be that best year, if
you make the most of it.
Some call for a stepped up effort to focus on the IOM
Competencies in year 4 of medical school (Stevens 2010
). Others, based on a review of the literature, say the goals for this 4th year are unclear, but should be clarified... to reflect the mission of the medical school and balance completing one big experience (medical school) and facilitating the transition to the next big one (residency).
There's more to it that just one Pediatric Career post (check back for more in future posts)
, but let's get started...
Related or unrelated to the well thought out requirements that your own medical school requires for graduation, here are some considerations as you delve into 4th year:This is your time to explore.
Get a broad and deep understanding of medicine that will help in whatever your ultimate field. You could see and do things that you might not see or do again, as this is your undergraduate
medical education. Moreover, you'll need to employ clinical reasoning, sharp physical exam skills, evidence-informed care, humanism, and professionalism in essentially whatever you do.
But another way to look at it is that this is your time to gain more exposure to those for whom you will be providing care. If you are planning to be a pediatrician, you might want to use your 4th year to learn more about the various pediatric subspecialties, and hone your skills in preparation for your future. You could opt for electives that will help you be better prepared for residency and thereafter. Then again, any elective
that you take seriously has the potential to
be helpful!And you'll be "acting like an intern"
at some point in your 4th year of medical school (and hopefully the following year as well). If you have an opportunity to do a pediatric
AI (acting internship or sub-internship) then that is helpful to gain that upper level training and demonstrate your advanced capabilities. However NOT EVERYONE can do a pediatric AI and not all can do so early in 4th year anyway, and that is okay
. If your AI ends up being scheduled for April, then you will use at as a true ramp up to internship. Regardless of when you do your AI, you want to be fully engaged and professional at all times. Help teach the 3rd years
(and 1st and 2nd years) while you are at it, too.A brief note on when to take USMLE Step 2
A culminating experience...
- If you had an extremely strong score for Step 1, perhaps you would take this later in the year. But if you had an average or weak Step 1, you could take and create an opportunity to demonstrate an upward trend, by preparing well and taking Step 2 early in 4th year. Then you've shown you can pass and that you can do even better than you did on Step 1. That could backfire if you do worse on Step 2, but then at least you've taken and passed both tests.
- GW has a 1 month capstone experience every March to reinforce clinical competencies and prepare students for life as a resident. For much of this course, students are grouped by future specialty with mentorship from faculty physicians in their specialty. Last week I led my favorite part, the "get ready for the first day (or month) of continuity clinic" session, though I'll note it is one of the only portions of our capstone course with an outpatient focus.
Other opportunities: (stay tuned for more in future posts)
- Your own school surely has a lot to offer, and going away you might miss out on that (-)
- You could take an elective in a field that your school doesn't have strengths or that your school doesn't offer (+)
- You will learn about another program, meet the residents, experience it more fully than you would on interview day (+)
- They will get to know you (hopefully a +)
- You will demonstrate to that school your sincerity in applying there (+)
- If you are on an away elective at a program where you are applying, you need to be on (learning, contributing, and professional) nearly 24x7 (+/-)
- Might be a logistical hassle and difficult financially (-)
- Bottom line, you don't need to do an away elective, but if you do, choose one you are interested in, at a program where you potentially want to be, and one where you will be ready to learn and contribute.
- Can you and should you conduct some research?
- An advocacy project?
- Might you travel abroad? Is global health in your future?
: (stay tuned for more in future posts)
Don't make the 4th year a lost year!References:
- ERAS, letters, interviews...
- Begin thinking about what you want to say in your personal statement. Who are you, what has influenced you, why does this program want you as a trainee, what have you done and what will you do someday? You can email PediatricCareer AT childrensnational.org with your answers.
Kanter SL. How to win an argument about the senior year of medical school. Acad Med. 2009; 84:815-6.Walling A, Merando A. The fourth year of medical education: A literature review. Acad Med. 2010;85:1698-1704.Stevens C. Commentary: Taking Back Year 4: A Call to Action. Acad Med. 2010;85:1663-4.