My Secrets to 4th Year Success

Christine, Fourth Year Medical Student

Hello!  If you have been following along with my posts, you already know that I am a 4th year medical student here at Loma Linda University.  I recently matched to Loma Linda University Preliminary Internal Medicine and University of California San Diego Neurology Residency, and I am still super excited!  It feels great knowing that my lifelong dedication has paid off.  Throughout the year, some students have been asking for my advice, and I have been doing my best to share what I know.  Honestly, I’ve gotten overwhelmed by all the questions, so I decided to make a MEGA post to address the topics that I feel are important for success in the 4th year of medical school.  Anything not on here that you want to know, I suggest you find on official sources.

Note: Please take my words with a grain of salt.  I consider it important to be prepared for worst case scenarios, so I give people practical advice.  These are all my opinions, not necessarily the opinions of Loma Linda University, any particular faculty members, or my classmates, and my opinions may not apply to everyone.  For more of my thoughts, please read my past posts.  What I write may not work specifically for you, but this is what worked for me.

The best thing you can do is figure out your game plan yourself.  Talking to your deans, faculty advisors, and residents is helpful.  However, don’t count on anybody to spoon feed you information about every little thing.  Look at the official NRMP, ERAS, specific program websites, etc. to give you the basics.  If you got into medical school, you are smart enough to find these resources and use them to your advantage.  It will be your personal interactions at the interviews and discussions with your loved ones that will help guide your decisions.  This is your future; grab hold of it.  Now that I’ve successfully matched, I am excited for my upcoming graduation and to start my journey as a medical doctor!

Before 4th Year

This is a no-brainer, but I suggest you study hard on all your classes and rotations.  You will be amazed how much better you understand clinical care with a strong basic science foundation.  In addition, grades and comments from basic science and clinical years will be on your Dean’s letter that is sent to the programs you apply to.  Your Step 1 score and class rank do matter, especially if your goal is to match to a well-known institution and/or competitive specialty.  It’s not all about scores and grades, but some programs will not know how awesome you are unless you pass their filters.  There are way too many stellar applicants from all over the country vying for the same spots.  Red flags, such as failing a year of medical school, will limit you.  Unfortunately, if you have a red flag, you do not have the luxury of being picky.  Don’t expect to match to a top program if you are not a top student, but of course, you can always dream and apply everywhere to see what happens.  If you can afford it, go for it because it is hard to predict what programs are looking for.  God does work miracles.

Always strive to learn and improve.  Be appreciative of what God has given you.  Not everybody is given the chance, nor the capacity to be a medical student.  While you are in medical school, find some time to give back to others if you can.  Offer whole person care to every patient that comes your way.  It does take more time, but touching a patient’s life in a special way is invaluable.  Being a doctor is not just about having an immense amount of knowledge, but also taking care of people.  At the same time, don’t prioritize extracurricular activities over academic difficulties.  Achieving a balance is difficult, but that is something that you will have to learn to do.  Unlike other professionals, a physician’s job does not end when the clock ticks a certain time.

4th Year Schedule

What electives should I take?

Honestly, 4th year is your time to do whatever you want, and nobody really cares what you do with your schedule as long as you meet the requirements to graduate.  During your 3rd year, you will receive an information packet on the requirements you need to meet.  Read that carefully.  Refer to my first blog post, Exciting Choices in 4th Year, if you want to know what electives I chose.  However, my schedule has changed several times, so don’t worry if you are not exactly sure how you want to schedule everything.  I did not finalize my entire schedule until February 2013.  Some of my other posts also detail experiences from electives if you want to know more of what I think.

When should I do sub-internship/specialty of interest rotations?

You should do your rotation early enough to solidify your interest in a particular specialty and get recommendation letters.  The earliest you can submit residency applications is mid-September, so anytime in July or August is good.  Doing it early is also helpful if you are unsure of what specialty you want to go into.

Should I do an away rotation at a program I am interested in?

This is entirely your decision.  It may or may not help.  I have heard stories from both sides.  Some people matched at places they did away rotations.  Some people did not even receive an interview at places they did away rotations.  I didn’t do any away rotations for neurology programs, so I don’t know what it would have done for me.

When should I schedule vacation?

It’s up to you how to schedule.  Interviews can be anywhere between October and February. The majority of interviews are in November, December, and January.  I took off 2 weeks in November and 2 weeks in December.  Most students also take off April or May for traveling or just having fun in general.

When should I schedule tests, Step 2 CK and Step 2 CS?

Schedule them whenever you feel you will be ready.  They just need to be taken by LLU’s deadlines.  Refer to your information packet.  I took Step 2 CK in July to get it over with and so that it would be available before I submitted my residency applications.  I held off until December for Step 2 CS because I needed more time to get ready.  I think I might have written about these tests in a previous post as well.  All the information about these tests are on the official websites.

How should I study for Step 2 CK?

If you already took Step 1 and successfully made it through 3 years of medical school, you should know your study strategy.  What worked for me was practice questions from USMLE World and a review book, Step up to Step 2.

How should I study for Step 2 CS?

The most important thing to do is practice.  Grab a classmate and grab a book with practice case scenarios, such as First Aid to Step 2 CS.  Time yourself through the practice sessions.  You want to be done with the history and physical portion before the 5 minute warning.  After the H&P portion, time yourself writing a physician’s note.  Compare it to the book’s examples.  Another important aspect of Step 2 CS is empathy.  Treat the standardized patients like a real patient that you care about.  If you need more help, talk to the PDX office.  They are great at offering tips and helping you improve.

Applying for Residency

How much money should I save?

Interviews and 4th year in general are expensive. First of all, Step 2 CK and CS are about $2,000. Applying to programs can be about $500. You can check the prices on the ERAS website. I think it’s better to apply to more programs than you need to because it is hard to predict who will offer interviews.  I think it’s reasonable to save at least $5,000 for travel. It’s better to have more money and not use it than to have to cancel an interview at a place you really want to go to.

When should I create my CV?

ASAP.  There are sample CVs in the Dean’s office.  They also give you a sample copy during your 3rd year.  Follow that format.

When should I write my personal statement?

Do it early.  Start before September.  An articulate and well thought out personal statement actually takes longer than you expect.  I gave some advice about personal statements in my previous post, 4th Year Rotations and Residency Applications.

Who should I ask for recommendation letters?

This may vary, depending on your specialty. At least 1 letter must be from your specialty of interest.  1 should be from a core rotation like internal medicine, surgery, peds, etc. if you can get a strong one.  If not a strong letter, then choose whoever can write you a strong letter.  The last can be from any doctor.  Quality is very much more important than quantity of letters.  3 letters is good enough.  My advice would be to ask for them early.  You need to have a CV and personal statement ready by August, so that you can give them to letter writers.  If possible, the goal should be for the letters to be available by the 1st day of submission.

When should I start my application?

Start it before the first day of submission.  It can take at least a few hours to complete.  Make sure you double, triple, etc. check it before you submit.

When should I submit my application?

Submit it on the first day if possible.  I suspect that interviews are given on a rolling basis.  I submitted my application on the day that it opened, September 15, and I got my 1st interview invite on September 18.

What programs should I apply to?

My main advice would be to apply broadly and realistically.  Although I matched to an amazing spot, I didn’t even get interviews at some of the top programs I applied to.  As someone who prepares for worst case scenarios, I think it is extremely important to also apply to non-competitive spots.  That means outside of desirable areas in California, outside of the Ivy League, outside of any place that most people would be impressed with.  What is considered non-competitive also depends on your individual Step 1 score and grades.  This information can be found on the NRMP reports and talking to the experienced deans/faculty advisors.  Some people in my class did not match, and unfortunately, I don’t think that every student found a job in SOAP.  Your goal is to make sure that you apply smartly and go to enough interviews.  Yes, it is all expensive, but if you don’t get a residency position, you won’t have a job.  A job in some random place is much better than no job at all.

How many programs should I apply to?

This depends on what specialty you are applying to and how reputable the programs you apply to are.  For any specialty, I would recommend applying to at least 20 programs.  This is assuming that some of the programs you apply to would impress a layman.  I tend to be more on the cautious side, so I think you should apply to as many programs as you can afford.  If you are applying to well-known places, you need to apply to extra.  As a warning, just know that no matter how competitive an applicant you are, you will inevitably get rejected by programs.  Consult your deans and faculty advisors if you need help.  They have years of experience in helping students succeed.

What do you think about neurology programs?

Well, I think that neurology is the best specialty!  Some programs are categorical with all 4 years.  Some programs are advanced and also need an intern year.  You need to weigh the advantages and disadvantages yourself.  Applying to advanced programs means you have to spend extra time and money interviewing for preliminary spots, so prepare for that if you are planning to do so.  It is all personal preference, and no one can tell you what you should do.  After learning about different neurology programs, I found most programs are more or less the same with differences of prestige and location.  I thought that every neurology program I interviewed at was great in their own ways.  Everybody has different reasons for why they like or dislike something.  This is something that you will have to figure out on your own.

What are my chances of getting an interview and/or matching at a certain program?

I don’t know.  If I could predict the future, I would be rich by now.  The only way you will know is to apply.  The top programs obviously favor applicants with high board scores, above-average class rankings, and no red flags.  If you are not restricted by finances, then apply and leave it up to God.

Interviews

How much money should I expect to spend on interviews?

For local interviews, it will be gas price unless you stay at a nearby hotel, which could be $50-100/night. I think West Coast interviews by plane with hotel/ground transportation is may be about $300 each. Midwest and east coast may be about $500 each. It depends on if you can get some deals. Southwest was usually cheapest for flights, but for flights and hotels, it’s good to shop around. Look at the company’s site, priceline, hotwire, hotels.com, etc. to find the best deals. If possible, you can try to group interviews in the same region but it’s hard and doesn’t usually match up, so don’t count on it.

How many interviews should I go on?

I don’t have a clear answer, but I recommend aiming to go on at least 10 interviews.  The worse of an applicant you are, the more interviews you should go on.  If you get fewer than 10 interview invites, you should go to all of them.

How should I prepare for interviews?

Be yourself.  I wrote about interviews in a previous post, What It’s Like to Go on Interviews.  You can refer to that if you’d like.  There is also a practice interview session offered by LLU.  Go to that.

Should I contact programs after I have interviewed?

It is up to you.  I sent some thank you emails and some thank you cards.  In the end, I don’t know if it made any difference.

Match

How should I rank programs?

This is entirely your decision.  Please read the Match algorithm on the NRMP’s website if you are unfamiliar with how the Match works.  It explains things better than I possibly can.  Pros and cons of each program need to be decided on by you.  Don’t depend on others to spoon feed you their opinions.  Everybody has different personal reasons.  I ranked programs based on my overall feelings and desire to attend them.  This is not something I can describe, but you will have to experience it for yourself.

How does the SOAP work?

I do not know, and I do not want to know.  Luckily, I did not have to know.  I’m sure you can find this information on the NRMP website if you want to know.

What is Match Day like?

Please read my post, Some Thoughts on Match Day! for my thoughts on Match Day.  Also, watch the Match Day 2013 video, which is featured in my last post, Ice, Eyes, and Nice Comments!  Match Day is just simply the best day of medical school for me.

How do you feel about your match?

I am very happy!  I can’t believe I matched to such an awesome place!  I am excited that I get to stay in Southern California and be near my family for all of my residency training.  I feel blessed to match to UCSD’s neurology program.  I also feel blessed to stay at LLU for my intern year.  After 20+ years of nonstop schooling, I will finally start my first job soon, so I am grateful that I get to have my parents around to support me with my transition to the working world.  I know that this is where God wants me to be, and I am thankful for His wonderful plans for me.  I feel great knowing that all my dedication and hard work have paid off and that my dreams of becoming a doctor are coming true.  At the same time, I feel like wherever I matched, I would be a bit sad that it wasn’t one of the other programs because I enjoyed all my interviews and loved meeting people everywhere.  In a way, I’m glad that I’m not the one who makes the tough ultimate decision of where to train next.  Overall, I feel like this is the best time of my young life so far.  I am looking forward to many more special events to come during my lifetime. :)

My Final Thoughts

Making it to 4th year of medical school is already an accomplishment.  The first 3 years of medical school are very difficult, and only people who have been through it will understand what it takes.  Be prepared for new challenges in your final year.  Never stop learning.  You still need to give it your best on every rotation.  Treat every patient like they are a VIP.  You will also have more well-deserved free time than in other years of medical school, so spend time with those you love.  This is the last year for a long time in which your time is truly your own.

When seeking residency positions, it is better to play it safe, but reach for the stars if you can afford it.  Even if you think you are a desirable candidate, not everyone will agree.  The money you lose from applications and interview experiences is extremely miniscule compared to the huge disappointment of not matching.  Have fun on interviews.  Be nice to everyone you meet.  Be yourself.  Form your own unbiased opinions.

Enjoy 4th year.  Have fun.  Do things that make you happy.  Hang out with your family and friends.  Don’t worry about every little thing.  Get comfort from the ones who will be there when no one else cares, your family and God.  Remember that God has brought you this far, and He will be faithful.  No matter where you end up matching and even if it does not work out the way that you want, remember that what God chooses for you is even greater than what you choose for yourself.

Ice, Eyes, and Nice Comments!

Christine, Fourth Year Medical Student

Hey readers!  As you probably already know, Match Day has come and gone, and I am still very excited for my next few years.  If you haven’t already watched it, Kristina Benfield, LLU School of Medicine’s Project Editor created a video about the celebration.  You can see it for yourself here:

Well, over the past few months, I have definitely been enjoying my 4th year of medical school.  I had fun traveling on interviews, meeting people, and eating lots of delicious food.  In addition, I have spent some time learning cool things too.

Some of my rotations/electives included:

  • Internal Medicine at the White Memorial Medical Center in Los Angeles, CA
  • EKG Cardiology class at Loma Linda University
  • Radiology at Riverside County Regional Medical Center
  • ICU/Critical Care Medicine at Kettering Medical Center in Kettering, Ohio
  • Anatomy at Loma Linda University

These were all excellent rotations that I recommend to future 4th year students.  I did not do any away rotations during my 3rd year of medical school, so it was fun to go to LA and Kettering to see how other hospitals work and meet new people.  The White Memorial and Kettering are both associated with LLU, and both are also beautiful hospitals.  Since I lived in California for almost my whole life, it was interesting to live in Ohio during the month of February.  I got to experience driving in snow and scraping my car, which are some things I am not used to.  Moreover, there was even a rare “ice day”.  After a night of frozen rain, I received the surprise of my car entrapped in layers of ice.  Oh my goodness!  I can handle rain.  I can handle snow.  But my car was literally an ice cube that morning!  I had to pull the car door really hard just to open it.  Then, I spent 45 minutes scraping a 1/4 of my windshield and rear.  Then, I was praying that nothing would happen to me as I was driving to work with an obstructed view.  Even though I only had to drive 1-2 miles to work, I had to pull over halfway because I was so scared.  In the future, if this ever happens to me, I’m taking a day off!  Besides that ice day, the snow was pretty.  I noticed the snow on the ground would sparkle, and it was beautiful!

Now, I am on Ophthalmology.  Wow, the eyes are like a whole new world!  They use some interesting instruments that magnify the eye.  There are even several ways to test the eye.  Even though I feel like I should be a confident 4th year medical student, being on this rotation where things seem so foreign can be depressing on my ego.  However, I am glad I get the chance to learn about ophthalmology.  Even more than that, I think that this rotation has reminded me of some important characteristics that a great physician should have.

Obviously, a solid knowledge of relevant medical knowledge is necessary.  This is something I felt I was lacking regarding ophthalmology, but the doctors have assured me that it’s okay because I am still learning, after all.  In fact, medicine involves constant learning.  Some other important characteristics that patients have told me they appreciate are: humbleness and empathy.  The ophthalmology patients that I interviewed and examined this week have told me that they appreciated that I would take the time to listen to them and explain what I was doing.

This week, God has blessed me with the opportunity to practice whole person care in the ophthalmology clinics.  One of the frustrating things about being a student is waiting to chief patients with residents/attendings.  However, I ended up using this time to get to know my patients outside of their eyes.  It was great.  Who knew I would spend my week in ophthalmology clinic praying with patients?

What I was surprised about were comments that patients left me with.  For some reason, patients seemed to be extra nice to me this week.  Here are some things that patients told me:

  • “Wow, you are almost done with medical school.  Congratulations!”
  • “Your parents must be very proud of you.”
  • “You are really smart!”
  • “I understand things better now that you explained it.”
  • “I feel like it was God’s plan for us to meet today.”
  • “You are so special!  I don’t know what it is about you, but I can just tell that you are special.  I feel like you are going to do great things in your life.  I don’t know why I feel like this, but you are just so special.”  Then, she says to my resident: “She is so special.  You are kind too, but she is just really special, and I don’t know why.”

What have I learned from all of this?  I have learned that a pleasant attitude, smiling, and patience go a long way.  Of course, solid medical knowledge is extremely important in treating patients, but humanism is what makes patients like doctors.  I already knew this, but it is good to have nice reminders.  :)

Some Thoughts of Match Day!

Christine, Fourth Year Medical Student

I just went through Match Day, and wow, it was a wonderful day!  My day started out when I woke up early without any alarm clock in anticipation of finding out where I matched.  However, I saw it was only 3am, so I tossed and turned until it was late enough to get up and get ready for LLU’s Match Day ceremony, which started at 8am.  I was so excited!

The ceremony was really nice.  Many students brought their spouses, families, and friends.  The room was packed.  The deans, Dr. Shankel and Dr. Wongworawat, would call students’ names to get their envelopes.  Before I got my envelope, I just felt excited.  I had already known I matched on Monday, but had to wait until Friday to find out where I would be spending the next few years of my life.  Honestly, I didn’t know exactly where I wanted to go, and I ended up changing my rank list many times before the submission deadline.  Since I only went on interviews at places I had already narrowed down to, I felt like I would be happy at any place I ranked.  It was just such an honor to be matched already!

So, after opening my envelope, I found out that I matched to: LLU for Prelim Medicine and UC San Diego for Neurology!  I was in shock pretty much the whole day.  I remember my interview at UCSD clearly.  It was one of my first residency interviews back in October, and I definitely did not feel like I had my best performance at that time.  In fact, I left the interview feeling like there was no way I would be able to match here.  The education, faculty, residents, facilities, location, and other fellow applicants seemed so amazing that I felt like there would be no way they would want me.  Of course, I still ranked UCSD hoping for a chance, and I matched!  I feel like I’ve gotten more and more excited as the day has progressed.  I was just so surprised that I matched there.  I guess it’s true that God already planned this out for me.  Also, I’m super excited to stay at Loma Linda for my intern year!

Later that morning, when the ceremony had ended, the UCSD program director called me.  I couldn’t believe this was really happening to me!

Later in the afternoon, my fellow matched friends celebrated at Fiesta Village.  We played mini-golf, laser tag, and go-carts.  It was really fun!

Wow, Match Day was so incredible.  13 hours after finding out where I matched, I felt like my face hurt from smiling and laughing so much!

I am so grateful to my family and friends who have help me in so many ways along this journey that is still continuing!

What It’s Like to Go on Interviews

Christine, Fourth Year Medical Student
Hi Readers,  I hope you are all doing well and enjoying the holidays.  I’ve been having a great “vacation” since the middle of November.  I’ve spent most of my time visiting different places around the country while going on interviews.

Before I continue, I ask that you please take a moment to pray for the many victims and their families who have lost their lives in 2012.  Unfortunately, natural disasters, train accidents, shootings, and cancer are only some of a few events that led to unexpected deaths last year.  Also, we should take a moment to be thankful for what we do have in our lives because no matter how bad things may seem, there will always be someone somewhere who has it worse.  As students, it is easy to complain about how hard we work, but we really are lucky.  We are lucky to have access to education and not fear punishment for studying.  Anyway, this is probably easier for me to say as a 4th year medical student.  During the past few weeks, I have been doing some of my favorite activities––meeting new people, traveling, and eating.  My interviews are fun.

So anyone curious, this is some of my experience on residency interviews.  First, it starts with packing and getting to the destination.  I have driven and flown depending on how far the interview place is.  Many times, the night before will begin with a dinner with current residents.  This is a time to ask residents anything you want, such as work environment, call schedules, places to live, fun things to do, etc.  These are good opportunities to get to know the residents and the program.  Don’t be shy.

The interview day usually starts around 7am or 8am.  When you get there, there is usually a meeting with the program coordinator who gives out information packets.  Breakfast has been provided everywhere I’ve been.  The program director or chair will give a presentation about the program structure and goals.  This is useful to know what the program’s mission and educational structure is about.  Most places will have some sort of grand rounds, morning report, or lecture that we get to see.  This gives an idea of what they normally do.  At some point, there will be a tour of the hospital and a free lunch.  In addition to seeing the different facilities, it is a good time to exercise off some of the dinner and lunch.

Throughout the day, we are able to ask anybody any questions we have.  Believe me, pretty much everybody will ask if you have questions.  Again, don’t be shy.  The interviews with faculty members can be either in the morning or afternoon depending on how the program does it.  At places I’ve interviewed, there can be 2-6 people to interview with.  Some will ask unique questions.  However, some common questions include: ‘Why this specialty?’, ‘Why did you apply here?’, ‘What are your future plans?’, ‘What will you bring to this program?’. For aspiring 4th year medical students, these are some of the questions you should be prepared for.  It can also be possible that the interviewers will ask about imaginary scenarios or test your knowledge.  Honestly, I don’t think it is only about what you say, but also the way that you handle yourself in answering these questions.  There is no need to freak out if you don’t know the right answer.  Sometimes there are no “right” answers.  My best advice: just be yourself.

I am almost done with my interviews.  It’s been a lot of fun.  What I’ll need to do is sit down and think about all of my experiences and impressions of each program.  After interviews are over, I have to rank the residency programs for the Match.  The programs will also rank me.  You can read more about this on the NRMP website if you want more information.

Well, I just wanted to give a brief update on interviews.  I think it’s a really fun time.  Meeting new people, traveling, and eating are some of my favorite things to do.  After going on some interviews, I know that I chose the right field because the attendings, residents, and fellow students I’ve met are awesome.  It’s been exciting to visit both new and familiar cities.  I’ve gotten to travel more in the past few months than I have in the past few years.  I definitely take advantage of all the free, delicious food I’ve gotten, especially since some of the entrees are foods I can’t afford myself.  If you were wondering, I can still fit in my suits.  I’m not sick of interviews, but I did literally get sick a few weeks ago.  I still went on a couple interviews at that time, and it was definitely more tiring.  Now that I’m recovered, I’m looking forward to my next interviews.  I don’t want my interviews to end yet, but it will soon.  However, I know there will be much more exciting things in 2013.  I wish you all a Happy New Year!

Waiting in airports

Right now, I am sitting at the Las Vegas airport waiting for my connecting flight. I have an interview tomorrow, and I’m pretty excited!  I’ve actually gone on a couple interviews already, but I feel like each one brings its own excitement and uncertainty.

2 weeks ago, I was also waiting at an airport but it was a little different. 2 weeks ago, I arrived at Ontario at 5:15am, which I thought would have been plenty of time to make a 6:20am flight. But man, the security line was the longest ever.  It went from the escalators all the way to the end of the baggage claim and snaked around a few feet! Once I got out of security, my flight was boarding.  I made it though. My only complaint was that I had to go to the bathroom, but the pilot never turned off the seat belt sign since it was a short flight to Las Vegas. However, I was happy that I was on a flight with no plane change, so I was able to relieve my bladder once it landed, and I didn’t need to search for my next gate.

The flight coming home 2 weeks ago was also a bit rushed. I made it to the airport early, and my flight was delayed. For this one, I had to change planes at Denver. Since my 1st flight was delayed, I pretty much ran to the next gate because my arrival time was about 10 minutes before my next departure. I made it of course. It also happened the flight was overbooked. They were asking people to give up their seats and get $300 in credits. I was so tempted. Too bad I had to go back to the hospital the next morning

Back to now, my plane has arrived. Today was not crazy at all. Security was a breeze and my 1st flight wears early. Actually my connecting flight is delayed so I have plenty of time. I guess that’s why I’m writing. I’m actually using my cell phone to blog all this stuff. Hopefully there isn’t too many grammatical or spelling errors. Please bear with me! Well, I’m going to board my flight soon. I’m just watching the “excited” people arrive in Las Vegas. Until next time, hope you’re having fun wherever you are!