Becoming a Competitive Residency Applicant

[The Duck Knows]

.

---

Members don't see this ad.

 

[PrettyLadyDoc24]

I don't want to come off as some gunner or obsessive MS1, but I was a bit naive and underprepared when I applied for med school and had to scramble to meet some research and experience requirements. I'm doing great in classes but I don't want to make the same mistake twice. So for you 4th years and residents, what's expected of us? I've heard research publications and volunteer positions are important, but what things qualify? Do applicants typically include items from undergrad? I'd love to hear any advice because so far I've just heard that I should focus on grades and Step scores, but I heard that about undergrad GPA/MCAT up until 6 months before I applied.

You're correct about the Step scores, you should make sure these are solid. I mentioned a few of my undergraduate activities on my residency application because they were relevant and important to me (I've been an avid writer all my life and published a few novels). I think medical student research will be important if you are applying in a very competitive field. Volunteerism is important but not as important as rotation grades and board scores. Have something that stands out that will be fodder for interview conversation. Lastly, audition rotations at places you want to match at can help if you really excel and get yourself noticed.

Good luck!

 

[Slack3r]

1) Step 1 = highest is best. Average this year was 228 +/- 21
2) Research = Experience is nice, but pubs are better. Pubs preferably in your field, but not required. Significant involvement in basic science research will probably look better than publishing a case report. Get involved early, and make connections. You can include undergrad research if it was productive, but med school > undergrad research (unless it was really mind blowing stuff)
3) AOA = usually based on grades +/- extracurriculars.
4) Grades = Hs are better than Ps. Don't be an idiot and "focus on step 1" and ignore classes
5) ECs/volunteering = nobody generally cares. You don't have to pretend to save 100 African babies anymore. If you're interested in something, do it. Don't be that guy that's "president" of 200 clubs that don't matter. That said, a blank CV looks pretty bad, so get involved in something.

 

[operaman]

You're not coming off as a gunner at all and I promise you that all the smart, motivated people in your class are wondering the same things. I remember meeting with our AOA faculty councilor early in M1 to ask about selection and what I would need to do to be competitive for it. I opened by apologizing that this was our first conversation and I was afraid I was looking like the biggest gunner ever; he simply replied that 20 or so of my classmates had already been by with the same questions and he expected more would follow. You're doing well in classes and found your stride; this is absolutely the right time to best asking these things.

Specific advice is VERY field-specific. Your school as a whole will give general advice that applies somewhat to everyone, but individual fields can vary significantly. Your best resource for this would be the residency program director in your desired field as this person knows exactly what your applicant pool is going to look like and what you need to be competitive. Their knowledge is CURRENT which is huge; you'll often get outdated advice from well-meaning faculty whose knowledge of the application process is not timely. You can look at Charting Outcomes from past years and see how much things change in a short period of time.

The best piece of advice I can give you at this point is to start making time for career exploration asap, unless you already know what you want to do. Focus primarily on the fields you may not rotate through as an MS3. Medicine keeps some of the best fields hidden, or so it seems. Look seriously at: Anesthesia, Dermatology, EM, ENT, Interventional Rads, Ortho, Path, PM&R, Radiology (diagnostic), Radiation Oncology, Urology. Some of those are more competitive than others, but they are fields you may not get to see otherwise. If you find that you really like one of the competitive ones, you'll have a huge advantage if you know early and can start preparing. IM and peds subspecialties I wouldn't worry as much about at this point because you'll have to do an IM or peds residency anyhow before you do your fellowship and you'll definitely get exposure to those in your clerkships.

Generally though:
1) Grades and boards -- as high as possible
2) Clinical grades -- you want your transcript to read like one long wheeze
3) Research -- the more the better. 3+ pubs (peer reviewed journals) with at least one as first author would be a good start and average for some fields/programs.
4) LORs -- huge. Start forming relationships as early as possible, especially with nationally known people.
5) Service -- make some time to give back
6) Leadership -- get some experience being in charge of something
7) ECs -- be an interesting person who does stuff, but not at the expense of 1-3

 

[Low Flow]

Would little to no research really be a death sentence for some middle-of-the-road specialties (ER, IM, Anesthesiology, etc.)? I'll have one 3rd or 4th author pub coming out of undergrad and I'll be an M1 in the fall. I'm not particularly fond of research and would much rather have the volunteering/clinical experience as an M1/2 than the research.

Say you have above average step scores (240?) and good preclinical and clinical grades with a bit of non-research ECs. Would that be a decently competitive residency application? What if you just rotate at a site and they love you, but you don't have research?

 

[Psai]

You're not coming off as a gunner at all and I promise you that all the smart, motivated people in your class are wondering the same things. I remember meeting with our AOA faculty councilor early in M1 to ask about selection and what I would need to do to be competitive for it. I opened by apologizing that this was our first conversation and I was afraid I was looking like the biggest gunner ever; he simply replied that 20 or so of my classmates had already been by with the same questions and he expected more would follow. You're doing well in classes and found your stride; this is absolutely the right time to best asking these things.

Specific advice is VERY field-specific. Your school as a whole will give general advice that applies somewhat to everyone, but individual fields can vary significantly. Your best resource for this would be the residency program director in your desired field as this person knows exactly what your applicant pool is going to look like and what you need to be competitive. Their knowledge is CURRENT which is huge; you'll often get outdated advice from well-meaning faculty whose knowledge of the application process is not timely. You can look at Charting Outcomes from past years and see how much things change in a short period of time.

The best piece of advice I can give you at this point is to start making time for career exploration asap, unless you already know what you want to do. Focus primarily on the fields you may not rotate through as an MS3. Medicine keeps some of the best fields hidden, or so it seems. Look seriously at: Anesthesia, Dermatology, EM, ENT, Interventional Rads, Ortho, Path, PM&R, Radiology (diagnostic), Radiation Oncology, Urology. Some of those are more competitive than others, but they are fields you may not get to see otherwise. If you find that you really like one of the competitive ones, you'll have a huge advantage if you know early and can start preparing. IM and peds subspecialties I wouldn't worry as much about at this point because you'll have to do an IM or peds residency anyhow before you do your fellowship and you'll definitely get exposure to those in your clerkships.

Generally though:
1) Grades and boards -- as high as possible
2) Clinical grades -- you want your transcript to read like one long wheeze
3) Research -- the more the better. 3+ pubs (peer reviewed journals) with at least one as first author would be a good start and average for some fields/programs.
4) LORs -- huge. Start forming relationships as early as possible, especially with nationally known people.
5) Service -- make some time to give back
6) Leadership -- get some experience being in charge of something
7) ECs -- be an interesting person who does stuff, but not at the expense of 1-3

man my grades are more like a stutter

 

[MrGrrrMonster]

ould little to no research really be a death sentence for some middle-of-the-road specialties (ER, IM, Anesthesiology, etc.)? I'll have one 3rd or 4th author pub coming out of undergrad and I'll be an M1 in the fall. I'm not particularly fond of research and would much rather have the volunteering/clinical experience as an M1/2 than the research.

I think you will get varying responses to this question, and it will definitely fluctuate depending on where exactly you are intending on applying to. I didn't have any significant research (had a poster presentation from undergrad that was basic science) on my application for IM residency, and I felt that I got a considerable number of quality interviews at places like vanderbilt, mayo, wash u, northwestern, ohsu, wisconsin..etc. However I did not even get a sniff from hopkins. So I think it depends on what program you are attempting to match into- and where. More seasoned individuals will probably tell you that it is a must, and while I don't necessarily see it as such, I would not be in complete disagreement.

 

[Slack3r]

Would little to no research really be a death sentence for some middle-of-the-road specialties (ER, IM, Anesthesiology, etc.)? I'll have one 3rd or 4th author pub coming out of undergrad and I'll be an M1 in the fall. I'm not particularly fond of research and would much rather have the volunteering/clinical experience as an M1/2 than the research.

Say you have above average step scores (240?) and good preclinical and clinical grades with a bit of non-research ECs. Would that be a decently competitive residency application? What if you just rotate at a site and they love you, but you don't have research?

To match in general? Probably doesn't matter. To match at a "top program", research certainly wouldn't hurt.

 

[Low Flow]

I think you will get varying responses to this question, and it will definitely fluctuate depending on where exactly you are intending on applying to. I didn't have any significant research (had a poster presentation from undergrad that was basic science) on my application for IM residency, and I felt that I got a considerable number of quality interviews at places like vanderbilt, mayo, wash u, northwestern, ohsu, wisconsin..etc. However I did not even get a sniff from hopkins. So I think it depends on what program you are attempting to match into- and where. More seasoned individuals will probably tell you that it is a must, and while I don't necessarily see it as such, I would not be in complete disagreement.

Thanks. I don't see myself as being extremely competitive anyway (as evidenced by my average MCAT), unless something drastic happens for my step scores. I am from the pacific northwest though and would ideally like to be in the WA/OR area.

 

[Low Flow]

To match in general? Probably doesn't matter. To match at a "top program", research certainly wouldn't hurt.

I was thinking more to match into a decent program in general. I'm basically getting at the fact that on my list of enjoyable (or even tolerable) activities I would like to do in medical school, research is circling the drain.

 

[Beacopp665]

I was thinking more to match into a decent program in general. I'm basically getting at the fact that on my list of enjoyable (or even tolerable) activities I would like to do in medical school, research is circling the drain.

The school you come from plays almost as large a part in this too. No name low tier state school and no research = tougher time at "decent" places than someone from a top 10 without research

 

[MrWhatupDoc]

Thanks. I don't see myself as being extremely competitive anyway (as evidenced by my average MCAT), unless something drastic happens for my step scores. I am from the pacific northwest though and would ideally like to be in the WA/OR area.

I personally don't think just because you had an average MCAT means you're destined for an average Step score. I'd get out of that mindset. I've seen people who barely got into med school get a 260+ and people who beasted the MCAT get below average step scores. It's about work ethic and curriculum set up.

 

[Low Flow]

I personally don't think just because you had an average MCAT means you're destined for an average Step score. I'd get out of that mindset. I've seen people who barely got into med school get a 260+ and people who beasted the MCAT get below average step scores. It's about work ethic and curriculum set up.

Good to hear. Guess I just wasn't sure how much work ethic vs aptitude factored into board scores. Seemed like the MCAT was more the latter.

 

[Psai]

I personally don't think just because you had an average MCAT means you're destined for an average Step score. I'd get out of that mindset. I've seen people who barely got into med school get a 260+ and people who beasted the MCAT get below average step scores. It's about work ethic and curriculum set up.

Yeah because you hear about the exceptions that prove the rule. You don't hear about the 40 mcat folks that got a 250. If you're a good test taker, chances are that you'll continue to be a good test taker

 

[superdoc2.0]

Yeah because you hear about the exceptions that prove the rule. You don't hear about the 40 mcat folks that got a 250. If you're a good test taker, chances are that you'll continue to be a good test taker

https://www.uworld.com/Step1/step1_facts.aspx

A 2007 meta-analysis evaluated the relationship between the MCAT and medical school performance. There was a small to moderate correlation of MCAT performance with performance during the preclinical years, with the r value equal to roughly 0.39. There was also a correlation of certain subtests with preclinical performance, particularly the biological sciences subtest. The correlation was less strong between MCAT performance and performance during the clinical years. The writing subtest of the MCAT was shown to have no correlation with either performance during the preclinical years or the clinical clerkships.

A small to moderate correlation was also found between MCAT and USMLE scores, with r values ranging from 0.38 to 0.60. This correlation was highest for USMLE Step 1. Among the different MCAT subsets, the highest correlation was found for the biological sciences and verbal sections. There was near zero correlation between the writing subtest and USMLE scores.

 

[superdoc2.0]

Good to hear. Guess I just wasn't sure how much work ethic vs aptitude factored into board scores. Seemed like the MCAT was more the latter.

https://www.uworld.com/Step1/step1_facts.aspx

A 2007 meta-analysis evaluated the relationship between the MCAT and medical school performance. There was a small to moderate correlation of MCAT performance with performance during the preclinical years, with the r value equal to roughly 0.39. There was also a correlation of certain subtests with preclinical performance, particularly the biological sciences subtest. The correlation was less strong between MCAT performance and performance during the clinical years. The writing subtest of the MCAT was shown to have no correlation with either performance during the preclinical years or the clinical clerkships.

A small to moderate correlation was also found between MCAT and USMLE scores, with r values ranging from 0.38 to 0.60. This correlation was highest for USMLE Step 1. Among the different MCAT subsets, the highest correlation was found for the biological sciences and verbal sections. There was near zero correlation between the writing subtest and USMLE scores.

 

[Low Flow]

http://www.slideshare.net/doctorneel1/data-are-questions-the-answer

 

[Low Flow]

The previous link I posted seems to suggest that pre-clinical grades are the most significant indicator on performance for Step 1. Makes sense, given that preparation over 2 years should trump 6 weeks of cramming.

 

[cbrons]

The previous link I posted seems to suggest that pre-clinical grades are the most significant indicator on performance for Step 1. Makes sense, given that preparation over 2 years should trump 6 weeks of cramming.

Based on a survey. Of students from one school.

The fact is that there are schools with horrible curriculum the first two years. At these schools (which may very well be a minority, but they do exist), the better you end up doing in-class is likely because you spend several hours per day memorizing factoids from a powerpoint that will never be on a board exam.

 

[superdoc2.0]

Based on a survey. Of students from one school.

The fact is that there are schools with horrible curriculum the first two years. At these schools (which may very well be a minority, but they do exist), the better you end up doing in-class is likely because you spend several hours per day memorizing factoids from a powerpoint that will never be on a board exam.

Bad schools exist, not a disputed point.

The point of this survey and others, is that MCAT scores correlate moderately with step 1 scores. Thus many students who did not do well on the MCAT do well on step 1 scores, and conversely many students who did well on the MCAT do not do as well on step 1.

 

[cbrons]

Bad schools exist, not a disputed point.

The point of this survey and others, is that MCAT scores correlate moderately with step 1 scores. Thus many students who did not do well on the MCAT do well on step 1 scores, and conversely many students who did well on the MCAT do not do as well on step 1.

Why u disputin' me brah?

 

[Psai]

The previous link I posted seems to suggest that pre-clinical grades are the most significant indicator on performance for Step 1. Makes sense, given that preparation over 2 years should trump 6 weeks of cramming.

The two years of preparation leads to those 6 weeks. It's not just cramming, it's integrating and applying the information that you're learning how to do. It's hard to understand before you stay medical school but you'll understand once you've taken the test. Also, published data is a guide, not the final word. Real life experience should trump literature. Papers are not to be read and regurgitated but analyzed carefully for flaws and limitations. Many people have trouble with this

 

[superdoc2.0]

Why u disputin' me brah?

Cause only the hardest dudes be disputin!

 

[superdoc2.0]

The two years of preparation leads to those 6 weeks. It's not just cramming, it's integrating and applying the information that you're learning how to do. It's hard to understand before you stay medical school but you'll understand once you've taken the test. Also, published data is a guide, not the final word. Real life experience should trump literature. Papers are not to be read and regurgitated but analyzed carefully for flaws and limitations. Many people have trouble with this

Real life experience should rarely trump literature. One of the largest flaws in human intellect is that we overemphasize our daily experience.

Tobacco companies convinced people that tobacco was good for them, until we statistically analyzed large cohorts of people. Real life experience could have never uncovered this.

Of course you have to dispute literature, there is a bunch of junk out there. You always compare a study to prior literature and knowledge and analyze this new info to see if it could expand your mental model of the world. But you don't trump research, n=300, with a real life experience, n=1.

BTW don't be an arse: "many people have trouble with this". Your arrogance is stifling.

 

[Low Flow]

The two years of preparation leads to those 6 weeks. It's not just cramming, it's integrating and applying the information that you're learning how to do. It's hard to understand before you stay medical school but you'll understand once you've taken the test. Also, published data is a guide, not the final word. Real life experience should trump literature. Papers are not to be read and regurgitated but analyzed carefully for flaws and limitations. Many people have trouble with this

That's exactly what I'm saying. A student that takes the time to analyze and integrate the material correctly the first time should be far better off than the guy in the bottom quartile of the class who slacks off because "he's a good test taker".

 

[MrWhatupDoc]

Exactly. I don't think anyone is saying anything wrong. There is a moderate correlation but I think we can all agree with the original point that just because you got an average MCAT means you are destined to have an average STEP score. It is more in how you do the first 2 years and how you integrate the material.

 

[tiedyeddog]

1) Step 1 = highest is best. Average this year was 228 +/- 21
2) Research = Experience is nice, but pubs are better. Pubs preferably in your field, but not required. Significant involvement in basic science research will probably look better than publishing a case report. Get involved early, and make connections. You can include undergrad research if it was productive, but med school > undergrad research (unless it was really mind blowing stuff)
3) AOA = usually based on grades +/- extracurriculars.
4) Grades = Hs are better than Ps. Don't be an idiot and "focus on step 1" and ignore classes
5) ECs/volunteering = nobody generally cares. You don't have to pretend to save 100 African babies anymore. If you're interested in something, do it. Don't be that guy that's "president" of 200 clubs that don't matter. That said, a blank CV looks pretty bad, so get involved in something.

Excellent advice. I would add a number 6. For LORs. Having a well known LOR writer who can put something meaningful in a letter is important. If they can speak about a knowing you for 2-3 years that is even better.

 

[startswithb]

Excellent advice. I would add a number 6. For LORs. Having a well known LOR writer who can put something meaningful in a letter is important. If they can speak about a knowing you for 2-3 years that is even better.

LORs are one of the most important aspects of small fields! You may have top scores, but if you show up in September of your 4th year asking someone you spent a week with on an elective, the letter may be essentially meaningless.