Fourth Year

After you submit your list in early January, the focus of medical school changes. Grades become unimportant (as residency programs are unlikely to see grades after July) and your priorities should be: a) gaining intern survival skills, b) increasing knowledge-base, and c) relaxing. Take electives that will enhance your ability to do and think independently. Some electives to think about in the fourth year include:

• General Surgery Sub-I: You will get to see cases that you were unlikely to see as a 3rd year and will probably not get a chance to scrub in on as an intern. This will also prepare you well to run the floor. 
• Medicine Sub-I: Every patient you will have from now on will have medical co-morbidities. Learn not to be afraid of DM, CHF, and the like.
• Nephrology: This is a hit or miss elective that gives you insight into the medical pathologies of the urinary tract.
• Radiology: Be sure to take this rotation if did not do so in the 3rd year.
• Cardiac Anesthesia: This is a great rotation to learn to do central lines (every cardiac patient gets one in the OR), to intubate, and to understand the basics of anesthesia.
• SICU: This is the place to gain ICU management know-how and learn to deal with very complicated patients.
• Infectious Disease: Thorough knowledge of infectious disease treatment is essential for any surgeon.

You will also need to take the USMLE Step 2 this year. Follow this link for advice on how to best handle this hurdle. Otherwise, be sure to enjoy your fourth year. You will not be this carefree again until retirement!