Things to consider in a medical school that frequently are not

Pre-Med & Medical School Pre-Med Topics
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<p>As an update, I have now finished my clinical year and am in the process of studying for the USMLEs (the MCAT equivalent) and preparing to take a year off to continue my research in the specialty that I intend to apply into. I thought I would just take a quick break from my studies to give my thoughts on what is important in a medical school curriculum, looking back on it from this perspective. People tend to focus on the pre-clinical format and all, but these are relatively homogeneous other than the few that shortened pre-clinicals. Sure, it is worthwhile knowing the exam schedule, etc, but here are somethings also worth noting:</p>

<p>1) Grades</p>

<p>Above all, know what you are getting into. Schools have a vast array of grading and ranking policies. Many schools have switched their pre-clinical years to a pass fail system, but a significant portion have retained an internal system of rankings (meaning they aren't really p/f it is just a farce). A select and growing group is unranked pass fail for the pre-clinicals. I personally am a fan of this, because of the fact that it takes the edge off of the learning experience. It gives you confidence to take advantage of the free time that you have rather than freaking out over random tables and appendices. The sad truth is pre-clinical grades don't mean much any more to residency programs. It is far more likely to hurt you than help you. If you do good, great how did this applicant do on their clincial courses and what were the USMLE scores? If you do bad, uh oh maybe this applicant isn't someone we want. Would being #1 in your pre-clinicals possibly be a distinguishing mark, absolutely. However, ONLY ONE PERSON WILL HAVE THAT DISTINCTION AND IT WON'T BE YOU.</p>

<p>Most programs continue to have clinical grades that have some form of ranking, or at the very least AOA (the phi beta kappa of medical school). Know what this entails. For some schools, it is just grades. Others look at grades, scores, research experience, etc, etc. Know what you are getting yourself into, even if it probably shouldn't be a determining factor.</p>

<p>2) When do you take USMLE Step 1</p>

<p>Step 1 is the most important exam of your medical school life. Know when you will take it, and just as importantly how long you get to study for it. Some schools get only a couple weeks off to study, whereas others get up to 10 weeks! That's a huge difference in stress level. A growing number of schools are starting to let students take the step 1 after their clinical training. I'm in favor of this approach. The clinical vignettes on the step 1 would definitely be easier with additional clinical knowledge, and stuff like genetic basis of diseases and pharmacology tend to come up a lot as well. You definitely forget a little more, but I think the net gain from more knowledge and more test taking experience (one major 3 hour exam per rotation) is worth while.</p>

<p>As an aside, don't listen to nonsense about teaching towards the step 1. Step 1 is an exam that, like the MCAT, requires copious review on your part. It is nice to know what resources are available to you (some schools host review classes, give you free books/question banks, etc).</p>

<p>3) Clinical Year Format</p>

<p>The clinical years are often ignored during the interview season, for the simple reason that they are further away and most of your interactions will be with first and second year students. Seek out people knowledgeable about the last two years,</p>

<p>Know exactly what the expectations are for you during clinical year. How many blocks during the third year are there and what rotations are mandatory vs electives (i.e. some schools do not require neurology, or surgical sub-specialties. It behooves you to get some electives in all specialties, so know if that is an option). Do you have any say in the order of your rotations? Are there breaks in between each block? How many vacation weeks? How long are each of the blocks (this is relevant for studying for the standardized exam at the end)? What is the general grading format (grades versus clinical evaluations. Which are more important. There is no right answer, but I prefer a combination of the two). How many fourth year electives do students get? How many students go abroad for electives? Do students get time to take the step 2 of the USMLE after clinical year, or do they have to make their own time.</p>

<p>You should also ask about how much time students get to interview. Two months is ideal.</p>

<p>4) Clinical Skills Prep</p>

<p>This is also very important. Know the institutionalized practices that help students improve as clinicians. Know how often students are educated on how to do interviews, physical exams, and presentations to attending physicians. Ideally, you want to have a solid understanding of each before starting the wards. You also want to know the general atmosphere of learning useful clinical skills. How often to students get to do blood draws, IVs, lumbar punctures, paracentesis, chest tubes, suturing, etc. Are there workshops given on these things? Are you taught how to do a rectal and genital exam prior to the clinical year? How much training are you given during the clinical year? For example, my school has one week rotations through the surgical subspecialties. As well as being an experience of itself, these rotations are expected to endow upon students certain skills. In anesthesia, we are allowed to intubate and place IVs, in urology we do genital exams and rectal exams, in optho we learn how to examine the eyes like a boss, etc. All of this stuff was taught to us prior to the clinical year, but getting it straight from the experts was far more useful.</p>

<p>As a warning, all students and schools will say that they get lots of hands on experience. This is why it is important to elicit the actual examples and programs.</p>

<p>5) Match list</p>

<p>This is not important. I only bring it up so that I can stress that it is not important. You can't read a match list, and I can barely read it (only in the specialty of my interest). So much has to do What is somewhat of interest, however, is the general geographic distribution of the class match. People often match close to the medical school for various reasons, which isn't really important to you. What is important, however, is students tend to benefit form programs that have had significant experience with a given medical school. If a schools match list doesn't have a single person sent to, say, Colorado, and Colorado is your dream residency location, then it may be worth taking note. You can still match in Colorado, but it may be a bit more of an uphill battle than if 32 kids in your class match there yearly. Likewise, one might think to do this within the specialty of your choice. I would discourage this only because specialty choice tends to fluctuate a lot from year to year (the year before me has 9 neurology applicants, the year before them had 1), where as locations tend to be pretty grounded.</p>

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<p>To piggyback on mmmcdowe’s post (I hope he doesn’t mind):</p>

<p>From the perspective of a 4th year student:</p>

<ol>
<li><p>Location, location, location. This was something I really undervalued when selecting medical schools. There is a HUGE regional bias when applying for residency. HUGE. It is really hard to break into an area if you have no connections (connections = places where you grew up, where you went to college, med school, where your family is, where your SO is). For example, it is hard to get into radiology residency in California if you have no connections there, no matter how well you did at Johns Hopkins. Hence, it becomes true that a good percentage (maybe 1/2) of your med school class will do residency in the immediate area of the med school. If you don’t want to live in TX long term, don’t go to med school in TX, that’s where you’ll have the greatest advantage when applying for residency.</p></li>
<li><p>Third-year schedules, as mmmcdowe mentioned, is really important and something not a lot of applicants ask about. In particular, I would look to see of the med school offers elective time IN THE THIRD YEAR. My school, for example, has ridiculously long internal medicine and surgery rotations (12 weeks each) and for those of us looking to do rads or derm or opthmo, we aren’t able to do any electives in those fields until the 4th year, close to application time. It is really hard to get a good recommendation letter in such a short period of time. Consequently, a few people in my class had to apply to two specialties (because they still weren’t sure which one they wanted to do). I personally think that internal medicine and surgery can be shortened to 10 weeks, leaving 4 weeks of time in the 3rd year to do an elective in rads or derm or whatever you want. I would look for a med school that either offers 1 month of elective time in the 3rd year or that allows you to defer one of your required rotations in favor of an elective.</p></li>
</ol>

<p>3: 4th year schedules are important as well. Mainly, I would look to see if the med school gives time off to interview for residency programs. From talking to other interviewees, it seems like the 4th year schedule is highly variable. Some interviewees have no elective time and no time off. At my school, we only have 3.5 months of required rotations and 3 months of electives the entire year + 12 weeks of vacation. If you choose to do a research elective, you essentially have 15 weeks of vacation (compared with only 5.5 months of rotations). Some of that has to be spent interviewing for residency. This is not as important in less competitive specialties like family med or peds, where you’ll only be doing 5-10 interviews. But, if you are applying for rads or anesthesiology, you’re going to be doing 20+ interviews (ideally) and you need to have dedicated time off.</p>

<ol>
<li><p>When to take step 1: I’m going to disagree with mmmcdowe a bit here. I think there are advantages and disadvantages to taking Step 1 after the clinical year. The disadvantages being that you are more removed from the basic science years (which is what Step 1 tests). The second disadvantage is that if you do poorly on Step 1, you typically have to take Step 2 early (before applications go out). Those taking Step 1 after the clinical year won’t have much time to prep before they have to take Step 2 again. It is extremely brutal to have to prep for and take Step 1 and Step 2 within months of each other (please let me know mmmcdowe if I don’t have the timing correct).</p></li>
<li><p>I’m also going to disagree about grading in the first two years. This was something that I thought was OVERrated during my med school interviews. Everyone talked about how they had P/F grading during the first two years and how that reduced stress. Personally, I don’t think it helped at all. My class was still pretty neurotic about the first two years (although we did end up with the highest USMLE scores in my med school’s history). Secondly, I don’t think the first two years should be regarded lightly. It is very true that grades from the preclinical years are worthless. However, Step 1 score is very important so it makes sense to pay some attention in your preclinical years if nothing than to do better on Step 1.</p></li>
<li><p>Match list: we’ll keep saying it, not that useful. As a premed student, you have no knowledge to evaluate match lists. You’re not going to know that the radiology programs at University Indiana and Thomas Jefferson are more highly regarded than the radiology programs at Columbia and Yale. Even the number going into a particular specialty is not useful. For example, it is not unusual for low-tier med schools to send 30+ kids a year to radiology and anesthesiology, mostly to low-tier residency programs. Meanwhile, at a lot of the more prestigious med schools, you may only see 7-10 a year go into radiology, often to top tier rads programs.</p></li>
</ol>

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<p>As the parent of a student in the process of making up a list of schools to apply to, thanks so much to the both of you! With all that one hears and reads on school websites, anything you can do to demystify the process is greatly appreciated.</p>

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<p>an anecdote of one to support ncg’s point #1 about location: friend’s D, born and raised in SoCal, attended Stanford undergrad, and then Duke for med. Did well, had plenty of research. Was only able to garner a couple of interviews in Cal for residency in opthalmology. (She did interview at Harvard & Hopkins and received offers from Penn, among other east coast programs, so she musta had competitive numbers.)</p>

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<p>Thanks very much to mmmcdowe and ncg for their geat posts.</p>

<p>Regarding locations, I heard in the past that the parents should be mentally prepared that the probability is quite high that your child will not come back to the home state if (s)he goes to an OOS college that is far away. I guess, for medical school, it is even more so.</p>

<p>Another saying is that when a person has significant achievement in his life time, tends to travel farther away from where (s)he was born.</p>

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<p>Have to wonder if the residency issue is sub specialty dependent.</p>

<p>My S received 1/4 of the residency interview invitations (4/16) that were not on conflicting dates from California programs. He had several others (including another CA program) that he had to eliminate due to date conflicts. He has his last CA interview this week.</p>

<p>All were very positive and have continued to remain in touch with him. One or more may end up in his top five when he finalizes his match list.</p>

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<p>Thanks for the great info everyone. I am currently deciding where to attend med school and this will be very helpful when I am making a decision!</p>

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<p>Thanks. </p>

<p>** scratches all Texas schools off my AMCA list **</p>

<p>:)</p>

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<p>^This is all directed to applicants who will get multiple med school admissions. The vast majority of applicants simply won’t have a choice of which med school they go to. TX is great for med school admissions if you’re in-state. For some applicants, they have to first worry about getting in.</p>

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<p>I know this may be too early for me to worry, but if i do want to return back to my home state CA for residency, would you suggest during 4th year, do rotation electives at cali?</p>

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<p>Absolutely do some in Cali.</p>

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<p>nocal.
I would totally disagree with your “location” concept. Residency acceptance is still “the olde boys club”. I pick up the phone daily during match season and talk to chairman at program xyz and tell him that Susan will be a great Surgeon and an addition to his program. My Susan’s have always gotten their first choice. This is true for residency and fellowships. If their is no “olde boy” network at the school you are in and where you want to go, you must make one. You must spend an elective at that school and impress them.</p>

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<p>The second best advice is where you want to live.
Med School is not “hard” - but it is stressful and takes alot of time. Thus go somewhere where you can blow off steam and relax. If you are a skiier, go somewhere where the slopes are close. If you are a biker, the same. IF you like to shop, then NYC, etc.</p>

<p>The kids that drop out of medical school (or commit suicide) are those who follow advice of going to x to get into y. Go where you will be happy. </p>

<p>eg. Johns Hopkins is one of the best medical schools. But it is inner city in almost a slum where there are lots of muggings, etc. At one of the inner city New Jersey schools, a professor was shot in his office by a discruntled patient. Not the best place for every body.</p>

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<p>Wasn’t the shooting at Hopkins?</p>

<p>[Johns</a> Hopkins | Hopkins doctor shot by patient’s son continues to recover - Baltimore Sun](<a href=“http://articles.baltimoresun.com/2010-09-18/news/bal-hopkins--doctor-condition_1_fair-condition-shot-cohen]Johns”>http://articles.baltimoresun.com/2010-09-18/news/bal-hopkins--doctor-condition_1_fair-condition-shot-cohen)</p>

<p>also the shooter was the son of a patient who lived in an affluent area of Arlington Va., NOT a local. </p>

<p>The only thing I could find in Jersey was a neurosurgeon who tried to kill his wife and her brother. </p>

<p>[ASU</a> professor was nearly shot protecting sister](<a href=“http://www.azcentral.com/news/azliving/articles/2011/02/14/20110214asu-professor-nearly-shot-protecting-sister.html]ASU”>http://www.azcentral.com/news/azliving/articles/2011/02/14/20110214asu-professor-nearly-shot-protecting-sister.html)</p>

<p>Amazing, so not all violence is perpetrated by “inner city” dwellers?</p>

<p>Baltimore is a beautiful city. The Inner Harbor is only minutes away from Hopkins, and I “blow off steam” there often, and I’m still alive. :)</p>

<p>[Inner</a> Harbor :: Baltimore.org](<a href=“http://baltimore.org/about-baltimore/inner-harbor/]Inner”>http://baltimore.org/about-baltimore/inner-harbor/)</p>

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<p>I am going to weigh in on the pass/fail thing and say that while NCG is right that even in p/f it is still stressful, there is a different type/level of stress. Yes, people still stress out because they want to do well for themselves and they want to actually learn the material so they will be good when the boards come around, but the fact that there is no competition among your classmates completely transforms the morale of the class. By the time you get to 3rd year, (when there are grades/competition) it’s going to be different if that’s a new thing and you’ve already formed good relationships with the class than if it’s been there all along.</p>

<p>In the small sample size of me, my classmates, and our friends at other schools. I don’t know anyone in P/F who wishes their school had grades or who doesn’t say P/F is the best system, and the kids who do have grades range from “it makes no difference” to “I wish it were P/F”</p>

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<p>As I said, the whole p/f is just an opinion of mine, but I will say that my school has the unique opportunity to observe the two systems at once. The dental school, which takes all pre-clinical first year with us, has h/hp/p/f and rankings. They are way more stressed than we are, and far more competitive (they voted to get rid of group anatomy practicals in favor of individual ones). True, there are other factors in play than just that system, but to me I’m glad that it wasn’t particularly worrisome that some people did better or worse than me in pre-clinicals.</p>

<p>As for the step 1 thing, also just my opinion. My school is 18 month pre-clinicals, and so we finish our clinical year 6 months early. We are required to take the step 1 by the end of february (the february of “third year”), and the step 2 has to be taken prior to applications the following fall. So you have a solid 4-6 months to study for step 2, and the best part is from february until July you have complete control over your schedule (I’m doing 3 months of research and a radiology elective. I plan to relax the first 2 months then study for step 2 in the last 2 months).</p>

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<p>This “location” thing has me confused. From reading this forum, it seems to me that my D will have the best chance of admission at her home state medical school. We live in the Midwest and D currently attends school in NOLA. She has no desire (other than saving money!) in coming back home. Loves the warmer weather and would not mind never holding a shovel again. So, are you saying that if she comes home for MS, she will most likely end up doing her residency here? If she wants to live somewhere else in the end, should that desire lead her to a private medical school(and the higher cost) in a state she may want to live in later? All of this, of course, is dependent on multiple acceptances.</p>

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<p>She will have an advantage. Of course, if she is strong enough, she can go wherever she wants.</p>

<p>Keep in mind, location isn’t strictly the area where you did medical school. It’s where you have connections: place where you did med school, where your family is, where you went for college. These don’t necessarily have to be the same place.</p>

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<p>Quite a bit of good stuff here. </p>

<p>Really want to continue to hit on the match list thing. It’s so completely and totally worthless to pre-meds and yet people here and on SDN freak out about it all the time. There’s so much that goes into the match beyond just “what’s the best place I can go”, that even if perceived program quality held true to undergrad rankings, you’d still never get a great understanding just by looking at names. The most useful information (which schools will likely rarely divulge) from a match list would be the number of people getting their #1 choice, but even then that may not be that helpful. </p>

<p>But really, the discrepancy between pre-med perceptions and actual program quality is the major issue. In pediatrics, few premeds would be excited by the University of Cincinnati, when in fact it’s easily, easily a top 5 program. But going even further, no pre-med knows that the top 3 pediatric ECMO centers (if they even know what ECMO is) in terms of volume are Emory, Arkansas and Michigan (varies year to year, but these three usually rotate). And since a match list doesn’t tell you that a particular matched student has an interest in pediatric critical care, the untrained eye, even a 4th year classmate, won’t have any idea that Arkansas could be a highly desirable match.</p>

<p>As far as the location thing - I’d say it’s been overstated a little bit thus far. Certainly there is an advantage if you go to school nearby, but it’s not impossible nor even unlikely that a medical student can flip regions (as I can personally attest). The other connection that hasn’t been mentioned is that most medical schools have mini-pipelines in certain fields to certain residency programs. My medical school on the Great Plains had known pipelines in surgery to a notable west coast program and one in internal medicine to a highly regarded east coast program. It’s also possible to utilize the connections that exist with faculty members - a phone call from a trusted colleague about an applicant can have a huge impact on match success.</p>

<p>While NCG is correct that a significant portion of people will stay “near” their medical school, I think this has way more to do with life events than with difficulty moving out of the region. Many more people have concerns about significant others and long term relationships now than they did when they started med school. There may be kids or sick parents to consider at this point. </p>

<p>The one thing I’m really in disagreement about though is the timing of step 1. My med school collected a lot of data about us and the way we prepared for step 1, and year after year, their results showed that studying for Step 1 was a classic example of diminishing returns. When controlled for class rank, scores increased each week of studying with the largest gains from week 3 to week 4 and then from week 4 to week 5. After that, there were much smaller gains in week 6 and then things really plateaued. If you’re really trying make the best use of your time, I’d advise choosing a school based on getting more than 8 weeks to prepare.</p>

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<p>Hi NCG, mmmc, and BRM,
Reg the STEP 1 - From your experience, could you let me know what percentage of the STEP 1 focused on the material from your MS1 and MS2, respectively? Thanks!</p>