Fourth Year Scheduling Advice

[tco]

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I'm looking for some advice as far as fourth year scheduling goes. I'm an MSIII planning on heading into radiology (eventually interventional radiology), and would like as much help as possible.

I suppose I should tell a little of my background so you can understand some of my concerns first...I entered medical school wanting to be involved with surgery of some sort. However, after my second year, I was presented with the opportunity to be involved with a post-sophomore fellowship in pathology. I ended up doing it, mainly for the experience with indirect patient care, and to contrast it with third year, just to make sure I wasn't missing something that I loved. Before entering the fellowship, I took Step I (255). During the year, I was treated like a resident, preparing for conferences, signing out cases, etc. for the duration of what would have been my third year. I enjoyed it, but wasn't in love with it. Now, to be brief, third year has been rough. While I was scoring mid 90's on all of my shelf exams during MSI and MSII, I'm now scoring mostly 60's to 80's on my shelf exams for third year. This has me worried that I'll - 1. Drop quartiles and 2. Not do well on Step 2. I've received all excellent narratives from attendings, and minimal criticisms, so I feel that I'm very good clinically for a third year medical student. As a positive from the year, I have learned that I want to be involved in all aspects of patient care, direct and indirect, that's why I'm really pushing now for an IR residency. It's the first field that really feels like it "fits" for me. Pshew. Glad that's out of the way.

My first concern with fourth year is to get finished with my board exams. I realize that different people have different opinions of when to take them, but I'd rather not have them lingering over my head for the year. Most of the people I've talked to suggest doing it early to just get it done with. As of right now, I have CS scheduled for the end of July, and haven't yet scheduled CK.

Here is my rotation schedule as of now. I believe that the only rotations that I can't change are my sub-I, anesthesia, rural and CCU rotations (all required). Our blocks are broken up into two, two week blocks. We also don't have any "IR" rotation, so I was thinking of going somewhere that I know allows medical students to be involved with cases for a month. I'd already have housing ready to go. However, it would likely be too late to get a letter.

1 - Board review/Vacation - July 1 to July 28
2 - General Radiology - July 29 to August 25
3 - Infectious Disease - August 26 to September 22
4 - Medicine Sub-I - September 23 to October 20
5 - Pulmonary Disease - October 21 to November 17
6a - Pathology (will be changing) - November 18 to December 1
6b - Anesthesia - December 2 to December 15
Interviews/vacation
7- Nothing currently scheduled. Originally wanted another Rads block, but I think it's full.
8a - Nothing currently scheduled.
8b - MICU
9 - Time off vacation.
10 - Rural Emergency Medicine.

I've been debating moving my radiology rotation to position 1, shortening my ID and Pulmonary rotations to 1/2 of a month each, getting rid of my pathology rotation, and trying to add at least 1 away rotation for radiology.

As far as letters go, I'm certain I have a great letter from my pathology year. I'm currently in contact with an IR guy at my hospital who seems very willing to be involved with a project with me, and upon finishing it up (very doable within the next half-year), would be willing to write another excellent letter. I also have an IM attending who has told me that he would write me a great letter, no matter what field I entered. It seems as if I'd only need a department chair letter to have everything I'd need in that area.

If you guys could give me any advice (constructive criticism of my schedule, point out errors in my thought process, provide suggestions to better my schedule), I'd really appreciate it. Also, if you have any suggestion for what to use for Step 2 (I used DIT for Step 1), I'd appreciate it, too. Thanks!

 

[DrBowtie]

I'm looking for some advice as far as fourth year scheduling goes. I'm an MSIII planning on heading into radiology (eventually interventional radiology), and would like as much help as possible.

I suppose I should tell a little of my background so you can understand some of my concerns first...I entered medical school wanting to be involved with surgery of some sort. However, after my second year, I was presented with the opportunity to be involved with a post-sophomore fellowship in pathology. I ended up doing it, mainly for the experience with indirect patient care, and to contrast it with third year, just to make sure I wasn't missing something that I loved. Before entering the fellowship, I took Step I (255). During the year, I was treated like a resident, preparing for conferences, signing out cases, etc. for the duration of what would have been my third year. I enjoyed it, but wasn't in love with it. Now, to be brief, third year has been rough. While I was scoring mid 90's on all of my shelf exams during MSI and MSII, I'm now scoring mostly 60's to 80's on my shelf exams for third year. This has me worried that I'll - 1. Drop quartiles and 2. Not do well on Step 2. I've received all excellent narratives from attendings, and minimal criticisms, so I feel that I'm very good clinically for a third year medical student. As a positive from the year, I have learned that I want to be involved in all aspects of patient care, direct and indirect, that's why I'm really pushing now for an IR residency. It's the first field that really feels like it "fits" for me. Pshew. Glad that's out of the way.

My first concern with fourth year is to get finished with my board exams. I realize that different people have different opinions of when to take them, but I'd rather not have them lingering over my head for the year. Most of the people I've talked to suggest doing it early to just get it done with. As of right now, I have CS scheduled for the end of July, and haven't yet scheduled CK.

Here is my rotation schedule as of now. I believe that the only rotations that I can't change are my sub-I, anesthesia, rural and CCU rotations (all required). Our blocks are broken up into two, two week blocks. We also don't have any "IR" rotation, so I was thinking of going somewhere that I know allows medical students to be involved with cases for a month. I'd already have housing ready to go. However, it would likely be too late to get a letter.

1 - Board review/Vacation - July 1 to July 28
2 - General Radiology - July 29 to August 25
3 - Infectious Disease - August 26 to September 22
4 - Medicine Sub-I - September 23 to October 20
5 - Pulmonary Disease - October 21 to November 17
6a - Pathology (will be changing) - November 18 to December 1
6b - Anesthesia - December 2 to December 15
Interviews/vacation
7- Nothing currently scheduled. Originally wanted another Rads block, but I think it's full.
8a - Nothing currently scheduled.
8b - MICU
9 - Time off vacation.
10 - Rural Emergency Medicine.

I've been debating moving my radiology rotation to position 1, shortening my ID and Pulmonary rotations to 1/2 of a month each, getting rid of my pathology rotation, and trying to add at least 1 away rotation for radiology.

As far as letters go, I'm certain I have a great letter from my pathology year. I'm currently in contact with an IR guy at my hospital who seems very willing to be involved with a project with me, and upon finishing it up (very doable within the next half-year), would be willing to write another excellent letter. I also have an IM attending who has told me that he would write me a great letter, no matter what field I entered. It seems as if I'd only need a department chair letter to have everything I'd need in that area.

If you guys could give me any advice (constructive criticism of my schedule, point out errors in my thought process, provide suggestions to better my schedule), I'd really appreciate it. Also, if you have any suggestion for what to use for Step 2 (I used DIT for Step 1), I'd appreciate it, too. Thanks!

Couple things:
1.) Schedule light rotations during Blocks 6-8. That is the prime interviewing time.

2.) Is MICU required? If not I'd drop it for something easier.

3.) Postpone your Step 2 until after apps go out. Your Step 1 is good.

4.) I'd shift General Rads to block 1, then do either IR or away rotation block 2. No use in doing a rads block after the first few blocks.

 

[deleted525628]

Schedule all of your radiology related stuff before ERAS is due so you can write about these experiences and discuss them on your interview trail. If there is no IR at your school you would need to do an away at a place that does. You're gonna get nailed by your interviewers if you tell them you want to pursue a career in something you haven't had a rotation in. If you honored medicine or don't a rec letter, put off your sub-i because anything less than honors in sub-i reflects poorly.

 

[tco]

Thanks for the responses.

Couple things:
1.) Schedule light rotations during Blocks 6-8. That is the prime interviewing time.

2.) Is MICU required? If not I'd drop it for something easier.

3.) Postpone your Step 2 until after apps go out. Your Step 1 is good.

4.) I'd shift General Rads to block 1, then do either IR or away rotation block 2. No use in doing a rads block after the first few blocks.

1) Sounds good. I most definitely will be scheduling something easy during those months. Relevant, but easy.

2) Yes, MICU is required. It's part of our CCU requirements (SICU, MICU, or PICU plus anesthesiology).

3) My scheduling block goes until September 30th, but my dedicated study time is all in July. Do you really think it's that big of a deal? Is there any way to change my block through the NBME?

4) I'll see what I can do.

Schedule all of your radiology related stuff before ERAS is due so you can write about these experiences and discuss them on your interview trail. If there is no IR at your school you would need to do an away at a place that does. You're gonna get nailed by your interviewers if you tell them you want to pursue a career in something you haven't had a rotation in. If you honored medicine or don't a rec letter, put off your sub-i because anything less than honors in sub-i reflects poorly.

Not to sound arrogant, but I feel like I have a much better grasp of what indirect patient care is like with my year long pathology rotation than the average student at this point. I lived treating patients without seeing them for an entire 12 months. I realize that path and rads are totally different animals in training and reading films/studies vs slides, but they're at least the same species in that they're a consult service that usually has no patient contact and churns through hundreds of studies per day.

Also, you're probably correct in the fact that my lack of IR rotation will be brought up in interviews, but I would counter that a month of glorified shadowing in a specialty isn't going to show me what that specialty is going to be like practicing it for the rest of my life. I'm going to do what I can to get an away at a place that lets me be involved, but I doubt I'm going to leave the month saying, "Ohhhh...That's what life will be like when I'm an attending."

The Sub-I is not a graded rotation. It's merely required. So "honors" is irrelevant.

Like I said, my anesthesia, Sub-I, and rural EM rotations are locked in.

Again, thank you guys for your advice. I'll try to incorporate what you've said into my schedule. Should have posted this a couple of months ago.

 

[shark2000]

I don't know what you mean by " I want to be involved in all aspects of patient care, direct and indirect". It looks beautiful, but does not have any meaning. And for sure that is not what an IR doctor does.

You are choosing IR for wrong reasons. It may or may not be a good fit for you, but not for the reasons you are mentioning here.

IMO, you have made an imagination of IR in your mind, which is far far from reality.

 

[tco]

I'm going to assume that what you're saying is out of concern that I'll ultimately be unhappy with my choice in career, so I'll first take time in this post to say, "Thank you for your concern."

However, since this wasn't my personal statement, I didn't feel that it was necessary to divulge all of the reasons that I want to do IR. Let's just assume, for argument's sake, that I've looked into it and am making an educated decision, and am not fabricating a grandiose idea of what the specialty is rather than having serious discussions with interventionalists and watching procedures done on my patients from my core rotations.

Now, do you have any suggestions for me as to my schedule, or did you just stop by the thread to throw the two cents that you felt I needed my way rather than the two cents that I asked for?

 

[qxrt]

Not to sound arrogant, but I feel like I have a much better grasp of what indirect patient care is like with my year long pathology rotation than the average student at this point. I lived treating patients without seeing them for an entire 12 months. I realize that path and rads are totally different animals in training and reading films/studies vs slides, but they're at least the same species in that they're a consult service that usually has no patient contact and churns through hundreds of studies per day.

Also, you're probably correct in the fact that my lack of IR rotation will be brought up in interviews, but I would counter that a month of glorified shadowing in a specialty isn't going to show me what that specialty is going to be like practicing it for the rest of my life. I'm going to do what I can to get an away at a place that lets me be involved, but I doubt I'm going to leave the month saying, "Ohhhh...That's what life will be like when I'm an attending."

You cannot extrapolate what radiology is like from pathology. Even if you could, this is not an excuse that will fly well with your interviewers.

And you do not need to emphasize the IR part of your career ambition so much. The path to get there is a 4-year diagnostic radiology residency, and emphasizing your sole interest in IR will cause some interviewers to question whether you are interested at all in DR (which is, after all, what you will be learning for the four years of your residency). Mentioning an interest in IR is fine, but interviewers generally like it if you keep an open mind...they don't want to be training someone who will be miserable during radiology residency and just wants to get to the IR fellowship.

Also, why would you call an IR rotation a "month of glorified shadowing" when you are planning to do a DR rotation, which is even more so a month of shadowing? In IR you have the ability to scrub in and get involved on procedures and impress the IR docs with something other than your wit and charm. If you are truly interested in IR, then why would you throw that opportunity away?

As shark2000 mentioned, the way you describe IR as a way to "get involved in all aspects of patient care" makes me wonder whether you know what a career in IR actually involves. Although it is shifting towards a more clinical model, IR is still largely a procedural specialty with relatively little clinical management. It sounds as if you'd be more interested in something like ENT or urology, which would fit much better for someone who wants to get involved with the surgery, medicine, and clinical management aspects.

Your application needs to be a cohesive story, yet there are several discordant aspects to your plan that would raise some eyebrows.

Here is some advice: You don't need to take Step 2 early; your Step 1 is strong enough that many programs will give you interviews without Step 2. Instead, spend your first two or three blocks doing rotations in IR and maybe DR. That will give you the story you need to convince potential interviewers that you know what you are getting into. Doing an IR rotation early will let you get a good radiologist letter early, as opposed to a DR rotation, where it is very difficult to impress the attendings.

The first three or so blocks are crucial to plan well, as you can use them to get any LORs that you might need in time before ERAS opens. Want a great clinical letter? Do a subI early on, do well, and get a kick-ass letter (easier to do in your subI, because you have more responsibilities than as a third year).

 

[tco]

Here is some advice: You don't need to take Step 2 early; your Step 1 is strong enough that many programs will give you interviews without Step 2. Instead, spend your first two or three blocks doing rotations in IR and maybe DR. That will give you the story you need to convince potential interviewers that you know what you are getting into. Doing an IR rotation early will let you get a good radiologist letter early, as opposed to a DR rotation, where it is very difficult to impress the attendings.

The first three or so blocks are crucial to plan well, as you can use them to get any LORs that you might need in time before ERAS opens. Want a great clinical letter? Do a subI early on, do well, and get a kick-ass letter (easier to do in your subI, because you have more responsibilities than as a third year).

Thanks for the advice. I'll see what I can do per the scheduling of Step 2. Unfortunately, I think I'm locked-in for the CS exam (late July), but can still take CK any time before Christmas break. I'm hoping that my schedule is still dynamic enough to allow me to change some things around.

I'm very much aware that IR is a mainly procedural specialty. That's why I'm interested in it. My roots of interest in medicine are in surgery, but I enjoy diagnostics and procedures as well. I'm also aware that IR is trying to become more clinically oriented, which is another reason that I'm interested in it. As I said, this isn't my personal statement, and I just wanted to give some background information so you guys could understand my concerns (mainly my difficulty with taking shelf exams this year). In the last few months, I've bounced around with my choices because it felt like no other specialty "fit" quite right. I'm not going to go much further into why I've chosen IR. Suffice it to say that I'm very happy with my choice, and look forward to all aspects of the training. Also, like I said, I realize that path and rads are two different animals...The comparison was only in the fact that I've experienced what it's like to treat patients without seeing them in person.

As for the IR experience, if I were to stay at my home institution and do it, it truly would be a glorified shadowing experience. There are a few places that I know of (mostly private) that would allow me to be very involved, and if I were to do a dedicated month, it would be there. So, my question becomes: Should I try to rotate at the away site in a private hospital to gain experience and a potential letter from a PP IR, or should I rotate away in DR to try to get a letter from a PD at another program?

Thanks again.

 

[qxrt]

So, my question becomes: Should I try to rotate at the away site in a private hospital to gain experience and a potential letter from a PP IR, or should I rotate away in DR to try to get a letter from a PD at another program?

Thanks again.

Try to do an IR away at an academic institution if you are planning to get a letter; names affiliated with academics tend to hold more weight than private practice letters. An away DR is fine too, but as I mentioned before, it's hard to impress anyone with your radiology knowledge, and there is pretty much no scutwork in radiology that a med student can help out with like in most other fields.

 

[tco]

So I changed my schedule yesterday.

1. General Radiology
2. Will be away after approval. Currently Pulmonary Medicine.
3. ID (will take CS at the end of this block)
4. Sub-I
5. Board Review month/Interviews
6. Path/Anesthesia
Vacation
Everything post-vacation is the same.

Thanks for your advice. I was always hesitant to put CK so late because our school harps, "take it as early as possible!" However, everyone I've talked to outside of my school (including you guys) have been telling me to take it later so I don't have to release it if I don't want to.

What have you guys heard about programs not interviewing applicants without a Step 2 score? Is this common? I'm guessing not since you all advised for me to take it later. Thanks.

 

[qxrt]

So I changed my schedule yesterday.

1. General Radiology
2. Will be away after approval. Currently Pulmonary Medicine.
3. ID (will take CS at the end of this block)
4. Sub-I
5. Board Review month/Interviews
6. Path/Anesthesia
Vacation
Everything post-vacation is the same.

Thanks for your advice. I was always hesitant to put CK so late because our school harps, "take it as early as possible!" However, everyone I've talked to outside of my school (including you guys) have been telling me to take it later so I don't have to release it if I don't want to.

What have you guys heard about programs not interviewing applicants without a Step 2 score? Is this common? I'm guessing not since you all advised for me to take it later. Thanks.

Some schools put an arbitrary deadline for Step 2. Check to see if your school has such a deadline. Even if they do, you should still be able to take it late enough that it doesn't go into your initial ERAS application on submission.

No program has Step 2 as a prerequisite for being granted an interview; however, a few programs (notably UCSF) require that you submit Step 2 CS and CK scores before the rank list deadline. Therefore try to take the Step 2 exams by October/November at the latest to ensure enough time for scores to come out for submission.

 

[badasshairday]

Totally fine to take Step 2 after interviews start flowing in. I had interviews at all the places I wanted and took Step 2 in December, both CS and CK.

I think it is fine to have an early interest in IR. Just keep your mind open because the whole field of Radiology is awesome.

 

[tco]

Has anyone done any away IR rotations? I'm curious as to what they'll expect out of me seeing as how we get very little experience during medical school. I'm a little nervous about shooting myself in the foot with a lack of knowledge.

 

[ar2388]

honestly i dont think away rotations are a good idea... the people i know who did them ended up not getting interviews at the places they did aways. and the attendings i have spoken to also did not recommend them.

 

[tco]

honestly i dont think away rotations are a good idea... the people i know who did them ended up not getting interviews at the places they did aways. and the attendings i have spoken to also did not recommend them.

Seeing as how I have no other option for an IR rotation, I guess it doesn't matter...

 

[qxrt]

honestly i dont think away rotations are a good idea... the people i know who did them ended up not getting interviews at the places they did aways. and the attendings i have spoken to also did not recommend them.

On the flip side, I have applicants from my school who "broke into" a top radiology program with which my school had previously had no history with and matched there after being proactive and performing well there on an away rotation. It is a double-edged sword.

 

[tco]

Every program that I've looked at on FREIDA has a section in their General Information that says "USMLE Step 1 and Step 2 requirements for interview consideration" and both the Step 1 and Step 2 score portion is filled out. It's not that I don't believe you guys, but it obviously has me a little worried. Is this just something that every program fills in, and it means more "Step scores required for ranking?" Thanks

 

[tco]

Couple of questions :
My student services office is telling us how terrible of an idea it is to take step 2 late, and that a number of programs won't interview without a step 2 Ck score. Is this a blatant falsity, or something that has recently changed?
I'm having a tough time coordinating an away at an academic IR program. Would it be better to just grab an away at an academic general rads rotation or a non academic IR?

 

[tco]

Reading on these forums it seems that the University of Colorado is a great place for residents who are interested in IR to go for training, but does anyone know what it's like there for medical students? I know some programs, like Arkansas, allow students to be very involved (AK doesn't allow away IR rotations).

Thanks.