Fourth Year

The final year of the curriculum allows our students to transition from medical school to the next steps in their career, including residency programs, industry, research, and advocacy.

Students work with their advisory deans to develop an individualized schedule that meets their specific learning needs and career goals.  


  • Sub-Internship- The four-week “Sub-I” is an in-depth experience where students serve in the role of an intern. Students generally select sub-internships in the field in which they plan to do their residency. Students typically follow the same schedule as Duke interns, serving as the primary provider for an increased number of patients with higher level responsibilities compared to second year.  Students are supported by faculty and residents throughout this immersive experience. There are approximately 25 Sub-Internships from which to choose. 

  • Acute Care Requirement- All students receive focused training in caring for the acutely ill patient through high fidelity simulation and direct patient care. They complete an elective in critical care, with over 10 courses that meet this requirement. All students, regardless of which course is taken, must complete a concurrent “Core Curriculum” component as well that meets 5 times during the course of the elective in small groups and uses high-fidelity simulation to teach core concepts in critical care. 

  • Capstone Course- All students complete a longitudinal Capstone course that teaches important information and tools to prepare them for their first year of residency. The course occurs primarily in March. Topics covered include clinical skills, bioethics, professionalism, advanced communication skills, advanced basic science principles, medical/legal issues, health systems, and self-care.  Students form lasting relationships with their Capstone coaches to help them prepare for life after graduation.   

  • Electives – With the guidance from their Advisory Dean, students complete a series of electives to round out their individual educational needs.  Students have over 125 electives from which to choose. The electives range from 1-4 credit block rotations in the medical and surgical specialties from inpatient to ambulatory settings.  In addition to direct patient care electives, students may choose up to 4 credits in classroom-based, non-direct patient care electives in topics that include humanities, informatics, health policy, leadership, and medical education.   

MS4 Curriculum Schedule

MS4 Curriculum Graphic