MS3 confused about a few things on app process

[baller999]

I am an MS3 in the US.
so I have heard conflicting reports on this and I was wondering if residents/attendings could help me on this. I plan on talking to my PD but wanted to get a relatively unbiased SDN information.

1. When should I take Step 2? I did well on step 1 (>240). I know this is school dependent, but I can't find it on a lot school's websites!! Should i just call every school i'm interested in? I would rather take it later but heard some schools require it earlier...and I may not do that well compared to step 1.

2. What kind of rec letters should I have prepared? I only see schools saying how many letters I need (usually 2-3). All from psych or 2 from psych and 1 from internal med?

3. What should I be looking for in programs? I am interested in research but other than that I'm clueless. I don't mind working hard but hate scutwork (well i guess nobody likes scutwork). Pharm is cool but so is psychotherapy.

4) What are good resources for students to look up program info?
I've seen (from SDN), scutwork.com, Frieda, searching SDN, reviewing the Interview threads, talk to students/residents...anything else? Hard to tell what is BS and what isn't.

Thank for helping a confused MS3!!

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[LimbicResponse]

- Do you have a geographic preference?

 

[Merovinge]

1) If did that well on STEP 1, STEP 2 will be a joke for you, unless you are particularly good at memorizing basic science and have not enjoyed your clinical year. That score will get your foot into the door at almost any program if the rest of your app is up to par and you don't have any red flags. CS is rarely needed, definitely don't need to take that early. CK is required by a few schools to rank, UCSF is notorious for this but there are others as well. That said, places can be flexible, especially with that kind of STEP 1 score, so if you want to rest on those laurels alone, it's probably fine.

2) Some will take up to 4, you want at least 2 from psych (3 max), and then 1-2 from other disciplines or better yet researchers or independent physicians you have worked with not through medical school. You could conceivably change letters based on the program, but probably more work than it's worth with that kind of board score.

3)In my opinion the most important things are in no particular order:
1) Location
2) Patient population and volume (making sure this matches the population you want after residency)
3) How well your personality syncs with the residents and attendings
4) Fellowship availability in the areas you are interested in (if planning on fellowship)
5) Matching the amount you want to work, to what will be required (aka lifestyle)
6) Finding the right mix of biologic vs psycho/social that matches the practice you want to have

4) You've listed most of the resources; there is no easy way to just know exactly how every program is without knowing some at that program. Second best is going to an interview and reading some of the stuff here. If you have a location in the country picked out, people here can definitely suggest stronger programs.

A bunch of people will say this, and I never believed it, but let me say it anyway, the process will go much more smoothly than you think and you'll almost inevitably be happy where you match. The hard part is getting good STEP 1 and good grades/letters, this part will be gravy.

 

[OldPsychDoc]

I agree--the Step I score will get you on just about any program's "Interview" list, especially if it has 1-2 good letters from psych, a decent personal statement, and the rest of the transcript matches.

That said, don't rest on those laurels--aim to have a passing Step II score in hand by the time you finish interviews, if not before. There are indeed programs that will not rank, or will demote you substantially, for lack of that at ranking time.

 

[vistaril]

I agree--the Step I score will get you on just about any program's "Interview" list, especially if it has 1-2 good letters from psych, a decent personal statement, and the rest of the transcript matches.

That said, don't rest on those laurels--aim to have a passing Step II score in hand by the time you finish interviews, if not before. There are indeed programs that will not rank, or will demote you substantially, for lack of that at ranking time.

the % of US students who fail step2(I say fail because you specify passing) who scored above 240 on step1 is so low as to be insignificant. In fact, I wouldn't be shocked if less than 15- 20 or so in the whole country. Which, when restricted to psych applicants it means it is very possible(maybe even likely?) that not a single person with that score on step1 applying to psych will fail step2 on their first attempt. Therefore, any psych program looking at such applicants(and screening for 'passing' step2 scores) wouldn't be consistent with who ends up failing step2.

 

[notdeadyet]

OP- Your Step 1 is great for any specialty. It will definitely put you in a good light in psych. You definitely want good LORs, some honors in third year, and a good PS. The only reason Step II CK and CS under your belt is a bad idea is if you think there's a real chance you won't pass. Otherwise, ticking those off are a smart idea.

You just need to pass Step II. The only time the score is relevant is if you have a questionable Step I. Getting a lower score on Step II than you did Step I will not make any PD think you somehow lost intelligence over the course of the 18 months. And several programs will not rank you without a passing Step II CS and CK in hand.

 

[C O M 2014]

Is 2 psych letters + IM generally what most people think should be used? Strong surgery + IM + 1 psych equally as good?

 

[Firewood]

Is 2 psych letters + IM generally what most people think should be used? Strong surgery + IM + 1 psych equally as good?

Two psych letters are generally (if not always) required. The third can be in anything. If a surgeon knows you well and can write you a strong letter, then go for it. My non-psych letter was from a pediatrician.

 

[baller999]

- Do you have a geographic preference?

yeah somewhere in the south but that's honestly it. i will factor this into where I choose residency.

OP- Your Step 1 is great for any specialty. It will definitely put you in a good light in psych. You definitely want good LORs, some honors in third year, and a good PS. The only reason Step II CK and CS under your belt is a bad idea is if you think there's a real chance you won't pass. Otherwise, ticking those off are a smart idea.

You just need to pass Step II. The only time the score is relevant is if you have a questionable Step I. Getting a lower score on Step II than you did Step I will not make any PD think you somehow lost intelligence over the course of the 18 months. And several programs will not rank you without a passing Step II CS and CK in hand.

that's the problem..I have one honor in Psych but otherwise only HPs , mostly due to my average board scores. i should be able to get good letters though so thats reassuring.

Thanks for everybody's help though!!!

 

[Firewood]

that's the problem..I have one honor in Psych but otherwise only HPs , mostly due to my average board scores. i should be able to get good letters though so thats reassuring.

Provided you have good letters, I don't think HP's in 3rd year will hurt you. My ms3 rotations were almost all HP's, I was strong clinically but average on the shelf exams. I even got an HP in psych. My grades were never even mentioned during interviews. I only applied in the south, however, so your mileage may vary.

 

[stitchie]

Relatedly--how much would you say 4th year course selection matters?

I am planning to do 3 psych rotations, 1 IM elective (endocrinology, purely because it's the only IM rotation I think I would actually enjoy), 1 advanced surgery elective (ugh, have to for graduation requirements), and then some fluffier stuff to meet requirements (case write ups/literature reviews, tutoring underclassmen, etc).

I am sort of concerned that this will make me look...lazy. Partly because our 4th year psych electives are notoriously not too taxing (not that other institutions will necessarily know this), but mostly because I'm not doing a medicine Sub-I (which I'm partially not doing due to scheduling difficulties, and partially because I just don't really wanna). Am I overthinking this? Will anyone really care what I do with my 4th year when I'm out on the interview trail? Is there any sort of expectation that students must do a medicine Sub-I?

Have a strong Step 1 score in the same range as the OP, a mix of honors and HP in 3rd year, and will be taking two psych electives early in 4th year which are specifically timed to provide me with strong letters. Also will be busting my bum to get a good letter out of my upcoming IM clerkship.

Any advice on 4th year rotation selection? Any particular choices that might set off a red flag when applying to residencies? Have talked to my advisor about this, and she has encouraged me to just enjoy myself and do what interests me, but I still feel paranoid that I'm being too lax.

 

[mass1]

Relatedly--how much would you say 4th year course selection matters?

I am planning to do 3 psych rotations, 1 IM elective (endocrinology, purely because it's the only IM rotation I think I would actually enjoy), 1 advanced surgery elective (ugh, have to for graduation requirements), and then some fluffier stuff to meet requirements (case write ups/literature reviews, tutoring underclassmen, etc).

I am sort of concerned that this will make me look...lazy. Partly because our 4th year psych electives are notoriously not too taxing (not that other institutions will necessarily know this), but mostly because I'm not doing a medicine Sub-I (which I'm partially not doing due to scheduling difficulties, and partially because I just don't really wanna). Am I overthinking this? Will anyone really care what I do with my 4th year when I'm out on the interview trail? Is there any sort of expectation that students must do a medicine Sub-I?

Have a strong Step 1 score in the same range as the OP, a mix of honors and HP in 3rd year, and will be taking two psych electives early in 4th year which are specifically timed to provide me with strong letters. Also will be busting my bum to get a good letter out of my upcoming IM clerkship.

Any advice on 4th year rotation selection? Any particular choices that might set off a red flag when applying to residencies? Have talked to my advisor about this, and she has encouraged me to just enjoy myself and do what interests me, but I still feel paranoid that I'm being too lax.

The way I approached 4th year was with the thought that this would be the last time I would be exposed to and learn all the other aspects of medicine. I would have the rest of my life to learn psychiatry. So, I took 2 psych electives, and the rest were cardiology, GI, med sub-I, peds ER, heme/onc, neurology, and family med (required). I thought that this would help me prepare for my medicine rotations in psychiatry residency. In addition, there were psych patients in every field no matter what service I was on, so it was great to learn how to handle medical ailments in the context of mental illness and psychiatric medications.

When I went on my interviews, several program directors took note of my choice to predominantly do medicine electives and thought it was a wise, less common approach. Of course, if you can't stand IM electives, this may not be the best course of action for you.

 

[Firewood]

The way I approached 4th year was with the thought that this would be the last time I would be exposed to and learn all the other aspects of medicine. I would have the rest of my life to learn psychiatry. So, I took 2 psych electives, and the rest were cardiology, GI, med sub-I, peds ER, heme/onc, neurology, and family med (required). I thought that this would help me prepare for my medicine rotations in psychiatry residency. In addition, there were psych patients in every field no matter what service I was on, so it was great to learn how to handle medical ailments in the context of mental illness and psychiatric medications.

When I went on my interviews, several program directors took note of my choice to predominantly do medicine electives and thought it was a wise, less common approach. Of course, if you can't stand IM electives, this may not be the best course of action for you.

That's a great way of looking at 4th year. My 4th year was fairly psych heavy. In retrospect, I should have done it the way you did. The psych we'll all learn in residency, this is one of the last chances to learn about the other stuff that interests you.

 

[Merovinge]

No need to overwhelm your schedule with Psych electives, but definitely would try to have at least 2 that fit into the criteria below:
1) Work with a doc(s) that will generate a great letter
2) Be in a specialty area you might want to pursue (Child, C/L, forensics, addiction, etc)
3) Be something your med school offers you might not get in residency (e.g. I did a month of community psych, taking people with chronic mental illness shopping, delivering meds, and working with a social worker run program. Really fantastic and helpful experience I wont get in residency).

As far as any other courses, I definitely agree with the do what interests you strategy. I did my medicine sub-i in heme-onc, and while I was a bit less prepared in general medical stuff, I got to work with a lot of people going through the dying process which was a first for me. I can always review heart failure, but the experience was a 1 time shot. If part of you wishes you had another life to live in a different specialty, spend a month doing it. Also tailor your work load to how burnt out you feel, medical school can be pretty brutal years 1-3 and you want to hit residency at 100% in your emotional/mental fuel tank!