I learned a lot last year, and one of the oft repeated nuggets of wisdom shared by residents and more advanced students alike was the joy of the year to come. They promised a less intense grading environment, electives chosen for purposes other than fulfilling core requirements, and more free nights and weekends. So far this is mostly true. I'm in the midst of a dermatology rotation at Henry Ford, a community teaching hospital in Detroit that is connected most closely to Wayne state, but at which UM students have the opportunity to do a few M4 year rotations. In spite of the fact that everyone seems slightly horrified that I'm not planning to go into dermatology, I've gotten to see a wide variety of dermatologic complaints while working with delightful residents and attending physicians.

Lessons I've already been applying from M3 year:

• You will never know exactly where you should be or what you should do, so don't be afraid to ask questions.
• Smile a lot. People are less likely to think you are dumb if you also appear friendly and they like you.
• Fake it. Listen closely to what your resident asks of patients so that when you have to see a patient by yourself, you know what questions they will think are important to ask and report back. Eventually you will make it and understand why they have asked those questions.
• Wear gloves. Especially when someone has a rash on the palms of their hands, as it could be secondary syphilis and that is contagious through the rash.

• The word elective not only means something you chose, but also something that is not required of everyone. This means that the rest of your medical school training is unlikely to have covered this material and you will need to read a lot.
• When someone tells you that something will be the best "X" since kindergarten, they do not necessarily mean that the entire thing will be filled with naps and snacks. They might mean that you can pick your poisons and that your schedule will be more predictable than previously.
• Smile more. Especially when someone gives you the stink eye after you delicately explain that you are leaning strongly toward (read: have already chosen) another specialty and are just there to learn about their specialty, not to audition for their residency program.