The fourth year of medical school is amazingly terrifying. By the time you begin the senior year of medical school, which happens here at the University of Vermont at little earlier than most med schools thanks to the Vermont Integrated Curriculum (VIC), it is time to make the decision on what you plan to do for the rest of your medical career. Some people know what they want to do long before this time. Others, like me, had it narrowed down to a specialty or two in the middle of third year and made the choice soon after. Some thought they knew what they wanted to do, but then had an amazing rotation early in fourth year and switched specialties. In fact, three of my classmates on the anesthesia rotation with me in April decided to apply to anesthesia because they had such a great experience (again, thanks for the extra time in fourth year, VIC!).
I had been interested in family medicine and emergency medicine in my third year, but ended up choosing emergency medicine. You may find that different personalities fit different specialties, and the emergency medicine people seemed like “my people.” That being said, I had been exposed to emergency medicine for many years before I made the decision to apply in to EM as a specialty. Starting in 2007, I became an Emergency Medical Technician (EMT), then an EMT-Intermediate/Advanced EMT in 2009 with St. Michael’s Fire and Rescue during my undergraduate studies. Pre-hospital care became my passion thanks to SMFR, and I continue to get on the ambulance when I can. In 2011, I was hired in the emergency department at the University of Vermont Medical Center Emergency Department as an ED Technician and as an Emergency Communications Specialist, allowing me to get a feel for what the emergency department is like “in the trenches.” I liked the ED so much, I have stayed on as a per diem employee throughout medical school. Interestingly, going to work a shift in the ED, especially during the didactic years, felt like a break from medical school! My fourth year rotations in the various EDs across the country confirmed I made the right choice.
In September, medical students across the country submit their applications to ERAS. I also participated in MODS, the military residency application system. As a Navy Health Professions Scholarship Program (HPSP) recipient, I applied to both Navy Emergency Medicine programs and “civilian” Emergency Medicine residency programs (you can only apply to military residency programs if you are in one of the branches of the armed forces). The big difference is the military match happens in December, while the NRMP match happens in March.
At the non-military institutions where I interviewed, there was some sort of dinner or resident-interviewee gathering the night before the interview day (read: free food!). These events were a great opportunity to get to know some of the residents, ask questions about the program, the area, and, of course, the people. I would highly recommend scheduling your interviews so you can attend these events. One of the best things you can do for yourself is record your thoughts on the program while it’s fresh. Maybe you’re a fan of pro/con tables or writing a short narrative of your day. I met someone who would leave himself a voicemail after each interview so he could hear in his voice how excited or unimpressed he was with a program when he came back to make his rank list in January. Another great idea is to keep a running rank list somewhere. That way you don’t have to go back and try to remember. Because believe me, details of the different programs get very blurry very quickly.
So, what did I learn from the interview process and what advice would I give to rising fourth years? Get connected with an advisor in your intended specialty. He or she is an invaluable resource. Make sure your ERAS application is ready to go the day applications open or within 24 to 48 hours. Do your research about a program before you interview and have questions! One question I asked every person who interviewed me was “what do you see as the biggest strength of the program, and what is one area that is currently being improved or could be improved?” You get some very candid answers. You can see if there is a consensus among faculty about what needs to change or the program’s strengths. It can also give you insight into the program director’s vision for the future. Talk with the residents and ask questions of them. Lastly, always remember that while you are at a program, from the dinner until you walk out the door at the end of the day, what you say and do is being evaluated. So use common sense: NEVER bad mouth other programs, know where you are going before you have to be there, be nice and polite to everyone (especially program coordinators) and subscribe to the “if you’re early, you’re on time, if you’re on time, you’re late” theory from October through January! Good luck in fourth year!