IM Sub-I necessity and timing

[swman]

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-My school doesn't give us any elective time in 3rd year (okay, I lied - I burned it before the year started for step 1 study)

-Of all the core rotations, IM is by far my favorite.

-But, before committing to IM it would be nice to try some electives out at the beginning of 4th year. I am specifically very interested in Neurology based on preclinical classes. Also mildly curious about Derm and PMR as both have better lifestyles and Derm is an IM-type specialty and PMR somewhat resembles Neuro. However, if I try some of these things out and decide that I still enjoy IM more, I was thinking I had best fit in an IM Sub-I somehow.

-So basically I have just July and August before submitting ERAS (September is basically shot since our school mandates we take Step 2 before Sept 30). Would you recommend pencilling in an IM Sub-I in August and only getting to "try out" 1 of the above 3?

-Is a Sub-I totally necessary? I honored my IM rotation and had a glowing eval that explicitly mentions that I functioned at the level of an intern, although this was at a smaller VA hospital from a non-famous clerkship director rather than a big shot from the ivory tower. With an October Sub-I I wouldn't have the grade in time to show up, but if I get an LOR how late can I submit it and still have it be a factor in the residency programs' decision process?

Thanks in advance

 

[Neurontin]

Granted, this is only my very biased opinion.

I was in a similar position to you -- I loved IM, but also was toying with the idea of derm and neuro (my Phd is in Neuro so I had a vested interest). However, I found clinical neuro very depressing, compared to IM, and I thought IM offered far more space to branch out and push the decision of subspecialization later -- cards, gi etc. Neuro did, however, have a very fascinating diagnostic aspect to it... the cases are far more challenging to diagnose than IM (and many patients remain just undiagnosed because nobody can figure out what they have).

Many of my friends told me this "derm is like IM" thing, but I was so disappointed to find how little medicine mattered for derm. In my personal experience, derm was more like radiology -- a lot of rapid pattern recognition rather than a data-driven "work-up", which is mostly what appeals me to IM or neuro.

If you have even a fleeting thought about another elective specialty I would recommend thinking about doing an elective in it. For something like derm, you need to get your act together pretty early since it's such a competitive match. For neuro, not so much.

I would strongly encourage you to consider doing an IM sub-I before your interviews, and to get a letter from your Sub-I attending or course director. I felt like I never understood what being an internist is really like until I did my sub-I and actually had serious patient responsibilities and had to make clinical decisions on-the-fly. If you're sure you want to do IM, and don't care too much about going to a very competitive program, I suppose then it's not necessary, but do it more for your own experience as it will be invaluable.

You can do a sub-I as late as August and safely get a letter and have it in your application (I did my sub-I in August of my application cycle year). September is also theoretically possible, if your LOR writers are on top of things, but October will be pushing it beyond your comfort zone.

Again, different residency programs assign different levels of importance to your coursework -- some programs like even outside applicants to have done a Sub-I in their program (like some of the Harvards), some (like JHH) place far more emphasis on your sub-I performance than on your clerkship, and other (I'm sure exist) that probably would gladly have you with an honors on your basic clerkship without a sub-I (although I'm not aware of any from personal experience).

I'm sure others on this board can chime in.

 

[NPR]

there have IM-derm combo programs for those who can't decide

a large percentage of those grads instantly drop the IM though and are purely derm

 

[dragonfly99]

I'm pretty sure I didn't do my IM sub-I until September and I still matched well in IM. It's not ideal to do it that late, but it's definitely possible.

This is a tough situation you are in...also sucky that you have to take Step 2 by Sept 30th, so you don't exactly want to be on a hard rotation in September (like a sub-I).

I hate to see you making a life altering decision with such limited experience to back it up.

Derm is very competitive. First I would talk with your school about how competitive they think you'd be for derm. Do you have a high Step 1 score? Are you likely to end up in the top 1/3 of your class?

Maybe you could do
a) July - neurology rotation
b) August - derm rotation and study for and take step 1 at the end of the month (or switch and do derm first, then neuro)
c) September - IM subI, and try to get your LOR maybe 1/2 the way through or at least by the end of the month or so. Usually this can be done. You could still submit the rest of your ERAS before having that last letter.

p.s. I thought neuro was a required 3rd year rotation at all schools...

 

[VandyMed2009]

I would advise you to talk to your registrar/advisor/whoever is in charge of scheduling at your school. You may find these restrictions/deadlines are much more flexible than you believe.

Perhaps you can push a third year clerkship you haven't done yet and that isn't as important (outpatient medicine, pediatrics, etc) to later in the year. I also bet they will let you take Step 2 later, there's really no reason related to residency application that you would need to have it done as early as September.

 

[swman]

Hey everyone, thanks for the responses and keep them coming...I have to decide on a 4th year schedule by Tuesday!

I'll try to answer everyone's questions:
-Vandy: Our school is flat out militant about 3rd year rotations being finished before the end of June as well as Step 2 being done by Sept 30 (A ridiculous rule I know, but I doubt I would be successful at breaking it)

-dragonfly: Neuro is a required 4th year rotation at our school.
Also, I'm competitive for derm
-Step 1 263
-Clinicals: All honors so far (Medicine, Peds, OB/GYN)
-Also got an award/large scholarship from our derm dept
based on preclinical grades/Step 1 score encouraging
us to go into academic derm.

Dragonfly, I really liked your scheduling idea and I'll definitely consider it. FWIW, I don't have a lot of interest in derm at the moment - most of the curiosity comes from the lifestyle, as well as the fact that I can. A small part of me wants to try it and be sure it's not for me, so that when I'm on a call night during IM or neuro residency I'm not wondering what could have been🙂 So yeah, I'm liking the Neuro in July/Derm + Step2 in Aug/IM Sub-I in Sept idea.

 

[dragonfly99]

I think you can definitely match in neuro or IM even if still doing rotation(s) in September. The dean's letter doesn't even come out until Nov. 1st and for IM, a lot of schools don't even invite people for interviews until they see that. Plus with your grades and Step 1, you are going to get IM interviews even if you aren't done with your subI by the time you submit your ERAS application. You could likely get away with a subI even later (like October) though it would be less than ideal.

I was freaking out early in my 4th year b/c I didn't totally decide on medicine until early fall, and a lot of students at my school had already turned in their ERAS applications and had all their LOR's etc. in before I even submitted mine, but everything turned out fine. Of course, there are some specialties where it's more important to turn stuff in early (or they have an earlier match, etc.).

I think it's most important to find a specialty that's a good fit for you, as opposed to feeling rushed and then wishing later you'd done something else...