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Does it make any difference what kinds of courses one takes during 4th year? For instance, besides a sub-internship and a medicine critical care rotation, do residency programs like to see other medicine (general or subspecialty) rotations, or can one feel free to experience a variety of specialties for which this may be their last chance for an in-depth exposure (e.g. anesthesia, dermatology, psychiatry, etc.)?

Program Director 1 Response
Do something you're passionate about so you can learn something and talk about the experience intelligently and with enthusiasm. There is no formula, and what works for one place won't necessarily work for another. A series of "audition" rotations (Cardiology in three different institutions) can be a red flag for someone who is "just passing through" IM, and therefore not low maintenance. Depth and rigor is good, add scholarly investigation to that, and it's a slam dunk.

Program Director 2 Response
I do not pay too much attention to medical student applicant's electives. Students should try to do their sub-internship early in the year, and try to get a letter or recommendation.

Program Director 3 Response
A Sub-internship in medicine is important and ideally done early so that the grade is reflected in the transcript. I also look for letters from applicant's Sub-internship attending. Other than that, I think the fourth year is a time to expand your experience in whatever areas interest you. Some programs may look favorably on research or community service experiences during the fourth year.

Program Director 4 Response
It is best to be broad in fourth year rotations. You'll have time to learn the internal medicine specialties, so pick things that you want to do and that will help you be well-rounded as a physician.

Program Director 5 Response
I do not look closely at what electives an applicant has chosen in his or her senior year. I feel this is the time to explore different experiences that they may not be exposed to after medical school.

Program Director 6 Response
The student should do a sub-internship in medicine. Otherwise, speaking as a generalist, I think the student should take electives in areas that that he or she will not be able to pursue during residency. Take advantage of educational opportunities that will make the program director jealous.