How to Best Use Your Forth Year of Medical School
You may already have received advice about how to plan your 4th year. If you have received advice from
more than one person, you likely have recognized that there are substantial differences of opinion. For example,
you may have heard that you should do something you will never have the opportunity to do again: spend time in
other fields before entering pediatrics full-time. Or that you should travel and enjoy yourself, since your nose will
be to the grindstone soon enough. Or that you should try your hand at research, particularly if you haven’t done
any. Unless individuals giving you advice know you and your interests very well, it is likely that their advice will
tell you more about them than about what you should do! So you’ll need to consider the source and decide if the
advice feels right to you.
My view comes from my long-standing attraction to pediatrics over other fields, my own experiences in
medical school and residency, and my many years as a residency program director. When I was in the 4th year of
medical school, the curriculum was largely prescribed. By the time I was a senior resident, the curriculum had
changed to allow more elective time. The result was there were interns who already had more experience in
pediatric subspecialties than I had, and I envied their breadth of exposure and training. I submit to you that you
should use your fourth year of medical school to add value to your total education as a pediatrician. Pediatrics has
grown considerably since I was in training, both in depth and in breadth. You can’t learn all you would like to
learn about pediatrics in 3 years of residency. There are now so many subspecialties in pediatrics that the old
residency model of doing “a month of this and a month of that” no longer works, because there are more
subspecialties than months; this is particularly true if you include disciplines that are generally not housed in
departments of pediatrics but relate to the care of children (eg, pediatric neurology, child psychiatry, pediatric
surgery, pediatric orthopedics, pediatric ENT, etc.) You will continue to learn “on the job” after residency, but
some valuable experiences are available to you during your fourth year of medical school in ways that will not be
available after residency, such as supervised clinical rotations, and that will enrich residency training.
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So, with my bias expressed, let me offer the following strategies to consider:
Augment what you will experience in pediatric residency. No residency curriculum is complete. If you happen
to know where you would like to go for your residency, you can examine the curriculum on the web and
consider ways to supplement it. If this sounds daunting, an alternative is to ask someone who graduated from a
peds residency program in the last few years what they wish they had learned or done. You will likely hear
responses such as more dermatology, pediatric orthopedics/ sports medicine, and others.
You can “try on for size” different career roles, such as specialist, generalist, community practitioner. The
purpose, in addition to content, would be to identify what these various roles entail to help you develop your
sense of what excites you (and what doesn’t).
If you know you will be moving from UNC-CH, you might want take advantage of particular strengths at
UNC-CH. This extends beyond pediatrics: If a certain rotation has a reputation for great teaching and great
clinical experience, it may be very worthwhile to you as a future pediatrician even if it isn’t focused on the care
of children.
You could also take a “competency” approach, with particular regards to communication skills. Residency
program directors commonly identify this as an area they wish was better addressed before internship; specific
examples include facility in delivering bad news, dealing with difficult situations, and even providing informed
consent for procedures.
All of the above strategies. Fortunately, there is enough flexibility in your 4th year that you do not have to pick
only one strategy. Think creatively for what will help you most.
Think about your choices; use the year wisely. And welcome to pediatrics!
Kenneth B. Roberts, M.D.