Advantage of School Pedigree on Internal Medicine Residency Matching

[bananafish94]

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 an amazing accomplishment but I’m talking more about broad strokes and general trends than individual examples of which I’m sure there are many. I worked two jobs in college and never paid for tutors or private courses either. I also never said it was the primary determinant, but let’s not pretend it doesn’t make a difference. If you take a cohort of students who have to take out loans or work part-time and compare it to an identical cohort who gets to devote all their time to pre-med activities, doesn’t have to worry about money, and has access to as many tutors or private courses as they want, I have a hard time believing there isn’t going to be a difference.

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[indecisiveconvention]

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 think your quote “We match regularly into these programs amongst our students that get AOA” sort of stood out to me and may encapsulate a lot of what has been discussed in this thread.

The vast majority of students matching IM in this WashU match list did not get AOA, yet almost 90% went to a top 20 program, with most of those being a top 10 program. And anecdotally, at least 1 of the non-top 20 matches was to a hometown.

The real reason for such disparities in matching between different tiers of schools is probably a mix of self-driven student performance and PDs favoring some tiers of schools over others.

 

[bananafish94]

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.

I think you and I might be arguing slightly different things. What I’m talking about is the inherent value of having gone to a certain college, which I think is basically nothing. You’re talking about taking advantage of the opportunities that one might be privy to at certain institutions. To be clear, I totally agree that research and publications from college are valuable but I think that has more to do with the person doing the research than the college. Hypothetically speaking, should two otherwise identical applicants from Harvard vs. the University of Nebraska be treated differently? I would argue no.

 

[throwaway1000000]

I think your quote “We match regularly into these programs amongst our students that get AOA” sort of stood out to me and may encapsulate a lot of what has been discussed in this thread.

The vast majority of students matching IM in this match list did not get AOA, yet almost 90% went to a top 20 program, with most of those being a top 10 program. And anecdotally, at least 1 of the non-top 20 matches was to a hometown.

The real reason for such disparities in matching between different tiers of schools is probably a mix of self-driven student performance and PDs favoring some tiers of schools over others.

See I think you didn't read the entire thread.
I don't have a problem with these students having advantage over low-tier MD applicants.
At the risk of sounding cocky, I think I have a better application than majority of these students but matched similarly as I am from a low-tier MD school which is OK with me.
What I am arguing against is someone suggesting earlier that going to a top med school means you are automatically a brilliant student which is not true. PDs are not stupid. They look at many factors other than your med school prestige. Just look at the match list at Northwestern I posted. I can probably find many similar match lists.
One of the commenters (I could be wrong) seems to think med school prestige is the strongest indicator as someone's strength as an applicant which I disagree with. PDs do too looking at the match lists I posted.

 

[altblue]

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.

Let's say we grant that students at top schools have already proven themselves to be extremely capable, meaning that Step 1 is more of a formality.... Even in that case, that doesn't mean Step 1 can't be used to by students who, I suppose, haven't proven themselves to show that they are extremely capable as well. A high Step score allows them to demonstrate that, but this ability is removed with Pass/Fail Step.

And I don't buy that ECs are necessarily always better at the top, which is another validating factor you had mentioned earlier... and we all know there are T20s that care about stats and not how special you are. In general maybe the ECs are better, but really only MCAT/GPA and research are the main methods of stratifying schools by tier, there plenty of fantastic business people, those people dedicated to service, successful attorneys, those who overcame poverty etc. at lower-tier schools.

EDIT: And since I didn't address your thoughts on the Step's validity, I'm not convinced MCAT/GPA, which isn't directly related to medical practice, is a better metric than Step, which is. I'm preclinical, so I won't explicitly argue for the value of Step as a predictive measure, but man it's difficult to for me to see how either of those metrics are more valid than Step

 

[efle]

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.

Think about the PD ratings for NYU. They've started climbing slowly but surely, reflecting the much improved caliber of students matriculating and graduating from NYU.

Programs like JHH and MGH have a mix every year of top tier and typical med schools. Top tier is always overrepresented, but this year they aren't even a majority. So yeah, PDs are directly comparing side by side the AOA cream of the crop from everywhere else, right next to the typical Top 10 graduates. And guess what they then do the next year...they continue to favor and overrepresent the top 10.

 

[indecisiveconvention]

See I think you didn't read the entire thread.
I don't have a problem with these students having advantage over low-tier MD applicants.
At the risk of sounding cocky, I think I have a better application than majority of these students but matched similarly as I am from a low-tier MD school which is OK with me.
What I am arguing against is someone suggesting earlier that going to a top med school means you are automatically a brilliant student which is not true. PDs are not stupid. They look at many factors other than your med school prestige. Just look at the match list at Northwestern I posted. I can probably find many similar match lists.

Admittedly did get a bit lost in this thread, since it's been derailed

I did a quick calculation for Northwestern - ~50% went to top 20 programs, with 2 going to top 10s.

It's hard to interpret match lists; so many reasons students want to end up where they do.

 

[7331poas]

Think about the PD ratings for NYU. They've started climbing slowly but surely, reflecting the much improved caliber of students matriculating and graduating from NYU.

Programs like JHH and MGH have a mix every year of top tier and typical med schools. Top tier is always overrepresented, but this year they aren't even a majority. So yeah, PDs are directly comparing side by side the AOA cream of the crop from everywhere else, right next to the typical Top 10 graduates. And guess what they then do the next year...they continue to favor and overrepresent the top 10.

The PD ratings for NYU reflect nothing more than the fact that they have appeared more in the media and they have a higher US news ranking recently.

 

[libertyyne]

Think about the PD ratings for NYU. They've started climbing slowly but surely, reflecting the much improved caliber of students matriculating and graduating from NYU.

Programs like JHH and MGH have a mix every year of top tier and typical med schools. Top tier is always overrepresented, but this year they aren't even a majority. So yeah, PDs are directly comparing side by side the AOA cream of the crop from everywhere else, right next to the typical Top 10 graduates. And guess what they then do the next year...they continue to favor and overrepresent the top 10.

IF you are coming from a T-10 program you dont have to have the same resume as someone coming from a non -t 10 program. This data is not publically available , but do you seriously think odds of people with similar applications in terms of grades, research , step coming from t-10 vs non t-10 programs are the same ?

 

[efle]

The PD ratings for NYU reflect nothing more than the fact that they have appeared more in the media and they have a higher US news ranking recently.

Disagree. Ten years ago NYU was not stealing away admits from top 10s. Now they are (largely from the blanket full rides).

IF you are coming from a T-10 program you dont have to have the same resume as someone coming from a non -t 10 program. This data is not publically available , but do you seriously think odds of people with similar applications in terms of grades, research , step coming from t-10 vs non t-10 programs are the same ?

No, I think the t10 are way more likely to have all the strong application components, that's my entire premise here. That's why school name is a valued heuristic. It's the people disagreeing with me who seem to think otherwise!

 

[detritus]

Haven’t started med school yet so take this with a grain of salt, but one thing missing from this convo is the halo affect. The medical students from Harvard, Hopkins, UCSF, Penn, etc. may be no better than the students from mid-low tier schools, but they will be perceived as better, even given the same publications, performance, etc. Once you know where someone goes to school, they seem to walk on water even if objectively speaking, you could switch the name brand sticker on any two applicants and couldn’t tell them apart. Ex. The Harvard kid remembers to check up on a patient that had a difficulty surgery during a sub-I and immediately you think “wow, Harvard produces some thoughtful med students” a student from a no name school does the same thing and it may be ignored. It’s human nature, happens with good looking people too, they may be objectively worse people, but are perceived as nicer, smarter, etc.

 

[efle]

Haven’t started med school yet so take this with a grain of salt, but one thing missing from this convo is the halo affect. The medical students from Harvard, Hopkins, UCSF, Penn, etc. may be no better than the students from mid-low tier schools, but they will be perceived as better, even given the same publications, performance, etc. Once you know where someone goes to school, they seem to walk on water even if objectively speaking, you could switch the name brand sticker on any two applicants and couldn’t tell them apart. Ex. The Harvard kid remembers to check up on a patient that had a difficulty surgery during a sub-I and immediately you think “wow, Harvard produces some thoughtful med students” a student from a no name school does the same thing and it may be ignored. It’s human nature, happens with good looking people too, they may be objectively worse people, but are perceived as nicer, smarter, etc.

You'll enjoy this study that found attractive headshots on residency applications were worth more than clerkship grades, AOA or class rank!

Bias in Radiology Resident Selection: Do We Discriminate Against the Obese and Unattractive? - PubMed

Findings provide preliminary evidence of discrimination against facially unattractive and obese applicants in radiology resident selection. Obesity and attractiveness were as influential in applicant selection for interview as traditional medical school performance metrics. Selection committees...

www.ncbi.nlm.nih.gov

 

[TheIllusionist]

You'll enjoy this study that found attractive headshots on residency applications were worth more than clerkship grades, AOA or class rank!

Bias in Radiology Resident Selection: Do We Discriminate Against the Obese and Unattractive? - PubMed

Findings provide preliminary evidence of discrimination against facially unattractive and obese applicants in radiology resident selection. Obesity and attractiveness were as influential in applicant selection for interview as traditional medical school performance metrics. Selection committees...

www.ncbi.nlm.nih.gov

Race also heavily determines what is considered attractive. People think they aren't like this, but most have incredible racial unconscious bias. This will mostly hurt non-URM minorities. But that is another quagmire. Head-shots should not even be a thing, and this is coming from someone good looking. They just allow the pretty blonde cheer leader type who has had it easy, all things held equal, relative to many other phenotypic groups of people, to continue to have a powerful edge. The interview itself also grants that edge, but the headshot just compounds it with the phase of committee review making it a factor again.

Also tech, consulting, finance, law, and elite PhD programs (more so tech and PhD but the others too) are thinking jobs. You need strong social skills for sure for some of those. But being a creative, intuitive, out of the box problem solver focused on principles and conceptual type learning and application are what makes you good in those professions. Clinical medicine is quite algorithmic and the procedural side is frankly just a ton of practice. Yes, the best of the best tend to be incredibly brilliant. But most physicians really don't have to be. If you aren't the one creating the algorithms, discovering the devices, creating the new surgical approaches, influencing policy, etc. you don't need to be this super star.

Most elite school grads are NOT this. Medicine isn't a gloaded profession like some of the other top jobs. It is a lot more vocational for the vast vast majority of practitioners, including those from top places. So whatever shine and glimmer these top grads, if in fact they are just more brilliant from say an IQ type stand point, it really doesn't matter.

What you need to demonstrate instead is a commitment to working hard at learning the facts and important algorithms for being a good clinician and practicing them over and over again. Being kind to patients and fellow staff also go a long way but being the even the type of social genius necessary to move up in a lot of the corporate world is also not a requisite.

What matters is devotion to learning the knowledge and skills of clinical medicine and also being able to navigate the power hierarchies of hospitals to get stuff done. This is demonstrated by STEP exams and clinical grades (done rigoursly, not like the T5s that give 80% of people honors not one in isolation but many together). Research is that extra umph that demonstrates a commitment to adding to new knowledge.

You know I knew a Stanford CS guy who went to a T5 med school. He created an insane molecular genetics algorithm for analyzing a few cancers. He has been published in Nature and Cell. He is an absolute tank. But he is the EXCEPTION. Most top school grads are NOT like that. Elfe can argue with me all day on this point, if he or she wants to. But I've met a whole ton and know many quite personally and frankly enough of their CVs are equivalent and many less impressive than mine.

So why do top schools do this. Well with NYU it is because the rank went up because a lot of the high GPA MCAT kids went there for the free tuition. With the media attention and average grades and scores rising, USWNR noticed and kept bumping them. Residencies noticed and realized the market value of having an "NYU med grad" went up. Top schools all exchange applicants to protect themselves.They know med school screening criteria is imperfect. And they want to continue being at the top no matter what. One way they know people applying will evaluate them will be on their match lists.

It is in their interest to function like a mafia or cartel. They keep taking each other's applicants like one big incestuous family, no matter how qualified on paper. They also work together to remove all meritocratic criteria like STEP exams. What happens? They just lock themselves further into a position of unchallengeable and unquestionable prestige and power. This just leads to less mobility over all and diminishes meritocracy. That is the big issue.

 

[sealfriendo]

Race also heavily determines what is considered attractive. But that is another quagmire.

Headshots should not even be a thing, and this is coming from someone good looking.

pics plz bb

 

[TheIllusionist]

pics plz bb

 

[sealfriendo]

View attachment 302674

shouldnt have asked for what i can't handle!!

 

[Oedipa Maas]

Ex. The Harvard kid remembers to check up on a patient that had a difficulty surgery during a sub-I and immediately you think “wow, Harvard produces some thoughtful med students” a student from a no name school does the same thing and it may be ignored. It’s human nature, happens with good looking people too, they may be objectively worse people, but are perceived as nicer, smarter, etc.

I think this cuts the other way too and expectations for those from prestigious backgrounds can be higher. I did an away rotation at an ivy league institution it did show me that some experiences, research opportunities, and didactics that I loved would not be available at many institutions. However, if anything was even slightly subpar there, it felt like a letdown in ways that it would not have if I didn't go in with high expectations.

 

[TheIllusionist]

I think this cuts the other way too and expectations for those from prestigious backgrounds can be higher. I did an away rotation at an ivy league institution it did show me that some experiences, research opportunities, and didactics that I loved would not be available at many institutions. However, if anything was even slightly subpar there, it felt like a letdown in ways that it would not have if I didn't go in with high expectations.

clinically my aways were the same at ivy tier places and my mid tier state school for previous speciality I wanted to do prior to picking IM. all had dedicated physicians with decades of experience. Teaching was quite similar. Research wise there was some difference with top tier people have easier access and more efficient system to work with

 

[aldol16]

I think you and I might be arguing slightly different things. What I’m talking about is the inherent value of having gone to a certain college, which I think is basically nothing. You’re talking about taking advantage of the opportunities that one might be privy to at certain institutions. To be clear, I totally agree that research and publications from college are valuable but I think that has more to do with the person doing the research than the college. Hypothetically speaking, should two otherwise identical applicants from Harvard vs. the University of Nebraska be treated differently? I would argue no.

All things are not equal. All things are never equal. The applicant from Harvard is going to have more resources available to him or her to be able to take advantage of research and networking opportunities that the other person will not. Every time this sort of argument comes up, somebody always tries to make it an apples to apples comparison. It will never be an apples to apples comparison. There is nothing innate about the student going to Harvard that makes them great. But going to Harvard conveys certain advantages that going to a state school will not. Those advantages will build upon one another. The person going to Harvard will be able to reach new heights that are not accessible to the person from the state school because of those advantages. So there's no such thing as all things being equal.

 

[Oedipa Maas]

clinically my aways were the same at ivy tier places and my mid tier state school for previous speciality I wanted to do prior to picking IM. all had dedicated physicians with decades of experience. Teaching was quite similar. Research wise there was some difference with top tier people have easier access and more efficient system to work with

This is probably somewhat specialty specific. For psych I definitely noticed a difference in what kinds of clinical experiences were offered, at least in terms of electives (ECT, TMS, partial programs, involuntary vs voluntary admissions (some places just had one or the other), multiple modalities of psychotherapy, etc). Obviously there was a difference in access to research opportunities as well like you mentioned. I will say that being able to see a broad spectrum in resident abilities during my away as well as at my home program allowed me to realize that I am the one who is responsible for my education. The program's job is to provide me with opportunities, but it is on me to learn and grow and become the physician I want to be, regardless of opportunity or ease.

 

[aldol16]

clinically my aways were the same at ivy tier places and my mid tier state school for previous speciality I wanted to do prior to picking IM. all had dedicated physicians with decades of experience. Teaching was quite similar. Research wise there was some difference with top tier people have easier access and more efficient system to work with

Yeah, that's probably a function of the aways you picked. Nothing wrong with picking aways at similar places. But other people have other strategies for picking aways, such as picking places that have different mix of affiliated hospitals (e.g. VA, county hospitals, etc.) or are located in diverse places (e.g. SF vs Midwest). So even among the top places, you'll get tons of variation just from that. Each place also tends to have its own culture and that can be huge for your experience as a resident. Residents are definitely closer at some places than others. Just depends on what you want.

 

[whoknows2012]

Haven’t started med school yet so take this with a grain of salt, but one thing missing from this convo is the halo affect. The medical students from Harvard, Hopkins, UCSF, Penn, etc. may be no better than the students from mid-low tier schools, but they will be perceived as better, even given the same publications, performance, etc. Once you know where someone goes to school, they seem to walk on water even if objectively speaking, you could switch the name brand sticker on any two applicants and couldn’t tell them apart. Ex. The Harvard kid remembers to check up on a patient that had a difficulty surgery during a sub-I and immediately you think “wow, Harvard produces some thoughtful med students” a student from a no name school does the same thing and it may be ignored. It’s human nature, happens with good looking people too, they may be objectively worse people, but are perceived as nicer, smarter, etc.

This is one of the best posts in the thread, incredibly from someone that hasn’t even started med school yet who totally perceives the issues were discussing.

 

[Pluto98]

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

PD ranking for Yale puts them at 14 vs 16 for northwestern. Hardly a difference in PD ranking yet there is a difference between the IM match lists. How do you explain that? I personally think PD ranking means nothing considering only something like 1/5 PDs return the survey

 

[medstud56]

Where are the true IM residency rankings anyway lol?
Doximity seems to be somewhat of a joke

 

[whoknows2012]

Where are the true IM residency rankings anyway lol?
Doximity seems to be somewhat of a joke

No such thing. Tiers are the best way to think about them

 

[TheIllusionist]

No such thing. Tiers are the best way to think about them

Doximity is very bad. They even **** up tiers at times. And switch places like Pennsy and Penn. there is a reason top institutions advertise their UNSWR #1 and it is not not because doximity is newer and not as established...

 

[Pluto98]

Doximity is very bad. They even **** up tiers at times. And switch places like Pennsy and Penn. there is a reason top institutions advertise their UNSWR #1 and it is not not because doximity is newer and not as established...

what are the tiers

 

[habibimarwan]

If you're smart, you get top residency match. If you want school to hold hand and give you free pass, better luck next time. Go where you are happy! Good luck!!

 

[efle]

PD ranking for Yale puts them at 14 vs 16 for northwestern. Hardly a difference in PD ranking yet there is a difference between the IM match lists. How do you explain that? I personally think PD ranking means nothing considering only something like 1/5 PDs return the survey

I don't find the Yale match list to be nearly as impressive as places like WashU or Hopkins either. They put what, half dozen out of 30 into the Big 4 despite being in the same region as 3 of them? It's a very recognizable name which makes it surprising to some people that they aren't as top tier in medicine. You can view PD and peer metrics as worthless all you like, to me they capture the tiers at a glance pretty accurately!

 

[whoknows2012]

Doximity is very bad. They even **** up tiers at times. And switch places like Pennsy and Penn. there is a reason top institutions advertise their UNSWR #1 and it is not not because doximity is newer and not as established...

Doximity is a complete disaster. I meant in general thinking about programs in tiers

 

[7331poas]

If you're smart, you get top residency match.

I think we have already demonstrated that this isn't necessarily true.

 

[Pluto98]

I don't find the Yale match list to be nearly as impressive as places like WashU or Hopkins either. They put what, half dozen out of 30 into the Big 4 despite being in the same region as 3 of them? It's a very recognizable name which makes it surprising to some people that they aren't as top tier in medicine. You can view PD and peer metrics as worthless all you like, to me they capture the tiers at a glance pretty accurately!

Just for fun, I went through the 2019 match list for several schools. I looked at the percentage of top 4 IM matches each school has. Yale had more top 4 matches than WashU, Penn, Columbia, Duke and significantly more than northwestern (by a wide margin). Using the top 4 as a cutoff introduces far too much bias for the med schools that have these home programs. Instead, look at the T20 IM programs. You will notice their really isn't any difference.


42.8% stanford
73.4% hms
42.3% hopkins
25.7% penn
14.3% columbia
30.7% Yale
2.5% northwestern
20.8% WashU
42.8% UCSF
23.8% Duke

 

[efle]

Just for fun, I went through the 2019 match list for several schools. I looked at the percentage of top 4 IM matches each school has. Yale had more top 4 matches than WashU, Penn, Columbia, Duke and significantly more than northwestern (by a wide margin). Using the top 4 as a cutoff introduces far too much bias for the med schools that have these home programs. Instead, look at the T20 IM programs. You will notice their really isn't any difference.


42.8% stanford
73.4% hms
42.3% hopkins
25.7% penn
14.3% columbia
30.7% Yale
2.5% northwestern
20.8% WashU
42.8% UCSF
23.8% Duke

You'll notice I mentioned region. WashU grads are more likely stay at Barnes or other big midwestern strengths like Mayo and Michigan. Duke more likely to stay at Duke or UTSW, etc.

The reason Yale list looks weaker to me is that Yale is not a comparably strong home program so a much larger portion are going elsewhere, and of those, only a handful are landing MGH or Brigham or JHH despite being in the northeast.

It's too much of a pain in the ass to do it myself, but I bet if you looked at the percentage of IM matches who went to one of the 3 closest top 10 IMs, the list would look different.

 

[Pluto98]

You'll notice I mentioned region. WashU grads are more likely stay at Barnes or other big midwestern strengths like Mayo and Michigan. Duke more likely to stay at Duke or UTSW, etc.

The reason Yale list looks weaker to me is that Yale is not a comparably strong home program so a much larger portion are going elsewhere, and of those, only a handful are landing MGH or Brigham or JHH despite being in the northeast.

It's too much of a pain in the ass to do it myself, but I bet if you looked at the percentage of IM matches who went to one of the 3 closest top 10 IMs, the list would look different.

I don't think region is as big a factor as your saying it is for these particular schools. Their have been years where california is the most popular state Yale students matched into (more than connecticut or Mass, see 2016 match list). Stanford is also known to send a lot of students to the east coast. Since I got time on my hands, I did the same analysis for the 2019 match list for all these schools. I looked at the percentage of students which matched into a T20 IM program (in reality there are 22 programs listed). I used the following list as a gauge for T20 rankings. As you can see, Yale matches more people into T20 IM programs than both WashU and Hopkins. This analysis should account for geographical differences



Internal medicine

Hopkins, MGH, BWH, UCSF (big four)
U Penn, Columbia, Duke, U Michigan, Wash U, Stanford, U Washington
And many others (UCLA, U Chicago, UTSW, BIDMC, Cornell, Mayo, Mt Sinai, Northwestern, Vanderbilt, Yale, Pitt)

92.8% stanford
94.4% harvard
71.4% cornell
76.9% hopkins
77% penn
74.4% Columbia
92.3% Yale
70.7% northwestern
70.8% WashU
66.6% UCSF
95.6% Duke

 

[efle]

Internal medicine

Hopkins, MGH, BWH, UCSF (big four)
U Penn, Columbia, Duke, U Michigan, Wash U, Stanford, U Washington
And many others (UCLA, U Chicago, UTSW, BIDMC, Cornell, Mayo, Mt Sinai, Northwestern, Vanderbilt, Yale, Pitt)

92.8% stanford
94.4% harvard
71.4% cornell
76.9% hopkins
77% penn
74.4% Columbia
92.3% Yale
70.7% northwestern
70.8% WashU
66.6% UCSF
95.6% Duke

Honestly what this proves to me is that all of the t20 med schools are overwhelmingly placing their students into t20 IM residencies, rather than there being any significant difference between Yale or Northwestern and the others. Can you easily trim your excel sheet to just show me top 10 IM matches?

 

[Pluto98]

Honestly what this proves to me is that all of the t20 med schools are overwhelmingly placing their students into t20 IM residencies, rather than there being any significant difference between Yale or Northwestern and the others. Can you easily trim your excel sheet to just show me top 10 IM matches?

I did this manually! But I will repeat for top 10 IM matches. Here ya go!

Top 10 (really 11 schools) are below:

Hopkins, MGH, BWH, UCSF (big four)
U Penn, Columbia, Duke, U Michigan, Wash U, Stanford, U Washington


92.8% stanford
85.2 % harvard
32% cornell
61.5 % Hopkins
60.5% Penn
57.1 % columbia
50% Yale
19% Northwestern
66.6% WashU
54.7% UCSF
86.9% Duke

Still dosent seem like any difference. The only difference here is that Yale is a t20 program as is northwestern instead of a T10. When you look at T20 matches on the whole, its a wash (except for a few outliers).

 

[efle]

I did this manually! But I will repeat for top 10 IM matches. Here ya go!

Top 10 (really 11 schools) are below:

Hopkins, MGH, BWH, UCSF (big four)
U Penn, Columbia, Duke, U Michigan, Wash U, Stanford, U Washington


92.8% stanford
85.2 % harvard
32% cornell
61.5 % Hopkins
60.5% Penn
57.1 % columbia
50% Yale
19% Northwestern
66.6% WashU
54.7% UCSF
86.9% Duke

Still dosent seem like any difference. The only difference here is that Yale is a t20 program as is northwestern instead of a T10. When you look at T20 matches on the whole, its a wash (except for a few outliers).

I agree, I think the only reason places like Cornell and Northwestern are lower are because none of their home-matches are being counted. Take home point for me is that across the board, t20 med schools place the overwhelming majority of their students into t20 IM residencies, especially their home residency.

With the context that 250+/AOA/pubs are rarely matching to these same residencies from mid level med schools, I think we've sort of proven that "tiers" really do matter while the nitty gritty doesn't. In other words, I wouldn't sweat the differences between #1-5 and #15-20, but I definitely might think twice about taking the scholarship to state school if I want that kind of match.

All of this has been SDN wisdom for years but it's great to see it displayed in the data. Much appreciated

 

[Pluto98]

I agree, I think the only reason places like Cornell and Northwestern are lower are because none of their home-matches are being counted. Take home point for me is that across the board, t20 med schools place the overwhelming majority of their students into t20 IM residencies, especially their home residency.

With the context that 250+/AOA/pubs are rarely matching to these same residencies from mid level med schools, I think we've sort of proven that "tiers" really do matter while the nitty gritty doesn't. In other words, I wouldn't sweat the differences between #1-5 and #15-20, but I definitely might think twice about taking the scholarship to state school if I want that kind of match.

All of this has been SDN wisdom for years but it's great to see it displayed in the data. Much appreciated

Basically, look at the top 4 schools matching the most number of kids into the T20 IM programs. Listed below they are

95.6% Duke
94.4% harvard
92.8% stanford
92.3% Yale

What do these schools have in common? Besides Duke, 3 of them do not rank their students. My bet is that a lot of people choose to stay at Duke because they like the area and low cost of living.


My bet is that Yale (and to some extent HMS and stanford) sneaks in a lot of students to the t20 IM programs because they dont rank their kids.
Compare this to a place like Hopkins (76.9%) or Penn (77%) which do rank their students (giving the best students the ability to distinguish themselves and match at T10/T4) but disadvantaging the rest at matching t20 (obv not to a large degree since 77% is still A LOT).


Not ranking your kids = more people matching T20 but less matching T4 (bc its harder for students to distinguish themselves). Personally, I rather have a guarantee for matching T20 (or matching whatever surgical sub speciality I want) than having the ability to distinguish myself and match at a T4 program but with the caveat that if I dont distinguish myself, I have a lesser chance of matching T20 or matching something like plastic surgery anywhere.

 

[efle]

Basically, look at the top 4 schools matching the most number of kids into the T20 IM programs. Listed below they are

95.6% Duke
94.4% harvard
92.8% stanford
92.3% Yale

What do these schools have in common? Besides Duke, 3 of them do not rank their students. My bet is that a lot of people choose to stay at Duke because they like the area and low cost of living.


My bet is that Yale (and to some extent HMS and stanford) sneaks in a lot of students to the t20 IM programs because they dont rank their kids.
Compare this to a place like Hopkins (76.9%) or Penn (77%) which do rank their students (giving the best students the ability to distinguish themselves and match at T10/T4) but disadvantaging the rest at matching t20 (obv not to a large degree since 77% is still A LOT).


Not ranking your kids = more people matching T20 but less matching T4 (bc its harder for students to distinguish themselves). Personally, I rather have a guarantee for matching T20 (or matching whatever surgical sub speciality I want) than having the ability to distinguish myself and match at a T4 program but with the caveat that if I dont distinguish myself, I have a lesser chance of matching T20 or matching something like plastic surgery anywhere.

Hopkins also doesn't rank. I'd need to see another year to read more into it - differences of 10-20% are really just 3-6 people out of >100. I think it's just random noise dictating the exact order

 

[Pluto98]

Hopkins also doesn't rank. I'd need to see another year to read more into it - differences of 10-20% are really just 3-6 people out of >100. I think it's just random noise dictating the exact order

Heres the 2018 data. Your right, the exact order looks like noise. Its the same grouping of schools pretty much maybe with northwestern as an outlier.

2018 IM match lists

Hopkins: 89.2%
stanford: 100%
Yale: 81.4%
harvard: 89.3%
northwestern: 57%
Penn 91.1%
WashU 83.8%
Duke 87.5%
79.4% Columbia (2020 match couldn’t find 2018 match)

 

[sharkbyte]

Haven't read all the posts, here's my 2 cents:

There were numerous examples on the IM reddit spreadsheet of applicants from top schools having average or below average step scores and so-so applications who still landed interviews at and matched at Top 10/20 programs. There were similarly even more examples of students from low-tier MD or DO schools who honestly killed it in med school and put together stellar applications with 250-260+ step, solid research, H in IM and other rotations, etc who were either getting shut out from the top 30 or only getting 1 or 2 scattered interviews. Better than nothing of course, but strikes me as kind of unfair. All because their school isn't a brand name or because they arbitrarily missed out on AOA. Which of these 2 would likely end up the better resident?

Would like to add a disclaimer that this probably isn't a super large # of students. I'm sure most of the people at Harvard/Hopkins/Yale/UPenn etc have been high achieving their entire lives and continue that way through med school. But it's significant enough to talk about. Isn't there a running joke that the bottom of the barrel Harvard students can still get Beth Israel? I could be wrong, maybe they've moved away from this but still.

 

[Lawpy]

Haven't read all the posts, here's my 2 cents:

There were numerous examples on the IM reddit spreadsheet of applicants from top schools having average or below average step scores and so-so applications who still landed interviews at and matched at Top 10/20 programs. There were similarly even more examples of students from low-tier MD or DO schools who honestly killed it in med school and put together stellar applications with 250-260+ step, solid research, H in IM and other rotations, etc who were either getting shut out from the top 30 or only getting 1 or 2 scattered interviews. Better than nothing of course, but strikes me as kind of unfair. All because their school isn't a brand name or because they arbitrarily missed out on AOA. Which of these 2 would likely end up the better resident?

Would like to add a disclaimer that this probably isn't a super large # of students. I'm sure most of the people at Harvard/Hopkins/Yale/UPenn etc have been high achieving their entire lives and continue that way through med school. But it's significant enough to talk about. Isn't there a running joke that the bottom of the barrel Harvard students can still get Beth Israel? I could be wrong, maybe they've moved away from this but still.

Seems like the best way to think of it is to imagine an IM "airline" that has its hub at Harvard airport or (insert any other brand name school here). The most frequent and lucrative routes are to Hopkins, Yale, Columbia, Duke, Stanford, UCSF etc and the other way around. You can get there multiple times a day and directly too. But if you want to get there from Albany or Kansas or MCW or Arizona or whatever, you'll need to wait for that once weekly flight or make a connection or two. I.e. it'll take more work, in the form of AOA or a big name letter or something.

If that's a stupid analogy please forgive me, I haven't done anything productive in weeks

How did people from non top schools with AOA fare in the spreadsheet?

 

[Lucca]

How did people from non top schools with AOA fare in the spreadsheet?

just gonna quote myself here

just to add some numbers to this comment:

so for the t8 IM II recipient data most actually reported no AOA or N/A (14 N/A, 21 Non-AOA, 29 AOA // 45% with AOA overall ).
stratifying by school ranking ( n/a, non-AOA, AOA)

low: 7 / 11 / 3 (~14% with AOA)
mid: 1 / 5 / 17 (~74% with AOA)
top: 6 / 5 / 9 (~45% with AOA)*

*keep in mind that many top schools either dont give out AOA / rank their students or only give out AOA after ERAS is submitted.

here's what the step 1 scores look like stratifying by rank and AOA. n are rly small here so any apparent difference between these distributions is most likely not meaningful, but showing it anyway in case anyone wanted to see it.

it would be better to look at AOA vs. class rank vs. Step 1 with the full IM spreadsheet but I didnt clean the data for those variables in the full IM spreadsheet. Maybe if I'm bored next week.

but doing a quick tabulation takes no time at all and in the overall IM spreadsheet 21% had AOA, 48% didn't have AOA, 30% reported N/A so unsurprisingly AOA is overrepresented in the t8 IM data, non-AOA is underrepresented.

 

[Lucca]

double posting since cant have more than 10 images in a single post but also quoting my original OP to give context to the AOA graph above

sup nerds, read on for some potentially spicy data related to step 1, med school prestige, top IM residency applicants, etc (ur too cool to care about those things but lets face it you're going to post about it anyway so might as well have some graphs to point to).

so every year, residency applicants on the internet will use spreadsheets to anonymously share information about interview invitations, experiences etc. Well, these spreadsheets also happen to have a wealth of information on the applicants themselves but the information has never, to my knowledge, been presented in a particularly helpful way. But Lucca, you might say, dont we have the NRMP Charting the Outcomes data, the best possible source of residency related information available to anyone???? Yes! That's completely right. But this is SDN where we also have endless arguments about things the AAMC (and probably no one else) doesnt care about, like how much the prestige of your med school matters. After doing some data cleaning I made up some graphs to try to extract some basic information from this snapshot of 171 anonymous IM applicants.

caveats and disclaimers:
-yes, this data is anonymous and comes from the internet so obviously grain of salt and all that
-this data (n=171) is a small fraction of the ~11,000 total US IM applicants so it's a snapshot. Think of it like shotgun sequencing a cup of water from a lake to get an idea of whats going on in the lake, but certainly not a thorough census of all life in the lake ecosystem.
-data cleaning: ppl often had funky answers to the school ranking question like Mid-Low tier (?????) so I've lumped all into just 3 buckets: Low, Mid, Top. DO and IMG were automatically sorted to the "Low" category. "Top" was reserved for people claiming Top tier or T20. Everything else was sorted into "Mid". N/A from the original spreadsheet data were removed for the sake of simplicity.

Now that the boring part is over let's look at some graphs.
here's the overall step 1 distributions by school tier:

obviously the folks on the IM spreadsheet tend to have pretty high Step 1s with the median floating around 240! Definitely not representative of the overall IM applicant population, but something good to keep in mind. There is also no meaningful difference from any of these distributions as far as Step 1 is concerned.


First, lets look at II to App Yield vs Step 1. Points are individual applicants. Density contours added to aid in visualization. App yield is defined as # of IIs / # of apps sent out.

These density maps are almost completely overlapping, with a clear trend for higher yields with increasing step 1 score. This suggests that looking at all potential IM programs in aggregate, Step 1 is a better predictor of overall App Yield compared to School Ranking. Matches up with the received wisdom passed down on Reddit/SDN. Neat.

That said, it looks like applicants from higher ranked medical schools tend to be more likely to send fewer applications (indeed, up to less than half as many) than those from lower ranked medical schools. The number of IMGs in this dataset is small enough that I don't think IMGs are skewing the low tier distribution.

Hmmm...but what happens when he zoom in on just the applicants who received an II to one of the Top 8 IM residencies as defined by the Top 100 rankings on the spreadsheet itself? Let's see what the Step 1 distributions look like for those programs as represented by applicants on the spreadsheet who reported receiving an invitation to one or more such places.

BWH = Brigham and Women's, MGH = Mass General, JHH = Hopkins. Only main-sites were included in this analysis, so places like UCSF-Fresno or Hopkins-Bayview were not counted with JHH or UCSF.

The Step 1 distributions for applicants reporting IIs at the T8 IM residencies are remarkably similar! Medians floating near 250 with short tails on the 25th percentile end and longer tails on the 75th percentile end, with the notable exceptions of Columbia and UCSF which appear to be more symmetrically distributed.

What does the school tier representation look like now that we've zoomed in on these so-called "top" programs?

Schools from all tiers appear to be pretty equally distributed across all T8 IM interviewees! We can more directly compare the difference in prevalence from the overall pool like this:

In other words, low and top tier schools are slightly overrepresented in the t8 Interviewee dataset compared to the overall IM spreadsheet applicant pool dataset; mid-tiers slightly underrepresented.

Have the step 1 distributions changed for applicants receiving IIs to T8 IM programs ?

Unsurprisingly, the distributions have jumped up on the Step 1 scale compared to the overall pool. Somewhat surprisingly, the distribution from the "Low" tier population his a bit lower than those in the mid and top tier bracket. This might challenge the oft-repeated wisdom that applicants from "lower tier" medical schools will have to score higher on Step 1 than their Mid and Top tier counterparts to break into the more elite academic IM programs. Given the similarity between these distributions, the better answer might simply be: Score high, period.

So myth debunked! there is no bias for more prestigious medical schools in IM resident selection. Well...let's not be too hasty.

What happens when we look at App Yield vs. Step 1 in the t8 IM cohort? After all, we can assume that these applicants regardless of what their medical school ranking is or isn't (or whatever their Step 1 scores are!) are the cream of the crop in many different dimensions of their CV.

It appears that in this cohort of so-called "elite" IM applicants, students from higher ranked schools tend to, on average, have much better app yields at equivalent Step 1 score levels compared to their counterparts at lower ranked schools.

Furthermore, the difference between total number of apps sent by school tier here in the stratosphere of academic IM programs is much more pronounced.

Also, consider this:

It was far more common for applicants from higher ranked schools to receive interview invitations to multiple of the T8 IM programs.

Although the data is highly limited, I thought it was interesting how well even this small snapshot was able to reproduce most of what we take to be basic wisdom about the way Step 1 score and school ranking are used in residency selection.

discuss

 

[bobjonesbob]

@Lucca I like your analysis but as you alluded to, your sample is highly skewed. The people who are commenting in this thread and the people who fill out those reddit spreadsheets aren't representative of the real populations. Honestly don't think any real conclusions can be taken from it. I will say the interview yield at top places seemed shockingly accurate though.

 

[anisecassia]

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

I'm normally a lurker but this was too perfect a comparison not to respond to. I had a nearly identical application (steps 260s, nearly all honors missed AOA, strong letters, mediocre ECs, 2 pubs) but from a upper mid-tier institution. lots of upper tier rejections. 1 t10 interview, lots of t25 interviews. Matched into a coastal t20.

 

[asdf123g]

Just goto Harvard or Yales match list and see for yourself. The top places tend to trade within their circle of schools making it harder to break in as an outsider so I was told.