Ask the Half M.D.: what is the fourth year of medical school like?

November 5, 2008 at 8:22 am (Ask the Half MD)

Over the past few weeks, several medical students in the first through third-year classes have been asking me what the final year of medical school is like. I’ll be the first to confirm that the fourth year is indeed the promised land of your medical education. After working nearly 80 hours a week as a third-year medical student, you can look forward to the warm light at the end of the tunnel that is your fourth year.

Whenever I encounter residents or attendings and tell them that I’m a fourth year student, they tilt their heads to the side, stare off into space for a few seconds, and release a nostalgic sigh as they remember the joys of their own fourth year. A typical conversation might go something like this:

Senior resident: You’re late. Where have you been?
Me: I’m a fourth-year medical student.
Senior resident: Oh, in that case you don’t even have to be here. Would you like to go home?

The final year for medical school can roughly be divided into two domains: getting into residency and vacation. You’ll certainly have to do some work this year as you will travel the country on externships in an attempt to impress various programs where you might want to enter residency later. During these externships you’ll serve as a star student reliving the 80-hour work weeks that you grew to hate so much during third year. You will study hard, work hard, arrived early, leave late, and introduce yourself to every faculty member in the department in the hopes that you can get a favorable review when the time comes to apply for residency.

Fourth-year is also filled with lots of administrative headaches such as tracking down grades, securing rec letters, meeting with deans, applying through ERAS, setting up interviews, booking flights, and voting in the presidential election. But after your you have finished all of those tasks, you are ready to enjoy the next six months.

Whereas the third years are required to take courses in surgery and obstetrics where they invariably get yelled at for not knowing everything on the first day, fourth years get away with courses such as nuclear medicine and geriatrics. Typically, the day starts at 9:00 a.m. when I come in and meet my resident to obtain his signature on my attendance form. I then go home at 9:05. Thanks to the accreditation board which requires that we attempt to learn something during this glorious year, clerkships hold afternoon lectures which usually revolve around having an attending show up late, tell us how wonderful fourth-year is, give out the answers to the final exam, and then end class early.

That’s not to say that all medical students take fourth-year so lightheartedly. There are a few scabs at could never let go of being a gunner for the previous three years and for some reason, feel the need to study and work away their last year of freedom. These students will take clerkships in the intensive care unit and hematology/oncology service where they will work to the point of exhaustion while the rest of us play drinking games during the presidential debates. As for me, I started brewing my own beer and I’ve been working my way through all of John Grisham’s novels. As far as I’m concerned, those are the only sorts of activities that fourth-year medical students should be involved in.



  1. Sammy K said,

    I’m in the OR right now, third year, and I’m depressed as all hell. can’t wait until 4th year

  2. Erin said,

    Please tell me that’s not sarcasm…

  3. halfmd said,

    No sarcasm this time around. 4th year really is that good.

  4. Aaron said,

    No sarcasm…fourth year rocks! The best year since college; a little break between med school and residency.

  5. Scrub Notes said,

    Agreed – fourth year is awesome. Especially if you go to a school that has a shortened basic science curriculum (UPenn, Baylor, Duke), potentially giving you even more free time your fourth year. For me, this means I won’t be required to do much of anything, school-wise, between October and graduation… =D

  6. happyhospitalist said,

    the goal of fourth year students every where is to sign up for as many outpatient rotations as possible. No weekends and no long days. Such rotations as dermatology, radiology, and “research”–now that’s a laugh. I remember my fourth year. People climbing over each other to get that coveted spring time dermatology month. Ah the memories. The most helpful fourth year rotation I did was EP cardiology. I got to read every single EKG in the entire academic hospital for an entire month. That’s how you learn EKGs. It made my first year of residency much more enjoyble and less frightening

  7. Kat said,

    To be fair, there’s some of us who couldn’t WAIT to get into the ICU and have the chance to really see what critical care was like.

    …ok, so I’m a gunner.

    Even though I am giving up prime drinking time, I am really glad I’m doing ID, nephro and cards rotations during 4th year. It’s nice to actually know what goes on with consult services. 🙂

  8. Frank Drackman said,

    4th Year WAS great. Best was the ER rotation where the Chairman said he didn’t care if we came in at all, so we didn’t (went in a few times just to make sure he wasn’t jokin). Even better if you had a military scholarship and got that Big O-1 pay for drinkin beer at the “O” Club. Also describes how much I learned, “O”. Not sure what was better, Surgical Pathology, with a Super Model Attending, or Radiology, where even the Attendings barely worked 6 hours a week.

  9. Frank Drackman said,

    And as easy as 4th year was (you did have to take a Surgery rotation, and either Neurosurgery or Neurology) there was a definate change once the Match was over, and you became a “FYiGMI”(pronounced FIG-ME) (for F-You i-Got-My-Internship) Warrior. Thats when you didn’t even have to hide the fact you were leavin at 9:15 am.

  10. said,

    Hooray. Just when I had begun thinking it would be best to forego medical school and join the circus instead, you talked me back into it. Sometimes you need the light at the end of the tunnel. FYIGMI– A mnemonic I shall never forget 🙂

  11. Miami_med said,

    Hey now, some of us just kind of like the ICU. I may be a nerd sir, but I am no gunner. I have the grades to prove it.

  12. Abiy said,

    in ethiopia, med 4th is z worst, its 5th yr which rocks, but 6th yr it realy rocks,

  13. jeff said,

    Damn, 4th year of veterinary school is very different. It’s definitely the best year, but you work the hardest (in terms of number of hours) and could essentially be described as indentured servitude. Of course, we are then rewarded with the option to practice rather than becoming a resident or intern, though more and more are doing that anyway nowadays.

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