Survey of All Residency Program Directors: Guidance for MSIV students’ Senior Year

All Program Director at the University of Pittsburgh were for their recommendations on
how medical students should structure their fourth year so that they are prepared and competitive
for their chosen residency. These recommendations were updated in 2012 and are provided
below. We intend these to be guidelines, not requirements. Students should always be in contact
with their departmental advisors and their Advisory Deans for optimal individualized scheduling.

SUMMARY

1. Board scores are important in the initial screen of applicants, though many Program
Directors recognize the limitation of scores as predictors of residency performance.
2. If contemplating a specific specialty, a student should try to take an elective early in the
fourth year to assure it is the right fit and to potentially get a letter of recommendation.
3. Students should not overload MSIV year with electives in chosen specialty. Keep the
fourth year broad.
4. The MS IV year should stress clinical experiences in which direct patient care, true
patient responsibility, independence and autonomy are stressed.
5. Case presentation and critical thinking skills are areas for continued emphasis in MSIV year.
6. Away rotations are specialty dependent and warrant individual advice regarding if they
are desirable and if so, location and timing.
7. For those planning surgical fields, the student should continue to develop and refine the basic
surgical skills during appropriate electives.
8. For all fields, a student should make sure there is at least one direct patient care elective
within 4 months of beginning internship.

UPSOM PROGRAM DIRECTORS RECOMMENDATIONS FOR SPECIFIC MSIV ROTATIONS

ANESTHESIOLOGY
 Anesthesia (MS III)
 Elective MS IV, pre-September if letter needed/pre-November otherwise
 No more than one away anesthesia rotation (good idea if you really want to go
somewhere and will do a good job on the elective)
 Critical Care Medicine
 Pain Medicine
 Pulmonary
 Cardiology
 Medicine or Surgery AI

EMERGENCY MEDICINE
 Emergency Medicine (at Pitt) (this is a “must”)
 Pediatric Emergency Medicine
 Critical Care (extremely important)
 Trauma (extremely important)
 Radiology
 Anesthesia
 No more than 2 away
EMERGENCY MEDICINE
 Emergency Medicine (at Pitt)
 Pediatric Emergency Medicine
 Critical Care
 Trauma
 Radiology
  Anesthesia
 No more than 2 away

DERMATOLOGY
 Intensive Care Unit
 Radiology
 Cardiology/EKG reading
 Emergency Medicine
 Pharmacology
 Rheumatology
 ID and HIV/AIDS
 Plastic surgery
 DERMATOLOGY
 AI
 Interest of student

FAMILY MEDICINE
 AI in Family Medicine or Internal Medicine
 One Rotation in FM during MSIV (could be AI)

GENERAL SURGERY
 2 surgical rotations in core areas (General Surgery, GI, Trauma, Surgical
Oncology, as opposed to Plastic Surgery, Urology, Orthopedics)
 Intensive Care Unit
 Cardiology (inpatient or consults)
 Nephrology

MEDICINE
 Medicine AI
 Radiology
 Dermatology
 Medical sub-specialty such as cardiology, nephrology, etc
 Critical Care Medicine
 Consider teaching elective

MEDICINE-PEDIATRICS
 Pediatrics or Medicine AI
 Medical Intensive Care Unit

NEUROLOGY
 One advanced neurology elective or an AI
 Critical Care
 Imaging
 Follow interests
NEUROSURGERY
 Neurosurgery Sub-I here as soon as feasible
 a minimum of one additional Neurosurgery sub I at a center where the applicant
would be competitive and where the applicant would like to consider training;
carefully consider whether a sub I at an elite program that only takes its own
graduates is appropriate
  ER
 Critical care,
 cardiology
 develop a mentor relationship with a senior Neurosurgical faculty member who
can write a strong support letter
 participate in a research program within the department; attend NS conferences
as much as possible during the year; participate in rounds with Neursurgery
residents- the more you are known and respected, the better

OBSTETRICS AND GYNECOLOGY

 1 or 2 of Medicine, Surgery, Intensive Care Unit AI
 Paul Roger’s course
 OB-GYN Sub I elective that is a “test” (4 good options for this at Pitt)
 Helpful to start residency with good basic surgical skills (suturing, knot tying)

OPHTHALMOLOGY
 Neuroradiology
 Neurology
 Dermatology
 Otolaryngology
 Rheumatology
 maybe Endocrine
 one month clinical elective to demonstrate to themselves and others they are
interested in the field. More than that is probably a waste of time.

ORTHOPEDICS
 Orthopedics AI (key): pre December
 Radiology
 Anesthesia
 Emergency Medicine
 Away – important to choose wisely – a place that would be acceptable to you,
and where you are a competitive candidate.

OTOLARYNGOLOGY
 Medicine AI
 Critical Care Medicine
 Several rotations on subspecialty services
 One ENT rotation is essential to be sure about choice and get letters
 Multiple rotations on ENT are a waste

PATHOLOGY
 At least one elective in either anatomic pathology or clinical pathology
 Two electives preferred (either anatomic or clinical)
 Away elective at institution high on application list
PEDIATRICS
 Pediatrics AI
 Radiology
 Critical Care Medicine, especially if pediatric slant
 don’t load with pediatrics electives
PHYSICAL MEDICINE AND REHABILITATION
 PM&R elective (must)
 PM&R sub I (desirable)
 Away elective in PM&R at site of first choice

PLASTIC SURGERY
 Pitt Plastic Surgery AI, prior to October
 Up to 1 or 2 AI away rotations, prior to October

PSYCIHATRY
 Psychiatry AI and
 Medicine AI (Internal Medicine or Family Medicine)
 Heavy medical bent: ICU, EM
 Emergency Medicine
 Palliative Care
 Primary Care
 Neurology related electives

RADIATION ONCOLOGY
 Radiation oncology
o (total of 2-3, including one at Pitt)
 1-2 away rotations in Radiation Oncology
 Medical Oncology
 Surgical Oncology
 Elective encouraged in 3rd year if possible, to give time for research, which is important

RADIOLOGY
 General Medicine (rigorous rotation)
 General Surgery
 At least one but no more than 2 rotations in diagnostic radiology

UROLOGY
 Anesthesia
 Medicine AI
 Intensive Care Unit
 Emergency Medicine
 No more than one rotation in Urology here and one away

VASCULAR SURGERY
 Vascular Surgery AI (here or away)
 participation in the student programs offered by various vascular surgery societies.