4th year is awesome

[DW]

I know, we've got the match and Step 2, et cetera, but I'm still loving life right now. I'm on a derm elective, and we finished at 1pm today.

who else is among the newly minted 4th year crowd?

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[xaelia]

Yep, I scheduled the easiest fourth year I could. I enjoy rotations where you could theoretically be in multiple places at once, meaning you don't technically have to be anywhere. If no one's looking for you, you can't be missing.

 

[cocoabutter]

I wholeheartedly concur. 4th year is the best EVER!

 

[Doctor Octopus]

Word. Finished my Medicine Sub-I ... smooth sailing from here.

 

[Sammich81]

I'm on my urology sub-i. Then anesthesia. Then outpatient derm when I finally get to move to the same city as my boyfriend (he graduated 2 years before me and is a resident). WOOHOOO

I tell you what though I've lost the 3rd year fire. This eager beaver is...uh...not so eager.

Is anyone still trying to decide what they're going to be when they grow up? My classmates and myself included are having fits about this.

 

[bearMD]

ditto. on radiology right now...get in at 8 try to stay awake then leave at 1. nice

 

[2TIM4:7]

4th year rocks so far. I'm doing path right now and I get in ~8AM and leave at ~5PM, BUT I'm going into path so the hours are fine. Plus, NO CALL!!! Sure beats surgery, IM and OB.

 

[DarksideAllstar]

Fourth year is going to make me the laziest bastard alive. I'm on Optho right now with a private practice surgeon. 3 days per week I'm in clinic trying to use the slit lamp seeing all the patients with the clinician, the other days we usually do 3-4 strabismus surgeries and then done by 11 am. Tomorrow we only have one case and she told me not to come in. The best part is that I haven't worked a full week yet. After Optho I've got anesthesia, rad onc, allergy and immunology, rads, a couple path electives, and derm. This year is gonna be sweet.

 

[Pox in a box]

4th year is so much better than 3rd so far. It's unreal how much more respect you receive as a sub-I than as a lowly MS-3.

 

[DarksideAllstar]

4th year is so much better than 3rd so far. It's unreal how much more respect you receive as a sub-I than as a lowly MS-3.

Sub-I? bah. My school doesn't require one and i'm going into path so I'm home free with regards to responsibility (and respect is overrated).

 

[Long Dong]

Sub-I? bah. My school doesn't require one and i'm going into path so I'm home free with regards to responsibility (and respect is overrated).

For some reason I always thought you were in the class of 2006.

 

[Pox in a box]

For some reason I always thought you were in the class of 2006.

Me too.

 

[DW]

Is anyone still trying to decide what they're going to be when they grow up? My classmates and myself included are having fits about this.

I'm still on the fence, but I may be headed into pathology. I have a few more electives to r/o some fields like gas.

I have a feeling this will be a recurring theme this year:

chief resident: "you can come to this lecture/journal club at 4:30 pm (or whatever time it is too late for me in the afternoon) if you're interested"

me: "uhh...i'm not really. see you tommorrow"

 

[DarksideAllstar]

For some reason I always thought you were in the class of 2006.

I actually was, but I took a year off between 3rd and 4th year to figure out what I was going to do with my life after my disillusionment with clinical medicine (or at least the specialties I was exposed to).

 

[DarksideAllstar]

I'm still on the fence, but I may be headed into pathology. I have a few more electives to r/o some fields like gas.

I had similar feelings at the end of my third year and was hesitant to make a snap decision after only one or two months of rotations in a field of interest early on in my fourth year. I was mainly considering radiology and pathology, so I spent a year basically acting as a poorly paid R1 in Pathology, which ultimately confirmed my decision to apply to path programs. I think medical education (at least at my school) is kinda screwed up. Your entire third year you participate in primary care oriented rotations (with the exception of GS), which is great if you plan on doing one of these (medicine without a doubt is a necessity in third year). Otherwise you have to choose a specialty at the beginning of your 4th year based on one month of exposure to it (then secure all letters of rec, etc in a brief period of tiime). Granted, this may be ok for some, or even most of students, but given the amount of people changing from one specialty to another during (or even after) residency makes me think that the system in place at most schools probably needs an overhaul with a little more freedom to explore other specialties earlier in the process, IMO.

 

[DW]

I absolutely agree, UCSFbound. My med school I think is a little more flexible than others with 3rd year scheduling (we only HAVE to to do medicine and surgery during 3rd year). But its tough doing all these rotations I could have told you before I started med school I had zero interest in doing (psych for one) and fitting in time to explore all the stuff I might be interested in. We haven't had someone go into family practice for like 5 years at my school, yet the rotation eats up a mandatory six weeks of your time with shelf exam, clinics, and a take home exam. Kinda wish I could shorten that commitment.

I had similar feelings at the end of my third year and was hesitant to make a snap decision after only one or two months of rotations in a field of interest early on in my fourth year. I was mainly considering radiology and pathology, so I spent a year basically acting as a poorly paid R1 in Pathology, which ultimately confirmed my decision to apply to path programs. I think medical education (at least at my school) is kinda screwed up. Your entire third year you participate in primary care oriented rotations (with the exception of GS), which is great if you plan on doing one of these (medicine without a doubt is a necessity in third year). Otherwise you have to choose a specialty at the beginning of your 4th year based on one month of exposure to it (then secure all letters of rec, etc in a brief period of tiime). Granted, this may be ok for some, or even most of students, but given the amount of people changing from one specialty to another during (or even after) residency makes me think that the system in place at most schools probably needs an overhaul with a little more freedom to explore other specialties earlier in the process, IMO.

 

[sophiejane]

You only have two required rotations in 3rd year? What about 4th year?

I'm personally a bit terrified at the prospect that nurses will be following my orders in <12 months, so my 4th year schedule is a little less cush, but that's just me...

 

[sophiejane]

Granted, this may be ok for some, or even most of students, but given the amount of people changing from one specialty to another during (or even after) residency makes me think that the system in place at most schools probably needs an overhaul with a little more freedom to explore other specialties earlier in the process, IMO.

I agree--there's no way to make a really informed decision about your future by the time you are 2 months into your 4th year. But rather than taking time away from core rotations like IM, peds, FP, surgery, etc...I think we should really revisit the way things used to be, i.e., a traditional internship.

It used to be that you applied for a specialty after your intern year, which makes a whole lot of sense,when you think about it. Yeah, it's an extra year, but look at how many people lose a year (or two or five) because they chose the wrong field?

Here's my radical idea that most people will probably disagree with: Medical school should be for learning the basics and becoming a solid intern with a wide base of knowlege. Intern year should be for figuring out what you really like to do. I think in our haste to hurry up and get out of residency, we have lost something really valuable--the time to make the most important decision of our professional lives.

Not to mention patient safety...how many interns are out there delivering babies and starting central lines when they never did either one in medical school? If 4th year was more like a long sub-I and less like a vacation,maybe there wouldn't be so much morbidity and mortality at teaching hospitals in the month of July...

 

[DW]

You only have two required rotations in 3rd year? What about 4th year?

The point is that we have two clerkships that we have to take during 3rd year, 12 weeks of medicine and surgery each. we have all the other required clerkships (psych, neuro, FP, ob/gyn, peds), but you can choose to take any one or more during 4th year if you really know you want to do an elective early in something. Most people end up putting off FP till 4th year.

 

[DarksideAllstar]

I guess this thread was bound to be hijacked...

But still, even if no one goes into FP... everyone has to do an intern year and you need to know all that basic stuff to survive it...rad onc, derm, and optho and getting out at 1 pm is nice but they ain't gonna help you at 3 am when you have 5 admissions...

I'm personally a bit terrified at the prospect that nurses will be following my orders in <12 months, so my 4th year schedule is a little less cush, but that's just me...

Pathology is the exception-- we are not required to do an internship year (therefore no admissions at 3AM, when I'll be in the middle of 8 glorious hours of sleep ). It is of little benefit to me as a pathology resident to have knowledge of admit orders for a patient in DKA (although I learned as a 3rd year), so I scheduled my 4th year with areas that I was interested in learning more about and in a few specialties that I would be working with (ie issuing pathology reports to) in the future. I would have scheduled an ICU month and other rotations accordingly if I was going into a patient care specialty.

It used to be that you applied for a specialty after your intern year, which makes a whole lot of sense,when you think about it. Yeah, it's an extra year, but look at how many people lose a year (or two or five) because they chose the wrong field?

It doesn't make any sense, and still impedes one from getting exposure to other specialties that lie outside of peds, IM, and surgery. First, is this intern year going to be surgery, IM, or peds? In this intern year, undoubtedly you will be doing a ton of scut and working the majority of your year in the ICU or general wards. You might get 2 electives during this year in which you can explore subspecialties. Now try and get time off during this intern year to interview (people who didnt match and scrambled into a prelim do this, but it aint easy). Other than providing an additional year of patient care experience in either IM, surgery, or peds I can't see how this *helps* you in deciding what specialty to pursue.

I am not arguing that we should not have exposure to the primary care fields, GS, and OB. In fact, I think my medicine rotation was probably the most helpful in terms of developing a differential, physical exam skills, and the like. I am arguing in favor of allowing a little more freedom to choose to do some subspecialty rotations during third year, along with medicine and surgery as requirements.

Anyway, that's my 0.10.

 

[DarksideAllstar]

If 4th year was more like a long sub-I and less like a vacation,maybe there wouldn't be so much morbidity and mortality at teaching hospitals in the month of July...

Do you have a link to an article that supports this statement?

 

[sophiejane]

It's not a hijack--we're still talking about 4th year schedules. Lighten up.

I don't have a link because I said "maybe"....if I had made an equivocal statement, I would have provided evidence. It's just a personal conjecture, nothing more, a "hmmm, what if?". Something to consider. However, if I cared enough to look for it (which I don't), I'm sure there is data about hospital M&M that spans the era of traditional internship into the increasing emphasis on specialization that we have today. There is documented evidence, however, that morbidity and mortality increases in July in teaching hospitals.

The traditional internship of the days of old was a rotating internship--not specifically peds, surgery,etc. You did it all. Much like an FP or IM resident does now.

Path is an exception, you are right. But not everyone is able to decide early on as you were. Maybe there are people who need to go through intern year to decide patient care is not for them. However...I have been told by more than one pathologist that having good strong experience in patient care and clinical diagnosis makes you a better pathologist.

No man is an island, after all...

 

[Sammich81]

I absolutely agree, UCSFbound. My med school I think is a little more flexible than others with 3rd year scheduling (we only HAVE to to do medicine and surgery during 3rd year). But its tough doing all these rotations I could have told you before I started med school I had zero interest in doing (psych for one) and fitting in time to explore all the stuff I might be interested in. We haven't had someone go into family practice for like 5 years at my school, yet the rotation eats up a mandatory six weeks of your time with shelf exam, clinics, and a take home exam. Kinda wish I could shorten that commitment.

My med school recently started something similar. 3rd year starts 2 or 3 months earlier and you only do core things--peds, IM, gen surg--no subspecialties. But then fourth year starts sooner so you can explore your interests more than, oh, July before you apply for residency. It's insane because if you wind up liking derm or ENT you're kinda hosed if you haven't already done some prep work looking into it.

The emphasis on primary care at my school is a mixed bag. I wouldn't have traded my medicine or general surgery rotations for anything, but doing outpatient peds for 2 wks, a month of family and a month of outpatient internal was overkill. I learned a lot of the same things, and I would rather have had that time to explore other areas that I knew I would want to pursue.

 

[sophiejane]

This is happening at other schools too--I know Baylor starts 3rd year in January or February instead of July. Maybe that's the answer--push back into the pre-clinical years...but I can't imagine having one second less to learn what I needed to learn in 2nd year...

 

[DW]

Hey, no serious debate in this thread!!! I'm trying to enjoy my afternoon off

 

[sophiejane]

Hey, no serious debate in this thread!!! I'm trying enjoy my afternoon off

oops...sorry...

now where were we?

Let's talk about whether it's better to nap on the couch or the bed, TV on or off?

 

[xaelia]

Let's talk about how much I missed the nice scenery at the gym when I was on IM. Ahh, Ophtho, I shall never leave thee.

 

[DarksideAllstar]

Hey, no serious debate in this thread!!! I'm trying to enjoy my afternoon off

Your afternoon off? ****, I've had the entire day off.

 

[Reaganite]

Your afternoon off? ****, I've had the entire day off.

That's nothing--i've had the last 3 months off (research electives )

 

[DarksideAllstar]

There is documented evidence, however, that morbidity and mortality increases in July in teaching hospitals.

Actually this is what I was interested in seeing references to. I should have clarified my original statement.

The traditional internship of the days of old was a rotating internship--not specifically peds, surgery,etc. You did it all. Much like an FP or IM resident does now.

This is fine, but I thought we were debating the merit of altering the third year curriculum in order to allow students (if they want) to have earlier exposure to non-primary care specialties (and thus make a somewhat more informed decision).

Path is an exception, you are right. But not everyone is able to decide early on as you were. Maybe there are people who need to go through intern year to decide patient care is not for them. However...I have been told by more than one pathologist that having good strong experience in patient care and clinical diagnosis makes you a better pathologist.

I took time off between third and fourth year in order to figure out what I was going into, so I dont know if I would say that I knew "early on" where I would end up. I took the time off so I wouldn't have to make a hasty decision. I agree with your point that having a solid clinical knowledge base is helpful in pathology, particularly understanding the patient care algorithm that is employed by clinicians once a particular diagnosis is made, however, I'm not sure that this by itself would warrant the re-implementation of an internship year (in the past to be BC/BE in pathology required an intern year), particularly with the degree of subspecialization that is occuring and the ability to find this information in journals, texts, etc.

 

[Dr. J?]

Is anyone still trying to decide what they're going to be when they grow up? My classmates and myself included are having fits about this.

Wow! I'm glad I'm not the only one losing sleep over this decision.

I concur with the sentiments that the current system for 3rd/4th yr students is complete BS.

WTF?!? Why do I have to languish on psych for 6wks, FP for 6wks and peds for 6wks during my third yr...when I am stone-cold-sure that I have no interest whatsoever in any of them!

OK, congratulations you're a 4th yr....you have 3 1/2 mos to confirm your future career choice, procure LOR's and complete your ERAS filings. Give me a f uki n break.

 

[Pox in a box]

I had similar feelings at the end of my third year and was hesitant to make a snap decision after only one or two months of rotations in a field of interest early on in my fourth year. I was mainly considering radiology and pathology, so I spent a year basically acting as a poorly paid R1 in Pathology, which ultimately confirmed my decision to apply to path programs. I think medical education (at least at my school) is kinda screwed up. Your entire third year you participate in primary care oriented rotations (with the exception of GS), which is great if you plan on doing one of these (medicine without a doubt is a necessity in third year). Otherwise you have to choose a specialty at the beginning of your 4th year based on one month of exposure to it (then secure all letters of rec, etc in a brief period of tiime). Granted, this may be ok for some, or even most of students, but given the amount of people changing from one specialty to another during (or even after) residency makes me think that the system in place at most schools probably needs an overhaul with a little more freedom to explore other specialties earlier in the process, IMO.

Great post!

 

[Pox in a box]

Not to mention patient safety...how many interns are out there delivering babies and starting central lines when they never did either one in medical school?

No kidding. This is a travesty.

 

[Long Dong]

Let's talk about how much I missed the nice scenery at the gym when I was on IM. Ahh, Ophtho, I shall never leave thee.

He'll yeah I actually have time to do cardio again. Man during ob and surgery I put on at least 10 pounds of straight fat eating junk from the cafateria, over eating the times I was able to get meal, not having the time to prepare healthy stuff to eat. My pants didn't fit me anymore, I had to unbutton the top of them to fit. Now I'm starting to fit back into them.

 

[sophiejane]

I know what you mean about the pants....hospital food is the ENEMY.

 

[Dr. J?]

I know what you mean about the pants....hospital food is the ENEMY.

8 lbs on surgery for me

 

[xaelia]

8 lbs on surgery for me

I lose weight when I don't exercise. But my muscle mass atrophies and migrates into an unsightly periumbilical bulge.

 

[VincentAdultman]

I lose weight when I don't exercise. But my muscle mass atrophies and migrates into an unsightly periumbilical bulge.

Lost 15-20 on surgery. Gained it all back on psych. Lost it again on medicine.

I looked like a cancer patient when I came home for break in June.

As for fourth year...

July- studying for Step 2
August- Ortho home rotaion
Sept- Away
Oct- Away
Nov- Radiology (yay)
Dec- Medicine Sub-I (doh)

A lot of work considering I got a good shot of not even matching in March.

 

[DW]

Lost 15-20 on surgery. Gained it all back on psych. Lost it again on medicine.

I looked like a cancer patient when I came home for break in June.

As for fourth year...

July- studying for Step 2
August- Ortho home rotaion
Sept- Away
Oct- Away
Nov- Radiology (yay)
Dec- Medicine Sub-I (doh)

A lot of work considering I got a good shot of not even matching in March.

sub I in december? thats going to make interviewing pretty tricky, no?

 

[Long Dong]

Lost 15-20 on surgery. Gained it all back on psych. Lost it again on medicine.

I looked like a cancer patient when I came home for break in June.

As for fourth year...

July- studying for Step 2
August- Ortho home rotaion
Sept- Away
Oct- Away
Nov- Radiology (yay)
Dec- Medicine Sub-I (doh)

A lot of work considering I got a good shot of not even matching in March.

Away rotation in what, ortho? Is that what your going into?

 

[mdphd2b]

I took time off between third and fourth year in order to figure out what I was going into, so I dont know if I would say that I knew "early on" where I would end up. I took the time off so I wouldn't have to make a hasty decision. I agree with your point that having a solid clinical knowledge base is helpful in pathology, particularly understanding the patient care algorithm that is employed by clinicians once a particular diagnosis is made, however, I'm not sure that this by itself would warrant the re-implementation of an internship year (in the past to be BC/BE in pathology required an intern year), particularly with the degree of subspecialization that is occuring and the ability to find this information in journals, texts, etc.

Hi UCSFbound,

Still sticking to the topic of scheduling, I heard that some people choose to do a Transtional Year after graduating to further explore specialty options. Wouldn't this be more useful than taking a year off before MS4? Just wondering about the pros/cons of this.

 

[Pox in a box]

He'll yeah I actually have time to do cardio again. Man during ob and surgery I put on at least 10 pounds of straight fat eating junk from the cafateria, over eating the times I was able to get meal, not having the time to prepare healthy stuff to eat. My pants didn't fit me anymore, I had to unbutton the top of them to fit. Now I'm starting to fit back into them.

Me too. I've dropped 25 since joining medicine.

 

[VincentAdultman]

Away rotation in what, ortho? Is that what your going into?

Yea, I have my sub-I in december. I've been told though that a lot of ortho programs don't send out interview invitations till late. So I have January off. With that said, I'm thinking of changing my sub I to later sice that's still pretty late.

 

[Sammich81]

Me too. I've dropped 25 since joining medicine.

How do you jokers lose weight on the hard rotations? The smell of the hospital crispy potato wedges and gooey mac'n'cheese are like a siren song...especially on tough call days when you hate the world.

I gained prob 5 lbs on surgery lost it on psych (phew)...

 

[VincentAdultman]

How do you jokers lose weight on the hard rotations? The smell of the hospital crispy potato wedges and gooey mac'n'cheese are like a siren song...especially on tough call days when you hate the world.

I gained prob 5 lbs on surgery lost it on psych (phew)...

Because I was also on my feet, running from one end of the hospital the other for whatever fun scut project I was doing. That and the fact that I was never in the gym and lost all my precious muscle mass.

 

[Pox in a box]

How do you jokers lose weight on the hard rotations? The smell of the hospital crispy potato wedges and gooey mac'n'cheese are like a siren song...especially on tough call days when you hate the world.

I gained prob 5 lbs on surgery lost it on psych (phew)...

Most of it was intentional...working out more and eating healthier.

 

[Fin-Nor]

hey dw,

you wouldnt believe what i saw on my peds rotation...

a person by the first name of "Darkwing." I **** you not. it was funny, at least to me.

btw, i loved that tv show back when it was on regulary.

 

[GoodMonkey]

well, DW, i'm liking 4th year, but no smooth sailing for me yet. i'm working my tail off (and have been since june) but it's a good kind - you know, where you're doing what you actually like, rather than suffering through rotations that are the death of you.

may: research (ok this was good.)
june: away ortho
july: home ortho sub I
aug: away ortho
sept: research
oct: gen surg subI
nov: EM (required)
then it eases up....
bony radiology
vacation month/interviewing
clinical anatomy month
pediatric pm&r
allergy

may 11, 2007: MD.

 

[DW]

G$!!! Long time no speak! Find me on IM sometime when you're not at the hospital.

Anyone planning an fun trips during 4th year? I have a month off before graduation, I'm thinking I might try to backpack in Europe

well, DW, i'm liking 4th year, but no smooth sailing for me yet. i'm working my tail off (and have been since june) but it's a good kind - you know, where you're doing what you actually like, rather than suffering through rotations that are the death of you.

may: research (ok this was good.)
june: away ortho
july: home ortho sub I
aug: away ortho
sept: research
oct: gen surg subI
nov: EM (required)
then it eases up....
bony radiology
vacation month/interviewing
clinical anatomy month
pediatric pm&r
allergy

may 11, 2007: MD.

 

[Woots32]

'Lo all.

Fourth year kicks third year's arse. Severely. With a paddle. Right now I'm on ER (actually sitting in the ED, trying to avoid being seen by anyone wanting me to do actual work). Next month I hang out w/ a family friend who'll let me be first assist on surgeries and catch some kids. (I'm going into OB. I love vaginas.) Then a sub-I (eep), but then I have NOTHING scheduled until January. No tests until then either. And in the spring, a month of "Literature, Poetics, and Medicine." I get 4 weeks a credit to read "The Kite Runner."

Love fourth year. Especially because I once again have time to waste on SDN.