Advice on crafting your MS4 schedule

Today’s inane image of the day:

The Boston Marathon finish line – a perfect photo to represent 4th year.


I hear from my panic-stricken MS3s that this weekend marks the beginning of the MS4 scheduling lottery. I also hear that they are running things a bit differently than last year [which, from what I’ve heard, sounds like an incremental improvement over the system we had last year]. Because I don’t quite know the details of how the different rounds of the lottery are organized this year, I’m not going to provide strategies on ranking courses, only ideas to consider when planning out what to do for the 10-months that constitute the best year of medical training.

Since everyone is going into different specialties, I’m also going to try to keep this as general as possible with comments on what I did and why. Take what you wish from this entry [and as always, feel free to reach out to me with personal questions].

I think there are a couple broad ways to categorize how many of my colleagues organized their MS4 year: those that wanted to get all of the required stuff out of the way and enjoy the second half of the year to the fullest, those that were still deciding between specialties and those that wanted to get a taste of life outside of Beaumont Hospital [and potentially leave the state for residency or were applying to a competitive specialty that expected them to do away rotations]. My class had 4 required months – a sub-internship [internal medicine, pediatrics, surgery or family medicine], emergency medicine, family medicine + ophthalmology, and anesthesia + diagnostic medicine – plus 3 months of electives and 3 months off. Now you guys have only 3 required months and 4 elective months [which is so much better – you cannot really secure an away rotation as a 3rd year because most institutions won’t accept you without finishing all core rotations], plus the 3 months off.

Let’s start with my schedule:

  • June: Step 2 CK/CS [look out for a future entry on how I studied for the exam]
  • July: Pediatrics Sub-I
  • August: [Away Rotation] Pediatric Immuno-Hematology at the University of Michigan
  • September: [Away Rotation] General Anesthesia + Pediatric Anesthesia at Stanford
  • October: [Away Rotation] Pediatric Pain and Palliative Care at UCLA
  • November: Independent Study in Ethics
  • December: Off for interviews
  • January: Emergency Medicine
  • February: Family Medicine + Ophthalmology
  • March: Anesthesia + Diagnostic Medicine
  • April: Off [for vacation]

A couple things you may notice:

  • I did an extra rotation [I didn’t use all 3 months] because my UCLA rotation was 3 weeks long and I needed something else to cover the last week of credit I wouldn’t be receiving… to me, it was easier just to do an extra one instead of signing up for some sort of independent study. Plus, this also shows that those of you that need to do an extra rotations in the same specialty [remember, MAX is 2 rotations in the same speciality for credit unless you’re doing medicine subspecialties or you are doing a required one] can do so by using one of your off months [and getting no credit for it].
  • I was basically away from Beaumont all of first semester – I enjoyed this and thought it was a good way to experience new health systems, build my network and learn from clerkships I will likely never be able to rotate on again.
  • I did an Independent Study in November so that I could earn credit and go on interviews. November was my heaviest month of interviewing, so this worked out well. I did clear with my Clerkship Director if it would be alright to be out of town for most of the month and he was open to it as long as I got my assignments done.
  • I got Step 2 out of the way early. If you did stellar on Step 1 and want the option of releasing your score, then take it in late-August/early-September so that your score comes out after you’ve already submitted ERAS [but get CS out of the way ASAP]. If you need to improve from Step 1, the earlier you take it, the more you will know. The later into the year you take it, the harder it is to study and the less you know – I feel like all of the knowledge I absorbed from 3rd year has fallen out of my head… seriously.
  • Finally, I made my last month of the year off because I wanted to go on a big vacation to celebrate finishing medical school. If you’re only interviewing locally, you could theoretically take the last three months off [meaning you’d be done at the end of January… wow] since you won’t need too much time off to interview.

Now for some general advice:

  • For those of you still deciding between specialties or need to confirm your decision, you should place those electives in July/August. The most important question for you is what specialty [or specialties – some people dual apply!] you’ll be applying to.
  • Want to leave the state for residency? If you have ties to a state already, that’ll usually be enough to get you some interviews. If you don’t have any ties, then consider doing an away in that state. The question of whether to do an away at your dream institution due to fear that you will screw up – well… that’s something to ask yourself. If you didn’t think you had a chance at a particular institution [because of Step 1 score, grades, etc], then you probably have nothing to lose [except maybe some money]. With a higher Step 1 score, this gets a bit sticky.
  • Need letters of recommendation? Do those rotations early in the year and go in prepared with the ask early on. If you need a letter from a heavy-hitting physician, then do an away where you can get one [some aways straight up tell you that they will not write a letter on your behalf before you apply – be mindful of those].
  • How to pick away/elective rotations? Lots and lots of factors go into this. I believe that this is the last time to do something fun, so I picked unique areas of medicine that I was interested in. Another way to approach it is to find specialties that may help you in the future [e.g. someone going into emergency medicine should learn how to intubate – anesthesia can be useful]. Some people just want easy rotations; in general, picking an outpatient one will guarantee weekends off. Otherwise, it’s best to ask around for what the hours were for specific electives as that’ll be the best representation of how “cush” it is.
  • Doing away rotations early in the year also gives you time to pester people about submitting your grade. I still only have 1 grade processed from my 3 away rotations…
  • Give yourself enough time to interview. Find out from your colleagues when your specialty typically interviews candidates, but be flexible around October-January because you never know when your dream institution will come knocking. Also, if you’ll be going on a lot of out-of-state interviews, remember to give yourself at least 2 days for interviews since you need to factor in travel [unless you’re already in the region]. Luckily, I did my West coast interviews while I was out there… but I wasn’t so lucky with Chicago and Boston – had to fly to each city twice because I just couldn’t schedule those interviews together.
  • Try to give yourself time before September to make sure you have everything in order to submit ERAS on Day 1. If you’re going from hard rotation to hard rotation, you may find yourself scrambling to write your personal statement, entering all of your research/activities into ERAS, getting all of your letter writers to submit their letters and deciding which programs to apply to. Remember, you only apply to residency once [well, let’s stay positive here!], so make sure you do it right the first time.
  • For those of you wondering about exams… emergency medicine has an OSCE + shelf exam, pediatric sub-I has a shelf exam [none of the other sub-Is had an exam this last year] and anesthesia/diagnostic medicine have quizzes. I suspect the emergency medicine sub-I will use the in-house exam because rotators had to do it, however don’t quote me on that.

Most importantly, don’t freak out! Even if the lottery doesn’t quite give you everything you wished for [I feel like I should replace “lottery” with “Santa” or “Genie”], you can still make the most of your schedule. Most of my colleagues’ schedules were in flux all year because an opportunity came up [e.g. interviews] or they changed their mind about something. It’s totally possible to change your schedule during the year!

Did I miss anything?

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