Since going back to clinical rotations, I have felt the nebulousness of being a fourth year medical student eat at me. Although I am no longer the third year medical student who needs to be constantly monitored and who is under the direction of some resident, whether they like it or not, I’m also not quite an intern. On top of these murky waters, I haven’t seen and talked to a real patient in the past four months because I had been doing research, completing non-clinical independent projects, and interviewing all over the country. It’s a tough spot to be in!
I worry about not doing enough for the patients that I am taking care of. I can obtain the history and do the physical exam, but the actual management, the assessment and plan, are still up in the air. I can call consults and page other services, but often times, I’m ignored or the resident on the line only wants to talk to another resident or attending. My orders must be co-signed and even the notes I write mean little as the residents and attendings still have to go see the patient and write their own notes. I do wish there was less redundancy in the system!
Nevertheless, I wouldn’t trade fourth year away for accelerated medical school training. After such a packed third year, I do like that the flexibility I get in terms of scheduling my fourth year. I have been able to explore things I probably wouldn’t be able to do if I had only done stuff required for my specialty. I recently read a Journal of the American Medical Association article that talked about the value of fourth year. In this article, the authors wrote about how if one wanted to shift the paradigm of fourth year, there must be change to the overall residency application and interviewing system that pervades much of fourth year. Without such systematic change, making fourth year more rigorous at the expense of decreased flexibility wouldn’t fare well for students. I think I agree with the authors…there is only so much I can do with the limited time that I have in fourth year, outside of the interviewing season.