Advanced hospital selectives 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.

Students work directly with a faculty psychiatrist, usually a psychiatry resident, and a multi-disciplinary team in an inpatient setting with older adult patients. Students perform initial evaluations and help manage patients throughout their hospitalization (if desired, the student may participate in the ECT Service). The site available is Borgess Medical Center.