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The Fourth Year of Medical School: Closing In on Xanadu

The fourth year of medical school is as close to Xanadu as medical students get. There are numerous aspects that set the fourth year apart from the prior years, and here we briefly focus on three: refinement, education and adventure.

At the outset of the fourth year, the majority of students know what they are going to pursue for residency. The point, therefore, is to solidify and reinforce material focused on excelling in the selected specialty. For example, students pursuing pediatrics will each do a subinternship in that field, and will choose electives specific to advancing their knowledge of the principles and practice of pediatrics. By doing so, fourth-year students are given a deeper understanding of the intricacies of their chosen field, and have more opportunities to engage leaders within that specialty.

The fourth-year curriculum typically has several unassigned months to be used for elective rotations. In addition to focused electives within a particular specialty, students use this time to educate themselves in areas they have yet to explore or to reinforce areas they have had little exposure to. Many students do electives in radiology, a field that is fundamental to the practice of medicine across multiple disciplines. Dermatology is also a popular elective, as it has overarching import and is an area that is relatively underrepresented.

Another aspect of the fourth-year curriculum is the opportunity to do research. For example, at Einstein there is a required Independent Scholarly Project (ISP). Typically two months in length, the ISP provides an opportunity for students to examine critically an area of interest; this work culminates in a scholarly paper. The ISP and similar programs at other medical schools may lead to publications or presentations at medical or scientific meetings.

The fourth year is also a fabulous opportunity for students to engage in medical activities internationally. What sets this apart from travel after the first year of medical school is the knowledge base that the fourth-year medical student brings to the delivery of medical care in these diverse environments. Many Einstein students enthusiastically participate in a global health program in Uganda, providing primary care to an underserved population. Students can also elect to do their ambulatory rotations at a rural Native American health clinic in Montana.

Across the country, medical students travel to participate in elective rotations at other institutions. These “away electives” are often used to “audition” at the targeted institutions, and also allow the students to evaluate how the practice of medicine differs geographically and institutionally.

One of the costly additions to the fourth year is the interview season. On average, students visit 15 to 20 programs from December through February. This is an exciting yet exhausting time, as some students travel across the country to visit programs of interest. It is not uncommon for students to spend a few days in each new location as they bounce along the interview trail.

As with any worthwhile adventure, the trip to Xanadu is almost as important as the destination. It is largely through these experiences that fourth-year students become superbly poised to excel as residents in outstanding programs across the country.

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