Medical Student Perspective: Tips for Rocking 4th Year
Disclosure: This article relates my own experiences and opinions, as learned through failures, successes, and may not represent the norm. That said, I have shared these statements with some friends, classmates, and mentors who have found these statements to be generally true and helpful. Some of what follows is common sense, some you’ve got to live through and figure out for yourself, and some, hopefully, will inspire you to plan actively for your fourth year, so you’ll be able to sail through it with a little less of the constant anxiety that has been my most reliable companion of late. So, here goes…
Get letters ASAP. I list this first because it is the item that seemed furthest from my mind after finally, agonizingly, zeroing in on my chosen specialty in the 11th hour of third year. If you haven’t already collected all the written accolades you’ll need to apply for residency during third year, don’t worry, but do get down to business. If you can begin fourth year with at least one strong recommendation from someone you worked with previously, you’ll thank yourself later. Most programs want two from clinicians/professors in your chosen specialty (unfortunately, names and titles do matter, especially if you’re angling for an academic program), and one from a different specialty or aspect of your education. For this one, my advice is to try to pick someone who knows you well on several fronts and can provide a longitudinal account of your merits. For example, mine was written by a surgeon-professor I’d known since practically day one of medical school, and with whom I’d interacted in a variety of settings, both clinical and nonclinical, who could attest to my character as well as my skills. As an aside, pay attention to where the people you work with did their training—they may have connections at programs you apply to, and are often willing to make phone calls on your behalf.
As for how to obtain these letters, and quickly, the key is to be proactive and upfront about it. Be sure to ask the faculty member to tell you honestly if they are willing to write you a strong letter of recommendation, and, if they will not, you may want to ask someone else. I happened to luck out with a specialty mentor who also knew the application process intimately, and her biggest gift to me was to set me up with a challenging Sub-I as my first rotation of fourth year, and to communicate to the professor overseeing me that I was in desperate need of referees. From day one of that rotation, the bar was set high, but visibly so, such that all expectations were laid out clearly with checkpoints set for evaluating my progress. At the end, I walked away with a clear idea of my abilities, strengths and areas of weakness, in addition to what I presume was a strong letter from a well-respected department delineating my performance.
Do a lot of independent studying, as in the elective kind, to facilitate schedule flexibility during interview season. Most programs begin interviewing late October/early November and conclude sometime in January. If you’re motivated, you can squeeze probably 10-15 interviews into a two-month window (ten is pretty average for giving you a good chance of matching into most specialties), but you’ll basically need to be capable of jet-setting continuously during that period. At my school and possibly yours, independent study electives are referred to as reading electives, presumably because they typically consist of self-paced reading on a preset topic, often culminating in a paper or presentation for evaluation purposes. If you’re lucky, your school has something similar. Either that, or I hear many schools have built-in time for interviews. The point is, you’ll need to find a way to earn credit toward graduation while allowing for very little face-time with the source of those credits.
Be persistent with the programs you’re interested in. Personalize your personal statements to each program individually, if writing is your thing, but don’t be surprised if not every program takes the time to actually read them—especially now that Dean’s Letters are now available to programs October 1. Once your board scores (Step 1 and Step 2 CK) and at least a couple recommendation letters are uploaded, you should start receiving interview invitations about a week after submission. And I mean it when I say that they trickle in at a painfully slow pace. Mine seemed to plateau a couple weeks after I first started hearing back, at which point I began to panic. We’ve all read the stats about how many interviews we need to have a decent shot at matching, and frankly I just wasn’t there yet. So, I took the advice of a fellow student and started individually emailing the programs I hadn’t yet heard from . Every. Single. One. Now, by default, I’m the type of person who’d prefer to wait patiently rather than bother already busy program coordinators with desperate emails, but in this instance I’m so glad that I took action. Almost immediately, I began receiving responses that ranged from “we’re sorry, we have extended all interview invitations already so good luck to you” to “please be patient as we make our way through a long list of qualified applicants” to “we hope you will accept this invitation to interview at one of the following dates.” As difficult as it is to field rejection, the interviews I received as a result more than made up for any mild disappointment. And I can honestly say, I don’t know if I’d have received any of them if not for my pesky emails. In fact, I was told by one program director during an interview that without my personal email he would not have considered my application due to sheer geographic distance between my school and the location of his program.
Keep up with the medical literature as much as possible, everyday if you can. You can use ACP JournalWise, which is a site that summarizes and reports on the freshest and most groundbreaking medical research being published. You can sign up for free emails from a variety of categories, which you can tailor to your specific interests and may want to adjust for various rotations. Keeping up to date doesn’t just apply to fourth year, but constitutes literally the single most useful piece of advice I received during my third year, from a Hopkins-trained professor who clearly knew his stuff. Thanks to him, I have impressed a fair number of attendings and residents and been able to contribute much more constructively to discussions of patient care. If these article summaries aren’t your thing, be sure to regularly scan respected journals in your specialty keep yourself up to date and to establish habits that will make you an effective clinician.
University of Arizona College of Medicine
Class of 2013
Nikki also writes for in-Training.org, an online newspaper for medical students.
Students: Join ACP for Free
Benefits of Membership for Students: ACP's free Medical Student Membership includes benefits designed especially to meet students' needs.
Join Now: Sign-up today and begin enjoying the benefits of ACP Medical Student Membership.
Find a Residency
Search ACP's Internal Medicine Residency Database for information on all internal medicine residency programs in the U.S. and Canada. (ACP Members only)
Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health, 2nd Edition
This new edition reflects recent clinical and social changes and continues to present the important issues facing practitioners and their LGBT patients. Read more about the Guide. Also see ACP's recent policy position paper on LGBT health disparities.
Join Us in Washington, DC for the Most Comprehensive Meeting in Internal Medicine
Register now and enjoy:
Discounted rates, the best national faculty, a wealth of clinical and practice management topics and hands-on sessions! Learn more about the meeting.