ROLL CALL: Who's Program or State Requires Step 3 by PGY3?

[MysticHealer]

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Who's program By state require Step 3 done by PGY3? and Bonus if you know if you have an open PGY3 spot. PM me please.

 

[nitemagi]

California does.

 

[MysticHealer]

Any one else? I know some programs in NJ do. Some in NY do not.
To the MS4 that just interviewed anyone ask this or hear about it on the way?

 

[belle54321]

Who's program By state require Step 3 done by PGY3? and Bonus if you know if you have an open PGY3 spot. PM me please.

No offense, but why do you ask?
IMHO, regardless of what the program requires, I would say it is advantageous to get step 3 out of the way during your PGY-1 when medicine is still fresh in your mind.

 

[MysticHealer]

I'm intrested to see what the trend is by state or part of the country. I had heard about California. Like many things in life I had planned to take it PGY but the timing was off, so it was pushed to a more calm part of PGY2. My program does not have a requirement for it by PGY3.

 

[beezley]

WI does

 

[clement]

...And actually the trend among programs recently when I was interviewing all across the country was to start requiring Step 3 by the end of PGY ONE year.

If you're in a brutal IM program in the trenches or smtg I can understand putting it off, but for most psych interns, why not just get it out of the way before you start logarithmically forgetting all those peds rashes and frothy green STD's.

Who's program By state require Step 3 done by PGY3? and Bonus if you know if you have an open PGY3 spot. PM me please.

 

[nitemagi]

The reason for doing it in PGY-1 is that some states (again, like california) don't mandate step 3 by any date, but that a resident be independently licensed by a certain point in their training (PGY-3 in california). Since it can take however many weeks even to get your step 3 results after taking it, then the application period, then up to 6 months (again in california) to get licensed after all your material is in, that's why it's pushed to take it as early as possible. You can't even start PGY-3 without having your own license.

 

[strangeglove]

Some places want it so that you can involuntarily commit patients instead of relying on attendings to do this.

 

[Leo Aquarius]

Can I take step 3 the summer before residency begins or during orientation week?

 

[TexasPhysician]

TN seemed to not require Step 3 before graduation according to Vandy PD.

 

[splik]

Can I take step 3 the summer before residency begins or during orientation week?

you can but you would be better off doing it in intern year- those months of internal medicine do help. it is not really based on things you learn in books but what you learn in practice. some programs will reimburse you for step 3 if you do it in residency too.

 

[notdeadyet]

you can but you would be better off doing it in intern year- those months of internal medicine do help. it is not really based on things you learn in books but what you learn in practice. some programs will reimburse you for step 3 if you do it in residency too.

Good advice this ^^^. Wait until half-way or so through intern year, after you've had some medicine experience. The Step 3 will be a lot easier to study for.

 

[belle54321]

Good advice this ^^^. Wait until half-way or so through intern year, after you've had some medicine experience. The Step 3 will be a lot easier to study for.

I took my step 3 in april of my intern year without studying and passed. I am not advocating not studying, but anyone who has done medicine for a few months will do fine. Just get in done, really it is not a big deal.

 

[Leo Aquarius]

thanks for the good advice!

 

[Doctor Bagel]

We have no requirements at all for either, but most people try to get their licenses by 3rd year for moonlighting. The residents in programs where no one moonlights (IM, neuro, and I'm sure lots of others) don't seem to take Step 3 until their last year.

This is reminding me that I need to get started on this whole full license thing. And about Step 3 -- I did it at the start of 2nd year, which worked out fine for me due to the fact that there's no reason to get a full license in 2nd year here since we can't moonlight. I'd probably advocate some studying for it, though.

 

[notdeadyet]

We have no requirements at all for either, but most people try to get their licenses by 3rd year for moonlighting. The residents in programs where no one moonlights (IM, neuro, and I'm sure lots of others) don't seem to take Step 3 until their last year.

I'm pretty sure I would have found the Step 3 a lot harder had I taken it very long after my ward months. A lot of the questions felt familiar because of my ward months in medicine, my ED months, and outpatient month in peds. Those are only a few months old at this point and I already feel the info slipping away.

I would think the ideal time to take the Step 3 for most psych residents would be somewhere near the end of intern year when the info is still fresh, but hopefully before the burnout stage of intern year, if you attend one of those programs.

 

[Doctor Bagel]

I would think the ideal time to take the Step 3 for most psych residents would be somewhere near the end of intern year when the info is still fresh, but hopefully before the burnout stage of intern year, if you attend one of those programs.

You're writing this as if burnout is something only experienced by some interns presumably at toxic (or merely very hard working) programs. From my experience, I'd say burnout is a near universal experience amongst interns. I suspect a lot of your colleagues are feeling it right now and maybe the culture of your program is one where people don't discuss it.

I don't know why, but I feel some need to argue against the persistent optimism on this forum where the construct is that all residents are happy (and never burnt out) or they train at a malignant program. I guess this isn't so much in response to your post and more related to various complaints I've made that are universally met with the notion that I train at some horrible place when in reality I train at a place where I work fairly hard and where I have some bad days. And where I got freaking burnt the hell out as an intern and where I'm feeling burnt out right now as a 2nd year. But I'm pretty darn sure I'd be burnt out if I were at your program or probably any other not super cushy program as well. Residency is hard.

Anyway, sorry for the rant. I just feel the need to get the message out there that burn out is fairly normal experience in our profession (especially during internship) and that if you're feeling that way, it's OK. Talk to people about it, get help, but it's kind of part of a natural process. And on the burnout, Step 3 note, if adding step 3 to internship adds too much stress, it's OK to put it off until 2nd year.

 

[billypilgrim37]

I guess this isn't so much in response to your post and more related to various complaints I've made that are universally met with the notion that I train at some horrible place when in reality I train at a place where I work fairly hard and where I have some bad days. And where I got freaking burnt the hell out as an intern and where I'm feeling burnt out right now as a 2nd year. But I'm pretty darn sure I'd be burnt out if I were at your program or probably any other not super cushy program as well. Residency is hard.

Everybody's complaint filter is set at a different gain, but learning what that threshold is requires sitting over beers and watching bad movies together. We just get to look at a cute picture of your cat. Those of us who have been around long enough to get a sense of your style and know where you're at can adjust for these co-variates, but for the random med student who wanders on to the board, you are the queen of doom. Or your cat is. I'm never sure if it is you or your cat posting here, actually.

 

[notdeadyet]

You're writing this as if burnout is something only experienced by some interns presumably at toxic (or merely very hard working) programs.

I reread what I wrote and I see I wrote poorly.

Burnout can happen anywhere. What I meant to say in fewer words was that some programs have a known point in time in which the entire intern class is burnt out ("at that stage"). I'm not sure if it's due to poor scheduling of rotations or call schedule, but I know of several programs in which there's a specific point in time by which the upper levels know the interns as a whole are going to be burnt out. This is a different experience than at many other programs in which different folks have different periods in which they're burned out. It's much healthier when we all take turns... ;-)

Sorry for not being more clear. Burnout does not equal toxic program. Burnout is more common at toxic programs, but burnout of interns is not symptomatic of one.

From my experience, I'd say burnout is a near universal experience amongst interns. I suspect a lot of your colleagues are feeling it right now and maybe the culture of your program is one where people don't discuss it.

I go to a very touchy-feely program with a weekly process group in which burnout and individual gripes and challenges are freely shared.

But if burnout is "near universal" at a program, there are either issues afoot or folks are using the term "burnout" rather loosely. I think folks sometimes throw the word around to describe "overworked and tired" which is a lower threshhold than I'd use. When I think of burn-out, I think of folks who become depersonalized, show behavior changes, have reduced satisfaction outside the job front, etc. I read a good article about it but am too tired to look it up right now.

 

[notdeadyet]

I don't know why, but I feel some need to argue against the persistent optimism on this forum where the construct is that all residents are happy (and never burnt out) or they train at a malignant program. I guess this isn't so much in response to your post and more related to various complaints I've made that are universally met with the notion that I train at some horrible place when in reality I train at a place where I work fairly hard and where I have some bad days. And where I got freaking burnt the hell out as an intern and where I'm feeling burnt out right now as a 2nd year. But I'm pretty darn sure I'd be burnt out if I were at your program or probably any other not super cushy program as well. Residency is hard.

I hear you. It's natural for folks to want to believe the grass is always greener, so medical students sometimes have a vested interest in believing that while 3rd year med is hard, things aren't so bad in residency. Therefore, anyone who challenges this comforting notion must be an outlier and either a wimp or attending a particularly malignant program. No one who has read your posts over time could really walk away pegging you for either.

I think there's probably a middle ground that can be sometimes hard to appreciate. Folks who aren't burnt out can naturally overlook folks who are, and folks who are burnt out can sometimes assume everyone is. The real problem is when folks are burnt out and assume they are the only one.

Burn-out happens. And unless you're at a particularly toxic or cush program it has a lot to do with luck (the intensity of your particular rotations) and also each individual's background. I don't feel burnt out, but it's not because I'm any kind of rock star (and I have evals that will attest to that) or attend an easy program. I think a lot of it is because I'm an older dude that came to medicine later in life and has already had a career path in which I consistently worked more hours than I have as an intern and in a very pressured and intense environment. Experience helps me know how to balance out the hours (and more importantly, leave work at work) and the few extra years helps me keep perspective (I don't need to be top of class, I don't need to have every attending like me, and at the end of the day even if a patient dies, my wife is home sleeping safely, so it's all good).

Sorry, drifting here. My point, DoctorBagel, is that while the first couple years of residency may find you with times when you're burnt out, from my experience it really does act as a buffer later. You'll hit easier months (or, touch wood, years) of residency, maybe a few cush years at a new job, and then you'll find yourself in a particularly rough professional situation in which you're working hard and have a lot at stake. And when that happens, because you've already been challenged to the point of prioritizing things in your life very carefully and finding out where your limits lie, you'll be able to manage things a lot easier and know when and where to push back to do the best possible job at work without driving your self or your family crazy. The burnout you're feeling now will pay dividends later.

Hope that makes sense. Hang in there. And my apologies if my attitude sounded flippant or pollyanna. I didn't mean to make light of burnout or anyone experiencing it.

 

[MysticHealer]

You guys just had to turn a nice simple report your program and state thread in to a place to preach. Advising residents to get Step3 done early is all well and good. But some times it happens. Malignant or not was not the question. Thanks to those who did responded on topic. Everyone else, it was fun and entertaining.

 

[whopper]

I remember a buddy of mine in residency was studying for his step III and when the attending found out, he pretty much let the resident go to the library for about 3 weeks during his rotation, with the attending only asking him to show up if the workload was too much.

The pro in psychiatry of getting Step III out of the way is that you can focus now on real psychiatry. That is reading psychiatric texts and articles in-depth and study for the board exam. The problem with requiring Step III too soon is that psychiatry residents are often in training in a field of medicine hyper-focused on areas that are usually outside the norm of what is on that exam. It's no surprise that fields such as IM and FM tend to do better on that exam since what they encounter daily is the bread and butter of it while our field is only about 10% of the questions, and just my luck, I usually did bad on the psychiatry questions (about 70% correct, when you figure it should be 90%+) even though I knew them well (to this day I think I should've been right on many of them marked wrong).

Another con is that the contour of timing may not fit well with most programs in getting step II out of the way for the fearful. Usually most programs' workloads become light in 3rd and 4th year, leading to more time to study for the exam.

As for residency being tough, so long as it's fair, with attendings teaching, not putting residents in no-win situations, free from hazing, and residents have an outlet to complain for positive change, IMHO that's acceptable. Whether I had to work 80+ hours or 40 hours, it for me was very upsetting when something violated the situations I mentioned. For example, I had a situation where a nurse manager would start screaming at the resident whenever the attending screwed up, even when I told the attending I didn't agree with what she was doing. Another situation was one resident never showed up on time and didn't do all of his work, prompting the chief or attending to ask other residents to cover for this guy's mistakes but no one addressed this guy's problems. (When they asked me to cover for him again, for about the umpteenth time, having warned them I would not tolerate this again, I refused and threatened a lawsuit if they punished me because they really weren't going after the real source of the problem. Very odd day for me, I was raising my voice against my chief and an attending and told them I was 10 minutes away from calling a lawyer if they pushed this. It would've made a good reality show). Of course less hours were usually better, but I at least I think I didn't get upset when everything was within the guidelines.

As for that resident, they never did anything apparent to me to fix that mess. He graduated, but they knew not to ask me to cover for him again. Had gone on for about 1.5 years with me politely asking them to stop it, telling this guy (a senior resident) to stop it, bringing it to the PD before I drew the line. As a chief, I was basically told something to the effect that he was given a free pass because his aunt was a professor in the program.

 

[MysticHealer]

Anyone know if Yale requires Step 3 for moving on to a PGY year?