Arranging Your Fourth Year Schedule

It's approaching the time of year where third year medical students are starting to think about how to arrange their rotations for the fourth year.

This is probably the most control you will have over your schedule throughout your medical school career. Where I went to medical school, we had three months of required rotations and seven months of electives. That leaves two months for vacation. We also had one month of vacation available during the third year, and if you did an elective during that month, you had three vacation months available and were only required to do 6 months of electives.

Let's start with the important part. How might you consider spending your vacation month(s)? First, and foremost, is interview season. Most, if not all interviews take place during December and January. You should plan to be able to travel during both of these months. I did fifteen interviews, six in December and nine in January. You don't necessarily have to use your vacation months as many schools have electives available in their catalogs that do not require an extensive time commitment. There is time for trips if you would like to travel the country/world. Many of my friends have gotten married during their vacation months, so please, do not make it all about business. This is the last year in life that you will get to enjoy, so build in some time for enjoyment.

There is one other matter to consider as you are thinking about scheduling a vacation - board exams. If you are not already aware, you must take two parts of Step 2: the clinical knowledge (CK) examination and the clinical skills (CS) examination. First, you must think about your Step 1 score. Are you happy with that score? Does it make you competetive for Orthopaedics. I would venture to say, if you have a score of 240 or greater, you do not need to worry about taking Step 2 right away. If your score is lower than that, you might want to consider taking the exam earlier in the year. Otherwise, put off the exam for as long as you can. I have been told by many people whom I trust that Step 2 scores are not heavily considered by program directors as long as the Step 1 score meets the cutoff.  Which brings us one other important point.  Many programs have a cutoff that is programmed into ERAS.  If you don't meet that cutoff, they don't ever look at your application.  If you think your score might be on the borderline, I would talk to the program director at your school, or the program director of places that pique your interest.

Now, to scheduling.

June - August - Start the year with some orthopaedics, preferably at your home institution.  This will allow you to get familiar with what is expected of an ortho sub-i in a relatively safe environment.  I've written a post about it in the past, but I'll hit the highlights.  Expect to work your tail off.  Be helpful but not annoying.  Read and prepare yourself for cases.  As an alternative, you might want to take one month during this time frame to get involved in a research project.  It's not required, but having some research on your CV will prevent you from getting thrown out of a program's interview pile for no good reason.  Speaking of CV's, don't forget about ERAS.  Make sure you have time to complete your application and run down letters of recommendation.  You might be getting these letters during the early part of the year, which is OK - but you should expect to have all of your letters by the end of October, middle of November.

August - October - This is the prime time for away rotations.  Pick one or two places that interest you and go visit.  If the program allows you to pick which attending(s) you can work with, do some research first and find the program director or chair.  Make a point to work with people who can go to bat for you when it's time for the program to make their rank list.  Remember, this is a month long job interview, so be on your best behavior at all times.  I've seen the match process from the other side now, and I can tell you, it's somewhat difficult to get yourself to the top of the rank list.  It is NOT HARD AT ALL to find yourself at the bottom, or off the list completely if you piss someone (even an intern) off.  That said, this is probably the best way, if you play your cards right, to get to the top of the list.  Programs will rank you higher if you spent time there and did a good job, mostly because all applicants look very similar, and having taken the time to spend a lot of money to work at a place means a lot.

November - Interview offers will start rolling in November 2nd or 3rd.  Use this month to do something fun or something required and get organized for your upcoming interviews.

December - January - Keep it light, if you do any rotations at all.  You'll be traveling all over during these two months trying to get a job.

February - June - Finish up your required rotations.  Spend time with your family and friends.  Travel the world.  Drink a lot.  Do whatever you want because come July, you are a career (wo)man, and you just won't have as much time for that kind of stuff any longer. 

July - Time to start learning your trade.  Hopefully, you've matched at your #1 program and you are ready to rock and roll.