When does MS4 get sweet?

[Green Chimneys]

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All I heard during my 3rd year of medical school was how awesome MS4 would be. So far this couldn't be further from the truth.

1. I'm working just as many hours as last year. In July I was on a sub-intership in my chosen field. I worked 28 days straight, took q3 call without post call days, and put in 90+ hours a week every week. It was largely self inflicted, but I had no problem with it as the work was rewarding and the attendings noted my work ethic by offering letters unsolicited. However, since then I've been working 60+ in elective rotations not in my field. I've been asked to come in weekends and take call to serve no legitimate purpose to the team. I have been told to sit around and do nothing because "it's too early to send the medical students home yet." I run out of the hospital and dance a jig if I leave by 5PM.

2. The attendings don't have any desire to teach me since I'm not going in to their specialty. It's too late to lie like third year as I've already chosen my field and actually applied. I didn't take off the wall stuff that is totally unrelated, I chose every elective for a reason. There's plenty of stuff I could learn in my current rotation that would help me in my future profession, but apparently my attendings think that sending me off to their office to write up a bunch of disability claim notes is a better use of my tuition money. Even direct questions are often differed for "hold on I have to do xxx first, then we'll talk." I'm still waiting...

3. The ability to direct my own education has been virtually nil. On the first day of my last rotation I was told "here are some things you can do. Let us know what interests you and we'll get you involved." Apparently my requests were misinterpreted as "I'd like to spend every possible waking moment in the clinic." I am applying to a specialty which does virtually no clinic work, and I'd rather not be there. I'm all for helping the team when possible, but lets not act like I move things along faster in the clinic. My attending always asks the same things I do anyway, so in actuality I just slow the pace.

4. 4th year gives us the beloved stress of residency applications, the wonderful cost of driving or flying all over the country for interviews, and the pain of studying for step 2. How exactly is this better than a few shelf exams?

I'm sure I'll get some haterade about how I'm either a worthless medical student, or that I should cherish this time because intern year will be much worse. I don't doubt it will be, but where is this mythical 4th year that allows everyone to decompress before the hellish reality that is residency? I sure haven't seen it.👎

Maybe the spring will be better, but aside from #4 being out of the way, I don't see how things are going to change.🙁

 

[smq123]

Things get better in the late winter and in the late spring. In the late winter (February-ish), your rank list is in and there is basically nothing else to do for a while.

Early spring sucks because the Match is looming over your head.

Late spring becomes fun again. Attendings know that you don't care, and you can put in your time browsing apartment listings on the internet. I mean, at this point there's no one to impress really.

Summer kind of starts to suck again because intern year is coming like a freight train, you will likely have to move, etc.

Don't worry, a lot of fourth years feel the way that you do. I think that everyone's "fond memories" of fourth year are biased by memory....I also didn't find it to be the lovely golden land that everyone promised it would be.

To be honest, I haven't found intern year to be worse than MS4. Since you are actually responsible for patients now (and not just kind-of responsible), it's harder for attendings to blow you off. If there IS a serious lack of teaching on the attendings part, now there are people who actually care (i.e. your PD and the ACGME)....which was never the case for MS4. And, of course, you're getting paid. Getting paid to sit around and be ignored is still much better than PAYING to sit around and be ignored.

 

[meister]

And, of course, you're getting paid.

Can't wait for this, even if it's $10/hr at 80 hrs/week.

 

[Doctor Bob]

I'm sure I'll get some haterade about how I'm either a worthless medical student, or that I should cherish this time because intern year will be much worse. I don't doubt it will be, but where is this mythical 4th year that allows everyone to decompress before the hellish reality that is residency?

You're clearly a worthless medical student. You should cherish this time because intern year will be much worse. 4th year allows you to decompress before the hellish reality that is residency.


But seriously... the adage that 4th year is the best year of medical school is a generality. For a lot of people, the chance to do electives in the fields of your choosing make it better, the treatment by attendings because you're wise and experienced makes it better, and so on and so forth. If you aren't having that experience then you've just got sucky rotations and sucky attendings.

 

[Law2Doc]

If you have multiple sub-I's, and opt to take non-gut electives to actually learn something, and are doing the residency job search intensely, then yeah, the first half of fourth year can be your hardest year, in terms of hours and work. But generally you get to make some choices in terms of electives, so most consider that "better" than being thrown into eg OBGYN because it's a core. And once the match ends, and you are successful (assuming this is the case), you can become mentally relaxed -- and probably actually enjoy things, and not take everything so seriously.

 

[calvinNhobbes]

It was largely self inflicted

There's your problem. Just ease off the gas, just coast, no need to be first anymore, ease off, there ya go, feel better?

 

[Green Chimneys]

There's your problem. Just ease off the gas, just coast, no need to be first anymore, ease off, there ya go, feel better?

Done and done. Trust me, I have eased up a lot after that July rotation where I felt I needed to push myself. I definitely haven't been volunteering to go above and beyond recently, but I'll still do what is asked of me. I'll take work off the interns when I can not to make myself or them look better, but because I know how much their job sucks.

FWIW, I think just putting this frustrated post out on SDN has been good mojo for me. Aside from Monday, I've been pretty much chilling every afternoon and the mornings haven't been too rough either. The attending wants a couple 5 minute presentations on random topics a couple of times a week, but it's nothing I can't throw together in <30 minutes. I hope it continues!👍

 

[superflyDO]

After the audition rotations when you stop giving a F 😀

 

[Cerberus]

I agree with the OP. M4 year is a gigantic lie. The only awesome thing about it is that you get to do more rotations in your chosen field. Otherwise it is a major pain in the ass.
What is particularly annoying about it is that on your Sub-I's you function at the level of an intern, probably know as much as the fresh interns, but still have to hunt down cosigner if you want to give your pt a tylenol.

 

[45408]

It just got sweet this month for me, thank God. Yesterday was orientation from 9-10:15. That was it. Today, we had wheelchair day, which went from 9a-1p. And that was it. I've got the weekend off, and then I'll be at the medical examiner's office on Monday for probably just the morning. I can use the break.

 

[Pinkertinkle]

thanks for that essay Vasca

 

[Momentum70]

You already mentioned you have been overworking yourself doing some sub I stuff, and the first part of the year sucked for me as I did the same. I think it really starts to get better around now. After you have done you interview rotations and completed step 2. I know after I got my step 2 results it was as if a HUGE weight was lifted off of me. With nothing but electives left now, i know all i have to do is complete them and there are no more shelf exams or tests in the way. Also it sounds like you might not have chosen very good electives. I talked with a lot of friends in the class before mine when signing up to figure out which were good and which were not. You might want to ask around and switch some to ones that are more fun. This is our time to explore anything we want, and if you find attendings that just love teaching students, regardless of their chosen specialty, I think you will enjoy it a lot more.

 

[BigRedBeta]

When does it get better? When you start doing fun rotations. I mean, if you chose crappy, intensive rotations, then you're never going to get to decompress. But if you're taking advantage of the fact that expectations are lower, if you made sure to find the easy rotations, you're going to fun locations for aways (like going abroad). then 4th year gets great...

Or just wait until you start intern year and then 4th year gets sweet.

 

[Taurus]

I mentally checked out at the end of September last year after my last sub-I. I'm still having trouble checking back in since I'm doing a transitional year and I hate floor medicine with a passion. 😀