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Medical Student Perspectives: How Should You Plan Your Fourth Year?


Medical students commonly underestimate the benefits of arranging a desirable schedule for themselves during their fourth year. Below are some questions to ask yourself while scheduling your fourth year rotations.

What Do You Want To Get Out Of Your Fourth Year?
If you are looking for varied experiences to prepare you for residency, you may choose to do electives in a wide range of fields in addition to internal medicine, such as emergency medicine, critical care, neurology, or radiology. If you think you may be interested in a particular subspecialty, complete a rotation in that field to solidify your interest. If you want to get into more competitive residency programs, you should consider doing away rotations at these programs. To get experience teaching students, become a teaching assistant for a basic science class at your medical school. This will help prepare you for the teaching that is required during your residency.

What Rotations Are Required During Your Fourth Year?
If your school requires medicine ward months, medicine subspecialty months, or acting internships in internal medicine, you can use these rotations as opportunities to solidify your interest in medicine. Your school may allow you to schedule these rotations away, allowing you to gain insight into other residency programs while fulfilling your requirements for graduation.

How Many Away Rotations Are You Allowed? How Many Do You Want To Take?
Be sure to confirm how many rotations you are allowed to take at other institutions. Some schools do not have a limit on the number of away rotations students are allowed, while others limit students to only a few away rotations. To increase your chances of matching in more highly ranked programs, try to schedule your rotations at these programs.

When Does Your School Require You To Take The USMLE Step 2 CK (Clinical Knowledge) And CS (Clinical Skills) Exams?
If you want to take boards early or you have to travel a long distance to take Step 2 CS, plan an elective which allows more flexible scheduling and off time during testing time. Step 2 CK exams vary in the way they are administered, but some students feel that emergency medicine and neurology rotations are good preparation for these tests. Many schools do not specify at what time during the third or fourth year students should complete these rotations. Some schools do not require that students complete these rotations at all. If you choose to take these rotations you should enroll in them early in the school year. You should also keep in mind that some residency programs do, while others do not, require that Step 2 CK and CS be successfully completed at the time of interview, match, or post-match confirmation of your residency position.

Do You Want To Do Research Or Write Publications?
Remember that it sometimes takes several months for acceptance and publication of articles in scientific journals. It is a good idea to choose to do a research month early in the year if your goal is to get published.

How Many Programs Do You Want To Interview With? Where Are These Programs Located?
Many times it is difficult to know what programs you want to apply to and interview with during your fourth year, where they are located, and how many you should choose. Many students use the interview trail as an opportunity to travel. If you choose more flexible rotations during late November to late January, you will find it easier to schedule your interviews or to take a second look at a program if you deem necessary. Scheduling less stressful rotations at your own school during interview season will also ease the stress of the interview process.

Factors To Consider When Scheduling Your Fourth Year

  • Know your school’s requirements and scheduling limitations.
  • Determine what you want to get out of your fourth year.
  • Choose electives in fields you want to experience.
  • Keep in mind the application, interview, and match process.
  • Allow yourself ample time for interviewing.

John Baker
Council of Student Members Representative, Southeastern Region
University of South Carolina, 2007

Back to February 2007 Issue of IMpact

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