Preparing to be a competitive applicant for residency

[The Squid]

I have been finding it difficult, if not impossible for me to honor my classes, but several classmates and advisors have told me that general surgery is getting more competitive and I need to be near the top of my class to match. I think I can high pass everything, but just trying to honor classes usually goes well for the first test, then I get so burned out that I end up high passing. I'm worried that I will burn out completely and won't do well on the boards, which I know are far more important (I'm only on my second class and I'm already feeling a little burned out). Are there other things I can do to make up for just high passing my classes (I would end up probably in the top 1/3 of my class)?

I am a first year and have the opportunity to shadow a surgeon and hopefully get to know some of the attendings and residents. The problem is, if I want to honor the classes, I can't spend much time with them. I know this could help me with letters down the road, but I'm not sure it will make much difference. Does getting to know the surgery department early help with letters or does it mostly come down to my performance 3rd and 4th years? I also really miss being in the OR and I think it might help motivate me. This might also open the door for me to do some research with them this summer. How helpful is that for general surgery? I keep seeing "You need research" for ENT and neuro, but what about gsurg?

Do residency programs care about extracurricular activities, and if so, what kinds? I like getting involved in student organizations, particularly leadership, but that takes a lot of time. Is my time better spent preparing for the boards and getting to know my surgery department or possibly doing better in my classes?

I know that some people will say that I should try to honor the classes and do well on the boards, but I'm not sure that's a realistic goal for me. When I was an undergrad, I was always doing something (job, research, extracurriculars, studying) but the variety seemed to keep me from getting too sick of any one thing. Now all I do is study to try to get the grades and I was thinking it might be better to lower my academic goals a little (to high pass) and do other things, but if the other things won't help in getting a residency, then I have to rethink it. I know it's early to be worried about this stuff, but I really want to be a surgeon and I don't think I'll be very happy if I end up in something non-surgical in the end because I'm not competitive enough. Thanks for any advice.

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[njbmd]

Hi there,
You cannot do much about the grades and the things that are behind you. You still have USMLE Step I in the future. Getting a competitive score here can greatly help you in securing a categorical general surgery spot as can doing well (honors)in your General surgery clerkship third year.

Your letters of recommendation are not as important as making sure that you have a letter from the chairman of surgery and from another surgeon who knows your desire and performance well. If you consistantly perform well on all of your clerkships in third year, and honor surgery, you can greatly increase your chances. Many times, a very strong third year can more than overcome a lack-luster first year.

If you can manage to do some meaningful research (where you can publish) you can greatly increase your chances of matching categorical. Try to find out who is doing research in the surgery department and spend a summer doing some meaningful work on a good project. If there are any honors fellowships for surgery or any other specialties related to surgery like pathology, try to get one of these.

You can also do an audition rotation (early fourth year) at your dream program or a nationally known program and do extremely well. You can get strong letters from nationally known surgeons and get some good practice knowledge at the same time. You might also catch the eye of the program director and greatly increase your chances. This does not mean that you can expect to match at a top 10 program if your grades and board scores are poor but it does mean that if you do well from here on out, get a good USMLE Step I score and good third year grades, you might get into a top program.

Contrary to popular belief, categorical general surgery can be achieved at many levels. If you are dead set on doing a fellowship in Pediatric Surgery, then you need to match at a strong academic surgery program. If you want to be a general surgeon, you can match at a strong community program (Wilmington, NC, Spartansburg, SC, etc) and master solid surgical skills that will enable you to practice at a high level anywhere in the country.

While surgery has become more competitive, it is more of a case of selecting a wide range of programs, applying to enough programs and making sure that you will be a good fit. If you are not AOA, strong USMLE Step I, you need to have a wider range of programs that you can your clinical advisor have selected. Also remember that USMLE Step II will not make up for a poor USMLE Step I. You need to minimally beat the mean on Step I for most community programs and you need to beat the 235 mark for most academic programs.

There is not going to be much in the scramble for categorical general surgery and you do not want to find yourself in a non-designated preliminary position at a program that you stand no chances of getting into a categorical position.

1. Work smart from here on out. (Good USMLE Step I and good grades)
2. You cannot hurt your chances by getting to know the surgery department well, especially the chairman and being active in extracurriculars that pertain to surgery but this is not enough to ensure a match.
3. Make sure that you have a strong third year, especially general surgery.
4. Do an audition rotation in the program that interests you most and do well.
5. Apply to enough programs across the board to ensure that you have at least 15 solid interviews. If you do not get enough interviews, apply to more programs.
6. Talk to some of the residents in your department. Find out where they interviewed and what the current situation is like. The interns are fresh from the Match process and can provide you will good information as can your General Surgery Program director.

Good luck!
njbmd

 

[drpectin]

I guess the main theme I would like to convey is that you are way too early in med school to already count yourself out. In my first semester of medical school I did not count on how much study is actually involved in attaining honors for a class. Anytime you think you've studied too much - go back and study some more. You can never study enough for medicine. You have embarked on a wonderful journey that will require (allow for) a lifetime of learning. Personally speaking, the second semester I worked extremely hard pushing myself beyond what I thought were my "limits" and came back and honored some classes.

That being said, perhaps it is too much for you....But considering that you really want to do surgery (as I do) that can't possibly be it. I mean, surgery will be exponentially more difficult. Consider: Med school is 4 years and your career is measured in decades.

Its October, you've only finished 2 months of Med school. Training for this profession is about realizing that you are in control of your own destiny. Think about how badly you want to be a great physician (surgeon). Find other people who you study well with or who just study well. Medicine is a team sport - lean on each other for help and inspiration. Remember, mental toughness is a requirement - there is no job too tough, no problem that can't be solved, and no obstacle that can't be overcome. If you already think of yourself as sub-par: GAME OVER. You cannot have any regrets. You are the best that you can be - you have to live that mantra every day. Be happy with what you have - the priviledge of being a doctor, much less a surgeon, is not given nor taken lightly.

Its too early to tell anything about your surgical candidacy. Wait until your surgical clerkship to worry about that.

Your job is to master everything, especially (unfortunately) test-taking.
Don't trip yourself up on every bump. Don't dwell on the long road ahead. You've got plenty to do in the here and now. Get to work

Cheers

 

[Darth Asclepius]

I'm glad this thread is here. I was wondering some of the same things. I'm also a first year set on surgery (not sure what kind of surgery, but definitely something surgical).

Work smart from here on out. (Good USMLE Step I and good grades)

Does that mean that high pass isn't good enough?

You cannot hurt your chances by getting to know the surgery department well, especially the chairman and being active in extracurriculars that pertain to surgery

Does this mean residencies don't care about other extracurriculars? Maybe this is a stupid question, but what kinds of extracurriculars pertain to surgery? We have a surgery club, but they haven't had a meeting yet this semester. Do you mean research? I'm just trying to get some suggestions of good things to get involved in. Any input is greatly appreciated!

spend a summer doing some meaningful work on a good project

I'm going to be here all summer and might do some research. What counts as meaningful? I know there's a big difference in the basic science research, but I spent 2 years working hard full time in a lab as an undergrad and the work never got published (they're still trying to get it published, but I'm not holding my breath). At the time, I didn't know enough about this stuff to realize that I should have put my efforts elsewhere. I still felt that I got a lot out of the experience, but if publications are what count here, I want to avoid that situation again. How can you tell what is a good project? I know that a PI's prior publications are a good indicator, but that really can't tell you if the current project is going to work out. If that work does get published, does that matter for residency or will nobody care about some molecular bio research I did as an undergrad?

Thanks to anybody that gives us any feedback

 

[The Squid]

Thank you for the replies.

drpectin - That sounds like great advice. I am not counting myself out, so much as trying to be realistic. I know I am just starting out and might be able to adapt my studying and get better grades, but I'm also trying to explore my options (i.e.- what can make up for not honoring- if anything). You are right about focusing on the present. I will try to keep that in mind.

njbmd - Thank you for the suggestions. I have some similar questions as Darth Asclepius does. Did you mean when you said to get good grades that I need to honor the classes or is high pass considered "good". I know it's hard to draw a line there, but I am just wondering what is roughly considered good. About the research- Can this be case studies or chart reviews or does it need to be something more in basic science? I too am concerned with how to pick which surgeon to do research with. Does it need to be the department chair or just anyone who has research I am interested in? Any advice on how to convince a surgeon they want an inexperienced (at least in clinical research) first year student to work on their project?

Thanks!

 

[drpectin]

Does that mean that high pass isn't good enough?; Did you mean when you said to get good grades that I need to honor the classes or is high pass considered "good". I know it's hard to draw a line there, but I am just wondering what is roughly considered good.

I guess this can't be emphasized enough. Your goal should be to Honor every class. Work smart, work hard, and use every resource you have available (friends, collegues, librarians, teaching assistants). That being said, its not the end of world if you high pass. If you desire a career in General Surgery, you need to work as hard as possible to achieve that end. Main idea: Set the bar very high. You only get one chance to do well. I should mention that some of my medschool classmates at first did not think they would ever do well on a test, Honor a class, do well on the boards, Honor a clerkship etc...
Let me just say that these same people (not AOA) all placed into their chosen fields: Radiation Oncology, Radiology, Opthomology, GSurg.... Listen to NJmd don't focus on the past, and MOST IMPORTANTLY there is no such things as "good enough." Do your best. What's good? Good is what you have to offer. Good is what grades will be on your transcipt. What NJmd was trying to get across (what I think anyway) is that no one thing makes a PD want you for their residency. You will put together an entire package of a med student that they will think fits in their program.


Does this mean residencies don't care about other extracurriculars? Maybe this is a stupid question, but what kinds of extracurriculars pertain to surgery?

Don't care about extra-curriculars? Well like college and med school they want to see that you are not a total homebody/no fun person. Personally I've heard that PD's like activities that demostrate you have some manual dexterity (like playing an instrument), some athleticism, maybe some public health, but they also would like leadership positions (a surgeon is a leader).

But its not that important. Grades, Boards, LOR's, Research, Personal statement. Thats a lot of wiggle room.

I'm going to be here all summer and might do some research. What counts as meaningful? About the research- Can this be case studies or chart reviews or does it need to be something more in basic science?

I am still a 4th year med student. I 've completed 3 years of med school, I've honored classes, got a 99%'tile on my boards. Right now I'm in the middle of my second year of research in the Surgery Branch of the NCI at the NIH. I stated that to give my point some credibility. Meaningful research is ANYTHING that you have contributed to. It can be a chart review, patient interviews, animal dissections, or database searching/mining. BUT - you have to be able to speak intelligently about it; such as to an interviewer. So research can be from 2 weeks to 2 years. The best short projects are the ones that in your field of interest. I haven't been published yet - but that's a huge feather in your cap.

Did you mean when you said to get good grades that I need to honor the classes or is high pass considered "good". I know it's hard to draw a line there, but I am just wondering what is roughly considered good.

Again good is what's you got! If you were a PD, would you take a student whose transcript was all High passes? The answer is "maybe." So good board scores, Great LOR's, maybe a research project or a Audition clerkship.

I hope I'm not being arrogant, but you can't be reactionary or worrying about what other people think. Be professional, work as hard as you can, and look for every opportunity to put yourself forward.

PS - If you're interested in Clinical Research, check out http://www.training.nih.gov/crtp/index.asp or www.CRTP.org . I spent my first year here at the NIH in the Clinical Research Training Program and I loved it.

 

[drpectin]

I just wanted to add that NJbmd's comments are exactly what I heard from my Deans when I talked to them during my first year when I was in the exactly same place as you - I was going to have to work hard just to High Pass all my first semester classes. Believe me, there is alot of room for improvement.

If you are still in your first year, you are still learning how to improve your studying skills. Push your limits.

A Book to check out is Iserson's Getting into a residency. Again the book is only going to reiterate what NJbmd, only in greater detail and also talks about many other things. The best time to read it is now, it sets out a timeline that begins in first year.

Cheers

 

[Darth Asclepius]

Thanks for the answers. You were very helpful.

 

[USCTex]

You still have USMLE Step I in the future. Getting a competitive score here can greatly help you in securing a categorical general surgery spot as can doing well (honors)in your General surgery clerkship third year.

................................

You need to minimally beat the mean on Step I for most community programs and you need to beat the 235 mark for most academic programs.

I'm a little confused. When I read the message boards and talk to academics in REALLY competitive fields (ortho, integrated plastics, derm, neuro) I walk away with three things.

1) Your Usmle Step 1 score is MUCH MUCH MUCH more important than your pre-clinical grades for your app, simply 'cause these two figures measure the same thing and obviously grading/curriculum between schools can vary a lot while Step 1 is standardized. Indeed I came away thinking your Step 1 score was the most important thing on your app (although certainly not a guarantee of anything without other quality traits).

I'm sure there's a strong correlation between basic science grades and Step 1 scores, but I've walked away with the impression that stand alone your MS-1 and MS-2 grades aren't a terribly important thing (i.e. your Step 1 score, letters of rec, clinical grades, research were all weighted more at most programs).


2) The Step 1 average for Derm and Inegrated Plastics (probably the matches' most competitive specialities) is generally put around ~240 and the average in '05 for neurosurg was 235. I know general surgery is going through a very competitive cycle right now but do you think the Step 1 average for a general surgery spot at an academic program is really 235???? That is sort of depressing.

I'm sure there are major differences between residency programs in terms of what they look for, but just in a general review of academic general surgery programs what are some of people's impressions concerning the above.

 

[Smurfette]

no, 235 is not average for an academic program. Probably for a top academic program though. I would guess solid 220s for *most* academic programs, less for community programs.

 

[blue2000]

no, 235 is not average for an academic program. Probably for a top academic program though. I would guess solid 220s for *most* academic programs, less for community programs.

I second Smurfette, and would add that I'm an intern at a program that has a very good reputation (probably one of the 25 programs that people list in the top 10 ) and I am bringing down the average if it is indeed 235. Honestly though, I had AOA, leadership, research, great letters, etc. My step I score was the weakest part of my application, and I beat the mean. So keep reminding yourself that your application is the sum of many parts, and one does no have to absolutely perfect in everything to get a spot, or even a "top" spot. Work as hard as you can, and then work a little harder.

 

[USCTex]

and one does no have to absolutely perfect in everything to get a spot, or even a "top" spot. Work as hard as you can, and then work a little harder.

Thanks a lot!

 

[EvoDevo]

I second Smurfette, and would add that I'm an intern at a program that has a very good reputation (probably one of the 25 programs that people list in the top 10 ) and I am bringing down the average if it is indeed 235. Honestly though, I had AOA, leadership, research, great letters, etc. My step I score was the weakest part of my application, and I beat the mean. So keep reminding yourself that your application is the sum of many parts, and one does no have to absolutely perfect in everything to get a spot, or even a "top" spot. Work as hard as you can, and then work a little harder.

Great advice. Thanks!

 

[tarheel04]

Contrary to popular belief, categorical general surgery can be achieved at many levels. If you are dead set on doing a fellowship in Pediatric Surgery, then you need to match at a strong academic surgery program. If you want to be a general surgeon, you can match at a strong community program (Wilmington, NC, Spartansburg, SC, etc) and master solid surgical skills that will enable you to practice at a high level anywhere in the country.

What kind of grades and scores are needed for wilmington or spartanburg? Are these generally competative community programs and how competative are most community programs?

 

[njbmd]

What kind of grades and scores are needed for wilmington or spartanburg? Are these generally competative community programs and how competative are most community programs?

Hi there,
These are outstanding community programs so they will be a bit more competitive than many lesser programs. You probably need to have some very solid grades (top 1/4 of your class) and have something in the neighborhood of 220+ on USMLE Step I. You also need to have done very well in your General Surgery clerkship.

There are community programs where you can match with being above 200 on USMLE and passing your courses comfortably. Just make sure that you have applied to enough programs to get 10 to 15 solid interviews. If you are not in the top half of your class and you barely passed USMLE Step I, you might have a bit of a problem getting interviews. Surgery (even the community programs) has been a bit more competitive the past couple of years with the 80-hour work week.

Good luck
njbmd

 

[tarheel04]

Hi there,
These are outstanding community programs so they will be a bit more competitive than many lesser programs. You probably need to have some very solid grades (top 1/4 of your class) and have something in the neighborhood of 220+ on USMLE Step I. You also need to have done very well in your General Surgery clerkship.

There are community programs where you can match with being above 200 on USMLE and passing your courses comfortably. Just make sure that you have applied to enough programs to get 10 to 15 solid interviews. If you are not in the top half of your class and you barely passed USMLE Step I, you might have a bit of a problem getting interviews. Surgery (even the community programs) has been a bit more competitive the past couple of years with the 80-hour work week.

Good luck
njbmd

thanks for the info.

 

[The Squid]

Hi there,
These are outstanding community programs so they will be a bit more competitive than many lesser programs. You probably need to have some very solid grades (top 1/4 of your class) and have something in the neighborhood of 220+ on USMLE Step I. You also need to have done very well in your General Surgery clerkship.

There are community programs where you can match with being above 200 on USMLE and passing your courses comfortably. Just make sure that you have applied to enough programs to get 10 to 15 solid interviews. If you are not in the top half of your class and you barely passed USMLE Step I, you might have a bit of a problem getting interviews. Surgery (even the community programs) has been a bit more competitive the past couple of years with the 80-hour work week.

Good luck
njbmd

Do community programs look for different things in their residents? (Do they value clinical grades and LOR's more than pre-clinical grades and research?) If you ultimately want to go into private practice, is there really any advantage to going to a university program?