Which is the most difficult: MS2 (step P/F), MS3, or MS4?

[baylafan]

See poll.

---

Members don't see this ad.

 

[M&L]

Difficult in what way ? Intellectually? Time-consuming ? Emotionally ?

 

[baylafan]

Difficult in what way ? Intellectually? Time-consuming ? Emotionally ?

I wanted to keep the poll open to interpretation, but I am personally most interested in time-consuming/emotionally.

 

[giguerex35]

idk about which is most difficult but i will say 3rd year is not the party everyone makes it out to be

 

[Datypicalpremed]

Personally think it depends on your situation and/or goals.

Want to do primary care and/or just want to match anywhere and/or go to a top school that has sweet P/F during 3rd year? Congrats you’ll probably enjoy 3rd year like you are supposed to.

Want to do derm/neurosurg/etc and/or match a top program and/or go to a mid/low tier school that makes it almost impossible get honors? Better get ready to suck **** for that 5/5 eval (just kidding, best you’ll get is 4/5, enjoy fam med in rural Alaska!!)

 

[Matthew9Thirtyfive]

idk about which is most difficult but i will say 3rd year is not the party everyone makes it out to be

Third year has been amazing so far, but it is definitely not a picnic lol.

 

[M&L]

Third year has been amazing so far, but it is definitely not a picnic lol.

I absolutely hate my third year so far . Hahaha

 

[Matthew9Thirtyfive]

I absolutely hate my third year so far . Hahaha

Really? How come?

 

[MedScat]

I loved third year...somehow I had more free time than I did during preclinical even though I spent more time away from my home since I was usually home studying until like 6pm most nights during preclinical. I like seeing patients so when I have patients, the clinical day goes by quickly. There's also enough down time on the wards to study/do UWorld and Anki so you don't have much to do when you go home. Obviously, surgery really sucked and OBGYN nights sucked but for the most part, M3 was nice. M4 on the other hand....is like a vacation. A really expensive 50k vacation.

 

[Schwifty]

I’m only a month into 3rd year, but I love it. 10x better than preclinical and I have a lot more free time. Not just at a desk studying all day, but I actually get to leave my apartment and interact with people lol

 

[Matthew9Thirtyfive]

OBGYN nights

What does it say about me that I love obgyn lol

 

[odyssey2]

I thought most of med school was a lot of fun…except third year. That was unrelenting hell.

 

[MedScat]

What does it say about me that I love obgyn lol

Psycho lol. JK OBGYN was good, just overnight L&D was not ideal for me

 

[deleted50541]

I found MS2 to be more difficult. While I'd already gotten into a groove from MS1, I was pretty bored sitting in lectures by then and was looking forward to being back in a more working world setting. There was also the pressure of Step1 lingering over my head, which wasn't helped by everyone else's paranoia about it as we got closer to the exam.

MS3 was challenging, but in a good way. I liked the variety of situations and the chance to actually start putting into practice what we'd been learning.

MS4 was a comparative cake walk as we headed into the home stretch. The biggest anxiety came from applying and interviewing for residency.

 

[hiiiiiiiiiii]

I got almost all honors and still hated 3rd year. I would never want to relive that year of my life. M4 is freaking amazing in comparison

 

[differentiating]

As someone who had non-P/F Step 1, MS3 was far and away the worst year of med school. MS4, when you get to choose what you're actually interested in rotating on, is much, much better.

 

[Lawpy]

I'm struggling to see how MS3 isn't the most difficult even if it's enjoyable. Being in hospital for long hours and having to study at night after a long day sucks and is worse than spending 2 years regurgitating Anki flashcards

 

[TelemarketingEnigma]

MS3 is 100% the most physically/emotionally draining, just because of the hours and lack of personal time. Even if I enjoyed my rotations, I frequently came home and immediately crashed on my couch and didn't move again except to go to bed. Having to study for shelves/do busywork on top of that is really draining. My experience was partially influenced by being compounded by all the general COVID stress, but I think it's a tough year in normal times too.

however one thing that I think is a little easier about MS3 is that the concern about just passing is much lower - the couple people I know who failed shelf exams were able to remediate successfully, I think there's a much bigger risk of academic failure in MS1/2. So for some people 3rd year may come as a relief.

MS4 is so much more fun. Even on tougher rotations like my SubI I appreciated actually getting autonomy and responsibility, and on easy rotations it's nice to go home early lol. Not having to study or do busy work at the end of the day means I actually have time for self care and hobbies too which makes overall life better

 

[Vyzzle]

MS3 was a blast, you finally made it, you're 'doctoring,' you're gaining competencies (by some standards), but also bittersweat as I didn't get to see a lot of my preclinical friends as much.

However, and this is just from the sample I've encountered, folks that have never at least worked full-time before med school got assblasted on their first rotation.

 

[longhaul3]

It's probably much different now, but pre-covid, 4th year was the most difficult for most people going into competitive specialties. Travel, interviews, multiple sub-is, starting from square one with an entire new body of knowledge. For the most part you spend 3 years in med school learning internal medicine and learn nothing about the smaller subspecialties.

 

[Chelsea FC]

MS2 sucks if u are **** at test-taking (that was me) and MS3 was easier if u were really personable and work well in a team (also me)

 

[Matthew9Thirtyfive]

MS2 sucks if u are **** at test-taking (that was me) and MS3 was easier if u were really personable and work well in a team (also me)

MS3 is easier in that I’m enjoying myself more and having a great time. But it’s definitely more stressful in that you have to be “on” every day.

 

[TelemarketingEnigma]

However, and this is just from the sample I've encountered, folks that have never at least worked full-time before med school got assblasted on their first rotation.

meh, I worked full time before med school. My full time employment gave me a lot of autonomy, advanced notice of my schedule, time for hobbies, PTO for vacation, weekends off, no homework to do after I got home from work, flexibility for medical appointments... unless you're really lucky, 3rd year is not that. I overall enjoyed 3rd year but I won't pretend it wasn't pretty inhumane at times

my sub-I was 100x better even though I was working way harder, mostly because of the actual autonomy I mentioned before (and no homework/shelf exam)

 

[Matthew9Thirtyfive]

meh, I worked full time before med school. My full time employment gave me a lot of autonomy, advanced notice of my schedule, time for hobbies, PTO for vacation, weekends off, no homework to do after I got home from work, flexibility for medical appointments... unless you're really lucky, 3rd year is not that. I overall enjoyed 3rd year but I won't pretend it wasn't pretty inhumane at times

my sub-I was 100x better even though I was working way harder, mostly because of the actual autonomy I mentioned before (and no homework/shelf exam)

It’s all anecdotes. I know students who worked full time in grueling, grinding jobs with long hours who still got kicked in the ovaries by third year, and I know plenty of people who didn’t have jobs first who had the same thing happen. But there does seem to be an anecdotal trend that the people who seem the most astonished at what actual work entails and are the biggest complainers are the ones who never worked a real FT job.

 

[TelemarketingEnigma]

It’s all anecdotes. I know students who worked full time in grueling, grinding jobs with long hours who still got kicked in the ovaries by third year, and I know plenty of people who didn’t have jobs first who had the same thing happen. But there does seem to be an anecdotal trend that the people who seem the most astonished at what actual work entails and are the biggest complainers are the ones who never worked a real FT job.

I think thats fair overall, my issue with 3rd year has less to do with the actual work on rotations (I think that's where people who haven't worked before tend to struggle) and more to do with the lack of respect from the "system" I guess for like, being a human being who needs to go to medical appointments or get adequate sleep or whatever. It's a problem with medicine overall but i think it's especially bad in 3rd year because you get basically no control over your life

edit: also with real employment you get PAID

 

[Fried Plantaris]

how do you even measure the results of this poll? Step just became P/F so no one will have experience of all three years to compare between them. People that just started third year are going to vote on the poll based off a single rotation. But to answer your question M1(most difficult)<M2<M3<M4

 

[Matthew9Thirtyfive]

how do you even measure the results of this poll? Step just became P/F so no one will have experience of all three years to compare between them. People that just started third year are going to vote on the poll based off a single rotation. But to answer your question M1(most difficult)<M2<M3<M4

People that go to schools like mine can at least answer the MS2/3 part. I started rotations halfway through second year, so I’m actually only 2 rotations from being done with my 3rd year rotations. And we take step 1 after that, so it will be P/F.

 

[efle]

Honest opinion MS3 is worse than MS2 in every way. NBME shelf exams are nastier than preclinical exams. You're working 6 days/week or at night now, often in required subject matter you DGAF about. You're frequently useless, forgotten about, ignored, etc and nobody cares what you think about anything - rightly so because you don't know diddly about squat and will get sent to a different subject as soon as you start to get a grasp on basics. Evals are often more about luck with your site/preceptor than your performance. Often it's hard to even stay involved in your patients because you usually aren't the person getting called about developments in their care. I'm a medicine intern right now and would 1000% do another intern year before I'd repeat MS3, which says a lot.

If you absolutely love patient care and hate studying I can see preferring MS3 over MS2, but MS4 is still much much better because you'll get to choose cool electives to rotate on and don't have to care anymore about evals or shelf performance, just your education.

 

[Matthew9Thirtyfive]

Honest opinion MS3 is worse than MS2 in every way. NBME shelf exams are nastier than preclinical exams. You're working 6 days/week or at night now, often in required subject matter you DGAF about. You're frequently useless, forgotten about, ignored, etc and nobody cares what you think about anything - rightly so because you don't know diddly about squat and will get sent to a different subject as soon as you start to get a grasp on basics. Evals are often more about luck with your site/preceptor than your performance. Often it's hard to even stay involved in your patients because you usually aren't the person getting called about developments in their care. I'm a medicine intern right now and would 1000% do another intern year before I'd repeat MS3, which says a lot.

If you absolutely love patient care and hate studying I can see preferring MS3 over MS2, but MS4 is still much much better because you'll get to choose cool electives to rotate on and don't have to care anymore about evals or shelf performance, just your education.

M3 year is highly dependent on the sites you’re rotating at. At my school we have a lot of different rotation sites, naturally. I’m on OB right now, and I have classmates who are having bad experiences because they are doing nothing except basically shadowing with the occasional opportunity to do something, they are working a lot of hours despite that, and feel like they don’t know ****. Then I have classmates who are having great experiences, myself included. I’ve been lucky so far. Every rotation of this year has been pretty much the opposite of what you described.

Except shelf exams. **** them.

 

[operaman]

I’ve never understood this universal hatred for MS3. I had a really good experience across the board as did many of my colleagues.

Having been on the other side now, I would argue that many poor MS3 experiences are actually the fault of the student. I look on my own services and there are some students that I’ve basically ignored and others I’ve scrubbed into every case, let them do as much as possible, taken aside and taught how to scope and do ear work under the microscope. I’ve even taken students to the bone tab to drill mastoids and put in cochlear implants.

Most students do the bare minimum and blend into the paint and typically disappear around lunch. At best they ask me every morning after being totally unprepared for rounds: “what cases should I go to today?” These students are probably not going to have a good experience because they’re putting in zero effort.

Then there are those who show up early, help the juniors get ready for rounds. They look ahead to the OR board for the week and ask me questions on Monday about a case scheduled for Thursday. They help out in clinic and ask to take call and genuinely seem interested in the field. These are the students I invest in and they probably come away saying they had a wonderful experience.

Look, there are definitely some crap rotations and terrible preceptors out there and no amount of effort is going to make those great experiences. But if you find your entire year is full of bad rotations, maybe it’s worth examining whether there’s some other common denominator at play.

 

[Lucca]

I kept an internal record of the people in my class I thought would love M3 and those who would hate it, and tbh I have been pretty damn accurate. It's a bit of a je ne sais quoi though. And the site / preceptors you get definitely seem to have a big impact. Also, your own identity, unfortunately; i.e. I've noticed my women and minority classmates have felt a lot more unwelcome, ignored, patronized on some rotations than others.

 

[deleted1081396]

M2 was the worst for me. Hated constantly studying for Step 1 and also having to deal with horribly written lectures and exams. Having to remember useless crap like embryology or which genes cause which diseases made it feel meaningless. M3 was better despite the hours because I had good preceptors and the material actually felt meaningful.

 

[Lawpy]

M3 year is highly dependent on the sites you’re rotating at. At my school we have a lot of different rotation sites, naturally. I’m on OB right now, and I have classmates who are having bad experiences because they are doing nothing except basically shadowing with the occasional opportunity to do something, they are working a lot of hours despite that, and feel like they don’t know ****. Then I have classmates who are having great experiences, myself included. I’ve been lucky so far. Every rotation of this year has been pretty much the opposite of what you described.

Except shelf exams. **** them.

There's a problem inherent to MS3 if the quality of the experience is so heavily site dependent and not uniform across all sites

 

[Lawpy]

Honest opinion MS3 is worse than MS2 in every way. NBME shelf exams are nastier than preclinical exams. You're working 6 days/week or at night now, often in required subject matter you DGAF about. You're frequently useless, forgotten about, ignored, etc and nobody cares what you think about anything - rightly so because you don't know diddly about squat and will get sent to a different subject as soon as you start to get a grasp on basics. Evals are often more about luck with your site/preceptor than your performance. Often it's hard to even stay involved in your patients because you usually aren't the person getting called about developments in their care. I'm a medicine intern right now and would 1000% do another intern year before I'd repeat MS3, which says a lot.

If you absolutely love patient care and hate studying I can see preferring MS3 over MS2, but MS4 is still much much better because you'll get to choose cool electives to rotate on and don't have to care anymore about evals or shelf performance, just your education.

Hating MS3 because of crappy shelf exams is definitely understandable and relatable. But it feels underreported on SDN, which is skewed towards being anti evals and pro shelf.

 

[efle]

I’ve never understood this universal hatred for MS3. I had a really good experience across the board as did many of my colleagues.

Having been on the other side now, I would argue that many poor MS3 experiences are actually the fault of the student. I look on my own services and there are some students that I’ve basically ignored and others I’ve scrubbed into every case, let them do as much as possible, taken aside and taught how to scope and do ear work under the microscope. I’ve even taken students to the bone tab to drill mastoids and put in cochlear implants.

Most students do the bare minimum and blend into the paint and typically disappear around lunch. At best they ask me every morning after being totally unprepared for rounds: “what cases should I go to today?” These students are probably not going to have a good experience because they’re putting in zero effort.

Then there are those who show up early, help the juniors get ready for rounds. They look ahead to the OR board for the week and ask me questions on Monday about a case scheduled for Thursday. They help out in clinic and ask to take call and genuinely seem interested in the field. These are the students I invest in and they probably come away saying they had a wonderful experience.

Look, there are definitely some crap rotations and terrible preceptors out there and no amount of effort is going to make those great experiences. But if you find your entire year is full of bad rotations, maybe it’s worth examining whether there’s some other common denominator at play.

I think what you consider lame/lazy students are folks who DGAF about your particular subject. Someone going into psych needs to be asking to take call on their surgery rotation to not get ignored? Doesn't sound like a good experience across the board to me

 

[aldol16]

MS3. You need to pretend to give a **** about things that bore the hell out of you. And depending where you are and what the service is like, you might not even get to do much. Watching people doing stuff sucks.

 

[Redpancreas]

I agree with others who’ve said there’s an infinite variation in factors and while this thread will spark interesting discussion and people will have certain preferences in common with others, there’s going to be no major consensus especially since the system is in flux now with P/F Step 1. I agree with what Efle is saying about how MS3 (and oftentimes MS4s) are put in no win situations.

I think the MS3/4 model is less than ideal. To put my whining hat on for a minute and generalize a bit, I think it favors people who have had prior experience in the real/healthcare world or those who have just developed better work skills in general. I’m not saying skills you get rewarded for having in M3/4 aren’t important to learn, but when you select for things certain qualities (namely scholastic test-taking) for 18 years of formal school and then suddenly expect students to turn on a separate skillset, it can be rough. Some people will catch on faster and it’s not necessarily because they’re ultimately going to be better doctors, but ultimately they’re the ones who get better evaluations, etc. Sorry if this comes off as whiny. I don’t have any ideas to mitigate the issue. It’s the MS1/2 equivalent of someone who’s done an SMP of the exact material covered in M1 and does well (hence why they got into medical school) and then repeats the same material and is graded on the same curve as students seeing the information for the first time.

 

[Matthew9Thirtyfive]

I think what you consider lame/lazy students are folks who DGAF about your particular subject. Someone going into psych needs to be asking to take call on their surgery rotation to not get ignored? Doesn't sound like a good experience across the board to me

Uh yeah. When someone is rotating on a specialty and clearly could not give even enough of a **** to act interested and try to learn things from it, of course they’ll have a ****ty rotation.

 

[operaman]

I think what you consider lame/lazy students are folks who DGAF about your particular subject. Someone going into psych needs to be asking to take call on their surgery rotation to not get ignored? Doesn't sound like a good experience across the board to me

Your clear struggles with reading comprehension notwithstanding, yes students do need to engage with all of their rotations if they want to get the best experience possible. Nobody is interested in everything and yet plenty of people honor all their rotations and have a great third year experience.

It’s very much a get out of it what you put in to it endeavor. My own observation is that those who are unhappy are the same people not really putting in much effort to begin with.

 

[DOVinciRobot]

Honest opinion MS3 is worse than MS2 in every way. NBME shelf exams are nastier than preclinical exams. You're working 6 days/week or at night now, often in required subject matter you DGAF about. You're frequently useless, forgotten about, ignored, etc and nobody cares what you think about anything - rightly so because you don't know diddly about squat and will get sent to a different subject as soon as you start to get a grasp on basics. Evals are often more about luck with your site/preceptor than your performance. Often it's hard to even stay involved in your patients because you usually aren't the person getting called about developments in their care. I'm a medicine intern right now and would 1000% do another intern year before I'd repeat MS3, which says a lot.

If you absolutely love patient care and hate studying I can see preferring MS3 over MS2, but MS4 is still much much better because you'll get to choose cool electives to rotate on and don't have to care anymore about evals or shelf performance, just your education.

Hell, I’m a surgery intern and I agree completely. So much better. Honestly it’s better than any year in medical school IMO.

 

[efle]

Your clear struggles with reading comprehension notwithstanding, yes students do need to engage with all of their rotations if they want to get the best experience possible. Nobody is interested in everything and yet plenty of people honor all their rotations and have a great third year experience.

It’s very much a get out of it what you put in to it endeavor. My own observation is that those who are unhappy are the same people not really putting in much effort to begin with.

I mean I honored a bunch of stuff I wasnt interested in but not by asking to take more call. If that's the kind of thing you look for to praise a student you're gonna be the resident nobody wants to be assigned to. But, sure, let's say that's the students problem.

 

[Matthew9Thirtyfive]

I mean I honored a bunch of stuff I wasnt interested in but not by asking to take more call. If that's the kind of thing you look for to praise a student you're gonna be the resident nobody wants to be assigned to. But, sure, let's say that's the students problem.

Why do you keep focusing on that one single thing? If he had left that one phrase out, his post still would have been right, and he didn’t say students need to request to take call.

 

[efle]

Why do you keep focusing on that one single thing? If he had left that one phrase out, his post still would have been right, and he didn’t say students need to request to take call.

Because it's the most absurd, but the other examples like asking about cases days away or coming in earlier are the same vein. If a student shows up at the expected time, knows their stuff for the cases that day, and are pleasant to be around they're doing great in my book. But it's really just a personality difference. Just because me and my friends all preferred the chill residents with the latter set of expectations doesnt mean everyone does. I'm recalling one of my surgery residents who used to come into the hospital on her day off like the satirical character in House of God. She would have thrived with operaman as her resident or attending. Different strokes for different folks

 

[ciestar]

M2 was my worst year by far. I almost dropped out.

M3 was so much better. I preferred having to actually deal with the hell that was surgery for 10 weeks than I did having to be isolated in a classroom studying for exams during preclinical.

 

[efle]

M3 year is highly dependent on the sites you’re rotating at. At my school we have a lot of different rotation sites, naturally. I’m on OB right now, and I have classmates who are having bad experiences because they are doing nothing except basically shadowing with the occasional opportunity to do something, they are working a lot of hours despite that, and feel like they don’t know ****. Then I have classmates who are having great experiences, myself included. I’ve been lucky so far. Every rotation of this year has been pretty much the opposite of what you described.

Except shelf exams. **** them.

Missed this post earlier. Good point about sites. I think a lot of it is how broken down from overwork the residents are. The more intense or malignant, the more likely you're going to be ignored or used to alleviate scut, and less likely to get teaching.

M2 was my worst year by far. I almost dropped out.

M3 was so much better. I preferred having to actually deal with the hell that was surgery for 10 weeks than I did having to be isolated in a classroom studying for exams during preclinical.

Preclinicals during COVID must be awful for extroverts! That's another reason I could see MS3 preferred for sure

 

[sloop]

I personally found MS3 to be the most difficult, even though step 1 was not pass/fail when I did it.

MS3 was a pain in the ass. You don’t really know anything and you’re totally incompetent, but the game you’re being asked to play seemed to be to demonstrate competence and find some way to “be helpful.” I felt like I was in the way much of the time (which, now having graduated residency, I can see was because med students are actually in the way much of the time). The evaluations were subjective. The shelf was the only part of the grade that wasn’t totally subjective, but usually the things that were discriminatory on the shelf were not the things that were covered in your rotation. As a result, I always felt torn between trying to be present and constantly “helpful” when in reality I just wanted to be able to go off and study for a few hours.

Even with step 1 being scored, I enjoyed the fact that I could really manage my schedule as I wanted. I always went to class because that was how I learned best but I always had the option of just watching the lectures. During dedicated for step 1, I was able to take whatever day I wanted off. That meant that I could spend more time with my significant other than I could normally. I honestly find studying satisfying as long as I have enough time to just focus on doing it. I had a nice morning routine where I would grab some breakfast and coffee, set up in a room at the med school and relax for like 30 minutes before I really launched into the studying. I really enjoyed that time to clear my head. I would make ambitious but realistic goals for studying and would be able to go home feeling accomplished as long as I completed those.

 

[Matthew9Thirtyfive]

Missed this post earlier. Good point about sites. I think a lot of it is how broken down from overwork the residents are. The more intense or malignant, the more likely you're going to be ignored or used to alleviate scut, and less likely to get teaching.

It doesn’t even have to be malignant. If there are too many learners, your chances of getting bumped goes up a lot. My friends in places with tons of students, subIs, interns, etc are all mostly just standing around watching. It sounds super ****ty.

 

[ciestar]

Missed this post earlier. Good point about sites. I think a lot of it is how broken down from overwork the residents are. The more intense or malignant, the more likely you're going to be ignored or used to alleviate scut, and less likely to get teaching.


Preclinicals during COVID must be awful for extroverts! That's another reason I could see MS3 preferred for sure

Im currently a PGY-2, but yes, i totally agree. Online learning for extroverts must be brutal.

For me, i think it was all mental health driven. I didnt have friends in med school, unfortunately, so the whole experience was very isolating.

 

[odyssey2]

M4 doesn't really count because it was basically a vacation, so aside from that M2 was by far my favorite year. I had gotten used to the rhythms of med school studying by then and had found my social group in med school, so the stressors of getting oriented to the new environment had gone. I would study with my friends so it wasn't socially isolating and we all set our own schedules. The tests were easier since I was studying a little bit every day, and there's so much ancillary help with Anki, Sketchy, and UFAP that it made the whole process relatively painless. My only job that year was to score high on a test at the end of it so it simplified everything. It was so enjoyable for me I wondered why anyone complained about med school. Then I got to M3 and understood.

 

[Lawpy]

M4 doesn't really count because it was basically a vacation, so aside from that M2 was by far my favorite year. I had gotten used to the rhythms of med school studying by then and had found my social group in med school, so the stressors of getting oriented to the new environment had gone. I would study with my friends so it wasn't socially isolating and we all set our own schedules. The tests were easier since I was studying a little bit every day, and there's so much ancillary help with Anki, Sketchy, and UFAP that it made the whole process relatively painless. My only job that year was to score high on a test at the end of it so it simplified everything. It was so enjoyable for me I wondered why anyone complained about med school. Then I got to M3 and understood.

How is spending grueling hours in Sub Is and aways, and stressing every second over interviews sent in awkward times a vacation?

Post-match MS4 is the best imo