….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   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…

- 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)   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   US News 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 1 st )  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)

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