While the fourth year is generally elective in nature, it is expected that certain requirements will be met - the first being the completion of at least one intensive advanced clinical clerkship, or equivalent, which will demonstrate the student's ability safely to care, by themselves, for acutely ill patients 24 hours a day.  The second requirement is the completion of one of three "Return to the Classroom" selective months, with lecture/seminar format, which emphasize the foundation of medical knowledge and the critical appraisal of data rather than the day-to-day aspects of patient management. The required "Return to the Classroom" month focuses on one of 3 areas (Clinical Pathology, Pathophysiology, or Pharmacology) and also includes weekly Clinical Practice (CP4) sessions and twice weekly sessions in Biomedical Informatics. The Clinical Practice sessions foster collegial discussion of challenges facing physicians and medicine today. The Biomedical Informatics sessions focus on both concepts and practical skills that will prepare graduating students for the role of informatics in their future clinical careers.

During the third year, the student begins a series of decisions which culminates in a choice of a particular residency program for postgraduate education. During March and April of their third year, the students plan their fourth year elective curriculum. To make the best choices, the students must consider where their interests lie and then decide what to study, at which institution, and at which point in the year.

To help the students become aware of the decisions to be made and the options available, the Senior Associate Dean for Student Affairs (x5-3806) provides information in the form of memoranda and meetings throughout the year. Advisory Deans also provide numerous opportunities for students to meet with and learn about different residencies. At the same time, the student is supported by the class ahead as well as the Dean's Office.

All fourth year students are required to take the United States Medical Licensing Examination (USMLE II - Clinical Knowledge and Clinical Skills) no later than October 31, 2006. Passing Clinical Knowledge is required of all students for graduation from P&S.

Phone/web registrations are scheduled for April, July, October, and February for fourth year students.

• December of their third year, students meet with the Senior Associate Dean for Student Affairs and with faculty from P&S affiliates for a planning session about the fourth year and discussion of the various elective opportunities.
• In January the Senior Associate Dean commences meetings with each student individually to review their academic achievements and discuss plans for fourth year and residency applications.
• In February, there are a series of meetings at which fourth year students advise the third years on how to plan their elective schedules.
• In April of the third year, students begin the process of telephone/internet registration for fourth-year electives.
• In May, the Senior Associate Dean for Student Affairs meets with the entire class to go over the residency application process step by step.
• In June, students meet in a series of small-group discussion sessions with individual clinical department chairmen and senior faculty in the various specialties in which they may be interested.
• To help students with their decision-making, the P&S elective catalog is available on-line: Web address: (http://cpmcnet.columbia.edu/dept/ps/electives)
• Brochures from residency programs throughout the country are available in the Dean's Office, as well as evaluations by students who have visited them in previous years.

By the start of their fourth year, all students are involved in registering for the National Residency Matching Program (N.R.M.P.), requesting letters of recommendation from the faculty, and researching on-line programs that might fit their needs. At a meeting with the Senior Associate Dean for Student Affairs, the student selects a faculty advisor in the field of medicine in which the student is interested in pursuing a career. With the help of the advisor, the students identify residency programs they may be interested in and follow the necessary procedures for applying.

Most interviewing for residency programs is done during December and January. By the third week in February, the various programs and applicants across the country have ranked each other in order of preference and submitted their rank order lists to the National Residency Matching Program. Each applicant is then matched to the most preferred program on their rank order list that offers him/her a position, and each program matches the most preferred candidates who accept its offer of a position. The final match is announced on Match Day in March of the fourth year.