Planning 4th year of med school

Okay, this is about to be a long post. Obviously, a lot goes into planning your 4th year of med school. Especially if your school is like mine and basically gives us complete control of the planning process. I had to plan each rotation myself, including finding preceptors/institutions, applying through VSAS/VSLO, establishing affiliation agreements, and onboarding at each institution. I didn’t want an easy 4th year, I wanted to be challenged – to push myself and learn as much as I can while I’m still a student. I planned every single rotation outside of my home institution, which took months of communication and mountains of paperwork. But I started my planning early, and that made the biggest difference in my success.

This is how I did things. But remember that everyone’s situation is completely different. So as I talk through the following points, remember that I can only give you advice on what I have experienced (or things that my friends did). Ask other people what they did. Listen to their advice. And then after you have this huge melting pot of information, pick and choose what things will work best for you. 

Edit: this post was featured on The DO!

Scheduling away rotations

• Start planning EARLY. Even if VSAS/VSLO isn’t open yet, start getting things together that you know you will need and act on any tasks that you can offload now while you have time before the busy season hits. Most applications open in March or April, so I suggest starting to plan by February.
• Stay organized. I used an excel sheet to visualize my 4th year and I changed the colors of each rotation as my planning went on (eg, white for planned, light green for when I submitted the rotation for approval for my school, dark green for when my school approved the rotation, etc). Create a system that works for you so that as you plan and go through the process of finding and solidifying various rotations, you can keep track of them in an organized manner.
• Plan around interview season. Plan to have at least one easy rotation or a month off during interview season. Interview season starts about mid-October and ends late January. That said, the highest interview months are November and December. I scheduled a lighter rotation during November with a preceptor who let me take as many days for interviews as I needed. I packed most of my interviews during that month and then only scheduled during the other months when November didn’t work for whatever reason.
• Decide how many away rotations/auditions you want to do. This number is totally different for everyone and is based on what specialty you’re going into, how competitive your application is, whether or not you want to stay within a certain region, etc. I did 4 (and was told I was crazy for doing that many & that I’d be too tired to perform well) but felt great about my decision and completed them all with confidence.
  • Reasons to do more auditions:
    1. You are personable and will perform well on an audition (be self-reflective, look back at your evaluations from 3rd year, and ask yourself, “Do I work well with people and do my preceptors like working with me?” Hopefully the answer is yes, but if the answer is no, I would stay away from doing any auditions.
    2. Your specialty places high importance on experience in the field and/or audition rotations — PM&R cares a lot about whether you actually have experience in the specialty, since most medical students don’t complete PM&R rotations. PM&R is also big on teamwork and personality, which places a ton of importance on doing an audition rotation. So, I personally wanted to do a lot.
    3. You want to get a feel of various types of work environments (inpatient vs. outpatient, private vs. community hospital, etc).
  • As stated above, if you’re not someone who works well with others or gets poor evaluations from your rotations, I’d stay away from doing any auditions for obvious reasons.
  • Other reasons you may choose not to do many auditions may be that you need to stay in town for your family/children or you don’t have enough funds to cover temporary housing in addition to your permanent housing (I’ll talk more about how I made this work below).
• Decide where you want to do audition rotations. Choose places you would actually want to go to residency. Keep in mind that audition rotations are all about showing the program who YOU are. You will become close with the faculty and staff at these program and work with them every day. You will network and make friends, and they will undoubtedly get to know YOU. You can’t hide for a month. So be careful about choosing where you rotate – if you don’t want to be there, they will be able to tell. 
  • You can use websites like FREIDA, Doximity, and program’s websites to learn more about each program and determine which ones you might be interested in.
  • The BEST people to talk to about a specific residency program are the current residents at that program. You can do this a few different ways: (1) Contact the department chair at your medical school and ask for a list of previously graduated students from your university who went into your desired field. Usually, your school will have information about their previous students, including where they matched for residency, and can give you their contact information. (2) Look for your school’s interest group Facebook page and find current residents that graduated from your medical school. Since they are alumni of your school, they are usually open to talking to you about their program and giving you an honest perspective. 
• Apply for auditions at programs. Most programs use VSAS/VSLO, but some use their own application systems. You can usually find this information on their residency program website under “medical students” or “visiting students.” I would suggest applying for a few extra programs in addition to the ones you really want, because you will probably not get all of the auditions you apply for. However, be smart about this and don’t over-apply because you don’t want to have to cancel a ton of auditions you over-booked yourself with. If you have to withdraw your application or cancel an audition rotation, be professional about it and explain to the program why you’re still interested in their program regardless of being unable to rotate with them.
• Be ready to apply day 1. After I decided where I wanted to apply, I marked down the date their VSAS/VSLO application opened. You’ll be able to see all the documents/statements that each elective rotation requires, so get all that ready early. Increase your chances of getting that rotation and hit submit as soon as it opens.
• Some rotations will require a personal statement. I know it’s early in the game to prepare a personal statement, but if one of the rotations you are applying to requires one, prepare a preliminary one. It doesn’t have to be the finished product that you’re going to submit to ERAS later in the year for residency applications.
• Use a professional photo on your application. Wear a suit, do your hair, and get a professional-quality photo done. You’ll be able to use this photo for ERAS residency applications, so might as well get one done now.

Organization and logistics

• Create a file (on your computer, in the cloud, whatever) where you can keep all the documents you may be asked for when setting up away rotations. These documents include things like your school’s letter of good standing, BLS/ACLS certifications, recent drug screen, background check, AAMC Standardized Immunization Form, TB mask fitting, proof of insurance, etc. Get all of these things in one place so that when someone from another institution needs them, you aren’t running around trying to find them all. If you don’t have these things completed yet, go ahead and get them done before applications open. Because I was so organized with this, every rotation commented on how easy it was to onboard me. The coordinators appreciate this and it makes a big difference. 
• Treat EVERYONE with the upmost respect, even when things like onboarding, a million orientation modules, and stacks of paperwork get frustrating. Not only are the program coordinators very close with the program directors (and will talk about you), but it’s important just to be a nice human. I can’t even count the number of times I had to re-send emails, call to check on the status of something, or ask around until I was talking to the right person who could help me. Communication is key – and that will be a theme for the rest of your career, so get used to it now.
• If you didn’t catch it above, here is a link to the spreadsheets I used to organize my year. You can download them for yourself. Notice that there are tabs at the bottom for different sheets where I organized my rotation by month, my interviews, working rank list, and even a tab I used to write out my thoughts for interview questions.

Buy me a coffee?

Housing

• I decided not to keep my apartment. I let my lease expire and moved out in June of 2019 (end of my 3rd year of medical school, before my dedicated USMLE Step 2/COMLEX Level 2 study time). Doing this one not-so-simple act immediately saved me $12,000+ on rent and utilities, which I could now use for temporary housing, travel for interviews, application fees, and other 4th year expenses. That being said, I had to plan extra for this because I had to make sure I had a place to sleep every single night for the next year. It was difficult, but so worth it to me since I wasn’t going to be at my home institution at all. Again, my master spreadsheets saved me.
• Other options that may work for you: 
  • Renting out your room to other medical students while you’re away on sites such as AirBnB (click this link to be an AirBnB host) or Rotating Room
  • Moving in with a roommate so that you cut your rent in half
  • Moving in with family
• While you’re traveling, stay with family and friends as much as you can. You can offer to pay them a small fee, pay for their utilities that month, or cook them dinner, but this option will usually be cheaper than any other temporary housing you can find.
• When I didn’t have family or friends in the area, I used AirBnB (click this link for $55 off your first stay) and Rotating Room to find deals on temporary housing.

Things to sign up for now

• TSA Precheck/Global Entry. I did not understand how great this was until I had it. I can’t even count the amount of times TSA precheck saved me when I was running from an interview to catch the last flight out. One of my credit cards covered the cost of TSA Precheck ($85) or Global Entry ($100) , so I went with Global Entry since it include TSA precheck and I’ll be able to use it for international travel. Both TSA Precheck and Global Entry last 5 years – worth the investment!
  • Make sure to sign up at least 2-3 months before interview season as it does take time for them to process your application and then for you to go in for an in-person interview in your area.
• Get a credit card! I’m not going to tell you which one to get because you should choose one based off of the benefits that will benefit you personally. But I can tell you which ones I like and why I chose them. I personally have a couple different cards because I use them for different things based off their benefits. Disclaimer: I am not a financial advisor or anything of the sort so this is only my personal opinion. Please be careful and keep track of what you’re spending on your card(s). Credit card debt is not something to take lightly. My rule is that I don’t swipe my card unless I have the money in my bank account. The only reason I use credit cards is for the benefits, NOT to spend money I don’t have.
  • Southwest Airlines card – you’ll get 40,000 bonus points if you use this link
    • My favorite because I used Southwest Airlines for EVERY flight during 4th year. Pretty much everyone will tell you they’re the best for interview season because they allow you to check 2 bags for free, they have the lowest flight cancellation/delay rate of all airlines, and they never charge you fees for canceling/rescheduling flights. That last point is VERY important because you will undoubtedly have to cancel or reschedule multiple flights as you accept and cancel new interview offers. Interviews don’t all come at once, so your schedule will constantly be in flux – you want an airline that lets you change your schedule without penalty. Plus, the 40,000 bonus points you’ll get from this referral can cover up to 4-6 flights for FREE depending on the flight price.
  • United Explorer card – you’ll get 40,000 bonus miles + $0 intro annual fee if you use this link
    • I like this card because it has lots of international benefits (covers your choice of TSA Precheck or Global Entry!) and having the card does give you a free checked bag and free rental car insurance. I never used this card for interview flights because Southwest flew everywhere I needed to go, BUT I love it for all the other benefits. Again, the 40,000 bonus miles from this referral link will get you at least 4 flights for free.
  • Discover card – you’ll get $50 statement credit if you use this link
    • I use this card for all my personal things like groceries and gas because it gives me a good cash back percentage.
  • These are my personal referral links, so I get a little something too when you use them. But it benefits both of us and the little gift is much appreciated 🙂

Money and budget

• Everyone’s budget is different, depending on whether or not you have loans and how much you have. At the end of the day there are things you will HAVE to spend money on and things that are frivolous and you can totally live without this year.
• My biggest advice: start thinking about this now and write down your expenses, think through what you’ll have to purchase, and then decide if you’re going to need to get another student loan or borrow money from family, etc. 
• If borrowing from family is an option, I suggest swallowing your pride and asking for it. Your bank account will thank you in the future for the lack of insane interest.
• Necessary expenses to account for when planning ahead:
  • VSAS/VSLO application fees ($40 base fee which covers 3 electives + $15 per elective after that)
  • Fees for audition rotations such as admin fees and parking passes (ranges from $0-$200 depending on institution and location) 
  • ERAS application fees (can be anywhere from $500-2000, depending on how many programs you apply to)
  • Housing and transportation for interviews

Travel Essentials

Here are some things that made my life easier while traveling. And also some things that you should just make sure not to forget while on the road.

• Backpack that slides over luggage handles
• Clothing rack in your car
• Storage bins for the back of your car
• Toiletry bag that’s easy to unfold & hang up
• Reusable water bottle
• Collapsible coffee mug
• Travel steamer to get rid of those horrid wrinkles in your suit
• Lint roller to keep all your clothes looking fresh
• Hand sanitizer (so many germs on airplanes)
• Laptop & chargers
• 2 suit sets (shirt, pants, jacket) in case one gets lost or damaged
• Versatile, comfy professional shoes. I have Rothy’s (use that link for $20 off) and Clark’s Ballet Flats.
• Snacks. DON’T waste money on marked-up snacks at the airport. I like Larabars, KIND bars, and nut mixes.

Do YOU

In typical Nicolet fashion, I’m ending this massive stream of advice by telling you not to listen to everything I, or anyone else says. Take it all for what it is – advice based on personal experience. Also a couple important points:

• Stop listening to people who tell you that you can’t and don’t stop trying when you hit a road block. You’re an adult. You can make decisions for yourself. Trust yourself and your experience. If you hit a road block, think outside the box. How else can you get done what you want to do? There is always another way.
• Remember that at the end of the day, you won’t be able to prepare for everything. Instead, go into this year knowing that it won’t be perfect. Things will go wrong and the unexpected will happen. But lucky for us we live in a world where anything forgotten can be bought at a convenience store, Ubers can be used when transportation falls through, and hotels are always an option in the case of an AirBnB fail. We live in a world where chaos is pretty avoidable, and hey, a little chaos never hurt anyone.
• Jump in, let things come as they will, and enjoy the ride. 

You got this!