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Guide to Fourth Year and Scheduling

There is much anxiety around 4th year and scheduling 4th year because you are worried about letters of recommendation, away rotations, ERAS, interview season, and maybe even deciding between 2 or more specialties! Don't worry - you're not alone. We have all been there, it will work out, and importantly, 4th year will be amazing no matter what! This guide is meant to hopefully answer some common questions and give you a general idea of how to approach scheduling your 4th year. For information about specific specialties it's best to meet with a specialty specific advisor and talk with 4th year students going into that specialty.

First, you should know that your 4th year schedule is MUCH more flexible that your 3rd year schedule. So even if you do not get the schedule you want immediately (or don't know what you want), there is a lot of switching that can occur and changes that can be made as the year goes on. It seems like you only have a couple weeks to figure out your schedule (and for some of you it may feel like you only have a few weeks to figure out your specialty and career), you will be able to change things later if necessary.

In order to develop a general strategy for scheduling it's nice to have some commonly asked questions answered.

Letters of Recommendation

How many letters of recommendation do I need?
Most programs require 3-4 letters of recommendation. ERAS will not allow you to send more than 4 letters of recommendation to any individual program. Therefore, getting 4 letters of recommendation will be recommended for most people. For some specialties, one of those letters will be a chairman's letter, which means you only need 2-3 other letters (see below for chairman's letter). You may need more letters of recommendation if you are applying to more than 1 specialty or you have chosen a specialty where you also have to apply to a transitional or prelim year. In this case, you should get all the letters of recommendation you think you will need. However, remember some letters may work for applying to multiple specialties or for applying to both your categorical and transitional/prelim year (e.g. internal medicine letter). You are allowed to get as many letters of recommendation as you want and upload them onto ERAS. When it is time to send letters to a program, you will just select which of your letters you want to send to each given program. Therefore, you will send a maximum of 4 letters to each program you apply to, but you can pick from any of the letters you have uploaded to ERAS and you can send different combinations of letters to different programs. Letter writers may submit their letters to the Registrar's Office before the ERAS application opens. They will be kept in your file and uploaded when your ERAS application is available.

From whom should I get letters of recommendation?
In general, you want to get letters of recommendation from someone who has been able to work with you enough to write you a strong letter. Your sub-I rotations or electives early in 4th year are when most people get their letters of recommendation. It is best to plan to get letters during blocks 10-12 (July, August, and September). This will allow enough time for letters to be written then uploaded to ERAS for programs to see them as they begin to offer interviews. In the past, a letter from block 13 (October) could still be helpful depending on when your chosen specialty tends to make most of their interview invitation decisions (some specialties and/or programs are known for waiting for dean's letters ). However, now that dean's letters will come out October 1st, a letter from block 13 may be less helpful. So it will be better and less stressful for you if you get all your letters within the first 3 blocks. Therefore, you want to plan to schedule your first couple rotations with your need for letters of recommendation in mind (specialty, specific attending, away institution, Also, keep in mind that you CAN submit your ERAS application prior to having all of your letters of recommendations (refer to information sessions by the Deans).

Do I have to get letters of recommendation during 3rd year?
No. It is okay if you do not get any letters of recommendation from 3rd year. However, if you do get a letter from 3rd year then that is one less you need 4th year. Keep in mind that you will probably perform better as a 4th year on your rotations than during your 3rd year. So waiting until 4th year may mean your letters will be stronger. Also, attendings expect 4th year students to be requesting letters so you may feel more comfortable asking for one. As a 3rd year, you do not want to ask for letters on each rotation "just in case." Be courteous of your attendings' time and don't waste their time if you don't intend to use a letter from them.

What is a good letter of recommendation to get 3rd year?
It depends on what specialty you decide to pursue. If you have the opportunity to work with an attending for several weeks or more, this may be a good opportunity to ask for a letter, especially for rotations done at the end of your 3rd year when you are more comfortable and knowledgeable.

What if an attending offers to write me a letter of recommendation?
This is great! The general rule is don't turn down an offer to write a letter of recommendation. There is one caveat though. If you have no or little intention of using the letter, then it's better to not waste their time. Thank the person and maybe state that you would appreciate being able to contact them as you approach 4th year and begin to arrange letters of recommendation (just use your judgment).

What is the chairman's letter?
For departments that require chairman's letters, there is a specific faculty member or two in the department that usually write all these letters. You will usually need to meet briefly with this person so they can get to know you in order to write the letter. Pay attention to any emails sent about specific chairman's letter requirements and deadlines


When are interviews?
For most people the majority of interviews will be in November, December, and January. Some programs will start interviewing at the end of October and/or end in early February. Find out from your specialty specific advisor or 4th years which months tend to be the most interview heavy for your specialty. For most people, December is their busiest month. This is a good month to take a vacation block in order to interview.

Do I have to take a vacation block for interviews?
It is often recommended, but depends on the rotations you schedule during interview season, how many interviews you will be doing, and how much traveling you have to do for interviews. Interviewing is fun but will be much more tiring than you anticipate, so having one block as a vacation block to focus on interviewing and catch up on things in between, is very helpful for a lot of people. If you really want to save vacation until the end of the year, you can make it work but you should get advice from 4th years that have done this. If you will be applying to transitional or prelim programs, or if you may be applying to more than one specialty, you will likely be going on many more interviews so scheduling a vacation block during interview season will be important.

What rotations should I schedule during interview season?
Talk with upper years to find out what rotations have a lighter schedule and/or are flexible with interview season. In general, it is best to not schedule your required rotations during interview session. However, interviewing while on your ER rotation is possible since you have flexibility with your shift schedule. Keep in mind that there are Friday lectures and skills sessions for ER that you will need to attend.

Away Rotations

Should I do an away rotation?
There are a couple of reasons to do away rotations but you do NOT have to do any away rotations.
Away rotations are often viewed as audition months. It can be an opportunity to rotate at a program you are interested in and show them your interest, have them get to know you, and put your best foot forward. With that said, if you have had some difficulties with your clinical rotations, doing an away rotation may not be the best way to put your best foot forward to a program. You should discuss this with your dean and/or specialty specific advisor. Also, keep in mind that while you are making your first impression, you will be learning a new hospital system, meeting new people and possibly learning a new computer system.

Another reason to consider an away rotation is to have the opportunity to get an up-close look at a program in which you think you are very interested. Interviews are helpful, but you cannot truly know what a program is like without spending time with people in the program. You may find an away rotation helpful for this reason. It may be particularly helpful if you think you will be trying hard to match in a certain limited geographical area such as California or many places in the West.

How do I apply for an away rotation?
Many programs use a central application process called VSAS (Visiting Student Application Service). The registrar's office will need to authorize you for VSAS. If you want to do an away rotation at a College that does not use the VSAS application, you need to visit the College's website to find out how to apply. You will need to get a letter of good standing and possibly a transcript from the registrar's office. You will also need to go to student health to get documentation of your recent PPD results and the lab results proving your immunity to all the standard infections that are vaccinated against.

When do I need to apply for away rotations?
Most deadlines for away rotations will not be until April or May, however refer to VSAS or the College's website for exact deadlines. Since most deadlines are not until the spring, it is okay to wait until you are working on your Jefferson schedule to start deciding on specific away rotations to apply to. It is helpful to have thought about whether or not you want to do an away or multiple away rotations prior to creating your Jefferson schedule so that you can take that into account.

What should I know about scheduling away rotations?
You should know that you might not hear back about away rotations to which you have applied until a couple weeks before the rotation will begin. So you will need to have back-up rotations scheduled through Jefferson in case you do not get the away rotation. Be prepared to be flexible with your schedule because you may need to rearrange rotations in order to accommodate an away rotation. Also, remember that you will likely have to arrange your own housing for the away rotation. Check out the Rotating Room site to see if another student or a resident has a room available to sublet for a month.

What if I haven't chosen a specialty?

What do I do?
It's okay! Many students have not chosen a specialty by the time they schedule 4th year and some students may apply to 2 or more specialties and decide on a specialty at varying times during the application process. It's best to talk with your dean about this, but you may find this general advice helpful.

How should I schedule the beginning of my year?
You probably want to plan to schedule a rotation in each specialty in which you're interested at the beginning of the year. This will allow you to see each specialty again (or for the first time), which may help you make your decision. Then you could consider scheduling your inpatient and/or outpatient sub-I for block 12 and/or block 13. This will help satisfy requirements early in the year and may also help you get another letter of recommendation if necessary.

What about getting letters of recommendation?
All your letters of recommendation do not need to be from your eventual chosen specialty. In fact, a general letter from internal medicine, for example, can be helpful for many specialties. So you may be able to get a letter from 3rd year or a 4th year sub-I that may be helpful for one or both of the specialties in which you are interested. Also, depending on the specialties you are deciding between, a letter from rotations in both specialties may be helpful for both specialties. Also, remember that if it's necessary, you can get extra letters and use different letters for applying to each specialty. ERAS will allow you to select which letters are sent on a program-to-program specific basis so you will have plenty of flexibility.

Miscellaneous Questions

When is the best time to schedule vacation?
Everyone gets two months of vacation 4th year. It is helpful to take a vacation block during interview session. Many people choose to take December off if they take a month off for interviews. Depending on how many interviews you will go on (depending on your chosen specialty), you may not need to take a month of vacation for interviews. If you plan to do this, it will be important to schedule a light elective. Talk to upper year students to find out which electives are good during interview season.

When should I schedule international electives?
The most important thing is to not schedule an international elective during interview session. In general, most people wait until block 17 (end of January-February) or later to schedule international rotations. It may be possible to go internationally earlier in the year, but remember that you will be submitting your ERAS application around September 1st and then you will be scheduling interviews as you get interview invitations in September, October, and November. It's important to have good internet access during this time, as replying quickly to interview invitations is incredibly important. It is also not a good idea to be international during match week just in case you do not match and have to apply via the SOAP process.