Making the Most of Your Summer

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Looking forward to the summer months, it can be overwhelming to decide what you should do as an EM-bound medical student. To alleviate some of this stress, here are some tips from fellow medical students and personal experiences.

SUMMER BETWEEN YEARS 1 AND 2
Research
Emergency medicine is not a specialty that requires research for residency applications. If you are interested in research, go for it. If you aren’t, find another service project, global experience, or summer-long hiking trip to complete this summer. It’s most important that you are passionate and committed to your summer plans. If you are interested in doing research during the summer, start looking for a project now. Contact the chair of your school’s emergency medicine department to ask if you can help this summer. You can also email your local residency program director and see if any residents need assistance with data collection or chart review. If you have your own idea for a project, write a research project proposal. Contact your advisor to set up the process of bringing your research ideas from paper to an actual study. For EM residency applications, research projects don’t necessarily need to be in EM. They do, however, need to be research questions that are interesting to you. Be passionate about your research, as the project will undoubtedly be discussed during residency interviews!

Global Experiences
Consider a global health experience if you have 4-6 weeks off this summer. There are a few questions to consider when selecting a global health program. How often does the program return to the same location? This helps you gauge the program’s impact in the communities they serve. A “one-and-done” clinic may help for imminent health care needs, but a 90-day supply of antihypertensives or prenatal multivitamins is only helpful if there is a team returning to the same town in 90 days. Ask your fellow medical students, residents, and faculty if they have had a positive global health experience with a specific program. Check out EMRA’s International Emergency Medicine: A Guide for Clinicians in Resource Limited Settings.

Service Projects
Do you have an idea for a service project that would positively impact your local community? Devote some time to it this summer. It doesn’t need to be medicine-related. Some ideas might include teaching hands-only CPR courses for community members, volunteering at a local camp for kids with cancer, or sharpening your language skills by translating at migrant worker or immigrant health clinics. Talk to your more senior classmates to find out about service projects in your area and at your medical school.

Pursuing a Personal Hobby
In emergency medicine, you may have heard of the “work hard, play hard” mantra. At the Medical Student Forum at ACEP16, we heard many program directors talk about the unique interests and hobbies of residency applicants that helped the applicant snag a coveted interview spot. If your dream has been hiking the Appalachian Trail or spending one last summer performing with your band, this is the summer to do it. The weeks of vacation between first and second year will likely be your last true summer break. Be prepared to talk about what you did during this time in residency interviews, but feel free to adventure or check an item or two off your bucket list.

SUMMER BETWEEN YEARS 2 AND 3
Step 1
Focus your time this summer on rocking Step 1. Take 2 weeks, 4 weeks, or 6+ weeks to prepare. You don’t want to go overtime with your studies, but you also need to take whatever time you feel is necessary for you to be successful.  According to Charting Outcomes in the Match for U.S. Allopathic Seniors, the average Step 1 score for medical students who matched into EM in 2016 was 233.

Take the time now to talk with 3rd and 4th years about what study materials worked for them, but don’t bog yourself down with too many study resources. Pick one comprehensive study program, one comprehensive book, and 1-2 question banks. Supplement subjects you know you are deficient in with subject specific Step 1 prep textbooks and/or online resources.

Take an NBME practice exam (CBSSA) at the beginning of your designated study time, as this will allow you to see your subject areas of strength and weakness, as well as give you a baseline estimated score. Take one NBME no more than once every 1-2 weeks during your designated study time. Use your estimated scores to ensure you are ready to go come test day, but it is not recommended to take any NBMEs during your final week of studying, as any negative change in your estimated score could cause unnecessary anxiety on test day.

For students at schools that take Step 1 at a different time in the curriculum, talk to older students who have done well on the exam. Many schools offer tutoring groups to go through study material as a first pass; this can be an excellent way to keep a consistent study schedule during busy rotations.

Finally, come test day – Take a deep breath, strike a Power Pose, and show Step 1 who’s boss!

Research
Research can offer you an opportunity to demonstrate your interest in EM, and also form a personal relationship with EM faculty and residents. As an EMRA member, you receive Annals of Emergency Medicine. This is a top-notch EM journal and a great way to stay abreast of current topics in EM and get ideas for research projects. If you already have a project, tie up loose ends for presentation and publication. These measurable research outcomes can help demonstrate your ability to execute research projects and stick with them to completion on a residency application. ACEP and SAEM meetings are great forums to present your projects.

If you are looking for a research project, see above, under Summer Between Years 1 and 2, for more helpful hints in terms of finding an existing project to work on.

Core Rotations
When your core rotations begin, focus your time and effort on learning all that you can from each and every attending, resident, and fellow medical student whom you work with. During your clerkships, a few general tips will serve you well:

  • When you are in clinic or at the hospital, be fully present. Pull out a book when you are looking up something pertinent to your patients. Otherwise, unless there is an aggressive amount of downtime, focus on learning in the moment.
  • Take the initiative to check on your patients throughout your shift. Update your team when laboratory and imaging results come in. Obtain consults for your patients, and update your team with recommendations.
  • Ask for help when you need it; you are not expected to know everything. If you don’t know the answer to an attending’s or resident’s questions, be honest. Know your limits. It is okay to say, “I am sorry, I forgot to listen to the patient’s lungs. I will go back and let you know what I hear.”
  • When you are at home, study for your shelf exam, but don’t forget to see your friends, family, loved ones, and pets. Shelf scores are important, but so is your sanity. Make a study schedule at the beginning of each clerkship, and stick to it. One you have finished your daily studying to-do list, take some time to walk your dog, read a book, work out, or watch “The Bachelor” with your friends.

SUMMER BETWEEN YEARS 3 AND 4
Audition Rotations
Audition rotations, also known as away rotations or externships, are an opportunity to showcase yourself at a program that you may potentially want to choose for residency. These rotations allow you to observe the culture of a program while assessing if it is the right “fit” for your training.This is also your opportunity to obtain a Standardized Letter of Evaluation (SLOE). Many applicants have 2+ SLOEs submitted with their ERAS application, which opens on September 15th each application cycle. Because of this, July and August are very competitive months to schedule away rotations. Some students choose to do a “warm-up” emergency medicine rotation at their home institution (also a potential opportunity to obtain a SLOE) prior to auditioning at another program. For more in-depth advice on away rotations, see EM Resident articles:

Step 2 CK
According to Charting Outcomes in the Match for U.S. Allopathic Seniors, the average Step 2 CK score for medical students who matched into EM in 2016 was 245. Remember that USMLE scores can take anywhere from 4-6+ weeks to be reported, so you want to plan on taking Step 2 CK by mid- to late July. ERAS sends medical student applications to programs in mid-September, and you want your Step 2 score to be on your ERAS application. Most EM programs look at Step 2 as an essential part of your residency application. You don’t want to miss out on an interview at your top choice because you don’t have a reported Step 2 score.

You are now a seasoned pro at taking board exams. You survived Step 1 and now it’s on to Step 2 CK. Think back to your study schedule for Step 1 and which resources worked best for you. As with Step 1, there are a multitude of resources available. This time around, you have a better idea of which of those resources best fit with your personal learning style. Limit yourself to those that work best for you. In addition, any other resource you found useful to study for your shelf exams should translate very well to Step 2 CK! Similar to Step 1, there are NBME practice exams available (CCSSA) to track your progress.

Take whatever time you need to study for Step 2 CK. Make a schedule based on your chosen resources to determine just how many weeks you need. Some students will take as little as 2 weeks and others 4 or more weeks. Once you finalize a study schedule, try to stick to it! Be confident that you chose the resources that work best for you and don’t get overwhelmed by comparing your study schedule to the approach your peers are taking. You know yourself better than anyone!

Step 2 CS
If come summertime you haven’t already registered for Step 2 CS, sign up as soon as possible! Dates fill up very fast, and if you don’t live in one of the 5 cities with test centers (Atlanta, Chicago, Houston, Los Angeles, Philadelphia) you will have to plan your travel.

Anecdotally, students report that emergency medicine rotations are excellent practice for Step 2 CS. Consider scheduling this exam during or immediately following your EM rotations, as your schedule allows. Keep in mind, however, that you want to be as present and involved in your audition rotations as possible, and it may be difficult to request time off to take this exam depending on the particular institution’s policies.

Although not a requirement for your ERAS application, there are programs that require your Step 2 CS score before putting you on their rank list in late February. Familiarize yourself with the Score Reporting Schedule to plan accordingly.

Research
Review your past research projects, reread your papers and abstracts, and think about how you will talk about your research in residency interviews. Knowing the significance, a “one-liner” of results, and your role in the project will be important. Review the research sections above for the M1 and M2 summers.

Erin Karl, MSIII

Erin Karl, MSIII

EMRA MSC Midwest Coordinator, 2016-17 | University of Minnesota | Minneapolis, MN
Morgan Bobb

Morgan Bobb

Morgan Bobb is the 2016-2017 Great Plains Representative to the EMRA Medical Student Council.
Elena DiMiceli, MSIV

Elena DiMiceli, MSIV

EMRA MSC Southeast Coordinator, 2016-17 | Florida International University | Miami, FL
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