4th yr IM auditions for pulmCC hopeful?

[thayermartini]

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3rd yr DO student here with no insight from school regarding this whole process. I want to match IM at a university program somewhere along the coasts, ideally in the NW, SW, or SE, that will provide me a good chance of matching a pulmCC fellowship after residency. Stats detailed below. I've done pretty well throughout third year and fear that I will have a poor performance on auditions when accounting for the stress of traveling, working every hour of the day,being in an unfamiliar environment, etc and hurt my chances of matching at these places but all everyone that I encounter from my school talks about is scheduling audition rotations so it's my impression that auditions are really important.

Stats: Probably 50-65%ile 1st/2nd year grades (no ranks reported so this is a guess based off of system histograms). 242 Step 1. 695 Level 1. COMATs: 125 on FM and pediatrics; 127 OB/GYN; 111 Psych. Typically scoring very high to perfect points on each evaluation except for OB/GYN which probably scores out to an average of 4.5-5.5/6 for each component of the evaluation but I have no idea what is standard at my school. COMATs and evaluations are each weighted 50% of the grade and honors is awarded to the top 15%ile of the class. I anticipate that I should be able to get honors with my performance so far but won't know until August.

 

[IntheClouds4ever]

What do you want to know? You’ll have to schedule an audition if you want a chance at a competitive institution... put your big kid pants on and get it done.

 

[deleted480308]

They are important

If you go and do poorly you can ruin your chances at that place

Don’t do poorly

 

[Dr. Death]

What do you want to know? You’ll have to schedule an audition if you want a chance at a competitive institution... put your big kid pants on and get it done.

This is not true at all. For ACGME University IM, your best chance is to NOT do "auditions." Auditions are a DO phenomenon that ACGME residencies don't subscribe to. If you are doing a surgical subspecialty, you do a Sub-I, which functions like an audition. If you are targeting one specific program, you could consider doing an IM sub-I at that institution. Even then, you'd probably be better off not going. Over the course of your four weeks you're going to have to learn the preferences of the attendings and residents, the EMR, where the bathrooms are, etc, etc. You'll be compared to the students that are at their home institution and have all these things down already. By the end of 4 weeks you'll certainly have the hang of it but by then the rotation is over. ACGME IM programs have too many spots to fill, they're looking for good stats, research and a good interview. Don't waste your time and money doing away rotations that are as likely to hurt you as help you.

See the IM subforum for more info on this topic

 

[thumbz]

I have to agree with Dr. Death. When I was a medical student I thought Sub-I's were a mandatory thing to match somewhere. Now that I'm on the other side of the table as a teaching attending my observation has been:

1. Students who look great on paper who would be ranked to match here more often than not sink themselves with a SubI when they come and don't function well. I would say this is 20% of our SubI's.
2. Students who would not match here based on their stats but do a SubI and are underwhelming to the point of reaffirming not to match them - this is 60% of our SubI's
3. Students who would easily be ranked to match with their stats who come and do a SubI and do a great job - this is 15% of our SubI's
4. Students who would not be ranked to match based on their stats but come to do a SubI and impress us to the point of being ranked to match - these unicorns are 5% of our SubI's

Keep in mind the above stats are subject to a 5% rounding error...

 

[InternistDO]

I was told that for DO applicants without an established IM home program, a subI at a reputable IM spot can get you a LoR that can give you some legitimacy, though I was also told to avoid doing one at a program you really really wanted to go to for the reasons listed above.

 

[Dr. Death]

I was told that for DO applicants without an established IM home program, a subI at a reputable IM spot can get you a LoR that can give you some legitimacy, though I was also told to avoid doing one at a program you really really wanted to go to for the reasons listed above.

I agree with this assessment. I don't even think it needs to be particularly reputable. A mid-tier University IM subI should be good enough. You just want a letter saying "he/she has adequate/above average/excellent clinical skills despite coming from a DO program."

 

[jdh71]

You need to worry about matching IM prior to matching into a palm/cc program.

Your IM program reputation and performance during residency (based on your letters of rec) + residency academic work (posters and papers) will get you interviews and a potential match.

 

[TeddyBoomBoom]

I agree with this assessment. I don't even think it needs to be particularly reputable. A mid-tier University IM subI should be good enough. You just want a letter saying "he/she has adequate/above average/excellent clinical skills despite coming from a DO program."

Lol... I hate you right now... but you ain’t wrong. ✅

 

[gergles]

So my question is if getting a LOR from a reputable program is better than doing auditions at a program you hope to match at. Is it better to do SubIs at strong programs that you have virtually no chance at matching (ie because you're a DO) and just get a letter vs trying to get a letter from one of your top choices that you can realistically match at?

 

[Dr. Death]

So my question is if getting a LOR from a reputable program is better than doing auditions at a program you hope to match at. Is it better to do SubIs at strong programs that you have virtually no chance at matching (ie because you're a DO) and just get a letter vs trying to get a letter from one of your top choices that you can realistically match at?

I think this is a good idea. The caveat being that there are only 40ish IM programs in the country that won't take a DO. These are programs like Duke, Penn, Harvard, the NYC big 4, etc. I would imagine getting a rotation there wouldn't be easy. And then you're competing with the best of the best for a letter, so you'd have to be really confident in your clinical skills.

 

[NontradICUdoc]

A pulmCC program is not going to care much for how you did in your SubI or your audition rotation. It boils down to how well you did in your ICU and pulmonary rotations in residency. In addition, how much interest did you show in the field during your residency. If you come to a pulm/cc interview and the only thing you have been reading are the Annals of Internal Medicine, then maybe you need to rethink your strategy.

At this juncture, your job is to get into a residency program in IM and then focus on getting into pulm/cc. Once you get into the ICU you may see that you want to do both, either one or the other, or neither.