Course Catalog

The goal of this elective is to increase the knowledge of students in prosection in specific anatomical areas.  Objectives are to identify and prosect an area of anatomic interest, identify one pathological condition associated with the area dissected and describe findings, describe clinical significance of dissected area during the course of a clinical procedure, describe age-related variations in the dissected area, describe how an age-related difference would affect clinical care, and identify normal variations, if any.

• Prerequisite(s): Successful completion of Phase I and II
  
• Co-requisite(s): None
  
• Duration:  2 weeks

Medical students will be exposed to daily procedures of Forensic Pathology with the expectation that students will learn to determine cause of death based on circumstances surrounding death, past medical history, and pathological diagnoses determined in the course of autopsy examination.  Students will learn to properly complete a death certificate and how to testify in court as an expert witness.  Students will also learn about the impact of cases on public health and safety.

• Prerequisite(s): Successful completion of Phase I
  
• Co-requisite(s): None
  
• Duration: 4 weeks

This elective will consist of reviewing gross and microscopic pathology specimens with attending pathologists, attending and participating in multidisciplinary conferences, observing the operation of the clinical and histologic laboratories, participating in autopsy pathology, and correlating pathologic diagnoses with patient management using principles of evidence-based medicine.  The medical student will review the patient’s clinical history, physical exam, laboratory data, and radiologic studies and correlate the relevant information with gross and microscopic findings of patient specimens.  From this information, the medical student will develop a differential diagnosis, plan the diagnostic evaluation, and relate the final pathologic diagnosis to patient outcome, based on sound anatomic pathology and laboratory medicine principles.

• Prerequisite(s):  Successful completion of Phase I + 9813, 9815, 9816, or 9819 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

Physicians routinely rely on tissue diagnoses and clinical laboratory tests to guide patient care.  The student will learn the role of anatomic pathology and clinical laboratory medicine in the multidisciplinary care of patients.  This course aims to provide a deeper understanding of tissue testing and clinical laboratory test utilization, and how specimens should be submitted.  Specifically, every physician needs to know where laboratory tests are performed, limitations, and what pathologists and other laboratory professionals need in order to provide the most meaningful report results for their patients and how to develop a differential diagnosis.  Such needs include sample size, adequacy, quality, fixative, and proper type to fit each specific test, as well as knowing what pertinent information should be provided.  In this manner, the medical student will know the importance of proper test utilization for which they ultimately one day may be responsible to interpret in the context of the patient’s clinical history, radiologic studies and physical findings.  The medical student will also learn how to best consult pathologists, and other laboratory medicine professionals, and discover an amazing resource for collaborative patient care.  System cost savings due to decreased laboratory overutilization and improved interdepartmental communication is the goal. 

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  2 weeks

Physicians routinely rely on tissue and clinical laboratory tests to guide patient care.  This course aims to deepen the understanding of tissue testing and clinical laboratory test utilization.  The student is expected to analyze gross and microscopic pathology specimens independently, functioning at the level of a sub-intern.  Emphasis will be placed on recognition of histological patterns and correlation of this information to the patient’s clinical history, physical examination, laboratory data, and radiologic studies to form working diagnoses for each case.  Attendance and participation in autopsy pathology and multidisciplinary conferences will also be required.  The student’s hours will match those of the attending with om they are scheduled to work.  The student will be required to observe the duties of an on-call pathologist one weekend during the clerkship.  There will be no night duties. 

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  4 weeks

How do we make decisions?  What thought processes occur when a physician assimilates multiple pieces of information to arrive at a plan of action, a diagnosis, or a treatment modality?  What are sources of error in our thought processes, and how can we learn to overcome them to be more effective decision makers?  This two-week elective will consist of several readings, discussions, and direct observation of physician decision-making in the Emergency Department setting.  The location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I 
  
• Co-requisite(s): None
  
• Duration: 2 weeks

This two-week elective will consist of learning to perform basic limited point-of-care ultrasound examinations on patients who are in the Emergency Department at Carilion Roanoke Memorial Hospital.  The medical student will perform bedside ultrasounds under supervision and create a portfolio of studies and interesting cases that were performed.  From these studies, the medical student will develop an understanding of ultrasound physics, learn standard ED scan protocols, and learn to interpret positive and negative findings in real time.  The location is Carilion Roanoke Memorial Hospital. 

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  2 weeks

This elective will consist of didactics and observational ride-along shifts with EMS units in the Roanoke area.  The medical student will receive education in the principles of pre-hospital medicine, including capabilities, limitations, skill levels, and costs associated with pre-hospital transportation methods.  Over the course of two weeks, the student will receive several hours of didactic education as well as participate in 8-10 shifts with EMS and fire units in multiple locations.  The locations are Carilion Roanoke Memorial Hospital and area EMS services.

• Prerequisite(s): Successful completion of Phase I 
  
• Co-requisite(s): None
  
• Duration: 2 weeks

This elective will consist of shifts in the Pediatric Emergency Department at Carilion Roanoke Memorial Hospital.  The medical student will do the patient’s chart review, history taking, and physical examination.  From this information, the medical student will develop a differential diagnosis, plan the diagnostic evaluation, and design the acute management of the patient.  The medical student will then observe and/or participate in the medical care and procedures that make up the patient’s management plan.  Emphasis will be placed on age-appropriate exam techniques and treatment modalities for acutely-ill and injured children.  This elective is meant to be an intensive clinical experience in Pediatric Emergency Medicine.

• Prerequisite(s): Successful completion of Phase I + 9812 or 9813, 9815, 9816, 9819  
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

The four-week Acting Internship (AI) in Emergency Medicine elective is meant to complement an EM clerkship.  While it is not required, it is recommended that students have had a prior clerkship experience to gain the baseline fund of knowledge.  The AI is meant to serve as a month-long “interview” rotation, and therefore students are expected to have an interest in pursuing a career in Emergency Medicine with Carilion Roanoke Memorial Hospital as a possible residency destination.  Students will work a schedule similar to that of an intern in our Emergency Medicine residency in the Emergency Department at Carilion Roanoke Memorial Hospital.  Students will be responsible for initial patient assessment, presentation to attending physicians, as well as developing independent management plans.  Focus will be on multitasking skills and development of plans of care appropriate for the student’s educational level.  Opportunities will exist for students to gain extra exposure to an area of interest (ultrasound, pre-hospital, tactical, wilderness medicine, academic/educational development), and students are encouraged to contact us ahead of time to allow time to arrange these experiences.

• Prerequisite(s): Successful completion of Phases I and II + 9811 
  
• Co-requisite(s): None
  
• Duration: 4 weeks

This elective will be an immersive experience in wilderness medicine.  Over the course of the two weeks, students will develop the skills and knowledge necessary to practice medicine in an austere environment.  They will also learn the skills necessary to survive in such environments and the means by which they can bring patients to definitive care.  Their experience will include small group learning, hands-on work stations, and immersive trips to the outdoors.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  2 weeks

The Emergency Department is a unique environment in the hospital because unselected patients with undifferentiated chief complaints arrive with no appointment.  Physicians need to rapidly triage, stabilize, rule in and rule out diagnoses, and determine appropriate destination for further work-up or definitive treatment.  This elective is designed for the student who is interested in emergency medicine as a career and needs earlier exposure to this field.  For example, the student has changed career choice and did not complete EM clerkship in M3 year.  Acceptance to the elective is based on application directly to the emergency medicine clerkship director.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s):  None
  
• Duration:  2 weeks

Why did we order that test?  What is the evidence for ordering a CBC on a patient with belly pain?   Why would you reflexively order a CT scan on a patient older than 65 with new onset abdominal pain?  These questions and many others will be answered as you search for the primary literature for support of medical decisions made in the Emergency Department.  This two-week elective will consist of several readings, discussions, and direct observation of physician decision-making in the Emergency Department setting.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s):  None
  
• Duration:  2 weeks

This elective will introduce the medical student to a more rural population of individuals with a wide variety of Emergency Department presentations.  The student will become familiar with a different hospital system in this more rural setting.  It will be expected that the medical student will further develop their skills of history taking, physical examination, critical thinking, and knowledge of emergency room medicine, including pharmacology, while becoming competent and confident in the diagnosis and management of these issues.  This elective is to assist the student in understanding the type of care that can be offered in a rural setting.  More specifically, the student will see the contrast in the rural and urban setting in managing patients in terms of onsite specialists, onsite medical equipment, and onsite ancillary services.  The student will learn that these limited resources may determine the need to transfer the patient to a higher level of care in an urban medical center where their core Emergency Medicine clerkship has been completed.

• Prerequisite(s): Successful completion of Phases I and II + 9811 
  
• Co-requisite(s):  None
  
• Duration:  2 weeks

This four-week elective is an immersive residential experience in wilderness medicine.  Over the course of the four weeks, the students will develop the skills and knowledge necessary to practice medicine in an austere environment.  They will also learn the skills necessary to survive in such environments and the means by which they can bring patients to definitive care.  Their experience will include small group learning, hands-on work stations, and immersive trips to the outdoors.  Students will be eligible for Wilderness First Responder Certification at the completion of the course.  The course will be taught by nationally known wilderness medicine faculty.

• Prerequisite(s): Successful completion of Phases I and II + 9811 
  
• Co-requisite(s): None
  
• Duration:  4 weeks

The medical student will do inpatient chart review, history taking, and physical examination.  From this information and based on sound geriatric principles, the medical student will develop a differential diagnosis, plan the diagnostic evaluation, and design the geriatric management of the patient.  The location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9812
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

The overall goal of this course is to immerse students in primary care as practiced in a setting distant from immediate access to a tertiary care center.  The focus is on the following themes: 

• Development of autonomy dealing with common and serious conditions in rural primary care 
• Exploration of roles played by physicians in the community • Service learning, particularly as applied to rural underserved care 
• Understanding referral and consultation relationships in a rural environment  

The location is a local nursing home.

• Prerequisite(s): Successful completion of Phase I + 9812
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

The Acting Internship in Family Medicine is designed to engage fourth-year medical students in learning a high level of responsibility for primary, inpatient care from a unique family medicine approach and to understand the family physician’s role in the hospital setting.  Other opportunities for student learning may include assisting with or performing, under supervision, simple procedures; participating in the evaluation of patients in the emergency room under the supervision of an upper-level resident; working in the antepartum service, labor and delivery, and the obstetrical wards, as these areas relate to family medicine training.  The preceptor is the Family Medicine inpatient attending and the location is Carilion Roanoke Memorial Hospital. 

• Prerequisite(s): Successful completion of Phases I and II 
• Co-requisite(s): None 
• Duration: 4 weeks 

The Acting Internship in Family Medicine is designed to engage fourth-year medical students in learning a high level of responsibility for primary, inpatient, and outpatient care from a unique family medicine approach and to understand the family physician’s role in the hospital and ambulatory settings.  Other opportunities for student learning may include assisting with or performing, under supervision, simple procedures; participating in the evaluation of patients in the emergency room under the supervision of an upper-level resident; working in the antepartum service, labor and delivery, and the obstetrical wards, as these areas relate to family medicine training.  The students may also work in the pediatric wards, the newborn nursery, and the intensive care unit, as these are all areas where the Family Medicine service cares for patients in the hospital.  The preceptors are the attendings in the various settings.  The locations are the outpatient practice and Carilion Roanoke Memorial Hospital.   

• Prerequisite(s): Successful completion of Phases I and II 
• Co-requisite(s): None 
• Duration:  4 weeks 

Burnout is a long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment. In this course, conditions and situations that promote burnout and psychological distress in physicians will be extensively explored. Resilience-building strategies and the development of resilience networks that will be applicable throughout a medical career and will be discussed. Students will learn how to apply these strategies to all aspects of their lives and will be able to create resilience networks throughout their practice and systems. Several work and home scenarios will be explored via discussion and role-playing. Adaptive and maladaptive responses to such scenarios will be explored. The majority of the course will be conducted online.

• Prerequisite(s): Successful completion of Phase 2
  
• Co-requisite(s): None
  
• Duration:  2 weeks

This two-week elective equips medical students to address spiritual issues that arise in patient care. Students examine how spiritual and religious orientations influence patients, physicians, and caregivers in clinical decision-making, health, and healing. The course emphasizes recognition of caregiver attitudes, appropriate use of spiritual histories, and consultation with chaplains or other advisors. Students also have the option to spend time shadowing a member of the pastoral care team. Topics include spirituality in medicine, specialty-specific applications, research on spirituality and health outcomes, pastoral care models, and clinical approaches to integrating spirituality into patient care. Learning occurs through case narratives, facilitated discussions, and reflection.

• Prerequisite(s): Successful completion of Phase 2
  
• Co-requisite(s): None
  
• Duration:  2 weeks

This elective is a course primarily focusing on development of medicine in the western world from antiquity to the later 19th century.  The course will highlight individuals, theory, and practice.  The course will also explore the role of social, cultural, and religious forces in influencing the practice of medicine.  The contents of this course are offered uniquely in the discussions and readings of the course and provide a background to the path of medicine as we know it and practice it today.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 2 weeks

This course is designed to provide exposure to important aspects of both patient safety and healthcare quality.  The student will spend time shadowing experts in the fields of human factors, infection prevention, process improvement, event reporting, and root cause analysis.  Students will participate in deep dives to understand the root causes of healthcare associated infections (Referred to as HAIs moving forward) and can identify ways for performance to improve.  In addition, the students will spend time with physicians who are quality improvement leaders in their sub-specialties.  The student will join safety huddles and various patient safety meetings as their schedule allows.  The student will present an article of their choosing at a hospital-wide quality meeting. 

• Prerequisite(s): Successful completion of Phases I and II 
• Co-requisite(s): None 
• Duration:  2 weeks 

This elective will focus on understanding neurosurgery from the perspective of a global view.  Immersive experience in which students will work with the neurosurgery team at the Bir Hospital (National Academy of Medical Sciences), Nepal.  Beyond acquiring knowledge and skills related to complex neurosurgical cases, insight into the dynamics of an alternative healthcare landscape, a nuanced understanding of the challenges and solutions unique to global healthcare contexts will be experienced.  Students will learn to foster global citizenship and learn effective communication skills needed in crosscultural health care settings.  Students will gain an appreciation for diverse healthcare landscapes and the importance of adapting medical practices to different cultural and socioeconomic contexts. 

• Prerequisite(s): Successful completion of Phases I and II 
• Co-requisite(s): None 
• Duration:  4 weeks 

The goal of this course is to expose students to the applications and context of clinical ethical issues. This elective aims to deepen students' understanding of medical ethics, enhance their skills in evaluating ethical dilemmas, and provide practice in analyzing situations within a multidisciplinary team context. Additionally, students will develop clinical ethics consultation skills and explore ethical issues from individual, organizational, and societal perspectives. Over this two-week elective, students will improve their ability to navigate ethical challenges in clinical scenarios, apply ethical principles effectively, and engage in ethical decision-making across multiple levels of healthcare practice. Students are required to participate in all clinical ethics consults at Carilion Roanoke Memorial Hospital as well as other relevant ethics educational activities as appropriate.

• Prerequisite(s): Successful completion of Phase I and II
  
• Co-requisite(s): None
  
• Duration:  2 weeks

This elective course offers a “boots on the ground” experience in health policy. Students will explore policy in action through a two-or four-week placement at the Roanoke City Health Department that includes development and execution of an independent project involving health policy. The independent project may include directly working with VTC partners such as Carilion Clinic, Bradley FreeClinic, or other community-based organizations. Supervised by the Course Director, students may also collaborate with policy partners (e.g., a local elected official or executive director of a local community based organization, local, state, and federal policy making bodies, or other agents of change).

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

This elective will consist of consulting on patients who are hospitalized with infections. The medical student will do the patient’s chart review, history taking, and physical examination.  From this information, the student will develop a differential diagnosis, plan the diagnostic evaluation, and design the infectious disease management of the patient, based on sound microbiological, antibiotic, and physiological principles.  The preceptor is the attending on the inpatient service and the location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s):  Successful completion of Phase I + 9813 
  
• Co-requisite(s): None
  
• Duration:  4 weeks

The Cardiology Consult elective will give the medical student an introduction in rendering consultative advice on a wide variety of cardiovascular issues in a hospital setting.  Typical patients will include pre-operative clearance for non-cardiac surgeries, post-operative complications including arrhythmias and hemodynamic instability, or patients with acute coronary syndromes, heart failure, or other cardiovascular issues admitted to non-cardiology services.  The student will perform complete reviews of the patient’s electronic medical record, take an independent history, and perform a complete physical examination.  From this information, the student will develop a differential diagnosis, plan the diagnostic studies including laboratory tests and imaging studies, and design the cardiovascular management plan for the patient.  The student will be part of the rounding team that will include the attending, cardiology fellow, and often one or more medical residents.  The student will review his/her management plan with the fellow and/or resident before presenting it to the attending.  The preceptor is the attending on the inpatient service and the location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s):  Successful completion of Phase I + 9813 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

This two- or four-week elective provides students with clinical experience in the evaluation and management of musculoskeletal andrheumatologic diseases, primarily in the outpatient setting. Students will perform patient-centered histories, physical examinations,and electronic documentation, and will develop differential diagnoses and diagnostic plans. Through supervised patient encounters,students will refine their ability to distinguish mechanical and degenerative conditions from systemic inflammatory and autoimmunediseases, interpret laboratory and imaging studies, and observe musculoskeletal ultrasound. The course emphasizes outpatientconsultation, clinical reasoning, and concise case presentation.

• Prerequisite(s): Successful completion of Phase 2
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

Students will learn how to assist individuals who have permanent impairments (paralysis, sensory loss, cognitive dysfunction, alteration of consciousness, decreased endurance, etc.) in identifying their remaining abilities and developing them to their maximum potential.  There is a strong emphasis on the team approach, with communication as the vital link between team members, most importantly the patient and the patient's family.  We will try to focus on issues that students will likely see in their primary practices.  The location is the Rehabilitation Unit at Carilion Roanoke Community Hospital.

• Prerequisite(s): Successful completion of Phase I 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

This elective provides students with exposure to the inpatient and outpatient evaluation and management of pulmonary diseases at Carilion Roanoke Memorial Hospital and affiliated clinics. Students will conduct chart reviews, obtain patient histories, and perform physical examinations. Using physiopathological principles, students will develop differential diagnoses, propose treatment plans,and apply diagnostic testing in the context of pulmonary disorders. The course emphasizes history taking, physical examination, clinical reasoning, and the application of evidence-based diagnostic and therapeutic measures in pulmonary medicine, including considerations of the patient's quality of life in clinical decision-making and communication. Students will also prepare and delivercase presentations that demonstrate their ability to synthesize clinical findings, diagnostic data, and management strategies.

• Prerequisite(s): Successful completion of Phase 2
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

Students will be paired with a faculty member in Internal Medicine.  Students will be exposed to a wide array of patients with diseases and conditions typically seen in an outpatient internal medicine setting, such as diabetes, hypertension, and chronic lung disease.  Students will learn to do a focused history and physical exam pertinent to the patient’s reason for being seen.  Students will then report their findings to the attending physician and together formulate a management plan for the patient.  The preceptor is the ambulatory faculty attending and the location is Carilion Clinic Riverside complex.

• Prerequisite(s): Successful completion of Phase I 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

This elective will consist of consulting on patients who are hospitalized with serious illnesses.  The medical student will do the patient’s chart review, history taking, and physical examination.  From this information, the student will be able to synthesize information to develop an interdisciplinary plan of care incorporating palliative care principles for the patient and family that address comprehensive views of suffering.  The location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9813 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

The Internal Medicine Acting Internship (AI) elective seeks to provide the senior medical student an inpatient learning experience similar to that of a PGY1 internal medicine resident.  The student will be assigned to an inpatient faculty internal medicine teaching team comprised of an attending physician, a PGY2 or PGY3 resident, two PGY1 residents, and possibly one or two other medical students.  The student will be assigned patients who are admitted to their team and will assume an integral role in providing care for that patient during their hospitalization.  The student on the AI elective will be assigned duties and responsibilities very similar to those of the PGY1 residents.  These duties include, but are not limited to, taking a complete history and performing a complete physical on the patients assigned to them, initiating appropriate orders on their patients, which will require co-signature, following the patient throughout their hospitalization, and assisting with discharge planning.  The AI student may also be involved in procedures on their patients when indicated. The student will be expected to be on call when their team is on call, including overnight call similar to other PGY1 residents, as well as follow all duty hour rules of the program.  The student will also be expected to participate in teaching activities including contributions to teaching rounds and morning report.  The student will be expected to attend the didactic conferences provided to the students and residents.  The preceptor is the inpatient attending and the location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 4 weeks

The fourth-year medical student who takes this elective will be immersed in a busy inpatient cardiology service with exposure to a wide spectrum of cardiovascular diseases including acute coronary syndromes, valvular heart diseases, cardiomyopathies, and common dysrhythmias.  He/she will also help manage an outpatient cardiology observation unit.  Most patients in the observation unit will be low-risk patients with chest pain or those with heart failure exacerbations.  Chest pain patients will be ruled out for myocardial necrosis, then undergo appropriate non-invasive studies such as exercise treadmill testing, exercise or dobutamine stress echocardiography, nuclear cardiology study (e.g. Lexiscan), or cardiac computed tomographic angiography study.  The Acting Intern (AI) will be involved in deciding the most appropriate noninvasive/imaging modality for the patient as well as participate in analyzing the electrocardiogram (ECG) and imaging aspects of the study.  Patients with heart failure will be investigated for etiology of HF exacerbation and have appropriate diagnostic studies and adjustment of medical regimens.  Some of the patients from the observation unit will be admitted to the AI’s inpatient service.  The AI will work closely with the attending, mid-level provider, and resident.  On most rotations, a cardiology fellow will also be involved in teaching the AI and intern.  The preceptor is the inpatient attending and the location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  4 weeks

The Coronary Care Unit (CCU) provides intensive care for a wide range of cardiovascular issues.  The student will be exposed to unstable acute coronary syndromes, cardiogenic shock, decompensated heart failure, unstable rhythms, hypothermia protocol, and many other unstable cardiac conditions requiring intensive care.  The elective occurs in the CCU of Carilion Roanoke Memorial Hospital, and the student will work with the CCU team to provide care for the patients in the unit.  The student will participate in cardiac catheterizations and other procedures as warranted.  The preceptor is the CCU faculty attending.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

The medical student will do the patient’s chart review, history taking, and physical examination.  In consultation with the attending, the student will develop a differential diagnosis, plan the diagnostic evaluation, and design a management plan for the patient’s skin disease.  The locations are Carilion Clinic Riverside complex and Carilion Roanoke Memorial Hospital. 

• Prerequisite(s): Successful completion of Phase I + 9813 + 9819 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

Students will be exposed to a wide array of common and unusual gastrointestinal conditions.  Additionally, students will attend procedures in the endoscopy suite.  They will review the patient’s chart, obtain a pertinent history, and perform an appropriate physical examination.  In consultation with the attending, students will develop a differential diagnosis, plan the diagnostic evaluation, and design management options for the patient’s gastrointestinal disease.  The locations are Carilion Clinic Riverside complex and Carilion Roanoke Memorial Hospital.

• Prerequisite(s):  Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

This elective will consist of working primarily in the outpatient setting in conjunction with the faculty hematologist/oncologist.  The medical student will do the patient’s chart review, history taking, and physical examination.  From this information, the student will develop a differential diagnosis, plan the diagnostic evaluation, and discuss the patient’s management options with the attending. The location is Blue Ridge Cancer Care.

• Prerequisite(s):  Successful completion of Phases I and II 
  
• Co-requisite(s): None
• Duration: 2 or 4 weeks

This elective is intended to expose medical students to a wide variety of acute and sub-acute medical pathologies and to enable them to provide physiologic support for patients who have suffered acute catastrophic insult.  Students will gain experience in coordinating the management of critically ill patients with multiple health care providers and will apply evidence-based concepts to diagnosis, care, and outcome prediction of critically ill patients.  The preceptor is the Intensive Care Unit attending and the location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s):  Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

This elective will consist of inpatient/outpatient work in conjunction with the nephrologist.  The medical student will learn about fluid management as well as dialysis management and the illnesses that typically accompany renal disease such as hypertension (HTN).  The preceptor is the attending of record from Valley Nephrology and the location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s):  Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

In this elective, the student will learn how to assist individuals who have permanent impairments (paralysis, sensory loss, cognitive dysfunction, alteration of consciousness, decreased endurance, etc.) in identifying their remaining abilities and developing them to their maximum potential.  There is a strong emphasis on the team approach, with communication as the vital link between team members, most importantly the patient and the patient's family.  We will try to focus on issues that the student will likely see in their primary practice.  On the Advanced Physical Medicine and Rehabilitation rotation, the student will be engaged in discharge planning and follow-up planning and is expected in general to have a wider knowledge base of how to care for patients on the service.  The student will make an oral  presentation to the preceptor on a topic agreed upon by the preceptor and the student.  The M4 student will be expected to gain a level of independence on the Advanced PM&R elective that is indicative of their prior experience in a PM&R setting.  The location is the Rehabilitation Unit at Carilion Roanoke Community Hospital.

• Prerequisite(s): Successful completion of Phases I and II + 9304 
  
• Co-requisite(s): None
  
• Duration:  2 weeks

The medical student will do the patient’s chart review, history taking, and physical examination.  In consultation with the attending, the student will develop a differential diagnosis, plan the diagnostic evaluation, and design a management plan for the patient’s skin disease.  The student will review the literature and make a 15-minute oral presentation to the attending on a relevant topic agreed upon by the attending and the student.  The student will be expected to be more actively engaged in diagnosis and treatment planning with skills congruent to having had a previous dermatology elective and will be expected to be more involved in the management of procedures in the office setting.  The locations are Carilion Clinic Riverside complex and Carilion Roanoke Memorial Hospital. 

• Prerequisite(s): Successful completion of Phases I and II + 9312
• Co-requisite(s): None
  
• Duration: 2 weeks

Students will make home visits with home health nurses, a physician, and a nurse practitioner.  They will attend the interdisciplinary team rounds on Thursday mornings and will learn the regulations around eligibility for hospice services.

• Prerequisite(s): Successful completion of Phase I + 9813 
  
• Co-requisite(s): None
  
• Duration: 4 weeks

Students will learn the principles of radiation oncology as well as communication skills with patients who have been determined to have a malignancy which may be responsive to radiation.  Students will also learn interprofessionalism through communication with techs, nursing staff, and possibly oncologists.  The location is Blue Ridge Cancer Care.

• Prerequisite(s): Successful completion of Phase I + 9813 
  
• Co-requisite(s): None
  
• Duration: 2 weeks

The Elective is an online dermatology course for students who may utilize the skills learned in any specialty of clinical practice.  Included in this course are terminology for describing the morphology of basic skin lesions, the appropriate conduction of a skin exam, forming a differential diagnosis based on morphologic diagnosis, recognizing characteristic appearances of benign and malignant skin lesions, describing drug reactions, and identifying therapies for dermatologic illnesses or lesions.

• Prerequisite(s): Successful completion of Phase I  
  
• Co-requisite(s): None
  
• Duration: 2 weeks

Throughout the course, the student will be exposed to the variety of hormonally active conditions in a clinical setting.  The student will examine patients while practicing empathy and identify endocrine problems to include by not limited to diabetes, thyroid disease, metabolic bone disease, and adrenal and pituitary disease.  The student will utilize appropriate laboratory and radiological data.  Supplementing this will be a series of didactic presentations led by experts in the field of Endocrinology to complete a review of the common conditions encountered and their treatment. 

• Prerequisite(s):  Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  2 weeks

This two-week elective provides the student insight into incorporating acupuncture and integrative medicine into modern medical practice, as well as practical applications for the use of Botulinum toxin injections for spasticity and other approved diagnoses.  Students will also learn the basic principles of electromyography and nerve conduction study, and pain management in a Physical Medicine and Rehabilitation stetting. 

• Prerequisite(s): Successful completion of Phase I 
  
• Co-requisite(s): 
  
• Duration:  2 weeks

Stroke accounts for more than half of all neurology inpatient admissions and is the leading cause of neurologic mortality.  This elective will provide education in acute stroke treatment, stroke prevention, and stroke diagnosis.  The goals are to master current principles of the diagnostic evaluation of patients with cerebrovascular disease, become skilled in the acute treatment of stroke, and acquire proficiency in treatments to prevent stroke.  This location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I 
  
• Co-requisite(s): None
  
• Duration:  2 weeks

This elective will be offered to fourth-year medical students seeking a more extensive exposure to inpatient neurology.  This elective is intended for students interested in intensive care or hospitalist medicine, emergency medicine, neurology or neurosurgery.  It deals with inpatients suffering from strokes, metabolic encephalopathies, seizures, and neurologic complications of non-neurologic conditions.  In this setting, students will work with faculty attendings to evaluate patients on a busy consult service.  Students will present their findings directly to the attending who will review the case with them.  Appropriate supervision will be provided.  There will be time to review the relevant literature prior to presenting these cases.  The location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I
  
• Co-requisite(s): None
  
• Duration: 2 weeks

This elective will be offered to fourth-year medical students seeking a more extensive exposure to outpatient neurology.  An individualized program will be prepared by the course director to suit the particular interests of each student.  The student may choose from a wide variety of neurologic subspecialty experiences including movement disorders, epilepsy, electromyography (EMG) and neuromuscular disease, among others, but will also spend at least 50% of the time seeing general neurology consultations.  Outpatient evaluation and management of neurological complaints is often challenging for physicians.  Performance of simple exam skills and knowledge of a few clinical principles make it much easier to manage these patients in an efficient and cost-effective manner.  The location is Carilion Clinic Riverside complex.

• Prerequisite(s): Successful completion of Phase I
  
• Co-requisite(s): None
  
• Duration:  2 weeks

This elective is designed for fourth-year medical students with a strong interest in neurology who intend to pursue residency training in neurology (or a related discipline including, but not limited to, Neurosurgery or Psychiatry).  The goal of this elective is to give students an opportunity to take an active role on the neurology team in both inpatient and outpatient settings.  Emphasis will be placed on improving skills in taking a thorough and relevant history, performing complete, as well as problem-focused neurological examinations, ordering diagnostics, and formulating treatment plans.  Students may also assist residents or attending physicians in procedures as appropriate.  Students will rotate for two weeks on the inpatient consult service to gain experience with a wide breadth of neurological diseases.  Students will also spend a week on the stroke team to increase depth of knowledge in vascular neurology and a week in the outpatient clinic to develop experience with multiple sclerosis, headache, movement disorders, neuromuscular diseases, and epilepsy.  Depending on the student’s interests and availability of resources, experience in the Epilepsy Monitoring Unit may be arranged.  The locations are Carilion Clinic Riverside complex and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  4 weeks

The goal of this course is to provide medical students with a comprehensive understanding of headache disorders, focusing on their pathophysiology, diagnosis, and management. Students will gain the necessary skills to assess and manage both acute and chronic headaches, utilizing evidence-based treatment strategies and procedural interventions. This course will also emphasize the importance of patient education and multidisciplinary collaboration while navigating complex clinical scenarios. Over this four-week elective students will engage in both didactic and hands-on learning, including patient interactions, case discussions, and procedures. They will have the opportunity to assess real-world headache cases in clinical settings, collaborate with specialists, and enhance their diagnostic and treatment planning skills. Additionally, students will be introduced to advanced therapeutic techniques, including OnobotA injections and nerve blocks for headache management. Students are required to actively participate to complete didactic requirements, patient assessments, diagnostic workups, and treatment planning discussions. They will also be expected to apply their knowledge from previous clerkships and coursework. Throughout the elective, students will work closely with Neurology and Pediatric Neurology team to ensure holistic patient care, while refining their clinical, procedural, and communication skills.

• Prerequisite(s):  Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  4 weeks

This elective is designed for a student interested in obstetrics and gynecology or primary care with a strong emphasis on women’s health or a surgical subspecialty.  This elective will expose the student to the evaluation and management of patients with pelvic organ prolapse and urinary incontinence.  The student will be involved in the outpatient management of patients with the above conditions.  They will become familiar with medical and surgical management options.  The student will have an opportunity to participate in fitting pessaries and observing urodynamics and outpatient cystoscopy.  At least one day a week will be spent in the operating room and the student will be responsible for following post-operative patients during their hospital stay.  Students will also participate in Friday morning didactics with the residents.  The locations are the outpatient clinic and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

This is a sub-internship elective designed for a student interested in obstetrics and gynecology or a surgical subspecialty.  The student will gain experience in the outpatient evaluation of patients with potential gynecologic malignancies.  The student will observe and assist with surgical cases including robotic cases.  The student will gain an understanding of post-operative management of complicated surgical patients and will round on these patients with the gynecologic oncology team as an acting sub-intern.  The student will be expected to present a topic of their choosing to the team at the end of the rotation or participate in an oral exam given by one of the gynecologic oncologists.  The fourth-year student will participate in the same didactic curriculum with the residents.  There is no on-call responsibility, but the student will be expected to participate in inpatient rounds during two of the four Saturdays.  The locations are Carilion Clinic Riverside complex and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 4 weeks

This elective is designed to provide the participating student with exposure to the breadth of high-risk obstetrics.  The student will evaluate and manage high-risk obstetrical patients in the office and hospital setting.  In the outpatient setting the student will participate in genetic counseling sessions, ultrasound and Maternal Fetal Medicine consultations including conditions of anemia, diabetes mellitus, urinary tract disorders, infectious diseases, asthma, surgical abdomen, and chronic hypertension.  The student will participate in the care of patients with preterm labor, in the care of patients when fetal anomalies are identified, and in the care of patients with multifetal gestations.  The student will interact with the Maternal Fetal Medicine attendings, OB residents, genetic counselors and sonographers. The student will participate in the management of acute and high-risk obstetrical conditions by rounding daily on the antepartum service with the residents and faculty.  The student will participate in intrapartum management during this rotation.  There is no call requirement for this rotation. 

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 4 weeks

This 2-week elective is designed for 4th year medical students who will enter an obstetrics and gynecology residency after graduation.  Students will review and manage obstetrical and gynecologic conditions.  This elective is modeled after the CREOG-APGO Step Up to Residency curriculum, and will include self-study, didactics, computer modules, simulation, and clinical time.  The goal of this elective is for each student to be prepared for entering residency, with the following national objectives set by CREOG-APGO: enhance knowledge of applications of simulated patient cases; practice skills helpful in early stages of residency; discuss critical skills necessary for success in residency.  If there are fewer than three students enrolled, then the elective will include self-study, computer modules, and clinical time but there will not be simulation or didactic time. 

• Prerequisite(s): Years 1, 2, 3 + all core clerkships
  
• Co-requisite(s): None
  
• Duration: 2 weeks

 This course is designed for exposure to the assessment and treatment of advanced gynecologic pathology.  This experience will provide experience in both the clinic and operating room for patients with chronic pelvic pain symptoms.  The student will participate directly in all aspects of care including initial outpatient consult and workups in clinic, decision analysis of treatment modalities including but not limited to physical exam assessment, surgical planning, medical regimens, incorporations of pelvic physical therapy, trigger point injections, and amendment of treatment plans.  Emphasis will also be placed on intra-operative exposure and participation in laparoscopic and hysteroscopic surgeries each week.  The student will be required to observe the duties of an on-call physician (home call for one weekend) during the clerkship.  Travel will be involved to Carilion Stonewall Jackson Hospital in Lexington, VA and to Carilion Franklin Memorial Hospital in Rocky Mount, VA. 

• Prerequisite(s):  Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 4 weeks

This course is designed as a well-rounded exposure to the assessment and treatment of pelvic floor disorders, clinically and surgically within the specialty of Obstetrics and Gynecology (OBGYN).  The student will participate directly in all aspects of care including initial outpatient consult and workups in clinic, decision analysis of treatment modalities including but not limited to physical exam assessment, surgical planning medical regimens, incorporations of pelvic floor physical therapy, and amendment of treatment plans.  Emphasis will also be placed on intra-operative exposure and participation in surgeries each week, and students will round postoperatively on patients on remain inpatient.  In the inpatient and outpatient setting, the student is required to function at the level of an acting intern. The student will have the opportunity to observe pelvic floor physical therapy, urodynamics, and other office-based procedures.  Attendance and participation in multidisciplinary conferences and didactics will also be expected. Students will be required to give a brief presentation at the end of the rotation on a literature review of a pertinent urogynecologic topic of their choice. Travel will be involved to Carilion New River Valley Medical Center, Christiansburg, VA. 

• Prerequisite(s):  Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 4 weeks

This course is designed to raise awareness and highlight opportunities to learn about equitable care in maternal health.  The course will also focus on discussing policies at a system level and government/state level that dictate maternal health care and evaluate ways to advocate for our patients.  The student will be an added member of the clinical team on Labor and Delivery (performing basic obstetrical skills) during the two-week rotation.  The student will participate in all aspects of care including triage, management and clinical-decision making of antepartum and labor and delivery patients.  Emphasis will be placed on evaluating each patient’s antepartum course and determinants of health through an equity lens.  The student will learn the basics of advocacy as a physician by analyzing current system, local, state, and national policies, and will be able to identify opportunities for advocacy.  Students will be required to give one brief presentation at the end of the rotation.  The presentation will be a literature review of a pertinent policy, law, or bill of their choice that has a direct impact on maternal health care.  There will be no travel necessary. 

• Prerequisite(s):  Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  2 weeks

This course is designed to raise awareness and highlight opportunities to learn about equitable care in maternal health.  The course will also focus on discussing policies at a system level and government/state level that dictate maternal health care and evaluate the various ways to advocate for our patients.  The student will be an acting intern on the clinical team on Labor and Delivery.  The student will participate in all aspects of care including triage, management and clinical-decision making of antepartum and labor and delivery patients.  Emphasis will be placed on evaluating each patient’s antepartum course and determinants of health through an equity lens.  The students will evaluate a patient’s medical course and identify opportunities for advocacy.  The students will be required to give two brief presentations, one at the end of week two and one at the end of the rotation.  For the first presentation the student will select a patient encounter and give a presentation about possible healthcare disparities based on social determinants of health and offer more equitable choices of care.  The second presentation will be a literature review of a pertinent policy of their choice that has a direct impact on maternal health care.  There will no travel necessary. 

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  4 weeks

This elective is designed to provide the participating student with exposure to the outpatient high risk obstetrics.  The student will evaluate and manage high risk obstetrical patients in the office including conditions of anemia, diabetes mellitus, urinary tract disorders, infectious diseases, asthma, surgical abdomen, and chronic hypertension.  In the outpatient setting the student will participate in genetic counseling sessions, ultrasound, and Maternal Fetal Medicine consultations.  The student will interact with the Maternal Fetal Medicine attendings, OB residents, genetic counselors and sonographers.  There is no call requirement for this rotation. 

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  2 weeks

This course is designed to raise awareness and highlight opportunities to learn about equitable care in maternal health.  The student will learn to define and identify health inequities in maternal care, identify social determinants of health in obstetrical care, and will learn how to improve the quality of care delivered to all.  The course will also focus on discussing policies at a system level and government/state level that dictate maternal health care and evaluate the various ways to advocate for our specialty.  The student will be an added member of the clinical team on Labor and Delivery during the two weeks.  The student will participate in all aspects of care including triage, management and clinical decision making of antepartum and labor and delivery patients.  Emphasis will be placed on evaluating each patient’s antepartum course and determinants of health through an equity lens.  The student will learn practical ways to actively deliver more equitable care.  Students will be required to give a brief presentation based on a patient case of their choosing and discuss healthcare disparities based on social determinants of health and offer more equitable choices of care.  There will be no travel necessary. 

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  2 weeks

This course is an interdisciplinary elective combining Obstetrics and Gynecology and Addiction Medicine, specifically related to the care of pregnant women with substance use disorder.  The elective is designed to give the student well-rounded exposure to the assessment and treatment of substance use disorder in the setting of obstetrical care, and exposure to the assessment and treatment of advanced obstetric pathology complicated by the medical and socioeconomic implications of substance use disorder.  The student is expected to participate directly in all aspects of care including office-based opioid treatment (OBOT) group sessions, outpatient management of substance use disorder, outpatient prenatal and postnatal obstetrical care workshops, decision analysis of treatment modalities including but not limited to physical exam assessment, medical regimens, group-based therapy, and individual psychiatric care, and amendment of treatment plans.  Emphasis will also be placed on the collaborative effort required in the treatment of substance use disorder in the setting of obstetrics between psychiatry and OB/GYN healthcare teams.  The student will be able to discuss the racial, geographical, and socioeconomic implications of substance use disorder in obstetrical patients.  Attendance and participation in OBOT group and didactics will also be expected.  The student’s hours will match those of the attending with whom they are scheduled to work.  Travel will be involved to Carilion New River Valley Medical Center in Christiansburg, VA and to Carilion Franklin Memorial Hospital in Rocky Mount, VA. 

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  2 weeks

To improve understanding of the spectrum of care required for orthopaedic patients and the concept of continuity of care, the hybrid elective in orthopaedics/musculoskeletal (MSK) will include operating room exposure at least one day per week with the goal of an integrated understanding of perioperative assessment, rationale of surgical intervention for a specific subset of patients and orthopaedic issues, surgical anatomy, and post-operative management.  Exposure to anesthesia principles and acute care pain management are also components of this elective.  The preceptor is an orthopaedic faculty member and the locations are the orthopaedic outpatient facilities and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I 
  
• Co-requisite(s):  None
  
• Duration: 2 or 4 weeks

This elective is designed for those students considering a career in orthopaedic surgery.  It is available from July-December only and priority is given to students who have completed a MS3 orthopaedic elective.  It is designed to allow increased exposure to orthopaedic subspecialties and/or one-on-one faculty interaction, if requested and mutually agreeable to student and faculty.  Each 2- or 4-week block will have students assigned to a cross section of faculty and with one week of  one-on-one faculty interaction, if requested.  Students will follow the attending schedule (including on-call when applicable).  ALL rotations include a mandatory one-week trauma/fracture service rotation.  Students may select a one-week specific subspecialty rotation or they may be assigned to a number of providers to broaden the subspecialty exposure.  The option of a one-week rotation will be offered only to students who have done a four-week MS3 orthopaedic elective.  The preceptor is an orthopaedic faculty member and the locations are the orthopaedic outpatient facilities, Carilion Roanoke Memorial Hospital, Carilion Roanoke Community Hospital and Roanoke Ambulatory Surgery Center.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

This elective is designed for those students considering a career in specialties that will have clinical overlap with orthopaedics and musculoskeletal care.  It is available from November-May and previous orthopaedic elective exposure is not required.  It is designed to allow increased exposure to orthopaedic subspecialties and a large number of orthopaedic faculty.  Each 2- or 4-week block is divided into rotations with students assigned to a subspecialty for each week when possible.  Students will be assigned to faculty and office or operating room on a day-by-day schedule.  While there are no mandatory rotations, time on the trauma/fracture service rotation is advised.  Students may select specific subspecialty rotation(s) and every effort will be made to honor requests.  Rotation selection and one-week options are dependent on faculty availability and coordination with MS3 rotations.  The preceptor is an orthopaedic faculty member and the locations are the orthopaedic outpatient facilities, Carilion Roanoke Memorial Hospital and Carilion Roanoke Community Hospital.

• Prerequisite(s): Successful completion of Phase I 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

This elective is designed for the student who is interested in primary care or emergency medicine.  It is designed to give acute orthopaedic injury exposure to the student who may see this type of injury in the above noted settings.  The location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9813, 9819 
  
• Co-requisite(s):  None
  
• Duration: 2 or 4 weeks

This elective will expose students to common pediatric musculoskeletal pathologies including plicas, bone and soft tissue cysts, pes planus (flat foot), developmental dysplasia of the hip, tendon contractures, and more.  Students will spend time in the clinic and operating room working alongside a fellowship-trained pediatric orthopaedic surgeon.  Students will have an opportunity to strengthen their history taking and physical exam skills, as well as their orthopaedic fund of knowledge.  Students will be allowed to attend surgeries with the expectation that they have a strong knowledge of the patient’s history and the procedure they are undergoing.  The location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s):  None
  
• Duration:  2 weeks

This elective will be primarily an outpatient experience, evaluating patients presenting for consultation or follow-up to the Pediatric Endocrinology Clinic.  Students may also participate in inpatient consultations when they are available and educationally relevant.  Common problems encountered will include type 1 and type 2 diabetes, obesity and the metabolic syndrome, disorders of the thyroid, pituitary, and adrenal glands, and disorders of growth, puberty, and bone/calcium.  The locations are the outpatient clinic and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9816 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

The mission of this elective is to provide an in-depth learning experience in the field of non-invasive pediatric cardiology.  Emphasis will be placed on outpatient management of children with heart disease.  Students will be participating in non-invasive testing for heart disease including electrocardiography (ECG), echocardiography, fetal echocardiography, and stress testing.  Students will become familiar with the work-up and management of pediatric patients with murmurs, chest pain, palpitations, and syncope.  Students will evaluate patients with suspected cardiovascular abnormalities with special emphasis on the longitudinal management of patients with congenital heart disease.  Students will develop clinical skills in cardiac auscultation and interpretation of pediatric ECGs.  Students will attend teaching and patient care conferences.  The locations are the outpatient clinics and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9816 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

Students will rotate in the inpatient ward, the pediatric intensive care unit (PICU), the neonatal intensive care unit (NICU), and the outpatient clinics, as well as experience the bronchoscopy lab and pulmonary function testing (PFT) lab.  Rotations will include rounding with the physicians in these areas.  In some instances, students will examine patients, perform physical examinations, and develop a differential diagnosis and a proposed work-up and treatment plan in both an inpatient and outpatient setting.  Goals and curriculum components for this elective will be similar to those of the pediatric residency program.  The locations are the outpatient clinic and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9816 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

This elective is intended to develop the medical students’ clinical skills and enhance their fund of knowledge in the evaluation and management of inpatient and outpatient gastroenterology (GI), hepatology, and nutrition disorders.  The locations are the outpatient clinic and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9816 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

This elective will consist of caring for patients on the pediatric inpatient service.  The fourth-year medical student will work with the pediatric inpatient team in direct patient care of hospitalized patients on the general pediatric inpatient service.  The student will take the history and perform the physical examination at the time of admission.  From this information, the student will develop a differential diagnosis, plan the diagnostic evaluation, and design the management of the patient.  The student will then take primary responsibility of the patient until they are discharged from the hospital.  They will be directly supervised by an upper level (PGY2, PGY3) resident and the pediatric attending physician.  The location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 4 weeks

The mission of this elective is to provide an in-depth learning experience in the setting of a busy outpatient pediatric clinic.  This elective will emphasize preventive and anticipatory care as well as sick office care within the setting of a pediatric medical home.  Students will learn about pediatric growth and development, perform and document history and physicals on well and sick children, provide age specific anticipatory guidance for pediatric patients and their families, and manage the care of sick infants and children over serial office visits to promote and understand continuity of care, including the evaluation, diagnosis, and treatment of common acute pediatric diseases.  The location is the outpatient clinic.

• Prerequisite(s): Successful completion of Phase I + 9816 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

This elective will introduce the medical student to the evaluation and management of special needs children by participation in the Child Development Clinic.  The student will share in the patient’s chart review, history taking, and physical examination.  From this information, the student will generate a differential diagnosis, plan the diagnostic evaluation, and create a management plan in consultation with the attending physician.  The location is the outpatient clinic.

• Prerequisite(s): Successful completion of Phase I + 9813, 9815, 9816
  
• Co-requisite(s): None
  
• Duration: 2 weeks

This elective will consist of consulting on patients with known or suspected genetic disorders.  The medical student will do the patient’s chart review, history taking, and physical examination.  From this information, the student will generate a differential diagnosis, plan the diagnostic evaluation, and create a management plan in consultation with the attending physician.  The location is the outpatient clinic.

• Prerequisite(s): Successful completion of Phase I + 9813, 9815, 9816 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

The general objectives of this elective are to obtain a broad understanding of the medical problems afflicting infants during the first month of life and to learn generally applicable principles in the neonatal intensive care unit (NICU) setting.  The location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

This elective will consist of consulting on patients with hematological and oncological conditions.  The medical student will do the patient’s chart review, history taking, and physical examination.  From this information, the student will develop a differential diagnosis, plan the diagnostic evaluation, and design the management of the patient.  The student may observe lumbar punctures and bone marrow tests as scheduled during their rotation.  They will also be required to give a 15-minute talk on a topic agreed upon by the attending if on the four-week rotation.  The locations are the outpatient clinic and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9816 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

The student will spend the elective time in the intensive care unit (ICU) and will have potential exposure to a wide range of illnesses from multiple organ systems.  The student will be expected to develop skills in interacting with critically ill children and also with the parents of these children.  The location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 2 weeks

This elective will consist of consulting on patients with the pediatric neurologists.  The medical student will do the patient’s chart review, history taking, and physical examination.  From this information, the student will develop a differential diagnosis, plan the diagnostic evaluation, and design the management of the patient.  The student will make a presentation to the preceptor if doing the four-week rotation.  The locations are the outpatient clinic and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9816 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

This elective highlights experiential learning in the local community by focusing on exposure to agencies who work with the underserved communities with significant health care disparities.  Students have clinical time in primary care settings or a hospital-based setting with low socioeconomic patient populations and will learn about social determinants of health and the impact on patients.  Field experiences expose them to real life scenarios and the interprofessional approach to management, prevention, and issues related to populations needs.  This may include but is not limited to visits to Children’s Trust, the Health Department, free clinics, Department of Social Services, and the Child Health Investment Partnership (CHIP).  There will also be time spent with a social worker, on interprofessional rounds, and with a Care Coordinator.  The interprofessional nature of care management will be highlighted.  This may be varied to provide exposure to broader primary care content and to the interest of students with emphasis on participation and analyses of various systems and their impact on health care and interprofessional management. 

• Prerequisite(s): Successful completion of Phases I and II  
  
• Co-requisite(s): None
  
• Duration: 2 weeks

This Acting Internship in General Pediatrics provides advanced clinical training in outpatient pediatric care, preparing students for the responsibilities of a pediatric residency. Students will independently evaluate patients, formulate differential diagnoses, and develop evidence-based management plans for common outpatient pediatric conditions under the supervision of attending pediatricians. The rotation emphasizes communication skills with patients, families, and healthcare team members while fostering professionalism and ethical decision-making. Clinical experiences will occur primarily at the Botetourt and Tanglewood outpatient pediatric offices, offering exposure to diverse patient populations and a variety of conditions commonly encountered in community pediatrics. In addition to these outpatient settings, participants will also have the opportunity to gain exposure to the resident clinic, further enhancing their understanding of pediatric residency training. Students will gain experience documenting encounters using the electronic medical record system and reflecting on the continuum of pediatric healthcare.

• Prerequisite(s): Successful completion of Phases I and II  
  
• Co-requisite(s): None
  
• Duration:  2 weeks

The Fourth-Year Pediatric Medical Student Chief Role is a longitudinal elective over the fourth year for selected medical students pursuing a future career in Pediatrics. This course focuses on students who are interested in furthering their leadership and education skills to help optimize the third year medical student experience at VTCSOM. As part of this role, medical student chiefs will provide resources to third year medical students during their clerkship including collecting and updating resources to help during the rotation, office hours for concerns and mentorship as well as individualized educational support, holding review sessions prior to the NBME and will also act as a liaison between medical students and faculty leadership for the Pediatrics Clerkship. They will also have the opportunity to lead a self-directed project or scholarly activity aimed at improving the medical student experience. The elective will culminate with presenting their project results. As part of the course, students will receive educational and leadership exposure,  mentorship and foster career development for future success within academic medical education.  This course can hold one to four students a year. 

• Prerequisite(s): Successful completion of Phases I and II  
  
• Co-requisite(s): None
  
• Duration:  4 weeks

This elective is based in the Psychiatry Department Outpatient Child and Adolescent Clinic.  Students will see children between the ages of 5 and 17 under the close supervision of a child psychiatry fellow and board-certified child psychiatrist.  Students will also interact with patient family members and caretakers.  Some exposure to liaison with public social service agencies will occur. Problems likely to be encountered in this patient population include mood disorders, behavioral dyscontrol disorders, reactive attachment disorders, attention disorders, and learning disabilities.  Students will be able to observe psychotherapy and pharmacotherapy with the pre-adult patient and learn about the importance of family interactions.  The location is Carilion Roanoke Memorial Hospital, Rehabilitation Center.

• Prerequisite(s): Successful completion of Phase I + 9817 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

This elective is based in a 12-bed unit taking children and adolescents between the ages of 5 and 17.  The student will function as an integral member of the treatment team including a board-certified child psychiatrist, child psychiatry fellow, general psychiatry resident, psychologist, social worker, and nursing staff.  The student will participate in rounds and will meet with patients in group and individual settings.  Close supervision will be given by the child psychiatry fellow and attending.  Problems likely to be encountered in this patient population include mood disorders, substance use disorders, behavioral dyscontrol disorders, reactive attachment disorders, attention disorders, and psychosis.  The student will be able to observe psychotherapy and pharmacotherapy with the pre-adult patient and learn about the importance of family interactions.  The location is Carilion Roanoke Memorial Hospital, Rehabilitation Center.

• Prerequisite(s): Successful completion of Phase I + 9817 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

This elective will focus on patients in medical, surgical, and rehabilitation units who are in need of psychiatric care and are seen under the supervision of a board-certified psychosomatic psychiatrist.  Ages of this population are 18 and older.  Problems likely to be encountered include mood disorders, psychosis, substance use disorders, adjustment to acute medical problems, delirium, and exaggeration of symptoms.  The student will accompany a board-certified psychosomatic psychiatrist during the course of providing inpatient consultation.  A first- or second-year psychiatry resident may also be involved in the teaching.  The student will be able to observe how the psychiatrist can usefully contribute to the care of medically or surgically hospitalized individuals. The location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9817 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

This elective will be an immersive experience in geriatric psychiatry. Over the course of the two weeks or four weeks, students will develop the skills and knowledge necessary to diagnose, manage, and treat a broad range of mental health disorders in older adults. Students will gain hands-on experience in outpatient geriatric psychiatry clinics, long-term care facilities, and geriatric medical/surgical consultation settings. Emphasis will be placed on clinical interviewing skills tailored to the geriatric population. Their experience will include small group learning, direct patient care, and interdisciplinary collaboration with geriatric psychiatry specialists, fellows, and general psychiatry residents. By the end of the course, students will have the opportunity to observe both psychotherapy and pharmacotherapy approaches in the geriatric population. They will also explore key aspects of aging, including the physiological and metabolic changes that impact treatment, the importance of family support, professional obligations regarding elder abuse, and end-of-life care considerations.

• Prerequisite(s): Successful completion of Phase I + 9817 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

During this elective, the student will work with the assigned attending, resident, and students as an active member of the treatment team on the inpatient psychiatry units.  The student will be assigned a maximum of six patients and will be an active team leader on the treatment team under the supervision of the resident and attending physicians.  The location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  4 weeks

During this elective, the student will work with the assigned attending and resident as an active member of the treatment team on the inpatient psychiatry units.  The student will be assigned a maximum of six patients and will be an active team leader on the treatment team under the supervision of the resident and attending physicians.  Duties will include leading daily treatment team meetings in discussion of patients, writing notes, making recommendations for the treatment plan, reviewing labs and imaging results, and communicating with consultants.  The location is the Veterans Affairs Medical Center. 

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  4 weeks

This elective will allow students who have previously completed outpatient child and adolescent psychiatry to experience community psychiatry services offered in the Roanoke Valley in addition to participating in standard outpatient clinics.  Students will have the opportunity to work in the community with Carilion providers and experience multiple psychiatric services that are unavailable during the introductory outpatient/inpatient child and adolescent psychiatry rotation.  Each student will have the opportunity to customize their learning experience based on individual interests and learning goals.  During this rotation, students will be encouraged to take additional responsibility in patient management with emphasis placed on initial diagnosis, pharmacological treatment, and patient disposition following each encounter.  At the conclusion of the rotation, students who choose the four-week option are expected to do a 5-10 minute presentation on a topic of personal interest related to child and adolescent psychiatry.  Locations include Pediatric Neurodevelopment Clinic, Community Teen Clinic, Intercept Youth Services, and Roanoke City Department of Social Services.  

• Prerequisite(s): Successful completion of Phases I and II + 9701 
  
• Co-requisite(s): None
  
• Duration:  2 weeks

During the Acting Internship (AI), the student will work with the assigned attending, resident, and students as an active member of the treatment team on the child and adolescent inpatient psychiatry unit.  The student will be assigned a maximum of six patients and will be an active team leader on the treatment team under the supervision of the resident and attending physician.  The student will perform and document a complete mental status exam, be involved in management plans, assess risk, discuss medicolegal issues, and explain the balance of personal and professional life.  Family meetings will be held for crisis stabilization and the student will participate in those meetings.  The student will utilize available resources to understand and treat patients and work within an interprofessional and multidisciplinary setting.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  4 weeks

The Emergency Psychiatry elective offers fourth-year students the opportunity to practice caring for patients presenting with acutepsychiatric complaints. The elective provides a comprehensive look at the multidisciplinary team involved in the care of thesepatients. Students will participate in patient interviewing, risk assessment, diagnostic evaluation, emergency management ofpsychiatric disorders, psychopharmacologic intervention, as well as management of patients with concurrent medical and psychiatriccomplaints. Students will gain familiarity with psychosocial topics central to Emergency Psychiatry and will gain confidenceinterviewing and intervening in a fast-paced setting.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

This elective will consist of further clinical experience in the subspecialty of interventional radiology to include management of conditions in genitourinary, gastrointestinal, vascular, biliary, neurological, and oncologic interventions in the spectrum of various clinical conditions.  Students will be exposed to daily teaching sessions with interventional radiologists and attend multidisciplinary conferences that incorporate patient management issues.  The location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9818 
  
• Co-requisite(s): None
  
• Duration: 2 weeks

This elective will consist of further clinical experience in the subspecialty of breast imaging to include the modalities of screening and diagnostic mammography, ultrasound, and magnetic resonance imaging (MRI) in the imaging diagnosis of benign and malignant diseases of the breast.  Students will be exposed to daily teaching sessions and attend multidisciplinary conferences that incorporate patient management issues.  The location is the Carilion Breast Care Center.

• Prerequisite(s): Successful completion of Phase I + 9818 
  
• Co-requisite(s): None
  
• Duration: 2 weeks

This elective will consist of further clinical experience in the subspecialty of musculoskeletal radiology to include the modalities of computed tomography (CT), magnetic resonance imaging (MRI), and arthrography in the imaging diagnosis of musculoskeletal diseases.  Students will be exposed to daily teaching sessions with radiologists and attend multidisciplinary conferences that incorporate patient management issues.  The location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9818 
  
• Co-requisite(s): None
  
• Duration: 2 weeks

This two-week elective is for the student with an interest in pursuing a residency in the neurosciences or a career in neuroimaging.  The intent is to provide an environment that provides the student an opportunity and time to work on a focused project in neuroimaging.  This might be a case report, limited research project, preparation of a grand rounds topic, or adding cases to a teaching file or online database. It is required that the interested student meet with the neuroradiologist several months ahead of time to discuss and choose a project so the elective time can be spent most productively.  This is especially important if the project involves the use of resources that may not be immediately available or involves a cooperative effort with other researchers or technical staff.  The location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9818 
  
• Co-requisite(s): None
  
• Duration: 2 weeks

This two-week elective will allow students who have previously completed the interventional radiology elective to learn more advanced aspects of interventional radiology including neurointerventional and oncological interventional radiology.  Students will observe and gain knowledge in advanced neurointerventional procedures such as acute stroke, intracranial aneurysms, and arteriovenous malformations (AVM).  Students will also observe and gain knowledge in radiofrequency ablation and catheter-directed therapies.  The location is Carilion Roanoke Memorial Hospital. 

• Prerequisite(s): Successful completion of Phase I + 9818 
  
• Co-requisite(s): None
  
• Duration: 4 weeks

This four-week elective is designed for students applying to residency in interventional radiology.  The AI is intended to give the prospective IR applicant an understanding of what a rotation will be like in residency.  The focus will be on understanding management and appropriateness of procedures rather than simply being exposed to the types of procedure IR performs.  Students will develop procedural skills, including ultrasound guidance with paracentesis, thoracentesis, and vascular access.  Students will be expected to perform at least eight jugular venous accesses with ultrasound guidance, five paracenteses, and prepare the list of procedures for rounds each morning.  The location is Carilion Roanoke Memorial Hospital. 

• Prerequisite(s): Successful completion of Phases I and II + 9801 
  
• Co-requisite(s): None
  
• Duration: 4 weeks

Students on this elective will experience about 40% of the week in the Neurosurgery and/or Spine Center Clinic and 60% in the operating room and inpatient floors.  Students will gain a deep appreciation for the evaluation and management of degenerative spinal disorders, radiculopathy, myelopathy, spinal column tumors, spinal column fracture, spinal column deformity, chronic spinal pain, scoliosis, and more.  Surgical experiences will include the opening and closing of large spinal wounds, pedicle screw placement, laminectomy, fusion, kyphoplasty, and more.  Students will participate in Tuesday afternoon academic sessions and will always be welcome on rounds and in the operating room.  The locations are the Institute for Orthopaedics and Neurosciences and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9819 
  
• Co-requisite(s): None
• Duration:  2 or 4 weeks
  

In this elective, students will work closely with two pediatric neurosurgery attending surgeons.  Students on this rotation will not only learn the nuts and bolts of pediatric neurosurgery but will also gain a deep appreciation for how to relate to critically ill children and their families.  This will involve both outpatient clinic work and inpatient evaluations and surgeries.  Students will experience patients with disorders such as hydrocephalus, spina bifida, tethered spinal cord, head trauma, spine trauma, brain tumors, non-accidental trauma, chiari malformation, skull masses, craniofacial synostosis and deformity, and more.  The pediatric volume of the service is variable, and a healthy mix of adult neurosurgery may be mixed into the rotation.  Students will participate in Tuesday afternoon academic sessions and will always be welcome on rounds and in the operating room.  The locations are the Institute for Orthopaedics and Neurosciences and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9819 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

In this track, students will spend a lot of time in the emergency room evaluating acute neurosurgical issues and interweaving their work with the trauma team.  They also will spend time in the intensive care unit (ICU) setting once the acute situation has been initially identified and evaluated.  The preceptor is the neurosurgery faculty and the location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9819 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

In this track, students will spend the vast majority of their time in the operating room.  They will participate in the daily operating schedule.  They will be expected to evaluate the patients and their radiographs in the pre-op area and then discuss the choice and execution of procedures with attending surgeons and residents involved in the procedure.  They can anticipate the development of skills in sterile technique, prepping and draping, operative positioning, opening and closing of surgical wounds, control of bleeding, tying, suturing, drain placement, burr hole placement, pedicle screw insertion, laminectomy, ventricular catheter placement, lumbar catheter placement, craniotomy, bone drilling, and more.  They will develop an appreciation for the fragility of the nervous system and will develop skills in the delicate manipulation of such tissues.  Students will participate in Tuesday afternoon academic sessions and will always be welcome on rounds and in the operating room.  The preceptor is the neurosurgery faculty and the location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9819 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

Students on the research track work predominately on ongoing projects of the team (although we are open to initiating novel proposed projects).  They will still participate in Tuesday afternoon academic sessions and will always be welcome on rounds and in the operating room.  Students will work with a faculty mentor and a resident mentor/partner.  Skills will be built in study design, literature search, data accumulation, and synthesis.  They will share authorship of finished research projects with team members (posters, presentations, papers).  The preceptor will be the chosen faculty member/mentor and the location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9819 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

Students will spend the majority of their rotation evaluating neurosurgery and Spine Center outpatients.  They will develop an exceptional acumen in neurological history taking, exam, differential diagnosis, synthesis, and treatment planning.  They will learn how to efficiently move a number of patients through a clinic.  They will develop patient interaction skills.  They will develop a strong background in neuroradiologic evaluation.  They will gain an in-depth appreciation for the evaluation and management of spinal disorders and also various brain and peripheral nerve disorders.  They will partner with attending neurosurgeons and residents each day.  They will independently evaluate each of their patients, review the patient’s studies, and formulate a diagnosis and treatment plan prior to discussing with their neurosurgical partners.  Students will be encouraged to follow their patients through their entire neurosurgical experience including inpatient care and surgery.  Students will participate in Tuesday afternoon academic sessions and will always be welcome on rounds and in the operating room.  The preceptor is the neurosurgery faculty attending and the locations are the Institute for Orthopaedics and Neurosciences and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I + 9819 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

This track is the most demanding and rigorous offered by the Carilion Clinic Neurosurgery team.  In this rotation, the medical student acts essentially as a neurosurgical intern.  They are assigned inpatients with whom they care for and follow throughout the patients’ hospitalizations.  They will spend a sizable amount of time in the intensive care units (ICUs), on the floors, and in the operating room.  They will write regular notes and will interact intimately with patients and their families.  They will take neurosurgical call with a resident one in every four nights.  They will participate in resident clinic every Tuesday morning.  They will gain an appreciation of the full gamut of neurosurgical issues encountered in a busy academic/clinic practice.  They will acquire skills in inpatient and outpatient neurosurgical evaluation, the neurologic exam, surgical tissue manipulation, neurological critical care, neuroradiology, patient and family interaction, and much more.  The location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II + neurosurgical elective 
  
• Co-requisite(s): None
  
• Duration:  4 weeks

The goal of the elective is to provide the medical student “hands on” exposure to the field of anesthesia and anesthesiology and can be taken by a third- or fourth-year student.  The student will work predominantly with anesthesiologists, but may also work with certified registered nurse anesthetists as the month presents itself for scheduling purposes.  At the end of the rotation, the student should have a basic understanding of the principles of pre-anesthetic evaluation, preparation, and anesthetic care, including history, physical examination, assessment of physiologic state, categorization of anesthetic risk, and care throughout the perioperative period.  The student will have participated with anesthesiologist preceptors in placement of monitors and conduction of anesthetics, including induction, intubation, maintenance, emergence, extubation, and post-anesthetic recovery care.  The student may also have opportunities to gain experience in regional anesthesia and sub-specialty anesthesia areas such as pediatric, obstetric, thoracic, cardiac, and neurosurgical anesthesia.  The preceptor is the anesthesia faculty and the location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

The goal of the elective is to provide the medical student “hands on” exposure to the field of anesthesia and anesthesiology and builds upon knowledge of the third year.  The student will work predominantly with anesthesiologists, but may also work with certified registered nurse anesthetists as the month presents itself for scheduling purposes.  At the end of the rotation, the student should have a basic understanding of the principles of pre-anesthetic evaluation, preparation, and anesthetic care, including history, preceptors in placement of monitors, and conduction of anesthetics, including induction, intubation, maintenance, emergence, extubation and post-anesthetic recovery care.  The student may also have opportunities to gain experience in regional anesthesia and sub-specialty anesthesia areas such as pediatric, obstetric, thoracic, cardiac, and neurosurgical anesthesia.  The preceptor is the anesthesia faculty and the location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II + 9920 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

The purpose of this two-week elective is to allow the student to work with the general surgery/trauma services team which handles surgical intervention and perioperative patient care.  The student will gain patient care skills and time management skills to offer quality care while managing multiple aspects of patient care.  The location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II
  
• Co-requisite(s):  None
  
• Duration:  2 weeks

During this elective, the student is expected to participate in daily rounds in the intensive care unit (ICU) and function as a sub-intern.  The student will present assigned patients on rounds, attend all lectures and conferences, and read required material.  The student will also have the opportunity to do procedures under close supervision.  There may be night and weekend call, and on-duty hours will follow resident duty hours.  Nighttime duties should be expected.  The location is Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II
  
• Co-requisite(s):  None
  
• Duration:  4 weeks

This elective will consist of working both in the outpatient and inpatient settings in conjunction with the faculty urologists. In the outpatient setting, the student will do the patient’s chart review, history taking, and physical examination.  From this information, the student will develop a differential diagnosis, plan the diagnostic evaluation, and discuss the management with the faculty urologist.  In the inpatient setting, the student will be expected to participate in surgical procedures under direct supervision of the faculty physicians.  Additionally, the student will have the opportunity to see urologic consults in the inpatient setting.  In this case, the student will be expected to do a chart review, obtain the relevant history and data, perform a physical examination, develop a differential diagnosis, and formulate a management plan to discuss with the attending physician.  The locations are the outpatient clinic and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phase I 
  
• Co-requisite(s):  None
  
• Duration:  2 or 4 weeks

The purpose of this elective is for students to gain familiarity with the causes of chronic wounds, principles of wound healing, and advanced wound management techniques.  Students will gain broad exposure to the field of wound care through a busy multidisciplinary wound care service.  This should be particularly useful for students interested in any specialty, from primary care to surgical subspecialties.  This will be a “hands on” rotation with bedside interventions involved in the care of most patients, as well as involvement in a uniquely interdisciplinary service.  The locations are Carilion Clinic Wound Center and Carilion Roanoke Memorial Hospital.  

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s):  none
  
• Duration:  2 or 4 weeks

This two-week elective with the breast service managing patients with benign and malignant breast disease allows the student to gain experience in the management of breast disease with a focus on surgical care in a multidisciplinary patient care setting.  The second week of the rotation is spent gaining experience on the plastic and reconstructive aspect of breast patient care.  The locations are Carilion Clinic Riverside complex and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 2 weeks

This elective consists of intensive training to prepare graduating medical students for their residencies.  Over the course of the rotation, students will obtain certification in Advanced Trauma Life Saving (ATLS), Pediatric Advanced Life Saving (PALS), and Fundamental Critical Care Support (FCCS).  If time and interest allow, students will also obtain Basic Disaster Life Support (BDLS) training and certification.  The location is Carilion Clinic Riverside complex.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s):  none
  
• Duration:  2 weeks

During this elective, the student will gain experience in operative and perioperative management of cardiac and thoracic surgical problems.  This includes illnesses of the esophagus, motility disorders, Boerhaave Syndrome, hiatal hernias, reflux disease, infections, benign neoplastic masses, malignancies, mediastinal masses, lung masses, aortic dissections, and trauma.  The student will also learn about surgical approaches.  The locations are the outpatient clinic and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

During this elective, the medical students will enhance their diagnostic and clinical skill sets by participating in inpatient, outpatient, and operating room care.  Such care will focus on total patient management through record review, medical and dental clinical evaluation, and assimilation and correlation of information leading to differential diagnoses and treatment. The elective will focus on the clinical application of material learned in years one through three as part of the comprehensive VTCSOM oral health/oral medicine curriculum.  The locations are Carilion Clinic Dental Care and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II 
• Co-requisite(s):  none
• Duration:  2 weeks

During this elective, the student will gain experience in surgery as practiced in a smaller community hospital setting with a mix of elective and emergent patient care.  The student will work with the community hospital general surgery service handling a broad range of issues.  Experience will be gained in how to care for surgical patients pre-operatively and post-operatively.  The student will also learn when a referral needs to be made to an outside facility such as a level 1 trauma center.  The location is Carilion New River Valley Medical Center.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

This elective is designed for fourth-year medical students with a strong interest in surgery and who intend to pursue residency training in surgery.  The goal of this elective is to give the students an opportunity to take an active role on the emergency general surgery team.  The students will evaluate and recognize patients with emergent surgical conditions, synthesize notes, manage orders, communicate with patients and other healthcare team members, participate in procedures as appropriate to level of training, and see patients in the outpatient setting after emergent surgical care.  The locations are Carilion Clinic Riverside complex and Carilion Roanoke Memorial Hospital. 

• Prerequisite(s): Successful completion of Phases I and II
  
• Co-requisite(s):  none
  
• Duration: 4 weeks

The purpose of this 2-week elective is to allow the student an ability to work with general surgeons with interest/expertise in colorectal surgery managing a broad range of problems including neoplasms, diverticulitis, inflammatory bowel disease, and anorectal disorders. 

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s):  None
  
• Duration:  2 weeks

The overall goal of this elective is to provide medical students preliminary exposure to the specialty of otolaryngology, head and neck surgery.  This includes an introduction to subspecialties within the field such as otology, neurotology, audiology, head and neck surgery, pediatrics, laryngology, allergy, facial plastic and reconstructive surgery, and maxillofacial trauma.  The elective will provide medical students with information about the diagnosis and management of disorders of the ear, nose, and throat in an inpatient and outpatient setting.  It will also provide exposure to various patient populations with acute and chronic head and neck pathologies.  The locations are Carilion Clinic Riverside complex and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

This elective aims to increase students’ proficiency with surgical skills and techniques in order to increase confidence when entering the intern year.  Students will spend time in the Virginia Intercollegiate Anatomy Laboratory (VIAL) at Radford University Carilion and the special projects lab at VTCSOM.  Other locations may be utilized as needs arise.  Students will have an opportunity to strengthen their suturing and knot-tying skills.  The course will be tailored to  acquiring requisite surgical skills essential to the specialty that interests the student, such as surgical subspecialties, emergency medicine or family medicine.  

• Prerequisite(s): YSuccessful completion of Phases I and II 
• Co-requisite(s):  none
• Duration:  2 weeks

The elective will consist of working in the outpatient setting in conjunction with the faculty ophthalmologist.  The medical student will do the patient’s chart review, history taking, and physical examination.  From this information, the medical student will develop a differential diagnosis, plan the diagnostic evaluation, and discuss the management with the faculty ophthalmologist.  The location is the outpatient clinic.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  2 or 4 weeks

This elective will introduce the medical student to common surgical problems seen in the neonate, infant, and younger children.  Emphasis will be placed on efficiently working up and treating pyloric stenosis, abdominal pain, necrotizing enterocolitis, intestinal obstruction, and inguinal hernia in this age group.  The student will also be introduced to more common congenital problems, including abdominal wall defects, head and neck lesions, thoracic masses, and genitourinary (GU) and gastroenterology (GI) tract anomalies.  Common pediatric hematologic and oncologic conditions will also be reviewed.  The physiology and nutrition of babies and children will be emphasized as it relates to the surgical care of these patients.  Common procedures specific to this age group, such as venous cutdown and airway management, will be covered.  The student will gain experience in the surgical management of common and less common pediatric surgical issues.  The locations are the outpatient clinic and Carilion Roanoke Memorial Hospital. 

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
• Duration: 2 or 4 weeks

This elective affords students the ability to further their development by being involved in the care of the both elective and emergent patients who are cared for by plastic surgeons.  This is both an inpatient and outpatient rotation.  The locations are Carilion Clinic Riverside complex and Carilion Roanoke Memorial Hospital.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

During this elective, the student is expected to participate in daily rounds in the intensive care unit (ICU). The student will present assigned patients on rounds, attend all lectures and conferences, and read required material.  The student will also have the opportunity to do procedures under close supervision.  There will be night-duty hours and on-duty hours, which will follow resident duty-hour regulations.  The location is Carilion Roanoke Memorial Hospital. 

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 2 weeks

The purpose of this elective is to gain familiarity in initial evaluation of trauma patients, including trauma alerts and consultations and management of post-trauma problems.  Activities include attendance and participation in the assessment and resuscitation of acutely injured patients in the emergency room; call (to be arranged); longitudinal management of selected patients through the emergency department, operating room, and intensive care units to recovery; observation of pre-hospital care by accompanying rescue squads on their calls; and selected readings in resuscitation, critical care, and trauma management.  The student will participate on the trauma service as a student member of the trauma team.  Time for regular attendance at scheduled trauma conferences and individual preceptorial conferences is provided.  The locations are Carilion Riverside complex and Carilion Roanoke Memorial Hospital. 

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 2 weeks

During this elective, students will gain experience in diagnosis and surgical management of vascular disease and perioperative patient care.  Students will also develop knowledge of anatomy and utilizing surgical techniques to safely operate utilizing the atomic knowledge.  Students will learn when to use medical versus surgical intervention.  The locations are Jefferson Surgical Clinic and Carilion Roanoke Memorial Hospital. 

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

In this case-based course, students will study the pathophysiology, diagnosis, neuroimaging, and management of clinical neuroscience entities and then online via a computer manage patients with representative neurological disorders. Students will apply scientific skepticism to pre-conceived diagnostic notions, recognizing cognitive and systemic bias, and management algorithms surrounding the care of these patients. Online sessions will involve students evaluating and addressing multiple clinical neuroscience and management dilemmas. Cases studied will include the conditions of dementia, MS, Parkinsons, depression, psychosis, coma,severe brain injuries, seizures, epilepsy, sudden onset of severe headache, gait disturbance, hydrocephalus, stroke, infection, andspinal cord syndromes. Students will consider multiple outcomes with every step of their diagnostic and management decision-making. Outcome analysis and complication-avoidance will be emphasized in this evidence-based medicine approach. Students will be required to write several papers on topics related to the day’s case histories. Discussions will include related socioeconomic, ethical, and medical-legal considerations of the cases presented.

• Prerequisite(s): Successful completion of Phases 2
  
• Co-requisite(s): None
  
• Duration: 2 weeks

Students will review the evaluation and management of common neurological emergencies encountered in both neurologically and non-neurologically related disciplines (particularly primary care). This is a case-based course where students will work with an instructor through a number of typical emergent neurological situations including initial evaluation and care, general and neurological exam, coordination with other emergency services, ordering of appropriate laboratory tests and imaging, differential diagnosis, interpretation of diagnostics, definitive management, complication management, rehabilitation considerations, and socioeconomic/ethical/medical-legal considerations. Cases will include but will not be limited to head injury, coma, brain death, and other altered states of consciousness, increasedintracranial pressure, cerebral herniation syndromes, strokes, hydrocephalus, hemorrhagic disorders of the brain, infections, seizures, spine injury, myelopathy, severe pain syndromes. They will review and become comfortable with neruo-Imaging modalities (example-CT scan, MRI) and other critical diagnostics (example- CT angiography, angiography).

• Prerequisite(s): Successful completion of Phases 2
  
• Co-requisite(s): None
  
• Duration: 2 weeks

This elective is designed for fourth-year medical students interested in pursuing a career in urology.  The Acting Internship (AI) is intended to give the students an opportunity to take an active role on the urology team and ensure a smooth transition to internship.  The rotation emphasizes diagnosis and management of adult and pediatric urological pathology.  Students will gain understanding of the he focused genitourinary history, examination, and interpretation of urological labs and imaging studies necessary to make thorough diagnoses, assessments, and management plans for patients with urological pathology.

• Prerequisite(s): Successful completion of Phases I and II + Urology Elective
• Co-requisite(s): None
• Duration: 4 weeks 

This 2-week elective is designed for 4th year medical students who will enter a general surgery or surgical subspecialty residency after graduation.  This elective is modeled after the American College of Surgeons resident prep curriculum. Surgery Boot Camp is an intensive elective designed to prepare senior medical students for the demands of surgical residency. The course focuses on advancing clinical decision-making, procedural skills, sterile technique, and professional communication through interactive lectures and simulation labs. Emphasizing the transition to graduate medical education, students develop the confidence and competence necessary to safely and effectively participate in surgical teams and manage perioperative patient care during residency.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  2 weeks

This course provides a comprehensive overview of the non-clinical and non-biomedical dimensions of a career in surgery. Through a combination of topical discussions, assigned readings, and reflective writing exercises, students will explore essential aspects of surgical training and practice, including career management strategies, diverse practice settings, and keys to successful residency and professional development. The course will examine the structure of the American healthcare delivery system, reimbursement models, the financial mechanisms underpinning surgical care, and the medicolegal landscape, including malpractice risk mitigation and deposition preparedness. Students will gain insights into the day-to-day life of a practicing surgeon and develop communication skills for engaging in difficult conversations with patients, families, and teams. In addition, the course will address emotional resilience, strategies for managing surgical complications, wellness and burnout prevention, and opportunities for professional advancement through involvement in institutional, regional, and national organizations. By the end of the course, students will possess a well-rounded, “eyes wide open” perspective on the personal and professional realities of a career in surgery.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  2 weeks

This two- or four-week elective is designed for medical students who have completed their core surgery clerkship and are preparingfor surgical residency. The rotation provides an immersive experience on a busy Elective General Surgery service, offering bothinpatient and outpatient exposure. Students will actively participate in patient rounds, outpatient clinics, operative procedures, andsurgery-specific conferences.Through this hands-on clinical engagement, students will refine essential competencies including patient evaluation, clinicaldocumentation, order management, perioperative decision-making, interprofessional communication, workflow organization, andsafe patient handoffs. The course supports the transition to graduate medical education by strengthening clinical judgment, timemanagement, and professionalism in surgical settings. 

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): 
  
• Duration:  2 or 4 weeks

This 2-week outpatient elective introduces students to the multidisciplinary management of chronic pain conditions. Studentswill evaluate patients with pain complaints, conduct focused physical exams, develop multimodal treatment plans, and observeinterventional procedures in the clinic and operating room. Emphasis is placed on integrating pharmacologic and non-pharmacologicstrategies, understanding pain perception and modulation, applying differential diagnoses, understanding procedure-based care, andworking within interprofessional teams to optimize outcomes.

• Prerequisite(s): Successful completion of Phases I and II 
  
• Co-requisite(s): None
  
• Duration:  2 weeks

This elective notates students enrolled in senior away electives at U.S. Liaison Committee on Medical Education (LCME) accredited medical schools and independent academic medical centers that are members of the Council of Teaching Hospitals and Health Systems (COTH).
Prerequisite(s): Years 1, 2, 3 + Medical Curriculum Committee Approval
Co-prerequisite(s):  None
Duration:  2, 4, or 6 weeks

The focus of this elective is to provide structured study time and educational resources for students who have been required to delay their USMLE Step 2 examination due to not achieving a target practice test score, or for students who have taken and failed the USMLE Step 2 examination.  Students will create a structured study plan and will work with the senior dean for academic affairs (or designee) in collaboration with the senior dean for student affairs and appropriate faculty to implement this independent study plan.
Prerequisite(s): Years 1, 2, 3
Co-prerequisite(s):  None
Duration:  2, 4, or 6 weeks

This four-week elective allows Phase 3 medical students to broaden their clinical knowledge and cultural competence through supervised clinical experiences at Wonju College of Medicine in South Korea. Students participate in patient care, review diagnostic data, engage in surgical skills training, and explore the structure and function of Korea’s healthcare system. The experience emphasizes global health disparities, interprofessional collaboration, and reflective practice, while fostering professional development in an international medical education environment.

• Prerequisite(s): VTCSOM students in good standing who have completed Phase 1 and 2, the Elective Selection process, and comply with the International Elective Policy
  
• Co-requisite(s): None
  
• Duration:  4 weeks

This four-week elective offers Phase 3 VTCSOM students the opportunity to broaden their medical knowledge through supervised clinical experiences in Taiwan. Students will engage in inpatient and outpatient care at MacKay Memorial Hospital and its affiliates, participate in interprofessional and culturally informed healthcare, interpret diagnostic imaging and lab results, practice procedural skills as appropriate for chosen specialty, and reflect on system-level differences in practice. The elective also emphasizes globalhealth, cultural exchange, and health equity, allowing students to explore Taiwanese approaches to care in a modern urban setting.

• Prerequisite(s): VTCSOM students in good standing who have completed Phase 1 and 2, the Elective Selection process, and comply with the International Elective Policy
  
• Co-requisite(s): None
  
• Duration:  4 weeks

This four-week elective allows Phase 3 VTCSOM students to broaden their medical knowledge through supervised inpatient andout patient clinical experiences at E-DA Hospital and I-SHOU University in Kaohsiung City, Taiwan. In addition to exposure to Western clinical care, students may participate in an integrated course in Traditional Chinese Medicine (TCM), learning about acupuncture, herbal medicine, and Eastern medical philosophies. Students will also interpret diagnostic images and lab results, explore healthcare disparities, global health systems, and medical tourism. The experience is tailored to individual student interests and provides aunique urban and cultural immersion.

• Prerequisite(s): VTCSOM students in good standing who have completed Phase 1 and 2, the Elective Selection process, and comply with the International Elective Policy
  
• Co-requisite(s): None
  
• Duration:  4 weeks

This four-week elective allows Phase 3 VTCSOM students to engage in supervised clinical rotations across two distinct locations in Taiwan: E-DA Hospital/I-SHOU University in Kaohsiung and MacKay Memorial Hospital in Taipei/New Taipei. Students will observe inpatient and outpatient care, participate in team-based rounds, and explore both Western and Traditional Chinese Medicine across general and specialty areas. This rotation includes exposure to healthcare disparities, cultural influences on medicine, and systems-based practice in a unique international setting.

• Prerequisite(s): VTCSOM students in good standing who have completed Phase 1 and 2, the Elective Selection process, and comply with the International Elective Policy
  
• Co-requisite(s): None
  
• Duration:  4 weeks

This four-week international elective provides Phase 3 VTCSOM students the opportunity to engage in clinical observation and practice at Wroclaw Medical University in Poland. Students will gain exposure to inpatient and outpatient care, including surgical and diagnostic techniques, and laboratory studies related to selected clinical case, across a variety of medical disciplines. The experience also includes exploration of healthcare delivery in a European public academic medical center, as well as the cultural, systemic, and educational dimensions of healthcare in Poland.

• Prerequisite(s): VTCSOM students in good standing who have completed Phase 1 and 2, the Elective Selection process, and comply with the International Elective Policy
  
• Co-requisite(s): None
  
• Duration: 2 or 4 weeks

Upon arrival at the International Health Central American Institute Foundation (IHCAI), the student's proficiency in Spanish will be evaluated using standardized oral and written exams. As a result of these assessments, the student will be assigned course workbased on that proficiency at a Level 1 - Beginner, Level 2 - Intermediate, or Level 3 - Advanced. The student will be in a classroom setting receiving instruction in Spanish grammar, vocabulary, pronunciation, and comprehension. Homework will be assigned in the classroom setting. The student will interact with patients in a clinical setting. The student will attend lectures and seminars on both the Costa Rican Health System and the specific diseases and challenges involved with Tropical Medicine. Simulated patients, medical chart analysis and comprehension, simulated interviews with peers, medical interviews and analysis on 3 different levels of complexity will be common pedagogical activities. By using the skills developed, the student will be able to effectively interview a Spanish-speaking patient, establish a presumptive diagnosis, and give recommendations.

• Prerequisite(s): VTCSOM students in good standing who have completed Phase 1 and 2, the Elective Selection process, and comply with the International Elective Policy
  
• Co-requisite(s): None
  
• Duration:  4 weeks

This elective will provide in-depth exposure to healthcare, healthcare disparities, and chronic disease management in the low to middle-income regions of rural Southwest Virginia. The student will spend four weeks rotating in Internal Medicine and/or Family Medicine with the Ballad Health System. Daily rotations will occur in the hospital setting as well as in outlying community clinics. As available, the student may also spend time in the mobile Health Wagon clinic and other community wellness clinics in the area. Additional supplemental activities, lectures, and learning sessions will also be part of the elective. The student will gain an insight into the dynamics of medicine, with significant social and economic resource challenges unique to rural and low-income healthcare contexts. The elective will help foster the effective communication skills needed in a diverse socioeconomic healthcare setting.

• Prerequisite(s): Successful Completion of Phase I and II
  
• Co-requisite(s): None
  
• Duration:  4 weeks

This elective focuses on providing an immersive general surgery experience in a global health context. Students will work closely with the surgical team at Mzuzu Central Hospital in Malawi. The elective aims to broaden participants' understanding of global healthcare, develop their surgical skills in a resource-limited environment, and foster an appreciation for diverse medical practices. Participants will leave the elective with a deeper appreciation for global health issues, improved surgical skills, and enhanced cultural competence, prepared to adapt medical practices to various healthcare settings worldwide. Outpatient setting and the treatment plans for surgical consults.

• Prerequisite(s): VTCSOM students in good standing who have completed Phase 1 and 2, the Elective Selection process, and comply with the International Elective Policy
  
• Co-requisite(s): None
  
• Duration:  4 weeks

The International Surgery Rotation at Shankara Cancer Hospital elective offers students the opportunity to observe surgical cases and take part in care for postoperative patients in the context of the Indian medical system. This elective provides exposure to adults and children undergoing various surgical procedures. Students will participate in surgical cases in the pediatric and adult outpatient setting and the treatment plans for surgical consults. This elective will allow the student knowledge in the adaptability in medical practices, along with cultural and socioeconomic considerations in the field of global neurosurgery and global health.

• Prerequisite(s): VTCSOM students in good standing who have completed Phase 1 and 2, the Elective Selection process, and comply with the International Elective Policy
  
• Co-requisite(s): None
  
• Duration:  4 weeks

The International Surgery Rotation at Shankara Cancer Hospital elective offers students the opportunity to observe surgical cases and take part in care for postoperative patients in the context of the Indian medical system. This elective provides exposure to adults and children undergoing various surgical procedures. Students will participate in surgical cases in the pediatric and adult outpatient setting and the treatment plans for surgical consults. This elective will allow the student knowledge in the adaptability in medical practices, along with cultural and socioeconomic considerations in the field of global neurosurgery and global health.

• Prerequisite(s): Years 1, 2, 3
  
• Co-requisite(s): None
  
• Duration:  4 weeks

The purpose of this elective is to provide an introduction to the fundamentals of adult learning, an opportunity to apply and improve teaching skills in a medical setting, and preparation as a future physician-educator. The student will learn to effectively facilitate in a small group learning process utilizing the principles of adult learning and skills of effective feedback, review and write cases for education and evaluation, and how to be an active member of the medical education team participating in basic curriculum design and development.
Prerequisite(s): Years 1, 2, 3
Co-requisite(s): None
Duration:  2 weeks

This course explores the nature of medical errors, the malpractice litigation process, medical-legal reporting systems, malpracticeinsurance, and their psychological and professional impact on the practitioner. Students will analyze the role of malpractice lawsuitswithin the healthcare system, evaluate risk-reduction strategies, and practice deposition testimony. Students will discuss real-life examples and practice testifying in deposition. This class will review other major medical-legal entities that a physician mightencounter in his/her career as well as the importance of maintaining wellness throughout the stressful medical-legal process.

• Prerequisite(s): Successful Completion of Phase 2
  
• Co-requisite(s): None
  
• Duration:  2 weeks

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This elective is for the student who will be spending time working on their research project.  The student will spend time continuing to learn the principles of research with the mentor in guidance.
Prerequisite(s): Years 1, 2 + the successful passage of the USMLE Step 1
Co-requisite(s): None
Duration: 2 or 4 weeks

Special Studies courses are designed to be used when a course is being developed or tried for feasibility.  Special Studies courses can be created as needed and then a proposal for a permanent course can be submitted through governance. 
Prerequisite(s): Years 1, 2 + the successful passage of the USMLE Step 1, associate dean for clinical science years 3 and 4 approval
Co-requisite(s): None
Duration: 2 or 4 weeks