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JAOA article regarding osteopathic students taking the USMLE

Discussion in 'Osteopathic' started by drpierre, 02.13.12.

  1. drpierre

    drpierre

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    SDN Members don't see this ad. (About Ads)
    Hey everybody,

    this is an article recently published in the Journal of American Osteopathic Association

    Summary Article JAOA Article regarding osteopaths taking the USMLE

    FULL Article JAOA Article regarding osteopaths taking the USMLE
  2. Dissected

    Dissected When in doubt, cut it out

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    Not surprising. All 1st/2nd years should read this.
  3. TeamZissou

    TeamZissou PGY1

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    Haha so much for the notion of not taking it. It's gonna be hard for school admins to argue with this one...

    You'd think that since so many DOs take the USMLE we might see more schools teach toward it instead of the position of COMLEX is always good enough.
  4. Charlie Hustle

    Charlie Hustle Scut Monkey

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    I've never understood why most schools seem to take this position. Is it pressure from the AOA? The idea of wanting to remain "autonomous"?
  5. MedPsy82

    MedPsy82 Just a Thought

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    Probably yes and yes
  6. Dissected

    Dissected When in doubt, cut it out

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    This should be a sticky! Very pertinent to students on the fence about whether to take both exams.
  7. TeamZissou

    TeamZissou PGY1

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    I think schools in the past have shied away from it because historically DO's don't do as well on step 1. I know CCOM's passing rate for Step 1 was atrocious 2 years ago at ~72% which makes no sense in that AZCOM's was in the 90's.

    I think following this kind of data schools need to stop avoiding the facts and HELP their students succeed on both exams. If taking the USMLE opens opportunities to students shouldn't the schools support that? If DO's could post similar scores on the USMLE to MD students wouldn't that help validate the profession?

    Furthermore most students feel that if you are going to put serious effort towards boards then you should take the USMLE simply because it is a better written test and you are more likely to get an accurate assessment of what you know as opposed to the COMLEX which is seemingly variable in what it takes and who gets the top scores.
  8. group_theory

    group_theory EX-TER-MIN-ATE!' Administrator SDN Senior Moderator

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    I would be interested in reading the Letters to the Editors in response to this article - my guess is the old guards will query why students are even taking the USMLE (and will obstinately hold their position that DO students should only take COMLEX because they don't need the USMLE)

    If it weren't for SDN, I wonder how many more students won't take the USMLE due to advice from their school (and AOA).

    I was a medical student when the AOA pushed for DO students to start using the designation "OMS" instead of "MS". I thought it was stupid (along with the AOA campaign to get a DO to be on TV). While their efforts were focused on getting students to use the OMS designation (and trying to get a character on a TV series to be a DO instead of MD), they missed Newsweek Cover (with a nation wide audience) showing Dr Jadick (who is a DO) as an MD. The AOA had to settle for a "correction" from Newsweek (but the opportunity was already lost)

    [​IMG]
  9. fiznat

    fiznat Senior Member

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    :thumbup::thumbup:

    It isn't just the USMLE/COMLEX issue. The most comprehensive, honest, and reliable advice I have received about my medical school path has come from SDN. It seems everyone else I've talked to has some sort of agenda: be it the school, other students, physicians, etc. It's true you sometimes have to separate the wheat from the chaff here a little bit, but thanks to SDN I know a LOT more about this whole process than many of my non-SDN using classmates.
  10. TeamZissou

    TeamZissou PGY1

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    Ditto:thumbup:
  11. DocEspana

    DocEspana I shall cast a spell on your roster

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    <~~~~ Chaff
  12. nlax30

    nlax30 Now with pumped up kicks

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    At least at my school we were given a USMLE First Aid review book and online question bank access to both COMLEX and USMLE when it came time for board review. They also brought in a big name Kaplan USMLE lecturer so all in all I don't think they were "COMLEX focused".

    But really, besides the way questions are worded they test the same material and I really don't think there's much in the way of preparing differently for one versus the other besides OMM of course.
  13. Xamwell

    Xamwell Englishologist

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    It's not so much as studying for a different exam. Yes, much of the material is overlapped. The problem at some schools is that the emphasis in certain courses may not yield good results on the USMLE. Our school does some things really well, but I didn't feel the path courses were emphasized to the degree that others were (i.e. pharmacology or microbiology). Therefore, in addition to the general path coursework, for preparation to take the USMLE I had to add in more material than was expected to be tested in class. It wasn't a Herculean effort but there was extra work involved. This likely differs from school to school.
  14. danzman

    danzman The Ace of Spades

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    I know the lead author pretty well, and he is a pretty amazing guy. Every year he gives a lunch lecture on setting up 3rd and 4th yr stuff to the 2nd years. One thing he talks about is who should take the USMLE. Even though the results of his study show that most students think everyone should take it, he certainly does not. He makes a valid argument that only a small portion of the class really needs to take it. If memory stands correct his take goes like this...

    The majority of students at a DO school will eventually go into a field that doesn't really require it. Most students will go into IM or FM, and most IM/FM programs will accept the COMLEX. That said, if you want to go to a top tier university program you will need to not only have taken the USMLE, but also be an excellent student. If you are interested in a super competitive field like Derm, ortho, NS, then your best bet by far is to set up a 4th yr that allows you to spend most of your time at DO programs, and apply to the DO programs (because if you spend your time rotating at MD programs, you will in fact have less time to rotate at DO programs). Unless, or course, you are an excellent student and think you can make a 260, then take both and see where you land. The gray area is in fields like EM and Gas where some programs will take both, but top programs will not. He makes a valid point that if you are interested in EM, take the USMLE and do poorly on it, you have shot any chance in the MD world. However, if you are interested in EM, take only the COMLEX and do well on it, you still have a door wide open to many MD programs that will take both.

    Also, if you are in the military there is no reason for you to take both.

    Essentially, he claims that only the top 20% of the class, that are also only interested in middle of the road specialties (ie IM) should actually take the USMLE. The poorer students are less likely to do well enough on it to make an impact, the average students have a large chance that it wont matter or that they can hurt themselves, and the people who want derm/ortho are much better off putting all their eggs in the DO match.


    I was an average student interested in EM and after taking both tests and doing very good on the COMLEX and very average on the USMLE I really don't think it helped me at all.
  15. fiznat

    fiznat Senior Member

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    The part of the argument that I don't understand is the assumption that a given student can choose to do well on the COMLEX, but still do poorly on the USMLE. I am under the impression that the exams aren't that different. Students who do well on one will probably do well on the other. mirite?

    The other part of it is that students preferentially applying to allopathic programs are going to have to forego the osteopathic match. It isn't like you can hedge your bets with osteopathic programs, because if you get one you are locked in. That said, any student who has a preference for allopathic programs would be silly to skip the USMLE. If you're going allo, go the whole way and make sure you can rank as many programs as possible.
  16. danzman

    danzman The Ace of Spades

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    You are correct, the tests are the same and studying for one automatically means you are studying for the other. Someone who does well on the COMLEX is more likely to do well on the USMLE.

    My take on this has less to do with how good you are at taking tests, but rather figuring out what field you want to go into. I really believe that an average student can do a ton of damage to their future if they get a 500 on the COMLEX and a 195 on the USMLE. I think if you are sold on the MD match, in a competitive field you have to gamble that being a DO will not hurt you, and take both. But if you look at charting outcomes in the match, DO are essentially shut out of super competitive fields like Rad onc, NS, Derm and ortho. Sure there are exceptions, and one could argue that DO's understand this and self-select out of the MD match because you would risk forgoing the DO match. But it is a hell of a gamble and not one I would be willing to make. Just how many DO's matched into ENT last year? None. How about Ortho, one, maybe two. Hell look at gen surg, an very middle tier field for MDs is essentially off limits to DOs. So why risk even pursuing MD spots Unless you are a top 20% kinda student, and thus should take both no matter what.

    You would only be silly to skip the USMLE if it would make a difference, as screwing it up can absolutely shut you out of the MD match.
    Thus..

    1. Poor students should only take it if they are willing to go DO (as a failed USMLE is the kiss of death, but many MD programs will take Comlex for many fields.)
    2. Average students should take it if they are interested in a less competitive field (IM/FM/Peds) as there are more options in the MD world. Average student interested in competitive fields (Derm, ortho etc) can take it but it probably wont matter(wont score high enough anyway to matter and may miss out of a DO spot because the skipped the DO match). Average students interested in mid-competitive fields like EM, Gas should take and do well or else..(this is the gray area)
    3. Top 20% students interested in all fields should take it as there is nothing to lose for them, but it probably wont matter to those interested in Der/ortho as they will go DO anyway.

    I got nothing against taking both, I did. But I can understand why one would skip it.
  17. heroes31

    heroes31

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    Do you think its a good strategy if someone is towards the top of their class and first preference is something like ent/optho but second is university IM program to take both the usmle and comlex. Then apply in the aoa match to ent/optho and if you don't get it you drop into the md match for IM.
  18. sylvanthus

    sylvanthus EM/IM/CC PGY-2

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    There is so much difference between those fields, I think your main focus should be on figuring out what in the world you want to do.
  19. fiznat

    fiznat Senior Member

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    Well wait a minute. First, it is difficult to say because the AAMC's "Charting Outcomes" report doesn't look at DOs as a group. Instead, DOs are lumped together with IMGs and other randoms into a group called "Independent Applicants." Maybe that by itself says something about the allopathic attitude towards DO's, but that's another story.

    In any case:

    ENT - last year there were 11 allopathic spots filled by "independent applicants." (That year's osteopathic match had 22 ENT spots total.).

    Ortho- last year there were 47 allopathic spots filled by "independent applicants." (That year's osteopathic match had 86 spots total.)

    Gen Surg - last year there were 108 allopathic spots filled by "independent applicants." (That year's osteopathic match had 104 gen surg spots total.)

    Derm - last year there were 56 allopathic spots filled by "independent applicants." As far as I know there are ZERO derm programs in the AOA.

    Obviously there is more competition for the allopathic spots. Match rates for independent applicants in those specialties rates between 20 to 30% (42% for derm!). And that includes whatever non-DOs are getting the spots. The statistics from the AAMC are much more robust than those from the AOA, but I think it is a fair assumption the match percentages are much higher in the osteopathic match (especially considering there were unfilled spots this year in all 3 of those specialties). Clearly it is more difficult for osteopathic students to match into these types of programs, but I think it is worth saying that 20-30% match rates is necessarily "locked out," and that these are at the extreme end of the spectrum. The situation is not nearly as dire for the borderline and less competitive fields.


    Yeah, this is the main point. The fact of the matter is that for most people, specialty choice and location preference probably plays a much larger role in this decision than any statistic.


    The only problem I see with this is time. You are not going to have time to rotate at and prepare for two different specialties across two different match programs. Doing this might work, but I would be worried that you would be a weak applicant in both rather than a strong applicant in one.
    Last edited: 02.15.12
  20. heroes31

    heroes31

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    I just wanted to know theoretically because let's say someone would really like a competitve field(was just using ent/optho as an example) but doesn't want to put all their eggs into one basket and would still be happy with an IM residency. I thought it would be a good strategy.
  21. st2205

    st2205

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    I would like to thank danzman for taking the time to lay out all the confounding factors in what all too often gets oversimplified. For a profession that educates to understand that a little history goes a long way and that not all data are generalizable, it's amazing that often times broad statements keep getting passed around, reaffirmed, and misunderstood until it becomes assumed fact
  22. painmd87

    painmd87 ASA Member

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    Two reasons I plan to take USMLE + COMLEX:

    1) I don't know what I want to do. I doubt I'll know by the end of second year.

    2) Even if I do think I know what I want to do, there's a significant chance I could change my mind during third year. I don't want to be left wishing I'd taken the second exam.

    You might be dead-set on doing AOA IM, but once you (deliver a baby/make your first incision/replace your first knee), you might change your mind. Since the timing requires that you choose just COMLEX or COMLEX+USMLE before you get the opportunity to have those experiences, you shouldn't risk your past choice coming back to bite you. Maybe you rotate through the AOA IM sites you had your heart set on, and decide they aren't the ones you want to apply to, and are now looking at ACGME IM sites. Sure, most will take COMLEX, but some won't, and some simply prefer USMLE over COMLEX. Why limit yourself? Unless you don't think you can do as well on both exams, of course.

    There are simply too many future unknowns for me not to take USMLE. It's almost an insurance policy, in a strange sense. I've taken a thousand exams in my life, all of them feeling like the end-all-be-all of exams. I can take one more.

    Que? This is an appropriate place for a paranoid parrot meme.

    :laugh::laugh:
  23. desijigga

    desijigga Newbie

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    Take the USMLE if you are planning on doing an MD residency, or are unsure what you want to do. Its a hard test, yes, but if you work hard, do bunch of uworld questions, take practice tests you should at least get around average.

    I don't like the assumptions people are throwing out here, being top in your class does not guarantee a high USMLE score or having a high COMLEX score. I was in the bottom 20% of my class, did average on comlex, but did reasonably well on both of USMLE's. I know plenty of students who were awesome the first 2 years of school, killed COMLEX, but got rocked on the USMLE. I think the best predictor is how you are doing on uworld, and the practice tests. Anything below a 210 on practice tests, postpone the usmle or do not take it...

    I agree for specialties like FM, PMR, Neurology, and maybe some community IM programs you can get by with COMLEX. But if you want the better, bigger programs having a step 1 USMLE helps alot. For EM, Gas, Gen Surgery USMLE is a must.

    Bottom line, to do well on standardized tests its 80% your effort + 20% what your school thought = score... I appreciated the curriculum at my school, ya some aspects were lacking, but they did a good job teaching, and prepared us well for rotations.
  24. Dissected

    Dissected When in doubt, cut it out

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    Yes. The NBME self-assessments don't lie. They are great predictors of your score and were worth every penny! They predicted my score within about 5 points.
  25. danzman

    danzman The Ace of Spades

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    I always find it odd that people don't think the AAMC keeps track of DO's in their match. It is pretty easy to find.

    http://www.nrmp.org/data/resultsanddata2011.pdf

    ENT = 0 DOs out of 283 spots

    Ortho = 2 DO's out of 670 spots

    Gen Surg = 28 DO's (18 prelims) out of 2287 spots

    Derm = 0 DO's out of 372 spots (Oh and there are quite a few DO Derm programs)

    Now look, Im not saying anything is impossible, but come on now, who wants to bet on these odds? When you look at charting outcomes and it says "Independent Applicants," I think the vast majority of them are MD's from other countries that come here and do a residency.

    Like I said before, take the USMLE under three conditions
    1. If failing it would have little impact on your future (willing to go DO)
    2. You are going to do well on it ( good scores on practice tests etc')
    3. It matters to your choice of residency (No DO is going into MD Derm, and it would be a waste to spend valuable elective rotations in search of it.)

    Just something to keep in the back of your head. Nothing more.
  26. fiznat

    fiznat Senior Member

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    Oh man. Foot in mouth. Thanks for pointing this out, I hadn't seen this data before. :eek:


    PS: as an OMS hoping to be competitive in the allopathic match some day, these numbers make me sick to my stomach.
    Last edited: 02.16.12
  27. Dissected

    Dissected When in doubt, cut it out

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    Just for clarification, there were 28 categorical matches in surgery and 18 additional matches in preliminary surgery positions. That may have been what you meant, but how you typed it can be interpreted as 10 categorical and 18 preliminary.

    And yes....the match rates into highly competitive ACGME specialties are pretty telling!

    On more positive notes though:
    11 pgy-1 and 51 pgy-2 diagnostic radiology matches
    72 pgy-1 and 46 pgy-2 anesthesiology matches
    [Edited for IDBasco's approval]


    I think when most people (maybe not fiznat) are referring to them not keeping track of DO stats, it is the average board scores and other applicant data in each specialty because this information is lumped in with other 'independent applicants'
    Last edited: 02.16.12
  28. DocEspana

    DocEspana I shall cast a spell on your roster

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    A more informative way to look at it is what percent of current ACGME residents are DO?

    ENT - 0.3%
    Ortho - 1.4%
    Gen Surg - 4.0%
    Derm - 1.3%
    Uro - 0.6%

    Those are all the depressing low matches that everyone cites. Most of the ones i didnt list are more forgiving and optimistic. But looking at the match over a few years does help better represent the odds.
  29. Dissected

    Dissected When in doubt, cut it out

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    I really don't think that is more informative....at all. It is more informative to look at the data in terms of how many individuals matched into each specialty. It's easier to put it into terms of how many DO schools there are and how many DO graduates there are versus how many students match. There are soooo many more USMD graduates every year that percentages like this are very hard to interpret

    Far more depressing way to look at it though, I'll give you that! :laugh:
  30. danzman

    danzman The Ace of Spades

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    Either way you want to look at it, its not very promising for DOs. Last I heard we make up more than 10 of total medical students (probably closer to 15% by now). My advice to anyone wanting to do these super competitive fields is to put all your focus into the DO match. There are plenty of DO friendly fields/programs but these aint them. There seems to be this pipe dream around here that if you just take the USMLE and do well on a rotation a DO has an equal shot at MD Derm etc'. This is simply not the case. Im all for breaking down doors and such, but at a certain point in time you have to be realistic about all this.
  31. danzman

    danzman The Ace of Spades

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    You are correct.
  32. fiznat

    fiznat Senior Member

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    :(
  33. Hernandez

    Hernandez Paranoid and Crotchety...

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    I noted the article on the cover as I swatted my cat away from my cheesy poofs before I threw this worthless rag away.
  34. DocEspana

    DocEspana I shall cast a spell on your roster

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    just meant that it compensates for random years (of which 2011 was one for derm) when zero match, when normally 2-3 DOs match.
  35. Dissected

    Dissected When in doubt, cut it out

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    I'm with you for the most part. I don't think it hurts to apply/interview (if you are granted interviews...) if you are a competitive applicant interested in one of these specialties though. If you match AOA it won't matter either way, but if you don't you will at least have another shot granted you are competitive. Being realistic is key though.

    Especially general surgery...28 matches is about 1 per DO school, and that is after a lot of very qualified surgery applicants have matched into DO programs so they are not in the mix at all.

    Sorry man, didn't mean to call you out! Merely clarifying. Those statistical reports are hard to wade through sometimes.

    Oh..I see what you did there. I mis-interpreted what you were getting at the first time around.
  36. IDBasco

    IDBasco Atypical agent

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    These numbers are incorrect. See page 5 of the NRMP pdf linked above. You are only including advanced positions.
  37. danzman

    danzman The Ace of Spades

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    Sure, but the process just doesn't really work like this. I will give you the example of ENT, as when I was trying to figure out what it was I wanted to do, only EM and ENT came to mind. In order for a DO to match into DO ENT they will need to devote essentially all of there elective time to that pursuit. By giving up one month to do an allo rotation (which is an absolute must to be considered in the MD world) you would destroy your chances at at least one DO program and there are already so few. The best way to get into these fields for a DO is to put all their time and energy into only one match. I just cant make the argument that any DO should put their eggs into the allo ent/derm/ortho etc' match based on previous match history. Best advice I ever got was sitting down with our one of our deans in the middle of my 3rd year. I had good grades/scores etc but couldn't decide between EM and ENT. I wanted to do electives in both, apply to both, and see where I landed. He said just to pick one field and one match and put all your eggs in that basket as both are too competitive to spare any rotation months.

    In hindsight, I overestimated just how competitive DO EM programs are and could have spent a month doing an ENT rotation but I doubt it would have mattered, plus I really fell in love with EM.
  38. Dissected

    Dissected When in doubt, cut it out

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    fixed that for you. Yea I forgot to add pgy-1 matches.
  39. Igor4sugry

    Igor4sugry Junior Member

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    I completely agree. SDN is invaluable.
    As an MS4, after speaking to MS2s it surprises me how little they know about what it takes to successfully match, and what residency choices are available if you go strictly DO vs MD.
    Many also do not know that ~50% of DO students are in allopathic residencies. Many find out the hard way, for example in the 4th year when they are forced into a limited selection of residencies.
  40. donkeykong1

    donkeykong1

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    wird.
  41. IDBasco

    IDBasco Atypical agent

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    Here I am, stuck in the middle with you
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    Dude, really?

    And after splitting hairs, you didn't add or change anything?
  42. Doctor4Life1769

    Doctor4Life1769 **tr0llin, ridin dirty**

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    ****in M1-M3s.
  43. Doctor4Life1769

    Doctor4Life1769 **tr0llin, ridin dirty**

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    **** 'em.

    hey, how's things going?
  44. Dissected

    Dissected When in doubt, cut it out

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    Look veeeeery closely at my quote of your post. It may take a trained eye to notice the bolded words.

    Was feeling snarky after getting yelled at by my attending earlier. Sorry bout that. Displaced some of my frustration on your online user tag.

    Btw, you were the one who started the splitting hairs business :rolleyes:
    Last edited: 02.16.12
  45. IDBasco

    IDBasco Atypical agent

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    Had a response typed up but I like your rolleyes approach. It makes the point nicely. :rolleyes:
  46. donkeykong1

    donkeykong1

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    :rolleyes: ha ha. well this thread has certainly gone downhill despite its important opening message
  47. IDBasco

    IDBasco Atypical agent

    Joined:
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    Pretty good. Just coasting out the rest of the year. March 12/16 can't get here soon enough. Ranked 11, hope thats good enough.

    Whatever.
  48. Dissected

    Dissected When in doubt, cut it out

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    Haha, yea.. I'm actually a pretty nice person. Gotta love communicating via text on an anonymous forum.

    Good luck with the match man. Hopefully things go well for you!
  49. bth7

    bth7 Did I actually sign up for this?

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    I find this to be a stunning phenomenon: how little OM2's understand about their own future. It's almost like DO school keep people intentionally in the dark to certain realities.
  50. lokiperson

    lokiperson

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    SDN 2+ Year Member
    My question is how each match works. I'm wanting to do EM and my first choice residency is a DO residency. So if I enter the DO match, does that automatically exclude me from the MD match since the DO match takes place first?

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