Advantage of School Pedigree on Internal Medicine Residency Matching

[aldol16]

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.

Well, that would be true if how you did in high school 100% determined where you go for college and where you go to college 100% determines where you go to med school and vice versa. That's not true. Sure, there is an effect. Maybe even a really strong one. But at each level, you're given the chance to work your ass off to get to the next level during your next level of training. Someone who never realized that they should work hard in HS and realizes that in college can work their ass off and get into a top med school. It gets harder at each level because the further you rise in your training, the more opportunities you will have had to distinguish yourself. Advantage builds on advantage. You working hard and spending those hours in the research lab in college doesn't just go away. Your papers stay with you forever. Your connections stay with you forever.

---

Members don't see this ad.

 

[AlteredScale]

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?

Don't most neurosurgery residency curriculums dedicate minimum 6 months to 2 years of training to research? If you look at the residents enter nsx at bigger university hospitals, most of them had many publications going from bench to bedside. So it would seem to me that they (the program) would want these types of applicants since such a big chunk of the curriculum is devoted to research.

CU's general surgery program requires a dedicated amount of research as well: Research Opportunities

 

[aldol16]

Don't most neurosurgery residency curriculums dedicate minimum 6 months to 2 years of training to research? If you look at the residents enter nsx at bigger university hospitals, most of them had many publications going from bench to bedside. So it would seem to me that they (the program) would want these types of applicants since such a big chunk of the curriculum is devoted to research.

Neurosurgery is a highly academic specialty. To understand the basis of this in any field you have to look back at the origins and development of that field but some fields are known to be much more academic than others. Neurosurgery is probably at one extreme of this spectrum for the surgical subspecialties.

 

[AnatomyGrey12]

CU's general surgery program requires a dedicated amount of research as well: Research Opportunities

Yeah there are a number of 7 year GS programs with 2 years of research built in.

 

[throwaway1000000]

Don't most neurosurgery residency curriculums dedicate minimum 6 months to 2 years of training to research? If you look at the residents enter nsx at bigger university hospitals, most of them had many publications going from bench to bedside. So it would seem to me that they (the program) would want these types of applicants since such a big chunk of the curriculum is devoted to research.

CU's general surgery program requires a dedicated amount of research as well: Research Opportunities

They do. And maybe neurosurgery is not a perfect example of what I am talking about because their residency has an in-built research year so they want to get students that have have some research experience.
But lot of other surgical subspecialties and competitive fields (derm, optho,urology, ENT) also require similar amount of research from their applicants when those fields are not that research-intensive compared to something like cardiology and oncology where hundreds of millions of dollars get pumped into new studies
If you work with a cardiologist or oncologist, you will see their practice heavily influenced and based on interpreting research studies. It would make sense to expect heavy research experience from someone practicing cardiology or oncology.
But when I worked with neurosurgery residents or other surgical subspecialty residents, didn't see nearly as much focus on research in their day to day practice.
I mean just look at the ischemia trial. Approximately 100 million dollars of tax-payer money was spent on funding it. Big amount of money also goes into oncology research. Are there any neurosurgery or surgical subspecialities studies that use of that much of funding?
I am just curious as to why these surgical subspecialties require so much research as an applicant? Is it just to separate medical students because of increased competition or is there some other reason that they require research when other research heavy fields don't expect that much from a med student applying (IM, Gen surg, etc)

 

[peachrings]

My guess is just as stratification or as a surrogate for work ethic, organization, etc. It is much rarer to see surgeons with independent research funding than IM subspecialists.

 

[throwaway1000000]

My guess is just as stratification or as a surrogate for work ethic, organization, etc. It is much rarer to see surgeons with independent research funding than IM subspecialists.

Exactly. What I think too.

 

[efle]

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.

If you're curious about my views on Step 1, was discussed very thoroughly in the Step 1 Pass/Fail megathread. Alternatively you can look at Dr. Carmody's blog posts or lectures chronicling the rise and surprising success of the USMLE Pass/Fail movement, I agree with nearly all of his views.

Agree that clinical grading is especially worthless at schools like mine

 

[Newyawk]

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.

Im not at HMS but also at a very highly ranked school. I will say that, while the wealth of knowledge never ceases to impress me, there are intangible factors that you and others here arent addressing. Being smart is just one necessary component of an outstanding doctor. Unfortunately, some of my classmates frankly just dont care that much about their patients.
Believe it or not, you can gain entrace into Harvard and HMS despite being a self-serving narcissist (you probably have to hide it well, though).

 

[7331poas]

If you're curious about my views on Step 1, was discussed very thoroughly in the Step 1 Pass/Fail megathread. Alternatively you can look at Dr. Carmody's blog posts or lectures chronicling the rise and surprising success of the USMLE Pass/Fail movement, I agree with nearly all of his views.

Agree that clinical grading is especially worthless at schools like mine

Would like to hear your explanation for how playing the violin or getting an A in organic chemistry better qualifies someone for a top IM program than a good step 2 score.

 

[longhaul3]

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?

There are probably a couple of reasons for this. First, there are only about 3500 neurosurgeons in the US, which is somewhere around 0.5% of physicians. Second, although neurosurgical disease is common, it's not nearly as common as medical disease, and this is one thing that prevents large-scale clinical trials. Third, and most importantly in my experience, RCTs are difficult to design and implement in neurosurgery (and in any kind of surgery to a lesser extent) for ethical and practical reasons.

RCTs are extremely common and can be extremely robust in IM because they include zillions of patients, 50% of the physician workforce, and usually drugs instead of surgeries. Almost any clinical question can be answered with an RCT, and many have been, so there is a much larger library of evidence available in IM to apply to daily practice.

The reality remains that research is of enormous (and outsize in my opinion, especially for residency applicants) importance in neurosurgery

What’s JHH?

Johns Hopkins Hospital

 

[longhaul3]

If most of JHH IM residents are from mid tier places, and JHH is where most of JHU’s IM med students match, does imply anything about JHU’s matching potential and/or potential to match a competitive sub-IM fellowship from JHH IM residency?

I wasn't the original poster talking about the Hopkins cohort (and I've never been affiliated with Hopkins or even applied there for med school or residency), but the IM residency at Hopkins is considered by most to be the cream of the crop, so I'm quite sure you could match into any sub-specialty fellowship from that program.

 

[bobjonesbob]

If most of JHH IM residents are from mid tier places, and JHH is where most of JHU’s IM med students match, does imply anything about JHU’s matching potential and/or potential to match a competitive sub-IM fellowship from JHH IM residency?

Hopkins IM doesn't match quite as well (ie: prestigious medical schools) as peer institutions (talking about matching medical students for residency, not fellowship) because:
1. it's in Baltimore (many people from NYC, Boston, SF, etc. won't consider it)
2. among the top programs, Hopkins IM is widely known to be the most intense place to train in the country

It's no doubt one of the most prestigious places to train and will open doors for any fellowship.

 

[WedgeDawg]

That's so interesting. I hadn't realized it was the most intense place to train, I wonder if clerkship is similarly difficult in IM. Do you think any of this relates to why Hopkins med students don't match IM in many other top places besides Hopkins? It just seems they're kind of stuck there, if that makes sense. Since their IM matches seem to be like mostly all JHU, 1 to HMS, 1 to UCSF, and the rest are top 20 programs. Do HMS/Stanford/UCSF/UCLA etc. IM programs not like to take hopkins med students?

I'm sure a lot of it is personal preference of the applicant.

 

[bobjonesbob]

That's so interesting. I hadn't realized it was the most intense place to train, I wonder if clerkship is similarly difficult in IM. Do you think any of this relates to why Hopkins med students don't match IM in many other top places besides Hopkins? It just seems they're kind of stuck there, if that makes sense. Since their IM matches seem to be like mostly all JHU, 1 to HMS, 1 to UCSF, and the rest are top 20 programs. Do HMS/Stanford/UCSF/UCLA etc. IM programs not like to take hopkins med students?

This is a common trend for most top schools. I gave an example of this earlier in this thread using HMS, Penn, and UCSF. This is probably just inertia (why leave a top tier place if you're already content there) and just drinking the cool aid. If you're a Hopkins student who loves their IM rotation, appreciates the history of the lineage of Osler, and buys into the merits of the intense training why would you go anywhere else?

 

[hellanutella]

That's so interesting. I hadn't realized it was the most intense place to train, I wonder if clerkship is similarly difficult in IM. Do you think any of this relates to why Hopkins med students don't match IM in many other top places besides Hopkins? It just seems they're kind of stuck there, if that makes sense. Since their IM matches seem to be like mostly all JHU, 1 to HMS, 1 to UCSF, and the rest are top 20 programs. Do HMS/Stanford/UCSF/UCLA etc. IM programs not like to take hopkins med students?

Someone asked about this in the Hopkins thread so will just regurgitate my response here:

"Disclaimer: didn't apply IM. I think if you're looking at IM match success as number of students getting the "top 5" (which I think I'll just naively bundle as US News tetrad of JHU, the Boston programs, UCSF, Penn), we're doing pretty gucci.

This year was an unusually small year for IM at Hopkins and a hot year for surg specialties. The 2020 IM match tally was JHU x7, Penn x2, UCSF x2, UTSW, NYU, UMich, Beth Israel, Mass Gen... which is pretty dang top heavy. There's also several couples matches in there, including people that co-matched to very sought-after programs/locales in very competitive specialties.

I think analyzing Match Lists – short of looking at broad, sweeping strokes – is supremely challenging to read due to a myriad of factors. Ex: couples' matches, geographic restrictions, personal program/researcher interest, nuances in program desirability, etc. Even in my tiny lil specialty, the only way I could tell if it was a strong match is if I knew that person got: 1) all the interviews they wanted and 2) the program they wanted. (And if they had to dual apply). The "desirability index" for my programs jostles on an almost annal basis, based on the shuffle of chairs, funding issues, acquisition/loss of hospitals, etc., which is lost on most unless they are intimately familiar with that specialty."

This is a common trend for most top schools. I gave an example of this earlier in this thread using HMS, Penn, and UCSF. This is probably just inertia (why leave a top tier place if you're already content there) and just drinking the cool aid. If you're a Hopkins student who loves their IM rotation, appreciates the history of the lineage of Osler, and buys into the merits of the intense training why would you go anywhere else?

Agreed. You either leave Hopkins as a "bury me in my matching tie/scarf" Oslerian or you actively seek a different environment.

 

[longhaul3]

That's so interesting. I hadn't realized it was the most intense place to train, I wonder if clerkship is similarly difficult in IM. Do you think any of this relates to why Hopkins med students don't match IM in many other top places besides Hopkins? It just seems they're kind of stuck there, if that makes sense. Since their IM matches seem to be like mostly all JHU, 1 to HMS, 1 to UCSF, and the rest are top 20 programs. Do HMS/Stanford/UCSF/UCLA etc. IM programs not like to take hopkins med students?

Hopkins has the intense reputation across all the specialties I'm familiar with.

Regarding Hopkins students not matching elsewhere, obviously being in Baltimore is much less of an issue for them, and as the home of modern medicine I'm sure it has some sentimental and egotistical (not judging here) appeal as well.

 

[throwaway1000000]

There are probably a couple of reasons for this. First, there are only about 3500 neurosurgeons in the US, which is somewhere around 0.5% of physicians. Second, although neurosurgical disease is common, it's not nearly as common as medical disease, and this is one thing that prevents large-scale clinical trials. Third, and most importantly in my experience, RCTs are difficult to design and implement in neurosurgery (and in any kind of surgery to a lesser extent) for ethical and practical reasons.

RCTs are extremely common and can be extremely robust in IM because they include zillions of patients, 50% of the physician workforce, and usually drugs instead of surgeries. Almost any clinical question can be answered with an RCT, and many have been, so there is a much larger library of evidence available in IM to apply to daily practice.

The reality remains that research is of enormous (and outsize in my opinion, especially for residency applicants) importance in neurosurgery


Johns Hopkins Hospital

I think you said a bunch of stuff but why exactly surgical subspecialties (neurosurgery can be exception because need to do a research year) require so much research from their applicants is still not clear. The main reason seems to be stratify applicants.
If anything, research heavy fields such as IM and general surgery? (maybe not sure) are the ones that should.

 

[longhaul3]

I think you said a bunch of stuff but why exactly surgical subspecialties (neurosurgery can be exception because need to do a research year) require so much research from their applicants is still not clear. The main reason seems to be stratify applicants.
If anything, research heavy fields such as IM and general surgery? (maybe not sure) are the ones that should.

I was only addressing your point about using evidence in daily practice in IM vs. surgical specialties.

I think it's a bad thing that neurosurgery and others require a ton of research from students. People have all sorts of hand-waving explanations for it, bu in the end you're right, it's just a way to evaluate applicants. You have no idea how academically productive your applicants are going to be when they start residency.

Hey, would you say IM clerkship at Hopkins is particularly intense compared to other places too? I keep hearing "Oslerian" from people but not sure what that means. Thanks for the insight!

Can't speak to the clerkships, but look up Sir William Osler and read about the history of JHH. I also recommend reading about Halsted, Harvey Cushing and Walter Dandy.

 

[throwaway1000000]

I was only addressing your point about using evidence in daily practice in IM vs. surgical specialties.

I think it's a bad thing that neurosurgery and others require a ton of research from students. People have all sorts of hand-waving explanations for it, bu in the end you're right, it's just a way to evaluate applicants. You have no idea how academically productive your applicants are going to be when they start residency.

I don't think there is anything inherently wrong with neurosurgery or other surgical subspecialties not being as research based as IM fields. It is the nature of the different fields.
I was mainly curious about the requirement of research in these fields when their day to day practice doesn't reflect that but we seem to be on the same page regarding my question.

 

[longhaul3]

I don't think there is anything inherently wrong with neurosurgery or other surgical subspecialties not being as research based as IM fields.
I was mainly curious about the requirement of research in these fields when their day to day practice doesn't reflect that but we seem to be on the same page regarding my question.

I agree. It's just not feasible. We're on the same page like you say—what I think is unfortunate is the emphasis on research productivity from applicants; faculty fawn over long CVs from med students but would almost never make clinical decisions based on the conclusions of the "research" any of them are publishing.

 

[efle]

Would like to hear your explanation for how playing the violin or getting an A in organic chemistry better qualifies someone for a top IM program than a good step 2 score.

As far as content tested, I'd much prefer using Step 2 CK >> Step 1. And both are much better than using PhD's self written MCQ tests to award AOA, now that I know that's a thing.

But, Step 2 CK has never been able to serve this role, and while it might fill the void for a few years here after the P/F change, I think it'll ultimately join Step 1 and CS in being Pass/Fail itself.

 

[efle]

Regarding "intensity" at JHU, I want to clarify everyone is perfectly nice and they've done everything possible to stop gunning/competitiveness. Examples include true Pass/Fail preclinical with no MSPE ranking, and no AOA awarded until after the match. But it's a place full of the people who want to live and breath medicine to become the absolute best trained physicians and surgeons in the world. 100% agree with Nutella that it is very love it/hate it depending on personality type.

 

[bananafish94]

Well, that would be true if how you did in high school 100% determined where you go for college and where you go to college 100% determines where you go to med school and vice versa. That's not true. Sure, there is an effect. Maybe even a really strong one. But at each level, you're given the chance to work your ass off to get to the next level during your next level of training. Someone who never realized that they should work hard in HS and realizes that in college can work their ass off and get into a top med school. It gets harder at each level because the further you rise in your training, the more opportunities you will have had to distinguish yourself. Advantage builds on advantage. You working hard and spending those hours in the research lab in college doesn't just go away. Your papers stay with you forever. Your connections stay with you forever.

I'm not arguing that it 100% determines where you go, I'm just saying in my opinion it's a worthless variable to consider at all. When you consider what factors go into getting an acceptance to a "top" college, I just can't imagine why medical schools would care at all. Ditto for why residencies would even begin to care about what I did before medical school.

 

[efle]

I'm not arguing that it 100% determines where you go, I'm just saying in my opinion it's a worthless variable to consider at all. When you consider what factors go into getting an acceptance to a "top" college, I just can't imagine why medical schools would care at all. Ditto for why residencies would even begin to care about what I did before medical school.

I've laid out data many times over in preallo showing that straight As at a "top" undergrad is a level above and beyond the average school. In fact the low end 3.3GPA students at "top" undergrads outperform the national 3.9GPA bin on the MCAT. It again makes total sense to me why a medical adcom would be more impressed by good grades at Ivy type feeder colleges.

This again may be from differences in experience though. I've noticed every person who attended a feeder undergrad understands why they're viewed differently, while everyone else seems to think that getting into and making straight As just means you paid good tutors or some such.

 

[Lawpy]

I've laid out data many times over in preallo showing that straight As at a "top" undergrad is a level above and beyond the average school. In fact the low end 3.3GPA students at "top" undergrads outperform the national 3.9GPA bin on the MCAT. It again makes total sense to me why a medical adcom would be more impressed by good grades at Ivy type feeder colleges.

This again may be from differences in experience though. I've noticed every person who attended a feeder undergrad understands why they're viewed differently, while everyone else seems to think that getting into and making straight As just means you paid good tutors or some such.

so go to a top high school --> top undergrad --> top med school --> top IM residency --> top fellowship --> get tenured immediately at top medical center --> become chair soon after --> retire and die

seems to fit the SDN standards pretty well!

and people wonder why there are massive SES disparities in higher education...

 

[altblue]

I've laid out data many times over in preallo showing that straight As at a "top" undergrad is a level above and beyond the average school. In fact the low end 3.3GPA students at "top" undergrads outperform the national 3.9GPA bin on the MCAT. It again makes total sense to me why a medical adcom would be more impressed by good grades at Ivy type feeder colleges.

This again may be from differences in experience though. I've noticed every person who attended a feeder undergrad understands why they're viewed differently, while everyone else seems to think that getting into and making straight As just means you paid good tutors or some such.

From a different perspective, there's something to be said for doing well on the MCAT despite not receiving the most rigorous undergraduate education. ~50% of takers get below a 500, and a good chunk of them potentially lacked the foundation from a weaker undergrad and didn't invest the extra time to make up for it. I'd be at least equally impressed with a high GPA and MCAT from a state school versus the same from a top university, because I know that from my time tutoring in my area that regional state schools don't always teach you the level of science necessary to apply it on the MCAT, at least without considerable relearning or innate ability... I went to one of the undergrads that periodically pops up on SDN for grade deflation as well so I have no skin in this game.

 

[efle]

From a different perspective, there's something to be said for doing well on the MCAT despite not receiving the most rigorous undergraduate education. ~50% of takers get below a 500, and a good chunk of them potentially lacked the foundation from a weaker undergrad and didn't invest the extra time to make up for it. I'd be at least equally impressed with a high GPA and MCAT from a state school versus the same from a top university, because I know that from my time tutoring in my area that regional state schools don't always teach you the level of science necessary to apply it on the MCAT, at least without considerable relearning or innate ability... I went to one of the undergrads that periodically pops up on SDN for grade deflation as well so I have no skin in this game.

If you say so. Everyone I know prepped using MCAT specific study books like Berkeley Reivew and Kaplan, not using any of their old lectures or coursework from their prereq classes. And those expensive review courses are definitely not needed at all.

 

[altblue]

If you say so. Everyone I know prepped using MCAT specific study books like Berkeley Reivew and Kaplan, not using any of their old lectures or coursework from their prereq classes. And those expensive review courses are definitely not needed at all.

It's more that a challenging undergrad provides a foundation in scientific thinking and conceptual understanding that makes the MCAT far more doable. The MCAT is a lot easier, and it takes less preparation, when your undergrad exams weren't just regurgitation and you learned everything well the first time. Not especially relevant to the thread at hand, but I suppose it goes against prestige as a general marker at the med school selection level

 

[bananafish94]

I've laid out data many times over in preallo showing that straight As at a "top" undergrad is a level above and beyond the average school. In fact the low end 3.3GPA students at "top" undergrads outperform the national 3.9GPA bin on the MCAT. It again makes total sense to me why a medical adcom would be more impressed by good grades at Ivy type feeder colleges.

This again may be from differences in experience though. I've noticed every person who attended a feeder undergrad understands why they're viewed differently, while everyone else seems to think that getting into and making straight As just means you paid good tutors or some such.

Well I am admittedly not familiar with any hard data so I'd be happy to look at that. I've heard so much about grade inflation at those schools from the media and people who actually attend them that it's hard for me to take it seriously. Isn't the average GPA at places like Harvard a 3.7 or something ridiculous like that? Correct me if I'm not, I could very well be wrong. And we all know that pre-meds specifically engineer their schedules to get the highest possible GPA. Obviously I'm not talking about all "top" colleges, if you have a 3.9 GPA from MIT or somewhere where the grades are serious business, I'm very impressed. That said, GPAs have to be taken with such a huge grain of salt depending on so many different factors it's probably hard to meaningfully compare anything.

Now I'm sure that some would argue that students at top schools are inherently "better" and that accounts for everything, and you seem to dismiss the financial argument outright, but I'm not so convinced. Just as an example, this article states that most of the Ivy League schools have more students with parents in the top 1% than they do in the bottom 60%. I mean, that's a huge disparity. How many of these students have to work part-time? How many of them have to worry about paying their rent? I'm sure a huge number of them do pay exorbitant amounts of money for MCAT tutors and the like and I would have a hard time believing that it doesn't make a difference.

I guess the thesis of what I'm saying is that there's obviously tons of extremely talented, gifted students at the top schools - probably more than others. So if that's the case, they should have no problem proving it on the field and don't need extra credit based on what they did in high school, which is muddled by all sorts of useless variables.

 

[throwaway1000000]

What surprises me in this thread is one of the commenters saying step 1 is not an indicator of a candidate's strength and hence should be pass/fail but high school gpa and test scores, undergraduate gpa and test scores are a potential indicator of their strength as a future resident. That argument doesn't make sense to me. If step 1 is not an indicator of anything, neither are high school/undergrad GPA and test scores. Performance on step 1 far outweighs anything you did in undergrad or high school.

In real life, prestige being desired by PDs makes sense. It happens in every field outside of medicine. Also, although I talked a lot about med school prestige in matching into IM, it is not everything. PDs are not that stupid.
This is Northwestern, arguably the most competitive mid-west program's match list at IM programs. If an applicant is not able to match at a strong program coming from NW, it is a pretty big indicator of how weak your app must have been. Yes, there are some people that probably chose a place for location, etc but not that many.
I think the match list at my low-tier med school looks pretty similar overall (we have some outliers that matched to community programs). But, if our match list looks similar to NW, it can be argued that our school's applicants must have been much more competitive than NW to land at the same places??
The point is not everyone going to a prestigious med school are automatically gifted and smart. If they all were, Northwestern's IM match list wouldn't look like this. This is probably similar to how match lists look at many prestigious places outside of top 5-10 med schools.
What should maybe be somewhat concerning to future applicants is if both step 1 and step 2 CK are made p/f these applicants could match at competitive programs just by virtue of their med school even if they are not that strong of an applicant.

 

[efle]

Well I am admittedly not familiar with any hard data so I'd be happy to look at that. I've heard so much about grade inflation at those schools from the media and people who actually attend them that it's hard for me to take it seriously. Isn't the average GPA at places like Harvard a 3.7 or something ridiculous like that? Correct me if I'm not, I could very well be wrong. And we all know that pre-meds specifically engineer their schedules to get the highest possible GPA. Obviously I'm not talking about all "top" colleges, if you have a 3.9 GPA from MIT or somewhere where the grades are serious business, I'm very impressed. That said, GPAs have to be taken with such a huge grain of salt depending on so many different factors it's probably hard to meaningfully compare anything.

Now I'm sure that some would argue that students at top schools are inherently "better" and that accounts for everything, and you seem to dismiss the financial argument outright, but I'm not so convinced. Just as an example, this article states that most of the Ivy League schools have more students with parents in the top 1% than they do in the bottom 60%. I mean, that's a huge disparity. How many of these students have to work part-time? How many of them have to worry about paying their rent? I'm sure a huge number of them do pay exorbitant amounts of money for MCAT tutors and the like and I would have a hard time believing that it doesn't make a difference.

I guess the thesis of what I'm saying is that there's obviously tons of extremely talented, gifted students at the top schools - probably more than others. So if that's the case, they should have no problem proving it on the field and don't need extra credit based on what they did in high school, which is muddled by all sorts of useless variables.

I'll try to find one of my old posts on it.

I was in that bottom 5% by SES at WashU. Yes, everyone around me had attended expensive private high schools and did expensive MCAT courses and didnt have to work part time like I did. I still beat them all on the curve every time and never needed to pay any tutors to do it.

Is being rich helpful in life? Sure. But is money the main determinant of academic performance in t20 college classes? Not even a little bit, no.

 

[efle]

What surprises me in this thread is one of the commenters saying step 1 is not an indicator of a candidate's strength and hence should be pass/fail but high school gpa and test scores, undergraduate gpa and test scores are a potential indicator of their strength as a future resident. That argument doesn't make sense to me. If step 1 is not an indicator of anything, neither are high school/undergrad GPA and test scores. Performance on step 1 far outweighs anything you did in undergrad or high school.

In real life, prestige being desired by PDs makes sense. It happens in every field outside of medicine. Also, although I talked a lot about med school prestige in matching into IM, it is not everything. PDs are not that stupid.
This is Northwestern, arguably the most competitive mid-west program's match list at IM programs. If an applicant is not able to match at a strong program coming from NW, it is a pretty big indicator of how weak your app must have been. Yes, there are some people that probably chose a place for location, etc but not that many.
I think the match list at my low-tier med school looks pretty similar overall (we have some outliers that matched to community programs). But, if our match list looks similar to NW, it can be argued that our school's applicants must have been much more competitive than NW to land at the same places??
The point is not everyone going to a prestigious med school are automatically gifted and smart. If they all were, Northwestern's IM match list wouldn't look like this. This is probably similar to how match lists look at many prestigious places outside of top 5-10 med schools.
What should maybe be somewhat concerning to future applicants is if both step 1 and step 2 CK are made p/f these applicants could match at competitive programs just by virtue of their med school even if they are not that strong of an applicant.

View attachment 302636

You'd need to look at the WashU match list to see where the top end of midwestern programs tends to match rather than Northwestern or U Chicago, imho. But yes I agree that list looks much closer to an established state university. More and more IQR overlap.

 

[Lawpy]

I'll try to find one of my old posts on it.

I was in that bottom 5% by SES at WashU. Yes, everyone around me had attended expensive private high schools and did expensive MCAT courses and didnt have to work part time like I did. I still beat them all on the curve every time and never needed to pay any tutors to do it.

Is being rich helpful in life? Sure. But is money the main determinant of academic performance in t20 college classes? Not even a little bit, no.

That's why i support an efle flex

No but really. Test prep courses blow. Self study ftw.

 

[aldol16]

I'm not arguing that it 100% determines where you go, I'm just saying in my opinion it's a worthless variable to consider at all. When you consider what factors go into getting an acceptance to a "top" college, I just can't imagine why medical schools would care at all. Ditto for why residencies would even begin to care about what I did before medical school.

The only scenario where it's worthless to consider is if it determines 0% where you go. Which is also not true. The truth is somewhere in between. So it's quite worthwhile to consider.

Although many things go into selection to an elite college, people don't try to dissect out every bit and piece. They see that and they tend to give you the benefit of the doubt. Then they look at what you did in college and what opportunities you took advantage of. If they see that you did nothing or didn't take advantage of any opportunities, that's when people start to question you. Residencies care about what you did before med school if it's relevant to that residency. You can bet that all your papers and presentations stay with you. For life. If you worked in that field before or did something related, then they'll also want to know. Imagine going to a top school, getting involved with clinical research early, publish papers, go to national meetings. Then come time for residency, all that **** counts.

 

[throwaway1000000]

You'd need to look at the WashU match list to see where the top end of midwestern programs tends to match rather than Northwestern or U Chicago, imho. But yes I agree that list looks much closer to an established state university. More and more IQR overlap.

Plenty of below average matches at WashU: Harbor-UCLA, Inova Fairfax, MCW, U maryland, North Shore Med Center
UPMC, Mayo, UTSW, WashU are moderately competitive, relatively speaking. We match regularly into these programs amongst our students that get AOA.
The only matches that truly stand out here are MGH, JHH, UCSF.
The point again is just because you go to a prestigious med school doesn't mean you are automatically brilliant. PDs realize this. Many mediocre students at top med schools.
Again shows the importance of step 1 and step 2 CK, otherwise I doubt these schools would have any mediocre matches.

 

[WedgeDawg]

Plenty of below average matches at WashU: Harbor-UCLA, Inova Fairfax, MCW, U maryland, North Shore Med Center
UPMC, Mayo, UTSW, WashU are moderately competitive, relatively speaking. We match regularly into these programs amongst our students that get AOA.
The only matches that truly stand out here are MGH, JHH, UCSF.
The point again is just because you go to a prestigious med school doesn't mean you are automatically brilliant. PDs realize this. Many mediocre students at top med schools.
Again shows the importance of step 1 and step 2 CK, otherwise I doubt these schools would have any mediocre matches.
View attachment 302641

I'm not sure what point you're trying to make here - 5 non-top 20 IM matches out of 32 matches, most of which are top 10?

 

[throwaway1000000]

I'm not sure what point you're trying to make here - 5 non-top 20 IM matches out of 32 matches, most of which are top 10?

The point that was made earlier that top med schools are comprised of mostly excellent students which is not true. There are a good number of mediocre students at prestigious med schools and there are a good number of excellent students at low-tier programs.
And that we need step scores as objective data points.
Also WashU has many in-house matches which makes it hard to interpret. NW match list posted above gives you a pretty good idea that these students match pretty similarly to any mid-tier/low-tier MD programs

 

[efle]

It's not hard to interpret in the slightest. They had a handful of non-top-20, with several of those probably being due to couples matches or other geographic restriction.

Their entire IQR is inside the top 20 IM programs, and that's simply not something you see happen elsewhere.

 

[throwaway1000000]

It's not hard to interpret in the slightest. They had a handful of non-top-20, with several of those probably being due to couples matches or other geographic restriction.

Their entire IQR is inside the top 20 IM programs, and that's simply not something you see happen elsewhere.

Again, the point is that just because you go to a top med school does not mean you are an excellent student. Many low-tier MD applicants match at these programs as well.
Step scores are needed to stratify applicants so mediocre applicants from top med schools don't get a significant advantage.

 

[libertyyne]

So either there is a significant amount of school snobbery at top residency programs or every t-20 student is a genius that immediately becomes average if they go to a lower ranked school.

 

[efle]

Again, the point is that just because you go to a top med school does not mean you are an excellent student. Many low-tier MD applicants match at these programs as well.
Step scores are needed to stratify applicants so mediocre applicants from top med schools don't get a significant advantage.

Step is a recognize-and-regurgitate bare minimum licensure exam that will soon be Pass/Fail. It was previously a way for students to identify themselves by devoting absurd amounts of time to flashcarding factoids, and while it sucks for DO and low tier MD students that this is going away, it's going away for good reason.

I promise you, the class that scored 234 avg step and the class that scored 248 step only two years apart at JHH, are not going to vastly differ in their quality as physicians. Both cohorts are going to be, on average, exemplary at what they choose to do. Pretending these two different step performances = two different calibers of classes is absurd, in my opinion.

 

[efle]

So either there is a significant amount of school snobbery at top residency programs or every t-20 student is a genius that immediately becomes average if they go to a lower ranked school.

There's a third option - those top 5 admits who choose their state school on full ride instead? They end up being the high end outlier match to MGH.

 

[throwaway1000000]

Step is a recognize-and-regurgitate bare minimum licensure exam that will soon be Pass/Fail. It was previously a way for students to identify themselves by devoting absurd amounts of time to flashcarding factoids, and while it sucks for DO and low tier MD students that this is going away, it's going away for good reason.

I promise you, the class that scored 234 avg step and the class that scored 248 step only two years apart at JHH, are not going to vastly differ in their quality as physicians. Both cohorts are going to be, on average, exemplary at what they choose to do. Pretending these two different step performances = two different calibers of classes is absurd, in my opinion.

So Step 1 is a not good indicator of anything. I can see that argument.
But MCAT and undergrad GPA are?? You made the point earlier that you think med school prestige (determined by undergrad GPA and MCAT) is a better indicator of someone's strength than step 1 score.
Do you feel the same about Step 2 CK? As long as Step 2 CK exists, I do not think low tier MD students and DO students have anything to worry about. Step 2 CK will continue to stratify applicants.
My ultimate point remains that there are many mediocre students at top med schools and many excellent students at low-tier med schools. There needs to be an objective measure to stratify these applicants (whether that's step 1, step 2 CK, some other speciality specific test, I don't really care). I would personally love to see IM applicants be stratified by their clinical reasoning skills in the form of an oral board exam since that's an extremely important skill in IM but that's in my dream world. As long as some objective measure exists to stratify applicants, I am OK.

 

[libertyyne]

There's a third option - those top 5 admits who choose their state school on full ride instead? They end up being the high end outlier match to MGH.

I'd be fairly surprised that those people who choose state schools are able to outlier match easily compared to people who got to top schools. It is human nature to assign higher value based on associated prestige of school. It happens in every other field, i am not surprised that it happens in medicine as well.

One person from my state school matched at a t-5 ortho program. That person did a year long fellowship there. Graduates of that t-5 school however did not do fellowships to match that program.

You are kind of white washing the bias by saying that t-20's have some innate quality that makes them better suited residents for t-20 programs. Is that more possible, or is it bias that program directors have towards t-20. Your school may have raised its step score, but that doesnt mean that the same corricula changes could not lead to similar increases in step at other schools.

 

[efle]

So Step 1 is a not good indicator of anything. I can see that argument.
But MCAT and undergrad GPA are?? You made the point earlier that you think med school prestige (determined by undergrad GPA and MCAT) is a better indicator of someone's strength than step 1 score.
Do you feel the same about Step 2 CK?

I think they aren't good, but are at least better than Step 1 was. Again, I'd say look to other fields where the trend is even more exaggerated to see why. It works this way in top law and finance and consulting recruiting, competitive STEM PhD admissions, hiring at competitive companies, etc. These recruiters aren't stupid people. They behave this way because the quality of product coming out of certain feeders is consistently top shelf.

I like the idea of using Step 2 better but I doubt we'll see it come to any fruition. The timing after 3rd year isn't conducive to filling this role, and similar to Step 1, the exam is built to have a high sensitivity at the bottom end of the distribution, with the 5th percentile at ~70% correct. It's going to be a really, really crappy metric to try and distinguish the top quartile once people start taking it seriously and creating a UFAPS/anki equivalent. And to top all these issues off, I think keeping Step 2 CK scored was a temporary compromise to placate program directors, and the NBME will eventually switch it to Pass/Fail as well.

 

[efle]

I'd be fairly surprised that those people who choose state schools are able to outlier match easily compared to people who got to top schools. It is human nature to assign higher value based on associated prestige of school. It happens in every other field, i am not surprised that it happens in medicine as well.

One person from my state school matched at a t-5 ortho program. That person did a year long fellowship there. Graduates of that t-5 school however did not do fellowships to match that program.

You are kind of white washing the bias by saying that t-20's have some innate quality that makes them better suited residents for t-20 programs. Is that more possible, or is it bias that program directors have towards t-20. Your school may have raised its step score, but that doesnt mean that the same corricula changes could not lead to similar increases in step at other schools.

I believe the PD bias comes from consistently receiving high quality residents from these kinds of schools. See the above. If it really was all in our heads, then competition should punish the idiots who are paying high salaries and focusing all their recruitment on graduates from a handful of elite feeders. But yet, somehow it keeps working fine in all these fields.

 

[throwaway1000000]

I think they aren't good, but are at least better than Step 1 was. Again, I'd say look to other fields where the trend is even more exaggerated to see why. It works this way in top law and finance and consulting recruiting, competitive STEM PhD admissions, hiring at competitive companies, etc. These recruiters aren't stupid people. They behave this way because the quality of product coming out of certain feeders is consistently top shelf.

I like the idea of using Step 2 better but I doubt we'll see it come to any fruition. The timing after 3rd year isn't conducive to filling this role, and similar to Step 1, the exam is built to have a high sensitivity at the bottom end of the distribution, with the 5th percentile at ~70% correct. It's going to be a really, really crappy metric to try and distinguish the top quartile once people start taking it seriously and creating a UFAPS/anki equivalent. And to top all these issues off, I think keeping Step 2 CK scored was a temporary compromise to placate program directors, and the NBME will eventually switch it to Pass/Fail as well.

You are right. PDs aren't stupid. Which is the reason NW and WashU both have many mediocre matches. Every student at Wash and NW would match at top 10 IM program if PDs thought all students at top schools were so brilliant.
As long as Step 2 or some other objective measure exists, there will continue to be mediocre matches at top schools and excellent matches at low-tier schools.
So your idea is to take out a crappy metric (step 1, step 2 ck) and base it on med school prestige (determined by worse metrics, MCAT and undergrad GPA)
I doubt step 2 CK will ever turn to pass/fail but I don't think either of us can predict that.
I think I made my points. I will add something else if I have more to say.

 

[timeflies]

Your school may have raised its step score, but that doesnt mean that the same corricula changes could not lead to similar increases in step at other schools.

Assuming efle goes to JHU, this increase was not due to curriculum changes and in fact was due to students abandoning the curriculum in favor of self-study targeted toward step 1 specifically. efle made this point earlier in this thread that the increase reflects priority being a large factor in step 1 scores, given that it is unlikely that the 234 and the 248 classes are actually that different in intelligence or ability, simply that one decided to prioritize step over the university-specific curriculum. I know this because I have a friend in the same cohort at JHU.

 

[libertyyne]

I believe the PD bias comes from consistently receiving high quality residents from these kinds of schools. See the above. If it really was all in our heads, then competition should punish the idiots who are paying high salaries and focusing all their recruitment on graduates from a handful of elite feeders. But yet, somehow it keeps working fine in all these fields.

Not really,Academic medicine is not the free market, and even if you use that analogy. Difference in recruitment is not going to make or break these programs at the level they are recruiting. The could easily fill their class up with non t-5 students for a long time and see zero difference considering the difference between residents at these levels is going to be fairly miniscule.
The systems have continued to work fine with nepotism, racism and recruitment from their own creed and class for decades. Just because something continues to function isnt evidence that the process they are using is maximizing talent or outcomes.