What Is Fifth Semester?

So I’ve gotten a few questions about what exactly fifth semester is from some students in other semesters. So here, I’d like to explain a little more about what fifth semester is like.

What classes do we take fifth semester?

During fifth semester we take five classes — Pharm II, Behavioral Science II, Med Ethics II, ICM 5, and ICM 6 (which is really like three short-term classes combined: ICC, Kaplan Live, and Physio Live, which I’ll explain later).

What is the schedule and requirements for Pharm II?

We take Pharm II for two 4-week blocks and we start on the first day of classes. The two block exams count for 30% of our grades each. We take the Pharm Shelf a week later, covering everything from Pharm I and II, and it counts as our final exam, 40% of our grade. The grade is not curved and the shelf exam average has been around 71% or so each semester.

What is the schedule and requirements for Behavioral II?

Like Pharm II, it consists of two 4-week blocks and we start on the first day of classes. The two block exams count for 40% of our grade each. We take the Behavioral Shelf a week and a half later, covering everything from Behavioral Science I and II, Biostats, and Neuro pharm. It counts as our final exam and is worth 20% of our grade. The exam is often more difficult than what most people would think going into it, but because the professor adds a huge curve, the class average for the shelf exam has been around 85% or so.

What is the schedule and requirements for Med Ethics?

Med Ethics lasts the first two weeks of school and it consists of two quizzes, two writing assignments about medical ethics cases, and a 40-question final exam. It may be one of the easier classes at AUC, but it is tricky, and the things you learn from that class will save you on the Behavioral shelf as well as on the Comp.

What is the schedule and requirements for ICM 5?

ICM 5 is a little complicated. It consists of 16 cases which we do in small group (which students present during every two-hour small group session), four quizzes over the cases, an ICM Shelf exam, lectures, a comprehensive physical exam practical, male and female genital/breast exams, a one-on-one patient interview with write-up, CPR course, two advanced interviews and case write-up, two team-based learning sessions (each with a quiz), and two mini-rotations at the hospital or clinic. Unlike previous ICM classes that only last 2-3 weeks, ICM 5 lasts an entire semester.

For the first two weeks of school (while you are taking Behavioral II, Pharm II, and Med Ethics) you’ll be scheduled to do a one-on-one patient interview. The student interviews a professional patient (actor) one-on-one privately in a patient room. Since the interview simulates a real interview, we needed to have all the sections of the interview memorized (i.e. the questions for HPI, PMH, Social History, Family History, etc.). The only part we don’t have to memorize is the Review of Systems (ROS), in which we may bring in a checklist (which is what doctors do anyway). The patient may present to you with any (or multiple) problems, so we must be prepared to face and tackle any type of interview. We must complete the interview within a certain time period (and we are timed). After the interview, we must turn in a write-up within 72 hours.

We start small group two weeks after school starts, after all the one-on-one interviews are finished. For small group, we are divided into groups of 15 or so students which we meet most days of the week for 2 hours each. We look at16 clinical cases throughout the semester. Each student is assigned a case to present and lead the class in discussion, which we each do over a period of two class periods. Over the semester, we have four 16 or 17-question quizzes over the material for each case. Unlike the previous ICM classes, the quizzes are actually hard. At the end of the semester, we take the ICD Shelf exam as our final exam.

We are also required to do a male and female breast/genital/rectal exam on real patients. We have two lectures plus a week of practice on plastic models, followed by a 6-student session in which we perform the exams one-by-one on a male patient, and a 3-student session which we perform the exams one-by-one on a female patient.

We also take the comprehensive physical exam test in which we perform by memory within 1 hour in front of an evaluator 251 things we need to be able to do on a physical exam. We must perform 85% of the 251 correctly in order to pass the class.

We also do two advanced interviews, similar to the advanced interviews we do in ICM 4, except that the only thing we are allowed to bring with us is a copy of the ROS and some scratch paper to take notes, similar to our one-on-one interviews we had to do the first two weeks of school. That means, we aren’t allowed a cheat sheet to see what to ask, but by this point since most of us have already done a lot of interviews already, this shouldn’t be too difficult. We only have to do a write-up on the second of the two advanced interviews. We turn it in within 72 hours of the interview.

We also do two team-based-learning sessions, one on preconception/prenatal care and another on pediatrics. For these sessions, we must do pre-reading and complete a quiz that counts for a grade. Afterwards, we get into groups of seven students, and as a team, solve a series of eight problems. After we come up with our answers, we compare them with other teams and discuss/debate them as a class.

For ICM 5, we are also required to do two mini-rotations in a range of different fields of our choosing, like family med, ER, radiology, derm, surgery, orthopedics, anaesthetics, or ENT. We do them at either the St. Maarten Medical Center, Mullet Bay Clinic, Simpson Bay Clinic, or a few other clinics around the island. We get an evaluation filled out by the doctor we followed as well as write a short reflection piece on our experience.

We are also required to take a Basic Life Support (BLS) course (basically CPR for health-care providers) and get certified. This course is for fifth semester students only and lasts seven hours.

What is the schedule and requirements for ICM 6?

Whereas ICM 5 lasts nearly the entire semester, ICM 6 doesn’t really start until after we finish Pharm II and Behavioral II. ICM 6 is really a combination of three separate classes: Intro to Clinical Clerkships (ICC), Kaplan Live, and Physio Live. The NBME comp exam and the Kaplan comp exam, both of which we need to pass, are also part of ICM 6. The mandatory path shelf exam and the optional neuro, micro/immuno, and physio shelf exams are also part of ICM 6.

Intro to Clinical Clerkship (ICC) consists of 2 to 2.5 hour lectures every afternoon for one-and-a-half weeks, after which we take a final exam. We must pass ICC with a 70% in order to pass ICM 6, and therefore pass the semester.

Right after ICC, we take the mandatory Kaplan Live, which is also part of ICM 6, and it lasts everyday for an entire week for seven hours each day.

Right after we finish Kaplan Live, we take Physio Live for an entire week, but unlike Kaplan Live, attendance here is not taken.

In order to pass ICM 6, we are required to pass two comps: the 4-hour NBME comp and the 8-hour Kaplan comp. We are given three chances to pass the NBME comp. The first NBME comp takes place about 2 months into the semester. The second NBME comp takes place 3 weeks after that. The third NBME comp takes place 2 weeks after that, which is two days before 1st-4th semester final exams. For each exam, we get the scores back within the next day.

Unlike the NBME comp, we only get 1 chance to pass the Kaplan comp, which takes place four, five, or six days before 1st-4th semester final exams, depending on when you are assigned. For those who have passed the first or second NBME comp, the Kaplan comp will be the last thing they need to do for the semester for ICM 6.

Even if we have already passed one of the previous NBME comprehensive exam, it’s still highly recommended we take another comp for all the practice you can get, so many people do stay to take the third comp. As a rule, once you pass a comp, you are allowed to take one more for practice.

For more info on comp exams and what scores you need to pass, please check out my post here.

Aren’t classes finished after two months and the rest is just studying for comps?

Not really. I think some people get the misconception that fifth semester students are done w/ classes after two months because that’s when Pharm II and Behavioral II are finished, and fifth semester students like to post on Facebook that we are done with lectures forever. But in reality, we aren’t, and neither are we done with learning new material. Just yesterday I learned how to write a medical admissions order, how to write a daily progress note, and how to determine what rate to give IV fluids in accordance to the patient’s weight. This is new material that I will be tested on in my Intro to Clinical Clerkships (ICC) final exam. In ICM 5, I just learned about pre-natal care and took a quiz on it. We may be done w/ Pharm II, Behavioral II, and Med Ethics, but we still have 2 hours of ICM 5 in the mornings and 2.5 hours of ICC in the afternoon, followed by 7 hours of Kaplan everyday for the next week, and then Physio Live along with more ICM 5 lectures, team-based learning session, small group, ICD shelf, and quizzes after that.

What shelf exams are we required to take during fifth semester?

During fifth semester, We are required to take four shelf exams: Pharm shelf, Behavioral shelf, ICD shelf, and Pathology shelf. Pharm, Behavioral, and ICD (aka ICM) shelves act as final exams for their respective classes. The Pathology shelf is not a final exam but is mandatory for passing ICM 6. In addition, there are also optional shelf exams we can take, which are all very good practice. The optional shelves include Physio, Neuro, and Micro/Immuno shelves.

 So when can fifth semester students leave the island?

If we’ve already passed either the first or second 4-hour NBME comp exam, we can leave as soon as we finish the 8-hour Kaplan comprehensive exam, which lasts from 8am to 4pm, either four, five, or six days before the 1st-4th semester final exams, depending on which day we were assigned. If we have not passed the NBME comp exam yet, we have to take the third NBME comprehensive exam, which takes place after the Kaplan comp exam, two days before the 1st-4th semester final exam. We may also choose to stay and take the third NBME comp exam for practice if we’ve already passed a previous NBME comp. In reality though, since we are moving off the island, we may need a few days to clean up, pack, sell things, check-out with our landlords, and say goodbye to our friends and professors on the island before clinicals.

12 comments to What Is Fifth Semester?

  • Thomas Schumacker


    I was just wondering if by the end of 5th semester, I would be done by December 2, 2011. I’m trying to plan a wedding a year in advanced. Thank you for your time.

    • Benji

      Hi Thomas,
      Unfortunately you won’t get done by December 2. Fifth semester usually ends around the second week into the last month of the semester.
      Good luck!

  • Yusra I

    Could you offer any feedback on how to prepare for the Pathology shelf?

    • Benji

      Hi Yusra,

      Thanks for the comment. The two things that I found most helpful are First Aid and USMLE World.

      I’d make sure to go through all the path sections in First Aid. This includes not just the “Pathology” section of the “High Yield Principles” unit but also the individual pathology subsections in the “High Yield Systems” unit as well (i.e. Cardiovascular pathology, Endocrine Pathology, Gastrointestinal Pathology, etc.” This will give a good summary of the most essential things you need to know for path.

      If you haven’t already, I’d also consider purchasing USMLE World and start doing questions from there. It’s a good idea to do them concurrently with First Aid so that once you are finished studying Cardiovascular Pathology in First Aid, for example, you do all the Cardiovascular Pathology questions from USMLE World. This will help you think about the stuff you just reviewed in all the possible ways they may test you.

      Good luck on the Path Shelf!

  • Yusra I

    Hi Benji,

    Thanks for the feedback!!

    A side question, maybe you’ll know.. are we required to take the USMLE during the free semester after we leave the island or can we take say 4-5 months to study, which would result in taking longer than the leave of absence to get our score?

    🙂 Good luck to you as well!!

  • Benji

    Hi Yusra!
    We are required to take the USMLE Step I the semester after we leave the island (which, like the other semesters, lasts 3.5 months or so). That is how much we are officially allowed by the school. Any more than this would be considered “gaps in your education” that you would need to defend in front of the residency directors when you interview for residencies. Studies by the school have shown that students who take the exam no more than 8 weeks after leaving the island will do better on the exam as you retain more knowledge. Good luck!

  • Lan

    How does our financial aid work during the 3.5 months between the time we leave the island, take step 1 and start rotation?

    • Benji

      Hi Lan,
      We are not covered by financial aid during that time, so make sure to take out enough loans Fifth semester to cover for that time. The max amount of loans you take out should be enough to cover for that time. Also, you don’t necessarily have to take all 3.5 months off. You could take off less than that if you feel prepared to take the exam earlier, and start rotations earlier.

  • Nelly

    Hi Benji,

    Would you know why AUC has five semesters instead of four like American medical schools do? Is it because of all the ICM classes that Pharm II, Behav Science II and Med Ethics II are in Sem 5? Thanks!



    • Benji

      Hi Nelly, that’s just how AUC divides the curriculum. Not all US medical schools do 4 semesters either. Actually, many of them have one big break after the first two semesters, and then no breaks between semesters 3, 4, or even 5 at some schools. There’s a lot of variation among US medical schools on how they divide the two years of Basic Sciences.

  • Jessie

    Hi Benji,

    I was wondering if you knew the difference between applying for the January vs. May vs September class for AUC? I was considering applying for the May class of this year rather than waiting for the September class.. Is there an advantage to studying for the Step 1 if you chose the January class rather than the September class and such?. Thanks!

    • Benji

      Hi Jessie,

      Thanks for the question. If you started September 2013, then you match in 2017. If you started May 2013, you also match in 2017, but since you started earlier than the September class, you’d have more time to finish your requirements for graduation. If you started January 2013, you’d have even more time (probably too much time) to match in 2017, and some people may even decide they would schedule their rotations back-to-back and take very little time off for breaks to study for the steps, and even make it for the 2016 match. However, this is challenging, and not very commonly done.

      Even though those who start in May or January have more time to complete their graduation requirements, there are still certain timing rules that need to be followed. For example, you are only officially (school-sanctioned) allowed to take a semester off (around 3.5 months) to study for the Step 1 exam. If you decide to take more time off to study, you would have to take a non-school-sanctioned leave of absence, and it would be considered a “gap” in your education, which does not look good when you apply for residencies. You’d have to explain to the residency programs why you took that leave of absence, when others did not. So in terms of advantage for studying for Step 1, I don’t feel there is a big difference between the different semesters. The biggest difference is probably that in the May and January semester, you can finish more rotations (and therefore getting more clinical experience) before taking Step 2 cs and ck, and get your exam scores ready by the time residency application season comes. You could also probably take more breaks in between rotations if you choose, or take a longer break to study for your exams. For those who start January semester, you may even graduate more than half a year before you start residency in July, but this is not necessarily an advantage, because that also means your financial aid repayment kicks in before you start making money during residency.

      If you want to do residency in California, California residency programs require that you must apply to their program a maximum of six months prior to your anticipated graduation date. Residency applications are open September 15, and so in order to apply to California programs, you must be able to graduate by March or so. In this case, starting May or January would be to your advantage, because you’ll more likely be able to finish all your rotations by then.

      So in conclusion, there are many factors to think about, such as: How well do you feel you can manage your time and pace your studies? Are you someone who need breaks? Are you willing to move from place to place for your rotations if that means doing your rotations back-to-back and graduating at a time that you want? Best of luck and I hope this helps.


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