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Clinical Rotations and then Step 1

Discussion in 'Clinical Rotations' started by TheJiggler, May 25, 2008.

  1. TheJiggler

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    Hi all,

    Does anyone here who's been through 3rd year have any advice on taking Step 1 after 3rd year? What's the best way to keep fresh on basic sciences (ones that are more relevant such as pharm, micro, pathophys) during clinical rotations? Do 3rd year books have a lot of relevant pathophys in them?

    With that said, anyone have any advice on how I should approach my third year rotations?
     
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  3. 71263

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    I dunno if most of us could help you here.

    Im not sure what your school's policy is, but at mine (and most others, from what I know), you are not allowed to start rotations until at least sitting in for Step 1. If you fail, you are notified, pulled from your rotation, and have to sit for the test again before you are allowed back on the floors.
     
  4. Tired

    Tired Fading away
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    Oh my God, you are so boned.
     
  5. lankysudanese

    lankysudanese antibiotics fetish
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    Didnt you start a similar threads some months back, and get plenty of responses? I think so - http://forums.studentdoctor.net/showthread.php?p=6608215
    Then your real question must be "any advice on how I should approach my 3rd year rotations"? And there several threads which are currently discussing scheduling of rotations, the necessary books for rotation, and how to ace the rotations. Just do a search.

    Sorry, but I just dont see the point of starting a duplicate thread.
     
  6. TheJiggler

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    I started a duplicate thread b/c I didn't get any responses from any 3rd or 4th years who took Step 1 after their clinical rotations...I attributed this to the fact that why would people who were done with Step 1 be on the "Step 1" forum. I was wondering if I would get better responses to my question here. But yeah, my basic question was "whats the best way to approach 3rd year with having Step 1 in the back of my mind?"

    My school allows us to take Step 1 whenever....as long as we take it before we graduate....no passing required actually even to graduate. It's a real medical school...I promise
     
  7. MrBurns10

    MrBurns10 Excellent, Smithers
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    I go to a school where everyone does the clinical year before taking the boards and I would say that, for the most part, students focus on studying for the rotations and don't think much about step 1 until we have to. The knowledge you gain during rotations can help you on the test (or so I've heard), and then maybe you can take a month off to study after 3rd year and before you take it.
     
  8. Law2Doc

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    I kind of doubt this. Step 2 yes, step 1 probably not so much. Nothing is better prep for Step 1 than second year. However you could certainly argue that taking a few more shelves might be good practice for NBME multiple choice tests like the steps.
     
  9. muscles

    muscles student of the month
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    You could make that argument, but at the same time, doing 150-200 UW questions daily, as well as a few practice full-lengths, would prepare you just as well.

    As far as pathophys in the third year... 3rd year is when you start to learn how to become a clinician. Attendings and residents don't emphasize the pathology and physiology, they are more bent on emphasizing clinical manifestations, diagnostic modalities and various treatment options for a given disease. 3rd year rotations are by no means adequate to prepare you for the path and phys parts of step I; you will definitely need to do outside reading on your own time.
     
  10. Tired

    Tired Fading away
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    Here's my advice: You're an idiot. After a year of clinical rotations, you're going to bomb Step 1, because your clerkships have zero to do with the basic science info on the Step 1 exam. If you have a choice, take Step 1 before MSIII. Because if you don't, you're going to fail it, not get into residency, and end up back here asking the same question as this guy: http://forums.studentdoctor.net/showthread.php?p=6698271#post6698271
     
  11. MrBurns10

    MrBurns10 Excellent, Smithers
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    Oh, I wasn't trying to argue that rotations help you just as much or moreso than the basic sciences. The arguments I've heard from people who say it helps is that most of the step 1 questions are in clinical vignette format and because it's oftentimes easier to know what the diagnosis is if you've already seen it (of course, then you have to make the jump to the pathophys behind that diagnosis).
     
  12. TheJiggler

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    It's b/c of people like you why I don't like posting on Student Doctor. Did you ever think there was a reason why I was postponing Step 1? Perhaps if you've been through what I've been through recently, you'd think twice about calling people idiots for having personal lives and people in them who they care about. I'm not postponing Step 1 for sh!ts and giggles....it wasn't my choice.

    In terms of 3rd year having nothing to do with Step 1, have you gone through medical school and really become a resident? You really thought pharmacology, microbiology, pathophys has nothing to do with being a doctor? You probably went to a poor excuse for a medical school then. Look at Baylor and Penn, they do their clinical rotations before they take step 1 and probably have the highest scores in the nation. Are their students that much smarter than the rest of the country? Probably not....it's just that they're prepared to approach everything clinically, the way Step 1 is being written now.

    I didn't post on this forum looking for criticism...I posted on it looking for advice on what's the best way to go into 3rd year without forgetting things that I learned 1st and 2nd year. It's people like you who make me hate SDN...from now on, keep your big mouth to yourself if you're gonna post garbage like that
     
  13. smq123

    smq123 John William Waterhouse
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    Hey, hey, hey. Calm down.

    I know - Tired can be a little bit harsh at times. But I've never heard him give crappy advice or say anything that was blatantly wrong on SDN so far.

    If you've read his other posts, then you'd know that Tired matched into an ortho program....so yes, he is an intern. And yes, he probably did extremely well on Step 1 and on rotations. So I'd probably listen to him.

    The whole idea that people at Penn and Baylor do better on Step 1 because they have done some rotations already is pretty heavily debated on SDN. Maybe it's because they do rotations first. Or maybe it's just because the people who attend Penn and Baylor are naturally good test-takers (i.e. they got high MCAT scores which got them into Penn and Baylor in the first place!), and so would do better on Step 1. Who knows?

    Having already gone through most of 3rd year, and having already taken Step 1, I can tell you that the pharm, microbio, and pathophys that you need for third year is VERY different from the stuff you need to know for Step 1. I almost felt like everything that I had studied for Step 1 was USELESS when it came to rotations. Does Step 1 tell you how to do a good MMSE? Or a good cervical exam during labor? Or how to put together a good differential diagnosis while interviewing a patient?

    The pharm that I studied for Step 1 did NOT help me during rotations. At all. The microbio that I studied for Step 1 was NOT useful either - the only thing, as it turns out, that I needed to know for rotations are the various ways that pneumonia can present....and not what kind of medium Neisseria grows on.

    Good luck. I don't think that taking Step 1 after third year rotations will be easy, just because the material is pretty different. But don't freak out at every person who bluntly calls you an idiot...otherwise you're going to go insane on your surgery and OB rotations.
     
  14. TheJiggler

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    I understand by what you mean that the practice of medicine is very different than what you learn during your first two years. In terms of not hearing him give "crappy advice," I'll go ahead and say that "you're going to fail" is crappy advice. There's a first time for everything.

    I know it won't be easy to take step 1 after 3rd year, but I've heard the 3rd year at my school is much much better than the first two years. That's why I brought this whole topic up. Of course you'll forget all the nuisances of basic science while you're doing clinical stuff...but aren't shelf exams on all of medicine. I know you won't see some cases while you're on the wards...but does that mean you won't be tested on it for shelf exams? Just b/c you don't see or do something on the floor doesn't mean you won't see it in the future either on a test or as a doctor.

    Clearly the best solution is to take step 1 after 2nd year, but given my circumstances, that path got thrown out the window by circumstances out of my control. So my goal now is to go into 3rd year but trying to stay fresh on basic sciences at the same time. I'm obviously going to keep my books from 2nd year that are the most helpful (RR path, First Aid, etc) and refer to them whenever I have a chance.

    Baylor and Penn do well on Step 1...but why wouldn't Wash U with an average mcat of 37-38 have a better performance than them? I go to a medical school on par with all of these schools...so I figure I should be able to do the same. I just didn't think it would be an accurate reflection of my knowledge if I were to take Step 1 now. I'm still studying for step 1 now so that way I've at least seen this material before when I study again next year.

    I think Tired's remarks were very rude. Perhaps the people in surgery and obgyn are harsh on the wards...but I can't imagine them calling you an idiot when you're going to them for advice on an important subject. I'm sure Tired did very well on Step 1 and in medical school....doesn't mean you have to be a jerk.
     
  15. smq123

    smq123 John William Waterhouse
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    "You're going to fail" may be crappy advice....but there's an element of truth to that.

    I'm sorry, but I honestly think that there IS a high possibility that you will fail Step 1 if you take it after third year. :(

    Unlike Step 2, and unlike NBME shelf exams, Step 1 requires long blocks of DEDICATED study time. Step 2 and the shelf exams do not. But since there is such a wide range of material on Step 1 (much of which you haven't really thought about since first year), you need to study at least for 12 hour blocks a day for, at least, 2-3 weeks. This is regardless of whether or not you've already taken third year.

    In your case, since you'll be SO far removed from the basic sciences, you might need even more time.

    Third year is MUCH "better" than first or second year - but it's definitely harder. There was a lot more stress. I was a lot more tired. The day-to-day stuff of third year was infinitely more interesting, but when I came home, I was never in the mood to study for more than an hour or so at a time. And, in that hour, I had to study for the rotation or the shelf.

    It's hard enough to study for the rotation AND for the shelf (which, by the way, are not the same thing - the stuff you see on the floors, and the stuff on the shelf, are totally different).

    But if I also had to study for Step 1 at the same time, it'd be really, really hard. There's just not enough time in the day to do all that stuff. And even when there is time, you're too tired. Or you want to do other stuff...like, you know, talk to people who are actually healthy and not sitting in a hospital bed. You might even want to date - I don't know. But studying for Step 1 during third year? Uggghhh. Even the idea horrifies me.

    Honestly, if needed, you might need to take a leave of absence after 2nd year, and take Step 1, and then enter rotations late. But don't bank on being able to keep upon the basic sciences while doing your rotations. There IS a high possibility that you will fail. Sorry. :(

    P.S. Correct me if I'm wrong, but at Baylor and Penn, they take Step 1 after a few months of rotations. They then get a full month off, and then take Step 1 after studying for a month.

    This is DRASTICALLY different from what you'll be doing. You'll be taking Step 1 after an entire YEAR away from the basic sciences. Your brain will be fried after long rotations like surgery and OB. And you won't have a month of dedicated study time - you'll have, at most, a couple of weeks. Plus, in those couple of weeks, you'll need to get started on ERAS, away rotations, getting LORs, etc. So the situations are not comparable, in my opinion.
     
  16. DrDre311

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    I beat Step I down like a red-headed stepchild. Same with Step II. I anticipate the same with Step III.

    I have no qualms about saying that if I had to take Step I again now I would do significantly worse, even with a couple of weeks or a month to study for it. I'd probably pass, but there's no way I would perform as well as I did right after second year of med school. Basic science stuff just magically osmoses itself right out of your head if you don't forcibly cram it in day after day.
     
  17. TheJiggler

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    Yeah, I see your point and I agree in many ways....but at least what you're saying is very sensible. Look at the original post Tired made. You can say that in a bit more civilized way. I'm not arguing your point. Of course you forget random details that you learned in class and don't have all day every day to study...you'll just learn what's important.

    the way my schedule is, I'll have about 5-6 weeks to study after third year is over. As long as I take the exam during July, I'll get my scores back in August and have time to apply for residency in September. The timing makes me very nervous...but I'm hoping it works out. Okay, I see how it's hard to get supportive advice on this website. thanks to those who actually gave good advice instead of arguing that I'm going to fail.
     
  18. deuist

    deuist Stealthfully Sarcastic
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    In regards to STEP I material: the amount of information that I've forgotten during third year far outweighs the amount of information that I've learned.
     
  19. calamityjane

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    Actually, you are wrong. Not sure about Penn, but at Baylor, most students take Step 1 in January or February of third year after completing a full year of clinical rotations. Many take winter break + 4-8 weeks off to study.
     
  20. smq123

    smq123 John William Waterhouse
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    Thanks for the correction. :)

    I'm kind of glad that I didn't have to go through third year with Step 1 over my head, but I know that different schools do things differently. But if your school isn't set up to take Step 1 after third year, and you don't have a lot of time to dedicate to studying for it, it's going to be painful.
     
  21. DrDre311

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    Me too. It would have hurt my application profile.
     
  22. Anka

    Anka Senior Member
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    I went to a med school where this was the case (WOW! so cool to put that in the past tense!) -- as Mr. Burns points out, we all just studied for our rotations, and focused on those. Then, you study for about six weeks before taking Step I, which will refresh all the nitty gritty details. You'll be surprised at how fast it all comes back. The clinical year actually does help quite a bit with the test, to the extent that I can tell having only ever taken the test after the clinical year. Most questions will come straight out of your studying for step I, but there are def questions which will be very easy for you because you've seen how it actually plays out (rather than trying to remember a series of ten basic science factoids, that remembered all at once would give you the correct answer, you're just going to remember a single clinical fact).

    Anka
     
  23. fakin' the funk

    fakin' the funk ASA Member
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    Buddy, you posted in early May about "should I or should I not postpone Step 1," and most people said "take it now." Then, having chosen to not take that advice, and to postpone it, you come here asking "How should I approach clerkships? It wasn't my choice!" and get mad when people call you out?

    It's a friggin unanswerable question anyway. Do your clerkships, then study for Step 1. How much simpler does it get?

    You don't like posting on SDN? Odd for a person who's started 2 threads about him/herself to say that...
     
  24. Tired

    Tired Fading away
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    You know it's the end of May right? And you know that you could devote the next month studying for Step 1, and still knock it out before clerkships, right?

    Here's a thought, if your "personal life" is such a distraction that you can't even schedule the most important exam of your life, then maybe you'd be better off taking a year off. At least that way you wouldn't get all the way through your MS3 year, only to fail out because you can't pass the USMLE.
     
  25. diosa428

    diosa428 SDN Angel
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    Everyone at my school takes Step 1 after clinical rotations and our average is like 235. Very few people fail. It's not the end of the world.
     
  26. smq123

    smq123 John William Waterhouse
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    diosa428 - you're missing the point. It's one thing if your school specifically schedules things in order to allow all students to take Step 1 after third year rotations. It's a totally DIFFERENT thing if you're going against the grain of your school's usual Step 1 policy, and trying to stay on top of third year exams, starting ERAS, AND taking Step 1.

    If taking Step 1 after third year forces you to send in your ERAS stuff starting in September....that's not so great. The timing IS a little tenuous, and the only reason for that is because TheJiggler is doing things out of sequence. If your school is set up to let you take Step 1 after rotations, then that's a different story.
     
  27. diosa428

    diosa428 SDN Angel
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    Yeah I guess I did think about the application thing, because we actually do rotations as second years and take Step 1 as third years. But I was mostly replying to Tired, who was insinuating that the OP was going to BOMB Step 1 if he waited until clinical rotations were over, and that's not necessarily the case. If he can get a month of solid studying in, there's no reason he couldn't do well. If he can't, then I agree that it could be a problem.
     
  28. TheJiggler

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    I'm sorry for starting this thread. My original question was not meant to be "Should I postpone Step 1?" My question was more looking for advice from those who took Step 1 after third year or had any experience that could help out. I'll word my questions better next time to make sure it's clear what I'm looking for.

    I didn't come on this site looking for criticism about my decision. I'm pretty shocked that some of you are becoming doctors. I guess it just goes to show you that not everyone who becomes a doctor is a nice person and just because you're going into medicine does not make you a good person either. For some of you to lash out at me for merely making a post on a forum looking for some advice doesn't make you a bad person..but I definitely do not like you at all and I'm happy I never have to see your face.

    Thanks to those who helped out by posting something constructive even if it was suggesting to take it this year. I'm pretty sure I won't fail taking the exam next year...I'd be willing to guarantee I do much much better than I would now and in plenty of time to apply for residency....

    I won't be responding or posting on SDN anymore just b/c its a waste of my time to deal with some of this....and yours too probably
     
  29. Inquiringmind24

    Inquiringmind24 "The fact man"
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    Don't do it dude. Get that crappy test over with while all of that material is fresh in you head. It's not even a question in my opinion.
     
  30. Tired

    Tired Fading away
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    Thanks for pointing out this obvious but overlooked point.
     

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