Most Important Things I Learned During Fourth Year...

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medschoolmentors

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Applications and interviews are hard. Of all the things I learned, these tips for fourth year would probably be my top 3. I wanted to put them out there in case it helps any MS3's applying next year! Feel free to ask/add on anything that I missed.

1. Do your research before going on away rotations. I applied to a competitive specialty, so away rotations were a given. I wanted to try out programs in cool cities that I would’ve loved to do residency in, figuring that they'd look favorably upon me if I had spent a month there. Wrong. Some programs (mostly top tier ones) simply don't care if you were there for a month. It doesn't increase your chances for an interview whatsoever. I really regretted dropping $1500+ on each away rotation when I could've spent that money going to programs that would've guaranteed me an interview and would've seriously considered me as an applicant. Use your time and money wisely by doing away rotations where it will boost your chances. Which programs are those? Ask previous applicants, stalk the past years' spreadsheets, ask mentors. This can change, so ask around.

[^edited for clarity... My goal in doing away rotations was to get interviews at places that would've seriously considered me as an applicant. I wanted to use away rotations to express major interest in certain programs I really wanted to go to. I made the mistake of bringing my A-game to higher-tier programs that never would've interviewed me to begin with.]

2. Take Step 2 CK early if at all possible. If you can do better or similar compared to Step 1, take Step 2 CK in the summer/early fall. The scores will come out before ERAS is due, and it will automatically be sent to every program you apply to, which can help your application. Moreover, it will be off your plate for the rest of the semester, which is an enormous bonus. I trusted my practice test scores on UWorld and took Step 2 early with a few weeks of dedicated studying. Best move of 4th year -- with interview scheduling and travel planning stress, there was absolutely no way I could've focused enough to study later in the fall.

(But if your UWorld practice scores aren’t great [particularly if you already had a solid Step 1], then take Step 2 CK later; that way, you can choose whether to upload your scores to ERAS or not. Programs probably like to see CK scores before interview invites, but it won't break your application.)

3. Be proactive and don’t be afraid to ask. If you’re applying to an advanced program, ask whether preliminary year programs will interview you on non-official dates that would fit your schedule better. They’re usually more flexible about interview dates, and this saved me a solid $600. If you want an interview at a very specific program and they didn’t give you one, email/call them (politely!!) and express interest. Granted, this probably only works for a few programs that are mid to lower tier, but it did get me an interview at a place that I ranked highly.


Let me know if there’s anything else I can help address!
 
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5. Don't get drunk and do stupid **** at the pre-interview dinners. You inevitably become part of the residency lore even as a non-resident.

Yes, I do hear stories from other residencies as well. Many fields are much smaller than you think. Don't sully your reputation before you even get started.
 
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1. Do your research before going on away rotations. I applied to a competitive specialty, so away rotations were a given. I wanted to try out programs in cool cities that I would’ve loved to do residency in, figuring that they'd look favorably upon me if I had spent a month there. Wrong. Some programs (mostly top tier ones) simply don't care if you were there for a month. It doesn't increase your chances for an interview whatsoever. I really regretted dropping $1500+ on each away rotation when I could've spent that money going to programs that would've guaranteed me an interview. Use your time and money wisely by doing away rotations at programs that will give you an interview. Which programs are those? Ask previous applicants, stalk the past years' spreadsheets, ask mentors. This can change, so ask around.
This cuts both ways. A program that has 20+ away rotators a year isn't going to like all of them and will have already decided not to rank some before interview season. If they interview all of them, they're wasting resources on the ones they already know they don't like (and wasting the rotators' resources as well). It feels harsh, but programs that don't invite all their rotators back for an interview are being merciful in a sense by not making you waste a trip.

I agree that it's really important to do your research before going on your away rotations. You should rotate at places at which you think you have a shot at matching. Away rotations are precious. In my field, rotating at a top-tier program with a 240 Step 1 score is just a waste. They will be gracious hosts, but you don't stand a chance of matching there regardless of your performance. And if they guarantee you an interview, it still means nothing, because you never had a chance to match there in the first place.
 
Generally agree but with some caveats

1) Yes research your away rotations but more to get the kind of experience you want rather than gunning for an interview. The away is really a month long interview and if you don't make the cut to get invited back, it just isn't gonna happen. Some places grant you a courtesy interview or interview rotators while they're in town - that's all nice and makes for some nice pipe dreams before match day but the dumb fact is that your ranking will be determined by your away performance far more than your interview. Better the program spares people the expense of interviewing than waste their time and money.

2) As noted above, CK timing depends heavily on desired field and Step 1 performance. Just use your brain and don't be an idiot on this one. As a rule though, earlier is better if it's a field that requires it for ranking/interviewing. You aren't getting any smarter during 4th year so get it done.

3) Agree 100% and I would go further and suggest enlisting your mentors to reach out on your behalf as well. I definitely picked up interviews this way. I had a friend not get an interview to a top program, have her mentor call, get an interview after the phone call, and then ultimately matched at that program. I'm sure there are limits to how far this carries you, but my experience has been that there is a smaller group of applicants for any field who are all pretty much equally stellar and it's from this group that things like regional bias and perceived interest play a big role. It's also a place where a well placed call or email can help you. It won't take you from bottom of the pile to an interview, but if you're part of the 100 similar looking people being looked at for 50 interview slots, it can make a difference. Besides, if their answer was already a 'no' then asking won't make it a bigger no.
 
Know all the chill rotations that are done by 1 or 2 PM and stack them up back to back to finish the year.

Additionally, know all the rotations for which you don't have to show up for. I had rotations where the attending was like, "You've already figured out what you want to do and ... yeah, I just want you come get a feel for our specialty. You can come and go as you like."
 
As an aside, it kinda blows me away that a 240 is starting to become the average...score inflation is real.
The average score is still close to 230.
A handful of specialties have medians in the 240s and then 2ish that are close to or at 250.
There are programs in almost each specialty, even uncompetitive fields, where the median score is going to be close to 240s.
 
Additionally, know all the rotations for which you don't have to show up for. I had rotations where the attending was like, "You've already figured out what you want to do and ... yeah, I just want you come get a feel for our specialty. You can come and go as you like."

That would be so nice. I got bashed in an evaluation because I showed preference for patients that were in the age group I would be seeing in my specialty. So also a warning don’t assume everyone is chill during 4th year.
 
The average score is still close to 230.
A handful of specialties have medians in the 240s and then 2ish that are close to or at 250.
There are programs in almost each specialty, even uncompetitive fields, where the median score is going to be close to 240s.

I'd say derm, IR, ortho, ENT, and plastics are all basically 250 as of 2018, and I wouldn't be at all surprised to see 3+ of them averaging over 250 in the 2020 NRMP data.
 
Know all the chill rotations that are done by 1 or 2 PM and stack them up back to back to finish the year.

Agree with this 100%.

Know how to play the game. Once you get sub-Is/important electives/away rotations (if applicable) done, there is no reason for you not to coast the rest of the year. Some people are the workaholic type who will be doing sub-I's and work-intensive rotations up until graduation to get as much experience as possible and be ready to go come start of intern year. That's good for them but I could never do that. M4 year (outside the exhaustion from interviews and stress surrounding matching, which are definitely not nothing) is a gift from above and this time will never come back again until you retire. I've never had such big boosts to my mental and physical well-being than my "research" elective when I pretty much had the month off except for some remote manuscript work and weekly 1 hour meetings, radiology when I got sent home latest by noon, and assorted other rotations with days off and half-days and all weekends off. I got to sleep in, work out consistently 4-5x a week, catch up on Netflix, get together with friends, go home for more than just a quick 4 day trip, etc. You should never feel bad about the time off because once residency starts the hard work will really start.
 
I'd say derm, IR, ortho, ENT, and plastics are all basically 250 as of 2018, and I wouldn't be at all surprised to see 3+ of them averaging over 250 in the 2020 NRMP data.
Its possible, but some of these are very small fields and end up with random up and down fluctuations even though competitiveness remains essentially the same.
 
Haha you do have a point. It hurt my feelings lol
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File the bad evals right here after the mspe.
 
The average score is still close to 230.
A handful of specialties have medians in the 240s and then 2ish that are close to or at 250.
There are programs in almost each specialty, even uncompetitive fields, where the median score is going to be close to 240s.

Yeah that's true...maybe it's the perception of score quality that has altered my perception a bit. I have been tutoring 1st and 2nd year students and people seem to be freaking out about 245s. When it was my year 240 w3as the number. I guess people have higher expectations now. ¯\_(ツ)_/¯
 
Yeah that's true...maybe it's the perception of score quality that has altered my perception a bit. I have been tutoring 1st and 2nd year students and people seem to be freaking out about 245s. When it was my year 240 w3as the number. I guess people have higher expectations now. ¯\_(ツ)_/¯

My personal goal was to be average. I failed to get there. Whoops
 
Yeah that's true...maybe it's the perception of score quality that has altered my perception a bit. I have been tutoring 1st and 2nd year students and people seem to be freaking out about 245s. When it was my year 240 w3as the number. I guess people have higher expectations now. ¯\_(ツ)_/¯

The fact that the scores/number of research papers increase seemingly every year makes me glad that I'm not an applicant 5 years from now.
 
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