How to plan the 4th year of medical school

Hi Everyone,

Woohoo – I completed COMLEX Level 2 CE today and boy was it a dooozy. I am so glad to be finished with that test!

Anywho, today I am here to provide current 1st, 2nd, and 3rd year med students on how to plan for 4th year through VSAS. I personally only used VSAS to plan 4th year electives and worked with my site coordinator to fill in the gaps. For those that don’t know, VSAS is strictly MD-route. I have yet to see a DO program utilize it, but please correct me if I’m wrong. FYI, I’ve invented the FAQ questions, if you have real questions, please feel free to leave them in the comment box below.

Q: What is VSAS? 

A: VSAS is the Visiting Medical Student application portal. It only applies to MD programs and usually larger academic institutions. You will probably not find community hospitals, newer residency programs, or AOA-associated residency programs here. You will need to contact those programs directly and early. Some schools have a list of contacts for local programs and you can work with your site coordinator to set them up.

Q: What do you mean, “VSAS will be opening”? When do I need to apply for programs? 

A: Program catalogs on VSAS for previous years are available on VSAS so most programs are searchable and you can read about them and their requirements, but you will not be able to apply for the current year until their application officially opens (i.e. when VSAS opens).

Typically programs allow application submissions on March 1st and you need to be ready. When you’re searching through VSAS for programs that you are interested in there is an option to flag the programs so that VSAS will notify you via email when the application portal opens for that program. This is super handy as you will likely flag a lot of them and they’re difficult to keep organized. (*HOT TIP: Apply on the day that the application opens – this will ensure you the best chances of getting a rotation*).

Q: What documents do I need to have ready in order to be ready for when VSAS opens? 

A: You will need to upload the following:

  • Your most professional photo.
  • Current Curriculum Vitae.
  • Immunization records. Most programs will provide an generic AAMC immunization record that you can use and upload. Some schools will require that you use their specific form. Be mindful that immunization records need to be signed by a doctor, either your personal doc or at the school and may take a while to complete.

You may need to upload:

  • Letter of Recommendation. It depends on the program that you’re interested in; programs that are more competitive to rotate at will be more likely to have this requirement. Be sure to read about each program before you apply to make sure you can get this completed in advance.
  • COMLEX/USMLE Score Report. That’s right, it’s back. Depending on the program (e.g. Plastics, Ortho, Ophtho, some Internal Med progs, maybe FM, Neuro, etc.) you may need to upload this extra piece of the past.

Your school will need to upload the following:

  • Certificate of insurance.
  • Official transcript.

Most schools will upload them automatically, but if they don’t it doesn’t hurt to email them and let them know you are planning to use VSAS and will need those documents uploaded.

Q: How do I apply to electives when I have no idea what I want to do or when I want to do what I want to do? 

A: This is something I wish others had discussed with me previously. Planning 4th year is super confusing and there is guidance out there, but no matter what you will be in some weird state of constant flux. Plus, by the time you’re halfway through 3rd year everyone expects you to know what you want to do. Maybe you will and maybe you won’t, but select your top 3 favorite specialties and work towards getting rotations in those early 4th year.

TIP #1: Plan electives in your Specialty of Choice throughout July to December. 

  • Typically, you will have 16 weeks of protected sub-I/elective time in your 4th year and ideally you will have an idea as to which specialties you’re interested in. Initially, when you start applying for programs you will be working with a blank schedule. My advice is to apply to 2 programs per block. One block = 4 weeks.
  • Each program you apply to will impose a $15 fee. Luckily, if you’re applying to several electives at one university you will only pay this fee once!
  • Keep in mind that VSAS allows a certain number of “Authorizations” or tokens. One token per elective. I don’t know why this exists, but when you run low on tokens, contact your school for more.

TIP #2: January to May electives are essentially a “Create Your Own Adventure!”

  •  My school requires us to complete a certain number of Surgery and Medicine electives in order to graduate. Make sure you know what your school requires and plan accordingly.
  • You can deviate from VSAS and take advantage of unique electives that your school offers or contact programs that have rotations you think will be interesting.
  • This is your last few months of medical school – take advantage of this luxury before residency! Everyone tells me that this is the golden period – no exams to study for and you’re just waiting to match and then you graduate!

TIP #3: Expect to communicate with VSAS coordinators. Be pleasant. They have hundreds of applications coming into their program and have a lot going on. In my experience they have all been super helpful and are willing to work with you on your schedule. If a certain date works better than others and you’ve already been approved on VSAS for the less favorable date, email the coordinator and politely ask if there are any other available dates. The worst they can do is say no.

TIP #4: Financial management & Housing & Transportation are key to consider for away rotations. Some resources for housing:

Some cities will be much more $$$ than others. For example, one of my away rotations is in Washington DC and the average cost for 1 month stay is $1,400. Another rotation is in Springfield, IL and the average cost for 1 month stay is $300. Plan housing carefully.

TIP #5: Be flexible. You will be putting together your schedule according to what interests you and which rotations you get and the two may not always align. Keep in mind your end goal and take the steps to achieve that goal.

Q: When do I hear back from programs? 

A: I didn’t start hearing back from programs until the end of May/early June and this was nerve-wracking. You may not get your schedule approved in chronological order, so be ready for mix and matching your schedule. I used a google excel spreadsheet to keep everything in order. Once you hear back, you will have < 1 week to accept or decline their offer and may have to pay an additional fee. $$$

So, this was a simplified run-down on how to plan 4th year with VSAS. For those of you that didn’t use VSAS, what advice do you have? Hope some of this was helpful. My mind is drifting onto bigger and yummier things… time for ice cream!


3 thoughts on “How to plan the 4th year of medical school

    1. Hello James and welcome back to EDC! Good point, yes that is something to consider. I have not come across this for psych. Is this for anesthesia?


  1. Yes fun to read a little about you all. I believe it is school dependent. The personal statement was for PM&R at the University of Utah.


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