Trying to figure out what to do with the rest of my fourth year. Some background (edit: WAY MORE background than is needed, lol)…

In September and October, I did a month of outpt peds and a month of outpt IM. However, those were pretty half-*ssed months for me as I was studying for Step 2 and burnt out - I was in 4th year but stuck doing a annoyingly basic 3rd year rotation I hadn’t been able to fit in during 3rd year. So really, the last clinical thing I truly DID was my peds sub-I in August. In November I took a journal club type course that met 1 hour a week, and in December, I did a “research” month spent almost entirely on interviews. For January and February, while most of my friends are doing super light electives, I am taking full-time graduate coursework in biostatistics and clinical research methods. I’m talking about homework assignments, lectures every day, recitations, lab sessions, exams, papers… UGH. It’s not all that bad but not what I want to be doing right now (I have to take these courses for my scholarship program). In March I will fulfill a med school requirement with a non-clinical course that will meet ~6 hours/day 2-3 days a week, and 3 hours a day on the other days. In May I am taking a vacation month - hubby and I will go on an actual vacation for a week and leave DD with the grandparents (eek!), and otherwise we will be working on finding a place to live, moving, etc.

You may have noticed I skipped April . Here is my dilemma. I am currently enrolled in an ICU elective for that month. The reason is not because I’m interested in the ICU (I’m not), it’s because it’s the highest rated elective in the entire med school. A couple hours every afternoon are spent in simulation sessions with one of the school’s most loved faculty members. All the course reviews say it is a “must take” course, “should be required”, “you will be comfortable running a code”, etc. These seem like really good reasons to take it. Also, it will be the only chance to do a get my feet wet with clinical work again before starting internship. On the other hand, the hours will be long(ish) - 7 am every morning (I know, that’s so not bad, but come on, I’m a 4th year!), going I’m not sure how late (depends on site and attending, I’m told). The alternative is for me to take some light easy elective (clinical or non-clinical), and have more hours to spend with my husband, be less tired with the time I’m spending with my daughter, finally finish that last manuscript I’ve been taking months to write up, be able to devote more time to all the administrative hurdles like looking for daycare, etc.

So I’m torn between the desire to be lazy and enjoy the lassitude of 4th year post-match, and the knowledge that maybe I should kick my butt into gear and actually learn something.

Other 4th years, what are your plans? To those who’ve been there before, what did you do spring of 4th year, and do you wish you’d done it differently? (Posting in General forum so non-med students can respond).

I am going to through my 2 cents in...remember that very soon, you will no longer have the comfort of the med student title and lack of expectations from patients. People will be calling you, "Dr. So and So" and expecting you to be more competent than you will be; while I can understand why you want to enjoy easier months...this rotation sounds like it will be invaluable prep for internship, which in my opinion was a frightening transition! Good luck, and do enjoy these last few months before the madness begins!

I did a critical care rotation in, I think, May prior to the start of internship and it was really valuable. I'd had a long clinical break, and the ICU is a great place to get back up to speed. Lots of interesting physiology, very sick patients ... plus, it's so fun. I love the ICU. (Granted, I'll probably tack a critical care fellowship on to my renal fellowship, so I guess I'm biased here.)

Anyway, I'd do it.

Yeah I'd do the ICU rotation - will be invaluable for intern year.

Man, I want to go to your med school!

I'm doing a sub-i in April (at the place I want to match--crossing fingers). My rotations this year were CICU, surgical sub-i, medical sub-i, anesthesia elective, subspecialty elective, and two humanities electives.

I thought my ICU month was invaluable (but stressful and exhausting)--and this is coming from someone with years of ICU experience! It sounds like you'll have plenty of time for particulars in May. Just my 2c Keep us posted!

I did a lot of ICU rotations 4th year, but I was going into anesthesia. Remember like mentioned above, depending on your internship, people will look to you to run codes and such.

But then how can you put a price on your time with your family?

It's a toughy.

You're going into psychiatry, right? Do you have a medicine internship? Do you have to do ICU months or not? I think back as a 4th year I would have advised you to do the ICU rotation, but now I would say ENJOY the down time. Internship is sink or swim anyway and learning is on the spot, not really from simulations etc. And in your case, it's really just about surviving the intern year. It's not like you'll have lifelong use for your ICU learnings.

Caveats:
1) I have a profound hatred for the sim suite. It's so unrealistic, I think it's useless.
2) In pediatrics, they would never let an intern run a code anyway (or maybe it's just my program?), and there's lots of supervision of interns in non-code situations as well(read: not that many responsibilities other than clerical of course). Lots of hand-holding. I acknowledge it's different in medicine.

Oh, yeah - if you're going into psych, you totally don't need to do it, in my experience.

Haha, I guess that added bit of background would have been helpful. Yes, I'm going into psych. At the top two places on my rank list (for now, at least), I would be doing a pediatrics internship (6 or 9 months, depending on which program). If I ended up at another program, I might do medicine, but only 4-6 months. Could possibly end up doing ICU at one of those programs, but don't expect to go there, and if I did, it's 1 month at a community hospital and the residents there described it as more of a step-down unit.

I wonder if that changes any of your opinions on the matter?

You have all managed to convince me that I should definitely do something clinical with my time. (asunshine, you put me to shame!). I guess I just got all caught up in the idea that I shouldn't be working now, and conveniently forgot about the fact that I'm about to be a DOCTOR, and should probably take some responsibility for my education. Though honestly if it waited one extra month until residency, I don't think it would make a huge difference on the other side...

Anyway, now that I'm thinking in this vein, I guess the question becomes do the ICU month, or do something more pertinent (and probably enjoyable) like a psych or peds elective. There is a peds ID elective people love, a developmental peds elective (though reportedly it is mostly shadowing), and there's a child psych C&L elective that reportedly would give me a lot of autonomy (and is something I've always been interested in experiencing). Many others to choose from... For those of you in peds or psych, any 4th year electives that were particularly valuable or that you wish you'd taken?

I guess my greatest source of hesitation in passing up the ICU course is the abundance of glowing "YOU MUST TAKE THIS COURSE!" reviews. I have this irrational fear that if I don't take it, I'll be missing out on some huge life-changing experience and I'll be a total failure of an intern, lol. On the other hand, adult medicine does NOT excite me, I don't enjoy procedures, and the idea of spending a month in the ICU is just so not appealing.

Easy easy: 1) pain clinic; 2) sleep medicine clinic.

You will spend a HUGE amount of your time talking about pain and sleep, with little formal training. If you have any room in your schedule whatsoever, that's where I'd spend it! If you can only do one, do pain.