytheAdvisoryDeansasagroup,toensurefairnessacrossSocieties.StudentsarealsopermittedtotakeStep2beforeStep1onlywiththepriorapprovaloftheirAdvisoryDean;ifapprovalisgranted,thestudentispermittedtoextendtheStep1deadlineuntilJanuary31(seefirstFAQbelow).TheComprehensiveClinicalSkillsExamisa4-hour,6-stationOSCEdesignedtoassessintegratedclinicalskills,includingfocusedhistory-taking,physicalexamwithpropertechnique,communicationandcounselingskills,anddemonstrationofclinicalreasoningthroughdocumentationofeachclinicalencounter,allinaprofessionalmanner.Thisrequiredexamcertifiesclinicalskillsforthepost-PCElevel,preparesstudentsforsuccessintheStep2CSexam,andprovidesfeedbacktostudentsattheendoftheexamday.TheComprehensiveExamisscheduledoveraperiodthatspansthemid-JuneandbeginningoftheJulyblocks,ensuringthatstudentscanscheduleitwhennotontheirsub-internshipmonth(studentsaregivenamorningorafternoonofffromclinicalelectivesandothercoursestodotheCompExam).TheexamisrequiredofallstudentsinthesummeraftertheycompletethePCE.AdvancedIntegratedScienceCourses(“AISCs”–SectionIII):Aminimumoftwoofthesefour-weekcoursesisrequired;theyareofferedinJanuary,February,andMarch.AtleastonemustbetakeninYearIII.AnoverviewofthesecoursesisfoundinSectionIIIbelow.EssentialsII:AdvancedSocialandPopulationSciencesforMedicine(SectionIV):Thisrequiredfour-weekcourseistakeninOctoberorMarchofYearIIIorYearIV.ClinicalElectives(SectionV):AllstudentsmustcompleteatleastthreeclinicalelectivesatHMS-affiliatedhospitals,inadditiontotherequiredsub-IandClinicalCapstone.Nomorethantwoelectiveswiththesamecoursenumbercancounttowardthisrequirement(e.g.,cannotcountthethirdofthreemonthsofneurosurgery).Itisexpectedthatmoststudentswilldomorethantheminimumnumberofclinicalelectives,alongwithothernon-clinicalelectives,awayrotations,internationalclerkships,etc.

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Sub-Internship(SectionV):Therequiredfour-week“sub-I”inmedicineorpediatricsistakenafterthePCEandnolaterthanJulyofYearIVforallPathwaysstudents(byAugustofYearIVforHSTstudents).Sub-InternshipsaredoneatadifferentclinicalsitefromtheonewherethePCEwascompleted.Notethatthe“requiredsub-Internship”iseithertheMedicineIIorAdvancedPediatricsrotation,andallstudents(bothPathwaysandHST)musttakeoneortheother(byJulyorAugust,respectively).Otheradvancedelectivesaresometimesreferredtoas“sub-I’s”(e.g.,doinga“surgicalsub-I”oran“GYNsub-I”):thoseareadvancedclinicalrotationswherestudentsaregivenmoreresponsibilitythanonatypicalclerkship,andstudentsapplyinginthosefieldsreceiveadviceastowhentheseother“sub-I’s”shouldbepartoftheirschedule,butnoneofthoseisrequiredforgraduation.ClinicalCapstone(SectionV):AllstudentsmustcompletetheClinicalCapstonecourseinJanuary,February,March,orAprilofYearIV.Thecourseinvolvesthreeweeksofanadvancedclinicalelectivethatmeetsthecriteriafordirectpatientresponsibility,alongwitharequiredone-weekprofessionaldevelopment/transitiontointernshipcurriculumconductedatTMEC.Forthethree-weekclinicalcomponent,studentsselectfromrotationssuchasemergencymedicine,ICUelectives,advancedsurgeryorOB-GYN,etc.–rotationswherethestudentworksuppatientsandwritestheorders(whichgetco-signedbyaphysician)inthewaytheydidintheirsub-Iinmedicineorpediatrics.TheClinicalCapstonepreparesstudentstoself-assesstheareasofclinicalworktheyshouldfocusonastheentertheirinternshipandensurestheyhavehaddirectpatientcareresponsibilityinthesixmonthsbeforeinternshipbegins.ScholarlyProjectRequirement(“SiM”–SectionVI):ThedeadlineforproposalisApril15ofYearIIIandthefinalscholarlyreportisdueMarch1ofthefinalyear.StudentsareencouragedtouseanAISCorEssentialsIItohelpidentifyaSiMtopicandmentorifthishasnotalreadyhappenedduringthepre-clerkshiporPCEphasesofthecurriculum.Thistimelinehelpsstudentschoosecourses,e.g.,ifastudentisconsideringanEssentials-relatedSiMproject(globalhealth,socialmedicine,clinicalepidemiology,healthpolicy,ethics),itisadvisabletodothatcourseinOctoberorMarchofYearIII;ifconsideringaSiMprojectinvolvingcancermedicine,takethecancerbiologyAISCinYearIII.Studentstypicallyhaveaminimumoftwofull-timemonthsofSiM500ontheirtranscript(unlesstheydotheirSiMthroughamaster’sorPhDproject),buttheymayhaveuptofivemonthsoffull-timeSiMandstillbeabletograduateinfouryears.Studentswhodoacombineddegree(mastersorPhD)generallyfulfilltheSiMrequirementbysubmittingthewrittenproducttheyproduceforthatothergraduatedegree.MaintainFull-TimeEnrollment:Allstudentsmustensurethattheyremainenrolledfull-timeforalleightsemestersintheMDprogramatHMSinordertograduate.Asstudentscompletestudycardsfortheirnextperiodofenrollment(typicallydoneinapproximatelynine-monthstudycardperiods),they–withtheiradvisors’help–mustensurethattheplanrepresentsastrongapproachnotonlytocompletingallgraduationrequirementsandpreparingforresidencyapplications,butalsothatnolapsesoffulltimeenrollmentoccur(recognizingthatapersonalillnessorfamilyemergencycanpullstudentsawayforperiodsoftime).

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Moststudentscanmeetallrequirementsandhaveuptofivetosixunscheduledmonthsacrossthe19-monthpost-PCEphase,buttheymustbeenrolledatleastthreemonthsineverysemester(Jan-JunandJul-Dec)toremainenrolled“full-time.”Onlyinthefinalgraduatingsemestermayastudentbeenrolledforonlytwomonths(eightweeksfulltimeJan-Apr),andthisonlyiftheyareontracktocompletetheirdegreerequirements.Anysemesterinwhichastudentisenrolledlessthanfull-time,exceptforthatfinalterm,mayaffectfinancialaideligibility.Enrollmentmonthsmayincludenotonlyclinicalelectivesandsub-Is,butalsoSiM500months,awayelectivesatothermedicalschools,andnon-clinicalelectives,suchastheleadershipcourse,advancedanatomy,medicalSpanish,student-as-teacher,advancedclinicalpharmacology,narrativemedicine,andmanyothers.Studentsinthe5-yearMD-MBAprogramshouldreviewtheirspecialprogramrequirementscarefully(seesectiononMD-MBArequirements).Studentswhocompleteothermastersprograms(MPH,MPP,MMSc,MBe)generallydothesedegreesintheacademicyearbetweentheirthirdandfourthyearofmedicalschool,sothisdoesnotaffectanyotherrequirements.FrequentlyAskedQuestions:1.ShouldIconsidertakingStep2beforeStep1?Asnotedabove,studentsarepermittedtotakeStep2beforeStep1onlywithpriorapprovaloftheirSocietyAdvisoryDean,inwhichcasetheyarepermittedtoextendtheStep1deadlineuntilJanuary31.ThisrequirementfortheAdvisoryDean’sapprovalisdesignedtoensurethatstudentshavecarefullyconsideredalloftheimplicationsofthisstrategyfromtheperspectiveoftheresidencyapplicationprocess.Mostothermedicalschoolsthathaveframe-shiftedtheclerkshipyearearlierallowstudentstotakeStep2first,butbenchmarkingsuggeststhatvirtuallynostudentsdoso.TakingStep2firstsoundscompellingtoastudentinthemidstofclerkships,sinceitfeelsasifitmightoptimizetheStep2score,giventheoverlapofcontentwithalltheshelfexams.Thisapproachdoesnottakeintoconsiderationalltheclinicallearningstudentsdoinadvancedelectives.Moreimportantly,itmeans“losing”amonththatcouldcontributetoresidencyplanningandapplication(sincestudentsotherwisetypicallyfitinStep2duringresidencyinterviewsanddonot“lose”acriticalpre-applicationmonthjuststudyingforStep2).ConventionalwisdomsuggeststhattakingStep2first“canonlyhurtyou”inresidencyscreening(i.e.,thescoreisgenerallynotafactorintheresidencyselectionprocessunlessitisalreadyavailableandverylow).Thepolicyof“optoutonlywithapprovalfromtheAdvisoryDean”allowsforflexibility,butensuresstudentsarenotoverthinkingtheadvantagesfortheirStep2scoreandlosingsightofthefactthatStep1istheonlyscorethatisusedasascreenforresidencyinterviewsbyprogramswhousesuchscreens.Furthermore,ifastudentapplyinginsuchaspecialtydoesnotgettheStep1scoreheorshehopedfor,additionalstudyingforStep2toproduceahigherscorecanoftenmitigatethis–butisonlyworthdoingaftertheStep1scoreisknown.

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2.Howdovacationsworkinthepost-PCEphaseofthecurriculum?Theentireacademiccalendarinthepost-PCEphaseworksjustlikethePCEcalendar.Theyearisdividedinto12four-weekblocks,withoneweekofspringbreakbuiltin,oneweekofasummervacation,andtwoweeksforwinterbreakattheendofDecember.ThecalendarsforeachyearareavailableontheRegistrar’swebsite:https://meded.hms.harvard.edu/academic-calendarsThismeansthereisa“drift”throughtheyearofwheneachfour-weekblockactuallystarts–withtheJanuaryblockstartinginearlyJanuary,buttheDecemberblockactuallystartinginmid-November,sinceitendswithtwomoreweeksinDecember.Thus,wheneveryouseeacourseorclerkshipreferencedas“April”or“October,”youshouldbeawarethatittypicallystartstheendofthemonthbeforeandfinishesbeforetheendofthatmonth(moresoasyoumovethroughthesecondhalfoftheyear).Inadditiontothosefourweeksofvacationbuiltintotheacademiccalendar,moststudentsleaveseveralfour-weekblocksunscheduled,includingoneortwomonthsforStep1study,oneortwomonthsoftravelforresidencyinterviews(althoughstudentsalsooftenfitinterviewsinduringSiMresearchmonths),andothervacations.Thecalendarhasenoughflexibilityforastudenttotakeuptofiveorsixunscheduledmonthsduringthepost-PCEperiod(inadditiontothefourvacationweeksbuiltin)andstillgraduateontime.Asnotedabove,itiscriticaltomaintainfull-timeenrollment,whichmeanshavingatleastthreecredit-bearingmonthsineachsemester(January-JuneandJuly-December),withtheexceptionofthefinalsemester,whentwofulltimemonthsareallowedifalldegreerequirementshavebeenmet.3.OnceIsubmitmystudycardandgetthenextphaseofmyschedule,mayIrequestchangesalongtheway?Yes.Oncestudycardassignmentsforeachperiodarecompleted,studentshavetheopportunitytorequestand/ormakechangestotheirpost-PCEschedulesbasedonavailability.TheschedulingofclinicalelectivesisusuallymoreflexiblethantheschedulingofAISCsandtherequiredmedicineorpediatricssub-internships:

• ForAISCsandrequiredmedicineorpediatricssub-internships,requestsforadd/dropsaremanagedbytheRegistrar'sOfficeandmustbedoneatleast60daysinadvance;

• Forclinicalelectives,ascheduleformonthlyonlineadd/droprequestswillbemadeavailable,andtheseareusuallysubmitteddirectlyonline.

II.NotesonAdvisingandSampleSchedulesPlanningthepost-PCEphaseofthecurriculumisoneofthecriticaljuncturesatwhichourSocietyadvisingsystemisofthemostusetoallstudents.Notonlydostudentshavetheirfirstmajoropportunitytochoosewhattheyaredoingfrommonthtomonth,butthereareanincrediblenumberofpossibleexperiencesandsequences.AllSocietyadvisorsarefullyinformedofthevariousstudent-specificfactorsthatmightplayaroleinpost-PCEplanningandhowbesttousethese,onanindividualizedbasis,torecommendpossiblechoices.

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TheoverarchinggoaloftheadvisingprogramduringYearsIIIandIVistohelpstudentscreatecoherentmulti-monthtracksinordertoaccomplishthefollowingaims,inapproximateorder:

• Toexploretheircareergoalsinmoredepththanispossibleinthepre-clerkshipcurriculumorthePCE

• Astheynarrowtheirspecialtychoicesandultimatelyselectaclinicalfield,toshapetheirschedulesaccordinglytomaximizelearningopportunitiesandstrengthencompetitivenessforresidencyapplications

• Toroundouttheirexperiencewithelectivesandotheractivitiesthatshoreupareasinwhichtheyneedmorework,helptopreparethemforinternship,stimulatequestionstoapproachinaSiMproject,orsimplybefunthingstotryout

AnimportantadvisingmeetingforallstudentstakesplaceduringthelastthirdofthePCEyear,whenstudentsdiscusswiththeirSocietyadvisorstheirevolvingcareergoalsandhowbesttousethepost-PCEphasetoachievethesemultipleaims.Oneexample,amongmany,ofhowastudent’sspecifictrajectorywouldhelpdeterminetheappropriatesequencingofpost-PCEactivitiesrelatestothetimingoftheSiMprojectmonths.Since,formoststudents,itisoptimalforSiMresearchtoberelevanttotheirdesiredcareerpath,studentsunsureabouttheirspecialtyinterestsimmediatelyafterthePCEmightbeadvisedtodomoreclinicalelectivesearlierandtheirSiMprojectlater,whilestudentswhoarealreadycommittedtoaparticularspecialtymightdotheirSiMprojectearlierandmoreclinicalelectiveslater.BesidestheindividualSocietyadvisingmeetings,therearealsoclass-widemeetings,specialtypanels,andothersessionsscheduledeachyearinwhichdetailsaboutspecialcasessuchasthecouplesmatch,militarymatch,earlymatchingspecialties,andtheCanadianmatchareprovided.Therearealsoclass-widesessionswithworkshopsonpreparingapersonalstatement,asetofmockinterviews,anddiscussionsofstrategiesforpreparingaranklist.Inaddition,HMShasdesignatedacadreofspecialtyadvisorsavailabletostudentsineachfieldtotoprovidespecialty-specifictipsontheapplicationprocess.Followingaremockschedulesforfivehypotheticalstudents:Hermionestartsoutthinkingshe’sgoingintoneurology,butswitchestointernalmedicine.HerSiMisonhealthpolicy.HarryfinishesthePCEfairlycertainaboutorthopedicsurgeryandwantstodoatranslationalresearchSiMinortho.RonfinishesthePCEtotallyundecided–mostlikelyleaningtowardeitherpsychiatryorpediatrics,butdefinitelyinterestedinglobalhealthandwantstodoaSiMprojectwithPartnersinHealthinRwanda.Hedecidesonpediatrics.Nevilleknowsitwillbesomething“procedural,”andafterafewexplorationsendsupgoingintoOB-GYN,alsowithaninterestintranslationalresearch.Lunahasbeenenthusiasticaboutsurgerysincefirstyearandplanstocontinuesomebasicsciencecancer-relatedresearchbegunbeforestartingmedicalschool.

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AISCsareshowninredandEssentialsIIingreen. Hermione Harry RonOct Step1study Clinelective:ortho EssentialsIINov Step1study/exam Step1study Step1studyDec Clinelective:advneuro Step1study/exam Step1study/examJan Clinelective:pedineuro RegenerativeMedicine Clinelective:pedsFeb Immunology Clinelective:SICU Clinelective:psychMar EssentialsII MedicineSub-I NeurobiologyApr MedicineSub-I SiM500 Clinelective:cardiologyMay Clinelective:nephrology Awayrotation:ortho PedsSub-IJun Clinelective:rheum/Comp Vacation/Step2CK Clinelective:GI/CompJul Vacation/wedding Clinelective:endocrine/CompVacation/weddingAug Clinelective:derm Awayrotation:ortho* SiM500/Step2CS Sep Vacation/Step2CK SiM500/Step2CS SiM500:abroadOct SiM500/Step2CS SiM500 SiM500:abroadNov SiM500/Interviews Unsched/Interviews SiM500:return/Step2CKDec Unsched/Interviews Unsched/Interviews Unsched/InterviewsJan ClinicalCapstone SiM500/Interviews Unsched/InterviewsFeb ComputMedicine Immunology ClinicalCapstoneMar Women’shealthelective EssentialsII Microbio/InfectiousDisApr NarrativeMedicine ClinicalCapstone Clinelective:ER Neville LunaOct Step1study SiM500(backtopreviouslab) Nov Step1study/exam Step1study Dec Clinelective:cardiology Step1study/exam Jan TranslationalPharm CancerBiologyFeb Clinelective:GynOnc Clinelective:SurgOnc Mar MedicineSub-I SiM500 Apr Clinelective:intervrays MedicineSub-I May SiM500 Clinelective:SICU Jun SiM500/Step2CS/Comp Vacation/Step2CK Jul Clinelective:MFM Clinelective:Adv.Surg/Comp Aug Clinelective:derm SiM500 Sep Vacation/Step2CK SiM500/Step2CS Oct EssentialsII EssentialsII Nov Unsched/Interviews SiM500/InterviewsDec Unsched/Interviews Unsched/Interviews Jan Clinelective:fammed Clinelective:InfectiousDiseases Feb ComputMedicine ClinicalCapstoneMar OB/GYN“BootCamp” Microbio/InfectiousDisApr ClinicalCapstone Clinelective:anesthesia

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*Thisthirdorthomonth,urgedbystudent2’sorthoadvisor,isnon-creditbearing.(Studentsarelimitedtonomorethantwoclinicalelectivesrepresentingthesamecourseinthesamemedical/surgicaldiscipline.Studentswhochoosetotakemorethantwowillnotreceiveadditionalacademiccredittomeetclinicalelectiveand/orunspecifiedelectiverequirements.StudentHandbookSection1.03:CourseandExaminationRequirements.)FrequentlyAskedQuestions1.HowshouldIthinkaboutthegoalsandobjectivesformypost-PCEcurriculum?Asyougothroughthepost-PCEphaseofthecurriculum,youofcoursehavemajorgoalsaroundthechoiceofaresidencyfieldandsuccessfullymatchingintoaresidencyinthatfield.Pleaserememberthatinadditiontothosecareer-choicegoals,youshouldbeorganizingyourprogramofstudytoensureyouaremeetingsuchcurriculargoalsforthepost-PCEphaseas:MedicalKnowledgeandPatientCare

• Tosolidifyandexpandknowledgeinthebiomedicalandclinicalsciencesandimprovetheabilitytousethatknowledgeinthecareofpatients

• Toassumeincreasingresponsibilityforpatientcare• Todeterminewhenapatient’sclinicalconditionisindicativeofaseriousand

potentiallylife-threateningproblem• Toprepareforthenextphaseofmedicaltraininginalaboratoryorclinicalsetting

Professionalism

• Todevelopanunderstandingoftheresponsibilityandprivilegeassociatedwithprovidingcareforpatientsandtocultivateasenseofownershipforapatient’sclinicalcourse

• Toapplyethicalprinciplesinthecontextofclinicalcare• Toseekandmakeuseoffeedback

CriticalThinkingandInquiry

• Toenhancecuriositythroughthepursuitofindividuallydefinedinterests• Tobuildupontheskillsneededtopursuescientificendeavorsandscholarlywork• Torefinecriticalthinkingandclinicalreasoningskills• Tobuildupontheskillsneededforself-directedlearning,includingtheabilityto

identifygapsinknowledgeandtouseandevaluateresourcesinthemedicalliterature

Interpersonalandcommunicationskills• Toworkwithinterprofessionalteamsinaneffectiveandrespectfulmanner• Tocommunicatemedicalandscientificinformationtocolleaguesinameaningful

manner• Tocommunicatemedicalinformationtopatientsandfamiliesinlaytermsandinan

empathicmanner

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• Tocommunicatetheuncertaintyinherentinmedicaldiagnosticandtherapeuticapproachesinamannerthatsupportstheprinciplesofhighvaluecareandshareddecision-making

OrganizationalandSocialDeterminantsofHealthcare

• Tosolidifyandexpandknowledgeinthesocialsciencesandimprovetheabilitytousethatknowledgeinthecareofpatients

• Tosolidifyandexpandknowledgeofthehealthcaresystemstoenhanceefficiencyandqualityofcarewhileensuringpatientsafety

• Tocareforpatientsrepresentingadiversepopulationwithsensitivityandrespect2.AsIhitthemid-pointofmyPCE,howmuchpressureshouldIfeeltofigureoutmypreferencesfortheperiodfollowingmyPCE?None!YoudonothavetodecideaboutthisuntilthefinalmonthsofyourPCE.Ifyouarefeelingpressureprematurely,pleaserereadtheintroductionabovecontainingtherationaleforprovidingallthisdetailsofaraheadofwhenyouneedit.Thisdocumentandourclassmeetingsarenotintendedtogetyoustressedaboutfeelingyoushouldalreadybefartheraheadincareerplanningthanyouneedtobe.RememberthatmoststudentsfinishthePCEunsureofwhattheywanttodo,andtherearemultipleclassmeetingsandadvisingsessionsscheduledtoassistyouinatimelyway.III.AdvancedIntegratedScienceCourses(AISCs)Scientificresearchisatthecoreofevidence-basedmedicineandistransformingmedicalcareatanincreasinglyrapidpace.Physicianshavetoevaluatenewresearchadvances,incorporatethemjudiciouslyintoclinicalpractice,andprovideleadershipfornewresearchintothemosturgentpatientneeds.TheAdvancedIntegratedScienceCourses(AISCs)aredesignedtoengagestudentsinthecriticaltwo-wayrelationshipbetweenresearchandclinicalmedicine:Howcancuriosityaboutclinicalexperienceandtheformulationofkeyquestionsleadtonewresearchprogress?Andhowcananunderstandingofcurrentresearchdevelopmentsinfluenceclinicaldecision-makingandpatientcare?TheAISCsuseflipped-classroomandotheractivelearningmethodsasinYearI,whilehavinganincreasedemphasisonself-directedlearning.Theyareparticularlydistinguishedbyengagingwiththefrontierofclinically-relevantresearchattheboundaryoftheknownandtheunknown.Clinicalorotherexperientiallearningactivitiesintegratedintoeachcourseservetoillustrateunderlyingscienceprinciplesandpromotethedevelopmentofscientificquestionsaboutthemechanismofdisease,diagnosisortreatment.Studentsactivelyparticipateinscientificinquirybyidentifyingandexploringunsolvedquestionsthatinterestthemwithfacultymentorship,culminatinginafinalproductattheendofthecourse.TheAISCsalsohelpstudentsdevelopgeneralizableskills:findingandevaluatingresearchinformation,communicatingaboutsciencetopeersorpatients,understandinghowresearchinfluencespatientcare,anddevelopingquestionsandideasforscientificinvestigationandmedicalprogress.TheAISCsaimtoenhancethe

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capabilitiesofstudentstoworkattheinterfaceofclinicalcareandresearch,asfirst-ratecontributorstothemedicineoftodayandthecomingdecades,whileprovidinganintroductiontofrontierresearchtopics.Thesegeneralizableskillsaremoreimportantasgoalsthantheparticularscientificareaagivencourseusestoteachthem.SimilartoYearsIandII,theAISCsaregradedonasatisfactory/unsatisfactorybasis.Anarrativeassessmentofperformanceisprovidedtoeachstudent.Atypicalcoursehasbothafinalproductandoneormoresmallerintermediateproducts(writtenororalpresentations)thattogetherserveasthebasisforassessment.Thenumberandtypeofassignmentsvarybycourse(seeFAQs,below).StudentsarerequiredtotaketwoAISCsoftheirchoice,atleastoneduringYearIII.EachAISCisofferedonceperyearduringJanuary,FebruaryorMarch.Duringeachfour-weekcourse,studentsshouldplantodevotetheirfull-timeefforttotheAISC;althoughtheremaybeblocksofunscheduledtime,thistimeiscriticalforpreparation,self-directedexploration,anddevelopmentoforiginalquestionsandworkproducts.ThefollowingAISCsarecurrentlyplannedforJanuary,FebruaryandMarchof2019;datesarestilltentative,andothercoursesmaybefinalizedinthemonthsahead.AfinallistofcoursesandmonthsofferedarepostedbyearlyJulyeachyear,wellbeforestudycardsaredue.CancerBiology(January)CourseDirectors:RandallKing,HaroldJ.Burstein.Arevolutioninthescientificunderstandingofthecellularandmolecularbasisofcanceristransformingthescienceandartofclinicalcancercare.Thecourseemphasizeshowthebasicscienceofcancerbiologyunderpinsissuessuchascancerprevention,screening,diagnosisandchoiceoftherapy.Studentsreviewanddeepentheirunderstandingofbasicprinciplesincellbiology,genetics,andpharmacologyinthecontextofcancerbiology.Participationinmultidisciplinaryoncologyclinicsserveasastimulustoidentifybasicsciencequestionswhichstudentsinvestigatethroughoutthecourse.RegenerativeBiomedicine(January)Coursedirectors:DavidT.Scadden,WilliamJ.Anderson,DavidP.Steensma.Regenerativebiomedicineaimstorepairtissuesandorganstorestorenormalfunctionandislikelytobecomeanincreasinglyimportantcomponentofclinicalmedicineinthecomingyears.Hematopoieticstemcelltransplantationisalreadyinwideclinicaluse,whileotherregenerativetherapieshaveenteredtheclinicmorerecentlyorareinclinicaltrials.Thiscourseexplorestheroleofstemandprogenitorcellsintissuehomeostasis,howdefectsinthisprocesscanleadtoillness,andtheroleofstemcelltherapyinthetreatmentofdisease.Thecoursechallengesstudentstothinkcriticallyintheareaofstemcelltherapyandregenerativebiologyasitappliestoclinicalapplicationsinstemcelltransplantation,woundrepair,andagingamongothers.Variedclinicalexperiencesrangingfromtransplantmedicinetogeriatricsfacilitateintegrationofbasicscienceconceptsandstimulateformulationofquestionsatthescientificfrontierwhichisexploredduringthecourse.

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TranslationalBiomedicalEngineering(January)Coursedirector:DavidR.Walt.Innovations in biomedical engineering are having a significant impact on healthcare. Advances in genomics technologies are transforming diagnostics/therapeutics, including personalized medicine. Prosthetic technologies are giving patients who have lost a limb the opportunity for near-normal lives. Robots, swallowed or injected, are changing surgery and diagnostics. Nanomaterials are being used as therapeutics and for new imaging modalities. In this course, students interact with faculty who have successfully translated their work to the private sector, and spend time in labs at the Wyss Institute where novel technologies are currently being developed. Students also meet with investors, visit startup companies to see how technologies are scaled and manufactured, and meet with business development and marketing groups. Student teams are then tasked with going into the clinic and developing a novel use case for technology. The course is designed to provide students with an understanding of the entire process from academic discovery to commercial and patient impact. TranslationalPharmacology(January)Coursedirectors:DavidE.Golan,CatherineI.Dubreuil,DonaldM.Coen,JageshV.Shah.Therehasneverbeenabettertimeinscienceandmedicinetodiscoveranddevelopeffectivetherapiesforhumandisease.TheTranslationalPharmacologyAISCcoversprinciplesofpharmacology,drugdiscovery,andtherapeuticdevelopmentfromunmetneedtodrugdeploymentintheclinicalsetting.Throughcasestudiesofsuccessesandfailuresintranslationandgroupprojectstoproposedrugdevelopmentstrategiesfromunmetneedthroughclinicaltrialsandpharmacovigilance,thiscourseexplorescurrenttopicsintherapeuticdiscovery.Visitstoclinicsandbiotech/pharmacompaniesaswellasmeetingswithpatientsandphysiciansinrelevanttherapeuticareasareutilizedtofurtherexaminehowunmetmedicalneedsaretranslatedintonewclinicalpractices.Computationally-EnabledMedicine(February)Coursedirectors:IsaacKohane,PaulAvillach.Computationalapproachestoanalyzinglargedatasetsandapplyingtheinsightsderivedtoclinicaldecisionmakingarecentraltothepresentandfutureofbiomedicine.Thiscourseenablesstudentstoacquireacomputationalframeworkandtoolkitforaddressingthisgrowinganalyticchallenge.Selectedexamplesfromgenomicsclinicaldecisionmakingandfromepidemiologyinformedby“bigdata”obtainedfromelectronichealthcaredata,claimsdataandeventhesocialwebserveasthebasisforexplorationofthecomputationalframework.Mentoredexperiencesatmedicaldatasciencecompaniesandstate-of-the-artclinicaldiagnosticsenterprisesenablestudentstoexperiencetheapplicationofandelaboratequestionsthatcanbeaddressedbycomputationalbiomedicine.HumanGenetics(February)Coursedirectors:MatthewL.Warman,DavidT.MillerThiscourseexaminesgeneticprinciplesandexperimentalapproachestoaddressfundamentalquestionsabouthumanvariation,health,anddisease.Byexaminingtopicssuchaschromosomaldisorders,genomics,genetherapyandforensicgenetics,aswellasparticipatinginwholeexomeandwholegenomesequencinganalyses,studentsgainan

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understandingofthescientificunderpinningsandtechnologythatdriveadvancesingenetics.Clinicalopportunitiesfocusedonthegeneticsofcancer,cardiovasculardisease,birthdefects,developmentaldisability,andneurodegenerativediseasepromotethedevelopmentofscientificquestionsinordertodeeplyinvestigatehowtousegenetictechnologiestodiagnoseandtreatpatientsaffectedbyageneticdiseaseandhowtocounselpatientswhomaybeatriskfordevelopingdisease.Immunology(February)Coursedirectors:StephanieK.Dougan,MichaelL.Dougan.Thebasicscienceofimmunologyhasresultedinanimpressivearrayofnewtherapiesoverthepastdecadethathavedramaticallychangedclinicaloutcomesinawiderangeofdiseases.Usingfourfundamentalconceptsasaframework(Bcelldevelopmentandantibodyfunction,antigenprocessingandpresentation,activationandregulationofadaptiveimmunity,andcell-cellcommunication),thiscourseexaminestheimmunologicfoundationsunderpinningtherapidexpansionofimmunemodulatingtherapeuticsinclinicaluse.Thecourseillustratestheseconceptsusingspecificdiseasesincludingprimaryimmunodeficiency,allergy,rheumatoidarthritis,inflammatoryboweldisease,andcanceraswellasthroughintegratedimmunology-focusedclinicalexperiencesacrossarangeofspecialties.Clinicalexperiencesandclassroomdiscussionsenablestudentstoidentifyandexplorequestionsthatexamineourunderstandingofhowwecanbroadentherepertoireofimmunetherapiesinthefuture.Metabolism,NutritionandLifestyleMedicine(February)Coursedirectors:Marie-FranceHivert,ChristopherDugganAlifestylewithhealthynutritionandphysicalactivitycouldpreventupto80%ofnon-communicablediseases,anddietarypatternsaretheetiologyfornumerousacuteillnessesinwomen,childrenandothersusceptiblepopulations.Recentadvancesinknowledgeandtechnologyaretransformingthewaythatweintegratelifestyleintoclinicalpractice.Thiscoursecoversfourmajorthemes:1)energyregulation,fromundernutritiontoovernutrition;2)gene-nutrition/lifestyleinteractions;3)developmentaloriginofhealthanddiseases;and4)noveltechnologicalapproachesinnutritionandlifestyle.Studentshavetheopportunitytoparticipateinawidevarietyofspecialtyclinicalprograms,includingweightmanagement,diabetescare,hyperlipidemia,parenteralnutrition,neonatalandotherintensivecareunits,celiacdisease,intestinalfailure,andothers.Classsessionsincludestudents’clinically-inspiredquestions,casediscussions,journalclubs,andexperientiallearning.ThisAISCcombinestheexpertiseofmultiplefacultymembersacrossHMS-affiliatedinstitutionstoofferstudentstheopportunitytoexpandtheirknowledgeandskillstointegratenutrition,physicalactivity,andotherlifestylebehaviorsintheirfuturecareers.MicrobiologyandInfectiousDiseases(March)Coursedirectors:CammieF.Lesser,MaxL.Nibert.Despiteoursubstantialprogressincontrollinginfectiousdiseasesthroughvaccines,therapeutics(e.g.,antibiotics),andotherpublichealthmeasures,theycontinuetobeasourceoftremendoussufferinganddeatharoundtheworld,especiallyinlow-resourcesettings.Thiscourseexploresthebidirectionalinteractionsbetweenthepracticeofclinical

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medicineandbasic/translationalresearchinBacteriology,Virology,andImmunology.Mentoredexperiencesinclinicalsettingsenablestudentstoformulateandinvestigatespecificquestionsattheinterfacebetweenmedicineandscience.Focusingonantibioticresistance,HIV/AIDS,thehumanmicrobiomeandemergingvirusessuchasZika,thiscourseexploresthechallengesandpossiblesolutionsthatinfectiousdiseaseswillbringtothe21stcentury.Neurobiology(March)Coursedirectors:JohnAssad,ToddHerrington.Thehumannervoussystemisoneofthegreatfrontiersofmodernbiology.Currentadvancesinneurosciencehavetransformedneurologyfromprimarilyadiagnosticspecialtytoonerichwiththerapeuticoptions.Inthiscourse,clinicalexperiences,inadditiontoneurology,incorporateradiology,psychiatryandneurosurgery.Topicsincludepainandsensoryloss,theetiologyandtreatmentofseizures,thedisruptionofcognitivefunctioninneurodegenerative,neurodevelopmentalandpsychiatricdisease,theroleoffunctionalneuroimaginginunderstandingbrainnetworks,andtheuseofneurotechnologyincludingdeepbrainstimulationtotreatneurologicandpsychiatricdisorders.Inthiscourse,studentsdeepentheirunderstandingofbasicneurobiologywithagoalthattheybecomeinspiredtocontributetoscientificunderstandingandtranslatediscoveriesintonoveltherapies.Note1:Othercoursesmaybeaddedtothislistandsomemonthsmayshift;thefinallist(withallcoursedescriptionsandmonthsoffered)ispublishedbyearlyJulyeachyear,beforestudycardsaredueforthefollowingyear.Note2:AISCcoursesarenotrequiredforMD-PhDstudents,whomayelecttotakethemaselectivesiftheywish.AISCFrequentlyAskedQuestions1.HowdoesanAISCdifferfromaclinicalelective?ThegoalsandobjectivesofAISCsdiffersignificantlyfromthoseofclinicalelectives.ThegoaloftheAISCsistopromoteanunderstandingofbasicscienceconceptsandtoencouragescientificinquiry,whilethegoalofaclinicalelectiveistopromoteadeeperunderstandingofclinicalmedicine.Forexample,thegoalofacancerclinicalelectiveistolearnaboutthediagnosisandtreatmentofvariousmalignancies.Incontrast,thegoalofthecancerbiologyAISCistoexplorehowthescientificunderstandingofthecellularandmolecularbasisofcancerrelatestoclinicalcancercare,toexplorequestionsatthefrontierbetweentheknownandunknown,andtoconsiderhowsuchquestionsmightbeanswered.Assuch,theAISCsdevoteasignificantamountoftimetoself-directedlearninganddeepexplorationofaquestionofinterestratherthanteachingindepthaboutthediagnosisandtreatmentofcancer.Thebulkofformalcoursetimeisspentintheclassroomratherthaninaclinicalsetting.

2.HowaretheclinicalexperienceswithintheAISCsdifferfromaclinicalelective?

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TheclinicalexperienceswithintheAISCsarefocusedonidentifyingunansweredquestionsrelevanttothepatientsencounteredduringtheclinicalexperiences,ratherthanfocusingonthecomprehensiveclinicalcareofapatient.Onaverage,therearetwohalf-dayclinicalexperiencesperweekinatypicalAISC.Theclinicalexperiencesvarybycourse,andtypicallyspananumberofdifferentspecialtiesorsub-specialtieswithinasingleAISC.Non-clinicalexperiencessuchaslaboratoryexperiencesorvisitstoindustryarealsoutilizedinsomeAISCs.Importantly,clinicalexperiencesareintegratedintothecoursethroughfacilitateddiscussionsattheclinicalsitesandatHMSfocusingonthebidirectionalinteractionbetweenbasicscienceandclinicalmedicine.3.Ihaveneverdonebasicscienceresearchpreviously;howwillthisimpactmyperformanceinanAISC?TheAISCsaredesignedtoaccommodatestudentsatdifferentlevelsofknowledgeandexperienceinbasicscienceresearch.Mechanismsformentorshipandfeedback,aswellasprimersonthebasicknowledgerequiredforeachcoursearebuiltintotheAISCstoenablestudentstoexploreascientifictopicandengageinthescientificprocessinanunfamiliarsubjectarea.Performanceevaluationstakepriorexperienceintoaccount.4.WhatdoesanAISCfinalworkproductlooklike?TheAISCsaimtoencourageself-directedstudyandindependentthought,andinkeepingwiththis,eachcoursehasacreativefinalworkproduct.Studentsareabletochoosetheirowntopic,withinthebroadscopeofthecourse,basedontheirclinicalexperiencesanddevelopingprofessionalinterests.Theformatoftheworkproductissetbyeachcourse,andsomecoursesoffermorethanoneoption.Examplesoffinalworkproductsincludearesearchproposal,anexplanationforapatientaboutresearchrelevanttotheirconditionandclinicalchoices,ashortreviewofprogressandchallengesinaresearchfield,educationalmaterialsforstudents,oranewspaperarticleforthegeneralpublic.Whateverthespecificformat,theworkproductprovidesanopportunitytodevelopanddisplaythegeneralizableskillsthattheAISCsaredesignedtoenhance:findingandcriticallyevaluatingresearchinformation;effectivelycommunicatingscientificinformationtopeersorpatients;understandinghowresearchcaninfluencepatientcareorclinicaldecision-making;andformulatinggoodquestionssuitableforfutureresearch.

5.CanIusemythirdyearAISCtodevelopmySiMproject?TheAISCsareofferedpriortotheApril15deadlineforsubmissionoftheSiMprojectproposalinYearIII.ThisisdesignedsothatstudentsmayusetheAISCs(and/orEssentialsII)todeveloptheirSiMprojectorinformaprojectalreadyunderdevelopment.DuringeachAISC,studentsinteractwithanumberofleadingHMSscientistsandclinicianswithafocusinresearch,whichcanhelpyoudevelopideasorfindmentorsforyourSiMproject.

6.Istherebeacaponenrollmentinindividualcourses?WhatifIdon’tgetmyfirstchoice?StudentsarerequiredtoranktheirtopthreeAISCcoursepreferences.Firstchoicesareaccommodatedwheneverpossible,althoughitisoftennecessarytocapenrollmentstoachieveaworkabledistributionofstudentsacrosscourses.Studentswhodonotreceive

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theirfirstchoiceAISCinYearIIIaregivenpriorityforthatcourseinYearIV,unlesstheylaterindicateadifferentpreference.

7.WilladditionalAISCsbeofferedinthefuture?InadditiontothefirstgroupofAISCsofferedin2018,additionalAISCshavealreadybeenaddedfor2019,andweplantodevelopadditionalcoursesinto2020.Potentialareasbeingexploredincludesocialsciencetopicssuchashealthcarepolicyandglobalhealth;aswiththeotherAISCs,thefocuswouldbeonadeepandrigorousengagementwithfrontierresearchinthosefields.However,planningfor2020isstillpreliminary.Ifyouhavesuggestionsfora2020course,pleasefeelfreetocontacttheAISCCurriculumDirectors(JohnFlanagan,flanagan@hms.harvard.edu;orEliMiloslavsky,emiloslavsky@mgh.harvard.edu).IV.EssentialsII:AdvancedSocialandPopulationSciencesforMedicine The“EssentialsoftheProfession”courseinYearIintroducedstudentstocoreprinciplesofclinicalepidemiology,healthpolicy,medicalethicsandprofessionalism,populationhealth,andsocialmedicine.ThatcoursetaughtstudentshowtothinkcriticallyaboutmedicalknowledgeandhowtounderstandthesocialandpoliticalcontextsofhealthandhealthcareintheUnitedStates.“EssentialsII:AdvancedSocialandPopulationSciencesforMedicine”buildsonthisfoundationandontheexperiencesstudentshadduringthePCE.Whatarethemostimportantmoraldilemmasofclinicalcareandhowcantheybeaddressed?HowcanhealthcaresystemsandfinancingbereformedtooptimizethevalueofcareintheUnitedStates?Whatroledoeshealthcareplayaspartofabroadersystemthatworkstoachievepublichealth?Whoisresponsibleforensuringthatpatientsachievethebestpossiblehealthoutcomes?ThecoursealsoincludesanovelcollaborationwithHarvardBusinessSchool,whereHBSfacultycometoHMStoteachclassicHBScasesonValue-BasedCare.“EssentialsII”isofferedinOctoberandMarchofbothYearsIIIandIV–therearefouroptionstoschedulethiscourse.LiketheAISCs,itisgradedonasatisfactory/unsatisfactorybasis,withanarrativeprovidedforeachstudent.Requiredclasssessionsareconcentratedintheafternoons,withstudentsusingthemorningstoprepareforclass,workontheirfinalprojectsforthecourse,andotherpurposesdependingonwhentheytakethecourseandtheirspecificinterests.StudentswhoplantodotheirscholarlyprojectsinanyoftheEssentialsIIdisciplinesshouldconsidertakingthecourseinOctoberorMarchofYearIII,sothattheycanusethetimeandmentorshipprovidedbythecoursetomakeprogressontheirprojectsanddeveloptheirproposals.SinceinternationalSiMprojectsaredueearlierthanotherprojects,studentsconsideringaninternationalSiMprojectareadvisedtotakeEssentialsIIinOctoberofYearIII(immediatelyfollowingthePCE).Otherstudentswillcompleteindependentorgroupprojectsrelevanttothecourseandtheirinterests.StudentswhotakethecourseinMarchofYearIV,forinstance,canconcentrateonproblemsinmedicalethicsorhealthpolicythattheyexpecttoencounterduringtheirresidency.Otherscancombinecourseworkwithclinicalexperienceswheretheycanapplytheperspectivesofsocialmedicineorpopulationhealth.

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EssentialsIIFrequentlyAskedQuestions1.HowdoIdecidewhichofthe4opportunitiestotakeEssentialsIIisbestforme?Anyofthefourofferings(OctoberorMarchofYearIIIorIV)isequallygood,sothisdependsentirelyona)howthecoursefitsintoyoureducationalplanandb)whatotherprioritiesmighttakeprecedenceforyouinoneormoreofthosemonths.Forexample:

• IfyouarethinkingofdoingyourSiMprojectinanarearelevanttothecourseorhaveaninterestinbuildingtheseacademicdisciplinesintoyourmedicalcareerinasignificantway,itwouldmakesensetoprioritizetakingEssentialsIIinOctoberorMarchofYearIII,asnotedabove(andmorelikelyOctoberifyouareplanningtodoaninternationalSiMproject,sincethoseproposalsaredueearlier).

• If,say,youarethinkingaboutdoingaSiMprojectinanarearepresentedbyanAICSofferedinMarch(suchasMicrobiologyandInfectiousDiseasesorNeurobiology),thenyoushouldchooseoneoftheotherofferingsofEssentialsII.YouwouldhavetheopportunitytotakeanyoftheMarchAISCsinMarchofYearIVaswell,ifitisasubjectofparticularscientificinterest(bynotaplanforyourSiMscholarship).NotethattherearealwaysfewerAISCsofferedinMarchthaninJanuaryandFebruary,sinceMarchisoneofthemonthswhenEssentialsIIisoffered.

• TheOctoberYearIVofferingisscheduledafteralltheresidencyapplicationsareinandbeforemostinterviewsbegin,soifyouareveryunsureofwhatspecialtyyouwantandprefertouseadditionalearliermonthstotryoutvariousclinicalelectives,OctoberofYearIVmightbeagoodoption.

• Asyourresidencyplansevolve,youmaydiscoverotherfactorsthatwillinfluenceyourchoice.Forexample,youmaybethinkingthatMarchofYearIVinitiallysoundslikeagoodoption,butovertherestofthirdyearyoumightdecidetogointoOB-GYN,andyourOB-GYNadvisormayinformyouofacourseofferedonlyinMarchofYearIVdesignedtopreparestudentsforresidencyinOB-GYN(afewspecialtiesorganizesuch“bootcamps,”whicharehighlyvalued).Onceyoudecideonyourspecialty,youshouldinquireabouttheschedulingofsucha“bootcamp”courseinthatfield,soifitisheldinMarchyoucouldthenscheduleEssentialsIIinOctober.

Thefourofferingsofthisrequiredcoursearedesignedtoensurethateverystudentcanscheduleitasoneamongmultiplepriorities,sothekeyisworkingcloselywithyourSocietyAdvisor,sinceEssentialsIImustbetakeninoneofthosefourslots.V.ClinicalElectives,Sub-Internships,andtheClinicalCapstone ClinicalElectives:HMSoffersover200clinicalelectives,providingstudentswitharichmenuofopportunitiestoexplorealmostanyclinicalfieldofmedicine,usuallywithachoiceofclinicalsettingsforeach.Thesearefour-weekexperiencesandofteninvolveparticipationonaspecialtyconsultationservice,sothatasthestudentontheendocrinologyorthegastroenterologyservice,youwillbecomepartoftheteamthatassessespatientswhenaconsultinthatareaiscalledbymedicine,surgeryorother

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services.Someoftheclinicalelectivesinvolvedirectpatientcare(moresimilartocoreclerkshipsduringthePCE),astypicallyisthecasewhenastudentdoesanelectiveintheemergencyroom,anintensivecareunit,andcertainprimarycareelectives.Intheseelectives,thestudentisassignedprimaryresponsibilityforasetofpatientsandengageswiththeirfamiliesandwritestheirorders.EverystudentisrequiredtodoatleastthreeclinicalelectivesatHMSaffiliatedhospitalsduringthepost-PCEphase,butmoststudentsdomanymorethanthatastheyexploreareasofinterestandthensolidifytheirspecialtychoice,meetfacultytogetlettersofrecommendationforresidency,andcontinuetolearnmoremedicine.AcompletelistofclinicalelectivesisavailableinthecoursecatalogueontheRegistrar’swebsite:http://www.medcatalog.harvard.edu/.Sub-Internships:AllHMSstudentsarerequiredtodoafour-week“sub-Internship”ineithermedicineorpediatrics.Fall-entryPCEstudentsarerequiredtodothe“sub-I”bytheJulybeforegraduation,sothattheevaluationcanappearinthestudent’sresidencyapplicationpacket,anditmustbedoneatasiteotherthanthePCEsite.Spring-entryPCEstudentsaregivenuntilAugustbeforegraduationtocompletetheirrequiredsub-I.Thecompletelistofthesecoresub-I’smayalsobefoundinthecoursecatalogueontheRegistrar’swebsite:http://www.medcatalog.harvard.edu/under“CoreClinicalClerkships”sincetheyarethe“CoreSub-Internships.”Theserotationsareuniquebecausethestructureoftheclinicalteamisalteredtoenablestudentstoactastheinternontheteam.Thestudenttherebyhasincreasedresponsibility,andmoststudentsfindthatthismonthiscrucialinpreparingthemforthemulti-taskingandclinicaldecision-makingthattheywillexperienceasanintern.Theterm“sub-I”islooselyusedforcertainotherelectiverotationswherestudentsaregivenmoredirectpatientresponsibility,butthese“surgicalsub-I’s”or“OB-GYNsub-I’s”usuallystillhavetheinternontheteam,butwiththestudentbeingentrustedwithmoreresponsibility.Sincethestructureoftheclinicalteam(howmanyinternsandresidentsareoneachservice)hastobescheduledwellinadvancefortherequiredsub-I’s,studentassignmentstothesesub-I’satspecificsitesarealwayssubjecttoavailability.ClinicalCapstone:Allstudentswhomatriculatedin2015orafter(includingbothPathwaysandHSTstudents)arerequiredtotaketheClinicalCapstoneinJanuary,February,MarchorApriloftheyearinwhichtheygraduate.Thiscourseinvolvesthreeweeksofa“sub-I-like”rotationinwhichstudentshavedirectpatientresponsibility,interactwithfamilies,writeorders(whichgetco-signedbyanMD),etc.(incontrasttoconsultservicerotations,andotherlessclinically-focusedexperiences).Thefulllistofclinicalrotationsthatareeligibleforthiswillbebuiltintothecoursecataloguewellbeforestudycardsforthatperiodaredue.TheotherweekoftheClinicalCapstone(threedaysduringthefirstweekandtwodaysduringthelastweek)isdevotedtoaclassroom-basedcorecurriculumthatincludesvariedprofessionaldevelopmentactivities,anOSCEfocusingoncomplexcommunicationskills,andopportunitiestoreflectonwhichclinicalskillsstudentsshouldfocusonfurtherdevelopingastheybegintheirinternships,alongwithpracticalcontenttopreparestudentstostartasinterns(howto“pronounce”apatientwhentheydie,howtoestablishcodestatus,tipsformaintainingone’shumanityasanintern,etc.).

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TheClinicalCapstoneensuresthatallgraduatingstudentshavehaddirectpatientresponsibilityduringthelastfourmonthsofmedicalschoolandarepreparedforcertainaspectsofthetransitiontoresidencythathaveconsistentlybeenidentifiedaschallengesforinterns.Itisgradedsatisfactory-unsatisfactory.FrequentlyAskedQuestions:1.HowdoIdecidewhichofthefourmonthstoschedulemyClinicalCapstone?Formoststudents,theschedulewilldependprimarilyonotherinterests.Thatis,ifastudenthasaparticularinterestinanAISCscheduledinFebruary,orstillneedstotakeEssentialsIIinMarch,heorshewouldscheduletheClinicalCapstoneinJanuaryorApril.Forsomestudents,thereareotherconstraints.Forexample,MD-MBAstudentswhospendthespringtermoftheirfinalyearatHBSalwaystaketheirClinicalCapstoneinJanuary,sincetheywillbeatHBSfromFebruarythroughgraduation.Inaddition,thereareasmallnumberofspecialties(suchasEmergencyMedicineandOB-GYN)thattraditionallyorganize“bootcamps”inMarchorAprileachyear.StudentswhodecidetoapplyforresidenciesinoneofthosespecialtieswillknowwellinadvancewhichmonthsthesespecialrotationsareofferedanddecidetoscheduletheirClinicalCapstone(andEssentials2)duringadifferentmonth.VI.ScholarlyProjectRequirement(ScholarsinMedicine–SiM)Topic:ManystudentsidentifytopicsandmentorsfortheirscholarlyprojectbythetimethePCEends.OthersseekascholarlyprojectoncetheycompletethePCEandthesestudentscantakeadvantageoftheAISCsofferedinJanuary,February,andMarchoftheirthirdyear(witheveryonerequiredtocompleteatleastoneAISCduringYearIII)aswellasEssentialsII(offeredinOctoberandMarch).Allofthesecoursesencouragestudentstoproposeresearchquestionsandconsiderwaysofansweringthem.Thisinterchange,alongwiththeopportunitytonetworkforaprojectmentor,isveryusefultostudentsseekingtodefineascholarlyproject.Thescholarlyprojectmayaddressanyquestionortopicrelevanttomedicineorhealth,andstudentsmayapproachthesetopicsthroughanydiscipline.Manystudentsdotheirscholarlyworkinbasicsciencelaboratoriesorclinicalresearchgroups.Othersexaminequestionsthroughthelensesofhistory,ethics,policy,healthcaredelivery,globalhealth,anthropology,literature,creativewriting,musicalcompositionorperformanceorart.Studentswhopursuemaster’sdegreeswhileatHMSmayusetherequiredwritingprojectintheirMaster’sprogramastheirscholarlyproject.Mentor(s):Thescholarlyprojectisamentoredexperience.StudentsworkinginaresearchgroupsettingwouldlogicallyhavethePrincipalInvestigator(PI)orafacultyco-investigatorinthegroupserveasmentorforthescholarlyproject.Studentspursuinga

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lesstraditionalscholarlyprojectmighthavetwomentors,oneintheclinicalareaandoneinthescholarlydiscipline.StudentsshouldworkwiththeirSocietyresearchfellows,whowillhelpstudentsnetworktoidentifyappropriatefacultymentorsfortheirwork.Timeline:WiththescholarlyreportduebyMarch1ofthestudent’sfinalyearinmedicalschool,studentswillneedtocarefullyplanthetimewhentheycarryouttheirscholarlyproject.StudentsplanningglobalhealthprojectsneedtosubmittotheScholarsinMedicineOffice(SMO)theirprojectconceptandon-sitementornolaterthanDecember31oftheirthirdyear.AllotherstudentswillsubmittheirscholarlyprojectconceptandmentortotheSMOnolaterthanApril15oftheirthirdyear.Onceapproved,thestudentwritesafullproposalthatdescribestheresearchorprojectquestion,mentor,afeasibleprojectdesign,andtimeline.ProposalsmustbeapprovedbySIMfacultypriortothestudentbeginningtheproject.TheReport:Forstudentswhosescholarlyworkconsistsofhypothesis-drivenresearch,thescholarlyprojectreportwilltaketheformofascientificmanuscript.TheSMOhasseveralscholarlyreporttemplates(seethecollaboratepageURLunder“Resources”below).Ifstudentshavesubmittedamanuscriptorpublishedapaperontheirscholarlyprojectalready,theymayincludethesubmittedmanuscriptorthepublishedpaperastheirreport.Inthesecircumstances,ifthestudentisnotfirstauthorthereportshouldalsoincludeafewpagessummarizingtheresearchgaptheprojectaddresses,thestudent’sroleintheproject,andtheimplicationsofthefindingsforresearch,practiceorpolicy.Studentsenrolledinjointordualdegreeprograms(e.g.MDalongwithMPH,MPP,MBA,M.Ed,etc.)generallymustcompleteawrittenproductasarequirementfortheotherdegree.Thestudentmaysubmitthisproductfortheirscholarlyprojectreport.CreditandFunding:Studentsmaydedicateuptofivemonthsontheiracademiccalendarstotheirscholarlyproject.StudentscanobtaincreditforthesemonthsbyregisteringforSIM500.TheSIMmonthsdonothavetobecontiguous(astudentcouldtaketwomonthsinspringandonethefollowingfall).StudentswhotakeafifthyearforresearchdonotneedtosignupforSIM500creditbutmayrequestfundingfromtheSMO.Forstudentswithmeritoriousapplicationsforfunding,theSMOprovides$1250permonth;thementorisexpectedtomatchthiscontribution.Inaddition,travelfundingisavailableforstudentswithprojectsoutsideofNewEngland.EachHMSstudentisrequiredtowatchtwoonlinevideosthatpresentfoundationalmaterialonIRBproceduresandonResponsibleConductofResearch.Thoseworkingabroadarerequiredtowatchanadditionalonlinevideothatsummarizeskeyprinciplesandproceduresforglobalhealthwork.HonorsinaSpecialField:StudentsmaypursueHonorsinaSpecialField.ThisprograminvolveswritinganHonorsThesisandthendefendingthethesisbeforethreeHMSfacultymembersinanoraldefenseheldduringthespringmonthspriortograduation.TheHonorsthesismaybeanelaborationofthescholarlyprojectreportoritmaybedoneinanentirelydifferentcontentarea.StudentsinterestedinthisprogrammaysignupthroughtheSMOinthefallbeforetheygraduate.

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Resources:Manyresourcesareavailabletohelpstudentsidentifytopicsandmentorsfortheirscholarlyprojects.PerhapsthebestsourceisoneofyourSocietyFellows,whoenjoyhelpingstudentstoidentifysuitableprojectsandmentors.Alloftherelevantformsthatfacilitatetheprocessesnotedhere(scholarlyprojectproposal,report,applicationforSIM500credit)canbefoundathttp://collaborate.hms.harvard.edu/display/scholarlyproject.Behindallofthepaperworkisadelightful,knowledgeablestaffintheSMOinTMEC347.FeelfreetoreachouttoKariHannibal,MarcieNaumowicz,andJasmineSteckertoclarifyanyoftheseprocesses.Also,feelfreetoreachouttotheSIMDirector,Dr.JeffreyKatz(jnkatz@partners.org).VII.HSTandMD-PhDStudentsHMSholdstwoclassmeetingseachyeartoreviewthematerialinthisdocumentindetailandanswerquestions:oneintheearlyspringforfall-entryPCE(mostlyPathways)students,andoneintheearlyfallforspring-entryPCE(mostlyHST)students.Allstudentsaregiventhateveningofffromtheirclerkshipstoattendthismandatorymeeting.MuchoftheinformationinthisdocumentisspecifictoPathwaysstudents,butallinformationrelevanttoHSTstudentsisnoted,andinformationtailoredforHSTstudentsisprovidedattheearlyfallmeetingeachyear.ThesemeetingsaredesignedforstudentsinthelasthalfoftheirPCEyear,astheystarttoconsidertheirpost-PCEschedules.ThemostobviousdifferencesforHSTstudentsinthepost-PCEphaseisthatallHST(aswellasreturningNewPathwayMD-PhD)studentsarenotrequiredtotakeEssentialsIIoranyAISCcoursesforgraduation.Subjecttoavailability,thesecoursesmayofcoursebetakenaselectives,buttheyarenotrequired.AllHSTandMD-PhDstudentshavealsoalreadysatisfiedtheScholarlyProjectRequirementbeforethePCE,buttheyare,ofcourse,encouragedtodoadditionalresearchinthepost-PCEphaseiftheywouldliketodoso(forexample,iftheywishtosubmitthesesforHonorsconsideration).WhatisnotdifferentisthatallHMSstudentsarerequiredtotaketheClinicalCapstonecourseinoneofthelastfourmonthsbeforegraduation(Jan,Feb,Mar,orApr)andtoremainfullyenrolledineachsemesterafterre-enteringtheMDcurriculum.DeadlinesfortheMatchprocessarealsothesame,whichmeansthatstudentsinthesegroupshaveslightlyamendedtimelinestoenablethemtofillouttheirresidencyapplicationsbySeptemberoftheirgraduatingyear:HST4-yearstudentsenteringthePCEinAprilwillcompletetheirPCEbytheendofMarch2018.ItisrecommendedthatthisgroupstudyforandtakeUSMLEStep1bytheendofApril2018tomaximizethenumberofmonthsofelectiverotationspriortoapplyingforresidency,asdiscussedattheirclassmeetingheldbeforetheyenteredthePCE.HST5-yearstudentswhodoaresearchyearbeforeenteringthePCEinJulyhavealreadytakenStep1.TheyarerequiredtoparticipateintDPgroupsfromApril-Julywhiletheyarecompletingtheirresearchyear.IftheyhavecompletedthetwomonthACErotationatMt.

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AuburnHospitalbeforetheirresearchyear,then,duringthe9monthsofthePCEfromJulythroughMarch,thesestudentshaveonemonthoftimeduringtheMedicinecorerotationwhenaclinicalelective,or(ifavailable)aone-monthrequiredPCEclerkship(psychiatry,radiologyorneurology),maybesubstitutedfortheout-patientambulatoryexperience.These5-yearstudentsmustcompleteallthreeofthoseone-monthrotationsbytheendofNovemberofYearIV.MD-PhDstudentsenteringthePCEinAprilhavealsoalreadytakenStep1andhavesimilarpost-PCEexpectationsasthe5-yearHSTstudentsabove.TheyarealsorequiredtoparticipateintDPgroupsstartinginAprileveniftheyarecompletingtheirresearchworkandnotenteringtheirfirstclerkshipsforoneormoremonths.Dependingonwhenthesestudentsstartclinicalrotations,theywillhavebetween9and12monthsofthecorerotationsbytheendofMarch.Thesestudentsmustalsocompleteallthreeone-monthrotationsbytheendofNovemberofYearIV.Again,detailedinformationaboutthepost-PCEphaseforthesegroupsiscoveredattheearlyfallclassmeeting,asthesestudentsenterthesecondhalfoftheirPCE.VIII.MD-MBA,OtherMastersDegrees,andResearchYearsMoststudentswhocompleteamastersdegreealongwiththeirMDinsertthisextradegreebetweentheirthirdandfourthyearsofmedicalschool.StudentstypicallyfinishtheirthirdyearinJulyorAugust,gointotheMastersofPublicHealth(HarvardT.H.ChanSchoolofPublicHealth),MastersofPublicPolicy(HarvardKennedySchool),MastersofBioethics(HMS)orotherdegreeinlateAugust/earlySeptember,andthenfinishthatotherdegreeinMay,sothey“gain”anextrasummerandactuallyendupwithafewextramonthsinwhichtocompletetheMDrequirements,givingthemaddedflexibility.Somedegrees,suchastheMMScinMedicalEducationandtheMMScinGlobalHealthDeliveryScienceinvolveadditionalexpectationsforaresearchthesis,andsostudentshaveaslightlymoreconstrainedschedulebycompletingboththeMDandMMSc-Med-EdorMMSc-GHDSinfiveyears.Sincealmostallmastersdegreesrequireascholarlyproduct,arrangementsaremadeforthisscholarshiptofulfilltheHMSSiMrequirement,sothesestudentsarenotexpectedtoscheduleadditionalSiMmonths(althoughtheymayiftheywanttopursueadditionalresearchorperhapsapplyforHonorsinaSpecialField).TheacceleratedMD-MBAjointprogramisaspecialcase,andstudentswhopursuetheMDandMBAprograminfiveratherthansixyearsarecommittedtoadditionalscheduleconstraintsformostoftheirpost-PCErequirements.FollowingthePCE,theyuseOctobertostudyforStep1andthentakeStep1atsomepointinNovemberorDecember,whiletheyhavealreadystartedtheMedicineandManagementcoursewhichrunsinNovemberandDecember(andwhichincludessomeStep1studytimebuiltin).Duringthatrequiredcourse,studentsreceiveapprovalfortheirSiMproposal,alongwiththepossibilityofcompletinganon-linecourserequirementforHBSaswell.

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Becausethefive-yearMD-MBAprograminvolvesafullyearatHBSstartinginAugust(aboutayearafterthePCE)andthenanadditionalfullsemesteratHBS,studentsinthisprogramhavetoworkcloselywiththeiradvisorstomeetallgraduationrequirements.ManyoftheconstraintsaredeterminedbywhethertheadditionalsemesterisdoneinthefallorspringofYearV.Forexample,ifMD-MBAstudentstaketheirfinalsemesteratHBSfromFebruaryuntilgraduationoftheirlastyear,theyarerequiredtotaketheClinicalCapstoneinJanuary.SincetheyarethenunabletotakeanAdvancedIntegratedScienceCourseintheirfinalyear,theywouldalsoneedtotaketwoAISCsandnotjustoneinthemonthsimmediatelyfollowingMedicineandManagementinYearIII.ThisstillgivesthemtwoopportunitiestoscheduleEssentialsII:MarchofYearIIIandOctoberoftheirfinalyear.

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SampleMD-MBASchedulefor5-yearjointdegreeprogram: YearIII(’17-’18) YearIV(’18-’19) YearV(’19-’20)July Clinelect:adolescentmed MedicineSub-IAug Unsched:vaca/Step2CK Clinelective:ER/Step2CSSep HBS Clinelective:dermOct Unsched:Step1study HBS Clinelective:adolescpsychNov Med&Mngmnt/Step1 HBS Unsched:InterviewsDec Med&Mngmnt/BeginSiM HBS Unsched:InterviewsJan CancerBiology HBS ClinicalCapstoneFeb Genetics HBS HBSMar EssentialsII HBS HBS/SubmitSiMApr Clinelective:MICU HBS HBSMay Clinelective:primarycare HBS HBSJun Clinelect:MICU/Comp Clinelective:cardsNote:thisisjustasample–someMD-MBAstudentstakeStep2CKduringtheirfifthyear,andsomedotheirlastsemesteratHBSinthefallratherthanthespring.Inthesamplescheduleabove,thestudentmeetsallMDandMBArequirementsinfiveyearsbyfinishingthePCE,spendingOctoberstudyingforStep1,takingMedicineandManagementinNovemberandDecemberwhiletakingStep1,andthendoingtwoAISCsinJanuaryandFebruary,followedbyEssentialsIIinMarch.ThisstillgivesthemAprilthroughAugustbeforetheRCyearandJunethroughDecemberaftertodoclinicalelectivesandthelike.Butthisacceleratedprogramclearlyplacesthemostpressureonstudentstoensurethattheysignupforcourseswithgreatcareandattentiontoconstraintsontheirschedule.NoteonMD-MBAProgram:Theaboveonlyappliestostudentsdoingtheacceleratedfive-yearMD-MBAcurriculum.Studentswhoelecttodothefulltwo-yearMBAandcompletebothdegreesinthestandardsixyearssimplyfollowtheusualMDscheduleduringthefouryearstheyareintheMDcurriculum,enteringHBSaftercompletingthreefullyearsatHMS.Pathwaysstudentswhotakeayearoutforresearch(eitherintheUSorabroad)generallydothisfortheacademicyearbetweentheirthirdandfourthyearsoftheMDcurriculum.Theseresearchyearsenablestudentstopursuearesearchprojectevenmoredeeply,whichalsoproducestheirSiMproject.Thus,studentswhodoayearoutforresearchtypicallydonotneedadditionalSiMmonthsintheirschedule.FundingforresearchyearsisorganizedthroughtheScholarsinMedicineOffice(SMO),andusuallyinvolvesmatchingfundsfromSMOandthestudent’sresearchmentor.VariousfoundationsandtheHowardHughesMedicalInstitutealsofundresearchyearsformanyHMSstudents,andinformationaboutthoseapplicationsissharedbytheSMOmonthsinadvanceofdeadlines(whicharetypicallyJanuaryofYearIII).InterestedstudentsshouldcontactSMOforfurtherinformationonresearchyearopportunitiesandfunding.

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IX.PathwaytoResidencyTimeline

Road to ResidencyTimeline: 2018

March

April

May

June

July

August

September

October

December

March 5Class Meeting on Years 3 and 4

Career PanelsGeneralist/Primary CareSurgery and SubspecialtiesSubspecialties

Class Meetings5th Year Options Meet with Society Advisor

May - July

Study Cards Due

Class Meeting:Approach to Step 1

Take Step 11 Clinical Elective

October to December

November

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Road to ResidencyTimeline: 2019

April

May

June

July

August

September

October

November

December

MarchFebruary

January

October –JanuaryInterview at Programs

MSPE goes into ERASSept - OctInterview Tips SessionMock interview Session

July- SeptemberWork on application

Submit application

May – AugustMeet with MSPE writer

Class MeetingsPersonal Statement

LettersCV

Class MeetingsThe Year AheadSpecialty Panels

Residency Application Process

January-MarchIdentify Specialty AdvisorMeet with Society Advisor

Summer Work Early Match

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Road to ResidencyTimeline: 2020

April

May

June

March

February

January

Enter Match List

MATCH DAY!!

GRADUATION!!

TO RESIDENCY!!

EARLY MATCH DAY!Interviews

Class Meeting: Rank list

Feb – AprilComplete Graduation Questionnaire