Clinical Science Credit Requirements for the Fourth Year
During the fourth year 28 clinical science credits are required. Students who were eligible to satisfy the Third Year Experience (Continuity, Interdis 305C) during Year 3, but did not, will be required to complete 32 credits in their fourth year. Refer to the Third Year Experience, (Continuity, INTERDIS 305C) course description under the Fourth Year Course Requirements section. The normal basic science/clinical science sequence may be relaxed only in extraordinary circumstances, if it is in the best academic interests of the student as determined by the advisory dean. Students that matriculated into Duke School of Medicine prior to 2010 must complete at least 32 clinical credits during the fourth year. Students must be enrolled in at least 8 MS4 credits per term during the fourth year.
Completion of Third Year Requirements for Promotion to the Fourth Year
The student will not be officially promoted to the fourth year until all third-year requirements have been met without prior approval of the Promotions Committee, and the student’s advisory dean. Additional information can be found in the Third Year section.
Fourth Year Course Requirements
Fourth year students that did NOT satisfy the Third Year Clinical Experience (Continuity) requirement for Year Three, are required to take an approved 3 or 4 credit outpatient-clinic, chosen from the list below. The students must successfully complete an approved three or four-week, 3-4 course credit course from the approved list of electives. The credit earned (by exempted students) for these courses will fulfill Interdisciplinary 305C and the 28-course credit requirement for the fourth year at the same time.
If a student was NOT exempt from the third-year Clinical Experience (Continuity) course requirement (INTERDIS 305C) but did not complete it, they are required to complete an approved outpatient course during their fourth year but must add an additional 3 or 4 course credits to the required 28 course credits. Students will be required to complete a total of 31 fourth-year course credits to meet requirements for graduation. Fourth year students must be enrolled with a minimum of eight credits per term. (Fourth year students are not eligible to take 200 level second year selective courses).
| Department | Course # | Course Name |
|---|---|---|
| ANESTH | 446C | Acute & Chronic Pain Management |
| COMMFAM | 405C | Family Medicine Rural Health Elective |
| COMMFAM | 435C | Health Promotion & Disease Prevention |
| DERMATOL | 450C | Clinical Dermatology |
| MEDICINE | 415C | Clinical Management of Diabetes |
| MEDICINE | 423C | Rheumatology |
| MEDICINE | 428C | Metabolism & Endocrinology |
| MEDICINE | 431C | Adult Allergy & Clinical Immunology |
| MEDICINE | 434C | Outpatient Hematology/Oncology (Duke or VA) |
| MEDICINE | 442C | Clinical Arrythmia (outpatient option) |
| MEDICINE | 446C | Nephrology |
| MEDICINE | 449C | Geriatric Medicine |
| NEUROSUR | 404C | Neuro-Oncology |
| ORTHO | 430C | Orthopaedic Sports Medicine |
| PEDS | 402C | Pediatric Gastroenterology (3 or 4 cr. only) |
| PEDS | 413C | Pediatric Pulmonary and Sleep Medicine ( 3 or 4 cr. only) |
| PEDS | 421C | Peds Infectious Diseases (3 or 4 cr. only) |
| PEDS | 427C | Pediatric Hematology/Oncology |
| PEDS | 429C | Pediatric Rheumatology (3 or 4 cr. only) |
| PEDS | 430C | Healthy Lifestyles Program: A Clinical Family-Based Approach to Ped. Obesity |
| PEDS | 431C | Clinical Pediatric Cardiology |
| PEDS | 433C | Allergy and Clinical Immunology |
| PEDS | 436C | Pediatric Neurology |
| PEDS | 441C | Pediatric Nephrology |
| PSYCHTRY | 443C | Addiction Psychiatry |
| RADONC | 415C | Radiation Oncology |
All fourth year (MS4) students must be enrolled in a minimum of 8 credits per term. All fourth-year students are required to have completed clinical electives that fulfill the following criteria by the time of graduation:
- a four-week, five-credit subinternship experience in the field of their choice, which must be completed at Duke
- a four-week, four- or five-credit critical care elective, which must be taken at Duke. Enrollment in the following courses would meet this requirement. If the student has had a placement in an Intensive Care Unit to meet their subinternship requirement, they should select one of the other course options to meet the critical care requirement. Students must complete a course that satisfies the critical care requirement and a second course to satisfy the subinternship requirement.
If the student has had a placement in an Intensive Care Unit to meet their subinternship requirement, they must select one of the other course options to meet the acute/critical care requirement.
Acute Care Course must be taken simultaneously with Acute Care Curriculum (INTERDIS 401C), which is offered during summer sections 42, 43, & 44; fall 41, 42, & 43; and spring 41 and 42).
| Department | Course # | Course Name |
|---|---|---|
| ANESTH | 402C | Cardio Intensive Care Elective |
| ANESTH | 430c | Diving & Hyperbaric Medicine |
| ANESTH | 440C | Clinical Anesthesiology |
| ANESTH | 441C | Surgical Intensive Care (SICU) |
| EMERGMED | 405C | Emergency Medicine Elective |
| MEDICINE | 404C | Cardiac Care Unit Sub-I |
| MEDICINE | 405C | Intensive Care Med Sub-I (MICU) |
| NEURO | 401C | Neurology Sub-I |
| PEDS | 411C | Pediatric Emergency Medicine |
| PEDS | 426C | Neonatology |
| PEDS | 440C | Pediatric Intensive Care Unit (PICU) |
| SURGERY | 441C | Sub-I Surgical Intensive Care (SICU) |
| SURGERY | 443C | Trauma Service |
| Department | Course # | Course Name |
|---|---|---|
| ANESTH | 401C | Cardiothoracic Intensive Care Sub-I |
| ANESTH | 441C | Sub-Internship SICU |
| COMMFAM | 401C | Sub-Internship in Family Medicine |
| EMERGMED | 401C | Emergency Medicine Sub-Internship |
| MEDICINE | 401C | Internal Medicine Sub-Internship (Duke/VA) |
| MEDICINE | 402C | Medical Sub-Internship in Hematology-Oncology |
| MEDICINE | 404C | Cardiac Care Unit Sub-Internship |
| MEDICINE | 405C | Intensive Care Medicine Sub-Internship (Duke) |
| MEDICINE | 407C | Sub-Internship in Internal Medicine/Psychiatry |
| NEURO | 401C | Neurology Sub-Internship |
| NEUROSUR | 401C | Sub-Internship in Neurological Surgery |
| OBGYN | 405C | Gynecologic Cancer Sub-Internship |
| OBGYN | 407C | Female Pelvic and Reconstructive Surg. Sub-Internship |
| OBGYN | 409C | Benign Gynecology Sub-Internship |
| OBGYN | 447C | Maternal-Fetal Medicine Sub-Internship |
| ORTHO | 429C | Sub-Internship in Orthopaedic Surgery |
| OTOLARYN | 401C | Sub-Internship in Otolaryngology Head and Neck Surgery |
| PATHOL | 401C | Pathology Sub-Internship |
| PEDS | 401C | Pediatric Sub-Internship |
| PEDS | 426C | Neonatology |
| PSYCHTRY | 401C | Sub-Internship in Psychiatry |
| PSYCHTRY | 407C | Sub-Internship in Internal Medicine/Psychiatry |
| SURGERY | 401C | Advanced Surgical Clerkship |
| SURGERY | 403C | Sub-Internship Plastic Surgery Integrated Program |
| SURGERY | 441C | Sub-Internship in Surgical Intensive Care |
| UROLOGY | 401C | Sub-Internship in Urologic Surgery |
*MEDICINE 406C is also approved to satisfy Acute Care Course or Sub-I requirement but not currently offered during 2026-2027
Fourth Year Non-Clinical Credits for Non-Direct Patient Care
Students are allowed to earn a total of four non-direct patient care course credits that may count toward the 28 required credits for fourth year graduation requirements. These are usually lecture-based or discussion-group based courses that must be approved by the Curriculum Committee prior to the start of the term in which the student enrolls and must be approved School of Medicine course credits. Students may not receive credit retroactively. These courses include approved courses that are offered in the third year that count toward fourth year credit. Credits for the Capstone Course are not part of this policy.
It is possible that additional courses may be added later, with approval of the Curriculum Committee.
| Department | Course # | Course Name |
|---|---|---|
| ANESTH | 445C | Physiology & Medicine of Extreme Environments |
| COMMFAM | 448C | Introduction to Informatics |
| DERMATOL | 402C | Dermatology for the Non-Dermatologist |
| IINTERDIS | 402C | Introduction to Healthcare Markets and Policy for Practitioners |
| INTERDIS | 403C | Narrative Medicine for Medical Learners |
| IINTERDIS | 406C | Physician Leadership: From Daily Challenges to Global Crisis |
| INTERDIS | 422C | Exploring Medicine: Cross-Cultural Challenges to Medicine in the 21st Century |
| MEDICINE | 424C | Fluids and Electrolytes |
| MEDICINE | 439C | Grief and Bereavement 101 |
| MEDICINE | 447C | Practitioners and Patients: The History of Clinical Medicine |
| MEDICINE | 452C | Clinical Medical Ethics: What Would a Good Physician Do? |
| MEDICINE | 453C | Medicine, Humanities and the Arts (not offered spring 2026) |
| OPHTHAL | 420C | Medical Ophthalmology |