Need advice

[loca Dr. chica]

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I'm currently a 3rd yr (just finished 2nd yr and will be taking Step 1 soon). I have an important decision to make and I was wondering if anyone here can give me some advice. I'm interested in doing EM in Cali, NYC, Boston, etc...basically a big city with a lot of options. I know EM is getting more competitive and a lot of the top programs in these cities are even more competitive. Right now, on my practice tests for Step 1, I'm really not where I want to be. I'm contemplating taking a rotation (2 months off) to study for a few more weeks and get a score that I would be happy with and that would make me competitive. If I take this rotation off, I'd have to make it up at the beginning of 4th yr, which means I won't get to do an EM rotation until September-October at the earliest. Would this be too late to get recommendations for residency? I will also be limited in my flexibility 4th yr, which means I'll have to study for Step 2 while on some elective rotation, and will probably only get to do 1 away rotation (if that). Looking at the FAQs on this forum, many people have said that they got interviews even before sending off their recommendations just based on their Step 1 score, which leads me to believe that Step 1 score is the most important factor to get an interview. Basically, my question is if it is worth it to take a rotation off and do really well on Step 1 and do less away rotations and have my recs in later? Or to get a mediocre Step 1 score and have more flexibility 4th yr to do more away rotations? What is more important: Very good Step 1 scores, less away rotations, recs in later OR mediocre Step 1 scores, more away rotations, and recs in earlier?

Any advice would be much appreciated and sorry for the long post.

Thanks

 

[Mighty Mouse]

My opinion is this:

Board scores follow you. You never want to be in a position where you get your scores back and you're not happy...and even worse, you can look back and say, "man, if only I had taken that extra month." If you feel you need the extra study time, then take it and be confident that you put forth the study time you feel you need.

I did EM rotations in September (at the institution I ultimately matched at), and then in October (my first 2 rotations of my 4th year). I also did a trauma surgery rotation at the same institution as my October EM to get more face time.

My application went in on Day 1. At that point, I had 3 great non-EM LOR's, but none from EM attendings. I asked an attending at my September rotation 2 weeks in, and it was filed in time for my first interviews. My October LOR did come in after many of my interviews....but in a way it was nice, because it gave me a reason to write to the places I was most interested in to touch base again...Dear Dr. X, as you review my application, I wanted to bring another LOR to your attention...blah blah, etc.

Ultimately, as a Caribbean grad who crushed both Step I and II (because I made sure I gave myself the needed study time to prepare and go in feeling confident), and got my LOR's in due time, I matched at my #1 choice.

Now, by no means is my situation 100% identical to yours. I am sure there are seasoned veterans out there who will chime in as well....but I firmly believe board scores don't lie, and show who can hang with the rest of the applicant pool. That helps get you through the initial filter to get the interview. All the rest matters more when you're sitting in the chair interviewing, and afterwards when the match crew is deliberating. If you have strong LOR's and performance evals from all your other rotations, I am sure that some extrapolation can be done to imply you were going to get a good one from your EM rotation too.

Bottom line...study till you're ready, crush it, and the rest will take care of itself.

EM, PGY-1

 

[SoCuteMD]

I just took my boards and am starting MS3. I honestly don't think that two months off is going to get you much further. I noticed that my progress plateaued significantly for the last two weeks (out of 5) that I studied. I don't think those two weeks got me anywhere and they would have been a nice vacation.

Ask yourself this "How much can I REALLY learn in two months?" I thought about deferring a rotation and decided that I could only learn so much. By the time I'd read over something 4 or 5 weeks ago, I needed to review it AGAIN to refresh it - and it became a vicious cycle.

Just my opinion.

 

[Mary Jane Watson]

I agree with SC. By the time I got to my 4th week of studying, I just wanted it to be over. If you REALLY feel you need that extra time, then take it, but that time I used during 4th year that you won't have was invaluable. I was caught up in Katrina, had to rearrange my away and step 2, plus do my apps and get my letters. Doing my surgery rotation during that time would have been difficult. Trust me, you will want to push the books away around weeks 4/5.

 

[quinsy]

I disagree with the idea that you won't gain from more studying. I think it is personality dependent and dependent on your studying techniques. I do have a friend who delayed Step 1 and is always regretting it, but if you ask me... well she was barely passing the practice test and I think a 205 in the end looks better than a 187 even though it's not an awesome score.

For me, I tend to slack off the further away the test is, so the closer the test is, the more high-yield and hard my studying is. I delayed Step 2 because I wasn't happy with my score on the practice test (205) and took it during a vacation a couple of months later and got a 241. Way happier!!

The thing is that there is REALLY high yield study material for Step 1, namely First Aid for Step 1 and the Qbanks. If you have enough time to do enough studying on those 2 main sources that you basically have stuff down pat/memorized or are doing repetitive questions, I really think you'll do better on the test, and I agree that Step 1 scores are inordinately important in residency apps. These other people are talking about studying details which you will forget over time, but if you are just drilling the high yield material, I think that would be the key. 2 months is probably too long though if you've already studied once for it!

 

[Cal2Lane]

Two months off is a long time. Why not take one month off and do a one month elective in a field that will help you in EM? Like Tox, Ultrasound or Anesthesia?

Step I is important and if you feel it will bump up your score (and its not just your paranoia of what may be) you should take some time off. But ask yourself candidly what, if anything, in your preparation is keeping your score at a level you are not happy with.

Best of luck

 

[Vytorin77]

This is coming from someone who just finished up 3rd year and is applying for EM this fall, so take it for what it is worth. I have a mediocre Step 1 score and my advisors here at my school, which has a strong EM program, don't seem to think it is going to hurt my application. What they have told me is that the grades in the EM rotations are the most important thing, followed by other clinical grades and LORs, and that rotating at programs in the geographic area you want to go to and doing well is the best thing to do. You can also try to improve on Step 2, which can help. As one of the other posters said, you will have a lot going on 4th year and it could be hard to get it all done while making up a rotation. I found it hard enough to get my away rotations scheduled while on Internal Medicine during the spring. Anyway, I am hoping for the best with my score and my advisor's advice and am glad I did not put anything off to try to improve my Step 1 last summer. We'll see how it goes. Good luck with everything.

 

[trkd]

I don't think sept-oct is too late at all to get letters. I got a letter a few weeks written for me early in oct. Most places don't offer interviews before the dean's letter goes out on nov 1st anyway. Though I disagree that step 1 is the most important part of getting a interview, I think you should take the time off now if you think you will be more comfortable taking the exam later.