Fourth Year of Medical School: The End Is Near!

“Welcome to the fourth year,” she said to me.
“Take a seat …”

Oh wait, I don’t think John Mayer’s song went exactly like that. Anyhow, welcome to the fourth year of medical school. You are soooo close to finishing … and one year closer to the most brutal year of your life — internship. But don’t worry about it now. Take in one year at a time.

So what is your last year gonna be like? Well, it will most likely be your favorite. Why? Because you will have a bunch of electives, which allows you to shape the year however you want. It could be the chillest (for the cool kids — pun intended) or the most intense (for those poor kids going into a surgical specialty).

If you wanna slack off and take it easy, do it this year! You’ll have a hard time doing so when you’re out in the real world trading your time for dollars.

Auditioning vs. Exploring

Most students spend a significant portion of their fourth year auditioning. That means they already have a specialty in mind. And most, if not all, of the electives are used to explore that particular specialty. So if someone is interested in internal medicine, he would do a bunch of IM rotations … preferably at places he wants to do residency.

Auditions serve two purposes:

  • It lets the student get an idea of what working in a particular program is like. Maybe he’ll love it and rank it higher. Or maybe he’ll hate it and rank it lower, if at all.
  • It lets the student impress the doctors and program directors. If he did a good job, he has a better chance of getting in. But an audition could be a double-edged sword. If he failed to make a good impression, he’ll have a harder time getting accepted as well.

Third year of medical school exposes you only to a limited amount of options: family medicine, internal medicine, pediatrics, surgery, etc. It is not a problem if you already know what you wanna do for the rest of your life. But what if you don’t know? Personally, at the beginning of my fourth year, I have yet to experience everything, from dermatology to ophthalmology to emergency medicine.

That is why there are a few people who choose not to do auditions. I fall into this category. We spend our last year sampling as much as we can, to get as big of a picture of medicine as possible. I’ve written a bit about auditions and explorations here.

The bottom line is that there isn’t just one path to travel. You can go straight or you can zigzag to get to your destination. But ultimately, you are responsible for wherever you end up. Are you sure you can make the right choice with a limited amount of information?

Get Ready to Travel

Although your last year could be really chill, it could also be a major pain in the rear. Why?

First, you will have to take Step 2.

Second, you will have to take COMLEX PE. (And there is only one place in the world where you can take it. Kids on the West coast, I do not envy you.)

Third, you may have to travel far for your electives.

Fourth, you will have to interview for residency. Depending on where you get invited to interview, you may have to travel far … numerous times throughout the academic year.

Who needs extra hassle right? So this is what I would recommend … Get the licensing exams out of the way as soon as possible. You don’t want to deal with them when you gotta interview all over the country.

Personally, I really lucked out. I took COMLEX Step 2 and COMLEX PE relatively early. I lived relatively close to both testing centers. And I did not have to travel too far for my electives and interviews. I did not have to fly anywhere. And the longest time I spent driving was 2 hours each way (which I only had to do for 1 interview.)

For those who are not as lucky as I am, be prepared to spend a bunch of money on travel and housing. It’s gonna hurt your wallet.

What My Fourth Year Was Like (Hint: It Rocked!!!)

I shaped my last year into the most awesome year ever! Why was it so awesome? For 2 reasons …

First, I experienced sooooo much.

Second, I had sooooo much free time.


Previously, I said you can treat fourth year as an audition or an exploration. I chose the latter. Thus, I had exposure to pretty much everything I could be interested in.

I experienced all the E-ROAD specialties — which are the most competitive and most sought-after specialties: emergency medicine, radiology, ophthalmology, anesthesiology, and dermatology. I could not see myself doing anything of them and crossed them out of my future.

Because of my surgery rotation, I already crossed off all surgical specialties.

Through my required medical-specialty rotations — pulmonology and cardiology — I ruled out inpatient medicine.

So that leaves me with outpatient medicine, namely family medicine. Or a non-medicine and non-surgery specialty … psychiatry. (Right now, if I have to choose, I am leanings towards psychiatry.)

All of my electives were done in an outpatient setting. I wanted to see how doctors run their private practices, and then adopt what they do right into my future practice. I also wanted to see how doctors practice medicine, especially treatments that are not conventional. I got exposure to addiction medicine, acupuncture, herbal treatments, homeopathy, Osteopathic medicine, and weight management. The experiences opened my eyes to the possibilities in medicine. Success!

A year ago, I felt a bit disappointed that nothing in medicine really appealed to me — especially my disappointment with family medicine. But now, I feel pumped! The world is my oyster and my future looks brighter and brighter (after residency, that is).

My experiences further convinced me that a cash-only practice is the wisest choice. No one but you gets to control your future. Not the government. Not the insurance companies. One doctor had to sell her “baby” — a practice she built up for more than 30 years — and join a local hospital as a paid employee, because she could not survive the changed medical environment.

I would not have been able to experience all these if I turned fourth year into an audition.

Free Time

The cool thing about establishing your own elective is that everything is between you and the doctor … including the schedule! I have a strong suspicion that some attendings in teaching hospitals don’t like students. But because of administrative pressures, they cannot send the students home early. So in the end, students waste time by doing meaningless scut work or by doing nothing at all. I have better things to do, especially after the match.

During all of my electives, I learned a whole lot in the most minimal amount of time. And I do mean minimal. (It doesn’t hurt that the doctors knew me personally, or knew someone I knew.) Not only is my schedule so boss, my grades were nothing short of honors! As if grades even matter at this point …

I won’t tell you my exact schedule. But I will say that I’ll be surprised if someone from my class had an easier fourth year than me. (Did I tell you about my rotation in the tropics?) Alright, you got me. I am an unashamed slacker. But seriously, if there is a time to take a chill pill, it is this year! I don’t feel too bad. Here’s a saying I came across that contains a kernel of truth:

The top third of medical students will make great teachers.
The middle third of medical students will make great doctors.
The bottom third of medical students will make great money.

Guess which category I am aiming for.

This article is part of the How to Survive Medical School series. Click on the link if you want more tips and hints about surviving academic hell.


  1. Ahah, I’ll go for great doctor xD

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