3rd Year:
1. Surgery & medicine clerkships are most important! Do well.
2. Because we can’t typically do an EM rotation until the beginning of 4th year, use 3rd year to “rule out” some specialties and “rule in” other specialties you might be interested in. Begin thinking about your second choice residencies should you decide EM is not right for you.
3. Always work for that letter of recommendation (LOR). It’s a good rule of thumb, and you never know when you might need a good LOR.

4th Year:
1. EM rotation early on & then do another EM away rotation, if needed.
2. ERAS application in September.
3. Schedule electives that interest you and may help prepare you for your residency.
4. Take some time to enjoy yourself.

Designing your Third and Fourth Year Clerkship Schedules – Chapter 16, Rules of the Road for Medical Students

Well, it’s that magical time of the year when medical students finally have a chance to sit down, relax and calmly reflect on the meaning of life (a.k.a. how are the rotations that I choose for the next year going to impact my chances of getting into my residency of choice which may also impact my future career opportunities). Wow! This is a lot. Take a deep breath; it’ll all work out in the end for the best!

Sharing advice on this topic is difficult, as each medical school has different required clerkships, but the general philosophy is the same…do what’s best for you! For each choice, there is a trade-off. Know the benefits and the trade-offs of your choices. The better you know yourself, the better decision you’ll make.

Although we try to “game” our rotation schedules to give us what we think will be the advantage, sometimes it’ll backfire. Don’t worry; you did what you thought was best. Now, it’s time to just work hard and learn from every experience, good and bad. In the end, all the planning in the world can’t make up for simply working hard on your rotations and having a positive attitude!

3rd Year Rotations:

Question #1 – Do I take medicine early in 3rd year or late in 3rd year?
ANSWER: It depends. Medicine is important for EM so you want to do well. At the same time, medicine can give you a good foundation for other rotations. Unfortunately, you’ll likely be compared to students on the rotation just before you, likely students who took medicine late in 3rd year. Keep this in mind as it may be a little harder to do well in clerkships at the beginning of 3rd year because of the learning curve. Consider postponing important rotations for later on in the year.

Question #2 – What about surgery?
ANSWER: See answer to question #1. Also, there is a lot of medicine in surgery. Therefore, taking medicine before surgery may make surgery less difficult but conversely, taking surgery before medicine may make medicine less taxing.

Question #3 – My school has a lot of required 3rd year rotations. Now what?
ANSWER: You may not have time to explore all the specialties in which you may be interested. That’s okay. Use these rotations to “rule out” specialties and begin to compile your “backup list,” in case you decide on your EM rotation that EM is not right for you.

Question #4 – How do I know if I’m going to like EM if I can’t do an EM elective until 4th year?
ANSWER: Just like the answer to #3, use 3rd year to explore other specialties you might be interested in. Unfortunately, you’ll have to do well in these and work for letters of recommendation at the same time in case you decide to come back to one of these specialties. This isn’t a bad thing because it’ll force you to work hard in all your rotations. EM incorporates aspects of almost every other specialty, so learn as much as you can.

Question #5 – What other advice do you have?
ANSWER: Pediatricians are just nice people. Starting 3rd year with pediatrics is a good way to learn about inpatient and outpatient medicine without as much stress, unless kiddos cause you stress. (Have you ever seen a pediatrician yell at someone? I don’t think they’re even allowed to.)

OB/GYN – OB/GYN may help prepare you for surgery as you may become more comfortable in the OR and do some rounding as well.

Psychiatry is another rotation that may ease you into third year, but it may not prepare you as well for later rotations.

Depending on the school, family medicine may incorporate aspects of medicine, pediatrics and OB/GYN into the rotation, so it may give you a good preview of upcoming rotations, in addition to getting comfortable in the clinic (which we all hate).

4th Year Rotations:

Ah, 4th year…almost done. Not quite. Early in 4th year, we finally get to do our EM rotation. You’ll love it. And, if you don’t, hopefully you listened to our advice for third year rotations. We’ll assume for now that you did. If you don’t have an EM residency at your school, you better consider doing an away rotation at another school. This may help you get another LOR and also prove to be an “audition” interview, so do your best!

What to think about for 4th year scheduling:
1. EM rotation (June – September)
2. Away EM rotation (if your school doesn’t have a residency) – (June – September) 3. Get letters of recommendation (August or earlier) 4. ERAS application (September) 5. Dean’s letter (a.k.a. Medical Student Performance Evaluation – MSPE, etc.) mailed out – (November 1) 6. Residency interviews/vacation time (November – January) 7. USMLE Step 2 (sometime during 4th year; if you didn’t do well on Step 1, consider taking Step 2 early in 4th year) 8. Elective Rotations – Here are some “recommended electives” to prepare for your EM residency:

*Anesthesiology
*Critical Care (e.g. ICU or SICU)
*Radiology
*Orthopedics
*Ophthalmology
*Trauma surgery

9. Attend an EM national conference, such as the AAEM 16th Annual Scientific Assembly in Las Vegas, February 15-17, 2010, to start networking with residency directors!