Notesfirst Blog Advice for Medical Students

Like most things in life, following exactly what some internet blog tells you may be a bad idea. However, I write this with the hope that some of this information may be helpful in tailoring your medical school experience and allow you to become an extremely desirable candidate for residency. Trends come and go but most of what I will say will hopefully stand the test of time. I will first make some general statements and then break it down by year.Residencies want students who will not be a liability to the program. This means that they will work hard to screen out "trouble makers". They don't want someone who will clash with patients, other residents, staff or attendings. You have to understand that training is an extremely stressful environment. If a student is difficult to work with right now, imagine what that person will become under tremendous amount of stress. When we pick students for internship and residency, we first screen all candidates by reviewing USMLE scores, clerkship grades, personal statement, and extracurricular/research activity. We want to make sure you will not fail your residency because you cannot academically succeed within that specialty. If we think you can do this, we invite you for an interview. Most directors do not have a formula that calculates whether a particular candidate fits some type of residency criteria. That is because this process is not an exact science. Every year, there are so many different candidates from all walks of life that it would be a disservice to have a "standardized" algorithm. They would lose many fantastic candidates with so much potential if they did. Most of the time, the departments get an overall feeling from the entire application whether a particular candidate is "good" for the program. I can't emphasize enough that the personal statement does play a big role in many cases. Many directors I have spoken to argue that if you cannot convey yourself in writing well, they question whether or not you will be able to converse with patients effectively and write an appropriate medical note detailing the patients' stories. If you get past the initial screening, the critical component begins. Imagine we have 50 students with similar USMLE scores, research experience, and clerkship grades on a list. Everyone looks and sounds about the same on paper. Everyone seems "nice". They know that the candidate can cut it academically. What's critical at this stage is whether at some point during residency, that person will get into a fight (I have seen fist fights), endanger patients with their incompetence, or conflict with other services. If we think that you are a decent human being who will be a good advocate for patients and become a team player, you will be ranked. We will go back to the committee, look at the interview scores and comments all of the faculty have given during the visit, look at all of your test scores and research, and decide how to rank you. Your personal statement will be used as tie breakers if there are any doubts or questions. Year By Year BreakdownThere are ways to get through medical school without being labeled as a gunner or a complete a**hole. Year 1This is your study year. You need to learn or relearn the basic sciences. Learn your anatomy and learn it well. You WILL be pimped on this (pimping in medical school and residency is when your senior (resident or attending) quiz you in an impromptu fashion in an effort to "teach" you something... or just humiliate you, depending on who you meet). One who knows anatomy will be far superior to any other student or even resident. The most critical aspect of your first year to me is the summer break. Some people take this time off to let off steam, relax or just do nothing. I think there is nothing wrong with that. However, most of my colleagues and friends used this time to get involved in research. Those looking to enter extremely competitive residencies (ie. dermatology) use this critical time to position themselves with a mentor in a field with the hope that they can publish something. Actually, some students looking toward ultra competitive fields or competitive residency programs ally themselves with a prolific mentor from day one of medical school. Now the problem is, the majority of you will NOT know what specialty you want to go into. Therefore, it is difficult to predict which mentor would align with your passions. If you're in that boat, my advice would be to pick a research project that has broad implications. I picked infectious disease and social policies regarding sexual assault victims as my research projects because these fields can be applied to most specialties. I had originally thought emergency medicine was my calling and that's why I picked these two projects. I pivoted in 3rd year to Neurology but these were still relevant. Plus, these two experiences really helped me solidify my topics for personal statements.Year 2Study for your Step 1. No matter what people say, the residency directors will rank you initially according to your USMLE scores behind closed doors. Every specialty and each program has an unofficial minimum score they are looking for. You will never get an exact cutoff on this. Depending on how desperate (or not) they are in recruiting residents for the match, this score will fluctuate from year to year. But these scores are important so you need to start early. My recommendation is to buy a Question bank early and slog through it. People put this off until 2-3 months before the exam but you should get started early because most qbank programs allow you to reset all the questions at least once. Therefore, you should plan on getting through it once, and reset a few months before the test to go over the questions. I think First Aid is helpful. Many swear by Goljan and USMLE World. I used all three. Hopefully, you are still continuing the research project you started in your first year. Hopefully, you are staying sane. Prepare for your clinical year. Hone your "people skills".Year 3Be enthusiastic. Keep your head down and work hard. Be an asset.Do not be annoyingDo not be an a**hole to your fellow classmatesDo not screw over your fellow classmatesDo not make your intern or resident look bad in front of the attendings.The WardsYour primary role as a medical student is to learn. Your secondary role is to be helpful in everyway. Do not be a liability. Help your intern and residents. Make them look good. I once had a med student make the intern on our service perpetually look really bad. In a poor attempt to impress the attending, he would make some snide comments about how "the person taking care of this patient did not realize this or that or observe something, et cetera" during rounds. The student never identified the intern by name but used what he probably considered "witty" ways of alerting us that the specific intern wasn't doing everything he/she was supposed to accomplish in a given day. This behavior did not make him look smart. Rather, it just reinforced the idea that he was not a team player. Instead of helping the intern with these inadequacies, all he did was belittle him/her.Little did this person know, that at the end of the rotation, the attending he wanted to impress did not remember this student at all. But as you can imagine, that intern and the senior resident remembered vividly. Guess who makes the recommendations for grades at the end of each rotation? In an attempt to "show off" during rounds, he pretty much lowered his chances of getting a great grade. I don't know why students forget that interns and residents were med students once. They remember all of those classmates they hated. If you reflect a personality that they abhorred in the past, do you think they will think highly of you when you act this way? I often get asked how students can excel in these clinical rotations. I think that 99% was attitude. I was never the smartest on the team but I was willing to do everything I could to learn. I was enthusiastic but I made sure my classmates didn't look bad. If a resident asked me if I wanted to do "so and so", my answer was always yes. Sure, I had do some scut stuff here and there but when the residents and interns found out I could be counted on, they gave me more and more responsibilities. I became an asset.It's crazy how some students (just because they are not interested in a particular specialty) just blow off the rotation and do the bare minimum. This is a bad idea. The medical field is a small world. Don't burn bridges and don't build a reputation that you are lazy. Plus, you NEED to learn these things. Make an effort!Step 2 CKWhile you are having fun on the wards, you need to start preparing for Step 2. Purchase some type of Question bank and go through each subspecialty section while you are rotating through said specialty. It's a great way to pass the shelf exam as well as study for USMLE Step 2. Again, most qbanks allow you to reset at least one time so after you go through each section during your rotations, reset it before the test and go through it again. Pre-test, Case Files, Blueprint, etc all have strengths and weaknesses. Most people I know (who did really well) picked two study materials and a qbank. Don't bother trying to read textbooks. You just won't have the time. Get through the high yield stuff. Step 2 CS This is a tricky one to cover. I'm not going to get into the politics behind this but I will just say that for this test, you need to find someone to practice with. The scenarios that you will face are pretty straightforward. Within a few seconds, you will know what pathology you are tackling in each room. From what I gathered from my patients who volunteer for this test, there is a standard checklist they go through to see if you have covered the basics in terms of history. But that checklist is pretty much the same across the board. What I find helpful is to practice over and over again the standard qu