Internal Medicine: If I think I want to do a fellowship after my IM residency, do I need to do anything now to make myself more competitive aside from taking electives in that specialty? Or is that mainly a concern in residency?

1) "If you know that you want to do a fellowship after IM residency then your goal will be to match into a competitive academic program with a good fellowship match list. Engaging in research during medical school can assist you in interviewing and ultimately matching at these programs. Is research necessary to get to a competitive academic program? No, but it does make you a more competitive applicant and the overall goal of the ERAS process is to make yourself look as competitive as possible on paper so you can secure the interview. Once in residency the research you do then will be much more important in ultimately securing a fellowship position.Your STEP 1, and STEP 2 scores obviously matter as it pertains to securing an interview and ultimately matching at the more competitive academic programs as well."

2) "I would doubt most fellowship programs take into account 3rd year rotations when selecting candidates. Getting to know someone who selects for that fellowship, doing research with them and honoring exams can never hurt though. Remember that cardiology fellowships usually consider 100 applicants for each position so it is super competitive. GI is similarly competitive. Performance in residency and IM boards are most important."

3) Doing research...especially research that results in posters or publications always helps no matter when you start it.

4) I don't think you need to do anything above and beyond what you would normally do to make yourself a competitive IM applicant. By all means, if you want to do research in that specialty, or use your elective to further explore that specialty, feel free to do so. Keep in mind, when sending out interview invites, some programs will want to know if you are specialty-bound so they can match interviewers from that specialty with you (to get more info about that specialty in that program, etc.). But as far as matching goes, I don't think it makes a difference.

5) Mainly concern in residency

6) It probably depends which specialty you want to do. And how competitive it is and whether the place you want applies is a namebrand competitive place. Any sort of significant research will make it look more competitive.

7) It's more of a concern in residency. Unless you do your residency at the same place you rotate on your clerkships (in which case you'll be more familiar with that particular subspecialty group), most places don't put much stock in whether you rotated on specialty X during medical school since you'll rotate through the main subspecialties during residency (and every program has elective months available in 2nd and 3rd year). It's more worth your time to get involved in a research project or two (not necessarily related to the field, but it helps). More than anything, just do great work and impress on all of your rotations!

8) Everything I've heard from residents is that you should focus on the most immediate next step - i.e. getting into a good IM program. Think of it like this - how much of what you did in undergrad is helping you get into residency right now?

9) The number one factor will likely be how you performed during your internal medicine residency and the reference letters you get for your application. Most programs allow you to do an elective in residency, which you should do at a location and in the specialty you are interested in. Beyond that, all of the usual things like volunteering, leadership positions, extracurricular activities will play a role in getting a fellowship, and it never hurts to start doing research in that field early so that you have a publication by the time you start fellowship applications.

10) Definitely a concern for residency. I started some GI research as a fourth year which was an opportunity that stemmed from doing an elective in GI third year...but it is most definitely not necessary.

11) Doing electives will add to your story of how you got to decide on something, which may help. This is probably more a residency concern, however.

12) Generally, this is a concern in residency as far as I'm aware.

Internal Medicine: Do we get internal medicine letter of recommendation during 3rd year rotation or 4th year sub-internship?

1) Either is fine. I am going into Med-Peds, and got a letter from third year since my sub-I is scheduled for March. Build positive relationships with everyone, you never know who will end up writing your letters! A letter should come from someone who knows (and presumably likes) you.

2) It depends. I didn't have time to do my Sub-I before I had to submit my letters. I got a letter from an IM attending that I rotated with during October of my 3rd year and it was still great. The important thing is to let them know right away so they can jot down notes or start it and then follow up with them in the Spring.

3) "If you had a good experience during your 3rd year medicine rotation, had good relationships with or received good feedback from your attending then ask if they'd be willing to write a LOR on your behalf at that point. It gives your potential letter writer an opportunity to take some notes (mental or otherwise) and remember specific things about you while they're still fresh in their mind. If 4th year rolls around and you still do not have the required number of LORs then getting a LOR during your sub-I is perfectly fine.

4) Remember that all of your LORs do not have to be from Internal Medicine physicians. If you had a great experience on another rotation and made good relationships there, then ask that attending for a letter as well. I wouldn't suggest this for more than 1 letter."

5) 3rd year because you may not get the SubI you want before August. If you take IM early, sow the seed that you want the letter during the rotation, reconnect with them around March April, then get the letter in June.

6) That depends on your personal experience. If you honored the rotation during 3rd year and connected with an attending, go ahead and ask for the letter. It is ok to ask during both opportunities if you think someone will write you a strong letter. You can always have 2 IM LORs....one from the clerkship and one from your Sub-I.

7) Both. Aside from the chairman's letter (which Wayne State is very prompt in delivering), you will need at least one letter (and preferably two) from Internal Medicine faculty, which can include your Continuity Clinic preceptor. You will likely have four attendings to choose from during your MS3 clerkship and two from your Sub-I, so there are ample opportunities to get those letters. At the end of the day, of course, choose the letters that you think are the best; you will have a fairly good idea of who will really advocate for you and who will be lukewarm.

8) You can do either. Usually you can't start getting letters until June though. So you need to keep a correspondence with whoever your clerkship is with. So they can remember you and write the letter for you if it's a couple months later.

9) I got letters during my sub-I, but I think either would be okay. If you are planning to get letters from sub-I, make sure to take it early in the year (July, August).

10) You can do both, but the purpose of the sub-I is to work with a few attendings and get at least one letter. Sometimes, if you have a great experience during your third year, you can ask for one right then, but the time delay between working your third-year clerkship and getting your ERAS put together can lead to a less personal letter. Most people won't write a letter without a CV, and some also want a personal statement. The ERAS letter form isn't available until the application service opens in July.

11) Either. Personally, I recommend getting a letter from anyone with whom you formed a good relationship. Having too many letters is a good problem to have. Also, don't wait to ask like everyone tells you - you'll likely lose touch and they won't remember you as well. Ask right after the rotation (3rd or 4th year) and have them send it to Student Affairs to hold onto until ERAS opens.

12) Both. Obviously you want to get a letter of recommendation from someone who you impressed and who can attest to your amazing performance. If you felt that you did well on both rotations, then ask for letters from both supervisors. I do think that the Sub-I letter carries more weight since you take on more responsibility during that rotation.

13) Depends. If you meet somebody you really click with, you can ask them to write you a letter for your application but definitely tell them they won't have to do so until August/Sept of your fourth year...you don't want to get a letter too early. If you don't meet somebody who you think could write you a good letter, just wait until you Sub-I...the docs know that fourth years doing a sub-I are looking for letters so just work hard and you will definitely get a letter from your Sub-I.

14) Both

15) "I'm going into med-peds and I received all of my IM letters of recommendation during my clerkship. I think it really is dependent on the experience you have with the attendings.

16) To be safe, I would ask for letters during both experiences, since you never know who might not come through. For example, I had an IM attending that seemed very interested in writing me a letter and gave me a great evaluation for the clerkship. I was excited to have his support for my application. Unfortunately, after contacting him and his staff on several occasions, I never received the letter and was thankful that I had a backup to use."

Emergency Medicine: What should I be doing as a third year to better prepare myself as an EM candidate?

1) Nothing in particular except pay attention to codes while on trauma surgery in the ED.

2) Take those rotations as early as you can as a 4th year. Take any EM related rotations that don't need a prereq. Get an EM mentor and just meet with them to see if they have any advice. Dr. Schwartz is retired now and would probably love to help out.

3) Contact Sarkis koumoujian

4) Study for step 2, some research doesn't hurt

5) Try to get a 3rd year elective in EM and get a letter from it. Do you 4th year EM early and take Step 2 early (july/august). EM programs value that at least as much as Step 1.

6) Do well on step II, familiarize yourself with EM research/big things that are going on in the specialty

7) This would be a great question for Dr. K (EM clerkship director - ask someone in student affairs for his email). He is awesome and would be the very best person to ask. I didn't have much research, and if you look in the literature (yup, there's literature on matching, even broken down by specialty!) or any of the advice books (there's a marroon one that's really good, or iserson's), they give a breakdown of the order of importance of what they look for in EM candidates...e.g. Step 2 matters more than step 1, MS3 grades are more important than basic sciences, etc. Overall, the more rockstar you are, the better though ;)

8) "I would try to do as much Emergency Medicine things as you can - for example, on peds, try to see if you can do any extra Peds EM shifts for your elective. There really are no ways to do EM as a rotation in your 3rd year to make sure it's really what you want to go in to besides an EM research elective. So see if you can get exposure to EM in any way possible to make sure - for yourself! ..and it's a good talking point in interviews. I would just focus on doing well in school and Step 2. "

Emergency Medicine: Given that we are Wayne applicants, are there any residency programs that seem to be notably Wayne-friendly as far as applicants go?

1) Cleveland, all michigan programs, St Louis

2) All programs would probably love Wayne since we have good, busy ERs.

3) Sinai grace takes about 50% Wayne grads each year. It also has highest GSW and knife injuries in the nation for those EM applicants who love that horrible stuff

4) That would be program specific, so it's hard to answer. I have definitely found Wayne alums at many of the places I will be interviewing at. I'm not sure that that necessarily makes the program Wayne friendly but it doesn't make them unfriendly. That being said, you still need the grades and the volunteering etc specific to what your field will be looking for.

5) Best thing to do is look into our previous match lists. That's the best indicator. If you're really ambitious - contact some of those folks if they are at a program you like and start networking a bit.

6) Anything in Detroit. Wayne residents are also all over the place - look up where people have matched in the past.

7) This would be a great question to send out closer to the end of the interview trail - I placed most of my Detroit/Michigan/Chicago interviews toward the end since I was most interested in those programs. That said, St. John is notoriously Wayne friendly for EM.

8) Detroit programs, of course. For instance, St. John had 7 Wayne grads last year. You'll find Wayne students all over, so apply to wherever you want... don't let the list of residents on the programs' websites deter you if you don't see any Wayne grads listed.

Surgery/Surgery Sub-Specialties: In what ways do the expectations of the residents and attendings change when you become a 4th year? Are you given greater responsibilities or allowed to participate more during surgeries, or are your responsibilities similar to what they were in 3rd year?

1) Typically they're similar. It doesn't matter if you're a M3, M4, or even a surgical intern... most of your OR responsibilities are going to be sucking, retracting, and closing. This is because you don't know how to perform surgery (and you don't magically learn how when you become a SubI). That said, generally attendings and residents will try and involve you more if they know you're going into surgery... you might be specifically invited to scrub the more complex cases, for example. The other thing is that as a SubI, you have a little more leeway when picking cases... you can tell the third years on your team what cases you want to do and they can then

choose from among the rest. But of course don't be nasty when you do this. Something that does change is out of OR management, at the DMC at least (I can't speak to HFHS), the SubI manages the SICU patients along with the resident (the PGY-3 at DRH, team dependent at Harper) and doesn't pick up any floor patients unless there are no patients in the Unit. This generally means more procedures on the Unit, sicker patients, greater responsibility for care, etc. SubIs at DRH are also expected to take full 24-hour call q3. If this sounds horrible to you, maybe surgery isn't the right field for you.

2) As an intern in surgery you will spend more time running floors than in the OR. At HF on trauma this is reflected in the SubI.

3) "Many of the surgery teams will expect you to act as an intern (although you can't write orders or put in prescriptions by yourself, you can have the residents help with this). You should be able to follow at least 5 floor patients or 3 ICU patients. Come up with what you think the treatment plan should be and discuss it with your team. Do notes on your patients if your team allows.

4) As for surgeries, you should try to know what the basic steps of each surgery are that you go into (if possible). If you are good at suturing, you will have plenty of opportunities to do so. You can take the place of the intern (still retracting and all that good stuff) and many attendings will allow you to use the staplers (for resections/anastamoses) and other tools. Depending how confident and able you are, you will be able to participate much more during surgery. In some of our breast reductions during the plastics rotation, I was allowed to do use the bovie to control bleeding on one side, on my own (obviously with someone double-checking at the end); in many of them I was allowed sew around the nipples (or sew them back on). I was allowed to suture quite a few incisions closed on my own. I de-epithelialized flaps. I even harvested a skin graft, meshed it, and applied it by myself (under supervision, but I physically performed all of this) twice. "

5) There is a huge difference. You are to manage more patients and during your Sub-I you are expected to manage the SICU patients. This means that each patient is more complicated and there is much more information to process and present. Whether fourth year students participate in surgeries or not varies on the Chief Resident. Expectations for your technical skills also will be higher. You must be comfortable with suturing and tying knots. Keep practicing!

6) Depends on the rotation. I did my SubI at Children's and they have interns and PAs cover the floors. I spent oodles of time in the OR. Absolutely loved it!

Surgery/Surgery Sub-Specialties: What are some of the key things residencies look for in applicants?

1) No great mystery, 3rd year grades, Step 1 (and kinda 2CK), AOA are the big ones. Research really depends on where you want to do residency; if you're going community or low-competitive academic, research doesn't matter so much. If you're trying to go to bigger places (east/west coast ivory towers) then it's essential. Sure you may be AOA, 250+ on steps, honors on all clerkships, but so is everybody who applies to Mass General... if you don't have research

and they do, who do you think a program director is going to take? Another thing that is not as emphasized are the importance of connections within the surgical world. Surgery is a relatively small world and attendings know each other. Good letters from people who have trained at a place you might want to go or who know people well at that program (and even better, if you can get that mentor to make a phone call or two on your behalf) will go very far in getting you interviews, even at places you might think you aren't totally competitive for. So speak to your attendings and mentors, tell them where you're interested in training, be proactive in asking if they know anybody from those programs and if they'd be willing to make introductions.

2) No idea. Step 1 Scores are weighted at about 70%. Average surgery is about 228 to my recollection.

3) "Self-motivation, ability to accept criticism and alter your behavior, and a commitment to the field. You do not necessarily need research experience for general surgery, but it doesn't hurt you to have it.

4) You will likely be asked at all of your interviews, ""Why surgery?"" Have a good answer for this. If you have any deficiencies in your application, be prepared to explain this but also know that some residencies will not ask you about the deficiencies (they are used as more of a screening tool than something that they are concerned about). Obviously this depends on what kinds of residencies you are applying for as well, but it's not hard to anticipate which programs will ask more details."

5) "1. Step 12. Letters of rec3. Personality 4. Research "Scores! Sure this may apply for almost any residency, but this is a little more emphasized in surgery, even General Surgery. However, once you get an interview, scores don't play as big of a role as much as the actual interview itself and the letters of recommendation. Personal statement, not so much.

6) "1. Board Scores - if you don't have these, you'll struggle to get interviews2. Strong letters of reference3. Leadership Experience4. Extracurricular/volunteer experience5. Unique characteristics e.g. if you sing Opera that could make you stand out/ be memorable"7) Depends on whether the program is solely academic, community or hybrid (community based, university affiliated). I will only speak to community/hybrid Gen surg: they want at least a 220 on Step 1 on first attempt, show at least 10 pt improvement on Step 2; it is not the end of the world if you don't honor surgery, but at least get S+, LORs are just as important at board scores, make sure you have 3 from surgeons, 4th can be from anyone else who knows you well, have something interesting to talk about in your interview (community service, travel, previous employment, etc). Have 3-4 stock questions you plan to ask each person who interviews you,

they can be the same questions for each person you just need enough to fill 15 mins worth of interview time, be genuinely enthusiastic on your surgical rotations and during your interview

Surgery/Surgery Sub-Specialties: How is the surgery sub-I?

1) Awesome.

2) Did not participate

3) "Surgery Sub-I is as busy as you'd expect. Depending on your team and your attending, you have the option of doing call or not. It should not count against you if you do not take call (and the residents support this; the attendings I worked with were very serious about duty hours and making sure people were out of the hospital on time). In all honesty, though, I recommend taking call at least twice during your sub-I month to see how it feels. How are you supposed to know if you want to do this or not if you can't get that experience?

4) Overall I enjoyed my surgery sub-I and I would recommend it for both general surgery as well as other specialties (including Ob/Gyn). You will get your internal/family med experience during ambulatory, so don't worry about that aspect of it."

5) Take this opportunity to take as much responsibility as you can. You will most often be asked to manage the SICU patients on most services which means that there is more information to process for each patient. I would highly recommend reading "The ICU Book" by Marino. Also, take every opportunity to practice your technical skills.

Surgery/Surgery Sub-Specialty: For those that applied to a competitive surgical subspecialty (ENT, Ortho, Urology, etc.) did you do anything specific to make your application stand out?

1) Lots of research. programs don't care about active projects, they mostly care about published/submitted research. Doing research with prominent name results in good letter which make you stand out. In the end being AOA and step 1 gives you interview offers, but research and letters of rec makes you stand out in interviews.

2) You've heard this before - Board Scores are the most important aspect of the application to very competitive specialties. Beyond that, try to get some research experience in your field of interest and a reference letter from a prominent faculty member. Most people have volunteering/extracurricular activities. If not, get working on that too.

Anesthesiology: Step 1 234. Can I expect interviews to some good programs, if so any thoughts on which ones?

1) I can't comment on your score because I'm not applying to anesthesia, but I can tell you from my experience after several interviews that the term good program is very relative. Yes there are

the top tier programs but you may find they are not your top programs. The fit with faculty and residents is something you can only figure out by going to the interview. Might as well apply for some they seem out of your reach as well as others. You may be pleasantly surprised by the interview offers you get.

2) You're fine. I have big names and lower score. Improve on step 2 means even more.

Other: What is The Best Way To Prepare For Step 2 (CK and CS)?

1)"CS: Go through the cases in First Aid, 1 week tops CK: 4 weeks dedicated study time, take it earlier rather than later, really no benefit to taking it later than August. Uworld, First Aid, and Step 2 secrets are really useful"

2) U World!

3) Lots and lots of questions.

4) "CS: Speak English and be nice. The entirety of my studying consisted of flipping through FA for CS the night before in my hotel room. I passed comfortably. CK: The biggest thing is to do well on shelves and learn the material well the first time. CK is essentially a giant shelf exam, so if you're comfortable with the shelves, you'll do fine on CK. Find what works for shelf studying and do the same thing for CK. "

5) Expect to do a lot less and still do better. My first piece of advice and something I wish I would have done: take Rads at an easy hospital during your study month, you'll be happy you did. For example take Rads at DMC in July or August, you'll have to go in a couple days each week (literally, maybe 2, or not at all) and you'll leave early. You're already on campus and can go to whatever study place you like. This way you'll have two months off for interviewing in Nov-Dec. So I went from 14 hrs a day 6-7 days a week for step 1 to 8 hrs a day (sometimes less) 5 days a week for Step 2. I used U world questions (reset the subscription) and one book (some use Step up, some use First Aid, I used Conrad Fisher's book, "Master the boards"), that's it, no flashcards, no supplementary lecture videos. I took 2 practice tests; the one that came with Uworld, then like a $50 on NBME website to get a feel. I still did 15-20 points better on the actual test. The moral of the story is you've been accidentally studying really hard for Step 2 all year by virtue of your clerkships. I studied much much less and got a 272.

6) "CK: Studying hard for your shelf exams is the best preparation to do throughout the year. Use a question bank during the year (USMLE World).CS: First Aid for CS"

7) Questions x2000

8) Lots of questions from the UWorld qbank throughout the year and then run thought them all again when you finish. Step up to ck and first aid for ck are similar and both good, but you really only need one. They are not in depth enough though so you need to supplement with more

reading or DIT if you like it. Because the exam is so IM heavy, I wish I had read more of step up to IM as a supplement.

9) UWorld Q bank, one time through during third year rotations, and a second time through the month before Step 2 CK. Do your incorrect questions as well. Step 2 CS honestly you don't really need to sturdy for it, Wayne does a good job preparing you for it. Step 2 CS first aid book, if you have to use something, was decent.

10) "CK - Do well on your shelf exams (AKA study hard for them), see as many patients as possible and actually think through the management yourself, and probably the most useful....know the steps in order for treatment...do you give the antibiotics first or do the LP first? etc CS - Just see lots of patients. The OSCE at the end of the year is just like the real CS so that will give you a good feel. There are review books...I think I used First Aid for CS and just read through and thought through the 30 cases or so in the back."

11) "CS: read through First Aid for CS once (maybe select sections twice, but no more than that) and go on the website to practice with their computer program (the layout is different from Wayne's and from other websites, so just be sure to take a look at it). CK: do whatever you did for Step 1. I did Doctors in Training for both, and although I felt it was beneficial for both, it was moreso for Step 1 than Step 2. Step 2 you will often rely on your clinical experiences, so pay attention during your Year 3 rotations and be involved in them."

12) Do well in 3rd year. Don't waste a lot of free time studying, can take during radiology or easy elective.

13) (From IM perspective) Similar to Step 1. UWorld is the one non-negotiable; I also used First Aid for Step 2. I took July off to take both Step 2s: about 4 weeks for CS and three days after that for CS. For IM, Step 2 CK is becoming increasingly important and you do not want to do worse relative to Step 1. As for CS, use First Aid for Step 2 CS and practice running through real cases with someone who has already done CS! They can give you feedback and tell you things which you might not be aware of. I cannot stress practicing enough.

14) Do questions, and you will have good score. I did questions for 3 weeks and got 265.

15) Uworld. Maybe the kaplan question bank too. Step up to medicine and step 2. Taking some of the practice tests from the usmle website help too. First aid CS

16) "For Step 2 CS, you will already be well-prepared. Just be sure to read over the NBME website so you know all the rules/format. I also read First Aid for Step 2 CK. You definitely don't need more than a few days to prepare.

17) For Step 2 CK, I just used the UWorld question bank, reviewed notes from the 3rd year rotations, and also took some of the practice NBME exams online."

18) "CK: Practice questions. Without a doubt. First Aid is nice, but there's no better way to keep the plethora of information you acquire in 3rd year fresh in your head.CS: A good night's sleep, a complete breakfast, and a nice cup of coffee. Seriously, if you've made it through third year, you have the requisite English-speaking skills to pass CS."

19) "CS - don't be an idiot. it's hard to fail, but don't let that stop you from reading through First Aid for CS once.CK - USMLE world and master the boards works well"

20) I did all of the UWorld questions for each rotation (even the numerous IM questions) with IM last (Track 6). Then I did 5 question blocks a day for a few weeks until I had gotten through all the questions a second time so I was able to take CK just a few weeks after third year ended. Then I read First Aid for CS, for a few days before my CS test so I had them both done before my first rotation fourth year. The Wayne practice for CS is actually pretty good so don't worry too much about that one.

21) "Step 2 CK - take a month to study and prepare much like you did for step I. Get a review book, study hard and do lots of USMLE world questions. The focus will be slightly different here. Try to focus on knowing the next step in management while you study. If you just focus on memorizing pathophysiology & basic science you won't do well.Step 2 CS - Read First Aid for Step 2 CS and wing it. It will be exactly like the WSU OSCE"

22) "CK: 3-4 weeks, UWorld, DITCS: WSU OSCE is very similar, get good sleep the night before, speak English, be appropriate, practice using the note software that our school provides"

23) QUESTIONS!!! (UWorld is all I did...got a 255...)

24) Questions. For CS - go over some common differentials with a friend. Spending a day studying is good enough - you just need to make sure you go through the progression of HPI, PSH, meds, FX, SX

25) I used DIT for step 1 and liked it, but it was *horrible* for step 2 so I switched to Kaplan - Conrad Fischer is a rockstar. I didn't think master the boards was enough alone, but I like detail and lectures (the more detailed Kaplan stuff), which aren't for everyone. Step 2 questions were way longer and tougher than UWorld for step 2, but I did just fine anyway, just know that going in and don't let it throw you, that's all. Uworld is still worth doing and will prepare you well!"Doctors in Training was GREAT! I would highly recommend it. Well worth the money!

26) I used Step Up to Step 2 (which DIT uses also) and supplemented it with Step Up to Medicine. I also referenced some of the First Aids from 3rd year, but that was just as I was doing questions or wanted to look something up. And of course, UWorld!"

27) "Read Step 2 Secrets for CK. It's a phenomenal little book that really packs a punch, giving you all of the highest yield facts you need to know about each discipline. I read Step Up to Medicine during my IM clerkship which was right before CK, so I also used that book to

strengthen my understanding of key disease processes. Also, go through UWorld during 3rd year as you study for shelf exams and then go through it again as you study for Step 2 CK. Be sure to take the UWorld practice exam and an NBME or 2.

28) For Step 2 CS, scan through First Aid for Step 2 CS. The main thing I struggled with was coming up with the differential diagnosis for each patient. This book can be potential helpful for that and for writing a strong note. Remember, that a lot of your points come from doing the basics: friendly demeanor, thorough history taking, washing your hands, basic exam maneuvers, and writing a complete note. Don't stress out too much and don't worry if you feel like the cases are kind of ambiguous/difficult decide on one diagnosis."

Other: Favorite electives?

1) "NephrologyInfectious DiseaseRadiology-if you're looking for something really laid back."

2) Peds ones because I want to do peds, though those are not for everybody. NICU as your peds subi is fine too, just as a sidenote (because they will tell you to stay away from and ICU subi)DMC Sports Medicine, it's required in a lot of residencies (EM, FM, PMR, Ortho) and was a great month. Lots of hands on experiences and procedures.

3) "Peds ER - good hours, nice attendings, get some procedures if you wantRadiology- very laid back schedule but does have test at the end that is kind of trickyPeds Neuro - Tons of teaching at CHM and the attendings are super nice. Weekends off."

4) "Plastics at Henry Ford was excellent as a surgery elective. The team is awesome and if you are well-prepared, you will be able to do A LOT in the OR. You will see a wide variety of cases and you can be in the OR as much as you want. It was spectacular.

5) MFM at Hutzel was good for anyone wanting to go into Ob/Gyn; it was busy during clinic days, you got to see many patients on your own and present directly to the attending (or the fellow during research clinic). There is a good amount of discussion of current research being done in obstetrics."

6) Nephrology and MICU.

7) Nurse Midwifery was good as it exposed me not only to low intervention births, but also some of the politics of medicine (unpleasant, but good to know about). It is not, as one third year suggested, just hitting your head against the wall until you've forgotten everything you learned in OB. It's also been favorably commented on by program directors and residents on my family medicine interviews.

8) Peds EM was a lot of fun

Other: Best/favorite sites for required rotations?

1) OB at Sinai is great.

2) Do Psych at DRH if you're at DMC. It is way more laid back (half days mostly) than Sinai (9-5). If you aren't interested in OB, do it at Sinai rather than Hutzel, you actually get to leave early and it's more laid back.

3) EM at Sinai Grace may be a thing to consider. Crazy stuff and a brand new cushy ER.

4) DMC

5) Henry Ford, no doubt.

6) DMC Receiving hospital, it was my fave place to rotate. You'll see things here that you won't see at other places.

7) I haven't worked with a bad team yet for required rotations; I did my surgery sub-I at Henry Ford on Red Trauma team, EM at DRH, and ambulatory at Oakland Medical Center with Dr. Sandberg (in Troy). I highly recommend this ambulatory site. Although you are there for a normal amount of clinic hours, you will see 95% of Dr. Sandberg's patients on your own before Dr. Sandberg sees them, and then you can keep clinic moving at a decent pace. They are pretty easygoing about missing days for interviews as well if you're doing your rotation during interview season.

8) DMC

9) I felt like Henry Ford was very hands-on. I got to do lots of ABGs and paracentesis and probably would've had a chance to do thoracentesis too. I'm more proactive though and I'm sure that helped. It's unalike the people I talked with the DMC didn't get as many chance to do things like that.

10) If you want to work downtown, Henry Ford is the vastly superior site. The residents and ancillary staff are much nicer and more helpful, the hospital is much more organized, and EVERYONE seems devoted to teaching.

11) "Ambulatory Medicine - ask around about a preceptor who is laid back for an optimal experienceDMC Radiology is a laid back rotation which can be helpful for scheduling time off for interviewsPediatrics Sub-I - do it at Children's Hospital of Michigan, the teaching is outstanding."

Other: How soon should we take Step 2, and how important is it to our application?

1) For EM it's important to have it early.

2) A good Step 2 score will definitely bolster an average Step 1 score and will get you those sought after interviews. Doing poorly on Step 2 reflects probably carries the opposite effect, so there is a tiny risk in taking it early. The goal is to do the same or better on Step 2. If you have a competitive Step 1 score, hold off on step 2; if you have a low to average Step 1 - definitely take Step 2 early. That being said, most of us at Wayne do improve our score on Step 2. Good luck!!!!It is becoming more important, but still pretty specialty (and even program) dependent. Some won't grant interviews without it, some will. You should really do research on the kinds of places you're interested in applying and see how necessary it is... go on program websites, ask M4s who are interviewing at programs you're interested in, etc. However, if your step 1 score is below average for the specialty (or program) you're interested in, then take it early and make sure to do well, it can go at least some distance in improving your application.

3) Might as well get CK done with while you're close to your 3rd clerkships. Take it July or August. Take CS when it's convenient, but well before your graduate.

4) "Take it as soon as possible, why wait? (unless of course you don't feel prepared).

5) STEP 2 is suggested to be less important than STEP 1, but still verify important. Programs generally want to see an improvement in your score vs. STEP 1. If you have a really competitive STEP 1 score, then you may be able to get away with delaying STEP 2 until later in the year but if your STEP 1 score was weak then you want your STEP 2 CK score to be reported by the time your submit ERAS."

6) "Take it in June or July unless you got over a 240 and suspect you may have fluked that score. Take 3-4 weeks to study for it. Timing exams is a bit tighter due to longer question stems, and drug advert style questions. Note that last year around 10% of people fail step 2cs. It costs 1200 dollars plus travel costs. Don't just assume speaking English guarantees a pass like I did."

7) Importance to your application depends on your residency plans, but I would say take it early (jun, jul, aug). I've met other applicants who still have to study for a and take it and they are stressed trying to worry about that and interviewing at the same time.

8) July, I needed to improve my score so I took it that month. You need to have at least CK scores back by the ERAS deadline to get first interview looks. If you destroyed Step 1 maybe it's not quite as important to do Step 2 as early.

9) Depends on what you are applying for. In general, if you feel pretty good about your third year, I say getting it done earlier rather than later is best. I am applying to peds and I took mine in July. Good to know where you stand.

10) Take it as soon as you can. It is important if your Step 1 score wasn't as strong as you wanted and is good for showing a trend of solid academic ability.

11) Get it over with soon as possible. U don't wanna have to take it while on interview trail that would be too much work. I don't think it's that important to apps, no where near step oneJuly/August. Some programs don't offer interviews until step 2 is posted.

12) Take it early if you have low step 1, take it in September/October if you have a good step on score and if you do better you can release it to programs.

13) July or August. Depends what you want to do. It's a competitive specialty need a competitive score. not a competitive specialty you don't.

14) I think there may be some residencies that require Step 2 scores as part of your application (not sure about this). Be aware that if you take Step 2 in July, when you release your USMLE transcript to ERAS in September, all scores that you have received to date will automatically be released together (cannot leave any out), but any score reports arriving after that initial release in September are not automatically released (at least that's how it worked this year - there may be changes).

15) It depends on the specialty you're applying into. Specialties like ER place a lot of value in CK, whereas some of the early-apply specialties (Optho, Urology) couldn't care less. I'd suggest taking CK relatively quickly into 4th year, just because the information will all still be fresh. If you're going into Medicine or doing an IM sub-internship, that's a nice month to have beforehand to refresh some core concepts. The majority of the test is IM-based.

16) Depends on your residency preference. Some care, some don't.

17) Realistically, taking Step 2 at the end of the year will be detrimental to your application. In fact, most programs require a passing score by the time applications are processed in order to get an interview, so take it in July or August.

18) Take July off to study, take CS during July, take CK at the end of July; general surgery wants to see you improve on CK

19) Depends what you're going into and how well you did on Step 1. I went up 20 points so it looks good...if I had gone down 20 points, that would have looked bad. I was SO happy I got it over with in July...I couldn't imagine studying for it now during interview season.

20) I can speak for EM - try to take it early. EM residencies want to see you improve in step II, and they want to see the score.

21) EM take it early, especially if your step 1 isn't strong - show improvement. Lots if people will give you different advice on this so you really just need to figure out what is best for you and the specialty you're interested in.

22) I would take it in July or August - you want it done and you don't want to have to worry about it! I took CK before CS to get the harder one out of the way. I studied about a week for CS just using First Aid for CS and reading those cases. I liked having CK first because it made

coming up with the DDx and tests to order easier on CS since you had already studied that for CK.

23) "I'd recommend taking it right after 3rd year is done. I took July off and used the 2 weeks in June plus the first 2.5 weeks of July to study and take CK and CS. Honestly, you will be at your peak right after 3rd year or right after your Sub-I. I'm not sure how important it is for the application, but I imagine it can only help you (if you score near or above your Step 1).

24) I was really worried because I had done well on Step 1. I didn't want to blow it and score lower on Step 2 because I wasn't honoring every 3rd year clerkship. In general, people score about 10 points higher on their Step 2 CK. I walked out of Step 2 CK feeling worse than Step 1, but ended up scoring 3 points higher. If you wait, I think you're less likely to reach your potential."

Other: How much time should we set aside for interviews? How much money should we set aside for interviews?

1) You're gonna need two solid months. Nov-Dec. It's good to have some flexibility in October and January, too. So if you can have easier rotations in Oct. (ambulatory with a notoriously easy preceptor) and Jan (Rads?) you'll be able to tackle a lot of interviews and be happy doing it. Money is a huge issue. Flights are awful and so is gas. Not all programs pay for any or all of your hotel stays and only pay for the night before the interview. Factor in taxis, shuttles, parking, food and it can be expensive. I took out the residency relocation loan (info on the financial aid website) through PNC for $5000 and it will be about right. However, I wish I would have taken out more because I will probably actually need funds for moving to my residency!

2) Take the month off. I would suggest $2000-$2500 if you plan to do 8+ out of state interviews

3) Take November or December off or schedule something that will allow you to travel. Many 4th year

4) Again this depends on your career desires/choices. Most people take off at least one month, a lot do two, especially if you will need to interview a lot of places for a competitive specialty. You will also need more time if you plan to travel further away for your interviews. Plan on needing 2 days off minimum for each interview because of the dinners the night before and frequently it can be challenging to drive or fly back the day your interview is done (if it ends a little later in the afternoon). Money totally depends on the person and residendcy and situation. But the process is not cheap regardless.

5) Time will depend on your competitiveness based on your application and how many programs you applied to vs expect interviews from. Most specialties people will do 10-15 interviews and it is possible to squeeze most of them into one month and scatter what is left. If you take a month off for step 2, you will only get 1 more month off for interviews so ask around for which month your field has most interviews. If you have 2 months to take off...take them together and get your interviews done then.

6) "Interview season seems to be extending itself from October to January. Depending on what you're applying to you should still take either November or December off, but ask your residents and 4th years going into that specific specialty. I had the ability to take both November and December off (and still ended up with an interview in October and one in January), but I would recommend taking December off for surgery interviews if you can only take one off. Choose an easier rotation for the month you don't take off (one where they will let you take time for interviews, i.e. an elective).

7) The money depends on specialty and how many places you plan to interview at and where you plan to interview. Based on my experience of interviewing in the midwest and many places in Michigan, I would put aside at least $3K. Plan about $200 for the hotel the night before for each interview you go on (some will pay for the hotel, but this is dependent on specialty). Gas money will probably be just as bad as flying places (although as long as you're over 25, you can get decent rental car rates too). If you can stay with an alumni host or a friend in the area, take advantage of that (I traveled with my husband for several of them, so I did not do this). "

8) I took no months off and am doing 15 interviews from Oct to Jan. Just sign up for chill electives and it should be ok. If you plan on applying all over the country, set aside several thousand for planes and hotels. Don't worry about money now, find the residency you love!

9) Nov/dec/jan. Do easy electives or take months off.

10) depends, for competitive field you need at least 6k, or $500 per interview.

11) The average amount, according to a survey someone did at one point, is about $2000. I believe this is part of the FAFSA budget as well. Don't quote me on this one.

12) Budget according to your travel needs. Taking a month off is probably a must (although I know of some people who aren't applying many places because they're staying local, they don't necessarily need the time off). Book interviews early and look for local hotel discounts for interviewing students. One trip to San Francisco is costing me upwards of $700, and if I had booked it earlier I probably could have saved a few hundred.

13) I took one month off (interviewing for family medicine) and have had a hard time getting everything into that one month, but I think two months would be overdoing it. Trying to get as many elective rotations during interview season as you can would be a good compromise; two days off in a required elective is enough for one interview (two if they're local).

14) Schedule 1 month off, and 1 month of a less busy elective to give you time for interviews.

15) Obviously total time off depends on how many places you apply to, competitiveness of the specialty, your own competitiveness - which all drives how many programs you interview at. If you are couples matching, you will need to interview at a lot of programs.

16) General Surgery: depends on where you want to go, if you want to stay in Michigan you can fit 12 interviews in from late October through January without taking an entire month off even if

a few are outside the state, money depends on airfare, hotel, new suit, new business casual attire for the pre-interview dinners; one PD told me to take advantage of the interview season to travel and enjoy myself (ie dont worry about taking out an extra loan to pay for things)

17) You should do 12-15 interviews. If you are applying all over the country, obviously it'll be way more expensive than if you apply locally. Google some flights, multiply by 7-10....boom.

18) A month

19) I put most of my interviews in November, with a few in October and a few in December. I would suggest spreading them out more because they get tiring!! I would recommend taking November off, as if you take December off, you lose part of the month due to the holidays when programs aren't really interviewing. Then take "easier" rotations and definitely only electives in the surrounding months so you can take more time off to go to the interviews.

20) I took Diagnostic Radiology at the DMC in November and squeezed in 5 interviews. I attended 6 out of 17 days. They don't know if you're supposed to be there because no one evaluates you. I have December off to go to 5 more interviews where I have to do more extensive traveling. At this point, it looks like I'm going to spend between $2000-2500 to go on 13 interviews (for 3 I had to fly, 4 gave me free hotels, most helped subsidize my hotels so that it cost between $60-75).

Other: Are there special loans for residency interviews?

1) Yes, residency relocation loans are meant for interview travel, a fun trip and actual relocation at the end of med school. Use them wisely, take a large chunk out early in 4th year and you can use it for all three. I think you can take 15,000 out. You can choose fixed or variable interest rate and when you want to start paying. I chose a fixed interest rate (government instability) and decided to start making payments right away to the tune of like $50 a month.

2) You get extra money if you want it, but it's the same loan type/process.

3) I don't know if any but I would love to hear about them ASAP.

4) Wayne approved an extra $2000 for us as travel/application money based on a survey from the class above us. That should cover it for most people, especially if you're applying locally or only have 1-2 that you need to fly to. But, if it doesn't there is the Residency and Relocation loan through private loan companies that you can apply for. Only M4s are eligible and you can borrow up to $15,000. But, there are different companies and rates and repayment options so be sure to research them before applying.

5) I believe you can get an extra $2K for interviews as a loan from the school.

6) $2000 I believe.

7) Not that I know of. Grad-plus is always an option, but the interest rate is a little prohibitive.

8) Yes, the school will allow you to increase your cost of attendance to include $2000 for interviews (but your check is only ~1500 because of fees). You can also apply for a private loan through Wells Fargo, PNC or Discover if you have a co-signer.

Other: When should we do our Sub-I during our 4th year? Any particular month?

1) Depends. If you're applying general surgery, internal medicine, family, pediatrics, or OB, do the requisite SubI in July or August and plan on getting a letter from the attending. If you're planning to apply to something that isn't offered as a SubI (ENT, Ortho, anesthesia, etc) then do electives in the field you're applying to in Jul-Aug and save your SubI for later in the year (usually people do them after interview season because you can't take as much time off from SubIs to travel as you can for regular electives).

2) Well, scheduling is done by the lottery so that is a roll of the dice. My IM sub-I is in January and it doesn't matter at all.

3) "For Internal Medicine, if you have all your LORs and don't need any from your Sub-I then it doesn't matter when you do it. Your 4th year grades are not included on your ERAS transcript and your evaluations from your sub-I will not be included in your MSPE letter.

4) If you do need a LOR from your Sub-I then I would suggest doing it in July or August. If you want to get a LOR from a particular attending, it would be wise to find out if they are scheduled to round during the month of your sub-I."

5) July-Nov

6) Depends on the residency choice entirely. For peds do it early (jul, aug, sep) so you can get another LOR.

7) "Depends on a few things. Do you need another LOR? Do you want to get your required rotations done early in the year and coast afterwards? Then do it early.

8) Do you need to explore a few fields to decide what you want to go into? Do you want to do lots of away rotations? Did you get stuck with your last choice for registration? Do it later."

9) I would do your Sub-I early on if you need a letter from it. If not, you can postpone it to January or February and use it as a month to say "look how good of a fit I am" for programs in MI you want to apply to. Otherwise, get it done by September.

10) As soon as possible. You get so lazy as the year goes on. I took it October and could not imagine having to work that hard again. I was q4 call

11) February is the shortest month of the year.

12) Depends on the desired residency. General surgery: ASAP so that you can get letters. You will be at either Henry Ford or DMC (mostly here).

13) Your surgery pediatrics internal medicine or emergency medicine you should probably try to get it done early. July August or September. Otherwise I don't know if it matters.

14) "I think there are advantages/disadvantages to different times of year for sub-I. I did my sub-I in July. Advantages: since the interns were new as well I felt like we were all able to learn together, and there were also lots of intro. lectures covering basic useful topics; early enough for letters of recommendation; useful review of medicine before taking Step 2. Disadvantages: things may be a little more hectic in the hospital since there are so many new people"

15) If you need a letter of reference from your Sub-I rotation, then take it in July, August or September. If you don't need a LOR, you can take it whenever it is convenient for you.

16) General Surgery: August so you can get a letter submitted by Sept 15

17) If you need a letter, obviously do it in either July or August. Otherwise doesn't matter. But you are expected to do more than on an elective so I wouldn't advise scheduling it in March or 18) April right before you graduate..

19) Don't do peds unless you have to.

20) 2 ways to look at it - early to get it over with or in the Spring to refresh your memory and make the transition to residency easier.

21) I did it in August after taking a month off for Step 2 CS and CK. I thought it was a good month because it gave me another opportunity to ask for strong letters. Because you're working longer hours, your attendings really get to know you. This is important for peds because your 2 weeks on the inpatient service doesn't usually give you enough face time to impress your attendings.

Other: I heard scheduling your EM shifts to fit them in is crazy. Any advice?

1) This is not true. Your EM shifts are scheduled by the clerkship director/coordinator. It isn't too bad, you have to make up missed days off so just don't schedule it during an interview heavy month.

2) It depends if you're trying to interview. It's a pretty inflexible rotation and I would recommend doing it during your interview months like Nov and Dec. I did it in October and was still able to fit 2 days of travel in for interviewing. The key is knowing you have an interview on a certain day before they ask you to request days off during the rotation. They will accommodate 1-2 interviews easily.

3) It is not crazy. 16 shifts, 4 lecture days, 1 exam day, 1 orientation day = 22 days, and 8 or 9 days off. Don't take it in February. If you want ER, you have to take it in July or August for your SLORs.

4) You technically only need to get anywhere from 15-17 shifts in for the month, depending on how many days are in the month. But, they're sticklers about duty hours and technically, you can't request more than two days off for the whole month since it's a required clerkship. Since we have so many months off in fourth year there aren't any holidays - not Thanksgiving, Christmas, anything. So be mindful of that getting factored into days off you would request during those months. Most sites are pretty ok with you asking for more than the 2 days off, especially if it is for interviews or holidays. The EM coordinator at Sinai Grace is not, nor is she flexible about switching the schedule after it is made. Bottom line is try to avoid scheduling EM in a month of potential interviews (Oct-Jan depending on the specialty) or if you think you might need more time off for whatever reason.

5) I did not see this as an issue at all. My suggestion would be not to schedule EM during interview season. No one in our month had complaints about their EM shifts and the program directors were very willing to work with you if you had issues with scheduling.

6) You don't schedule them at Henry Ford. They just tell you when to show up and give you a schedule. U can ask other med students to switch shifts around though.

7) Not hard at all. You have some nights and some days. I didn't have to schedule mine - Sinai Grace did it for me. I had a week off basically then 7-10 days straight then a day off then 7-10 straight. But keep in mind they are only 8 hour shifts and when you switch from days to nights you basically get a half day off (say, 9-4pm then you don't start nights until the following day at 11pm or something)

8) I'm confused about this question. But if you are asking about scheduling ER shifts for the required ER month, they schedule them for you. Yes, maybe you can switch a couple around, but don't count on being able to choose your schedule. With that said, you only work 16 days the whole month so you'll definitely have free time.

9) "This is confusing question. Shifts? You're given a schedule and you show up when they tell you. Unless you mean the actual rotations.

10) I did step 2 in July and EM in August, and only having one EM month hasn't been a problem on the interview trail. There might be a program director or two out there that really want you to have a SLOE from two different programs, but in general, I think that recommending more than one month might be more for candidates with lower scores on USMLE. Ask Dr. K!"

11) They schedule it for you... just don't put EM in a month you plan to have a lot of interviews since you can only miss 2 days in a required month.

Other: Are there any special programs or grants to do international rotations?

1) Yes, but you have to find them on your own.

2) I'm not sure about going through Wayne but I do know you can do a peds one through an away elective with UCLA if you time it right. I'm sure other away programs offer that as well.

3) Dr. Chuang has a lot of information about international rotations and opportunities if you are interested.

Other: How many hours did you spend on ERAS (I think that is spelled right) applications per night after it came out?

1) It was simple. The workshops at school made it so. Don't worry. Very easy software for us, not so much for program directors who are older.

2)"Maybe 10 hours in total. This includes inputting all the information, reviewing, proofreading etc. After ERAS was submitted, and all my programs were selected and paid for then I did not spend much time on the ERAS website at all.

3)Your interview invites can be forwarded directly to your personal email so I only went onto the ERAS website to verify that all of my programs had downloaded my application. I also checked the website every few days to make sure that I was receiving all of my interview invites, since some students had a problem with invites going to their junk folder or quarantine."

4) 2 hours. Go to the orientation thing and do it then. Researching the right program for you is most important because you will only want to do 10-15 interviews.

5) I just sat down in two or three sessions (one in the ERAS lab with ms. Harper) and entered everything, reviewed it, asked my questions, and then picked my programs. Total time was maybe 6hrs of work. Once I finalized in sept, I barley looked at it again, just waited for emails with invitations and I responded to those as quickly as possible (emails are supposed to go straight to your wayne inbox).

6) um....maybe 30 min a night if you divide it up. I had my CV ready though and almost completely updated, so I just had to copy and past most things in. Personal statement took some time and many edits though. I recommend starting that early.

7) "I had my ERAS application filled out in early August with my personal statement uploaded and my CV filled in, and I think I spent about 3 hours total messing around with it. Maybe another 3 hours went into writing my personal statement. I probably spent an hour the day before ERAS certification double checking my CV sections, wording, and making minor changes. I certified on the first day you were allowed to do so without issue; by that time I had 3 of my 4 letters of recommendation uploaded to the system as well.

8) After uploading my application, I probably spent 5 min a day checking to see which programs had downloaded my application until all of them had done so. I did have to log on one other time to assign my 4th letter of recommendation to the programs about a week and a half after certifying my application, and this probably took half an hour to do. "

9) I had a CV ready so copied and pasted so it was quick. Really didn't take long. Personal statement took time and deciding where to apply took more time

10) Less than one? Really, I just sat down on a couple separate days on weekends and pounded out the application. The personal statement is the hardest thing to write- the rest of the application is copy-pasting your CV and fleshing it out to make it sound more impressive.

11) "Not long. Everyone make such a big deal of it, but it took me maybe 5-10 hours total. They key is having an up-to-date CV all along. Then you can basically copy and paste. The personal statement took a while though too."

12) I filled it all in right away after I finished CK during July, which I had off. It took maybe six hours to find, organize, and enter all of the information.

13) It depends on how extensive your resume is. Expect to spend about a month working on it. This includes time for writing personal statements, updating your CV, getting letters of reference, etc. You can start working on these before the application opens too.

14) "Time on ERAS: 4 hoursTime on Personal Statement: a LOT longer, start your personal statement in July, revise, send it to accountable people to proofread, ask at least one attending in your field to read it and give feedback, finish by end of August"

15) Definitely did not work on it nightly. It's not that much work, main issue is remembering all the stuff you did!

16) Spent a few days writing my personal statement. Everthing else is quick

17) "Lots. The personal statement blows. Just deal with it. Use the class counselors for help if you need it!

18) Don't listen to Wayne's ERAS lady when she tells you to write a really short personal statement if you're applying EM. This is wrong. Dr. K also says this is wrong. One page max is the actual rule, but she'll tell you half a page (again, this is BS!). You can't sell yourself in half a page. "

19) I worked on it even before it came out - figure out what they want on the application (ie, word count for activities) and type it in word. Then you're just ready to copy and paste! Some did it this way, some did it another way. Just work on it when you have time and be ready to push submit the day it opens!!

20) I spent probably 25-30 hours on ERAS since I had a ton of volunteer activities to enter from doing co-curricular. Plus, I spent 10 hours or so on my personal statement. Definitely take some time to write a short paragraph (3-4 sentences) about each experience and try to connect it to why it helped you become a better future physician/helped you be more well rounded. Also, write your personal statement from your heart. There's no need to be extra creative if that's not your strength. One of my interviewers told me that he appreciated the honest, direct approach I took to writing my statement.

Other: Should we get letters of recommendation during our rotations or after the rotation is over? Any thoughts/experiences with this?

1) At the end of the rotation, but within a few months of it finishing so the attendings remember you and your time on the service.

2) "The attending physicans change on a different schedule than students so if you know you want to ask an attending for a LOR then ask shortly after they leave the service (or whenever you remember, but the sooner the better). This way you and your performance are still fresh in their mind.

3) You can ask in person or send an email asking to schedule a meeting to review your performance (if they did not already do this). If they already gave you a good review on your performance and you did not ask for the LOR in person then it is ok to ask for one directly in an email. Attendings know that students will ask for LORs so it's not a big deal to ask for one in an email. Be sure to include your CV with the email and ask if they would like you to schedule a meeting to follow up on the LOR request. Some attendings may feel like they know you well enough and will not ask for a face to face meeting while others may want to meet with you in person to discuss your goals etc."

4) Ask during, get at the end or in June-July

5) I think I always asked after, but it's up to you and what you are comfortable with.

6) Either will work. It just depends how you did with that attending. Did they seem to like you? Did you display good work ethic and knowledge and learning? If so, you can ask any time. Otherwise you may want to wait and see what comments you get on your eval before asking.

7) "I would get letters after the rotation is over. Ask for them on your last day, or email your potential letter writer sometime during the first week of your next rotation. If you are asking very early (during 3rd year), send them another request early in July or early August (so if they have to back out for whatever reason, you still have time to find another writer). I asked my letter writers to have them written by the end of August, knowing that some of them would need more time, so then I could give them an extra week and they would still be uploaded way before the deadline. I asked the letter writers I worked with in August to have them in done by Sept 15th.

8) Do not give your letter writers more than 2-3 weeks to write you a letter. This is enough time for them to write the letter for you but also keeps it in the front of their mind due to the ""short""

deadline. The best strategy is to have a ""fake"" deadline--if you need the letter in 4 weeks, ask for it to be done by 2 weeks, and then you can give them another week to write it if they need more time. This allows for mailing letters or issues uploading letters to ERAS as well and I found it prevented a lot of headache-inducing situations my classmates were going through."

9) Ask during your rotation and give the dr your CV and a cover letter, personal statement if u got it. Come and collect later.

10) Asked on last day.

11) At the end of rotation schedule a meeting and ask them for a letter.

12) At the end of the rotation was easier to ask. You will know who is worth asking or not based on your interactions. Near the end of the rotation, my strategy was to always speak with the attending personally and thank them for their time while informing them that my rotation was coming to and end. Usually, they offer a letter without you asking if you are going into their field and they like you. Take them up on that! If they don't ask, that would be a good time.

13) I don't think anyone started getting them until June because Eras won't accept them until then. I know that the general advice is to ask for recommendation letters way in advance and that's probably best, but if you do realize that you need a letter later on, I would say don't be afraid to ask - a lot of the attendings seem to understand this and may be able to write your letter quickly if you ask. As for during or after rotations, I'm not sure...

14) Ask on the last day the particular attending is on service. Most docs will want to give you feedback anyways- this is a good barometer to judge whether you can get a strong letter from that person. Always ask in person if possible.

15) Use your judgement. I would say generally, get it after so you can use the max amount of time to build rapport and impress people, but if you won't be with the attending again for the rest of a rotation there's no reason not to ask earlier.

16) Typically you should ask for a letter of reference sometime during or right at the end of the rotation when the faculty has a vivid memory of who you are. Don't wait until 6 months down the line when he/she has worked with hundreds of other students. Just use your judgement as to when the time is right. I typically asked on the last day or e-mailed the staff member within a week of the elective ending.

17) At some point during the rotation, towards the end once you have proven how badass you are, tell the attending you are interested in 'x' field, thank them for everything and ask if they would write you a strong LOR, if it is early in 3rd year they will prolly tell you to contact them closer to ERAS time and they will remember you, if it is after ERAS opens then you can easily send them the ERAS info (you will be instructed on this when you do ERAS training)

18) Ask an attending you got along with if he/she'd be willing to write a letter. Pretty straightforward

19) Either way, whenever the right time is to ask.

Other: We have heard after 3rd year you just cruise through and it is easy, although 4th year seems really busy with other stuff outside of the hospital (I.e applications etc….). Any general thoughts/advice that hasn’t been covered in any other questions?

1) 4th year is fun but not a cake-walk. Interviewing can be stressful and so can the responsibility you have on your sub-Is and electives. Plus you don't want to show up to residency not having had a real rotation since 3rd year. My advice is early 4th year: rotations for letters, application, ERAS. Middle fourth year: interview, relax, vacay. Late fourth year: EM or Sub-I (something real) and rigorous electives to get you back on your toes.

2) 4th year is absolutely more laid back than 3rd year. Why? Because once you're done with STEP 2 and other than the ER rotation you have no exams to study for. Your grades are not included in your ERAS transcript so there's no fear that a satisfactory grade will hurt your chances of matching, and your 4th year evaluations are also not including in your residency applications. A lot of your 4th year experience has to do with the electives you selective and how intense they are. The ERAS and overall interview process can be a little busy and stressful but it's also a lot of fun! I'm loving 4th year so far!

3) "False.When selecting a specialty:1 pace: do you like fast or slow, do you like clinic, rounding, being in the OR.2. People: do you like patients, do you want to help with fixing social issues, or do you hate that stuff. 3. surgery: do you like long procedures, medium length or short. 4. Generalists: do you want to keep seeing all medical issues or focus on 1 or 2 organ systems?5. Just because you have a 250 on Step 1 does not mean you should do Derm or just because you have a 215 does not mean you can't do urology. Around 90% of applicants get their first 1 or 2 choices in the match. That said you will be competing with a much higher level due to increased number of med schools and static numbers of residency positions. Probably foreign med grads will suffer worst and wayners will continue to be awesome."

4) 4th year is as busy as you want to make it. Mine is and I love it because I get to do all these rotations I like, including an international one, (that are not super easy, but not terribly crazy) plus I get to travel all over the US to interview and visit friends and family. But I will say that even though it's been a little stressful and definitely exhausting, I wouldn't change any of it because the experience is great. So my best advice is to enjoy 4th year, whether you're busy working and traveling or you take as much time off and as many easy rotations as you can find

5) "Whatever you use to organize your life....keep on top of it. This year has been hectic with so many tasks to accomplish with different deadlines and it's easy to loose track of what day it is. And have fun! You're almost a Doc!

6) Also, if any one has any couples match questions I can address them at the panel."

7) "Depending what you go into, 4th year will still be stressful. It will be busy during the months you are on rotation. The nice thing is that you only really have 1 exam from school (EM). Then you just have to worry about applying and interviewing for residencies. You will have day-to-day stresses to deal with, but overall 4th year is an easier year than 3rd year (because the stress is different).

8) General advice: Take time to travel for fun if you are able. Get an exercise regimen going if you lost it during 3rd year. Take advantage of the additional time to pick up your hobbies again, too. 4th year is a great year because you have more (supervised) independence in your rotations and you will build your confidence in your abilities as well. "

9) Fourth-year is as busy as you want it to be. The nice thing is you don't have very many tests that you need to take. I think the only one that you have to is for emergency medicine. You don't have to sit around and study as much like you did for the shelf exams. If you wanted to tougher rotations you can do that. If you want to take rotations you can skip out and leave early can do that too. The nice thing is that you have a lot of freedom. You can do pretty much what you want.

10) Outside of sub-I, you shouldn't have to work weekends. Consult services are more casual than inpatient floor work. Take the time to do something you'll never get to see again. Do away rotations, especially at places you're heavily considering but haven't worked at. Enjoy the year!4th years isn't a total blow-off. It's very heavily front-loaded. Once you get you sub-I done and get into interviews the coasting might start a little. Springtime will be cake, but with ERAS, Step 2, letters and audition rotations the fall can be pretty intense.

11) Fourth year is not a total breeze. You have to take your board exams, complete applications, and do a Sub-I. The whole interview process can also be stressful. The great thing is that you don't have constant exams like you do in 3rd year. So enjoy before you start residency because intern year is intense.

12) Yes, 4th year rotations can be light, but some people do many away rotations to increase their chances of matching at that program, in this case, 4th year is very busy and you must work very hard to make a solid impression; if you don't do away rotations, after you take Step 2 and do your SubI, clinical duties lighten up significantly, your body realizes this and tells you to sleep, a lot, then you are focused on ERAS and researching the programs you will be interviewing at, preparing for interviews, traveling to interviews, recovering from interviews and going to ambulatory clinic a few times, lol, your electives determine the amount of free time you have but most of them max out at 40hrs/wk; overall, 4th year is unlike any other year in med school, its fun and chill but you still have to work hard in ways you are not accustomed to which may leave you feeling exhausted, if you find yourself at this point, just go to bed early and find solace in the fact that there aren't any shelf exams, be sure to spoil yourself a little bit on the interview trail since it will be the last chance you get until you interview for fellowship/private practice

13) It's definitely more stressful/tiring for the first 7 months than I thought. However, the rotations feel more laid back because you don't need to study for tests. The interview trail is fun but also exhausting. Once interviews are done, I think the 4th year bliss will finally be realized.