The USMLE Step 1

The USMLE Step 1

Just like the SAT before college, and the MCAT before medical school, doing well on the USMLE Step 1 is the key to getting into residency.  The test covers a broad knowledge base from the first two years of medical school, which includes anatomy, behavioral science, biochemistry, microbiology, pathology, pharmacology, and physiology;  however, the coursework from the first two years of medical school is not enough to achieve an outstanding score on this test.  The key to doing well on Step 1 is early preparation with a limited number of resources that maximize information that is relevant to the test  Also, as one gets closer to the exam doing tons of practice questions is essential.  This article outlines some essential resources for doing well.

First Aid for USMLE Step 1 is the best resource.  Get it the first day of medical school; use and annotate it while studying the relevant topics during the first two years.  You may not have thought that memorizing a book is possible before you came to medical school, but memorizing this book is a medical school rite of passage.

Question banks are another essential study tool.  It doesn't matter which specific service you choose, but what does matters is that you go through all the questions.  For a bank of 2000 questions, if you do 50 questions per day, you need to budget 40 days to review every question once.  Schedule realistic goals.  The students who get the highest scores will tell you that they went through all the questions more than once.

BRS Pathology and BRS physiology are the best book in the BRS series.  Read relevant chapters and do the practice questions as you study the material during the first two years.  When it comes time to prepare for Step 1 you will have seen everything at least once before.  When studying these two very large topics the thing to avoid is opening a brand new review book six weeks before your exam; at that point you want to be reviewing and not studying for the first time.

Microbiology Made Ridiculously Simple is great to use during your Microbiology course.  Getting familiar with it before starting to review for the boards will make this subject one of your strengths.

BRS Biochemistry or High Yield Biochemistry is a must read.  Most medical schools do a poor job of making students learn this topic.  Having a good understanding of it will translate into big points.

The best source for reviewing pharmacology is pharm cards.  There are several versions circulating around, so be sure to get the right ones.

For a list of other useful review books see the Get Books section.

It is good to take a sample test, composed of real exam questions, a few weeks before your exam.  You can buy an NBME practice test for $50. The tests predict a 3 digit score and provides a breakdown of your strengths and weaknesses.

50% of doing well on the exam is knowing the material, and the other 50% is not messing up on the big day.  Make sure you wear comfortable clothes, dress in layers in case the temperature at the test center isn’t what you expected, bring food for your break, and headache medicine just in case and you will be 100% covered.  Good Luck.

The Sick Child by Edvard Munch

“The Sick Child” is the title given to a series of paintings by Edvard Munch.  The paintings depict the artist’s young sister who died of tuberculosis.  The theme of the series is the fragility of life.  Munch was a Norwegian painter who lived from 1863 to 1944.

How to Get an Amazing Letter of Recommendation

How to Get an Amazing Letter of Recommendation

Great letters from prominent faculty are key. This is especially important in smaller specialties like Plastic Surgery and Dermatology where program chiefs from all over the country know each other. Asking for a letter in person shows a greater level of courage and maturity than doing it over email.  An example of what you might say is: “Good Morning Dr. Smith. As you know I am applying for residency this year.  I was wondering if you could write a letter to support my application.” With such a clear and direct, yet humble approach you are sure to get a positive response.  Oftentimes your letter writer will ask you to schedule an appointment to meet and go over your application. 

Prepare for this conversation by making a packet of materials that will compel your letter writer to really go to bat for you.  Find high quality folders in a color that inspires confidence to give out.  On the left include a copy of your CV and personal statement all printed on thick high quality 25% cotton paper like you can get from Crane & Co; natural white or pearl works great.  If you can find something with a water mark thats even better.  Consider including copies of your transcript, articles you have written together, and any other relevant materials.  On the right place a copy of the ERAS instructions for your letter writer, and a stamped envelope addressed to ERAS.  Your letter writer will see how much you care about your application, as reflected in your preparation, and this is guaranteed to make him care more about your letter.

Before you actual meet with your letter writer try to anticipate possible topics of conversation.  These are likely to include your personal and academic background, your professional and outside interests, and your long-term goals.  Most senior faculty are experienced at these meetings, so let them steer the conversation.  The content of your discussion is less important than making sure that they are left with a positive impression of you as a courteous, mature, and intellectually curious.

A few days following the interview, be sure to mail a nice Thank You note.  For one, this is just the classy thing to do; they are doing you a huge favor. Two, in case your meticulously prepared application folder has drifted to the bottom of their To Do pile, your follow up note will serve as a reminder that they need to get to work.

Finally, remember to ask for your letters early.  Despite your best efforts some letter writers will be slow, and you want to avoid missing out on potential interviews because your application was incomplete.  If a month after you asked your letter still has not been submitted, then send a polite reminder email.

What Really Matters in the Residency Match

What Really Matters in the Residency Match

In applying for residency, as in life, there are things that matter more and things that matter less.  Take a look at the graphic of summary statistics for all specialties, which was generated based on data from the NRMP, the AAMC, and the NIH.  The things that seem to matter the most, as you may have guessed, are: USMLE scores, AOA status, medical school quality, and number of interviews.  This seems to be true for both US medical students and foreign grads.

Don’t misinterpret the data to think that research, extracurriculars, and volunteer experiences don’t matter.  You must have something to put in every text box on the ERAS application; otherwise you risk being screened out.  These metrics simply show that once you meet a minimum standard, there is a point of diminishing returns with how many things you extend yourself to.  I interpret it to mean that the quality of your activities is more important than quantity.

To learn more about the residency match visit www.bestresidency.com

When it’s Bad to be a “Good” Medical Student: The Secret Code of Dean’s Letters only Program Directors Know

When it’s Bad to be a “Good” Medical Student:

The Secret Code of Dean’s Letters only Program Directors Know

Each fall, as part of the residency application process, medical school deans write Medical Student Performance Evaluations also known as Dean’s Letters to be included with the ERAS application.  The letters, which are released on November 1, describe a student’s academic and extracurricular performance throughout his or her medical school career.  Students are allowed to review the letters for accuracy; for the vast majority this is a very pleasant experience because the letters are extremely complimentary.  However, hidden within the first and last sentence of each letter are code words that are known to program directors and are meant to stratify medical students from the top to the bottom of their class.  It is important to be aware of this secret ranking because only part of the ranking is based on fixed objective performance criteria like grades and USMLE scores; the other part is based on subjective perceptions, which can be easily be influenced.

Somewhere in the first sentence of every Dean’s Letter is a code word that sums up years of medical school performance.  “Outstanding” is the best and translates to mean that the student is roughly in the top 25^th percentile of the class.  “Excellent” means 50^th to 75^th percentile.  “Very Good” actually means “worse then average for our school,” and denotes a ranking in the bottom 50%.  Finally, “Good” or “Fine,” depending on the medical school, is meant to reflect that the student is actually in the bottom 25% of the class.

A similar set of codes can be found in the last sentence of the letter.  “Strongest recommendation” or “highest recommendation” are the same, and represent the highest praise.  “High recommendation” means that there is a whole quartile of the class that is better ranked.  And finally, the word “recommendation” without any adjective before it testifies to the lukewarm praise that is made.

The code word combination that appears in any letter has some degree of flexibility and can be influenced. At the beginning of your 4^th year, schedule an appointment with your dean to discuss the contents of your letter.  Dress professionally for this meeting and come prepared.  Bring a copy of your CV, your personal statement, as well as any other supporting documents.  In a 30-40 minute session be prepared to discuss your academics, extracurriculars, and residency application plans (See the section “Winning at Interviews” on www.bestresidency.com to see a more complete list of discussion topics).  This is not a meeting where you explore your potential career interests, but rather where you present the blueprint that you’ve designed for you medical career.  Deans are people too, and when they see a student who is prepared, motivated, and excited to pursue the next step in their career they are likely to bump up an “excellent” medical student to be an “outstanding” one, and recommend them with their highest praise.  When the letter gets written, be sure to go over it with a fine tooth comb as errors are common.  If you find something you don’t like, be sure to appeal it because until it is published through ERAS nothing is set in stone.

Before stressing out too much about meeting with the dean, keep in mind that it is in the dean’s best interest to have all the students match at programs they like, so think of this as helping them help you.  Finally, to put things in perspective, remember that the person that graduates last in their med school class is still called “Doctor.”