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Fourth year of medical school is an incredibly exciting time: the end of four grueling years of studying and testing is almost in sight, the opportunity to practice a specialty of your choosing is near, and you’re almost at the point where you’ll officially be called “Doctor!”. However, fourth year can also be quite stressful with: Step 2 CK and CS examinations, residency applications, traveling the country for residency interviews, completing required courses (including possible externships), making that final rank list, and more! Completing all these necessities, while also enjoying oneself and preparing for the challenges of residency can be difficult.

With that in mind, here are our top seven tips for making the most out of fourth year in preparation for residency.

1. Plan to Take Step 2 CK and CS (Ideally Early and Outside of Interview Season).

The USMLE Step 2 examinations are the last big hurdle of examinations before residency. In my experience, planning to take these examinations early in fourth year, if possible, is very beneficial. Getting these examinations passed and behind you will allow you to focus on the other critically important aspects of fourth year — like applying to residency! 

Moreover, in the event that you don’t pass one of the Step examinations: by taking it early, you’ll have ample time to retest to prevent it interfering with the ability to graduate. At the least, taking the examinations before interview season kicks off is generally a good plan. Having to try and schedule the exams around interviews can be quite stressful!

2. Apply for Externships Early (With the Goal of Completing Them Before Interview Season).

Certain specialties, such as emergency medicine, essentially require one to participate in away rotations (externships) at other programs or institutions. Applying for these programs can be a fairly intensive process given that each program require different: applications, essays, and immunization/health forms. Ideally, one will start this process no later than March-April of third year. Most people complete externships between July – October to try and have them finished — and to gather any helpful letters of recommendation — before interview season even starts. 

3. Prepare for the Financial Expenses.

Applying for residency can be extremely expensive. Depending on where you apply and how broadly, the application and interview process can cost thousands of dollars. If you’re planning to apply to programs all around the country (or on an opposite coast from where you live), know that the costs of flights, rental cars, hotels, etc. can really add up.

It’s not unheard of for students to have to take out additional loans just to cover the costs of interview season. That being said, do what you can to cut back on costs. If a program offers, try to stay with a resident host the night before interviewing to save on a hotel; if you’re in a major city, take public transportation or uber rather than renting a car.

4. Make the Most of Required Courses and Electives.

While fourth year is certainly a time to relax and enjoy oneself, remember that it’s still designed to act as preparation for residency. Make sure you’re still working hard in your required courses, sub-internships, and externships to try and learn as much as possible.

5. After You Find Out Your Match, Be in Close Touch With the PD or Coordinator.

Match is probably the most exciting time of medical school. You finally find out where you’ll be headed for residency after four years of hard work! Shortly after your match, you’ll want to be in close contact with your residency program coordinator. Unfortunately, there are usually mounds of paperwork to complete prior to you being able to step foot into your new residency position. It’s much better to stay on top of this and get it out of the way well before starting residency.

6. Start Planning for the Move & Transition to Residency.

Once you find out where you will match, start planning for the transition early! If you will be moving far away, decide how you plan to travel. Will you rent a moving vehicle to transport your items or are you planning to try to sell and rebuy at a new location? Depending on where you match, housing may or may not be easy to come by (especially affordable housing), so start looking for a place to live early! Contact current residents about the best places to live or try to seek out another resident or medical student roommate if that is an option.

7. Most Importantly, Make Time for Yourself!

Fourth year is about working hard. Fourth year is about preparing for residency. Fourth year is about interviewing and securing a spot in residency! However, fourth year of medical school is by far the most relaxed year of the four, so make sure to make time to enjoy yourself too. Take a fun vacation with friends or family; pick up that new hobby you’ve been wanting to try; join a sports team; or spend more time with loved ones. While residency will be an incredible journey, you won’t regret having had the time in fourth year to relax, sleep, and have some fun!

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Justine Falcone

Justine Falcone

Justine graduated Summa Cum Laude and co-valedictorian from Rollins College before pursuing an MD from the University of Florida. She is currently a PGY-2 in Emergency Medicine. Justine scored 245 on the USMLE Step 1 and 255 on the Step 2 examinations. She scored 80 or above on five of her NBME shelf exams during her clerkship years.
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