6 Sou .com BACKGROUND AND SETTING Graduates of U.S. medical schools often lack the key skills and knowledge necessary for the difficult transition to residency. Residency program directors recognize the gaps in medical school education and suggest broadening the educational experience for fourth-year students. In a recent review, Walling and Merando articulated a belief that the fourth year of medical student education must “achieve the complementary goals of successfully completing the medical school phase of education and transitioning to residency.” Many schools have successfully developed “capstone” rotations and multidisciplinary experiences designed to meet the broad needs of graduating students. However, most of these courses, although well intended, have been limited to that content deemed important by course directors, faculty and administrators —the students' needs have been very rarely considered.