4th Year of Med School: To go all out or coast to the end? 

In most U.S. medical schools the fourth and final year is full of elective time for students to mold their schedule into whatever they want. Years 1 and 2 were full of grinding book work and study marathons. Year 3 introduced you to basic clinical rotations, where the hours were often long and you still had to study for the dreaded shelf exams. But year 4? Year 4 can be whatever you want it to be. Which begs the question – do you push yourself for tough electives in hopes of better preparing yourself for intern year? Or do you coast through on easy electives knowing that intern year is a bear that cannot be prepared for, only experienced?

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Team Gunner:

You always wanted to score the highest, study the most, doctor the hardest. You aren’t going to stop now. Filling your schedule with brutal electives such as ICU, pulmonology, cardiology, infectious disease – you want to maximize every minute of education and show up intern year ready to show the upper level residents how the real doctoring is done!

Team Slacker:

You’ve made it through medical school with one motto, P=MD, baby! Happy with every pass, and unhappy with the fact you have to actually try in medical school (unlike undergrad), you aren’t going out of your way for extra work. You fill your electives up for minimal work. You take Path TA.. twice, computers in medicine, maybe an anesthesia month (you know you’ll never be there past noon), and any other elective known for many days off and light on work. Intern year will be tough sure, but there’s nothing you can do about that!


So who here is correct? Well like most things in life, the truth is in the middle. Intern year is brutal. But it’s brutal for its hours. It’s brutal for its never ending list of things to do. You aren’t really a doctor, more a patient’s general manager. The real doctors make all the decisions, you just give them information and schedule what they want done. Yes, you need to know some medicine. But unfortunately that med school ICU month or cardiology month, likely made you smarter, but NOT a better intern. A good intern isn’t the smartest – but is the most organized. The most efficient. The best at communicating between family to attending back to family. The best at coordinating care between multiple physicians. Unfortunately all things you tend to not do on a med school rotation – because the intern frantically does them while you are trying to learn actual medicine. Does it help to do hard electives in medical school? Probably, at least if they focus less on teaching and more on treating you like an intern. But does it make much real difference in how hard intern year is? Probably not.

What did I do? Well I was much closer to team slacker. I scored decent on the USMLE, especially doing well on Step 2. Mostly passed with the occasional high pass my first two years of book work. Then mostly high pass and honors my third clinical year, including the very rare double honor in medicine and medicine sub-I. But fourth year? I took the easy street. I scheduled all the required courses early in the year, knocked out my anesthesia sub-I, then did an extra elective in anesthesia. Then from December until graduating in May – never. saw. a. single. patient. I even took a couple electives you didn’t even have to go on campus, just submit papers at the end of the month. I vacationed, I relaxed, and I loved every minute of 4 year.

How’d that turn out for me? I was probably the best intern in our transitional year program. I continue to be one of the best residents in our anesthesia program. Why? Not because I’m the smartest – but because I do all that other stuff very well. I work hard, am efficient, organized, I get things done and you rarely have to tell or teach me something more than once. And I didn’t need some 4th year med school elective to teach me all that.

Should you take a Team Slacker 4th year? No academic advisor will ever say you should. But look how you did in your medicine rotations, especially the med sub-I. That’s the closest to intern you get. If you did well, and feel you do well with the efficiency and managing part, then I think you’ll be fine with lighter 4th year. If not, those extra electives could be useful to hone your skills prior to the big day.

What do you think about 4th year? Is it your last chance to learn before the pressure of being a doctor? Or is it your last year of freedom to enjoy before real life begins? Hit your thoughts in the comments below!


Update – Early 2017: There is now a study out (Fourth-Year Medical School Coarse Load and Success as a Medical Intern) suggesting that doing more rigorous courses during 4th year leads to better evaluations as an intern. I question a bit of the study because the “sub internships” they considered rigorous could be from courses and specialities not generally considered difficult (i.e. my own specialty, anesthesia – it is rare to be there past noon, even as a sub-I, but would have counted). They also looked at internal med residents only – which are more likely to have taken sub-Is in medicine or critical care rotations as a fourth year that would have “counted” for the study. But the results are what they are – and I’d be remiss not to mention this interesting study – even if it goes against my general experience with 4-year.  


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3 thoughts on “4th Year of Med School: To go all out or coast to the end? 

  1. This is a great post haha as I sit here and plan for my fourth year schedule this kind of helps. I think I am a lot like what is described here, I tend/try to be organized and have everything ready for the attending when they come in. I engage patients very well and I am a quick learner. Thanks for sharing!

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