Medical School Timeline (All 4 Years Explained)

You finally made it into medical school and there are just four years between you and earning your M.D. But, as any medical student or graduate will tell you, those years are intense and rigorous. Let’s discuss the entire medical school timeline from first year to graduation.

Medical school can often be broken down into three sections: preclinicals (MS1-2), clinical rotations (MS3), and electives/interviews (MS4). In this post, we’ll go over the full timeline and what to expect during each year.

First Year (MS1 or M1)

The first year will be the most radical transition for most students. Gone are the days of college, and now the rigors of medical school are thrust upon you. If you’re in medical school, you’ve studied for tests and exams before; however, the sheer volume of material will take some time to adjust to.

It’s for this reason that studying in medical school is often described as drinking out of a fire hydrant. Additionally, understanding what information is essential in a sea of details and facts is a skill that you will fine-tune as you progress through your schooling.

The first few weeks to months are challenging; however, you’ll soon get in the groove and learn that your first year offers you the most free time.

Learn how to make this adjustment as painlessly as possible in our in-depth article: Adjusting to Medical School 101 Post, which provides actionable advice.

Content-wise, the material may vary from school-to-school. Some schools have a traditional curriculum, where you learn all of the physiology (or what’s normal) first across all organ systems, then learn about how it can be abnormal (pathology), and then how to treat it (pharmacology).

Other schools have a systems-based approach, where you have blocks that last several weeks dedicated to a specific organ system, such as cardiovascular, pulmonary, gastrointestinal, etc. You will study physiology, pathophysiology, and pharmacology unique to that specific organ system and repeat this format for the next system block. There are several other disciplines sprinkled throughout your curriculum.

During this time, you should reassess and hone your study strategies, figure out your routines, and work to optimize your efficiency in preparation for the upcoming stages of medical school. Find your group of friends and figure out whether or not they are people you can actually study with. Sometimes studying with your closest friends is more distracting than motivating.

You’ll remember the middle and end of your first year as some of the best times in medical school. The stress is comparatively low to the later stages, you have more free time, and you are bonding with new people and solidifying lifelong friendships. You’ll be amazed by your classmates, as medical students are some of the most impressive and diverse people you’ll come across.

Second Year (MS2 or M2)

Historically, MS2 starts with an uneasy tension that will grow and expand for the rest of the year. That tension is because of one thing and one thing only—Step 1. Step 1 is the first of the three United States Medical Licensing Exams, or USMLEs, that you’ll be taking prior to obtaining your medical license. Step 1 and Step 2 are taken during medical school.

As of January 2022, the USMLE Step 1 exam is pass/fail. The goal of this change was to improve wellbeing and decrease burnout among medical students. Since USMLE Step 1 will be graded as pass/fail, it will no longer be the primary determinant of one’s competitiveness as a residency applicant.

Learn How USMLE Step 1 Pass/Fail is Changing Medical School.

In the second year, you will have honed your study strategies and time management, so you’ll be ready to increase the intensity of your studying. In the first couple of months, you may be solidifying your plan on how to study for USMLE Step 1. There are two stages: leading up to the dedicated period and the dedicated period.

Step 1 is a beast unlike any other test. For the MCAT, you can put in two months and achieve a 99th percentile score. But Step 1 is a different animal—it’s the culmination of your entire first two years of medical school, and you’ll spend most of your second year utilizing resources to adequately prepare for it.

Take a look at:

• What I Wish I Knew Before Taking USMLE Step 1
• Don’t Make the Top 4 Mistakes I Made Studying for Step 1

Medical schools are going through major curriculum changes to account for Step 1 moving to pass/fail. Most students take Step 1 in the spring at the end of their second year, which concludes their preclinical studies. In the fall and winter of your second year, you’ll hermit up and spend more time studying and less time socializing.

The end of winter and spring is when you’ll have your dedicated period and really go all out in studying. Right after you take Step 1, you’ll begin third year. However, other schools may schedule you to take Step 1 after your third year, arguing that spending some time on the wards during your clinical rotation will provide perspective for the exam.

Note that some schools are changing their curriculum to progress from two years of preclinicals to 1.5 years of preclinicals. With Step 1 moving to pass/fail, there is less weight on making sure students get a competitive score. There’s more focus on making sure students learn enough during their preclinicals before sending them off to rotation, where they will receive their true clinical experience in the hospital.

Third Year (MS3 or M3)

Most students love third year, and some students hate it. It’s an adjustment for everyone. Third year marks the beginning of your clinical years. While the first two years take place mostly in the classroom, the latter two years are primarily in the hospital or clinic. This is what you came to medical school for: to become a doctor and take care of patients.

Clinical rotations are particularly challenging because for the first time in your life, you’re not just studying out of books and taking tests. You still have to do that, but now most of your waking hours are spent in the hospital or clinic, and the evaluations from your seniors hold tremendous weight in your overall grade. It’s a different game entirely.

Every medical student has to take a series of core rotations before graduating. During your third year, you’ll likely be rotating on internal medicine, family medicine, general surgery, psychiatry, neurology, pediatrics, ob/gyn, and emergency medicine.

For clinical rotations, you can expect:

• You’ll be helpful to your interns, residents, and other team members by helping write notes, seeing patients, and presenting on rounds.
• You’ll be in the OR assisting in surgeries by retracting, suctioning, and occasionally suturing/knot tying.
• You will function as one of the healthcare team members and learn the clinical skills necessary through observing the residents and doctors you work with.
• You will still have to study, as all students have a Shelf exam at the end of each rotation. The stress of these exams is significantly less compared to other exams, like Step 1.

At the end of third year, you’ll be preparing for Step 2CK. Step 2 is similar to Step 1, except now it’s testing the culmination of knowledge from your third year of medical school. The most heavily tested concepts are from your internal medicine rotation.

Historically, you won’t be studying nearly as hard as you did for Step 1 as you’ve already learned the foundation necessary to understand medicine. However, note that since Step 1 has shifted to pass/fail, there will be more pressure to do well on Step 2CK. One month of studying for Step 2 will usually suffice.

Fourth Year (MS4 or M4)

Finally, MS4, the promised land! Hold your horses. Many people say that fourth year is a dream, and that everything is smooth sailing. Not so fast. The first half of fourth year is arguably the hardest part of the entire medical training process, at least if you go into a competitive surgical subspecialty.

Your core clerkships are complete and most of your rotations around this time are electives, which usually means they are no longer graded and are most likely pass/fail, though this varies by school. They no longer carry as much weight as they once did, but that’s not to say M4 will be easy.

The first half of your fourth year is challenging for two main reasons: sub-internships and preparing your residency application.

Sub-internships, also known as audition rotations, are rotations you perform at other institutions anywhere in the country. You’re essentially performing a month-long interview, and you have to be on your best behavior. Your sub-internship is an opportunity to show a program that they should take you into their residency. To accomplish this, you must show up early, stay late, and work hard to make the life of the residents easier. If you’re going into a specialty with a suboptimal lifestyle, like surgery, expect long hours and high stress.

Medical students apply to residency using ERAS, which stands for the Electronic Residency Application Service. The application usually opens around September 15th. It’s a single common application, just like AMCAS, and you submit a personal statement, letters of recommendation, and a work and activities section. It’s very similar to AMCAS, but thankfully, you don’t have any secondaries to complete.

Read our ERAS Residency Application Guide and 9 Essential Tips for Applying to Residency.

The timing of residency interviews vary by specialty, occurring anywhere between October to February. At the end of February, you submit your rank list. You don’t get accepted by programs in the traditional sense. Instead, both applicants and programs submit a rank list via the NRMP. An algorithm runs and a month later, around the middle of March, is Match Day.

You open your envelope with the rest of your classmates during a grand ceremony, and your fate is sealed. Inside that envelope is the program you’ll be training at for the next three to seven years.

After March, it’s smooth sailing. Residency starts on July 1st. Between Match Day and starting residency, most students take this opportunity to travel or spend time with loved ones because residency is going to be a rough ride.

Putting it All Together

Medical school consists of four rigorous years of studying and training, and no two years are alike.

First Year (M1)

• Preclinicals: learn about the body, diseases, and how to treat them.
• Comparatively lower stress
• Adjust to the volume of study material
• Hone your study strategies and build routines
• Optimize your efficiency

Second Year (M2)

• Finish the remainder of preclinicals.
• Complete USMLE Step 1 exam
• Time management is critical
• More time spent studying and less time socializing
• Many schools are shifting to a one and a half year preclinical curriculum

Third Year (M3)

• The beginning of your clinical years with a series of core rotations
• Complete Shelf exams for those rotations
• Most of your waking hours are spent in the hospital or clinic
• Still need to study when you are home from rotations
• A balance between tiring and rewarding
• Complete USMLE Step 2CK exam

Fourth Year (M4)

• Difficult, but easier than previous years.
• Especially difficult for those pursuing a competitive subspecialty
• Complete sub-internships (also known as audition rotations)
• Prepare your residency application (ERAS)
• Residency matching on “Match Day”

The four years of medical school are no joke. You’ll be tested and you’ll have your lows, but you may also remember medical school as some of the best years of your life. This is because of the bonds you’ll make with your newfound friends, the amount of knowledge you’ll gain, and the sense of accomplishment you’ll have from completing the most rigorous professional degree in the world.

Strive for Success at Each Stage

If you’re a premed, we’ve created a course just for you. The Premed Roadmap to Medical School Acceptance goes into painstaking detail through each year of college. It’s an adaptable blueprint that will help maximize your chances of getting into a top medical school.

We also have a wealth of videos and online guides available on our blog, covering topics like how to succeed on the MCAT, a complete Casper test guide, study strategies, and lifestyle advice for both premeds and medical students.

Let us know in the comments what part of medical school you are most looking forward to. I personally loved anatomy during my first year, but fourth year was the highlight for me.