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Steps for Success for Third-Year Medical Students

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Step 1: Understand Criteria Important to Residency Program Directors

With two years of medical school completed, it's important that you review the criteria that residency programs use to select residents. Medical students who are well informed can make appropriate decisions that will maximize their chances of success in the residency match. 


The NRMP [National Resident Matching Program] publishes data on matching outcomes every 2 years. This resource is known as "Charting Outcomes in the Match", and it's an extremely valuable data set. For each specialty, the NRMP includes remarkably specific data points, such as how many applicants with a USMLE score below 220 were able to match into orthopedic surgery in the 2018 cycle. 

After reviewing these documents, you'll have a better idea of where you stand. Compare your achievement inside and outside of the classroom with those who have matched before you. After identifying areas of weakness, you can take steps to turn these into strengths. 

There's much that you can accomplish in this next year before residency applications are due. But it all starts with a strong understanding of your strong and weak points.

The NRMP also surveys program directors (PDs) in every specialty. The PDs report on the factors that are most important to them in deciding whom to interview and whom to rank.

Step 2: Recognize the Importance of Clerkship Grades

The skills and traits reflected in core clerkship grades are considered so important to future success as a resident that residency programs use these grades as a major criteria in the selection process. In a 2006 survey of over 1,2000 PDs across 21 medical specialties, grades in required clerkships were ranked as the # 1 factor used in the selection process.


Although more recent studies indicate that the USMLE Step 1 and COMLEX Level 1 score have supplanted clerkship grades as the # 1 factor in deciding whom to interview, there is no disputing the fact that clerkship grades are a heavily weighted factor. 


"Do well in your clerkship," writes the Department of Medicine at the University of Washington. "Yes, this is obvious - and easier said than done - but it's also important. Most residency programs look closely at the third-year clerkship grade when selecting applicants."


Remember also that clerkship grades are used to determine class rank, and influence the quality of letters of recommendation written by faculty. Grades are placed in the MSPE, and comments from your clinical evaluation forms will also be inserted into this document. Many schools use clerkship grades in their decision-making for AOA election.


The evidence indicates that core clerkship grades may either limit or expand your future career options. 

Clerkship Advice for Students

Step 3: Adjust Quickly to Every New Rotation

Transitioning from one rotation to another is stressful. Just when students determine which behaviors, actions, and attitudes are valued and rewarded, it's time to rotate to the next clerkship. Every new rotation represents new responsibilities, a new team, a new physical environment, and an entirely new facet of medicine. 


These factors all impact student performance at the start of every single new rotation. It is crucial that you adapt to your new role and responsibilities quickly and learn how to integrate professionally into your new team and enviroment. 


In our book Success on the Wards, we devote an entire chapter to the "New Rotation." We also have separate chapters for the internal medicine, surgery, pediatrics, obstetrics & gynecology, family medicine, and psychiatry rotation. Within these chapters are numerous templates that you can use during prerounds, present patients during work and attending rounds, and checklists to ensure that your progress notes are thorough. 


With this information in hand, you'll be ready to impress sooner rather than later in your new rotation.

Step 4: Deliver Compelling Oral Case Presentations

During an oral case presentation, students formally "present" a patient to the team. Oral communication skills are vital inpatient care, and the development of these skills is emphasized during core clerkships. Poor skills have the potential to directly impact care.


Poor communication skills also impact a student's evaluation. Faculty and resident ratings account for the majority of a student's grade in core rotations. These ratings include comments on specific skills, such as a student's ability to take a history and perform a physical examination. Unfortunately, because of time constraints, attendings rarely or infrequently observe students in these areas. Therefore, many faculty draw conclusions about a student's ability in these areas from the quality of the oral case presentation. 


Because of the quality of the oral case presentation is used to provide insight in your overall abilities, it is essential that you spend the time to acquire these important skills. 

Step 5: Look for Ways to Solidify Relationships with Attendings

In order to be an outstanding physician, you must provide outstanding patient care. However, you typically won't be observed by the attending during direct patient care. Since your interactions will often be limited to attending rounds, your excellence in patient care must be conveyed by other methods. 


These involve being well-read on your patients' problems, delivering solid oral case presentations, turning in thoughtful and thorough patient write-ups, and giving outstanding talks. 


Your rotations will provide opportunities to make an impression in these areas. Seize these opportunities. Students who do so are more likely to build the types of relationships that lead to strong letters of recommendation. 

Step 6: Make a name for yourself outside of the classroom

As a preclinical student, you have seen that the learning environment in medical school extends beyond the classroom. Institutions offer valuable opportunities to participate in a variety of extracurricular activities. Involvement in these organizations provide a number of opportunities and benefits. As a third-year student, it's time to take inventory of what you have accomplished in these areas. 


Can involvement help students reach their professional goals? Absolutely. Data from NRMP surveys of program directors indicate that extracurricular activities do serve as a significant nonacademic factor in the residency selection progress. 


Evidence suggests that meaningful contributions in extracurricular activities, particularly leadership may serve as an indicator of residency performance. 


Plus getting involved in other pursuits can be fun and rewarding, offering you an opportunity to lead a more balanced life during medical school.


Although busy days in the hospital can make it difficult to find the time and energy to participate, motivated students can strenghthen their credentials in this area. 

Step 7: Win Scholarships and Awards

There is a belief among students that only academic superstars win scholarships and awards during medical school. While some awards favor high academic achievers, there are a surprising number of awards based purely on nonacademic criteria.


Are you an aspiring neurologist who has a love for poetry? Are you known for your ability to make compelling videos? Do you seek a fellowship that will provide an immersive experience at a center dedicated for the treatment of alcohol addiction? Would you like a stipend to pay for your overseas clinical elective?


Winning scholarships and awards can provide a major boost to your residency application, and set you apart from your peers. Awards can be placed in the application, MSPE (Dean's Letter), letters of recommendation, and CV. We have found that interviewers often ask about awards during residency interviews.

Step 8: Take action to Bolster your Credentials 

As you begin to narrow your specialty choice, it will be time to take additional action. And that involves a series of steps to bolster your credentials and strengthen your application. 


Our specialty-specific action items walk you through the process. These recommendations are applicable to both preclinical and clinical students. 

It's best to combine this detailed information with the guidance of a specialty-specific advisor or mentor. 

Step 9: Mantain a Balance in Your Life

Stress is common among medical students. In a survey of medical students at 16 U.S. medical schools, nearly 70% reported experiencing either "moderate" or "a lot" of stress in the last twelve months.


Increased stress in medical school can lead to depression, anxiety, substance abuse, and burnout. Think about your current coping strategies and reserve. Are they serving you well? If not, take the time and make the effort to establish new, more effective strategies. 


You'll hear about the importance of exercise, good sleep habits, and nutrition. You'll be reminded to maintain and nurture your relationships with friends and family. This is all excellent advice, and you must adhere to it for your emotional well-being. It sounds simple enough but plenty of evidence indicates that the demands of medical school make it difficult for students to follow these recommendations. 


If you tend to your psychological health, you'll be in better position to make good decisions in medical school, decisions which will maximize your chances of success in the residency match. This is especially important for second-year students as many students find this year to be more challenging than the first year, especially with the USMLE Step 1 and COMLEX Level 1 exams looming.

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