Tag: USMLE

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Top Blog Posts for Medical Students

I recently came back from a trip to Barbados where I gave the incoming first semester class of Ross University some advice on how to succeed in med school. Here’s a summary of my top med school blog posts broken up into various categories:

Med School Study Tips

Med School Study Resources

USMLE resources

Clinical Rotations

Should You Go To a Caribbean Med School

Discusses the discrepancy in the match rate between US-IMG’s and US MD and DO graduates

Residency Tips for Med Students

Residency Tips for Residents

Ross University Specific

Interviews with Residents in Various Specialties

Interview with Fellows in Various Specialties

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How To Study For USMLE Step 1

I’ve been getting a lot of messages on Instagram about how to study for USMLE step 1 so figured I would put all of my answers into one concise blog post. First off, take my advice with a grain of salt. Actually, you take anyone’s advice on how to succeed in medical school with a grain of salt. What worked for me might not work for you. That being said, I hit my goal of getting a +240 score on USMLE step 1 and this is how I did it.

 

 

Step studying starts day 1 of medical school

I struggled a lot my first semester of medical school because I had to learn how to learn. Everything you see from day one of medical school can show up on your USMLE’s. So my biggest advice on how to study for step 1 or step 2 CK is to learn everything right the first time around. Remember that at the end of the day you aren’t studying to pass your classes. You’re studying for your step exams.

 

 

Start using question banks early

I’ve previously written about how to study in medical school, my favorite resources in medical school and my favorite resources for USMLE Step 2 CK. A recurring theme is question banks. Again I will reiterate 2 things: (1) that question banks are meant to challenge you to apply your knowledge and find gaps in your knowledge to then go back and study and (2) UWorld is the gold standard. Save UWorld for when you are truly in your two months of intense step 1 studying. But when you are in medical school I encourage you to use other question banks like Kaplan. I used Kaplan as a second year medical student while I tutored gross anatomy to supplement my knowledge base and show me the scope and depth that I truly needed to know for the test. Incorporate question banks as early as possible.

 

 

Use your resources consistently

Just like question banks the rest of your study resources are important tools for success. The more you use them the more valuable they become. For instance, if you plan on using Picmonic you should start using it early in medical school. It loses its value if you only start using it in the months leading up to USMLE step 1. Similarly, don’t stop using whatever resources you found valuable during medical school. If you used Pathoma then keep using it. If you used FirstAid then keep using it! And if you found that you didn’t like certain resources then don’t use them!

 

 

My background

If you don’t already know, I went to Ross University School of Medicine. Back when I started at this Caribbean medical school it was strictly an accelerated program. We did the first two years of medical school in 18 months (they now have a ‘slow’ track too). This gave me 2 full months of strict step 1 studying before I started third year clinical rotations. On top of those two months, we finished our last semester of 2nd year a month early to allow us to study for a comprehensive exam that we had to pass in order to leave the island. So I was refreshing my knowledge for one month before I started my non-stop, pedal to the metal step 1 studying.

 

 

My resources

I used everything that helped me succeed in medical school. That included the following:

 

 

Overall and daily schedule

I had 2 months of strict step 1 studying time. I used Doctors in Training (DIT) which acted as the backbone of my study curriculum. DIT created an awesome two month calendar for me. Inside that timeline I put one true weekend off for a snowboarding trip. Other than that I isolated myself and didn’t really go out much.

My daily schedule consisted of the following:

  • 730am – 745am: review Picmonic
  • 745am – 8am: review notes from yesterday
  • 8am- 9am: 1 full UWorld question set
  • 9am- 12pm: reviewing UWorld
  • 12pm-1pm: lunch break
  • 1pm – 5pm: 4 hours of DIT videos
  • 5pm – 8pm: exercise, dinner, relax
  • 8pm – 10pm: relax and passively review topics

I hope this helps! If you have any more specific questions drop them below. As always don’t forget to subscribe so you don’t miss my next post!

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How To Study For USMLE Step 3

In my prior post, When You Should Take Step 3,  I went over the importance of USMLE step 3 with regard to fellowships moving forward and gave some insight into figuring out the right time to take the exam. The following post covers the nitty gritty details about how to actually study for the exam including study strategies and resources. Of course, this is not the only way to study for step 3 but its the most common and the most successful way.

 

 

Format of the test

Day one is the prototypical USMLE step exam consisting of 6 blocks of 38-40 items plus 45 minutes of break time leaving you with a 7 hour test on day 1. Day 2 is a little different. It’s a 9 hour day split up into two main sections. First you start off with another 6 blocks of multiple choice questions. They only give you about 30 per section on day 2 compared to about 38-40 questions per section on day 1. After you complete all 6 sections you move on to the simulation cases. These are 13 cases that are meant to simulate how you would treat a patient in the real world. Check out the details on the USMLE website here.

 

 

How to study for it- USMLE World

I’m not kidding when I tell you that the one and only resource I used to study for my step 3 exam was UWorld. Okay, and my Master The Boards book for USMLE Step 2 CK when I couldn’t remember some obscure fact or mnemonic. Okay, and I guess I also used Picmonic cards here or there for those super rare and hard to memorize tumors from my step 1 days. But I rarely used secondary resources. I mostly jotted notes down in a moleskin notebook. UWorld or bust!

 

 

Brush up on your biostats

On day one of the exam expect to have at least 6-8 biostatistics questions per section. 3-4 of those questions are from drug advertisements. It sounds daunting but you truly just need to know the basics. I’m talking about number needed to treat (NNT), number needed to harm (NNH), odds ratio, and different forms of bias. All that jazz. Know it cold and you’ll do fine.

 

 

Interactive cases- practice, practice, practice

Half of doing well on the 13 interactive cases on day 2 is knowing how to use the interface. The medicine is actually the easy part. Personally, I did a third of the cases over the span of a few weeks and then the remaining two-thirds over the course of the weekend prior to my exam and I felt adequately prepared. A few colleagues of mine did all of them the weekend prior to their exam. They are annoying and frustrating to get through but as long as you don’t kill too many imaginary patients you should be fine.

 

 

 

Still have some burning questions about how to study for step 3? Leave a question in the comments section below! And don’t forget to subscribe so you don’t miss my next blog post!!

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How To Learn More, Faster in Medical School

It’s been awhile since I used Picmonic. It was my go to medical school resource when I was a first and second-year med student and was even more valuable while I was studying for USMLE step 1 and step 2 CK.  The more I used it, the more valuable it became. It is still to this day one of my three favorite medical school resources, which is why I was so excited to team up with Picmonic to help spread the word!

 

 

What is Picmonic?

Picmonic is an online app that helps make studying easier, more efficient, and a little bit more fun. Let’s face it; medical school challenges you with a relentless barrage of information that requires absolute dedication to memorizing. And the worst part about studying in medical school is a simple fact that some stuff doesn’t make sense. You just have to memorize it. I’m talking about subjects like biochemistry, nutritional deficiencies, pharmacology, and microbiology. That’s why Picmonic is so amazing. It uses vivid pictures, stories, and wordplay to get all of that expensive medical school facts that you just have to know into your brain!

 

 

Let me just show you what I’m talking about

Each subject has a unique Picmonic ‘card’ that uses visual storytelling and pictures as mnemonics to help you remember more. They’re even better than flashcards! This is the Picmonic card for erythema nodosum, and I still remember it and use it to this day during residency. Inevitably during morning report, noon conference, patient presentations, or when I’m teaching my medical students this subject pops up. And my co-residents are just as shocked as my friends in medical school were when I rattle off the disease associated with erythema nodosum, represented by the Nodosaur with red bumps on its legs.

 

What I also love about Picmonic is that its cast of characters stays consistent throughout the Picmonic universe. For instance, take a look at the erythema nodosum card again down below. You’ll see a ‘cock (rooster) at sea’ representing coccidiomycosis circled in red.

 

 

Now check out the card for coccidioidomycosis. It’s the same rooster at sea, again circled in red.

 

 

Now take a second look at the coccidiomycosis card, but this time check out the granny-llama representing granulomatous inflammation, circled in yellow below. Now check out the same granny-llama circled in yellow on the Picmonic card for granulomatosis with polyangiitis (Wegeners).

 

 

And again, we see the same granny-llama representing granulomatous inflammation on the card for granulomatosis with polyangiitis (Wegeners).

 

 

 

Buy Picmonic Now!

Ultimately, I wholeheartedly believe that Picmonic helped me pass and succeed in medical school and helped me ace USMLE Step 1 and USMLE Step 2 CK (and even bails me out every once in awhile during residency). The more esoteric and difficult to memorize a subject is the more Picmonic flexes its muscles.

 

 

So if you’re tired of reading about Picmonic and ready to try it out, here is what you should do:

  1. Go to https://www.picmonic.com/redeem and enter KittyKatzFree for 2-weeks of free access to Picmonic!
  2. Once you’re ready to purchase: use my link to get 30% of any fixed term subscription!

 

 

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When You Should Take USMLE Step 3

I’m about to finish my first year of residency. Although I might not be ready to be a resident I sure as hell am ready to not be an intern anymore. Intern year of residency is exhausting. There’s no way around it. And studying for yet another seemingly pointless USMLE is the last thing anyone wants to do after a long day in the hospital.  Here are some tips to help you figure out when you should take USMLE step 3:

 

Does step 3 even matter?

Yes and no. It truly depends on what you plan on doing with your medical degree. If you don’t plan on specializing it is hard for me to see how your step 3 score will impact your ability to get a job. Especially when you have to pass a board certification exam in your respective field in order to practice.

But if you are looking to pursue a fellowship then you might not want to ‘just pass’. The 2016 NRMP program director (PD) survey asked fellowship PD’s the importance of various factors when looking at applicants. They rated importance of each factor from 1-5 with 5 being very important. Let’s take a look at a graph from the 2016 NRMP PD survey that shows which factors PD’s across every specialty found to be the most important when selecting applicants to interview:

interview 1

And now which factors were most  important in ranking applicants:

ranking 1

Ultimately, step 3 isn’t the most important factor. But it is still a factor. Additionally, each specialty is different. A vascular surgery fellowship program is clearly looking for something different than what a sleep medicine fellowship program is looking for (take a look at the data yourself if you know what fellowship you’re interested in: Results of the 2016 NRMP Program Director Survey). But in general, there are more important things than step 3 when it comes to fellowships. I would err on the side of caution however and make sure it isn’t important. Meaning, don’t score so poorly that they end up looking at your score and make it a big deal. Let it be just another check mark on your application. Something to keep you on par with other applicants.

 

 

What is your specialty?

Generally speaking, USMLE step 3 is skewed in favor of primary care fields like internal medicine and family medicine. The majority of the test is composed of medicine topics. So medicine residents see a lot of what is on the test in everyday practice. This means that medicine residents can probably wait until the end of intern year and study intensely for 2 months or so and take it and pass. Essentially, waiting till the end of intern year won’t hurt you much. However, for anyone going into specialties like pediatrics, psychiatry, OB/GYN, or surgery I suggest you take it as soon as humanly possible. Some of my colleagues from medical school even took it the first month of residency. Their program even gave them a month of ‘research’ to study for it. So for anyone not going into a primary field like internal or family medicine you should, for the most part, take it as soon as possible.

 

 

Should you take step 3 before before residency starts?

Depends on a few factors. First off, can you afford it? Step 3 costs $875. Second, you need to graduate prior to even applying to take USMLE step 3². So unless you graduate early and have a considerable amount of time prior to starting residency I wouldn’t even put the thought in your head. Trust me, during residency the last thing you are going to be thinking is ‘I wish I studied more before residency started’. But what you do prior to starting residency is up to you. So unless you are required to take step 3 prior to starting residency I would hold off on taking it until during residency.

 

 

What does your intern year schedule look like?

For the most part you only need 2 months or so to study for this exam. So find a period in your schedule when you are on a lighter service. For me that was in December right before Christmas when I had a week of clinic followed by a week of vacation and three weeks of elective followed by another week of clinic and a notoriously light general medicine service. So I had ample time to study. Find a time in your schedule that will allow you about two months of time to study.

 

 

How should you study for USMLE step 3?

That’s an entire blog post in and of itself. Keep on the look out and subscribe so you don’t miss it!

 

 

What other questions or concerns do you have about taking USMLE step 3? Comment below!

 

 

 

1-  (2017). Nrmp.org. Retrieved 23 May 2017, from http://www.nrmp.org/wp-content/uploads/2017/02/2016-PD-Survey-Report-SMS.pdf

2- Federation of State Medical Boards. (2017). Fsmb.org. Retrieved 24 May 2017, from http://www.fsmb.org/licensure/usmle-step-3/faq#g1

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What To Do Before Starting Med School & Residency

What to do before starting medical school is one of the most commonly asked questions I hear from students about to begin their first semester of medical school. It’s the same question that I wrangled with after graduating medical school before starting my internal medicine residency. Here are my top three things to do with your last remaining days of freedom before starting medical school or residency.

 

 

Travel

Before starting residency I explored Thailand for two weeks and my only regret is that I didn’t stay longer. Traveling is a source of sustenance for the soul that can never truly be satiated. Traveling pushes you out of your comfort zone and forces you to grow as a person. You learn a lot about yourself when you remove your familiarities and submerge yourself in another culture and society. Who knows what a few weeks in another country will do for you. Go get lost so you can find yourself.

 

 

Nothing

As a resident we average one day off per week each month. That means we get, at minimum, four days off per month and sometimes that’s exactly what you get. So during residency, when you finally have free time on your hands you are often forced to be productive despite your zeal to just stay in bed and sleep all day. You have groceries to buy, laundry to fold, and an apartment to clean. Not to mention that research project you’re working on because you want to go into a competitive specialty. The work never stops. And after medical school you think your days of studying are over but  step 3 and your specialty specific board exams always loom in the background. So if you want to sit and do nothing before you start medical school or residency then go sit and do nothing. You earned it and you don’t have to explain yourself to anyone.

 

 

Work

Med school is expensive and residency doesn’t pay too well so it certainly won’t hurt if you can muster up some extra cash while you can. I worked as the most overqualified AP bio tutor prior to starting residency. A friend of mine worked at our medical school as a standardized patient. A colleague of mine worked as a scribe in the emergency department. There are opportunities out there if you seek them out. Ultimately everyone’s financial and social situations are unique and you may not have the luxury to choose to work or not, let alone go on a vacation. For instance, the extra money I earned prior to residency helped me pay for my vacation while my friend who was a standardized patient used his money that he earned to pay for step 3 while my colleague used his extra money to pay for his kid’s braces. So work if you can but don’t overdo it. You don’t want to squander these last few weeks of sanity and freedom if you can afford to.

 

 

Take USMLE Step 3

Okay this is residency specific and should only be performed if you have so much extra time on your hands that you can do the aforementioned (1) Travel, (2) Nothing, and (3) Work and then still have more free time before starting residency. I would not advise anyone to take step 3 in lieu of traveling or doing absolutely nothing. Step 3 isn’t a particularly difficult test in my opinion. However, it is difficult to find the time and energy to study for it during residency. So do yourself a favor and if you have the time and money to take step 3 then register for the test, finish UWorld, and take it already (more detailed post on how to prepare for step 3 and when to take it is in the works).

 

 

What did you do the summer before medical school or residency?

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Spotlight interview: Joey from Brooklyn lands a PM&R residency

I know him as Joey from Brooklyn and had the pleasure to rotate with him before he was Dr. Seldin. Here’s what he had to say about his journey to landing a Physical Management & Rehabilitation (PM&R) residency.

 

 

Tell us a little bit about yourself. Who are you professionally? Who are you outside of the hospital? What was your path to medicine?

The best way to tell about myself is to start from where my family is from. My father is from Brooklyn and my Mother is from Queens. I grew up on Long Island and my wife is from the Bronx. And its not hard to tell when you talk to me, my accent says it all.

I went to college to the University of Buffalo and received a BS in Psychology. During this time I became very interested in Fitness and Nutrition, performed in Body Building Shows, and learned from one of the greatest Trainers in Buffalo John Schweikhard. This love for fitness and nutrition pushed me in the direction of perusing a masters degree in nutrition from Columbia University. While earning my Master’s I lived in Washington Heights and would spend my free time on the Upper West Side (UWS). One Friday in June of 2008 I was in a Bar on the UWS of Manhattan at a place called Burbon St. I was there early and she walked in, I looked at her and said “yo legs come over here” and we hit it off. At the end of the Summer, July 28, 2008 I was in a bad accident and lost my right eye. This was hard time for me. I finished my masters thesis a few months later. 90% of the people I studied with at Columbia went right into medical school all over the country.

I lost my flow, this was the first time in my life that I wasn’t in school anymore and didn’t have a job and didn’t know what to do. After a year and a half, when I had more confidence after loosing my sight and multiple surgeries, I fell back on my fitness and nutrition knowledge and decided to professionally train people. At the same time my little brother starting to box and I put a lot of effort into helping him train. I would make his meals and slept on his couch in return. Then I came to a point when I realized I needed to really go for what I wanted my whole life which was a to become a doctor. At this time I was professionally training several doctors and one of them who was a cardiologist said, ‘if you want it then go for it’. I took the MCAT and honestly very did poorly. So I took it again, and again and again. Finally I was at a party and this kid who was shadowing at one of my client’s offices was like, ‘I’m going to Ross’. I didn’t know anything about this school and said to myself it is worth a try.

Outside the hospital I am a family man, I had my son two weeks before the start of my 3rd year of medical school. It was hard to give time from my family and study but I pushed through. I had my 2nd child 6 weeks ago. She was due the day before we started residency but she arrived early. It was perfect timing because it gave me a chance to get to know her.

 

 

What specialties did you apply to? How did you come to choose them?

Before I started medical school, I came to know this field called PM&R, Physical Medicine and Rehabilitation. While I was training clients I came to build a lot of great relationships. One of them worked at North Shore LIJ hospital system and he helped me volunteer at their hospital in the PM&R division. I didn’t know it at the time but this small step may have gotten me the career I have today.

So I knew in my head before I started medical school that this may be the field for me. What most people don’t know is, I kept an open mind during my 3rd year of medical school and really enjoyed all of my rotations. The closest thing to PM&R for me was emergency medicine. I also met the best attending physician there who really inspired me and peaked my interested in that field too.

So I applied to both PM&R and EM.

 

 

So going into PM&R means you have to do a transition year. Did different programs have different requirements for that transition year?

Most programs require you to complete a preliminary year in either internal medicine, family medicine, surgery, or a transitional year (this is like 5th year medical school- you rotate in surgery, OB/GYN, medicine, the ICU, EM, and some electives). Some programs have a categorical position, meaning you do your first year in that program as a medicine resident. Medicine is the most relevant in my opinion. The thing I didn’t know was that internal medicine preliminary spots are very hard to get. See, the ophthalmology, dermatology, radiology, and anesthesia guys and gals are going for IM prelim spots as well. So they’ve got the top step scores and they are US students. Where I am just in the top of the scores applying as an international medical graduate.

 

 

What was it like applying and interviewing for both of them?

I truly enjoyed the interview process and anyone who knows me also knows I am a talker. And when it comes to interviews, I thought to myself this is probably the only time I can get away with talking about myself all day. Another thing about applying to specialty fields is you don’t get interviews until October and until late December. It was mid October and I had like 4 interviews. My buddy applying to IM had like 20 by the end of September. Then all of a sudden I was bombarded with them.

 

 

How many programs did you end up applying to? What was your reasoning for that number of programs? How many interviews did you receive for each respectively?

I applied to 129 programs but I didn’t break the bank like other people I know. It ended up costing about $1,600. I applied to 10 transitional, 39 PM&R, 55 EM, and 25 IM programs. I got 10 PM&R, 10 IM Prelim, 6 EM, 1 TY interview for a total of 27 interviews. Of these interviews, 6 of these interviews I got by bugging programs to interview me and one of them is where I matched.

 

 

How did you end of ranking your programs?

My ranking was not an easy task. I went on a lot of interviews and honestly there a few things to consider for you rank. Some people rank based on location, academics, specialty, and other things. For me the most important was location. Staying in NY and being close to both my wife’s family and my family meant a lot.

 

 

What was the most challenging aspect of applying to PM&R?

There are not a lot of programs and in many programs are only 2-4 spots per year. I think there is only like 116 spots in the whole northeast.
For EM the IMG is non-existant these days. The programs are big into US students. There was lots of spots, lots of programs but I got only a few interviews.

 

 

Any crazy stories from the interview trail?

So SUNY Downstate PM&R pre-interview social, was at a bar in the village. It was open bar with top-notch drinks. The kicker was that we had to drink a certain amount to get a discount. So the residents had us downing beers and shots. I drank 6 Chimays and Duvels and downed a glass of Jonny Walker Blue. Then I had the interview the next day…good thing it wasn’t until 12pm.

 

 

What do you think were your greatest strengths about your application?

I applied locally. There are by far the most programs in NYC and having ties to an area can boost your ranking. I also scored very well. It is a special feeling when you go on an interview and pretty much know you probably have better scores then most of the people sitting next to you. If you go to Ross you know how hard it is to make it off that island and you know how hard you can work. I know I can work harder than anyone out there. I had a child right before my 3rd year of school and still was able to go up 17 points on step 2.

 

 

In contrast, what were your greatest weaknesses about your application?

The medical school I attended I would say was the greatest weakness. But is only the limiting factor for getting interviews. 80% for sure if you get an interview, they really want you otherwise they wouldn’t interview you.

My first interview was at Stony Brook PM&R, the director said, hey you go to Ross, great school. I laughed hard in my mind. Turns out that a resident many years ago at Stony Brook was a super star. On the flip side, there are hurdles with advanced match. See you can score a PM&R place on match day but that is only years 2-4 for your residency. You still need to also match in prelim as well. Now I matched in both of course otherwise I wouldn’t be talking to you about it. But sometimes a programs ranks someone in PM&R and the person doesn’t secure a prelim spot, and can’t soap into a spot either. Pretty much just fucked.

 

 

How did you do on the USMLE’s? What were your step scores? Do you think your step scores negatively/positively affected the number of interviews your received?

Step 1 242 and Step 2 257. They definitely helped me and I looked up the average scores on the ERAS stats list. No one scored as high as I did in 2014 in PM&R on Step 2. I know if my scores weren’t as good I would not have gotten close to the number of interviews I had.

 

 

What advice would you give to other Caribbean and/or American medical graduates who want to apply to PM&R?

Take every interview you can get. Also make sure you can rotate at a place that will let you go on your interviews during your rotation. On one of my electives I went on 4 interviews in one week and they didn’t give me any shit about it, which was great.

If you have shit scores, plan for back ups. Don’t be foolish. And if your scores suck, make sure you can relate to the field you are going for and kill it on the interview. I know one guy (and if he reads this will know who he is) has bad step one scores, but improved on step 2 but still under the average and landed a great residency. The reason is he related to the field and in the end of the day you only need one place to rank you (or two places if you’re going into PM&R…one prelim and one advanced spot). Even if it was your last rank, it’s better than nothing.

Take your test seriously. In June during my last 3rd year rotation I took a practice NBME and got a 220. I took another NBME one month later and got a 225. I finished 3rd year and had 4 uninterupted weeks to study. I took my 3rd NBME and got a 235. Took another 1 week later and got a 236. I wasn’t too happy at this point. But had got a lot down in the last 2 weeks of studying. 1 week before my exam, I took the USMLE World self-assessment got a 256 and was happy. 1 week later and got a 257. Holy shit was I happy.

Don’t worry about how many hours you will work as a resident in one field or anther. Before I started I didn’t know if I could really do this. But I did know I can push myself hard. Honestly I am up at 5 am every day, get to hospital 6-6:15am and finish about 5-6pm on a regular day. Not to mention short call and weekends. But I never feel like I can’t do it. You will do it. You’re so busy that the day flies by. You know your job is awesome when I go in on a Saturday at 6:30am and look at my clock and its 5pm and I need to get these last few notes done before sign-out. You can do it too I promise. I really can say that I love my job.

 

 

Thank you Joey for giving us a candid look at your application process. Be sure to subscribe so you don’t miss my second interview with an unmatched psych applicant.

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Spotlight Interview: a family medicine resident who failed step 1

Emily Chan is a Ross University graduate who successfully matched into her top choice residency program. However, it wasn’t an easy route to residency. As a Canadian citizen she could only apply to programs that would sponsor her visa. Oh and she also failed USMLE step 1. Here’s her story.

As a close friend, I know you pretty well. Can you tell my followers a little bit about yourself? Who are you professionally? Who are you outside of the hospital?

I’m from the beautiful area of Niagara Falls, Canada. True to stereotype, I am polite, love maple syrup, and say “eh” often. I received my Bachelor’s in biomedical sciences at the University of Montréal – in French.

Professionally, I am a hard worker and a team player. I show up to the office or the hospital with a smile and do my best. People have described me as a problem solver because I will come up with quick solutions for anything.

Outside of the hospital, I indulge in my hobby of cooking and baking. Nothing makes me happier than sharing good homemade food with friends. I also attempt, with varying degrees of success, to justify my paid gym membership even though I hate working out.

You matched into your top choice family medicine program. That’s an amazing accomplishment. Why did you choose to apply to family medicine?

Thank you! It is the most amazing feeling. I knew since I was 12 years old that I wanted to be a family doc. I’ve always loved talking to people and listening to stories about themselves, their families, and their lives. I believe that every personality fits in a certain branch of medicine. How will you know? Trust me, you’ll just feel it, you’ll know. Family medicine was my perfect fit.

Where are you from originally? Did you want to match in the US or Canada? Did you experience any extra hardships trying to match in American programs as a Canadian?

As a Canadian, I knew the odds were not in my favour across the board. Many factors influenced my choice to not pursue a Canadian residency. Canada made it very difficult for me to apply (poor matching stats, inconvenient availability of mandatory tests, and difficulty to obtain Canadian electives). I felt that if my own country made it so challenging for me to come back, then I wasn’t going to put up a fight. Instead, I concentrated all my energy to match in the US. I am very glad my strategic gamble paid off. Yes, you face discrimination because as a resident you will require a visa. I was ineligible to apply to many programs because they did not want to deal with the headache of visas. Disappointing, sure, but I don’t blame them.

Speaking of hardships, I remember the day that we all received our step one scores. You and I, along with three close friends of ours, were living together in Florida. I remember the moment when you came downstairs from your room and told us what every medical student dreads to even think of. That you failed step one. What happened? Why do you think you failed? Were you doing poorly in school? Did it come as a shock to you?

Oh that dreadful day… It was awful! I was so glad to be surrounded by friends like you when I found out I failed. You all rallied around me in a big group hug and reassured me that everything was going to be ok.

Failing Step 1 was a huge blow and I did not expect it at all. Granted, I’m not the strongest student so by no means did I expect to have a stellar score. I just expected to pass. So when I learned I was a few points shy of passing, I was crushed. I had done fine in school up to that point. I never failed any tests on the island, never repeated a semester, and I even passed the comp on the first try. Everything suggested that I’d be fine.

In hindsight, I realized what I thought was enough preparation for the test ended up being insufficient. To tackle Step 1 a second time around, I had to prepare more than ever before.

What was step 2 CK like for you? What steps did you take to make sure you didn’t make the same mistakes again?

Step 2 CK was definitely better than Step 1. I will say, all the self-doubting and insecurities resurfaced when I was prepping for Step 2. I spent 6 months studying and even delayed my test till October – meaning I applied to match without a CK score. As anyone and everyone will tell you, it’s best to apply to match with a full and complete application but mine lacked the CK. It was a risk I was willing to take. I absolutely could not afford to fail a second USMLE exam. Aside from doubling the time I dedicated to study, I got weekly tutor help to go over questions on UWorld that I got wrong. I also made sure that I took plenty of practice tests.

How many programs did you end up applying to? How many categorical? How many preliminary? How many interviews did you end up going on?

I applied to every single FM program in the US for which I was qualified. All categorical, no prelim. I spent a little over $3,100 on my 140+ applications. In the end, I only had 2 interviews. Yes, you read that right, two interviews. One interview was where I did all my core rotations in 3rd year. I got the other interview because I clicked well with residents from that program while attending the AAFP National Conference. I knew from the get go that on paper I was less than stellar so I worked hard on networking. I attended family medicine residency fairs like it was going out of style. In 12 months, I attended 3 residency conferences.

What was match day like for you?

Every medical student will tell you that match day is a nerve-wracking day, and for me, it was no different. I was hoping to match but I also mentally prepared myself that there was a good chance I would not match. When I learned that I successfully matched, I cried tears of joy and relief. Knowing that I beat the odds was the most incredible feeling. It validated all the people along the way who believed in me and said I would make it. I now had proof that outside people (not just family and friends) believed I was worthy of pursuing this profession.

I know we’ve talked a lot about a major weakness in your application but what do you think were your greatest strengths about your application? What set you apart from the other applicants?

Academia has never been my forte. I knew clinical years were my time to shine. It’s what I do best; it’s where I feel most comfortable. I worked diligently and was rewarded with A’s in all my core and elective rotations, except surgery. I genuinely connected with my attendings and they wrote me beautiful letters of recommendation. My strong LORs were undoubtedly a key component to my match success. I’ve always been a people person so interviews came naturally to me. When applying to medical schools, I had 4 interviews and was accepted to all 4. I knew I had strong interview skills. I harnessed that same energy and left my 2 residency interviews feeling confident.

The fact that you failed step one, the proverbial kiss of death to any applicant’s dream of obtaining a residency, but still managed to match into your top choice family medicine program is quite an accomplishment. In closing, what advice would you give to a medical student who failed or didn’t do well on step one?

I want people reading this to say to themselves, if she can match her top choice in her dream specialty with a 203 Step 1 score, a 215 Step 2 score, and only 2 interviews, I can do it too. One failure does not define you. You will encounter people along the road who will encourage you to quit medicine (one of my Ross professors counseled me to pursue non medical careers) or take time off (I was strongly encouraged to delay my graduation date and my match by a year) or give up all together. Take all that advice as fuel to prove them wrong.

Thank you Emily for bravely sharing your inspirational story. You are proof that it is possible to fail USMLE step 1 and still earn a residency. I’m sure it was an emotionally tumultuous path and taught you a lot about yourself along the way.

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UPDATE: Unfortunately due to the high volume of requests to speak with Dr. Chan I can no longer forward her private email. If you have questions for her please comment below. After sufficient questions have been posted we plan to release an updated blog post with the most frequently asked questions. Thank you for your understanding.

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How to Prepare for the Comp

Here is how I approached the comp and used it to help prepare me to succeed on step 1 of the USMLE.

 

It’s just a practice test

At the end of the day the comp exam is a practice step 1 exam and nothing more. I took five practice exams when I studied for step 1 and step 2 respectively. These were NBME practice tests and were just like the comp because the comp is a practice exam that is meant to show you were you stand. Sure, it will suck if you have to retake the comp but your end goal is to crush step 1! So don’t worry about passing or failing the comp. In the long run it doesn’t matter if you pass or fail. If you fail, it means that you aren’t ready to take step 1. And hey, I passed the comp on my first try but I certainly wouldn’t say I was ready for step 1. I still required two more months of studying in order to get my scores up.

 

Pass the comp but focus on step 1

Back in my day we had 4 weeks to study for the comp after our fourth semester final. I understand that times have changed but my study strategy should still ring true. My strategy was simple: I wanted to pass the comp so I didn’t have to worry about it after I left the island. However, at the end of the day the comp doesn’t really matter. All that matters is crushing step 1. No residency program will know if you passed or failed your comp exam but they will certainly know what you got on step one.

 

Don’t try and study everything

It doesn’t pay off to try and study everything before you take the comp because there simply isn’t enough time. During my third and fourth semester I was using the Kaplan step one question bank to study for the NBME final exams so I chose to use a Kaplan diagnostic test to see where I stood. Turns out I sucked at everything but there were certain subjects I was particularly bad at. As I suspected, my best subjects were ones that I had just studied for my fourth semester final. Strategically, I chose not to study these subjects and hoped that I would remember them when I took the comp. Instead, I focused on a few organ systems that I was particularly bad at, specifically pulmonology, nephrology, and gastroenterology. I also chose to focus on cardiology because it is the single organ system that takes up the largest composition of questions on step one.

 

Start studying for step one when you start studying for the comp

When I left the island I had already studied four organ systems (the three I sucked at plus cardio). It wasn’t sufficient enough to allow me to skip them during my two months of preparation for step one but it gave me one hell of a head start. Again, it doesn’t matter if you pass the comp or not. Sure it will suck if you have to take it again but you have to keep the long-term goal in mind of not just passing step one but crushing it. Passing step one might get you a residency but killing step one will get you an amazing residency.

 

And do practice questions. Lots of practice questions.

The more practice questions you do the higher you will score. There is simply not way around it. By the time I took step 1 I had completed half of the Kaplan qbank once, all of UWorld, and all of the questions I answered incorrectly in UWorld once which comes to a grand total of 3,000 questions or so. Some people did all of Kaplan, UWorld, and one or two other qbanks but I personally felt like that’s overkill but everyone is different. UWorld should be the minimum though.

Practice questions will not replace your studying but instead should supplement and guide you in which topics you need to study. Practice questions show you your weaknesses and give you topics to go back and study. I suggest one full question set which should take you one hour followed by three hours to review those questions. Then study for four hours in the afternoon after an hour break. Then eat, sleep, repeat!

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What is ‘The Match’?

Are you in medical school? Sick and tired of explaining the process of step exams, clinical rotations, the interview process, and the dreaded match algorithm to your friends and family? Send them this post before you go home for the holidays and hopefully everyone will have a better idea as to when they can start calling you doctor if they haven’t done so already.

First let me recap the med school timeline for you so we’re all on the same page. The first two years of medical school are the basic sciences. It’s the classic classroom experience where we learn all of the science behind the medicine. This takes roughly two years and culminates with step 1 of the US Medical Licensing Exam (USMLE). Or the COMLEX (Comprehensive Osteopathic Medical Licensing Examination of the United States) level 1 if you are in an osteopathic school.

Now if you have a friend, family member, cousin, or are simply Facebook friends with a med student then you have likely heard of these exams. Or at least heard us complaining about studying for them. So what can possibly make these tests so important that we take months off to study for them? Although stellar board scores alone won’t secure you an interview they can certainly ‘pose a problem when they are significantly below the mean. Board scores have become ‘a threshold that must be achieved in order to receive an invitation for an interview’ (3). It’s a way to weed out thousands of applicants to a smaller pool of hundreds of interviewees to a handful of residents depending on the program and specialty.

Each specialty can be loosely broken down into highly competitive, moderately competitive, and less competitive specialties based on information obtained from previous residents who matched into each one respectively. Highly competitive specialties including dermatology, neuro surgery, orthopedic surgery, plastic surgery, radiology/oncology, radiology, urology, opthalmology, and otolaryngology. Moderately competitive specialties include emergency medicine, OB/GYN, and general surgery. Less competitive specialties include family medicine, internal medicine, neurology, pathology, and psychiatry (3). One of the important pieces of data used to signify each fields competitiveness is the average board score of matched applicants into those respective fields. More competitive fields can use a higher cutoff. So again, a high board score doesn’t guarantee you anything but a low board score can filter you out of the process.

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For instance, The following graph is taken from the 2014 National Resident Match Program (NRMP) data that is available online here.

step 1

This chart “displays the step 1 scores for matched US seniors and independent applicants by specialty. The horizontal bars are median values for successful applicants and the vertical lines show the interquartile ranges (the top and bottom scores of applicants). Scores are generally higher for more competitive specialties, but there is still substantial overlap when specialties are compared” (1). The same thing goes for step 2 scores. You have to do well and, on average, everyone does better on step 2 than step 1. In 2014, the average step 1 score for matched applicants was 230 and the average step 2 score was 243 (1). Here’s the step 2 chart:

step 2 scores

And if you were wondering to yourself, ‘what the hell is an independent applicant’ the answer is anyone who isn’t graduating from a US allopathic medical school. That includes students from Caribbean schools and also American D.O. programs (1)

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Okay, so you finished your first two years of medical school, wrote your step 1 exam, finished your third year of medical school, and wrote your step 2 exam. Now what? At this point you start applying for residencies. A survey performed by the American Medical Association (AMA) of 1,000 fourth year medical students from US allopathic programs from the showed that students applied to an average of 36.4 programs.

apply

This is where the dichotomy between ‘US senior applicants’ and ‘independent applicants’ is really staggering. Caribbean medical students are known to apply to upwards of 100 programs. Personally, I applied to 144 programs for internal medicine. So what’s so important about interviews these interviews? To answer that question we go back to the NRMP match data which shows that the greater the number of interviews you have the greater chance you have to match (and not be unemployed come July 1st).

contiguous rank list

This chart for internal medicine shows an applicants probability of matching based on the number of contiguous ranks. Contiguous ranks means that when it comes time for an applicant to rank programs, that the programs on an applicants match list is in the same specialty. Meaning that programs that you rank one through five are all in internal medicine. Not internal medicine and pediatrics. And in order to get that contiguous rank list you need interviews.

10 interviews seems to be the magic number that most students strive to surpass. What’s the probability of matching if an ‘independent applicant’ like myself gets 12.3 interviews? It’s still above 90% and I’d take those odds any day in Vegas. So 10 interviews seems to be the magic number that most students strive for. That still means that there are students out there who have 10 interviews and don’t match but your likelihood increases with the more interviews that you get.

So how does ‘the match’ work? It’s a complicated computer algorithm similar to what sororities use during rush (you know, minus the computer algorithm). Applicants make a list of the programs they want to go to, each program makes a list of which applicants they want, the information goes into a computer algorithm, and the algorithm spits out the match. Watch this 2-minute video to really understand it:

 

 

So in summary, get good board scores so you aren’t filtered out, score at least 10 interviews, don’t be a weirdo on the interview, and hope that you match. On Monday, March 14th applicants find out IF they matched. This gives unmatched applicants a week to participate in the SOAP (supplemental offer and acceptance program) and attempt to fill unmatched residency spots. Then on Friday, March 18th applicants across the country find out WHERE they matched. Then come July 1st, new interns start nationwide. Happy holidays!July 1st

 

 

1- Charting Outcomes In The Match. Characteristics Of Applicants Who Matched To Their Preferred Specialty In The 2014 Main Residency Match. 5th ed. Washington, DC: NRMP, 2014. Web. 23 Dec. 2015.

2- LWW,. “Going “Fourth” From Medical School: Fourth-Year Medical Stu… : Academic Medicine”. N.p., 2015. Web. 23 Dec. 2015.

3- Katta, Rajani, Samir P Desai, and Samir P Desai. The Successful Match. Houston, Tex.: MD2B, 2009. Print.