M4 going into Internal Medicine AMA

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nimph

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Hi,

I'm sure you guys are getting bored/tired of these threads but if you wanted to ask another med student and hear another/different perspective on things, here I am.

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I’ll start! How did your third year experience affect your decision to go into IM?
 
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What would be your advice for an incoming first year student to have success in medical school? And did your specialty goals change from M1 to M4?
 
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Are you looking at any fellowships after residency?
 
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I’ll start! How did your third year experience affect your decision to go into IM?
I think the personalities of the attendings and residents I worked with had the greatest influence on my decision. Related to that was also the fact that we just thought the same way. I was rewarded for asking thought-out questions and researching topics on a deeper level. Whenever I was curious about why things were done one way and not the other way, the attendings usually had answers and if not were just as interested in the answer as I was.

Interestingly, during 3rd year, I enjoyed working with the pediatrics attending and residents the most but didn't like the population as much. I was also very turned off by some experiences I had on surgery where the residents were very abrasive/dismissive and not very good towards the patients behind closed doors (just to be unnecessarily pc about this, it's not like all the surgeons are like that; in fact the attendings were quite outstanding)


What would be your advice for an incoming first year student to have success in medical school? And did your specialty goals change from M1 to M4?
First, I'll answer the easy question. Yes, my specialty goals did change and from my informal survey of peers that is very normal (in fact we had some people change their minds like weeks/months before applying to residencies and a few that applied and ranked multiple specialties because they are still unsure of what they want to do. When I started med school I was pretty convinced I wanted to do EM. That was what I was exposed to the most before med school and it seemed really fun. The interesting thing in my case is that I now want to do IM for all the same reasons that I wanted to do EM back then. As I found out more about the different fields and what the different doctors actually do, I figured what specialty actually was closest to what I wanted to do.

Second, my advice for incoming first years (I have plenty so if you want more advice just ask, but this time around I'll keep it short-ish).
1. Be true to yourself. When I started med school I wanted to prove to myself and everyone else that I was super smart and could honor everything. I spent endless hours studying and spent a lot of time memorizing things that I didn't find interesting but thought would get me points on the test. Long story short, that's not how I usually study. Usually I try to understand the material on a deeper level and get the details with practice/as I go. My test scores actually got better 6 months into med school when I went back to the way I used to be and I never honored anything (not that important anyway, in fact my school now doesn't even have honors for pre-clinical years). On the same topic, I started hanging out with a people who were into studying instead of people who had similar personalities and interests. 6 months later I found 3 of my new best friends and I don't really spend time with the other people at this point.
2. Med school, as well as medicine, is a routine and a way of life. Succeeding is all about getting in the habit of working and studying hard.
3. Enjoy it. I know there are a lot of people who do not enjoy med school but I am not one of them. I don't think those people and I went through different things, I think our mentality is different. When I asked them what they didn't like they would list off a bunch of things (scut work, stupid assignments, etc). Interestingly, I agreed with all those things and when I thought about it I remembered those things bothering me as well...but I quickly forgot them and the things that were on my mind the most were the awesome new friends I made, patients that taught me a lot or got better, and attendings/residents who inspired me. What I'm trying to say is you should focus on the important and the good stuff and ignore the bad stuff. That mentality can make med school fun and enjoyable.
4. I have a ton more advice I can give, but I'll stop here for now and if people are curious I can add more later...


Are you looking at any fellowships after residency?
Yes...I'm thinking pulm/crit for now. I was pretty set on being a hospitalist until my MICU rotation which I had in December (so fairly late in the year). MICU patients = floor patient on steroids (figuratively obviously). So it's actually no surprise I became interested in that. In 2 weeks, I'll be doing a pulmonology rotation so I will see if I enjoy the out/inpatient pulm part as well
 
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How difficult is it to match for a fellowship (Especially the more competitive ones like onco/hem or cardio) ?
What are the chances of not matching and becoming an internist?
Since you don't have any standardized exams (e.g step 1,2) after the internal medicine residency, what determines if you will get accepted to a fellowship program? If it is connections and networking how difficult is to make this type of things?
Sorry for the long question.
 
I am also curious about the fellowship application. Do they mostly look at pubs, lors etc, or they look at steps again?
Any stats they will put an emphasis on?
 
How difficult is it to match for a fellowship (Especially the more competitive ones like onco/hem or cardio) ?
What are the chances of not matching and becoming an internist?
Since you don't have any standardized exams (e.g step 1,2) after the internal medicine residency, what determines if you will get accepted to a fellowship program? If it is connections and networking how difficult is to make this type of things?
Sorry for the long question.

I am also curious about the fellowship application. Do they mostly look at pubs, lors etc, or they look at steps again?
Any stats they will put an emphasis on?
I'll be honest and say that since I haven't applied to fellowships yet I don't really know how difficult it is...especially into ones that are more competitive (usually people mention cardio and GI). But I will go even further and say that aside from the specific program directors few people know exactly what the programs are looking for. There is little transparency in the process and every program is different from the rest.

Also, and more importantly, I can give you the feeling I got from the people who have applied to fellowships and have successfully matched. The question for American medical students isn't WHETHER you will match but WHERE you will match. This is also largely (like ~95%) true for residencies. There are a couple factors that everyone knows will influence your chances to match at a competitive spot. LoRs are probably the most important ones. Connections your program director has with other program directors. Research is important but not THAT important because everyone knows that there is little time to do research in a 3 year residency where you might get maybe 1-2 months of dedicated time to do research. The "prestige" of your residency program probably plays a role if you are applying to the top 5 fellowships. Your step scores will also probably influence the decision to some extent.

Just to finish this up I will say this: please, for the love of god, don't be stressing over fellowships at this point in the game. You'll be fine. Getting into medical school is the "hard" part, everything else you'll figure out. In fact, don't stress out over residency applications or even the dreaded step 1. Enjoy the free time you have right now and prepare yourself to study/work hard in med school. Also, don't lose sight of what you are really in med school for...to help people. The rest you'll figure out as you go through the process
 
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4. I have a ton more advice I can give, but I'll stop here for now and if people are curious I can add more later...

Definitely interested in reading any more advice you have for incoming students!
 
I am also curious about the fellowship application. Do they mostly look at pubs, lors etc, or they look at steps again?
Any stats they will put an emphasis on?

They do actually use step cutoffs again for the competitive ones. While OP states the truth with LORs and research, GI fellowships do screen based on step scores which a lot of students don’t realize when they think “oh I will just match any IM program with my 205 and go to a competitive fellowship afterward”.
 
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Definitely interested in reading any more advice you have for incoming students!
1. Take the time before med school starts to enlighten yourself and make yourself a more rounded individual. Don't spend time studying anatomy, you'll do that in depth (and with proper guidance) when you are in med school. Take this time to read a bunch of books that aren't even medicine related (I made myself a project of reading 1 book/week and it was the best thing ever). Spend time with friends/family because you won't see them as much and you will probably miss them once your studying all day or in a different state.
2. Figure out the 1/2/3 thing(s) you can't live without. Write it down (don't just make a mental note because you'll later convince yourself it's not as important as you thought) and never stop doing that thing. Med school takes up a lot of time and if you won't make time for the activities you can't live without you'll stop doing them. For me, this was soccer. It's my exercise and my stress relief. When I play, I can't think of anything other than the game. When I started med school, again, I wanted to prove that I was super smart and all that so I just studied all the time and didn't do much else. 6 months later, I decided that I was being stupid and started looking out for my health and other things. I started playing soccer 1-2/wk and was much happier and because I was happier, studying was easier and I retained more of the material.
3. Make friends in med school. Somewhere in your class of 100s of med students are your new best friends. Try and find them. You can handle just about anything as long as you enjoy the people near you (this btw, was the same advice I got for when I start residency from my resident friends)
4. Here's a piece of some controversial advice. Don't study for step 1, but study for life. I mean, obviously you'll need to study for step 1 but to be honest I think a big portion of the test is silly. I guess if I wanted to rephrase my advice, I would say, study for life and add the stupid step 1 knowledge afterwards. i.e. understand pathophys of heart failure, how the patient presents, how to manage it, etc...and then just add the knowledge of the stupid iron-laiden macrophages in the lungs after. I could expand on all this more, but I hope that it's clear already and not too many people will challenge me on this
5. I have a bunch of advice I can give you guys for studying and taking tests as well...if you guys want it


They do actually use step cutoffs again for the competitive ones. While OP states the truth with LORs and research, GI fellowships do screen based on step scores which a lot of students don’t realize when they think “oh I will just match any IM program with my 205 and go to a competitive fellowship afterward”.
Although I don't disagree with what you said, I would like to add a little more dimension to your post. I think the top GI/Cards programs probably use every criteria available to them (step 1, step 2, penis size, etc) because they can. That said, I don't think a lower score means that you can't match into a GI/Cards program because there are many programs that choose their fellows based on many factors with the most important ones being subjective. When I talked to residency program directors, a lot of them said that they look at step scores last and have a hard time interpreting them and even giving them value. They also said that they carefully read the personal statement and even the hobbies listed. I imagine fellowship program directors will be just the same.

Anyway, I didn't mean to make that as confrontational as it came out but I think there is a lot of unnecessary panic/stress over this and everyone gets super obsessed over their step scores (especially some people on these forums) unnecessarily so. Step scores are important but they are not end all be all and I think we all need a reminder of that every now and then.
 
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Can you tell is how you picked the med school you are currently attending? And do you regret it/wished you looked at other aspects before picking?
 
Can you tell is how you picked the med school you are currently attending? And do you regret it/wished you looked at other aspects before picking?
From what I gather, picking med schools is easy for most...you go wherever they take you. For me I had a choice between 2 and I think I chose correctly. I picked my med schools the same way I now picked my residencies...I used the gut (if you knew me, you would know I am a big proponent of using the gut). I liked the atmosphere/vibe of the med school that I'm at so I went there.

The place I didn't go to med school at, btw, is now my top choice for residency. Basically, I probably would have been happy if I picked the other med school as well. Which brings me to my next point, nobody really knows what it's like at the other med schools cause every one just goes to one. There is the "grass is greener" (other med schools will always be better) and "nationalism/pride" (your med school will always be better) phenomena. Talking to friends at other med schools also doesn't yield great information because nobody can tell you the full experience, they generally point out either the good or the bad.

My advice for you, if you're choosing between a couple places, go with where you felt most at home. Where the people were accommodating and the administration seemed genuine. Where the students were interested in meeting you. I say this because the students in your class will probably have the greatest influence on your med school experience. Once you decide, take some solace in the fact that you could not have decided wrong. Every med school has it's pluses and minuses. And also, whatever choice you make, be happy with it. Don't do the what ifs because you never know what it would be like if you chose differently (and also 60% of happiness comes from your attitude)


Please keep it coming! This is great!
Study tips/advice (btw, I tutor med students of all levels at my school, so I have some practice with this):
1. 3 passes. That's how many times you need to read/look at some material to "get" it and retain it. Usually I recommend reading the material before lecture, then going to lecture (or reading through it without going to lecture), and lastly reviewing everything before the test.
2. Reading and not writing is the same thing as not writing. What I mean by that is that you have to underline/highlight/make charts as you read. This makes you read actively and not just let material pass between the ears. I also recommend stopping every so many slides/paragraphs and summarizing what you just read preferably using some sort of graphic (table, picture, whatever).
3. When taking a test, don't underthink, don't overthink...just think. I have seen WAAAAYYYY too many students come to an easy question and get hung up on a detail that had absolutely nothing to do with the answer. When I asked them what they initially thought this person had they gave the correct answer. This is an example of overthinking. Another scenario is when you read the question and halfway through commit yourself to an answer. Later, even though some of the information didn't quite fit, you pick the answer you were already committed to (or you didn't even finish reading the question). That's underthinking. I strongly suggest when time comes for you to study for step 1 to monitor your thinking and try to pinpoint when you do both of these (don't worry...we all do this). Figuring out where your sweet spot is can be a difference of scoring in the 60th percentile to scoring in the 90th...
4. Another thing I will say about step 1/2 is that they are written for STUPID medical students. You don't need to figure out the cure for cancer on the test nor do you need to imagine things the patient COULD have or think about WHAT IF the patient...Don't do that, just answer the question as if you were a stupid medical student and pick the association that you were taught and know almost reflexively.
5. Use the gut. If you are stuck on a question, don't know the answer, or are between 2 answer choices...use the gut. Did you know that the gut has more nerve endings than your brain!? That's a true fact (as opposed to alternative fact?). Anyway...use the gut...it's correct a lot of the time
6. When you are going through material (and especially when you are studying for step 1) get out of the habit of saying "I'll memorize that later/right before the test" (I know you do it). The problem with that thinking is that there will be WAAYYY too much stuff to memorize before the test or too little time or you'll forget or whatever. Spend a few minutes memorizing the material RIGHT NOW, it'll be much more efficient, trust me.
7. Whenever possible organize material in some way. It's impossible to memorize everything without some organization. A great example (you'll see when you learn it) is anemias. All anemias can be put into 3 categories and that's basically how everyone learns them. Do this for all the material you learn and you'll be a star.
8. Learn the big concepts first and then focus on the stupid details. Concepts stick much better than ideas and they are (in general) much more high yield on the test and in real life (especially in real life which is more important anyway)
9. There is no way around memorization...it's just impossible to learn medicine without memorizing a bunch of information so if you are a memorization snob...stop now. You can (and should) try to minimize the amount of straight up memorization you do by organizing your material, understanding the big concepts, and comparing diseases to each other.

That's all I got for now...unless you guys want advice on some specific topic. If I think of anything else, I'll add it to one of my next responses
 
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From what I gather, picking med schools is easy for most...you go wherever they take you. For me I had a choice between 2 and I think I chose correctly. I picked my med schools the same way I now picked my residencies...I used the gut (if you knew me, you would know I am a big proponent of using the gut). I liked the atmosphere/vibe of the med school that I'm at so I went there.

The place I didn't go to med school at, btw, is now my top choice for residency. Basically, I probably would have been happy if I picked the other med school as well. Which brings me to my next point, nobody really knows what it's like at the other med schools cause every one just goes to one. There is the "grass is greener" (other med schools will always be better) and "nationalism/pride" (your med school will always be better) phenomena. Talking to friends at other med schools also doesn't yield great information because nobody can tell you the full experience, they generally point out either the good or the bad.

My advice for you, if you're choosing between a couple places, go with where you felt most at home. Where the people were accommodating and the administration seemed genuine. Where the students were interested in meeting you. I say this because the students in your class will probably have the greatest influence on your med school experience. Once you decide, take some solace in the fact that you could not have decided wrong. Every med school has it's pluses and minuses. And also, whatever choice you make, be happy with it. Don't do the what ifs because you never know what it would be like if you chose differently (and also 60% of happiness comes from your attitude)



Study tips/advice (btw, I tutor med students of all levels at my school, so I have some practice with this):
1. 3 passes. That's how many times you need to read/look at some material to "get" it and retain it. Usually I recommend reading the material before lecture, then going to lecture (or reading through it without going to lecture), and lastly reviewing everything before the test.
2. Reading and not writing is the same thing as not writing. What I mean by that is that you have to underline/highlight/make charts as you read. This makes you read actively and not just let material pass between the ears. I also recommend stopping every so many slides/paragraphs and summarizing what you just read preferably using some sort of graphic (table, picture, whatever).
3. When taking a test, don't underthink, don't overthink...just think. I have seen WAAAAYYYY too many students come to an easy question and get hung up on a detail that had absolutely nothing to do with the answer. When I asked them what they initially thought this person had they gave the correct answer. This is an example of overthinking. Another scenario is when you read the question and halfway through commit yourself to an answer. Later, even though some of the information didn't quite fit, you pick the answer you were already committed to (or you didn't even finish reading the question). That's underthinking. I strongly suggest when time comes for you to study for step 1 to monitor your thinking and try to pinpoint when you do both of these (don't worry...we all do this). Figuring out where your sweet spot is can be a difference of scoring in the 60th percentile to scoring in the 90th...
4. Another thing I will say about step 1/2 is that they are written for STUPID medical students. You don't need to figure out the cure for cancer on the test nor do you need to imagine things the patient COULD have or think about WHAT IF the patient...Don't do that, just answer the question as if you were a stupid medical student and pick the association that you were taught and know almost reflexively.
5. Use the gut. If you are stuck on a question, don't know the answer, or are between 2 answer choices...use the gut. Did you know that the gut has more nerve endings than your brain!? That's a true fact (as opposed to alternative fact?). Anyway...use the gut...it's correct a lot of the time
6. When you are going through material (and especially when you are studying for step 1) get out of the habit of saying "I'll memorize that later/right before the test" (I know you do it). The problem with that thinking is that there will be WAAYYY too much stuff to memorize before the test or too little time or you'll forget or whatever. Spend a few minutes memorizing the material RIGHT NOW, it'll be much more efficient, trust me.
7. Whenever possible organize material in some way. It's impossible to memorize everything without some organization. A great example (you'll see when you learn it) is anemias. All anemias can be put into 3 categories and that's basically how everyone learns them. Do this for all the material you learn and you'll be a star.
8. Learn the big concepts first and then focus on the stupid details. Concepts stick much better than ideas and they are (in general) much more high yield on the test and in real life (especially in real life which is more important anyway)
9. There is no way around memorization...it's just impossible to learn medicine without memorizing a bunch of information so if you are a memorization snob...stop now. You can (and should) try to minimize the amount of straight up memorization you do by organizing your material, understanding the big concepts, and comparing diseases to each other.

That's all I got for now...unless you guys want advice on some specific topic. If I think of anything else, I'll add it to one of my next responses
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I am also curious about the fellowship application. Do they mostly look at pubs, lors etc, or they look at steps again?
Any stats they will put an emphasis on?

One of the most important factors that goes into fellowship competitiveness is where you train for residency. You can see if you look at the fellowship match list between say Duke vs Wake Forest (2 programs that are in the same geography but different tiers in reputation). If your goal is to train at the Clinic for cards or Denver for pulm/CC or MSKCC for heme/onc and all things being equal, you are gonna want to try to match into a top tier medicine program. while it is not impossible from a less reputable program, it will be much harder.

While I am not a program director, I would say that they do not care very much about your step 1 score. what he does care about is if a GI attending with clout at your program goes to bat for you and says that you're not a half bad physician so thats why its important to develop solid relationships with your attendings and show them that you're not a dumba**
 
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