Advice about fourth year scheduling

[Sheldor]

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At my school we will begin scheduling our fourth year in the next couple months and I feel very unprepared! Could those of you who have gone through or are going through currently offer any wisdom you may have?

Specifically advice regarding which months are musts to take off, the latest that an away rotation would be beneficial, the timing of Step 2CK, recommended electives, etc.

Thanks!!

 

[FSU2013]

Also, when would the latest you could do an away and still expect to get a rec letter that would be included in your app?

 

[RadOncDoc21]

Do at least 2-3 away electives, August-October are prime months. Do research during your aways and blow out Step 2.

-R

 

[FSU2013]

So you would recommend doing step2 early enough for residencies to see it? Is there a score that above which you wouldn't take step2 until later? Also, would you recommend just doing back to back to back aways?

 

[RadOncDoc21]

So you would recommend doing step2 early enough for residencies to see it? Is there a score that above which you wouldn't take step2 until later? Also, would you recommend just doing back to back to back aways?

If your Step 1 is great (>240), you can hold off on taking Step 2 until you're ready to take it. I would do the aways back to back if you can. To be honest with you, if you have a home program, I would get in on a clinical research project now to have something to submit for ASTRO 2012... Deadline coming up in a few months.

-R

 

[Seldon1985]

I did back to back aways (September then October). This worked out well, although I was definitely pretty tired by the end. A friend of mine whom I met on an away was doing 4 back to back rotations. I think this would be really tiring.

Certainly if you're in the 250's and 260's no need to worry about taking it early. The funny thing is though that people with these scores will do well on Step 2 anyway, regardless of when they take it. General wisdom on this board says if you scored >240 you should be fine with a late Step 2 and thats probably true. Step 2 isnt weighed all that heavily, but in all honesty, its probably the easiest of Steps 1, 2, 3 (IMHO).

 

[thesauce]

I also met someone that did 4 aways in a row. Funny enough, she ended up matching at her home program.

OP: I screwed up my 4th yr schedule as much as one can and it all worked out. Just be aware that interviews are heavy in Nov-early Jan so take those off (or set up a BS elective) if you can. I did the opposite (had my Sub-I at that time) and it worked out fine.

 

[t2oo5]

Along the same lines, I have noticed that some programs have designated time slots for away rotations. Do most programs have designated time slots, or are programs flexible in scheduling?

The reason I am asking is because our fourth year starts in the last week of July. I'm worried that this will "offset" my whole scheduling.

 

[RadOncDoc21]

Along the same lines, I have noticed that some programs have designated time slots for away rotations. Do most programs have designated time slots, or are programs flexible in scheduling?

The reason I am asking is because our fourth year starts in the last week of July. I'm worried that this will "offset" my whole scheduling.

In my experience, most programs are flexible but some you do have to schedule months in advance. I would send an email to the residency program coordinator to find out. I know with a few places, you have to fill out an application online.

-R

 

[johnthomas75]

Get Step 2 CS over w/early, do CK whenever as long as Step 1 was okay.
- jtl
http://the-d-o-c-t-o-r.blogspot.com/

 

[johnthomas75]

Get Step 2 CS over w/early, do CK whenever as long as Step 1 was okay.
- jtl
http://the-d-o-c-t-o-r.blogspot.com/

 

[Carotenoid]

Along the same lines, I have noticed that some programs have designated time slots for away rotations. Do most programs have designated time slots, or are programs flexible in scheduling?

The reason I am asking is because our fourth year starts in the last week of July. I'm worried that this will "offset" my whole scheduling.

Programs that have designated time slots (true of two quite competitive programs where I rotated) prefer to adhere to those slots - that way they can have N students rotate for a month, followed by N more students - it is just easier logistically. You can (and should) explain this to your school's registrar and try to "flex" your schedule. However, if the registrar is unyielding on this, you can email the rad-onc program coordinator and ask for an exception. If you are persuasive and humble, programs may be willing to make an exception for you. And don't underestimate the powers and influence of program coordinators!
A third program wheret I rotated (less competitive) didn't care when I rotated whatsoever.
Also, if you want to rotate at competitive programs, I'd start the elective application as soon as you can to reserve the spots, because they do disappear.

 

[nothingman]

+1 to getting CS over with as soon as feasible.

As to CK - generally agree with logic that if Step 1 is good take CK later, Step 1 less good take CK early. If you're in the gray zone, maximum flexibility time to take Step 2CK is around late August of MS4. Then you submit ERAS (with your Step 1 transcript) Sept 1 before your CK score is back, select to manually release further USMLE updates, and release your CK score PRN depending on how much you like it (knowing that of course it will need be made known eventually and you may get asked about it on interviews). If you are happy with your score, you will release it mid-Sept, plenty of time for it to help w/interviews.

Good luck!

 

[ramsesthenice]

Everyone already said it, ck doesnt really matter if step 1 is ok. Our PD said to put it off because and I quote: "neither labron or kobe score 40 points every night. Why risk it." I just enjoy the analogy.

One fine point, nationally there is a near 10 pt difference in step 1 and 2 scores overall but if you look at the charting data for rad onc its closer to 5 for what ever reason.

 

[Seldon1985]

On a slightly other note (and unsolicited, so please overlook if you don't care) but you should also consider taking Step 3 ASAP in intern year. I'm done with it, and its a great feeling not having to worry about sitting for another USMLE exam...

 

[Sheldor]

Thanks for all the great advice everyone! A couple of quick follow up questions:

1) So if you can only take 2 months off for interviews which two would you recommend? Nov-Dec? Or Dec-jan?

2) How late is late when we refer to taking Step 2 late? Is taking it in January or February too late?

 

[Gfunk6]

Dec-Jan

Taking Steo 2 late is fine for nearly every program. Feb is definitely not too late.

 

[Sheldor]

Dec-Jan

Taking Steo 2 late is fine for nearly every program. Feb is definitely not too late.

Thanks Gfunk!

Another question: How important is geographic diversity when selecting away rotations? More specifically, I'm trying to weigh doing two rotations in the same state in order to save money by living with extended family versus doing the second rotation elsewhere. Any thoughts would be appreciated!

 

[thesauce]

Thanks Gfunk!

Another question: How important is geographic diversity when selecting away rotations? More specifically, I'm trying to weigh doing two rotations in the same state in order to save money by living with extended family versus doing the second rotation elsewhere. Any thoughts would be appreciated!

Try not to be too cheap. This is (potentially) your one shot at this. It's true that away rotations can help you break into a geographical region and at that program in particular.

 

[Sheldor]

Not technically about fourth year scheduling but I had a LOR questions so I thought I'd put it here, rather than start another thread.

What is the prevailing opinion on how many, of what type of LOR? I believe you can submit 4 to most places correct? Is it best to get three clinically based letters from Rad Oncs and one research based letter?

 

[nothingman]

The conventional wisdom is 2-3 rad onc LORs ideally from people who know you well and have good things to say about you.

Most people I knew ended up using all 4 letter "slots."

I would substitute a glowing LOR from another specialty (esp if med/surg) for a rad onc LOR from someone who did not know you as well. If you did a PhD or an extensive non-clinical research project, a research LOR (even if from a non-clinician) is generally expected and takes up one of the slots.

 

[Seldon1985]

I sent 4 total LORS: 2 from Rad/Onc, 1 from medicine, 1 from research mentor

 

[FreeRadical2013]

Not technically about fourth year scheduling but I had a LOR questions so I thought I'd put it here, rather than start another thread.

What is the prevailing opinion on how many, of what type of LOR? I believe you can submit 4 to most places correct? Is it best to get three clinically based letters from Rad Oncs and one research based letter?

I sent four letters as well: 2 rad onc attendings from my home program, 1 from my first away rotation, and a medicine chair letter.

If you do ask for a medicine chair letter, be sure to make it very clear you are applying to radiation oncology, NOT medicine. My chair had to write so many medicine LORs that they initially had me applying to IM, not rad onc. Thankfully the person uploading the LORs noticed it and let me know.

 

[t2oo5]

Other than radiation oncology electives, what other rotations would be good experiences for 4th year? i.e. purely for educational merit

 

[nothingman]

In a nutshell, whatever you've always wanted to experience but will probably never do again as a resident, once you've fulfilled med school graduation requirements.

I did a month of anesthesia, some community advocacy stuff at a youth shelter, etc. Others I knew did rotations abroad - though of course this is school and curriculum permitting.

If you've never seen it, I'd recommend watching open heart surgery especially valve replacements, organ transplants, etc at least one time. It's really the frontier of surgery and there's something to being there in person and seeing it happen - and we'll never approach this kind of micro-handiwork in our field. Also it may be a bit of a dying art - especially open heart surgery, with more percutaneous options coming on board. If you want to mix it with a flexible schedule, again an anesthesia rotation might be the way to go, though scrubbing those cases (with good teachers around you) can be a lot of fun.

And of course, there is the well-reasoned school of thought to turn as much MS4 as possible into vacation/light research time.