Clinical grades for Top Psychiatry programs - which ones are important?

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lacrossegirl420

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Say one got Honors in IM and Psych, mostly HP’s (including neuro), and then a few P’s (surgery, OBGYN). Would these clinical grades still be considered competitive for the very top psych programs (e.g. Yale, Stanford, Harvard)? I have a very high step 2 (270+) but realize psych may not care as much about scores as say derm/ortho. I go to a T20 (MD-only). Thanks in advance for any thoughts

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Remember, most schools have moved to pass/fail for clerkships. Your grades are nice, but not hugely relevant and most won't know quite what to do with them (so will ignore them). Psych will also care a great deal less about your "T20" school... Just be a polite, cool person and you'll be fine. As I've said in some other posts, I think it's a really bad idea to focus on going to the "top." This is particularly true since your personal top is apparently all over the country. Focus on geography. Where do you want to live for the rest of your life? That's what is really being asked in your rank list. Programs are going to care a heck of a lot more about why you want to live in their geographic area than why you want to go to their particular program. They'll certainly take that a lot more into consideration when ranking you. Also, whatever random thing is drawing you to a given program can change a lot over the course of 4 years. Very rarely do programs move physically thousands of miles. Even if you really need a "top" program because you absolutely must become fantastically wealthy with a cash only practice, geography matters sooooo much more than name brand because you need to build a network and a reputation.
 
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Remember, most schools have moved to pass/fail for clerkships. Your grades are nice, but not hugely relevant and most won't know quite what to do with them (so will ignore them). Psych will also care a great deal less about your "T20" school... Just be a polite, cool person and you'll be fine. As I've said in some other posts, I think it's a really bad idea to focus on going to the "top." This is particularly true since your personal top is apparently all over the country. Focus on geography. Where do you want to live for the rest of your life? That's what is really being asked in your rank list. Programs are going to care a heck of a lot more about why you want to live in their geographic area than why you want to go to their particular program. They'll certainly take that a lot more into consideration when ranking you. Also, whatever random thing is drawing you to a given program can change a lot over the course of 4 years. Very rarely do programs move physically thousands of miles. Even if you really need a "top" program because you absolutely must become fantastically wealthy with a cash only practice, geography matters sooooo much more than name brand because you need to build a network and a reputation.
What about if there are class ranks, does that factor a lot into program choice
 
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It is absolutely not true that most places have gone to pass/fail for clerkships. Pass/fail for preclincial is common. For clerkships it is very rare.
 
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My mistake, it's more of a California thing. As far as I can tell, most of the public schools there have moved towards pass/fail for clerkships since COVID and did not return to the four tiered system. There is significant evidence that the trend will spread nationwide, but I can see it's clearly not there yet nationwide.
 
I'm at a top program in psych. Grades do matter, but really its the whole picture. Step score is a given and you have almost zero shot with a bad score. Otherwise, it's mostly "rule out" at the initial screening. Then most of your "score" at least here is based on how you interview and if we think you'd be a good fit for the program. Once you're offered an interview - that means that all else being equal the program wants to match you on paper. So use the interview as much as you can to figure out if you want to be there.

So really consider "fit" given that each program has a major focus area. I.e. don't go to a research-oriented residency and talk about how much you care about political advocacy. Find a place within the top programs that emphasize things you care about in a geography you want to live in. Geographic interest is a big point - i.e. Yale knows New Haven blows so if they think you have zero interest living there you are toast after interview. If you want a small town, UTSW is going to drop your score if they figure it out.
 
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I echo mistafab. The application is considered holistically. But at top programs, the median applicant did not get any passes on any clerkships and often they got more honors than HP. (And the top 30 applicants or so likely got H on everything.) So it will be a "mark" but won't sink you alone.

There's also wide variation in the way schools distribute grades. If you're at a school where 90% of students get honors in each clerkship, it looks way worse that you got a P than at the schools where only 10% get H and 50% get P.
 
I'm at a top program in psych. Grades do matter, but really its the whole picture. Step score is a given and you have almost zero shot with a bad score. Otherwise, it's mostly "rule out" at the initial screening. Then most of your "score" at least here is based on how you interview and if we think you'd be a good fit for the program. Once you're offered an interview - that means that all else being equal the program wants to match you on paper. So use the interview as much as you can to figure out if you want to be there.

So really consider "fit" given that each program has a major focus area. I.e. don't go to a research-oriented residency and talk about how much you care about political advocacy. Find a place within the top programs that emphasize things you care about in a geography you want to live in. Geographic interest is a big point - i.e. Yale knows New Haven blows so if they think you have zero interest living there you are toast after interview. If you want a small town, UTSW is going to drop your score if they figure it out.
But that's just for top programs, right

Like if I go rural or suburban those things shouldn't be a big issue?
 
But that's just for top programs, right

Like if I go rural or suburban those things shouldn't be a big issue?

I only got passes in third year. I received interviews at everywhere I applied too including top programs. I began declining and cancelling interviews. This isn’t a very important aspect in the big picture.
 
I only got passes in third year. I received interviews at everywhere I applied too including top programs. I began declining and cancelling interviews. This isn’t a very important aspect in the big picture.
Uh... Aren't you mid career or older? Things have gotten a lot more competitive. All passes isn't going to garner invites at top programs anymore. A handful of passes isn't going to sink someone but if I have a student with all passes they are going to have to apply pretty broadly and average number of applications per applicant is over 60 now.

This is why I'm always worried my kids are going to speak to senior faculty and get questionable advice (I'm an official dept advisor at a US MD school). Psychiatry is not a cake walk match anymore, although it's definitely not 'the new derm' either. Many big name schools have had students go unmatched in the last few years, and we had some very near misses with strong candidates.
 
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Celexa is right. Psychiatry isn't a walk in the park any more, but it isn't derm. Everyone who thinks they want to ask if they can get into a top 10 program and discusses their stats is fooled if they think anyone can provide an answer. On the flip side, psych still isn't derm and "competitive" is still relevant. (Insert Einstein's theory of relativity, and maybe the Heisenberg uncertainty principle because the more you place importance on location of training, the less it is likely the doctor will be where you think).

Please put in programs on your list that are geographically attractive. Please put in "reach" programs as high on your list as you want, and maintain a capacity for radical acceptance and you will do well. Putting reach programs high doesn't change your chances of getting into "non-reach" programs. There is still a wide variety of quality programs with a variable amount of competitiveness. You will get a job after graduation and you will earn or not earn a good reputation where you are and no one will ask where you trained. I know this process has made everyone paranoid and aggressively competitive, but psych still isn't like that. You will be judged by your talent and most programs can give you that if you apply yourself into learning and taking advantage of opportunities.
 
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Celexa is right. Psychiatry isn't a walk in the park any more, but it isn't derm. Everyone who thinks they want to ask if they can get into a top 10 program and discusses their stats is fooled if they think anyone can provide an answer. On the flip side, psych still isn't derm and "competitive" is still relevant. (Insert Einstein's theory of relativity, and maybe the Heisenberg uncertainty principle because the more you place importance on location of training, the less it is likely the doctor will be where you think).

Please put in programs on your list that are geographically attractive. Please put in "reach" programs as high on your list as you want, and maintain a capacity for radical acceptance and you will do well. Putting reach programs high doesn't change your chances of getting into "non-reach" programs. There is still a wide variety of quality programs with a variable amount of competitiveness. You will get a job after graduation and you will earn or not earn a good reputation where you are and no one will ask where you trained. I know this process has made everyone paranoid and aggressively competitive, but psych still isn't like that. You will be judged by your talent and most programs can give you that if you apply yourself into learning and taking advantage of opportunities.
Agree. A good thing about psychiatry as a field in general: less score and grades obsessed than other fields. A challenge as a psychiatry advisor: gauging how competitive people are for particular programs is not easy, as so much hangs in intangibles. And that's if we narrow the focus to the paper application/getting interviews. In terms of interviews themselves, I might have two students who look very similar on paper, but I may worry about how one will perform in interviews and not the other. Or I might have one student I am really anxious about whether they will get interviews at all, but confident once they are interviewed programs will want them.

There are a few straightforward aspects (some students, ie all passes in core clerkships, are simply not going to be competitive at the most competitive programs), but after that advising gets very complicated very quickly and requires a level of detail that is largely incompatible with an anonymous internet forum. And the situation is evolving each year so you can never fully count on history being a guide.

One of those rare straightforward points of agreement, though: do not use all your signals on reach programs. The most competitive programs get flooded with signals and if you're a marginal candidate for them the signal isn't going to change anything. You can spare a signal or two to dream programs but signals should mainly be used for programs you are a good match to, and places you may be more competitive than the average applicant but have strong geographic or personal reasons to be interested in.
 
Uh... Aren't you mid career or older? Things have gotten a lot more competitive. All passes isn't going to garner invites at top programs anymore. A handful of passes isn't going to sink someone but if I have a student with all passes they are going to have to apply pretty broadly and average number of applications per applicant is over 60 now.

This is why I'm always worried my kids are going to speak to senior faculty and get questionable advice (I'm an official dept advisor at a US MD school). Psychiatry is not a cake walk match anymore, although it's definitely not 'the new derm' either. Many big name schools have had students go unmatched in the last few years, and we had some very near misses with strong candidates.

I’m not sure as I don’t know what defines mid-career in psych. I finished training about 8 years ago. I’m sure things are a little different now as step 1 is no longer the factor it once was. That said, honoring ob/gyn, surgery, etc are not really relevant for us. Keep in mind that most schools don’t have more than 20-30% honor each rotation. Unless grade inflation has matched financial inflation, there are plenty of normal applicants still out there matching at good programs. My post was mainly about reducing the anxiety about applying. I’m not claiming anyone can not honor anything and match at Harvard.
 
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Say one got Honors in IM and Psych, mostly HP’s (including neuro), and then a few P’s (surgery, OBGYN). Would these clinical grades still be considered competitive for the very top psych programs (e.g. Yale, Stanford, Harvard)? I have a very high step 2 (270+) but realize psych may not care as much about scores as say derm/ortho. I go to a T20 (MD-only). Thanks in advance for any thoughts
Step and clinical scores do matter. Even if the clerkships are P/F, they still put you into a quartiles/ranking for each clerkship even without having individual clerkship grades, which we can see on the selection committee. Even schools with preclinical P/F have "letters of distinction" or something else that identifies strong performance.

If you are at an MD top 20 school, that really matters.

If the faculty know your letter of recommendation writer, that really matters.

Otherwise, it's going to be fit. I think doing an away rotation can help the residents/faculty get to know you and more importantly, for you to get to know them and see if these are your people and type of training you want. I was deciding between two top 10 residencies and glad I did away rotations at both since the one I liked more beforehand ended up being much worse fit for me.
 
I’m not sure as I don’t know what defines mid-career in psych. I finished training about 8 years ago. I’m sure things are a little different now as step 1 is no longer the factor it once was. That said, honoring ob/gyn, surgery, etc are not really relevant for us. Keep in mind that most schools don’t have more than 20-30% honor each rotation. Unless grade inflation has matched financial inflation, there are plenty of normal applicants still out there matching at good programs. My post was mainly about reducing the anxiety about applying. I’m not claiming anyone can not honor anything and match at Harvard.
Psych underwent a spike in competitiveness starting about 5-6 years ago (again, to being mid tier competitive, not strataspheric) but things have changed enough that if you finished training 8 years ago, which means you matched 10+ years ago, the match is very different now and unless you work directly with medical students and residents on at least one side of the process, it's really best to recognize that your information is extremely out of date and not weigh in. I mean this in the best possible way, but those of us who do this regularly have to invest quite a bit of time and effort making sure we are current and well meaning input from people who aren't involved in the process generally falsely reassures.

I also try and diffuse the worries about not matching, but, if I have to choose which side of misinformation I prefer, an anxious student is going to end up in my office for an advising meeting and I can ground them with realistic expectations. A falsely reassured one who applied to all big academic/research institions and little else and doesn't seek out help and then pops up desperate without interviews in November, and that's much worse.
 
Step and clinical scores do matter. Even if the clerkships are P/F, they still put you into a quartiles/ranking for each clerkship even without having individual clerkship grades, which we can see on the selection committee. Even schools with preclinical P/F have "letters of distinction" or something else that identifies strong performance.

If you are at an MD top 20 school, that really matters.

If the faculty know your letter of recommendation writer, that really matters.

Otherwise, it's going to be fit. I think doing an away rotation can help the residents/faculty get to know you and more importantly, for you to get to know them and see if these are your people and type of training you want. I was deciding between two top 10 residencies and glad I did away rotations at both since the one I liked more beforehand ended up being much worse fit for me.
I think the first paragraph is good advice for OP and for top programs, but this isn't a true blanket statement. I'm not saying grades don't matter, but where I'm at clinical performance (specifically through solid audition rotations) carry a lot of weight. Here, step scores only matter if they are low enough to cause concerns for passing Step/Level 3, otherwise we generally don't care about that much.
 
I think the first paragraph is good advice for OP and for top programs, but this isn't a true blanket statement. I'm not saying grades don't matter, but where I'm at clinical performance (specifically through solid audition rotations) carry a lot of weight. Here, step scores only matter if they are low enough to cause concerns for passing Step/Level 3, otherwise we generally don't care about that much.
i mean only for top 10-20 programs.
 
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Thanks for the advice everyone. Would having a lot of publications (25+, both psych and non-psych related) help negate the slightly weaker clinical grades for those programs in particular? I feel like the clinical grades are the main weakness right now
 
I only got passes in third year. I received interviews at everywhere I applied too including top programs. I began declining and cancelling interviews. This isn’t a very important aspect in the big picture.
Oh wow, good to know. I was worried about program choice or the possibility of psych getting too competitive. I guess relatively few (compared to the overall total) of med students prefer the more hands on and procedural specialties. Works for me, I don't care about getting some top tier residency as long as I still get good offers as an attending
 
Oh wow, good to know. I was worried about program choice or the possibility of psych getting too competitive. I guess relatively few (compared to the overall total) of med students prefer the more hands on and procedural specialties. Works for me, I don't care about getting some top tier residency as long as I still get good offers as an attending
TP's statement isn't really accurate with the current climate as others said above. You're not getting ii's at all the top places with a mediocre app. That said, you don't have to be a superstar to match psych either. I applied during one of the more competitive years (only 4 spots for SOAP) with an app that was quite weak statistically and did not struggle. Applied to 75 programs, went to 8 interviews, and matched by top choice. Fairly confident I wouldn't have dropped lower than my 3rd or 4th choice anyway but didn't matter. At the same time, I know people who had much better apps who didn't match at all. Having a good match strategy can be just as important as your actual stats and scores.
 
Thanks for the advice everyone. Would having a lot of publications (25+, both psych and non-psych related) help negate the slightly weaker clinical grades for those programs in particular? I feel like the clinical grades are the main weakness right now
I don't understand what the purpose of this question is. Are you able to go back in time and change your clinical grades? Apply to places you want to go, if you are shooting for a lot of tier 1 places, have some reasonable back ups in solid academic programs in geography you like. Learning to not fuel neurosis is a big part of psych and you can get a leg up on that part of residency training right now.
 
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TP's statement isn't really accurate with the current climate as others said above. You're not getting ii's at all the top places with a mediocre app. That said, you don't have to be a superstar to match psych either. I applied during one of the more competitive years (only 4 spots for SOAP) with an app that was quite weak statistically and did not struggle. Applied to 75 programs, went to 8 interviews, and matched by top choice. Fairly confident I wouldn't have dropped lower than my 3rd or 4th choice anyway but didn't matter. At the same time, I know people who had much better apps who didn't match at all. Having a good match strategy can be just as important as your actual stats and scores.

I think both sides are reading too much into this. I’m not saying you can get into top programs with a mediocre application.

I had passes 3rd year with multiple honors other years. I had an above average step score and publications. I received multiple awards in medical school.

I’m merely saying that I don’t think most top 25 programs immediately weed out applicants based on passes 3rd year. There is more to psych than that. That said top programs want to see a good application.

Psych has become more competitive over the years, but we still are far behind many other fields. We aren’t Derm, anesthesia, surgical fields, rads, etc.

By the end, you are at where you are at. Don’t apply to only top 20 programs. Be smart about it and interview well. You can still surprise yourself with where you get interviews.
 
I don't understand what the purpose of this question is. Are you able to go back in time and change your clinical grades? Apply to places you want to go, if you are shooting for a lot of tier 1 places, have some reasonable back ups in solid academic programs in geography you like. Learning to not fuel neurosis is a big part of psych and you can get a leg up on that part of residency training right now.
And also.... The person best positioned to evaluate your app is your dept advisor. Advising quality can vary a lot (particularly at schools without their own psych dept) which is one reason I answer questions here. But any top 20 school has at least one faculty member designated to be a main contact for medical students. Often it's the clerkship director. Make a plan to meet with them this summer. We want you guys to match and are usually extremely invested in the process.
 
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And also.... The person best positioned to evaluate your app is your dept advisor. Advising quality can vary a lot (particularly at schools without their own psych dept) which is one reason I answer questions here. But any top 20 school has at least one faculty member designated to be a main contact for medical students. Often it's the clerkship director. Make a plan to meet with them this summer. We want you guys to match and are usually extremely invested in the process.
Your students (and this forum) are lucky to have you!

Sincerely,
DO student who can't imagine having a psych advisor much less one who is extremely invested in my match lol
 
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