Fourth Year Advice

[grapejuice27]

I'm a third-year student finishing up my medicine clerkship and am set on applying to internal medicine residency programs. I have a few questions about next year, if anyone has any advice.

What electives I should choose? What would help me during my intern year/residency?
When should I take my IM Sub-I?
Should I do away electives? In what?
When should I take Step II?
Any other thoughts on preparing for IM residency applications?
To how many programs do people usually apply?

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[souljah1]

I'm in a very similar situation. I'll be starting fourth year in about 7 weeks and I'm in the process of getting my schedule together for next year.

Here, most students planning on going into IM do something medicine related (cards consult, GI, ID, etc) for block one and then take their SubI in medicine next. Additionally, we usually take either a subI in ED or in ICU (we have to take two medicine related SubI's our fourth year). Our fourth year starts in May so usually by August, most students have both of their required subI's done.

As far as away rotations are concerned...very few people do away rotations in medicine. If they do, they do a consult service or something like that, rather than a SubI. Lots of people do travel and clinical research for a few months of their fourth year.

Most applicants in medicine here (if they are happy with their step1 score) wait to take Step 2 until after interview season is over. (Feb-March) We are told that Step1 and Step2 matter less when applying to internal medicine. More important, are your clinical grades (especially your medicine clerkship), LORs, and (so I have heard) your medical school.

And I think most people initially apply to 12-15 programs, interview at about 8-10 and attend around 6 interviews. I would look at the match list at your school over the past several years, talk to your friends in the class above you who are currently applying, and make good use of the housestaff who have just recently gone through the whole process.

My schedule will look something like this (got some help from some friends and housestaff in figuring out the order and things like that).

GI consult service (4 wks), Nephrology consult (2 wks), Vacation (2wks), ICU subI (4wks), Med SubI (4wks), a mellow course called Diagnostic Radiology (4wks for roughly 4hrs/day), Evidence-based Physical Exam (2wks), a month of writing up a systematic review with one of my mentors (4 wks), Teaching 2nd years GI/Endocrine (6wks), Interviews/Vacation (6wks), and then 3 months or so of some really mellow courses ending with a 2wk vacation to costa rica or hawaii. I'll have every weekend off from mid-August to the start of internship (10 months or so!!!)

 

[grapejuice27]

My situation is a touch different. For one, I don't go to a terribly prestigious medical school, and applicants from here have had better luck matching at top programs if they've done an away elective there. Anyone have experience with this?

 

[doc05]

even so, most of souljah's advice applies. do a medicine consult service where you'll have contact with important attendings. do your medicine sub-I and make sure you're on the chair's/other important attending's team.

I would be surprised if an away rotation would be helpful, considering the numbers involved: IM dept's are huge, they get hundreds to thousands of applicants, interview 100+, and match 30-40 residents/year. So it is doubtful that an away rotation would have much impact on your application; and you would definitely not get to know most of the attendings. This of course is very different from such fields as ortho, GU, ENT, etc., where dept's are very small and a month away can be very helpful.

 

[Furrball]

even so, most of souljah's advice applies. do a medicine consult service where you'll have contact with important attendings. do your medicine sub-I and make sure you're on the chair's/other important attending's team.

I would be surprised if an away rotation would be helpful, considering the numbers involved: IM dept's are huge, they get hundreds to thousands of applicants, interview 100+, and match 30-40 residents/year. So it is doubtful that an away rotation would have much impact on your application; and you would definitely not get to know most of the attendings. This of course is very different from such fields as ortho, GU, ENT, etc., where dept's are very small and a month away can be very helpful.

Ahh, but an away rotation is a tool to get an interview at prestigious programs.

Do your sub-I early, you want to get letters of rec early.

 

[MypetCat]

Ok here goes:

About what to take fourth year and when: Definitely 2 sub-i's, at least one. Obviously in IM. Do it at a place where you can get a good letter. Do it in the first 3 blocks to get letter out it time. Do an ICU rotation if you can coz you gain a lot of education that you will need intern year. You will be ahead of the curve. If you are considering a particular field, ie ID or renal, do a block in that. Also, in the first three blocks. Your aim should be to get the app in by Sept and letter can keep coming until after that.

About step 2s: Taking Step 2s early can either help you or hurt you. If your Step 1 scores were good and your grades are good, you can take the boards after your interview trail and still be fine. This way, you are forcing the programs to judge you on available scores. If your step 1s are not so good, and you think you can put in time and get a good score in Step 2, take it early to get it in with app. This way, you are helping yourself.

About away rotations: Again, can hurt or help you. If you know your stuff (say you have alread done a sub i at your home institution and you do another away), it gets you in through the door at your away inst. If you go in unprepared, it doesn't reflect well on you.

Hope that helps. Again, this is my and my friends exp. Others may have different advice.