Advantage of School Pedigree on Internal Medicine Residency Matching

[eyejust]

What advantage does going to a top 20/10 institution bring when it comes to matching a top IM academic residency?

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[ginsengreset]

This has been rehashed a million times on SDN, but since the search function on this site is admittedly absolute trash, I don't blame you for asking.

From what I can tell, the following are possible benefits, using a hypothetical MS4 named Alex Applicant:

- "Wow, Alex did their IM rotation with [big-name doc who designed important thing] and got an excellent letter, this applicant must be the real deal"
- "Wow, Alex did a lot of research with [high-impact PI with lots of funding and big name in the field] and has been very productive in terms of publications, I think they'll be a good fit for our residency"
- "Alex came from [t20 school], we've had a lot of residents from there and they've all been very good"
- and possibly the least significant: "Alex came from [t20 school], we haven't really had them before but I've heard good things about that school (aka they're highly ranked)"

Note that the top 2 "benefits" require you to 1) be a good medical student and 2) work hard in research , things that are inherent to the person and not to the prestige of the program. It's admittedly easier to make the connections that help you get into a top residency at a t20, since a lot of the big-name people in the field are probably in those programs. However, "big names" are not confined to T20 programs - one of the developers of motivational interviewing in psychiatry is at the University of New Mexico, for example, and a glowing letter from him would probably open many doors.

 

[ace_inhibitor111]

You have the best chance of matching at your home institution, and it so happens that the Top 20 medical schools also have the Top 20 IM programs, so clearly going into a Top 10/20 medical school is automatically a huge advantage. But there is also a lot of lateral movement at the top schools. If you look at match lists, 80-100% of students at Top 10/20 medical schools also match Top 10/20 programs, either at their institution or elsewhere. Go down and compare the USNews rank 80 or below and it’s only like 10% of the class that match into Top 10/20 IM programs (basically only the AOA members).

I’d say school ranking is way more important than Step scores in matching into a Top 10/20, and approx. equivalent to having AOA. A student with 230 Step at Harvard has a great chance of matching at Harvard, Yale or whatever, while a student with a 260 Step without AOA at a place like FIU (nothing wrong with this school but just giving an example) has a quite low chance at the Top 20 but will probably do fine with mid-tier institutions. You can check the the 2019 match spreadsheet data for proof.

 

[throwaway1000000]

Huge advantage.
You can match into a top-tier institution from a low-tier institution but you need to have everything going in your favor. My example: Step 1 250s, Step 2 260s, nearly all honors missed AOA, strong letters, strong ECs, 2 published papers, matched into top 30. 1 interview from top 20, WashU. 1 interview from top 25 (baylor). Happy where I matched but pretty sure I would be competitive in terms of step scores, letters, research at top institutions (sure I missed AOA but not all the applicants have AOA).
Like said above, going to into a top-tier med school will allow you to match into a top-tier institution with average stats. Going into a med-school like mine can harm your app if you missed something like AOA.

 

[efle]

Huge advantage.
You can match into a top-tier institution from a low-tier institution but you need to have everything going in your favor. My example: Step 1 250s, Step 2 260s, nearly all honors missed AOA, strong letters, strong ECs, 2 published papers, matched into top 30. 1 interview from top 20, WashU. 1 interview from top 25 (baylor). Happy where I matched but pretty sure I would be competitive in terms of step scores, letters, research at top institutions (sure I missed AOA but not all the applicants have AOA).
Like said above, going to into a top-tier med school will allow you to match into a top-tier institution with average stats. Going into a med-school like mine can harm your app if you missed something like AOA.

I'm actually shocked to see you get only a WashU interview with that application - were you coming from a brand new and/or DO program?

 

[throwaway1000000]

I'm actually shocked to see you get only a WashU interview with that application - were you coming from a brand new and/or DO program?

Low-tier MD.
With AOA, I think I would have gotten Mayo, Vanderbilt, Duke and a few other universities.
AOA plays a pretty big role in IM. 240s+AOA will give you a better yield than 250s without AOA.
Sure, there are people without AOA that also get good programs but I didn't.
Don't think my experience is rare either. I would say 50% of the people with my app will have the experience I did. The other 50% with my app will get better programs than I will (mentioned above). Peek into some of the IM threads on sdn that list their stats and interviews they got. You will find many people with similar apps.
Why? Not sure. IM interview process is pretty random. I have met people with average apps get better programs than I did.

 

[efle]

Low-tier MD.
With AOA, I think I would have gotten Mayo, Vanderbilt, Duke and a few other universities.
AOA plays a pretty big role in IM. 240s+AOA will give you a better yield than 250s without AOA.
Sure, there are people without AOA that also get good programs but I didn't.
Don't think my experience is rare either. I would say 50% of the people with my app will have the experience I did. The other 50% with my app will get better programs than I will (mentioned above). Peek into some of the IM threads on sdn that list their stats and interviews they got. You will find many people with similar apps.
Why? Not sure. IM interview process is pretty random. I have met people with average apps get better programs than I did.

Interesting to know that AOA is so important, I thought that was more of a surgical subspecialty concern. The most recent JHH cohort is >50% from mid-tier and low-tier MD schools, but I guess they must all have hit AOA cutoffs.

 

[throwaway1000000]

Interesting to know that AOA is so important, I thought that was more of a surgical subspecialty concern. The most recent JHH cohort is >50% from mid-tier and low-tier MD schools, but I guess they must all have hit AOA cutoffs.

Ya I would say majority probably did. But this is just me guessing based on my school. That's how my school apps panned out. The ones with lower step scores but AOA had a better yield.
Also a big amount of geographical bias that goes in here. Coming from a mid-west school, even if I had AOA, my chances would be much higher at Northwestern, WashU, U chicago, Mayo, vanderbilt (i know not mid-west but lots of people from my school with aoa got it here) than the top east coast programs.

 

[bobjonesbob]

Huge advantage.
You can match into a top-tier institution from a low-tier institution but you need to have everything going in your favor. My example: Step 1 250s, Step 2 260s, nearly all honors missed AOA, strong letters, strong ECs, 2 published papers, matched into top 30. 1 interview from top 20, WashU. 1 interview from top 25 (baylor). Happy where I matched but pretty sure I would be competitive in terms of step scores, letters, research at top institutions (sure I missed AOA but not all the applicants have AOA).
Like said above, going to into a top-tier med school will allow you to match into a top-tier institution with average stats. Going into a med-school like mine can harm your app if you missed something like AOA.

My experience was the same. Mid tier school, 260s, 260s, AOA, strong letters, honored IM clerkship and sub-i, several 2nd author papers, ~15 total research items. Main weaknesses were school rank and all my research was geared toward a different specialty. Of the top ~20 programs only got interviews at: WashU, Michigan, Vandy, Emory, Yale, BIDMC

 

[efle]

What the hell...aren't there >1,000 seats at just the top 15-20 IM programs every year? There are only ~3500 US MD applicants to internal medicine in the first place.

It is blowing my mind that you guys aren't slam-dunk top 1/3rd of IM applicants. Would've predicted you'd get interviews from many or most.

 

[bobjonesbob]

What the hell...aren't there >1,000 seats at just the top 15-20 IM programs every year? There are only ~3500 US MD applicants to internal medicine in the first place.

It is blowing my mind that you guys aren't slam-dunk top 1/3rd of IM applicants. Would've predicted you'd get interviews from many or most.

You would think, but that's not exactly how it works. Home programs take loads of their own students as well as highly favoring other top 25 institutions even if they aren't as strong of applicants. That takes a lot of potentially available spots from qualified applicants from mid tier and lower tier schools.

Another major factor is diversity. Say 1000 spots at top 20 programs (average 50 per class). Programs are shooting for roughly 50/50 split of male to female even though most recent data from US grads shows males are 35% of IM residents and females 25% (I'd assume this gap will continue to narrow in future years though). Then consider race. Maybe of those 50% allotted to males, they shoot for no more than 70-80% of it as white or ORM and try to get 20% URM. Based on that, if you are male and white / ORM you are competing for maybe something like 350-400 spots instead of 1000. If you're not from a top 25 school, then probably cut that number in half.

 

[ace_inhibitor111]

What the hell...aren't there >1,000 seats at just the top 15-20 IM programs every year? There are only ~3500 US MD applicants to internal medicine in the first place.

It is blowing my mind that you guys aren't slam-dunk top 1/3rd of IM applicants. Would've predicted you'd get interviews from many or most.

There are 500+ students with AOA applying to IM every year... Half the Top 20 spots are going to students from the Top 20-30 medical schools, most of the rest are going to students with AOA.

 

[efle]

You would think, but that's not exactly how it works. Home programs take loads of their own students as well as highly favoring other top 25 institutions even if they aren't as strong of applicants. That takes a lot of potentially available spots from qualified applicants from mid tier and lower tier schools.

Another major factor is diversity. Say 1000 spots at top 20 programs (average 50 per class). Programs are shooting for roughly 50/50 split of male to female even though most recent data from US grads shows males are 35% of IM residents and females 25% (I'd assume this gap will continue to narrow in future years though). Then consider race. Maybe of those 50% allotted to males, they shoot for no more than 70-80% of it as white or ORM and try to get 20% URM. Based on that, if you are male and white / ORM you are competing for maybe something like 350-400 spots instead of 1000. If you're not from a top 25 school, then probably cut that number in half.

There are 500+ students with AOA applying to IM every year... Half the Top 20 spots are going to students from the Top 20-30 medical schools, most of the rest are going to students with AOA.

Looking at Tableau for IM, there are ~400 US MDs with AOA and a >240 per year. That shouldn't even be enough to fill half the top 20 seats!

Even using only the >240 to filter, that narrows the pool to ~1000 US MDs, about the number of annual seats in the top 20.

It just doesn't add up boys. Even if you're ORM from an average state school, there should be plenty of interview slots for a 260/AOA with research.

The only way I can make sense of this is from extrapolating the findings in this paper again. Maybe a very tiny group with scores, grades, research and a feeder med school are eating up the majority of t20 interviews, and leaving a disproportionately tiny fraction for the rockstars from unfamiliar names.

 

[throwaway1000000]

Looking at Tableau for IM, there are ~400 US MDs with AOA and a >240 per year. That shouldn't even be enough to fill half the top 20 seats!

Even using only the >240 to filter, that narrows the pool to ~1000 US MDs, about the number of annual seats in the top 20.

It just doesn't add up boys. Even if you're ORM from an average state school, there should be plenty of interview slots for a 260/AOA with research.

The only way I can make sense of this is from extrapolating the findings in this paper again. Maybe a very tiny group with scores, grades, research and a feeder med school are eating up the majority of t20 interviews, and leaving a disproportionately tiny fraction for the rockstars from unfamiliar names.

All my guess work is as below:
Looking at the 2018 charting outcomes for IM:
around 530 students with step 1>250 and 580 with step 2>260 (the stats I had).
Not all these 250+ and 260+ scorers will match into top 20 (I think 40 residents is more of an average class size so about 800 total spots at top 20 programs).
Main reasons being:
1) some programs weigh aoa heavily. 240 and aoa can give you better yield than 250 on s1. Not sure how many of 240+ s1 scorers (650) had AOA but almost all of them will be more competitive than me.
2) regional bias-overall there are 800 total top 20 spots but pretty big regional bias. I don't think anyone in my class matched into a top east program. even the ones with 260s on s1, 270s on s2 and aoa. So if you go to a mid-west school, that could potentially exclude you from top east coast programs of which there are many. not sure if mid-west programs have the same regional bias towards east coast students? If they do, this thing could even out. if they don't then east coast students might have better interview yield
3)bias towards top 40 med schools. I think quite a bit of these students here can take up top 20 IM interviews even with average stats

If AOA, regional bias, school prestige bias didn't exist than all 250+ s1 scorers (530) of them would match into the 800 or so spots. Given that lot of other factors exist, I think 20-30% of 250+ s1 scorers won't match into the top 20 programs. I happen to be in that 20-30% due to not having AOA, low-tier MD school, mid-west school

Overall, I don't really think going to a top 20 IM program is everything depending on your life goals. My life goal is to be an interventional cardiologist in private practice, so a top 30 IM program will absolutely fulfill that need for me. Even a top 40 program would have been fine.

 

[aldol16]

Basically, your question boils down to: Is it advantageous to come from a top academic program for matching at another top academic program? At which point the answer should be obvious. A lot of what goes into school "pedigree" and "prestige" is its research ranking, i.e. USNWR, and years of experience built up over decades. So yes, going to a top research school where you're pushed to generate research and are taught by/get to do research with great academic physicians is going to make it more advantageous when you're trying to match into a top academic program, regardless of specialty.

Just take a look at the match lists for Harvard, JHU, Stanford, Penn, etc. They tend to send a lot of people in IM to each other. That's no coincidence. Now, of course, there will always be students from other schools who match up because they're also impressive. But that doesn't mean that school doesn't matter.

 

[Amba]

Can confirm, went to top 10 med school with top 10 IM program, had plenty of average to below average (sometimes significantly below average) classmates who easily matched at home program for IM. And others who were average who matched at other top 20 IM programs.

 

[bobjonesbob]

Looking at Tableau for IM, there are ~400 US MDs with AOA and a >240 per year. That shouldn't even be enough to fill half the top 20 seats!

Even using only the >240 to filter, that narrows the pool to ~1000 US MDs, about the number of annual seats in the top 20.

It just doesn't add up boys. Even if you're ORM from an average state school, there should be plenty of interview slots for a 260/AOA with research.

The only way I can make sense of this is from extrapolating the findings in this paper again. Maybe a very tiny group with scores, grades, research and a feeder med school are eating up the majority of t20 interviews, and leaving a disproportionately tiny fraction for the rockstars from unfamiliar names.

Yeah I mean it's impossible to know for sure without inside knowledge from the PDs at these programs. But my guess is that you're significantly underestimating the number of people with step 1 <240 who are taking up interview slots. Only n=1 but a classmate with a solid app but step 1 score 50 points lower than mine, not AOA, decent research (but not phd or big time nature papers etc.) matched a top 10 IM program that no one else at my school even interviewed at.

Here is just an example of the inbreeding at these programs. These are compiled match results from 2020. 4 of the top IM programs in the country and ~30-40% of the seats are filled by students from only 3 different medical schools

MGH IM
Harvard - 9
Penn - 5
UCSF - 2

BWH IM
Harvard - 14
Penn - 2
UCSF - 1

UCSF IM
UCSF - 14
HMS - 4
Penn - 2

Penn IM
Penn - 21
Harvard - 0
UCSF - 0

 

[Chromium Surfer]

Yeah I mean it's impossible to know for sure without inside knowledge from the PDs at these programs. But my guess is that you're significantly underestimating the number of people with step 1 <240 who are taking up interview slots. Only n=1 but a classmate with a solid app but step 1 score 50 points lower than mine, not AOA, decent research (but not phd or big time nature papers etc.) matched a top 10 IM program that no one else at my school even interviewed at.

Here is just an example of the inbreeding at these programs. These are compiled match results from 2020. 4 of the top IM programs in the country and ~30-40% of the seats are filled by students from only 3 different medical schools

MGH IM
Harvard - 9
Penn - 5
UCSF - 2

BWH IM
Harvard - 14
Penn - 2
UCSF - 1

UCSF IM
UCSF - 14
HMS - 4
Penn - 2

Penn IM
Penn - 21
Harvard - 0
UCSF - 0

Damn, is this data publicly available? Specifically do you have a link that shows the incoming residents for Penn?

 

[bobjonesbob]

Damn, is this data publicly available? Specifically do you have a link that shows the incoming residents for Penn?

The data I used is from the medical schools' match lists not the residencies. Most schools are in the match list thread.

Match List 2020 - post what you got

Match List for 2020! Western Michigan Homer Stryker School of Medicine (WMed) https://med.wmich.edu/node/2289 Pretty impressive they got neurosurgery (UofM), Derm, ortho, IR

forums.studentdoctor.net

 

[throwaway1000000]

Yeah I mean it's impossible to know for sure without inside knowledge from the PDs at these programs. But my guess is that you're significantly underestimating the number of people with step 1 <240 who are taking up interview slots. Only n=1 but a classmate with a solid app but step 1 score 50 points lower than mine, not AOA, decent research (but not phd or big time nature papers etc.) matched a top 10 IM program that no one else at my school even interviewed at.

Here is just an example of the inbreeding at these programs. These are compiled match results from 2020. 4 of the top IM programs in the country and ~30-40% of the seats are filled by students from only 3 different medical schools

MGH IM
Harvard - 9
Penn - 5
UCSF - 2

BWH IM
Harvard - 14
Penn - 2
UCSF - 1

UCSF IM
UCSF - 14
HMS - 4
Penn - 2

Penn IM
Penn - 21
Harvard - 0
UCSF - 0

I knew there is a big bias but this is pretty incredible.

 

[5yewy5r]

Can confirm, went to top 10 med school with top 10 IM program, had plenty of average to below average (sometimes significantly below average) classmates who easily matched at home program for IM. And others who were average who matched at other top 20 IM programs.

Confirms what already seemed pretty obvious based on match lists. I mean, just eyeballing it statistically, if 90%+ your IM match is top 20... it's pretty obvious to me that the school name (or letter writers) essentially guarantees good match results for IM. Not sure if the same applies to the surgical subspecialties.

Glad to hear they won't even have to worry about pesky step 1 anymore.

 

[efle]

Just to clarify, I've always thought it was apparent that a big-name school could let you coast into a good IM spot. It's true that on a HMS match list, anyone not home matching into the Harvard system probably chose not to. They usually had a spot there waiting for them if they wanted it.

What's shocking to me is how fierce the competition is for the remaining 1/2 or 2/3 spots, after all the inbreeding is done. Those Big 4 lists have tons of representation from non-top schools too, and I didn't realize how much higher they were holding the bar for that half.

 

[efle]

Glad to hear they won't even have to worry about pesky step 1 anymore.

Everyone gets mad when they have to care more about boards and work harder than Top 20 students. But, they cared more and worked harder in college, that's what got them there. If we're all about rewarding hard work and merit why shouldn't getting accepted to a Top 20 come with a semi-reserved IM spot in their home residency? It's like getting free tuition when you get into NYU, it's part of the perk package and it makes no sense to throw shade about it, because they earned it by getting in.

 

[throwaway1000000]

Everyone gets mad when they have to care more about boards and work harder than Top 20 students. But, they cared more and worked harder in college, that's what got them there. If we're all about rewarding hard work and merit why shouldn't getting accepted to a Top 20 come with a semi-reserved IM spot in their home residency? It's like getting free tuition when you get into NYU, it's part of the perk package and it makes no sense to throw shade about it, because they earned it by getting in.

I think what's kind of stupid is if we are making step 1 p/f because it does not represent how strong of a candidate someone is, their undergrad performance would also not be indicative of what kind of resident they are going to be.
A double standard if step 1=useless but undergrad performance=representative of their strength as an applicant.

 

[efle]

I think what's kind of stupid is if we are making step 1 p/f because it does not represent how strong of a candidate someone is, their undergrad performance would also not be indicative of what kind of resident they are going to be.
A double standard if step 1=useless but undergrad performance=representative of their strength as an applicant.

Honestly, aside from the rare late bloomer, I think the admission process to medical school captures people better than clerkship grades or LORs does. Someone who was top of class at an Ivy League college and churned out papers at the NIH is still going to be smart, hardworking and capable of doing research 3 years later when they apply to residency.

I mean, look at the Yale system and how their students do despite no structure. I can see why PDs notice the name, it's not because they think the professors at Yale taught them any better, it's because getting into Yale makes you a safer bet for being a competent and self motivated individual.

 

[Lawpy]

Honestly, aside from the rare late bloomer, I think the admission process to medical school captures people better than clerkship grades or LORs does. Someone who was top of class at an Ivy League college and churned out papers at the NIH is still going to be smart, hardworking and capable of doing research 3 years later when they apply to residency.

I mean, look at the Yale system and how their students do despite no structure. I can see why PDs notice the name, it's not because they think the professors at Yale taught them any better, it's because getting into Yale makes you a safer bet for being a competent and self motivated individual.

I'm glad you view Yale positively because preallo already decided the school's reputation is somehow declining in medical community recently

 

[efle]

I'm glad you view Yale positively because preallo already decided the school's reputation is somehow declining in medical community recently

They went down in US News and preallo hasn't figured out how to track the PD/Peer ratings instead yet

 

[WedgeDawg]

I think what's kind of stupid is if we are making step 1 p/f because it does not represent how strong of a candidate someone is, their undergrad performance would also not be indicative of what kind of resident they are going to be.
A double standard if step 1=useless but undergrad performance=representative of their strength as an applicant.

Clinical performance +/- AOA will give you a chance to stand out as a medical student and is definitely more important from a practical standpoint than step 1 performance. Clinical evals chronicle your development as a clinician over the course of 1-1.5 years and integrate clinical ability, teamwork, knowledge, adaptability, dependability, and the overall impression you make on those you're working with, which aligns pretty well with (or at least along the same trajectory as) how you're going to need to function as a resident. Compare that to a one day representation of how well you take a test that tests a lot of esoteric knowledge that most people take before even setting foot in a clinical role. Not saying that the knowledge isn't important to be familiar with (because even stuff like the krebs cycle has implications for brain tumor prognostication), but it's not going to represent your strength as a resident.

Even in my highly competitive field that traditionally values high step scores, we are interviewing more and more applicants with lower than average (for the field) scores because of the incredible strengths of the rest of their application (research, letters, grades, etc). Plenty of these applicants come from non-powerhouse schools too. Of course there are still many applicants with 260s and 270s, but the other end is represented more than I would have thought.

There are ways to set yourself apart without a stratospheric test score regardless of what school you attend. Is going to a well-regarded school an advantage? Yes, but it's not a necessary component of a top-tier residency application.

 

[throwaway1000000]

Honestly, aside from the rare late bloomer, I think the admission process to medical school captures people better than clerkship grades or LORs does. Someone who was top of class at an Ivy League college and churned out papers at the NIH is still going to be smart, hardworking and capable of doing research 3 years later when they apply to residency.

I mean, look at the Yale system and how their students do despite no structure. I can see why PDs notice the name, it's not because they think the professors at Yale taught them any better, it's because getting into Yale makes you a safer bet for being a competent and self motivated individual.

Disagree. Board scores, LORs, clerkship grades are much better indicator for me of their strength as a resident than how they performed during their undergraduate years.
Plenty of average candidates at these big name medical schools.
Don't want to continue this discussion though because you won't change your opinion, neither will I. we can have different opinions and move on.

 

[throwaway1000000]

Clinical performance +/- AOA will give you a chance to stand out as a medical student and is definitely more important from a practical standpoint than step 1 performance. Clinical evals chronicle your development as a clinician over the course of 1-1.5 years and integrate clinical ability, teamwork, knowledge, adaptability, dependability, and the overall impression you make on those you're working with, which aligns pretty well with (or at least along the same trajectory as) how you're going to need to function as a resident. Compare that to a one day representation of how well you take a test that tests a lot of esoteric knowledge that most people take before even setting foot in a clinical role. Not saying that the knowledge isn't important to be familiar with (because even stuff like the krebs cycle has implications for brain tumor prognostication), but it's not going to represent your strength as a resident.

Even in my highly competitive field that traditionally values high step scores, we are interviewing more and more applicants with lower than average (for the field) scores because of the incredible strengths of the rest of their application (research, letters, grades, etc). Plenty of these applicants come from non-powerhouse schools too. Of course there are still many applicants with 260s and 270s, but the other end is represented more than I would have thought.

There are ways to set yourself apart without a stratospheric test score regardless of what school you attend. Is going to a well-regarded school an advantage? Yes, but it's not a necessary component of a top-tier residency application.

Uh, I agree with you on all those things.
I think your reply is out of context with what was being discussed in this thread. I think the crux of this thread was if average applicants from top schools should have a leg over excellent applicants from low-tier schools, which is a strong trend in IM. Can read mine and other posts above for more detail.
Although I do care, I don't think it's a huge deal if someone got a spot over due to their school status. But if we are talking about making the application process more representative of your strength as a med student and future resident, I would argue step 1 score is more indicative of that than your undergrad performance.
I think it would be good if your medical school was blinded to PDs in the application process. Let MD/DOs be evaluated by the strength of their application than the strength of their school. Should help DOs a lot.

 

[efle]

Clinical performance +/- AOA will give you a chance to stand out as a medical student and is definitely more important from a practical standpoint than step 1 performance. Clinical evals chronicle your development as a clinician over the course of 1-1.5 years and integrate clinical ability, teamwork, knowledge, adaptability, dependability, and the overall impression you make on those you're working with, which aligns pretty well with (or at least along the same trajectory as) how you're going to need to function as a resident. Compare that to a one day representation of how well you take a test that tests a lot of esoteric knowledge that most people take before even setting foot in a clinical role. Not saying that the knowledge isn't important to be familiar with (because even stuff like the krebs cycle has implications for brain tumor prognostication), but it's not going to represent your strength as a resident.

Even in my highly competitive field that traditionally values high step scores, we are interviewing more and more applicants with lower than average (for the field) scores because of the incredible strengths of the rest of their application (research, letters, grades, etc). Plenty of these applicants come from non-powerhouse schools too. Of course there are still many applicants with 260s and 270s, but the other end is represented more than I would have thought.

There are ways to set yourself apart without a stratospheric test score regardless of what school you attend. Is going to a well-regarded school an advantage? Yes, but it's not a necessary component of a top-tier residency application.

What percent of your co-residents there are from non-top-40 NIH schools?

Disagree. Board scores, LORs, clerkship grades are much better indicator for me of their strength as a resident than how they performed during their undergraduate years.
Plenty of average candidates at these big name medical schools.
Don't want to continue this discussion though because you won't change your opinion, neither will I. we can have different opinions and move on.

Hasn't been my experience and, per the match lists, clearly also not the experience of the PDs at major centers across the country. Curious what experience you've had to make you say that

 

[throwaway1000000]

Hasn't been my experience and, per the match lists, clearly also not the experience of the PDs at major centers across the country. Curious what experience you've had to make you say that
[/QUOTE]

Someone's reply above:
"Can confirm, went to top 10 med school with top 10 IM program, had plenty of average to below average (sometimes significantly below average) classmates who easily matched at home program for IM. And others who were average who matched at other top 20 IM programs."

Also talking to my friends at top schools about what they thought of their classmates.

Good point why PDs take these candidates from top schools that are average. Personally, not sure. Do they like their residents to come from pretigious schools? Does that make them look better? Very possible. Don't think all programs schools release their candidates' step 1 avg score but most programs do show which schools their residents are coming from.

Also, disclaimer, I don't actually care about this topic very much. Prestige bias is not unique to medicine, it happens in every field. In fact, being an MD candidate, I think I also benefitted from this. There are no doubt DOs with better stats than me that got left behind due to their school name.

But if we are talking about making the application process more fair then I think there are much much better indicators of your strength as a candidate than your med school name.

 

[WedgeDawg]

What percent of your co-residents there are from non-top-40 NIH schools?

~25%, though I'm not really sure what constitutes top 40 so that might be a little higher or lower depending on where some schools fall

I will say that for IM it seems to matter more, given where people from my medical school match. In surgical fields where away sub-Is are more common, you can make up for a weak home department by doing sub-Is at places with strong programs, though there are still a disproportionate number of applicants (and probably matched applicants) from strong schools, but it is difficult to tell its because the caliber of applicant is generally higher at these schools, more people are interested coming from these schools, or there is bias towards high-tier schools and/or schools with strong programs within that specialty. I'm willing to bet its most likely a combination of all these factors.

 

[efle]

I think they mean relative to their student body, they had average and below-average peers that still landed good IM spots. As in, the person at the 25th percentile at Harvard can still get a decent IM residency. Very different from saying that HMS is full of students who are below-average compared to the USA med student population at large.

Tell me the indicators then. Step 1 is disappearing, clinical grades are an inflated mess of playing "guess the 5-givers", research is a ratrace of who can present the same handful of small projects at the most conferences, and everyone has glowing LoRs that most people skip to the bottom paragraph when reading now. It doesn't surprise me at all that big names are so valued when that's the alternatives.

 

[libertyyne]

Clinical performance +/- AOA will give you a chance to stand out as a medical student and is definitely more important from a practical standpoint than step 1 performance. Clinical evals chronicle your development as a clinician over the course of 1-1.5 years and integrate clinical ability, teamwork, knowledge, adaptability, dependability, and the overall impression you make on those you're working with, which aligns pretty well with (or at least along the same trajectory as) how you're going to need to function as a resident. Compare that to a one day representation of how well you take a test that tests a lot of esoteric knowledge that most people take before even setting foot in a clinical role. Not saying that the knowledge isn't important to be familiar with (because even stuff like the krebs cycle has implications for brain tumor prognostication), but it's not going to represent your strength as a resident.

Even in my highly competitive field that traditionally values high step scores, we are interviewing more and more applicants with lower than average (for the field) scores because of the incredible strengths of the rest of their application (research, letters, grades, etc). Plenty of these applicants come from non-powerhouse schools too. Of course there are still many applicants with 260s and 270s, but the other end is represented more than I would have thought.

There are ways to set yourself apart without a stratospheric test score regardless of what school you attend. Is going to a well-regarded school an advantage? Yes, but it's not a necessary component of a top-tier residency application.

Could you shed some light on some phrases used in MSPEs that garner traction ?

 

[throwaway1000000]

I think they mean relative to their student body, they had average and below-average peers that still landed good IM spots. As in, the person at the 25th percentile at Harvard can still get a decent IM residency. Very different from saying that HMS is full of students who are below-average compared to the USA med student population at large.

Tell me the indicators then. Step 1 is disappearing, clinical grades are an inflated mess of playing "guess the 5-givers", research is a ratrace of who can present the same handful of small projects at the most conferences, and everyone has glowing LoRs that most people skip to the bottom paragraph when reading now. It doesn't surprise me at all that big names are so valued when that's the alternatives.

Uh..Already gave my reasoning. If you disagree, you disagree. If you think even the average applicant (Step score in 230s/240s, no AOA, average clinical evals) from a top med school is better than a strong candidate from a low-tier school (step score in 250s, 260s, AOA, strong clinical evals) then I can't argue with you. If there is some data to say the avg student at the top 30-40 med schools is automatically better than even the strong students at a low-tier MD or DO school, then I might agree with you. But I don't know of any such data other than the fact that PDs tend to prefer students from the top medical schools.

Clinical grades, LORs, Step 2 CK all have a pretty big role to play.
I agree research is BS.

What are med schools apps based on? Same things above. Instead of Steps, it's the MCAT. Instead of your clinical grades, it's your GPA. Instead of your attending LORs, it's your undergrad profs LORs.
Med school clinical grades, med school LORs, med school step scores are much better for me than your undergrad MCAT, undergrad GPA, and undergrad LORs.

Also, made all my points...my last post in this thread. Don't think I have other pertinent points to make. If you disagree, you disagree.

 

[echidna001]

I think low tier + AOA levels the playing field to some degree in internal medicine. I was lucky enough to receive a lot of top 20 interviews coming from a low tier school but I was able to get into AOA (barely) and had some other unique things on my application. I ended up matching into a top program but definitely feel like the exception to the rule.

I somewhat disagree that students from top 20 med schools tend to work harder/care more in undergrad than students who end up going to average/low tier medical schools.
1. Some students have to work to support themselves during undergrad. While you can work super hard to maintain good grades, you pretty much cannot do any of the unique extracurricular activities that might help your application. Especially when you're working full time.
2. Some individuals don't realize they want to do medicine in undergrad. In my program, a B was considered hard to reach in certain classes. I was THRILLED with a B in calc III, thermodynamics, differential equations, and fluid mechanics - I didn't know my science GPA was going to be considered a little low by med schools. I know A's in some architecture/art programs are basically unobtainable as well. People with different undergraduate degrees may be at a disadvantage in regards to GPA, letters of rec and MCAT preparation.
3. Some people can't afford to attend some of the schools that offer them acceptance and want to keep their student loan debt managable. Some people have family or other geographic reasons to stay in a certain location for the time being. Some people receive large scholarships at low tier schools. Some people just get a great vibe at a certain program. I think there are plenty of reasons for a high achieving student to go to a low tier school and continue to do well. I chose my med school over some that are more well regarded and wouldn't change a thing!

That being said, while I felt my non-trad status worked against me when I was applying to medical school, I felt it worked in my favor when applying to residency - so it balanced out .

Moral of the story (for the OP) - coming from a top med school gives you an advantage but you can overcome that with a well rounded application, AOA, good letters of rec and decent board scores if you go to a low tier school.

 

[efle]

Uh..Already gave my reasoning. If you disagree, you disagree. If you think even the average applicant (Step score in 230s/240s, no AOA, average clinical evals) from a top med school is better than a strong candidate from a low-tier school (step score in 250s, 260s, AOA, strong clinical evals) then I can't argue with you. If there is some data to say the avg student at the top 30-40 med schools is automatically better than even the strong students at a low-tier MD or DO school, then I might agree with you. But I don't know of any such data other than the fact that PDs tend to prefer students from the top medical schools.

Clinical grades, LORs, Step 2 CK all have a pretty big role to play.
I agree research is BS.

What are med schools apps based on? Same things above. Instead of Steps, it's the MCAT. Instead of your clinical grades, it's your GPA. Instead of your attending LORs, it's your undergrad profs LORs.
Med school clinical grades, med school LORs, med school step scores are much better for me than your undergrad MCAT, undergrad GPA, and undergrad LORs.

Yeah, I have a fundamentally different view of these things. I think step score for a capable person is mostly reflective of how much they prioritize it; hence Hopkins having a near average score (234) and then among the highest (248) just a couple years later. The priority of the exam changed. AOA is largely meaningless at these schools; for example HMS doesn't award it and JHU gives it after the match, so there's no such thing on anyone's residency app. Plus there's schools like Yale with such rampant inflation that the most common transcript is pan-Honors anyway. I just don't buy into their value at all.

But, it sounds like we both agree this phenomenon is happening in PD's minds. If you want to scratch your head and say until there's data you can't understand why they're doing it...well, I dunno. I usually love data but I don't need any in this case, I just already know that a typical HMS student is an above average student.

 

[AnatomyGrey12]

I think they mean relative to their student body, they had average and below-average peers that still landed good IM spots. As in, the person at the 25th percentile at Harvard can still get a decent IM residency. Very different from saying that HMS is full of students who are below-average compared to the USA med student population at large.

Tell me the indicators then. Step 1 is disappearing, clinical grades are an inflated mess of playing "guess the 5-givers", research is a ratrace of who can present the same handful of small projects at the most conferences, and everyone has glowing LoRs that most people skip to the bottom paragraph when reading now. It doesn't surprise me at all that big names are so valued when that's the alternatives.

I just already know that a typical HMS student is an above average student.

Average is average dude. If someone has average board scores, average grades, average clinical evals, and average LOR's then I fail to see why they are more qualified for a top residency than someone from a lower ranked school with 250/AOA/Excellent Clinical evals/etc purely because they played the pre-med game better and ended up at Harvard/Hopkins/UCSF/Etc.

Your fundamentally different view is a product of where you are at on the ivory tower.

 

[efle]

Average is average dude. If someone has average board scores, average grades, average clinical evals, and average LOR's then I fail to see why they are more qualified for a top residency than someone from a lower ranked school with 250/AOA/Excellent Clinical evals/etc purely because they played the pre-med game better and ended up at Harvard/Hopkins/UCSF/Etc.

Your fundamentally different view is a product of where you are at on the ivory tower.

I've had this position since I was a teenager, remember all the threads about how grading shouldn't be compared the same across undergrads? I kept having to remind everyone that the average JHU premed is facing much, much harder competition for those prereq grades than the folks down the road at U Maryland are. This feels like the same thing, being average amidst the student body at Perelman is a higher bar than being average amidst Drexel or Penn State. It's surprising to me that anyone disagrees.

 

[AnatomyGrey12]

I've had this position since I was a teenager, remember all the threads about how grading shouldn't be compared the same across undergrads? I kept having to remind everyone that the average JHU premed is facing much, much harder competition for those prereq grades than the folks down the road at U Maryland are. This feels like the same thing, being average amidst the student body at Perelman is a higher bar than being average amidst Drexel or Penn State. It's surprising to me that anyone disagrees.

It's a position only held by those who live in the bubble at the top of ivory tower academia.

 

[efle]

It's a position only held by those who live in the bubble at the top of ivory tower academia.

...and most PDs at strong programs, in every specialty, all over the country.

Do you extend this logic to other areas too? Do the big firms recruit heavily from t14 law because they're in a clueless bubble, or because the typical students there are much more capable? How about research funding and faculty track positions being easier to get when your PhD was from a leading lab at a leading university? Do silicon valley giants recruit more from top colleges because they want bragging rights, or because that's where the brightest software engineers are concentrated?

At some point we have to admit that cream rises and the student bodies at the well known, highly competitive, top ranking places aren't the same as the local state schools.

 

[ace_inhibitor111]

Honestly, aside from the rare late bloomer, I think the admission process to medical school captures people better than clerkship grades or LORs does. Someone who was top of class at an Ivy League college and churned out papers at the NIH is still going to be smart, hardworking and capable of doing research 3 years later when they apply to residency.

I mean, look at the Yale system and how their students do despite no structure. I can see why PDs notice the name, it's not because they think the professors at Yale taught them any better, it's because getting into Yale makes you a safer bet for being a competent and self motivated individual.

Not sure how undergraduate performance somehow supersedes actual performance in medical school. The whole point of the med school application process is to try and predict which undergraduate students will succeed in medical school. As with all predictions, they can frequently be wrong. If I wanted to predict who will be a good resident, why not use the most recent data points rather than those from 4-5 years ago?

 

[efle]

Not sure how undergraduate performance somehow supersedes actual performance in medical school. The whole point of the med school application process is to try and predict which undergraduate students will succeed in medical school. As with all predictions, they can frequently be wrong. If I wanted to predict who will be a good resident, why not use the most recent data points rather than those from 4-5 years ago?

Now obviously this is all biased by my personal experiences. Maybe other schools have wonderful, meaningful clerkship grading systems and wonderful, meaningful relationships resulting in unique letters of rec, and all the research you and your friends do is high quality work that will impact care.

But that's certainly not been my experience. I don't care that someone presented their tiny retrospective at six conferences. I don't care whether you got Honors or High Pass on your surgery clerkship because I know 90% of the time that's dictated by the site or team you're assigned. Letters are often boilerplate effusive crap for everyone, usually from people you only spent a few weeks with as a transient, small sub-I role on their team.

So yeah, the fact that you got past the HMS admissions committee could absolutely impress me just as much as your "actual performance in medical school" by any of those metrics. Clearly PDs feel similarly.

And don't get me wrong. This probably reads as self-masturbatory prestige mongering. I mean it more like an indictment of our garbage metrics. Familiar, respected school name is only valuable because so little else can meaningfully differentiate, just like is/was the case with Step 1.

 

[AnatomyGrey12]

At some point we have to admit that cream rises and the student bodies at the well known, highly competitive, top ranking places aren't the same as the local state schools.

No one said they weren't. But an average student at those schools is not inherently better than the top students at the local state schools by pure virtue of going to an elite school.

Do you extend this logic to other areas too?

Yes. Big law firms don't take just anyone from the T14 for pure fact of taking from the T14, Silicon Valley Giants don't take the below average students at the Ivy's simply because they went to any Ivy (if you don't perform you get ousted from Silicon Valley very quickly), and research funding is its own incestuous bag of worms.

At some point you have to perform at the level you're currently at and can't sit back and point at what you did before.

 

[efle]

No one said they weren't. But an average student at those schools is not inherently better than the top students at the local state schools by pure virtue of going to an elite school.


Yes. Big law firms don't take just anyone from the T14 for pure fact of taking from the T14, Silicon Valley Giants don't take the below average students at the Ivy's simply because they went to any Ivy (if you don't perform you get ousted from Silicon Valley very quickly), and research funding is its own incestuous bag of worms.

At some point you have to perform at the level you're currently at and can't sit back and point at what you did before.

Oh, absolutely agree. The top student at U of State is not coming in below the worst student at HMS. But the IQRs look different.

Put yourself in their shoes. If you had to make guesses at the population level - a randomly sampled 240 HMS versus a 250 at unfamiliar U of State - you can see why they'd give the benefit of doubt to the former. They're much more likely to get rewarded than burned.

 

[WedgeDawg]

Could you shed some light on some phrases used in MSPEs that garner traction ?

To be honest, I'm not sure that we looked at MSPEs that much (or at least I personally didn't). When I looked at applications, I would look at where they went to school, what kind of research they did and who they did it with, glance at their grades and maybe eyeball class rank, eyeball step, and then see where they did their sub-Is and read their letters. I don't think I read a single personal statement, definitely didn't read an MSPE, and didn't really look at anything else.

But for me, I didn't really care about all that. By virtue of getting an interview, I just assumed they met whatever academic standards the program set forth. I was more concerned with what were they going to bring to the table as a new intern. Is the someone who learns quickly and is adaptable, someone easy to work with, someone who I can depend on and who is honest and knows when to ask for help, and someone I just generally like. For small fields, that's why interviews, sub-Is, and resident/applicant dinners are so important. I literally do not give a flying f if you have 6 nature papers, a 285 step 1, glowing letters, AOA with all honors, and came from the best medical school in the galaxy - if you're an ass or give off a vibe that I'm not going to want to be around you for 90% of my waking hours, I do not want you training in the same program as me.

Luckily, in my program, residents have a say in the rank list, and we definitely have moved people around that otherwise interviewed well and were good on paper but did not get along well with the current cohort or vice versa.

 

[WedgeDawg]

@efle and @AnatomyGrey12 I think there is some truth to what both of you are saying but I also think that in practice it isn't as neatly defined as either of those scenarios. I think the process and what's important also differs significantly between specialties.

 

[TheIllusionist]

Non URM. 247 step1 261 ck. Mid tier. No AOA. Busted my ass and honored all rotations.

Onc research from research year including a couple middle authors on two basic pubs, some posters, and oral.

National and state leadership positions and big commitment to organized medicine. testified a few times in state legislature for med students in my state.

Matched at a T25. Interviews at mostly T40-60. 1 T25 and 1 T15 USWNR interview.

Kids who were AOA or GHHS or URM got way more elite tier interviews (little more for GHHS but lot more for others).

I made a spreadsheet. Out of 20 kids matching at top programs of nearly 80 from my school applying IM (crazy big cohort in class of 200+)- 13 AOA, 2 GHHs, 2 URM, 3 nothing (I was one of them and only 1 matched above me but at a T15, so he got his #1 but I got my #2.

My friends at top schools with 230s interviewed at better places than me without AOA.

AOA is a screen used for non top tiers.

Btw, IMO easier to be middle of the pack at an elite than top at even a low tier. And AOA can be VERY political. Please, unless MAJOR money diff, always pick higher tier school.

Btw, all of us non URM AOA GHHS matched in the middle of country at T25. Middle of the country like Mayo, UTSW, Baylor, Wash U, etc are less if prestige ****** than places like NYU, Sinai, Cornell, Emory, BU, BIDMC on the E Coast.

Btw, we had some 250 step1s with mostly clinical honors but no AoA and little research be relegated to a T40-50.

also weird trend, in some of the AoAs with similar stays but Ivy Tier undergrads doing better. Inb4 someone says they are probably smarter naturally or more charismatic than the state undergrad kids...Just no. They are mostly similar with a couple of guys even more awkward not more charismatic.

EM seemed A LOT more egalitarian with interviews. Hell even ENT, uro, and optho looking at our match.

 

[AnatomyGrey12]

But the IQRs look different.

I agree.

Put yourself in their shoes. If you had to make guesses at the population level - a randomly sampled 240 HMS versus a 250 at unfamiliar U of State - you can see why they'd give the benefit of doubt to the former. They're much more likely to get rewarded than burned.

I'm not thinking of 240 v. 250. There isn't really a difference there and in that scenario I agree with the PD. I'm talking the 225-230/non AOA v. the 250/AOA situations, which we do see born out fairly regularly. The post above about average to very below average students at a top 10 matching elite IM programs (or elite programs in many specialties honestly) is not the only time I've seen a student from a T10 say that.

There is nothing wrong with a home program giving a bump to it's own grads, however it's pretty obviously to the point of self-masturbatory prestige mongering in many instances at the top of the IM ivory tower (In the running for phrase of the year lol).

*this might be only applicable to IM or more generalist fields with large class sizes. Smaller fields might be more varied.