AOA vs.step I

[mele]

How much can AOA compensate for mediocre boards score (high 220s). Can I still have hope that I am in the running for my top choices (which include some pretty competitive programs location-wise) or cast my net wide across the country. I have no rads research, but interesting extracurriculars (for whatever that's worth) and good letters of rec.

Should I try to take step II early and rock it? or give up rads now?

thanks in advance for your advice. some of the stats on this board are pretty intimidating!

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[ears]

Relax. Don't let the stat ****** on this board (or on AuntMinnie, where they're even worse) psych you out.

First, "high 220s" isn't that bad; no one's going to be worried that you can't take tests. (This is very relevant for radiology residents; apparently, the radiology boards are hard.)

Second, there are many relevant aspects to your application, and the Step 1 score is only one of them. You're right, AOA and clinical grades are another. Extracurriculars (if they're someplace you've actually achieved something interesting) could be another. Fitting in with the department's culture is another important one.

Third, if there are programs you've targeted, go do an away rotation there. Try and make friends with residents and faculty members. Get a letter from someone. It can definitely help to have been there, and demonstrated that you fit in.

Fourth, almost everyone applying to radiology has to apply pretty broadly, even very competitive applicants. That's just the nature of the game these days. You can definitely target an region if you want to be there, but you have to be prepared to move somewhere you hadn't counted on. What the heck, it's only four years.

Fifth, you can do yourself a lot of good by getting connected with your school's radiology department. Find a mentor, and an easy radiology project. One of the beauties of radiology is that there's always stuff going on that someone should write up. And that'll be someone to go to bat for you, and give you cool stuff to put on your application.

Sixth, if you think you can rock Step 2 (and you should know that most people do about what they did on Step 1), definitely take it in that window where you can report the scores if you want to, but you don't have to. (Like, in late September after you've submitted your application.)

Bottom line: a US allopathic graduate with decent scores (which yours are) can definitely match in radiology, provided he/she applies broadly enough and submits a long enough rank list.

 

[scootad.]

First off, you wont have any problem matching somewhere if you apply broadly.

But that wasn't your question. You wanted to know if you can match at a 'high tier/competitive program'.

The answer: yes, but you have a couple of things going against you. Your step 1 and your lack of any rads research. The people who match at places like brigham, penn, ucsf, stanford, nyu, etc. usually have sky high boards (250+), are AOA, AND have done research (often at least one pub). You can work on getting involved in research easily if you are at a med school with a decent rads dept, many rads projects can be completed in a month (not including the paper writing part). I agree with the above suggestions about doing aways, taking step 2 in sept, etc. It will still be an uphill battle.

AOA is a huge help for your application, but i think it most helps those with step 1s in the 240s for getting into an elite program.

That said, you should evaluate whether you even need/desire to go to an elite program. There are many solid uni & community programs in decent locations that will make you a fine radiologist.

 

[samsoccer7]

I believe an away rotation can help you tremendously. If you're not from one of those locales you'd like to go to, pick a program there and do an away or two. Also, doing well on Step 2 can help you a lot as well. Take it close to when you submit your app so you don't have to release the score if you don't want.

Get involved in a research project too. Case reports are of little help I think. But if you have something ongoing when you interview or do your away, it will lend a bit more credibility to your app I think. AOA is great, but if you don't make a cutoff with your Step I, they won't know it anyway. Your best chance is to make some connections via research and aways and get hooked up.

 

[mele]

Thanks all for your thoughtful advice. I definitely don't mind looking beyond competitive programs, it's just that the area I'm interested in is mostly filled with competitive programs. Thanks again for your thoughts

 

[MedGeek42]

I think it's better than having a 260 and no AOA...it all depends where you go to school, I think.

 

[samsoccer7]

I think it's better than having a 260 and no AOA...it all depends where you go to school, I think.

You really think so? I always thought Step I was more of a hard cutoff than being AOA or not. Then again, you probably need high Step I AND AOA to go to the really competitive places, but I can't imagine having a 225 and AOA is better than 260 and not AOA. I was in between with Step I and not AOA and I did pretty well. My school is nothing to brag home about

 

[puglover]

Don't be discouraged. I matched at a very competitive rads program in california with step 1 in high 220s. my advisor originally told me I had only a 30% chance of matching in cali. I'm AOA and did take my step 2 early and improved my score by 20 points. I had research/publication in another field and had a very interesting background (i.e. work experience, extracurriculars). However, I know a lot of schools screen on board scores and/or AOA alone. But there are great programs that don't and look at your entire application. good luck.

 

[bigfrank]

I wonder how most PDs view the AOA selection process and how that affects their perception RE: applicatants.

 

[windsurfr]

I would think that AOA would trump Step I as it represents 3 years of both clinical and pre-clinical work, as opposed to one test.... just a thought

 

[ears]

These aren't quantitative... I would imagine that a great step 1 score is viewed as a good achievement, and making AOA is also viewed as a good achievement. But it's probably hard to compare, and in any event would vary a lot between individual programs (and even different people at a given program).

AOA has the advantage that it (usually) says more about work over time, as windsurfr points out. On the other hand, the AOA selection processes are not standard at all, and some schools don't even have chapters. Step 1 has the advantage that it's taken by everyone, and scores could theoretically be compared. On the other hand, the NBME is quite explicit the test is not designed for that purpose, and studies have shown little correlation between scores and measures of resident performance.

Bottom line? If you want to try for a really competitive specialty/program, you should do as well as you can on Step 1, and you should try to make AOA. But you should be aware that many people match wherever it is you want to go with less-than-spectacular scores and without AOA. There are many things you can do to impress programs with your potential as a resident and a physician, and scoring well on Step 1 and making AOA are only two of them.

 

[jimdoc]

Your AOA status is much more impressive. Anyone can score high boards, most anyone. Two of my med-school roommates had a very difficult time with the MCAT, only to bust 250 on step I.. How?? They spent two months slaving away every day. Both were mediocre med students, both matched ortho at top 25 porgrams. In my opinion, those boards are well above average, and fine. Once you bust 230, I am not sure the difference between 245 and 235 is any....

 

[wannaberad]

Careful.UCSF states outright they won't interview you without a 240.

I would argue there's no difference between a 260 and a 250.

AOA seems to be more important anyway, judging from the match list at my school.

 

[bigfrank]

I was speaking to an M-4 at my school who happened to make AOA as a senior. She was given a certain ranking in her dean's letter before the AOA announcement and, when she was announced to be senior AOA, she quickly received an email that she had been "bumped up" to a higher standing (superior, great, grand, wonderful, or whatever idiotic jargot schools use to qualify students in their dean's letter).

The bottom line is that most applicants to radiology are not AOA and do not have >250 on their Step I. I keep hearing that the interview is extremely important: Once you have an interview, your performance on interview day is the key ingredient.

 

[trouta]

For what its worth our school doesnt even have AOA and our Rads applicants still match to competitive programs. Thats not to say it doesnt help...

 

[wannaberad]

Yes, but I see you are located in 'Rochester, MN'...

Home of the world famous MAYO CLINIC!

Might've helped a bit, too...

 

[bigfrank]

PDs know which schools do and do not have AOA. Most do, extraordinarly few schools don't. I've heard that there are <<10 schools that don't have AOA (allopathic schools).

 

[novacek88]

Step I is far more impressive. Step I is the only fair way to compare students accross the board. AOA varies with each school and their policy. Politics can play into AOA as well especially since clinical grades are often subjective. And let's be honest, not all medical schools are created equally. The competition varies with each medical school. It's easier making AOA at a average state medical school whose applicants had lower entrance stats versus a reputable private school whose average entrance stats were much higher. And if scoring high on Step I was so easy then everyone would do it but we see plenty of AOA students fail to score above 230 or even 220 every year.

 

[peehdee]

why do schools care so much about aoa and step 1? i mean how many radiologist do you see having to take care of patients, or know the side effects of all the drugs (they don't have to write prescriptions, and if they need something they can just look it up, they're in front of computers all the time), and some small detail about some disease that only a small set of patients get (again, they can look the stuff up if they need to bc they can go into a reading room where people can't see them)? it seems to me step 1 measures how much facts you can remember in a huge amount of areas (biochem, anatomy, physio, pharm, path, etc..) and this is probably something that most people in radiology don't really need? people who do internal med probably need to know and hold on to these facts more. and having a good bed side manner is probably more important in ped, family med, internal med, than radiology. when you're in rad you probably just have to know some basic medical stuff, because you'll end up doing and seeing the common things related to imaging, which you'll pick up in the 4 years of residency. so i'm at a loss why people who get high board scores aren't better suited to do internal med.

so the questions are:
1) does having a high board score which means knowing lots and lots of facts in many subjects help you to bet an excellent radiologist who does routine readings of scans/images or is it used mainly because there are only a few spots. in other words, if they were to pick people who did not score so high on board, would that fact (not having high step 1) alone make them not excellent radiologist? it seems to me, if you spend 4 to 5 years looking at x-rays, rmi scans etc.. you'd have to be pretty stupid not to know all the details in those years.

2) to get good clinical grades, it helps for people to like you (there are of course exams), which probably means you have good bedside manners. so doesn't it that make sense that med students who get good grades and are well-liked should be doing a profession that has more patient care (eg family, internal, peds etc) instead of being how should i put this, 'hide in dark reading rooms away from much patient contact'

3) radiology is in some ways 'geeky'. lots of high tech stuff. so those who love math, physics, computers and technology should go into it? not someone necessarily that knows lots of random facts about a ton of stuff from the 1st 2 years of medical schoo and gets high board scores?

 

[scootad.]

Why is step 1 & aoa so important for dermatology? Derms certainly dont need to know all that minutiae. Plastic surgery? same thing

The bottomline is programs want the best candidates they can get, and it obviously follows that the most competitive fields will require the highest scores for entrance. And the only way they can objectively brag about their candidates is if they have stingent requirements even if such reccs have little to nothing to do with the field itself.

But I will say that knowing minutiae from the 1st 2 years of med school is more applicable to rads than say derm or plastics. And while what you say is true that rads can sit and look things up radiologists days are too busy to do that (in private practice) so obviously it helps to have a good foundation in knowledge from med school

 

[ears]

If I'm a PD, I'm comforted by applicants with high Step 1 scores, because I'm confident they'll be able to pass the radiology boards. (Quite challenging, I'm given to understand.)

If I'm a PD, I'm interested in clinical grades because I know that correlates well with people who are good to work with. I want that because I have to work with them myself, and also because getting along with and helping clinicians is a big part of being a good radiologist.

 

[deleted50478]

If I'm a PD, I'm interested in clinical grades because I know that correlates well with people who are good to work with.

Really? Seems better correlated with major a-- kissers who are willing to step on the neck of their fellow students if it helps them look good. very different perspective.

 

[bigfrank]

Really? Seems better correlated with major a-- kissers who are willing to step on the neck of their fellow students if it helps them look good. very different perspective.

Are you serious? Really?

So the people who are lazy, show up late, bomb the shelf, and make "pass" are really the GREAT medical students. And I've been bustin' my hump to make honors.....

 

[wannaberad]

The real problem is that clinical grades reward both prosocial behaviors like showing up early and taking on extra patients and antisocial behaviors like making your fellow students look bad.

Since clinical grades have to be doled out by people, who are susceptible to corruption, I see no way of getting around this. Sure you could make clinical grades dependent on the shelf exam but how well does THAT correlate with actual doctoring skill? I could study for the exam 24/7 and never see a patient...

It's problematic, but there's really no way of getting around the problem. Sort of like the way the worst people always tend to rise to the top in bureaucracies.

 

[novacek88]

The real problem is that clinical grades reward both prosocial behaviors like showing up early and taking on extra patients and antisocial behaviors like making your fellow students look bad.

Since clinical grades have to be doled out by people, who are susceptible to corruption, I see no way of getting around this. Sure you could make clinical grades dependent on the shelf exam but how well does THAT correlate with actual doctoring skill? I could study for the exam 24/7 and never see a patient...

It's problematic, but there's really no way of getting around the problem. Sort of like the way the worst people always tend to rise to the top in bureaucracies.

I see your point but you could also look at the situation differently. Programs want the best residents possible. Part of what makes a resident good is his or her ability to work with others and get along with them. If I have my choice between someone who has top grades and clinical evals versus one with just top grades, I'm going to select the person who has both every single time. And yeah, I'm aware this student probably kissed a lot of butt to get these high clinical grades.....but you know what...good. I wish more students kissed a$$. I would much rather be around a student who is pleasant to be around and is trying to get to know me than someone who is quiet because they were too proud to kiss up. A quiet student may have a great personality but unless he or she shows it, I'm never going to know what they are like and I'm not going to guess and give them the benefit of the doubt. People who are funny and sociable are great people to work with and many times, patients like them too which makes everyone's job easier.

 

[bigfrank]

It's just part of playing a game. Make honors if you can, but don't do anything underhanded. I've made honors every rotation this year and I can honestly say that I haven't screwed over a single classmate in the process.

 

[novacek88]

It's just part of playing a game. Make honors if you can, but don't do anything underhanded. I've made honors every rotation this year and I can honestly say that I haven't screwed over a single classmate in the process.

very well said, I fogot to include that in the above. You don't have to sell out your colleagues in the process.

 

[peehdee]

so the bottom line is that people who can get the best grades (either bc they have supper memories, work hard, both, or what ever) are the 'best' applicants. therefore, the brightest people are in radiology, derms, ent, and surgery? wouldn't we rather have the brightest (top grades) in fields that require the most patient contact like family and internal medicine?

very well said, I fogot to include that in the above. You don't have to sell out your colleagues in the process.

 

[scootad.]

therefore, the brightest people are in radiology, derms, ent, and surgery? wouldn't we rather have the brightest (top grades) in fields that require the most patient contact like family and internal medicine?

derm/ent/surgery all require patient contact. besides, why do you assume its more important for a doctor in a patient-centered field to be brighter than a doctor in a non-patient centered field?? I'd argue the opposite - fields like Rads & Path require more knowledge & a wider knowledge base than most other fields precisely b/c they spend less time blabbering with patients and more time doing the intellectually demanding part of medicine - coming up with diagnoses.

 

[p53]

Step 1 has the advantage that it's taken by everyone, and scores could theoretically be compared.

Agree with this comment. Step 1>AOA because AOA is school specific, and you can compare Step 1 scores from any medical student in the country.

Also, if someone barely missed AOA from a top twenty school, this person would have earned AOA in a bottom twenty medical school.

 

[bigfrank]

To play the devil's advocate: ERAS has an "AOA" box (Y/N/school hasn't chosen yet). Programs can sort applicants based on this feature. Some schools (albeit few) can afford to interview only AOA applicants.

 

[p53]

Step I is far more impressive. Step I is the only fair way to compare students accross the board. AOA varies with each school and their policy. Politics can play into AOA as well especially since clinical grades are often subjective. And let's be honest, not all medical schools are created equally. The competition varies with each medical school. It's easier making AOA at a average state medical school whose applicants had lower entrance stats versus a reputable private school whose average entrance stats were much higher. And if scoring high on Step I was so easy then everyone would do it but we see plenty of AOA students fail to score above 230 or even 220 every year.

A++++ POST.

 

[LAZYGUY]

Agree with this comment. Step 1>AOA because AOA is school specific, and you can compare Step 1 scores from any medical student in the country.

Also, if someone barely missed AOA from a top twenty school, this person would have earned AOA in a bottom twenty medical school.

how do you know this?

 

[QuothTheRaven]

this is once again the subjective vs. objective argument. aoa and clinical grades are quite frankly, school and department dependent. step 1, like the SAT and MCAT, are standardized national tests. perhaps more important to grades or aoa is what school you went to. i'm pretty sure they're not caring too much about the grades or aoa status from a kid who went to harvard or john hopkins med. my 2 cents.

 

[novacek88]

this is once again the subjective vs. objective argument. aoa and clinical grades are quite frankly, school and department dependent. step 1, like the SAT and MCAT, are standardized national tests. perhaps more important to grades or aoa is what school you went to. i'm pretty sure they're not caring too much about the grades or aoa status from a kid who went to harvard or john hopkins med. my 2 cents.

That's because graduates of those schools have already proven themselves to some degree because it's nearly impossible to get into Hopkins and Harvard medical school. And let's inject some common sense into the equation. Someone who got a 37 MCAT and had a 3.9 GPA is probably not going to do poorly on the boards unless he exposed himself to gamma rays and went meathead as soon as he got angry. If someone worked that incredibly hard to get into these schools, it's doubtful that they would completely change who they were and stop studying at that same intensity all of sudden. In other words, people from Hopkins and Harvard probably have amazing scores so this is a moot point.

 

[novacek88]

To play the devil's advocate: ERAS has an "AOA" box (Y/N/school hasn't chosen yet). Programs can sort applicants based on this feature. Some schools (albeit few) can afford to interview only AOA applicants.

Some programs will probably do this like derm, neurosurgery, optho, and ENT at prestigious programs but usually these programs seek both AOA and high Step I. How many people boast both of these? Programs also set cutoffs for Step I scores too.

 

[AlternateSome1]

so the bottom line is that people who can get the best grades (either bc they have supper memories, work hard, both, or what ever) are the 'best' applicants. therefore, the brightest people are in radiology, derms, ent, and surgery? wouldn't we rather have the brightest (top grades) in fields that require the most patient contact like family and internal medicine?

Our desire to have bright people in other fields is really a moot point unless you set up a system to reward people for going into those specialties. It is really just a matter of supply and demand. Since there are few rads spots with many applicants, programs can be picky. Family practice and IM don't have that luxury.