Did you take off a month for Step 2?

eyesteve said:

Rocketbooster: Many threads discuss this concept, but I think a broad overview of application timeline and Step 2 scheduling may be helpful in making your decision.

When to take Step 2?

You will find many different opinions about when is the optimal time to take Step 2 CK. I believe this decision should be based on one main question: What can you do between June and August to best strengthen your application? I know it is frustrating to have such a broad answer, but I think that is the best answer, and it takes into consideration a few of the following factors: 1 – Step 1 score, 2 – away rotations, 3 – letters of recommendation, 4 – study time needed to do well
(please note that I am not giving score cutoffs…that is up to you/your mentor to determine into which category you best fit).

If you did great on Step 1, then Step 2 is somewhat less of a priority for ophthalmology applications. While other specialties may look more heavily on Step 2 performance, the reality is that Step 2 is not looked at nearly as carefully as Step 1 is for ophthalmology, largely because not everyone has taken Step 1 by the time they apply so it is difficult to compare performance between applicants. If you rocked Step 1, you will likely rock Step 2 (smart people are smart). If you are in this group, it may be a good idea to strengthen your application in other ways (research, away rotations, etc). In my opinion, someone that rocks Step 1 has more to lose by taking Step 2 early (May-July) than they have to gain by rocking it, so it might be best to take it after your application goes in.

If you did poorly on Step 1 but still think you have a shot at matching into ophthalmology, then your answer to the main question of how best to strengthen your application will likely be to improve your Step 2 score. Take it early enough that you will at least have a score that you can report to your potential programs by the time they start screening applications. If you get it to them when they have already invited for interviews, it is too late, as they likely already screened your application out by having a somewhat lower USMLE score than they typically invite. My recommended timeline would be to report your score by mid to late September or early October if you hope they will have it in time for reviewing your application. If you just want them to have it by the time you interview, then give yourself a month before the bulk of interviews take place to take the exam.

If you didn’t rock Step 1 but you didn’t do poorly either. Blast…welcome to the group in which most of us find ourselves, in the cluster of 1-2 standard deviations from the perpetually-increasing mean. Unfortunately, the decision isn’t quite as clear for this group in my opinion. Again, what can you do to best strengthen your application?
Are you weak in research? Do a research rotation
Are you somewhat weak in clinical grades or have had little clinical exposure to ophtho clinically? Do an ophtho rotation
Will an away rotation at some other rotation be the best use of your time? Go away
Will a rotation at your home program and a subsequently awesome letter of recommendation be the best for you? Stay home
If at the end of the day you feel that doing well on Step 2 is the best use of your time to strengthen your application, then that’s your answer.

Whenever you do decide to take Step 2, take into account how much time you needed to study for Step 1 and if you felt that was enough to do well. Were you ready for Step 1 in 2-3 weeks of hardcore studying? That might be all you need for Step 2, or even less. Did you need 4-6 weeks or more to really feel ready? Plan accordingly, but keep in mind, if you study for this much time during May-July/August, you are doing so at the expense of giving your all in some other area of application-strengthening, and it may be best to take Step 2 a bit later (after application goes in) so that you can submit your newly-strengthened application in other areas before you get your hardcore study on.

Sorry for the generalities, but you are unique (ahh precious) and the strategy of how to schedule your fourth year must also be unique. As evidence of this, among the four classmates from my school applying for ophtho, one took Step 2 in June, one in October, one in December, and one in January.

What was my story? I was in that blasted middle category of standard deviation clustering about the mean. I felt as though the time it would take me to study well enough to do well on Step 2 was not worth the application-strengthening of June-August, and thus chose to take Step 2 after my application had gone in. I did 8 weeks of research in June-July, sent in the application, did a month of ophtho at home program, then studied for Step 2 from mid-September to mid-October and took it the third week of October right before interviews started. I got my score back in enough time to be able to tell programs my score if they asked me at interviews. For what it’s worth, however, out of the 13 interviews I did, I think only two asked about my Step 2 score.

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eyesteve said:

It is actually fairly common for schools to have deadlines for taking Step 2. Your deadline of the end September actually is fairly reasonable and shouldn't be too much of a problem. Given your situation I would actually continue to do research and see if you can be involved in 3-5 or more projects by the time your application goes in. It is only January, and you have until August.

Are your first author publications ophtho-related? If not, then getting some ophtho research should be a priority in my opinion, especially as it seems you may be a little bit anxious about getting strong letters of recommendation. If you do ophtho-related research from now until June, you will have no problem at all having an attending that can vouch for your interest in the field, dedication, dependability, etc for a strong LOR. I ended up getting a LOR from an attending I worked with clinically for just 3 days in December of the year before I applied, but with whom I started doing several clinical research projects, writing textbook chapters, grants, etc. I would highly recommend this type of approach if I were in your shoes, and would probably have my schedule be research month in June (possibly get LOR from attending you've worked with on projects this spring and in June), ophtho clinical in July (hoping to get a LOR from an attending in this month), get application in at end of July/first weeks of August while doing some other rotation, and then take all of September to study for Step 2 CK or vice versa and study for/take Step 2 in August and do a rotation in September.

The main point here is that doing ophtho-related research is a good idea on so many levels, one of which being that it may give you more time working with an attending for them to get to know you and for you to get to learn from them than the few short hours chasing them around clinic as they busily see patients and you try not to get in the way. Furthermore, if the time arises that you need a phone call on your behalf, an attending that you know well will be much more inclined to make that call than someone with whom you only worked for one month in July.

I'm sure others that have matched would have even more valuable insights, so hopefully they will also add some thoughts. If not, I suppose I can continue to ramble.

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eyesteve said:

Rocketbooster: From what I understand from your post, you are hoping to get 1 letter from your "big wig," 1 letter from a faculty member you have been shadowing, and 1 letter from your PhD research PI.

Keep in mind that while there is no absolute rule on from whom you get letters, the San Francisco Match CAS Instruction Manual (downloadable on the website) states, "Three (3) ORIGINAL letters of reference are required for review by the programs. No more, no less. It is recommended that residency applicants provide one letter from a core rotation."

I would encourage you to follow that SF Match recommendation and only submit 2 ophtho letters and 1 letter from a core rotation. That means you will need to choose which of your current potential letters not to send. In your case it would probably be best to submit the research PI letter as one of your letters, even though she is a PhD. I imagine having worked with her for "1.5 years" that she knows you best. She will undoubtedly vouch for your efforts in her lab, which may help provide you with opportunities to discuss your research in your interviews. The flipside of that is that she will not be able to mention your clinical acumen, interactions with patients, etc. If you do decide to use her letter, you should try to get to know your "big wig" well enough between now and July that he/she can not only give their stamp of approval on you as a potential resident, but also speak to your clinical abilities. I would suggest doing what you can to ensure that your "big wig" letter says everything that your other letter from the physician you are shadowing would say, as this will be your only opportunity to have an ophtho letter speak to your clinical abilities, given that you plan on using the other letter from your PhD mentor which will speak to your research.

With reference to your comments about your 2 first-author publications. We and many others could go on and on debating about whether quality is more important than quantity when it comes to publications. While there is no right answer to this debate, the fact remains that the entire last page of the CAS application is dedicated to "Research activities, papers, and/or additional information." Nowhere is there a column for "Impact Factor" or anything to allow you to demonstrate the "quality" of the research in the CAS application, except perhaps the biographical sketch. Yes, you will have that opportunity in an interview, but unless your paper is a first-author basic science publication in "Cell," Science," or "Nature," the faculty member will see the citation and think, "Hmmm, cool, he/she has a basic science first-author publication in some journal." If that entire page-long box has just that and a case-report, he/she may be impressed, but a similar scores/grades applicant with more "quantity" may be given greater consideration. Don't get me wrong, your pubs are awesome, but be careful about being lulled into a false sense of security because of the "quality" of the projects, and keep in mind also that clinical projects are not necessarily all quantity and no quality. Yes, they take less time typically, but can still be very high quality. I bet with as capable and proactive an applicant as you appear, that with a bit of effort you can find a few clinical projects to work on between now and July and feel even more comfortable that your combination of quality and quantity will ensure great interviews and a great match.

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