Preparing for the transition from third to fourth year of med school

Transitions can be scary, especially when you’re in medical school. It is often very helpful to hear insights from DOs and medical students who have already been through these changes.

I am currently an emergency medicine resident at Christiana Care in Delaware. Below, I answer common questions about the transition from third to fourth year of medical school. Read on for tips about studying for the Comprehensive Osteopathic Medical Licensing Examination (COMLEX), scheduling rotations and preparing for rotations.

When did you take COMLEX Level 2 and how did you prepare?

I took COMLEX Level 2 at the end of July, which was the beginning of my fourth year. Some students will elect to take it earlier, while some students will elect to take it later in the fall. My best advice would be to take it when you are ready, but most preferably before you begin your sub-internship rotations, as you will want to be on your A game for these.

Regarding how I prepared, I mainly used UWorld for COMLEX Level 2, and repeated Sketchy Micro and Pharm, which I thought was a nice review from the last time I studied those sections (which was when I was studying for COMLEX Level 1). For those of you wondering, I did not rewatch all the Sketchy videos, but simply reviewed the associated card with each video on my Sketchy account. You must remember that if you are studying for your Comprehensive Osteopathic Medical Achievement Test (COMAT) throughout each rotation, during third year you are also studying for COMLEX Level 2 at the same time.

I used subject-specific sections in UWorld to study for COMATs during third year, and when January of third year came around, I started doing UWorld on random and timed modes, with a goal to make it through the bank with one thorough pass. Some people complete UWorld multiple times, but I knew getting through the question bank once thoroughly with an intensive review of the questions and explanations is what was going to work best for me, especially because questions are added to the bank almost daily.

Lastly, I reviewed Robert Savarese’s green osteopathic manipulative medicine (OMM) book (which I previously read during my COMLEX Level 1 dedicated period), and this helped me review a lot of the OMM material that tends to show up on COMLEX.

How did you prepare for your auditions/sub-internship rotations?

Because I knew I was going to apply to emergency medicine (EM) residencies, I listened to the EM Clerkship podcast and followed a lot of its advice. This podcast was extremely helpful, and there are dedicated lessons that discuss how to perform extremely well on your emergency medicine audition rotation, and how to get an outstanding Standard Letter of Evaluation (SLOE). I cannot recommend this podcast enough. I also studied a lot of the chief complaints that were listed on the Society for Academic Emergency Medicine (SAEM) website, which were all within the “M4 Curriculum” tab.

However, no matter what specialty you are applying to, you should expect to arrive early and not leave until you are told. The audition rotation is basically a month-long interview, and you are being watched at all times. I say this not to instill fear, but simply to emphasize the importance of performing well on audition rotations, as well as the importance of being engaged while you are there. A lot of specialties rank an applicant’s performance on an audition rotation as a top factor that they consider when reviewing which applicants to offer residency interviews, so keep this in mind.

To schedule your audition rotations, I recommend researching the residency programs where you have a strong interest in matching for residency and finding out which platform they use to accept applications. A lot of programs use the Visiting Student Learning Opportunities (VSLO) platform, but many programs also have links on their department websites that students can use to schedule an audition rotation. If you can’t find out how to apply, it does not hurt at all to email the residency program coordinator and inquire about an audition rotation. The coordinator’s information is usually on the program’s website.

How should students approach scheduling their rotations during fourth year?

Every school is different, but my school allows students to schedule fourth-year rotations on their own with the support of our clinical administrative team. Looking to schedule rotations as early as December of third year does not hurt. A lot of programs focus on matching their class for next year during this time so they will not review applications this early, but it can be beneficial to inquire about scheduling audition rotations or even general fourth-year rotations early.

Also, make sure that you are in compliance with any necessary vaccines, health forms, etc., that your designated medical school requires, as this could create barriers down the line with obtaining a rotation if these things are left until the last minute. I scheduled my fourth-year rotations (starting in July) with two audition rotations in a row, followed by rotations that my medical school requires all fourth-year students to complete.

For fourth-year electives, I recommend scheduling rotations in subspecialties outside of your specific specialty to help you be more prepared for residency. For example, because I was interested in emergency medicine, I scheduled rotations in ultrasound and ophthalmology because I knew these skills would be crucial to have as an emergency medicine physician.

Related reading:

Overcoming obstacles as a medical student: A journey of resilience

The joys of primary care