I often read on here that 3rd/4th year are the worst, but why is that? I'm a nurse and loved actually going to clinicals to put a face to the book knowledge. I've loved every moment of patient care in the years I have been a nurse and feel that by 3rd year you will have already completed the grueling book work/boards, will be interacting with patients in a professional role, and figure it will be all down hill from there until graduation. Is it because of the need to please your instructors for recommendation letters or can anyone elaborate what exactly it is about 3rd-4th year that is worse than 1-2? Long hours? Thank you, I am just curious as I am not a med student yet, so your insight would be appreciated. I personally am both looking forward to/not looking forward to 1st year simultaneously because of how crazy I have read it will be! 😉
Why do I read on here that 3rd/4th year are the worst
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I think people with negative MS3 experiences are more likely to complain about it on SDN.
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You're working full-time and long hours trying to impress attendings or trying to stay out of everyone's way the entire day. Once you come home you realize you haven't really studied anything for months because you're too tired. You have a shelf coming up which your school made it impossible to honor. You do some passive studying, fall asleep on the computer, and wake up early to put on a fake smile again while convincing yourself that you don't need any honors in 3rd year.
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I don't think MS3/MS4 were worse than MS1/MS2 but I can tell you a few reasons why they suck.
You change rotations every 4-6 weeks, so as soon as you get used to something, you start doing something completely different, in a different specialty, often in a different hospital, with completely different people, etc. So basically you feel stupid the whole time, and need to adjust to a lot of changes very quickly and once you adapt you start all over.
You are working full time, which would be completely fine if you got to go home and enjoy life and sleep. However, once you get home you have to study for an exam that covers all of that specialty. That exam is a huge component of your grade and will determine whether you pass/fail or honors, which is a huge deal while applying to residency (for some specialties more than other but it definitely matters). You're so tired at the end of the day that it is super hard to study, so you end up spending your precious few days off of the month studying or you end up risking not honoring.
You are not only evaluated on your clinical knowledge but also you're basically being evaluated by your personality. Even if you have no interest in whatever specialty you are doing, you have to act enthusiastic at all times, act interested at all times, and basically be a suck up the whole time you're there. It's like you're constantly putting up a performance. I have been evaluated on the way I smile, how much I smile or not, my facial expressions, the tone of my voice, my personality, anything that you can think of. Usually my evaluations comment on how I need to completely change my personality (I am definitely more of an introvert so I tend to be on the quieter side and look things up by myself if I want to learn about a topic, which means that you will get poorer evaluations than someone who is super outgoing and asking questions all the time). You are being evaluated by your personality/performance at all times and again this score is vitals in determining whether you get honors or not. This is not only about getting a few letters of recommendations. This matters for every single rotation you do.
My being there contributes little to patient care so I rarely get the satisfaction of feeling like I did something useful.
Edit: forgot to add that you still have to take boards in MS3/MS4. Also MS4 is challenging because you have to be doing rotations (changing every month, putting on a performance to impress other people, studying for tests, taking boards) PLUS be working on your applications and traveling all over the country for residency interviews and being stressed about whether or not you'll match. Additionally, for some specialties you have to do audition interviews, which means you have to travel to another institution, be there for a month and basically work your ass off to impress everybody, and then do that several times over the years (specialty dependent but for some you need multiple aways).
You change rotations every 4-6 weeks, so as soon as you get used to something, you start doing something completely different, in a different specialty, often in a different hospital, with completely different people, etc. So basically you feel stupid the whole time, and need to adjust to a lot of changes very quickly and once you adapt you start all over.
You are working full time, which would be completely fine if you got to go home and enjoy life and sleep. However, once you get home you have to study for an exam that covers all of that specialty. That exam is a huge component of your grade and will determine whether you pass/fail or honors, which is a huge deal while applying to residency (for some specialties more than other but it definitely matters). You're so tired at the end of the day that it is super hard to study, so you end up spending your precious few days off of the month studying or you end up risking not honoring.
You are not only evaluated on your clinical knowledge but also you're basically being evaluated by your personality. Even if you have no interest in whatever specialty you are doing, you have to act enthusiastic at all times, act interested at all times, and basically be a suck up the whole time you're there. It's like you're constantly putting up a performance. I have been evaluated on the way I smile, how much I smile or not, my facial expressions, the tone of my voice, my personality, anything that you can think of. Usually my evaluations comment on how I need to completely change my personality (I am definitely more of an introvert so I tend to be on the quieter side and look things up by myself if I want to learn about a topic, which means that you will get poorer evaluations than someone who is super outgoing and asking questions all the time). You are being evaluated by your personality/performance at all times and again this score is vitals in determining whether you get honors or not. This is not only about getting a few letters of recommendations. This matters for every single rotation you do.
My being there contributes little to patient care so I rarely get the satisfaction of feeling like I did something useful.
Edit: forgot to add that you still have to take boards in MS3/MS4. Also MS4 is challenging because you have to be doing rotations (changing every month, putting on a performance to impress other people, studying for tests, taking boards) PLUS be working on your applications and traveling all over the country for residency interviews and being stressed about whether or not you'll match. Additionally, for some specialties you have to do audition interviews, which means you have to travel to another institution, be there for a month and basically work your ass off to impress everybody, and then do that several times over the years (specialty dependent but for some you need multiple aways).
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MS3 is the worst year because you’re being judged for not knowing things you’re literally there to learn, you’re working long hours, and your accomplishments are often brushed aside and overlooked if your attending doesn’t feel like giving honors. Especially when compared to MS 1/2, which are easy, and MS4, where you’re actually allowed to be first call on your patients, MS3 just sucks. You couldn’t pay me enough to do that year again.
Is honors necessary if you're not gunning for a competitive specialty? I work pediatrics now and am pretty confident my mind will not change and I get a sense that pediatrics is not often sought after.
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I enjoyed ms3 but I can see why some people don’t. You’ve spent your entire college and med school career thus far trying to get 100% on everything and all it takes is one attending to put you in your place with some hardcore pimping. I remember some of my classmates got really shook up with some of the rounds to the point they probably should have been prerounding with Xanax. Just try to take everything in stride and always try to find things you can connect with residents/attendings other than medicine. For instance, if you rotate with me and start talking about snowboarding, you’re gonna be hella more memorable than the fact that you knew what Reynold’s pentad is.
MS4 was dope. If you don’t enjoy ms4, you’re doing it wrong.
MS4 was dope. If you don’t enjoy ms4, you’re doing it wrong.
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It’s been fine for me thus far in MS3. The nursing schools I’m familiar with have set criteria largely based around attendance and number of competencies in whatever achieved so the grading is much less subjective compared to med school. Barring some wildly inappropriate behavior or just not showing up, it would be hard to do poorly on nursing clinicals. Med school rotations are A LOT more hours than nursing school. Then when you get home you’re supposed to study because you have to rock a shelf exam at the end of the month and exactly no one is giving you any direction on how to do well on it. Finally, your grades in nursing don’t matter that much. If you pass...cool you passed. If you just pass in third year it’s considered a red flag. You need to do well and some attendings just won’t give you the marks to do so.
given your background, you’ll probably enjoy it more than others bc it’s familiar to you.
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You’ll be expected to get honors in pediatrics still.
Where do you want to do peds? Sure, you definitely don’t need honors to match somewhere in peds, but if you want to go somewhere competitive you’ll need honors in peds at least and if you want to go somewhere highly sought after you’ll need honors in more than just peds.
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People who hate MS3 and MS4 are usually (not always) those who've never actually worked. They usually (not always) went straight through from high school to college to med school.
Also, these are the ones who are most likely to detest residency with the red hot fire of a thousand suns.
Also, these are the ones who are most likely to detest residency with the red hot fire of a thousand suns.
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Clinical years are hard because:
- You are constantly moving from service to service and being supervised by a bunch of different people, all with their own quirks. It can be extremely difficult to feel "settled" because, often, as soon as you do, you're moving on to the next clerkship or clinical site.
- You are typically spending a lot of time at the hospital, and, in addition to your clinical work, you're very likely spending a lot of time studying for shelf exams. Many people feel like there isn't enough time to get everything done that you would like.
- Despite spending all this time working, your final grades can feel arbitrary, and sometimes they might be. Obviously there are few things more unsatisfying than spending a lot of time working and trying your best only to get a final assessment that you don't feel like reflects the effort you put into what is going on.
All that said, I personally much preferred clinical work over classroom work because it was closer to what I actually imagined myself doing as a physician. Sitting in a classroom/library/at home reading a bunch of seemingly irrelevant minutia is itself tiring. However, the task is pretty clear and concrete: learn as much as you can and demonstrate that knowledge on exams. Many students are more comfortable with that lack of ambiguity, and it's more familiar since that's literally most of what you've done during your academic career, albeit at a much faster pace. In contrast, clinical work is much different, the goals and standards that you're held to are more abstract and seemingly arbitrary, and your performance may feel less in your control.
- You are constantly moving from service to service and being supervised by a bunch of different people, all with their own quirks. It can be extremely difficult to feel "settled" because, often, as soon as you do, you're moving on to the next clerkship or clinical site.
- You are typically spending a lot of time at the hospital, and, in addition to your clinical work, you're very likely spending a lot of time studying for shelf exams. Many people feel like there isn't enough time to get everything done that you would like.
- Despite spending all this time working, your final grades can feel arbitrary, and sometimes they might be. Obviously there are few things more unsatisfying than spending a lot of time working and trying your best only to get a final assessment that you don't feel like reflects the effort you put into what is going on.
All that said, I personally much preferred clinical work over classroom work because it was closer to what I actually imagined myself doing as a physician. Sitting in a classroom/library/at home reading a bunch of seemingly irrelevant minutia is itself tiring. However, the task is pretty clear and concrete: learn as much as you can and demonstrate that knowledge on exams. Many students are more comfortable with that lack of ambiguity, and it's more familiar since that's literally most of what you've done during your academic career, albeit at a much faster pace. In contrast, clinical work is much different, the goals and standards that you're held to are more abstract and seemingly arbitrary, and your performance may feel less in your control.
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It depends on where you want to go for residency. If you are happy going wherever, then you don't need them. If you want to go to a more competitive/academic/big name program then you probably want honors. Even if you don't need honors, it is still disappointing to work so hard and still not get honors because someone didn't like your personality.
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Yeah not gonna lie I can’t wait for clerkships.
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I dont think anyone hates clinicals itself, it's the discrepancy between expectation and reality.
Expectations: being an important part of a team, evaluated on successfully getting h&p, providing a decent a&p, time during ambulatory rotations to relax/hang out.
Reality: often you are ignored, graded subjectively based on what specialty you intend to pursue/how much you kiss a**, time off is spent studying for shelves/future tough rotations.
Dont get me wrong, some people have experiences closer to expectations (my 3rd year was relatively close, except for a couple of rotations where the grading was disappointing), but there are definitely students that have rougher 3rd years and that's where the frustration comes from. For me, from best to worst: M4>M3> M1>M2
4th year has been awesome, either I'm doing something productive or I'm relaxing..no in between. 3rd year was pretty great too. 1st year was a little rough adjusting but manageable..2nd year, dedicated changed my personality for a solid 2 months..it was worth it, but people were definitely concerned about me.
Expectations: being an important part of a team, evaluated on successfully getting h&p, providing a decent a&p, time during ambulatory rotations to relax/hang out.
Reality: often you are ignored, graded subjectively based on what specialty you intend to pursue/how much you kiss a**, time off is spent studying for shelves/future tough rotations.
Dont get me wrong, some people have experiences closer to expectations (my 3rd year was relatively close, except for a couple of rotations where the grading was disappointing), but there are definitely students that have rougher 3rd years and that's where the frustration comes from. For me, from best to worst: M4>M3> M1>M2
4th year has been awesome, either I'm doing something productive or I'm relaxing..no in between. 3rd year was pretty great too. 1st year was a little rough adjusting but manageable..2nd year, dedicated changed my personality for a solid 2 months..it was worth it, but people were definitely concerned about me.
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I think a way to improve MS3 experiences is probably to actively look for good sites and good attendings well in advance (and look for the malignant preceptors and 3-bombers to avoid). This is school specific and the info is better received from upperclassmen. But doing so will probably pay off well.
I loved MS1/2 and hated MS3/4. First and second year has clear goals: here's the material, learn it. And like college, you're in an environment where you can manage your own time, hang out with friends, and enjoy the atmosphere.
Third and fourth year have more vague goals: learn some stuff for shelf/Step 2, but also learn daily hospital tasks that perhaps no one will explicitly tell you what or how, and also impress your preceptors in ways that are inscrutable and may conflict from one to the next. You really don't get to manage much of your time and a lot of it will be wasted or boring. You may not see any of your friends on rotations for long periods. It was a slog for me.
That said, I'm in pathology now and it's a perfect fit. Lots of people will love MS3/4 and find something that suits them. Everyone is different.
Third and fourth year have more vague goals: learn some stuff for shelf/Step 2, but also learn daily hospital tasks that perhaps no one will explicitly tell you what or how, and also impress your preceptors in ways that are inscrutable and may conflict from one to the next. You really don't get to manage much of your time and a lot of it will be wasted or boring. You may not see any of your friends on rotations for long periods. It was a slog for me.
That said, I'm in pathology now and it's a perfect fit. Lots of people will love MS3/4 and find something that suits them. Everyone is different.
I love spending time with patients. Makes my day when I make one of them smile.
But...
In M3, you are at the whim of your team. Anyone and everyone can take out their anger and frustration on you. I've had one abusive preceptor and one abusive chief resident-latter so bad he got in trouble w/ the school.
I've had nurses who had bad days yell at me due to no fault of mine or the team.
Had employees make sexist/creepy comments to/about me.
Our school makes it impossible to Honor and evals are so subjective.
A few months in and I feel beaten down not due to my lack of ability or patient interaction...but rather how I've been treated. It's subhumane sometimes.
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I think it depends on the person. Honestly, I've enjoyed my clinical years immensely, but I've always been someone who learns better when I'm actually doing something vs. memorizing a textbook. The hours can be long, longer than M1/M2 depending on what kind of a student you were in terms of study habits, and it sucks having to balance clinical obligations with studying for SHELF exams. For me, that was the most difficult part. I was lucky in that I didn't have much issues with the people I worked with, but I've heard stories otherwise as well. I wouldn't say you need to be good at buttering up people, but generally, a smile, asking how you can help, and introducing yourself to everyone, including the nursing and ancillary staff can go a long way. If you work hard, show interest and spend time getting to know your patients well, you are going to do fine. I was worried about recommendation letters, but when it came time, I was able to find plenty of people.
Thinking about it differently, you are paying for your medical education and 3rd year is really the year I feel like we as students learn the most. After all, we all want to be doctors, not professional bookworms. Clinical medicine is what we are going to be doing as a professional. As such, there's no reason to cheapen your medical experience by just going through the motions and looking for easy experiences. Tell yourself that you are going to learn something new everyday from your patients, and honestly, it makes things much more enjoyable to learn from them than from a textbook. If you know you struggle with certain concepts, look to pick up patients with those pathologies. It's going to help you a lot in your 4th year AIs, and I anticipate your intern year as well. Plus, attendings really appreciate students that come to learn, at least that is the feedback I've received.
4th year can be difficult depending on your schedule, but I recommend front-loading, which is what I did. I did 6 straight clinical rotations including 3 AIs/sub-Is in a row, but now that I'm finishing off a chill rotation and about to go into 7 weeks of vacation/"interview" time, life is great. You no longer have to worry about SHELF exams to study for and really can just focus on whatever rotation you are on. You also have more freedom in picking rotations of interest, and I would definitely recommend that. I would also recommend picking some rotations that may help you later on (like cardiology, pulm or nephrology if you're going into IM; derm/rheum/endocrine if you're going into family, etc.). After interviews for me, it's going to be straight downhill until graduation.
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My sentiments exactly. 2nd year was sooo stressful bc you need a solid step 1 score. Otherwise, 3rd year was tough but rewarding. 4th year is great after you've submitted your app and finished subi's - at that point, you're just finishing requirements.
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Can't jerk off all day like you used in in MS1/MS2.
Although you can start doing that again after you match.
Although you can start doing that again after you match.
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Did you just say M2 is easy? lmao damn bro what planet you livin on
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M2 was hands down the worst year of med school
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Why is that, and how does that translate to an 18 month preclinical curriculum?
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Well, the stress of boards and comprehensive exams really is the killer there. My school tacked on a lot of SP stuff toward the end of it too.
That and personal crap. I had a hard time.
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Gotcha. We don't take boards until halfway through third year after a year of clerkship.
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Im in the middle of this ****storm right now haha it sucks and I havent even hit preded or dedicated yet
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Compared to MS3, it’s totally easy. Honestly, MS2 wasn’t as bad as people make it out to be - step is stressful, but otherwise it’s pretty chill. I’d do MS2 a hundred times over doing MS3 again.
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The expectation as a third year is to be where you need to be, be prepared to answer any question, be willing to do as much as possible without looking like a huge suck-up (because that's annoying to everyone), and do as you're told...with a smile of course. Your attendings/residents may teach you or maybe they won't, either way you need to be there until they let you go but make sure your notes are finished (which may or may not get looked at). When you are off, you run your errands, get home, and study both for your shelf and for topics covered that day in the hospital or clinic which may or may not overlap. Change the expectations and learning material around every month and it can just get tiring.
MS4 is fine. The first few months can kinda of suck when you're doing sub-i's because you have to grind harder than everyone else and the expectation is that all of a sudden, you will act like an intern when you potentially may have never ever put in an order before lol. But the rest of MS4 can be fun during interviews as long as you aren't stressing too hard about money and what not.
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You put in a ton of hours at the hospital to achieve essentially nothing of importance to anyone. Then at the end, your grade is pulled from a hat at random.
What's not to love?
What's not to love?
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Youre an outlier man. If M2 was easy for you then God bless
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Except maybe your own education, which is actually the point.
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I think this is the crux of it. A lot of people assume that, since it’s the clinical years, you get to really have an impact on patient care - but realistically, you don’t get to do much of anything. It’d be one thing to work hard but know you’re actually having an impact, but without that it’s just a recipe for burnout. That’s why both 4th year and PGY-1 are better than MS3, even if you work just as much or more.
I really don’t think so; my opinion was fairly standard at my school. Once you go through clinical years, you’ll probably get more of a perspective as to what I mean. When you’re stuck in the 2-3 months of studying for step, it’s easy to think it’s the worst thing.
I fall into the small group of people for which M2 has been much easier than M1. I find the information so much more interesting/relevant and am also able to use so many more resources to learn the material in a way that works for me (ie visual mnemonics/memory hooks in sketchy, pixorize, etc). Granted, I'm not maturing Zanki or going all out on board prep just yet, so that might change after Christmas break.
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Always curious about those who straight honor MS3 since they did something right
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Could be at a super inflated school where honors is the norm on all rotations. Could be at a school where the NBME/shelf exam is a large determinant and they're miles ahead of their classmates academically. Or, for rotations that are majority evals and where evaluators are assigned at random, could just be lucky.
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That would have to be a lot of luck.
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Depends on your school and grading system. If you're in a super inflated eval system (say an average of ~4.3/5), the odd 2-giver or 3-giver can single-handedly kill your shot at Honors, but they are rare. Dodging that a few times in a row on the hardest rotations is a prerequisite to get all Honors, and is straight up luck.
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There are people who give straight 2's...?
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Yeah, at least here, the trend is generally that people who trained here or have been here a long time know how inflated the system is and give all 4s-5s. But someone who is a new evaluator from a very different background (e.g. international) can give much, much more deflated averages
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You will match somewhere without honors.
It’s always nice to have honors because it makes you more competitive.
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MS3 yes, it sucks the life out of you...but you get it back and then some with MS4; the most expensive vacation you will take
Assuming you actually learn anything on wards
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In term of the actual medical school experience, M4 has probably been the best year followed by M1 > M3 > M2. M1 just felt like an extension of undergrad so it didn't really phase me that much. M3 sucked for all the reasons and people have stated and honestly M2 is only at the bottom because of Step 1.
However, in terms of my personal life experience, M1/M2 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> M3/M4. I had a bunch of personal stuff go on that have ruined by quality of life so for me even though M4 is supposed to the "best" year (which I liked from a school perspective it is) I will have more negative recollections of the clinical years because my life outside of school went to absolute ****.
However, in terms of my personal life experience, M1/M2 >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> M3/M4. I had a bunch of personal stuff go on that have ruined by quality of life so for me even though M4 is supposed to the "best" year (which I liked from a school perspective it is) I will have more negative recollections of the clinical years because my life outside of school went to absolute ****.
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M3 was friggin dope. You get to run around and play doctor, call the shots, and hang with residents.
The students who have a hard time either 1) have trouble with shelves, 2) are not easy to get along with, 3) have never had a job (and lack professionalism), or 4) whine all friggin day.
The students who have a hard time either 1) have trouble with shelves, 2) are not easy to get along with, 3) have never had a job (and lack professionalism), or 4) whine all friggin day.
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Having to worry about shelves was the worst part about M3. Finding time/desire to study was sometimes hard. For me, my hours weren’t bad for the most part since I worked with reasonable residents/attendings who acknowledged there was nothing for the students to do. Exceptions obviously surgery which was 6-5 a lot (but i was leaving 2-3 some days) and OB.
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Was it worst than M2?
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