Academic psychiatry residencies

[tortuga87]

Hi everyone,

I've been fortunate enough to receive acceptances from MSTP programs this cycle, and I've always had the most interest in psychiatry. However, I have several concerns:

1. About PhD research. My research background is in computational neuroscience. Not many people work in this field in psychiatry as compared to fields such as neurology (e.g., epilepsy, Parkinson's) and neurosurgery (e.g., neural prosthetics). I'm wondering if academic psychiatry residencies "discriminate" against specific neuroscience sub-disciplines. For example, are they more receptive to behavioral neuroscientists?

2. Does anyone know the average Step 1 score for residencies in major academic centers? I know I should do my best regardless, but I'm curious to know a ballpark range.


Thanks!

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[psychattending]

Hi everyone,

I've been fortunate enough to receive acceptances from MSTP programs this cycle, and I've always had the most interest in psychiatry. However, I have several concerns:

1. About PhD research. My research background is in computational neuroscience. Not many people work in this field in psychiatry as compared to fields such as neurology (e.g., epilepsy, Parkinson's) and neurosurgery (e.g., neural prosthetics). I'm wondering if academic psychiatry residencies "discriminate" against specific neuroscience sub-disciplines. For example, are they more receptive to behavioral neuroscientists?

2. Does anyone know the average Step 1 score for residencies in major academic centers? I know I should do my best regardless, but I'm curious to know a ballpark range.


Thanks!

To my knowledge academic psych residencies don't discriminate. If you do well in medical school, I'm sure that most academic programs would be very happy to have you. You will need to find a program that provides you with excellent psych training and has the research training in your area of interest. Not all of the programs will meet that bill but as you go through your PhD training you will learn where are the better imaging centers in the country and which ones psychiatrists have access to.

 

[Manicsleep]

They do not but ignorance can sometimes have drawbacks.

As such, you may want to go to an academic center where the neurologist are strong and can be a source of support. They can help guide your training and guide/strong arm your chairperson/training director into giving you needed resources.

 

[notdeadyet]

Does anyone know the average Step 1 score for residencies in major academic centers? I know I should do my best regardless, but I'm curious to know a ballpark range.

Don't know about ranges, but I've been invited to interviews at what I thought of as decidedly reaches (UCSF, UCLA-NPI, etc.) with a Step 1 in the 210's and a Step 2 only slightly better. 7 interviews down and my Step 1 wasn't mentioned anywhere. If you have a strong app, I don't think a marginal or even below average Step 1 will keep you out of too many places.

 

[dl2dp2]

Hi everyone,

I've been fortunate enough to receive acceptances from MSTP programs this cycle, and I've always had the most interest in psychiatry. However, I have several concerns:

1. About PhD research. My research background is in computational neuroscience. Not many people work in this field in psychiatry as compared to fields such as neurology (e.g., epilepsy, Parkinson's) and neurosurgery (e.g., neural prosthetics). I'm wondering if academic psychiatry residencies "discriminate" against specific neuroscience sub-disciplines. For example, are they more receptive to behavioral neuroscientists?

2. Does anyone know the average Step 1 score for residencies in major academic centers? I know I should do my best regardless, but I'm curious to know a ballpark range.


Thanks!

Computational neuroscience is actually an excellent choice for a future career in psychiatry. Quite a few famous psychiatrist-scientists these days are essentially systems/computational oriented. If you are interested in more details PM me. Neurology, though traditionally more associated with this field, is now more focused on vascular biology, immunology and critical care. You'd be surprised by how little research most neurosurgeons do, and I don't blame them. While movement disorder/epilepsy is still strong, they have not been as active as some of the systems/computational work in psych, such as addiction, psychosis and more basic questions in cognition.

Regarding the second question, I would say that with an MSTP and good research in neuroscience and good clinical grades, step I is less important. However, I'd probably shoot for a standard deviation above the average. In 7-8 years, psych might become more competitive. But definitely don't stress over it.

 

[OldPsychDoc]

Computational neuroscience is actually an excellent choice for a future career in psychiatry. Quite a few famous psychiatrist-scientists these days are essentially systems/computational oriented. If you are interested in more details PM me. Neurology, though traditionally more associated with this field, is now more focused on vascular biology, immunology and critical care. You'd be surprised by how little research most neurosurgeons do, and I don't blame them. While movement disorder/epilepsy is still strong, they have not been as active as some of the systems/computational work in psych, such as addiction, psychosis and more basic questions in cognition.

Regarding the second question, I would say that with an MSTP and good research in neuroscience and good clinical grades, step I is less important. However, I'd probably shoot for a standard deviation above the average. In 7-8 years, psych might become more competitive. But definitely don't stress over it.

A PhD will trump a high Step I. Trust me, unless academia totally collapses before you graduate (um...don't take too long to defend your thesis...), programs will literally salivate over you at interview time. Definitely pass, and try to be above the mean--hey, you're a MudPhud, above the mean comes naturally to you--but with that PhD you will experience the advantage of being competitive by your mere existence!

 

[atsai3]

A PhD will help your application, but it cannot make up for severe deficiencies. In our committee deliberations we definitely passed on rockstar MD/PhDs whom (based on low grades / bad letters / low board scores) we didn't think would pass clinical muster at our program. However, as long as they had reasonable grades/letters/scores, the quality of their PhD experience did help them in the ranking process.

-AT.

 

[st2205]

A PhD will help your application, but it cannot make up for severe deficiencies. In our committee deliberations we definitely passed on rockstar MD/PhDs whom (based on low grades / bad letters / low board scores) we didn't think would pass clinical muster at our program. However, as long as they had reasonable grades/letters/scores, the quality of their PhD experience did help them in the ranking process.

-AT.

When you say "reasonable" what kind of ranges are we talking about? I'm having a hard time understanding how anything above a 200 would be a rule-out as an MD/PhD unless the other criteria you mentioned were sketchy. Perhaps this is what you mean (something below 200ish) but from all the talk (rumors and speculation, I know) of even the top programs taking applicants with less-than-stellar scores I'm trying to imagine what kind of score would put an MD/PhD out of contention. Perhaps you were just emphasizing the amalgamation of the other components of the application and I missed it.

 

[OldPsychDoc]

I will say that I have known MD/PhD types who were almost autistic in their lack of ability to demonstrate human empathy, so perhaps this is what atsai refers to as far as academic "rockstars" who really can't be taken seriously as psychiatry applicants. You do still need to have some humanity, some clinical acumen left.

 

[strangeglove]

I will say that I have known MD/PhD types who were almost autistic in their lack of ability to demonstrate human empathy, so perhaps this is what atsai refers to as far as academic "rockstars" who really can't be taken seriously as psychiatry applicants. You do still need to have some humanity, some clinical acumen left.

A PhD does not guarantee you an interview in any program you wish. The most competitive research-oriented programs, such as Columbia and MGH-McLean, are very much interested in your performance in the core clinical rotations. Any indication in your dean's letter that you were sub-par in these rotations can sabotage your application, even with a stellar publication record. Basically, they want people who can hack it as interns. This isn't about "people skills." It has more to do with motivation, attention to detail, and commitment to patient care. These are more important than Science papers, which do little to advance the care of patients. I know several MD-PhD's who failed to get interviews at Columbia and MGH-McLean, and they were not autistic and had some clinical acumen (but merely passed all of their clinical rotations). There are certain programs, such as Stanford, UCLA, Pitt and Yale, that will be more forgiving of sub-par clinical work as a medical student - if you have good publications. Notably, these are programs with "research tracks" that usually involve some short-shrifting of clinical duties. The above-mentioned MD-PhD's got interviews at all of these places.

 

[atsai3]

When you say "reasonable" what kind of ranges are we talking about? I'm having a hard time understanding how anything above a 200 would be a rule-out as an MD/PhD unless the other criteria you mentioned were sketchy. Perhaps this is what you mean (something below 200ish) but from all the talk (rumors and speculation, I know) of even the top programs taking applicants with less-than-stellar scores I'm trying to imagine what kind of score would put an MD/PhD out of contention. Perhaps you were just emphasizing the amalgamation of the other components of the application and I missed it.

One person we interviewed had a PhD from an outstanding program, along with outstanding letters from the research advisors. However, USMLE Step 1 was something like high 190s? I don't remember the exact number. Maybe it was just a hair above 200. In any case, the exact number is unimportant. What gave us more concern was that the clinical aspect of the application (clinical letters were also ho-hum, and this applicant didn't get any honors, or maybe 1 at the most) was markedly different from the research aspect of the application. This applicant was not autistic -- actually was a pleasant person to talk to, and many of my colleagues emailed me to say that this person would be a great addition to our program. But just not strong enough clinically as far as we could tell, and given that our program is one of the more rigorous ones out there (ie, in terms of work load, call, etc) we just had to pass.

There is no hard cutoff for "reasonable". From what I can tell from my years on the selection committee, <200-210 would be "there would have to be some strong extenuating circumstances, and the rest of her application had better be rockstar for us to take a chance on her", 210-230 is reasonable, 220-240 is average, >240 is "hey, he has pretty good scores", >265 is "holy crap". Note the overlaps -- again, these are not hard cutoffs. Certainly in the past 5 years there have been people accepted who had <200 board scores, and they turned out fine.

Similarly, good scores and a PhD really really aren't sufficient. Every year we have several applicants who come through with 250s, all honors, and/or multiple high powered publications. Interview day rolls around and they make multiple bad impressions, and we amass a data set with multiple perspectives that points to "we would rather take our chance on a scramble than have to work with this guy, but since we want to know where he ends up, we'll rank him in the bottom 5%". And s/he ends up at MGH, Columbia, etc.

You could view this as all very frighteningly arbitrary. Or you could view this as a matching process where both the programs and the medical student applicants are trying to find the best 'fit'. Once you start viewing it as a matter of 'fit' and stop trying to shoehorn the process into neatly defined categories (eg., meeting Step 1 cutoffs, having X number of publications, etc) it will be much less anxiety provoking.

-AT.

 

[notdeadyet]

From what I can tell from my years on the selection committee, <200-210 would be "there would have to be some strong extenuating circumstances, and the rest of her application had better be rockstar for us to take a chance on her", 210-230 is reasonable, 220-240 is average, >240 is "hey, he has pretty good scores", >265 is "holy crap".

>240 is "pretty good"? That's higher than the average score for Radiology. You folks run an impressively tight ship!

For the sake of the skittish applicants-to-be, I just wanted to point out that the scale above would probably only be found at just a handful of even the top programs. At the end of the day, the average for Psych (meaning, without a Ph.D. in hand) is still <215.

I know that's a point a bit off topic from the intent of our post, atsai3, but there's so much nervous panic from folks considering psych I just like to reinforce that average numbers will not be as limiting in Psychiatry as it would be in other more competitive specialties.

 

[Chimed]

>240 is "pretty good"? That's higher than the average score for Radiology. You folks run an impressively tight ship!

For the sake of the skittish applicants-to-be, I just wanted to point out that the scale above would probably only be found at just a handful of even the top programs. At the end of the day, the average for Psych (meaning, without a Ph.D. in hand) is still <215.

I know that's a point a bit off topic from the intent of our post, atsai3, but there's so much nervous panic from folks considering psych I just like to reinforce that average numbers will not be as limiting in Psychiatry as it would be in other more competitive specialties.

Yeah, I want to second this before applicants start freaking out...My Step 1 and 2 scores were below the mean. I did honor in all my psych rotations and did some minor research in psych (nothing major, though). I had excellent LORs. But with my scores and background, I matched into a "top program."

 

[cleareyedguy]

For a research-oriented MD/PhD, clinical evals trump the score, though the score isn't disregarded (we aren't worried that you can't cognitively do the work, but we do want to see ongoing effort, and the effort is visible in grades and to a lesser extent in scores).

If you are trying to get in to a top place based on your research, you should be able to discuss specifically what you want to do, and, preferably, with whom in the department you want to work. While a clinically-oriented resident can say they intend to "do some clinical, administrative, and writing," which is what we often hear from applicants, people who have devoted an additional several years to research should be held to a higher standard of sophistication. What we're looking for: it's not uncommon for MD/PhD's to choose psych because they no longer want to be researchers, and that's fine, but--if true--we don't need to give them the eval bump afforded to serious researchers.

When looking at residencies, it's useful to look at how many MD/PhD's are there, what they end up doing, whether the program will let you do research during your first few years as a resident, and whether they'll let you do the research outside the institution.

Your likely area of concentration would fit in well at a bunch of places.

One concern: you seem not to have even started medical school and are already wondering what minimum level of performance will get you into a top-notch residency. It may seem that school is a zero sum game, and you'll excel in research only if you give short shrift to the clinical stuff, but I'd suggest that's not a great attitude for a medical student. A half hearted attitude to medicine will irritate your teachers and fellow students, reduce your ability to serve the ill, and increase the likelihood that you will get bored and jaded. Further, the best research questions are asked by clinically sophisticated researchers, and you don't get sophisticated by being mediocre.

Incidentally, I've found MD/PhD's to be some of the very best medical students and residents since they seem more likely to retain intellectual curiosity through a system that tends to make people too cautious.