Step 1 Before or After Clerkships (Input from M3+ appreciated!)

[Shockwave456]

So some schools (Penn, Baylor, NYU, etc.) have curricula in which students take Step 1 after the clerkship year, while schools have students take Step 1 before.

Any thoughts on which is a better time to take it? On interview days, some students have said that the clinical knowledge is helpful on Step 1, but I have read in previous threads on this subject that rotations aren't helpful for Step 1 and that the best time to take it is after pathophysiology.

The most recent thread I could find on this was a few years ago, so I figured I'd reask this question, especially since a lot of curricula have changed recently.

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[hownowmauvecow]

many times when you take step will be dictated by what school you attend NOT by your personal preferences. for example at my school (and many others) you have to have taken Step 1 before you start your 3rd year rotations. In my opinion, you can do just fine on step without having done your clinicals (since you should have seen all the material in your first two years). Clinicals may help reinforce certain topics but I wouldn't say that they are at all necessary in order to do well.

 

[Law2Doc]

So some schools (Penn, Baylor, NYU, etc.) have curricula in which students take Step 1 after the clerkship year, while schools have students take Step 1 before.

Any thoughts on which is a better time to take it? On interview days, some students have said that the clinical knowledge is helpful on Step 1, but I have read in previous threads on this subject that rotations aren't helpful for Step 1 and that the best time to take it is after pathophysiology.

The most recent thread I could find on this was a few years ago, so I figured I'd reask this question, especially since a lot of curricula have changed recently.

Take it when your school requires you to take it. You will forget more Step 1 info than you reinforce during the clinical years (as the test is mostly second year information) so I wouldn't say that taking it later is advantageous. And since Step 1 is the single most important guide you will have in terms of what residency specialties will be realistic for you, it benefits you to know here you stand the earliest you can, so you can line up good mentors, do targeted research, line up away rotations, etc.

 

[mvenus929]

Hopefully it won't come down to you choosing schools based on this, but I'll give you my 2 cents.

Step 1 sucks. You have to spend months studying for it (whether you do explicitly or not is another discussion). Residency programs require Step 1 before they will grant you an interview most of the time.

All that in mind, I think it's better to take it before rotations. Yes, rotations will help you master the material more, but you also have to take Step 2 (which has two parts) before graduation. I can't imagine having to take Step 1, then turn around and take Step 2, especially since the material on them is rather different... Step 1 focuses on basic science concepts that aren't necessarily reinforced during rotations, while Step 2 focuses on management that you spend all of rotations learning. Plus, because I know it would happen to some people, it would suck to have your hopes set on a specific specialty, only to have them dashed a few months before you have to turn in residency applications. It's hard enough picking a specialty as it is.

 

[Sophocles]

Hopefully it won't come down to you choosing schools based on this, but I'll give you my 2 cents.

Step 1 sucks. You have to spend months studying for it (whether you do explicitly or not is another discussion). Residency programs require Step 1 before they will grant you an interview most of the time.

All that in mind, I think it's better to take it before rotations. Yes, rotations will help you master the material more, but you also have to take Step 2 (which has two parts) before graduation. I can't imagine having to take Step 1, then turn around and take Step 2, especially since the material on them is rather different... Step 1 focuses on basic science concepts that aren't necessarily reinforced during rotations, while Step 2 focuses on management that you spend all of rotations learning. Plus, because I know it would happen to some people, it would suck to have your hopes set on a specific specialty, only to have them dashed a few months before you have to turn in residency applications. It's hard enough picking a specialty as it is.

At the same time you are done with your major clinical rotations 6 months before everyone else- giving you ample time to decide on the specialty which you truly did enjoy and want to pursue, or give you an extra six months to solidify what it is that you want to do before everyone else with the traditional 2+2.

At Columbia, they were able to increase their average score from ~238 to a ~241. I'm not in medical school so I don't really know if this is a big difference or even if this can be attributable to the new curriculum or the students that year. Regardless, it doesn't seem that it hurt them and talking to the students (very small sample size- I confess) they seem to like the new schedule.

 

[mvenus929]

At the same time you are done with your major clinical rotations 6 months before everyone else- giving you ample time to decide on the specialty which you truly did enjoy and want to pursue, or give you an extra six months to solidify what it is that you want to do before everyone else with the traditional 2+2.

For the record, I'm also in a school with a shortened preclerkship curriculum. We finish in December, take Step 1 in Jan/Feb, then start on the wards in March. Most of my classmates are gearing up to take Step 2 now that we're done with third year. We get 6 months before applications for residency open for submission (and our school is pretty anal about making sure we get our applications in practically as soon as the application opens). In that time, you have to decide for certain which specialty you want, and start getting letters of recommendation. You also have to start figuring out away rotations, especially if you're going into a specialty that requires them (such as ortho). Some programs also want Step 2 scores, so you have to take that before applications go in.

So it's not an extra 6 months you get, it's an extra 3. And if you don't take Step 1 until April of the year you apply, then realize your score isn't high enough for the specialty you were pursuing, you have less time to get things together. More time, perhaps, than the people ending third year in June, but still, less time.

And the most important thing to remember about Step 1 is that you are not your school's average. Going to a school with a high average just means that you're going to a school with smarter than average (or better test taker than average) med students. There are still people who fail, and people who do far below the school's average (even if they do pass). You are the biggest force in determining what your score is, not the school you attend.

 

[Sophocles]

For the record, I'm also in a school with a shortened preclerkship curriculum. We finish in December, take Step 1 in Jan/Feb, then start on the wards in March. Most of my classmates are gearing up to take Step 2 now that we're done with third year. We get 6 months before applications for residency open for submission (and our school is pretty anal about making sure we get our applications in practically as soon as the application opens). In that time, you have to decide for certain which specialty you want, and start getting letters of recommendation. You also have to start figuring out away rotations, especially if you're going into a specialty that requires them (such as ortho). Some programs also want Step 2 scores, so you have to take that before applications go in.

So it's not an extra 6 months you get, it's an extra 3. And if you don't take Step 1 until April of the year you apply, then realize your score isn't high enough for the specialty you were pursuing, you have less time to get things together. More time, perhaps, than the people ending third year in June, but still, less time.

And the most important thing to remember about Step 1 is that you are not your school's average. Going to a school with a high average just means that you're going to a school with smarter than average (or better test taker than average) med students. There are still people who fail, and people who do far below the school's average (even if they do pass). You are the biggest force in determining what your score is, not the school you attend.

Great points! Thanks for your input.👍