Congratulations! You’ve made it through two years of basic science studying, Step 1, and your third-year clerkships. Now comes the best year. Yes, fourth-year has some stress, but you will realize just how much you learned in the last three years and maybe have some fun along the way.
USMLE Step 2
The first step of the application season is finishing your board exams. Although some specialties recommend waiting to take Step 2 Clinical Knowledge until after applying if your Step 1 score is stellar, it is typically recommended you complete both Step 2 Clinical Knowledge and Step 2 Clinical Skills between May and September of your fourth year. It typically takes three weeks for CK scores to be released and two months for CS results to be released. The final cutoff is you must have taken and passed Step 2 CS when you certify your rank list in February, but more on that later.
Fourth Year Schedule
Fourth-year is typically organized by month-long rotations again, but you have much more flexibility on what you want to fill your year with. Schools typically have a couple required rotations such as a sub-internship and Emergency Medicine. You must also save some time dedicated to Step 2 CK studying. It is up to you if you want to take Step 2 CS during this month or during a month with a hospital rotation as it takes far less preparation. Fourth-year is also the time to schedule away rotations and sub-internships in the specialty of your choosing. (Check out our posts on becoming an orthopaedic surgeon, neurosurgeon, trauma surgeon, plastic surgeon, ER doctor, or cardiologist!) People fill up the remaining months with rotations they will never be exposed to again but find interesting, as well as rotations that might have a lighter workload such as radiology or online rotations. You will also schedule some time off for interviewing, typically November or December.
Below, I will take you through a sample schedule and what you should complete along the way.
You will finish third year and take Step 2CK in early summer. It is good to take CK right after you finish third year as it is similar to a cumulative shelf exam. Take it when the information is freshest in your mind. That said, considering the current pandemic, Step exams are being canceled, so schedules might need to be adjusted appropriately. Try to stay flexible as none of us have lived through a pandemic such as this before and we are all learning how to mesh our normal lives with social distancing. This is also a good time to meet with an advisor in your specialty.
Early June is when applicants may register for ERAS and start filling it in. You will enter your work, volunteering, and research, each with a short description. One good rule of thumb when describing each activity is to answer three questions in three sentences. What is it? What did you do? What did you learn? This helps the reader get background information and an idea of what it meant to you. Many interview questions will come from this section.
Your school will compile your MSPE Letter and upload it on your behalf, but they may require you to review it before their October deadline. They will also upload your transcripts. Many schools will also have a photographer come to school and take your ERAS photo, but you may have to upload this yourself.
This is the ideal time for a sub-internship in your specialty. Work extra hard during these rotations and earn the rest of your letters of recommendation from attendings in your desired field. Sometimes these rotations are called “audition rotations” as programs watch how hard you work and if you fit in and will use this information when deciding whether to offer you an interview. If you have an away rotation at a place you would like to match, show them why they’ll need you.
If you already have enough letters of recommendation and your specialty does not recommend away rotations, this is also a good time to complete other higher workload required rotations. Trust me, you will not want a hard rotation in March or April, right before graduation.
You will need to write and edit your personal statement over the next few months as well. You can have one personal statement for all programs or create specialized statements for specific programs. For example, I added a blurb at the bottom for programs in certain states I had connections to.
Once you have completed your personal statement, send it with your CV and a letter writer request from ERAS to each of your letter writers as soon as possible. Attendings are busy and may forget, so feel free to send gentle reminders about the deadline. It is a good idea to give letter writers the deadline of August 30th just in case some upload them late. The actual letter deadline to aim for is when you submit your application. Although letters can be added after programs download your application, they may not see them.
The last task during this period is my personal favorite – choosing to which programs you will apply. Talk with your advisor to determine which programs are most appropriate for you and to how many you should apply. If you want to stay local and match into a less competitive field, the number of programs you need apply to will be significantly fewer than if you are aiming for a competitive field in a sought-after location. (For more info on how the match algorithm works check out our article NRMP Residency Match Algorithm Explained.)
You may consider cost in how many programs you are applying to as well. The first 10 applications cost $99 total. The next 10 cost $15 each. The third 10 cost $19 each. Each additional over 30 cost $26 each. For example, if you apply to 50 programs, it will cost 99+150+190+520=$959. There are also additional fees for having your USMLE scores sent and registering for The Match. It is wise to budget for these and travel and lodging costs while interviewing.
This will be like any other month with a rotation, except that it is also the month you submit your application! Finish your final edits, make sure all letters have been uploaded, and then submit! Applications may be submitted at any point between September 5th and 15th, but I would suggest doing it earlier as the site tends to crash with such a high volume around the 15th. After you hit submit, focus on your rotation and relax. You have worked hard and will need your energy to interview.
You will have to separately apply for the NRMP around this time and will update ERAS with your NRMP number once approved.
On October 1st, MSPE letters are released to programs. Most programs will wait for this to download your application, but some may start reviewing applications as early as mid-September. Invitations for interviews tend to come throughout October. Some specialties have a suggested day that all programs should send invitations, but not all adhere to this suggestion. For this reason, it is still necessary to be attached to your email the whole month. Ideal interview spots fill up quick, so you will want to be close to your computer. Most rotations know this process and will be understanding that you have your phone out to check email. If not, have a close family member or friend oversee your email during work hours.
It is also a good idea to have an updated calendar on you when you are scheduling interviews. This can be digital or physical, whichever you prefer. This will allow you to pick optimal dates quickly.
If you already scheduled an interview for a particular day, but a program you highly prefer offers you an interview for that day as well, you may cancel your other interview. Just make sure to give them notice at least a week before when the interview is scheduled. Preferably, you would cancel immediately so they have more time to invite another applicant. A short but polite email will suffice.
If your school does not offer interview prep, find a list of standard questions, and practice your answers out loud with a friend. This will help you be more comfortable and clearer-headed during your first interview.
Speaking of interviews, some may start as early as mid-October. Get your suit dry cleaned and reread your application to be ready to discuss anything mentioned, as it is all fair game.
Most people will take one or both months off to interview. Another option is to enroll in a light or online rotation. Each interview will include a gathering the night before to meet some of the program’s residents. This is usually a casual dinner at one of the resident’s homes. This is a good time to watch and learn from the residents. Are they happy? Do they seem excited to see each other? Are any interns around? You will also get the opportunity to ask the residents questions you may not want to ask during your official interview. Try not to grill the residents with questions though, as this is a casual time and you may be perceived negatively. Enjoy the food and talking with other candidates. Indulge in a beverage if you would like, but do not get drunk. You want to represent yourself as someone they would want to hang out with after a long shift, not someone they’d have to take care of. You also do not want to be hungover for your interview the next day.
Interview days are all unique, but there tend to be a few consistencies among them. Most interview days start with an informative presentation given by the program director or manager, followed by individual interviews, a tour, and lunch. Some programs will have a morning and afternoon group, usually overlapping only at lunch. Others may have just one full day interview group.
Interviews tend to be quick, only 15-30 minutes each before you are shuffled to the next room to repeat. Often, the interviewer is given a challenge question to ask everyone and then they ask specific questions about your application. They end with asking what questions you have about their program. I recommend creating a list of questions ahead of time. You can bring in a notebook to review your notes and write down answers.
As soon as you get home from an interview, or on the plane if you flew, is the perfect time to write down everything you learned about the program. Note what you liked and what made you skeptical. Make a system to compare programs that work for you and stick to it. For example, I had an Excel document with 10 key metrics I would get for each program. It included everything from the number of residents per year and how many hospitals we staffed to how friendly the residents were and my overall feel of the interview.
Some programs may continue to interview through January. Once you finish your last interview, it is time to make your rank list. You can start to enter programs into NRMP on January 15th, but you do not have to certify your list until later February. Again, the system is trying to process thousands of lists, so try to certify a few days before the deadline if you are certain about the ranks.
Try to keep yourself busy until the Monday in March when you find out if you matched and the following Friday when you find out where you matched. Then take time to finish up rotations and relax when you can. Visit your friends and family and rediscover your hobbies. Take that vacation you have wanted to go on for years. Before you know it, you will have graduated and be working 80 hours a week in your dream career.
I know this is a fun, stressful, and busy year, but if you keep organized, I know you will be proud of what you can accomplish! We have all worked so hard. There is a light at the end of the tunnel.
Please comment below if you have any questions! I know this is a lot of information, but together, we can MATCH!