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Empowering Fourth-Year Medical Students: The Value of the Senior Year

Cosgrove, Ellen M. MD; Ryan, Michael J. MD; Wenrich, Marjorie D. MPH

doi: 10.1097/ACM.0000000000000191

In this issue of Academic Medicine, Wolf et al explore the purposes and value of the senior year of medical school as viewed by graduating students at their institution. Using data from student focus groups and questionnaires, they report that students all found there to be significant value in but identified different purposes for the fourth year. The authors of this commentary believe that study adds to the discussion of fourth-year curriculum reform an important voice that has been lacking—that of students.

Previous articles focusing on the perceived lack of clarity of educational purpose in the senior year curriculum have reflected a faculty perspective and have led some to call for increasing the structure of, decreasing the elective time in, or even completely eliminating the fourth year. In this commentary, the authors ask for a pause in this debate to consider the implications of the student perspective as well as important trends in the medical education continuum that affect the senior student (e.g., milestones that will set new expectations for first-year residents, increasing pressure associated with matching to a residency). They propose that providing students with time for career exploration and for focusing on areas of interest would allow them to individualize their preparation for residency and to be more sure of their career choices. They share the University of Washington School of Medicine’s planned new fourth-year approach as an example of a flexible, individualized senior year curriculum.

Dr. Cosgrove is vice dean for academic affairs and professor, Department of Medicine, University of Washington School of Medicine, Seattle, Washington.

Dr. Ryan is associate professor, Department of Medicine, Division of Nephrology, associate dean for curriculum, and director, Center for Medical Education, University of Washington School of Medicine, Seattle, Washington.

Ms. Wenrich is chief of staff, UW Medicine, associate vice president for medical affairs, and affiliate assistant professor, Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington.

Editor’s Note: This is a commentary on Wolf SJ, Lockspeiser TM, Gong J, Guiton G. Students’ perspectives on the fourth year of medical school: A mixed-methods analysis. Acad Med. 2014;89:602–607.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Dr. Cosgrove, University of Washington School of Medicine, 1959 NE Pacific St., Suite A-300, Box 356340, Seattle, WA 98195; telephone: (206) 218-5328; e-mail:

© 2014 by the Association of American Medical Colleges