Medical School - ClinicalResidency & Beyond

Things I Wish I Knew Before the 4th Year of Medical School

Considering a medical specialty

By: Sarju Panchal, PharmD

The goal of any medical student is to find the specialty that they love and will thrive in. This is a challenge for many students because of factors such as grades, Step 1 score, research or late exposure to the specialty. There are several steps I believe that students can take early on in medical school to ensure they are set to match in the specialty of their choice.

Grades and Step 1 score

Step 1 is by far the most significant hurdle that a medical student must overcome to match into a competitive specialty. The average Step 1 score of candidates applying to competitive specialties such as plastic surgery, dermatology or radiation oncology is around 240. Other competitive specialties include Orthopedic Surgery, Urology, Ophthalmology, and Anesthesia.  Even less competitive specialties such as Internal Medicine can become competitive if the student wishes to match in a highly ranked program such as Hopkins or Mayo.

Early on, students should evaluate their studying skills and strategy. If a student requires more time to absorb information, then they should devise study schedule months ahead. A study schedule for Step 1 is a must. Students can certainly deviate from their schedule or lag, but all the top scoring students I know used a study schedule. Finding a study partner with similar study habits is also effective to stay on task and motivate each other.

Questions, questions, and questions are also the key to a high score. It is recommended to complete at least 4000 questions to score a 240 on Step 1.

Final advice, clerkship grades are as important as Step 1! Students should strive to obtain honors in all clerkships, even those in which they have no interest in.

Read More: How to Choose Extracurricular Activities as a Medical Student

Shadowing and networking

I firmly believe that students should start shadowing competitive specialties early on during medical school. Core medical specialties (medicine, surgery, OB/GYN, etc) to which students are exposed to during their third-year clerkships are likely not worth shadowing since they will have ample time and experience before their fourth year. However, I would recommend if students even have a remote interest in any of the competitive specialties listed above, then they get exposure early on. Shadowing early provides adequate time for the student to decide and allows for more opportunities for research, networking and building a strong CV. The summer between the first and second year of medical school is a great time to get some shadowing experience and research under your belt. A good reference to learn about different medical specialties is “The Ultimate Guide to Choosing a Medical Specialty,” by Brian Freeman.

Final advice is to keep an open mind when choosing a specialty. Choose a specialty that sparks an internal desire to learn and discover and one that fits your future lifestyle. Do not choose a specialty for money or prestige because, in the end, these will not bring you happiness.


I think having some form of research under your belt will only make you a stronger candidate, even if it is not your end goal. Again, the best times to do research is the summer between your first and second year, and during your third-year clerkships. Seek out research in a specialty that interests you and put your efforts into a project from start to finish. Do not sign up for multiple projects merely to have your name on a publication to which you contributed very little. Residency program directors place value on research if you can extensively explain the project and your role in it. Also, seek out cool cases during your clerkship year and ask the attending if you can write it up for publication. You will get early exposure to the process and maybe a publication in return.

Bottom line is, get involved in research even if you aren’t going into a competitive specialty. It will sharpen your writing skills and make you a stronger candidate.

Read More: Navigating Research in Medical School

Having initiative and motivation can really help you decide on a specialty and greatly enhance your residency application. Be proactive, and make the most of the opportunities you have in medical school!


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