Fourth Year: The Final Stretch

Fourth year is pretty much amazing.  After the stress and intense learning curve of third year, fourth year is a brief moment in time where you can take a step back and take a breather.  There certainly are stressors between applying for residency and finishing up rotations.  However, it is the last time before residency that you can really have some solid break time.  And, by the end, you will be a doctor!

Rotations

I had a chance to take some pretty neat rotations this year.  There are a few required rotations (Advanced Medicine, Neurology, and Surgical Subspecialties), but the rest you get to choose. I completed 3 psychiatry rotations (general psych, psych ER, and hospital psych consults).   I participated in a Forensic Pathology rotation, assisting in autopsies at the county morgue.  Through a Faith in Medicine course, I worked with patients at Hospice and free clinics. 

Board Exams: 

We had to take 2 additional board exams: Step 2 CK (Clinical Knowledge) and Step 2 CS (Clinical Skills). 

CK:

CK is similar to step 1 in that it is multiple-choice format.  However, it is a bit longer and centered more on clinical medicine.  Luckily, most students find it to be a bit easier.  It took only 3 weeks to study for this one (vs. TEN weeks for step 1). 

CS:

CS tests your ability to interact with patients.  This should be a pretty easy test by the end of medical school, as it incorporates skills you have been developing over the last 4 years.  Largely, I think it is an expensive way to be sure that (1) you can speak English and (2) you feel comfortable interacting with patients. 

CS tests your ability to interview a patient, write up the encounter, and come up with a differential diagnosis (list of conditions the patient could possibly have based on symptoms).  The exam takes place in an office-based setting.  Unfortunately, there are only a few places to take the exam in the U.S.  Tony and I chose the closest site we could find, which ended up being Philadelphia, PA.

For Tony and I, the logistics of the CS exam were more challenging than the exam itself.  Stupidly, we waited for the weekend before the exam to arrange our hotel accommodations.  Needless to say, we didn’t have the best selection.   We ended up at probably the sketchiest hotel in Philly.  You know you are really in trouble when you see this on your room door:

However, I can’t complain too much as we did make it out alive and passed our exams!

Interviewing and the “Match” Process:

During fourth year, most medical students travel across the country interviewing with potential residency programs.  It is a time-consuming, exhausting, and expensive process.  However, most students find it to be a really valuable experience.  It allows them to get a feel for many programs and end up somewhere they really like.

All medical students must go through a “match” program.  For most students, they go through the NRMP match, which is a nation-wide matching system.  Med students can “couples match” (enter the process with another student) or match singly.  Students select their top choices for programs, and each program also ranks the students that have interviewed there.  If the program ranking is similar for both the student and the residency, the student will end up a resident at that location.  Students find out in March (Match Day) where they will be going! 

For Tony and I, our process was a little bit different.  As military medical students in HPSP (a program for students who will commit time to the military in exchange for a medical school scholarship), our match pool is smaller.  It is a more intimate process.  Students rank their programs, which can include military and civilian programs. In November, all of the specialty program directors for each military residency program actually meet together and decide on their residents.  It is not an automated system like the national match.  They take into consideration the students’ choices.  We couples matched through the military, and found out in December where we would be going.

Our interviewing process was MUCH easier than the average medical student.  We had the opportunity to interview with our program directors during our away rotation (medical rotation done at a military site).  We liked our programs so much that we didn’t interview anywhere else and only ranked one program each (this is NOT generally recommended, but worked our really well for us).

Away Rotation:

We LOVED our away rotations in San Antonio.  My away rotation experience really couldn’t have been any better.  I loved the patient population I worked with, which consisted largely of current military members and veterans.  In the psychiatry program, the staff and students worked so well as a team.  I could really see myself fitting into that clinical environment.  It was my first real look into residency life.  Also, Tony and I had a chance to catch up with our friends, the Sky family, as well as our military training friend, Mamie. 

The location was a pretty nice icing on the cake.  San Antonio is a beautiful city, with so many interesting places to explore including the River Walk, King Williams District, the Alamo, and a ton of great restaurants.  But, I would have to say that the weather really sold me.  I loved that it was pretty much always warm and sunny… a welcomed change after the seemingly endless cold winters in Buffalo (although this past mild winter was a welcomed surprise)

Letters of Acceptance and MATCH DAY!!

As part of the military match process, we received the great news in December that we had both matched San Antonio for our programs!  It was a HUGE weight off of our shoulders to know so early where we will be going.  It certainly made the rest of the year really enjoyable.

When March came, the rest of our classmates found out where they would be headed.  On Match Day (when everyone learns where they will be going), each student receives a sealed envelope that contains the program he or she matched into.  Even though Tony and I knew what was in our envelopes, it was great to watch the feelings of trepidation turned into excitement as our classmates received their matches.  We were so happy for all of our friends, and most students were really happy with the results. 

                   

Time off:

At my school, students are given three months of time off from rotations.  It is intended that these months be used for interviewing, studying for/taking board exams, and preparing for residency.  Due to the very small time commitment incurred by our interviewing schedule, Tony and I ended up with a lot of extra time off!

If you have been reading this blog or following my Facebook, you will know that Tony and I added a furry friend to our family.  Of course, raising a puppy (even though we cheated and got him at 6 months) was a time commitment.  We are enjoying watching him grow and fit in with our family.  It is now hard to imagine our life without him!

We also spent a lot of time with friends and family!  This is likely the last year in many where we can spend multiple holidays with family.  We enjoyed Easter, St. Patrick’s, Christmas, and Thanksgiving celebrations.  What a blessing! 

The last four years have been a whirlwind.  It was incredibly challenging working our way through med school, and it is a great feeling being at the end looking back. We look forward to the next step as we begin residency.  However, we are thankful for the experiences that led us to this point.