Advantage of School Pedigree on Internal Medicine Residency Matching

[WedgeDawg]

I agree.


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.

For what it's worth, people from my top 10 med school matched top programs in pretty much every field with 220s and 230s, and our peds/IM match list is always stellar (finding a non-top 15 program is the exception to the rule). I know for a fact that people with few or no honors and average to below average step scores matched top programs. I also know that people matched surgical subs with 220s. Again, my familiarity with the match process outside of my own specialty is somewhat limited, but that's just the data that I have.

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[bobjonesbob]

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.

I agree a lot of the evaluations aren't the best but in aggregate they were decent reflections of performance at my school. As you already alluded to in previous posts, the worst offenders of putting out worthless evaluations are the top tier schools. They give everyone pass and don't give out AOA. They don't want to stratify their students because it'll hurt the ones who aren't actually that strong. Whereas many mid and low tier schools still use class rank and AOA to distinguish students.

 

[Lawpy]

Why does IM suffer from a prestige problem that other specialties like EM and some surgical subs managed to avoid/reduce?

 

[efle]

Why does IM suffer from a prestige problem that other specialties like EM and some surgical subs managed to avoid/reduce?

EM doesnt feed into competitive academic fellowships and careers like top IM programs do.

The relatively higher equality in surgical subs probably comes from how stupidly overqualified even the average person is. When everyone has the scores, grades, letters and research you cant go wrong.

 

[Surgeonvivor]

This thread has surprisingly had some really good discussion.

 

[Dr. Death]

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.

Efle I love your analytical mind and agree with nearly everything you post, but I think the "late bloomer" is far less rare than you realize. Several people in my peasant DO class with 500 or lower MCAT finished med school top quartile, board scores 245-260 and 10+ publications. I think what is frustrating from our side of the fence is that we can't make up the gap. No matter how hard we try, the guy with a 221 with 2 pubs in the bottom quartile of HMS will get interviews we could never dream of, all because they had pre-med adivising that was worth a damn

 

[ExcitatorySynapse]

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.

Sometimes things just don't work out - I went to an elite undergrad but had a very hard time as an international student applying to MD/PhD programs. My American classmates are at the same tier med schools as our undergrad. Graduates from my program have actually matched well in recent years but they all noted that having high step scores helped them out. ¯\_(ツ)_/¯

It'll be interesting to see how AOA criteria changes as step goes P/F. I really hope that preclinical doesn't get weighted more, b/c imagine trying to compete with gunners who went hard for preclinical 5 years after you took those classes. All we can do is our best, I guess.

 

[efle]

Sometimes things just don't work out - I went to an elite undergrad but had a very hard time as an international student applying to MD/PhD programs. My American classmates are at the same tier med schools as our undergrad. Graduates from my program have actually matched well in recent years but they all noted that having high step scores helped them out. ¯\_(ツ)_/¯

It'll be interesting to see how AOA criteria changes as step goes P/F. I really hope that preclinical doesn't get weighted more, b/c imagine trying to compete with gunners who went hard for preclinical 5 years after you took those classes. All we can do is our best, I guess.

Forgive my ignorance since AOA isn't an important thing for my class - isn't it based on clinical performance, maybe plus or minus board scores? Are schools really out here awarding AOA based on preclinical exams?

 

[Frogger27]

Forgive my ignorance since AOA isn't an important thing for my class - isn't it based on clinical performance, maybe plus or minus board scores? Are schools really out here awarding AOA based on preclinical exams?

My school is 50% preclinical 50% clinical

 

[ExcitatorySynapse]

Forgive my ignorance since AOA isn't an important thing for my class - isn't it based on clinical performance, maybe plus or minus board scores? Are schools really out here awarding AOA based on preclinical exams?

Officially, you need to be top 15% for junior, top 25% for senior based on grades in "required courses/clerkships" for the first 3 years to apply. And actual application is 30% step, 30% clinicals, 40% scholarship or w/e that means. That being said, I talked to a senior from my program who got it (really exceptional student/scientist) and she said preclinicals didn't count for much but they were still there, which is a little confusing. Maybe they will end up subbing step 2 for step 1, as PDs likely will do.

Med school feels like such a rat race sometimes.

 

[libertyyne]

So, the key takeaway of this thread seems to be to send your kids to top undergrads, so that they can get into top medical schools, so that they can get into top residencies.

 

[efle]

So, the key takeaway of this thread seems to be to send your kids to top undergrads, so that they can get into top medical schools, so that they can get into top residencies.

Theres plenty of state college alumni in the top medical schools, just like the state med graduates in the top residencies. I'd offer my kid 200k to spend how they want. Hopefully theyll be smart enough to invest it and still go to state school for cheap. 30 years down the road that could become half a decade sooner for their retirement.

 

[deleted393595]

Efle I love your analytical mind and agree with nearly everything you post, but I think the "late bloomer" is far less rare than you realize. Several people in my peasant DO class with 500 or lower MCAT finished med school top quartile, board scores 245-260 and 10+ publications. I think what is frustrating from our side of the fence is that we can't make up the gap. No matter how hard we try, the guy with a 221 with 2 pubs in the bottom quartile of HMS will get interviews we could never dream of, all because they had pre-med adivising that was worth a damn

DO = MD, so lets get that out of the way. Arguably even > than MD with the MSK stuff you guys pick up.

But from my limited experience, unranked MD and DO schools teach to Step 1 and provide a substantial amount of dedicated study time for it. Clerkship grading is also far easier - you aren't competing against human memorization machines that nailed the 99%+ percentile on their MCATs while excelling at underwater piano recitals when not doing crew and maintaining an active Greek life.

From my experience with the HMS crowd, the guy with a 221 with 2 pubs in the bottom quartile of HMS probably didn't do so academically well since he/she used their limited time to instead do some high powered national or internationally recognized activity. They're a literal breed of superhumans and I'm frankly glad I don't have to compete with them at my school.

Correct me if I'm otherwise wrong on both observations.

 

[aldol16]

So, the key takeaway of this thread seems to be to send your kids to top undergrads, so that they can get into top medical schools, so that they can get into top residencies.

Theres plenty of state college alumni in the top medical schools, just like the state med graduates in the top residencies. I'd offer my kid 200k to spend how they want. Hopefully theyll be smart enough to invest it and still go to state school for cheap. 30 years down the road that could become half a decade sooner for their retirement.

Here's where economic principles can help. There's no doubt that sending your kid to a top school - at any level, whether that be undergrad or med school - is going to stack the odds in their favor. That doesn't mean they can't **** it up. That just means that they're in a better position to take advantage of their advantage. Advantages build on one another. But that also does not mean that you can't go to a state school and get to the same place. It also doesn't mean it won't be harder. Imagine a ladder. Everyone's trying to get to the top. But the guy who starts on the bottom rung is going to have a harder time than the guy who starts on the 75th rung. Both of them can fall. But they're not equal.

So then the question becomes what is the marginal benefit you derive from going to a top school compared to the marginal cost that you're paying? The marginal cost is easy to quantify. As you infer, it's high. But the marginal benefit is difficult to quantify. Some people will say it's high. Some people will say it's low. Some people will say it's worth the extra cost. Some people will say it's not. At that level, it's individual-dependent. No one should push someone one way or another, unless they know the full extent of that person's hopes, dreams, and values.

 

[efle]

To give some examples for perspective: We recently had a match panel where one of the guys (who had matched the #1 program in this specialty) was an author on >30 papers (~10 first author) during med school.

A different person applied to the school MD-only and was offered free funding for a PhD/admitted for MSTP instead. Why? He graduated MIT with a perfect GPA in engineering and put out not one, but two first author papers in one of the big Nature journals.

I know multiple people here with perfect MCAT scores. I know multiple people who did productive PhDs before med school. Multiple people that were previously working for the brand name consulting firms.

I could go on. Some schools don't have AOA for a reason. It's hard to appreciate without experiencing it I guess, but in some student bodies "average" is anything but.

 

[efle]

Here's where economic principles can help. There's no doubt that sending your kid to a top school - at any level, whether that be undergrad or med school - is going to stack the odds in their favor. That doesn't mean they can't **** it up. That just means that they're in a better position to take advantage of their advantage. Advantages build on one another. But that also does not mean that you can't go to a state school and get to the same place. It also doesn't mean it won't be harder. Imagine a ladder. Everyone's trying to get to the top. But the guy who starts on the bottom rung is going to have a harder time than the guy who starts on the 75th rung. Both of them can fall. But they're not equal.

So then the question becomes what is the marginal benefit you derive from going to a top school compared to the marginal cost that you're paying? The marginal cost is easy to quantify. As you infer, it's high. But the marginal benefit is difficult to quantify. Some people will say it's high. Some people will say it's low. Some people will say it's worth the extra cost. Some people will say it's not. At that level, it's individual-dependent. No one should push someone one way or another, unless they know the full extent of that person's hopes, dreams, and values.

I'll add that the cost vs benefit discussion is largely hypothetical. Elite colleges have massive endowments and incredible financial aid. The private top 20s I got into were actually cheaper than all the UC state school packages were. The only families being asked to pay sticker price at Ivy type schools are the ones who will suffer no QoL hit at all from paying it.

 

[aldol16]

I'll add that the cost vs benefit discussion is largely hypothetical. Elite colleges have massive endowments and incredible financial aid. The private top 20s I got into were actually cheaper than all the UC state school packages were. The only families being asked to pay sticker price at Ivy type schools are the ones who will suffer no QoL hit at all from paying it.

Well, I do think it goes beyond the mere hypothetical. Many students don't get full scholarships from the Ivies. A lot of students face the choice between reduced tuition at an Ivy-type school versus lower tuition at their state school. So while the magnitude of the marginal cost may not be so large, there still is a marginal cost. And so these students need to balance that with their marginal benefits from going to the more expensive school. If it's worth it to them and their family, then they should do it and never look back. No one else should tell them it's not worth it because nobody else knows what they and their family is willing to pay for that added benefit. That's just like how nobody can tell you whether you should spring for that expensive wine. They can tell you what the marginal benefit is, i.e. the better taste, quality, etc., and you can balance it with the added cost. But whether to actually buy it depends on how much you like wine.

 

[TheIllusionist]

Forgive my ignorance since AOA isn't an important thing for my class - isn't it based on clinical performance, maybe plus or minus board scores? Are schools really out here awarding AOA based on preclinical exams?

Yes lmfao

Junior AOA at my school is first two year preclinical grades

Senior is all 3 year grades. So same people basically qualify since junior is still weighted 2:1

I was in like the top 5% at my school for clinical grades .with all clinical honors and very high clinical grades even numerically and didn't qualify. above average but not great preclinical

STEP scores were NOT factored in.

And trust, my state school has its share of former I bankers, consultants, we have a former olympian, etc.

And we have a lot of students with assymetries. They got 3.1s at Emory because of a rough engineering major but a 39 MCAT and got in versus the kid who did a psych major got a 3.8 and a 37 and is now at Cornell. That type of **** is a little too common.

Btw, I posted my stats on page before. Preclinical true P/F for us (no reporter rank) and only used for AOA. What do you think I did wrong? And no my school isn't new or DO or even low tier. Well established mid tier state school.

 

[ace_inhibitor111]

To give some examples for perspective: We recently had a match panel where one of the guys (who had matched the #1 program in this specialty) was an author on >30 papers (~10 first author) during med school.

I know a DO student with 20 publications done in medical school. It’s called: be the clinical coordinator or go-to statistician. That said, knowing him he absolutely deserved to match into his desired specialty (orthopedic surgery). If he had applied to IM though, I don’t think there would be any chance of him matching into the Top 20.

 

[AnatomyGrey12]

I know a DO student with 20 publications done in medical school. It’s called: be the clinical coordinator or go-to statistician. That said, knowing him he absolutely deserved to match into his desired specialty (orthopedic surgery). If he had applied to IM though, I don’t think there would be any chance of him matching into the Top 20.

I know one with 37. At least 10-15 of those first author in elite journals. Could be the same person haha

I will never be convinced a bottom quartile, 220, no AOA, 2 pub student from a T5 med school is more qualified than these types of applicants from unranked schools. But looking at a T5 match list you will NEVER be able to tell who that student was.

 

[TheIllusionist]

I know one with 37. At least 10-15 of those first author in elite journals. Could be the same person haha

I will never be convinced a bottom quartile, 220, no AOA, 2 pub student from a T5 med school is more qualified than these types of applicants from unranked schools. But looking at a T5 match list you will NEVER be able to tell who that student was.

tHeY JUsT hAVE BeTteR Iq. cuz McaT SaT brah

 

[longhaul3]

Forgive my ignorance since AOA isn't an important thing for my class - isn't it based on clinical performance, maybe plus or minus board scores? Are schools really out here awarding AOA based on preclinical exams?

AOA criteria are left up to each chapter's election committee, with the requirement that I think no more than 1/6 of the class is elected.

In my experience, it is useful. Clinical grades aren't perfect, and obviously there's enough discussion around here arguing that they're counterproductive, but there are always observable trends. It's far from random. The best students tend to make honors consistently across multiple rotations. There's always the argument about whether the honors student is the best student or has just figured out how to make honors, but for the most part, in my experience, the cream rises to the top when you look at longitudinal performance.

 

[TheIllusionist]

AOA criteria are left up to each chapter's election committee, with the requirement that I think no more than 1/6 of the class is elected.

In my experience, it is useful. Clinical grades aren't perfect, and obviously there's enough discussion around here arguing that they're counterproductive, but there are always observable trends. It's far from random. The best students tend to make honors consistently across multiple rotations. There's always the argument about whether the honors student is the best student or has just figured out how to make honors, but for the most part, in my experience, the cream rises to the top when you look at longitudinal performance.

Sadly, my school legit makes junior and senior preclinical contests. Those PhD MCQs are what determine who is going to go to the highest tier of IM. Just how it is for us. They told us that on day 1 btw. It was my laziness in preclinical in the end. But I still think it sucks how clinical really isn't a second shot for us.

 

[whoknows2012]

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 not sure where you are in you’re schooling/training/career so I mean no offense when I say this but this is a very naive take on a complicated issue.

 

[efle]

I’m not sure where you are in you’re schooling/training/career so I mean no offense when I say this but this is a very naive take on a complicated issue.

MS3 at a "top 5" med school. So having seen firsthand the kind of people who make it past the adcom, and having experienced firsthand what clerkship grading and USMLEs actually capture about us, I stand by my take. Caring that someone got into Harvard is just as good (or better) a heuristic as the other crap we have to work with.

 

[efle]

There's always the argument about whether the honors student is the best student or has just figured out how to make honors

Definitely the latter in my experience. Like very literally people are out here telling their graders about the grading system to ensure they get the H on rotations they need it. But this is probably very school dependent, I can imagine a much better system where the average isn't a 4.5/5 and getting good marks might actually mean something.

 

[whoknows2012]

MS3 at a "top 5" med school. So having seen firsthand the kind of people who make it past the adcom, and having experienced firsthand what clerkship grading and USMLEs actually capture about us, I stand by my take. Caring that someone got into Harvard is just as good (or better) a heuristic as the other crap we have to work with.

Back in IM residency, We had several T10 rejects at my mid tier academic program that were awful compared to the no name school superstars. You’re ability to understand this issue is majorly biased by where you are. Getting into medical school reflects what you did in undergrad and maybe after if you took some years for research etc. I don’t even know how you can reasonably compare this to how you perform in medical schooI, despite the known flaws in grading and evaluations. I get that this is your view and you stand by it (and appreciate the self reflection you’ve had from prior posts) but there’s a reason why basically no one agrees with you here on this issue.

 

[efle]

Yes lmfao

Junior AOA at my school is first two year preclinical grades

Senior is all 3 year grades. So same people basically qualify since junior is still weighted 2:1

I was in like the top 5% at my school for clinical grades .with all clinical honors and very high clinical grades even numerically and didn't qualify. above average but not great preclinical

STEP scores were NOT factored in.

And trust, my state school has its share of former I bankers, consultants, we have a former olympian, etc.

And we have a lot of students with assymetries. They got 3.1s at Emory because of a rough engineering major but a 39 MCAT and got in versus the kid who did a psych major got a 3.8 and a 37 and is now at Cornell. That type of **** is a little too common.

Btw, I posted my stats on page before. Preclinical true P/F for us (no reporter rank) and only used for AOA. What do you think I did wrong? And no my school isn't new or DO or even low tier. Well established mid tier state school.

I have no idea what happened for you my man, I can't even justify how rough it went for the people earlier in the thread. A 260/AOA with papers should be getting interviews. Looking at the numbers just made it even stranger.

 

[efle]

Back in IM residency, We had several T10 rejects at my mid tier academic program that were awful compared to the no name school superstars. You’re ability to understand this issue is majorly biased by where you are. Getting into medical school reflects what you did in undergrad and maybe after if you took some years for research etc. I don’t even know how you can reasonably compare this to how you perform in medical schooI, despite the known flaws in grading and evaluations. I get that this is your view and you stand by it (and appreciate the self reflection you’ve had from prior posts) but there’s a reason why basically no one agrees with you here on this issue.

At the same time you can turn the bias accusations around and say people are bitter about the system only because they didn't recognize the important of a brand-name school early enough to benefit from the achievement themselves.

And like I said before, I 100% agree the top of class superstars at U of State are just as good as the bottom of class at HMS. You were probably working with those bottom end students, because the typical HMS grad doesn't land in a mid tier IM program.

 

[whoknows2012]

Btw I was 242/257 (taken in 2011/2012 when averages were much Lower) top 20% not great ecs but great letters not AOA didn’t get 1 T30 interview. Went to a low/mid tier private med school well known in Northeast. This was common in my school and others have described common in many low and mid tier medical schools if you don’t have AOA. And even if you do get AOA it can still be tough to break into the best programs

 

[whoknows2012]

At the same time you can turn the bias accusations around and say people are bitter about the system only because they didn't recognize the important of a brand-name school early enough to benefit from the achievement themselves.

And like I said before, I 100% agree the top of class superstars at U of State are just as good as the bottom of class at HMS. You were probably working with those bottom end students, because the typical HMS grad doesn't land in a mid tier IM program.

You could make that argument but that’s not how I’ve read the other posters in this thread. The clear difference is that they’ve been through the process and you haven’t. For a variety of reasons not everyone is as lucky as you to be able to attend a top 5 school. The reasons don’t start and end with, they just didn’t work hard enough.

I know you’re not calling me out directly but you suggest bitterness or bias on the other side of the argument so I’ll at least confirm no bitterness on my end. I have an academic faculty position in leukemia at an Ivy League institution and am very happy where I am having come from a low/mid tier med school

On your last point I’m not sure we agree. I think the top students at good but not top x medical school are roughly equivalent to those at the top med schools and way better than those at the bottom of the class. Some people also choose to not go to a top school for financial reasons or geographic reasons...

 

[efle]

You could make that argument but that’s not how I’ve read the other posters in this thread. The clear difference is that they’ve been through the process and you haven’t. For a variety of reasons not everyone is as lucky as you to be able to attend a top 5 school. The reasons don’t start and end with, they just didn’t work hard enough.

I know you’re not calling me out directly but you suggest bitterness or bias on the other side of the argument so I’ll at least confirm no bitterness on my end. I have an academic faculty position in leukemia at an Ivy League institution and am very happy where I am having come from a low/mid tier med school

On your last point I’m not sure we agree. I think the top students at good but not top x medical school are roughly equivalent to those at the top med schools and way better than those at the bottom of the class. Some people also choose to not go to a top school for financial reasons or geographic reasons...

Again, flip it around. None of the posters so far against the prestige points have actually gone to medical school with one of these student bodies. I can come back next year after my match, I promise my opinion of USMLEs and clinical grading will be the same.

I'm not suggesting bitterness, I'm suggesting neither side should be calling the other biased since both positions are self serving. I don't think anyone disagreeing with me is doing it out of bitterness and I also don't think my opinions are motivated by prestige whoring. I've been very, very impressed by my average classmate is all. I can see why PDs treat student bodies differently.

Those people end up being the superstars that make up the >50% of JHH match list that come from non-top names. I'm talking about populations, since that's what PDs are working with when they give interviews based on school name. I'm talking about IQRs, not outliers.

 

[Lawpy]

people keep emphasizing AOA importance, and here I am wondering what people at some top schools with AOA are doing. especially if AOA is determined and given before residency apps are sent out.

also is IM the only field with this exaggerated emphasis on AOA vs top school name? because really that's the main specialty that immediately comes to mind in these discussions...

 

[TheIllusionist]

it is all about screens. That's what it comes down. Screen at a >245 or 250 for non high tiers along with need for at least on of following: some major hook, GHHS, AOA, or URM is necessary for all non high tier students to get more than a couple of T25 interviews.

High tiers need far less and are evaluated as people. High tier programs automatically assume they are academically okay. They just look at exam grades as formalities. And keep it moving.

Also, it is in the interest of the high tiers to he completely in bed with one another, just trading applicants. Keep circle tight. And then let in some super qualifieds for non high tiers that are good bets.

IM seems more old boys type at the elite level.

 

[TheIllusionist]

people keep emphasizing AOA importance, and here I am wondering what people at some top schools with AOA are doing. especially if AOA is determined and given before residency apps are sent out.

also is IM the only field with this exaggerated emphasis on AOA vs top school name? because really that's the main specialty that immediately comes to mind in these discussions...

AOA at top school guarantees a top 5 program. But a T15 is pretty much a given for a very middling board score performance and average clinical grades (mostly HPs and a few honors) even for most of the non AOA.

You better be a killer from a non high tier, especially low tier and below (IMG, DO, carib, etc).

 

[whoknows2012]

Again, flip it around. None of the posters so far against the prestige points have actually gone to medical school with one of these student bodies. I can come back next year after my match, I promise my opinion of USMLEs and clinical grading will be the same.

I'm not suggesting bitterness, I'm suggesting neither side should be calling the other biased since both positions are self serving. I don't think anyone disagreeing with me is doing it out of bitterness and I also don't think my opinions are motivated by prestige whoring. I've been very, very impressed by my average classmate is all. I can see why PDs treat student bodies differently.

Those people end up being the superstars that make up the >50% of JHH match list that come from non-top names. I'm talking about populations, since that's what PDs are working with when they give interviews based on school name. I'm talking about IQRs, not outliers.

But some have trained with those type of students in residency so I’m pretty sure that actually makes them less biased because they’ve had their own medical school experience then worked with residents from top tier programs. You only have your medical school experience to draw on.

Regarding you last paragraph I think it’s fair how PDs treat school name but that doesn’t mean I believe that it’s the best way to do it or that it identifies the best possible candidates. My issue is with you equating that (Pd’s choosing based on school name) with what the reality of the situation is, which is MUCH more opaque. For example we do not share the same view that just because you get into a top x program you’re deserving of a residency spot there. Everyone needs to prove themselves at every level otherwise that breeds complacency

 

[TheIllusionist]

what makes a good resident?

1. Knowledge work ethic (what USMLE and shelves-largely non gloaded crystallized intelligence tests capture)
2. Ability to play nice (what repeated or lack there of of clinical honors demonstrate)
3. Research productivity (papers for the program)

The first two really are what make or break one as a clinician.

99% of docs don't go on to do the truly creative **** in medicine, even at top programs. CEOs or politicians or writers or policy makers at elite level, Patenting several devices, inventing new surgeries, discovering new treatmemt modalities, etc. A lot of it is high level technician, social harmony, and clinical research churning ability (aka correlation monkeying over mechanistic elucidation as a focus- btw this is still ultra important, just less thought provoking on average).

School tier should matter but not the way it does. Elfe thinks her/his classmates are somehow so awesome that meritocratic criteria in med school itself should just be a formality for them. To me, that is nonsensical.

They should get a little break perhaps But not like they do now. You can even argue no break because they have even greater, not fewer, resources to do better on paper relative to their lower tier counterparts.

Clinical competence is the purpose of residency. Med school grades, scores, and research (actually low tiers should get bit more leeway here since less access) should matter for everyone because they actually are the most related.

And trust me, I am actually happy I came our with a T25. Not by much. But I think the system didn't at least screw me like it did some kids I know with equivalent or better scores at my school without AOA. Their lack of performance on the disjointed factoid recollection PhD exams really broke their application in the end.

No matter. They will work their asses off in residency to get fellowship once again. And some of those same lazy high tiers who were numerically underqualified at the high tier residencies now will once again ride the same train into high tier fellowship.

 

[efle]

But some have trained with those type of students in residency so I’m pretty sure that actually makes them less biased because they’ve had their own medical school experience then worked with residents from top tier programs. You only have your medical school experience to draw on.

Regarding you last paragraph I think it’s fair how PDs treat school name but that doesn’t mean I believe that it’s the best way to do it or that it identifies the best possible candidates. My issue is with you equating that (Pd’s choosing based on school name) with what the reality of the situation is, which is MUCH more opaque. For example we do not share the same view that just because you get into a top x program you’re deserving of a residency spot there. Everyone needs to prove themselves at every level otherwise that breeds complacency

Like I said, I don't think the Harvard med students training in mid-tier IM programs are good representatives of HMS. They're the low end outliers on the HMS match list. I'm not saying this to be elitist, just that glancing at any recent match lists from Harvard or Hopkins or Penn, matching top-tier is the norm by far. At my school, these were the institutions matched in IM this year: Harvard, Hopkins, Michigan, NYU, U Chicago, Penn, UCSF, UTSW. That's it. That's the entire list (multiple people to some of them). You basically have to screw up in a big way not to match well.

I guess I think the spot should be yours to lose. If you're absolutely awful, then yeah, you shouldn't be able to coast to success. But if the PD has a long history of being impressed by their school's typical student, and wants to heavily favor their own students or students from similar schools, that makes sense to me. I don't think that's some great blow to meritocracy, just a heuristic that consistently works for them.

 

[efle]

School tier should matter but not the way it does. Elfe thinks her/his classmates are somehow so awesome that meritocratic criteria in med school itself should just be a formality for them. To me, that is nonsensical.

They should get a little break perhaps But not like they do now. You can even argue no break because they have even greater, not fewer, resources to do better on paper relative to their lower tier counterparts.

I think that's a bit of a strawman towards me dude. My position is that I know firsthand what gets past the adcoms, what a 250+ requires, what gets your name on chart reviews, and what gets Honors on the wards, and if I had to pick one filter I'd pick the first one. Like I said, don't take that as me championing school prestige as a fantastic metric. Take that as me crapping on the alternatives as terrible metrics.

 

[deleted915325]

I think that's a bit of a strawman towards me dude. My position is that I know firsthand what gets past the adcoms, what a 250+ requires, what gets your name on chart reviews, and what gets Honors on the wards, and if I had to pick one filter I'd pick the first one. Like I said, don't take that as me championing school prestige as a fantastic metric. Take that as me crapping on the alternatives as terrible metrics.

Just some commentary, I think you both make good, legitimate arguments. It’s okay to have different viewpoints and opinions. I can see both sides of the coin making sense depending on how you look at it and your experiences. I’ve enjoyed this thread so far so it might be safe to say agree to disagree before this devolves into a typical SDN dumpster fire

 

[Dr. Death]

I think that's a bit of a strawman towards me dude. My position is that I know firsthand what gets past the adcoms, what a 250+ requires, what gets your name on chart reviews, and what gets Honors on the wards, and if I had to pick one filter I'd pick the first one. Like I said, don't take that as me championing school prestige as a fantastic metric. Take that as me crapping on the alternatives as terrible metrics.

Just genuinely curious. What does get past adcoms at your school? Any diversity? 1st generation doctors? Anybody from a low SES? Because it seems to me that these ivory towers take the kids that went to their undergrads or other strong undergraduate schools. Which leads to a lot of upper-middle class asian and white kids. You grow up poor or didn't get into a strong university because of your high school performance and I suspect you never have a chance at these ivory towers. But maybe I'm wrong.

 

[bobjonesbob]

I think that's a bit of a strawman towards me dude. My position is that I know firsthand what gets past the adcoms, what a 250+ requires, what gets your name on chart reviews, and what gets Honors on the wards, and if I had to pick one filter I'd pick the first one. Like I said, don't take that as me championing school prestige as a fantastic metric. Take that as me crapping on the alternatives as terrible metrics.

You pretty clearly think the metrics used to evaluate medical students are less useful than most people in this thread which is where a lot of the disagreement is coming from.

What's your issue with Step 1? (I'm sure you've posted plenty about this but I'm not sure where you stand). I pretty much agree with @TheIllusionist - I think Step 1 is a pretty useful for measuring a combination of someone's work ethic and intelligence. I don't know anyone who has managed a great score without being pretty high in some combination of those two attributes. Sure the merits of some of the small details tested can be debated, but is incentivizing people to try to master as much of the basic medical science as possible a bad thing? Maybe its overemphasized etc. but there comes a point in time where we have to know some stuff and that means having it memorized. I just don't really understand the anti-step 1 logic.

As far as clinical evals, I think your experience is more extreme because of rampant inflation at the top schools. At my school we have 7 core 3rd year rotations and the people for got honors on 4+ of them were all strong students and were the people who got into senior AOA (there was no large cohort of people basically getting honors on every rotation which sounds like is the case at your school). Part of the reason for this is we're required to honor the shelf and the clinical evals. Even on an easy rotation where maybe 50-60% of people (eg: psychiatry) get clinical honors, some of those people won't honor the shelf which required ~70th percentile score. One or two individual rotation grades were not necessarily useful but overall the trend across the year felt accurate to be able to lump people into categories (majority honors, some honors, no honors).

I think we all agree that 99% of medical student research (very much including everything on my CV) is pretty much a waste of time and should not be emphasized to the extent that it is.

 

[7331poas]

MS3 at a "top 5" med school. So having seen firsthand the kind of people who make it past the adcom, and having experienced firsthand what clerkship grading and USMLEs actually capture about us, I stand by my take. Caring that someone got into Harvard is just as good (or better) a heuristic as the other crap we have to work with.

Sounds like BS. What does an adcom see in a premed that better approximates their candidacy for neurosurg residency than step1/2, sub-I preformance, and research output?

 

[bobjonesbob]

Sounds like BS. What does an adcom see in a premed that better approximates their candidacy for neurosurg residency than step1/2, sub-I preformance, and research output?

I don't think anyone in this discussion is talking about surgical subspecialties or other specialties that heavily weight aways. I suppose neurosurgery in part considers research as evidence of dedication to the field but I'd argue that even neurosurgery overweights research given that majority of the specialty is doing elective spine surgery not running brain tumor labs.

 

[throwaway1000000]

I don't think anyone in this discussion is talking about surgical subspecialties or other specialties that heavily weight aways. I suppose neurosurgery in part considers research as evidence of dedication to the field but I'd argue that even neurosurgery overweights research given that majority of the specialty is doing elective spine surgery not running brain tumor labs.

Sidetrack to this thread: Ya felt the same about research in neurosurgery. I was interested in neurosurg for a while and the residents/attendings really did not care about research at all. Most of it was operating based on the surgeons' preference. They had a "journal club" monthly or something which the residents used to make fun of.
Where as in IM, residents/attendings love to emphasize research for every single decision that they make. If anything, research should be emphasized much more in IM candidates than the surgical fields.

 

[chord]

I don't think anyone in this discussion is talking about surgical subspecialties or other specialties that heavily weight aways. I suppose neurosurgery in part considers research as evidence of dedication to the field but I'd argue that even neurosurgery overweights research given that majority of the specialty is doing elective spine surgery not running brain tumor labs.

In most programs, you're expected to be academically productive during training, and the vast majority of your attendings will be involved in research in some capacity. Not everyone will be running a lab, but clinical research is also very important in academic neurosurgery.

Sidetrack to this thread: Ya felt the same about research in neurosurgery. I was interested in neurosurg for a while and the residents/attendings really did not care about research at all. Most of it was operating based on the surgeons' preference. They had a "journal club" monthly or something which the residents used to make fun of.
Where as in IM, residents/attendings love to emphasize research for every single decision that they make. If anything, research should be emphasized much more in IM candidates than the surgical fields.

This is atypical at any academic program (i.e. most of them).

 

[throwaway1000000]

This is atypical at any academic program (i.e. most of them).
[/QUOTE]

I don't want to sidetrack too much from this thread-but that is interesting.
My experience has been very different. I found research in IM to be much much more emphasized in terms of day to day decisions. I don't think there is a single day in IM that goes by without hearing residents and attendings cite research studies for a decision they are making. It makes sense too. Most amount of research money goes into IM fields-cardiology and hem/onc. Recently around 100 millon dollars were spent on a single trial in cardiology to look at stenting vs medical therapy. Don't think nearly that much money goes into neurosurgery research.
It would make more sense to me for research to be emphasized in someone going into cardiology or hem-onc where your practice is heavily based on interpreting research studies.
Maybe residents at different programs treat research differently-but how important is understanding, performing and interpreting research as a neurosurgeon compared to a field like cardiology or oncology? Every physician needs to know how to interpret research but I am talking particularly in the context of how much research is emphasized for surgical subspecialty applicants. Does it make sense for research to be so heavily emphasized?

 

[Lawpy]

I think that's a bit of a strawman towards me dude. My position is that I know firsthand what gets past the adcoms, what a 250+ requires, what gets your name on chart reviews, and what gets Honors on the wards, and if I had to pick one filter I'd pick the first one. Like I said, don't take that as me championing school prestige as a fantastic metric. Take that as me crapping on the alternatives as terrible metrics.

but the system's badly broken if what adcoms decide is as good or better metric than what's actually happening in school...

 

[7331poas]

I don't think anyone in this discussion is talking about surgical subspecialties or other specialties that heavily weight aways. I suppose neurosurgery in part considers research as evidence of dedication to the field but I'd argue that even neurosurgery overweights research given that majority of the specialty is doing elective spine surgery not running brain tumor labs.

True. Im also bitter because I dont have the pubs for nsg.

 

[bananafish94]

I've never really understood why at every stage of training there's an emphasis on the prestige of the last institution you attended. Medical schools care about where you went to college. Why? Where I went to college is a reflection, at best, of what I did in high school. So, my high school GPA and ACT score. Plus, the only people I know who went to those fancy schools had lots of family connections or came from huge wealth. Then residencies care about where you went to medical school. Why? That's mostly a reflection of my college GPA and MCAT, neither of which I even remember. I couldn't care less about what someone did in college, I care about what they did in medical school. Then fellowships care about where you did residency. This makes more sense, but again - what determines where you go to residency? Step 1, clinical grades, where you went to medical school, etc. Does this really have much bearing at all on how you perform as a resident? Is someone who goes to a university program a better physician than someone who goes to a community program? I certainly don't think so, maybe they have more access to research but that's it. To be clear, I'm extremely happy with every single place I've ended up, from college to residency. But once you really see how a lot of the sausage is made it's a bit odd.