title: Students' perspectives on the fourth year of medical school: a mixed-methods analysis.
abstract: OBJECTIVE
  Little is known about the purpose and value of the fourth year of medical school from the perspective of medical students. In this study, the authors systematically explored the year's purpose and value as determined by students.
  
  
  METHODS
  In April 2011, the authors conducted semistructured focus groups with graduating fourth-year students at the University of Colorado School of Medicine to understand their perspectives on the purpose of the fourth year. Using results of a thematic analysis of the focus group data, the authors developed and administered a 10-item questionnaire to all graduating fourth-year medical students in May 2011. Questionnaire data were analyzed using descriptive statistics and exploratory factor analysis.
  
  
  RESULTS
  A total of 17 students participated in two focus groups. Six themes related to the purpose of the fourth year emerged from the focus group data: career development and preparation, pursuing personal interests, career identification, exploration of diverse practice settings, influence of emotion, and flexibility and individualization. The questionnaire was completed by 134 of 148 students (91% response rate). Factor analysis of the questionnaire data identified five factors: strengthening one's residency application, developing skills, pursuing personal interests, exploring diverse practice settings, and identifying a career.
  
  
  CONCLUSIONS
  Medical students uniformly identified the fourth year of medical school as having purpose and value, but their views on the fourth year's purpose differed. This finding underscores the importance of the individualization of the fourth year. Students' perspectives should inform any decisions made about modifying fourth-year curricula and structure.
authors.affiliation: Dr. Wolf is associate professor and director of medical education, Department of Emergency Medicine, and associate dean for curriculum, University of Colorado School of Medicine, Aurora, Colorado. He is also staff physician, Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado. Dr. Lockspeiser is assistant professor, Department of Pediatrics, University of Colorado School of Medicine, and staff physician, Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado. Dr. Gong is assistant professor, Department of Family Medicine, and assistant director, Office of Evaluation, University of Colorado School of Medicine, Aurora, Colorado. Dr. Guiton is associate professor, Department of Internal Medicine, and director, Office of Evaluation, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Wolf
authors.forename: Tai M
authors.initials: TM
authors.lastname: Lockspeiser
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gong
authors.forename: Gretchen
authors.initials: G
authors.lastname: Guiton
mesh_terms: D002321:Career Choice; D003120:Colorado; D003430:Cross-Sectional Studies; D003479:Curriculum; D003657:Decision Making; D005069:Evaluation Studies as Topic; D005163:Factor Analysis, Statistical; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D010549:Personal Satisfaction; D012577:Schools, Medical / Q000458:organization & administration; D013337:Students, Medical / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013997:Time Factors