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Med students matching: What do you wish you would have known/done in med school?

Discussion in 'Allopathic' started by forsparta, Dec 26, 2011.

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  1. forsparta

    forsparta

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    Med students matching: What do you wish you would have known/done in med school?

    Is there anything you would have done differently? Are there any insights you learned that you think would have made you more competitive? Any awards you learned about after applying?
  2. PSurg530

    PSurg530

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    I think this is a hard thing for us to answer until we know whether/where we matched... Basically, it's hard to know if you're competitive enough until you get to whatever it is you were competing for
  3. gutonc

    gutonc No Meat, No Treat Administrator SDN Senior Moderator

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    I'm not a med student, but I've matched a couple of times so I have some insight. Here are my thoughts about things I wish somebody had told me.

    1. Step 1 is not "important," Step 1 is the most important thing you will do during your first 2 years, bar none. Seriously. You may be junior AOA and have several first author pubs, but with a Step 1 of 208, your chances of getting a Derm/RadOnc/Ortho/Plastics spot border on zero.
    1a. No amount of research or ECs will make up for crappy grades or board scores. ​

    2. Everything is important, everything matters. Stop asking if something is important or matters (during med school and during the application/interview season), it makes you look like a tool.

    3. Somebody is always watching. Your course performance, clerkship performance, SubI performance, behavior on interviews...it's being watched by somebody. Act like what you're doing matters or go to B school where it really doesn't.

    4. Your teachers/supervisors/deans/PD do really want you to succeed. They may not be very good at showing you that (or helping you when you're not) but they do. If you think you need help, get it.
  4. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    Moving to allopathic.

    And a big :thumbup: to gutonc's spot-on advice.
  5. nygiants fan

    nygiants fan

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    This is the best advice for med students I've seen on SDN. Thank you, Dr. Gutonc.
  6. dienekes88

    dienekes88

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    Agree c above.

    Sometimes it's easy to forget that people are watching. Too damn easy.
  7. Postal

    Postal

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    good advice. I've been told that I must consider med school like an on going interview. That advice made me very wary though. Made me really think twice about everything I say and do.
  8. 2012mdc

    2012mdc Enjoying the Dark Side

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    Great post by gutonc

    Anything that can be seen in ERAS matters. Don't sacrifice Step 1 or clinical grades for EC's but don't ignore them either.

    In competitive specialties almost everyone has great numbers so it helps to have that extra kick.

    Med school prestige matters and it can matter a lot in some cases. If you know you want to end up at an ivory tower for residency and you go to a less presitgious school know what you're up against and be proactive (summer research, aways, conferences to make connections, etc.). I faslely assumed that grades and Step 1 would be enough and that the rest would take care of itself in a sense.
  9. 2012mdc

    2012mdc Enjoying the Dark Side

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    Just be cognizant of how you act in the school setting. If you're normal it's not hard. And be smart about what you post online. Again not hard as long as you remember you're not in college anymore.

    Just think of med school being a different social group. Most people act differently with close friends vs people they just met vs their parents etc.
  10. gutonc

    gutonc No Meat, No Treat Administrator SDN Senior Moderator

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    You're welcome.

    But if this is the best advice you've seen, you haven't been looking very hard.
  11. turkeyjerky

    turkeyjerky

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    Now don't go overboard there son, it's not like every single little thing you do is cataloged for program directors to review come match time.
  12. gutonc

    gutonc No Meat, No Treat Administrator SDN Senior Moderator

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    Your sort of got - but mostly missed - my point.

    People are watching, not because they give a s**t about you, but because they care about what you represent and the potential damage you can do to their school/program/patients.

    You don't need to watch everything you say and do. You do need to act like a responsible, intelligent adult who understands your role in the system.
  13. FunnyCurrent

    FunnyCurrent Ripe Prince of Westwood

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    Thank you for your post. I am interested in matching RadOnc. Does this mean I should let my pre-clinical grades slip to mediocrity in favor of spending the time reviewing FirstAid for the Step1 and USMLERx? (My school is on a P/F system without rank and AOA for the first 2 years.) To me this always seemed like a bad idea because as you said "somebody is always watching"
  14. Postal

    Postal

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    Haha. I did think the term "on-going interview "was a bit much when I heard it.

    I got your point though .
  15. FSU2013

    FSU2013

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    I'm hoping to go into RadOnc as well - read the RadOnc message board (if you haven't), the moderator(s) has done a great job of addressing a lot of these types of questions.

    As far as radonc goes, a few things are HUGE:
    1 - research

    Research is huge in radonc, especially the top programs. If you have free time (especially during M1), I would spend it doing research, especially this early in the game. Talk to some attendings at your school and see if they have any projects you can work on. Also, most material for step1 comes from your 2nd year. You're not going to remember any biochem pathways by the time the end of M2 rolls around so you're going to relearn them anyway. Anything important from histo you see again in path......basically you relearn what you need to from UWorld, FA, and BRS/Hi Yield books.

    2 - step 1
    You need to do well on step1. It's not a "I got a 265 so I'm going to match at harvard" type of thing, but it is a filter. Basically, it helps you get your foot in the door. The problem is that it's hard to do well on step1 without doing well in the first two years of med school. Yes it's possible, but it's much harder. The first two years go a little further in depth than you need for step1, but you need a broad and deep knowledge of the subject matter. Work hard your 2nd year both on coursework and step1 prep.

    I'm an M3 and if I had to do it over again I would have gotten involved in radonc specific research day 1 of M1. If I was at a school like yours (P/F, no rank), I would still stay focused on the course work. You never know when a mundane fact from the first two years will pop up as a 'pimp' question and you can impress an attending.

    Basically, that was a longwinded way of saying that the radonc match is intimidating - they want you to have high board scores, have great research, be from a good school, etc etc. You kind of have to be the whole package. Good luck!
  16. LoveandHate

    LoveandHate

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    Thanks for this. My motivation is renewed.
  17. FunnyCurrent

    FunnyCurrent Ripe Prince of Westwood

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    You got that right!!!
  18. RySerr21

    RySerr21 i aint kinda hot Im sauna

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    for those of us not going in to the 4 most competitive specialties in medicine (an overwhelming majority)......the step 1 is not as important. In fact, step 2 may be more important.

    You need to know what your goals are, where you want to be, and in what field. There are no blanket rules that ring true for every person in every specialty. If you know what you want to do, start talking to people who are in that field and figure out what they did, what their experiences were, etc. Thats the only thing that matters.

    Step 1 is way overhyped and causes a lot of unnecessary stress. for many.
    Last edited: Dec 29, 2011
  19. DirtyNetter

    DirtyNetter Member

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    Step I scores are consistently one of the most cited factors given consideration for an applicant across all specialities. I suggest you look at what the data says before you offer your subjective thoughts: http://www.nrmp.org/data/chartingoutcomes2011.pdf
  20. CatFactorial

    CatFactorial

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    You're missing his point. Yes, Step 1 is hugely important, but ceases to be once you are in the acceptable range of scores for a given specialty/region/program. Step 2 is increasingly seen as a good indicator of performance as a resident, and often can make up for a less stellar step 1 score.
  21. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    The problem with your advice is that you're assuming that things remain static between the time you take Step 1 and the time you have to apply via ERAS. They frequently change, though. Many people start 3rd year wanting to do peds, and end it wanting to do rads or rad onc. Or they think they want to stay in the Midwest, until their fiancé is transferred to San Diego. Etc.

    So your advice is true for someone that is taking Step 1 a month before applying to ERAS (I.e. no one in the US). But, while you see a crap ton of posts on SDN that say "crap, I realized just now that I love rads/rad onc/ENT/anesthesia, but I only got a 220 on Step 1," you almost never see posts that say "my Step 1 score is so good that I'm guaranteed to match....boy, studying that much was STUPID."
  22. b-real

    b-real What, me worry?

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    Why is anesthesia in that group? 220 is right around average for it.
  23. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    It's just an example. You get my point, though - don't aim low, because goals can (and probably will) change.
  24. 2012mdc

    2012mdc Enjoying the Dark Side

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    No matter what field you decide on Step 1 is important. If it's a noncompetitive field a high score may not be needed for matching in general but a higher score will always help you. One of my friends got 240+ and is applying to Peds and can basically write his own ticket to where he wants to go.

    Unless you are 100% certain you want to do an noncompetitive residency in an noncompetitive region, Step 1 still matters a lot and Step 2 while important still isn't the same
  25. PistolPete

    PistolPete :)

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    Looking back, I wish I knew the amount of sacrifices medicine would take out of me. But you can't really get this until you go through 3rd/4th year. No way to understand this by shadowing. Would have helped if my parents were doctors.

    If I knew back then what I know now, I would have chosen dentistry. Similar income with way better lifestyle. But too late for that.

    As far as matching:

    1. Wish I was smarter, and did better on Step 1. Most important aspect of application.
    2. Wish I kissed ass more on 3rd year rotations to get those honors rather than HP or P.
    3. If you want anything remotely competitive, do research.

    That's all that matters. Most PD's don't give a crap about EC's.
  26. Shoushu

    Shoushu

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    Besides doing research, isn't there any close EC next to research? Are all all other ECs, no matter how great, a distant second to research?

    Which is valued more? Basic science research or clinical research? It's a full winter break time for me (almost upon me :) , and I got initially accepted by a PI to do some heart research (things to do with heart function,physiology, and lots of medicine). Starting with spending the whole winter break month and then maybe during some school year.

    I hear basic science is harder and not as easily published as clinical research. But I'm in basic sciences, not qualified to do clinical stuff.
  27. RySerr21

    RySerr21 i aint kinda hot Im sauna

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    :confused::confused::confused:

    i never said don't study hard. Of course you want to learn as much as you can and get the best score than you can, regardless of what your field of choice is. My point was that MOST people don't go in to those top 4 most competitive specialties. You need to keep it all in perspective, thats all. While a score of 208 will screw you if you were dead set on rad onc at ucsf, if your goal was family medicine somewhere you would not have trouble matching.


    no one is arguing that a higher board score won't help. Yes, a 240 is great, especially for peds. For the prestigious places like CHOP and boston, maybe they care a lot about that score, I dont know. But ive talked to my own director, and directors at other programs in my area (these are well respected schools) who say they really don't care about it (barring you didn't fail or come close to doing so). Does that mean you shouldn't try? Of course not. But its just another part of your application, not the end all be all that everyone makes it out to be.
    Last edited: Jan 5, 2012
  28. Lunasly

    Lunasly

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    I apologize if this is a silly question, but how do you get involved with research so early on during M1 without looking like a complete tool. I don't know what I want yet, but what if I do decide plastics, term, optho, etc is for me? Something tells me that going right up the one of the PI's and asking to get involved so early on will not go so well. If you are being serious, however, then please share. :p
  29. 2012mdc

    2012mdc Enjoying the Dark Side

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    I don't know why you want to downplay Step 1. Of course it's not the end all be all bc there are many other things that go into an app. But Step 1 and 3rd year grades are easily the two most important aspects of your application and that shouldn't be discounted. Step 1 is the only objective measuring stick that can be applied across schools and it's importance should be emphasized and not downplayed.

    I have many friends applying to less competitive specialties (incl Peds) and the ones with higher Step 1 scores are getting better interviews.

    Yeah most people don't go into the top 4 (I'm guessing Derm, Plastics, NSurg, ENT) but there are plenty that go into rads, IM, Gen Surg, Anes, EM, Ortho, Rad Onc, Optho, Uro etc and Step 1 is important in all of those fields especially if you go to a less prestigious school and/or want to combat regional bias.
  30. Slack3r

    Slack3r Sicker than your average

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    +1
  31. ru4real1666

    ru4real1666

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  32. smq123

    smq123 John Singer Sargent Administrator SDN Senior Moderator SDN Advisor

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    Why would asking to get involved early go badly? It's not an offensive question, and it's something that is commonly done.

    Many PIs are more than happy to have free unpaid labor (i.e. medical students) in their labs. Your request will likely be met with an enthusiastic, positive response.
  33. drizzt3117

    drizzt3117 chick magnet

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    Step 2 isn't important, a lot of people don't even take it prior to match. Many don't release their scores even if they did take it. Step 1 and clinical grades are the only things that matter besides research.
  34. Doublecortin

    Doublecortin

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    Wish had gunned the $hit out of med school and the boards. Everyone is a gunner in med school, period. Those who lament about other people gunning them down are the biggest gunners in the class.
  35. dynx

    dynx Yankee Imperialist

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    One thing I wish I had known from day 1 was that my "pass/fail" school has "letters of distinction". Yeah, that's not in the pamphlet. After the first quarter I get a couple of letters mailed to me stating I scored in the top 5% of class X so I get a letter for my file and deans letter. hmmmmmm...sounds like honors to me. Now granted I didn't mention it to anybody and I never heard anyone else talking about it either although somewhere out there 5% of people were getting letters so the non-competative atmosphere that pass/fail systems go for was maintained. But, it helped motivate me after that point.
  36. KLycos

    KLycos

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    how can being proactive make you look like a tool, it's called knowing that you want to have options and being someone that can multitask.
  37. RySerr21

    RySerr21 i aint kinda hot Im sauna

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    That is your opinion. I have mine. I happen to think it is over emphasized and that it causes a lot of unnecessary stress on most individuals. I'm not saying its unimportant. I'm not saying you shouldn't try. I'm just saying a lot of people have a mentality that they need to get a 270 to be competitive. For some people, maybe. For most, no.

    Thats actually not true at all.

    % of programs citing each factor in selecting applicants to interview:

    LORs in specialty - 71%
    Deans letter - 60%
    Required clerkship grades - 62%
    Step 1 - 73%
    Step 2 - 61%
    personal statement - 68%

    Mean Importance Ratings of Factors (out of 5)

    LORS in specialty - 4.2
    Grade in desired specialty - 4.2
    Honors in required clerkships - 4.0
    Step 1 - 4.1
    Step 2- 4.0


    Step 1 and step 2 performance appear pretty damn equal in importance. While less schools report using it as a factor in consideration, if they do use it, its considered on the same level as step 1. And, gasp, both tests are less important than quite a few other factors when deciding to grant an interview. There are many more factors evaluated in the report itself, i just listed a few.

    http://www.nrmp.org/data/programresultsbyspecialty2010v3.pdf

    Again, my point is not that step 1 is unimportant. It is that it is nowhere near the only thing that people care about, which is a pretty common belief. While many people wait to take step 2 and hide their scores and bla bla bla, a lot of programs do pay attention to it. There are no blanket rules or statements that fit for everyone applying to every field, which is why I said you need to know for yourself what your goals are, where you are applying, what field, etc. In fact, what if you want to do IM? It actually lists step 2 as more important than step 1 (4.0 to 3.9, respectively). Whaaaaaat? You've been killing yourself over the wrong test! OH NOOO! Begin mind meltdown.
    Last edited: Jan 5, 2012
  38. Jack is Back

    Jack is Back

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    Basically, what you are saying is best for 1/4 of medical students while what 2012mdc, drizzt3117, gutonc, and most everyone else believes is best for the other 3/4.

    How could applying serious effort and focus to one of the most critical application factors be over doing it? Like Smq said, who have you seen say, "I wish I didn't focus on Step 1 and spent more time doing _____." Which begs the question, what are you sayin to *insert into that blank? What is the more important thing that clinical grades and Step 1?

    These discussions are rarely productive. It's pretty clear that doing well on Step 1 will help MOST, if not all, students. Your analysis doesn't help, looking at any of the match data shows that what they are asserting is true.
  39. RySerr21

    RySerr21 i aint kinda hot Im sauna

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    uhhhhh i dont follow your math.... at all.

    I'm getting really tired of repeating myself. I never said it wasn't important. I never said you shouldn't focus on it. Of course doing well on step 1 will help you, I never said otherwise. But the opinion is that step 1 and clinical grades are the only things that matter. That simply is not true. You can say "Well my friend is applying to peds and he has a 240 and he has great interviews." Thats fine. 240 is a great score and it certainly did help him receive those itnerviews. But if he had a 240, ****ty deans letter, poor clinical and clerkship grades, and poor evals...would he still have those interveiws? No. He probably has those interviews because he excelled in all aspects of his application, not just the step 1.

    I didn't do any analysis, I showed you someone else's analysis which for some reason you are choosing to ignore. Step 1 is important. Clinical grades are important. Step 2 is important. Many other things are equally as important. THAT IS ALL THAT I AM SAYING. People live and breathe for that stupid test. It's just a test. They call it a step for a reason! Its one step out of the billion steps you must take to you final goal of doing whatever it is that you want to do.
    Last edited: Jan 5, 2012
  40. drizzt3117

    drizzt3117 chick magnet

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    I'm just telling how things really are. A good portion of my friends are doing IM. None of them have taken step 2. Seems pretty vital, huh? Hasn't stopped them from interviewing at MGH, Hopkins, ucsf, etc. Lors and the rest of your app are certainly taken into account, but many people don't even take step 2 until 2nd sem of m4. Afaik only ucsf requires step 2(cs and ck) to rank.

  41. RySerr21

    RySerr21 i aint kinda hot Im sauna

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    * sigh *

    its like banging my head against a wall. I give up.


    ALL HAIL STEP 1, THE ONLY IMPORTANT THING YOU WILL DO IN YOUR LIFE.
  42. drizzt3117

    drizzt3117 chick magnet

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    I think the nrmp PD survey is somewhat useful, but it also says the PS is used more often than clinical grades pre-interview. From the blank stares I've gotten from PDs when I mentioned a point I brought up in my PS. I highly doubt that's true.

  43. MilkmanAl

    MilkmanAl Al the Ass Mod

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    Unfortunately, your opinion is...uh...not the most rational one I've ever seen. Step is, without question, the absolute most important thing in your application. You should always bust your butt to do as well as possible on it, regardless of what specialty you want to do. You might be like me and drop a standard deviation from your practice scores out of nowhere. If you'd done that with peds in mind and the mentality that above-average for your specialty of choice is fine, that'd get you a failing score. I'm guessing you didn't approach the MCAT in this way, so why would you do so for a FAR more important test.

    Also, just speaking from a utilitarian point of view, Step 1 has by far the biggest return on your efforts of anything you could be doing in med school. What's the upper end of how much people who are trying to maul Step 1 study for it? 12 hours a day (of actual study time, mind you) for 6 weeks? That's ~500 hours. Even during third year when your grades matter a lot, that's WAY more efficient than anything you could possibly hope to get out of your efforts at school. I easily put in 500 hours during my 3 months of surgery, but I'm willing to bet my surgery grade (or psych and OB grades or however you want to slice it up) don't mean nearly as much as my Step score.

    I think the 8 programs that offered me an interview before seeing anything other than my PS, my essentially blank CV, and my Step score would disagree.
  44. Asp

    Asp

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    Grades/AOA, Step 1, Research, Med school prestige, personal connections. Those are the most important factors.
  45. MilkmanAl

    MilkmanAl Al the Ass Mod

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    Meh. Not for the first 2 years, unless they're used for (and get you) AOA.
    *sigh* Seriously?
  46. KnuxNole

    KnuxNole Sweets Addict

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    The top 4 I thought was the ROAD stuff, so Anes, Ortho, Rad Onc, etc. which are super competitive would fit in the first group right? At least I don't think the numbers going into those three are as high as the others....
  47. Butler

    Butler

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    ROAD stands for Radiology, Ophthalmology, Anesthesiology and Dermatology. Its not an acronym for competitiveness (whatever that means) of specialties. It is an acronym for fields with good lifestyles and, supposedly, good pay.
  48. 2012mdc

    2012mdc Enjoying the Dark Side

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    ROAD is Rads, Optho, Anes, and Derm. Besides derm - plastics, ent, ortho, uro are all more competitive than the ROAD ones.

    My point is that most students (especially the ones who use SDN as well as allos) are going into something reasonably competitive where Step 1 matters a lot. It is the most important test you will take in med school and the return you get on your investment is extremely high. Of course not everyone needs to gun for a 250 but if you aim for a 220 and underperform test day and get a 200 (below avg for any specialty) that will definitely hurt you.

    Just had an interview today. Was able to see notes my interviewers had made pre interview and Step 1 score and AOA were listed. Haven't been asked about Step 2 on one interview
  49. Asp

    Asp

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    Med school prestige does help a lot.

    If you went to HYPSM for undergrad, that helps too, albeit less, believe it or not.

    Different PDs/chairs weight things differently, but there is definitely a subset that emphasizes this notion called "pedigree." This is mostly at top programs where they could fill the spots many times over with people with great grades / AOA, Step 1, etc.
  50. gutonc

    gutonc No Meat, No Treat Administrator SDN Senior Moderator

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    Look...here's the thing you're not really getting (and that's OK, it's not the most intellectually intuitive thing in this really random process). While PDs may say that things that are not Step 1 (LORS, PS, MSPE, etc) are more important in choosing who to rank (which is what the NRMP survey measures), Step 1 is critical in who gets an interview. And, again, while all that other crap does often play a role in who gets invited, the number one thing that gets used as a first pass screen of applicants is Step 1 score, simply because it's easy to do and, while imperfect, tends to correlate with overall performance (with clear and obvious outliers on both sides of the Step 1 score curve).

    So you can have stellar LORs, awesome clerkship grades and a f***ing Nobel Prize in Physiology or Medicine but, if you've got a Step 1 of 204, you're not getting that integrated PRS, Rad Onc or Derm invitation because your app won't ever get seen by the PDs who screen their apps with a Step 1 of 240+ (because they can).

    I will give you a concrete example from my institution. Our surgery program (which I am not a part of but a good friend of mine is on the adcom this year) is a moderately competitive program (in a moderately competitive specialty) due primarily to location and the recognition by the powers that be that surgeons are human too and occasionally need to go home and sleep...it's not Sesame Street or anything but it's probably as close as a university surgery program gets. That said, it's in no way a "powerhouse" in spite of excellent faculty (some of the best at the institution, across specialties). They have 12 categorical spots and generally interview 120-150 applicants each year. This year they had >2000 applications for categorical spots. So they started with two filtering criteria, US MD grad and a Step 1 >240 and got >300 applicants who met those two criteria (they also dialed it up to 250 but got <100 applicants so went back to 240). And those are the only applications they looked at any further. Period. Full Stop. End of discussion. Somebody with a Step 1 of 230 (more than respectable) and a Step 2 of 260 (stellar)? No interview. The Junior AOA, PhD with step scores <240? No love.

    So...big picture...you are not wrong, there is more to the process than Step 1 score.

    But if you don't make that Step 1 cutoff (which incidentally is fluid and will never be broadcast/advertised/published by programs so please stop asking), none of that other stuff matters because nobody will see your application. Are there specialties/programs that focus less on Step 1? Absolutely. Which ones are they? Your guess is as good as mine. Are you absolutely sure, at the end of your 2nd year of med school, that you want to wind up in one of those places? No...you're not...don't lie, it makes you look bad.

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