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Going “Fourth” From Medical School: Fourth-Year Medical Students’ Perspectives on the Fourth Year of Medical School

Benson, Nicole M. MD; Stickle, Timothy R. PhD; Raszka, William V. Jr MD

doi: 10.1097/ACM.0000000000000802
Research Reports

Purpose To learn what graduating medical students considered the primary purposes of the fourth year of medical school, their approach to residency selection, and the challenges they faced in meeting their fourth-year goals.

Method A 52-question Web-based survey was administered to fourth-year students from 20 U.S. MD-granting medical schools in spring 2014. Quantitative data were analyzed with one-way analysis of variance, chi-square analysis, or paired t tests. Responses to an open-ended question were coded into themes and confirmed.

Results A total of 1,367/2,884 (47.4%) students responded. Students applied to a mean of 36.4 (SD = 22.6) residency programs and interviewed at a mean of 12.3 (SD = 5.6) programs. Surgery applicants applied to more programs (mean = 58.2, SD = 22.3; P < .001); radiology applicants interviewed at more programs (mean = 16.9, SD = 8.5; P < .001). Students took a mean of 1.8 (SD = 0.8) monthlong away electives in their career specialty of choice; surgery and emergency medicine applicants were more likely to complete away electives (P < .001). Students agreed the fourth year has multiple valuable purposes, including maximizing the likelihood of matching into their residency of choice, gaining a broad educational experience, and preparing for residency. The main purpose varied by specialty, but overall students ranked preparing for residency highest. Completing away electives and interviewing were expensive; approximately 35% of students could not complete away electives because of financial constraints.

Conclusions Medical students view the fourth year as a time for residency selection and preparation.

Supplemental Digital Content is available in the text.

N.M. Benson is a first-year resident, Department of Psychiatry, Massachusetts General Hospital and McLean Hospital, Boston, Massachusetts.

T.R. Stickle is associate professor, Department of Psychological Science, University of Vermont, Burlington, Vermont.

W.V. Raszka Jr is professor of pediatrics, Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: The University of Vermont institutional review board and committees on human subjects granted exempt status for this study.

Supplemental digital content for this article is available at

Correspondence should be addressed to William V. Raszka Jr, Department of Pediatrics, University of Vermont College of Medicine, Given Courtyard N202, Burlington, VT 05405; telephone: (802) 656-2296; e-mail:

© 2015 by the Association of American Medical Colleges