nilla_wafer

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Hello,
I'm just a fourth year, currently in the midst of ERAS/NRMP. However, I am trying to think ahead a little.. I am potentially interested in applying to fellowship in a couple years, and I have what would be considered unimpressive USMLE record . I'm motivated to do much better on exams in residency, though unfortunately I cannot seem to express that enough these days.

My question to residents and fellows out there: how much does all that matter in applying to fellowship? I've definitely heard that the reputation of one's residency program makes the biggest difference in getting well-reputed "name brand fellowships", but I'm hoping to get real perspective from you all.

Thank you very much for your time!
 
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dragonfly99

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I think we could help you more if you specified what types of fellowships you are talking about. For example, are you talking about ortho sports med fellowship or an internal medicine rheumatology fellowship? Those would have a significantly different level of competitiveness.

For cardiology fellowships, I know that some places did/do use the USMLE score, but it's just one factor. I don't think it's as important as say, the USMLE Step 1 score in picking derm or radiology residents. They have more stuff to judge you on by the time you apply to medicine fellowships. Some programs specifically say they don't want to see your USMLE scores, while some required that they be sent. If you are a lower scorer, you could just avoid the ones that want to see it, I guess. I think you are correct in thinking that for IM, the reputation of your residency program will mean as much or more than your step scores, but if you want GI or cards I would recommend you try to do as well as you can on Step 3, hopefully average or better.
 
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dragonfly99

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I'm not so sure about that for all specialties, Winged Scapula. I know that the in service exam is used heavily for promotions, etc. in most or all surgical programs, at least the ones my friends were in...
However, I was specifically told during my medicine residency that our program didn't use the in service exam scores for anything related to promotions, and we didn't even have to take it every year (only required to take it once during the residency, and requested to take it all three years). I also never was asked for my in service exam scores during the fellowship application process, and I'm not even sure they were on the PD's letter of evaluation...I think they weren't. The USMLE Scores were requested as part of the application for some of the cards fellowships I applied to, though...
 

yaah

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Yeah, in service exams don't always matter. In pathology, no one sees your score except your program director. They use it to evaluate programs, not individual residents (although i suspect there are some programs that use it as a factor in their own internal evals of residents). For my fellowships, some requested my USMLE scores but the vast majority did not.

As said above, it likely depends on your specialty. Competitive ones are more likely to require them because it is another way to stratify the numerous applications they get.
 

frank51

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I've been told that for Pain Management board scores matter a lot, I also remember the program director at a Pain Management fellowship saying at the end of a lecture that they heavily look at in service exam grades for Anesthesia residents.
 

nilla_wafer

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wow, thank you all for your input.

Specifically, I'm applying to Med/Peds, which I know is competitive based on the small size of the programs AND daunting in the face of double-boarding; so I also am applying Peds categorical as my "back-up".

I've heard the peds residents at my school say that in-service exams didn't count for anything in terms of promotions etc. So, for both IM and peds, how are chief residents chosen? Does doing a chief residency do enough towards your application towards a cards fellowship that Step 1 and Step 2 aren't that important?

I would like to do cards someday, though honestly intellectually I feel a little drawn towards ID sometimes so it is relevant to learn that different fellowships do require medical school scores. Does anyone here know about ID?

Also, one program director I interviewed with at happened to mention something about a "cognitive skills specialist" at the program for people who struggle with one aspect or another of training. Have you heard of any such resource, and what other resources do you have if you have any such struggles? I mean, I never USED to be so needy, but I am more nervous after medical school eroded my confident bluster, and I would like to have my resources visible to me (besides being nearer to family and friend support).

Is Step 3 much harder than Step 2?

Thank you again!
 

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I'm not so sure about that for all specialties, Winged Scapula. I know that the in service exam is used heavily for promotions, etc. in most or all surgical programs, at least the ones my friends were in...
However, I was specifically told during my medicine residency that our program didn't use the in service exam scores for anything related to promotions, and we didn't even have to take it every year (only required to take it once during the residency, and requested to take it all three years). I also never was asked for my in service exam scores during the fellowship application process, and I'm not even sure they were on the PD's letter of evaluation...I think they weren't. The USMLE Scores were requested as part of the application for some of the cards fellowships I applied to, though...

Interesting, I had assumed (or thought I knew) that it was important for fellowship rankings in medical specialties. Thanks for the info. It is definitely important for surgical programs (where we do not have a choice of whether to take the exam and the scores are requested for fellowship apps).

RE: Step 3 vs Step 2.

I found it easier, as do most people (in the old days it was "study two months for Step 1, two weeks for Step 2 and bring a #2 pencil for Step 3), although the lack of surgical questions on Step 3 made it somewhat harder for me as I'd been out of general medicine and peds for a couple of years. I'd imagine that a Med-Peds resident would have an easier time given the distribution of the questions.
 

carrigallen

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Interesting, I had assumed (or thought I knew) that it was important for fellowship rankings in medical specialties. Thanks for the info.
I agree, I think it is only allowed to be used in surgery fellowships. Medicine fellowships I am not even allowed to list ITE scores voluntarily.

Re: Nilla Wafer: Medical chief residents are chosen based on their ability to lead and supervise people, and foster teaching. Your step exam scores have almost nothing to do with this.
Step 3 is easier than Step 2 especially if you will be doing a medicine intern year.
 

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I believe the poster above is correct about ITE exam scores in medicine...I think there is some rule about them not being able to be used for fellowship placement...that might be why a few places use the USMLE scores. But as I said, there were numerous cardiology fellowships that specifically said they did NOT want the USMLE score and/or wouldn't even look at it. For ID, I don't think having high board scores would be very important at all, as it isn't a competitive subspecialty.

Our residency didn't have any special programs or any study materials for the ITE...you were just pretty much on your own. The PD said the scores were not used for anything, and I thought the exam was kind of random and didn't have much of a point, so I didn't really specifically study for it...I just studied up on my patients and things I needed to know for clinic and patient care. I also didn't get a score that was particularly good on the in training exams every....very average scores but passed easily. My USMLE scores Step 2 and 3 were pretty good because I actually did study. I thought Step 2 and 3 were similar in difficulty and my Step 2 and 3 scores were within about 4 points of each other. They were also almost 20 points better than my Step 1 score, which might give hope to some of you who didn't do awesome on Step 1.

As far as how chief residents in medicine are chosen, the answer is it varies at different programs. At some places, people actually apply to be chosen chief resident. At some places, the house staff have a hand in picking the chiefs. At our institution, they were picked near the beginning of 2nd year (i.e. based on intern year perceptions of their abilities, I assume) and there was no application process, and residents had no say in who was picked. I assume the PD, the medicine dept chair, +/- a few other faculty got together and just decided who they wanted. I don't know if ITE exam scores played a part, but would think they might have played some part, though doubt they were the major thing. Being a chief resident isn't really necessary to getting any fellowship, but I guess it would be somewhat helpful. One of the chief residents @ my program couldn't even match into our pulmonary program, so getting a fellowship spot at your own institution seems more a function of the subspecialty dept. faculty's perception of you rather than being picked as a chief or any other specific honor.
 

NotAProgDirector

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Specifically, I'm applying to Med/Peds, which I know is competitive based on the small size of the programs AND daunting in the face of double-boarding; so I also am applying Peds categorical as my "back-up".

I've heard the peds residents at my school say that in-service exams didn't count for anything in terms of promotions etc. So, for both IM and peds, how are chief residents chosen? Does doing a chief residency do enough towards your application towards a cards fellowship that Step 1 and Step 2 aren't that important?

I would like to do cards someday, though honestly intellectually I feel a little drawn towards ID sometimes so it is relevant to learn that different fellowships do require medical school scores. Does anyone here know about ID?


I think you could use some career counseling. If you do Med/Peds, you'll be dual boarded in Med and Peds. if you then go and do a cards fellowship, you're going to need to choose either an Adult cards fellowship or a Peds Cards fellowship. You can't do both (that I know of). Hence, half of your residency training will be useless, as once your a Ped Cards doc, you're not going to be seeing adults for general medicine.

If you go into ID, you can be both an adult and pedi ID doc.

So, if cards is your choice, you're probably better off choosing either Med or Peds.
 

generic

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There are fellowships for both (Adult Congenital Heart disease), etc. Or just plain both. But I hear it takes 5 years (after your 4 yrs of M-P residency), so it's not a short road
 

howelljolly

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I think you could use some career counseling. If you do Med/Peds, you'll be dual boarded in Med and Peds. if you then go and do a cards fellowship, you're going to need to choose either an Adult cards fellowship or a Peds Cards fellowship. You can't do both (that I know of). Hence, half of your residency training will be useless, as once your a Ped Cards doc, you're not going to be seeing adults for general medicine.

If you go into ID, you can be both an adult and pedi ID doc.

So, if cards is your choice, you're probably better off choosing either Med or Peds.

I had asked this on some other thread, out of curiosity... which (single) fellowships will allow a Med/Ped to practice their specialty on both adults and children? Medical Genetics... Allergy/Immunology....ID?
I was just looking at the curriculum for an adult ID program and saw that there are required peds-ID blocks.
 

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Interesting, I had assumed (or thought I knew) that it was important for fellowship rankings in medical specialties. Thanks for the info. It is definitely important for surgical programs (where we do not have a choice of whether to take the exam and the scores are requested for fellowship apps).

At least for IM, the Association of Program Directors in Internal Medicine in conjunction with the ABIM forbids the use of InService exam scores as a tool for fellowship selection process. They want to maintain the exam as a tool to give the residents a guide of the progress and likelihood of passing Boards
 

Winged Scapula

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At least for IM, the Association of Program Directors in Internal Medicine in conjunction with the ABIM forbids the use of InService exam scores as a tool for fellowship selection process. They want to maintain the exam as a tool to give the residents a guide of the progress and likelihood of passing Boards

Sounds like APDIM uses the exams like they are supposed to be used.

It is not uncommon for surgical programs to fire residents who do not score above a certain threshold on the ABSITE.
 

dragonfly99

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Wingedscapula, I know you are right. I personally know a IMG who did surgery and was not retained/invited to stay after a surgery prelim year due to not having the best ITE score. He didn't fail, but he just got outscored by a couple of the other prelims. So the ITE is used much differently in surgery programs than medicine programs.

I don't entirely agree with aprogramdirector that the med/peds residency would be useless if one wants to do cardiology. One of the medicine chief residents @my program was a med/peds resident and she went on to do an adult cardiology fellowship program. I know she felt the med/peds residency program helped her a lot in understanding congenital heart disease, etc. We don't see too many of those type patients in adult medicine - it's mostly CAD, CHF due to HTN or CAD, or arrhythmias.

I think to do both peds and adult cards fellowships would take more time than anyone would want to spend in fellowship, though. At minimum it would be 4 years med/peds, 3 years adult cards, and I guess 3 years of pediatric cards. That's WITHOUT subspecializing in any area of cardiology.

In general I'd say med/peds is more for folks who want to do primary care (in general) but at my hospital where I did residency, I think 40-50% of med/peds residents ended up subspecializing in some area, so it's not impossible to do. I just don't think you'll be able to do both adult and peds cardiology ultimately, so you might want to think about whether it's worth it to do the extra year of residency vs. not.
 

howelljolly

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Actually, with this specific case... A pediatric cardiologist can actually see adults with congenital heart disease. So, a Med/Ped who did a pediatric cardiology fellowship could build themselves a pretty good niche.
 

dragonfly99

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I totally agree howell jolly. In fact, I think that for someone whose primary interest is congenital cardiac dz, I would recommend either pediatrics or med/peds as a residency, and not IM.
 
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