Preparing for Residency

What I wish I knew in medical school about balancing M4 priorities

Brendan Murphy , Senior News Writer

The Match is a constant focus of one’s final year in medical school, but growth and development shouldn’t take a back seat. First-year resident physician Leanna Knight, MD, clearly remembers the time as one of balancing multiple interests.

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Dr. Knight, who uses they/them pronouns, was going through clerkship and away rotations while trying to grow clinically and complete residency applications.

“For me, June was my emergency medicine clerkship, July was my home sub-internship and then my away rotation filled the month of August. Before I knew it September was upon me,” Dr. Knight said. “I definitely experienced the inherent stress of fourth year as we work through this triathlon of applications, interviews and eventually ranking. There are so many facets of the residency application cycle.”

Now an emergency medicine PGY-1 resident at the Warren Alpert Medical School of Brown University, Dr. Knight has the benefit of hindsight while reflecting on the whirlwind of balancing multiple priorities as an M4 for the AMA’s “What I Wish I Knew in Medical School” series.

As a new batch of fourth-year medical students confront the match process while also trying to grow their skills for residency, Dr. Knight offered some key advice.

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“One of the things that I've thought about a lot is that there's nothing that happens during that fourth year of medical school that is going to make you a doctor,” said Dr. Knight, an AMA member who is involved with the AMA Advisory Committee on LGBTQ Issues. “Magically, though, one day very soon you will wake up and be a doctor.

“This is why I think it is so important to see this M4 period as an opportunity to think about who you want to be as a physician,” Dr. Knight added. “Who do you want to be to your patients and  colleagues? Most importantly: Who do you want to be for yourself? Fourth year, we spend so much time focused on the Match. But the truth is you've already done the hard part before applications even begin. 

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“It's different for everybody, but during this time, we all should think deeply about what our identity is now, and what we want it to be when we’re going to have that title of ‘physician.’ I’m not talking about your specialty. Of course, that’s also important but this is something deeper.

“For me being a physician who is compassionate, kind, and present while also being someone who has integrity is critical. I also want to be the kind of doctor who works hard to make the healthcare system better for everyone.

“I sought advice from mentors and students I looked up to when thinking about who I wanted to become. I also paid attention to what my patients needed from me. It is an iterative process that you start in medical school and hopefully will never end.”

Awaiting the varying steps of the residency-application process such as interview invitations and finding out one’s actual residency destination, Dr. Knight “tried really hard to stay grounded, and I don’t really know that I did. It’s tough not to think about. I’m a Buddhist who meditates, but it’s still difficult.

“It's very easy to go in, after application submission and think that you've crushed it—you're definitely going to get your No. 1. But I'm telling you, a few weeks in all of your confidence can be gone and you just hope that you match somewhere.

“The best advice that I could give is to stay engaged in your community and hobbies,” Dr. Knight said. “Continue doing things that bring you joy. Try to take care of yourself. Find some rest and recovery, because fourth year is the foundation for your first year of residency.”

“As an M4, this is the last time that you have an opportunity to select diverse electives in all parts of medicine,” Dr. Knight said. “It's really important to choose electives that interest you, especially electives outside your specialty you will not be exposed to in residency. I would also consider what electives could best prepare you for residency and make you a more well-rounded physician. These are opportunities for growth that will not be afforded to you later.”

Dr. Knight advised working to increase the breadth of your knowledge and skills as an M4 “because once you go into a specialty everything becomes narrower.”

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“I applied to about 35 programs, but I didn't take more interviews than I thought was absolutely necessary,” Dr. Knight said. “Everybody's situation is different, but something that often gets forgotten is that interviewing is exhausting., I think everyone should plan accordingly.

“Because I didn’t take too many interviews, I was able to dedicate more energy to each of those interviews. Some of my colleagues went on twice as many—even two and a half times as many—as I did.”

And for Dr. Knight, that more parsimonious approach to interviewing paid off.

“I matched into my dream program.”

M4s “have a limited amount of time. The key is what to do with that time. You can either put a lot of that towards interviews to calm your anxiety, or you can do the number of interviews you need to match and have an adequate amount of time to focus on the other things you need.”

“Match day is a joyous occasion, but quickly you realize that everything is about to change. You have to move! Consider moving early. I can’t tell you the difference signing a lease in March made to my quality of life.

“I moved in mid-May right before graduation. This afforded me a lot of extra time to relax, vacation, and just recover from medical school before I started my residency, which was incredibly valuable to my mental health and wellness when starting residency.

Dr. Knight stressed the importance of self-care during the fourth year of medical school and throughout the residency-application process.

“Regardless of where you match, you will be a doctor. You will graduate,” Dr. Knight said. “It's important to also ground back into that—that you're going to be a part of an amazing profession, and residency is just one more step along that way.”

The AMA Road to Residency series provides medical students, international medical graduates, and others with guidance on preparing for residency application, acing your residency interview, putting together your rank-order list, and more.