Thinking Ahead to Your Fourth Year

Although you are busy with your clinical clerkships, you are now well into the second half of the academic year and it won’t be long until you are a fourth year student. Although much of your energy for the rest of your third year will be spent focusing on your rotations and preparing for the USMLE Step 2 examinations, once they are over you can turn your attention to what happens in your fourth year. However, to get the most out of your fourth year, it is helpful to look ahead now.

Although the focus of the first half of the fourth year tends to be on applying for residency, it is both an important and interesting time in your training. There are occasional discussions about shortening the time in medical school to three years with the argument being made that adequate factual knowledge can be learned in three years with the rest being able to be acquired during residency training. Although this concept has some merit, the fourth year has been preserved primarily because of its value in helping you process, consolidate, and expand what you have learned over the previous time in medical school. Although there is still much factual medicine to be learned during this time, it is often the development of the less tangible aspects of becoming a physician that makes the fourth year so meaningful.

Here are some key ideas for getting the most out of your fourth year:

• Don’t lose sight of the big picture of medical training by focusing primarily on residency application. Although this process will (appropriately) consume much of your time and effort, keep in mind that there is much more to the 4^th year than simply seeking a residency position.
• Structure your schedule as much as possible to take advantage of learning opportunities that your school has to offer and that may help you become a better physician. Although it may be desirable or necessary to take certain courses early in the fourth year (such as an acting/subinternship), remember that residency programs are structured to provide you with all of the skills you will need to be a practicing clinician. It is therefore not necessary to take only courses related to your desired field at the expense of not taking other diverse or unique learning opportunities your school has to offer. This frees you up to possibly take other courses or participate in other experiences (such as working in another country) that will likely to be much more difficult to do once you are a resident.
• Once you have learned the basics, you can focus on honing the knowledge and skills you have learned.  By the time most students have reached their fourth year they have developed a certain level of comfort having successfully rotating through their core clerkships.  Because of this, most of the things you experience are not completely new, and learning tends to become more comfortable and allows you to focus on integrating and expanding what you have already learned. 
• Use the greater autonomy that comes with being a fourth year to learn more and explore what it is like to be a physician. The fourth year is the time when you transition from being a relatively new trainee to one who has made considerable progress on the way to becoming a physician. Accordingly, you will have more autonomy as a fourth year student, such as when you rotate through an acting/subinternship, although along with this will come with an increased level of responsibility and expectation. This will provide a wonderful opportunity for you to further grow and develop your patient care skills.
• Move beyond learning facts and work on developing your professional identity and style. Along with the increasing autonomy and level of responsibility in the fourth year will be an increase in your professional stature. You will be making the transition from student to clinician and will find that you are becoming a more integral part of the patient care team. This is a major and extremely important role change, and will enable you to work on developing your personal professional identity and style, which includes how you approach carrying out this new level of responsibility, how you work with your patients and colleagues, and how you will want to practice the type of medicine you wish to pursue.

So remember that there is much more to your fourth year that just residency application – think ahead and be sure to take advantage of what it has to offer!