Tag: USMLE Step 3

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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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The life of a family medicine intern who failed step one

Thanks for taking the time to let me interview you…again. I introduced my readers to you a few months ago in an interview about the residency application and interview process. Specifically about how it’s still possible to match after failing step one. Fast-forward to today and we’re both about six months into intern year. So what is it like to be an intern?

My pleasure! I’m so glad to share more with your readers. Being an intern is great. It’s not as scary as people make it out to be. I’m learning so much working on different services and with different attendings.

 


 

What has been the most rewarding part of being a family medicine intern?

As cliché as this may sound, the best part is feeling that I’ve helped someone. Knowing that I’ve touched a patient and made their day a little better makes me smile – whether it is addressing depression that has been overlooked and neglected for decades or reassuring an anxious first time mom-to-be that her pregnancy is safe and viable.

 

 

What has been the most frustrating part of residency?

Lack of flexibility with my schedule can get frustrating… More frequent than not, I cannot commit to social events, like dinner with friends on a Friday night or holiday parties. Luckily everyone around me is understanding of my rigid schedule and they’re cool with me scheduling get together on average 3-5 weeks in advance.

 

 

What has been your most challenging aspect of residency?

One of the internal questions I wrestle with daily is “am I good enough?” Am I learning enough? Am I giving my best to my patients? After years of schooling and studying, it’s easy to take time to relax and fall into a lull of complacency. Integrating study time into a full time residency is my challenge.

 

 

What was your biggest fear going into intern year? Have they come to fruition? How have you dealt with those issues?

I think my biggest fear was that I would be a completely incompetent physician and my residency would regret hiring me. I’m glad to say, that hasn’t come up yet. Every new intern comes in with fears, it is normal and to be expected. People are aware that you’re climbing a steep learning curve. Self-reflection was my preferred way to deal with my fears. I even visited a psychologist for a session just to talk out loud about this new chapter in my life (settling in a new place, moving in with my boyfriend, having real responsibilities at work, no longer being a student, “officially” moving from Canada, etc…)

 

 

What are you hours like? What’s a typical day for a family medicine intern?

There are usually two types of “typical” days: at the hospital or at the clinic. Hospital days are almost always longer than clinic days. A day in the hospital can range from 8-13 hours, whereas in the clinic or with private physicians I can clock in 7-10 hours. It’s hard to describe a regular day for me because it varies depending on which rotation I’m on. I could be working a 10h shift in the emergency department, helping manage a service at the Children’s hospital, seeing patients at my clinic, or working on a consult service at my hospital.

 

 

What do you do outside of the hospital to keep your sanity?

When I’m outside of the hospital I try and disconnect. I have always been a big proponent of separating work life and home life. My parents rarely talked about work when they were at home. I intend on following suit. I relish in wandering the aisles of the grocery store, strolling through the mall, calling my friends with no purpose other than to catch up, and planning how I will spend my next vacation.

 

 

How often do you exercise? More or less compared to before residency started?

I’m embarrassed to admit that I exercise MUCH less than before residency. At this point, I barely exercise once a month. Shameful, yes I know. I ended up canceling my gym membership because I simply was not going. I wish I had established a more diligent work out habit before starting residency but now I value sleep more.

 

 

How often are you able to see your family or significant other?

My family lives 9+ hours away so I see them max once a year. I haven’t been great at calling my mom very often but I try and touch base with home once a week or once every other week. My boyfriend and I moved in together before the start of residency. We’ve been good at making a point to have one activity a week – going out to dinner, opening a bottle of wine at home, going for a long walk near the woods. As with any relationship, you have to make it a priority and dedicate time and energy.

 

 

How are you handling the debt?

Money management is always a work in progress. Budgeting and number crunching was essential to me. I found it insightful to hash out on paper how much I got per paycheck then subtracting my fixed and variable expenses. It helped me see where my money was going and I would be more mindful of my spending as to not go into credit card debt.

 

 

When do you plan on taking step 3?

I have my Step 3 scheduled in April 2017. I’m nervous as with any exam but my goal being to pass regardless of the score is somewhat comforting.

 

 

What’s it like having the responsibility of teaching medical students?

I haven’t fully grasped yet this responsibility. I’m trying to keep my own head afloat! Since I don’t feel at this time that my medical knowledge is all that phenomenal, I make a point to teach my students about the art of medicine. I like to show them my approach to difficult subjects, how I weave humor into interviews, and my use of analogies to simplify medicine to patients.

 

 

In retrospect, with the knowledge that you have now, are there any questions you would recommend to medical students to ask during their interviews?

I would encourage medical students to ask programs what kind of support they have in place to help residents through the years. Do they have board review courses? How do they handle resident burn out? What support will they offer if you score below average on the yearly in service exam? While some students may fear that asking these questions show weakness on their part, I think it is important to know what is available to you in your new work place.

 

 

Speaking of medical students, do you strongly feel that there is anything you wish you did differently while you were in medical school that would have better prepared you for residency?

I don’t think there is anything that I would do differently per se. As a student, I took full advantage of the various opportunities offered to enrich my learning by attending conferences, going to drug rep talks, and striking up conversations with other physicians. I would encourage students to do the same. You never know what you will learn and you never know whom you might meet.

 

 

For the current medical students reading this, what general advice do you have regarding residency?

For medical students approaching residency, I urge you to enjoy the process. Although residency and the match are riddled with stress, anxiety, and uncertainty, have faith and trust the process. Everything happens for a reason and you will end up where you are meant to be. I know it is easier said that done to relinquish control but things will happen the way they were intended to. You will get out of residency what you put in. Your attitude and outlook are the biggest factors in your satisfaction with residency.

 

 

 

Thank you so much Emily for taking the time for this interview. I know there are plenty of other students out there who have come short on big exams like the USMLE’s or COMLEX and it’s encouraging to see someone else who still managed to match and continues to succeed in residency.