The acronym MS4 stands for Medical Student Year 4, representing the final stage of undergraduate medical education in the United States. This period serves as the bridge between being a student and becoming a practicing physician. The fourth year is heavily focused on career specialization and securing a post-graduate residency position, which is the required next step for all medical doctors. This final year prepares the student for the responsibilities of residency training.
Defining the MS4 Title
Medical school is typically structured as a four-year program, where the “MS” title denotes the student’s current year. The first two years, MS1 and MS2, are dedicated to pre-clinical sciences, focusing on classroom learning, anatomy, physiology, and pathology. This academic phase prepares students for their initial standardized licensing exams.
The third year, MS3, shifts the focus entirely to core clinical rotations, or clerkships, in areas like internal medicine, surgery, pediatrics, and obstetrics and gynecology. The fourth year signifies a transition from the structured learning of the first three years to a period of personalized education and professional application.
The Focus of the Fourth Year Curriculum
The fourth year curriculum is characterized by a significant increase in scheduling flexibility, allowing students to tailor their education to their chosen specialty. The schedule is dominated by specialized electives and required sub-internships, often called Sub-Is, rather than rotating through all core services. These rotations allow students to explore a specific field, such as cardiology, neurology, or orthopedics, through a four-week clinical block.
The sub-internship is a graduation requirement designed to simulate the role of an intern, or first-year resident. During a Sub-I, the MS4 is assigned greater responsibility for patient management, including writing admission orders, coordinating with other services, and presenting patients to attending physicians. This hands-on experience functions as a final assessment of competence and demonstrates the student’s readiness to function at the level of a newly graduated doctor. Academic requirements often include an acute care rotation and an integrated life science course.
Navigating the Residency Application Process
The most intense aspect of the MS4 year is navigating the residency application process, which determines the student’s medical specialty and the location of their post-graduate training. This process begins in the summer before the fourth year with the preparation of the Electronic Residency Application Service (ERAS) submission. ERAS is the centralized platform through which students submit their application, including transcripts, a personal statement, and the Medical Student Performance Evaluation (MSPE) from their dean’s office.
A crucial component is securing letters of recommendation from faculty who supervised the student during clinical rotations, particularly the Sub-Is. Students must also register with the National Resident Matching Program (NRMP), which administers the “Match,” the algorithm-based system that pairs applicants with residency programs.
The period between October and January is dedicated to the interview trail, where applicants meet with program directors and residents at their top-choice institutions. Following the interviews, both the applicants and the residency programs submit a ranked list of preferences to the NRMP. On a day in mid-March, known as Match Day, applicants simultaneously receive notification of the single residency program they have been assigned to. For students who do not match, the Supplemental Offer and Acceptance Program (SOAP) provides a mechanism to apply for unfilled positions during Match Week.