Clerkship Year 4

Step II Clinical Knowledge

Step II Clinical Skills

The Step II Clinical Skills exam is a way for the USMLE people to
evaluate your ability to interact with patients. And as long as you
master the 3 'C's that make up the word 'interaction' you will do
swell. They include communication, compassion, and least important,
competence. Bottomline, the CS exam is not STEP 1. What they are really
looking for is your basic ability to talk with patients, perform a
focused 'H & P', and communicate your expectations to the patient.

That said, the exam consists of 12 patient encounters, each patient
presenting with a unique (yet simple) set of complaints, that the
examinee must "workup." Again the exam is not meant to test your fund
of medical knowledge, but more importantly to understand your thought
process and organizational skills. It is very similar to our beloved
CPM clinical skills exams. Although we complain about it, CPM has
actually prepared us exceptionally well for this exam.

The hardest part of the exam is simply the length. The total length
of the exam probably spans about 7 hours, with two breaks. After you've
finished the first four, you're ready to be done, so you can only
imagine what you will feel like after standardized patient #10. But, as
long as you can keep a smile on your face you will do just fine!

So don't sweat it! At least it's not Step I !!


ERAS, also known as Electronic Residency Application Service, is your portal to the residency of your dreams. It’s the application for nearly every specialty you could possibly apply to. It’s intimidating initially but like stealing candy from a little kid, it gets easier with time.

The service opens up near the end of third year when every student gets their token into ERAS. Think of it like the golden tickets to get into Willy Wonka’s factory… except everyone gets one… and instead of serving up sweet, sweet candy, you’ll get the opportunity to fill out yet another application! Then, every year, on September 1st, the “post offices” for every residency program opens up and you can submit your applications and programs can download your life file.

The application comprises of various parts: profile, picture, activities, personal statement, recommendations, and other information about your past and present. It’s helpful to start early, even if you’re not sure of what you want to apply to yet. As soon as you get your token, start filling out the things that will never change: who you are, what you did, etc. It’s a chore you’re going have to do anyway, so bite the bullet and just get it out of the way. Your picture will be automatically handled after you get your composite/yearbook photo taken.

As soon as you know what you want to do in your life, start writing your personal statement. It’s all pretty much the same format. Say who you are, why you want to do what you want to do, why you would be good at it, and where you see yourself in that field. Format aside, it’s pretty difficult to write your personal statement. So, again, start early! And once you get done, make sure you get other people to read it: significant others, family members, physicians in the field you want to go into, random homeless people. The more input you get, the better. You don’t want to screw up your chance for your residency because of your Greco-Roman wrestling match with grammar and thought organization.

Once you’re finished with everything, go over every part carefully and submit it. It’s always better to submit your application earlier than later. Most residencies treat these on a first-come, first-serve process. And even the most qualified applicants won’t get a chance to interview if all the interview spots are already taken.

So, in conclusion, the earlier the better and get as much help as you need and make ERAS your b*tch.

Obtaining Recommendations



An email written to the Class of 2009 from Dr. Nancy Nielsen

This is not intended to freak you out about matching, as the vast majority of you will get a
nice "You matched" email on 3/16. But a few of you have asked how it works if you don't. Here's the way it goes.

Noon on Monday: email notification that you didn't match. Or that you matched to a prelim year (if you listed some on your primary list but not to any of the advanced programs you applied to), or that you matched to an advanced program but not to a prelim program. In the latter two cases, I will be told where you matched for the one program, so you have some geographic guidance in scrambling for what you need (either the prelim or the advanced position you're lacking). Note that I will know that day how many openings there are in each field and the broad geographic location - no specifics till 11:30 a.m. on Tuesday. For example, 3 openings in psych in the Northeast.

Monday afternoon: I meet with each unmatched student, separately. We go over the possible scenarios for the scramble, and the student then gathers any new documents needed. For example, suppose you didn't match in Surgery and you decide to scramble for a position in Family Med, you'll need to madly get someone in Fam Med to write you at least one LOR, right? You'll also need to write a personal statement directed toward a career in Fam Med rather than Surgery. So there's work you will need to do after we meet. And the preparation of the documents is critical.

Tuesday morning: you come with a team of people (two more is good, three is also OK, more than that is just confusing) to help you. EVERYONE should bring a cell phone! We go through the drill as a group (no shame, no worries about privacy, this is Team UB!), as there are very important directions and advice you will each need to negotiate this successfully. We will give you copies of your documents, as faxes will be at a premium and your "team" will be helping you on the phone.

Tuesday: 11:30 a.m. I find out the exact openings. We duplicate it and give the right section to each team (so if you're looking for a Fam Med position, I give your team that section of the openings, for example). Your team disperses to search FREIDA for the descriptions of the programs that have openings.

Tuesday: Noon: you begin calling programs and sending your documents electronically or by fax. Then we all help you make decisions as programs do phone interviews and hopefully) offer you a contract. We have a location chart in OME, so that when the offer comes in, we can find you! That includes bathroom breaks - you let us know. We will feed you lunch.

Wed: If everyone isn't matched Tuesday afternoon, the same thing goes on Wed. It will all work out.

Thurs: Noon: Match ceremony!

Important: If you find out that you matched on Monday, please be prepared to help out a classmate who didn't. That's what friends do. It really is important. You will be surprised at the comeraderie that develops.


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