Med School Update: How to Schedule 4th Year Electives

Scott and I having a "kitty" calendaring video chat on his last rotation

We are more than half way through the third year of medical school and it is already time to plan our life. Scott has completed nine rotations, but already he is faced with the decision of what residency, and ultimately future specialty, he would like to do. Ideally, you should know what specialty you would like to pursue going into medical school. That way you can plan research activities, community service, and third-year electives tailored to that specialty. Sounds like medical school applications all over again, right?!

Scott has known from the beginning that he would like to consider sports medicine as his future profession, and luckily he has already had rotations that have confirmed his love of all things musculoskeletal. He hasn't done any research yet. We must have been under the impression that research was only needed for highly competitive specialties. However, having research during medical school on your resume will make any student more competitive for scholarships and preferred residencies. There may still be a chance for him to work with a faculty member on a case (hopefully my writing this out doesn't diminish his opportunities or ego).

To start the process of scheduling electives for fourth year, you need to know where you might want to do your residency. There are MD residencies and DO residencies to consider. You can search for MD residencies on FREIDA Online and search by US state and specialty (login required to search, but even I have a user name). There is a separate site for osteopathic residencies: http://www.opportunities.osteopathic.org/. In our search, we considered specialty, location, residency curriculum, affiliated school, and length of residency. I'm not saying those are the perfect set of characteristics... I'm especially not saying that because at this point we haven't applied for or been accepted to a residency. It's just the criteria we thought were important.

The majority of your electives in year four will be visiting the residencies you're considering for applications, in order for the residency and you to evaluate best fit. Once you know what residencies you're considering, you want to get their residency coordinator information from either FREIDA or Opportunities and contact them about doing rotations during your fourth year. This conversation will likely include them telling you how competitive their residency is and asking any questions you need before submitting documents to do a rotation.

Many rotations will require you to submit a formal request to do elective rotations. Rotation requests are submitted through the Visiting Student Application Service (VSAS). Most institutions will publish their available rotations between January - April of your third year and accept applications until later in the summer. Be aware that there are fees to submit requests and institutions may have their own processing fees. Applications include a photograph, CV, transcript (provided by your school), immunization report, and maybe an essay. Again, sounds like medical school applications!

Scott has spoken with rotations offices in Oregon, California, Washington, and Texas to arrange rotations. I plan on him being on elective rotations all over the country from July to December of next year. Best to have the expectation that I won't see him very much, and then be pleasantly surprised and grateful for the times when I will get to see him. We've had great conversations whenever he was on an away rotation this year. I know he loves this hands-on work and I support him in finding a place where he will love what he does.

UPDATE 10/2014: At this point Scott has done several audition rotations and is starting to receive invitations for residency interviews. Residency interviews start around November, involving a lot of traveling on the student's part.

If we had a second chance to schedule fourth year rotations, I would recommend scheduling one audition to begin early on (July or August) so your student gets a better idea for what curriculum or residency characters tics he/she prefers (good to know when applying to residencies in August and September). You will need to be flexible with your calendar, fluctuating based on what rotations your desired residencies have available.

To fill up your student's fall schedule, I would recommend submitting "tickets" (requests for rotations through the school's system) early, even before fourth year begins, in order to cover required rotations.  Required rotations can be scheduled at any time, and can be rescheduled if auditions are offered during the same time. At COMP-NW required rotations include sub-internships in Emergency Medicine, Internal Medicine, and Surgery. Scheduling these rotations in the fall can act as a back-up if your student doesn't get auditions scheduled, and then graduation requirements out of the way.

November and December will involve traveling for residency interviews. It may be possible to interview with the residency while your student is completing an audition there. Otherwise, your student will want to schedule rotations in November and December that will be flexible for travel. It may be necessary to use what limited vacation time your student has during those months for interview travel.