Fourth Year (MS4)

Introduction to the Fourth Year of Medical School for Plastic Surgery Applicants

Exams: Step 1 and Step 2 CK

What to Expect in Step 1 and Step 2

• Shift to using step 2 CK as screening tool while step 1 becomes pass/fail
• Emphasis on letters of recommendation, research, away rotations and and interviews

The Sub-Internship: Making the List

How to Stand Out

• Show initiative by making the patient list including abnormal vitals, I/Os, microbiology and cultures and other to-do items
• Reach out to nurses if there are missing data proactively

The Sub-Internship: Supplies for "The Bucket"

Staying Prepared

• Facilitate dressing changes by having supplies to carry with you
• Staple/suture removal kits, saline flushes, paper tape, ABD pads, Tegaderms, xeroforms, kerlix, 4x4, ACE rolls, marking pens, baci, lube, alcohol swabs, Q-tips, scissors and steri strips
• Take note of dressing changes for each patient so you are ready every morning

The Sub-Internship: Operating Room Etiquette

Getting Inside the Operating Room

• In operating room, be prepared for cases (why we are doing the case, surgical anatomy, complications, expected outcomes, etc.)
• Use three unique resources for each case preparation
• Help with rolling the patient in, transferring the patient and taking the bed out of the room
• Introduce yourself to everyone in the room (nurse, anesthesia, tech, etc.)
• Record your name on white board
• Prepare patient for surgery: Security belt, SCDs, bair hugger, padding pressure points, securing the arms, prepping, pull your gowns/gloves and ask other residents and nurses if they need gowns and gloves
• Read the room, and don’t make small talk or ask questions during stressful parts of the case
• Ask the scrub tech/nurse before taking instruments from the mayo stand
• After the case, grab warm blankets, ask anesthesia when to bring in the bed and help the resident write postop notes or give postop sign-outs
• Check your patients postop

The Sub-Internship: Navigating the Interpersonal Aspects

How to Conduct Yourself

• Extended interview where programs get to know you and you get to know them
• Social and emotional IQ is important
• Treat everyone as you want to be treated (including other medical students)
• Start in a more reserved manner, get a sense of the environment, observe the dynamic and program culture before slipping in
• Always be a professional, be on time and prepared, own up if you make errors and keep a positive attitude
• Show interest in growing by asking for feedback
• Be respectful of other programs – no trash-talking
• Be honest with yourself: Can you see yourself in that program for six years?

Choosing Away Sub-Internships

Picking Your Away Rotations

• Away rotations act as extended interviews, so choose programs you are interested in going to (consider family, geography and program size)
• Pick rotations in different regions of the country (shows programs you are willing to move)
• Look to see how many residents at a program did away rotations there as students (most programs favor taking medical students as residents who rotated there)

Interviews: Tips for Applicants

Acing Your Interview

• Be yourself
• Know common questions
  • Tell me about yourself
  • Tell me why you decided to go into plastic surgery
  • Tell me about a time that you failed and how you overcame it
• Be ready to talk about anything on your application – it is all fair game

Ranking Programs

How to Rank the Programs

• Extremely personal decision
• Take notes during interviews – goods and bads

Advice for Unmatched Applicants

What to Do If Unmatched

• SOAP
• Research year
• Advanced degree
• Involve mentors early

What If You Decided Late on Plastic Surgery?

How to Get Caught Up

• Decide about halfway through your third year – get letters of recommendation or away rotations
• If deciding later, important things are letters of recommendation and research – identify mentors!
• Start doing research, especially projects that can be done quickly
• Figure out who else in your class is applying and compare your application against them
• Consider a research year – strongly recommended!