
The fourth year of medical school is a time of newfound freedom and flexibility, where students can focus on discovering what type of medical practitioner they want to be and exploring their research interests. While the first two years of medical school are mostly classroom-based, the latter two years are primarily spent in hospitals or clinics, where students gain hands-on experience and work closely with patients. As an MS4, students have more autonomy in choosing their shifts and electives, allowing them to explore different specialties and gain diverse clinical experiences. During this time, they may also need to complete residency applications and prepare for graduation. While the MS4 year offers a break from the intense studying of the earlier years, it is still crucial for students' professional development and well-being to make the most of this time.
| Characteristics | Values |
|---|---|
| Purpose of MS4 year | Not self-evident |
| Restrictions | Cannot start or stop treatment plans |
| First half of MS4 | Arguably the hardest part of medical training |
| Rotations | Elective, pass/fail |
| Notes | Unread and unsigned |
| Time period | February to June |
| Suggested activities | Hobbies, travel, sleeping, researching PGY-1 salaries |
| Hospital culture | More freedom, less academic meaning |
| EM rotation | Pick your own shifts |
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What You'll Learn
- MS4 students have more freedom to focus on their interests and research before their internship
- They can choose their shifts and have time for hobbies, travel and self-care
- MS4 students can't start or stop treatment plans but can observe and learn from treatment teams
- They can focus on figuring out their preferred style of interaction with patients
- MS4 students can prepare for the future by researching PGY-1 salaries and budgeting

MS4 students have more freedom to focus on their interests and research before their internship
The MS4 year is a time when students have more freedom to explore their interests and focus on research before beginning their internships. While the first three years of medical school are intense and rigorous, with a heavy focus on academics and clinical rotations, the fourth year offers a different experience.
During the MS4 year, students have the opportunity to choose their rotations, such as Emergency Medicine (EM), which provides a lighter schedule and the chance to pick their own shifts. This freedom allows MS4 students to explore their interests and gain experience in their chosen specialties. While the core clerkships are complete, MS4 students can still participate in clinical studies and gain valuable hands-on experience.
The extra time and flexibility in the MS4 year allow students to discover what type of medical practitioner they want to be. They can reflect on their preferred interaction style, teaching methods, and how to establish effective working relationships with colleagues. This self-discovery journey is an essential aspect of the MS4 year, enabling students to shape their medical careers according to their passions and strengths.
In addition to clinical work, MS4 students can take advantage of their time freedom to revise their research interests and seek mentorship in medical administration, safety, informatics, or policy. They can also focus on personal development, such as budgeting and time management, and reconnecting with friends and family. This holistic approach to the MS4 year ensures that students enter their internships with a strong foundation, both professionally and personally.
While the MS4 year offers freedom and flexibility, it is not without its challenges. Students may experience anxiety due to the lack of structure and the impending transition to internship. Additionally, they must maintain professionalism and stay engaged in their rotations, even if they are primarily focused on research, applications, and graduation requirements. Striking a balance between enjoying the freedom of MS4 and staying focused on their goals is essential for a successful and fulfilling final year of medical school.
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They can choose their shifts and have time for hobbies, travel and self-care
The fourth year of medical school is a time of newfound freedom and flexibility. While it may be challenging academically, with core clerkships complete and most rotations being electives, MS4 students can enjoy more control over their schedules and have the opportunity to pursue hobbies, travel, and self-care.
One of the advantages of being an MS4 student is the ability to choose your shifts. For example, during an Emergency Medicine (EM) rotation, students can pick their shifts, allowing them to plan their time off for leisure activities, self-care, and spending time with family and pets. This flexibility enables a better work-life balance and can enhance overall well-being.
The freedom of the MS4 year also extends beyond shift choices. With interviews and residency applications taking precedence, students can focus on discovering their preferred interaction style, teaching methods, and working relationships with other medical professionals. This self-discovery process is an integral part of shaping the type of medical practitioner they want to become.
Additionally, MS4 students can take advantage of their free time to reconnect with loved ones, nurture their hobbies, and travel. This period is ideal for strengthening relationships, pursuing personal interests, and exploring new places without the same time constraints as in previous years. It is a chance to recharge and refocus before embarking on the next stage of their medical journey.
While the MS4 year offers these opportunities for self-care and exploration, it is important to maintain professionalism and stay engaged with the surgical team and residents. Striking a balance between taking advantage of one's freedom and fulfilling academic responsibilities is key to making the most of the MS4 experience.
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MS4 students can't start or stop treatment plans but can observe and learn from treatment teams
While MS4 students have more freedom and flexibility in their schedules, they cannot start or stop treatment plans. Instead, they play a supportive role in treatment teams, observing and learning from experienced medical professionals.
MS4 students can take advantage of their time in the hospital to focus on their professional development and figure out their preferred interaction style, teaching methods, and working relationships with other healthcare professionals. They can also explore their research interests, participate in clinical studies, and seek mentorship in specialised areas such as medical administration, safety, informatics, or policy.
During rotations, MS4 students can gain valuable experience by interacting with patients, taking notes, and learning from different medical specialties. They can also use this opportunity to build their professional network and make meaningful connections with residents and faculty members.
While MS4 students cannot initiate or discontinue treatment plans, they can actively contribute to patient care by assisting residents, staying up to date with their studies, and applying their knowledge in a clinical setting. This hands-on approach allows them to bridge the gap between academic learning and practical patient care, fostering a deeper understanding of healthcare nuances.
Although MS4 students have restrictions, they can maximise their learning by embracing discovery, gaining diverse experiences, and reflecting on their ideal medical practice. This phase of observation and exploration equips them with valuable insights that will prove beneficial as they transition into their internships and residency programmes.
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They can focus on figuring out their preferred style of interaction with patients
The fourth year of medical school can be a time of self-discovery and reflection, as students prepare for the transition to internship or residency. During this time, students have the opportunity to explore their preferred style of interaction with patients and develop their unique approach to medical practice.
One aspect of this is determining whether a more formal or casual demeanour is most comfortable for them when interacting with patients. This can significantly impact the patient-doctor relationship and the overall patient experience. For example, a more casual approach may help put patients at ease and create a friendly atmosphere, while a more formal style may be perceived as authoritative and commanding.
Additionally, MS4 students can focus on refining their teaching style to effectively educate patients about their medical conditions and treatment plans. This is a critical skill, as patient education empowers individuals to take an active role in their healthcare journey, improving outcomes and satisfaction. Students can experiment with different teaching methods and receive feedback from patients and colleagues to identify the most successful techniques.
Furthermore, MS4 students can use this time to establish solid working relationships with RNs, pharmacists, and other healthcare professionals. Effective collaboration and communication with these professionals are essential for providing comprehensive patient care. Students can explore different approaches, such as assertiveness, empathy, or shared decision-making, to find the style that best suits their personalities and promotes positive interprofessional relationships.
While the final year of medical school offers increased freedom and flexibility, it is also a time to focus on personal and professional development. Students can seek mentorship from medical administrators, learn about safety and policies, and establish continuing education habits to lay the foundation for their future medical careers. This self-discovery will help them enter their internships or residencies with a clearer understanding of their preferred interaction style and a stronger sense of professional identity.
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MS4 students can prepare for the future by researching PGY-1 salaries and budgeting
For MS4 students, the final year of medical school is a time to prepare for the future, both in terms of their career and financial stability. While the MS4 year is often considered a time to relax academically, with core clerkships complete and most rotations being electives, it is important for students to stay focused and take advantage of the time to research PGY-1 salaries and budgeting.
PGY-1 salaries can vary depending on the location and specialty. For example, the average starting salary for first-year integrated plastic surgery residents is around $65,000, while a Resident Physician PGY-1 in Chicago Heights, IL can expect an average salary of $80 per hour. MS4 students can use resources like ZipRecruiter to research the job market and salary trends in their desired location and specialty. Additionally, students can explore loan programs, such as the Harvard University Employees Credit Union Resident & Fellow Loan Program, which offers competitive rates and repayment plans designed to minimize costs during training.
When considering salary, it is important to factor in the cost of living, as this can significantly impact surplus income. As Dr. Wang advises, budgeting skills are crucial for making the most of your salary. The 50-30-20 rule is a popular budgeting strategy, where 50% of your income goes to essentials like rent, groceries, and utilities, 30% is for flexible spending, and 20% is allocated to savings and debt payments. Budgeting calculators, such as the one offered by Laurel Road, can also help residents track their income and expenses.
In addition to financial planning, MS4 students should also focus on discovering their preferred working style and establishing relationships with colleagues. This is the time to figure out what type of medical practitioner they want to be and to seek out mentors in their desired specialty. By taking advantage of clinical rotations and electives, MS4 students can gain exposure to different specialties and build their professional network.
Overall, while the MS4 year can be a challenging and busy time, it is important for students to prioritize their financial education and career development. By researching PGY-1 salaries, budgeting wisely, and gaining clarity on their career goals, MS4 students can set themselves up for a successful and fulfilling future in medicine.
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Frequently asked questions
During an MS4 hospital rotation, students have more freedom and independence. They can choose their shifts and are able to focus on figuring out what type of medical practitioner they want to be. They can also take advantage of their free time to pursue their research interests and participate in clinical studies.
On a typical day, an MS4 student will attend lectures, didactics sessions, and help out in the emergency department (ED). They may also be involved in putting stitches in patients and observing residents and doctors.
The MS4 year is a time for students to prepare for their residency applications and gain more clinical experience. It is a time to discover what type of medical practitioner the student wants to be and to develop their patient management styles.











































