I didn’t get any of my choices. (oh, so long ago: 32 years!)
I had HPSP (Health Professions Scholarship Program) financing for medical school through the Air Force. My GPA put me in the middle of the graduating class. Applied for a Family Practice residency spot. Was “deferred for civilian training”. Interviewed at several hospitals-put on their waiting list.
So I decided to take a year off and go out for a year as a missionary. I told the Air Force that I would reapply for an Family Practice residency spot the following year. Six other doctors told the Air Force the same thing. . .so they made an internship program for us.
The next decision point came near the end of that internship year. I applied to be accepted into the second year of the Family Practice residency at that hospital. But I was not sure there would be an opening in the second year. Would I be willing to start over as a first year FP resident? Yikes! I really didn’t want to go through that year again! Fortunately, I did get into the second year of the program. And was chosen by the staff to be one of the 3 residents to serve a portion of the third year as Chief Resident.
The most common thing that keeps people from getting into a residency right away (in my experience) is an inability to pass the board exam. The US Medical Licensing Exam has three parts, or “steps”; Step 1 is taken after the second year of med school, Step 2 is usually taken in the fourth year and is often required for graduation from med school, and Step 3 is taken during residency. (Many programs, like mine, require the Step 3 to be passed to graduate from the first year of residency.)
The last two years of med school are made up of clinical rotations. At my med school half of our rotation grades were usually our performance on the rotation itself and the other half came from a very difficult and comprehensive test at the end of each rotation or set of rotations. We also had a lot of traditional didactic learning during our rotations. At the time I was surprised at how much emphasis was taken away from the practical experience, but I don’t think anyone in my class failed the Step 2.
The med school I work with most closely now is exactly the opposite; their grades come 100% from the evaluations from their clinical rotations and they rarely take exams or have traditional didactics. They get a fair bit more clinical experience that we did, but a LOT of them fail the Step 2, including some people I consider very good students.
If someone can’t pass the Step 2 before graduation they’ll almost certainly have to sit out for a year. What really sucks is that many states have a limit on how many times you can take it; in my state you can’t get a training license if you’ve failed the Step 1 or Step 2 four times. This happened to someone we really liked otherwise (one of the few whose issues I really do think stem from being a “bad test taker”) and now she’ll have to go out of state.
A lot of others want into a competitive residency, and others limit themselves by geography because they don’t want to leave their family or whatever. In my experience, someone who isn’t picky about location, is willing to do a less competitive specialty, and is able to graduate and pass the Step 2 will be able to get in somewhere unless he has some big glaring issue.
DoctorJ, that’s really interesting at your school, since traditionally Step 2 has a bit higher scores than Step 1. I know that for myself, at least, I did much better on Step 2 than Step 1. Unfortunately, most residencies seem to use Step 1 as a sort of first pass screening tool, so if you don’t make the grade you really don’t have much shot of getting an interview.
I should also state that Step 2 is actually composed of two parts: Step 1 Clinical Knowledge, which is a written test with multiple choice answers; and Step 2 Clinical Skills, which is a series of standardized patients designed to test the student’s history taking and physical exam skills, as well as note writing and planning. Step 2 CS was historically used for international students only, and was sort of a way to make sure they spoke and understood enough English to be able to work here. I’m not sure when they made it so everybody has to take it, but the passing rate for it is well over 90% for US students. I know that I was less than amazing on my own Step 2 CS, and I still passed easily. That was the most expensive exam I’ve taken so far, though. Cost me ~$1100 for that one part. I was lucky and lived close enough to one of the five testing sites, but for many students travel and lodgings are also part of that.
Also for interviewing, while some interviewing programs and specialties may pay for you to come, I think the majority do not. I slept on more than a few couches and floors to save money, but airplane tickets were not cheap. If anybody reading this knows or is a third year medical student, I’d advise them to save all the money they can starting 6 months ago to help cover the cost.
They may also have trouble with the Step 1; they’re generally done with that by the time they get to us. But their first two years are fairly traditional, so I doubt it. They rely a lot on community faculty for the 3rd and 4th year, and everybody is at different sites so it’s hard to structure anything. The students learn a lot about the patients they see but they don’t get the comprehensive review they need for the board exam. It’s actually a great setup for the truly self-motivated, but it’s also the first chance most med students have had to find out how self-motivated they are.
The Class of 2003 was the first that had to take the Step 2 CS; I was in the Class of 2002. It really sucks for students here because the closest site is in Atlanta, almost 400 miles away.
All the programs I interviewed at paid for my hotel (one night, anyway) and the residents usually took me out to dinner, but none paid for actual travel. I took out a supplemental loan to pay for interview travel and moving expenses, but I was able to do that because I hadn’t maxed out my borrowing. The people who had, and hadn’t planned on all the extra expenses, had it rough.
My brothers school had a 50/50 raffle for the last one pulled. His friend that I was sitting next to won it. Apparently there was way more than a dollar per person in there
I could get behind that kind of tradition, but then again, waiting the 15 minutes with my envelope in hand was already pretty bad. Not to mention trying to open it while carrying a mini champagne bottle in the other.
