Faculty and Students: Let’s Change the Mindset of Fourth Year

By Brittany Chan

At the end of my third year of medical school, an attending told me, “You’re about at the pinnacle of your medical knowledge. Fourth year all the knowledge just disappears. Enjoy it.” I heard the same message from med students gone before me. “You have so much free time fourth year. You can totally slack off.” Having almost finished my senior year, I’m calling for students and faculty alike to fight the lazy culture of fourth year. Your mindset makes all the difference.

During senior year at my school, exams are practically nonexistent, and grades don’t matter as long as you pass your rotations. (Many other medical schools follow a similar structure for the fourth year.) My schedule was filled with electives that interested me, and I loved them. When not on interviews or rotations, I made time for myself. I caught up with old friends, spent valuable time with my family, and even managed to plan a wedding. I finally read the stack of leisure books that had been piling on my desk (and in my Kindle). Being able to unwind before the chaos of residency is an important part of this year, and I enjoyed my time to the fullest.

However, I didn’t feel like fourth year was a complete mind-dump. In fact, it was a very valuable time of learning and personal growth that allowed me to pursue my interests both in and outside of medicine. Without the pressure of grades and scores constantly looming, I was able to learn for the sake of learning. While I won’t say I didn’t suffer the occasional bout of senioritis, the educational freedom was exhilarating to me, and I actively tried to combat the brain atrophy I had heard about so often. I was able to explore areas of medicine that I hadn’t yet been exposed to, such as pediatric palliative care. I honed my skills in diagnosis and patient care on the wards and in clinic. I joked about suffering brain atrophy, and at times I felt like I was, but the truth is that I learned a lot. I was fortunate to work under several great attendings and residents who helped me improve my skills.

There’s a widespread assumption that senior med students, especially after the match, no longer care about learning and would rather be sitting at home watching Netflix. Most of us have heard repeatedly about how easy it is to slack off during fourth year. Though some students remain enthusiastic, many reinforce this stereotype by skipping rotations, failing to prepare for rounds, or otherwise blatantly displaying their apathy. After years of expending their best efforts, they half-heartedly complete rotations.

In perhaps a vicious feedback loop, I’ve noticed some attendings start to expect less of fourth year students during the spring semester. They dismiss students early or spend less time teaching. Some do this out of kindness, knowing well the long hours that await us in just a few short months. Or perhaps they believe we are less receptive to their lessons, our minds elsewhere.

But our final year, despite its reputation for being the time to catch up on TV shows, go to happy hours, and lay out on the beach, is and should be a crucial year for our growth as clinicians. We’re more comfortable examining and taking care of patients. Despite what we feel we have forgotten, we have more knowledge and experience under our belts. We have never been closer to being doctors, yet there’s still so much we don’t know.

To my fellow fourth years, congratulations! We have made it so far and should be proud of all we’ve accomplished. I hope you enjoy the rest of your year and your time off before residency starts. I also urge you fight the stereotype and get the most you can out of any remaining rotations, because in a few short weeks, we’ll finally be the real deal! (Plus, you’re still paying tuition for this year, so why not?)

And to the faculty, and all the more seasoned doctors out there, thank you for being such fantastic teachers throughout the course of medical school. Don’t stop teaching because it’s the end of our fourth year. If you assume we’d rather be anywhere else, please don’t. Impart us your wisdom. What should we know as new interns? What would help us as we take the next big leap of our careers? Can we practice a few more of that procedure? Push us to continue to improve ourselves even as we eagerly anticipate graduation. Many of us still want (and all of us need!) to learn.

–Brittany Chan is a fourth year medical student at Texas Tech University Health Sciences Center; she is about to start pediatric residency. She can be reached on Twitter @bchanmed

0 thoughts on “Faculty and Students: Let’s Change the Mindset of Fourth Year

  1. The point of medical school is not to learn medicine but to match to a residency where you can learn the corner of medicine you are tasked to learn.

    Medical school is but a formality. Once matched, there is no incentive to put in any effort from that point forward, because very little of what’s left will be applicable come July.

    In fact, very little of what’s taught in medical school is applicable at all, except for those in primary care and internal medicine. Almost half of the clerkship year is spent on pediatrics, psychiatry and obstetrics, three fields that are particularly niche and that have very little overlap with other fields. Fields like radiology, anesthesiology and ophthalmology are barely factored into the curriculum, yet arguably have a more broadly applicable relevance to all specialties.

    Med school is, succinctly put, a joke based on recommendations that are more than a century old.

  2. Thanks for your comment!

    I do agree that radiology and anesthesiology should probably have a bit more emphasis (not so sure about opthalmology). But I do think it’s important to rotate through all the “core” clerkships in order to become a well-rounded physician with a solid background. Though it may not seem so at the surface, psychiatry is indeed applicable to almost all fields (some of my best interview skills were gained on that rotation, you’re likely to run into patients with depression no matter what field you’re in, etc). Pediatrics, though seemingly niche, is important to know even for doctors who care for adults, since many problems that present in the adult years can be traced back to problems in childhood or birth.

    Sadly, I think medical school has somewhat degenerated from what it has been in the past. No longer are we allowed to take much responsibility for patients or take as active roles in the team as medical students used to do long ago, and I think it served them well back then. Perhaps we can work together to change this rather than accepting medical school as a useless “formality.” I still think medical school is useful for giving students a basic understanding of clinical medicine as well as honing fundamental skills such as H&P, forming differentials, and learning to interact with patients, and as such can provide useful learning even in the fourth year.

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