Fourth Year (MS4) Coursebook Information

Fall & Spring Semesters

  • Basic Neurology
  • Advanced Clerkship in Medicine
  • Surgical Subspecialties
  • Transition to Residency
  • Electives (5)
  • USMLE Step 2 Clinical Knowledge (CK)
  • USMLE Step 2 Clinical Skills (CS)

Note: If Surgical Subspecialties and/or Basic Neurology were taken as a third year elective, additional electives must be completed during fourth year. A total of 8 rotations must be completed during fourth year.

MS4 Timetable (Click for full-size)

MS4 Timetable

Curriculum Information

The curriculum is designed so students may plan, with faculty advisement, a significant part of their educational program. The elective approach to curriculum affords students with different backgrounds and aspirations an individual educational experience. Through the elective program, they are able to try out possible career choices, gain additional clinical experience, embark upon or conclude research work, or re-examine the basic medical sciences. Instructions for registration will be e-mailed to the student's UB e- mail account; therefore students must report and maintain complete up-to-date addresses in the Office of Medical Education.

Fourth-year students are required to take eight (8) four-week modules. Required modules in the fourth year include Neurology (NEU-801), Advanced Clerkship in Medicine (MED-802), Surgical Specialties (SUR-800), and Transition to Residency (IDM-810). All required courses must be taken in Buffalo. The current fourth year (ending with module L) has a total of 11 available modules and affords students three modules of "unscheduled time." For fourth year students, Module M may only be used to remediate a course failure or if the student’s progress was delayed because of a leave of absence, for example.


  • Required courses in Medicine, Neurology and Surgery will be determined by lottery. Changes will be made until the Friday after the lottery is held, no exceptions.
  • Students must be registered for a module at least 4 weeks prior to the start date of the module.
  • A course/elective cannot be taken more than once.
  • No more than three courses/electives can be taken in any single department.
  • Up to two modules of research can be taken in the fourth year; this is not available to MSTP students.
  • No more than four out of town electives are allowed (See Out of Town Electives below).
  • Only two out of town electives may be taken at any one institution.
  • A maximum of one international elective is allowed. An international elective also counts as one of the four out of town electives allowed.
  • All drop and add forms must be approved and signed by the course director (not the department chair); it must then be sent to OME.
  • All drop and add forms must be completed and returned to OME no later than 4 weeks before the module begins.
  • Double registration is not allowed; the only exception is when an out of town elective is pending. Once the out of town elective is confirmed, the other course/elective must be dropped using the drop/add form.
  • Any course or elective failure must be made up within 2 modules.
  • No retroactive registration is permitted for any course (local or away).

USMLE Step 2
Passing both Step 2 CK and Step 2 CS are requirements for graduation. In order to be eligible to participate in the Match, students must meet the following deadlines:

  • Step 2 Clinical Knowledge (CK): must be taken by December 31 of the 4th year.
  • **Step 2 Clinical Skills (CS): must be taken by December 31 of the 4th year.

** The Office of Medical Education highly recommends taking Step 2 CS immediately after completion of the third year.

Out of town electives
Only 4th year students in good standing are eligible to take an out of town elective.

A current affiliation agreement must be in place between UB and the training institution.

A student wishing to participate in an out-of-town elective must discuss with UB's appropriate department chairperson or course coordinator the possibility and advisability of taking an out of town rotation in a comparable department. If there is agreement that such an elective is possible and advisable, then the student will communicate directly with the desired program. If he or she is accepted into the elective, the department may request confirming letters and/or program descriptions. The department then notes their approval on the Out of Town Elective Form and forwards it to the Office of Medical Education for final approval/disapproval. A drop/add form must also be completed for registration purposes. Approval of "away" programs are made on an individual basis, taking into account the academic value of the elective and student’s academic status.

Clinical affiliation agreements and student liability insurance

The purpose of an affiliation agreement between UB and an affiliated institution is to advance UB students’ educational programs in a particular educational discipline.

Why is a written Affiliation Agreement necessary? The State University of New York is considered an agency of the State of New York, and therefore, its liability is the same as the State of New York. The affiliation agreement sets forth the educational purposes of the arrangement; the responsibilities of each party; allocation of the risks; any insurance covering any risks; duration of the agreement; and how the parties will coordinate the clinical experience. Without an affiliation agreement, no academic credit can be earned and no medical liability coverage is provided.

SUNY’S insurance for UB Students
For students who are participating in health-related clinical experiences, especially those with hands on in either patient care or laboratory testing, there is a risk of a lawsuit. Pursuant to the mandates of the policy, UB must have a written agreement between itself and the Host Institution in order to have insurance coverage extended to the student participating in that particular clinical program. Therefore, for health-related student affiliation agreements, SUNY purchases commercial insurance to cover malpractice claims against students. Both defense costs and indemnification in the event of judgment or settlement are covered in the event of a lawsuit being filed naming the student as a Defendant. Without a written Affiliation Agreement in place, the student will not have coverage for either defense costs or indemnification if such a suit is brought by a third party.

A student is not covered when he or she shadows or does any type of health related clinical experience with a physician, nurse or any other health care provider who is a friend, relative or neighbor of the student, without a written agreement between UB and the Host Institution. In these cases, the student is solely liable for their actions because the student’s activities are not under authority or consent of UB.

Policy limits
The current policy is a typical professional insurance contract with an amount not less than $3 Million aggregate for bodily injury and property damaged combined single limit, the standard of the health care industry as determined by the New York State Health Department.

Clinical experiences outside of the US
SUNY’s student liability policy does not cover affiliation agreements outside the continental United States. A student wishing to do a clinical experience outside the US would have to obtain their own policy of insurance, which can be quite expensive. Liability exposure is not limited just to professional liability. Insurance also covers legal defense costs, which can be quite expensive. In the past, SUNY has entered into several affiliation agreements with agencies in Ontario, Canada so long as the Host Institution signs SUNY’s Standard Affiliation Agreement complete with the Exhibits.

Establishing an affiliation agreement
Any student who wishes to work in a physician’s office, a research laboratory, or a hospital/clinic must do the following:

  • 1. Check in the Office of Medical Education (OME) to determine if an Affiliation Agreement with the host institution is currently in place.
  • 2. If there is an Agreement in place, see number 4.
  • 3. If currently there is no Affiliation Agreement, obtain and complete a “Student Affiliation form” from OME and return it to an Assistant Dean in OME at least six weeks before the experience is to begin.
  • 4. If an Affiliation Agreement is currently in place or if a new one has been established, you must register for an appropriate course through appropriate channels.
  • 5. Under no circumstances is a student permitted to begin an experience without confirmation of an Affiliation Agreement.


Program planning
Advisors and faculty as well as members of the Dean's staff in the Office of Medical Education are available to assist third- and fourth-year students in the program-planning process. Requests for special scheduling (such as participation in a program of more than two months in duration or spending more than one month at the same institution) must be brought to the attention of the Office of Medical Education and must be approved. When determined to be of educational beneficial for the student, individual programs may be modified by the Office of Medical Education.

Graduation honors
Students may qualify for Latin, research or thesis honors at graduation.

Students have the opportunity to apply for both research and thesis honors prior to graduation. Candidates interested in these honors must write a thesis for review by a special committee. Research honors simply require evidence of continuous research that has resulted in either publication(s) or presentation(s) at national meetings. Additional information and applications for graduation honors are on the UB School of Medicine and Biomedical Sciences webpage:

Visiting students
Visiting students from other medical schools within the U.S. must successfully complete an application process in order to take fourth-year clinical electives at any of the School's affiliated hospitals or institutions. The Office of Medical Education administers this program. The tremendous demand for educational experiences by students’ trained elsewhere, especially foreign-trained students far exceeds our ability to accommodate them. We have, therefore, established a policy that will keep open visiting student opportunities for domestic medical students only. For information, students should call (716) 829-2802 for instructions on how to apply for visiting courses

Contact Info

Office of Medical Education
40 Biomedical Education Building
3435 Main Street
Buffalo, New York 14214

P: (716) 829-2802
F: (716) 829-2798

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