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What to Expect as a Med School Spouse: Years 3 and 4

Created May 4, 2017 by Amy Rakowczyk

With Step 1 completed, and hopefully after a little R&R, your spouse is ready to get out there and try their hard-won knowledge in the clinics! Also coming up, your spouse will be selecting a specialty and starting the process of researching residency programs. They will put their application package together, go through the interview process, rank the programs, and wait for the much anticipated Match Day, then graduation! It will be a lot in a short amount of time, so here’s your breakdown of what to expect!

Medical School Year 3

Your spouse will likely be very relieved when they reach MS3. The long study hours will finally be behind them and they will feel eager, albeit a bit nervous, to get out into the clinics and hospitals. MS3 is a series of rotations (lengths vary by school) in different clinics/specialties where your spouse will start developing their skills through hands-on experience.

During these rotations, your spouse will be on high alert to impress the higher-ups. MS3’s are focused on getting good evaluations from each rotation as well as making a good impression so they can ask for letters of recommendation for residency program applications. Your spouse will want to appear competent, able, and skilled even when they are encountering patients and health problems for the first time in “real life,” and not in a textbook or with a practice patient.

They will likely get “pimped” regularly which means that their attending (the supervising doctor for the team) will ask them questions on the spot related to the medical situation at hand (or sometimes completely random information), and your spouse is expected to know the answer. If they don’t know the answer off the cuff, they will experience a very humbling moment and then will make a mental note to review the topic before the next day.

Some people thrive in this environment or are not too bothered by it. Other people get very stressed under this type of pressure. Always trying to impress, being ready to produce correct answers at any moment, and having knowledge gaps exposed can feel overwhelming and defeating. All MS3’s are in the same boat, but some people find this environment more challenging than others.

Third year is also when many medical students start to solidify their specialty choices. They may find that they unexpectedly love a rotation and can see themselves doing that work forever, or they may confirm that their initial instinct from first year was correct.

The second half of third year will mark the preparation period for residency applications. By about March, your spouse will need to consider which attendings to ask for letters of recommendation for residency. They will start putting together their CV, and at some point late in third year or early in fourth year, they will take Step 2 of the medical licensing exams. (This is actually split into two separate exams on two different dates: one clinical knowledge exam and one series of simulated patient encounters.)

If your spouse was unhappy with their Step 1 score, Step 2 is their chance to redeem themselves, as many residency programs are happy if the applicant shows a strong improvement in their score between Step 1 and Step 2. If they scored strong on Step 1 there is less pressure, but they will want to maintain their strong showing. All of this is to say that your spouse will have another intense study period leading up to Step 2, but this time around will probably be a little less stressful because they’ve already been through it once.

Medical School Year 3 – What it means for you

Flexibility in MS3 is key. Each of your spouse’s rotations will be at a different location, with different staff, a different set of norms and rules, and different hours. One month you might see your spouse a lot and you’ll be able to enjoy each other. You’ll see your spouse’s “regular” self come out again. Other months, you will rarely see them and they may regularly be in bad moods or over-tired. Some attendings like to keep med students late, either because there is just that much work to do, or simply because that’s how it was for them when they trained, “back in the day.” Some rotations will have unpredictable schedules.

During this time, you will either feel like you finally have your spouse back after all that studying, or you’ll be entering into one of the toughest times during medical school. Each couple is different! Look out for your spouse getting overly stressed and taking it out on you. Make sure they have an outlet to decompress from all the pressure.

But fear not, this too will pass, and there are many things you can do for yourself and your relationship during this time. Here are a few articles that may help you weather the storms:

1. Sustainability: How Your Relationship Can Survive and Thrive
2. Sharing Our Doctor Spouses
3. Defining Your Expectations
4. Making Time For Fun

Medical School Year 4

Hallelujah!! It’s your last year of medical school! The finish line is so very, very close. In my experience, fourth year was a much-needed breath of fresh air. Life will feel much more spacious. Your spouse will have some control over their time by selecting their rotations and time off. The rotations will be related to the specialty they hope to go into, so overall, your spouse will be much happier with their work environments.

MS4 does come with quite a bit of traveling. Away rotations are common and there is also interview season, which can last several months. After the interviews, you and your spouse will create a program rank list to submit before Match Day. Rank lists are typically due in February.

The Match happens in March for all specialties except for a select few such as ophthalmology and urology. Military matches also run on their own schedule, so if your spouse is matching into a military residency, they will know long before the rest of their classmates. Once the Match happens, you’re basically in the waiting process to start residency (usually in June). You may be moving, so you’ll be focused on that!

Medical School Year 4: What it means for you

If your spouse is doing away rotations, there may be some stress on your relationship during that time. Only seeing your spouse for sporadic hours throughout med school is one thing, but them being completely gone for weeks at a time is another, especially if you have children. I talk more about away rotations here. If you’re considering starting a family at some point in the near future, read about that here.

If you’ve read my previous articles, you know that I frequently advise to FIND YOUR MEDICAL PEOPLE. You need other medical spouses in your life! Whether it’s in person or online, knowing you’re not alone is so incredibly important.

For the traveling aspect of fourth year, it will be exciting but a bit exhausting toward the end, especially if your spouse is doing a large amount of interviewing. If you have the opportunity to go on any of the trips with them, take advantage of it! Sure, you might spend most of your time in a hotel, but you’ll get a break from the house, your work, the never-ending to-do list, and get a few more hours with your spouse!

Once interviews are complete, your life will be consumed with comparing the different residency programs, researching program cities and offerings, and making your rank list. This is an exhilarating time full of hope, opportunity, and nerves. You’ll try to imagine yourself living in each city and what life would look like there. Ranking programs feels like a very big decision, and it is exciting, yet stressful. You’ll experience a lot of back-and-forth and rearranging of the programs before you settle on your final list. My advice during this time is to do the research you need to do, make your pros and cons lists if that helps, and then go with your gut. For more on Match Day, check out my previous article: A Guide For The Big Day: Match Day.


You deserve a huge round of applause (and a nice vacation!!) for not only taking care of yourself throughout medical school but for being a pillar for your spouse as well! If you haven’t felt acknowledged yet for all the seasons you’ve weathered and the sacrifices you’ve made, you receive it now. I acknowledge what you’ve done and continue to do. You are the strength and glue holding this sailing ship together. Congratulations not only to your incredible spouse on completing the arduous demands of medical school, but also to you, for your support, love, and resilience through it all! You’re off to the next leg of the medical training journey – residency! Time to celebrate!

About the Author
Amy Rakowczyk is a medical spouse, mother, writer, singer, and former voice instructor. She currently resides in Galveston, TX with her husband and two young daughters. She enjoys helping other spouses navigate the world of medicine and actively participates in support groups and activities. Her husband is a Family Medicine resident at UTMB Galveston and did his medical training at The Ohio State University.

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