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Optimal Order of Rotations to Max Step 2 CK Score


Full Member
5+ Year Member
Oct 7, 2014
  1. Resident [Any Field]
- Medicine before surgery (there is some medicine in surgery)
- Medicine closer to Step 2CK (so medicine and surgery could be last 2)
- I enjoyed doing OBGYN right before Peds because it helped with peds shelf questions.

I think those are the most important points, in my opinion.
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Full Member
5+ Year Member
Nov 1, 2015
  1. Medical Student
There are pros and cons to every schedule you can think of. Here are some general principles that people tend to follow (some are contradictory and I will point these out below):

1) Medicine before surgery. Important for the aspiring surgeons out there because you really want to shine on surgery and the surgery shelf is quite difficult. A lot of the surgery shelf is about managing medical problems for which the final treatment option is surgery. They do this because surgeons and to a lesser extent everybody else need to know the indications for surgery. It's pointless to test you on surgical techniques and approaches because that's not relevant to non-surgeon doctors. So they test you on whether you know when surgery would be indicated for common conditions and if surgery is not indicated, what the next treatment should be. I like to think of this as a treatment ladder - conservative -> medical therapy -> surgical treatment.

2) Medicine near the end of the year. This helps you shine on medicine which, along with surgery, is one of the most important rotations you will do in medical school. Having it near the end allows you to capitalize on all your prior experience. While content from psych or neurology may be less relevant to medicine (or at least make up only a small part of it), you would be surprised at how much the day-to-day knowledge you get from just being on clerkships builds up. If you've done a lot of inpatient rotations already and know how the hospital generally runs, it really helps you during medicine because you don't have to learn those things and can focus on the breadth of things there are to learn for medicine. Incidentally, this also helps you for Step 2 CK because medicine makes up the lion's share of questions on there so studying for the medicine shelf is the closest you'll get to studying for CK on clerkships. This material will then be fresh in your mind as you enter dedicated period, thus allowing you to condense your time and start off stronger.

3) Medicine early in the year. Others advocate for doing medicine early because it really sets the pace for all your subsequent rotations. You learn a ton on medicine that is directly relevant to clerkships like family medicine, neurology, etc. It's very helpful to be able to sit down, look through a patient's hospital meds, and understand exactly what it is, why they're getting what they're getting, and knowing how much room you have to go with the doses. The specialties are all interconnected and medicine is the centerpiece. Having medicine under your belt will help you perform well on those other rotations in this way.
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Full Member
5+ Year Member
Aug 23, 2016
  1. Medical Student (Accepted)
I think more important than the order is gonna be your ability to keep up with the info throughout the year. A lot of people only focus on the rotation they’re on but I kept up with all anki cards from every rotation throughout the year so I wouldn’t forget stuff. But I also have a weird 3rd year that allowed me to do that
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Dr. Doctor MD

Full Member
2+ Year Member
Jun 2, 2018
For honoring rotations I think optimal order is:
Psych -> IM -> OBGYN -> Peds -> Surgery -> FM
Ease into clinical rotations with psych, then set a foundation for the entire year with IM, then learn the basics of the OR in OBGYN so you know how to act during surgery, peds is good right after OBGYN, then end with FM since it's so broad and essentially encompasses all other shelf exams. IMO this is the best schedule for clinic and shelf exams.

For Step 2 CK, ending with Peds/Surgery -> IM as your last three would probably best. Taking and studying for the IM shelf after 2 to 3 months of IM is amazing preparation for step. For maxing out your step 2 CK, taking IM last is definitely the best.
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not an elf
7+ Year Member
Apr 6, 2014
  1. Resident [Any Field]
FYI your school is probably gonna give you an order different than the schedule you ask for anyways. All the students ahead of you have to get placed onto the rotations they need to graduate first, and then the MS2s can be placed into what's left. I don't know a single person who got the whole MS3 layout they asked for. I counted it as a blessing just to get my Step dedicated time off when I wanted, some of my friends didn't even get that.


Full Member
2+ Year Member
Jun 1, 2018
  1. Medical Student
In terms of ERAS, getting letters and such, does the order of these rotations matter, or is it more the away and sub-internships that tend to be time crunched? I am very interested in surgery and want to make sure I get the recommendations that I need. FYI I am starting at a school that does an 18 mo pre-clinical.
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