Tips & Pointers for the Fourth-Year of Medical School

uvmmedicine blogger Kelsey Sullivan '18
uvmmedicine blogger Kelsey Sullivan ’18

Starting fourth year of medical school is an exciting time. Here at the University of Vermont Larner College of Medicine, it is really the first time that you have a chance to customize your schedule to your unique interests and aspirations. There are a few things you should keep in mind when getting ready for that last year of your medical school journey:

  1. Know your deadlines for the residency application process

For the main match, residency applications are due around September 15. The MSPE (Medical Student Performance Evaluation, formerly known as the Dean’s Letter), goes out on October 1. Many people choose to use the months leading up to this time to showcase their talents by completing rotations in their chosen specialty, participating in away rotations, completing Step 2, and finishing up research projects.

  1. Knowing your learning style can help you decide when to take USMLE Step 2

The Larner College of Medicine allows students to take up to four weeks to study for the USMLE Step 2. Although some students take Step 2 in April, at the beginning of fourth year, it is recommended that Step 2 be taken by mid-August, so that scores will be in before submitting residency applications in mid-September. Some students find it useful to wait to take the exam until after taking their internal medicine acting internship or their emergency medicine rotation. This is an approach you may consider if you are someone who learns best by hands-on learning. However, most people are successful if they take the exam before completing these rotations.  The Office of Medical Student Education also has a number of resources to support your Step 2 preparation.  These resources include tutoring and NBME Comprehensive Clinical Science Self-Assessment vouchers, which can be requested by emailing

  1. Have a plan for interviewing

For most specialties, the interview season starts in mid-October or November and concludes in mid-January. The Associate Dean for Students recommends interviewing at 10 to 15 programs; however, students who are couples matching, applying into competitive specialties, or applying into specialties that include a preliminary year may have to interview at substantially more programs. Interviewing is an extremely time-consuming process, and it is important to learn when your specialty conducts interviews to arrange your schedule accordingly. Most students take low-impact courses, such as a reading month, or use vacation time in November or December in order to allow for interviewing.

  1. You may want to have a “theme” for your fourth year in mind

While not a necessary part of putting together your fourth-year schedule, it may be useful to keep in mind an overarching theme for your electives. You don’t want your schedule to scream “senioritis;” rather, you want to show that you are a lifelong learner and have put some thought into this last year of medical school, which represents an enormous amount of time to learn about anything that interests you. Some people like to explore topics that they won’t have the opportunity to experience after they begin residency, while others like to get a jump-start on their field of interest.

  1. Away rotations are not required, but they can help you make a good impression and “unlock regions”

The topic of away rotations can be pretty complicated, and before talking about them, I need to disclose that I did not do away rotations in my fourth year. They are not required for graduation, but depending on your circumstances, you may want to consider doing one to two away rotations. This is useful for getting letters of recommendation, especially if you are going into a field which is not offered at this hospital. You may have also heard of the concept of an “audition rotation,” where you rotate at a program where you might like to go for residency. Doing an away rotation is also useful for “unlocking” regions—e.g. showing your interest in moving to the Midwest by doing a rotation in Chicago, which in turn may make programs in that area more likely to extend you an interview invitation. But be careful when arranging away rotations—you shouldn’t plan on going to interviews while you are away, and you certainly don’t want to burn out and end up making a bad impression!

  1. Yes, it is possible to change your schedule

After going through the whole lottery process of selecting acting internships and emergency medicine rotations, I found out I was pregnant and due at the same time I was scheduled to complete my pediatrics and internal medicine acting internships. If something similar happens to you, do not panic! I was able to swap my internal medicine acting internship, my pediatrics acting internship (twice!), and my emergency medicine rotation, as well as re-arrange pretty much all of my electives. If you have to change your schedule in a substantial way after the lottery process is complete, there is plenty of time to do so. There is also support from the medical student education office to help make sure you have all of your requirements for graduation.

  1. Have fun!

As you know, life is very different after starting residency. Fourth year represents a great opportunity. Carpe diem!

What are your thoughts about this topic?