During the fourth year, residents are able to further pursue their own specialized interests. 11 blocks of the year are dedicated for electives where the resident can organize their schedule to include a variety of educational experiences. A resident may choose to repeat past rotations for more in-depth learning, as listed under the first three years. Options might include work in pharmacology, psychotherapy, community psychiatry, forensic psychiatry, and/or research. One may opt to rotate in settings such as a correctional facility, the partial hospitalization program, a homeless shelter, a state psychiatric facility, or the Center for Disabilities and Development.   
 
The other two blocks of the year, the fourth- year resident will function as a senior resident on one of the inpatient psychiatry units or the consult service. The resident will have more of a leadership role and will be responsible for supervising junior residents and medical students. There will also be significant opportunities to teach junior residents and medical students. Fourth year residents on the inpatient units usually carry one to two patients on their own and are not expected to round on the inpatient units on holidays or weekends.  
 
Throughout fourth year, one half-day each week is designated for a continuity clinic where the resident continues to treat a smaller panel of his or her patients from the year prior. These patient encounters can be focused on medication management or psychotherapy. Residents are given greater autonomy with patients during the fourth year, and the continuity of care can be truly rewarding. The fourth-year resident also continues to learn by attending didactic sessions and providing support on back-up call.