Mastering M3: Top questions for your third year of medical school

As a third-year medical student, you are halfway home, and have many meaningful patient-facing and learning experiences ahead. Throughout your journey as a medical student, some key questions are likely to arise. The AMA offers answers to questions medical students frequently ask during their undergraduate medical training.

The majority of medical students begin clerkship rotations during their third year of training. The move signifies a transition from classroom to clinic, making for a different type of learning environment. Tips from those who have gone through these key rotations include maintaining professionalism, remembering your patient experiences to help your learning and using the experience to hone your specialty choice options.

Having recently completed his family medicine residency at United Health Services in Binghamton, New York, James Docherty, DO, is a few years removed from his own clinical rotations as a medical student at New York Institute of Technology College of Osteopathic Medicine.

“If I could do it again, I'd definitely be more forthright with my thoughts,” Dr. Docherty said in an interview for the AMA’s “What I Wish I Knew in Medical School” series. “I'd be more confident with how I spoke and really put my thoughts out there.”

“What you are really learning is how to develop a concrete plan. It’s a different phase of medical school. In your first and second years you learn about individual diseases, and you learn how to treat individual diseases because they give you all the pharmacology knowledge, and now you have to combine all those different diseases in a real person. It's so rare that one person has one chronic disease.”

Dive deeper:

• The science of scheduling: When to do key medical school rotations
• 4 tips to enhance patient communication as a medical student

This is likely going to be dictated by your institution. Traditionally, Step 2 the United States Medical Licensing Examinations® (USMLE®) was taken between M3 and M4 year.

And, historically, Step 2 was broken into two parts. Step 2 Clinical Knowledge is a multiple-choice exam that covers the application of the basic sciences highlighted in Step 1. Unlike Step 1, Step 2 test-takers are given a numerical score. The other half of Step 2—Step 2 Clinical Skills (CS), a simulated patient exam—was permanently canceled in 2020.

The questions most students want to know is a simple one: What should I study?

“For Step 2 CK the dominant area is going to be internal medicine. Even for things like the surgery questions, a fair number of them have internal medicine principles,” said Christopher Cimino, MD, chief medical officer, Kaplan Medical.

“For example, things like nutrition are in the surgical domain. They are surgical principles, but because they don’t involve cutting, students tend to think of them as internal medicine. So the internal medicine aspects of all the disciplines are probably a good place to focus on in Step 2 CK.”

Dive deeper:

• USMLE high-yield topics: In the eye of the beholder?

With residency applications for most students going out in the fall of year four, most students pick a specialty at the end of their third year of medical school.

For students who are still deciding, subinternships—advanced rotations that typically take place after the core clerkships have been completed at a hospital affiliated with your training institution—offer one last chance to get specialty exposure before sending out applications.

“Subinternships allow students to work in a more autonomous way,” said Lindia J. Willies-Jacobo, MD, senior associate dean for admissions and equity, inclusion and diversity at Kaiser Permanente Bernard J. Tyson School of Medicine. “Most subinterns will work similarly to the way an intern would work. They are fairly independent in their engagement with the stations. In that autonomy and being in that role in a pretty intense way is a way in which students can use that [experience] to settle on a specialty.”

Dive deeper:

• Future physicians: When's the right time to choose a specialty?
• When picking a physician specialty, don’t ignore your instincts
• 5 things students overlook when choosing a specialty
• The AMA's “Shadow Me” Specialty Series
• FREIDA's Specialty Guide

Medical students are more likely to experience burnout and depression than other similarly aged individuals pursuing different careers, and this elevated risk persists into residency training. Systemic solutions are generally considered the more effective method for preventing medical student burnout.

At the individual medical student level, however, one piece of advice to combat burnout is to try to get back to parts of your past wellness routine. That, of course, is easier said than done for the stretched-thin medical student.

“At the end of my third year of medical school, I was a physical mess,” said Sandra A. Fryhofer, MD, immediate past chair of the AMA Board of Trustees and a practicing internal medicine physician in Atlanta. “I had no time to exercise. I was exhausted. I looked in the mirror and I said: What is happening? I'd always gone to dance classes for exercise, but as a third-year medical student there was no time. There was no schedule. But I then joined a health club, and I went to exercise every day. This health club was close to my home, so I had to change what I'd always done—and it helped.

“Knowing self-care strategies can be helpful. … Organized study groups can really be helpful. They can reduce stress, anxiety and depression.”

Dive deeper:

• Burnout’s not about you—it’s about the broken health system
• 8 ways to cut medical student burnout
• Medical school burnout: How to take care of yourself
• Take a mindful approach to manage med school stress

Where you will do your residency training becomes a focal point of your final year in medical school—though it’s key to stay on point with your studies.

The final months of your third year of medical school and the ensuing summer should be spent making sure you have your ducks in a row. Some key tasks include: Finalizing letters of recommendation; crafting a personal statement and comprehensive CV; and obtaining your token for the Electronic Residency Application Service (ERAS), which transmits students’ residency program applications and key information from their designated dean's office to program directors. 

Dive deeper:

• Residency match made simple: From M4 to PGY-1 in 6 steps
• 4 tricks to a successful residency program search
• How social media can aid medical residency program searches

Medical students may not have all the answers in a classroom or clinical setting. That knowledge comes over time. Still, what students may lack in know-how, they tend to make up for in passion.

Channeling that passion can take on many forms. One of them is advocating for changes to the modern health care industry that can better serve physicians and patients.

Anyone can be an advocate. To do it effectively, past members of the AMA Medical Student Section Committee on Legislation & Advocacy say one should demonstrate creativity and resourcefulness to take ambitious motivation and channel it into something that truly makes an impact.

Dive deeper:

• How to get involved in advocacy work as a medical student
• In unprecedented times, medical students fight for these 4 issues
• How this medical student led way to battle mental health stigma
• How medical students can build leadership skills on campus

The AMA’s Facilitating Effective Transitions Along the Medical Education Continuum handbook takes a deep dive into the needs of learners along the continuum of medical education—from the beginning of medical school through the final stage of residency. Download now.