2008 NRMP Program Director Survey

[PeepshowJohnny]

Well, well, well...look what just landed in my Inbox.

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

Basically, last year they took a survey of residency program directors over what was important in offering an interview and determining rank position in nineteen different subspecialty areas.

This should give us plenty of stuff to obsess over in the future....

One quick highlight: 74% of ENT Program directors care about honors in basic sciences vs. 35% for Family Medicine for offering interviews.

 

[size_tens]

The most surprising statistic to me was the relatively high value placed on Step 2. It was lower than step 1 but still pretty highly valued overall. I had been under the impression that step 2 is relatively unimportant. There are many applicants in my class with strong step 1 scores who held off on taking step 2 for fear of doing badly and losing credibility lent by the step 1 score.

 

[Pinkertinkle]

Personal statement seems to be a bit overvalued considering everyones sounds the same.

 

[Doctor4Life1769]

Personal statement seems to be a bit overvalued considering everyones sounds the same.

I noticed that, as well. Also a relatively high importance in honoring basic science, so much for "M1/M2 grades not being all that important"

 

[spospo]

not sure if these are the same stats seeing as i haven't combed through them, but there is something similar on the "careers in medicine" part of the aamc website under the specialty data, just fyi

 

[BigRedBeta]

It is interesting. There's a lot of data though and in looking over it I'm having a very difficult time figuring out what's significant (statistically and in practice) and what's not...The only thing that seems absolutely clear is that the interview carries an extremely substantial amount of weight. Comparatively, bad vibes there can sink a candidate much faster than merely passing all their pre-clinical course work.

I think everyone would agree that deciding who to interview and creating rank lists is an extremely complex process. Personally, I'm finding it extremely difficult to figure out which program out of 12 to rank #1...I can only the imagine the difficulty and the splitting of hairs that comes from the program side of things in trying to sort out 50, 100, or even 200 applicants.

 

[phospho]

what's "transitional year" ?

also, why is there stuff like plastic surgery but not something like medical oncology? don't you have to do general surgery no matter what, and then you subspecialize? is that what an integrated program is, i.e. it combines GS with plastics? is there something integrated for med onc (not rad onc)?

 

[Droopy Snoopy]

what's "transitional year" ?

also, why is there stuff like plastic surgery but not something like medical oncology? don't you have to do general surgery no matter what, and then you subspecialize? is that what an integrated program is, i.e. it combines GS with plastics? is there something integrated for med onc (not rad onc)?

Yes, integrated plastics is a direct match specialty, 5 years I believe. The easier (as far as competitiveness) and more commonplace route is to match general surg with a plastics fellowship. MedOnc is a fellowship requiring completion of an IM residency, no direct path. A transitional year is an intern year, similar to a prelim IM/GS year but more diverse as far as electives go. It's utilized by residents matching to specialties like ophtho or rads whose training doesn't conform as well into the usual prelim IM/GS positions, and/or for those who are competitive for it that are looking for an easier year.

I'm actually heartened by some of the data. Never understood why subjective > objective, like clinical > preclinical. Always heard the argument that clinical was more important in terms of evaluating future resident performance, but if so why was Step I > Step II? Seems like PDs have recognized all this.

 

[phospho]

Yes, integrated plastics is a direct match specialty, 5 years I believe. The easier (as far as competitiveness) and more commonplace route is to match general surg with a plastics fellowship. MedOnc is a fellowship requiring completion of an IM residency, no direct path. A transitional year is an intern year, similar to a prelim IM/GS year but more diverse as far as electives go. It's utilized by residents matching to specialties like ophtho or rads whose training doesn't conform as well into the usual prelim IM/GS positions, and/or for those who are competitive for it that are looking for an easier year.

thank you so much!

one last Q:

let's say after I finish med school, i realize i want to do medical oncology... I do the IM residency, and then I apply for the medonc fellowship. What if I don't get in? Can I reapply again? What if I decide that I don't want to do anything BUT medonc, do i just keep reapplying to the fellowship over and over again? or am i screwed, and must therefore stick with the IM residency...?

thank you

 

[PeepshowJohnny]

thank you so much!

one last Q:

let's say after I finish med school, i realize i want to do medical oncology... I do the IM residency, and then I apply for the medonc fellowship. What if I don't get in? Can I reapply again? What if I decide that I don't want to do anything BUT medonc, do i just keep reapplying to the fellowship over and over again? or am i screwed, and must therefore stick with the IM residency...?

thank you

Yes, you would typically "try again" but usually its expected you jive up your CV. For example, I think if you finished your IM residency and did not match, you could perhaps apply for a research position at something like the NIH or ACS and get some publications and letters of recommendation. (I know a guy who did something similar with Cardiology and AHA).

There's no hard limit on how many times you can reapply, but there is the limit that each time you do and don't match, you're wasting money and losing income you could be getting by focusing on an IM career full time. Now, Heme-Onc (if I remember correctly) is competitive, not "super competitive" like Cards and GI (I'd check on the IM board to be sure) so you'll likely be okay.

That said, if it NEVER happens, there are ways to customize your career. I med an IM attending who does hospitalist work STRICTLY for the inpatient oncology units at a BIG hospital (i.e., it's a full time job). That said, he's not really staging cancers and dosing chemo, but he is still seeing a lot of problems common to oncology patients (i.e. some guy comes in with immunosuppresion and fever, you do the work up).

Back on topic though: I'm not jiving this report as much as I did at first. As someone mentioned, it needs more data analysis because it all just kinda feels vague and says "All this matters". Maybe it's an artifact of how, even within a field, certain PDs value some things more than others.

 

[phospho]

Yes, you would typically "try again" but usually its expected you jive up your CV. For example, I think if you finished your IM residency and did not match, you could perhaps apply for a research position at something like the NIH or ACS and get some publications and letters of recommendation. (I know a guy who did something similar with Cardiology and AHA).

There's no hard limit on how many times you can reapply, but there is the limit that each time you do and don't match, you're wasting money and losing income you could be getting by focusing on an IM career full time. Now, Heme-Onc (if I remember correctly) is competitive, not "super competitive" like Cards and GI (I'd check on the IM board to be sure) so you'll likely be okay.

That said, if it NEVER happens, there are ways to customize your career. I med an IM attending who does hospitalist work STRICTLY for the inpatient oncology units at a BIG hospital (i.e., it's a full time job). That said, he's not really staging cancers and dosing chemo, but he is still seeing a lot of problems common to oncology patients (i.e. some guy comes in with immunosuppresion and fever, you do the work up).

makes total sense, thank you

 

[dragonfly99]

I don't find this info that helpful. I guess it helps you "ballpark" the importance placed on various factors in your application according to which specialty you are applying for. However, I think that since individual schools vary so much in what they think is important in an applicant, looking at aggregate data like this isn't super helpful. It looks like some of the more competitive specialties look @preclinical grades a bit more, and value Step 1 perhaps > step 2, while specialties like IM care more about clinical grades and Step 2. I also think the Step 2 score can come into play more if your Step 1 score wasn't great but you did well on Step 2...

 

[DoctaJay]

A couple of things that thought were interesting:

1) The extremely low importance that is place on doing away rotations in your desired speciality. If anything this has helped me view away rotations as more of a getaway than a pre-interview

2) The > 50% (usually) interest in you doing some sort of community service. From reading these boards I thought it would be alot lower than this.

3) For general surgery at least, the importance than place on you getting an LOR from the chair of the department

4) I was also surprised as I compared the different specialities in which ones required you to just pass Step 1 or required you to reach a target score. I mean it kinda went along with the known competitiveness of the speciality but it was still interesting.

5) How highly they regarded those insanely subjective med student evals. That truly is scarey.

 

[howelljolly]

what's "transitional year" ?

also, why is there stuff like plastic surgery but not something like medical oncology? don't you have to do general surgery no matter what, and then you subspecialize? is that what an integrated program is, i.e. it combines GS with plastics? is there something integrated for med onc (not rad onc)?

Transitional Year is an internship year that you have to do for some residencies, such as Derm, Rads, Gas, Optho, EM... otherwise the first year of your categorical IM or GS residency is your intern year.

Plastics can be a residency in itself (or an integrated program) or it can be a fellowship after GS.

Theres something like an "integrated" oncology program.... kinda.... theres the American Board of Internal Medicine Research Pathway. The basic idea is, you do two years of Internal Med, two years of research in Oncology (or whatever), and then one or two years in that clinical specialty (depending on which one). At the end, you'll be board elegible in IM, and a specialty, and have an impressive CV.

 

[dilated]

The only useful information in here is the percentage of programs that claim to require step 2 scores for evaluation. But this doesn't jive with what students at my school usually do, so I'm not sure what to think of it.

 

[ENThopeful]

What this survey, IMO, fails at doing is showing how important the overall picture is. I have been told over and over simply checking off all the boxes in that list wont do, they have to have a picture of what kind of student you are. Furthermore, it makes it seem like to get into a competitive specialty, you have to be junior AOA, 250, peace corp, etc etc. Someone correct me if Im wrong but I dont think thats the case.

What I have been told is that if you work at a certain specialty, show genuine interest, and meet the cut off of grades (ie: not bottom in your class), more likely than not you will get your speciality of choice.

 

[masterofmonkeys]

Personal statement seems to be a bit overvalued considering everyones sounds the same.

Perhaps that's why it's seen as important. If you can actually make them sit up and notice when they read your personal statement, it might mean something special?

 

[Pinkertinkle]

Perhaps that's why it's seen as important. If you can actually make them sit up and notice when they read your personal statement, it might mean something special?

Realistically when deciding interviews attendings get a pile of applications 20 deep to go through, the personal statement will get a 2 minute look at best if at all.

 

[jake2]

This survey seems pretty useless. I'd imagine if I were a program director, I would consider pretty much everything important. Grades, board scores, etc. would all help in getting a general impression of a candidate. So if a survey came around asking what was important, I would answer that I used pretty much every piece of information available. This survey seems to confirm that program directors use all information available, but not much else.

 

[BigRedBeta]

What this survey, IMO, fails at doing is showing how important the overall picture is. I have been told over and over simply checking off all the boxes in that list wont do, they have to have a picture of what kind of student you are. Furthermore, it makes it seem like to get into a competitive specialty, you have to be junior AOA, 250, peace corp, etc etc. Someone correct me if Im wrong but I dont think thats the case.

I don't think that's what it's saying at all.

What I took away from it is that, overall...whatever you do will play a role in getting an interview or how you are ranked at one program or another...BUT, there were 35 different criteria that played a role in getting an interview (and obviously no program uses all 35) and there were 45 criteria that played into the ranking of applicants. Certainly when it comes to rankings, the interview carries the most substantial weight as there are 6 items that are solely related to the 5-8 hours you are within the program's presence that all have mean ranks of importance of >4.0 plus two other criteria (dedication to field and interest in program) that you can use the interview to greatly enhance perception that also have high mean importance ranks.

I think the other key point that can't be repeated enough is that ~93% of US Seniors match in a given year, and roughly 85% of those who don't have to scramble will get one of their top three choices (which expands to greater than 90% when you include top 4 choices...and about 50% get their top choice in the match). And that's for all specialties combined, so if you're applying to the less competitive specialties like peds or IM (which is a significant number of individuals) you have a great shot at going where you want to go.

Bottom line is that no matter what, the match is still in favor of the students. Certainly surprises (like 87% of ENT PD's being worried about AOA membership) play a role in your chances, but any student, particularly those from US Allopathic Schools are starting with the odds in their favor.

 

[cgk]

Transitional Year is an internship year that you have to do for some residencies, such as Derm, Rads, Gas, Optho, EM... otherwise the first year of your categorical IM or GS residency is your intern year.

Plastics can be a residency in itself (or an integrated program) or it can be a fellowship after GS.

Theres something like an "integrated" oncology program.... kinda.... theres the American Board of Internal Medicine Research Pathway. The basic idea is, you do two years of Internal Med, two years of research in Oncology (or whatever), and then one or two years in that clinical specialty (depending on which one). At the end, you'll be board elegible in IM, and a specialty, and have an impressive CV.

Can you tell me where I can find more information about the IM Research Pathway? Where can I find a list of programs? Do they participate in NRMP? Please advise, Thanks!

 

[BigRedBeta]

For Internal Medicine
http://www.abim.org/certification/policies/research/requirements.aspx

For Peds:
Go to the ABP website: https://www.abp.org/ABPWebSite/
Click on the "Resident and Fellow Training" tab across the top, then in the left hand column on that page, there's a menu option that says "General Pediatric Special Training Pathways". The Accelerated Research Pathway is for anyone interested in becoming more of a physician scientist in a peds subspecialty and get more research time. The Integrated Research Pathway is limited to MD/PhD or comparable research experience and the Special Alternative Pathway is designed to finish General and sub-specialty training in 5 years rather than the standard 6 (but you have to be well prepared).

I only know what it's like in peds (and even though I want to do a fellowship, I'm not particularly interested in these programs, so my knowledge is limited), but it seems that the main limiting factor is having the fellowship program at your institution. Certainly, for IM, that's probably less of a concern as those fellowships are more widespread than their pediatric counterparts.

 

[howelljolly]

Can you tell me where I can find more information about the IM Research Pathway? Where can I find a list of programs? Do they participate in NRMP? Please advise, Thanks!

you can Google "American Board of Internal Medicine Research Pathway"
http://www.abim.org/certification/policies/research/requirements.aspx

You'll have to know which IM programs offer this pathway, and apply to them via the NRMP.

There are a few threads on this topic on the SDN, including a list of participating programs.

 

[waldenwoods]

Personal statement seems to be a bit overvalued considering everyones sounds the same.

Perhaps that's why it's seen as important. If you can actually make them sit up and notice when they read your personal statement, it might mean something special?

Realistically when deciding interviews attendings get a pile of applications 20 deep to go through, the personal statement will get a 2 minute look at best if at all.

The survey was exploring factors for both interview selection and ranking to Match. Perhaps, when time is limited and you're selecting whom to interview, 2 minutes really is all someone would spend on a personal statement. However, it gives the interviewer a window into the applicant's life, something to talk about during the interview and can lead to discussion that the applicant will inevitably be evaluated on post-interview. I'd agree with masterofmonkeys that the personal statement is important, and it wouldn't be important if they all sounded the same. My n=1 experience is that people have noticed what I've written. On the other hand, I've had one interviewer I don't think read any part of my application, and occasional interviewers who don't get the entire application to read. As the survey results show, personal statement is a factor cited by many, but not all, program directors. I guess the purpose of my posting a reply here is to say that personal statements can be important; I don't think their importance should be dismissed by future groups of applicants. People do read them.

 

[cgk]

you can Google "American Board of Internal Medicine Research Pathway"
http://www.abim.org/certification/policies/research/requirements.aspx

You'll have to know which IM programs offer this pathway, and apply to them via the NRMP.

There are a few threads on this topic on the SDN, including a list of participating programs.

Thanks for the invaluable information. Do you by chance know the thread that has the list of participating programs? Thanks!!

 

[PeepshowJohnny]

About the personal statement...

When I had my PD read my personal statement he liked it and (paraphrasing) that he didn't put much weight in personal statements.

He thought about it, then took that back and said that, while a personal statement doesn't get people interviews, they do keep people from getting them.

Personal statements that are long and rambling, full of spelling/grammar errors, or tell stories that wouldn't make anyone want them (I decided I wanted to do pathology after I got in a big fight with my internal medicine attending and didn't want to work with a bunch of jerks in Internal medicine).

So, personal statements DO have some value: they are a screen against loonies without having to invite them out and figure it out. Maybe that's what we're seeing.

 

[masterofmonkeys]

I'd agree with masterofmonkeys that the personal statement is important, and it wouldn't be important if they all sounded the same. My n=1 experience is that people have noticed what I've written. On the other hand, I've had one interviewer I don't think read any part of my application, and occasional interviewers who don't get the entire application to read.

It'd be interesting to do a survey of med student attitudes toward the personal statement and see if their views on personal statement importance are based on their attitude toward the exercise itself, their personal opinion on how well they think they did in expressing themselves, and how much they enjoy writing.

My n=1 experience was that the contents of my PS got brought up on a regular basis and in many cases formed the bulk of what we talked about during my interviews.

I suspect that the PS might not be of much help in getting an interview (it might be the reason you don't get one, though), but it may play a pretty key role in ROLs. No matter how objective you try to make a ranking process, ultimately subjective feel is going to be pretty critical. And the way a PS grabs the selection committee (and allows the student to express themself on interview day) probably does indeed play a crucial role in how you end up getting ranked. I find it hard to believe that especially in homogeneous applicant pools, subjective factors don't play a large role.

 

[Pinkertinkle]

It'd be interesting to do a survey of med student attitudes toward the personal statement and see if their views on personal statement importance are based on their attitude toward the exercise itself, their personal opinion on how well they think they did in expressing themselves, and how much they enjoy writing.

My n=1 experience was that the contents of my PS got brought up on a regular basis and in many cases formed the bulk of what we talked about during my interviews.

I suspect that the PS might not be of much help in getting an interview (it might be the reason you don't get one, though), but it may play a pretty key role in ROLs. No matter how objective you try to make a ranking process, ultimately subjective feel is going to be pretty critical. And the way a PS grabs the selection committee (and allows the student to express themself on interview day) probably does indeed play a crucial role in how you end up getting ranked. I find it hard to believe that especially in homogeneous applicant pools, subjective factors don't play a large role.

Pretty sure they're going to be focused on what you looked and acted like at the interview when making the ROL. I'd estimate 90% of personal statements read alike, 5% totally suck and can get you ruled out, and 5% may actually add a small amount to an application.

 

[masterofmonkeys]

I'd probably agree with that estimate. Which is kinda my point lol. If only one out of twenty actually stands out, you are going to remember it.

It's also going to be specialty dependent. If I'm in psych, I'm going to read a PS to look for passion, mature reasoning, and potential psychopathology. If I'm a neurosurgeon, I'm going to skim through your app to look for evidence that you can at least pretend not to be on the spine gravy train. If I'm in family, I want to look for evidence that you actually are committed to the idea of primary care and not just supremely lazy. Etc.

 

[BigRedBeta]

It'd be interesting to do a survey of med student attitudes toward the personal statement and see if their views on personal statement importance are based on their attitude toward the exercise itself, their personal opinion on how well they think they did in expressing themselves, and how much they enjoy writing.

My n=1 experience was that the contents of my PS got brought up on a regular basis and in many cases formed the bulk of what we talked about during my interviews.

I suspect that the PS might not be of much help in getting an interview (it might be the reason you don't get one, though), but it may play a pretty key role in ROLs. No matter how objective you try to make a ranking process, ultimately subjective feel is going to be pretty critical. And the way a PS grabs the selection committee (and allows the student to express themself on interview day) probably does indeed play a crucial role in how you end up getting ranked. I find it hard to believe that especially in homogeneous applicant pools, subjective factors don't play a large role.

Definitely would be an interesting survey. I've also had interviews that were dominated by aspects of my PS. And I also used my PS to directly address certain weaknesses in my application...which many interviewers have also commented on. Further many said they appreciated my openness about the issue and that it reflected favorably on me. So there is the chance for significant utility in the PS.

I think what it all comes down to is that interviewing for residencies is interviewing for a job which is not what med school interviews are like at all. At least while interviewing for pediatrics, I've felt the process is so completely different than med school interviews. The emphasis has been on finding people that are compatible to work with for the next 3 years. The PS is very first chance students have to show who they are. My friends going in medicine say they've felt the same way as I have. Perhaps it's different in the ultracompetitive specialties, but from talks with my friends going into these fields, it still seems that is a key element programs are looking for though it may not be the most important consideration.

 

[DoctaJay]

When do medical students normally starting writing their PS? Also, do you make it general or do you tailor it torwards the specialty you are interested in? I'm trying to figure out how different a medical school PS would be from a residency PS (besides the obvious differences).

 

[waldenwoods]

When do medical students normally starting writing their PS? Also, do you make it general or do you tailor it torwards the specialty you are interested in? I'm trying to figure out how different a medical school PS would be from a residency PS (besides the obvious differences).

(Hmm...the topic of personal statements could become a separate thread. I'm not a mod--but you are--can posts be split off?)

I started writing my PS about two weeks before ERAS allowed people to submit their applications, so about mid-August. It was something that I'd been thinking about for quite a while, just a group of ideas bouncing around in my head but not yet connected in a logical way. I didn't sit down to write until I'd thought about it several times over. That's just the type of person I am; others may have different opinions.

Definitely tailor it to the specialty to which you're applying. Your avatar has "FACS" on the white coat; I guess you're interested in surgery? So a personal statement might mention specific experiences, goals, or thoughts about a future career in surgery--whatever you want to write about--things that are unique and important to your identity that you want the selection committee to know about. Since you're talking about why you want to enter a particular specialty and not why you want to become a doctor, the things you write in a residency PS may be differerent from what you write in a medical school PS.

 

[Samoa]

What a waste of bandwidth. You can't use a Likert-type scale for something like this. You have to give people a certain number of points to distribute, and make them choose percentages. All that this kind of data really tells you is that PDs think everything is very important.

However, they could make this data more valuable if they presented the overall average of the weight placed on each item, and then reported instead the extent to which each specialty differed from the average on each variable.

This would highlight the fact that surgeons of all types care far more about who wrote your LORs and what they say about you, than do the non-surgical specialties.

I noted a bunch of other things about it, but my computer freezes up now whenever I try to download the report from NRMP, so I can't quote anything specific.

 

[PeepshowJohnny]

I agree, I think a survey that forces PD's where rank factors that are important vs. just assigning as score to all of them would probably be more discriminative.

Agree about the surgeons and LOR's. Also compare the importance of Step 2 for interviews between less competitive fields (IM, FM) and stuff like Rads and Derm. Even though the data is hazy, it does seem comfirm some long held beliefs on this board.

 

[masterofmonkeys]

However, they could make this data more valuable if they presented the overall average of the weight placed on each item, and then reported instead the extent to which each specialty differed from the average on each variable.

They did the former but not the latter. SDs would have been nice too. Still, at least the NRMP is taking a stab at giving us information in this and their outcomes data, even if it could be better.

I still wish we could get program-specific information (board scores, pubs, etc).

But they seem to have taken a greater interest in us than the NBME has (*cough* CS *cough*)

 

[drbetty]

I don't find this info that helpful. I guess it helps you "ballpark" the importance placed on various factors in your application according to which specialty you are applying for. However, I think that since individual schools vary so much in what they think is important in an applicant, looking at aggregate data like this isn't super helpful.

i agree. although what i did find interesting was that for pediatrics, many interview slots had been awarded prior to the MSPE release compared to most specialties.

Perhaps, when time is limited and you're selecting whom to interview, 2 minutes really is all someone would spend on a personal statement. However, it gives the interviewer a window into the applicant's life, something to talk about during the interview and can lead to discussion that the applicant will inevitably be evaluated on post-interview.

Definitely agree. Several components of my PS have formed the basis of the conversation for many of my interviews. However, on several interviews, my interviewer had allotted the majority of the time to a sales-pitch of the program &/or location and/or to answering my questions, rather than asking me specific questions about my application. Many have literally defined the "interview" as the opportunity for me to learn about the program...as opposed to vice versa I guess. So this leads me to the impression that either

1. Applicants are pre-ranked prior to the interview, or
2. The interviewer bases his/her evaluation on the application

and in both cases, the interview simply confirms that the applicant possesses decent social graces. Anybody have thoughts about this?

 

[Droopy Snoopy]

Definitely agree. Several components of my PS have formed the basis of the conversation for many of my interviews. However, on several interviews, my interviewer had allotted the majority of the time to a sales-pitch of the program &/or location and/or to answering my questions, rather than asking me specific questions about my application. Many have literally defined the "interview" as the opportunity for me to learn about the program...as opposed to vice versa I guess. So this leads me to the impression that either

1. Applicants are pre-ranked prior to the interview, or
2. The interviewer bases his/her evaluation on the application

and in both cases, the interview simply confirms that the applicant possesses decent social graces. Anybody have thoughts about this?

Probably more true for peds or FM than something like ENT or ortho, but yeah I see what you're saying. It's much more of a two-way sales pitch than med school admissions for example.

 

[drbetty]

It must vary by specialty, as I've heard applicants doing powerpoint presentations, knot-tying, apple-peeling (!) for more competitive specialties. At times, I found myself wishing non-inquisitive interviews to ask more questions, so I could feel like something was accomplished during the interview.

I wonder if we are pre-ranked at some of these places and the interview moves us up/down/no-change. I made a pre-ROL before my interviews and have been tweaking it after each interview - it seems easier this way while the gut-feeling is fresh.