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Transitions can be scary before they happen but look a lot less frightening once you’re on the other side. To help ease these transitions, we’ve reached out to our colleagues who just experienced some of the stressful transitions of being a medical student. Here is their advice for those moving through the process.
When did you take COMLEX Level 1 and how did you prepare?
I took COMLEX Level 1 at the end of May (second year) in 2023. My medical school ends the semester at the end of April, so I gave myself four to five weeks of dedicated study time. I used the UWorld Qbank (six-month subscription), TrueLearn, AMBOSS, Sketchy, Pathoma and Savarese to study for boards. For my own personal boards preparation, my goal was to build mental endurance in terms of gradually increasing question amount and total blocks completed. I also wanted to increase my physical endurance to be able to mentally focus at my best for an eight-hour exam.
Overall, my rough study schedule started during my OMS II second semester in January, when I began to transition my study focus from class-focused to a more boards-focused mentality. During this time, I focused on modifying my schedule to incorporate boards material into school-related material more than I had in previous months. I tried to do 10-15 questions that paralleled with whatever I was learning in medical school, and as I progressed to May, I found that I built mental stamina and endurance, which allowed me to complete more questions effectively.
I began to focus on maintaining a consistent schedule which included daily questions, supplemental material, daily movement/exercise, healthy meals and at least seven to eight hours of sleep per night. As the semester progressed, I began to increase my question load every day and transitioned to “timed” mode rather than “tutor” mode to practice simulating exam-like conditions. In March my goal was to consistently complete 20-30 questions each day, and by April my goal was to do 40-60 questions each day.
During dedicated (end of April to the end of May) my goal was to complete 60-100 questions a day. It was also equally as important to review every single question (correct and incorrect), and to figure out why I answered the way I did—particularly noting if a question was missed due to weak content knowledge (this allowed me to review said content), versus did I miss the question because I read the stem or answer choices wrong (this allowed me to perfect my test-taking mode to carefully read important aspects of the question/answer choices), versus if I guessed (which would prompt further investigation as to why).
I also found it helpful to use a notebook to write down key missed concepts, mnemonics or topics that I constantly reviewed up until test day. I was able to complete all Sketchy Micro videos, the entire Pathoma book and associated videos and the Savarese book prior to dedicated, which helped greatly with the microbiology, pathology and OMM portions of the COMLEX exam.
As much as test-taking strategy and studying played into my boards preparation, I also took the time to incorporate self-care and mindfulness into my journey. I used Headspace for daily meditation and mindfulness exercises and worked in daily walks or gym sessions where I used the time for me and did not study or think about boards—mostly I watched reality TV or listened to music, which helped me recharge for the next study session.
My friends and I also embraced a weekly “Wellness Wednesday” during our four to five weeks of dedicated, where we would all silently and separately study at a chosen location and then go to a group workout class at a local Barre fitness studio. This helped us all to connect during a stressful time and gave us something to look forward to—knowing we were in this together kept us all grounded.
How did you schedule your rotations?
When I scheduled my rotations, I did not know what specific specialty I would eventually choose, but I knew it would be in a primary care field—either pediatrics, family medicine or internal medicine. My goal was to schedule these three rotations during the first half of the year to help me decide what I liked best and to gain experience earlier rather than later in these fields to strengthen any interest in pursuing them. I had previous experience observing surgical specialties and knew based on my interests that I preferred the primary care end of medicine rather than surgery, so I coordinated my schedule with the primary care specialties in the first half of the year and the surgical specialties in the second half of the year.
What should students expect during clinical rotations?
The first and second year of medical school are the didactic years—very classroom-based, where you are studying from lectures and PowerPoints with an emphasis on more frequent test-taking with lower-stakes exams. The frequent tests allow students to become acclimated to longer and more endurance-based exams, eventually preparing you for the boards. During the third year of medical school, you are out of the classroom and working in different hospitals, clinics and outpatient settings to gain experience in the core specialties to help you decide where your interests align and what specialty you will ultimately end up pursuing for your future career. During the clinical third and fourth year of medical school, you are able to apply what you have learned in the classroom to real patient scenarios and begin learning the clinical side of medicine.
What resources did you use to prepare for rotations?
I used a variety of resources, and they varied depending on the rotation:
How did you study for the COMATs?
For my own personal study strategy for the COMATs, I used Microsoft Excel to create a calendar of the rotation and took the number of TrueLearn and UWorld Qbank Questions for that specific rotation (i.e., psychiatry block) and built a study plan with the number of questions I needed to complete for the rotation over a six-week period. I also took the number of questions that I consistently wanted to complete each day to meet this goal and integrated that into my plan—leaving wiggle room and flexibility to adjust. There are some days that are more difficult than others, so it was helpful to have a consistent goal of questions per day without being too regimented so that I could adjust as needed to be prepared for test day.
After completing an allotted number of questions, I would review questions (similar to how I reviewed questions for boards) to learn why I got a question wrong—was it content weakness? Misreading questions stem or an answer choice? Missing key information in the question stem? Or was it a straight guess? Once I figured out why I got a question wrong, I could guide my studying accordingly. When reviewing questions, if I did not know a concept, I would use resources like AMBOSS or Sketchy to solidify/review the content. I also utilized free time that I had during longer commutes to my rotations where I listed to the Divine Intervention Podcast for the specific rotation I was on, which helped to reinforce my learning.
When did you take COMLEX Level 2 and how did you prepare?
I took COMLEX Level 2 at the end of July at the beginning of fourth year. Some students will elect to take it earlier, while some students will elect to take it later in the fall. My best advice would be to take it when you are ready, but most preferably before you begin your sub-internship rotations as you will want to be on your A-game for these. Regarding how I prepared, I mainly used UWorld for COMLEX Level 2, and repeated Sketchy Micro and Pharm, which I thought was a nice review from the last time I studied those sections (which was when I was studying for COMLEX Level 1). For those of you wondering, I did not rewatch all the Sketchy videos, but simply reviewed the associated card with each video on my Sketchy account. You must remember that if you are studying for your COMATs throughout each rotation during third year you are also studying for COMLEX Level 2 at the same time. I used subject-specific sections in UWorld to study for COMATs during third year, and when January of third year came around, I started doing UWorld on random and timed mode, with a goal to make it through the bank with one thorough pass. Some people say they completed UWorld multiple times, but I knew getting through the question bank once thoroughly with an intensive review of the questions is what was going to work best for me, especially because questions are added to the bank almost daily.
Lastly, I started to incorporate a review of the Savarese green OMM book (which I previously read during my COMLEX Level 1 dedicated period), which helped me review a lot of the OMM material that tends to show up on COMLEX.
How did you prepare for your auditions/sub-internship rotations?
Because I knew I was going to apply to emergency medicine (EM) residencies, I focused my attention to preparing mainly with the EM Clerkship podcast. This podcast was extremely helpful, and there are dedicated lessons that discuss how to perform extremely well on your emergency medicine audition rotation, and how to get an outstanding SLOE (Standard Letter of Evaluation). I cannot recommend this podcast enough. I also studied a lot of the chief complaints that were listed on the SAEM (Society for Academic Emergency Medicine) website, which were all within the “M4 Curriculum” tab.
If I were to generalize my advice though, I would say that no matter what specialty you are applying to, you should expect to arrive early and expect to not leave until you are told. The audition rotation is basically a month-long interview, and you are being watched at all times. I say this not to instill fear, but simply to emphasize the importance of performing well on audition rotations, as well as the importance of always being engaged while you are there. A lot of specialties rank an applicant’s performance on an audition rotation as the number one factor that they consider when reviewing which applicants to offer residency interviews, so keep this in mind.
Another piece of advice, which is an important first step, is of course obtaining audition rotations. I recommend researching the residency programs where you have a strong interest in matching for residency and finding out which platform they use to receive audition applications. A lot of programs use the VSLO (Visiting Student Learning Opportunities) platform, but many programs also have links on their department websites that students can utilize to schedule an audition rotation. If you can’t find out how to apply, it does not hurt at all to email the residency program coordinator and inquire about an audition rotation. The coordinator’s information is usually present on a program’s website.
How should students schedule their rotations during fourth year?
Every school is different, but my school allows students to schedule fourth year rotations on their own with the support of our clinical administrative team. Looking to schedule rotations as early as December of third year does not hurt. A lot of programs focus on matching their class for next year during this time so will not review applications this early, but I want to emphasize that it does not hurt to inquire about scheduling audition rotations or even general fourth-year rotations early.
Also, make sure that you are in compliance with your vaccines, health forms, etc., with your designated medical school, as this could create barriers down the line with obtaining a rotation if these things are left until the last minute. I scheduled my fourth-year rotations (starting in July) with two audition rotations in a row, followed by rotations that my medical school requires all fourth-year students to complete.
For fourth-year electives, I recommend scheduling rotations in subspecialties outside of your specific specialty to help you be more prepared for when you start residency. For example, because I am applying to emergency medicine residencies, I scheduled rotations in ultrasound and ophthalmology because I knew these skills would be crucial to have as an emergency medicine physician.
What advice would you give to a fourth-year medical student who is about to create their rank?
Dr. Barnes-Waiz: Before you begin forming your rank list, first figure out what your priorities are—research, big city, being close to family, free food, etc. I would suggest looking back at notes you have on each program and even discussing with your family and friends what they remember about your initial reaction to the program after your interview. Can you see yourself in that city? Can you see yourself connecting with the people in that program? You will likely run into the challenge of having to rank multiple programs that you felt all deserve the same spot. How will you decide which program will be ranked higher or lower than the others? While challenging, it’s not impossible. Consider again your priorities—which program do you feel will provide you with the training you’re looking for?
Also consider what you’re looking for in a program—unique opportunities, good benefits, respect for mental wellness, etc. Which program best aligns with what you’re looking for? You may have some programs that have most but not all of the things you want or need.
Remember, you don’t have to rank all the programs you interviewed with. There may have been a program you were interested in when you initially applied, but then after the interview you didn’t feel a connection. Ask yourself if you would rather not rank that program and potentially go unmatched.
Many people get caught up in wanting to rank “brand-name” programs high on their list purely because of the name. If you feel this way, truly reflect on how you felt during and after the interview. Were you impressed? Were you bothered by anything? Base your decision on your needs and not what you think others will think of you. Also, don’t rank based on how you think the program will rank you—the rank process is in the applicant’s favor
Lastly, don’t feel pressured to figure out the rank list in one sitting. You may need time away to think and process. Something I was told many times was don’t change your rank list at the last minute unless you really feel you made a BIG mistake.
Dr. Boehler: When making your rank list, I recommend making a card for each program at which you interviewed and then start lining them up. I personally wrote pros/cons/random facts on the back of each one. As you look over them, think back to when you interviewed with each program. How did you feel? Most importantly, in my opinion, how did you feel amongst the residents? It’s okay to take a little time with this. I moved some of my cards around until the day my list was due, but because I took the time to do this, I was 100% satisfied when I pressed submit. One of the best pieces of advice I received regarding making my list was, “If you don’t want to go somewhere, don’t rank them.”
What factors were important to you in creating your rank list?
Dr. Barnes-Waiz: As I previously mentioned, your priorities should lead your ranking strategy. For me, location, my wife’s input, involvement in DEI and unique clinical opportunities were my priorities. I had difficulty ranking my top four because I could see myself at all of them; however, I went back to my priorities and what I wanted in a program. Remember, you will be at this program for three-plus years and even potentially stay for fellowship or your first job as an attending.
Dr. Boehler: The most important factor to me was going to a program that felt like home, as well as a place where I felt I would get the most experience. There were very few programs to which I applied that did not provide adequate education in all fields (I was Primary Care if you haven’t figured that out), but some programs provided more opportunities than others and therefore got bumped higher on my list. The most important thing to me was the community at a program, not just among residents but also among faculty. You’re going to spend a lot of time with these people, so how you interact with them matters much more than the food in the doctors’ lounge.
Looking back on your journey, what is something you wish you knew before the Match process?
Dr. Barnes-Waiz: Throughout my fourth year of medical school, I was told numerous times to “trust the process” and “go with your gut.” Honestly, I didn’t believe these things until after I had gone through Match, but it was good advice which I now extend to you. As much anxiety and uncertainty as the process generates, just know that whatever decision you make will be the best one for you.
Some people may feel if they don’t get their number one choice “it’s the end of the world” and somehow they have failed themselves. In reality you have not failed, you have succeeded in becoming a doctor. Understand that regardless of where you match, you will manage to make things work indeed your rank list reflects your certainty and willingness to be a resident in that program.
Dr. Boehler: I wish I knew just how quickly everything happens. We all seem to have this idea that after Match Day everything calms down and the stress is over, and you have a second to breathe. Do not get me wrong, the bad stress and anxiety that kept me in bed the entire week leading up to Match—that was gone. However, I received a phone call from my program within two hours of Match to welcome me and give me info on next steps. The next week I was looking for housing. A month later I moved. Then I graduated. By June 15, I was an employed physician! On July 1st I was treating patients, and it still hasn’t slowed down, in the best way!
Something else that I wish someone would have told me (not that I’d have listened) is that no matter where you end up, there is a reason for you to be there.
What advice do you have for new interns about to start residency?
Dr. Barnes-Waiz: My first piece of advice for beginning the transition to residency is take the time between now and June to relax! Reflect on how much work you’ve put into not only the process of Matching, but the whole journey to become a doctor. It’s been a long road, but you’ve made it, and you deserve to enjoy any free time you have. Sure, you will need to start looking for housing in your new city, but other than that you should focus on celebrating yourself and your accomplishments.
Many people feel pressured to study because they want to be “prepared” prior to July 1. Remember that the purpose of residency is to learn on the job. I was nervous for my first day, expecting that I would be the sole person in charge of all these patients and would have no idea what I was doing. While some of that is true (I had no idea what I was doing on day one), the expectation of being the only physician for a bunch of patients was not true. Instead, I had supportive upper-level residents and attendings who understood the reality of a first-day intern (and an intern in general). Nobody is expecting you to have the knowledge of an attending. Again, residency, especially intern year, is the time to learn and build your clinical skills. This is the time to ask questions, make mistakes and build your confidence. It’s easy to get overwhelmed with everything you have to get done day-to-day while working but try to set goals for yourself each month (or each rotation). Just as swiftly as you navigated through medical school, residency will be the same; however, in the end you will be the attending working independently and making the decisions.
Make sure you have a good support system at home and start to create one during orientation. Like medical school, you will have ups and downs, and will need people who will listen to you vent and encourage you to see another day at the hospital. Seek help and guidance from your upper-levels and don’t forget about your nurses and techs that can help you too!
Transitioning from medical school to residency is also a financial adjustment. Prior to your first paycheck (you may not get this until mid-July or the beginning of August), you will have some big expenses—moving, deposit on housing, first month’s rent, graduation, travel, fingerprinting—so hopefully you have saved some of your money for these things. You’re now going to make real money (yay!) and you will need to create a budget. Now that you will be out of school, you will have to start paying your loans back. There are companies like Student Loan Professor (previously known as Doctors Without Quarters) and GradFin who help students with PSLF and repayment options.
One very important component to this transition is self-care. I recommend establishing care with a primary care provider (and other specialties that you may need), so that when you’re busy and something happens you aren’t scrambling to find a doctor to address your needs. Don’t forget about your hobbies either (or new ones you want to pick up). Try to find things in your new community that fit your needs (trivia, pick-up games, coffee bars, dog parks, etc.).
Dr. Boehler: You’ve definitely heard that residency is hard, but in my experience, it is hard for so many reasons that you would not expect and cannot predict. My best advice is to go with the flow!
What is something about intern year you wish you knew before you started?
Dr. Barnes-Waiz: Similar to what I mentioned before, I thought I would need to know so much before July 1st. What I realized was, being an intern isn’t all about knowing treatments and differential diagnoses, it’s also about learning and understanding your hospital system—how to navigate the hospital, knowing the supports for patients in the community, understanding some pieces of insurance, learning the electronic medical record (EMR) and more. The scope of intern year is similar in some ways to medical school. You must apply information you’ve learned in addition to starting your role as a physician. Best of luck to you in the Match and beyond, and don’t forget to enjoy your moment!
Dr. Boehler: I wish I’d known how much my patients would affect me and how much I would care about them. Of course, we all care about our patients; that’s why we’re in this business. But I didn’t know that I would fall asleep thinking about a case from the day, making a mental list of what more I could do to help a patient that I just didn’t get to complete at that visit. I didn’t know that I would watch our inpatient service list to see if any of my clinic patients had been admitted. I wish I’d known how exciting it would be to get to deliver a baby for the patient I met in my first week of residency.