An Informal Guide to the Fourth Year

Introduction

After the hardships of junior year, the senior year will seem like a vacation, or at least, a 9-to-5 job! The senior year classes are mostly electives that you can choose. You can determine your course schedule and the timing of your vacation. Courses are generally two weeks to one month long and require less weekend time than junior year rotations. Also there are no call nights unless you are doing a sub-intemship (which is required). Highlights of this final year include Step II of the USMLE, residency applications and interviews, the Senior Skit, and at long last, graduation!

Preparation for the senior year begins in the Spring Quarter of junior year, or earlier for some exotic / popular electives. This can pose a problem if you have a lot of patient care responsibilities during your last rotation (like medicine or surgery). However, most house staff are pretty understanding of your requirements to attend the planning sessions for the fourth year.

A minimum of twelve course credits (one course credit equals 100 units) is required of each student in order to receive full credit for the year. Of these twelve course credits, all students must complete required senior selective courses (150 inpatient units and 150 basic science units), in addition to 75 units of neurology (two weeks). Beginning in 1998-99, 75 units (two weeks) of perioperative medicine and pain therapy (aka anaesthesia), will be added as a fourth year requirement if this course was not completed in the third year,. Most of the courses are 100 units per month except sub-internships which are 150 units, and some busy clinical consult months which are 125. The remaining course credits may be fulfilled by formal course work, research in clinical or non-clinical areas, or additional clinical electives. All M.D./Ph.D. students, however, must register for a minimum of 6 course credits in clinical electives if they plan to petition for 6 months of research to be credited to the senior year. The Committee on Promotions dictates the courses that must be pursued for these 6 units.

Students are guided in their choice of electives by their chosen advisors, the Dean of Students, and, when necessary, the Committee on Promotions. Clinical rotations usually occur in one month blocks. Most students spend most of the fourth year on clinical electives, but many students also choose a variety of non-clinical electives. Some students use this time to engage in a research project. Some spend from one to three months working in other medical centers. A few work abroad for a part of the year.

Planning Your Senior Year

Most of this planning takes place after the Senior Electives Handbook comes out in early March of your junior year. Senior course options include subinternships (where you assume the duties of an intern for a month), consult services (where you work with a sub-specialty team such as Infectious Diseases), outpatient clinics, reading courses, research, lecture courses, and any course in another Division or professional school of the University that you can convince the Dean of Students you need for your health and happiness as a physician! Talking to seniors will give you an idea of which courses have been popular in the past. Your advisor can also tell you what preparation is most appropriate for your residency plains and long-term goals.

Most students like to schedule one or two rotations in their intended field of specialization during the Summer and Fall Quarters in order to get additional faculty recommendations to support their residency applications. Those who have not chosen a specialty often do additional rotations in the areas they are considering in order to narrow down their choices. Some students also do one or more electives away from the U of C, often at hospitals they are seriously considering for their residencies.

You should apply for off-campus electives at least one quarter ahead of time (February or March would be a good time to start applying for summer off-campus electives). Also, consider doing elective course work abroad. Students have gone to England, Brazil, Africa, India, and other exotic spots in the past.

Vacation during fourth year is up to you. It is required that you schedule 1200 units of credit during your fourth year to maintain full-time status and graduate. Some students accomplish this by working hard without taking much vacation time until late March when they are done with classes. Others like to spread out their time off throughout the fourth year, sometimes planning for residency interviews. It doesn’t matter how you do it as long as you complete 1200 units by June and have fun doing it. Many seniors choose easier electives the Spring Quarter, as they wind down from the prior four years.

Choosing an Advisor

Once you have chosen a specialty, you should choose an advisor in that field. The advisor should be accessible and someone with whom you feel comfortable talking, because you will need to confer with him/ her throughout the year while planning your schedule and residency applications. You must choose one faculty member as your advisor by the end of May of your junior year, even if you haven’t decided on a specialty yet. Remember that you can always change your advisor if you change your career plans. Also, you should be consulting other faculty members for their advice. Be aware that if you are applying to residency programs which require a preliminary year of clinical medicine, you will eventually need an advisor from the Internal Medicine Department.

The Nitty-Gritty of Scheduling and Lottery for Senior Electives

Scheduling of the senior year involves a maze of meetings following distribution of the Senior Elective Bulletin in early March. The Dean’s Office holds three meetings; the initial one in March informs students of the Senior Elective Lottery. Additional meetings are directed toward the residency selection process.

After the initial informational meeting, you have about two months to decide on a tentative course of study. The current seniors will still be around at this time, so remember to seek out their words of wisdom!

A computerized elective registration system (lottery) is used to maximize each student’s chances of getting the selective/elective schedule he/she most desires. The lottery matches Pritzker students with selectives/electives available at the Pritzker School of Medicine for the academic year. Senior students rank order their preferences and enter them into the lottery system.

The process is run in two phases. Phase I matches seniors’ choices with available selectives, neurology, and pain management. Phase II assigns the remaining electives and unfilled selective choices based on students’ preferences.

During the interval between the two phases (about two weeks), students may trade electives on a one-for-one basis with other students if they’re not satisfied with the results of the lottery. The second phase lottery then assigns remaining "hot" courses and all other electives. If the schedule of courses is still not satisfactory at the end of the second phase, remember that many students drop courses during the academic year, which serves to open up more positions. As a general policy, it is better to schedule only courses which you know you want because it is generally more difficult to drop credits (especially in highly desired areas such as ICU and Cardiology) than it is to pick courses up.

Elective assignments can be changed only if a Drop/Add form, signed by the elective course director, is brought to the Dean of Students’ Office. The departments will get a final list of each elective’s enrollees two weeks prior to the elective’s starting time; requests to drop an elective, subsequent to the two week deadline will be scrutinized and approved at the elective director’s discretion. A student may not graduate unless all electives for which a student has enrolled (not officially dropped) are passed, even if the minimum graduation requirements have already been met. An elective will be considered passed only when an evaluation of the student’s performance designating a grade of Pass by the elective’s director or the director’s designate is received in the Registration Coordinator’s Office in BSLC 104.

The Neurology Clerkship

Director of Student Medical Education, Neurology

Avertano Noronha, M.D.

Neurology Student Program Coordinator

Tracy DeMack

702-3815

The Neurology Clerkship is a two week rotation at the University of Chicago Hospitals. Students will spend the first week in either the neurology ward service or the clinic/consult service and then switch service for the second week. During the ward service students will make rounds with residents, followed by morning report and attending rounds. Diagnostic studies, particularly imaging, will be reviewed. The goal of this week is to train students to perform a complete neurological evaluation, to consider a differential diagnosis, and to plan diagnostic tests. Students generally do not take call, but they do write admission notes, and attend conferences.

During the clinic/consult service mornings students will generally spend time in the clinics and afternoons on consult service. The goal of this week is to emphasize the recognition and management of stupor, coma, seizures, and neurological complications of medical diseases. In the specialty clinics students will not be required to independently examine patients but may have the opportunity to do so. For non-specialty clinics students are encouraged to evaluate the patient and present the case to the attending. While on the consult service students will examine patients independently and present them to the attending. Students will also accompany residents to the ER for neurology consults.

Evaluation

Students will be evaluated on diagnosis and management in Neurology, oral and written communication, and professional behavior.

The United States Medical Licensing Exam (Step II) and Senior Examination

Seniors are strongly encouraged to take the USMLE Step II in the late summer of the senior year. Decision to delay until late in senior year requires the student to take a two-day comprehensive in December in order to meet graduation requirements. Step II of the USMLE covers the clinical material of the third year plus Preventive Medicine and Public Health. It is administered in a computerized format at a time chosen by the student in August through November. . Applications are distributed earlier in the year and coordinated by the Dean of Student’s Office. The Step II scores will be available before.

The amount of time students study for Step II usually depends on the competitiveness of their chosen field, and the perceived impact the scores will have on current and future applications to residencies and fellowships. While the minimum passing score for Step II is lower than for Step I (170 vs. 176), more Pritzker Students fail Step II than Step I.

Students often take a lighter rotation during August, or vacation during part of the month to prepare for Step II. They usually employ the same techniques and types of review books used to prepare for Step I. Te best preparation for Step II, however, is the time spent in the hospital during third year rotations.

Step III is administered after the first year of residency for those who have passed Steps I and II, and with the passage of Step III, candidates can obtain licensure in all states after they meet the minimum number of years of residency. Applications are available in the Dean’s Office. The 2000 USMLE registration fee for Steps I & II will be $340 per exam.

Residency Applications

& the Match

Formal information about the residency application process, including a National Resident Matching Program (NRMP) application and a directory of program addresses, is distributed during May of the junior year. By late July you should be writing away for residency applications. Your advisor can help you prepare and whittle down your application list.

You should apply to at least 35 programs if you are applying in a competitive field (e.g., Orthopedic Surgery and Obstetrics and Gynecology), while a minimum of 20 applications should suffice for less competitive fields. While you might be aiming for some top programs, be sure to include some solid backups. A complete application consists of a completed application form , a personal statement, the Dean’s Letter, and a minimum of three letters of recommendation from faculty members (one of which is the Chairperson’s letter). Many students obtain 4-6 letters. ERAS allows four letters per application, but students can designate which letters go to which program. Try to get a letter from a full professor if you are applying to competitive programs.

Also, include a C.V. (curriculum vitae, which is a resume for physicians and academics), even if you don’t have a string of publications, as the C.V. presents important information about you in an easy-to-read format. The Dean’s Letter is written by the Dean of Students. It summarizes your strengths as a candidate, and provides some general background information about you. Even though the Dean’s Letter cannot be mailed until November 1st, you should submit the other components of your application in early September.

It is now possible to apply to some residency programs electronically through the Electronic Residency Application Service (ERAS). The Dean of Students’ Office will transmit applications, letters of recommendation, Dean’s Letters, transcripts, and other supporting credentials to residency program directors using the internet from the Dean’s Office Work Station. Students can complete the application on any computer that will run Windows 3.1 or higher. For the 2000 match, ERAS is available for OB/GYN, Diagnostic Radiology, Orthopedic Surgery, Family Practice, Radiology, Emergency Medicine, Internal Medicine, Transitional Year programs, Surgery, Pediatrics, Physical Medicine and Rehabilitation, all combined medicine programs and all Army positions. Check out the ERAS web site at www.aamc.org/eras.

Once your application (ERAS or regular) is complete, interested residency programs will contact you for an interview. However, you should not fail to be assertive (in a kind manner) to determine whether or not the program will be interviewing you, so call. While you are waiting, organize your application materials well. Prepare two interesting cases to present during your interviews and a list of questions (about 10) to ask your interviewer, such as "How much time do attendings devote to teaching house staff?" or "What types of fellowship and employment opportunities have recent graduates of the residency program been offered?"

Setting up interview trips can be a bit tricky. Call the program as soon as you are offered an interview, as times that you have set aside in your schedule may fill quickly. Remember that many programs interview into February since your Rank Order List is not due until early February. Mondays and Fridays are popular days for interviewing as students can often get Supersaver plane fares if they stay over Saturday night and book the flight three to four weeks in advance. If you are applying to the East Coast, Amtrak service between many cities is convenient and relatively cheap. Also, ask about dormitory accommodations and discount hotel rooms close to the hospitals where you will be interviewing.

Recently, the BSD Alumni Association has been sponsoring a program where alumni host interviewing students around the country. Also, since interviewing now extends into January and February, students should be aware that expenses associated with a job search are tax-deductible, if the expenses are incurred in the year the student gains employment. So keep those receipts.

When you go for your interviews, remember that you are an intelligent person from a top medical school. Be confident and enthusiastic. Be able to state clearly why you have chosen your field, and let your interviewer know what makes you an interesting person. You will be expected to initiate much of the conversation during your interview, so be prepared.

Ask residents (not attendings) about vacation time, salary, and real call schedules. After each interview, take notes; otherwise, all the programs will begin to blur together after a while. The U. of C. tends to have a good reputation at East Coast programs. These programs also usually want some geographical diversity among their house staff. California programs are very popular, and thus, sometimes harder to get into. The greater variety of programs you see, the more you will be able to decide what programs have in common with your subspecialty. It will help you figure out what is important to you, thereby assisting you in submitting a rank list.

Match Day

Match Day, by all accounts, is an assault on the nerves equaled only by D-Day! The Office of the Dean of Students receives a list of matched and unmatched students prior to Match Day. In the past, approximately one to three students per class have not matched initially. These students generally applied in competitive fields without enough safety schools.

The Dean of Students’ Office notifies unmatched students as soon as possible, and is generally able to place them in a residency program by Match Day. The Dean of Students’ Office has been very successful placing unmatched students in good programs, but this is getting harder since the competition for positions has increased dramatically with a larger applicant pool and fewer positions.

The Match Day festivities begin at 10:00 a.m. The Dean of Students first announces statistics detailing how the class has done as a whole. Each student then receives a sealed envelope at 12:00 noon E.S.T. or 11:00 a.m. here, with his/her residency destination inside. A special reception is held in the student lounge after opening ceremonies, sponsored by the Alumni Association.

Pritzker 1999 Class Composite Statistics

Total of 1998 Graduates 112

Total Entering Residency Programs 111

Total Choosing Other Options 1

First Choice 67.0%

Second Choice 13.0%

Third Choice 8.0%

Senior Events

The Senior Skit

The Senior Skit is a lavish production produced annually by the senior class. It is a humorous, sometimes tasteful, satire of life at Pritzker. The Senior Skit usually plays the Wednesday before graduation at Mandel Hall. It is well attended by students, administration, faculty, and house staff, and is followed by a big bash at Ida Noyes Hall.

The student-faculty reception (the weekly TGIF in the medical student lounge) is run by the senior class to raise money for the Senior Skit. The Dean of Students’ Office, many faculty members and various pharmaceutical companies also contribute funds. Enterprising seniors usually take it upon themselves to organize the receptions and other fund raising events.

Organizational meetings for the skit usually start late in Summer Quarter, but the nitty-gritty preparation usually does not begin until April. The meetings are open to all members of the senior class whether or not they have theatrical talent. The more the merrier!

The Senior Banquet

The Senior Banquet takes place the day before graduation. The names of faculty members who have been voted by the graduating class to appear in the Class Composite Photograph, as well as basic science and clinical science professors of the year and resident of the year, are announced at the Banquet. Many faculty and administrative officers, as well as students and family members, attend. Recent banquets have been held at the Drake Hotel. The student may bring one guest for $25 while additional guests are charged $50 per person.

Graduation

Graduation generally falls on a Friday in early June. In the past it had been held at Rockefeller Memorial Chapel. In 1999 the ceremony was outside on the University of Chicago quadrangle. Each student is assigned four tickets, but more tickets can usually be obtained from the Dean of Students’ Office. In 1990, the Division introduced a new Awards Ceremony in which each graduate receives an M.D. hood from the Dean. In addition, all of the prizes and awards for the graduating class are made known at that time. Normally, 1000 people (family and friends of graduates) attend this event in a tent in the Crerar courtyard. There is a luncheon provided for all attendees.

Honors and Awards

Graduation with Honors

Each year, the faculty, through the Honors and Awards Committee, selects a small number of students in the senior class (12 total) to graduate With Honors, the highest distinction that can be bestowed by the University of Chicago. Nominations are made by individual departments and committees. In order to graduate With Honors, a student must have demonstrated leadership qualities, outstanding scholastic performance, and significant research abilities and accomplishments. This can be accomplished with a PhD, a senior authored peer reviewed publication, or presentation at the Senior Scientific Session. The names of the students so honored appear in the Convocation Program, followed by the notation With Honors. This notation also appears on the permanent academic record and on the diplomas of such students. Decisions on graduation With Honors are made during the Spring Quarter of the students’ senior year, but not announced until the awards ceremony.

Alpha Omega Alpha (AOA)

Each year, approximately 18 senior medical students are elected to the Illinois Beta chapter of AOA, the honorary medical society, in recognition of outstanding clinical abilities, leadership and character. Nominations are solicited from each clinical department, based primarily on performance in the required junior clinical clerkships. Students elected to AOA are notified early in the Autumn Quarter of their senior year.

Senior Awards

Each year, a number of awards are made to graduating senior medical students at a Divisional Honors Ceremony, just prior to graduation. These include awards for outstanding ability and performance in the various clinical fields, demonstrated research accomplishments, general academic excellence, and service through extracurricular activities. Nominations are solicited from both clinical and basic science departments and committees.