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For many, 3rd year is the most taxing year of medical school. Gone are the days when you could spend all day on your own schedule, watching lectures whenever it felt right. There’s no more wearing pajamas until noon; we must now dust off and don our dress clothes and white coats. But it’s not all doom and gloom! It’s the year that you’ve been waiting for — the year when you can pull your nose out of that stack of books, and actually deliver medical care to real patients in need. The transformation that you will make as third year progresses — from novice clinician to (almost) doctor — is second only to the enormous stride you will make during intern year.

Ahead of you lies 4th year, the final year of medical school, and most immediately, the joy and stress of getting to submit your applications to desired residency programs. There’s no better way to start 4th year than by finishing 3rd year STRONG.


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#1: Start ERAS Early.

Your ERAS application is a bit of a bear. It’s large, hairy, and can easily get the better of you if you don’t go in with a good plan of attack. It almost always takes longer than you think it will, so the earlier you can get cracking on it, the better. The application is a mixture of boring necessary information that requires some time but not much thinking, and other free response areas that will require you to scratch your head and find an eloquent way to transmit who you are. As you can imagine, it is the second part that takes a bit of time and soul searching.

ERAS opened on June 6th, a full 3 months before September 15th, the day that ACGME programs start receiving applications. This is a huge chunk of time that, to put in med school commandment terms, thou shalt not squander. As we say for USMLE tests, preparedness = good, cramming = bad. Don’t be left scrambling and stressing. Get going!

If you haven’t already, even if you are far from ERAS, keep a google document of all of your extracurricular and research experiences as you compile them. This way, you aren’t left forgetting experiences or misremembering anything. 

#2: Build a strategic schedule.

With the luxury of finally getting to schedule some electives (and maybe even a vacation), building your 4th year actually allows you to craft a schedule that can meet your particular needs. Let’s say, for instance, that you didn’t do as well as you’d hoped on Step 1, and want to do whatever it takes to meet your Step 2 goals. Scheduling a free block of time leading up to your test is the way to go. Are you only 85% sure about going into emergency medicine? An early month-long elective in the field should help you make your decision. What months are you doing away rotations? Have you begun research projects that need a dedicated “research month” to finish? Start thinking about these preparations early on, so you have a clear picture of how to construct your schedule when the time comes.

#3: Begin working on letters of recommendation and personal statement(s).

Towards the end of third year, you should be approaching clinical medicine stardom, flaunting your physical exam and differential diagnosis skills at every opportunity. This is the time to get recognized and obtain high-quality, very personalized letters of recommendation from your attendings. In addition to securing a possible letter during third year, you should build your 4th year schedule so that you will have good interaction with prospective letter-writers early in the year. The sooner you have your letters all accounted for and placed into your file, the sooner your mind will be at ease.

Once your mind is made up on future discipline, the time will come to grind out that personal statement. This single document will require a great deal of brainstorming, free thinking, writing, re-writing, and editing. Even after you are finished, you’ll want to run it by some mentors or contacts in the field to make sure that everyone understands the point you are driving home. Get started early while time permits.

#4: Start to think about Step 2 CK and CS scheduling.

Planning is everything. You should at the very least attempt to place these two tests on the calendar (if you haven’t taken them already) with some tact. We understand the lottery and scheduling doesn’t always drop into our laps the way that we want it to, and that’s all right. But, if you have got the luxury of getting to put things where you want them, put them in spots that make sense. Perhaps the most important part: Don’t just think about when you want to take the test — actually register and schedule it! I think every medical school class has a student who waits too long, and after a $750 plane ticket and hotel stay, ends up taking CS in a far away place against their will. 

#5: There will be a time to coast - but it’s not now.

Everyone knows that the life of a 4th year medical student can become pretty cushy at times. And that’s a good thing. You will definitely need a pause after all of the stress, interviews, applications, grades, exams, etc. in order to start residency with a fresh mind and body. The first half of 4th year is not a time to coast -- you will likely find yourself in demanding sub-internships, preparing for Step 2, and working to get your letters of recommendations and applications in order.

The key here is to take your third year momentum and carry it with you through the beginning of 4th year, going strong until you are over the hump.

There’s no magic bullet or book recommendation to help you here. Just a call to action - for you to find the power within and stay self-motivated until the finish. Don’t stop running the marathon in the 25th mile.

To sum up the general idea in one sentence: As you transition from 3rd to 4th year, carry the momentum of a long and tough year for just a little bit longer; the light at the end of the tunnel is growing brighter.



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Brian Radvansky

Brian Radvansky

USMLE Tutor & Senior Writer
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