I feel that every year of medical school has a different focus. The goal of first year is simply to adjust to medical school and get used to memorizing huge volumes of new information. Second year, having had survived one year of med school, we were able to relax a bit more although the dark cloud of the boards was constantly looming overhead; even if school wasn't very demanding at a given time, you knew you should be devoting some time to boards studying. Third year you are thrust into the hospital, full of book knowledge, but absolutely clueless how to perform on the wards -- and pretty damn scared because of it.
Here I am now at the start of fourth year, wondering what my priorities are.
I am no longer scared of the hospital, as I have enough experience with clinical rotations to feel comfortable with patient care and the workings of the hospital. The motivation of before is also gone. With no more required rotations (which is what third year was filled with) the grading scale is now simply pass/fail -- no more honors, high pass, pass, or fail. This is a huge relief. Now there is no more struggle to out brown-nose the other medical students in order to appear more eager than them. This grading scale is also the reason why, when your resident tells you, "You can go home, or stay if you want to", you have no problem saying "see ya", instead of forcing out a "OK I'll stay".
With all that in mind, I realized the goal for this year really is not just to get by, but to prepare myself for internship. This is my chance to learn about true patient care, which, thus far, I have left to the responsibility of my interns and residents. Seeing how I'll be in that position in less than a year, I should start getting used to performing all these things myself.
And now with that in mind, I am more serious about fourth year. I am trying to learn the boring details of patient care that interns are typically responsible for, such as writing orders, learning medication dosages, following up abnormal lab values, etc. When a Mg returns at 1.8, I now know to write an order for Mg Oxide 400mg PO x 3, instead of running immediately to my resident. Hopefully this mindset will prepare me better for internship, and make the inevitable shock next year a little less overwhelming.