Fourth-Year Student Information

The fourth year of medical education marks a significant shift from the structured curriculum of the first three years. For the first time, students have the flexibility to select their own electives and customize their schedule, allowing them to focus on areas of interest and prepare for their future specialties. Below, you will find general information on the requirements, key dates, and structure of the fourth year. Additional class-specific details are provided further down the page.

Promotion to 4th Year: You must pass all third-year clerkships and exams. If you’ve delayed any M3 clerkships, they must be completed before moving forward.

Overview

Structure of the 4th Year

• 13, 4-week blocks
  The fourth year consists of 13 blocks, each 4 weeks in duration. The Fall term consists of Blocks 9-15, the Spring term consists of Blocks 16-21.
• Weeks vs. Contact Hours vs. Credits
  Students must complete a minimum of 36 weeks. Each week consists of 40 contact hours – the equivalent of 1 credit. Students must earn a minimum of 36 credits (1440 contact hours) to graduate.
• Required Weeks vs. Allotted Weeks
  Students must complete at least 36 weeks, but can take up to 48 weeks of rotations in their fourth year.
• Open Blocks
  There are 52 schedulable weeks during the M4 year. Students may have unscheduled periods of time, during which they are responsible for documenting work toward their longitudinal requirement.
  

4th Year Requirements

• Sub-Internship (4 weeks)
  This is a mandatory 4-week rotation that is assigned via the lottery optimization process. It must be completed at BMC as part of the core 36-week requirement.
• Geriatrics Rotation (4 weeks)
  This is a mandatory 4-week rotation that is also assigned via the lottery optimization process. It must be completed at BMC as part of the core 36-week requirement.
• Longitudinal Requirement
  Students must complete 20 or more hours in approved longitudinal activities, such as teaching, quality improvement electives, research, or self-directed learning.
• Additional Rotations
  Students must complete additional elective rotations to fulfill the 36-week requirement. A minimum of 8 weeks must be from the CAMED Fourth Year Elective Catalog, with no more than 20 weeks outside the BU system, no more than 12 weeks in non-clinical electives, and no more than 16 weeks within a given sub-specialty.
• Take Step 2 CK
  Students are required to take USMLE Step 2 CK by November 1 of their fourth year.

Building your Schedule

Lottery

• Preferences Input (early December)
  Students input their preferences for required courses, like the Geriatrics and Sub-Internship rotations.
• Results Released (by early February)
  Lottery results for Sub-Internship and Geriatrics rotations will be available.

Electives

• Early February
  The add/drop system opens for students to begin scheduling elective rotations.
• Add/Drop System
  Elective courses are assigned through an ongoing add/drop process, allowing flexibility in building the schedule.
• Elective Lotteries
  Certain departments use internal processes, such as elective lotteries or waitlists, to manage enrollment in early blocks. This ensures equal access to key rotations for students applying to those fields, particularly those seeking letters of recommendation.
• Research Elective
  Students may take up to 12 weeks of research for credit, either within BU or through outside electives.
• Ongoing
  Students can continue to make changes to their schedule through the add/drop system after submission.

Outside Electives – VSLO, Non-VSLO

• VSLO (Visiting Student Learning Opportunities)
  Students can arrange electives at LCME-accredited U.S. medical schools through the VSLO program. Acceptance must be added to the student’s BU schedule through the add/drop system.
• Non-VSLO Outside Electives
  Students can also arrange electives outside of the VSLO program. Approval from BU faculty is required before arranging these electives, and the approval form must be submitted prior to starting the elective.

Additional Information

Alternate Paths

• Dual Degrees – MBA, MPH, MS, JD, PhD, OMFS
  Students pursuing dual degrees can adjust their fourth-year schedule to accommodate coursework for degrees like MBA, MPH, MS, JD, PhD, or OMFS.

Research

• At BU
  Students in good academic standing may take up to 12 weeks of research at BU for fourth-year credit.
• Outside BU
  Research done outside BU counts toward the 20-week limit on outside electives. Research approval is required before starting.
• Research Year
  Medical students at BU Chobanian & Avedisian School of Medicine may choose to take an additional year (outside of the medical school curriculum) to undertake full-time research under the guidance of a mentor.

Time Away

• Policy
  Students should familiarize themselves with the Attendance, Time Off, and Personal Days Policy.
• Excused Absence
  Students may request an excused absence for a variety of reasons, including illness, religious observances, residency interviews, or personal emergencies.
• Leave of Absence (LOA) 
  Students may apply for a leave of absence for reasons including research, fellowships, outside degrees, or personal circumstances.

Modified Curriculum

• M4 Split Over 4 Part-Time Semesters
  Some students may choose to split the fourth year over four part-time semesters. Approval for this option is required from the medical education office.

Fourth Year Elective Catalog

Add/Drop Tool Instructions

Class of 2025 Fourth Year Scheduling Information

Class of 2026 Fourth Year Scheduling Information

Scheduling Information for Canadian Electives and Applying for Canadian Residencies