Fourth Year: A Chance To Explore

Last Updated on June 25, 2022 by Laura Turner

By Adelle, Medical Student

The process of applying to residency can surely be daunting. I’ve compiled a list of programs that I am interested in (as a quick refresher, I’m applying to OB/GYN programs), whether that be in terms of geography, the size of the program, proximity to family, etc. Many, many factors go into just deciding on a list of programs, and then there’s the process of actually completing and submitting applications. I feel like my life thus far has been a series of applications: college, medical school, residency . . . when will it end? Apparently not yet, because there is yet another application process: one for “away” rotations, or those away from your home institution that (usually) take place during the fourth year of medical school. They are a unique opportunity to explore medical specialties and settings in a way you will never have again.

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Each medical school has a certain cohort of students every year. Usually the schools take on the responsibility of making sure that each student’s core requirements are fulfilled in the third year. That’s when medical students rotate through “core” specialties such as internal medicine, general surgery, pediatrics, etc. But once fourth year approaches, medical schools are much more flexible in terms of which rotations students can and cannot complete. For example, my school leaves the entire fourth year up to the individual student. In some cases, we are even allowed to choose a preceptor and rotate with them wherever in the world they may be. Pretty cool, right? In theory, I could do a plastic surgery rotation in China next year if I were so inclined. Some schools have a group of existing programs and rotations that you can pick from, but they tend to be more of the “cooler” rotations/subspecialties you may never be exposed to again. These can include plastic surgery, pediatric cardiothoracic surgery, gastroenterology, cardiology, endocrinology, radiation oncology, and many more. I’m so grateful for such opportunities because I know that they will most likely never come around again.

The other side of fourth year rotations is also getting the opportunity to rotate through residency programs you are interested in. AAMC even has a special application for this called VSLO (visiting student learning opportunities, formerly called VSAS). These can be referred to as sub-internships (SUB-I), acting internships (AI), away rotations, or audition rotations. It took me a long time to figure out that they all meant the same thing—but essentially you are expressing your interest in a very specific program in a specific specialty and get to show them how awesome you are in person, sometimes even before you apply for residency! This can be very scary. Typically, the rotations last for four weeks, and you are expected to perform at intern level for those four weeks—and potentially get judged by the program director. I’ve heard from many people that these can either make or break you. Many people who can push themselves and shine or would like to make up for other deficits in their application pursue these. However, it is also perfectly acceptable to rotate at a residency program just to see what it’s like even if you are not necessarily interested in that particular program.

Fourth year is an amazing time to explore specialties that you will likely never encounter again. I love how traveling anywhere can be so easily incorporated into it! One of my friends is planning on going to Greece, and another colleague spent one month in Argentina working at a children’s hospital in the infectious disease unit. These experiences are once in a lifetime and are truly the light at the end of what seemed like a very, very long tunnel. Now that I’ve completed all of my third-year rotation requirements, I’m so excited to begin planning my final year of school!

About the Author

Adelle is a 3rd year medical student who loves to hike, bake chocolate chip cookies, and doodle on the corners of papers.