Things I wish I knew in the beginning of my MD-PhD experience

[achamess]

So this thread is directed mostly at the senior MD-PhD students on here. With a lot of us about to embark on a 8 year+ journey, it would be extremely valuable to hear from current MD-PhD students about things they wish they knew/did when starting out in their training. Anything, anything at all - we're all ears.

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[QofQuimica]

All right, I'll get you started. Since I did my degrees separately, I'm going to give one answer for each degree.

For grad school: I wish I knew how essential it is to find the right mentor. It's more important than finding the right project, more important than just about everything else you can think of in terms of securing your happiness and a modicum of success in grad school. I would have taken more time to talk to senior students and alumni of the labs I was considering before committing to one. I would have looked more carefully at each PI's graduation and publication records.

For med school: I wish I knew how different the MD and PhD worlds really are. It was something of a culture shock for me, and I think that is also true for a lot of MD/PhD students returning to the wards post-PhD. I would have spent more time on the wards during grad school/first two years of med school. I would have made the time even though I was busy and felt like I didn't have any time. Maybe I would have used the time I spent posting on SDN.

 

[mercaptovizadeh]

I agree with Q. Choosing the right mentor is the #1 most important thing to do for success in grad school. I went through two bad labs. I left the first after 2 months (crazy husband-wife pair) and as it turns out I wasn't the only one: another student left them after almost 2 years of work with them just last month. My second lab was bad, but in a different way. The mentor left the university very abruptly, and I couldn't and (didn't want to) follow (he left academia). Right now I'm in a wonderful lab and while there have been annoying times, like writing grants, IACUC protocols, etc. the dynamic has been so much better and that has made me much more productive. The biggest mistake in the first and second labs was choosing on the basis of research topic. That's completely irrelevant. Look at the mentor's track record, what his students and technicians say, how quickly students finish, etc.

Choosing a mentor is a lot more scientific than it looks. Look at the objective evidence of past success and choose on that basis, not on your own vague research interests that can and do change.

Also, don't trash the first 2 years of med school, try to get honors here and there, it can help for AOA, and it does help as Step 1 prep. Step 1 is crucial and a PhD can't make up for a mediocre score for most highly competitive residencies (excepting maybe IM or peds or path tip-top places that like research and will forgive a weaker Step 1 if the research is strong).

 

[RxnMan]

I agree with Q. Choosing the right mentor is the #1 most important thing to do for success in grad school. I went through two bad labs. I left the first after 2 months (crazy husband-wife pair) and as it turns out I wasn't the only one: another student left them after almost 2 years of work with them just last month. My second lab was bad, but in a different way. The mentor left the university very abruptly, and I couldn't and (didn't want to) follow (he left academia). Right now I'm in a wonderful lab and while there have been annoying times, like writing grants, IACUC protocols, etc. the dynamic has been so much better and that has made me much more productive. The biggest mistake in the first and second labs was choosing on the basis of research topic. That's completely irrelevant. Look at the mentor's track record, what his students and technicians say, how quickly students finish, etc.

Choosing a mentor is a lot more scientific than it looks. Look at the objective evidence of past success and choose on that basis, not on your own vague research interests that can and do change.

Also, don't trash the first 2 years of med school, try to get honors here and there, it can help for AOA, and it does help as Step 1 prep. Step 1 is crucial and a PhD can't make up for a mediocre score for most highly competitive residencies (excepting maybe IM or peds or path tip-top places that like research and will forgive a weaker Step 1 if the research is strong).

This post is sound as a pound. I completely agree.

The choice of mentor is likely the difference between finishing the PhD and not. Definitely the difference between enjoying yourself and feeling horrible for 4-5 years. Also, resident selection rests primarily on med school performance, and strength in one area will not overcome non-competitive grades and/or Step I.

 

[Vader]

I agree with the other posters.

The following is more personal, but I also wish that I had been disciplined enough to get through my PhD years in 3 years rather than 4 (I also wish that I had realized how truly beyond your control this is). Also, I wish I had realized how doing a PhD would make me a peon for an additional 4 years of my life, during the prime of my life (20's). And how rich you initially feel making $20k per year fresh out of college (while other med students are paying for education) and eventually how poor you ultimately feel when you're making only $7k more after 8 years.

 

[nomogram3]

I agree with Q. Choosing the right mentor is the #1 most important thing to do for success in grad school. I went through two bad labs. I left the first after 2 months (crazy husband-wife pair) and as it turns out I wasn't the only one: another student left them after almost 2 years of work with them just last month. My second lab was bad, but in a different way. The mentor left the university very abruptly, and I couldn't and (didn't want to) follow (he left academia). Right now I'm in a wonderful lab and while there have been annoying times, like writing grants, IACUC protocols, etc. the dynamic has been so much better and that has made me much more productive. The biggest mistake in the first and second labs was choosing on the basis of research topic. That's completely irrelevant. Look at the mentor's track record, what his students and technicians say, how quickly students finish, etc.

Choosing a mentor is a lot more scientific than it looks. Look at the objective evidence of past success and choose on that basis, not on your own vague research interests that can and do change.

Also, don't trash the first 2 years of med school, try to get honors here and there, it can help for AOA, and it does help as Step 1 prep. Step 1 is crucial and a PhD can't make up for a mediocre score for most highly competitive residencies (excepting maybe IM or peds or path tip-top places that like research and will forgive a weaker Step 1 if the research is strong).

This is all solid, with the exception that "tip-top" IM places aren't going to forgive a mediocre Step I score, they need all of their residents to be able to provide good clinical care. Scores that are good enough to get into the best IM residencies are good enough to get into Derm. Work hard at everything you do: get the best grades during the preclinical years, pick a good mentor with a track record of successful students and publish (yes, the currency of academics, it only helps you during interviews when even the clinicians you meet with recognize the journals you have published in), get out of grad school as quick as you can as long as you publish, and get the best clinical grades. It's not rocket science.

 

[Neuronix]

This is all solid, with the exception that "tip-top" IM places aren't going to forgive a mediocre Step I score, they need all of their residents to be able to provide good clinical care.

Just to be a pita, I want to ask the obvious question... What do the two bolded things have in common?

 

[nomogram3]

Just to be a pita, I want to ask the obvious question... What do the two bolded things have in common?

They don't. But you need to have them both.

 

[solitude]

I agree with the other posters.

The following is more personal, but I also wish that I had been disciplined enough to get through my PhD years in 3 years rather than 4 (I also wish that I had realized how truly beyond your control this is). Also, I wish I had realized how doing a PhD would make me a peon for an additional 4 years of my life, during the prime of my life (20's). And how rich you initially feel making $20k per year fresh out of college (while other med students are paying for education) and eventually how poor you ultimately feel when you're making only $7k more after 8 years.

By more disciplined, what do you mean? More hours worked, or quality of the hours that you did work?

 

[solitude]

This is all solid, with the exception that "tip-top" IM places aren't going to forgive a mediocre Step I score, they need all of their residents to be able to provide good clinical care. Scores that are good enough to get into the best IM residencies are good enough to get into Derm.

I am really confused about this. This seems to be an article of faith among med students, and yet when I talk to faculty, they will tell me directly that board scores do not matter. I have heard at least 5 faculty members that select residents tell me, upfront, that they don't care what students get on Step I, within reason. These were all faculty members in "tip-top" departments at top med schools, mostly Internal Medicine at my own, but one being ophtho at a top-5 program. Now they never define the "within reason" part, but I get the sense that the expectations are reasonably low. They realize, as we do, that step I is somewhat bogus.

Then for Honors and AOA, all I hear from students is that you desperately need them to get into a competitive field, or a tip-top residency. Then I check out the post-match data from my med school, here are some examples (yes, I know this is anecdotal, but hear me out):

-neurosurg, out of 3 applicants who matched, 0 had AOA, only half honored Surgery clerkship, average Step I of 232 with 18 std dev, 2 of 3 matched at #1 on their list
-plastics, 1 applicant who matched, lacked AOA, 232 step I, didn't honor Surgery
-derm, 7 applicants who matched, 6 of 7 matched at #1 on their rank list, 238 avg step I with 16 std dev, half honored Medicine, only 2 were AOA
-rad/onc, 3 applicants who matched, 2 of 3 matched at #1 on their rank list, 240 avg step I with 10 std dev, 3 of 4 honored Medicine and 2 or 3 were AOA
-rads, 7 applicants who matched, 5 at #1 on their rank list and 2 at #2 on their list, 235 avg step I with 18 std dev, 3 of 7 were AOA
-Internal Medicine, 63 applicants who matched, 48 to their #1 and 12 to their #2, nobody matched below their #5, 225 avg step I with 22 std dev, 40% honored Medicine, 13 were AOA

(sorry some of the denominators are not consistent--I am citing the actual data provided rather than modifying it to be consistent)

I will concede that this is just a handful of data. I will concede that you can only rank a school if you received an interview. I will concede that we don't know where these students ended up, how many were "tip-top" programs, but I know that, for example in Internal Medicine, about half end up at UCSF/Brigham/MGH. I will concede that we don't know how much the "reputation" of the med school comes into play with this.

So I don't know who to believe. If you talk to older students they rant and rave about all of this stuff, how it's impossible to get into residency programs unless you walk on water. Then you think about it and realize that there are going to be only a handful of students in your class who got a 260 on Step I and made AOA, but a much larger percentage of your class ends up in killer residencies. Then you look at the data and realize that people do really quite well with "mediocre" Step I and clinical performance (e.g., 235 Step I, no AOA, no H in Surgery and you match neurosurg at UCSF).

Who am I supposed to believe?

Thoughts? I hope that bringing in some objective data (albeit limited in scope) could aid the discussion. Also, please don't lecture me on how I need to just take older students' word for it and study my ass off for step I--already done!

 

[nomogram3]

I am really confused about this. This seems to be an article of faith among med students, and yet when I talk to faculty, they will tell me directly that board scores do not matter.

After going through the process (in IM) I don't believe faculty when they say this. Programs use board scores as a cutoff to decide who to invite for interviews. I'd like think that once you have an interview everyone is on equal footing, but I doubt that too. The top programs have a high board cutoff, if you have something else that's exceptional on your CV it may help, if you went to a big name medical school, that may also help you. It would be nice to know what the average Step 1 score is at MGH/Brigham/UCSF/Hopkins but that info isn't available (and if you look at those who posted on the IM matched forum the numbers were astronomical).

As for AOA and honors, I can say that there seemed to be programs who did not grant interviews to people unless they had an H in medicine. AOA helps, but there are plenty of people who will be going to big programs who are not AOA.

You don't need to walk on water to get a residency, but it only helps you to have good numbers if you want to go to the top places in IM. Further down on the list doesn't matter as much. The advice I give is to shoot for at least 240 on Step I and work hard getting good grades in your clerkships.

 

[Neuronix]

Thoughts? I hope that bringing in some objective data (albeit limited in scope) could aid the discussion. Also, please don't lecture me on how I need to just take older students' word for it and study my ass off for step I--already done!

My thought is that this seems to have changed a lot in the past 5 years. Also, a lot of the people that used to tell me crap like "Step 1 doesn't matter" aren't actually on the admissions committee.

Also, this: http://www.radiology.ucsf.edu/residents/apps

Performance on the USMLE is only one of several factors that we consider when choosing candidates whom we would like to interview. We review each application as a whole, and we do not have a threshold value for USMLE scores. However, in recent years, most of our interviewees have had three-digit scores of 240 or higher on Step 1. The small number of our interviewees with Step 1 scores between 200 and 239 have had offsetting factors such as a combination of top clinical grades at a competitive medical school and extraordinary research experience and academic promise.

Most of our interviewees are members of AOA and have received "A" or "honors" grades in most or all of their core clerkships.

We should emphasize that because ours is a clinically rigorous program, we prefer applicants who have shined on the wards as well as in the laboratory.

I remember when that same website said 230 a few years ago when I got my step 1 score.

The only other thing I can say is that I've talked to a lot of graduating (post-match) students at this point. Some got their first choices, most did not. This is in stark contrast to when I was a first, second, third year and every year we got to hear that everyone got their first choice match... All of a sudden it's counting the number of students who didn't match at all. What happened? I'm not entirely sure.

 

[RxnMan]

I am really confused about this. This seems to be an article of faith among med students, and yet when I talk to faculty, they will tell me directly that board scores do not matter...Who am I supposed to believe?

Thoughts? I hope that bringing in some objective data (albeit limited in scope) could aid the discussion. Also, please don't lecture me on how I need to just take older students' word for it and study my ass off for step I--already done!

To bring some more data into the discussion, I've done a survey of applicants to EM residencies and looked at the effect of Step Scores and so on (links in my sig). My data also does not differentiate into "tip-top" and "bottom-feeder" programs (or anything in between), but you can infer somewhat based on application effectiveness (i.e., a highly effective application will be able to garner an interview from just about anywhere).

The top applicants in any specialty are simply going to be strong all around. One facet won't make up for another, because your competitors for those top spots will be strong in everything.

 

[solitude]

interesting replies, thanks for the comments.

 

[Shifty B]

Also, a lot of the people that used to tell me crap like "Step 1 doesn't matter" aren't actually on the admissions committee.

Haha. So true. I can imagine a faculty member that interviews the 10 people that are selected for him by the program director or close associate. Out of his stack of 10, every one of them has a good board score within a fairly tight range of 230-250. So, to him, it doesn't matter because the board score related selection has already been done. He never even sees the guy with 215-225.

 

[Vader]

By more disciplined, what do you mean? More hours worked, or quality of the hours that you did work?

Probably both, but definitely more quality vs. quantity. The difficulty is that it is very difficult to identify where to place your bets. Hindsight is 20/20 of course.

 

[kapMD/PhD]

So to post another "what I wish I knew" comment...

for the love, buy endnote - or some other reference program - at the beginning of your grad school training and collect ALL of the articles that you even remotely think that you might use for your dissertation - it makes your life immensely easier. This is probably obvious too but no one really tells you - keep meticulous lab notes every day. Organization is KEY to good research - even if your mentor is less than organized it will help you both out. Make a schedule for yourself every day in the lab too and try to stick to it - it all depends on your mentor, but a lot of times it's up to you to keep yourself on track - any time that you slack off or take time off - you're only hurting yourself and extending your time. The other thing - if your program is 2-3(or 4)-2 - Grad school is NOT med school. M1 & 2 you can study really hard and do really well in classes - you are rewarded on your tests for your diligence. In the lab -regardless if you get there at 6:00am daily, your mice will still be genetically incorrect, your cells will get contaminated and your techs will not order the right materials in time and there won't be anything that you can do about it. Learn to roll with it and be flexible.

As for going back to the wards -I used grad school time to read through Cecils Essentials - a group of the other md/phd-ers and i got together each week and assigned a section, then we answered step 2 questions on this topic. Even if you miss most of the questions, you're at least attempting to keep your brain fresh on actual clinical medicine - this helps on wards (in light of the previous posts - you can 'shine' when you know the random answers). Also if there is a department that you think that you're interested in, try to arrange your lab schedule during grad school to attend some of their grand rounds - good time to meet folks and learn some too.

the extra 3+ yrs of maturity that you have upon returning to the wards is a + as well. after dealing with faculty for grad school - you have a much better handle on how to approach attendings, and are a lot less intimidated by the residents (perhaps b/c some of them were your classmates M1&2.)

On the financial front - try to apply for F30 if you can - this a good way to get your foot in the NIH door, and also your department will like you b/c you'll be paying your own salary (& they give you $ for books and travel!!) Also if you get a stipend, find out if it's taxed, and if taxes are taken out before you get the money, if not be careful to find out what percentage you will be taxed and hold enough out to cover it at the end of the year - i got burned on this one year .

It's a long road but hopefully well worth it. Only 1 more year left for me - YEAH!!

 

[Elixir6]

I am really confused about this. This seems to be an article of faith among med students, and yet when I talk to faculty, they will tell me directly that board scores do not matter. I have heard at least 5 faculty members that select residents tell me, upfront, that they don't care what students get on Step I, within reason. These were all faculty members in "tip-top" departments at top med schools, mostly Internal Medicine at my own, but one being ophtho at a top-5 program. Now they never define the "within reason" part, but I get the sense that the expectations are reasonably low. They realize, as we do, that step I is somewhat bogus.

Then for Honors and AOA, all I hear from students is that you desperately need them to get into a competitive field, or a tip-top residency. Then I check out the post-match data from my med school, here are some examples (yes, I know this is anecdotal, but hear me out):

-neurosurg, out of 3 applicants who matched, 0 had AOA, only half honored Surgery clerkship, average Step I of 232 with 18 std dev, 2 of 3 matched at #1 on their list
-plastics, 1 applicant who matched, lacked AOA, 232 step I, didn't honor Surgery
-derm, 7 applicants who matched, 6 of 7 matched at #1 on their rank list, 238 avg step I with 16 std dev, half honored Medicine, only 2 were AOA
-rad/onc, 3 applicants who matched, 2 of 3 matched at #1 on their rank list, 240 avg step I with 10 std dev, 3 of 4 honored Medicine and 2 or 3 were AOA
-rads, 7 applicants who matched, 5 at #1 on their rank list and 2 at #2 on their list, 235 avg step I with 18 std dev, 3 of 7 were AOA
-Internal Medicine, 63 applicants who matched, 48 to their #1 and 12 to their #2, nobody matched below their #5, 225 avg step I with 22 std dev, 40% honored Medicine, 13 were AOA

(sorry some of the denominators are not consistent--I am citing the actual data provided rather than modifying it to be consistent)

I will concede that this is just a handful of data. I will concede that you can only rank a school if you received an interview. I will concede that we don't know where these students ended up, how many were "tip-top" programs, but I know that, for example in Internal Medicine, about half end up at UCSF/Brigham/MGH. I will concede that we don't know how much the "reputation" of the med school comes into play with this.

So I don't know who to believe. If you talk to older students they rant and rave about all of this stuff, how it's impossible to get into residency programs unless you walk on water. Then you think about it and realize that there are going to be only a handful of students in your class who got a 260 on Step I and made AOA, but a much larger percentage of your class ends up in killer residencies. Then you look at the data and realize that people do really quite well with "mediocre" Step I and clinical performance (e.g., 235 Step I, no AOA, no H in Surgery and you match neurosurg at UCSF).

Who am I supposed to believe?

Thoughts? I hope that bringing in some objective data (albeit limited in scope) could aid the discussion. Also, please don't lecture me on how I need to just take older students' word for it and study my ass off for step I--already done!

Okay - I know this thread is years old. But one huge thing I have gathered from your previous posts that you are not mentioning here is that I believe you go to UCSF. Something I wish I knew going into MSTP was how much your school pedigree seems to matter for residency interviews/matching.

 

[solitude]

Okay - I know this thread is years old. But one huge thing I have gathered from your previous posts that you are not mentioning here is that I believe you go to UCSF. Something I wish I knew going into MSTP was how much your school pedigree seems to matter for residency interviews/matching.

data?

 

[Elixir6]

data?

Ugh - its pretty obvious and actually I have a very good piece of data. Go to the 2014 MSTP match thread. I compiled all of the match data gathered into one thread. You can paste the compilation into Excel. Without using R or MatLab or SPSS etc... you can see that there is a very very strong trend that students from the "top 15" schools shuffled around into "top 5-10" residencies in each specialty. Fewer students from the "lower" rung schools matched into those competitive spots.

Not a huge amount of upward mobility was demonstrated. This fact is ridiculously obvious for MD onlys, but I didn't think it was as important for MSTPs until I started looking into the data. For MDs, its clear the guy who goes to Harvard and ends up in the bottom 10% of his class matches as easily as the guy who busted his butt at SUNY and was top 10% of his class. I really don't think the guy at Harvard is as better or even equal to the guy at SUNY, but that's the way things work. Oh well.

 

[solitude]

Ugh - its pretty obvious and actually I have a very good piece of data. Go to the 2014 MSTP match thread. I compiled all of the match data gathered into one thread. You can paste the compilation into Excel. Without using R or MatLab or SPSS etc... you can see that there is a very very strong trend that students from the "top 15" schools shuffled around into "top 5-10" residencies in each specialty. Fewer students from the "lower" rung schools matched into those competitive spots.

Not a huge amount of upward mobility was demonstrated. This fact is ridiculously obvious for MD onlys, but I didn't think it was as important for MSTPs until I started looking into the data. For MDs, its clear the guy who goes to Harvard and ends up in the bottom 10% of his class matches as easily as the guy who busted his butt at SUNY and was top 10% of his class. I really don't think the guy at Harvard is as better or even equal to the guy at SUNY, but that's the way things work. Oh well.

Although I think you are partly right, I am not sure it is so cut and dry. For example, it may be the case that students graduating from these programs had better MCATs and college grades, etc., so are able to get better Step scores, better pre-clinical and clinical grades, etc. It also may be the case that students graduating from these programs were more prepared for grad school and therefore had more productive PhDs. Furthermore, it may be the case that these medical schools are considered "good" for a reason, i.e. that they provide a higher quality of education to their students. Not to mention that the level of competition from fellow students is higher. So a student at Top 5 School who gets AOA maybe got a better education and out-performed higher quality peers, whereas a student at #100 School who gets AOA maybe (or maybe not?) got the same education, but their AOA means less as the competition was not as stiff.

I don't know how true any of this is, having never served on a residency admission committee, but my perception is that name recognition helps you, but not as much as you think. If you want to play the anecdote game, I can promise you that going to a Top 5 School and graduating in the bottom 10% of the class will not help somebody much when it comes time to apply to residency. There are plenty of people from my school who matched at pretty weak programs. And I know plenty of MD-PhDs at good programs who have not even matched.

 

[Neuronix]

My n=1 experience was that school reputation didn't matter very much. I discussed it more thoroughly in this thread: http://forums.studentdoctor.net/thr...n-of-the-medical-school-for-residency.902677/

I maintain that if you're at an MSTP, other things matter much more than rankings. The USNews rankings you could probably shuffle 1-10 and then 11-40 and be just as accurate. I suspect that they do this every year to sell magazines.

 

[Erufaelonion]

1. The PhD will not save you.
2. Destroy Step 1 because if you get an average score now, by the time you apply to residencies, you will be below average later. You must obliterate it with 0.999 probability. This is the most important thing you can do. If you cannot even remotely entertain this consideration, take time out of the PhD for an intensive review course (not DIT). Money should not be an issue since you have a stipend and no tuition bills.
3. During the PhD, try to regularly volunteer at a free clinic and do some light Step 2 reading. Over 3-7 years, this experience will prove helpful when you return to clerkships.
4. Find an advisor with tenure.
5. Find an advisor with money.
6. Time your return to medical school to coincide with the start of 3rd year with regular MD students. Otherwise, you may look like an idiot in comparison. The PhD will not save you. Also, you will get to know your new class better than if you start mid-way through (you'll still be a third year while they've moved on to fourth). Your new class will also provide you with study resources.
7. Smile. Smile, even if it kills you.
8. If your school has more than one "campus," pick the one with easier evaluators. Evaluations matter in your grade. High-passes and honors matter when applying to residency. Do not attempt to be noble and get mediocre marks at location x even though it is harder there. The PhD will not save you.
9. Do not apply to residencies before completing your core rotations. The PhD will not save you. It did not save me.

 

[Neuronix]

Erufaelonion, it sounds like we had a lot of similar experiences as MD/PhDs. I thought I'd match to a big name research program of my choice so that I could continue in a research track residency, and in retrospect, I got lucky to have matched at all.

Did you match? Do you feel comfortable filling us in on what happened?

1. The PhD will not save you.
2. Destroy Step 1 because if you get an average score now, by the time you apply to residencies, you will be below average later. You must obliterate it with 99.9% probability. This is the most important thing you can do.

I agree with and have varying levels of enthusiasm for all of your points. These particular points I agree with you very strongly about. I wrote an article about the rise in step 1 scores and residency competition during the length of MD/PhD programs causing a rise in MD/PhDs not matching. This was spurred on after 4 MD/PhDs from my home program didn't match in one year. I couldn't get any journal to take the article, and it's now on my blog. It seems that not enough MD/PhDs are failing to match that programs are ignoring this career altering, crucial issue.

 

[Erufaelonion]

Hi Neuronix! We are kindred spirits indeed! I am hopefully matching this year. It has been a complete and unmitigated disaster. I could not have imagined the excrement-storm that has been unfurling before me. I will try to keep it brief.

Essentially, I am a mediocre medical student all around but exceptionally amiable. I did admirably as a PhD. I was Erufaelonion the Great. Several first author papers, two of which have won awards. My dissertation was voted best in my department. Tons of presentations. Et cetera et cetera. All of this means nothing.

I returned to medical school half-way into the year. Which is just a terrible idea. I was assured I would graduate the following year allowing me a rare 7-year MD-PhD. My first rotation was IM, in which I looked like a complete idiot owing to more seasoned classmates and being in research for 3.5 years. Things pretty much remained not-good. Then I applied to residency without having completed pediatrics or surgery. I applied to 24 programs (the whole range of top and low tier academic and community programs). I received interviews for eight mid-/low-tier programs. Eight. Of these eight, you could argue that three are academic programs. In reality, only one is.

In addition, I had to take Step 2 CK with only 2 weeks of study to have the scores return in time. Remember that I am a mediocre medical student? I should have taken 2 months.

Behold the cluster-farge.

Confucius said: "By three methods we may learn wisdom: First, by reflection, which is noblest; Second, by imitation, which is easiest; and third by experience, which is the bitterest." It appears you and I learned points 1 and 2 in my first post by the third method.

 

[solitude]

Erufaelonion, it sounds like we had a lot of similar experiences as MD/PhDs. I thought I'd match to a big name research program of my choice so that I could continue in a research track residency, and in retrospect, I got lucky to have matched at all.

Did you match? Do you feel comfortable filling us in on what happened?



I agree with and have varying levels of enthusiasm for all of your points. These particular points I agree with you very strongly about. I wrote an article about the rise in step 1 scores and residency competition during the length of MD/PhD programs causing a rise in MD/PhDs not matching. This was spurred on after 4 MD/PhDs from my home program didn't match in one year. I couldn't get any journal to take the article, and it's now on my blog. It seems that not enough MD/PhDs are failing to match that programs are ignoring this career altering, crucial issue.

I agree with Erufaelonion and Neuronix. Very well-done posts. I would like to add that if and only if you can excel in medical school, then I think the PhD helps a lot for applications to academic programs. But if you don't have good Steps and a lot of Honors (hopefully even AOA), if you are applying in competitive specialties especially, then beware. Also, as Neuronix has written in the past, be aware that community programs probably won't take you seriously no matter whether you did well or poorly in med school--they will just write you off as too academic. (There may be an exception here for Prelim/IM applications.)

Erufaelonion provides a nice list of how to maximize your chances to excel. Just to reiterate:
-crush your Step scores
-if you do poorly on Step 1, take Step 2 before applying. Do well on it.
-do your PhD quickly (pick a mentor with tenure and money, who is an MD/PhD or MD himself, and tell him upfront that you want to graduate in 3 years). Non-researchy types, who are the ones that predominantly interview residency applicants, look more favorably on short PhDs with less production than they do on long PhDs with substantial production.
-in grad school, read NEJM or Step II CK prep weekly or so. Even just an hour a week will help.
-after finishing PhD, take a week or two to just sit in the library and review all of your medicine before going back to wards. Re-read your First Aid for Step 1, go back through old MS1/MS2 lectures, flip through an Anatomy book. This really helps.
-DO NOT DO ANY RESEARCH DURING MS3. Your lab should expect to never see you again. Any time you spend doing this detracts from getting AOA.
-get as many Honors and AOA as possible. Do this by going back on time. Work your ass off during MS3. Seriously. You should plan to study 1 to 2 hours per night, even after 12 hour days. You must demolish shelf exams and be able to shine on wards when discussing your patients, or piping in on random topics with factoids.
-kiss ass, but in a non-obvious way. Develop efficiency on wards. Be pleasant all the time, even the middle of the night when you are being scutted. If you help your resident, and he likes being around you, he will give you good evals. If you are a time-suck for them, and he doesn't like you, he will give you bad evals. Neither has anything to do with your medical knowledge, but it will most certainly affect your grades
-apply very broadly to residencies (regions, academic vs. community, reputation, etc.). Don't trust the MSTP or specialty-specific advisors. It will cost you some money in application fees, but gives you more options for interviews.
-if you are applying in a competitive specialty, consider double applying (e.g. also in IM, Peds, etc.) to cover your bases. Again as Neuronix has stated, a good portion of MSTPs don't match, especially in competitive specialties.
-in your residency app, emphasize how much you like patients. Harp on this during interviews.
-if there are research heavy faculty interviewing you, develop a strong rapport with them. They may have some pull, but remember that you only meet them IF you can get in the door for the interview, which is largely based on Step scores and MS3 grades.
-use the freedom of grad school to cultivate interesting hobbies, then milk these during the interviews. Interviews are about 75% small talk. If you are a science geek and not the most personable (be honest with yourself), consider doing practice interviews or hiring an interview coach.

 

[gbwillner]

Hi Neuronix! We are kindred spirits indeed! I am hopefully matching this year. It has been a complete and unmitigated disaster. I could not have imagined the excrement-storm that has been unfurling before me. I will try to keep it brief.

Essentially, I am a mediocre medical student all around but exceptionally amiable. I did admirably as a PhD. I was Erufaelonion the Great. Several first author papers, two of which have won awards. My dissertation was voted best in my department. Tons of presentations. Et cetera et cetera. All of this means nothing.

I returned to medical school half-way into the year. Which is just a terrible idea. I was assured I would graduate the following year allowing me a rare 7-year MD-PhD. My first rotation was IM, in which I looked like a complete idiot owing to more seasoned classmates and being in research for 3.5 years. Things pretty much stayed not-good. Then I applied to residency without having completed pediatrics or surgery. I applied to 24 programs (the whole range of top and low tier academic and community programs). I received interviews for eight mid-/low-tier programs. Eight. Of these eight, you could argue that three are academic programs. In reality, only one is.

In addition, I had to take Step 2 CK with only 2 weeks of study to have the scores return in time. Remember that I am a mediocre medical student? I should have taken 2 months.

Behold the cluster-farge.

Confucius said: "By three methods we may learn wisdom: First, by reflection, which is noblest; Second, by imitation, which is easiest; and third by experience, which is the bitterest." It appears you and I learned points 1 and 2 in my first post by the third method.

For context, what specialty are you applying to? I think this this the $60,000 question.

An MSTP CAN save you**. But I do agree with most of your points.
If you apply to community programs, a PhD is in no way a positive. Probably more of a negative.


** Applies to IM, Peds, Neuro, Path only. YMMV in Psych, Derm, maybe a few others.

 

[solitude]

For context, what specialty are you applying to? I think this this the $60,000 question.

An MSTP CAN save you**. But I do agree with most of your points.
If you apply to community programs, a PhD is in no way a positive. Probably more of a negative.


** Applies to IM, Peds, Neuro, Path only. YMMV in Psych, Derm, maybe a few others.

I agree with you. To add nuance to my post, the specialty matters a ton.

Also, I want to emphasize that my posts earlier in this thread represent the naivete of an MSTP in the midst of grad school, and the evolution of my views is reflective of having gone through the match and watched many classmates do the same.

One topic that was addressed above was whether reputation of the med school/MSTP matters. I now believe that the difference in your residency chances if you go to #5 or #50 is relatively small, but again, it depends on the specialty. If you are applying to a competitive specialty, going to #5 can actually hurt you because it will be VERY difficult to get AOA, and for academic programs in these specialties AOA is de facto required. OTOH, it may be easier to get AOA going to #50. There are not enough applicants from top 5 programs to fill all the spots, and many/most spots at top residencies in competitive specialties are filled by grads of middle tier med schools. However, if you are applying in a non-competitive specialty, going to #5 will help you a lot. There are so many slots and the competition is relatively low, so you can almost skate in based on the reputation of your med school alone.

 

[gutonc]

The PhD is no longer the free ride to whatever residency program in whatever specialty you want that it used to be. It's modestly more beneficial than AOA...modestly.

 

[Erufaelonion]

For context, what specialty are you applying to? I think this this the $60,000 question.

I am applying to IM. I was told that, "you will be fine."

I feel I would have been better off if I had been expelled from the MD-PhD program after the first one or two years of unexceptional performance. I remain surprised that I wasn't. With each year, the scores creep. And IM is getting more and more competitive. Everyone wants to specialize.

It is difficult to predict medical school performance. I did great in undergrad. Well-above-average MCAT. But I did do a Master's which eroded some good study habits.

 

[Shifty B]

I returned to medical school half-way into the year. Which is just a terrible idea.

This.

If you are planning on re-entering medical school after the MD-only students have been on service for 3-6 months, you are in trouble. It's better to just bide your time and enter just before or at the same time as them.

 

[VitaminVater]

Can some of the more experienced members give feedback/advice on choosing mentors based on these criteria:

Established tenured proff vs. rising faculty

MD or MD/PhD PI vs PhD only PI

 

[tr]

This.
If you are planning on re-entering medical school after the MD-only students have been on service for 3-6 months, you are in trouble. It's better to just bide your time and enter just before or at the same time as them.

Just to offer a counterpoint, this strategy can work very well if you are able to choose the order of your rotations, because the comparison to other third years works against you in the beginning but for you later on. I went back to the wards mid-year and didn't do particularly well my first few rotations, but they were relatively less important or easier ones. I started with family med, then went to psych, which didn't depend much on prior clinical knowledge and which I was easily able to honor (neuroscience background helped). I scheduled medicine to coincide with the next crop of incoming third years and, with several months of rotations under my belt, I looked like a superstar compared to the newbies.

By the way, I also think it would be helpful if posters in this thread would mention the specialty they applied in. My experience applying to a noncompetitive specialty (psychiatry) was the polar opposite of what Neuronix and Erufaelonion encountered. I had a very mediocre PhD record, mediocre Step I, reasonable 3rd year clerkship performance but nothing outstanding (I honored all the important rotations, which for me were medicine, psych, peds, and my medicine sub-I, and passed everything else). Good letters but everyone does, and I did come out of a 'name-brand' institution. I got interviews at all the top programs and calls from the residency directors at most of them. This was back in 2007 though, things may be getting tighter. I do interview applicants to our research-track residency and personally, I mostly concentrate on their research interests and barely even look at their board scores.

 

[Erufaelonion]

Just to offer a counterpoint, this strategy can work very well if you are able to choose the order of your rotations, because the comparison to other third years works against you in the beginning but for you later on.

This is true. In my case, I was handed a schedule and told to deal. While I did well on my last two rotations in comparison to my peers, they did not appear on my transcript until well after decisions for interviews were made and certainly did not appear in the form of an updated Dean's Letter.

 

[Erufaelonion]

Can some of the more experienced members give feedback/advice on choosing mentors based on these criteria:

Established tenured proff vs. rising faculty

MD or MD/PhD PI vs PhD only PI

This depends on your risk preference. If you are risk-averse, the tenured faculty is the better choice. If you are risk-seeking, then choose the rising faculty. If you are risk-neutral, I think the tenured faculty would still be the better choice. Rising faculty may not know how to manage a lab. They may not have money. They may leave for any number of reasons. All these things will adversely affect your experience. Some may argue that tenured faculty may not push you hard enough. That is fine. That just means you need to discover and exploit your own initiative which is only a good thing.

As for the degree, it does not matter. What matters is that they can empathize with you, are interested in your development as a scientist, and are supportive of your needs. My PI was a PhD with all of these things. Money helps a bit, too.

 

[Elixir6]

This depends on your risk preference. If you are risk-averse, the tenured faculty is the better choice. If you are risk-seeking, then choose the rising faculty. If you are risk-neutral, I think the tenured faculty would still be the better choice. Rising faculty may not know how to manage a lab. They may not have money. They may leave for any number of reasons. All these things will adversely affect your experience. Some may argue that tenured faculty may not push you hard enough. That is fine. That just means you need to discover and exploit your own initiative which is only a good thing.

As for the degree, it does not matter. What matters is that they can empathize with you, are interested in your development as a scientist, and are supportive of your needs. My PI was a PhD with all of these things. Money helps a bit, too.

Sounds like a cluster f*uck Erufaelonion. I'm sorry it was so difficult for you. Very good advice you gave

What I hope the junior students reading this thread is that your program directors were setting us up for some upset by telling us we are the special warm fuzzy center of the universe and that we could match anywhere over and over like they did at my school. WRONG. First off, that is a bad way to motivate students and it causes arrogance which is pet peeve of mine that I like to stomp out if I can. I hate nothing more than an arrogant prick. Anyways, that's an aside.

At first you see some people matching at good places but then when someone scrambles (or SOAPs now) you think maybe they were just a bad student. The reality is that PhD was some special golden ticket in the good ol' days that the PD is remembering. This is not the case. The value seems to be dropping each year. Secondly, no program wants to take a student that is a bumbling wonky eccentric that is going to kill a patient because they treat the ward like their dirty a$$lab bench.

Maybe my views will change next year after I match. I'll come post after I have some first hand knowledge, but after seeing rounds of students match I think I understand the reality fairly well.

'lixir

 

[RustBeltOnc]

Erufaelonion --

Your original post triggered my PTSD, but it is awesome advice.

 

[zookeepr]

It's troubling but SDN is literally the only place that I hear this stuff. It makes sense to me and I believe you, but it's hard to reconcile with what I've heard from our senior students recently or currently going through the match. A student (who granted, has yet to match and maybe this will end up not working out) told me that he was a mediocre medical student without any honors, thought it would matter but really didn't, as he got interviews everywhere he applied and has now gotten a few "you're ranked to match" statements. This is in IM and he's hoping to stay at our institution which is unquestionably top tier. I don't know if it's where I am, if everyone I'm talking to is just being humble and not mentioning that they got something stupid high on step 1, or what. He did say that the sub-I trumps all, and honoring it will make up for other things. (Though in contrast, a friend only passed her sub-I with horrible comments and still got into her first choice name-brand residency in peds.) I want to believe him because I'm not a perfect medical student, either, but it seems too good to be true.

 

[Neuronix]

It's troubling but SDN is literally the only place that I hear this stuff.

Most people are not upfront about things when they don't get what they want. Most people either rearrange their brains to accept whatever fate they have, pretend like they love whatever they got even if they don't, or just don't talk about it.

A student (who granted, has yet to match and maybe this will end up not working out) told me that he was a mediocre medical student without any honors, thought it would matter but really didn't, as he got interviews everywhere he applied and has now gotten a few "you're ranked to match" statements. This is in IM and he's hoping to stay at our institution which is unquestionably top tier.

I saw several people with better stories than this who didn't get what they wanted in the IM match. Location plays a big role. Connections play a role. Also people can be very surprised on match day.

I don't know if it's where I am, if everyone I'm talking to is just being humble and not mentioning that they got something stupid high on step 1, or what. He did say that the sub-I trumps all, and honoring it will make up for other things. (Though in contrast, a friend only passed her sub-I with horrible comments and still got into her first choice name-brand residency in peds.) I want to believe him because I'm not a perfect medical student, either, but it seems too good to be true.

Specialty has a lot to do with it. You can land a big name IM program as an MD/PhD student pretty easily assuming no red flags. You may not get the best one in the best locations, but you'll get a pretty big name academic place. Even moreso for peds. In rad onc, I didn't even get interviews at a lot of places that are supposedly strong in research and do my area of research.

The program I went to went in two years from everyone getting their "first choice" (and we were assured in their first choice specialty and they got all the interviews they wanted) to four people not matching. I'd be surprised if many people at my old program even know about the four people not matching. It's not like people talk about it. I've met several MD/PhDs who wanted to do rad onc but didn't think they'd match well and did another specialty instead, got their first choice in that specialty, and nobody ever knows the truth or what might have been.

It's hard for junior students to understand all of this. So I wrote about it pretty extensively here: http://www.neuronix.org/2011/07/nrmp-puts-out-charting-outcomes-in.html

 

[solitude]

Specialty has a lot to do with it. You can land a big name IM program as an MD/PhD student pretty easily assuming no red flags. You may not get the best one in the best locations, but you'll get a pretty big name academic place. Even moreso for peds. In rad onc, I didn't even get interviews at a lot of places that are supposedly strong in research and do my area of research.

The program I went to went in two years from everyone getting their "first choice" (and we were assured in their first choice specialty and they got all the interviews they wanted) to four people not matching. I'd be surprised if many people at my old program even know about the four people not matching. It's not like people talk about it. I've met several MD/PhDs who wanted to do rad onc but didn't think they'd match well and did another specialty instead, got their first choice in that specialty, and nobody ever knows the truth or what might have been.

As usual, this is spot on. IM and peds are about as uncompetitive as they come, with hundreds and hundreds of spots at the name-brand programs. It is very uncommon for MSTPs to not end up at top IM/peds programs. OTOH, it is becoming quite common for MSTPs to not match in competitive specialties, or to double apply just in case.

The sub-I does not trump everything. AOA trumps everything. If an MSTP can get 1 standard deviation above the average on Step 1, and gets AOA, I promise you that he/she will match in a competitive specialty. Without those two things, it becomes dicey.

One thing that MSTPs don't understand until they go through MS3 and MS4 is that there are very good reasons non-competitive specialties are not competitive. You may find that you would rather be a Radiology resident at a top 25 program than an IM resident at a top 5 program.

 

[Shifty B]

You may find that you would rather be a Radiology resident at a top 25 program than an IM resident at a top 5 program.

Any day! I was in fact a radiology resident at a top 25 program after completing an MD/PhD, and I would take no IM program over it. I won't say that there is deliberate deception on the part of the programs, but it's definitely not to the advantage of anyone at the program level to draw attentions to what are considered failures.

IM used to be the king of the hospital. They ran the show, and the smartest residents and attendings in the hospital took care of the sickest patients in the hospital. Sounds great, right? The biggest IM programs are huge, with maybe 40-50 residents a year. Even the most competitive IM residencies are taking a third of a full medical school class! (just translate this to peds for a childrens hospital) MD/PhDs traditionally (and still) have no real problem matching in these larger programs at top institutions.

However, over the past couple of decades, medicine has gotten so complex and subspecialized that a great deal of the care consists of consulting the appropriate subspecialty. It's not uncommon for the sickest patients in the hospital to be followed by 4, 5, even 6 consult services, with IM acting as an intermediary. Hmmm, starting to get less fun. Add in the dreary endless paperwork which only increases every year, and people start fleeing for the specialties. Less scut, higher salary, smaller scope of practice.

As MD only students at the top schools have fled for the specialties, so have MD/PhD students. It even makes sense, because you can limit yourself to a specialty practice which complements your research. However, there just aren't as many spots. A top radiology program may have 10 spots a year, and it's by no means the most competitive. ENT, radonc, derm, are much worse and may be only 2-5 residents per year, and the competition is fierce. An MD/PhD who is also an exceptional medical student (many honors, AOA, top step scores) will do very well in the match in these specialties. MD/PhDs who are average medical students are going up against some of the top MD only applicants, some of whom have many papers and extensive research to boot. Expectedly, the outcome is not as good. Add in the fact that a 4 year hiatus from medical school actually makes it harder to be an exceptional medical student and you are running into some hurdles.

But I think most of this is centered around the fact that more people, including MD/PhDs, want to do specialties now. If you want to do IM, more power to you, and it will definitely be easier.

 

[bd4727]

About to graduate this spring. A few of my own random thoughts to the original question:

1) outside of academia (certainly within science at least, but even PhDs dont know all the details) no one even knows what MD/PhD is, let alone cares. You will spend your life explaining that you didn't do the two separately and then justifying spending your 20s as a student. If your long-term goal is not to stay in academia reconsider.

2) MD/PhD definitely gives you a leg up in 'traditional' medical specialties (peds, medicine, neurology, path, now psych) especially if your phd time was productive in terms of number of pubs and/or high impact pubs

3) Having a PhD degree is all that matters. Pubs, awards, etc no one cares including residencies (unless you are trying to do some unique research intensive residency). Just get out as fast as possible.

4) Finishing medical school is painful, especially if you had a fairly successful PhD experience, bc you feel like an adult among very immature/short-sighted med students who are hyper focused on things you could care less about (shelf scores)

5) at every step of the way people will talk about how hard it is to be an academic. I have no plans of staying in academic but actually I think its not all that hard if you just know how to be super efficient with your time and work on things that matter and will results in publications. Just getting a ton of publications is super easy these days if you pick the right projects and plan them correctly.

6) other med students and then young residents in MS3/4 year will always be intimitated by you and assume you have a super high step score and are a shoe in for any residency you want. Also they are super jealous about their indebtedness versus yours.

7) in contrast to 1. although no one understands it or has ever heard about it, MD/PhD credientials (alone, no residency/fellowship/etc) are impressive to non-scientists (eg business people) especially if it was from a name-brand school.

8) you have so much time in PhD to work on side stuff/personal life/etc that you have no idea how flexible it is until you get back to clinics and miss it

9) who your PhD supervisor is can not only have a huge impact on your PhD but can greatly influence your residency and career if that person is a MD who is important in the field you are going into

10) this forum provides a nice discussion with people who are obviously very thoughtful but I would argue the people who are very succesful in academia and non-academia are not the majority on here and so you should not let this message board skew your thoughts about the ability to obtain your 'dream' job assuming you are realistic with yourself about what is actually takes to get that done.

 

[Elixir6]

bd4727 and solitude....

Looking at the NRMP Match data and what's been compiled here, I have to say although IM as a whole is not competitive, it is very competative to go to a top 10 program, heck a top 25 program. Obviously, I have no way of knowing how well the MSTP students in the match did in their PhD and MD degrees (i.e. pubs, Step 1/2 scores, honors, AOA etc...), but looking at the data tells me a different story. For instance, at the top programs, even though there are 40 spots, they on average have ~10% MD/PhDs. To me this shows that although MSTPs make up ~4-5% of IM applicants, they are not a shoe-in at anywhere by any stretch of the imagination. Moreover, and disappointingly to me, those who match at these programs tend to come from another top 10 school. To me, this shows two things:

1) MSTP only gives a soft leg up
2) Pedigree is as important or more important than merit... or at least, given a certain level of merit, the only way programs have to differentiate between good applicants is just to choose the ones that come from the ones with a "name brand" reputation

Some other points (see bolded comments in quote)

1) outside of academia (certainly within science at least, but even PhDs dont know all the details) no one even knows what MD/PhD is, let alone cares. You will spend your life explaining that you didn't do the two separately and then justifying spending your 20s as a student. If your long-term goal is not to stay in academia reconsider.

2) MD/PhD definitely gives you a leg up in 'traditional' medical specialties (peds, medicine, neurology, path, now psych) especially if your phd time was productive in terms of number of pubs and/or high impact pubs

3) Having a PhD degree is all that matters. Pubs, awards, etc no one cares including residencies (unless you are trying to do some unique research intensive residency). Just get out as fast as possible.

Your points 1), 2) and 3) seem to be a little bit at odds. I guess either no ones knows or cares what an MD/PhD is, or your pubs and productivity mean something. I guess what you are trying to say is that it matters more at academic institutions, and even if they don't quite understand an MSTP, having more awards/pubs is better than not having any?

4) Finishing medical school is painful, especially if you had a fairly successful PhD experience, bc you feel like an adult among very immature/short-sighted med students who are hyper focused on things you could care less about (shelf scores)

Not the case for me. I've found med school to be easier to correlate my hard work with outcome. I hated the fact that I could bust my a$$ on a project that turned out to be a bunch of nothing in the end.

5) at every step of the way people will talk about how hard it is to be an academic. I have no plans of staying in academic but actually I think its not all that hard if you just know how to be super efficient with your time and work on things that matter and will results in publications. Just getting a ton of publications is super easy these days if you pick the right projects and plan them correctly.

Are you serious? If you knew how to pick the right project, do the right experiments and foresee and technical problems, you should have a Nobel, or at least be ****ting Nature and Cell papers left and right. I really cannot disagree with this point more. If its so easy and its just a matter of efficiency than why are most scientists struggling? It's far harder to get a decent publication these days than 10-15 years ago. Maybe what you meant here was that good planning and efficiency are the key to get publications, and I just read your statement too literally?

6) other med students and then young residents in MS3/4 year will always be intimitated by you and assume you have a super high step score and are a shoe in for any residency you want. Also they are super jealous about their indebtedness versus yours.

7) in contrast to 1. although no one understands it or has ever heard about it, MD/PhD credientials (alone, no residency/fellowship/etc) are impressive to non-scientists (eg business people) especially if it was from a name-brand school.

8) you have so much time in PhD to work on side stuff/personal life/etc that you have no idea how flexible it is until you get back to clinics and miss it

9) who your PhD supervisor is can not only have a huge impact on your PhD but can greatly influence your residency and career if that person is a MD who is important in the field you are going into

10) this forum provides a nice discussion with people who are obviously very thoughtful but I would argue the people who are very succesful in academia and non-academia are not the majority on here and so you should not let this message board skew your thoughts about the ability to obtain your 'dream' job assuming you are realistic with yourself about what is actually takes to get that done.

Agree with you on points 6-10. Not to pick on you here, but I really felt that some of your statements are a reflection of exactly the misconceptions and pitfalls MSTPers - especially juniors - believe that causes them to run into major problems through their training.

'lixir

 

[bd4727]

bd4727 and solitude....

Looking at the NRMP Match data and what's been compiled here, I have to say although IM as a whole is not competitive, it is very competative to go to a top 10 program, heck a top 25 program. Obviously, I have no way of knowing how well the MSTP students in the match did in their PhD and MD degrees (i.e. pubs, Step 1/2 scores, honors, AOA etc...), but looking at the data tells me a different story. For instance, at the top programs, even though there are 40 spots, they on average have ~10% MD/PhDs. To me this shows that although MSTPs make up ~4-5% of IM applicants, they are not a shoe-in at anywhere by any stretch of the imagination. Moreover, and disappointingly to me, those who match at these programs tend to come from another top 10 school. To me, this shows two things:

1) MSTP only gives a soft leg up
2) Pedigree is as important or more important than merit... or at least, given a certain level of merit, the only way programs have to differentiate between good applicants is just to choose the ones that come from the ones with a "name brand" reputation

Some other points



Agree with you on points 6-10. Not to pick on you here, but I really felt that some of your statements are a reflection of exactly the misconceptions and pitfalls MSTPers - especially juniors - believe that causes them to run into major problems through their training.

'lixir

Impossible to know, but my personal feelings on this is that at least a large proportion of it is not related to the 'pedigree' of the school that MSTPers are coming from, but rather that MSTPers from those top name brand places were doing their PhD work with people are influential in the field and well-known by academic clinicans (basically what I said in my previous post point 9) and that is what is giving them the 'leg up' not just the name on their diploma. But who knows I'm sure the brand name doesn't hurt...

 

[Shifty B]

Impossible to know, but my personal feelings on this is that at least a large proportion of it is not related to the 'pedigree' of the school that MSTPers are coming from, but rather that MSTPers from those top name brand places were doing their PhD work with people are influential in the field and well-known by academic clinicans (basically what I said in my previous post point 9) and that is what is giving them the 'leg up' not just the name on their diploma. But who knows I'm sure the brand name doesn't hurt...

I'm going to just flat out tell you that you are wrong.

How do I know this? Well, I've been involved in resident selection for a competitive program and I've seen the inside of the machine.

Why are you wrong? The people who are involved in selecting residents (program director, assistant program director, a few key department faculty, and chief/senior residents) are, for the most part, not researchers. They are primarily interested in the training and education of quality residents. If they wanted to identify whether you worked for an influential person in the field, they wouldn't even know. Even if they are researchers, odds are they work in a different field and don't even know who's influential in your little niche. You might work with the world's leading expert in patters of HIV drug resistance, and at best you'll get some guy who models sodium transport in HTN. You'd have a better chance of your interviewer randomly being college roommates with your advisor.

Mostly these people are looking for people who will be good, problem free residents that provide good clinical care, and how well known your advisor is not helpful. So how do people evaluate the strength of your PhD? The name brand of your institution (which also speaks to the name brand of your medical school, +2), really strong letters from your advisor that speak to a strong work ethic (and other personal characteristics that will help in clinical medicine), and a proven track record of publishing papers. If I see someone's reference letter that says they are the best graduate student they have seen in 20 years, that's huge.

But you still better do well on step 1/2...

 

[Fencer]

Agree with Shifty B... I have been PD for fellowship for over a decade, and was also an Assistant PD for Neurology residency before taking the MD/PhD directorship. I would only add that the outcome of the particular clerkship relevant to the specialty is also key. With the exception of another clinician scientist, the rest of the residency selection adcom had no idea of the quality or depth of research. They did recognize the names of some supervising professors who were clinician scientists, but that was rare.

 

[gbwillner]

Caveats abound...
At many top places the program directors can be/are MD/PhDs (or have significant research components to their job) as well and will fully appreciate your work in a relevant field. Furthermore, assuming you want to continue doing research and apply to PSTP-type residency programs, your PhD, mentor, institution, and publication record will be THE most important factor, bar none.

 

[RustBeltOnc]

Erufaelonion --

I am curious -- did things go better this time? How did the other students in your program fare in the match, 2015?

 

[Erufaelonion]

All four of us matched. Two got into extremely competitive specialties. Another matched into a very competitive program. They were in-sync with the rest of the class, unlike me. And unlike me, I do believe they were excellent medical students.

 

[RustBeltOnc]

Get back to us in 6, 7 years.

I think you will find that all four will be productive, high-octane professionals with great careers. You may very well have the best job satisfaction and best working conditions.

Proud of you.