Advanced Hospital Medicine provide the opportunity for students to assume greater responsibility for patient care of the hospitalized patient, with oversight from supervising residents and attending physicians. Students expand upon competencies they develop during the third year as they care for one to two patients at a time. Additional expectations include responsibility for developing management plans, writing orders, patient handovers and transfers of care, recognizing the policies that support patient safety, and developing competency in procedures that they will perform independently as residents. Fourth year students also assist in teaching third year students.

Hospital medicine is a growing professional track for internal medicine physicians. The Society for Hospital Medicine defines a hospitalist as a physician "who engages in clinical care, teaching, research, or leadership in the field of general hospital medicine. In addition to their core expertise managing the clinical problems of acutely ill, hospitalized patients, hospital medicine practitioners work to enhance the performance of hospitals and healthcare systems." The M4 selective in hospital medicine exposes the student to the medical problems commonly seen in hospitalized adult patients and permits the student to have a greater role in the evaluation and management of these patients than they had during the M3 clerkship.