Auditions, Step 2, and matching psych as a DO

[Dr. YNWA]

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Hey Guys,

So I'm at the point where I need to be finalizing Step2/Level2 plans and potentially scheduling auditions for next year and I wondered what your guys' thoughts were on my profile as my school has essentially been unable to provide me with solid advice. So first...

Step 1: 249
Level 1: 737

I have Comlex Level 2 scheduled, is it worth my time and money to sit for Step 2? I hear the specialty is becoming more competitive.

LoR's: My 3 LoR's are all from PDs within FM, Neuro, and Psych. And from what I've gathered they should be strong letters.

Second, auditions...

Starting my 4th year next fall I will have 1 audition under my belt in my hometown. There is another residency in town I may set up an audition for, but honestly I could end up anywhere and be happy (I live in the midwest). On a side note, my "top" spot for residency is at the state school that doesn't allow DO's to audition but they do allow interviews and many DO's get in. With that being said, is it worth my time auditioning at a ton of different places given the profile I have presented? I appreciate any of your insight!

 

[whopper]

One thing I've noticed among DOs are "audition rotations." I've never seen this talked much among MD students. I'm sure there are but I've seen this audition-rotation thing cut corners into education.

Someone I know, for example did several several audition rotations in psychiatry and for this reason she never honed her medical knowledge. If anything this put her behind her peers in such things and as a resident was seen as strongly behind.

Of course I've seen MD students want to do a rotation at a place where they wanted to do residency, but I've seen several DOs do this as if this was the only way to get into a program.

 

[Dr. YNWA]

One thing I've noticed among DOs are "audition rotations." I've never seen this talked much among MD students. I'm sure there are but I've seen this audition-rotation thing cut corners into education.

Someone I know, for example did several several audition rotations in psychiatry and for this reason she never honed her medical knowledge. If anything this put her behind her peers in such things and as a resident was seen as strongly behind.

Of course I've seen MD students want to do a rotation at a place where they wanted to do residency, but I've seen several DOs do this as if this was the only way to get into a program.

I would agree with you in that it seems bizarre. My school didn't do a good job explaining the necessity behind them or why you would even want to do them in the first place. I guess it is seen as a way of getting your foot in the door, but I see it really only being a benefit if you want to test out a program before applying or in an attempt to bolster your profile if your application doesn't look so hot on paper.

 

[Sushirolls]

Some DO schools have more clinical week requirements compared to MD schools in 3rd and 4th year, that they aren't really undercutting their training. For instance once DO school had ~84 weeks and there are some MD schools that had high ~50 weeks in total.

Auditions are considered more amongst DO because residual bias does exist at some places, and this is a way to break down the barrier.

 

[whopper]

Auditions are considered more amongst DO because residual bias does exist at some places, and this is a way to break down the barrier.

Which is what I thought, but if someone's only doing psych rotations as every single elective rotation you're not going to know your stuff you need outside of psychiatry. I've said this in prior posts, neurology, endocrine, IM are very important for psychiatry. It can in effect only add to the bias if DO students who want to do psych do too many audition rotations, thus not honing their non-psych knowledge, thus making others think DOs don't know as much as their MD peers.

The fact that across several differing institutions it's gotten it's own name in the Lexicon as an "audition rotation" would have me alarmed if I was DO faculty because of the above, when MD students don't have to worry about this to anywhere near the degree I'm seeing it in DO students. People doing a rotation to get a foot in the door vs not trying to hone their own medical knowledge is worrisome. I don't say that as a jab against DO students who I'm sure are just worried about their futures but that DO faculty should try to address this issue.

 

[OldPsychDoc]

I've also seen that many of our DO applicants have much weaker core psych rotations than MD applicants from university medical schools. They may have to dig on their own to get even a core rotation in a regular teaching hospital.

 

[Sushirolls]

Just wait, a change is afoot. I know one local MD school that is adopting a curriculum where there is no psych rotation. That simply seeing mental health patients on their FM longitudinal (or with the SW embedded in their FM longitudinal clinic) thru 3rd year is considered the psych rotation.....

Only the students who express an interest in Psych might be able to get a 3rd year traditional rotation.

 

[whopper]

I did a rotation at a hospital, and they had psych rotations there but only for DO students. I didn't know why, but later on learned that it was because DOs could do core rotations at hospitals where there was no residency program.

This is in hindsight but when I asked my DO friends why this was, none of them would give me a straight answer. None of them mentioned the differences in educational requirements, and I suspect now it was because they were ashamed of the bias, cause I know for fact they would've known when I asked them.

The attending running the psych unit pretty much only spent an hour with them a day and told them to go home and watch Awakenings with Robert Deniro and Robin Williams. I have a cousin who is a DO and told me most of her rotations was her just "shadowing" an attending.

Again I say the above not to jab at DOs but this isn't education on par with doing IVs yourself, doing intakes, progress notes, having a resident work with you or an attending that's part of an academic program mentor the student.

I know one local MD school that is adopting a curriculum where there is no psych rotation. That simply seeing mental health patients on their FM longitudinal (or with the SW embedded in their FM longitudinal clinic) thru 3rd year is considered the psych rotation.....

Only the students who express an interest in Psych might be able to get a 3rd year traditional rotation.

Sounds horrendous.

 

[7000101201110]

Hey Guys,

So I'm at the point where I need to be finalizing Step2/Level2 plans and potentially scheduling auditions for next year and I wondered what your guys' thoughts were on my profile as my school has essentially been unable to provide me with solid advice. So first...

Step 1: 249
Level 1: 737

I have Comlex Level 2 scheduled, is it worth my time and money to sit for Step 2? I hear the specialty is becoming more competitive.

LoR's: My 3 LoR's are all from PDs within FM, Neuro, and Psych. And from what I've gathered they should be strong letters.

Second, auditions...

Starting my 4th year next fall I will have 1 audition under my belt in my hometown. There is another residency in town I may set up an audition for, but honestly I could end up anywhere and be happy (I live in the midwest). On a side note, my "top" spot for residency is at the state school that doesn't allow DO's to audition but they do allow interviews and many DO's get in. With that being said, is it worth my time auditioning at a ton of different places given the profile I have presented? I appreciate any of your insight!

I'd recommend Step 2.
I'd recommend doing 2-3 auditions at places you want to go. 1) to make a good impression 2) maybe get a LOR

Consider getting letters from within the field of psych instead of outside, a lot of it is about who you know. Most LOR's speak very positively of the applicants (there's published research analyzing this) so it's lost a lot of its value.

One thing I've noticed among DOs are "audition rotations." I've never seen this talked much among MD students. I'm sure there are but I've seen this audition-rotation thing cut corners into education.

Someone I know, for example did several several audition rotations in psychiatry and for this reason she never honed her medical knowledge. If anything this put her behind her peers in such things and as a resident was seen as strongly behind.

Of course I've seen MD students want to do a rotation at a place where they wanted to do residency, but I've seen several DOs do this as if this was the only way to get into a program.

Because MD's don't get discriminated against like DO's, that's why you dont see it.
A lot of times it is the only way to get into the program. Lots of programs discriminate, especially upper-tier (Not just the 'top 10'). This is reflected by the number of programs saying they never/seldom even consider interviewing a DO and the number of DO's who have successfully matched at programs. Look at residency explorer also which demonstrates this as well.

Which is what I thought, but if someone's only doing psych rotations as every single elective rotation you're not going to know your stuff you need outside of psychiatry. I've said this in prior posts, neurology, endocrine, IM are very important for psychiatry. It can in effect only add to the bias if DO students who want to do psych do too many audition rotations, thus not honing their non-psych knowledge, thus making others think DOs don't know as much as their MD peers.

The fact that across several differing institutions it's gotten it's own name in the Lexicon as an "audition rotation" would have me alarmed if I was DO faculty because of the above, when MD students don't have to worry about this to anywhere near the degree I'm seeing it in DO students. People doing a rotation to get a foot in the door vs not trying to hone their own medical knowledge is worrisome. I don't say that as a jab against DO students who I'm sure are just worried about their futures but that DO faculty should try to address this issue.

I don't disagree, however you can't blame the DO who's being discriminated against. The fact its called an 'audition rotation' is reflective of how bad the discrimination is.

I did a rotation at a hospital, and they had psych rotations there but only for DO students. I didn't know why, but later on learned that it was because DOs could do core rotations at hospitals where there was no residency program.

This is in hindsight but when I asked my DO friends why this was, none of them would give me a straight answer. None of them mentioned the differences in educational requirements, and I suspect now it was because they were ashamed of the bias, cause I know for fact they would've known when I asked them.

The attending running the psych unit pretty much only spent an hour with them a day and told them to go home and watch Awakenings with Robert Deniro and Robin Williams. I have a cousin who is a DO and told me most of her rotations was her just "shadowing" an attending.

Again I say the above not to jab at DOs but this isn't education on par with doing IVs yourself, doing intakes, progress notes, having a resident work with you or an attending that's part of an academic program mentor the student.



Sounds horrendous.

This is probably the DO's schools which have horrendous board pass rates, including the COMLEX-PE. Not all schools are like that.The number of schools with ~80% pass rate is embarassing. Problem is all of these DO schools popping up that have no business in even existing. Definetely a lot of schools giving a bad name.

 

[Mass Effect]

One thing I've noticed among DOs are "audition rotations." I've never seen this talked much among MD students.

It's just as prevalent among MDs in more competitive specialties. You don't hear it talked about much when it comes to psych because most of psych is more open to MDs.

Someone I know, for example did several several audition rotations in psychiatry and for this reason she never honed her medical knowledge. If anything this put her behind her peers in such things and as a resident was seen as strongly behind.

It wasn't audition rotations that put her behind her peers. It was likely her core IM rotations. Some DO schools have horrid clinical rotations. Horrid. But let's not pretend MD students are busting their butts in MS4 year. They're spending January on some mountain in Vail doing an elective rotation in sports medicine or at Big Sky doing a rural family medicine rotation with the ski patrol.

Of course I've seen MD students want to do a rotation at a place where they wanted to do residency, but I've seen several DOs do this as if this was the only way to get into a program.

In some programs, it is. I know for a fact I wouldn't have gotten at least 3 of the interviews I did (and my match) had I not done an audition rotation there.

I would agree with you in that it seems bizarre. My school didn't do a good job explaining the necessity behind them or why you would even want to do them in the first place. I guess it is seen as a way of getting your foot in the door, but I see it really only being a benefit if you want to test out a program before applying or in an attempt to bolster your profile if your application doesn't look so hot on paper.

I disagree. The problem is that DO schools are variable. PDs are taking a chance on DO students because some of them do rotations at community hospitals with no residents. Some have a preceptor only. Some shadow. Fortunately, most of my rotations were at a decent medical center, but not all of them were there. So yeah, it's important for DOs to prove they know their stuff if they want to match at a university program.

I did a rotation at a hospital, and they had psych rotations there but only for DO students. I didn't know why, but later on learned that it was because DOs could do core rotations at hospitals where there was no residency program.

This is in hindsight but when I asked my DO friends why this was, none of them would give me a straight answer. None of them mentioned the differences in educational requirements, and I suspect now it was because they were ashamed of the bias, cause I know for fact they would've known when I asked them.

I don't know how long ago this was, but I can tell you as recently as 3 years ago, there were MD students doing rotations at place with no residents in that field as well, so that isn't exclusively a DO thing, though it happens more on the DO side. There aren't enough DO residencies to accommodate all the students and many MD programs have their hands full with their own students to take DO students on-board.

Again I say the above not to jab at DOs but this isn't education on par with doing IVs yourself, doing intakes, progress notes, having a resident work with you or an attending that's part of an academic program mentor the student.

So how can you say this and in the same thread, not understand why they do audition rotations? Part of the reason some do auditions is to actually LEARN psychiatry at a place that's likely far superior to their core psych rotation. I think the best thing to happen to DO schools is actual regulation and shutting down of the schools like the one your friend attended.

 

[7000101201110]

It's just as prevalent among MDs in more competitive specialties. You don't hear it talked about much when it comes to psych because most of psych is more open to MDs.

NRMP: "Higher proportions of unmatched U.S. seniors and independent applicants have been observed in traditionally competitive specialties like Orthopaedic Surgery, Neurological Surgery, Plastic Surgery, Otolaryngology, Dermatology, and General Surgery. Since 2018, however, the historically less-competitive Psychiatry has joined that list. The competitiveness of those specialties also is demonstrated by their high fill rates"

From 2016-2018 the number of programs "never/seldom" interviewing a DO ranged from 23-35%. These numbers are probably higher as they are the ones who admit to discriminating and when you look at residency explorer which was made by NRMP, it shows the discrimination is much worse than reported in surveys. For example, well over 100 of the 247 programs (probably closer to 150 actually) have less than 11% of DO's matching successfully.

Other fields have it may have it worse but its still not good.

 

[Dr. YNWA]

I'd recommend Step 2.
I'd recommend doing 2-3 auditions at places you want to go. 1) to make a good impression 2) maybe get a LOR

Consider getting letters from within the field of psych instead of outside, a lot of it is about who you know. Most LOR's speak very positively of the applicants (there's published research analyzing this) so it's lost a lot of its value.


Thanks for the insight! I'll look into getting scheduled for Step 2, it seemed a bit overkill taking Step/COMLEX 2 considering some faculty at my school didn't even think taking Step 1 was necessary for a midwest psych spot. I'm seeing that most if not all programs take 3 LoR's. So would you suggest I get and submit 2+ psych letters as opposed to diversifying with 1 psych and 2 other areas (FM, Neuro etc)? The way things currently stand, the in state allopathic program is definitely the top of my list, but sadly I can't audition there. Outside of that my 2nd choice would be either programs in my hometown, and my remaining 10-12 choices consisting of surrounding state programs would be third. I guess I could audition at one of the out of state programs. I just have no idea how competitive it will be when I apply, on paper my profile appears relatively strong based on FREIDA program stats, and I know the Midwest is not a highly sought after area, but I guess I just don't want to have to do more than I have to in terms of taking out loans for travel and housing if it isn't necessary haha. Once again, thanks for the comment.

 

[7000101201110]

@Dr. YNWA PM me

 

[MacDonaldTriad]

"Shadowing" should not be in the vocabulary of medical schools. Schools need to have control over the faculty that train their medical students and have the ability to set grading standards. Anything else looks like an online college. If your clinical experiences are yours to go out and find, you should think about why you are paying for your tuition. I'm not just saying.

 

[MLT2MT2DO]

Hey Guys,

So I'm at the point where I need to be finalizing Step2/Level2 plans and potentially scheduling auditions for next year and I wondered what your guys' thoughts were on my profile as my school has essentially been unable to provide me with solid advice. So first...

Step 1: 249
Level 1: 737

I have Comlex Level 2 scheduled, is it worth my time and money to sit for Step 2? I hear the specialty is becoming more competitive.

LoR's: My 3 LoR's are all from PDs within FM, Neuro, and Psych. And from what I've gathered they should be strong letters.

Second, auditions...

Starting my 4th year next fall I will have 1 audition under my belt in my hometown. There is another residency in town I may set up an audition for, but honestly I could end up anywhere and be happy (I live in the midwest). On a side note, my "top" spot for residency is at the state school that doesn't allow DO's to audition but they do allow interviews and many DO's get in. With that being said, is it worth my time auditioning at a ton of different places given the profile I have presented? I appreciate any of your insight!

I'll go ahead and chime in though it's been 5+ years since I've been there I have my N=1. I had a slightly higher step 1 and a similar COMLEX to you I chose to only take COMLEX 2 and scored exceptionally well on this too. Top 1/3rd of my class no yellow/red flags, maybe a "lower tier DO school" is about what you can pull.

In regards to how not taking USMLE Step 2 hurt me:
My residency of choice indicated on their website that they don't rank without a USMLE step 2. I just assumed this was saying "take step 2 if you want to be ranked" and didn't realize it may have been literally meaning they don't care for COMLEX, despite my previous scores. At the end of the day that PD was a lady from Harvard and had a fairly clear bias against DOs. Another poster on here from the area, and as far as I can tell was a good student with an audition, didn't even get an interview. Additionally the 2-3 year period she was PD I don't believe there was a single DO on their residency website and this has since changed as has their PD. With this in mind I'm not sure even if I had taken Step 2 it would have made a difference.
No where else I interviewed gave a rats behind that I only took COMLEX 2.
Full insight/disclosure this is one of my two interviews where I was nervous and probably didn't present my best self; though after being on an attending's side of this and seeing this years applicants I'd say it was probably an average performance

In regards to Auditions:
I did one "Audition", these are basically to make sure you're not completely socially awkward or a sociopath for the program, if you're a hard worker and you can display such you'll probably put yourself in a good position. I would only do one of these if there's a place you were in love with. In my case I was able to find out how miserable the residents were and ended up ranking that place lower than where I did my residency and I'm not sure I would have been able to get this from a simple "interview dinner" as everyone puts on a smile there. This likely would have been my residency as I planned to rank them higher then where I landed, prior to this audition


Lastly, since you're in the Midwest I find this is probably the least biased geographic location when it comes to DOs. I anticipate you'll be fine whatever program you're looking at. Neither of my examples were the Midwest (where I ultimately ended up)

 

[whopper]

I don't disagree, however you can't blame the DO who's being discriminated against. The fact its called an 'audition rotation' is reflective of how bad the discrimination is.

I don't blame individual students who are trying to do their best to graduate and practice, but I do fault a system where students are allowed to do a rotation without a structure or curriculum.

Shadowing into a program where the attending has not given a required curriculum, minimum standards, where I know for a fact that the students and residents often times just sat there sometimes falling asleep while being asked to do nothing other than watch is not a good core rotation or just rotation at all.

I've always been a proponent of not judging students from a label of simply their exam scores, or if they are an MD or DO. I will, however, say bar none you will learn more if you're actually engaging in the activity yourself, are in a structure of people dedicated to teaching. This requires a curriculum to encourage better standards. If there is none you're on a roll of a dice if the rotation is good or not. You "shadow" in a private practice you actually slow the practitioner down when they teach hence the effect this has in many of those unstructured rotations-you're just an observer.
I'm repeating myself on this point so I'll leave it there on this point.

As for students needing to do "audition rotations" to get in, my point is this is thing where you just do psych only rotations for every possible elective you're taking risks of cheating yourself. And for all of you DOs upset with the discrimination, make it a personal point of yours once you become an attending to try to open some doors. Tell your peers and colleagues in academia to push for higher requirements in DO curriculums. Also go into academia yourself and try to make some changes.

 

[BorntobeDO?]

The only student I met who was doing psych only electives during all of 4th was an MD. In fact my school requires 40 weeks of rotations, 12 of which are required IM, Outpatient primary care, and ER during 4th year. Compare that to most MD who have only 28-32 usually including a research rotation requirement which is usually fluff. This thread actually makes me annoyed at the implication that DOs just do electives in 4th. Here I am required to do many extra rotations after having to do 48 weeks of rotations 3rd year with only 4 of those weeks being elective. At least at my school, clinical exposure was not an issue.