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.