Preclinical Years

Full Episode Transcript

Hello and welcome back to episode two of the Road to Rank podcast. My name is Dr. Steven Krueger and I’m here to give you advice for a successful residency match! Thanks for joining me again today! I’ve already had a few listeners reach out either with questions or feedback about the podcast, or even offering to be on the show to talk about some area of expertise they have, which I think is so cool. Please continue to do that! You can always email me at I want to focus today’s episode on the preclinical years, and how you can use them to differentiate yourself among the other residency applicants in your specialty. Before we get started though, I do have to give my usual disclaimer, which is that what’s contained in this podcast is only one person’s opinion. The truth is there are many roads to a successful match, and mine is not the only one! Ask as many other people as possible for career-related advice, and then go with whatever feels right for you. So let’s break this episode down into the two main components of your preclinical years: school and activities. It all comes down to school and activities. But this isn’t new for any of you. You had to have figured this out by now to get to where you are today! Let me put it bluntly - the better you perform in school, and the more effort you put into a few carefully selected activities, the more likely you are to be offered the residency interviews you want, and the more you’ll be able to chat about during those interviews. I’ll start with the school piece. Obviously medical school is a steep learning curve for everyone at the beginning, especially folks who have been out of school or chose a non-science college major. Take a breath and allow yourself a few weeks to get settled into the proverbial “firehose” of new information that’s coming. Find what works best for you, and be flexible with yourself. Change up your study plan every few weeks and see if one method is more efficient than another. The key is to stay on top of the material. I guarantee some of you got away with cramming one to two days before college exams, but that just won’t work anymore. It really is a marathon and not a sprint. I think it all boils down to repetition. It’s how we learn and remember absurd amounts of detail. They say if you don’t use it, you lose it, and I think that’s true. So what might that look like for you, the repetition? Maybe that means quickly skimming over all the new slides presented at the end of each day, and then an even higher level pass through all the material for each week and each block. You’ll start to see the same obscure facts over and over again and it will start to become second nature. I would recommend you attend or listen to as many lectures as possible. I know, sometimes it can feel like the stuff you’re learning isn’t all that relevant to the boards or the wards, and you may even feel like you could be more efficient learning the stuff on your own time. But I swear there were times during my Step 1 and Step 2 exam where a small detail I heard in lecture helped me answer a crazy random question. It also makes professors respect you more, and you never know where that will come in handy. At least keep an eye and an ear on what’s going on in your courses, because this really can help you stay flexible on exam day, and realistically it is what you’re paying tuition for… You should also pay close attention to your school’s curriculum. Some schools are what I would call a one-pass curriculum, while others are a two-pass curriculum, and I’ll explain what I mean by that. The curriculum at UMass Med school where I went was what I’d consider a two-pass curriculum, where the entire first year was devoted to the normal anatomy and physiology of each organ system, while the second year circled back on each of these systems with an emphasis on pathology and pathophysiology. By the way, I do think this makes a lot of sense because it represents that repetition I mentioned before. I mention this because there are going to be some subjects that are only taught during the first year, so it’s important to take good notes on those topics before you start studying for the Step 1 exam at the end of your second year. So with that curriculum structure in mind, let’s now talk about resources. My biggest warning is not to succumb to resource overload. What I mean by that is to pick a few good resources and stick to them. As a first year, my main resource was honestly just the lecture slides. The professors made the exams at that point in my medical school so it only made sense to study their material, and learning it well prepared me for the start of second year and Step 1 studying. Things changed a bit as a second year thinking about the Step 1 exam in the not-so-distant future. From the start of the year, I still glanced at lecture slides but spent much more time with my go-to resources that I’d recommend to all of you. These included First Aid, Pathoma, UWorld, and Sketchy Micro (it’s now called sketchy medical, but honestly the micro is the best part in my opinion). Honestly, I didn’t use much else. Any time I opened a new book because another classmate raved about it, I found it only made me more anxious and diluted my learning. So instead I learned these few major resources inside and out, and I answered thousands of practice questions. I actually started with the Kaplan Qbank during the year so that UWorld questions were fresh and I wouldn’t remember the answers during my eight weeks of dedicated study time. That system worked for me but it’s also fine to just do two passes through the UWorld Qbank during the year and during dedicated. I can’t stress the importance of practice questions enough, and we’re going to come back to this in a second. Now I want to give a few Step 1 tips, although I fully admit this could be an entire podcast on its own and it just might be down the road. My main thing here is don’t let this exam take over your life, especially as a first year med student. I admit that it is a very important piece of getting in the door of competitive specialties, but there’s a formula for success that should take a lot of the worrying out of the equation. If you just chip away little by little throughout second year, take good notes, and then work hard and smart during your six to eight weeks of dedicated study time, you will do well on this test. I promise you that. I think it’s also important to figure out where you’re going to study. Some people like the library, others like to be home, and some people actually want to be in a coffee shop or some other location. I myself was mostly a home studier, but I actually reserved my own library cubicle during my dedicated study time for the Step 1 exam because the change of scenery was important for my sanity! This next point is true for the entirety of the preclinical years, but especially during Step 1 studying: don’t let your peers stress you out. It’s just noise. Some people just like to stir the pot and it’s their way of dealing with their own stress. Stay in your own lane, keep your eyes on the prize, and do what you need to do to achieve success. It’s certainly okay to do group studying and bounce ideas off of other classmates. I think that’s great. But be careful not to start comparing yourself to other people in your class. That won’t be helpful and it may even hurt your progress. Let’s turn now to our very first listener question that I want to try to answer on the show. This question comes from Nick Leonard. He’s a current second year at UMass Medical School preparing to take the Step 1 exam. He asks: “How did you organize your time during dedicated Step 1 studying? I used Anki flashcards, Pathoma, and a Kaplan Qbank throughout the year. During dedicated, I want to get through UWorld, but I am not sure how much time I should put in to keeping up with the flashcards versus reviewing First Aid. I am also not sure of the best way to review the UWorld practice tests. I have been told that some people make new flashcards for things they get wrong in UWorld, would you recommend taking the time to do this?” Well thank you for the question, Nick! I am sure you’re not the only one with a lot of these same questions. It sounds like you’re on a great path where you’re at right now in second year. Let’s take your questions one by one. How did you organize your time during dedicated Step 1 studying? This is the crucial question to ask, and really what it all comes down to is calendar creation. You need to spend the time up front deciding exactly how you’re going to spend each day, each week, and each month that you have leading up to the Step 1 exam. You want both a long-term calendar schedule and a daily task list. So I would suggest just downloading a calendar template from Google, plot everything out, and then seek guidance from some trusted mentor you have. At my school, we had what was called the Center of Academic Achievement, and I met with somebody from that office a handful of times throughout second year to plot out my exact study plan. What I did, and this is what I would recommend you do as well, is essentially made a list of all the topics I needed to cover, and I basically designed my calendar as a two-pass system like I’ve already been mentioning for the repetition. I would spend that first pass very slowly and carefully going through each topic and I basically took those topics from the First Aid chapter titles (Cardiology, GI, Microbiology, etc). Then during the second pass, I would go through each of those topics a little bit more quickly, and of course I built in time for questions each day. I would recommend pretty quickly ramping up to about 80 UWorld questions per day, and then I set aside whole days for practice exams. I took about four practice exams during my study time. And then as I mentioned I also had a daily task list where I knew exactly what I had to do at certain times of the day - either morning, afternoon, etc - to get everything done that I needed to. This system worked for me. I think it’ll work for you, Nick and other listeners out there. I would also mention please build in some days or half-days where you have completely off to just relax, rest your mind a little bit, because it is a pretty grueling six or eight weeks. The next thing Nick mentions is that he’s been using Anki flashcards, Pathoma, and the Kaplan Qbank throughout the school year, which I think is great. He’s doing everything right so far. He says he wants to get through UWorld, which I think is a must. You absolutely have to get through the UWorld Qbank at least once before the test. He mentions wanting to keep up with the flashcards versus reviewing First Aid. To be honest I think it’s more important that he knows First Aid front to back rather than reviewing the flashcards he’s made during the year, but of course if he has time for both that’s great, too. He then asks about reviewing UWorld practice tests, and whether he should be making new flashcards for the answers he got wrong. What I would say for this is there are multiple ways to review your question sets and practice exams, but beware of taking too long to do this. I’m a little afraid that making flashcards in this way might be too time consuming, especially if you’re answering up to 80 questions per day and taking all kinds of practice tests. I would really just recommend reading through the entire explanation at the end of the question, maybe taking a few notes here and there and having a list, and really just going over the wrong answers you get. Don’t even bother going over the correct answers because you have so much material to cover during this time and really your priority should be new practice questions and finishing that Qbank. I do want to give a special shoutout to a company I’ve worked with for a few years called Med School Tutors, and they specialize in all three USMLE exams. If you are feeling like you need extra help from a tutor with calendar creation, study techniques, going through questions together, they are a great resource and I would highly recommend them! Alright, let’s now turn to the other key component of the preclinical years: activities. Just like in college, most med schools have some kind of activities fair, and you’ll find yourself signing up for way too many things. Be smart about what you commit yourself to... you aren’t doing yourself or your other group members any favors by overcommitting and not being able to contribute meaningfully to projects. Please take my advice and take the opportunity to get involved in something that genuinely interests you. Many of you have some inkling at this point as to what specialty you may end up in, so I would say it’s okay to dip your toes in an interest group, a research project, or even shadowing in that specialty, but I would also try finding activities that can be translated into many different specialties. For example, since I thought I might end up in a surgical specialty at one point, I spent my summer after first year dissecting cadavers and preparing anatomy prosections. I also got involved in a research project with an orthopedic spine surgeon on surgical smoke, which I thought could be translated into any surgical field. Remember, this is where you’re building up your activities list for the ERAS application when it’s time to prepare for residency. Let me just take a quick little detour here and explain the different sections of your ERAS application, because I think this is actually pretty helpful for preclinical students to know about. On the ERAS application, you are essentially putting in demographic information, your prior education, membership in different honorary or professional societies, other awards or accomplishments you’ve made, even hobbies and interests as well. But then the majority is going to be the activities section, which is broken down into volunteer experiences, work experiences, and research experiences. The work section is essentially only for paid work that you’ve done. The research section is broken down into publications, poster presentations, etc. The volunteer section is essentially where you’ll put everything else that you’ve done in medical school. Now as you’ve probably figured out by now, there are so many opportunities available to the preclinical student. There is shadowing, student interest groups, student-run electives you can take, community service, and even organized medicine. I think it’s most important to do whatever you are passionate about. It is nice to do some kind of mix of all of these types of activities. I’m always telling preclinical students they should be shadowing as much as possible with the free time they might have during the week. It’s so much easier now than it was a premed student to get the shadowing experience. Really all you have to do is just reach out to any attending who either gave you a lecture or is part of your school’s mentoring program, and boom you’re in. I think shadowing is a great thing, but it should be taken with a grain of salt. There are pros and cons. The pros are that shadowing will help you choose your third year electives more carefully, and they’ll also give you a sense of what’s out there beyond just the mainstream tracks in medicine. Shadowing will also help you start building your network, and I’ll do plenty more on this in episodes to come, and it will get your name out there as a potentially interested applicant in that specialty. The cons of shadowing: well to be honest it can get pretty boring and exhausting to just stand there and watch something for hours on end, and I would also be careful about wearing rose-colored glasses. Of course it’s great to be in the operating room seeing a big operation, but you aren’t necessarily seeing the 5am rounds or the call weekends, which you will get a better taste of during third year clerkships. I would also say every medical student should be somehow involved in community service, not just to pad the resume, but because you're privileged and you owe it to your community. So find a cause you appreciate and jump on in! Regarding clubs and organizations, again please do something you’re passionate about or maybe have never tried before. I want you to try to fast forward a few years to an interviewer asking what makes you special. For me I had branded myself as a future mentor and clinical educator, and I had experience on my school’s student government and curriculum committees to show for it. Your elevator pitch is a lot more believable when you have the experience to back it up. I want you to think to yourself starting now, what special passion or experience do I want to bring to a residency program? If you can start to hone in on this now, it will pay off big time during interviews. Finally, I just want to say a word about organized medicine. I think this is a great opportunity for med students to get involved in medicine at large. There are a number of ways you can do this. There is of course the American Medical Association. In my state there’s the Massachusetts Medical Society. Of course there’s a similar society in every other state. I was actually on a Men’s Health Committee as part of the Mass Med Society, and that was not only a great experience for me as a medical student, but it was also something that I talked a lot about during interviews. So I highly recommend you find a way to get involved in organized medicine, either at the state or the national level. Of course, the last major activity is research. I do want to spend an entire episode discussing research with a guest so that we can get multiple perspectives on this, so I’m going to hold off on discussing that for now.
Phew! So that about wraps up everything I can think of regarding the preclinical years. If you have any questions, or want to send me feedback (or hate mail!), you can do so by emailing, and I look forward to seeing you back for the next episode!