How will I be contacted during my last year of medical school?
Early in your fourth year of medical school, the Chairman of Medicine’s office will contact you to arrange a meeting with Naga Chalasani, MD, the program’s Interim Chair of Medicine, and a separate meeting with one of a dozen key medical education faculty members in the Department of Medicine. These faculty members have been carefully chosen to help you achieve the best possible training that’s tailored to your career goals.
These faculty members provide career advice specific to internal medicine, even if you’re unsure about pursuing this field as a career. They can review your personal statement and draft a letter of reference from the Department of Medicine chair, which is often requested by Internal Medicine residency programs around the country. While this letter will be signed by the faculty member and Dr. Chalasani, it does not count as one of the three typically required by most programs, nor does it serve as your official Medical Student Performance Evaluation (Dean’s Letter). This Department of Medicine letter may include information beyond your performance during your Internal Medicine clerkship and sub-Internship (if available), but the authors do not have access to your school transcript.
How do I notify the Department of Medicine of my interest in Internal Medicine?
At any time during your third year, contact Cassie Fisher at firstname.lastname@example.org to let her know of your interest. Also, the school often sends results of student surveys of this department in which you may have identified Internal Medicine as a possible career choice. The department also obtains a list of interested students from the school’s Medicine Student Interest Group, which is an excellent way to learn more about the field and get to know people with similar interests.
How else can I prepare myself for residency?
Since work-hour regulations limit patient contact time and time in the hospital, anticipate a more active role in your education. One approach is to begin systematic study of a textbook of medicine (this department generally prefers Kelley, Harrison, or Cecil). The review books and board question panels may not explore pathophysiology and etiology in sufficient depth for an internist. It also makes sense to read chapters pertaining to a clinical rotation (e.g., cardiology chapters during a cardiology rotation), and budget time to cover as much of the rest of the book during other parts of your senior year. It’s unlikely you’ll finish, but you will have an excellent start on reading the remainder as a house officer. Cecil contains about 2400 pages, and conceivably you could read it in a year at about 10 pages per day; break it down to easier chunks. The program also recommends re-learning physical exam skills using the JAMA Rational Clinical Exam series (now published as a book with new updates) along with some cardiac auscultation practice using Harvey at the Sim Center. An excellent summary for physical examination is McKee’s Evidence Based Physical Examination.
Should I consider an away rotation?
Generally, Internal Medicine does not give much weight to completing an away rotation, as this practice is more important for other specialties. However, some may want to pursue an away rotation to experience a program or region of the country. If you need match in a specific city for family or other personal reasons, and your application is not highly competitive, it is appropriate to do an away rotation at an institution of your choice. In this situation, an away clerkship can allow you to gain experience at the institution and facilitate earning a letter of recommendation from them, since programs tend to pay more attention to letters from faculty at their own institution.
Should I pursue a dual degree to make myself more competitive for residency placement?
If you’re truly interested in the business side of medicine and can foresee yourself in a business or administrative role, an MBA may be a good preparation for that career. However, the mere addition of another degree to your CV is not advised. Many return to school to pursue an MBA degree and their clinical experiences may add much more perspective and meaning to their MBA pursuits than simply the clinical experience of a third-year medical student.
What about an ICU experience?
Take an ICU month, if possible, in addition to a ward-based Sub-I. This will be a challenging month; however, when you start your intern year, you’re likely to feel much more capable and comfortable with very ill patients.
What are residency program directors looking for in terms of service projects research or additional degrees such as MS MBA or PhD?
Residency directors are looking for hard-working candidates who’ve excelled in the coursework and clinical rotations. Performance in the medicine clerkship, especially the sub-internship, suggests how you may perform as an intern. Your scores on USMLE are evidence of your mastery of the first years of medical school, and the department likes to see the USMLE 2 CK scores. Programs often set minimum levels of USMLE 1 and/or USMLE 2 scores needed for an interview because they receive thousands of applications and are unable to interview them all. Letters of recommendation should reflect your hard work, contribution to the evaluation and management of the patients, and eagerness to learn, including evidence you have developed good habits in reading about your patient’s illnesses during your time away from the hospital.
Individual service activities or research electives carry very little weight in comparison to the above. A passion for service is certainly appreciated but won’t increase your competitiveness if your overall performance is average. Academic performance is more important in this context than honors and society inductions. While evidence of serious research involvement and publications are excellent reflections of your intellectual curiosity and abilities, they’re less impressive in entering residency than your performance as a medical student, working with patients who have complex illnesses.
What electives should I take?
Concentrate on your weaknesses; recognize them and take electives in these areas. For example, if you feel you’re lacking in knowledge of infectious disease or cardiology, take an elective in that area. When you are a resident on-call by yourself, be the person who can help the patient with any condition, not just with conditions that pertain to the subspecialty you may be considering entering. Being a high-quality generalist is an excellent first goal.
Another approach is to take electives you may never experience during an IM residency. You’ll have plenty of opportunities to learn infectious diseases and cardiology during your residency, but you may consider augmenting your education with an elective in anesthesia or dermatology. Each student is unique, and it may be your last chance to fill a relative gap in your general medical school training.
What should I learn from my other clerkships during my fourth year of med school?
Radiology will be lighter than some of the traditional clerkships, but it is a core (required) clerkship with specific learning objectives. It’s also an excellent time to lay the framework for examining radiographs. This may be the only time in your medical career that you have time to sit down with the attending radiologist so use this time to lock down your technique and identify reference resources for the future when you are not on the rotation. Attempt to review the greatest volume of material you can.
Emergency Medicine is a core clerkship that provides a look at this high-paced, high turnover field of medicine with a wide spectrum of disease severity and care. You’ll gain an incredible exposure to pathology and learn techniques for becoming more efficient in your data gathering, as well as presentation speed and decision making. The emergency department also teaches you to treat many common conditions quickly and safely; a skill you will need to master as in the future you will have a number of walk-in patients. It also provides useful insight into how patients transition safely through the medical system.
When do I take my Sub-I?
Pursue a sub-internship in Internal Medicine early in the year, if possible. Most schools recognize that many students are not able to have an early sub-Internship, so don’t worry if it doesn’t happen. Even with this department’s lottery systems, the school attempts to give those with an interest in internal medicine their Sub-Is as early as possible. The Sub-I is also a good time to secure additional letters of recommendation.