So…. You are going to be an MS-4

1. ….light at the end of the tunnel or an oncoming train? So….You are going to be an MS-4

2. 1ST THINGS FIRST • 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 youwant – 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

3. Things to consider • 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!)

4. Scheduling for MS-4 • 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)

5. The Tests • 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

6. MUSOM Requirements • 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)

7. Electives • 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

8. The Big TWO ?s of MS4 scheduling • 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…

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

11. Mentors • 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)

12. The big scheduling conundrums • When to take Step 2 CK? • When to take Step 2 CS? • Away Rotations: Yes or No? • Interview Season Scheduling?

13. Step 2 CK – what to consider • 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

14. Step 2 CK Prep • 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

15. Step 2 CS • 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)

16. Away Rotations • 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

17. Program considerations (for away rotations & applications) • 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

18. Interview Season • 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

19. So how does this all work out? • 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

20. The Take HOME Messages • 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)

21. We’ll be back…. …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)

22. Useful Links • 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