Fall of MS4 scheduling advice (LORs, Step 2CK)

[MoiMoi]

Hi, I'm trying to plan out the first half of my MS4 year and have been waffling on what's the best schedule for applying to IM. My two main issues are getting LORs and when to take Step2CK. For LORs, I currently have one solid one from an asst prof so I need 1-2 more besides the chairman's letter which will be composed from comments from the Medicine clerkship (over a year ago) and Medicine electives/subI that I plan to do in July and August.

Original plan:
July: Sub-I --> will work hard to get a letter from this
Aug: Medicine elective --> hope to get a letter
Sep: Last required core rotation
Oct: Easy elective + take step2CK at the end of the month

I scored a 258 on Step 1 so I originally thought I could just wait until late October to take Step2CK but after perusing some threads in the IM forum there seems to be the (possibly controversial) suggestion to have Step2CK scores in hand when submitting your application especially for the top programs even if you have a good step 1 score. I'm mainly interested in the southern university IM programs (Duke, Emory, UNC, Vandy, etc). So should I take Step2CK at the end of August and just try to study while on harder rotations or can I wait until I have more free time in October? I really don't want to move either my subI or medicine elective since I am hoping to get letters from those months though I guess the August elective is not strictly necessary. I'm just not sure if it's more helpful to have a Step2CK score in by the time interviews come out or a 3rd faculty letter + potentially better chairman's letter.

Thanks for any advice!

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[Meridian32]

Hi Moi - my $0.02 is that with your excellent Step 1 score, letters are probably more important. If you do well on Step 2 CK in October, you can submit your score to programs then. If you don't do well, you can not submit it (unless you are applying to one of the few programs that requires Step 2 scores before rank list submission).

I was in a similar situation - did well on Step 1 and took Step 2 CK in late October. I didn't do as well as I'd have liked (couple of points lower than Step 1), so didn't submit my Step 2 score to programs (I applied to one program that required it before rank list submission, but talked to their program coordinator and they were fine with my sending it to them shortly after rank list submission). I still got all the interviews I wanted and matched where I wanted (a "top" program) - so I don't think not submitting a Step 2 score will hurt you in the context of your excellent Step 1 score.

I'd also consider taking all of October to study for Step 2 CK if possible - that's what I did and I initially thought it was overkill, but ended up needing every day of that study period. It was a harder test than I expected.

 

[MoiMoi]

Thanks for your thoughts! That was what I was leaning towards too. Good to know about Step 2 as well, I've heard sort of mixed things about how hard it is.

 

[DocWithGoodHandwriting]

Hi, I'm trying to plan out the first half of my MS4 year and have been waffling on what's the best schedule for applying to IM. My two main issues are getting LORs and when to take Step2CK. For LORs, I currently have one solid one from an asst prof so I need 1-2 more besides the chairman's letter which will be composed from comments from the Medicine clerkship (over a year ago) and Medicine electives/subI that I plan to do in July and August.

Original plan:
July: Sub-I --> will work hard to get a letter from this
Aug: Medicine elective --> hope to get a letter
Sep: Last required core rotation
Oct: Easy elective + take step2CK at the end of the month

I scored a 258 on Step 1 so I originally thought I could just wait until late October to take Step2CK but after perusing some threads in the IM forum there seems to be the (possibly controversial) suggestion to have Step2CK scores in hand when submitting your application especially for the top programs even if you have a good step 1 score. I'm mainly interested in the southern university IM programs (Duke, Emory, UNC, Vandy, etc). So should I take Step2CK at the end of August and just try to study while on harder rotations or can I wait until I have more free time in October? I really don't want to move either my subI or medicine elective since I am hoping to get letters from those months though I guess the August elective is not strictly necessary. I'm just not sure if it's more helpful to have a Step2CK score in by the time interviews come out or a 3rd faculty letter + potentially better chairman's letter.

Thanks for any advice!

You should also consider away rotations at one of the southern university programs you mentioned (unless you are already at Duke/Vandy). A letter of recommendation from a faculty member at one of those institutions would boost your application. In addition, you can either set up a meeting with PD or also ask about internal letters of recommendation while you are on your away rotation (one of the attendings I worked with at one of the southern programs emailed the PD "he/she would be a great fit at our program and I would enjoy working with him/her next year."

Do you need to do an away? No. But if you are coming from a non-top 20 medical school, then a letter from a well-known faculty at a top-20 program helps. The best time to do an away is in August. You will be seasoned by your home institution sub-I, and will be ready to knock it out of the ballpark in Aug.

I think that with a 258 on Step 1, you aren't in a rush to take Step 2. The best time to take Step 2 may be in late-Oct/early-Nov. You can take some time to relax after sending out ERAS, study in Oct, and take Step 2 prior to interview season. You may want to take Step 2 earlier if your medical school is non-top 20. I took Step 2 in early Sept. It kinda sucked trying to study for Step 2 and getting ERAS ready. Nobody mentioned my Step 2 score during interviews, although multiple people mentioned the Step 1 score.

Good luck. Try to schedule chill rotations in spring. You will be much, much happier if you aren't doing an ICU rotation in March/April.

 

[gutonc]

Do NOT do an away. Could a great LOR from a well known faculty member somewhere boost your app? Of course. The likelihood of you winding up on service somewhere with such a unicorn and then completely rocking your away (unknown city, unknown hospital, new EMR, different culture) asymptotically approaches 0.

For most IM applicants, away rotations are, at best, a neutral experience, rarely positive and often a bad idea.

Your plan as it stands looks good.

 

[DocWithGoodHandwriting]

I don't see why not. I really enjoyed my multiple away rotations at top academic programs. Yes, it's a lot of work on the students' part. However, exploring a new city is fun and I met a lot of great people and learned about the culture of medicine at different parts of the country. The original poster scored a 258 on his/her Step 1, so work ethic and clinical acumen will not be an issue. The only question is aside from a LoR, is there another compelling reason to shell out $$ for an away rotation? (i.e. strong geographical interest due to significant other being in a different city, etc) If the answer is yes, I would suggest doing away rotation(s). If you are already at a top-notch institution and you are considering aways only for LoR, I would recommend against it.

 

[MoiMoi]

Thanks DWGH and gutonc for your input! I appreciate the discussion. I agree with both of your thoughts about aways. I am at a top 20ish school and have family/school ties in the south so I feel comfortable not doing an away rotation. It does seem like it could be a fun experience but for me personally, a month isn't enough time to get acclimated in terms of the things gutonc mentioned and then also be a superstar.