Rising 4th Year

[DarkBluMage]

I just passed my last Shelf exam for clerkships and I'll be taking Step 1 in May as well as sitting for Step 2 a few months later. I'm also debating taking Step 3 before I start my intern year. I've been feeling anxious about being prepared for Intern year. What are some tips or advice for how to prepare myself during 4th year? I know the learning curve is steep, but I want to go into residency as prepared as possible.

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[differentiating]

It may depend a little on what field you're going into. Learning the EMR at the hospital(s) you match to would be helpful, but ultimately isn't practical, as you won't know where you match until late in 4th year and can't exactly get exposure to an EMR not available at your rotation sites anyway. You'll have to do sub-Is, so do them seriously and try to have as much ownership of your patients as you can, but it won't be the same as actually being an intern. I'm pretty sure intern year is going to be a kick in the butt no matter what you do.

 

[DarkBluMage]

It may depend a little on what field you're going into. Learning the EMR at the hospital(s) you match to would be helpful, but ultimately isn't practical, as you won't know where you match until late in 4th year and can't exactly get exposure to an EMR not available at your rotation sites anyway. You'll have to do sub-Is, so do them seriously and try to have as much ownership of your patients as you can, but it won't be the same as actually being an intern. I'm pretty sure intern year is going to be a kick in the butt no matter what you do.

I’m going to apply Peds with the end goal of nicu or picu fellowship

 

[DarkBluMage]

It may depend a little on what field you're going into. Learning the EMR at the hospital(s) you match to would be helpful, but ultimately isn't practical, as you won't know where you match until late in 4th year and can't exactly get exposure to an EMR not available at your rotation sites anyway. You'll have to do sub-Is, so do them seriously and try to have as much ownership of your patients as you can, but it won't be the same as actually being an intern. I'm pretty sure intern year is going to be a kick in the butt no matter what you do.

Outside of taking ownership of my patients is there anything else concrete that I can work on? Is there anything you wish you would have done as a 4th year before becoming an intern?

 

[differentiating]

Outside of taking ownership of my patients is there anything else concrete that I can work on? Is there anything you wish you would have done as a 4th year before becoming an intern?

It's hard for me to say if I wish I'd done anything else as a 4th year because it was more than a few years ago now. I definitely would've done different rotations than what I ultimately chose, but otherwise I'm not sure there was much else to do.

The biggest things I learned intern year were probably a) how to become more efficient with writing notes, so I could finish before 11pm and also include more relevant information, b) how to prioritize between multiple tasks/pages/calls for attention, and c) what organization strategy worked best for me for both patient info and tasks needing completion. If you're able to make headway on any of these things as an MS4, it'll only benefit you, though I imagine there's a fair amount of all of these that really only comes from experience. In residency, one of my big struggles early on was getting comfortable putting my nickel down rather than offering options to the attending and letting them pick, but this really only improved for me as I felt more comfortable with my clinical knowledge base; still, you can practice saying what you think should be done, be it with your resident when you're preparing a presentation or with your attending.

If you're interested in peds, you could try and have a good pediatric exam established sooner rather than later, and get used to dosing meds in mg/kg. Try to do a few pediatrics rotations so you're at least a little familiar with the common peds illnesses you'll see. Make sure you can handle the general peds residency culture.

 

[RangerBob]

Step 1 is enjoy 4th year--it's a more relaxed/fun year.

I found it helpful to do one of my SubI's (we had two required) late--I did mine in March. Quite a bit of 4th year rotations are electives, many of which are lighter, some of which are actually just "fluff" (radiology... they sent everyone home by 11 or so). You don't want to go from working 3-4hrs/day and having no responsibility whatsoever to internship. At least to me, that's a tough adjustment. So having a serious rotation in the months preceding July 1 can be helpful to kick you back into shape, so to speak.

With that said, you still need to take it with a grain of salt. My theory was I'd have a tough rotation right before internship. Instead, my attending (and head of IM at that particular VA hospital) kept saying "I'm so impressed you showed up after Match Day!" and typically sent me home by 3 or 4pm. I showed up around 7, and had a few patients of my own though, so it was certainly better prep for intern year than my radiology elective.

It's helpful to use your time off for Nov/Dec/Jan for interviews (your specialty may skew earlier or later). If you don't have enough time off, this is where you schedule those fluff electives/self-study electives. Typically they're the most accommodating to last minutes interview changes/offers.

 

[DarkBluMage]

Step 1 is enjoy 4th year--it's a more relaxed/fun year.

I found it helpful to do one of my SubI's (we had two required) late--I did mine in March. Quite a bit of 4th year rotations are electives, many of which are lighter, some of which are actually just "fluff" (radiology... they sent everyone home by 11 or so). You don't want to go from working 3-4hrs/day and having no responsibility whatsoever to internship. At least to me, that's a tough adjustment. So having a serious rotation in the months preceding July 1 can be helpful to kick you back into shape, so to speak.

With that said, you still need to take it with a grain of salt. My theory was I'd have a tough rotation right before internship. Instead, my attending (and head of IM at that particular VA hospital) kept saying "I'm so impressed you showed up after Match Day!" and typically sent me home by 3 or 4pm. I showed up around 7, and had a few patients of my own though, so it was certainly better prep for intern year than my radiology elective.

It's helpful to use your time off for Nov/Dec/Jan for interviews (your specialty may skew earlier or later). If you don't have enough time off, this is where you schedule those fluff electives/self-study electives. Typically they're the most accommodating to last minutes interview changes/offers.

Thanks! I was definitely thinking of starting with harder electives and then taking the easier electives before intern year so I could feel rested. I didn’t think about how hard it may be to jump back into the fire after relaxing though.

 

[chord]

1. Take a deep breath. You are going to be fine. Almost everyone is
2. Don't take step 3 before intern year. It's not supposed to be a stressful exam and depending on your specialty, may have little to no relevance to your day to day practice.
3. The best way to prepare for intern year during M4 is to do everything you can to ensure you match in your preferred specialty at a program you like.
4. The best practical way to prepare for being an intern in terms of performance is to do a couple (not a lot) of tougher medical school electives with a higher degree of responsibility/autonomy. You say you're interested in pediatrics, so in my mind that means doing a NICU sub-I (or equivalent), PICU sub-I (or equivalent), and pediatric floor sub-I (or equivalent) - and take them seriously. That should be plenty of learning.
5. Make sure you take time to yourself. Post-rank list 4th year is the last time you'll have for quite some time to have a lot of free time without other significant obligations. Do something fun, decompress, don't stress out.

Good luck, but enjoy the year - 4th year of med school is great.

 

[DarkBluMage]

1. Take a deep breath. You are going to be fine. Almost everyone is
2. Don't take step 3 before intern year. It's not supposed to be a stressful exam and depending on your specialty, may have little to no relevance to your day to day practice.
3. The best way to prepare for intern year during M4 is to do everything you can to ensure you match in your preferred specialty at a program you like.
4. The best practical way to prepare for being an intern in terms of performance is to do a couple (not a lot) of tougher medical school electives with a higher degree of responsibility/autonomy. You say you're interested in pediatrics, so in my mind that means doing a NICU sub-I (or equivalent), PICU sub-I (or equivalent), and pediatric floor sub-I (or equivalent) - and take them seriously. That should be plenty of learning.
5. Make sure you take time to yourself. Post-rank list 4th year is the last time you'll have for quite some time to have a lot of free time without other significant obligations. Do something fun, decompress, don't stress out.

Good luck, but enjoy the year - 4th year of med school is great.

I was thinking of taking step 3 so I could go home and actually relax after work my intern year instead of studying for step 3. Super tired of feeling like I have no life. What’s the benefit of waiting until after intern year to take step 3?

 

[pinkowl250]

I was thinking of taking step 3 so I could go home and actually relax after work my intern year instead of studying for step 3. Super tired of feeling like I have no life. What’s the benefit of waiting until after intern year to take step 3?

I'm a first year peds resident. I would wait until you start residency to register for step 3. Depending on where you match, your program may cover some or all of the registration costs. Where I matched, we are encouraged to take it before December so we don't forget all of our adult knowledge, and thus they cover half the cost if we take it before December. If you have any other questions you can message me and I'll get back to you when I can!

 

[DarkBluMage]

I'm a first year peds resident. I would wait until you start residency to register for step 3. Depending on where you match, your program may cover some or all of the registration costs. Where I matched, we are encouraged to take it before December so we don't forget all of our adult knowledge, and thus they cover half the cost if we take it before December. If you have any other questions you can message me and I'll get back to you when I can!

Thanks! I’ll PM you