Once MS4 year arrives, stop and take a look around. You’ll realize how crazy the last 3 – or perhaps even the last 15 – years have been. And there’s more to come! The first three-quarters of MS4 year will revolve around performing internships, finalizing your ERAS application, and attending interviews. Then, all of a sudden, the buzz of Match Day will come, allowing you to take a breather.

Indeed, the 4th year of medical school comes in like a lion and goes out like a lamb. We’ve compiled four tips to help you succeed during this dynamic time, ensuring that you’ll make the most of it without burning out.

On Rotations: Follow Directions Explicitly And Exactly

One of my salient memories of medical school was a 24-hour call shift on my trauma surgery rotation. A 46 year old man presented with a through-and-through gunshot wound. Luckily, the wound only went through his extra-abdominal fat. No organs, muscles or major blood vessels were injured, so he got discharged with some bandaids and morphine. About 6 hours later, however, he was back in the ED with continued bleeding from the wound. This time, the surgeon on call decided it was worth an early AM debridement and washout. 

I was weary but eager: it was my 20th hour awake. But a chance to operate on a patient whom I “knew” from the previous encounter…oh, pure excitement. I watched between my droopy eyelids as the trauma fellow washed and sutured. His flow and focus enamored me.

Then, he stopped and looked into my eyes directly and deliberately.  “It’s your turn. Focus. Watch precisely what I’m doing, and repeat it exactly.” In my medical training up to this point, I had been taught to observe and do my best to replicate. The way that the fellow demanded I do “exactly” what he was doing startled me. I shouldn’t just try to suture like him, I realized. I must exactly replicate his technique. My focus on the procedure was so much greater than it would have been without his directive. 

The lesson is simple: give the totality of your focus to every procedure you are doing. Cast aside, “I’m tired.” “I wonder what time I’ll get to go home.” “I wish I was getting paid for this.” “I’m not even going into this specialty.” Focus deeply on what you are doing, and your results will improve.

On Rounds And On Interviews: Remember The Importance Of Likability

I recently had a medical student rotating with me in the OR. He was going into neurology, but he thought an anesthesia rotation would be a good adjunct to his learning, especially when it came to spinals, epidurals, and nerve blocks. I asked him if he was interested in throwing in any IVs or performing an intubation. “No, no…I’m all right,” he replied.

How odd, I thought.

What’s a medical student doing on an anesthesia rotation if he isn’t interested in the huge procedural component to the specialty?

I felt he was taking the spot from someone more passionate about the field, who would be willing to try harder. At the same time, when it came time to review his performance, I had a hugely positive bias. He was so likable and told great stories. He was engaged with other staff members and me. He was cordial, funny and just enjoyable to be around. 

If you come across as a likable candidate (without obviously trying too hard), it will pay dividends on your rank list.

For better or for worse, this “soft skill” is a huge component to your rotations, and perhaps more importantly, to your interviews. You can boost your stellar (or even ho-hum) ERAS application by being a wonderful human being. If you come across as a likable candidate (without obviously trying too hard), it will pay dividends on your rank list. Here’s a useful tip: be someone whom your interviewer would want to grab a beer or a coffee with. If so, then you are in a good spot. 

Along The Way: Take An Easy Rotation

This is a simple reminder that you don’t have to give everything you’ve got every single day during this busy time. Don’t get me wrong – give it your all to your Step 2 CK studying. Be impeccable in your interviews. At the same time, don’t miss opportunities for downtime. Interview season is a great moment to take an easier elective, or to participate in an activity where you can control the schedule, like a research month. Recharging can help you reset and focus as you prepare for the extreme demands of intern year. Give yourself a much needed break, and your brain will thank you. Check out our recent blog post on self care practices in medical education.

At Every Moment: Stay Receptive As A Learner

There is always a way to learn. Everyone has the capacity to teach you something. Just think about it: some of your attendings were practicing medicine before you were born…If you truly want to derail something they are trying to teach you, here’s how to do it: finish their sentences. 

“But I need to demonstrate that I knew where they were going with their thoughts! I need to show them I am the best medical student of the bunch!” Sure, there’s a small chance you will “impress” them with your fund of knowledge…but there are plenty of other opportunities to do the same in a more natural way. When someone is teaching you, devote yourself to listening. Don’t try to predict where your mentor is going with a particular thought; you will learn much more by staying receptive instead of trying to flaunt your knowledge. This way, your mentor will be able to deliver the material exactly the way she or he intended to.

There are plenty of other opportunities to impress your mentors. When someone is teaching you, devote yourself to listening.

If you have questions, feel free to ask. If you want to take the conversation in a particular direction, feel free to do so when it’s your turn to. Still, answering questions that no one asked simply to show off is pointless.

MS4 year by no means is easy!

As challenging as it is, this year will somewhat determine your future in medicine. Hopefully, one of these messages will help you achieve your goals and excel as a 4th year medical student and way beyond.