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4th Year IM Overview

As a fourth year student, you are beginning the process of applying to residency fairly early in the year, usually in early August. However, planning your overall timeline begins as soon as third year is finished. Your ERAS applications are available on or about July 1 and you can submit your residency applications through ERAS beginning on September 1. Most programs interview between late November and January, with the majority falling between December and January. Your Rank order list for the match is available on-line in January and due towards the end of February. The Match results are released on the third Thursday of March. It is important to meet with your advisor toward the end of third year so as to your 4th year and the application process. Before you submit your application, it is vital to have completed the Internal Medicine Sub-Internship.  The sub-internship is one of the two required fourth year rotations and students are assigned their time based on a lottery system. Students that indicate the earlier summer months to do their rotations usually have little trouble getting these times.  Students should also focus on compiling a list of faculty who they can ask for recommendation letters.  Besides the attending one has during the Internal Medicine Sub-Internship, attendings’ from other rotations during the months before September 1st are also great potential letter writers. When it is time to apply, it is wise to apply to several programs (at least eight), and may be many more depending on one’s geographic preferences. As you are making your MATCH list, you should meet with the Internal Medicine clerkship advisor and discuss your rank list and your personal considerations for the kind of program you are interested in, where you would like to live and what your personal goals are within Internal Medicine. The clerkship advisor has weekly office hours. You are also welcome to talk with any of the Internal Medicine KSOM faculty about this process. You also want to consider how you use your elective and selective times during your 4th year.

PLANNING 4th YEAR SELECTIVES & ELECTIVES

In addition to choosing selectives and electives that will help you in your career in Internal Medicine, you should let your interests guide you.

Selective A Recommendations

  • ER at LAC+USC: Providing care to our patient population at LAC+USC is an amazing opportunity to see pathology and meet patients who truly depend on the system for their medical care. Nowhere else will you ever get this kind of experience.
  • The LAC+USC MICU rotation is also a great experience as it offers great preparation for those who must complete several months of ICU during their Internal Medicine residencies.

Selective B Recommendations

  • Most of these electives are sub-specialties of Internal Medicine or Pediatrics. Completing any of these rotations is helpful to your eventual practice. Your required selective B should be an inpatient experience.
  • Cardiology: is so basic to primary care that it is an excellent choice
  • Endocrine/ Diabetes. Becoming familiar with how to evaluate and care for patients with diabetes is vital in a healthcare system where this is an ever-growing epidemic.
  • Infectious Disease is a good choice if you are interested in global health

Selective B or C Recommendations

  • You need to choose 2 more selectives from either B or C
  • Any selective B is good; let your interests be your guide.
  • Dermatology is a good choice since there is so much in any primary care physician’s practice.
  • Radiology is a good choice if you focus your learning on what you need to know; chest x rays, bone films, abdominal films, and some basic ultrasound.

Electives

  • An elective in ophthalmology is just 2 weeks and a good idea if you can fit it in.
  • Since the Internal Medicine Sub-Internship is required, another sub-internship is not necessary, unless you are interested in doing an away rotation in a program that interests you. This is not required or expected by program directors but can be helpful especially if you are interested in a competitive program.
  • Round out the 4th year with something you may not otherwise get to do- for example a global health experience or working with the Indian Health Service or whatever seems fun and exciting!

To see the official list of selectives and electives, go to MedWeb.

APPLYING TO RESIDENCY & THE MATCH

Should I do an externship (sub I) at all the programs I am interested?
No! You should probably consider doing one sub I in Internal Medicine for one of your electives but no more than one. Choose a program you are most interested in or one you are considering but not sure about. If you have any major “dings” in your academic record this is also an opportunity to show a program what you can do.

How many programs should I apply to?
There is no set answer to this question since it depends on many factors such as how competitive an applicant you are and what your own geographical and interest areas are. You should rank all programs you interview at unless you are convinced you would rather go unmatched than to go to a certain program. Virtually all U.S. graduates in 2007 who ranked 8 programs successfully matched in Internal Medicine. The great majority of KSOM students who matched into Internal Medicine in the 2011 match got their first or second choice.

What do I need to have as a step I and step II board score to be competitive?
Nationwide, the mean USMLE step 1 score for U.S. students who successfully matched into an Internal Medicine residency in 2007 was 222.

Who should I get to write my letters of recommendation?
Your letters should come from faculty who have worked with you closely, know you well, and can write you a strong recommendation. It is less important that the letter come from any particular rotation than that it is a personal and strong letter. For Internal Medicine, typically a letter from the program director or associate program director is required, along with at least one other Internal Medicine faculty member. The Internal Medicine Sub-Internship is a prime time to receive a letter because you will be able to show your skills as a more experienced fourth year. The faculty in the clerkship understand this and generally try to pair students interested in Internal Medicine with experienced, well-known attending. Of course, if you can get a strong letter from you Internal Medicine attending during third year, that is also helpful. A letter from faculty in other specialties is acceptable, but in general, faculty should be experienced and somewhat well known at other programs.

Do I need to have research experience to be competitive?
Although research experience is always desirable, research experience is generally not necessary to be a competitive applicant in Internal Medicine, unless you want to go to a very competitive academic program that focuses on research. Generally, any type of research, from basic science to clinical care to primary care or community oriented practice are all acceptable and strengthen your application.

INTERNAL MEDICINE RESIDENCY PROGRAMS
For a full listing of residencies by region, please visit the Clerkship page.


FELLOWSHIPS IN INTERNAL MEDICINE
Once you have completed a residency in Internal Medicine, there are several options for fellowship that fall into both the General Internal Medicine and sub-specialties, including:

General:

Adolescent medicine

Geriatrics

Hospitalists
Sports medicine

Sub-specialty

Allergy and Immunology

Cardiology

Endocrinology

Gastroenterology

Hematology

Infectious Disease

Nephrology

Oncology

Pulmonology

Rheumatology

. . .and many others. For more information on these and a list of programs, please visit the MS III/IV Clerkship.

CAREERS IN INTERNAL MEDICINE
Internal Medicine is a specialty which offers many postgraduate training options/fellowships and a tremendous breadth and scope of practice when training is completed. For further information about the many career opportunities in internal medicine, please see the following link: www.acponline.org

–Overview written by Nicholas Arger, Class of 2011, IM