How do I plan my 3rd year rotations with enough time to know my STEP 2 CK score, apply for away rotations, and choose my specialty by applications?

[CuriousMDStudent]

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This is a bit complicated so I would appreciate if people could take some time to read my post as I think a lot of 3rd years are going to face this issue: I am part of the class of 2024 where STEP 1 will be P/F. STEP 2 CK will be the highest priority now.

The issue is that it is recommended that students take their STEP 2 CK after they have finished all of their "core rotations". I think all schools are similar in that we all have these core rotations (internal medicine, surgery, ob gyn, pediatrics, etc. etc.)

My third year runs from May 1 2022 to May 1 2023. This is a total of 12 months and 12 "rotational spots". My fourth year is the same. It will run from May 1 2023 to May 1 2024 with "12 rotational spots".

So the issue I am running into is that any way I schedule my rotations is bad in my opinion. I could be wrong but hear me out.

Context I am currently interested in orthopedic surgery but anesthesiology is a second choice I like a lot. Overall though I am going into 3rd year open minded. I frankly have liked all of the classes I've taken in med school except neuroscience so I could see myself liking something else. Overall excited for third year! Anyways, back to the problem/puzzle!

Let's call this the "straight through route":
- Complete all 12 core rotations from May 1 2022 to May 1 2023.
- Request a study elective from May 1 2023 to June 1 2023 and just study for STEP 2 CK. (Our school allows us to take electives during 3rd and 4th year and some of them can be just study periods)
- Take STEP 2 CK June 1 2023.
- Find out my score July 1 2023.
- Apply for residency September 2023.

The issue here with this plan are multiple things.
1. I'm not 100% sure if I want to do ortho. I like it and I've working towards it since I started med school but I want to do an elective before I'm sure. Therefore, I want to fit in an ortho elective during 3rd year. This would push back my STEP 2 CK as I would need to do my final core rotation from May 1 2023 to June 1 2023 instead of studying for STEP 2 CK. Then I study from June 1 2023 to July 1 2023 and take STEP 2 CK July 1 2023. Find out my score August 1 2023. Apply in September 2023.

- I'm not a big fan of this because I literally find out if I'm elgible for ortho about a month from the application process lol. But this isn't even the biggest issue. If I find out I', not competitive for ortho. I'll just switch to something less competitive.

2. This is the BIG issue I am trying to figure out. How am I going to schedule away rotations when I don't even know my STEP 2 CK score and don't even know if I'm eligible for ortho. Let's say I end up getting a score that is not competitive for ortho but is competitive for anesthesiology. Away rotation applications are due April 2023 I believe. So I essentially need to commit to a specialty prior to knowing if I am competitive for that specialty. What if I apply for ortho away rotations and realize I'm not competitive for it. I can't apply for away rotations in other specialties because it will be August 2023 by the time I find out my STEP 2 CK score and applications are due September 2023.

I don't know if I'm missing something here. But essentially I feel like I have to commit to a specialty by April 2023 when I apply for away rotations and gamble on if I can even do that specialty by application time.

This is a very complicated, logic-based problem/puzzle and I tried to make it as simple as possible. If any upperclassmen, residents, attendings can provide some insight that would be appreciated.

 

[calivianya]

The biggest thing IMO is getting step 2 done as soon as possible. I took a week and a half for dedicated - finished a rotation on Friday, took a week off, and then took the exam the next Wednesday. That was enough time for me to score 255+, but it’s really going to depend on how much work you’ve put in over third year.

If I was in your situation, I would start Uworld from day 1 of third year and aim to get it done by March at the latest, so you have the rest of the year to study weak spots/go over incorrects/use score predictors. You could be hypothetically prepared and scoring in your target range before your core rotations are over. Then, you wouldn’t have to wait until June to take step 2, and would have an idea of where you’re at much earlier.

I would dual apply for away rotations, since you’re not going to know how competitive you are. Try to secure one anesthesia and however many ortho are allowed… students doing aways this year were recommended to only do one per specialty due to COVID, so your experience will hopefully be a little different than mine. If you have landed a rotation and you have to pull out later, that’s not ideal… but it’s better than not getting a rotation in the first place, which is what can happen if you wait to apply. I had lots of classmates say things like, “Oh, I’ll do it later, I’m busy” and they ended up with nothing.

Be aware that rotations on VSAS may be on a different time table than your school‘s, so it’s hypothetically possible for you to finish at the beginning of May, take one week for boards, and start electives as early as the second week of May. That would allow you to have up to four rotations before ERAS apps are due, which would leave you plenty of time to get letters in more than one specialty, just in case.

 

[Lawpy]

Yeah this is a clear example that NBME and med education leaders weren’t thinking properly when they pushed for Step 1 P/F and placed all the stress and weight on Step 2, making MS3 and specialty decisions all the more stressful. Next few years will be quite a ride

I think Step 2 in March-June is the main goto strategy

 

[GoSpursGo]

The biggest thing IMO is getting step 2 done as soon as possible. I took a week and a half for dedicated - finished a rotation on Friday, took a week off, and then took the exam the next Wednesday. That was enough time for me to score 255+, but it’s really going to depend on how much work you’ve put in over third year.

If I was in your situation, I would start Uworld from day 1 of third year and aim to get it done by March at the latest, so you have the rest of the year to study weak spots/go over incorrects/use score predictors. You could be hypothetically prepared and scoring in your target range before your core rotations are over. Then, you wouldn’t have to wait until June to take step 2, and would have an idea of where you’re at much earlier.

I would dual apply for away rotations, since you’re not going to know how competitive you are. Try to secure one anesthesia and however many ortho are allowed… students doing aways this year were recommended to only do one per specialty due to COVID, so your experience will hopefully be a little different than mine. If you have landed a rotation and you have to pull out later, that’s not ideal… but it’s better than not getting a rotation in the first place, which is what can happen if you wait to apply. I had lots of classmates say things like, “Oh, I’ll do it later, I’m busy” and they ended up with nothing.

Be aware that rotations on VSAS may be on a different time table than your school‘s, so it’s hypothetically possible for you to finish at the beginning of May, take one week for boards, and start electives as early as the second week of May. That would allow you to have up to four rotations before ERAS apps are due, which would leave you plenty of time to get letters in more than one specialty, just in case.

I pretty much agree with this. I think you have to plan as if you’re going to get the score you need, and then if you fall short you can always cancel your away rotations. Most importantly, UWorld throughout the year.

 

[Captain_Falcon]

Determine the 2 or 3 fields you could see yourself in for the next 40 years. Schedule away rotations and electives in them early summer. Take Step 2 when you are ready (you can schedule it say early May and push it back to August if you needed to and still get your score in time for applications -> in this scenario it may be wise to prepare to dual apply)



Regarding 12 months of 3rd year rotations. Im assuming these are FM IM Surg Peds Psych OB and what else? You describe your 3rd year as 12 rotation slots. So what other fields are you forced to rotate in? You may rotate throughout the year and fine something you like that you didn't expect and at the same time determine you don't like other fields

 

[Matthew9Thirtyfive]

So what other fields are you forced to rotate in?

My school also requires neuro, anesthesia, and EM.

 

[Captain_Falcon]

My school also requires neuro, anesthesia, and EM.

Mine requires Neuro and has a pseudo EM requirement. Even so, our M3 year is a total of 42 weeks. So if OP has 10 weeks of electives they could easily arrange a few week elective in anesthesia and subspecialty surgery

 

[Med Ed]

This is a very complicated, logic-based problem/puzzle and I tried to make it as simple as possible. If any upperclassmen, residents, attendings can provide some insight that would be appreciated.

The advice from @calivianya is solid.

The timing of Step 2 has become a new topic of discussion on the admin side. All data that has been shared points in the same direction: scores are highest when the exam is taken right after the end of third year. A larger time gap to increase dedicated is actually counterproductive. So plan to take it as early as possible (by mid-May).

High Step 2 scores do not appear out of thin air. Their strongest formal predictor is shelf exam scores. Between those and UWorld (and other practice exams) you should have a very good idea of how you will perform on Step 2 long before you sit for the exam. Step scores are usually released on the third Wednesday following the exam. So if you take by May 16 you should have your score on or before May 31.

VSLO probably won't open until April 15 of 2023, and away rotations won't really kick into gear until July. If I were in your shoes I would anticipate doing a home ortho rotation in June, a home anesthesia rotation in July, and dual apply to away rotations for the late summer/fall. There will be ample time before interview season (and certainly before rank lists are due).

 

[TelemarketingEnigma]

Agree with Med Ed about Step 2 scores not appearing out of thin air. this is anecdotal, but it seems from my experience that shelf scores are much more helpful in determining how you'll do on Step 2 than preclinical exams were for Step 1. My scores varied a bit between rotations, but I scored somewhere right around the average percentile of my shelves I think. Nothing surprised me about my Step 2 score. However you plan your schedule, if you're acing shelves you'll probably do similarly on Step 2 (but still good to think about plan B). If you're tanking them, I'd move to plan B much sooner.