….light at the end of the tunnel or an oncoming train?
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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
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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!)
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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
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Four parts, which play out differently for
everyone & will drive your schedule choices:
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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
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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/
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 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
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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?
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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?
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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
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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)
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When to take Step 2 CK?
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When to take Step 2 CS?
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Away Rotations: Yes or No?
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Interview Season Scheduling?
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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
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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
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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
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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)
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You should definitely consider if:
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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
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Visiting Student Application Service (VSAS)
 http://www.aamc.org/programs/vsas/
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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
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 Expect some Bias
 See Linda Holmes for list of graduates in a specialty
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Ask MS-4s going into that specialty (they know)
Freida (on the AMA site)
 Specialty Training Statistics
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StudentDoctor.net
 http://forums.studentdoctor.net/
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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
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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
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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)
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…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