Phase 3: Advanced Clerkships
Advanced Electives
Most students choose to schedule one or two ophthalmology electives early in Phase 3 as this allows them to obtain a letter of recommendation from a faculty member before submitting applications. At CCOM, 4-week clinical ophthalmology rotations include External Eye Disease (Cornea), Plastic & Reconstructive Surgery (with faculty permission), Neuro-ophthalmology, and the VA. Other advanced electives include Research in Ophthalmology, Molecular Ophthalmology, and Ocular Pathology. You may also arrange personalized rotations in nearly any department if you contact the medical education coordinator, Dr. Pavlina Kemp, with adequate advanced notice and a plan. There is no significant benefit to doing more than one or two clinical rotations—you will have all of residency to explore the field!
Away Rotations
You may elect to arrange for an away rotation at another institution. Many students choose to do this, although it is by no means mandatory. Away electives may help you get a foot in the door and can increase your likelihood of matching at the institution where you are rotating. Bear in mind, the opposite can also be true. If you do not make a good impression during the away clerkship, you may actually hurt your chances of being offered an interview.
It is also worth mentioning that most other schools do not run on the same schedule as Iowa, so if you are an Iowa student rotating elsewhere, you will likely have to use a week of vacation time both before and after the rotation. If you are not planning on using the elective for a letter of recommendation, you can save 1 week of vacation by scheduling your away as your final elective before your time off for interview season.
If your institution is home to an outstanding ophthalmology program, away rotations are even less imperative. While no program director will question your choice if you snag an away at another highly ranked program, they may overlook your application if you rotate at a significantly lower-ranked program as an indication that you intend to go to that institution.
Time Off
If you are an Iowa student, you will want to schedule time off during interview season. CCOM offers a total of 16 flex weeks (vacation) to be used throughout Phases 2 and 3. The majority of these weeks are used for interview season, Spring M4, and dedicated study time for board exams (excluding the 4 weeks of Step 1 dedicated time built into the curriculum). If you absolutely do not wish to use your flex weeks for interviews, you may be able to arrange for a more flexible rotation during this time, such as an individually arranged research elective, although 40 hours/week of research time are still expected even when interviewing.
USMLE Step 2 Board Exam
Students must take Step 2 Clinical Knowledge (CK) during their Advanced Year. Scheduling this exam is currently done on an individual basis.
For those with a scored Step 1: If you did well on Step 1, we would advise you to delay taking Step 2 CK until later in the year (i.e. October to December) to avoid jeopardizing your application. Another good score will likely not help your application much, while a poor score could lead to disaster. If taken in December, you will not receive your score until after the Match. On the other hand, if you were unhappy with your Step 1 score, an outstanding Step 2 CK score can give your application a needed boost. In this scenario, it is in your favor to schedule the exam early. There is a "sweet spot" in late fall where your score comes back too late to be sent out with your application, yet you have it before interviewing. You then have the choice of revealing your score to programs if you did well or concealing it if you did not do as well as you had hoped. However, keep in mind that interviewers may ask you for your score. Most people study at least 2 weeks for the CK exam.
For those with pass/fail Step 1: We recommend taking Step 2 CK within 3 months of taking Step 1. There is significant overlap in the exam content and internal CCOM data show that students score significantly higher on Step 2 if taken within this time frame. A three-digit Step 2 CK score provides an objective measure to program directors of your medical knowledge.
Curriculum Vitae
Begin preparing your CV in late spring or early summer, prior to requesting your letters of recommendation. In contrast to a resume, a CV is more focused on your professional and academic activities. Only include things that are relevant to your residency application unless they are very distinctive activities or achievements that will set you apart from the crowd. This CV does not need to be limited to activities only in medical school; give your letter writers a more holistic picture of your professional journey. You will not actually send this CV with your application, but it is useful to organize your achievements and you can usually copy the information directly over to your residency application later in the summer. Additionally, it is useful if you provide your letter writers with a CV so they may learn more about you before writing your letter of recommendation. CCOM has an excellent website containing several example CV's.
Letters of Recommendation
During your advanced clerkships, think about who you may want to ask for letters of recommendation. It is helpful to have letters from well‐known faculty in the ophthalmology department, but only if they know you well. Try to obtain your letters from individuals you have worked with for at least a month, so the letter is meaningful and personalized, and supply them with your CV and transcript so they have even more information on which to base the letter. You will need 3 letters for your ophthalmology application. The SF Match system will allow you to upload more than 3 letters and tailor which letters are sent to which institution, should you desire to customize a given application. One letter must be from an ophthalmologist, but many students obtain two from ophthalmology faculty and one from a faculty member in another department to diversify your application. Another framework to use is to have 1 letter each describing your strengths in (1) clinical skills (e.g. from a Medicine Sub-Internship), (2) interest in ophthalmology (e.g. from an advanced ophthalmology elective), and (3) research (whether in ophthalmology or not).
Do your writers a favor and ask them for the letters at least a month or two before you need them (July/August for a September application due date) so they are not forced to write them on short notice. If possible, alert your attending at the beginning of a month-long rotation that you are interested in having them write a letter for you so that they can pay special interest throughout the month. If you are planning on asking someone with whom you worked early in your third year, such as a later core clerkship, it may be wise to let them know after you finish working with them so they may make some memorable notes to keep you fresh in his or her mind come letter‐writing time.
Alpha Omega Alpha (AOA)
AOA Honor Society status is awarded in two waves – one in Spring of your third year and one in late Summer of your fourth year. Unless you were selected during your third year, you will not know if you obtained AOA status prior to submitting your application if you are sticking to the recommended timeline. On the Central Application Service (CAS) form, there is an AOA status radio button to select "yes" or "no" – do not click either if you were not elected in your third year as it is still uncertain whether you will be elected during your fourth. On your main online profile (not within the CAS application), there is a section for your board scores and AOA status. Here they include an "unknown" button which you may select. You may not revise your CAS application after submitting it, but you can change this main profile page to reflect AOA status updates. The timing of the AOA selection during your fourth year works in your favor if you do not think you will make AOA as this will not be shown on your application ("unknown" looks much better than "no"). AOA status is not essential and most matched applicants are not AOA members, but it does significantly increase the odds of matching (Figure 1) [5].
Figure 1. Ophthalmology match results by AOA Honor Society membership (2011). [5]
EyeRounds
The University of Iowa Department of Ophthalmology maintains an excellent website called EyeRounds. The site contains a collection of interesting photos, videos, and cases provided by residents, fellows, faculty, and students from the University of Iowa. The site generates huge amounts of web traffic and the articles quickly shoot to the top of the Google search results. This is a peer‐reviewed website, and you can later list all of your articles as publications on your application. You may write as many articles as you wish, and this is a great opportunity to meet faculty members in the department. We would recommend writing at least one article during medical school. EyeRounds is an exclusive opportunity for students at CCOM, as you must attend the University of Iowa to submit materials for the site. Residents often have potential cases in mind; contact one of the residents that you meet during your rotations if you are interested.
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