Making the Fourth Year More Meaningful

A medical student advisee recently met with me to plan his fourth-year rotations. He ranked near the top of his class after his third-year rotations, and I anticipated we would be discussing which residency programs he should consider and how he could best use the fourth year to prepare for his internship. I suggested a subinternship experience in critical care and emergency medicine, and electives in medical and surgical subspecialties. However, as I looked at the preliminary schedule he had prepared, I was surprised to see several away rotations in the same specialty—all audition rotations for the specialty into which he hoped to match. " Why are you taking all these away rotations? " I asked. " Everyone has told me I need to do this so that the programs will get to know me. It is very competitive for the good programs. I want to be sure to match. I don't feel like I have any other choice. " " But you have excellent grades and board scores. I don't think you need to do this. You will almost certainly match into one of your top choices. The fourth year should be an opportunity for you to explore other topics and learn skills that you may not have a chance to during residency, " I said. " What else would you like to learn this year? " But he remained focused on his original concern and replied, " Can we talk about programs where I should apply? " We went back and forth discussing elements of the fourth year—the uncertainty of the Match interview process, the benefits of exposure to fields that would broaden his perspective, and the need for flexibility to complete scholarly projects and to solidify skills that would be needed before the start of internship. We also discussed several residency programs I was familiar with and how they might fit his interests. It was an excellent discussion about the fourth year. However, I realized that my perspective on the fourth year was heavily influenced by my experience as a former program director, and that students might have very different views. What are some of those views? In this month's Academic Medicine, Wolf et al 1 describe graduating students' perspectives on the fourth-year curriculum at the University of Colorado School of Medicine. This mixed-methods study, using focus groups and a survey, suggests that students look to the …