Call can be brutal. Some schools have gotten away from 36-hour call, but others have not. Although much of the third year is hard, some rotations during the third year are less demanding than others, with hours ranging from 40-50 per week and only a few days of call per month. The fourth year is spent in many elective rotations and is much easier than the third year. There is almost always much less call, less stress, and more time to concentrate on selecting a specialty to practice.
Some students actually spend a month or two at another hospital or city.
Top-notch residencies in competitive specialties are extremely difficult to land. Less competitive programs may have only several dozen applicants. This is not nearly as easy as in college or high school, as med schools usually have only outstanding students, who are competitive and want to be ranked as high as possible. In addition, excellent recommendation letters and perhaps published research is necessary for the better programs. Less competitive programs are certainly easier to obtain and usually provide a high quality education.