The Fourth Year Lexicon

I’ve written twice before about funky medical words – once in first year, with Commonest Erythematous Palpation, and once at the end of second year with A Lexical Update. As I hit the big orange “CERTIFY” button on the rank list page last week, I realized that there is a completely different dictionary for the fourth year medical student.

As useless extra hands in the hospital go, we have basically completed our penance and have become experts in the Med Student Daily Apologia For Being An Idiot. In celebration, many of us – yours truly included – took huge chunks of time off to apply for and interview at residency programs. The process, while fun and exhausting and replete with enormous amounts of Netflix binge-watching, also generated a lexicon all on its own.

For those of you with fourth year student friends or family, I present you with a few keys for understanding your tormented fourth year student.

Application Phase

  • ERAS (n): The Electronic Residency Application System. A website where the Fourth Year (FY) spends all of September copying and pasting their CV, line by line, into a form that ends up formatting their information as if written by a third grader.
    • ERAS is a secure pay portal for stealing large sums of money from Fourth Years in the form of Application Fees.
  • ERAS Has Crashed, (n): A yearly, panic-inducing ritual where the ERAS website, overwhelmed by neurotic mouse-clicking Fourth Years, folds like a paper fan on September 15. This process is responsible for at least ten fatal brain aneurysm ruptures per year, usually from applicants into neurosurgery.
  • Waiting For Upload, (n): An ERAS status where the Fourth Year has requested a Letter of Recommendation from a busy faculty member, who has yet to upload this letter to ERAS. This usually induces a flurry of panicked emails and calls to the faculty member’s administrative assistant, who often pretends to be out of the office to avoid an episode of homicidal rage.

Interview Phase

  •, (n): The automated mailer for interview invitations sent through ERAS. Fourth Years receiving email communication from this address often experience a brief episode of a hypertensive emergency and are forced to excuse themselves from whatever they are doing to immediately seek broadband internet access, or a bathroom with solid LTE cell coverage, in order to schedule their interview before all the other neurotic Fourth Years across the country beat them to the punch. This extends even to FY’s actively participating in patient care, such as pretending to be an actual doctor in the operating room.

This relevant picture was too good to not include.


  • Interview Social, (n): The pre- or post-interview gathering with residents, designed to be an informal and optional gathering for the Fourth Year to meet actual, real life trainee doctors in their natural environment. This is most often a bar, but can also be the home of a resident or faculty member. The chief advantages of the Interview Social are the presence of free or greatly discounted alcohol and/or food. The chief disadvantages are needing to pretend to be nicer for extra hours, plus the added chance that the FY miscalculates their alcohol intake and ends up as the Drunkest Girl At the Bar (see also: Drinking To Alleviate Unavoidable Social Awkwardness) plus or minus hungover the next day for the actual interview.
  • United Airlines, (n): The surest path to Missing The Interview Day. See also: Your Flight Has Been Canceled and I’m Sorry, Sir, Your Bag Went To Houston. 
  • Interview Day, (n): A seemingly high-stakes encounter that, early on, the Fourth Year enters full of hope and nervousness and exits somewhat confused and thoroughly lost. As the interview season progresses, the Fourth Year begins entering these Days with less nervousness, increased apathy, and a greater interest in lunch than the tour.
  • Do You Want To See The ICU, (q): Speaking of the tour. A question asked by the tour guide, to which the answer is either “YES!!!!” or “absolutely not are you out of your mind,” depending on whether the FY has had at least one interview before.
  • Do You Have Any Questions, (q): see also: What Questions Do You Have. The one question guaranteed to send a veteran of the interview trail into spontaneous combustion out of sheer frustration. Also is a question asked by every single interviewer and every single resident, including those who admit, “I hated being asked if I had any questions, but…” The Fourth Year is then required to regurgitate one of a list of three or four questions they have developed over the course of the fall, when in reality the FY is thinking NO I DO NOT HAVE ANY GODDAMN QUESTIONS JUST LET ME EAT MY SANDWICH AND GO. Again, too good to not include:


    • For the record, I had three questions. They were, “What do you love about your program and where do you think it still has room to grow?” “What made you decide to come here?” and “Where do you see this program going or changing in the next five to ten years?”
    • Careful observers will note the third question and the first are exactly the same, but since we all follow the same script on Interview Day no one is actually paying attention.

Post-Interview Phase

  • Thank You Letter, (n): A questionably valued exercise in needless stress, requiring the collection of numerous business cards, followed by the Fourth Year needing to remember what in the actual hell they talked about on that interview day to personalize their email or handwritten note. Many programs will request that students do not send thank you messages, but since medical students are the most neurotic creatures on earth they usually do so anyway. Ostensibly this is to encourage the interviewer to remember the Fourth Year, but in reality the message usually gets thrown directly into the nearest receptacle.
  • Love Lettering, (v): The process of sending an email, or emails, to the top programs on a Fourth Year’s Rank List (a topic covered extensively in How The Match Works. Love Lettering the FY’s #1 program usually entails telling the program as such, with the goal of influencing the applicant’s position on the program’s rank list. Other programs may be informed that they are ranked “very highly,” which is of very high questionable usefulness to anyone. But people do it anyway, because they are neurotic medical students who are crazy.
    • Why this may work is also covered in the above link.
    • A final sidenote: every year, some idiot Fourth Year emails multiple programs and tells them all they are ranked #1. This inevitably backfires, as program directors talk and that Fourth Year is thereafter looked down upon as the Lying Resident, much the same way as Ted Cruz will now forever be remembered as “Lyin’ Ted” and for that phenomenal Bad Lip Reading of his campaign commercial.
  • Certifying The Rank Order List, (v): The process of promising the company running the match, the NRMP, that the Fourth Year is entering into a binding contract to become the employee of wherever they match. To break this contract requires the assistance of a spell by Professor Dumbledore, may he rest in peace, and a 5-4 majority of the Supreme Court.
  • Match Day, (n): A ritualistic induction into the indentured servitude of medicine whereby all Fourth Years realize, simultaneously, that they have been committed by law into chronic sleep deprivation, early hypertension, and a toxic relationship for two to eight years. The Fourth Years – now Almost Doctors – typically celebrate that evening by poisoning their livers together with unfortunately not-free alcohol.
  • Graduation, (n): An expensive and confusing ceremony including thousands of excited 21-year-olds with new bachelor’s degrees in communications, wizard robes, and something called a Hooding Ceremony. The school promises this is not a KKK ritual.

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