….light at the end of the tunnel or an oncoming train?

What do you want to do with your life? RULE #1 – Don’t freak out if you don’t know,

work hard on all the rotations RULE #2 – If you do know, still work hard on all

the rotations (those surgery program directors will read your psych rotation eval first to see if you are a slacker)

RULE #3 – Work on developing the knowledge and skills you’ll need to be a great doc – not matter what you go into

RULE #4 – BE HONEST WITH YOURSELF▪ Specialty choice requires an appraisal of your

personality, your strengths, your weakness and what you want – this is not the time to please your parents, your spouse, have delusions of grandeur or humility. Residency (and your career!) will be long – you have to be happy with your choice

Are you interested in the common patient complaints? Are there patients you really don’t like dealing with? Are there patients you would be miserable not seeing? Lifestyle choices? (shift-work, call schedules,

procedures, clinic, hospital) Practice choices? (community, county, rural, academic,

international) Your colleagues Geography Try to see as many patients as you can third year If you are really unsure – talk to some fourth years and

talk to faculty (this is a BIG MUSOM advantage – use it!)

Back to RULE #1 – Do NOT freak out. Fourth year will be different for EVERY single

person – even people going into the same field, you must resist the med student mob mentality

Four parts, which play out differently for everyone & will drive your schedule choices: The Tests Things required for MUSOM Things required for your residency goals Things required by/for you (aka FUN, which may

be a new concept)

Step 2 CK: Essentially just like Step 1, only generally considered “easier” and 1 block of questions longer, have to take by end of dec

Step 2 CS: 12 patient OSCE that you have to travel for, pay lots of $$ for, but not study much for; have to take by end of dec

MUSOM Radiology Exam: On-line 100 question exam that you have to take by April. (study resources online)

Stay tuned – more details on these later

1 week of ACLS (weekend class, although you get a week of credit)

4 weeks of IM at the VA 4 weeks of Emergency Med at CHH 4 weeks of Surgery (1 wk anesthesia + 3 wks of

subspecialty) Those pesky tests (plus in-house tests at the end of

EM and Surgery) Plus…lots of electives/away rotations/rural if you

need it I.E. you can’t just take the rest of the year off – these

grizzly details will be discussed in your scheduling meeting with Dr. L (right now we need 35 weeks to graduate)

The things for your residency goals & for FUN Away rotations Extra rotations in your field or subspecialties Stuff you may never see again International or Wilderness electives Time off for interviews/vacation

http://musom.marshall.edu/students/senior-handbook/ Listing, description & contact info for all the fourth year

electives Check them out BEFORE the scheduling meeting so you

have an idea what is out there

How strong of a candidate are you?▪ Do you need to take Step 2 early?▪ Do you need to apply to more than one specialty?▪ Will you need to do a lot of interviews?

What do you want to do?▪ Do we have an academic department?▪ Is it a highly competitive specialty?▪ Do you want to go to a highly competitive

area/specific program? As for the answers…

http://www.nrmp.org/ - then go to the “Data & Reports” section, then entire 281 page PDF is there for all specialties

Help you honestly gage your chances as an applicant in your chosen field

Guide for away rotations Guide for where to apply Help with personal statement Letter of recommendation (you’ll need at least 3).

If you don’t have one – find one! Join the American College of Whatever Specialty,

some have virtual mentors Remember the current MS-4s Access to faculty is a MUSOM strength – use it!

Iserson’s Getting into a Residency (library or purchase)

When to take Step 2 CK?

When to take Step 2 CS?

Away Rotations: Yes or No?

Interview Season Scheduling?

Your Residency Candidacy If step 1 low: need a boost, take early If step 1 high: maybe consider late Doing worse on step 2 than 1 is a red flag

Preparation Have you struggled on mini-boards? Do you know you need extra study time?

Timing Have to sit by end of December – but fit around

away rotations, required rotations, interviews, etc.

Takes 3-wks to score, if going for the “boost” try to take by the end of Sept at the latest so score will be in by Nov 1st

Time & Resources MUCH more varied than Step 1 (1-6 wks) Kaplan/USMLE World QBANK (Both are pretty good) Step 2 Review Course – Pretty Good, 2 weeks, mostly half days First Aid Step 2 – unlike Step 1 this is only ok not the best Step Up to Medicine – Great, but long and detailed Secrets – Very popular – detailed Crush Step 2 – Very Popular – very general

Main Focus of test: Internal Medicine – As pathology was to Step 1 OB/GYN & Pediatrics – MUSOM typically perform well here Surgery (subspecialties) – Use Qbank for review *Neurology/Biostats – Fill in your knowledge gaps, biostats VERY

high yield Psychiatry – First Aid for Psychiatry is great

Travel: Houston, Chicago, Philly, Atlanta or Los Angeles (philly hardest to schedule)

Does NOT require a lot of preparation, no advantage to waiting, OSCE at the end of MS3 is GREAT prep for it

Realize it is administered directly by the USMLE not Prometric

First Aid for CS is all you’ll need. Review it the couple of days before your test

Squish it in whenever is it convenient given the travel.

Schedule ASAP (you can change it relatively easily if you have enough advance notice)

You should definitely consider if: MUSOM does not have an academic department You want to go to a specific program You want to go to a specific city You want to do something extremely competitive, or

something at a competitive place Everyone: just to see a different way of doing things

Visiting Student Application Service (VSAS) http://www.aamc.org/programs/vsas/

Other Institutions – check their websites Most are 4 weeks: check MUSOM rules for how many

you can do

Programs/schools are grouped into somewhat arbitrary tiers – there is no “10-best” list

NIH grant funding lists Ask Faculty in the field

Expect some Bias See Linda Holmes for list of graduates in a specialty

Ask MS-4s going into that specialty (they know) Freida (on the AMA site)

Specialty Training Statistics StudentDoctor.net

http://forums.studentdoctor.net/ US News Best Hospitals

http://health.usnews.com/sections/health/best-hospitals

How much time off you’ll need will again (shocker!) be individual. Some of you will interview at 4 places, some at 24…. Can only miss 3 days of the 3 required rotations

Late Oct – End of Jan. You will probably need at least 4 weeks (keep the holidays in mind) where schedule is free “Flexible” electives (academic medicine, medical

spanish, readings in international/rural health, medical education)

Generally: competitive specialties & programs interview late, non-competitive start early

You only have direct absolute control over the first three months of your schedule (after that things can get a bit dicey depending on the assignment of your required rotations) Required/away/elective/step 2 Required/sub-I/away Away/away/step 2/elective Away/away/away, etc

You can trade required times with your classmates

$$ is a issue for interviews & aways – you do NOT get much school loan money (except for some international electives) Credit cards, parents, residency & relocation

loans

Start planning/thinking about things NOW (but not to the detriment of your rotations!)

You should start working on your application in LATE spring – it will take WEEKS to finish it (due Sept 1st) Personal Statement Letters of Recommendation (Ask early!) Compiling all of your extracurricular activities

Research Community service Leadership/Awards Hobbies (be VERY honest here – you will

get a lot of interview questions!) Things more complicated if you want to do

Ophtho, Child Neuro, Urology, or possibly plastics (they have separate match process…more about that later)

…in mid-march (shortly after Match Day)

The dirty details of the Applications (ERAS)

Interviewing 101 The Matches & Ranking (NRMP) Small-group discussions with

freshly matched MS-4s and current residents)

http://musom.marshall.edu/students/senior-handbook/

http://www.nrmp.org/

http://www.aamc.org/programs/vsas/

http://forums.studentdoctor.net/

http://health.usnews.com/sections/health/best-hospitals