My Secrets to 4th Year Success

Christine, Fourth Year Medical Student

Hello!  If you have been following along with my posts, you already know that I am a 4th year medical student here at Loma Linda University.  I recently matched to Loma Linda University Preliminary Internal Medicine and University of California San Diego Neurology Residency, and I am still super excited!  It feels great knowing that my lifelong dedication has paid off.  Throughout the year, some students have been asking for my advice, and I have been doing my best to share what I know.  Honestly, I’ve gotten overwhelmed by all the questions, so I decided to make a MEGA post to address the topics that I feel are important for success in the 4th year of medical school.  Anything not on here that you want to know, I suggest you find on official sources.

Note: Please take my words with a grain of salt.  I consider it important to be prepared for worst case scenarios, so I give people practical advice.  These are all my opinions, not necessarily the opinions of Loma Linda University, any particular faculty members, or my classmates, and my opinions may not apply to everyone.  For more of my thoughts, please read my past posts.  What I write may not work specifically for you, but this is what worked for me.

The best thing you can do is figure out your game plan yourself.  Talking to your deans, faculty advisors, and residents is helpful.  However, don’t count on anybody to spoon feed you information about every little thing.  Look at the official NRMP, ERAS, specific program websites, etc. to give you the basics.  If you got into medical school, you are smart enough to find these resources and use them to your advantage.  It will be your personal interactions at the interviews and discussions with your loved ones that will help guide your decisions.  This is your future; grab hold of it.  Now that I’ve successfully matched, I am excited for my upcoming graduation and to start my journey as a medical doctor!

Before 4th Year

This is a no-brainer, but I suggest you study hard on all your classes and rotations.  You will be amazed how much better you understand clinical care with a strong basic science foundation.  In addition, grades and comments from basic science and clinical years will be on your Dean’s letter that is sent to the programs you apply to.  Your Step 1 score and class rank do matter, especially if your goal is to match to a well-known institution and/or competitive specialty.  It’s not all about scores and grades, but some programs will not know how awesome you are unless you pass their filters.  There are way too many stellar applicants from all over the country vying for the same spots.  Red flags, such as failing a year of medical school, will limit you.  Unfortunately, if you have a red flag, you do not have the luxury of being picky.  Don’t expect to match to a top program if you are not a top student, but of course, you can always dream and apply everywhere to see what happens.  If you can afford it, go for it because it is hard to predict what programs are looking for.  God does work miracles.

Always strive to learn and improve.  Be appreciative of what God has given you.  Not everybody is given the chance, nor the capacity to be a medical student.  While you are in medical school, find some time to give back to others if you can.  Offer whole person care to every patient that comes your way.  It does take more time, but touching a patient’s life in a special way is invaluable.  Being a doctor is not just about having an immense amount of knowledge, but also taking care of people.  At the same time, don’t prioritize extracurricular activities over academic difficulties.  Achieving a balance is difficult, but that is something that you will have to learn to do.  Unlike other professionals, a physician’s job does not end when the clock ticks a certain time.

4th Year Schedule

What electives should I take?

Honestly, 4th year is your time to do whatever you want, and nobody really cares what you do with your schedule as long as you meet the requirements to graduate.  During your 3rd year, you will receive an information packet on the requirements you need to meet.  Read that carefully.  Refer to my first blog post, Exciting Choices in 4th Year, if you want to know what electives I chose.  However, my schedule has changed several times, so don’t worry if you are not exactly sure how you want to schedule everything.  I did not finalize my entire schedule until February 2013.  Some of my other posts also detail experiences from electives if you want to know more of what I think.

When should I do sub-internship/specialty of interest rotations?

You should do your rotation early enough to solidify your interest in a particular specialty and get recommendation letters.  The earliest you can submit residency applications is mid-September, so anytime in July or August is good.  Doing it early is also helpful if you are unsure of what specialty you want to go into.

Should I do an away rotation at a program I am interested in?

This is entirely your decision.  It may or may not help.  I have heard stories from both sides.  Some people matched at places they did away rotations.  Some people did not even receive an interview at places they did away rotations.  I didn’t do any away rotations for neurology programs, so I don’t know what it would have done for me.

When should I schedule vacation?

It’s up to you how to schedule.  Interviews can be anywhere between October and February. The majority of interviews are in November, December, and January.  I took off 2 weeks in November and 2 weeks in December.  Most students also take off April or May for traveling or just having fun in general.

When should I schedule tests, Step 2 CK and Step 2 CS?

Schedule them whenever you feel you will be ready.  They just need to be taken by LLU’s deadlines.  Refer to your information packet.  I took Step 2 CK in July to get it over with and so that it would be available before I submitted my residency applications.  I held off until December for Step 2 CS because I needed more time to get ready.  I think I might have written about these tests in a previous post as well.  All the information about these tests are on the official websites.

How should I study for Step 2 CK?

If you already took Step 1 and successfully made it through 3 years of medical school, you should know your study strategy.  What worked for me was practice questions from USMLE World and a review book, Step up to Step 2.

How should I study for Step 2 CS?

The most important thing to do is practice.  Grab a classmate and grab a book with practice case scenarios, such as First Aid to Step 2 CS.  Time yourself through the practice sessions.  You want to be done with the history and physical portion before the 5 minute warning.  After the H&P portion, time yourself writing a physician’s note.  Compare it to the book’s examples.  Another important aspect of Step 2 CS is empathy.  Treat the standardized patients like a real patient that you care about.  If you need more help, talk to the PDX office.  They are great at offering tips and helping you improve.

Applying for Residency

How much money should I save?

Interviews and 4th year in general are expensive. First of all, Step 2 CK and CS are about $2,000. Applying to programs can be about $500. You can check the prices on the ERAS website. I think it’s better to apply to more programs than you need to because it is hard to predict who will offer interviews.  I think it’s reasonable to save at least $5,000 for travel. It’s better to have more money and not use it than to have to cancel an interview at a place you really want to go to.

When should I create my CV?

ASAP.  There are sample CVs in the Dean’s office.  They also give you a sample copy during your 3rd year.  Follow that format.

When should I write my personal statement?

Do it early.  Start before September.  An articulate and well thought out personal statement actually takes longer than you expect.  I gave some advice about personal statements in my previous post, 4th Year Rotations and Residency Applications.

Who should I ask for recommendation letters?

This may vary, depending on your specialty. At least 1 letter must be from your specialty of interest.  1 should be from a core rotation like internal medicine, surgery, peds, etc. if you can get a strong one.  If not a strong letter, then choose whoever can write you a strong letter.  The last can be from any doctor.  Quality is very much more important than quantity of letters.  3 letters is good enough.  My advice would be to ask for them early.  You need to have a CV and personal statement ready by August, so that you can give them to letter writers.  If possible, the goal should be for the letters to be available by the 1st day of submission.

When should I start my application?

Start it before the first day of submission.  It can take at least a few hours to complete.  Make sure you double, triple, etc. check it before you submit.

When should I submit my application?

Submit it on the first day if possible.  I suspect that interviews are given on a rolling basis.  I submitted my application on the day that it opened, September 15, and I got my 1st interview invite on September 18.

What programs should I apply to?

My main advice would be to apply broadly and realistically.  Although I matched to an amazing spot, I didn’t even get interviews at some of the top programs I applied to.  As someone who prepares for worst case scenarios, I think it is extremely important to also apply to non-competitive spots.  That means outside of desirable areas in California, outside of the Ivy League, outside of any place that most people would be impressed with.  What is considered non-competitive also depends on your individual Step 1 score and grades.  This information can be found on the NRMP reports and talking to the experienced deans/faculty advisors.  Some people in my class did not match, and unfortunately, I don’t think that every student found a job in SOAP.  Your goal is to make sure that you apply smartly and go to enough interviews.  Yes, it is all expensive, but if you don’t get a residency position, you won’t have a job.  A job in some random place is much better than no job at all.

How many programs should I apply to?

This depends on what specialty you are applying to and how reputable the programs you apply to are.  For any specialty, I would recommend applying to at least 20 programs.  This is assuming that some of the programs you apply to would impress a layman.  I tend to be more on the cautious side, so I think you should apply to as many programs as you can afford.  If you are applying to well-known places, you need to apply to extra.  As a warning, just know that no matter how competitive an applicant you are, you will inevitably get rejected by programs.  Consult your deans and faculty advisors if you need help.  They have years of experience in helping students succeed.

What do you think about neurology programs?

Well, I think that neurology is the best specialty!  Some programs are categorical with all 4 years.  Some programs are advanced and also need an intern year.  You need to weigh the advantages and disadvantages yourself.  Applying to advanced programs means you have to spend extra time and money interviewing for preliminary spots, so prepare for that if you are planning to do so.  It is all personal preference, and no one can tell you what you should do.  After learning about different neurology programs, I found most programs are more or less the same with differences of prestige and location.  I thought that every neurology program I interviewed at was great in their own ways.  Everybody has different reasons for why they like or dislike something.  This is something that you will have to figure out on your own.

What are my chances of getting an interview and/or matching at a certain program?

I don’t know.  If I could predict the future, I would be rich by now.  The only way you will know is to apply.  The top programs obviously favor applicants with high board scores, above-average class rankings, and no red flags.  If you are not restricted by finances, then apply and leave it up to God.

Interviews

How much money should I expect to spend on interviews?

For local interviews, it will be gas price unless you stay at a nearby hotel, which could be $50-100/night. I think West Coast interviews by plane with hotel/ground transportation is may be about $300 each. Midwest and east coast may be about $500 each. It depends on if you can get some deals. Southwest was usually cheapest for flights, but for flights and hotels, it’s good to shop around. Look at the company’s site, priceline, hotwire, hotels.com, etc. to find the best deals. If possible, you can try to group interviews in the same region but it’s hard and doesn’t usually match up, so don’t count on it.

How many interviews should I go on?

I don’t have a clear answer, but I recommend aiming to go on at least 10 interviews.  The worse of an applicant you are, the more interviews you should go on.  If you get fewer than 10 interview invites, you should go to all of them.

How should I prepare for interviews?

Be yourself.  I wrote about interviews in a previous post, What It’s Like to Go on Interviews.  You can refer to that if you’d like.  There is also a practice interview session offered by LLU.  Go to that.

Should I contact programs after I have interviewed?

It is up to you.  I sent some thank you emails and some thank you cards.  In the end, I don’t know if it made any difference.

Match

How should I rank programs?

This is entirely your decision.  Please read the Match algorithm on the NRMP’s website if you are unfamiliar with how the Match works.  It explains things better than I possibly can.  Pros and cons of each program need to be decided on by you.  Don’t depend on others to spoon feed you their opinions.  Everybody has different personal reasons.  I ranked programs based on my overall feelings and desire to attend them.  This is not something I can describe, but you will have to experience it for yourself.

How does the SOAP work?

I do not know, and I do not want to know.  Luckily, I did not have to know.  I’m sure you can find this information on the NRMP website if you want to know.

What is Match Day like?

Please read my post, Some Thoughts on Match Day! for my thoughts on Match Day.  Also, watch the Match Day 2013 video, which is featured in my last post, Ice, Eyes, and Nice Comments!  Match Day is just simply the best day of medical school for me.

How do you feel about your match?

I am very happy!  I can’t believe I matched to such an awesome place!  I am excited that I get to stay in Southern California and be near my family for all of my residency training.  I feel blessed to match to UCSD’s neurology program.  I also feel blessed to stay at LLU for my intern year.  After 20+ years of nonstop schooling, I will finally start my first job soon, so I am grateful that I get to have my parents around to support me with my transition to the working world.  I know that this is where God wants me to be, and I am thankful for His wonderful plans for me.  I feel great knowing that all my dedication and hard work have paid off and that my dreams of becoming a doctor are coming true.  At the same time, I feel like wherever I matched, I would be a bit sad that it wasn’t one of the other programs because I enjoyed all my interviews and loved meeting people everywhere.  In a way, I’m glad that I’m not the one who makes the tough ultimate decision of where to train next.  Overall, I feel like this is the best time of my young life so far.  I am looking forward to many more special events to come during my lifetime. 🙂

My Final Thoughts

Making it to 4th year of medical school is already an accomplishment.  The first 3 years of medical school are very difficult, and only people who have been through it will understand what it takes.  Be prepared for new challenges in your final year.  Never stop learning.  You still need to give it your best on every rotation.  Treat every patient like they are a VIP.  You will also have more well-deserved free time than in other years of medical school, so spend time with those you love.  This is the last year for a long time in which your time is truly your own.

When seeking residency positions, it is better to play it safe, but reach for the stars if you can afford it.  Even if you think you are a desirable candidate, not everyone will agree.  The money you lose from applications and interview experiences is extremely miniscule compared to the huge disappointment of not matching.  Have fun on interviews.  Be nice to everyone you meet.  Be yourself.  Form your own unbiased opinions.

Enjoy 4th year.  Have fun.  Do things that make you happy.  Hang out with your family and friends.  Don’t worry about every little thing.  Get comfort from the ones who will be there when no one else cares, your family and God.  Remember that God has brought you this far, and He will be faithful.  No matter where you end up matching and even if it does not work out the way that you want, remember that what God chooses for you is even greater than what you choose for yourself.

Why Two Degrees?

Looking over the long road ahead of me, one might consider asking, incredulously, why somebody would want to do an MD/PhD program at all. It’s certainly a justified question, to which the short answer is that I think receiving training in both clinical medicine and research science will be especially valuable in my future career.

The MD and PhD degrees differ in more than just the requirements – they represent two perspectives on problem-solving. The way I see it right now, medicine ultimately teaches students how to correctly apply what we have learned to new situations, and how to recognize something you have seen before when it is placed in a new context. Graduate school, however, teaches students how to find the gaps in what we know, and design questions that will yield new information.

I think the two schools of thought are complementary, and that having experience with both will improve my skills as a clinician and as a researcher. Additionally, in the field I’m currently looking at, neurology/neuroscience, I will be able to help bridge the gap between what we’re continually learning in the lab (neuroscience) and the application of that knowledge to patient care (neurology). Not only through translational research (a popular buzzword) I do myself, but also by being cognizant of and having experience with developments on both angles.

I wrote this a while back on mistypedURL, but I think it’s worth sharing again here.

Reflections

Laura, Third Year Medical StudentIn eight short weeks, my third year of medical school will be over. I cannot believe how fast this year has flown and how memorable it has been! Here are some reflections from each rotation:

1. Obstetrics & Gynecology

Delivering a baby was by far the most thrilling experience from this rotation. I enjoyed having the privilege of sharing such a precious moment with several families. It will not be soon forgotten. On a lighter note, I was reminded of just how “green” I was on this rotation when a baby was out of mom in a crash c-section before I could even get my second glove on. Oh well, practice makes perfect right?

2. Family Medicine

What a broad field! I truly enjoyed seeing a diverse population of patients everyday I went in to work. From 3 week old babies to elderly individuals with every medical problem in-between, it was all there. My favorite part of this rotation was the personal relationships formed. Family docs have the unique opportunity to oversee all of an individual’s care, not just one condition. I felt that this led to a closer relationship between doctor and patient, what an awesome benefit!

3. Internal Medicine

Wow, what an experience! Many medical students consider this to be the “meat & potatoes” rotation during third year where the most information is learned. I found this to be true. Although busy, the rotation was also quite fun for me both from working with great teams and from the patients I had the opportunity to follow. One patient in particular, Mr. C, was 98 years old and had served in WWI! Serving such individuals made both this rotation and the year as a whole worthwhile and reminded me of just how blessed I am to be in this profession.

4. Neurology

For this rotation I decided to have a change in pace and fly across the country to Kettering, OH. I am very glad I did! Kettering is not only a lovely city but the hospital there was also wonderful to work at. I also felt that it was a very good experience for me to branch out and see how other hospitals are run. The most memorable patient encounter from this rotation was getting to see Anton’s syndrome, a condition in which damage from a stroke renders an individual blind but having them still believe they can see. Although very sad such diseases remind me of just how intricate our bodies are made & of just how well we are at compensating after damage has occurred.

5. Psychiatry

Spending one week on the addictions unit and three weeks working with individuals battling eating disorders was by far the most memorable in this rotation. Although they may appear to be quite different I found both of these areas to be similar with the issue of “control” at their center. It was interesting to listen to the stories and to see just how much these problems can consume an individuals life. After completing this rotation I have a new respect for people fighting these diseases.

6. Surgery

Phew! This was by far the most difficult rotation for me. After completing it I can honestly say that I am not cut out for long hours in the operating room. I have a high respect for surgeons; they do amazing work. That being said, I will happily refer my patients in need of an operation to them during my medical career.

7. Pediatrics

The kids are adorable & they have such resilience! They are the best part of being on the pediatric rotation and I find that I am constantly smiling with them around me. I can’t wait to see what the rest of this rotation has in store for me.

This year has had its ups and downs but overall I am truly thankful that I am here in medical school and look forward to the opportunities that await me in the time to come.

Time Management

Kari, Third Year Medical StudentHi friends. Guess what? Even though I did my Pediatrics rotation a while ago, I’ve managed to sneak my way onto another Pediatric service as part of the Neurology rotation. I so miss the fifth floor when I have to go other places. But this post is about what I do with my time when I’m not on the fifth floor.

I was whining to my fiance John last night about how it seems like I waste time and don’t get anything done – lamenting my time management skills. It seems like I get home, wind down a second, have some dinner and the next thing I know I’m supposed to go to sleep and I’ve barely had time to study.

This is the USMLE World Question Bank. We should probably hang out more than we do.

I presented a recent night as an example: I was in the hospital from 6 am to 5:30 ish, made it over to the gym for an exercise class, got home, and by the time I cleaned up and made dinner it was literally like 8 pm. And of course Criminal Minds was on and I got a little sucked in and even though I was simultaneously getting worked over by some Neurology questions it didn’t really feel like I accomplished anything.

So I was whining.

John’s response?

“So you’re saying you worked about 12 hours and went to the gym and you’re concerned because you didn’t get anything done?”

Oh. Right. I worked for 12 hours.

I think we forget sometimes that all the things we accomplish as part of the work day count too. I know I’m not alone in that – we really expect a lot of ourselves.

We expect that we should somehow be able to learn ALL the things on top of the long hours. When I don’t know the answer to a question when I’m on service I feel sad. Like it was my responsibility to find time to already have that memorized. It doesn’t matter what it is; it feels like I should know.

My ideally time-managed day from an academic perspective would probably not include anything fun because the hours of studying I would fit in would crowd out everything else. And that just doesn’t make sense.

Bottom line?

Time management = Doing your best. And when you’ve watched some TV,  took your time chopping up vegetables for dinner and gone to bed too late because you were reading something that’s not a textbook, that’s okay.

Because you work hard. And because medical school isn’t just about learning medicine – it’s a trial by fire of how to spend your time, and we’ll all make it. Right?