School of Medicine

Wayne State University School of Medicine

STUDENT AFFAIRS HOME


Academic Support


Contact Us


Counseling


Financial Aid


General Programs


Policies


Records and Registration


Student Activities Program


Student Open Door Committee

Information for Year III students

Important Documents

Internal Medicine Specialty Specific Advising Guidelines

  1. Year IV ROTATIONS - CHOOSE WISELY!

You are paying a lot for this year. Don't waste the money or the opportunity. You are going to be a real doctor and take care of real patients.

  1. Elective Rotations in field of interest
    • Medicine electives
      • Explore specialties that you are interested in pursuing as a career (Heme/Onc, GI, geriatrics, etc.)
      • Choose electives in areas of weakness or perceived weakness
      • Choose electives to gain specific skills (e.g. cardiology so you can read an EKG or Pulmonary Medicine so you can interpret a chest film)
      • Choose electives that are difficult. If you are going into medicine you will likely do these rotations again as a resident. However, some things you need to do twice to gain expertise (e.g. Infectious Diseases, Nephrology)
      • Choose electives that are interesting
      • Don't only do Medicine electives; 3 electives should be enough.
      • Choose subspecialty rotations. You will do a subinternship. You do NOT need another general medicine rotation.

    • Do not completely front load your schedule
      • You do not want to have done all meaningful electives in the first half of the year so that you have the light weight electives from January-graduation. You will be out of practice and not in the best shape for your internship.
    • Away electives
      • Away electives may improve your competitiveness at that program but don't count on it! You cannot overcome average medical school performance and average USMLEs with a good clinical rotation.You are competing against a large pool of good candidates.
      • Do away electives in subspecialty Medicine to check out residency programs to gage your interest in the program.
      • Do away electives to check out a region or city or to see if you do well away from your family and social support system.

  1. Sub Internship
    • Do your Sub I early, preferably before interviews
      • July and August are great months. Most residencies have a summer lecture series that orients new interns to Medicine and to taking care of sick patients (e.g. "Approach to Chest Pain", Emergencies in Infections Diseases, etc). These lectures are a great review for USMLE and a great overview of Internal Medicine.
      • September and October are not too late.
      • Note: the highly competitive programs may want a letter from your Sub I but most programs do not.

  2. Other required rotations (ER, ambulatory)
    • Ambulatory Medicine
      • Early ambulatory is a fairly light weight rotation. There are no weekends or call. Also, there is a lot of ambulatory medicine on USMLE.  Consider doing early while completing ERAS application.
      • During interview season - some people interview during ambulatory. You can miss 2 days without having to make up.
      • Late - some like to finish with ambulatory medicine as it is a nice review before internship. You do not want to finish with all light weight rotations and have not examined a patient since November or December.
    • Emergency Medicine is a great review for USMLE. But remember there are limited positions in July, August, and September. Let the ER wanna-bees have those time slots.
  3. Electives
    • Recommended electives - any subspecialty.
      • ID is highly recommended as they teach you to review a chart, do a great physical examination, develop a great differential diagnosis and read critically.
      • Critical care is required by some residencies. You will get an opportunity to learn to care for complex patients and do procedures.
      • Consider cardiology, nephrology, hematology, oncology, endocrinology, rheumatology, gastroenterology, and pulmonary medicine.
    • Do choose non-Medicine electives. This is your last chance to learn things from the experts.
      • If you are going into primary care, consider urology (remember half your patients will be men!). Consider radiology; everyone gets an imaging test at some point in their care. Consider pre-operative consultation, ophthalmology, ENT, and dermatology; for all internists consider anesthesiology (remember you will be doing pre-op "clearance."You need to understand the anesthesiologist's point of view and you need to see what happens from the other end of the table. Also, it is a great way to do procedures.
  4. Away rotations
    • Rehearsal rotations rarely help secure a residency in Internal Medicine. Do them to see if the program you are interested in is as good a fit as you think and to see if you will like living in a particular location.
    • September, October and November are good months to do away rotations. It is very difficult to secure an away rotation in July and August. Most schools are working on scheduling their own students. You may not get confirmation until just before the rotation and you may find you do not have a rotation at all.
  5. Pros and cons of research electives
    • Exposure is good
    • Unless done early they do not improve chances or matching at research institutions. However, the experience and potential abstract may improve your application for fellowship
  6. Out- of-country rotations are a wonderful experience. Talk with Dr. Tranchida.


B.  USMLE:

  1. Step 1
    • What score is competitive for residency depends on the residency you want? Elite programs want great scores and AOA. For research institutions great scores and class rank aren't enough; you need research too. However, there are wonderful programs that will take students with scores above 200.
    • A single failure does not preclude getting a good residency.
  2. Step 2
    • Program directors value both Step 1 and 2. Some of us value Step 2 more than Step 1.
    • The good news is that a good Step 2 score can compensate for a poor Step 1 score, but only if you take it early enough.
    • When to take: the sooner the better. Try to take by the end of October. The longer you wait the more you will have to review. Get Step 2 done early!
      1. If you had Internal Medicine at the beginning of Year 3 you may want to do your Sub I in July and then take August off to study and take Step 2.
      2. If you took Internal Medicine at the end of Year 3 you may want to take July off to study and take Step 2.
      3. There is a lot of ambulatory on Step 2. You may want to take ambulatory medicine before you take the exam.

C. LETTERS of RECOMMENDATION:

  1. You need 3 letters of recommendation. Anyone applying to a University program also needs a chairman's letter; this is a fourth letter. Even though the Chair doesn't really know you it is an opportunity for you to meet with the chair and for the Chair to provide you with advice.
  2. You should have at least one of your three letters and preferably two from Internal Medicine or subspecialty medicine. Your continuity preceptor is an excellent person to ask for a letter. He or she knows you and your performance over an extended period of time.
  3. Ask your potential letter writers if they "feel comfortable writing you a really strong letter as you are planning to apply to some high powered places."

D. APPLICATIONS

  1. The number of places you apply to depends on your competitiveness.
  2. If you are a marginal student (course failures, USMLE failure(s), etc) you need to apply to a lot of Medicine programs, 100-150 programs, including mostly if not all community programs.
  3. On average most people should apply to 20-30 programs.
  4. If you are a solid student, USMLEs of 220 and applying to in-State programs, you can probably get away with 10-15 programs.
  5. If you are applying to elite programs you need to apply to at least 30 programs including some less competitive programs.
  6. The way you really know your competiveness is by the number of interviews you get.
  7. It is best to apply to more that you want to interview at. You can always decline offers to interview. You can also accept offers and then decline later as more desirable program interviews are offered.


E. INTERVIEWS

  1. Most are scheduled in November, December, and January
  2. Plan to take one of these months off. If you are interviewing at a lot of programs you will need to make sure another month is a light-weight non-required rotation.

F. MISCELLANEOUS:

  1. Complete your CV between Year 3 rotations. It is a wonderful feeling to be ready for ERAS.

Have your materials ready to submit to ERAS on time. This is one time you do NOT WANT TO BE LATE.

PEDIATRICS Faculty Advising Guidelines

  1. Year IV ROTATIONS
  1.  Elective Rotations in field of interest
    • How many to do - Your job is to graduate as a generalist not as a specialist
    • When to do - Do the things you are interested in or disciplines you plan to interview in early.
    • Where (home vs away) Can only do 3 away electives per SOM. Important to visit settings you are strongly considering. Especially important to evaluate the area to look for activities outside of the hospital. Evaluate academic vs non-academic. You need to do an academic center if you plan to specialize OR do research OR teach. You can also look for NIH grants to the institution as a sign of academic virtue. Evaluate how you learn best - Hands on with patient OR READING. Free standing pediatric hospital offers another advantage for specialty - even if NOT university affiliated.
  2. Sub I
    • Recommended Sub I (medicine, surgery, pediatrics, family medicine) Ped subI's are seen very positive for peds residency. Can use PICU, NICU, nephrology, hematology-oncology, general peds floors at Childrens (Red, Yellow, Green and Rainbow) 
    • Do early so you can get the grade back and use it as a positive.
    • Even if you do your subinternship in Oct or Nov, an "addendum" can be sent to ERAS so the program will know how well the student did during the subinternship.
  3. Other required rotations (ER, ambulatory)
    • When to do considering application and interview schedule for residency application. Do the rotations relevant to your chosen discipline early. If you have no interest in ED (eg) leave it for those who want that discipline.
    • You are allowed to do Ambulatory Medicine in a Pediatric site.
  4. Electives
    • recommended electives. You are at the stage when everything you do will make you a better physician. Look for things that you may not have time to take in the next 4 years. Look for things you know nothing about to motivate you to continue studying. Part of your job this year is to develop habits that will improve time management AND  your continued education. You must learn to self-initiate and self-criticize. The goal is to graduate as a "GENERALIST" not as a specialist. That's what residency is for.
    • In field vs out of field electives The SOM restricts you to 3 electives in the same field.
    • when to do  - whenever it works in your schedule. If you think the experience would give you an advantage for interviewing, do it before you interview
  5. Away rotations - are rehearsal rotations necessary, do they help? The best way to evaluate a program (and for them to evaluate you) is to BE THERE in a clinical setting. You need to determine interactions with faculty and ancillary staff and university and community. You need to evaluate the culture and attitudes of the community. An away also lets you evaluate the environment for activities, climate etc. You will not spend all of your time in the hospital. Make sure your non-medical interests are available!! It is good to get the sense of academic vs community vs free standing vs small/large program.
  6. Pros and cons of research electives - A great way to assess your interest; to enhance your CV; to improve self-initiation and self-evaluation. It is not a must, but if you are considering an academic career, try it. Can provide you with a topic of discussion
  7. Out-of-country rotations. Same as #6

B.  USMLE

  1. Step 1 pass is 188
    • What score is competitive for residency - Check the website for that particular residency. Some places will list their cut-off.
    • What score is not (honesty is IMPORTANT)
    • What if student fails on first attempt? Admit problems up front. Explain issues and/or contributing problems and detail your remediation plan.
  2. Step 2 pass is 189
    • When to take (Recommend that the student not delay on the taking of this exam. USMLE Step 2CK - Required to take the examination by the end of December to allow for a 1st attempt result to be reported by the end of January. USMLE Step 2CS - Required to take the examination by the end of October to allow for a 1st attempt result to be reported by the beginning of January. The "take by" dates for these exams were developed based on the reporting schedules, to allow for a 2nd attempt prior to graduation if the 1st attempt is unsuccessful. In order to be certified for graduation and allow sufficient time to have medical licensing forms completed, a passing result for both examinations has to be received by May 1) . Check the website. Some programs will not schedule for interview without a score; some will schedule but the score must be posted BEFORE you interview; some will not rank you until a score is posted.
    • Scores (what's a competitive score for your field?)
    • Value of both 2 CK and 2CS in program director decision making - It gives another dimension in peds of ability to communicate. Clinical abilities are essential in this field.

Step 2 CK (knowledge test)
Students must post a first attempt score for Step 2 CK (knowledge test) by the end of January in the year they expect to graduate.
Students must post a passing score by May of the year they plan to graduate.

Step 2 CS (skills)
Students must take Step 2S no later than May of the year they plan to graduate.

C. LETTERS of REC

  1. Should comment if residency requires Chairman's letter - Not always helpful. We do have a mechanism for providing the letter should you need it. Some programs do not like to letter because they prefer information from people who worked with you directly.
  2. Recommendations other letters (e.g. How many in-field, other fields, etc.). Get out-of-field so that you show you have many strengths. Especially in pediatrics, we want to make sure can communicate with adults. Remember, parents/adult caregivers provide the care for children.
  3. Who to ask for letter and when (SOM asks that letters of recommendation be submitted by September 15). Remember, the beginning of the academic year is July 1st for most SOM faculty. A lot of other things happen - 3rd year medical students and first year residency.
  4. Not waiving the right to see the LOR before it is sent to ERAS sends out an alarm.

D. INTERVIEWS

  1. When to schedule - No ramification. Be sure you do not tell the residency that it is a "Practice" interview.
  2. How to find programs
  3. Always have questions!! Even if you ask the same question to everyone. Even if you know the program, still ask questions.
  4.  Be sure you know something about the program before you interview. Review the website. Talk about specifics of that program.
  5. Admit transcript issues up front.

Miscellaneous

Do extracurricular activities and community service make a difference? In peds we look for someone who can demonstrate sensitivity to children, can communicate with children, volunteer/exposure to children in any kind of activity. We look for a 3-dimentional person.

Year IV Advising for Family Medicine

Scheduling Guidelines

  • Plan to be here in August (away elective not recommended!) to avail yourself of local resources (SOM Clerkship Director and faculty) for completion of your ERAS application (review of and guidance with your personal statement and CV) and to and to meet with Dr. Boltri (Department Chair) for your Chair's letter
  • Recommend taking Step II CK by September, Step II CS by October (want to post passing scores for programs no later than January)
  • Schedule time off for interviewing in October, November, or December. US FM programs complete most of their interviewing in these 3 months.
  • If you need to do multiple interviews in another geographic location, schedule an elective there and time off to accommodate interviews.
  • Delay required EM rotation until after January.
  • Schedule to do your Sub-I in FM ( this is an excellent inpatient experience and available at all of our clinical campus sites)
  • Delay Ambulatory Med rotation until after January or schedule it for the month you are scheduling your Step II CS
  • Schedule important personal events (weddings, travel, etc.)

Electives Guidelines

  • Strongly recommend: Radiology, Cardiology, Dermatology
  • Recommend: FM Elective in rural/small town practice or in other geographic area of interest, Obstetrics (Family-Centered), Infectious Disease, Endocrinology, Oncology
  • Recommend taking electives that are of interest to you: International, Sports Medicine, FM Research, Law and Medicine, Public Health
  • Not Recommended: ICU, CCU, SICU, hospital-based electives unless you need to improve your in-patient skills.

Orthopaedic Specialty Specific Year 4 Advising Guidelines

Scheduling

  1. Recommend taking Step IICK by September, StepII CS by October (want to post passing scores by January so programs know you have passed)
  2. Schedule time off for interviewing in November or December, home elective in October to accommodate early local interviews
  3. If need to do multiple interviews in other geographic location, schedule an elective there and time off to accommodate interviews
  4. Do not schedule an away elective in August - you need to be around here while you are working on your ERAS application to avail yourself of local resources (SOM and faculty) and to meet with the Chair for your Chair's letter for your application
  5. Schedule important personal events (wedding of your own or close friends, leisure travel, etc.)

Year 4 electives

  1. Strongly recommend: Orthopaedics at a site you are considering
  2. Recommend: Away elective if you are seriously considering a particular program/location in that area

Letters of Recommendation

  1. Three letters are sufficient- At least one from the Orthopaedic Chair or Program Director, (Surgery can be additional)
  2. Chair's letter STRONGLY recommended (fourth letter)
  3. Ask that ALL of your letters reference your interest in Orthopaedics

Interviews:

  1. Most will likely be in November and December
  2. Find programs through ERAS, Chair's recommendations, WSU grads, Year 4 Orthopaedic Advisor
  3. If an academic/research career interests you, focus on university-based residency programs

Obstetrics/Gynecology Specialty Specific Year 4 Advising Guidelines

Scheduling

  1. Recommend taking Step IICK by September, StepII CS by October (want to post passing scores by January so programs know you have passed)
  2. Schedule time off for interviewing in November or December, home elective in October to accommodate early local interviews
  3. If need to do multiple interviews in other geographic location, schedule an elective there and time off to accommodate interviews
  4. Do not schedule an away elective in August - you need to be around here while you are working on your ERAS application to avail yourself of local resources (SOM and faculty) and to meet with the Chair for your Chair's letter for your application
  5. Delay required EM rotation until after January
  6. Schedule to do your Sub-I in ? Surgery
  7. Delay ambulatory med rotation until after January or schedule it for the month you are scheduling your Step II CS
  8. Schedule important personal events (wedding of your own or close friends, leisure travel, etc.)

Year 4 electives

  1. Strongly recommend: Cardiology, Radiology, Dermatology
  2. Recommend: Endocrinology, Oncology, Infectious Disease
  3. Recommend: Away elective if you are seriously considering a particular program/location which is out of your reach
  4. Recommend taking electives that are of interest to you like: Law and Medicine, Advanced Surgical Skills, etc
  5. Recommend taking ICU, CCU, SICU, hospital-based electives unless you need to improve your in-patient skills

Letters of Recommendation

  1. Three letters are sufficient- At least one from OBGYN, (Surgery, Medicine, Peds can be additional)
  2. Chair's letter STRONGLY recommended (fourth letter)
  3. Ask that ALL of your letters reference your interest in our specialty

Interviews

  1. Most will likely be in November and December; many local programs will interview in October
  2. Find programs through FREIDA, Chair's recommendations, WSU grads, Year 4 OB Advisor
  3. If an academic/research career interests you, focus on university-based residency programs

Anesthesiology Specialty Specific Year 4 Advising Guidelines

Scheduling

  1. Recommend obtaining USMLE Step 1 scores above 215 to compete for interviews - and equivalent or better Step 2 CK by October in the year prior to interview season.
  2. Interviews are November to January and, with 140 programs nationwide, we advise ranking about 10 programs to ensure acceptance.
  3. ERAS applications are due in September - therefore, schedule Anesthesiology electives locally well ahead of this to obtain the needed letters of support.
  4. In planning, please remember that a good Anesthesiologist is an outstanding internist - with skills in cardiopulmonary assessment and management, fluid and electrolyte management and organ protection. Rotations should reflect these needs.

Year 4 Electives

  1. Strongly recommend Cardiology, Pulmonology, Neurology, Nephrology.
  2. Recommend Endocrinology, Oncology, Infectious Disease, Surgery Specialties.
  3. Recommend away elective if you are seriously considering a particular program/location which is out of your reach.
  4. Recommend taking electives that are of interest to you like Law and Medicine, Medical Genetics, etc.
  5. Recommend taking ICU, CCU, SICU, and hospital-based electives like Radiology for ultrasound imaging.

Letters of Recommendation

  1. Three letters are sufficient - at least one from Anesthesiology (Surgery, Medicine, Peds can be additional).
  2. Chair's letter STRONGLY recommended (fourth letter).
  3. Ask that ALL of your letters reference your interest in our specialty.

Interviews

  1. Most will likely be in November to January; some local programs may begin in October.
  2. Find programs through FREIDA, Chair's recommendations, WSU grads, Year 4 Anesthesiology Advisor.
  3. If an academic/research career interests you, focus on university-based residency programs.
  4. Choose categorical programs first as the full four year continuum at one site is a great advantage.

Plan a fellowship year and talk about this in interviews as it shows your seriousness

Faculty Advising for Year III Students Considering Psychiatry

Electives to Consider

  1. Good Internal Medicine electives to consider are those that deal with chronic illness (Hematology-Oncology, Hospice and Palliative Care, Nephrology, Endocrinology/Diabetes Care).
  2. Research electives may help, but they are not obligatory when applying for Psychiatry residency positions.

USMLE Step 2

  1. Previous WSU students have advised taking Step 2 CS as close to the end of the Year III OSCE as possible.
  2. It is wise to take Step 2 CK as early in the year as possible, preferably early fall. Programs submit rank lists in February; passing scores for both parts of Step 2 should therefore be available by February 1. Register early for your Step 2 exams, and leave time to retake the examination should you fail because some programs will not rank you without passing scores in USMLE 2 CK and 2 CS.
  3. Because the Sub-Internship may be helpful to some students in preparing for Step 2, consider scheduling that required month early in Year IV.

Months Off

  1. If you are an "on-time" graduate, you are allowed 3 months off during your fourth year. Most students take a month off to study for Step 2, one month to interview and one month at the end of the year (e.g., May)

Interviewing

  1. The typical WSU student interviews in November, December and January, and takes one of those months off to do so.
  2. Required Year IV months (Ambulatory, Emergency Medicine, and the Sub-I) generally allow 2 days off for interviewing. It may be difficult to schedule days off during Emergency given the nature of its shift work. Elective months typically allow 5 days for interviewing, but you need to give ample advance notice to all electives of the days you will be away for interviews.
  3. Business attire is necessary. A suit for both genders and a tie for men are the norm.
  4. Be prepared to answer the following with ease:
  5. Why do you want to become a psychiatrist?
  6. Tell me about yourself.
  7. Come prepared to discuss any time off which has lengthened your medical school education. Be honest and up-front.
  8. Interview days vary widely. You should expect to meet with residents in the program and be given contact information for later use

Personal Statement

  1. Make sure you proofread your personal statement (and your entire ERAS application) carefully.
  2. Do not borrow any material from internet websites to write your personal statements. Some residency programs have software which checks for plagiarized material.
  3. It is acceptable to mention personal difficulties or a family history of psychiatric illness in your personal statement, but do not make that the theme of your statement.
  4. If you have taken time off which has lengthened your medical school education, the personal statement is a good place to briefly mention the reason unless it was explained in the body of your ERAS application (Medical Education/Training Extended or Interrupted? Reason:)

Letters of Recommendation

  1. Psychiatry programs do NOT routinely require or expect a chairman's letter.
  2. Try to obtain 2 letters from psychiatrists and one from an Internal Medicine or Pediatrics faculty member.
  3. Try to have at least one letter come from a faculty member who knows you well and can describe you personally; one suggestion is your Year III Continuity Clinic preceptor.
  4. A description of your psychosocial interactions with patients should be included in at least one of your letters of recommendation.

It is a good plan to complete a practice interview with someone who is experienced in interviewing.

After your residency interview

  1. Training directors can NOT ask you how you have ranked their programs.
  2. Within a week after you interview, send a brief, personal thank-you email to the program director and others with whom you interviewed. Mentioning what you like about the program is a good idea. A warm, hand-written thank-you note to the program director also is appreciated if you are interested in that program. Do not send holiday cards, etc.
  3. ONLY RANK THE PROGRAMS WHERE YOU WANT TO TRAIN. THE MATCH IS A BINDING CONTRACT!!
  4. If you are in the Couples Match, make sure to cast a wide net, particularly if you or your partner is applying to a competitive specialty.