MS1-3 = Hell, M4 = Heaven. Why?

[The Angriest Bird]

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Has anyone ever wondered why this system is designed in this way? Why can't we shift some of the stress towards 4th year? Instead, I heard people spending half the 4th year on traveling, slacking off, so they forget everything they've learned before entering residency where they actually take care of patients.

 

[AlleghenyPOD]

Because they can.

 

[45408]

You WILL need a fair amount of time to do your interviewing, for one.

 

[Tired]

Has anyone ever wondered why this system is designed in this way? Why can't we shift some of the stress towards 4th year? Instead, I heard people spending half the 4th year on traveling, slacking off, so they forget everything they've learned before entering residency where they actually take care of patients.

1) The main reason you aren't as stressed 4th year is that you've learned a substantial chunk of what you need to know: ie - how to function on the wards, how to write orders, common medical conditions. I'm not sure how you could transfer this stress to 4th year.

2) You don't forget how to take care of patients. Trust me.

 

[Flopotomist]

my thoughts - 70 years ago, my school graduated their first class after four years of schooling. 70 years later, we still take only four years in spite of the huge amount of information that has been learned. My proposed solutions...

1. Apply to medical school after 2 years of undergrad... then don't waste two more years studying french poetry or some such silliness.

2. Add a year or two to medical school. I know.. not a popular idea, but remember, we shortened undergrad.

That way, I can actually spend time learning the information well instead of feeling like I am sprinting a marathon.

 

[PeepshowJohnny]

It's your transition year. Your decision on how and where you want to match has far reaching implications. I'd much rather be able to focus more attention on those matters than have that stress on top of the hassle of studying for subject exams, Q4 call, honoring rotations etc.

 

[EMH]

If you think that is nuts, how about these schools that put the first two years into 18 months.

At least I heard there are some Caribbean schools that do this. I'd prefer to stretch it out at this point.

 

[smq123]

my thoughts - 70 years ago, my school graduated their first class after four years of schooling. 70 years later, we still take only four years in spite of the huge amount of information that has been learned. My proposed solutions...

1. Apply to medical school after 2 years of undergrad... then don't waste two more years studying french poetry or some such silliness.

2. Add a year or two to medical school. I know.. not a popular idea, but remember, we shortened undergrad.

That way, I can actually spend time learning the information well instead of feeling like I am sprinting a marathon.

Wouldn't the better idea be to just cut out some of the useless crap that a) never shows up on Step 1, b) never shows up in the wards, c) could easily be looked up in a reference text?

 

[Law2Doc]

my thoughts - 70 years ago, my school graduated their first class after four years of schooling. 70 years later, we still take only four years in spite of the huge amount of information that has been learned. My proposed solutions...

1. Apply to medical school after 2 years of undergrad... then don't waste two more years studying french poetry or some such silliness.

2. Add a year or two to medical school. I know.. not a popular idea, but remember, we shortened undergrad.

That way, I can actually spend time learning the information well instead of feeling like I am sprinting a marathon.

This is basically the way some foreign countries did or used to do it. The current US system came later and decided this model was not desirable. In a service industry such as medicine, well rounded, well read and more mature individuals are more desirable, so the french poetry silliness and extra years of "ripening" in college are actually key to creating the kind of physicians the US system has decided it needs. I don't know that the med school path can get abbreviated -- every year there is going to be more to know. Many residency paths are discussing increasing by a year to expand the training knowledge base.

As for better balancing out the load, the problem with playing with 4th year is that people need the ability to do away rotations, go on many interviews, study for and take Step 2 etc. So there will be people who need the free time. Also bear in mind that there will be people going into certain fields who don't take advantage of the lighter load and will be doing fairly intense rotations even in 4th year, to learn a bit more targeted info before starting their residency, maybe complete some research etc. You can't close off these options because some people choose to use the post-match time as a vacation.

 

[linuxizer]

If you think that is nuts, how about these schools that put the first two years into 18 months. At least I heard there are some Caribbean schools that do this.

Caribbean schools? There are some U.S. schools that do it too.... Penn, for instance. Duke compresses it down to 12 months.

Ari

 

[shreypete]

This is basically the way some foreign countries did or used to do it.

yes indeed, and some of the european medical schools (such as those in the UK, Poland etc.) still follow a similar system. For eg. in some polish medical schools (taught in english), they have 4 yr, 5yr, 6yr, and 7 yr. medical programs (4 yr. for students who have an undergrad degree; 5 yr yr. if they've done the basic sciences ; 6 yr. for the high school students as well as everyone else; and 7 yr. for those who want to combine their medical degree along with another degree such as social sciences or arts or whatever)...but most of europe follows the 6 yr. medical program.

 

[Hard24Get]

Caribbean schools? There are some U.S. schools that do it to.... Penn, for instance. Duke compresses it down to 12 months.

Ari

The first 2 years play very little role in learning to be a physician, it is all about clinical time, which Penn and Duke give you more of. 😎

BTW, 4th year looks breezy, but by the time you figure out what you want to specialize in (usually involves taking electives), do your specialty Sub-Is, figure out what residency programs you want, get your LORs and ERAS together, schedule and and attend an average of 15 interviews all over the country, study for and take step 2 CK and CS, match, take an elective or two you have always wanted, figure out how to move to your new place, and graduate, you will be glad that the actual clinical time is light. 😱

 

[45408]

The only pre-meds I know who had their full complement of physics and organic chemistry for the MCAT after 2 years were chemical engineering majors.

I knocked all my pre-reqs for the MCAT out of the way in my first two years (and then took the MCAT right after I turned 20), just because I knew I was going to be going to med school right from the start. Any time it's mentioned in pre-allo, a number of other people seem to have had the same idea. In addition, back in the "old days" of having the MCAT twice a year, if I'd had to re-take the MCAT, I would not have been behind schedule the way someone who takes the August MCAT for matriculation 12 months later is going to be.

 

[sendwich]

.

 

[AmoryBlaine]

Third year would not be so bad if you could start it with a fourth year mentality. Most of us spent half of our M3 year thinking that our grades depended on whether or not our ties looked nice, if we appeared appropriately enthusiastic, and whether or not we were beating the residents to the hospital.

Most of us are able to approach 4th year with a bit more incousiance. My first month of 4th year was hard as hell but I just had a better perspective on things.

 

[MyNameIsOtto]

So...I don't know about all medical schools but from what I've heard at my school throught the grapevine is that this "MS4 slacker mentality" might change at least a little...

Apparently the LCME is trying to push schools to have new, mandatory electives 4th year.

 

[montessori2md]

If they combine the Steps, or reorganize them, then schools could theoretically have more flexibility in how they present the material. But that's not going to come out of commitee for awhile.

Just imagine how much it would suck to fail Step I and II simultaneously😱

 

[enanareina]

So...I don't know about all medical schools but from what I've heard at my school throught the grapevine is that this "MS4 slacker mentality" might change at least a little...

Apparently the LCME is trying to push schools to have new, mandatory electives 4th year.

My school instituted new fourth year required rotations this year. There's ambulatory medicine (either IM or FM); critical care (surgical or medical ICU); sub-internship (most major specialties available); and a transition to residency month in March where we'll all take the Jurisprudence exam and hang out together until Match Day. There are 5 elective months and up to 2 months off (if you don't have to finish third year stuff).

Having required rotations in the middle of trying to interview, take Step 2 CS and CK, do aways that may overlap with your school's schedule, etc. is kind of a pain, as we're limited in how much time we take off. I would say that sub-internship and critical care are very useful rotations, though, so it's a decent trade-off. The elective months vary widely in toughness, but there's definitely a "you show up, you pass" mentality among the attendings and the students. After all, they were there, too.

 

[Sean2tall]

My school instituted new fourth year required rotations this year. There's ambulatory medicine (either IM or FM); critical care (surgical or medical ICU); sub-internship (most major specialties available); and a transition to residency month in March where we'll all take the Jurisprudence exam and hang out together until Match Day. There are 5 elective months and up to 2 months off (if you don't have to finish third year stuff).

Having required rotations in the middle of trying to interview, take Step 2 CS and CK, do aways that may overlap with your school's schedule, etc. is kind of a pain, as we're limited in how much time we take off. I would say that sub-internship and critical care are very useful rotations, though, so it's a decent trade-off. The elective months vary widely in toughness, but there's definitely a "you show up, you pass" mentality among the attendings and the students. After all, they were there, too.

Oooh I like that, especially the "transition to residency month." That sounds like a cool idea. We have 2 required SubI's (Fam, Med, Surg, OB, Psych, Peds), one of which must be Medicine, plus Emergency, and 2 vacation with 5 electives. I think the class after us has some different required things, maybe Rads?

Anyhow, I would not in any way want 4th year to be harder. As mentioned, you have to get all of your interviews in, get ready to move to where your residency is, take boards, etc. Also, a lot of the "easiness" is just that you know what you are doing compared to 3rd year.

 

[keeping-it-real]

So...I don't know about all medical schools but from what I've heard at my school throught the grapevine is that this "MS4 slacker mentality" might change at least a little...

Apparently the LCME is trying to push schools to have new, mandatory electives 4th year.

It's true, the slacker mentality of only working 40 hours a week must end. 4th year also needs more yelling and degradation. Any other 4th years sick and tired of people treating them as colleagues?

You guys do know that the reason healthcare is in a crisis is because for the last 70 years, all 4th year medical students haven't had rigid and strict schedules in place, right? RIGHT?!

 

[SnowTown]

Hell only has the letter 'e' and 'E' kinda looks like a backwards 3

And heaven has 'a' and 'A' kinda looks like 4

 

[PeepshowJohnny]

Do pretty much all schools have some sort of mandatory rural rotation during the fourth year? Just curious--it seemed perfunctory when I was interviewing.

Dear God, no. Yuck.

 

[Xandie]

My school instituted new fourth year required rotations this year. There's ambulatory medicine (either IM or FM); critical care (surgical or medical ICU); sub-internship (most major specialties available); and a transition to residency month in March where we'll all take the Jurisprudence exam and hang out together until Match Day. There are 5 elective months and up to 2 months off (if you don't have to finish third year stuff).

Having required rotations in the middle of trying to interview, take Step 2 CS and CK, do aways that may overlap with your school's schedule, etc. is kind of a pain, as we're limited in how much time we take off. I would say that sub-internship and critical care are very useful rotations, though, so it's a decent trade-off. The elective months vary widely in toughness, but there's definitely a "you show up, you pass" mentality among the attendings and the students. After all, they were there, too.

We have four required rotations during our fourth year: either ambulatory or inpatient medicine, depending on whether you do ambulatory as a third year, a medical acting internship, a surgical acting internship (yep, both), and an integrated selective. Plus 4 (or 5) electives and 3 (or 2) months of vacation, again, depending on what you do as a third year. The acting internships are rough months, but otherwise the year is still really nice. Electives are always easier than required months, since you're "electing" to take them, so I think some of it just has to do with having four electives instead of one.

I agree with most of the things people have said about why fourth year is easier though... in some ways, it's more stressful than the others, as the match has a whole out-of-control thing going. Plus, you're taking boards while rotating (unless you use a vacation month), and trying to schedule interviews around things.

 

[mountainman123]

If you think that is nuts, how about these schools that put the first two years into 18 months.

At least I heard there are some Caribbean schools that do this. I'd prefer to stretch it out at this point.

My school does this and it is no fun. The only reason they do is so we can do a 9-week rural FP rotation in some small crappy city in NM, and yes we have to do 4 more weeks of the similiar thing 4th year.