4th year: it's just not that great

getunconcsious · Feb 12, 2009

Sorry to tell those of you that are looking forward to it, MS4 is not the paradise that it's made out to be. In fact, I'd say that MS2 is much better. Why? Any number of reasons...

-If you want to go into a specialty that is not covered in the third-year, your first 2 or 3 rotations next year will likely be very high stakes with all the grade-grubbing anxiety you've grown to hate this year.

-Remember AMCAS? ERAS is basically the same thing on crack. Essays, CV, ordering transcripts, all the same old BS.

-Most schools require a critical care rotation, so ICU or ER. Which sucks. Unless you're just nuts about watching people die/try to die.

-Nearly all schools require an AI which means back to q4. All the pain of internship with none of the perks (i.e. you're still "just a med student"). The upper-level is usually annoyed that (s)he has to look after your patients more closely, sign your orders, etc. The attending is invariably disappointed that you can't hold your own with the real interns, never mind that you haven't seen their specialty in six months. Woe to those of you at stupid obnoxious schools that require both surgical AND medical AI's. How ridiculous is this? You'll never be expected to be a surgical intern if you're going into IM, and vice versa.

-Remember the god-awful interview process for medical school? Well, get ready to re-live it complete with flight delays, tremendous expense, uncomfortable dress clothes, and endless ass-kissing. Even better, it's more difficult to get time off to go to interviews.

-Match anxiety. By January it's the first thing you think about when you wake up, and the last thing you think about before going to bed.

-You also have to live with the impending doom of knowing that next year will be one of the worst years of your life (i.e. internship).

-You're still forced to do rotations in specialties you have absolutely no interest in.

-Still get treated like crap for wearing a short coat, just like in MS3.

-The "you can slack off" concept is really overblown. You WILL still have to show up every day. You WILL still be forced to attend useless didactics every week.

-USMLE Step 2 CK, which really isn't that bad I suppose unless you've done poorly on Step 1.

-USMLE Step 2 CS, which is a misery. And then they make you wait three months to find out if you failed this turkey (which more and more AMG's seem to be doing!). So I get to find out on April 1, which if I failed will mean that it'll hold up my license and possibly even get me dismissed from residency despite the fact that I'll have already matched.

So you see, 4th year is really not nearly as good as everyone says. I suppose it's not *as* miserable as MS3 b/c after October you really don't have to care about your evaluations as long as you pass. But I definitely wouldn't say it's "one of the best years of your life" as so many Pollyanna/bubble-head residents and attendings claim. Just know what it is don't have too high of expectations for enjoying the year.

Krazykritter · Feb 12, 2009

I've enjoyed some of my fourth year rotations w/ the extra independence (sometimes), but for the most part, I totally agree with you.

Where are those 9-2 rotations that people talk about?

I spend way more time reading journals & other rotation relevant material that I may or may not have to present now than I did studying for rotation appropriate exams.

Despite all this though...I have had way more time during fourth year to slack off on out-of-hospital time than I did as a third year.

pmpkn219 · Feb 12, 2009

I think this must be highly med school/resident dependent. I am loving the fourth year life.

We don't have daily didactics, I'm able to slack off on some rotations, or on certain days when I feel like it. When I am there I do my work, and well, and residents do treat me differently than a third year.

I think my school has relatively few requirements maybe- which almost certainly helps my outlook. We have to do 2 weeks of intensive care (I did NICU, no deaths), 2 weeks Anesthesia and 4 weeks on a sub-internship (med/surg/FP/Ob/Peds). The other 26 weeks or so are completely at my discretion, and I appreciate it!

I will wholeheartedly agree with CS being the biggest waste of my precious time, energy (ok, didn't use much of that) and of course, money. Actually, CS has likely been the worst part of my fourth year, hands down.

Then there's the Match- which I'm not sweating, but I'm also not applying into a specialty where there's only what, 10 programs nationwide?! That would increase my stress eleventybillion-fold. I thought residency interviews were a much better experience on the whole than those for med school... and I think I've formed a mental block about AAMCAS... I'm sure it did resemble ERAS, I just can't recall!

getunconcsious · Feb 13, 2009

I suppose it makes sense that match anxiety would vary a lot depending on the specialty...yeah the 10 programs/23 spots nationwide thing kinda makes me a little paranoid. It is definitely better than third year, just not as great as everyone says!

smq123 · Feb 13, 2009

pmpkn219 said:
I think my school has relatively few requirements maybe- which almost certainly helps my outlook. We have to do 2 weeks of intensive care (I did NICU, no deaths), 2 weeks Anesthesia and 4 weeks on a sub-internship (med/surg/FP/Ob/Peds).

No deaths? Really? 😱

You got lucky. I had 6-7 on my unit month (can't remember the exact number, now). Wow....

Doctor Bagel · Feb 13, 2009

Yeah, I'm figuring the whole applying for residencies thing is going to add a considerable element of suck to 4th year. I'm glad I'm going to be applying in a non-competitive area. Your post also made me happy about my school with its very minimal 4th year requirements -- 1 month of ambulatory IM and one month of rural primary care is all we've got to do. I'm surprised by how much stuff some other school force into 4th year.

waldenwoods · Feb 13, 2009

One of the nice things that has come out of this very tiring interview process is that I have met so many people who are really passionate about their patients' well being. It's so interesting to hear about the unique things they've done because they believe so strongly in helping to make a difference.

AK_MD2BE · Feb 13, 2009

I have to agree...to a certain extent. It seems like everyone says 4th year is so great and carefree, not really buying it. Well, as far as my schedule shapes up...I am going to have 16 really stressful weeks (4 weeks each of 2 away rotations, sub-I and SICU). But, after January 1st...it should be smooth sailing. 😀

efex101 · Feb 13, 2009

I have to agree that 4th year was not all that great which of course varies btw schools, the suck can be huge depending on residency choice. I am now an intern and to be honest (this is OFF topic), intern year IS hard but doable. Yeah, the hours spent taking care of patients are endless or so it seems, but it goes by super fast. So for all you senior med students out there, enjoy what is left of this year, and get plenty of R&R.

Thanatos · Feb 13, 2009

it varies....I feel like I've had to work just as hard on some rotations as I did during third year. At the same time, you don't have a shelf exam hanging over your head at the end either. I still read some, but its strictly for practical purposes or my own curiosity. I don't spend time memorizing useless crap anymore.

It seems like the attendings have also laid off the minutiae....if they ask me anything at all its an important point and not some totally random bs.

I have liked fourth year because its more focused for me....I've spent a lot of time doing rotations I wanted to do and getting things out of them that I was looking for.....as opposed to sitting through some (*&^ conference/lecture/soapbox speech that does me absolutely no good. The exception is my school requires an ambulatory month.....as if the month of family medicine and a month of outpatient pediatrics wasn't enough clinic.....dammit I hate clinic.

taurus70 · Feb 14, 2009

The good thing about the 4th year is that we are almost done. 4 weeks of neurology that I put off to the end. Funny, I just got an email form NRMP "encouraging" me to finish up and certify my list. They then scared me with all the horrors of waiting until the last minute. I'm going to be marrying one of these guys for a while. Let me think about it at leat one more day before telling me I'm doomed if I don't submit NOW! LOL! :laugh:

ranmyaku · Feb 14, 2009

It must vary a lot between schools. I've had a great time 4th year.

Sure I had to work in the ER for 4 weeks which sucked and do an ICU rotation. But I have taken no call 4th year. In fact, the last time I was in the hospital past 1pm was back in October. I basically made the easiest 4th year schedule that was possible, with the minimum number of hours to see patients. I'll have spent 2 months overseas doing international electives/vacation as well.

I'll agree spending a ton of money on interviewing wasn't fun (~5k), but all of the traveling was fun. The interviews are really low stress and easy for what I'm gonna do also. Just show up and have small talk/conversation for 30 to 45 mins. The endless "do you have any questions?" can get annoying though.

I had some people tell me to do some difficult rotations 4th year in order to 'keep sharp.' I totally disregarded that advice and went 'as easy as possible.' I'm really glad I did. Intern year will be here soon enough.

meister · Feb 14, 2009

getunconcsious said:
-USMLE Step 2 CS, which is a misery. And then they make you wait three months to find out if you failed this turkey (which more and more AMG's seem to be doing!). So I get to find out on April 1, which if I failed will mean that it'll hold up my license and possibly even get me dismissed from residency despite the fact that I'll have already matched.

This is just absolutely unacceptable. There is no reason why they can't have this early in the year, grade it quickly so you find out the results, and have a second round for those that failed, all in time for match day.

Why the **** does it take these people so long to grade tests? They cut MCAT scoring down from 8 weeks (****) to 4, they should be able to cut down on step 2 CS so that it doesn't throw a live grenade right in the middle of someone's life. I can only imagine what my wife would do if we had already started making plans to move somewhere for residency and I find out I failed the CS test.

I mean the goddamned thing is P/F, WHY DOES IT TAKE SO LONG TO GRADE?!

MeowMix · Feb 14, 2009

meister said:
There is no reason why they can't have this early in the year

you can take CS as early as you like. If you choose to take it so late that it imperils your starting your residency program, it's your own damn fault.

SoCuteMD · Feb 14, 2009

waldenwoods said:
One of the nice things that has come out of this very tiring interview process is that I have met so many people who are really passionate about their patients' well being. It's so interesting to hear about the unique things they've done because they believe so strongly in helping to make a difference.

Please tell me you are kidding!

MeowMix said:
you can take CS as early as you like. If you choose to take it so late that it imperils your starting your residency program, it's your own damn fault.

You can take CS as early as you like...as long as you have the money to register for it in time. I scheduled it back in May and the earliest I could take it at the closest testing site was December. I eventually got a spot in October, but only after haunting my computer/availability emails for a couple days!

smq123 · Feb 14, 2009

meister said:
This is just absolutely unacceptable. There is no reason why they can't have this early in the year, grade it quickly so you find out the results, and have a second round for those that failed, all in time for match day.

Why the **** does it take these people so long to grade tests? They cut MCAT scoring down from 8 weeks (****) to 4, they should be able to cut down on step 2 CS so that it doesn't throw a live grenade right in the middle of someone's life. I can only imagine what my wife would do if we had already started making plans to move somewhere for residency and I find out I failed the CS test.

I mean the goddamned thing is P/F, WHY DOES IT TAKE SO LONG TO GRADE?!

Well, even though it's P/F, there are a lot of components to grade. There's the actual written portion of it (where you write a fake H&P), the communication portion of it (which, in borderline cases, needs to have someone review a videotape of your test), and the "empathy" portion of it. 🙄

Plus, there's a huge bottleneck - they offer the exam almost daily, but only at a handful of spots in the country, which is another HUGE gripe about this stupid exam. This also makes rescheduling the exam extremely difficult, because the schedule is so packed.

The people who are most likely to fail this (besides FMGs who can't speak English well) are the people going into ortho/ENT/derm/neurosurg - i.e., the "best and the brightest." This is because most of them take this in the middle of 4th year, when they haven't done any outpatient clinic primary care stuff in months.

I tell people to take the exam at the end of 3rd year, instead of in the middle of 4th year. There is no rule or requirement that says that you MUST be a 4th year when you take this exam. As soon as you have your family med, IM, peds, and outpatient OB/gyn rotations out of the way, take the darn exam. I took it at the end of my 3rd year, found out that I passed in the beginning of 4th year, and haven't thought about it since (well, except to complain about it on SDN 😉).

meister · Feb 14, 2009

smq123 said:
I tell people to take the exam at the end of 3rd year, instead of in the middle of 4th year. There is no rule or requirement that says that you MUST be a 4th year when you take this exam. As soon as you have your family med, IM, peds, and outpatient OB/gyn rotations out of the way, take the darn exam. I took it at the end of my 3rd year, found out that I passed in the beginning of 4th year, and haven't thought about it since (well, except to complain about it on SDN 😉).

Good information, thanks. I'll definitely keep that in mind and try to schedule it as early as possible, although I must admit I'm not sure how I'm going to pay for it without calling up mom or dad (ugh).

Having it be all over the country and nowhere near me is pretty sad. They have computers grade MCAT essays now, I still say they could bang out a P/F for most people in a few days tops. The only excuse they have with the other step exams is that they have to normalize it, but not so with this. As far as the communication section, just have the damn standardized patient give you a P/F and have a physician observer give the thumbs up or thumbs down.

How long does it normally take to get your results? I admit I rushed into outrage mode a bit early.

getunconcsious · Feb 14, 2009

MeowMix said:
you can take CS as early as you like. If you choose to take it so late that it imperils your starting your residency program, it's your own damn fault.

That's an unfair statement. Because of all the goddamned FMG's taking it, it's outrageously hard to get spots to take the test between July and October. Then you don't want to put it in November or December b/c of interviews. I took it on January 3rd, that's plenty early and only halfway through the school year. It's THEIR fault, not mine, that this could imperil me starting residency. You really should think before you make thoughtless comments that hurt peeps' feelings. :cry::cry::cry:

smq123 · Feb 14, 2009

getunconcsious said:
That's an unfair statement. Because of all the goddamned FMG's taking it, it's outrageously hard to get spots to take the test between July and October. Then you don't want to put it in November or December b/c of interviews. I took it on January 3rd, that's plenty early and only halfway through the school year. It's THEIR fault, not mine, that this could imperil me starting residency. You really should think before you make thoughtless comments that hurt peeps' feelings. :cry::cry::cry:

😳

getunconcsious - I normally love your posts. I really do. I agree with your rants about med school and 4th year, in particular.

But I think this post is a little unfair itself.

It's no secret that you need to register MONTHS in advance to take Step 2 CS. It's not just the FMGs, but all the other med students in the country, who need to take this exam and clog up the testing centers.

In order to take it in May, I registered in January. Spots were filling up even then. Some of my classmates watched that website like hawks, waiting for spots to empty up so they could jump on it. And we live in Philadelphia, which is the site for the ECFMG office, and therefore attracts even MORE FMGs than Houston does.

Furthermore, you could have taken the test in May or June. No need to wait for July, August, September, or October. I was about 80% finished with my last rotation of 3rd year when I took it, and I figured that that was good enough.

I agree that Step 2 CS is a waste of time and money. But, there are ways around the inconveniences, for the most part.

meister said:
How long does it normally take to get your results? I admit I rushed into outrage mode a bit early.

I took it in late May and got my results back in July or August. I think it takes about 2-3 months, but I may be remembering incorrectly. It's a surprisingly long time, though.

Definitely schedule it EARLY - 6-7 months before you plan on taking it.

rka · Feb 14, 2009

well, when you become an intern, you'll realize just how awesome 4th year was :smack:

rockit · Feb 14, 2009

Having a bad 4th year is a scheduling problem. Take your step 2 (both parts) early and get any difficult requirement done by Christmas. Also, pick stuff you like or stuff like ophtho where nobody cares if you show up.

It's all about scheduling.

beavis · Feb 15, 2009

4th year is the ****....get all the hard rotations done early.

MeowMix · Feb 15, 2009

hey, I felt the CS financial pain. I scheduled months in advance. Then my sister decided to get married, and in August I had to change dates 3x. I had MULTIPLE choices for dates in Sept and Oct (you have to be willing to travel at short notice). It's a pain and it's expensive, but it's possible. Do not blame the FMGs.

OrnotMajestic · Feb 15, 2009

MeowMix said:
you can take CS as early as you like. If you choose to take it so late that it imperils your starting your residency program, it's your own damn fault.

Thank you. It's ridiculous that anyone would claim that FMG's impede the taking of the exam. CS is awful and pointless, I think we all agree...but just put on your pink tu-tu and leap through the flaming hoop on the stage like everyone else. I registered last February and had my choice of dates. I took CK in July and CS in August and didn't have any trouble scheduling either.

So far, 4th year has been the greatest thing that has ever happened to me. I got to spend a month in Nigeria, catch a ton of babies on my MFM rotation (I'm going into OB/GYN) and basically take every slacker rotation available. I refuse to take call, leave early, skip work and basically just grow stupider as the year proceeds. Interviews are done (I did 16, which did suck....but I got to miss a ton of my required IM rotations, even though we aren't technically "allowed". I just made friends with the chief resident) and my rank list is certified. So far since October, I haven't stayed past 2pm on ANY rotation. I know this is all school dependent....but so far, I arranged my schedule to suit me and what I wanted/didn't want to do.

ih8biochem · Feb 15, 2009

I took my CS in May as well. Registered in Jan. Best decision I made for my 4th year. Also took CK in July. I remember my IM and surg sub Is being murder but that memory has faded. Interview season was a blast, can't see how you could have a s**ty attitude toward it. Hang in there. When you no longer have the steps and required rotations hanging over your head, you will also find nirvana.

getunconcsious · Feb 15, 2009

What? You mean we CAN'T just reflexively blame any and all problems on FMG's? I must've missed a memo or something...

Anyways my main problem with the test is how long it takes them to grade it, rather than the scheduling issues which are also a thorn in the side. It really should not take 3 months to grade a pass/fail exam of any kind.

I suppose I have a $h*tty attitude towards most things, and am good at focusing on the downsides. What can I say, it's a gift. 😀

Maybe once the match is over I will be happy for a day or two until I start spending the whole time dreading internship and freaking out about having to move.

OrnotMajestic · Feb 15, 2009

getunconcsious said:
It really should not take 3 months to grade a pass/fail exam of any kind.

I couldn't agree more. It bugged the absolute crap out of me that I paid in excess of a grand for a P/F test that I had to travel out of the state for so that I can wait months for results.

I heard a rumor that they are dropping CS soon. Anyone else hear this?

pmpkn219 · Feb 15, 2009

I've heard they may change it if they adopt that post-3rd year StepI/II combined mega-test. But the quote implied they would "replace it with something of equal caliber"... which sounds like not dropping it at all.

They really have no impetus to drop it- I don't know how much it costs to hire the SPs and rent the space x 5 locations, but there's an Awful lotta students pay a grand to take it = cash cow to me. Maybe I'm a little jaded...

waldenwoods · Feb 15, 2009

SoCuteMD said:
Please tell me you are kidding!

I was being serious. Ive met a lot of people who have done things that I thought were pretty cool. While not all of the things they do are unique, I have met plenty of passionate doctors on the interview trail.

-- One recently graduated general pediatrician who works in a clinic in an urban underserved area, who would rather see some of the kids come in to her clinic for answers/help rather than see them go elsewhere.
-- Several people who have spent time going to talk state legislators about issues they see as interfering with kids' health and/or well being. They do not get paid for it, but choose to spend their time doing this. One of them has started programs for early childhood intervention as well as for children who are victims of abuse/violence and has demonstrated that these programs have measurable benefit.
-- People who were pioneers in a subspecialty field. When they finished residency, fellowships didnt yet exist that matched up with their interests (for example, child abuse/neglect and anesthesia/pain management). While I was listening to them talk, I could sense their passion for the specialty and unreserved empathy for kids who arent meeting their milestones/suffer abuse or kids who have chronic pain. Both have made substantial contributions to their fields.

If you take a moment to reflect on your interview experiences, haven't you admired something that someone else has done? Just one thing?

Anyone?

getunconcsious · Feb 15, 2009

waldenwoods said:
I was being serious. Ive met a lot of people who have done things that I thought were pretty cool. While not all of the things they do are unique, I have met plenty of passionate doctors on the interview trail.

-- One recently graduated general pediatrician who works in a clinic in an urban underserved area, who would rather see some of the kids come in to her clinic for answers/help rather than see them go elsewhere.
-- Several people who have spent time going to talk state legislators about issues they see as interfering with kids' health and/or well being. They do not get paid for it, but choose to spend their time doing this. One of them has started programs for early childhood intervention as well as for children who are victims of abuse/violence and has demonstrated that these programs have measurable benefit.
-- People who were pioneers in a subspecialty field. When they finished residency, fellowships didnt yet exist that matched up with their interests (for example, child abuse/neglect and anesthesia/pain management). While I was listening to them talk, I could sense their passion for the specialty and unreserved empathy for kids who arent meeting their milestones/suffer abuse or kids who have chronic pain. Both have made substantial contributions to their fields.

If you take a moment to reflect on your interview experiences, haven't you admired something that someone else has done? Just one thing?

Anyone?

Of course, I agree. I have met a few attendings and even fellows and residents who seemed genuinely interested in finding a niche to make a difference. My experiences were very very similar to yours b/c we're interviewing for the same specialty. And don't get me wrong--it IS refreshing to see it. It's just that these inspirational type things take up oh, about 2% of the interview day and the rest is all lies and bullcrap and having to be fake.

TOXOSIS · Feb 17, 2009

If you take rotations in clinics without residents that upperclassmen have told you have a 3-hour-per-day or 3-day-per-week schedule - you will LOVE 4th year. You are about to graduate medical school and don't have to do ANYTHING (except for the required ER rotation) that you don't want to. It has been the best year of my entire educational career BY FAR! 👍

BigRedBeta · Feb 18, 2009

seriously...maybe I could see, if you took 4th year as a completely isolated experience without the first three years of med school to compare to, it's not that great...but since it's not - holy cow it's been awesome.

As others have said, it's scheduling.

During this year I've:

gone to Lollapalooza which included a ridiculous set by Radiohead as fireworks were going off from the Field Museum overhead...
did an away rotation where I found out my ideal specialty
while on my away rotation got to spend a month living with one of my best friends
was able to get football season tickets to my alma mater and scheduled rotations that would allow me to go to every home game
visit several old friends while traveling for CS or on the interview trail
meet a lot of amazing people on the interview trail - it's awesome to meet people who want to do the same things you do
got to see parts of the country I've never been to before
did a rotation in Australia and because of my schedule was able to take extra time in Sydney and other parts of the country
get to build skills that will help me as an intern next year

Seriously, other than senior year of college (actually just post acceptance senior year), this has been the most amazing year. Yeah there's a little stress and I worry about the possibility of not matching and CK and CS were a pain, but in the overall scheme of things...ridiculously awesome. Oh and I'm thankful that my school doesn't have any required rotations during the fourth year...that's a big help.

yaah · Feb 18, 2009

The above is a good point, except for the fact that you are paying (probably) tens of thousands of dollars in tuition, living expenses, etc, all for the privilege of doing the above. It would cost tens of thousands less to take a year off and still do all of that stuff. There are also the "lost" expenses of a future year of income that is lost because of the year of wandering around. This appeals to a lot of people. I get it. But not to others.

I hated fourth year because 75% of it was worthless, and the 25% that was not worthless could have been replaced by eliminating extended vacations (like summer break) in the first three years. It was a waste of a year's tuition and of my future earning potential. I realize that it is "fun" to go through different specialties, and is also educational, but it is also not that necessary for most people. I enjoyed my extra rotations. They taught me a lot. But I could have designed my own med school curriculum and still fit them in in much less time.

If I could change med school scheduling, I would eliminate the second half of fourth year and have residency start sooner than July 1. The problem is though that too many people seem to enjoy the privilege of spending tens of thousands of dollars to have a relatively leisurely year and do cake rotations that have little to do with their chosen field. I agree it is important to have some less busy rotations to provide an opportunity for self growth and study, as well as relaxation. But in my view, it's harder to justify this when you're paying through the roof for that privilege.

smq123 · Feb 18, 2009

yaah said:
The above is a good point, except for the fact that you are paying (probably) tens of thousands of dollars in tuition, living expenses, etc, all for the privilege of doing the above. It would cost tens of thousands less to take a year off and still do all of that stuff. There are also the "lost" expenses of a future year of income that is lost because of the year of wandering around. This appeals to a lot of people. I get it. But not to others.

I hated fourth year because 75% of it was worthless, and the 25% that was not worthless could have been replaced by eliminating extended vacations (like summer break) in the first three years. It was a waste of a year's tuition and of my future earning potential. I realize that it is "fun" to go through different specialties, and is also educational, but it is also not that necessary for most people. I enjoyed my extra rotations. They taught me a lot. But I could have designed my own med school curriculum and still fit them in in much less time.

If I could change med school scheduling, I would eliminate the second half of fourth year and have residency start sooner than July 1. The problem is though that too many people seem to enjoy the privilege of spending tens of thousands of dollars to have a relatively leisurely year and do cake rotations that have little to do with their chosen field. I agree it is important to have some less busy rotations to provide an opportunity for self growth and study, as well as relaxation. But in my view, it's harder to justify this when you're paying through the roof for that privilege.

YES. This is so true.

It's great that people got to take a month off and travel a lot....but not everyone has the money for that. And I honestly think that it's somewhat hypocritical for med schools to stress that it's important, as residents, to spend our money carefully and pay back our debt in a timely manner....when that 4th year of med school is such a huge financial drain.

There were 2 rotations that were genuinely useful that I would not be able to do as an intern. That's about it.

And I'm tired of "cake" rotations that have nothing to do with my future field. I picked a field, I'm going to stick with it, and I'm antsy to start LEARNING about the day-to-day practice of that field.

pmpkn219 · Feb 18, 2009

The money point is a good one!

I have definitely made my 4th year heavy on electives in my field, and I have been learning stuff through them. It's nice to learn at my leisure though (as someone else said) without the 'threat' of a Shelf hovering every 8 weeks... I think it's made it easier for me to focus my reading on what I'm doing now, whereas before if I saw RSV bronchiolitis 7 days a week... I couldn't read about it that long- there was other material to cover!

BigRedBeta · Feb 19, 2009

yaah said:
The above is a good point, except for the fact that you are paying (probably) tens of thousands of dollars in tuition, living expenses, etc, all for the privilege of doing the above. It would cost tens of thousands less to take a year off and still do all of that stuff. There are also the "lost" expenses of a future year of income that is lost because of the year of wandering around. This appeals to a lot of people. I get it. But not to others.

See, I look at it and say that I was able to do all those things because I was taking out all those loans. If I were to take a year off, I'd have to support myself and get a job. More than likely, anything that was going to pay well enough, fast enough to allow me to do all these things when I wanted to, wasn't going to be open to me or wouldn't have hired me for 6 months. Any job that I could have gotten on short notice with the required flexibility (like waiting tables) wouldn't have paid enough to allow me to do all these things.

And again, this year has been awesome, but almost entirely because of context. I LOVED third year but mainly because first and second year were absolutely miserable, but on it's own, third year was still not that great of year. For sure, every year of college was better than fourth year has been.

vtucci · Feb 22, 2009

I agree. I cannot wait for this year to be over. I found it very stressful and ultimately, not that helpful.

I, however, have always known what field I planned on entering- emergency medicine. I do think 4th year is helpful for those who still don't know or who haven't had exposure to certain fields (anesthesia, rads, ophtho etc).

At this point, I wish I knew for certain where I am going to match. The fact that this antiquated system of getting a job/residency really annoys me. Not to mention the huge amount of money it costs to interview all over the country. I have worked in the real world where you apply for a position and interview and if you are offered a job, you accept. Why does this need to be a 6 month plus process to get a job? I really am looking forward to life after residency.

I also agree that the CS is a complete waste of time and money for anyone who speaks english as a first language.

UCLAstudent · Mar 1, 2009

I love fourth year. I'm working 12 hours (3 half-days) per week right now on outpatient allergy. 😀 It's nice to veg before intern year starts.

Waiting for Match Day is stressful, though.

meister · Mar 1, 2009

vtucci said:
Why does this need to be a 6 month plus process to get a job? I really am looking forward to life after residency.

Soon you'll be treated like an adult, very soon. (maybe not)

Ashers · Mar 1, 2009

UCLAstudent said:
I love fourth year. I'm working 12 hours (3 half-days) per week right now on outpatient allergy. 😀 It's nice to veg before intern year starts.

Waiting for Match Day is stressful, though.

Nice hours. I'm starting outpatient allergy tomorrow, and my hours are basically 8:30-5pm, with a late clinic (7pm) 1 day a week. I guess it's my fault that I changed my schedule so I could have April off to go look for a place to live, and I couldn't get transfusion medicine in March.

I agree CS is a waste of money. As for time of score release, on their website, they give a list of date ranges for when scores will be released. I was in the 1 Nov-31 Dec (approx dates), and the release dates were something like 28 Jan-some time in March. I took it on 4 Nov, and my score was released on 28 Jan. My friends who took it later in November got their score the same day I did too.

I just finished my required medicine sub-I which sucked since I'm not going into medicine, but I guess I did learn how to write orders, since I never did that on any rotation before. Fortunately, it was in the shortest month.

The fun stuff I got to do this year:
-Away rotation at home in Hawaii
-Miss a few days of a rotation to fly to homecoming (I'd never ask to do that as an M3)
-A couple road trips -- fun!
-Hang out with friends on interview trips and go to places I've never been before.

PeepshowJohnny · Mar 1, 2009

There ARE a few rotations at our place that have the stand "Just because you're a fourth year, you're still a medical student" and expect you to pre-round and do weekends and call...thankfully very few of them are "required." I can somewhat respect this view, but the problem is, you're given no increased anonymity than a third year would be.

UCLAstudent · Mar 1, 2009

Ashers said:
Nice hours. I'm starting outpatient allergy tomorrow, and my hours are basically 8:30-5pm, with a late clinic (7pm) 1 day a week. I guess it's my fault that I changed my schedule so I could have April off to go look for a place to live, and I couldn't get transfusion medicine in March.

It was actually a complete surprise to me because the syllabus said that the hours would be 9 to 5 every day.

bbake87 · Mar 2, 2009

Maybe 4th year does vary from school to school, but for me it was a time of unparalleled joy and wonderment. As one of the posters stated above, get your hard rotations done early. Also, boards are much less stressful than Step 1 (for me anyway). After your first few interviews, they are not that bad (more of a nuisance than anything). Agreed, it is not the fun waiting for match day, but after you submit your rank list, it is out of your hands so enjoy glorious 4th year. Please PM me with any ?'s about the Nirvana that is 4th year.

NPR · Mar 3, 2009

Definitely get your easy rotations done early. 4th year has been a joy so far because I frontloaded with easy.

Currently doing my subI. Nothing like working 12 hour days to make you appreciate missing days for Match week.

Fortunately, the days are so long that my call days (q4) are no big deal. I work 7-7 but call takes me until 8pm instead of 7pm. Brutal.

The worst part is trying to fill the downtime. Not allowed to leave the hospital. Not allowed to access outside websites. I've resorted to napping in the library.

Ashers · Mar 3, 2009

NPR said:
Definitely get your easy rotations done early. 4th year has been a joy so far because I frontloaded with easy.

Currently doing my subI. Nothing like working 12 hour days to make you appreciate missing days for Match week.

Fortunately, the days are so long that my call days (q4) are no big deal. I work 7-7 but call takes me until 8pm instead of 7pm. Brutal.

The worst part is trying to fill the downtime. Not allowed to leave the hospital. Not allowed to access outside websites. I've resorted to napping in the library.

On my medicine sub-I last month, I had to do that too. My main hospital blocked facebook and outside emails. That's when my blackberry came in handy. I found out at the end of the month they had not blocked youtube. =)

NPR · Mar 3, 2009

Ashers said:
On my medicine sub-I last month, I had to do that too. My main hospital blocked facebook and outside emails. That's when my blackberry came in handy. I found out at the end of the month they had not blocked youtube. =)

Oh I tried it all today. Facebook, youtube, entertainment sites, sports sites, game sites, even most forums (not SDN though)

I'm actually leaving early tomorrow to pick up a Blackberry. It'll save my sanity. :laugh:

pdp2001 · Mar 4, 2009

i will admit, this year is a little anticlimactic once everything's done, but it's all about scheduling.

frontload, i was finished by oct. took 2.5 months off to interview and chill the hell out all over the country.

i have found those 9-2 electives that also don't know when you're supposed to come in - radiology, ekg, and anesthesia. welcome to 3-4 months of awesomeness. plus it's only 3 hours of actual learning since they have fantastic lunch breaks.

ranmyaku · Mar 4, 2009

NPR said:
Definitely get your easy rotations done early. 4th year has been a joy so far because I frontloaded with easy.

Currently doing my subI. Nothing like working 12 hour days to make you appreciate missing days for Match week.

Fortunately, the days are so long that my call days (q4) are no big deal. I work 7-7 but call takes me until 8pm instead of 7pm. Brutal.

The worst part is trying to fill the downtime. Not allowed to leave the hospital. Not allowed to access outside websites. I've resorted to napping in the library.

Why would you do easy rotations early? doesn't make any sense. Get the hard stuff out of the way first. Do step 2 ck and cs early. Then you have the rest of the year to chill. I would hate to go from 3rd year -> easy -> then back to working like a 3rd year.

vtucci · Mar 4, 2009

meister said:
Soon you'll be treated like an adult, very soon. (maybe not)

I'm already treated like an adult. I also had a previous career so this system of employment is a little annoying to me. Looking forward to the match.

Good luck everyone.

NPR · Mar 5, 2009

ranmyaku said:
Why would you do easy rotations early? doesn't make any sense. Get the hard stuff out of the way first. Do step 2 ck and cs early. Then you have the rest of the year to chill. I would hate to go from 3rd year -> easy -> then back to working like a 3rd year.

1. everyone tries to do their subi early

2. i got married in that time, always nice, even took a month off for honeymoon

3. in the end, it's still 4th year. i'll miss a couple of days for match, leave a couple days early (really? they're going to dock me points? who cares? are they really going to fail me beaause i missed afternoon rounds a couple of times?)

4th year: it's just not that great

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