Medical School Advice for 3rd & 4th Year Students

Advice for Every Rotation

  • Read the section corresponding to your upcoming rotation in First Aid for the Wards prior to the start of the rotation (or at least within the first week). If you  study no other resources during your rotation, make sure you know this information.
  • Practice questions are a great way to quiz yourself during each rotation. More students are leaning toward a year subscription to an online Step 2 question bank, but there are also decent Q&A review books divided by specialties such as: Lange Q&A: USMLE Step 2 CK
  • No matter how tired you are, make sure you study at least one hour every day. Many students learn easiest when they study a chief complaint they encountered that day.
  • Determine on DAY ONE how many pages of your basic text you need to read every day to achieve your reading goal. Then stick to your daily reading assignment.
  • Listen and take notes on rounds. Always be on time. Act interested. Be a person that others like to have around. These will help increase your chances of success and a good evaluation.
  • Ask your resident and/or attending what is expected of you and how they like to hear you present. Do this within the first week of the rotation, at the latest.
  • Help your residents, do not try to outshine them. Fill them in on cases/patients and if they are in a situation where you know the answer and they don’t, hand them a note. They will let the attendings know you are awesome and sing your praises when it comes time for evaluation.
  • Learn the art of being concise and presenting pertinent information in your presentations. This will endear you to your attending, resident, and the rest of any team of which you are a part.
  • Don't be too hard on yourself. Third year is all about doing something wrong every single day. So just relax, and continue to do stupid things because that means you're learning. It is ok to do things wrong now, because you are not the one making the final decisions. If you don't mess-up now, you're going to mess up later when it matters. So now is your chance.
  • Try to get as many letters of recommendation during third year as you can. If you are not 100% certain what field you will go into, have the attending write a generic letter. More letters mean that you will have more to choose from when applying to residency programs next year, and having multiple choices means you can choose the best program to fit your needs. You should try to walk away from every rotation with a letter of recommendation. But in the majority of cases you will be surprised by how good of a letter an attending will write for you. Additionally, when your attending writes a letter for you, he or she will be forced to look at you in a more positive light, so you may end up getting a better evaluation because of it!
  • For every rotation you will need Tarascon Pocket Pharmacopoeia, Maxwell Quick Medical Reference pocketbook, and a smartphone or PDA loaded with Epocrates Rx or another free drug reference. Here are some other iPhone applications that students have recommended - the prices reflect current price as of this posting and are subject to change by the provider: Monthly Prescribing Reference (aka MPR, free app), AHRQ ePSS (free preventative medicine screening guide), Mediquations ($4.99) or MedCalc (free), ABG (free), Hypermunes Pregnancy Wheel (free), iMurmur2 ($2.99; has great sample murmur recordings), ECG Guide ($0.99; great pocket reference for ECG interp), and Diagnosarus DDx ($.0.99; helps you come up with differential diagnoses for a given sign/symptom).

Studying for the USMLE Step 2 CK

The Doctors In Training USMLE Step 2 CK Online Review begins on any date you want. It gives you 60 days of access to 15 days worth of high-yield material that you won't find anywhere else. Most students take about a month to study more intensively for Step 2. If you did not do as well as you wanted on Step 1, this is your chance to show residency programs you have improved. If you need to cover your Step 1 blemish, then take Step 2 early (before October of 4th Year) so residency programs will have a chance to look at your mastery of the clinical sciences. If you think you might do worse on Step 2 than you did on Step 1, then take the test later so residency programs only have your Step 1 score when making their decision to offer you an interview. If you plan on this second option, make sure the residency programs in which you are interested in do not require a Step 2 score for interviewing, because some do. Most programs now require Step 2 CK and CS scores prior to ranking; however, some do not, so check program information closely. Here are some of the best resources for Step 2 study:

Studying for the USMLE Step 2 CS

The last AAMC (American Association for Medical Colleges) meeting revealed that the CS exam will soon begin using new methods for testing students, causing the test to become more challenging. We will keep you posted on our blog as more information becomes available to help you better prepare for the new CS exam. For now, the tried-and-true techniques that currently apply will be very helpful to you.

Enlisting a study buddy that is also preparing for the Step 2 CS exam is invaluable. Each of you can take turns being the simulated patient/evaluator and the student physician. Be sure that you simulate timing and each section of the CS exam, including writing the patient note.

Scheduling Your Fourth Year Rotations

  • Know that your first few rotations will appear on your transcript and Dean's Letter (now called the medical student performance evaluation, or MSPE). Since these grades will appear on your transcript and the written evaluations in your MSPE, you may want to adjust your schedule to overshadow your 3rd year grades with better 4th year grades. Conversly, you may decide totake more P/F classes during  early in 4th year so your 3rd year grades stand out on your current transcript.Most residency interviews take place October through January. Schedule easy rotations and/or time off during these months to go on interviews.
  • If you are undecided between 2 career choices, do rotations in these fields first so you can hurry-up and make up your mind.  It is difficult to apply to more than one specialty.
  • If you still need letters of recommendation, rotations that will provide you with strong letters should be scheduled early in the year.
  • If you are going into  a competitive field and have not yet done research, you need to schedule a research rotation early in the year.

Whether doing an away rotation is essential is dependent on several factors such as specialty choice and residency program. Whether a student should do audition rotations is a highly debated topic even at annual AAMC meetings. Away rotations are suggested for certain specialties such as orthopedics and some residency programs will not rank an applicant if he/she has not auditioned at their program.  If you choose to do an audition rotation at an institution, be aware that it could hurt you unless you are at the top of your game and work your hardest at that program. Seek out the best, most current advice possible from reliable leaders at your institution before making these choices. If it is important for you to check out a program prior to spending the next 3-5 years there, then make sure you are willing to arrive first in the morning and leave last in the evening each day of your rotation.

On Writing Your Personal Statement and Applying to Residency

Use Iserson's Getting Into a Residency. Check out the several articles we have posted on our blog for insights into writing the personal statement.

If you are a medical student and have additional information that you think third and fourth year medical students would find helpful or questions about success in medical school, please send your comments/questions to [email protected].

It’s important to have a strategy for what and when you will study. Many students find the structure of the Doctors In Training USMLE Step 2 Review Course beneficial to their exam preparations. Our course presents the high yield information you need to know and is updated annually to reflect student feedback.