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Dr. Brian Radvansky and Dr. Shelby Wood contributed to this post. 

For many, third year is the most taxing year of medical school. Gone are the days of dragging yourself out of bed to attend early-morning classes and labs after staying up far past your bedtime to study. The time has come to step out of the lecture halls and onto the hospital wards!

It’s the year 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 fourth year, the final year of medical school, and most immediately, the combined joy and stress of submitting your applications to desired residency programs. There’s no better way to start fourth year than by finishing third year STRONG.

Here are 5 Ways to Wrap Up MS3 for a Strong Start to Your Fourth Year of Med School:

1. Start ERAS early.

Your ERAS application is a bit of a bear 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 opens in early June, a full three months before programs start receiving applications in mid-September (this timeline was altered in the 2020-2021 application cycle due to COVID-19 but is expected to return to normal in 2021). 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 opening day, keep a spreadsheet or document of all of your extracurricular, leadership, 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 fourth year actually allows you to craft a schedule that can meet your particular needs.

Not sure where to start with electives? Read our blog post on how to choose the right electives during your clinical years

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.

Which 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.

If you need a letter of recommendation from a specific specialty, make sure to schedule this away/audition rotation early in the year so that the letter will be ready before ERAS opens (especially EM applicants seeking SLOEs!).

 

3. Begin working on letters of recommendation and personal statements.

Toward 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 attending physicians.

In addition to securing a possible letter during third year, you should build your fourth year schedule so that you will have good interactions with prospective letter-writers early in the year. The sooner you have your letters accounted for and placed into your file, the sooner your mind will be at ease.

Once your mind is made up on your 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 your personal statement, 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 thinking about Step 2 CK scheduling.

Planning is everything, and you should schedule this important exam as strategically as possible. If you have the luxury of getting to put things where you want them, schedule this exam on a date that makes sense.

If you have a lower-than-average Step 1 score, it may be worth taking four to six weeks off between clinical rotations as dedicated prep time to ensure that you are able to thoroughly review all of UWorld (ideally twice through!) and any other test prep resources you might be using.

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 CK in a far away place because all of the nearby dates were booked far in advance. 

 

5. There will be a time to coast, but it isn't now.

Everyone knows that the life of a fourth 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 fourth 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 fourth 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 third to fourth 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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